Most older adults, including those with dementia, receive their health care from generalist physicians. Although primary care physicians prescribe most psychoactive medications to older adults, the primary care setting appears to be poorly designed and underresourced to provide comprehensive management approaches for dementia, according to background information in the article. 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.
Christopher M. Callahan, M.D., of the Indiana University School of Medicine, Indianapolis, and colleagues conducted a randomized controlled trial to test the effectiveness of collaborative care management for older adults with Alzheimer disease compared with augmented usual care. Physicians caring for patients at primary care practices within 2 university-affiliated health care systems were randomized to administer collaborative care management (received by 84 patients) or augmented usual care (received by 69 patients). The study was conducted from January 2002 through August 2004.
Intervention patients received 1 year of care management by an interdisciplinary team led by a nurse practitioner working with the patient's family caregiver and integrated within primary care. The team used standard protocols to initiate treatment and identify, monitor, and treat behavioral and psychological symptoms of dementia, including protocols for personal care, mobility, sleep disturbances, depression, agitation or aggression, delusions or hallucinations, and the caregiver's personal health. The pr
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