Psychiatric University Clinic Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany.
BMC Health Serv Res. 2010 Nov 18;10:314. doi: 10.1186/1472-6963-10-314.
More than 90% of dementia patients are cared for by their general practitioners, who are decisively involved in the diagnosis, therapy and recommendation of support services.
To test whether special training of general practitioners alters the care of dementia patients through their systematic recommendation of caregiver counseling and support groups.
129 general practitioners enrolled 390 dementia patients and their informal caregivers in a prospective, three-arm cluster-randomized 2-year study. Arm A constituted usual care, in Arm B and C support groups and caregiver counseling (in Arm B one year after baseline, in Arm C at baseline) were recommended by the general practitioners. The general practitioners received arm-specific training. Diagnostic and therapeutic behavior of physicians was recorded at baseline. Informal caregivers were questioned in follow-up after 2 years about the utilization of support services.
The diagnostic behavior of the general practitioners conforms to relevant guidelines. The procedure in newly-diagnosed patients does not differ from previously diagnosed patients with the exception of the rate of referral to a specialist. About one-third of the newly-diagnosed dementia patients are given an anti-dementia drug. The utilization of support groups and counseling increased five- and fourfold, respectively. Utilization of other support services remained low (< 10%), with the exception of home nursing and institutional short-term nursing.
Trained general practitioners usually act in conformity with guidelines with respect to diagnosing dementia, and partly in conformity with the guidelines with respect to recommended drug therapy. Recommendations of support services for informal caregivers by the general practitioner are successful. They result in a marked increase in the utilization rate for the recommended services compared to offers which are not recommended by the general practitioner.
ISRCTN68329593.
超过 90%的痴呆症患者由全科医生照顾，他们在诊断、治疗和推荐支持服务方面发挥着决定性作用。
测试全科医生的特殊培训是否通过系统推荐护理人员咨询和支持小组来改变痴呆症患者的护理方式。
129 名全科医生将 390 名痴呆症患者及其非正式护理人员纳入一项前瞻性、三臂聚类随机 2 年研究。A 组为常规护理，B 组和 C 组由全科医生推荐支持小组和护理人员咨询（B 组在基线后 1 年，C 组在基线时）。全科医生接受了特定于手臂的培训。在基线时记录医生的诊断和治疗行为。在 2 年后的随访中，询问非正式护理人员对支持服务的利用情况。
全科医生的诊断行为符合相关指南。新诊断患者的程序与以前诊断的患者没有区别，除了转介给专家的比例。大约三分之一的新诊断痴呆症患者接受了抗痴呆症药物治疗。支持小组和咨询的利用率分别增加了五倍和四倍。其他支持服务的利用率仍然很低（<10%），除了家庭护理和机构短期护理。
经过培训的全科医生通常在诊断痴呆症方面符合指南，在推荐药物治疗方面部分符合指南。全科医生对非正式护理人员推荐支持服务的建议是成功的。与未经全科医生推荐的服务相比，这导致推荐服务的利用率显著增加。
ISRCTN68329593。
