The Effects and Cost-Effectiveness of an Integrated Multidisciplinary Approach for Psychogeriatric Patients

Study Overview
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Brief Summary
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The purpose of this study is to determine the effects and cost-effectiveness of a Diagnostic Observation Center for PsychoGeriatric patients (DOC-PG). Our main hypothesis is that DOC-PG has added value compared with usual care regarding Health Related Quality of Life (HRQoL).

Detailed Description
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An integrated multidisciplinary approach to diagnosing and managing dementia is generally recommended, though rarely investigated. In recent years, multidisciplinary memory clinics (MCs) for patients with dementia have been established in many places over the world. These services have recently also been criticised for being principally hospital-based, for their apparently limited focus that entails only medical diagnostics and pharmacotherapy and for thus diverting resources from community mental health teams(CMHTs) .On the other hand, CMHTs are mainly concerned with the provision and organisation of integrated care, and unlike MCs, CMHTs generally have limited access to hospital-based diagnostics such as brain-imaging. In April 2002, an outpatient diagnostic facility, the Diagnostic Observation Centre for PsychoGeriatric patients (DOC-PG) was established in Maastricht, the Netherlands. DOC-PG combines the hospital-based approach of the MC with the care-oriented approach of the regional CMHT and aims to provide the general practitioner (GP) with elaborate diagnostic and therapeutic advice for patients with cognitive disorders. Comparison: DOC-PG is compared with usual care i.e. the GP took care of the diagnosis, or he or she referred the patient to one of the separate regional services, e.g. the Maastricht Memory Clinic (MMC), geriatric medicine, or the department of mental health for the elderly of the mental health community service (CMHT).

Official Title
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A Prospective Randomized Trial on the Effects of a Psychogeriatric Diagnostic Day Hospital

Conditions
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Delirium, Dementia, Amnestic, Cognitive Disorders, Memory Disorders

Intervention / Treatment
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* Procedure: DOC-PG: integrated multidisciplinary assessment
* Procedure: Usual care: assessment by GP or one of the regional services


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Aged 55 years or over Suspected of having dementia or combined somatic/psychiatric disorder No referral to other local/regional services in the last two years Availability of a proxy (visiting the patient at least once a week) Exclusion Criteria: Acute disorders that need a prompt therapeutic intervention Living in a nursing home or receiving care that is comparable to that of a nursing home

Ages Eligible for Study
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Minimum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: DOC-PG: integrated multidisciplinary assessment|nan|
|Procedure: Usual care: assessment by GP or one of the regional services|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The Visual Analogue Scale of the EuroQol-5D |  |  | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Utility score of the EuroQol-5D |  |  | 
| Short Form 36 (SF-36) |  |  | 
| Mini Mental State Examination (MMSE) |  |  | 
| Global Deterioration Scale (GDS) |  |  | 
| NeuroPsychiatric Inventory (NPI) |  |  | 
| Instrumental Activities of Daily Living scale (IADL) |  |  | 
| Cornell Scale of Depression in Dementia (CSDD) |  |  | 
| Perceived Pressure from Informal Care (Dutch translation, EDIZ) |  |  | 
| Informal care questionnaire |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Health Services for the Aged, Geriatric Psychiatry