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Padovani A, Falato S, Pegoraro V. Extemporaneous combination of donepezil and memantine to treat dementia in Alzheimer disease: evidence from Italian real-world data. Curr Med Res Opin 2023; 39:567-577. [PMID: 36803101 DOI: 10.1080/03007995.2023.2182530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Providing evidence on donepezil and memantine administration as extemporaneous combination (DM-EXT) to treat Alzheimer Disease (AD) in Italy, and describing demographic and clinical features of AD patients prescribed DM-EXT. METHODS Retrospective observational study using IQVIA Italian LifeLink Treatment Dynamics (LRx) and Longitudinal Patient Database (LPD). Prevalent users of DM-EXT were identified on the databases (cohorts DMpLRx and DMpLPD) including patients with donepezil and memantine overlapping prescriptions during the selection period (DMpLRx: "July 2018-June 2021"; DMpLPD: "July 2012-June 2021"). Demographic and clinical profiles of patients were provided. Starting from cohort DMpLPD, new users of DM-EXT were selected to calculate treatment adherence. Three additional cohorts of prevalent users of DM-EXT were identified on IQVIA LRx over subsequent 12-month periods, from July 2018 to June 2021, to get national-level yearly estimates accounting for database representativeness. RESULTS Cohorts DMpLRx and DMpLPD included 9862 and 708 patients, respectively. For both cohorts, two-third of patients were female, and more than half were aged 80+. Concomitant conditions and co-treatments prevalence was very high; most frequent comorbidities included psychiatric and cardiovascular diseases. An intermediate-to-high adherence was observed in 57% of DM-EXT new users. National-level yearly estimates showed an increasing trend (+4%) in DM-EXT prescription, which led to estimate about 10,000 patients being treated during the period "July 2020-June 2021". CONCLUSIONS Prescription of DM-EXT is a common practice in Italy. Because the administration of fixed-dose (FDCs) instead of extemporaneous combinations improves treatment adherence, the introduction of an FDC containing donepezil and memantine might enhance AD patients' management and reduce caregiver burden.
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Affiliation(s)
- Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Serena Falato
- RWS Department, IQVIA Solutions Italy S.r.l, Milan, Italy
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Welberry HJ, Brodaty H, Hsu B, Barbieri S, Jorm LR. Measuring dementia incidence within a cohort of 267,153 older Australians using routinely collected linked administrative data. Sci Rep 2020; 10:8781. [PMID: 32472058 PMCID: PMC7260191 DOI: 10.1038/s41598-020-65273-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/28/2020] [Indexed: 12/29/2022] Open
Abstract
To estimate dementia incidence rates using Australian administrative datasets and compare the characteristics of people identified with dementia across different datasets. This data linkage study used a cohort of 267,153 from the Australian 45 and Up Study. Participants completed a survey in 2006-2009 and subsequent dementia was identified through pharmaceutical claims, hospitalisations, aged care eligibility assessments, care needs at residential aged care entry and death certificates. Age-specific, and age-standardised incidence rates, incidence rate ratios and survival from first dementia diagnosis were estimated. Estimated age-standardised dementia incidence rates using all linked datasets was 16.8 cases per 1000 person years for people aged 65+. Comparing incidence rates to the global published rates suggested 77% of cases were identified but this varied by age with highest coverage among those aged 80-84 years (92%). Incidence rate ratios were inconsistent across datasets for: sex, socio-economic disadvantage, size of support network, marital status, functional limitations and diabetes. Median survival from first dementia diagnosis ranged from 1.80 years in the care needs dataset to 3.74 years in the pharmaceutical claims dataset. Characteristics of people identified with dementia in different administrative datasets reflect the factors that drive interaction with specific services; this may introduce bias in observational studies using a single data-source to identify dementia.
