Dementia
Conditions
Keywords
Occupational Therapy, Evidence-Based Practice, Continuing Education, utilization, Guideline, Dementia, Guideline implementation
Brief summary
The main purpose of this cluster randomized controlled trial is to evaluate the difference in effectiveness between a combined implementation strategy and an educational strategy on the implementation of a community occupational therapy program for clients with dementia and their primary caregivers.
Detailed description
Dementia is associated with a major decrease in quality of life of clients and their caregivers and a major driver of costs in health care. Recently, evidence was found for the effectiveness and cost-effectiveness of a community-based occupational therapy (OT) intervention for older adults with dementia and their caregivers (COTiD program). This intervention resulted in significant improvements in both clients' and caregivers' daily functioning, quality of life, mood and health status. In addition, caregivers experienced an increased sense of competence. Currently occupational therapists (OTs) are trained in using the program during a 3-day course. In a pilot implementation study it was found that this course was not effective enough as only 20% of the OTs actually used the COTiD program in practice because of a lack of implementation skills, feedback and organisational barriers. In order to increase the use of this program and increase the quality of care a new implementation strategy is developed. This combined implementation strategy provides the OTs with two implementation training days, coaching on the job, regional meetings, discussion platform, web-based registration system and newsletters. In addition physicians and managers are provided with extra information on the COTiD program. The current study is designed primarily to evaluate the following research questions: * What is the difference in adherence to the community OT guideline in dementia between OTs receiving the combined implementation strategy and OTs receiving the educational strategy? * What is the difference in community OT use(referral rate + actual provision of OT) between clusters provided with the combined implementation strategy and clusters provided with the educational strategy? * What is the difference in cost-effectiveness between the combined implementation strategy and the educational strategy with regard to adherence of OTs to the community OT guideline? In addition the effect of the implementation strategies on patient and caregiver outcomes will also be measured.
Interventions
OTHER3-day post-graduate course
A 3-day course in using the COTiD program in clinical practice. The 3 days are not provided uninterrupted but there are at least two weeks between each day to provide time to practice with the guideline (for discussion on the 2nd day). The course consists of theory on the content of the guideline and its effectiveness, Practice parts of the guideline by rol playing, and discussing each others skills through watching video material.
OTHERCombined implementation strategy
The combined implementation strategy provides strategies for occupational therapists (OTs), physicians, and managers. OTs receive: * 3-day post-graduate course * 2 extra training days: Lectures and skills practice focused on using the COTiD program and promoting the use of the program within their organization and network. * Coaching on the job: Barriers to using the COTiD program in practice are discussed using motivational interviewing. * Discussion platform * Web-based registration system: Provides guidance in using the COTiD program for every individual client. * Regional meetings: successes and difficulties in using the COTiD are discussed. Managers and physicians receive: * Information on the COTiD program through a website and newsletters. * Motivational reminders.
Sponsors
HAN University of Applied Sciences
ZonMw: The Netherlands Organisation for Health Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
Because of the clustered design, there are inclusion and
Exclusion criteria
for clusters as well as for clients with dementia and their caregivers.A cluster is a unit that exists of at least one occupational therapist, one physician, and one manager. Criteria for clusters Inclusion Criteria: * The organization provides outpatient OT. * The organization expects that they will be able to include a minimum of 8 clients in the study. * There are at least two OTs, one manager, and one physician willing and able to participate in the study.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Adherence of occupational therapists to the COTiD program | one year (baseline, T1, and T2) | Adherence is measured using vignettes. Vignettes are realistic case descriptions about which occupational therapists are asked to answer open ended questions. |
| Community occupational therapy use according to the COTiD program | one year | Community OT use reflects: * How many people with dementia were referred to OT services in total * How many people with dementia were referred specifically to OT according to the COTiD program. |
| Costs of the implementation strategies | October 2009 - December 2011 | The following cost data is collected: Costs of the implementation strategies * Costs made by the OTs, managers, and physicians receiving the combined implementation strategy. * Costs made by the OTs receiving only the educational strategy. * Development and execution costs of the combined implementation strategy. * development and execution costs of the educational strategy. Costs made buy the cliënt and caregiver * Costs made by client and caregiver (using the RUD Lite instrument)regarding healthcare consumption * Time the caregiver spends om informal care |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Knowledge of the healthcare professionals about the COTiD program | one year (baseline, T1, and T2) | measured using a multiple choice knowledge test on the most important aspects of the COTiD program. |
| COTiD program treatment outcome on client and caregiver level | one year (baseline, T1, and T2) | The following outcomes are evaluated: * Clients'processing skills (Assessment of Motor and Process Skills) * Need for assistance in daily activities (Interview of Deterioration of Daily Activities in Dementia) * Caregivers Sense of Competence (Sense of Competense Questionnaire) * Client and caregiver quality of life (EQ5D and Dementia Quality of Life Scale) * Client and caregiver self-perceived performance and satisfaction (Canadian Occupational Performance Measure) |
Countries
Netherlands
Outcome results
None listed