STAR Caregivers - Virtual Training and Follow-up

摘要 阿尔茨海默病和相关痴呆症（ADRD）是一种使人衰弱的疾病，影响超过500万人 2014年美国人预计在未来15年内将有840万人被诊断患有ADRD 到2050年，ADRD的医疗保健费用预计将超过1.2万亿美元。行为和 痴呆的心理症状（BPSD）是常见的，通常涉及攻击行为， 家庭照顾者（CG）应对未满足的需求，不适，或挫折。BPSD经常导致CG 寻求药物治疗以控制患者症状。抗精神病药物在痴呆症（PWD）患者中的使用超过 死亡风险加倍美国精神病学协会的明智选择指南， 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治疗管理 《老年人服务计划》获政府认可。然而，这些方案并没有得到广泛实施- 部分原因是方案的强度/成本以及开展外联的困难。没有研究调查了 CG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， 星星虚拟培训和跟踪（星星-VTF）的可行性和可接受性，其中：（a）培训材料 （B）护理人员有两次家庭访问， 工作者和（c）其中护理者经由安全消息传递（电子邮件）从社会工作者接收支持， 基于Web的门户网站。我们将比较STAR-VTF组与注意力控制组（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 STAR-VTF到照顾者;（2）评估支付者对该计划的可行性和可接受性 （3）检验以下假设：（H1）STAR-VTF中的照顾者参与者将具有较低的 与注意力控制组相比，8周和6个月时的照顾者负担;（H2）PWD参与者 在6个月时，STAR-VTF患者的每日抗精神病药物使用率低于关注组 控制我们计划招募100例CG-PWD二联体（每组50例）。这将是第一项测试低血糖的研究。 强度，自我导向的护理人员培训计划与安全的信息支持，从社会工作者。它还将 这是第一个测量PWD在CG训练后抗精神病药物使用变化的研究。这项研究是 也是创新的，因为它汇集了护理人员培训，健康信息， 管理和护理管理。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，以确定在抗精神病药物治疗时需要教育/支持的潜在护理人员 开始用药。这项研究的结果将为精神健康研究中未来的多中心试验提供信息。 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.