Evidence-based care of older people with suspected cognitive impairment in general practice: Protocol for the IRIS cluster randomised trial

Joanne Ellen McKenzie, Simon D French, Denise Ann O'Connor, Duncan Stuart Mortimer, Colette Joy Browning, Grant Mervyn Russell, Jeremy M Grimshaw, Martin P Eccles, Jill J Francis, Susan Michie, Kerry Michele Murphy, Fiona Kossenas, Sally Elizabeth Green

Research output: Contribution to journalArticleOther

Abstract

Background: Dementia is a common and complex condition. Evidence-based guidelines for the management of people with dementia in general practice exist; however, detection, diagnosis and disclosure of dementia have been identified as potential evidence-practice gaps. Interventions to implement guidelines into practice have had varying success. The use of theory in designing implementation interventions has been limited, but is advocated because of its potential to yield more effective interventions and aid understanding of factors modifying the magnitude of intervention effects across trials. This protocol describes methods of a randomised trial that tests a theory-informed implementation intervention that, if effective, may provide benefits for patients with dementia and their carers.Aims: This trial aims to estimate the effectiveness of a theory-informed intervention to increase GPs (in Victoria, Australia) adherence to a clinical guideline for the detection, diagnosis, and management of dementia in general practice, compared with providing GPs with a printed copy of the guideline. Primary objectives include testing if the intervention is effective in increasing the percentage of patients with suspected cognitive impairment who receive care consistent with two key guideline recommendations: receipt of a i) formal cognitive assessment, and ii) depression assessment using a validated scale (primary outcomes for the trial).Methods: The design is a parallel cluster randomised trial, with clusters being general practices. We aim to recruit 60 practices per group. Practices will be randomised to the intervention and control groups using restricted randomisation. Patients meeting the inclusion criteria, and GPs detection and diagnosis behaviours directed toward these patients, will be identified and measured via an electronic search of the medical records nine months after the start of the intervention. Practitioners in the control group will receive a printed copy of the guideline. In addition to receipt of the printed guideline, practitioners in the intervention group will be invited to participate in an interactive, opinion leader-led, educational face-to-face workshop. The theory-informed intervention aims to address identified barriers to and enablers of implementation of recommendations. Researchers responsible for identifying the cohort of patients with suspected cognitive impairment, and their detection and diagnosis outcomes, will be blind to group allocation. ? 2013 McKenzie et al.; licensee BioMed Central Ltd.
Original languageEnglish
Pages (from-to)1 - 18
Number of pages18
JournalImplementation Science
Volume8
Issue number1
DOIs
Publication statusPublished - 2013

