The number of Australians with dementia is increasing and so is the frequency of people with dementia presenting to general medical practice. Most people with dementia are living in their family homes in the community. A recent evidence-based clinical practice guideline to inform the diagnosis and management of people with dementia, and support of their carers [1], contains several key recommendations relevant to Australian general practitioners (GPs) with the potential to improve the quality of care and quality of life for people with dementia and their families.
IRIS is investigating the current care of people with dementia in general practice, and the effectiveness of a targeted, theory-based implementation strategy to implement these evidence-based recommendations into clinical practice. We are exploring ways of changing practice in line with recommendations and measuring the benefits to health outcomes of people with dementia. This project builds on our work to date and is one of a series we are conducting to inform the uptake of evidence into clinical practice (see IMPLEMENT and ALIGN).
This project is funded by the Australian National Health and Medical Research Council through the Dementia Research Grants Program, Round Two. The aims of this three stage project are to:
- Identify the barriers to and enablers of implementing evidence-based recommendations for the diagnosis and management of dementia in general practice using a theoretical framework informed by behavioural theory.
- Develop and pilot a targeted implementation strategy to increase the uptake of these key recommendations which addresses the modifiable barriers identified in Phase 1.
- Test the effectiveness and cost-effectiveness of this strategy for implementing evidence-based recommendations for the diagnosis and management of people with dementia in GPs in a cluster randomised controlled trial.
A mixed methods approach will be used for this project. A qualitative approach using semi-structured interviews with GPs, patients with dementia and their carers will be conducted to identify the factors that help or hinder GPs implementing the recommendations in caring for patients with dementia. Behavioural theory will guide the development of the interview content. Information from the interviews will be used to develop a survey to canvas the views of a larger population of Australian GPs to determine the most important factors. The results of the interviews and survey will be used to inform the design of a strategy for implementing the recommendations into practice.
A cluster randomised controlled trial will then be conducted to determine the effect of the strategy. GP practices will be randomised to receive either the developed implementation strategy, potentially including strategies targeted at GPs, people with dementia and their families and carers, or to a control group receiving access to the evidence-based clinical practice recommendations alone. The outcomes of the implementation strategy will be assessed at the level of the GP (did the strategy result in a change in behaviour?); the patient (did the strategy result in improved patient quality of life?); and the carer (did the carer have an improved quality of life?).
The IRIS Study Group:
Sally Green, Colette Browning, Martin Eccles, Leon Flicker, Jill Francis, Simon French, Jeremy Grimshaw, Claire Harris, Joanne McKenzie, Susan Michie, Duncan Mortimer, Kerry Murphy, Denise O’Connor, Daniel O’Connor, Neil Spike, Barbara Workman.
Project Coordinator:
Fiona Kossenas
Contact:
iris@med.monash.edu.au or fiona.kossenas@monash.edu; Phone: 03 9903 0112.
[1] SIGN 2006 Management of patients with dementia: A National Clinical Guideline SIGN 86.