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Affiliation(s)
- Heidi J Welberry
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Benjumin Hsu
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sebastiano Barbieri
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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Ponjoan A, Garre-Olmo J, Blanch J, Fages E, Alves-Cabratosa L, Martí-Lluch R, Comas-Cufí M, Parramon D, Garcia-Gil M, Ramos R. Is it time to use real-world data from primary care in Alzheimer's disease? Alzheimers Res Ther 2020; 12:60. [PMID: 32423489 PMCID: PMC7236302 DOI: 10.1186/s13195-020-00625-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The analysis of real-world data in clinical research is rising, but its use to study dementia subtypes has been hardly addressed. We hypothesized that real-world data might be a powerful tool to update AD epidemiology at a lower cost than face-to-face studies, to estimate the prevalence and incidence rates of AD in Catalonia (Southern Europe), and to assess the adequacy of real-world data routinely collected in primary care settings for epidemiological research on AD. METHODS We obtained data from the System for the Development of Research in Primary Care (SIDIAP) database, which contains anonymized information of > 80% of the Catalan population. We estimated crude and standardized incidence rates and prevalences (95% confidence intervals (CI)) of AD in people aged at least 65 years living in Catalonia in 2016. RESULTS Age- and sex-standardized prevalence and incidence rate of AD were 3.1% (95%CI 2.7-3.6) and 4.2 per 1000 person-years (95%CI 3.8-4.6), respectively. Prevalence and incidence were higher in women and in the oldest people. CONCLUSIONS Our incidence and prevalence estimations were slightly lower than the recent face-to-face studies conducted in Spain and higher than other analyses of electronic health data from other European populations. Real-world data routinely collected in primary care settings could be a powerful tool to study the epidemiology of AD.
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Affiliation(s)
- Anna Ponjoan
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
- Girona Biomedical Research Institute (IDIBGi), Girona, Catalonia, Spain
- Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), Catalonia, Spain
| | - Josep Garre-Olmo
- Girona Biomedical Research Institute (IDIBGi), Girona, Catalonia, Spain
| | - Jordi Blanch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Ester Fages
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
- Primary Care Services, Catalan Institute of Health (ICS), Girona, Catalonia, Spain
| | - Lia Alves-Cabratosa
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Ruth Martí-Lluch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
- Girona Biomedical Research Institute (IDIBGi), Girona, Catalonia, Spain
- Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), Catalonia, Spain
| | - Marc Comas-Cufí
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Dídac Parramon
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
- Primary Care Services, Catalan Institute of Health (ICS), Girona, Catalonia, Spain
| | - María Garcia-Gil
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain
| | - Rafel Ramos
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Barcelona, Catalonia, Spain.
- Department of Medical Sciences, School of Medicine, Campus Salut, University of Girona, Girona, Catalonia, Spain.
- IDIAPJGol, c/ Maluquer Salvador, 11 baixos, 17002, Girona, Catalonia, Spain.
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Abstract
Background: Studies on prevalence or the therapy of dementia are rare or non-existent in Russia. Objective: The purpose of this study was to analyze the prescription patterns of antidementia therapy in Russia in 2018. Methods: This retrospective cross-sectional study was based on the IQVIA Russia LRx database, which covers approximately 11% of all patients enrolled in federal or regional reimbursement state healthcare programs. We descriptively analyzed the proportions of patients treated with antidementia drugs, antipsychotics, antidepressants, and benzodiazepines. Results: A total of 12,051 dementia patients were available for analysis. Of those, 6,394 patients had a vascular dementia (VaD) diagnosis, while 3,413 were diagnosed with dementia in other diseases (DOD), 1,128 with Alzheimer’s disease (AD), and 1,116 with unspecified dementia (UD). The therapy with the highest patient proportion was antipsychotics, with 74% of VaD patients, 73% of UD patients, and 47% of DOD patients receiving these drugs. The proportion of patients treated with antidementia drugs was 68% in AZ, 56% in VaD, 45% in UD, and only 9% in DOD. Antidepressants were a relatively rare therapy in dementia patients (between 4% and 12%), and 30% of DOD patients received benzodiazepines, while the proportions of patients receiving this therapy class in other dementias was low (7–10%). Most patients were treated with old-generation drugs. Conclusion: The proportion of older drugs prescribed in Russia is higher than in Western Europe, which may likely be due to their low prices, resulting in a higher chance for successful health insurance reimbursement claims.
