Ignite Creation Date:
2024-05-05 @ 11:59 AM
Last Modification Date:
2024-10-26 @ 9:18 AM
Study NCT ID:
NCT00202150
Status:
COMPLETED
Last Update Posted:
2015-03-11
First Post:
2005-09-13
Brief Title:
Primary Care ManagementAction Plans for Advanced Chronic Diseases
Sponsor:
Queens University
Organization:
Queens University
Study Overview
Official Title:
Primary Care ManagementAction Plans for Advanced Chronic Diseases The RoadMAP Project
Status:
COMPLETED
Status Verified Date:
2015-03
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Patients living with advanced chronic diseases ACD such as congestive heart failure CHF and chronic obstructive lung disease COPD present substantial care and economic challenges for the health care system due to frequent emergency room visits and acute care hospitalizations Morbidity and mortality is high in these complex populations and patient quality of life is often compromised
Care of patients with ACD occurs across health care sectors by providers in the acute primary and community settings Despite recent efforts to enhance the care of patients with ACD through multidisciplinary disease management programs variations and gaps exist along the continuum of care The available evidence suggests that there are opportunities to optimize the primary care of patients with ACD We are proposing to build upon the current evidence and guidelines for disease management programs our existing specialized resources our existing primary care practices and develop and test a model of care that is primary care based sensitive to the unique demands and characteristics of different primary practices Our goal is to design linkages and care strategies of relevance and importance to the primary care providers who care for patients with advanced COPD and CHF
This demonstration project is a randomized controlled clinical trial of the RoadMAP program intervention delivered by a Primary Care Nurse Specialist PCNS compared to usual care control group The primary outcomes will be degree of adherence to clinical practice guidelines Secondary outcomes will be patient satisfaction quality of life use of community-based services number of emergency room visits and number of hospitalizations
Care of patients with ACD occurs across health care sectors by providers in the acute primary and community settings Despite recent efforts to enhance the care of patients with ACD through multidisciplinary disease management programs variations and gaps exist along the continuum of care The available evidence suggests that there are opportunities to optimize the primary care of patients with ACD We are proposing to build upon the current evidence and guidelines for disease management programs our existing specialized resources our existing primary care practices and develop and test a model of care that is primary care based sensitive to the unique demands and characteristics of different primary practices Our goal is to design linkages and care strategies of relevance and importance to the primary care providers who care for patients with advanced COPD and CHF
This demonstration project is a randomized controlled clinical trial of the RoadMAP program intervention delivered by a Primary Care Nurse Specialist PCNS compared to usual care control group The primary outcomes will be degree of adherence to clinical practice guidelines Secondary outcomes will be patient satisfaction quality of life use of community-based services number of emergency room visits and number of hospitalizations
Detailed Description:
The available evidence suggests that there are opportunities to optimize the primary care of patients with ACD We are proposing to build upon the current evidence and guidelines for disease management programs our existing specialized resources our existing primary care practices and develop and test a model of care that is primary care based sensitive to the unique demands and characteristics of different primary practices Our goal is to design linkage and care strategies of relevance and importance to the primary care providers who care for patients with advanced COPD and CHF
The study is a randomized controlled clinical trial of the RoadMAP program intervention delivered by a PCNS compared to usual care control group The primary outcome will be degree of adherence to clinical practice guidelines Secondary outcomes will be patient satisfaction quality of life use of community-based services number of emergency room visits and number of hospitalizations The purpose of the RoadMAP program is to improve the care of people with advanced stage COPD and CHF Specifically activities will be aimed at improving patients self care ability facilitating access to the most appropriate services ensuring medical treatment according to consensus guidelines and promoting consistency of health care communication Adherence to guidelines is a process that involves activities by the patient PCNS and the Primary Care Physician The PCNS would follow-up the patient again at approximately one month after initial contact and then every 3 months to assess and monitor adherence to the proposed MAP by the patient the physician and the nurse Patients will have the option of returning to the physician office or to be monitored by phone An office visit will be recommended if there is a perceived need for medical assessment and intervention The family physician would continue to see the patient as required in order to carry out the medical portion of the MAP and to deal with other primary care problems as needed Additionally the PCNS would be available to work with nurses and other health professionals in each primary care practice in the provision of care to the ACD patients
The study is a randomized controlled clinical trial of the RoadMAP program intervention delivered by a PCNS compared to usual care control group The primary outcome will be degree of adherence to clinical practice guidelines Secondary outcomes will be patient satisfaction quality of life use of community-based services number of emergency room visits and number of hospitalizations The purpose of the RoadMAP program is to improve the care of people with advanced stage COPD and CHF Specifically activities will be aimed at improving patients self care ability facilitating access to the most appropriate services ensuring medical treatment according to consensus guidelines and promoting consistency of health care communication Adherence to guidelines is a process that involves activities by the patient PCNS and the Primary Care Physician The PCNS would follow-up the patient again at approximately one month after initial contact and then every 3 months to assess and monitor adherence to the proposed MAP by the patient the physician and the nurse Patients will have the option of returning to the physician office or to be monitored by phone An office visit will be recommended if there is a perceived need for medical assessment and intervention The family physician would continue to see the patient as required in order to carry out the medical portion of the MAP and to deal with other primary care problems as needed Additionally the PCNS would be available to work with nurses and other health professionals in each primary care practice in the provision of care to the ACD patients
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None