@article {11, title = {Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): study protocol for a cluster-randomised controlled trial.}, journal = {Implement Sci}, volume = {10}, year = {2015}, month = {2015 Jun 04}, pages = {82}, abstract = {

BACKGROUND: The majority of nursing home residents with dementia experience behavioural and psychological symptoms like apathy, agitation, and anxiety. According to analyses of prescription prevalence in Germany, antipsychotic drugs are regularly prescribed as first-line treatment of neuropsychiatric symptoms in persons with dementia, although guidelines clearly prioritise non-pharmacological interventions. Frequently, antipsychotic drugs are prescribed for inappropriate reasons and for too long without regular reviewing. The use of antipsychotics is associated with adverse events like increased risk of falling, stroke, and mortality. The aim of the study is to investigate whether a person-centred care approach, successfully evaluated in nursing homes in the United Kingdom, can be implemented in German nursing homes and, in comparison with a control group, can result in a clinically relevant reduction of the proportion of residents with antipsychotic prescriptions.

METHODS/DESIGN: The study is a cluster-randomised controlled trial comparing an intervention group (two-day initial training on person-centred care and ongoing training and support programme) with a control group. Both study groups will receive, as optimised usual care, a medication review by an experienced psychiatrist/geriatrician providing feedback to the prescribing physician. Overall, 36 nursing homes in East, North, and West Germany will be randomised. The primary outcome is the proportion of residents receiving at least one antipsychotic prescription (long-term medication) after 12~months of follow-up. Secondary outcomes are residents{\textquoteright} quality of life, agitated behaviour, as well as safety parameters like falls and fall-related medical attention. A health economic evaluation and a process evaluation will be performed alongside the study.

DISCUSSION: To improve care, a reduction of the current high prescription rate of antipsychotics in nursing homes by the intervention programme is expected.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT02295462.

}, keywords = {Accidental Falls, Antipsychotic Agents, Costs and Cost Analysis, Dementia, Drug Utilization, Germany, Homes for the Aged, Humans, Inservice Training, Mental Disorders, Nursing Homes, Patient-Centered Care, Psychomotor Agitation, Quality of Life, Research Design}, issn = {1748-5908}, doi = {10.1186/s13012-015-0268-3}, author = {Richter, Christin and Berg, Almuth and Fleischer, Steffen and K{\"o}pke, Sascha and Balzer, Katrin and Fick, Eva-Maria and S{\"o}nnichsen, Andreas and L{\"o}scher, Susanne and Vollmar, Horst Christian and Haastert, Burkhard and Icks, Andrea and Dintsios, Charalabos-Markos and Mann, Eva and Wolf, Ursula and Meyer, Gabriele} } @booklet {549, title = {Versorgungsmodell f{\"u}r Betroffene mit {Chronisch-Entz{\"u}ndlichen} Darmerkrankungen in Wien {\textendash} Interdisziplin{\"a}r konsentierte Versorgungspfade gem{\"a}{\ss} der Wiener Zielsteuerung Gesundheit}, year = {2015}, author = {Vogelsang, Harald and Maier, Manfred and Novacek, Gottfried and Feichtenschlager, Thomas and Pichlh{\"o}fer, Otto and Beyer, Anita and Gross, Evelyn and Linsbichler, Susanna and Sokele, Sigrid and Stift, Anton and Pichlbauer, Ernest G} } @article {18, title = {Diabetes care among older adults in primary care in Austria--a cross-sectional study.}, journal = {Swiss Med Wkly}, volume = {142}, year = {2012}, month = {2012}, pages = {w13646}, abstract = {

QUESTIONS UNDER STUDY: The prevalence of diabetes mellitus in the older population is high, but hardly any data are available on current diabetes care in the primary care setting. We aimed at investigating the diabetes management of older patients with type 2 diabetes (T2DM) in the primary care setting, including adherence to current guidelines, comparing patients aged 70-79 years to those aged 80 years and above.

METHODS: From November 2008 through March 2009 a total of 23 primary care physicians and one consultant in internal medicine consecutively enrolled 203 unselected patients with T2DM aged >=70 years.