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Thyrian JR, Michalowsky B, Hertel J, Wübbeler M, Gräske J, Holle B, Schäfer-Walkmann S, Wolf-Ostermann K, Hoffmann W. How Does Utilization of Health Care Services Change in People with Dementia Served by Dementia Care Networks? Results of the Longitudinal, Observational DemNet-D-Study. J Alzheimers Dis 2019; 66:1609-1617. [PMID: 30507578 DOI: 10.3233/jad-180758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is no common definition for the Dementia Care Network (DCN). They are heterogeneous and there is no general, longitudinal evidence for the effects of DCN. OBJECTIVE We describe changes in utilization of health services by people served by dementia care networks in Germany and factors associated with those changes over time. METHODS Primary data was assessed in 560 people with dementia (PwD) and their caregivers supported by DCN in Germany; sociodemographic and clinical variables, utilization of services; DCN were characterized according to governance. The design: observational study with face-to-face interviews at two time points over a period of one year. Data was assessed via semi-structured interviews at the participants' homes. RESULTS Utilization of health services in this study is consistently higher than reported for the general population and does not significantly change over time. The strongest predictor of utilization of any service after one year was the use of this service at baseline (OR from 3.23 to 44.16). Higher activities of daily functioning increased the chances to utilize specialist physicians (OR = 1.32; 95% -CI: 1.08-1.63) or occupational therapy (OR = 1.24; 95% -CI: 1.02-1.50) significantly. Being a female decreased chances to utilize specialist physicians (OR = 0.57; 95% -CI: 0.37-0.87) and increased the chances to utilize no services (OR = 2.08; 95% -CI: 1.29-3.33). CONCLUSION While health care acknowledges the importance and benefits of dementia care networks (i.e., in Germany, the results were considered in new German legislation (SGB XI)), further research is needed to define this kind of service delivery to facilitate comparison as well as promote evidence-based implementation.
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Affiliation(s)
- Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Greifswald, Germany
| | - Markus Wübbeler
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Greifswald, Germany
| | - Johannes Gräske
- Department of Health and Nursing, Campus Alt-Saarbrücken, University of Applied Sciences, School of Social Sciences, Saarbrücken, Germany
| | - Bernhard Holle
- German Center for Neurodegenerative Diseases (DZNE), Site Witten, Witten, Germany
| | - Susanne Schäfer-Walkmann
- Institute for Applied Social Sciences (IfaS), Baden-Wuerttemberg Cooperative State University Stuttgart, Fakultät Sozialwesen, Stuttgart, Germany
| | - Karin Wolf-Ostermann
- Institute for Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/ Greifswald, Greifswald, Germany.,Institute for Community Medicine (ICM), University Medicine Greifswald, Greifswald, Germany
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Trends of antidementia drugs use in outpatients with Alzheimer's disease in six major cities of China: 2012-2017. Int Clin Psychopharmacol 2019; 34:312-316. [PMID: 31274694 DOI: 10.1097/yic.0000000000000278] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease is a devastating neurodegenerative disease that requires pharmacological intervention. We conducted a descriptive study using pharmacy prescription data of antidementia drugs. Prescription information of 99 541 patients was obtained from 55 hospitals. Overall the number of Alzheimer's disease outpatients of sampling days increased from 10 239 in 2012 to 20 546 in 2017. The main age range of patients suffering Alzheimer's disease was 75-84, while the patients aged above 85 was increasing. Nonusers of antidementia drugs, cholinesterase inhibitors (ChEIs) and memantine slowly decreased over the study period. The percentage of patients taking ChEIs and ChEIs-combined memantine increased. The most frequently prescribed ChEI was donepezil. These results are mostly in line with the guideline recommendations and clinical evidence during the study period. Efforts should be made to reduce the number of nonusers and optimize the use of antidementia drugs.
