Feasibility of a Novel Systems Approach for Improving Utilization of Alzheimer's Disease Services Among Latinos Attending Primary Care Practices
试验速览
- 阶段
- 1 期
- 状态
- 已完成
- 入组人数
- 243
- 试验地点
- 2
- 主要终点
- Provider Recruitment Feasibility
研究概览
简要总结
The research team will train primary care practitioners from Kansas City clinics to enhance skills in cultural competence, dementia detection, treatment and referral to a Health Navigator among Latinos 65 and older with dementia. The Health Navigator will provide patient/caregiver dyads referred by Alianza Latina providers with care management, psychosocial support and links to relevant community resources. Outcomes include feasibility and acceptability of 1) PCP training and 2) patient and caregiver dementia care.
详细描述
Alzheimer's disease and related dementias (ADRD) are a major cause of mortality and disability in later life and cost the US healthcare system more than cancer or heart disease. The National Alzheimer's Plan Act and the National Institutes of Health have identified ADRD disparities among ethnic minorities as a public health priority. Latinos with ADRD experience substantial disparities with reduced rates of early diagnosis and lower quality care compared to their non-Latino white peers, which put them at an increased risk for steeper cognitive decline, morbidity, mortality and higher caregiver burden. A number of barriers conspire to create these disparities including a lack of an evidence-based strategy to address ADRD in clinics, patient and primary care provider (PCP) reduced ADRD knowledge, negative attitudes regarding ADRD, PCP's lack of time, cultural and language barriers and health insurance status. To improve healthcare delivery to Latinos with ADRD, researchers need to redesign current ADRD detection and care systems to follow evidence-based recommendations for early detection and culturally appropriate chronic care.
The overall aim of this proposal is to enhance the delivery of ADRD services to Latinos in primary care through a scalable systems approach that includes evidence-based recommendations. Primary care clinics are the ideal setting to provide ADRD services, as 93% of older Latinos have a usual source of healthcare. The novel systems approach (Alianza Latina/Latino Alliance) will enhance timely ADRD diagnosis and optimal care to minimize behavioral symptoms and cognitive decline among Latinos in a linguistically and culturally-appropriate way. Alianza Latina will use the Collaborative Care Framework that capitalizes on PCPs and Health Navigators. 1) PCPs will undergo evidence-based training to enhance timely and culturally appropriate diagnosis and implement it in their work routine. 2) PCPs will detect, treat and refer Latino ADRD patients to a bilingual Health Navigator to provide chronic care management, which will reduce PCP time burden.
Aim 2: Test the feasibility and acceptability of Alianza Latina. Aim 2.a: The research team will train PCPs from Kansas City clinics to enhance skills in cultural competence, ADRD detection, treatment and referral to a Health Navigator among Latinos 65 and older with ADRD. Aim 2.b. The Health Navigator will provide patients/caregiver dyads referred by Alianza Latina PCPs with care management, psychosocial support and links to relevant community resources. The research team will assess the feasibility and acceptability of 1) PCP training and 2) patient and caregiver ADRD care. Caregivers will be enrolled in a text messaging program, called CuidaTEXT, that will educate about memory and thinking problems, solve problems that are common among families with memory and thinking problems, send reminders for appointments and medications, and improve communication with the PCP, family, friends, and other resources.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Supportive Care
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •for care recipients within the dyad:
- •Identify as Latino
- •Community dwelling
- •Diagnosed with mild cognitive impairment or dementia
- •Have a caregiver 18 years old or older
- •Have co-participant with access to a privately-owned cell phone with a flat fee for text messages
- •Inclusion Criteria for primary care providers:
- •Be 18 years old or older
- •Work as a primary care provider in the US
排除标准
- •for care recipients within the dyad:
- •Not identify as Latino
- •Not community dwelling
- •Not diagnosed with mild cognitive impairment or dementia
- •Not having a caregiver 18 years old or older
- •Not having a co-participant with access to a privately-owned cell phone with a flat fee for text messages
- •Exclusion Criteria for primary care providers:
- •Younger than 18 years old
- •Not work as a primary care provider in the US
研究组 & 干预措施
Alianza Latina
The main components of Alianza Latina are 1) providing primary care providers with education, training and tools for timely dementia diagnosis and optimal treatment and 2) providing Latino dementia patients with enhanced chronic care through bilingual Health Navigators.
干预措施: Alianza Latina (Combination Product)
结局指标
主要结局
Provider Recruitment Feasibility
时间窗: During the 9 months of the provider intervention period
Metrics of the number of providers who agree to be trained per month
Provider Retention Feasibility
时间窗: During the 9 months of the provider intervention period
Metrics of the percentage of providers who continue to partner with the study team by the end of the provider intervention period
Provider Fidelity Feasibility 1
时间窗: 9 months (end of the provider intervention period)
Percentage of providers able to implement screenings in regular workflow, measured via survey with the question "To what extent were you able to implement screenings in regular workflow" with three response options: "not at all", "to some degree", "usually", "almost always" and "always"
Provider Assessment Feasibility 1
时间窗: During the 9 months of the provider intervention period
Metrics of the percentage of providers who complete baseline and follow-up surveys about dementia knowledge, attitudes and skills
Provider Fidelity Feasibility 2
时间窗: During the 9 months of the provider intervention period
Metrics of the Number of referrals to Health Navigator per month
Overall Provider Satisfaction With Training
时间窗: 9 months (end of the provider intervention period)
Survey question including a 5-item Likert scale on satisfaction with training (not at all to very much)
Importance of Navigators to Providers
时间窗: 9 months (end of the provider intervention period)
Survey question including a 5-item Likert scale on the perceived importance of Navigators to providers (not at all to very much)
Participant Recruitment Fidelity
时间窗: During the 15 months of the whole intervention period
Metrics of percentage of referred Latino dementia dyads who enroll in Health Navigator services
Participant Retention Fidelity
时间窗: During the 6 months of the Navigator intervention period
Metrics of percentage of referred Latino dementia dyads followed up at six months
Participant Assessment Fidelity
时间窗: During the 6 months of the Navigator intervention period
Metrics of the percentage of planned baseline and follow-up survey ratings completed
Participant Treatment Adherence
时间窗: During the 6 months of the Navigator intervention period
Metrics of the percentage of referred Latino dementia dyads who attend at least 50% of Health Navigator visits
Overall Participant Satisfaction With the Clinic Side of the Intervention
时间窗: 6 months after baseline
Survey question including a 5-item Likert scale on caregivers' satisfaction with clinic services (not at all to very much)
Overall Participant Satisfaction With the Navigator Side of the Intervention
时间窗: 6 months after baseline
Survey question to the caregiver including a 5-item Likert scale on satisfaction with Navigator services (not at all to very much)
Participant Suggestions of Improvement
时间窗: 6 months after baseline
Survey question to the caregiver including an open-ended question about which aspects of the intervention they would change
Practitioner Adherence to Guideline Recommendations
时间窗: 6 months after baseline
10-item checklist administered to the dyads asking about the implementations of different aspects of dementia service guidelines
次要结局
- Patients' Behavioral Symptoms(Baseline and 6 months from baseline)
- Patients' Depression(Baseline and 6 months from baseline)
- Patients' Quality of Life(Baseline and 6 months from baseline)
- Caregivers' Quality of Life(Baseline and 6 months from baseline)
- Caregivers' Depression(Baseline and 6 months from baseline)
- Caregivers' Burden(Baseline and 6 months from baseline)