Skip to main content
Top
Published in: Trials 1/2011

Open Access 01-12-2011 | Study protocol

The chronic care for age-related macular degeneration study (CHARMED): Study protocol for a randomized controlled trial

Authors: Anja Frei, Katja Woitzek, Mathyas Wang, Ulrike Held, Thomas Rosemann

Published in: Trials | Issue 1/2011

Login to get access

Abstract

Background

Neovascular age-related macular degeneration is the leading cause of irreversible blindness in people 50 years of age or older in the developed world. As in other chronic diseases, several effective treatments are available, but in clinical daily practice there is an evidence performance gap. The Chronic Care Model represents an evidence-based framework for the care of chronically ill patients and aims at closing that gap. However, no data are available regarding patients with neovascular age-related macular degeneration.

Methods/Design

CHARMED is a multicenter randomized controlled trial. The study challenges the hypothesis that the implementation of core elements of the Chronic Care Model (patient empowerment, delivering evidence based information, clinical information system, reminder system with structured follow up and frequent monitoring) via a specially trained Chronic Care Coach in Swiss centres for neovascular age-related macular degeneration results in better visual acuity (primary outcome) and an increased disease specific quality of life (secondary outcome) in patients with neovascular age-related macular degeneration. According to the power calculation, a total sample size of 352 patients is needed (drop out rate of 25%). 14 specialised medical doctors from leading ophtalmologic centres in Switzerland will include 25 patients. In each centre, a Chronic Care Coach will provide disease specific care according to the Chronic Care Model for intervention group. Patients from the control group will be treated as usual. Baseline measurements will be taken in month III - XII, starting in March 2011. Follow-up data will be collected after 6 months and 1 year.

Discussion

Multiple studies have shown that implementing Chronic Care Model elements improve clinical outcomes as well as process parameters in different chronic diseases as osteoarthritis, depression or e.g. the cardiovascular risk profile of diabetes patients. This study will be the first to assess this approach in neovascular age-related macular degeneration. If our hypothesis will be confirmed, the implementation of this approach in routine care for patients with with neovascular age-related macular degeneration should be considered.