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Nikelski A, Keller A, Schumacher-Schönert F, Dehl T, Laufer J, Sauerbrey U, Wucherer D, Dreier-Wolfgramm A, Michalowsky B, Zwingmann I, Vollmar HC, Hoffmann W, Kreisel SH, Thyrian JR. Supporting elderly people with cognitive impairment during and after hospital stays with intersectoral care management: study protocol for a randomized controlled trial. Trials 2019; 20:543. [PMID: 31470912 PMCID: PMC6716860 DOI: 10.1186/s13063-019-3636-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The sectorization of health-care systems leads to inefficient treatment, especially for elderly people with cognitive impairment. The transition from hospital care to primary care is insufficiently coordinated, and communication between health-care providers is often lacking. Consequences include a further deterioration of health, higher rates of hospital readmissions, and institutionalization. Models of collaborative care have shown their efficacy in primary care by improving patient-related outcomes. The main goal of this trial is to compare the effectiveness of a collaborative care model with usual care for people with cognitive impairment who have been admitted to a hospital for treatment due to a somatic illness. The aim of the intervention is to improve the continuity of treatment and care across the transition between the in-hospital and adjoining primary care sectors. METHODS/DESIGN The trial is a longitudinal multisite randomized controlled trial with two arms (care as usual and intersectoral care management). Inclusion criteria at the time of hospital admission due to a somatic illness are age 70+ years, cognitive impairment (Mini Mental State Examination, MMSE ≤26), living at home, and written informed consent. Each participant will have a baseline assessment at the hospital and two follow-up assessments at home (3 and 12 months after discharge). The estimated sample size is n = 398 people with cognitive inmpairement plus their respective informal caregivers (where available). In the intersectoral care management group, specialized care managers will develop, implement, and monitor individualized treatment and care based on comprehensive assessments of the unmet needs of the patients and their informal caregivers. These assessments will occur at the hospital and in participants' homes. Primary outcomes are (1) activities of daily living, (2) readmission to the hospital, and (3) institutionalization. Secondary outcomes include (a) frailty, (b) delirium, (c) quality of life, (d) cognitive status, (e) behavioral and psychological symptoms of dementia, (f) utilization of services, and (g) informal caregiver burden. DISCUSSION In the event of proving efficacy, this trial will deliver a proof of concept for implementation into routine care. The cost-effectiveness analyses as well as an independent process evaluation will increase the likelihood of meeting this goal. The trial will enable an in-depth analysis of mediating and moderating effects for different health outcomes at the interface between hospital care and primary care. By highlighting treatment and care, the study will provide insights into unmet needs at the time of hospital admission, and the opportunities and barriers to meeting those needs during the hospital stay and after discharge. TRIAL REGISTRATION ClinicalTrials.gov, NCT03359408 ; December 2, 2017.
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Affiliation(s)
- Angela Nikelski
- Division of Geriatric Psychiatry, Evangelisches Klinikum Bethel, Bethesdaweg 12, 33617 Bielefeld, Germany
| | - Armin Keller
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Fanny Schumacher-Schönert
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Terese Dehl
- Department of Epidemiology and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Jessica Laufer
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Ulf Sauerbrey
- Institute of General Practice and Family Medicine, University Hospital Jena, Bachstr. 18, 07743 Jena, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Adina Dreier-Wolfgramm
- Department of Epidemiology and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, University Hospital Jena, Bachstr. 18, 07743 Jena, Germany
- Institute of General Practice and Family Medicine, Faculty of Medicine, Ruhr-University Bochum (RUB), Gebäude MA, Universitätsstraße 150, 44801 Bochum, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
- Department of Epidemiology and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
| | - Stefan H. Kreisel
- Division of Geriatric Psychiatry, Evangelisches Klinikum Bethel, Bethesdaweg 12, 33617 Bielefeld, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
- Department of Epidemiology and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489 Greifswald, Germany
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Abstract
The objective of this study was to evaluate the use of antidementia drugs (ADDs) in patients with Alzheimer's disease (AD) regarding German guideline recommendations and to assess correlations between the use of ADDs and the patients' characteristics. A total of 395 community-dwelling and institutionalized patients with AD across all severity stages of dementia were recruited in this cross-sectional study. Associations between the prescription of ADDs and patients' sociodemographic and clinical parameters (neuropsychiatric symptoms, cognitive capacity, daily activities, and health-related quality of life) were analyzed in multiple logistic regression analyses. ADDs were prescribed in 46.6% of all participants and less often in institutionalized patients (38.2 vs. 50.4%, P=0.025). Patients with mild-to-moderate dementia had a higher chance of receiving ADDs [odds ratio (OR)=3.752, 95% confidence interval (CI): 1.166-12.080 and OR=3.526, 95% CI: 1.431-8.688] as well as those treated by neurologists/psychiatrists (OR=2.467, 95% CI: 1.288-4.726). Overall, 39% of the patients with mild cognitive deficits (Mini-Mental Status Examination 27-30) received ADDs and 21% of the mildly demented patients (Mini-Mental Status Examination 20-26) received memantine. The treatment with ADDs was in part not in line with German guideline recommendations. Particularly, the lower use of ADDs in patients not attending neuropsychiatric specialists should be further evaluated.
