Multidisciplinary collaborative care (Callahan)

Name of Intervention: A Program of Collaborative Care for Alzheimer Disease

Principal Investigator (s): Christopher Callahan, MD

Institutional Affiliation: Indiana University Center for Aging Research & Regenstrief Institute, Inc.

Caregiver Intervention Description

1. Summary of Intervention

A multidisciplinary team approach to care for patients with dementia. This care was coordinated through a geriatric nurse practitioner working in the primary care clinic. The team included primary care and specialist physicians, psychologists, other health care workers, and relevant social service agencies working to adhere to recommended standards of care for primary care patients with dementia.

Therapeutic interventions in the Integrated Program of Collaborative Care:

  • Tailored patient and caregiver education and support program:
  • Individual and family counseling
  • Support group participation
  • Exercise program for patients
  • Telephone support
  • Consideration for referral to specialty care
  • Active case-finding and treatment for depression, psychoses, behavioral disturbances and hazardous activities
  • Active case-finding and treatment for excess disability due to comorbid conditions
  • Consideration of treatment with cholinesterase inhibitors
  • Facilitated communication among care providers both within the heath care system and the community
  • Active surveillance and tracking of patient outcomes with feedback to health care team
  • Active monitoring and support of the caregiver’s emotional and physical health

The program resulted in significant improvement in the quality of care and in behavioral and psychological symptoms of dementia among primary care patients and their caregivers. These improvements were achieved without significantly increasing the use of antipsychotics or sedative-hypnotics.

Key search terms

collaborative care

primary care

dementia

2. Intervention Materials

Caregiver Educational Handouts (http://iucar.iu.edu/research/behavioralprotocols.html)

Capacity for disseminating training has not been developed. For further information, contact Christopher Callahan, MD at ccallaha@iupui.edu or Mary Guerriero Austrom, PhD at mguerrie@iupui.edu.

3. Implementing the Intervention

Capacity for disseminating training has not been developed. The intervention tested in the randomized trial used advanced practice nurses.

Estimated costs of implementing the intervention:

Not established.

4. For more information

Callahan CM, Boustani MA, Unverzagt FW, Austrom MG, Damush TM, Perkins AJ, Fultz BA, Hui SL, Counsell SR, Hendrie HC. Effectiveness of Collaborative Care for Older Adults with Alzheimer Disease in Primary Care: A Randomized Controlled Trial. JAMA. 2006 May 10;295(18):2148-57.

Guerriero Austrom M, Damush TM, Hartwell CW, Perkins T, Unverzagt F, Boustani M, Hendrie HC, Callahan CM. Development and implementation of nonpharmacologic protocols for the management of patients with Alzheimer's disease and their families in a multiracial primary care setting. Gerontologist. 2004 Aug;44(4):548-53.

Boustani M, Callahan CM, Unverzagt FW, Austrom MG, Perkins AJ, Fultz BA, Hui SL, Hendrie HC. Implementing a screening and diagnosis program for dementia in primary care. J Gen Intern Med. 2005 Jul;20(7):572-7.