title: Evidence-based care of older people with suspected cognitive impairment in general practice: protocol for the IRIS cluster randomised trial.
abstract: BACKGROUND
  Dementia is a common and complex condition. Evidence-based guidelines for the management of people with dementia in general practice exist; however, detection, diagnosis and disclosure of dementia have been identified as potential evidence-practice gaps. Interventions to implement guidelines into practice have had varying success. The use of theory in designing implementation interventions has been limited, but is advocated because of its potential to yield more effective interventions and aid understanding of factors modifying the magnitude of intervention effects across trials. This protocol describes methods of a randomised trial that tests a theory-informed implementation intervention that, if effective, may provide benefits for patients with dementia and their carers.
  
  
  OBJECTIVE
  This trial aims to estimate the effectiveness of a theory-informed intervention to increase GPs' (in Victoria, Australia) adherence to a clinical guideline for the detection, diagnosis, and management of dementia in general practice, compared with providing GPs with a printed copy of the guideline. Primary objectives include testing if the intervention is effective in increasing the percentage of patients with suspected cognitive impairment who receive care consistent with two key guideline recommendations: receipt of a i) formal cognitive assessment, and ii) depression assessment using a validated scale (primary outcomes for the trial).
  
  
  METHODS
  The design is a parallel cluster randomised trial, with clusters being general practices. We aim to recruit 60 practices per group. Practices will be randomised to the intervention and control groups using restricted randomisation. Patients meeting the inclusion criteria, and GPs' detection and diagnosis behaviours directed toward these patients, will be identified and measured via an electronic search of the medical records nine months after the start of the intervention. Practitioners in the control group will receive a printed copy of the guideline. In addition to receipt of the printed guideline, practitioners in the intervention group will be invited to participate in an interactive, opinion leader-led, educational face-to-face workshop. The theory-informed intervention aims to address identified barriers to and enablers of implementation of recommendations. Researchers responsible for identifying the cohort of patients with suspected cognitive impairment, and their detection and diagnosis outcomes, will be blind to group allocation.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry: ACTRN12611001032943 (date registered 28 September, 2011).
authors: School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Australia. joanne.mckenzie@monash.edu
authors: Joanne E
authors: JE
authors: McKenzie
authors: Simon D
authors: SD
authors: French
authors: Denise A
authors: DA
authors: O'Connor
authors: Duncan S
authors: DS
authors: Mortimer
authors: Colette J
authors: CJ
authors: Browning
authors: Grant M
authors: GM
authors: Russell
authors: Jeremy M
authors: JM
authors: Grimshaw
authors: Martin P
authors: MP
authors: Eccles
authors: Jill J
authors: JJ
authors: Francis
authors: Susan
authors: S
authors: Michie
authors: Kerry
authors: K
authors: Murphy
authors: Fiona
authors: F
authors: Kossenas
authors: Sally E
authors: SE
authors: Green
mesh_terms: D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D003072:Cognition Disorders / Q000175:diagnosis / Q000628:therapy*; D003704:Dementia / Q000628:therapy; D019317:Evidence-Based Medicine; D058006:General Practice; D006801:Humans; D011364:Professional Practice; D016896:Treatment Outcome; D014739:Victoria
references: Aust New Zealand Health Policy. 2007 Jun 05;4:12
references: 17550622
references: PLoS Med. 2009 May 26;6(5):e1000065
references: 19536323
references: Can Fam Physician. 1997 Mar;43:477-82
references: 9116519
references: Am J Epidemiol. 2003 Feb 15;157(4):364-75
references: 12578807
references: Implement Sci. 2009 Apr 07;4:18
references: 19351400
references: Psychol Health Med. 2010 Oct;15(5):540-9
references: 20835964
references: PLoS Med. 2012;9(11):e1001346
references: 23185138
references: Implement Sci. 2009 Jul 03;4:37
references: 19575790
references: J Am Geriatr Soc. 2006 Feb;54(2):311-7