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Heinrich S, Sommerfeld U, Michalowsky B, Hoffmann W, Thyrian JR, Wolf-Ostermann K, Roes M. How to Initiate Dementia Care Networks? Processes, Barriers, and Facilitators During the Development Process of a Practice-Oriented Website Toolkit Out of Research Results. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2017; 37:151-160. [PMID: 29022833 DOI: 10.1177/0272684x17736245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite its high relevance, scientific evidence often fails to be disseminated into practice. Information websites can be a successful information dissemination tool, but very little is known about the processes involved in the interdisciplinary development of such websites. This article aims to demonstrate the processes, barriers, and facilitators during the development and publication of a practice-friendly information website grounded in scientifically based research findings about dementia care networks obtained by the DemNet-D study. METHOD The qualitative data of this article are based on a work progress protocol and a recorded interview with the project's science journalist. The interview was transcribed, analyzed, and coded based on structured content analysis. Quantitative data were extracted to display the website usage rate. RESULTS The results indicate that interdisciplinary teamwork is an essential factor for successful website development. Furthermore, the use of a formalized model can help to organize the development structure. To transform scientific content, a specialized expert in the field is needed. Continuous evaluations and marketing strategies are vital for the success of a website. The final website had a high access rate 1 month after launch. CONCLUSION Crucial processes, barriers, and facilitators during the development of a practice-related information website about dementia care networks are presented and discussed. These findings can help people who aim to disseminate research findings to other practitioner-associated priority groups as well as public health-related groups.
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Affiliation(s)
- Steffen Heinrich
- 1 375064 German Center for Neurodegenerative Diseases (DZNE), Witten , Germany
| | - Ulrike Sommerfeld
- 1 375064 German Center for Neurodegenerative Diseases (DZNE), Witten , Germany
| | - Bernhard Michalowsky
- 2 German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Wolfgang Hoffmann
- 3 Institute for Community Medicine, University of Greifswald, Germany
| | - Jochen René Thyrian
- 2 German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Karin Wolf-Ostermann
- 4 Institute for Public Health and Nursing Science, University of Bremen, Germany
| | - Martina Roes
- 1 375064 German Center for Neurodegenerative Diseases (DZNE), Witten , Germany
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Thyrian JR, Hertel J, Wucherer D, Eichler T, Michalowsky B, Dreier-Wolfgramm A, Zwingmann I, Kilimann I, Teipel S, Hoffmann W. Effectiveness and Safety of Dementia Care Management in Primary Care: A Randomized Clinical Trial. JAMA Psychiatry 2017; 74:996-1004. [PMID: 28746708 PMCID: PMC5710469 DOI: 10.1001/jamapsychiatry.2017.2124] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Dementia care management (DCM) can increase the quality of care for people with dementia. Methodologically rigorous clinical trials on DCM are lacking. OBJECTIVE To test the effectiveness and safety of DCM in the treatment and care of people with dementia living at home and caregiver burden (when available). DESIGN, SETTING, AND PARTICIPANTS This pragmatic, general practitioner-based, cluster-randomized intervention trial compared the intervention with care as usual at baseline and at 12-month follow-up. Simple 1:1 randomization of general practices in Germany was used. Analyses were intent to treat and per protocol. In total, 6838 patients were screened for dementia (eligibility: 70 years and older and living at home) from January 1, 2012, to March 31, 2016. Overall, 1167 (17.1%) were diagnosed as having dementia, and 634 (9.3%) provided written informed consent to participate. INTERVENTIONS Dementia care management was provided for 6 months at the homes of patients with dementia. Dementia care management is a model of collaborative care, defined as a complex intervention aiming to provide optimal treatment and care for patients with dementia and support caregivers using a computer-assisted assessment determining a personalized array of intervention modules and subsequent success monitoring. Dementia care management was targeted at the individual patient level and was conducted by 6 study nurses with dementia care-specific qualifications. MAIN OUTCOMES AND MEASURES Quality of life, caregiver burden, behavioral and psychological symptoms of dementia, pharmacotherapy with antidementia drugs, and use of potentially inappropriate medication. RESULTS The mean age of 634 patients was 80 years. A total of 407 patients received the intended treatment and were available for primary outcome measurement. Of these patients, 248 (60.9%) were women, and 204 (50.1%) lived alone. Dementia care management significantly decreased behavioral and psychological symptoms of dementia (b = -7.45; 95% CI, -11.08 to -3.81; P < .001) and caregiver burden (b = -0.50; 95% CI, -1.09 to 0.08; P = .045) compared with care as usual. Patients with dementia receiving DCM had an increased chance of receiving antidementia drug treatment (DCM, 114 of 291 [39.2%] vs care as usual, 31 of 116 [26.7%]) after 12 months (odds ratio, 1.97; 95% CI, 0.99 to 3.94; P = .03). Dementia care management significantly increased quality of life (b = 0.08; 95% CI, 0 to 0.17; P = .03) for patients not living alone but did not increase quality of life overall. There was no effect on potentially inappropriate medication (odds ratio, 1.86; 95% CI, 0.62 to 3.62; P = .97). CONCLUSIONS AND RELEVANCE Dementia care management provided by specifically trained nurses is an effective collaborative care model that improves relevant patient- and caregiver-related outcomes in dementia. Implementing DCM in different health care systems should become an active area of research. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01401582.
