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家庭干预随机试验:针对痴呆症照料者的电话跟踪护理——社区和医疗资源的利用

Randomized Trial of the Family Intervention: Telephone Tracking-Caregiver for Dementia Caregivers: Use of Community and Healthcare Resources.

作者信息

Tremont Geoffrey, Davis Jennifer D, Ott Brian R, Galioto Rachel, Crook Cara, Papandonatos George D, Fortinsky Richard H, Gozalo Pedro, Bishop Duane S

机构信息

Department of Psychiatry, Rhode Island Hospital, Brown University, Providence, Rhode Island.

Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island.

出版信息

J Am Geriatr Soc. 2017 May;65(5):924-930. doi: 10.1111/jgs.14684. Epub 2016 Dec 23.

Abstract

OBJECTIVES

To examine the effects of a telephone-delivered intervention, Family Intervention: Telephone Tracking-Caregiver (FITT-C), on community support and healthcare use by dementia caregivers.

DESIGN

Randomized, controlled trial.

SETTING

Academic medical center.

PARTICIPANTS

Dyads (n = 250) of distressed informal dementia caregivers and care recipients.

INTERVENTION

Caregivers were randomly assigned to receive the FITT-C (n = 133) or telephone support (TS; n = 117). Both groups received 16 telephone contacts from a master's-level therapist over 6 months. The FITT-C intervention provided psychoeducation, problem solving, and other directive approaches based on assessment of critical areas (e.g., mood, behavior, family functioning, social support). TS provided supportive therapeutic strategies.

MEASUREMENTS

Outcome variables were caregiver report of community support service use, number of visits to the emergency department (ED) for caregivers and care recipients, and hospital stays for caregivers during the interventions.

RESULTS

Intervention groups did not differ in demographic characteristics, use of support services, or use of healthcare resources at baseline. Caregivers who received the FITT-C used community support services at end of treatment significantly more than those receiving TS (P = .02). FITT-C caregivers had a significantly lower rate of ED visits (rate difference 9.5%, P = .048) and hospital stays (rate difference 11.4%, P = .01) over the 6-month course of the intervention than TS caregivers. Care recipient use of community or medical resources did not differ according to group.

CONCLUSION

An entirely telephone-delivered intervention was effective in increasing caregiver engagement in community resources and reducing caregiver use of hospital-based healthcare resources. Results highlight the potential effect of FITT-C on healthcare use.

摘要

目的

研究通过电话进行的干预措施“家庭干预:电话跟踪-照顾者(FITT-C)”对痴呆症照顾者社区支持及医疗保健利用情况的影响。

设计

随机对照试验。

地点

学术医疗中心。

参与者

苦恼的非正式痴呆症照顾者与受照顾者组成的二元组(n = 250)。

干预措施

照顾者被随机分配接受FITT-C干预(n = 133)或电话支持(TS;n = 117)。两组在6个月内均接受来自硕士水平治疗师的16次电话联系。FITT-C干预基于对关键领域(如情绪、行为、家庭功能、社会支持)的评估,提供心理教育、问题解决及其他指导性方法。TS提供支持性治疗策略。

测量指标

结果变量包括照顾者对社区支持服务使用情况的报告、照顾者及受照顾者去急诊科就诊的次数,以及干预期间照顾者的住院天数。

结果

干预组在人口统计学特征、支持服务使用情况或基线时的医疗资源使用情况方面无差异。接受FITT-C干预的照顾者在治疗结束时使用社区支持服务的情况显著多于接受TS干预的照顾者(P = 0.02)。在为期6个月的干预过程中,FITT-C组照顾者的急诊科就诊率(率差9.5%,P = 0.048)和住院率(率差11.4%,P = 0.01)显著低于TS组照顾者。受照顾者对社区或医疗资源的使用情况在两组间无差异。

结论

完全通过电话进行的干预措施在提高照顾者对社区资源的参与度及减少照顾者对医院医疗资源的使用方面是有效的。结果凸显了FITT-C对医疗保健利用的潜在影响。

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