Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial

I. Leroi, John Woolham, R. Gathercole, R. Howard, B. Dunk, C. Fox, J. O’Brien, A. Bateman, F. Poland, P. Bentham, A. Burns, A. Davies, K. Forsyth, R. Gray, M. Knapp, S. Newman, R. McShane, C. Ritchie

    Research output: Contribution to journalArticle

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    Abstract

    Background: Assistive technology and telecare (ATT) are relatively new ways of delivering care and support to people with social care needs. It is claimed that ATT reduces the need for community care, prevents unnecessary hospital admission, and delays or prevents admission into residential or nursing care. The current economic situation in England has renewed interest in ATT instead of community care packages. However, at present, the evidence base to support claims about the impact and effectiveness of ATT is limited, despite its potential to mitigate the high financial cost of caring for people with dementia and the social and psychological cost to unpaid carers. Method/design: ATTILA (Assistive Technology and Telecare to maintain Independent Living At Home for People with Dementia) is a pragmatic, multi-centre, randomised controlled trial over 104 weeks that compares outcomes for people with dementia who receive ATT and those who receive equivalent community services but not ATT. The study hypothesis is that fewer people in the ATT group will go into institutional care over the 4-year period for which the study is funded. The study aims to recruit 500 participants, living in community settings, with dementia or significant cognitive impairment, who have recently been referred to social services. Primary outcome measures are time in days from randomisation to institutionalisation and cost effectiveness. Secondary outcomes are caregiver burden, health-related quality of life in carers, number and severity of serious adverse events, and data on acceptability, applicability and reliability of ATT intervention packages. Assessments will be undertaken in weeks 0 (baseline), 12, 24, 52 and 104 or until institutionalisation or withdrawal of the participant from the trial. Discussion: In a time of financial austerity, CASSRs in England are increasingly turning to ATT in the belief that it will deliver good outcomes for less money. There is an absence of robust evidence for the cost-effectiveness and benefit of using assistive technology and telecare. The ATTILA trial meets a pressing need for robust, generalisable evidence to either justify continuing investment or reappraise the appropriate scale of ATT use. Trial registration: Current Controlled Trials ISRCTN86537017.
    Original languageEnglish
    Article number349
    JournalTrials
    Volume14
    Issue number1
    DOIs
    Publication statusPublished - 2013

    Fingerprint

    Self-Help Devices
    Dementia
    Randomized Controlled Trials
    Caregivers
    Cost-Benefit Analysis
    Institutionalization
    England
    Independent Living
    Costs and Cost Analysis
    Social Welfare
    Random Allocation
    Nursing Care
    Social Work

    Bibliographical note

    This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Keywords

    • assistive technology
    • community living
    • dementia
    • independence
    • randomised control trial
    • telecare

    Cite this

    Leroi, I., Woolham, J., Gathercole, R., Howard, R., Dunk, B., Fox, C., ... Ritchie, C. (2013). Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial. Trials, 14(1), [349]. https://doi.org/10.1186/1745-6215-14-349

    Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial. / Leroi, I.; Woolham, John; Gathercole, R.; Howard, R.; Dunk, B.; Fox, C.; O’Brien, J.; Bateman, A.; Poland, F.; Bentham, P.; Burns, A.; Davies, A.; Forsyth, K.; Gray, R.; Knapp, M.; Newman, S.; McShane, R.; Ritchie, C.

    In: Trials, Vol. 14, No. 1, 349, 2013.

    Research output: Contribution to journalArticle

    Leroi, I, Woolham, J, Gathercole, R, Howard, R, Dunk, B, Fox, C, O’Brien, J, Bateman, A, Poland, F, Bentham, P, Burns, A, Davies, A, Forsyth, K, Gray, R, Knapp, M, Newman, S, McShane, R & Ritchie, C 2013, 'Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial' Trials, vol. 14, no. 1, 349. https://doi.org/10.1186/1745-6215-14-349
    Leroi, I. ; Woolham, John ; Gathercole, R. ; Howard, R. ; Dunk, B. ; Fox, C. ; O’Brien, J. ; Bateman, A. ; Poland, F. ; Bentham, P. ; Burns, A. ; Davies, A. ; Forsyth, K. ; Gray, R. ; Knapp, M. ; Newman, S. ; McShane, R. ; Ritchie, C. / Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial. In: Trials. 2013 ; Vol. 14, No. 1.
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    AU - Leroi, I.

    AU - Woolham, John

    AU - Gathercole, R.

    AU - Howard, R.

    AU - Dunk, B.

    AU - Fox, C.

    AU - O’Brien, J.

    AU - Bateman, A.

    AU - Poland, F.

    AU - Bentham, P.

    AU - Burns, A.

    AU - Davies, A.

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    AU - Gray, R.

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    AU - Newman, S.

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    N2 - Background: Assistive technology and telecare (ATT) are relatively new ways of delivering care and support to people with social care needs. It is claimed that ATT reduces the need for community care, prevents unnecessary hospital admission, and delays or prevents admission into residential or nursing care. The current economic situation in England has renewed interest in ATT instead of community care packages. However, at present, the evidence base to support claims about the impact and effectiveness of ATT is limited, despite its potential to mitigate the high financial cost of caring for people with dementia and the social and psychological cost to unpaid carers. Method/design: ATTILA (Assistive Technology and Telecare to maintain Independent Living At Home for People with Dementia) is a pragmatic, multi-centre, randomised controlled trial over 104 weeks that compares outcomes for people with dementia who receive ATT and those who receive equivalent community services but not ATT. The study hypothesis is that fewer people in the ATT group will go into institutional care over the 4-year period for which the study is funded. The study aims to recruit 500 participants, living in community settings, with dementia or significant cognitive impairment, who have recently been referred to social services. Primary outcome measures are time in days from randomisation to institutionalisation and cost effectiveness. Secondary outcomes are caregiver burden, health-related quality of life in carers, number and severity of serious adverse events, and data on acceptability, applicability and reliability of ATT intervention packages. Assessments will be undertaken in weeks 0 (baseline), 12, 24, 52 and 104 or until institutionalisation or withdrawal of the participant from the trial. Discussion: In a time of financial austerity, CASSRs in England are increasingly turning to ATT in the belief that it will deliver good outcomes for less money. There is an absence of robust evidence for the cost-effectiveness and benefit of using assistive technology and telecare. The ATTILA trial meets a pressing need for robust, generalisable evidence to either justify continuing investment or reappraise the appropriate scale of ATT use. Trial registration: Current Controlled Trials ISRCTN86537017.

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