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

Memory Disorders Clinical Trial

Official title:

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

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00402311
• Other study ID #: 945-02-055
• Status: Completed
• Phase: N/A
• First received: November 20, 2006
• Last updated: January 19, 2007
• Start date: April 2002
• Est. completion date: August 2005

Study information

• Verified date: November 2006
• Source: Maastricht University Medical Center
• Contact: n/a
• Is FDA regulated: No
• Health authority: Netherlands: The Central Committee on Research Involving Human Subjects (CCMO)
• Study type: Interventional

Clinical Trial Summary

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).

Description:

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).

Recruitment information / eligibility

• Status: Completed
• Enrollment: 216
• Est. completion date: August 2005
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 55 Years and older

Eligibility

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

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Diagnostic

Related Conditions & MeSH terms

• Cognition Disorders
• Delirium, Dementia, Amnestic, Cognitive Disorders
• Disease
• Memory Disorders

Intervention

Procedure:
• DOC-PG: integrated multidisciplinary assessment

• Usual care: assessment by GP or one of the regional services

Locations

Country	Name	City	State
Netherlands	Academic Hospital Maastricht	Maastricht	Limburg

Sponsors (2)

Lead Sponsor	Collaborator
Maastricht University Medical Center	ZonMw: The Netherlands Organisation for Health Research and Development

Country where clinical trial is conducted

Netherlands, 

References & Publications (3)

Wolfs CA, Dirksen CD, Severens JL, Verhey FR. The added value of a multidisciplinary approach in diagnosing dementia: a review. Int J Geriatr Psychiatry. 2006 Mar;21(3):223-32. Review. — View Citation

Wolfs CA, Verhey FR, Kessels A, Winkens RA, Severens JL, Dirksen CD. GP concordance with advice for treatment following a multidisciplinary psychogeriatric assessment. Int J Geriatr Psychiatry. 2007 Mar;22(3):233-40. — View Citation

Wolfs CAG, Severens JL, Dirksen CD, Kessels A, Jaspers N, Verhey FRJ. 2005. A Randomized Clinical Trial on the Effects of a Diagnostic Observation Centre for PsychoGeriatric patients (DOC-PG). International Psychogeriatrics 17: 370-371

Outcome

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

External Links

•   Link