Trial Registration

Current controlled trials ISRCTN32507927.
Appendix
Available only for authorised users
Literature
1.
go back to reference World Health Organization: The World Health Report 2003: Shaping the future. 2003CrossRef World Health Organization: The World Health Report 2003: Shaping the future. 2003CrossRef
2.
go back to reference Epping-Jordan JE, Pruitt SD, Bengoa R, Wagner EH: Improving the quality of health care for chronic conditions. Qual Saf Health Care. 2004, 13: 299-305. 10.1136/qshc.2004.010744.CrossRefPubMedPubMedCentral Epping-Jordan JE, Pruitt SD, Bengoa R, Wagner EH: Improving the quality of health care for chronic conditions. Qual Saf Health Care. 2004, 13: 299-305. 10.1136/qshc.2004.010744.CrossRefPubMedPubMedCentral
3.
go back to reference Tsai AC, Morton SC, Mangione CM, Keeler EB: A meta-analysis of interventions to improve care for chronic illnesses. Am J Manag Care. 2005, 11: 478-488.PubMedPubMedCentral Tsai AC, Morton SC, Mangione CM, Keeler EB: A meta-analysis of interventions to improve care for chronic illnesses. Am J Manag Care. 2005, 11: 478-488.PubMedPubMedCentral
4.
go back to reference Wagner EH: Chronic disease management: what will it take to improve care for chronic illness?. Eff Clin Pract. 1998, 1: 2-4.PubMed Wagner EH: Chronic disease management: what will it take to improve care for chronic illness?. Eff Clin Pract. 1998, 1: 2-4.PubMed
5.
go back to reference Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A: Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001, 20: 64-78. 10.1377/hlthaff.20.6.64.CrossRef Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A: Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001, 20: 64-78. 10.1377/hlthaff.20.6.64.CrossRef
6.
go back to reference Lenfant C: Shattuck lecture--clinical research to clinical practice--lost in translation?. N Engl J Med. 2003, 349: 868-874. 10.1056/NEJMsa035507.CrossRefPubMed Lenfant C: Shattuck lecture--clinical research to clinical practice--lost in translation?. N Engl J Med. 2003, 349: 868-874. 10.1056/NEJMsa035507.CrossRefPubMed
7.
go back to reference Rosemann T, Joos S, Laux G, Gensichen J, Szecsenyi J: Case management of arthritis patients in primary care: a cluster-randomized controlled trial. Arthritis Rheum. 2007, 57: 1390-1397. 10.1002/art.23080.CrossRefPubMed Rosemann T, Joos S, Laux G, Gensichen J, Szecsenyi J: Case management of arthritis patients in primary care: a cluster-randomized controlled trial. Arthritis Rheum. 2007, 57: 1390-1397. 10.1002/art.23080.CrossRefPubMed
8.
go back to reference Szecsenyi J, Rosemann T, Joos S, Peters-Klimm F, Miksch A: German diabetes disease management programs are appropriate for restructuring care according to the chronic care model: an evaluation with the patient assessment of chronic illness care instrument. Diabetes Care. 2008, 31: 1150-1154. 10.2337/dc07-2104.CrossRefPubMed Szecsenyi J, Rosemann T, Joos S, Peters-Klimm F, Miksch A: German diabetes disease management programs are appropriate for restructuring care according to the chronic care model: an evaluation with the patient assessment of chronic illness care instrument. Diabetes Care. 2008, 31: 1150-1154. 10.2337/dc07-2104.CrossRefPubMed
9.
go back to reference Gensichen J, von Korff M, Peitz M, Muth C, Beyer M, Guthlin C, Torge M, Petersen JJ, Rosemann T, Konig J, Gerlach FM: Case management for depression by health care assistants in small primary care practices: a cluster randomized trial. Ann Intern Med. 2009, 151: 369-378.CrossRefPubMed Gensichen J, von Korff M, Peitz M, Muth C, Beyer M, Guthlin C, Torge M, Petersen JJ, Rosemann T, Konig J, Gerlach FM: Case management for depression by health care assistants in small primary care practices: a cluster randomized trial. Ann Intern Med. 2009, 151: 369-378.CrossRefPubMed
10.
go back to reference Bressler NM: Age-related macular degeneration is the leading cause of blindness. JAMA. 2004, 291: 1900-1901. 10.1001/jama.291.15.1900.CrossRefPubMed Bressler NM: Age-related macular degeneration is the leading cause of blindness. JAMA. 2004, 291: 1900-1901. 10.1001/jama.291.15.1900.CrossRefPubMed
11.
