Abstract
BackgroundMost people with dementia (PwD) are cared for at home, with general practitioners (GPs) playing a key part in the treatment. However, primary dementia care suffers from a number of shortcomings: Often, diagnoses are made too late and therapies by GPs do not follow the guidelines. In cases of acute crises, PwD are too often admitted to hospital with adverse effects on the further course of the disease.The aim of this study is to implement and evaluate a new GP-based, complex dementia care model, DemStepCare. DemStepCare aims to ensure demand-oriented, stepped care for PwD and their caregivers.Methods/designIn a cluster randomized controlled trial, the care of PwD receiving a complex intervention, where the GP is supported by a multi-professional team, is compared to (slightly expanded) usual care.GPs are clustered by GP practice, with 120 GP practices participating in total. GP practices are randomized to an intervention or a control group. 800 PwD are to be included per group. Recruitment takes place in Rhineland-Palatinate, Germany. In addition, a second control group with at least 800 PwD will be formed using aggregated routine data from German health insurance companies. The intervention comprises the training of GPs, case management including repeated risk assessment of the patients’ care situation, the demand-oriented service of an outpatient clinic, an electronic case record, external medication analyses and a link to regional support services. The primary aims of the intervention are to positively influence the quality of life for PwD, to reduce the caregivers’ burden, and to reduce the days spent in hospital. Secondary endpoints address medication adequacy and GPs’ attitudes and sensitivity towards dementia, among others.DiscussionThe GP-based dementia care model DemStepCare is intended to combine a number of promising interventions to provide a complex, stepped intervention that follows the individual needs of PwD and their caregivers. Its effectiveness and feasibility will be assessed in a formative and a summative evaluation.Trial registrationGerman Register of Clinical Trials (Deutsches Register Klinischer Studien, DRKS), DRKS00023560. Registered 13 November 2020 - Retrospectively registered. HTML&TRIAL_ID=DRKS00023560.
Highlights
Approximately 50 million people worldwide live with dementia [1, 2]
The General practitioner (GP)-based dementia care model DemStepCare is intended to combine a number of promising interventions to provide a complex, stepped intervention that follows the individual needs of people with dementia (PwD) and their caregivers
The study is intended to bundle a number of possibly effective interventions to provide a complex, stepped intervention that follows the individual needs of PwD and their caregivers
Summary
Background and rationale Approximately 50 million people worldwide live with dementia [1, 2]. Primary dementia care still faces a number of problems. Provide timely and accurate diagnoses Some of the problems can be ascribed to general practitioners (GPs), who should often be the first to detect the onset of dementia and deal with it adequately. It has been shown that GPs are often reluctant to face the diagnosis of dementia and do not follow the existing guidelines [5,6,7,8,9]. Most people with dementia (PwD) are cared for at home, with general practitioners (GPs) playing a key part in the treatment. Primary dementia care suffers from a number of shortcomings: Often, diagnoses are made too late and therapies by GPs do not follow the guidelines. DemStepCare aims to ensure demand-oriented, stepped care for PwD and their caregivers
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