references: 16460384
references: J Clin Epidemiol. 2010 Jan;63(1):2-6
references: 19230611
references: Med J Aust. 2003 Oct 20;179(8):438-40
references: 14558871
references: Stat Med. 2002 Oct 15;21(19):2917-30
references: 12325108
references: Arch Gen Psychiatry. 2009 Mar;66(3):313-23
references: 19255381
references: Ann Intern Med. 2008 Feb 19;148(4):295-309
references: 18283207
references: Implement Sci. 2007 Sep 25;2:31
references: 17894893
references: BMC Med Res Methodol. 2009 Feb 26;9:12
references: 19245713
references: Int Psychogeriatr. 2009 Apr;21(2):330-7
references: 19138460
references: J Gerontol A Biol Sci Med Sci. 2000 Feb;55(2):M98-102
references: 10737692
references: BMC Fam Pract. 2010 Jul 01;11:52
references: 20594302
references: Implement Sci. 2006 Feb 23;1:4
references: 16722571
references: Health Technol Assess. 1999;3(5):iii-92
references: 10982317
references: Ann Intern Med. 2006 Nov 21;145(10):713-26
references: 17116916
references: Int Psychogeriatr. 2011 Nov;23(9):1433-41
references: 21729424
references: Int J Geriatr Psychiatry. 2007 Aug;22(8):782-8
references: 17243196
references: Int J Epidemiol. 2006 Oct;35(5):1292-300
references: 16943232
references: Lancet. 2002 Jan 5;359(9300):57-61
references: 11809203
references: Implement Sci. 2009 Jul 16;4:40
references: 19607700
references: Implement Sci. 2008 Feb 22;3:11
references: 18294375
references: BMJ. 1998 Jan 24;316(7127):285
references: 9472515
references: Implement Sci. 2010 Nov 10;5:86
references: 21067614
references: Aging Clin Exp Res. 2007 Oct;19(5):356-63
references: 18007113
references: Alzheimers Dement. 2013 Jan;9(1):63-75.e2
references: 23305823
references: BMC Health Serv Res. 2008 Apr 02;8:71
references: 18384675
references: Stat Methods Med Res. 2010 Jun;19(3):237-70
references: 19608601
references: Stat Med. 1990 Dec;9(12):1455-62
references: 2281233
references: BMJ. 2006 Mar 25;332(7543):692-6
references: 16565124
references: Implement Sci. 2010 Sep 29;5:71
references: 20920277
references: J Pers Soc Psychol. 1986 Dec;51(6):1173-82
references: 3806354
references: Qual Saf Health Care. 2003 Jun;12(3):215-20
references: 12792013
references: Alzheimer Dis Assoc Disord. 2005 Jul-Sep;19(3):128-34
references: 16118529
references: Stat Med. 2004 Mar 30;23(6):897-905
references: 15027079
references: J Health Serv Res Policy. 1996 Jul;1(3):154-64
references: 10180862
references: Stat Med. 1999 Oct 15;18(19):2655-79
references: 10495463
references: BMJ. 2012 Sep 04;345:e5661
references: 22951546
references: Alzheimers Dement. 2009 Jan;5(1):43-9
references: 19118808
references: J Med Ethics. 2000 Apr;26(2):108-13
references: 10786321
references: Implement Sci. 2012 Apr 24;7:38
references: 22531013
references: Am J Epidemiol. 1998 Apr 1;147(7):694-703
references: 9554609
references: BMC Health Serv Res. 2009 Jun 06;9:91
references: 19500383
references: Int J Geriatr Psychiatry. 2009 Jul;24(7):748-54
references: 19206079
references: Aust Fam Physician. 2006 Nov;35(11):923-4
references: 17099817
references: Dement Geriatr Cogn Disord. 2007;24(4):300-6
references: 17717417
references: Qual Saf Health Care. 2005 Feb;14(1):26-33
references: 15692000
references: Implement Sci. 2011 Apr 23;6:42
references: 21513547
references: PLoS Med. 2008 Jan 22;5(1):e20
references: 18215107
references: Health Technol Assess. 2004 Feb;8(6):iii-iv, 1-72
references: 14960256
references: Implement Sci. 2012 Apr 24;7:37
references: 22530986
references: Implement Sci. 2010 Feb 09;5:14
references: 20181130
references: Aging Ment Health. 2004 Nov;8(6):498-504
references: 15724831
references: Implement Sci. 2006 Nov 21;1:28
references: 17118180
references: BMJ. 1999 Sep 11;319(7211):670-4
references: 10480822
references: Implement Sci. 2007 Nov 26;2:38
references: 18039362
references: Stat Med. 1989 Apr;8(4):467-75
references: 2727470
references: Health Psychol. 2004 Sep;23(5):443-51
references: 15367063
references: Implement Sci. 2010 Jan 04;5:1
references: 20047652
references: J Clin Epidemiol. 2010 Aug;63(8):e1-37
references: 20346624
references: Trials. 2010 Feb 10;11:13
references: 20146803
references: Neurology. 2006 Nov 14;67(9):1592-9
references: 17101889
references: Med J Aust. 2008 Nov 3;189(9):487-9
references: 18976188
references: Implement Sci. 2008 Feb 22;3:12
references: 18294376
references: BMC Fam Pract. 2012 Mar 07;13:12
references: 22397614