go back to reference Friedman DS, O'Colmain BJ, Munoz B, Tomany SC, McCarty C, de Jong PT, Nemesure B, Mitchell P, Kempen J: Prevalence of age-related macular degeneration in the United States. Arch Ophthalmol. 2004, 122: 564-572.CrossRefPubMed Friedman DS, O'Colmain BJ, Munoz B, Tomany SC, McCarty C, de Jong PT, Nemesure B, Mitchell P, Kempen J: Prevalence of age-related macular degeneration in the United States. Arch Ophthalmol. 2004, 122: 564-572.CrossRefPubMed
12.
go back to reference Sassa Y, Hata Y: Antiangiogenic drugs in the management of ocular diseases: Focus on antivascular endothelial growth factor. Clin Ophthalmol. 2010, 4: 275-283.PubMedPubMedCentral Sassa Y, Hata Y: Antiangiogenic drugs in the management of ocular diseases: Focus on antivascular endothelial growth factor. Clin Ophthalmol. 2010, 4: 275-283.PubMedPubMedCentral
13.
go back to reference Dong LM, Childs AL, Mangione CM, Bass EB, Bressler NM, Hawkins BS, Marsh MJ, Miskala P, Jaffee HA, McCaffrey LA: Health- and vision-related quality of life among patients with choroidal neovascularization secondary to age-related macular degeneration at enrollment in randomized trials of submacular surgery: SST report no. 4. Am J Ophthalmol. 2004, 138: 91-108.CrossRefPubMed Dong LM, Childs AL, Mangione CM, Bass EB, Bressler NM, Hawkins BS, Marsh MJ, Miskala P, Jaffee HA, McCaffrey LA: Health- and vision-related quality of life among patients with choroidal neovascularization secondary to age-related macular degeneration at enrollment in randomized trials of submacular surgery: SST report no. 4. Am J Ophthalmol. 2004, 138: 91-108.CrossRefPubMed
14.
go back to reference Hawkins BS, Miskala PH, Mangione CM, Bass EB, Bressler NM, Mann AC, Dong LM, Marsh MJ, Grp SSTR: Health- and vision-related quality of life among patients with ocular histoplasmosis or idiopathic choroidal neovascularization at enrollment in a randomized trial of submacular surgery - Submacular surgery trials report no.5. Archives of Ophthalmology. 2005, 123: 78-88.CrossRef Hawkins BS, Miskala PH, Mangione CM, Bass EB, Bressler NM, Mann AC, Dong LM, Marsh MJ, Grp SSTR: Health- and vision-related quality of life among patients with ocular histoplasmosis or idiopathic choroidal neovascularization at enrollment in a randomized trial of submacular surgery - Submacular surgery trials report no.5. Archives of Ophthalmology. 2005, 123: 78-88.CrossRef
15.
go back to reference Ferris FL, Kassoff A, Bresnick GH, Bailey I: New visual acuity charts for clinical research. Am J Ophthalmol. 1982, 94: 91-96.CrossRefPubMed Ferris FL, Kassoff A, Bresnick GH, Bailey I: New visual acuity charts for clinical research. Am J Ophthalmol. 1982, 94: 91-96.CrossRefPubMed
16.
go back to reference Ferris FL, Sperduto RD: Standardized illumination for visual acuity testing in clinical research. Am J Ophthalmol. 1982, 94: 97-98.CrossRefPubMed Ferris FL, Sperduto RD: Standardized illumination for visual acuity testing in clinical research. Am J Ophthalmol. 1982, 94: 97-98.CrossRefPubMed
17.
go back to reference Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD: Development of the 25-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol. 2001, 119: 1050-1058.CrossRefPubMed Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD: Development of the 25-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol. 2001, 119: 1050-1058.CrossRefPubMed
18.
go back to reference Mangione CM, Lee PP, Pitts J, Gutierrez P, Berry S, Hays RD: Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ). NEI-VFQ Field Test Investigators. Arch Ophthalmol. 1998, 116: 1496-1504.CrossRefPubMed Mangione CM, Lee PP, Pitts J, Gutierrez P, Berry S, Hays RD: Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ). NEI-VFQ Field Test Investigators. Arch Ophthalmol. 1998, 116: 1496-1504.CrossRefPubMed
19.
go back to reference Owen C, Rudnicka A, Smeeth L, Evans J, Wormald R, Fletcher A: Is the NEI-VFQ-25 a useful tool in identifying visual impairment in an elderly population?. BMC Ophthalmology. 2006, 6: 24-10.1186/1471-2415-6-24.CrossRefPubMedPubMedCentral Owen C, Rudnicka A, Smeeth L, Evans J, Wormald R, Fletcher A: Is the NEI-VFQ-25 a useful tool in identifying visual impairment in an elderly population?. BMC Ophthalmology. 2006, 6: 24-10.1186/1471-2415-6-24.CrossRefPubMedPubMedCentral
20.
