Evidence based interventions in dementia: the EVIDEM early diagnosis trial Steve Iliffe, Jane Wilcock, Mark Griffin, Priya Jane, Ingela Thuné- Boyle, Frances Lefford, David Rapp for the EVIDEM-ED project team

March 2012ADI, London2 The problem Early intervention can improve QOL and delay move to care home Late recognition, sub-optimal management in primary care Modest success in increasing case finding, but not in improving management (Downs et al BMJ 2006) Dementia diagnosis and review incentivised since 2006

March 2012ADI, London3 NIHR programme grant Research as a dialogue > expert activity Adult learning, workplace-based Collaborative reflection, team learning, problem-solving Short-range interactions Co-design Kernick D Wanted- new methodologies for health service research. Is complexity theory the answer? Family Practice 2006;23: Bate P & Robert G Toward more user-centric organisation development J Appl Behav Science 2007; 43:41 Hall J Professionalising action research – a meaningful strategy for modernising services? J Nurs Management 2006;14:

March 2012ADI, London4 Educational intervention Self-diagnosis of learning needs Semi-structured interview with 11 questions Group discussion with facilitator & non- participant observer Educational prescription Tailored educational workshops in practices

March 2012ADI, London5 Eleven questions How would you rate your current care for people with dementia and their carers? What grounds or criteria is your rating based on? After diagnosis, what follow-up do you provide to people with dementia and their carers? What do you think are the important quality markers in caring for people with dementia? (What would you want for yourself?) Is there anything in your current practice that you would like improve?

March 2012ADI, London6 Educational prescription 1. Update diagnostic skills and review assessment tools 2. Develop a ‘shared care’ protocol for management of patients with dementia, with emphasis on global assessment of disease progression. 3. To learn how to manage BPSD problems as they arise 4. To find a way to discuss complex cases of patients with dementia (e.g. those living in ‘problem families’, isolated PWD with language barriers) Absent topics: Carers’ needs, MCA2005

March 2012ADI, London7 Pragmatic randomised control trial Two arm trial: Educational workshops vs ‘Normal care’ in 23 practices Primary outcome: dementia reviews increase from one to two yearly Secondary outcomes: concordance with management guidelines; knowledge, skills and attitudes; carer satisfaction Before and after measures capture policy effects & Hawthorne effect Between arm comparison captures intervention effect

Primary outcomes InterventionControl (incomplete) T1 cases T2 cases % change+4+14 T1 reviews T2 reviews % change+8+14 March 2012ADI, London8

Secondary outcomes (selected) T1 (%)T2 (%) Capacity documented2423 Care plan in records4046 BPSD management5460 Power of Attorney64 Preferred place of care67 Functional ability3956 Carers needs discussed24 March 2012ADI, London9

March 2012ADI, London10 Thank you for listening This study has received financial support from the Department of Health National Institute for Health Research Programme Grants for Applied Research funding scheme. The views and opinions expressed therein do not necessarily reflect those of the Department of Health or the NIHR