Management of Dementia
As expected, the clinical characteristics showed serious clustering, and sociodemographic variables, such as sex, age, and living status, were not GP-dependent. The per-protocol analyses, sensitivity analyses, and the intraclass correlations for the main outcomes are reported in eTable 4 in Supplement 2. In our study, DCM was beneficial for optimizing treatment and care in patients with dementia. We found medium to large effects of DCM for community-dwelling patients with dementia in primary care on behavioral and psychological symptoms, caregiver burden, and pharmacologic treatment with antidementia drugs.
Referring to neuropsychiatric symptoms measured by the Neuropsychiatric Inventory, a decrease in 4 points would be regarded as clinically meaningful. The study methods were in line with the demand to use standardized sets of outcome measures 20 and well-defined interventions 19 to improve comparability across studies, and our results contribute empirical evidence to currently inconclusive research 18 on DCM approaches in primary care. The results suggest that DCM increased the quality of dementia care. Improvements included a higher use of antidementia drugs.
Although this is a simple proxy for good medical dementia care, the data do not indicate whether drug treatment conformed to guidelines.
Five strategies for better management of dementia patients | The Advisory Board Company
To our knowledge, there is no benchmark for the percentage of people who should be treated with antidementia drugs in primary care that we could have used for comparison. This proportion is comparable with other studies. Neuropsychiatric symptoms and caregiver burden are among the most important risk factors for institutionalization of people with dementia.
This could save long-term costs. A small effect on quality of life was restricted to patients not living alone. This result should not be overestimated because validity and reliability of quality of life measures in people with dementia are limited. However, this finding implies that further analyses could identify target groups with an increased benefit. We speculate that the effectiveness of DCM could be associated with socioeconomic status, functional ability, or severity of dementia.
This is unexpected because comprehensive medication management was part of the intervention. We speculate that the intensity was probably too low in this trial because recommendations to the GP regarding pharmacologic treatment were provided only once. An effective reduction of PIMs may require a higher intensity of care management and follow-up reviews. Screening and recruitment were part of routine care so that selection bias cannot be ruled out.
However, all participating GPs agreed to recruit systematically while adhering to the requirements of the study design.
- Hatchet 79.
- Medical Management and Patient Care | Alzheimer's Association.
- When Heaven Weeps (The Heaven Trilogy)?
- RACGP - Dementia – an update on management;
The number of participants was imbalanced between the intervention and control groups. Fewer GPs were randomized to the control group. Furthermore, there was the tendency that GPs in the control group included less patients. We expect that during the trial, GPs noticed their assignment, which resulted in a loss of motivation for an inclusion of further patients.
Clinical Practice Guidelines for Management of Dementia
However, there were no significant group differences according to primary outcomes or sociodemographic variables. The DelpHi trial was not a diagnostic trial. The identification of patients with dementia was based on a screening instrument. A state-of-the-art diagnostic procedure was not required. However, the DemTect was designed for this specific purpose and is widely used in routine care. The study was incorporated into routine care as closely as possible so that the external validity of the results is high.
However, because of the rigorous design in the context of this trial, there were restrictions in time, length, and content of DCM activities. In routine care, nurses have more freedom to decide what, when, and how activities are performed. Additionally, generalizability might be limited because of the region and health care system being studied. It is possible that differences in access and availability of health care resources in other health care systems may affect the effectiveness. However, challenges of dementia care are mainly triggered by the disease itself and require similar resources that are available in different regions and health systems.
Dementia care management provided by specially trained nurses and supported by a computer-based IMS is an effective and safe collaborative care model that has clinically relevant patient- and caregiver-related effects on treatment and care. Therefore, implementation in routine care could be beneficial for people with dementia and their relative caregivers. Further analyses should identify specific subgroups of people with dementia with higher effectiveness of DCM and should evaluate cost-effectiveness to adapt DCM to other settings and health care systems. Published Online: July 26, Author Contributions: Drs Hoffmann and Thyrian had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Critical revision of the manuscript for important intellectual content: All authors. Administrative, technical, or material support: Thyrian, Eichler, Zwingmann, Kilimann. Conflict of Interest Disclosures: None reported.
Medicines to treat dementia
All persons mentioned were compensated for their contributions as part of their employment. All Rights Reserved.
- Polarisation: Applications in Remote Sensing.
- Unstable Release.
- Related CE!
- The Girls of St. Phils;
- Managing dementia in hospital?
- Search form.
View Large Download. Table 1. Baseline Characteristics of Patients With Dementia a. Supplement 1. Trial protocol. Supplement 2. Dementia: A Public Health Priority. Geneva, Switzerland: World Health Organization; Dementia care in the context of primary care reform: an integrative review. Aging Ment Health. PubMed Google Scholar Crossref. Unmet care needs and key outcomes in dementia. J Am Geriatr Soc. Identification of community-residing individuals with dementia and their unmet needs for care.
Int J Geriatr Psychiatry. What do community-dwelling people with dementia need? Int Psychogeriatr. Unmet needs of community-dwelling primary care patients with dementia in Germany: prevalence and correlates. J Alzheimers Dis. Correlates of objective and subjective measures of caregiver burden among dementia caregivers: influence of unmet patient and caregiver dementia-related care needs.
Burden of behavioral and psychiatric symptoms in people screened positive for dementia in primary care: results of the DelpHi-study. Caregiver burden assessed in dementia care networks in Germany: findings from the DemNet-D study baseline. PubMed Google Scholar. Predictors of nursing home admission for persons with dementia. Med Care. Eur J Health Econ. Economic analysis of formal care, informal care, and productivity losses in primary care patients who screened positive for dementia in Germany.
Diagnosis and management of dementia in primary care: exploratory study. Can Fam Physician. Preliminary data from the Caring for Older Adults and Caregivers at Home COACH program: a care coordination program for home-based dementia care and caregiver support in a veterans affairs medical center.
The enthusiasm: evidence ratio for comprehensive chronic disease care? Introducing case management for people with dementia in primary care: a mixed-methods study. Br J Gen Pract. Case management approaches to home support for people with dementia.
Cochrane Database Syst Rev. Z Gerontol Geriatr. A European consensus on outcome measures for psychosocial intervention research in dementia care. Life- and person-centered help in Mecklenburg-Western Pomerania, Germany DelpHi : study protocol for a randomised controlled trial.
Dementia care management: going new ways in ambulant dementia care within a GP-based randomized controlled intervention trial. Community-dwelling people screened positive for dementia in primary care: a comprehensive, multivariate descriptive analysis using data from the DelpHi-study. Consort statement: extension to cluster randomised trials. Ann Intern Med. Qualifications for nurses for the care of patients with dementia and support to their caregivers: a pilot evaluation of the dementia care management curriculum.
Nurse Educ Today. DemTect: a new, sensitive cognitive screening test to support the diagnosis of mild cognitive impairment and early dementia. Dementia care and general physicians—a survey on prevalence, means, attitudes and recommendations.
Cent Eur J Public Health. Akt Neurol. S3-leitlinie demenzen.