New study: Cholinesterase inhibitors

Issue: BCMJ, Vol. 52, No. 4, May 2010, page(s) 223 Pulsimeter

The Alzheimer’s Drug Therapy Ini­tiative is conducting five research projects investigating the impact on cholinesterase inhibitors on patients and caregivers. These studies are each concerned with a different aspect of drug coverage and outcomes. 

Two studies (Utilization and Cost Project and Clinical Epidemiological Project) are analyzing provincial data (Pharma­Net, Medical Services Billings, Hospital Discharge Abstract Database, Continuing Care Databases, Vital Statistics) and relationships between cost, service utilization, and health outcomes for those with mild to moderate dementia compared with the general population. A third study, Clini­cally Meaningful Assessment of Therapy (CLIMAT), involves semi-structured in-person clinical interviews with patients. It aims to develop a better method for assessing patients. 

The Caregiver Study is concerned with the impact of cholinesterase inhibitors on informal caregivers who are supporting family members taking these medications. Based at the Centre on Aging at the University of Victoria, the study has interviewed over 400 caregivers to date and would like to meet with another 1000. 

Referrals are accepted from across BC; most areas have interviewers able to visit individual homes to ensure the least interruption. Two interviews are scheduled 12 months apart for approximately 1.5 hours each. The Caregiver Study requires no extra work from the physician aside from the referral, and interviews are only completed with the caregiver. For this study, caregivers may contact the study directly as well to become involved.

The Seniors’ Medication Study rounds out the research. This study has implemented the clock-drawing test as the main data collection tool. From the physician standpoint, the study involves faxing clock drawings from individual patients who can complete them as part of the regular routine of care. Scoring is done by study staff.

A funding algorithm has been im­plemented, allowing physicians to be compensated for their time in the study. The algorithm is a key result of negotiations between the Ministry of Health Services and the BCMA. Phy­sicians are able to submit Fee Items 97002-97007 for the optional section of the ADTI Special Authority and study forms (Referral, Allocation, and Clock Drawing) with payment ranging from $15 to $50 depending on the form.

Researchers have noted through numerous discussions with family phy­sicians that participating in dementia-related research can be challenging. Study researchers worked with family physicians and MOAs to develop a clinical resource binder to assist participating physicians, Cognitive Impairment in the Elderly Reference Guide for Clinicians and Medical Office Assistants. 

The binder provides exemplars of Special Authority forms, GDSs, SMMSEs, Activities of Daily Living, and study documents. A section has been added specifically for MOAs and accounting clerks to assist in the remittance of claims to MSP. Copies of the binder and additional research forms can be requested through the study office. Physicians can refer patients and caregivers by fax to 250 853-3799.

Contact information for study staff:
• Project coordinator, ADTI: Carren Dujela, 250 472-4464,
• Study administrator, Seniors’ Medication Study: Myriam Gerber, 250 721-6574,
• Interview supervisor, Caregiver Study: Chelsie Kadgien, 250 472-4468,
• Fax line for both studies: 250 853-3799
• Toll-free line for all incoming calls: 866 511-2594

—Carren E. Dujela, BA
University of Victoria Centre on Aging