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Affiliation(s)
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany,Department of Psychiatry and Psychotherapy, Greifswald Medical School, University of Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | | | - Adina Dreier-Wolfgramm
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Greifswald Medical School, University of Greifswald, Greifswald, Germany
| | - Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany,Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Greifswald Medical School, University of Greifswald, Greifswald, Germany
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Calvó-Perxas L, Turró-Garriga O, Vilalta-Franch J, Lozano-Gallego M, de Eugenio R, Márquez F, Carmona O, Gich J, Manzano A, Viñas M, Roig AM, Garre-Olmo J. Trends in the Prescription and Long-Term Utilization of Antidementia Drugs Among Patients with Alzheimer's Disease in Spain: A Cohort Study Using the Registry of Dementias of Girona. Drugs Aging 2017; 34:303-310. [PMID: 28258538 DOI: 10.1007/s40266-017-0446-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Acetylcholinesterase inhibitors (AChEIs) and the N-methyl D-aspartate-antagonist memantine are indicated for the symptomatic treatment of Alzheimer's disease (AD). OBJECTIVES Our aims were to describe the baseline characteristics of patients with AD according to prescription of these treatments after the diagnostic work-up to describe long-term trends in the use of these medications and to identify baseline characteristics associated with the frequency of use of each treatment. METHODS This was a cohort study with a sample of 2992 patients with AD recorded in the Registry of Dementias of Girona (ReDeGi) between 2007 and 2014. Consumption of AChEIs and memantine was assessed using the Pharmacy Unit database from the Public Catalan Healthcare Service. We used generalized estimating equation analyses to identify the baseline characteristics associated with the consumption of AChEIs and memantine over time. RESULTS Most of the patients (70.4%; 95% confidence interval [CI] 68.7-72.0) were prescribed antidementia medication at the time of diagnosis. Of these, 75.0% (95% CI 73.1-76.8) were prescribed AChEIs, 14.7% (95% CI 13.2-16.3) were prescribed an AChEI plus memantine, and 10.3% (95% CI 9.0-11.6) were prescribed memantine. Advanced age reduced the likelihood of AChEI consumption. Mild dementia severity increased the use of AChEIs, and moderate-advanced dementia increased the likelihood of memantine consumption. After diagnosis, the likelihood of AChEI consumption decreased from the first year until the fifth, whereas the likelihood of memantine consumption, either alone or in combination with AChEIs, increased. CONCLUSIONS Antidementia drug use in this study showed the initial use of AChEIs alone with later use of AChEIs in combination with memantine and memantine alone in older patients with severe AD. Our findings are in agreement with current clinical practice guidelines for the pharmacological treatment of AD.