Cite this

McKenzie, Joanne Ellen ; French, Simon D ; O'Connor, Denise Ann ; Mortimer, Duncan Stuart ; Browning, Colette Joy ; Russell, Grant Mervyn ; Grimshaw, Jeremy M ; Eccles, Martin P ; Francis, Jill J ; Michie, Susan ; Murphy, Kerry Michele ; Kossenas, Fiona ; Green, Sally Elizabeth. / Evidence-based care of older people with suspected cognitive impairment in general practice: Protocol for the IRIS cluster randomised trial. In: Implementation Science. 2013 ; Vol. 8, No. 1. pp. 1 - 18.
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abstract = "Background: Dementia is a common and complex condition. Evidence-based guidelines for the management of people with dementia in general practice exist; however, detection, diagnosis and disclosure of dementia have been identified as potential evidence-practice gaps. Interventions to implement guidelines into practice have had varying success. The use of theory in designing implementation interventions has been limited, but is advocated because of its potential to yield more effective interventions and aid understanding of factors modifying the magnitude of intervention effects across trials. This protocol describes methods of a randomised trial that tests a theory-informed implementation intervention that, if effective, may provide benefits for patients with dementia and their carers.Aims: This trial aims to estimate the effectiveness of a theory-informed intervention to increase GPs (in Victoria, Australia) adherence to a clinical guideline for the detection, diagnosis, and management of dementia in general practice, compared with providing GPs with a printed copy of the guideline. Primary objectives include testing if the intervention is effective in increasing the percentage of patients with suspected cognitive impairment who receive care consistent with two key guideline recommendations: receipt of a i) formal cognitive assessment, and ii) depression assessment using a validated scale (primary outcomes for the trial).Methods: The design is a parallel cluster randomised trial, with clusters being general practices. We aim to recruit 60 practices per group. Practices will be randomised to the intervention and control groups using restricted randomisation. Patients meeting the inclusion criteria, and GPs detection and diagnosis behaviours directed toward these patients, will be identified and measured via an electronic search of the medical records nine months after the start of the intervention. Practitioners in the control group will receive a printed copy of the guideline. In addition to receipt of the printed guideline, practitioners in the intervention group will be invited to participate in an interactive, opinion leader-led, educational face-to-face workshop. The theory-informed intervention aims to address identified barriers to and enablers of implementation of recommendations. Researchers responsible for identifying the cohort of patients with suspected cognitive impairment, and their detection and diagnosis outcomes, will be blind to group allocation. ? 2013 McKenzie et al.; licensee BioMed Central Ltd.",
author = "McKenzie, {Joanne Ellen} and French, {Simon D} and O'Connor, {Denise Ann} and Mortimer, {Duncan Stuart} and Browning, {Colette Joy} and Russell, {Grant Mervyn} and Grimshaw, {Jeremy M} and Eccles, {Martin P} and Francis, {Jill J} and Susan Michie and Murphy, {Kerry Michele} and Fiona Kossenas and Green, {Sally Elizabeth}",
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Evidence-based care of older people with suspected cognitive impairment in general practice: Protocol for the IRIS cluster randomised trial. / McKenzie, Joanne Ellen; French, Simon D; O'Connor, Denise Ann; Mortimer, Duncan Stuart; Browning, Colette Joy; Russell, Grant Mervyn; Grimshaw, Jeremy M; Eccles, Martin P; Francis, Jill J; Michie, Susan; Murphy, Kerry Michele; Kossenas, Fiona; Green, Sally Elizabeth.

In: Implementation Science, Vol. 8, No. 1, 2013, p. 1 - 18.

Research output: Contribution to journalArticleOther

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AU - French, Simon D

AU - O'Connor, Denise Ann

AU - Mortimer, Duncan Stuart

AU - Browning, Colette Joy

AU - Russell, Grant Mervyn

AU - Grimshaw, Jeremy M

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AB - Background: Dementia is a common and complex condition. Evidence-based guidelines for the management of people with dementia in general practice exist; however, detection, diagnosis and disclosure of dementia have been identified as potential evidence-practice gaps. Interventions to implement guidelines into practice have had varying success. The use of theory in designing implementation interventions has been limited, but is advocated because of its potential to yield more effective interventions and aid understanding of factors modifying the magnitude of intervention effects across trials. This protocol describes methods of a randomised trial that tests a theory-informed implementation intervention that, if effective, may provide benefits for patients with dementia and their carers.Aims: This trial aims to estimate the effectiveness of a theory-informed intervention to increase GPs (in Victoria, Australia) adherence to a clinical guideline for the detection, diagnosis, and management of dementia in general practice, compared with providing GPs with a printed copy of the guideline. Primary objectives include testing if the intervention is effective in increasing the percentage of patients with suspected cognitive impairment who receive care consistent with two key guideline recommendations: receipt of a i) formal cognitive assessment, and ii) depression assessment using a validated scale (primary outcomes for the trial).Methods: The design is a parallel cluster randomised trial, with clusters being general practices. We aim to recruit 60 practices per group. Practices will be randomised to the intervention and control groups using restricted randomisation. Patients meeting the inclusion criteria, and GPs detection and diagnosis behaviours directed toward these patients, will be identified and measured via an electronic search of the medical records nine months after the start of the intervention. Practitioners in the control group will receive a printed copy of the guideline. In addition to receipt of the printed guideline, practitioners in the intervention group will be invited to participate in an interactive, opinion leader-led, educational face-to-face workshop. The theory-informed intervention aims to address identified barriers to and enablers of implementation of recommendations. Researchers responsible for identifying the cohort of patients with suspected cognitive impairment, and their detection and diagnosis outcomes, will be blind to group allocation. ? 2013 McKenzie et al.; licensee BioMed Central Ltd.

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