Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Beek-Ubbergen, the Netherlands.
Am J Geriatr Psychiatry. 2011 Jun;19(6):521-31. doi: 10.1097/JGP.0b013e3182110599.
To evaluate the effectiveness of the Systematic Care Program for Dementia (SCPD) on patient institutionalization and to determine the predictors of institutionalization.
Single-blind, multicenter, cluster-randomized, controlled trial.
Six community mental health services (CMHSs) across the Netherlands.
A total of 295 patient-caregiver dyads referred to a CMHS with suspected patient dementia.
Training of health professionals in the SCPD and its subsequent use. The SCPD consists of a systematic assessment of caregiver problems and alerts health professionals in flexible, connecting, proactive interventions to them. The intensity of the SCPD depends on the judgment of the health professional, based on individual caregiver needs.
Institutionalization in long-term care facilities at 12 months of follow-up.
No main intervention effect on institutionalization was found. However, a better sense of competence in the control group reduced the chance of institutionalization but not in the intervention group. The caregiver's sense of competence and depressive symptoms and the patient's behavioral problems and severity of dementia were the strongest predictors of institutionalization. The intensity of the program was low, even for dyads exposed to the SCPD.
Although no main effect was found, the results suggest that the SCPD might prevent a deterioration of the sense of competence in the intervention group. The intensity of a program is crucial and should be prescribed on the basis of evidence rather than left to the discretion of health professionals. Future controlled trials in daily clinical practice should use a process analysis to control for compliance.
评估痴呆症系统护理计划（SCPD）对患者住院的效果，并确定住院的预测因素。
单盲、多中心、集群随机、对照试验。
荷兰六个社区精神卫生服务中心（CMHS）。
共有 295 对患者-照顾者被转诊到 CMHS，疑似患者患有痴呆症。
对卫生专业人员进行 SCPD 培训，并随后使用该计划。SCPD 包括对照顾者问题的系统评估，并向卫生专业人员发出灵活、连接、主动干预的警报。SCPD 的强度取决于卫生专业人员根据个别照顾者需求的判断。
12 个月随访时在长期护理机构的住院情况。
未发现干预对住院的主要影响。然而，对照组中更好的能力感降低了住院的机会，但在干预组中没有。照顾者的能力感和抑郁症状以及患者的行为问题和痴呆严重程度是住院的最强预测因素。即使接触 SCPD 的对子，该计划的强度也很低。
尽管未发现主要影响，但结果表明 SCPD 可能预防干预组能力感恶化。计划的强度至关重要，应根据证据而不是卫生专业人员的判断来规定。未来在日常临床实践中进行的对照试验应使用过程分析来控制依从性。
