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Information about ongoing health services research and public health projects

Extension connection: advancing dementia care for rural and Hispanic populations
Investigator (PI): Carnahan, Ryan Michael
Performing Organization (PO): (Current): University of Iowa, College of Public Health, Health Effectiveness Research Center / (319) 384-1500
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2013
Final Year: 2019
Record Source/Award ID: PCORI/1131
Funding: Total Award Amount: $1,659,924
Award Type: Grant
Award Information: PCORI: More information and project results (when completed)
Abstract: The need to balance serious side effects with effectiveness of antipsychotics for behavioral and psychological symptoms in Alzheimer disease and other dementias sets the stage for difficult decisions for patients, families, and health care providers. While evidence supports the effectiveness of certain atypical antipsychotics in treating behavioral disturbances, these drugs have been found to increase the risk of death and stroke in people with dementia. Despite these warnings, antipsychotic use in people with dementia remains common, and, in many cases, it does not meet criteria for appropriate use. Training providers to understand proper evaluation strategies, non-drug management, and antipsychotic selection and use may improve antipsychotic utilization patterns and, as a result, the safety and quality of life of people with dementia. Through a project currently funded by the Agency for Healthcare Research and Quality, we have developed a toolkit and online training program to improve management of problem behaviors and reduce inappropriate antipsychotic use in dementia. However, we have identified unmet needs. This collaboration of the Iowa Geriatric Education Center, the Health Effectiveness Research Center, Iowa State University Extension and Outreach, and the Texas Consortium Geriatric Education Center proposes to test a new outreach and education strategy to improve dementia care for rural older adults and develop new dementia care training and resources for Hispanic and Latino care providers and patient families. Aim 1 is to conduct an intervention study in 10 rural Iowa counties with large percentages of older residents, and compare prescribing patterns and patient outcomes in these 10 counties compared to 20 counties with similar resident characteristics. Our intervention will include 1) local extension office outreach to deliver our toolkit and marketing materials and to recruit prescribers, consultant pharmacists, and nursing home directors of nursing and administrators for academic detailing (i.e., educational discussions with academic specialists; 2) four academic detailing sessions over six months with a psychiatric pharmacy specialist or nurse specialist in geriatric psychiatry, using videoconferencing equipment to improve the sustainability of the approach for rural settings; and 3) multidisciplinary team consultation for challenging clinical scenarios, the results of which will be delivered as guidance to academic detailing participants and form the foundation for future resources. Aim 2 is to translate our existing online training program and toolkit into Spanish and distribute this translation. Aim 3 is to evaluate long-term outcomes associated with use of our online training program and toolkit in Iowa. Antipsychotic use patterns and behavioral outcomes for aims 1 and 3 will be evaluated by analyzing Minimum Data Set, Medicare, and Medicaid data for Iowa beneficiaries from 2009 to 2014. More on this project: Urick BY, Kaskie BP, Carnahan RM. Improving antipsychotic prescribing practices in nursing facilities: The role of surveyor methods and surveying agencies in upholding the Nursing Home Reform Act. Research in Social and Administrative Pharmacy. 2016 Jan-Feb;12(1):91-103. doi: 10.1016/j.sapharm.2015.04.006. PubMed PMID: 25990258.
MeSH Terms:
  • Aged
  • Antipsychotic Agents /administration & dosage
  • Dementia /*ethnology
  • /*therapy
  • Geriatrics /methods
  • Hispanic Americans
  • Humans
  • Inappropriate Prescribing
  • Iowa
  • Language
  • Medicare
  • Outcome Assessment, Health Care
  • Quality of Life
  • Rural Health Services /organization & administration
  • Rural Population
  • Texas
  • United States
  • United States Agency for Healthcare Research and Quality
Country: United States
State: Iowa
Zip Code: 52242
UI: 20142254
CTgovId: NCT02455310
Project Status: Completed
Record History: ('2019: Project extended to 2019. 2017: Project extended to 2018',)