Effectiveness of educational interventions in improving detection and management of dementia in primary care: cluster randomised controlled study

OBJECTIVE: To test the effectiveness of educational interventions in improving detection rates and management of dementia in primary care. DESIGN: Unblinded, cluster randomised, before and after controlled study. SETTING: General practices in the United Kingdom (central Scotland and London) between 1999 and 2002. INTERVENTIONS: Three educational interventions: an electronic tutorial carried on a CD Rom; decision support software built into the electronic medical record; and practice based workshops. PARTICIPANTS: 36 practices participated in the study. Eight practices were randomly assigned to the electronic tutorial; eight to decision support software; 10 to practice based workshops; and 10 to control. Electronic and manual searches yielded 450 valid and usable medical records. MAIN OUTCOME MEASURES: Rates of detection of dementia and the extent to which medical records showed evidence of improved concordance with guidelines regarding diagnosis and management. RESULTS: Decision support software (P = 0.01) and practice based workshops (P = 0.01) both significantly improved rates of detection compared with control. There were no significant differences by intervention in the measures of concordance with guidelines. CONCLUSIONS: Decision support systems and practice based workshops are effective educational approaches in improving detection rates in dementia.