Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA; Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA.
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA; Screen Inc., Seattle, WA.
Am J Geriatr Psychiatry. 2014 Aug;22(8):746-55. doi: 10.1016/j.jagp.2013.11.001. Epub 2013 Nov 12.
Improving dementia care in health systems requires estimates of need in the population served. We explored whether dementia-specific service needs and gaps for patients and caregivers could be predicted by simple information readily captured in routine care settings.
Primary family caregivers (n = 215) rated their own current stress, challenging patient behaviors, and prior-year needs and gaps in 16 medical and psychosocial services. These were evaluated with other patient and caregiver characteristics in multivariate regressions to identify unique predictors of service needs and gaps.
Caregiver stress and patient behavior problems together accounted for an average of 24% of the whole-sample variance in total needs and gaps. All other variables combined (comorbid chronic disease, dementia severity, age, caregiver relationship, and residence) accounted for a mean of 3%, with none yielding more than 4% in any equation. We combined stress and behavior problem indicators into a simple screen. In early/mild dementia dyads (n = 111) typical in primary care settings, the screen identified gaps in total (84%) and psychosocial (77%) care services for high stress/high behavior problem dyads vs. 25% and 23%, respectively, of low stress/low behavior problem dyads. Medical care gaps were dramatically higher in high stress/high behavior problem dyads (66%) than all others (12%).
The Dementia Services Mini-Screen is a simple tool that could help clinicians and health systems rapidly identify dyads needing enhanced dementia care, track key patient and caregiver outcomes of interventions, and estimate population needs for new service development.
要改善卫生系统中的痴呆症护理，就需要对所服务人群的需求进行评估。我们探讨了患者和照护者的痴呆症特定服务需求和差距是否可以通过在常规护理环境中容易获得的简单信息来预测。
初级家庭照护者（n=215）对自己当前的压力、患者的挑战性行为以及前一年在 16 项医疗和心理社会服务方面的需求和差距进行了评分。这些评分与其他患者和照护者特征一起在多元回归中进行评估，以确定服务需求和差距的独特预测因素。
照护者压力和患者行为问题共同解释了总需求和差距样本中 24%的方差。所有其他变量（合并的共病慢性疾病、痴呆严重程度、年龄、照护者关系和居住地点）合计解释了平均 3%的方差，没有任何一个变量在任何方程中超过 4%。我们将压力和行为问题指标合并为一个简单的筛查工具。在初级保健环境中常见的早期/轻度痴呆症患者（n=111）中，该筛查工具识别出高压力/高行为问题患者与低压力/低行为问题患者相比，在总（84%）和心理社会（77%）护理服务方面存在差距。医疗护理差距在高压力/高行为问题患者中（66%）明显高于其他所有患者（12%）。
痴呆症服务迷你筛查工具是一种简单的工具，可以帮助临床医生和卫生系统快速识别需要加强痴呆症护理的患者，跟踪干预措施的关键患者和照护者结果，并估计新服务开发的人群需求。
