Dementia in Long Term Care Facilities: Telemedicine for the Management of Neuropsychiatric Symptoms

Overview

Telemedicine may facilitate adequate treatment of Neuropsychiatric symptoms (NPS) by identifying underlying causes and tailoring a treatment plan (pharmacological or non-pharmacologic treatments including provision of staff education and support, training in problem solving, and targeted therapy directed at the underlying causes for specific behaviors).

Full Title of Study: “Dementia in Long Term Care Facilities: Telemedicine for the Management of Neuropsychiatric Symptoms.”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Supportive Care
    • Masking: None (Open Label)
  • Study Primary Completion Date: November 2017

Detailed Description

During a 6-months period, patients will be included in both arms, whenever they present a disruptive NPS that requires a specialist consultation based on the long-term care facility (LTCF) staff judgment. In the intervention group, a telemedicine (TM) consultation between the LTCF staff (medical and nurse staff) and the Memory Center from the University Hospital, will occur at inclusion (T0). Then, a second TM consultation will occur at 1 month (T1). In the control group management of NPS will be done as usual care. In both groups, patients' parameters such as non-programmed hospitalizations and/or consultations due to disruptive NPS, psychotropic drugs use, and health costs, will be evaluated at inclusion, 1 month and at 2 months. Acceptability of the TM among the LTCF staff will be assessed during the study in the intervention group. The two university hospitals are composed of a group of institutions for elderly people located near Toulouse and Limoges.

Interventions

  • Procedure: telemedicine
    • psycho-behavioural care by telemedicine

Arms, Groups and Cohorts

  • No Intervention: normal care
    • patients who will have normal care
  • Experimental: telemedicine
    • patients who will have telemedicine

Clinical Trial Outcome Measures

Primary Measures

  • Acceptability of the TM among the LTCF staff
    • Time Frame: 6 months
    • Acceptability of the telemedicine (TM) among the LTCF staff which will be assessed in the intervention group by quantitative indicators (proportion of the solicitation of the TM solution among patients with disruptive NPS, the delay to obtain a TM consultation and the number of the staff participants at each TM consultation) and qualitative indicators (staff global satisfaction will be evaluated by focus groups and interviewing).

Secondary Measures

  • Rate of non-programmed hospitalizations and/or consultation due to disruptive NPS
    • Time Frame: 6 months
    • Calculation of the rate of non-programmed hospitalizations and/or consultation due to disruptive NPS in both groups
  • The psychotropic drugs used
    • Time Frame: 6 months
    • Description of psychotropic drugs used in both groups
  • describe the health costs
    • Time Frame: 6 months
    • Description of the health costs in both groups
  • describe the estimation of the cluster effect (“design effect”)
    • Time Frame: 6 months
    • Estimation of the cluster effect (“design effect”) in both groups

Participating in This Clinical Trial

Inclusion Criteria

  • patient aged 65 or more, with a dementia diagnosed by a specialist or the general practitioner; – patient presenting with a disruptive NPS as defined in French Haute Autorité de Santé (HAS) recommendations (2009), that requires a specialist consultation based on the LTCF staff judgment; – informed and written consent by the patient or the legal representative or the reliable person when appropriate; – general practitioner agreement. Exclusion Criteria:

  • patient's life expectancy less than 6 months; – Non agreement of study participation of patients or legal representative or the reliable person when appropriate.

Gender Eligibility: All

Minimum Age: 65 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University Hospital, Toulouse
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Official(s)
    • Maria Soto, MD, Principal Investigator, University Hospital, Toulouse

References

Piau A, Nourhashemi F, De Mauleon A, Tchalla A, Vautier C, Vellas B, Duboue M, Costa N, Rumeau P, Lepage B, Soto Martin M. Telemedicine for the management of neuropsychiatric symptoms in long-term care facilities: the DETECT study, methods of a cluster randomised controlled trial to assess feasibility. BMJ Open. 2018 Jun 12;8(6):e020982. doi: 10.1136/bmjopen-2017-020982.

Citations Reporting on Results

Piau A, Vautier C, De Mauleon A, Tchalla A, Rumeau P, Nourhashemi F, Soto-Martin M. Health workers perception on telemedicine in management of neuropsychiatric symptoms in long-term care facilities: Two years follow-up. Geriatr Nurs. 2020 Nov-Dec;41(6):1000-1005. doi: 10.1016/j.gerinurse.2020.07.009. Epub 2020 Aug 6.

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