Faculty Opinions recommendation of Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial.

Abstract Background Polypharmacy in older adults can be associated with negative outcomes including falls, impaired cognition, reduced quality of life, and general and functional decline. It is not clear to what extent these are reversible if the number of medications is reduced. Primary care does not have a systematic approach for reducing inappropriate polypharmacy, and there are few, if any, approaches that account for the patient’s priorities and preferences. The primary objective of this study is to test the effect of TAPER (Team Approach to Polypharmacy Evaluation and Reduction), a structured operationalized clinical pathway focused on reducing inappropriate polypharmacy. TAPER integrates evidence tools for identifying potentially inappropriate medications, tapering, and monitoring guidance and explicit elicitation of patient priorities and preferences. We aim to determine the effect of TAPER on the number of medications (primary outcome) and health-related outcomes associated with polypharmacy in older adults. Methods We designed a multi-center randomized controlled trial, with the lead implementation site in Hamilton, Ontario. Older adults aged 70 years or older who are on five or more medications will be eligible to participate. A total of 360 participants will be recruited. Participants will be assigned to either the control or intervention arm. The intervention involves a comprehensive multidisciplinary medication review by pharmacists and physicians in partnership with patients. This review will be focused on reducing medication burden, with the assumption that this will reduce the risks and harms of polypharmacy. The control group is a wait list, and control patients will be given appointments for the TAPER intervention at a date after the final outcome assessment. All patients will be followed up and outcomes measured in both groups at baseline and 6 months. Discussion Our trial is unique in its design in that it aims to introduce an operationalized structured clinical pathway aimed to reduce polypharmacy in a primary care setting while at the same time recording patient’s goals and priorities for treatment. Trial registration Clinical Trials.gov NCT02942927. First registered on October 24, 2016.

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Should Care Managers for Older Adults Be Located in Primary Care? A Randomized Controlled Trial

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2011.03763.x ◽

2012 ◽

Vol 60 (1) ◽

pp. 86-92 ◽

Cited By ~ 25

Author(s):

Matthew Parsons ◽

Hugh Senior ◽

Ngaire Kerse ◽

Mei-hua Chen ◽

Stephen Jacobs ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Randomized Controlled ◽

Care Managers

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Diabetes, Depression, and Death: A Randomized Controlled Trial of a Depression Treatment Program for Older Adults Based in Primary Care (PROSPECT): Response to Thombs and Ziegelstein

Diabetes Care ◽

10.2337/dc08-0655 ◽

2008 ◽

Vol 31 (6) ◽

pp. e55-e55

Author(s):

H. R. Bogner ◽

K. H. Morales ◽

E. P. Post ◽

M. L. Bruce

Keyword(s):

Older Adults ◽

Primary Care ◽

Randomized Controlled Trial ◽

Treatment Program ◽

Controlled Trial ◽

Depression Treatment ◽

Randomized Controlled

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Diabetes, Depression, and Death: A randomized controlled trial of a depression treatment program for older adults based in primary care (PROSPECT)

Diabetes Care ◽

10.2337/dc07-0974 ◽

2007 ◽

Vol 30 (12) ◽

pp. 3005-3010 ◽

Cited By ~ 120

Author(s):

H. R. Bogner ◽

K. H. Morales ◽

E. P. Post ◽

M. L. Bruce

Keyword(s):

Older Adults ◽

Primary Care ◽

Randomized Controlled Trial ◽

Treatment Program ◽

Controlled Trial ◽

Depression Treatment ◽

Randomized Controlled

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Managing Depression in Diabetes Mellitus: A Multicentric Randomized Controlled Trial Comparing Effectiveness of Fluoxetine and Mindfulness in Primary Care: Protocol for DIAbetes Mellitus ANd Depression (DIAMAND) Study

Indian Journal of Psychological Medicine ◽

10.1177/0253717620971200 ◽

2020 ◽

Vol 42 (6_suppl) ◽

pp. S31-S38

Author(s):

Mina Chandra ◽

Dhanya Raveendranathan ◽

Johnson Pradeep R. ◽

Suravi Patra ◽

Rushi ◽

...

Keyword(s):

Quality Of Life ◽

Diabetes Mellitus ◽

Primary Care ◽

Randomized Controlled Trial ◽

Glycemic Control ◽

Collaborative Care ◽

Controlled Trial ◽

Randomized Controlled ◽

Primary Care Settings

Background: Suboptimal management of depression in type 2 diabetes mellitus (T2DM) often translates into poor glycemic control, medical complications, and impaired quality of life. Feasibility and effectiveness of collaborative care models of depression in diabetes in low- and middle-income countries (LMICs) remain unexplored. DIAbetes Mellitus ANd Depression (DIAMAND) study, a multicentric single-blind randomized controlled trial (SBRCT) comparing effectiveness of fluoxetine and mindfulness in primary care settings, addresses this gap in scientific literature. Methods: This trial conducted in diverse geographic settings of New Delhi, Bengaluru, and Bhubaneswar will comprise module-based training of primary care providers (PCPs) for screening, diagnosing, and managing depression in diabetes in phase I. Phase II will involve four-arm parallel group RCT on 350 participants with T2DM with comorbid depressive episode randomly allocated to receive fluoxetine, mindfulness therapy, fluoxetine plus mindfulness therapy, or treatment as usual at primary care settings. Interventions would include fluoxetine (up to 60 mg/day) and/or sessions of mindfulness for 16 weeks. Primary outcomes on standardized rating scales include depression scores (Hamilton Depression Rating Scale), treatment adherence (Adherence to Refill and Medication Scale), self-care (Diabetes Self-Management Questionnaire), diabetes-related distress (Diabetes Distress Scale), and glycemic control. Secondary outcomes include quality of life (World Health Organization Quality of Life Brief version [WHO-QOL BREF]) and mindfulness (Five Facets Mindfulness Questionnaire). Discussion: This RCT will investigate the effectiveness of module-based training of PCPs and feasibility of collaborative care model for managing depression in T2DM in primary care settings in LMICs and effectiveness of fluoxetine and/or mindfulness in improving diverse outcomes of T2DM with major depression.

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