STAR Caregivers - Virtual Training and Follow-up

摘要 阿尔茨海默病和相关痴呆症(ADRD)是使人衰弱的疾病，影响着500多万人 2014年的美国人。据预测，在未来15年内，将有840万人被诊断为ADRD 预计到2050年，可归因于ADRD的医疗成本将超过1.2万亿美元。行为和 痴呆症的心理症状很常见，通常涉及攻击性行为。 家庭照顾者(CG)对未得到满足的需求、不适或挫折做出反应。BPSD经常导致CG 寻求药物来控制病人的症状。痴呆(PWD)患者中抗精神病药物的使用超过 使死亡风险加倍。来自美国精神病学协会的选择明智指南和 美国老年医学会都建议不要将抗精神病药物作为一线治疗药物 BPSD。行为干预，如明星照顾者，是有效的一线管理治疗方法 政府当局在老龄化问题上通过的BPSD。然而，这些计划并未得到广泛实施- 部分原因是方案的强度/成本以及开展外联工作的困难。还没有研究调查过 CG是否愿意减少或停止使用抗精神病药物。我们建议进行第三阶段临床试验，以确定 STAR虚拟培训和后续行动(STAR-VTF)的可行性和可接受性，其中(A)培训材料 是通过电子方式提供的，学习是自我指导的，(B)照顾者有两次上门探访，有一个社会团体 工作人员和(C)护理人员通过安全消息传递(电子邮件)从社会工作者获得支持的情况 基于Web的门户。我们将比较STAR-VTF组和注意对照组(邮寄)的结果 材料加上通用安全消息)。我们的具体目标是：(1)评估项目的可行性和可接受性 STAR-VTF给照顾者；(2)从付款人那里评估该计划的可行性和可接受性 前景；以及(3)检验假设：(H1)STAR-VTF中的照顾者参与者将具有较低的 与注意对照组相比，照顾者在8周和6个月时的负担；以及(H2)PWD参与者 在STAR-VTF中，与注意相比，6个月时每日抗精神病药物的使用率较低 控制力。我们建议招募100名CG-PWD二元组(每组50人)。这将是第一项测试低点的研究 高强度、自我指导的护理员培训计划，并得到社会工作者的安全信息支持。它还将 是第一个测量在CG训练后PWD使用抗精神病药物的变化的研究。这项研究是 它还具有创新性，因为它汇集了护理者培训、健康信息方面的领先专家 管理和护理管理。第三，这将是第一次使用自动数据和自然数据的研究 在服用抗精神病药物时识别需要教育/支持的潜在照顾者的语言处理 开始用药。这项研究的结果将为未来心理健康研究中的多点试验提供信息 网络。

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.