NCT01117285

Implementation and Evaluation of the COTiD Program in the Netherlands

Implementation and Evaluation of an Effective Community Occupational Therapy in Dementia (COTiD) Program

• Status: Unknown
• Phase: N/A
• Study type: Interventional
• Enrollment: 180 (estimated)
• Sponsor: ZonMw: The Netherlands Organisation for Health Research and Development · Academic / Other
• Sex: All
• Age: —
• Healthy volunteers: Not accepted

Summary

The main purpose of this cluster randomized controlled trial is to evaluate the difference in effectiveness between a combined implementation strategy and an educational strategy on the implementation of a community occupational therapy program for clients with dementia and their primary caregivers.

Detailed description

Dementia is associated with a major decrease in quality of life of clients and their caregivers and a major driver of costs in health care. Recently, evidence was found for the effectiveness and cost-effectiveness of a community-based occupational therapy (OT) intervention for older adults with dementia and their caregivers (COTiD program). This intervention resulted in significant improvements in both clients' and caregivers' daily functioning, quality of life, mood and health status. In addition, caregivers experienced an increased sense of competence. Currently occupational therapists (OTs) are trained in using the program during a 3-day course. In a pilot implementation study it was found that this course was not effective enough as only 20% of the OTs actually used the COTiD program in practice because of a lack of implementation skills, feedback and organisational barriers. In order to increase the use of this program and increase the quality of care a new implementation strategy is developed. This combined implementation strategy provides the OTs with two implementation training days, coaching on the job, regional meetings, discussion platform, web-based registration system and newsletters. In addition physicians and managers are provided with extra information on the COTiD program. The current study is designed primarily to evaluate the following research questions: * What is the difference in adherence to the community OT guideline in dementia between OTs receiving the combined implementation strategy and OTs receiving the educational strategy? * What is the difference in community OT use(referral rate + actual provision of OT) between clusters provided with the combined implementation strategy and clusters provided with the educational strategy? * What is the difference in cost-effectiveness between the combined implementation strategy and the educational strategy with regard to adherence of OTs to the community OT guideline? In addition the effect of the implementation strategies on patient and caregiver outcomes will also be measured.

Conditions

• Dementia

Interventions

Type	Name	Description
OTHER	3-day post-graduate course	A 3-day course in using the COTiD program in clinical practice. The 3 days are not provided uninterrupted but there are at least two weeks between each day to provide time to practice with the guideline (for discussion on the 2nd day). The course consists of theory on the content of the guideline and its effectiveness, Practice parts of the guideline by rol playing, and discussing each others skills through watching video material.
OTHER	Combined implementation strategy	The combined implementation strategy provides strategies for occupational therapists (OTs), physicians, and managers. OTs receive: * 3-day post-graduate course * 2 extra training days: Lectures and skills practice focused on using the COTiD program and promoting the use of the program within their organization and network. * Coaching on the job: Barriers to using the COTiD program in practice are discussed using motivational interviewing. * Discussion platform * Web-based registration system: Provides guidance in using the COTiD program for every individual client. * Regional meetings: successes and difficulties in using the COTiD are discussed. Managers and physicians receive: * Information on the COTiD program through a website and newsletters. * Motivational reminders.

Timeline

• Start date: 2009-10-01
• Primary completion: 2011-12-01
• Completion: 2011-12-01
• First posted: 2010-05-05
• Last updated: 2010-05-21

Locations

1 site across 1 country: Netherlands