title: Tailored educational intervention for primary care to improve the management of dementia: the EVIDEM-ED cluster randomized controlled trial.
abstract: BACKGROUND
  Early diagnosis of dementia is important because this allows those with dementia and their families to engage support and plan ahead. However, dementia remains underdetected and suboptimally managed in general practice. Our objective was to test the effect of a workplace-based tailored educational intervention developed for general practice on the clinical management of people with dementia.
  
  
  METHODS
  The tailored educational intervention was tested in an unblinded cluster randomized controlled trial with a pre/post-intervention design, with two arms: usual/normal care control versus educational intervention. The primary outcome measure was an increase in the proportion of patients with dementia who received at least two documented dementia-specific management reviews per year. Case identification was a secondary outcome measure.
  
  
  RESULTS
  23 practices in South-East England participated. A total of 1,072 patients with dementia (intervention: 512, control: 560) had information in their medical records showing the number of reviews within 12 months (or a proportion of) before intervention or randomization and within 12 months (or a proportion of) after. The mean total number of dementia management reviews after the educational intervention for people with dementia was 0.89 (SD 1.09; minimum 0; median 1; maximum 8) compared with 0.89 (SD 0.92; minimum 0; median 1; maximum 4) before intervention. In the control group prior to randomization the mean total number of dementia management reviews was 1.66 (SD 1.87; minimum 0; median 1; maximum 12) and in the period after randomization it was 1.56 (SD 1.79; minimum 0; median 1; maximum 11). Case detection rates were unaffected. The estimated incidence rate ratio for intervention versus control group was 1.03 (P = 0.927, 95% CI 0.57 to 1.86).
  
  
  CONCLUSIONS
  The trial was timely, coinciding with financial incentives for dementia management in general practice (through the Quality Outcomes Framework); legal imperatives (in the form of the Mental Capacity Act 2005); policy pressure (The National Dementia Strategy 2009); and new resources (such as dementia advisors) that increased the salience of dementia for general practitioners. Despite this the intervention did not alter the documentation of clinical management of patients with dementia in volunteer practices, nor did it increase case identification.
  
  
  BACKGROUND
  NCT00866099/Clinical Trials.
authors.affiliation: Research Department of Primary Care & Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. j.wilcock@ucl.ac.uk.
authors.forename: Jane
authors.initials: J
authors.lastname: Wilcock
authors.forename: Steve
authors.initials: S
authors.lastname: Iliffe
authors.forename: Mark
authors.initials: M
authors.lastname: Griffin
authors.forename: Priya
authors.initials: P
authors.lastname: Jain
authors.forename: Ingela
authors.initials: I
authors.lastname: Thuné-Boyle
authors.forename: Frances
authors.initials: F
authors.lastname: Lefford
authors.forename: David
authors.initials: D
authors.lastname: Rapp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection; D003704:Dementia / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care; D018401:Sample Size