go back to reference Revicki DA, Rentz AM, Harnam N, Thomas VS, Lanzetta P: Reliability and Validity of the National Eye Institute Visual Function Questionnaire-25 in Patients with Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci. 2010, 51: 712-717. 10.1167/iovs.09-3766.CrossRefPubMed Revicki DA, Rentz AM, Harnam N, Thomas VS, Lanzetta P: Reliability and Validity of the National Eye Institute Visual Function Questionnaire-25 in Patients with Age-Related Macular Degeneration. Invest Ophthalmol Vis Sci. 2010, 51: 712-717. 10.1167/iovs.09-3766.CrossRefPubMed
22.
go back to reference Hirneiss C, Neubauer AS, Gass CA, Reiniger IW, Priglinger SG, Kampik A, Haritoglou C: Visual quality of life after macular hole surgery: outcome and predictive factors. Br J Ophthalmol. 2007, 91: 481-484. 10.1136/bjo.2006.102376.CrossRefPubMed Hirneiss C, Neubauer AS, Gass CA, Reiniger IW, Priglinger SG, Kampik A, Haritoglou C: Visual quality of life after macular hole surgery: outcome and predictive factors. Br J Ophthalmol. 2007, 91: 481-484. 10.1136/bjo.2006.102376.CrossRefPubMed
23.
go back to reference Pauleikhoff D, Scheider A, Wiedmann P, Gelisken F, Scholl HP, Roider I, Mohr A, Zlateva G, Xu X: [Neovascular age-related macular degeneration in Germany. Encroachment on the quality of life and the financial implications]. Ophthalmologe. 2009, 106: 242-251. 10.1007/s00347-008-1797-9.CrossRefPubMed Pauleikhoff D, Scheider A, Wiedmann P, Gelisken F, Scholl HP, Roider I, Mohr A, Zlateva G, Xu X: [Neovascular age-related macular degeneration in Germany. Encroachment on the quality of life and the financial implications]. Ophthalmologe. 2009, 106: 242-251. 10.1007/s00347-008-1797-9.CrossRefPubMed
24.
go back to reference Glasgow RE, Whitesides H, Nelson CC, King DK: Use of the Patient Assessment of Chronic Illness Care (PACIC) with diabetic patients: relationship to patient characteristics, receipt of care, and self-management. Diabetes Care. 2005, 28: 2655-2661. 10.2337/diacare.28.11.2655.CrossRefPubMed Glasgow RE, Whitesides H, Nelson CC, King DK: Use of the Patient Assessment of Chronic Illness Care (PACIC) with diabetic patients: relationship to patient characteristics, receipt of care, and self-management. Diabetes Care. 2005, 28: 2655-2661. 10.2337/diacare.28.11.2655.CrossRefPubMed
25.
go back to reference Rosemann T, Laux G, Droesemeyer S, Gensichen J, Szecsenyi J: Evaluation of a culturally adapted German version of the Patient Assessment of Chronic Illness Care (PACIC 5A) questionnaire in a sample of osteoarthritis patients. J Eval Clin Pract. 2007, 13: 806-813. 10.1111/j.1365-2753.2007.00786.x.CrossRefPubMed Rosemann T, Laux G, Droesemeyer S, Gensichen J, Szecsenyi J: Evaluation of a culturally adapted German version of the Patient Assessment of Chronic Illness Care (PACIC 5A) questionnaire in a sample of osteoarthritis patients. J Eval Clin Pract. 2007, 13: 806-813. 10.1111/j.1365-2753.2007.00786.x.CrossRefPubMed
26.
go back to reference Gensichen J, Serras A, Paulitsch M, Rosemann T, König J, Gerlach F, Petersen J: The Patient Assessment of Chronic Illness Care Questionnaire: Evaluation in Patients with Mental Disorders in Primary Care. Community Mental Health Journal. 2010, 1-7. Gensichen J, Serras A, Paulitsch M, Rosemann T, König J, Gerlach F, Petersen J: The Patient Assessment of Chronic Illness Care Questionnaire: Evaluation in Patients with Mental Disorders in Primary Care. Community Mental Health Journal. 2010, 1-7.
27.
go back to reference Bonomi AE, Wagner EH, Glasgow RE, VonKorff M: Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Health Serv Res. 2002, 37: 791-820. 10.1111/1475-6773.00049.CrossRefPubMedPubMedCentral Bonomi AE, Wagner EH, Glasgow RE, VonKorff M: Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Health Serv Res. 2002, 37: 791-820. 10.1111/1475-6773.00049.CrossRefPubMedPubMedCentral
28.
go back to reference Steurer-Stey C, Frei A, Schmid-Mohler G, Malcolm-Kohler S, Zoller M, Rosemann T: The German version of the Assessment of Chronic Illness Care: instrument translation and cultural adaptation. J Eval Clin Pract. 2010 Steurer-Stey C, Frei A, Schmid-Mohler G, Malcolm-Kohler S, Zoller M, Rosemann T: The German version of the Assessment of Chronic Illness Care: instrument translation and cultural adaptation. J Eval Clin Pract. 2010
29.
go back to reference Lowe B, Kroenke K, Herzog W, Grafe K: Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord. 2004, 81: 61-66. 10.1016/S0165-0327(03)00198-8.CrossRefPubMed Lowe B, Kroenke K, Herzog W, Grafe K: Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord. 2004, 81: 61-66. 10.1016/S0165-0327(03)00198-8.CrossRefPubMed
