Ensemble Feasibility Cluster Trial: Impact on patient anxiety and quality of life of a training package for evaluation of dementia symptoms in primary care using test bundles

Funding

National Institute for Health and Care Research (NIHR) Research for Patient Benefit (RfPB) Ref. NIHR207180

What is the Research Question?

Co-design with our PG, three test-modules for GPs to request from HCAs, based on GP initial clinical interview, for the evaluation of cognitive symptoms, taking account of diagnostic accuracy and the need to be responsive to patient presentation. (WP1)
Co-design a training package to deliver the test-modules, which is scalable and deliverable to a wide audience, improves knowledge and confidence, and fulfils adequate quality assurance. Can at least 80% of staff complete and attain accreditation? (WP2)
Determine the feasibility of a large-scale trial of a training package, delivered to GPs and Health Care Assistants, in primary care, to deliver cognitive assessments to people with symptoms. Is trial recruitment of 5 patients per practice per month, with 80% useable measures at baseline and follow-up feasible? (WP3)

What is the problem?

Dementia costs the UK economy £23 billion a year, more than heart disease, stroke and cancer. Around 676,000 people in England have dementia and there are 540,000 carers. A diagnosis of dementia is a key step in getting support for carers and wellbeing resources, and can also help inform the care provided. GP referral patterns and diagnosis rates for dementia may vary for people from different backgrounds. Medicine for dementia can slow progression of symptoms and help people to stay independent and live at home. Having symptoms of dementia, and waiting for a diagnosis, can be a very anxious time.

What is the aim of the research?

This research aims to develop and test training, that we can scale up, to support staff to undertake tests to assess symptoms of dementia in primary care. We aim to assess the feasibility and acceptability of recruiting people to a trial, and the feasibility of measuring the impact of the tests on patient and supporter anxiety and quality of life.

How will this be achieved?

No single test is enough on its own to confirm dementia and standard tests don’t account for individual factors. A diagnosis usually requires a structured history, cognitive test, information from a supporter, and test of everyday functioning. Which tests to use depends on the individual and symptoms. We previously compared several tests in primary care to find which work well, and we are working on new technology that could help diagnosis in primary care. We want to establish which tests work for whom, and develop 2-3 modules of tests for primary care clinicians to use with patients, based on the symptoms the patient has.

Our approach will support experts to continue to provide care with a renewed focus on the most diagnostically challenging cases but allow some people to be given a diagnosis by GPs.

We will work with patients, supporters, clinicians, social care, and the third sector, building on existing networks, to co-produce a set of 2-3 “modules” of tests for dementia symptoms that could be done in primary care by a trained health care assistant. A trained GP will use results of these tests, with a clinical interview, to inform diagnosis and prescribing. We will work with adults over 75 years in areas of high deprivation, working closely with those of global majority to ensure applicability and relevance for the future trial. We will develop a training package for these tests. We will assess the practical issues of doing a trial in primary care, and measuring patient and carer quality of life and anxiety, as well as looking at patient outcomes using electronic record follow-up.

We have developed a partnership group with experts by experience who will support us to design, interpret, and spread our work.

Who is leading the Research?

Dr Sam Creavin, NIHR Clinical Lecturer in General Practice, Bristol Medical School (PHS).

Further Information

CI Email: Sam.Creavin@bristol.ac.uk

For more information or to get involved in this project, please contact bnssg.research@nhs.net.

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.