Dementia Early Recognition and Response in Primary Care (EVIDEM-ED)

National Institute for Health Research, United Kingdom, Central and North West London NHS Foundation Trust, King's College London, University of Hertfordshire, St George's, University of London, London School of Economics and Political Science, Imperial College London

The purpose of this study is to develop and test an educational intervention for dementia in primary care, combining timely diagnosis, psychosocial support around the period of diagnosis and management concordant with guidelines.

Dementia presents many challenges for primary care. Early diagnosis is important as this allows those with dementia and their family care networks to engage with support services and plan for the future. These actions can relieve the significant psychological distress that people with dementia and close supporters may experience , and provide knowledge about the availability of medical and psycho-social support that can improved functioning and morale The main efforts to improve the identification and diagnosis of dementia should logically be targeted at primary care as this is the first point of contact for most individuals and their carers when faced with experiences of 'ill health'. There is, however, evidence that dementia remains under-detected and sub-optimally managed in general practice . An educational intervention that could enhance clinical practice, improving the skills of practitioners in the recognition of and response to dementia syndromes, could therefore be beneficial to people with dementia and their families, and potentially to health and social services.

Primary care practices randomly allocated will be given a summary of the NICE/SCIE dementia guidelines (2006) and offered workshop training and software at the end of the study.

Practices randomly allocated to the intervention arm will be asked to participate in tailored learning activities on dementia, over a three-month period and will be given an electronic training manual (based on Microsoft packages) which they can run in the background during and after consultations with people with known or suspected dementia syndrome and face-to- face individualised workshop sessions.

Tailored learning activities on dementia, over a three-month period and will be given an electronic training manual (based on Microsoft packages) which they can run in the background during and after consultations with people with known or suspected dementia syndrome and face-to- face individualised workshop sessions. Tailoring of the education programme is carried out in a three step process: 1) an educational needs analysis is carried our using a standard checklist to identify aspects of dementia care which the practice perceives as problematic for them; 2) a prescription for education is then written to address shortcomings; 3) the best forms of learning are then identified.

An increase in the proportion of patients with dementia receiving two dementia reviews per year, from 20% to 50%

documented concordance with intervention recommendations on recording disclosure decisions & consequences

documented concordance with informing people with dementia and their carers about relevant local voluntary organisations

Inclusion Criteria: Patients with memory or other cognitive impairments suggestive of dementia syndrome those with a formal diagnosis of dementia, of any type. Exclusion Criteria: Patients and carers who are already involved in concurrent research If the key professional feels that an approach to the person with dementia or their carer would be inappropriate, for example the dementia is very severe, or that an approach may increase distress and any other important reason that the key professional may have for why the person with dementia or their carer should not be contacted.

Wilcock J, Iliffe S, Griffin M, Jain P, Thune-Boyle I, Lefford F, Rapp D. Tailored educational intervention for primary care to improve the management of dementia: the EVIDEM-ED cluster randomized controlled trial. Trials. 2013 Nov 20;14:397. doi: 10.1186/1745-6215-14-397.

Iliffe S, Wilcock J, Griffin M, Jain P, Thune-Boyle I, Koch T, Lefford F. Evidence-based interventions in dementia: A pragmatic cluster-randomised trial of an educational intervention to promote earlier recognition and response to dementia in primary care (EVIDEM-ED). Trials. 2010 Feb 10;11:13. doi: 10.1186/1745-6215-11-13.