Hunter R, McGill L, Bosanquet N, Johnson N
Health Economics Research Group, Cambridge Pharma Consultancy, UK.
Qual Health Care. 1997 Sep;6(3):146-52. doi: 10.1136/qshc.6.3.146.
Alzheimer's disease is a growing challenge for care providers and purchasers. With the shift away from the provision of long term institutional care in most developed countries, there is a growing tendency for patients with Alzheimer's disease to be cared for at home. In the United Kingdom, this change of direction contrasts with the policies of the 1980s and 90s which focused more attention on controlling costs than on assessment of the needs of the patient and carer and patient management. In recent years, the resources available for management of Alzheimer's disease have focused on institutional care, coupled with drug treatment to control difficult behaviour as the disease progresses. For these reasons, the current system has led to crisis management rather than preventive support--that is, long term care for a few rather than assistance in the home before the crises occur and institutional care is needed. Despite recent innovations in the care of patients with Alzheimer's disease, the nature of the support that patients and carers receive is poorly defined and sometimes inadequate. As a result of the shift towards care in the community, the informal carer occupies an increasingly central role in the care of these patients and the issue of how the best quality of care may be defined and delivered is an issue which is now ripe for review. The objective of this paper is to redefine the type of support that patients and carers should receive so that the disease can be managed more effectively in the community. The needs of patients with Alzheimer's disease and their carers are many and this should be taken into account in defining the quality and structure of healthcare support. This paper shows how new initiatives, combined with recently available symptomatic drug treatment, can allow patients with Alzheimer's disease to be maintained at home for longer. This will have the dual impact of raising the quality of care for patients and improving the quality of life for their carers. Moreover, maintaining patients in a home environment will tend to limit public and private expenditure on institutional care due to a possible delay in the need for it.
阿尔茨海默病对护理人员和医保机构来说是一个日益严峻的挑战。在大多数发达国家，随着长期机构护理服务的减少，阿尔茨海默病患者越来越倾向于在家中接受护理。在英国，这种护理方向的转变与20世纪80年代和90年代的政策形成了鲜明对比，当时的政策更侧重于控制成本，而不是评估患者及护理人员的需求以及患者管理。近年来，用于阿尔茨海默病管理的资源主要集中在机构护理，同时辅以药物治疗以控制疾病进展过程中的棘手行为。由于这些原因，当前的体系导致了危机管理而非预防性支持——也就是说，是对少数患者的长期护理，而不是在危机发生和需要机构护理之前在家庭中提供帮助。尽管最近在阿尔茨海默病患者护理方面有了创新，但患者和护理人员所获得的支持的性质仍不明确，有时也并不充分。由于护理向社区转移，非正式护理人员在这些患者的护理中发挥着越来越核心的作用，如何定义和提供最佳护理质量的问题现在已经到了需要重新审视的时候。本文的目的是重新定义患者和护理人员应获得的支持类型，以便在社区中更有效地管理这种疾病。阿尔茨海默病患者及其护理人员的需求多种多样，在定义医疗保健支持的质量和结构时应予以考虑。本文展示了新举措与最近可用的对症药物治疗相结合，如何能让阿尔茨海默病患者在家中维持更长时间。这将产生双重影响，既提高患者的护理质量，又改善护理人员的生活质量。此外，让患者维持在家中环境往往会因可能延迟对机构护理的需求而限制公共和私人在机构护理上的支出。
