STAR Caregivers - Virtual Training and Follow-up

STAR 护理人员 - 虚拟培训和跟进

• 批准号: 9791152
• 负责人: Robert B. Penfold
• 金额: $ 54.61万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9791152
• 关键词: Affect; Aggressive behavior; Aging; Agitation; Alzheimer' s disease related dementia; American; American Psychiatric Association; Antipsychotic Agents; Anxiety; Behavior Therapy; Behavioral Symptoms; Caregiver Burden; Caregivers; Caring; Clinical Trials; Control Groups; Data; Dementia; Diagnosis; E-learning; Education; Effectiveness; Electronic Mail; Emergency department visit; Enrollment; Family Caregiver; Frustration; Future; Geriatrics; Guidelines; Health; Health Care Costs; Health Services; Health system; Healthcare; Home environment; Home visitation; Improve Access; Information Management; Integrated Delivery Systems; Intervention; Lead; Measures; Mediator of activation protein; Mental Depression; Mental Health; Modality; Natural Language Processing; Online Systems; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Population; Preparation; Primary Care Physician; Primary Health Care; Program Acceptability; Research; Risk; Secure; Self Efficacy; Self-Direction; Site; Social Workers; Social support; Societies; Symptoms; Telephone; Testing; Time; Training; Training Programs; Training Support; Training and Education; Travel; Washington; arm; attentional control; behavioral health; care coordination; caregiver depression; caregiver education; cost; follow-up; innovation; member; mortality; mortality risk; multi-site trial; outreach; payment; pragmatic trial; program costs; programs; psychological symptom; randomized trial; recruit; response; retiree; secondary outcome; time use; urgent care; virtual; willingness

ABSTRACT Alzheimer's Disease and related Dementias (ADRD) are debilitating conditions affecting more than 5 million Americans in 2014. It is projected that 8.4 million people with be diagnosed with ADRD over the next 15 years and health care costs attributable to ADRD are projected to be more than $1.2 trillion by 2050. Behavioral and Psychological Symptoms of Dementia (BPSD) are common and often involve aggressive behavior towards family caregivers (CG) in response to unmet needs, discomfort, or frustration. BPSD frequently lead to CG seeking medication to control patient symptoms. Antipsychotic use in persons with dementia (PWD) more than doubles mortality risk. The Choosing Wisely Guidelines from the American Psychiatric Association and American Geriatrics Society both recommend against prescribing antipsychotics as a first-line treatment for BPSD. Behavioral interventions such as STAR-Caregivers are efficacious first-line treatments for managing BPSD endorsed by the Administration on Aging. However, the programs have not been implemented widely – partly due to the intensity/cost of the programs and difficulty conducting outreach. No study has investigated CG willingness to reduce or discontinue antipsychotic use. We propose a Stage III clinical trial to ascertain the feasibility and acceptability of STAR Virtual Training and Follow-up (STAR- VTF) in which (a) training materials are delivered electronically and learning is self-directed, (b) caregivers have two in-home visits with a social worker and (c) where caregivers receive support from a social worker via secure messaging (email) within a web-based portal. We will compare outcomes in the STAR-VTF group to an attention control group (mailed material plus generic secure messages). Our specific aims are: (1) Assess the feasibility and acceptability of STAR-VTF to caregivers; (2) Assess the feasibility and acceptability of the program from the payer perspective; and (3) Test the hypotheses that (H1) caregiver participants in STAR-VTF will have lower levels of caregiver burden at 8 weeks and 6 months compared to an attention control group; and (H2) PWD participants in STAR-VTF will have lower rates of daily antipsychotic medication use at 6 months compared to attention control. We propose to recruit 100 CG-PWD dyads (50 in each arm). This will be the first study to test a low intensity, self-directed caregiver training program with secure message support from social workers. It will also be the first study to measure changes in antipsychotic medication use by PWD after CG training. The study is also innovative because it brings together leading experts in caregiver training, health information management, and care management. Third, this will be the first study to use automated data and natural language processing to identify potential caregivers in need of education/support at a time when antipsychotic medication use begins. Results of this study will inform a future multi-site trial in the Mental Health Research Network.

抽象的 阿尔茨海默病和相关痴呆症 (ADRD) 是影响超过 500 万人的衰弱疾病 2014 年的美国人。预计未来 15 年内将有 840 万人被诊断患有 ADRD 到 2050 年，ADRD 造成的医疗保健费用预计将超过 1.2 万亿美元。 痴呆症的心理症状 (BPSD) 很常见，通常涉及对他人的攻击行为 家庭照顾者（CG）对未满足的需求、不适或挫败感的反应常常导致 CG。 寻求药物来控制痴呆症患者 (PWD) 患者症状的使用超过 美国精神病学协会的明智选择指南和 美国老年病学协会均建议不要将抗精神病药物作为一线治疗 诸如 STAR-Caregivers 之类的行为干预措施是有效的一线治疗方法。 BPSD 得到了老龄化管理局的认可，但该计划尚未得到广泛实施—— 部分原因是该计划的强度/成本以及开展外展工作的困难，尚无研究对此进行调查。 CG 愿意减少或停止使用抗精神病药物，我们建议进行 III 期临床试验来确定。 STAR 虚拟培训和跟进 (STAR-VTF) 的可行性和可接受性，其中 (a) 培训材料 以电子方式提供，学习是自我导向的，(b) 护理人员与社会护理人员进行两次家访 (c) 护理人员通过安全消息传递（电子邮件）在社区内获得社会工作者的支持 我们将比较 STAR-VTF 组和注意力对照组（邮寄）的结果。 （材料加上通用安全消息）。我们的具体目标是： (1) 评估可行性和可接受性。 向护理人员提供 STAR-VTF； (2) 评估付款人该计划的可行性和可接受性； 观点；以及 (3) 检验以下假设：(H1) STAR-VTF 中的护理人员参与者将具有较低水平 与注意力对照组和 (H2) PWD 参与者相比，第 8 周和第 6 个月时的照顾者负担； 与注意力相比，STAR-VTF 在 6 个月时每日使用抗精神病药物的比例较低 我们建议招募 100 名 CG-PWD 双人组（每组 50 名），这将是第一个测试低值的研究。 强度、自我指导的护理人员培训计划，以及社会工作者的安全信息支持。 是第一个测量 CG 训练后残疾人抗精神病药物使用变化的研究。 同样具有创新性，因为它汇集了护理人员培训、健康信息方面的领先专家 第三，这将是第一个使用自动化数据和自然的研究。 语言处理，以识别在抗精神病药物治疗时需要教育/支持的潜在护理人员 这项研究的结果将为未来的心理健康研究多中心试验提供信息。 网络。