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Affiliation(s)
- Laia Calvó-Perxas
- Girona Biomedical Research Institute (IdIBGI), C/Dr. Castany, s/n, Salt, 17190, Girona, Catalonia, Spain
| | - Oriol Turró-Garriga
- Girona Biomedical Research Institute (IdIBGI), C/Dr. Castany, s/n, Salt, 17190, Girona, Catalonia, Spain.,Dementia Unit, Hospital de Santa Caterina, Salt, Catalonia, Spain
| | - Joan Vilalta-Franch
- Girona Biomedical Research Institute (IdIBGI), C/Dr. Castany, s/n, Salt, 17190, Girona, Catalonia, Spain.,Dementia Unit, Hospital de Santa Caterina, Salt, Catalonia, Spain.,Department of Medicine, University of Girona, Girona, Catalonia, Spain
| | | | - Rosa de Eugenio
- Dementia Unit, Hospital de Palamós, Palamós, Catalonia, Spain
| | - Fabián Márquez
- Neurology Department, Hospital d'Olot, Olot, Catalonia, Spain
| | - Olga Carmona
- Neurology Unit, Hospital de Figueres, Figueres, Catalonia, Spain
| | - Jordi Gich
- Neurodegenerative Disease Unit, Hospital Universitari Dr. Josep Trueta, Girona, Catalonia, Spain
| | - Anna Manzano
- Neurology Department, Hospital de Campdevànol, Campdevànol, Catalonia, Spain
| | - Marta Viñas
- Geriatrics and Neurology Department, Hospital de Blanes, Blanes, Catalonia, Spain
| | - Anna Mª Roig
- Pharmacy Unit, Health Region of Girona, Girona, Catalonia, Spain
| | - Josep Garre-Olmo
- Girona Biomedical Research Institute (IdIBGI), C/Dr. Castany, s/n, Salt, 17190, Girona, Catalonia, Spain. .,Dementia Unit, Hospital de Santa Caterina, Salt, Catalonia, Spain. .,Department of Medicine, University of Girona, Girona, Catalonia, Spain.
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12
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[People with dementia in primary care : Prevalence, incidence, risk factors and interventions]. Z Gerontol Geriatr 2017; 50:32-38. [PMID: 28386806 DOI: 10.1007/s00391-017-1223-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Approximately 110 years after the first description of Alzheimer's disease (AD) healthcare systems worldwide face the challenge of increasing numbers of people affected by dementia. There is a need to develop (national) dementia plans on a societal level to implement strategies to combat these challenges. These plans, among other topics, explicitly aim at scientific and research strategies as well as support and healthcare structures. OBJECTIVE This article describes a selection of current healthcare research studies and projects in Germany. Selected studies are presented which deliver concepts and approaches to answer the most pressing issues in dementia healthcare research in primary care and the scientific evidence is summarized. Future needs in dementia research and healthcare research are presented. MATERIAL AND METHODS The projects under examination are (a) the Leipzig longitudinal study of the aged (LEILA75+), (b) the German study on aging, cognition and dementia (AgeCoDe), (c) the dementia care initiative in primary practice (IDA), (d) the Dementia: life- and person-centered help in Mecklenburg-Western Pomerania (DelpHi) trial, (e) studies analyzing dementia care networks (IDEMUCK and DemNet-D) and (f) the general hospital study (GHoSt). RESULTS AND DISCUSSION Prevalence and incidence studies have shown how high the impact of AD is on the current healthcare systems and how it is expected to be in the future. Other studies have identified risk factors as well as protective factors that can serve as target points for the development of effective interventions. They also give hints on where the healthcare system might benefit from changes. Healthcare research has identified scientific methods helpful in providing sound evidence for decision makers in health policy. These have been applied in healthcare research close to routine care and have shown their impact on routine care; however, there are healthcare-specific challenges when applying scientific methods in routine care, which are briefly described.
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Lee SAW, Sposato LA, Hachinski V, Cipriano LE. Cost-effectiveness of cerebrospinal biomarkers for the diagnosis of Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2017; 9:18. [PMID: 28302164 PMCID: PMC5356269 DOI: 10.1186/s13195-017-0243-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 02/08/2017] [Indexed: 12/14/2022]
Abstract
Background Accurate and timely diagnosis of Alzheimer’s disease (AD) is important for prompt initiation of treatment in patients with AD and to avoid inappropriate treatment of patients with false-positive diagnoses. Methods Using a Markov model, we estimated the lifetime costs and quality-adjusted life-years (QALYs) of cerebrospinal fluid biomarker analysis in a cohort of patients referred to a neurologist or memory clinic with suspected AD who remained without a definitive diagnosis of AD or another condition after neuroimaging. Parametric values were estimated from previous health economic models and the medical literature. Extensive deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of the results. Results At a 12.7% pretest probability of AD, biomarker analysis after normal neuroimaging findings has an incremental cost-effectiveness ratio (ICER) of $11,032 per QALY gained. Results were sensitive to the pretest prevalence of AD, and the ICER increased to over $50,000 per QALY when the prevalence of AD fell below 9%. Results were also sensitive to patient age (biomarkers are less cost-effective in older cohorts), treatment uptake and