RESULTS: From the 203 study participants 66\% were 70-79 years of age, and 34\% were 80 years or older. Mean HbA1c and LDL-cholesterol were not significantly different between the older and the younger age group (7.6 {\textpm} 1.6 vs. 7.1 {\textpm} 0.9\%; p = 0.080; and 122 {\textpm} 40 vs. 114 {\textpm} 34 mg/dl; p = 0.273), whereas BMI was lower (27.5 {\textpm} 5.0 vs. 29.6 {\textpm} 5.0 kg/m2, p = 0.010), and the prevalent rates of coronary heart disease (55.1 vs. 37.1\%, p = 0.011) and of dementia (29\% vs. 6.1\%, p = 0.001) were higher in the older age group. LDL-cholesterol (77.6\% vs. 66.7\%, p = 0.012), creatinine clearance (34.6\% vs. 30.9\%, p = 0.049) but not HbA1c (74.6\% vs.73.9; p = 0.520) were monitored significantly less often in the older than in the younger age group.

CONCLUSIONS: While glycaemic control on average appears strict, there may be ample room for improvement in reaching lipid targets and in the monitoring of lipid and renal function among older adults in primary care, in particular among individuals aged >=80 years.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Austria, Body Mass Index, Chi-Square Distribution, Cholesterol, HDL, Cholesterol, LDL, Creatinine, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Glomerular Filtration Rate, Glycated Hemoglobin, Humans, Male, Practice Patterns, Physicians{\textquoteright}, Statistics, Nonparametric, Triglycerides}, issn = {1424-3997}, doi = {10.4414/smw.2012.13646}, author = {Mann, Eva and Vonbank, Alexander and Drexel, Heinz and Saely, Christoph H} } @article {31, title = {Comprehensive Geriatric Assessment (CGA) in general practice: results from a pilot study in Vorarlberg, Austria.}, journal = {BMC Geriatr}, volume = {4}, year = {2004}, month = {2004 May 19}, pages = {4}, abstract = {

BACKGROUND: Most comprehensive geriatric assessment (CGA) programs refer to hospital-based settings. However the body of geriatric healthcare is provided by general practitioners in their office. Structured geriatric problem detection by means of assessment instruments is crucial for efficient geriatric care giving in the community.

METHODS: We developed and pilot tested a German language geriatric assessment instrument adapted for general practice. Nine general practices in a rural region of Austria participated in this cross-sectional study and consecutively enrolled 115 persons aged over 75 years. The prevalence of specific geriatric problems was assessed, as well as the frequency of initiated procedures following positive and negative tests. Whether findings were new to the physician was studied exemplarily for the items visual and hearing impairment and depression. The acceptability was recorded by means of self-administered questionnaires.

RESULTS: On average, each patient reported 6.4 of 14 possible geriatric problems and further consequences resulted in 43.7\% (27.5\% to 59.8\%) of each problem. The items with either the highest prevalence and/or the highest number of initiated actions by the GPs were osteoporosis risk, urinary incontinence, decreased hearing acuity, missing pneumococcal vaccination and fall risk. Visual impairment was newly detected in only 18\% whereas hearing impairment and depression was new to the physician in 74.1\% and 76.5\%, respectively.A substantial number of interventions were initiated not only following positive tests (43.7\% per item; 95\% CI 27.5\% to 59.8\%), but also as a consequence of negative test results (11.3\% per item; 95\% CI 1.7\% to 20.9\%). The mean time expenditure to accomplish the assessment was 31 minutes (SD 10 min). Patients (89\%) and all physicians confirmed the CGA to provide new information in general on the patient{\textquoteright}s health status. All physicians judged the CGA to be feasible in everyday practice.

CONCLUSION: This adapted CGA was feasible and well accepted in the general practice sample. High frequencies of geriatric problems were detected prompting high numbers of problem-solving initiatives. But a substantial number of actions of the physicians following negative tests point to the risks of too aggressive treatment of elderly patients with possibly subsequent negative effects.

}, issn = {1471-2318}, doi = {10.1186/1471-2318-4-4}, author = {Mann, Eva and Koller, Michael and Mann, Christian and van der Cammen, Tischa and Steurer, Johann} }