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痴呆症照护管理:在基于全科医生的随机对照干预试验中,为门诊痴呆症照护开辟新途径。

Dementia care management: going new ways in ambulant dementia care within a GP-based randomized controlled intervention trial.

机构信息

German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Germany.

Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, Ernst-Moritz-Arndt-University, Greifswald, Germany.

出版信息

Int Psychogeriatr. 2014 Feb;26(2):247-56. doi: 10.1017/S1041610213001786. Epub 2013 Oct 23.

Abstract

BACKGROUND

Increasing prevalence of dementia is a major challenge for the German healthcare system. The study DelpHi-MV ("Dementia: life- and person-centered help in Mecklenburg-Western Pomerania") aims to implement and evaluate an innovative subsidiary support system for persons with dementia (PwDs) living at home and their caregivers.

METHODS

DelpHi-MV is a GP-based cluster randomized controlled intervention trial. DelpHi-Intervention aims to provide "optimum care" by integrating multi-professional and multimodal strategies to individualize and optimize treatment of dementia within the framework of the established healthcare and social service system. The intervention is conducted by Dementia Care Managers (DCMs)--nurses with dementia-specific training--at the people's homes. Based on German guidelines for evidence-based diagnoses and treatment of dementia, a comprehensive set of 95 interventio--modules--the "DelpHi-Standard"--was defined. Each module consists of predefined trigger condition(s), a subsequent intervention task, as well as at least one criterion for its completion. The intervention begins with a comprehensive assessment of the care situation, needs, and resources. The DCM develops and implements an intervention plan tailored to the individual conditions in close cooperation with the GP. EXPECTED RESULTS AND CONCLUSIONS: We expect statistically significant differences between control and intervention group in primary outcomes (quality of life, behavioral and psychological symptoms of dementia, pharmacotherapy, caregiver burden). Results can provide evidence for the effectiveness and efficacy of dementia care management according to the "Delphi-Standard"--prerequisites for implementing this concept into routine healthcare.

摘要

背景

痴呆症的患病率不断上升,是德国医疗保健系统面临的主要挑战。DelpHi-MV 研究(“痴呆症:梅克伦堡-前波美拉尼亚的以人为本的生活和帮助”)旨在实施和评估一种针对居家痴呆症患者(PwD)及其照护者的创新附属支持系统。

方法

DelpHi-MV 是一项基于全科医生的集群随机对照干预试验。DelpHi 干预旨在通过整合多专业和多模式策略,为每个人提供“最佳护理”,在既定的医疗保健和社会服务系统框架内,针对痴呆症进行个体化和优化治疗。该干预措施由痴呆症护理经理(DCM)——接受过痴呆症专业培训的护士——在患者家中进行。基于德国痴呆症循证诊断和治疗指南,制定了一套全面的 95 项干预措施模块——“DelpHi 标准”。每个模块都包含预定义的触发条件、后续干预任务以及完成标准。干预从对护理情况、需求和资源的全面评估开始。DCM 与全科医生密切合作,制定并实施适合个人情况的干预计划。

预期结果和结论

我们预计在主要结局(生活质量、痴呆的行为和心理症状、药物治疗、照护者负担)方面,对照组和干预组之间会有统计学上的显著差异。研究结果可为根据“Delphi 标准”进行痴呆症护理管理的有效性和功效提供证据,这是将这一概念纳入常规医疗保健的前提条件。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1342/3891295/0a49b572e027/S1041610213001786_fig1.jpg

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