Transmural Collaborative Care Model for CVRM and Medication Review for Patients Using Antipsychotics

NCT ID: NCT05647980

Last Updated: 2023-10-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

480 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-03-01

Study Completion Date

2024-11-01

Brief Summary

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Currently, monitoring of usage and effects of antipsychotic treatment and cardiovascular risk screening in patients with severe mental illness or antipsychotic treatment is not sufficient.

A transmural collaborative care model for cardiovascular risk management and medication review for patients using atypical antipsychotics in general practice (TACTIC) was developed. This trial aims to assess the effectiveness of TACTIC regarding predicted cardiovascular risk and mental quality of life.

Detailed Description

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It is well established that patients with severe mental illness and patients treated with atypical antipsychotics have excess metabolic dysfunction and are at an increased risk of cardiovascular disease. Currently, monitoring of usage and effects of antipsychotic treatment and cardiovascular risk screening in patients with severe mental illness or antipsychotic treatment is not sufficient. General practitioners experience barriers regarding knowledge, collaboration with psychiatrists, and patient compliance. To overcome these barriers a transmural collaborative care model for cardiovascular risk management and medication review for patients using atypical antipsychotics in general practice (TACTIC) was developed. TACTIC is a one-time transmural intervention comprising three steps: 1) an online information video to inform patients about the cardiovascular risks of antipsychotic use and the procedures of the multidisciplinary meeting, 2) a multidisciplinary meeting with the patient to review his or her antipsychotic use and cardiovascular risk and to provide tailored treatment advice, and 3) a follow-up contact with the general practitioner to translate the treatment advice into an individualised action plan through shared decision making.

This trial aims to assess the effectiveness of TACTIC regarding predicted cardiovascular risk and mental quality of life.

Conditions

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Mental Disorders, Severe

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

Incomplete stepped wedge cluster randomised trial
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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TACTIC

Participants in the TACTIC intervention will be provided a 3-step approach, i.e.

1. an online information video to inform patients about the cardiovascular risks of antipsychotic use and the procedures of the multidisciplinary meeting
2. a multidisciplinary meeting with their general practitioner, the primary care nurse, a psychiatrist, and an experience expert to discuss cardiovascular risk and side effect and to provide personalised treatment options
3. a consultation with their general practitioner to translate treatment options into an individualised treatment plan including lifestyle and medication treatment and monitoring frequency, based on shared-decision making

Group Type EXPERIMENTAL

TACTIC

Intervention Type OTHER

Participants execute the three steps of TACTIC Participants fill in questionnaires Participants take laboratory and biometric tests to measure their cardiovascular risk

Care as usual

Care as usual, i.e. renewal of prescriptions for antipsychotics by the general practitioner without multidisciplinary treatment advice and without the use of scheduled and structured monitoring visits.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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TACTIC

Participants execute the three steps of TACTIC Participants fill in questionnaires Participants take laboratory and biometric tests to measure their cardiovascular risk

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* using atypical antipsychotic medication for at least 3 months at baseline
* the atypical antipsychotic medication is prescribed by the general practitioner
* a 10-year cardiovascular risk of at least 5% (as measured with QRISK3 score) at baseline

Exclusion Criteria

* diagnosis of dementia or organic psychosis
* diagnosis of cardiovascular disease (acute myocardial infarction, acute coronary syndrome, heart failure, ischemic stroke, transient ischemic attack, peripheral artery disease, aortic aneurysm or a revascularization procedure, i.e. percutaneous coronary intervention or coronary artery bypass grafting)
Minimum Eligible Age

25 Years

Maximum Eligible Age

84 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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ZonMw: The Netherlands Organisation for Health Research and Development

OTHER

Sponsor Role collaborator

Onze Huisartsen BV.

UNKNOWN

Sponsor Role collaborator

Radboud University Medical Center

OTHER

Sponsor Role lead

Responsible Party

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E. Bischoff

Principle investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Erik E Bischoff, PhD

Role: PRINCIPAL_INVESTIGATOR

Radboud University Medical Center

Locations

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Radboud university medical centre, Dept. Primary and Community Care

Nijmegen, , Netherlands

Site Status RECRUITING

Countries

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Netherlands

Central Contacts

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Karlijn KJ van den Brule-Barnhoorn, MD

Role: CONTACT

+31 24 36 13 237

Kirsti KM Jakobs, MD

Role: CONTACT

+31 61 24 70 221

Facility Contacts

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Radboud U medical centre, Dept. Primary and Community Care

Role: primary

+31622221879

References

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Bischoff EWMA, Jakobs KM, Assendelft WJJ. Cardiovascular risk management in patients using antipsychotics: it is time to take action. BMC Med. 2020 Nov 2;18(1):339. doi: 10.1186/s12916-020-01811-7. No abstract available.

Reference Type BACKGROUND
PMID: 33131496 (View on PubMed)

Jakobs KM, Posthuma A, de Grauw WJC, Schalk BWM, Akkermans RP, Lucassen P, Schermer T, Assendelft WJJ, Biermans MJC. Cardiovascular risk screening of patients with serious mental illness or use of antipsychotics in family practice. BMC Fam Pract. 2020 Jul 29;21(1):153. doi: 10.1186/s12875-020-01225-7.

Reference Type BACKGROUND
PMID: 32727372 (View on PubMed)

Jakobs K, Lautan L, Lucassen P, Janzing J, van Lieshout J, Biermans MCJ, Bischoff EWMA. Cardiovascular risk management in patients with severe mental illness or taking antipsychotics: A qualitative study on barriers and facilitators among dutch general practitioners. Eur J Gen Pract. 2022 Dec;28(1):191-199. doi: 10.1080/13814788.2022.2092093.

Reference Type BACKGROUND
PMID: 35796600 (View on PubMed)

Jakobs KM, van den Brule-Barnhoorn KJ, van Lieshout J, Janzing JGE, Cahn W, Kievit W, Teerenstra S, van den Muijsenbergh M, Biermans MCJ, Bischoff EWMA. Transmural collaborative care model for cardiovascular risk management and medication review in patients using antipsychotics in primary care (TACTIC): A study protocol of an incomplete stepped wedge cluster randomized trial. Contemp Clin Trials Commun. 2025 Jan 9;44:101418. doi: 10.1016/j.conctc.2024.101418. eCollection 2025 Apr.

Reference Type DERIVED
PMID: 39897941 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Other Identifiers

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10140021910502

Identifier Type: -

Identifier Source: org_study_id

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