May 10, 2006 — A collaborative team headed by an advanced practice nurse improves treatment outcomes for Alzheimer disease in a primary care setting, according to the results of a randomized trial reported in the May 10 issue of JAMA. This approach improved quality of life and behavioral and psychological symptoms for both Alzheimer patients and their caregivers without increasing use of antipsychotics or sedative hypnotics.
"Most older adults with dementia will be cared for by primary care physicians, but the primary care practice environment presents important challenges to providing quality care," write Christopher M. Callahan, MD, from the Indiana University School of Medicine in Indianapolis, and colleagues. "Over the past decade, quality improvement efforts for geriatric syndromes in primary care have focused on decision support, care management, and other systems-level innovations to deliver guideline-level care."
From January 2002 through August 2004, 153 older adults with Alzheimer disease and their caregivers were randomized by clinician to receive 1 year of collaborative care management (n = 84) or augmented usual care (n = 69) at primary care practices within 2 US university-affiliated healthcare systems. Eligible patients, who were identified via screening or medical records review, met diagnostic criteria for Alzheimer disease and had a self-identified caregiver.
An interdisciplinary team performed collaborative care management, led by an advanced practice nurse working with the patient's family caregiver and integrated within primary care. Using standard protocols, the team began treatment and identified, monitored, and treated behavioral and psychological symptoms of dementia, stressing nonpharmacological management.
http://www.medscape.com/viewarticle/532082?sssdmh=dm1.261440&src=nldne
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