Newcomer R, Yordi C, DuNah R, Fox P, Wilkinson A
Dept. of Social and Behavioral Sciences, University of California, San Francisco 94143, USA.
Health Serv Res. 1999 Aug;34(3):669-89.
Does improved access to community-based care reduce perceived burden and reported levels of depression among primary caregivers of people with dementia?
Baseline and periodic caregiver interviews with participants in the Medicare Alzheimer's Disease Demonstration. Client and caregiver attributes and caregiver outcomes such as depression and burden scores were among the measures.
Applicants to the demonstration (all voluntary) were randomly assigned into treatment and control groups. Treatment group cases were eligible for case management and for up to $699 per month in community care benefits. (The actual monthly entitlement varied among the eight demonstration communities due to regional cost differences and inflation adjustments over the four-year demonstration period.)
A total of 5,307 eligible individuals received a baseline assessment at the time of application to the demonstration and at least one semi-annual reassessment. Clients and their caregivers were periodically reassessed producing a total of 20,707 observations.
Persons in the treatment group had a high exposure to case management and a greater likelihood of community service use relative to those in the control group. Treatment group membership was associated with statistically significant, but very small reductions in caregiver burden (in four of eight sites) and depression (three of eight sites) over a 36-month tracking period. These findings are not sustained with all cases combined, or among a higher-resource demonstration model considered separately.
Both the fact that these programmatic differences did not translate into substantial treatment group reductions in caregiver burden or depression, and the consistency of these findings with those of prior case management evaluations suggest the need to reformulate this programmatic intervention into areas not previously tested: 24-hour care, crisis intervention, coordination with primary care, or chronic disease management.
改善社区护理服务的可及性是否能减轻痴呆症患者主要照护者的感知负担并降低其报告的抑郁水平？
对医疗保险阿尔茨海默病示范项目参与者进行的基线和定期照护者访谈。测量指标包括服务对象和照护者的特征以及照护者的结果，如抑郁和负担评分。
示范项目的申请者（均为自愿参与）被随机分为治疗组和对照组。治疗组的案例有资格接受个案管理，并每月获得高达699美元的社区护理福利。（由于地区成本差异以及在四年示范期内的通胀调整，八个示范社区的实际每月补贴有所不同。）
共有5307名符合条件的个体在申请示范项目时接受了基线评估，并至少接受了一次半年期重新评估。服务对象及其照护者定期接受重新评估，共产生了20707条观测数据。
与对照组相比，治疗组的人员接受个案管理的频率更高，使用社区服务的可能性也更大。在36个月的跟踪期内，治疗组成员的照护者负担（在八个地点中的四个）和抑郁水平（八个地点中的三个）在统计学上有显著但非常小的降低。这些发现并非在所有案例合并后都成立，也未在单独考虑的高资源示范模式中得到验证。
这些项目差异未能转化为治疗组照护者负担或抑郁水平的大幅降低，以及这些发现与先前个案管理评估结果的一致性，都表明有必要将这种项目干预重新制定到以前未测试过的领域：24小时护理、危机干预、与初级护理的协调或慢性病管理。
