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A call for comparative effectiveness research to learn whether routine clinical care decisions can protect from dementia and cognitive decline.

ABSTRACT: Common diseases like diabetes, hypertension, and atrial fibrillation are probable risk factors for dementia, suggesting that their treatments may influence the risk and rate of cognitive and functional decline. Moreover, specific therapies and medications may affect long-term brain health through mechanisms that are independent of their primary indication. While surgery, benzodiazepines, and anti-cholinergic drugs may accelerate decline or even raise the risk of dementia, other medications act directly on the brain to potentially slow the pathology that underlies Alzheimer's and other dementia. In other words, the functional and cognitive decline in vulnerable patients may be influenced by the choice of treatments for other medical conditions. Despite the importance of these questions, very little research is available. The Alzheimer's Drug Discovery Foundation convened an advisory panel to discuss the existing evidence and to recommend strategies to accelerate the development of comparative effectiveness research on how choices in the clinical care of common chronic diseases may protect from cognitive decline and dementia.

SUBMITTER: Dacks PA

PROVIDER: S-EPMC4992192 | biostudies-literature | 2016 Aug

REPOSITORIES: biostudies-literature

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A call for comparative effectiveness research to learn whether routine clinical care decisions can protect from dementia and cognitive decline.

Dacks Penny A PA Armstrong Joshua J JJ Brannan Stephen K SK Carman Aaron J AJ Green Allan M AM Kirkman M Sue MS Krakoff Lawrence R LR Kuller Lewis H LH Launer Lenore J LJ Lovestone Simon S Merikle Elizabeth E Neumann Peter J PJ Rockwood Kenneth K Shineman Diana W DW Stefanacci Richard G RG Velentgas Priscilla P Viswanathan Anand A Whitmer Rachel A RA Williamson Jeff D JD Fillit Howard M HM

Alzheimer's research & therapy 20160820

Common diseases like diabetes, hypertension, and atrial fibrillation are probable risk factors for dementia, suggesting that their treatments may influence the risk and rate of cognitive and functional decline. Moreover, specific therapies and medications may affect long-term brain health through mechanisms that are independent of their primary indication. While surgery, benzodiazepines, and anti-cholinergic drugs may accelerate decline or even raise the risk of dementia, other medications act d ...[more]

PMID: 27543171

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Project description:BACKGROUND: A multifaceted implementation (MFI) strategy was used to implement an evidence-based occupational therapy program for people with dementia (COTiD program). This strategy was successful in increasing the number of referrals, but not in improving occupational therapists' (OTs) adherence. Therefore, a process evaluation was conducted to identify factors that influenced the effectiveness of the MFI strategy. METHODS: A mixed-method approach of qualitative and quantitative research was used to evaluate the implementation process. The MFI strategy as planned and as executed were reported and evaluated based on the framework of Hulscher et al. (2003; 2006). Data on OTs attitudes and expected barriers were collected at baseline from 94 OTs using a 19-item questionnaire. Data on the experiences were collected after finishing the implementation using focus groups with OTs and telephone interviews with physicians and managers. For quantitative data, frequencies and correlations were calculated and qualitative data were analyzed using inductive content analysis. RESULTS: The implementation strategy as executed had a stronger focus than planned on increasing OTs promotional skills due to an initial lack of referrals. This resulted in less attention for increasing OTs' skills in using the COTiD program as initially intended. At baseline, OTs had a positive attitude toward the program, however, 75% did not feel experienced enough and only 14.3% felt competent in using the program. Focus groups and interviews revealed various determinants that influenced implementation. Most managers were positive about the program. However, the degree of operational support of managers for OTs regarding the implementation was not always adequate. Managers stated that a well-defined place for occupational therapy within the dementia care network was lacking although this was perceived necessary for successful implementation. Several physicians perceived psychosocial interventions not to be in their area of expertise or not their responsibility. All professionals perceived inter-professional collaboration to be a facilitator for effective implementation, and general practitioners were perceived as key partners in this collaboration. However, collaboration was not always optimal. OTs indicated that increasing the referral rate was most effective when promoting OT via other disciplines within a physician's network. CONCLUSION: Our data suggests that a first step in successful implementation should be to make sure that individual and organizational barriers are resolved. In addition, implementation should be network-based and encourage inter-professional collaboration. Initial promotion of COTiD should focus on physicians that have a positive attitude toward non-pharmacological interventions.

Project description:BackgroundMany clinical questions arise during patient encounters that clinicians are unable to answer. An evidence-based medicine approach expects that clinicians will seek and apply the best available evidence to answer clinical questions. One commonly used source of such evidence is scientific literature, such as that available through MEDLINE and PubMed. Clinicians report that 2 key reasons why they do not use search systems to answer questions is that it takes too much time and that they do not expect to find a definitive answer. So, the question remains about how effectively scientific literature search systems support time-pressured clinicians in making better clinical decisions. The results of this study are important because they can help clinicians and health care organizations to better assess their needs with respect to clinical decision support (CDS) systems and evidence sources. The results and data captured will contribute a significant data collection to inform the design of future CDS systems to better meet the needs of time-pressured, practicing clinicians.ObjectiveThe purpose of this study is to understand the impact of using a scientific medical literature search system on clinical decision making. Furthermore, to understand the impact of realistic time pressures on clinicians, we vary the search time available to find clinical answers. Finally, we assess the impact of improvements in search system effectiveness on the same clinical decisions.MethodsIn this study, 96 practicing clinicians and final year medical students are presented with 16 clinical questions which they must answer without access to any external resource. The same questions are then represented to the clinicians; however, in this part of the study, the clinicians can use a scientific literature search engine to find evidence to support their answers. The time pressures of practicing clinicians are simulated by limiting answer time to one of 3, 6, or 9 min per question. The correct answer rate is reported both before and after search to assess the impact of the search system and the time constraint. In addition, 2 search systems that use the same user interface, but which vary widely in their search effectiveness, are employed so that the impact of changes in search system effectiveness on clinical decision making can also be assessed.ResultsRecruiting began for the study in June 2018. As of the April 4, 2019, there were 69 participants enrolled. The study is expected to close by May 30, 2019, with results to be published in July.ConclusionsAll data collected in this study will be made available at the University of Queensland's UQ eSpace public data repository.International registered report identifier (irrid)DERR1-10.2196/12803.

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A call for comparative effectiveness research to learn whether routine clinical care decisions can protect from dementia and cognitive decline.

Publications

A call for comparative effectiveness research to learn whether routine clinical care decisions can protect from dementia and cognitive decline.

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