30.
go back to reference Gensichen J, Torge M, Peitz M, Wendt-Hermainski H, Beyer M, Rosemann T, Krauth C, Raspe H, Aldenhoff JB, Gerlach FM: Case management for the treatment of patients with major depression in general practices--rationale, design and conduct of a cluster randomized controlled trial--PRoMPT (PRimary care Monitoring for depressive Patient's Trial) [ISRCTN66386086]--study protocol. BMC Public Health. 2005, 5: 101-10.1186/1471-2458-5-101.CrossRefPubMedPubMedCentral Gensichen J, Torge M, Peitz M, Wendt-Hermainski H, Beyer M, Rosemann T, Krauth C, Raspe H, Aldenhoff JB, Gerlach FM: Case management for the treatment of patients with major depression in general practices--rationale, design and conduct of a cluster randomized controlled trial--PRoMPT (PRimary care Monitoring for depressive Patient's Trial) [ISRCTN66386086]--study protocol. BMC Public Health. 2005, 5: 101-10.1186/1471-2458-5-101.CrossRefPubMedPubMedCentral
31.
go back to reference Connell PP, Keane PA, O'Neill EC, Altaie RW, Loane E, Neelam K, Nolan JM, Beatty S: Risk factors for age-related maculopathy. J Ophthalmol. 2009, 2009: 360764-CrossRefPubMedPubMedCentral Connell PP, Keane PA, O'Neill EC, Altaie RW, Loane E, Neelam K, Nolan JM, Beatty S: Risk factors for age-related maculopathy. J Ophthalmol. 2009, 2009: 360764-CrossRefPubMedPubMedCentral
32.
go back to reference Jager RD, Mieler WF, Miller JW: Age-related macular degeneration. N Engl J Med. 2008, 358: 2606-2617. 10.1056/NEJMra0801537.CrossRefPubMed Jager RD, Mieler WF, Miller JW: Age-related macular degeneration. N Engl J Med. 2008, 358: 2606-2617. 10.1056/NEJMra0801537.CrossRefPubMed
33.
go back to reference Gupta B, Adewoyin T, Patel SK, Sivaprasad S: Comparison of two intravitreal ranibizumab treatment schedules for neovascular age-related macular degeneration. Br J Ophthalmol. 2010 Gupta B, Adewoyin T, Patel SK, Sivaprasad S: Comparison of two intravitreal ranibizumab treatment schedules for neovascular age-related macular degeneration. Br J Ophthalmol. 2010
34.
go back to reference Subramanian ML, Ness S, Abedi G, Ahmed E, Daly M, Feinberg E, Bhatia S, Patel P, Nguyen M, Houranieh A: Bevacizumab vs ranibizumab for age-related macular degeneration: early results of a prospective double-masked, randomized clinical trial. Am J Ophthalmol. 2009, 148: 875-882 e871. 10.1016/j.ajo.2009.07.009.CrossRefPubMed Subramanian ML, Ness S, Abedi G, Ahmed E, Daly M, Feinberg E, Bhatia S, Patel P, Nguyen M, Houranieh A: Bevacizumab vs ranibizumab for age-related macular degeneration: early results of a prospective double-masked, randomized clinical trial. Am J Ophthalmol. 2009, 148: 875-882 e871. 10.1016/j.ajo.2009.07.009.CrossRefPubMed
35.
go back to reference Globe DR, Wu J, Azen SP, Varma R: The impact of visual impairment on self-reported visual functioning in Latinos: The Los Angeles Latino Eye Study. Ophthalmology. 2004, 111: 1141-1149. 10.1016/j.ophtha.2004.02.003.CrossRefPubMed Globe DR, Wu J, Azen SP, Varma R: The impact of visual impairment on self-reported visual functioning in Latinos: The Los Angeles Latino Eye Study. Ophthalmology. 2004, 111: 1141-1149. 10.1016/j.ophtha.2004.02.003.CrossRefPubMed
36.
go back to reference Suner IJ, Kokame GT, Yu E, Ward J, Dolan C, Bressler NM: Responsiveness of NEI VFQ-25 to changes in visual acuity in neovascular AMD: validation studies from two phase 3 clinical trials. Invest Ophthalmol Vis Sci. 2009, 50: 3629-3635. 10.1167/iovs.08-3225.CrossRefPubMed Suner IJ, Kokame GT, Yu E, Ward J, Dolan C, Bressler NM: Responsiveness of NEI VFQ-25 to changes in visual acuity in neovascular AMD: validation studies from two phase 3 clinical trials. Invest Ophthalmol Vis Sci. 2009, 50: 3629-3635. 10.1167/iovs.08-3225.CrossRefPubMed
Metadata
Title
The chronic care for age-related macular degeneration study (CHARMED): Study protocol for a randomized controlled trial
Authors
Anja Frei
Katja Woitzek
Mathyas Wang
Ulrike Held
Thomas Rosemann
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Trials / Issue 1/2011
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/1745-6215-12-221

Other articles of this Issue 1/2011

Trials 1/2011 Go to the issue