adherence, biomarker test characteristics, and the degree to which patients with suspected AD who do not have AD benefit from AD treatment when they are falsely diagnosed. Conclusions The cost-effectiveness of biomarker analysis depends critically on the prevalence of AD in the tested population. In general practice, where the prevalence of AD after clinical assessment and normal neuroimaging findings may be low, biomarker analysis is unlikely to be cost-effective at a willingness-to-pay threshold of $50,000 per QALY gained. However, when at least 1 in 11 patients has AD after normal neuroimaging findings, biomarker analysis is likely cost-effective. Specifically, for patients referred to memory clinics with memory impairment who do not present neuroimaging evidence of medial temporal lobe atrophy, pretest prevalence of AD may exceed 15%. Biomarker analysis is a potentially cost-saving diagnostic method and should be considered for adoption in high-prevalence centers. Electronic supplementary material The online version of this article (doi:10.1186/s13195-017-0243-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Spencer A W Lee
- Ivey Business School, Western University, 1255 Western Road, London, ON, N6G 0N1, Canada.,School of Medicine, University College Cork, College Road, Cork, T12 YN60, Ireland
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, N6A 5A5, Canada.,Stroke, Dementia & Heart Disease Laboratory, Western University, London, ON, N6A 5A5, Canada.,Department of Anatomy & Cell Biology, Western University, London, ON, N6A 5A5, Canada
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, N6A 5A5, Canada.,Department of Biostatistics and Epidemiology, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A 5C1, Canada
| | - Lauren E Cipriano
- Ivey Business School, Western University, 1255 Western Road, London, ON, N6G 0N1, Canada. .,Department of Biostatistics and Epidemiology, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A 5C1, Canada.
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Heinrich S, Uribe FL, Wübbeler M, Hoffmann W, Roes M. Knowledge evaluation in dementia care networks: a mixed-methods analysis of knowledge evaluation strategies and the success of informing family caregivers about dementia support services. Int J Ment Health Syst 2016; 10:69. [PMID: 27777614 PMCID: PMC5062951 DOI: 10.1186/s13033-016-0100-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/03/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In general, most people with dementia living in the community are served by family caregivers at home. A similar situation is found in Germany. One primary goal of dementia care networks is to provide information on support services available to these caregiving relatives of people with dementia via knowledge management. The evaluation of knowledge management tools and processes for dementia care networks is relevant to their performance in successfully achieving information goals. One goal of this paper was the analysis of knowledge evaluation in dementia care networks, including potential barriers and facilitators, across Germany within the DemNet-D study. Additionally, the impact of highly formalized and less formalized knowledge management performed in dementia care networks was analyzed relative to family caregivers' feelings of being informed about dementia support services. METHODS Qualitative data were collected through interviews with and semi-standardized questionnaires administered to key persons from 13 dementia care networks between 2013 and 2014. Quantitative data were collected using standardized questionnaires. A structured content analysis and a mixed-methods analysis were conducted. RESULTS The analyses indicated that the development of knowledge goals is important for a systematic knowledge evaluation process. Feedback from family caregivers was found to be beneficial for the target-oriented evaluation of dementia care network services. Surveys and special conferences, such as quality circles, were used in certain networks to solicit this feedback. Limited resources can hinder the development of formalized knowledge evaluation processes. More formalized knowledge management processes in dementia care networks can lead to a higher level of knowledge among family caregivers. CONCLUSIONS The studied tools, processes and potential barriers related to knowledge evaluation contribute to the development and optimization of knowledge evaluation strategies for use in dementia care networks. Furthermore, the mixed-methods results indicate that highly formalized dementia care networks are especially successful in providing information to family members caring for people with dementia via knowledge management.
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Affiliation(s)
- Steffen Heinrich
- German Center for Neurodegenerative Diseases (DZNE) - Site Witten, Stockumer Straße 12, 58453 Witten, Germany
| | - Franziska Laporte Uribe
- German Center for Neurodegenerative Diseases (DZNE) - Site Witten, Stockumer Straße 12, 58453 Witten, Germany
| | - Markus Wübbeler
- German Center for Neurodegenerative Diseases (DZNE) - Site Rostock, Ellernholzstraße 1-2, 17487 Greifswald, Germany
| | - Wolfgang Hoffmann
- Institute of Community Medicine, University of Greifswald, Ellernholzstraße 1-2, 17487 Greifswald, Germany
| | - Martina Roes
- German Center for Neurodegenerative Diseases (DZNE) - Site Witten, Stockumer Straße 12, 58453 Witten, Germany
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