Mavandadi Shahrzad, Wright Erin M, Graydon Meagan M, Oslin David W, Wray Laura O
VISN4 Mental Illness Research, Education, and Clinical Center, CPL Michael J. Crescenz Veterans Affairs (VA) Medical Center.
Department of Psychology, University of Maryland, Baltimore County.
Psychol Serv. 2017 Feb;14(1):102-111. doi: 10.1037/ser0000118.
Dementia care is largely provided in primary care settings. This article describes a pilot project aimed at evaluating the effectiveness of an accessible, telephone-based, patient- and caregiver (CG)-centered, collaborative care management program that involves CG education and psychosocial support in improving CG and patient outcomes. CGs (n = 75) of older veterans with dementia receiving care from Veterans Affairs (VA) Medical Center primary care practices were randomized to receive either dementia care management or usual care (UC). Of interest in this study were the frequency and severity of patients' dementia-related symptom, CG distress related to patients' behavioral and neuropsychiatric symptoms (primary outcomes), and CG coping and mastery (secondary outcomes). Adjusted, intention-to-treat longitudinal models suggest that CGs receiving care management reported significantly greater reductions in distress due to patients' dementia-related (p = .05) and neuropsychiatric (p = .01) symptoms compared with CGs in UC. Additionally, CGs in the intervention reported significantly larger improvements in their ability to cope (p = .03) and caregiving mastery (p = .03). No significant group differences were found in CG burden or patients' dementia-related symptom frequency or severity over time. Findings suggest that CGs of veterans with dementia may benefit from a telephone-delivered, care management program in improving CG-related outcomes. Further research of care management programs for CG of veterans with dementia in addressing barriers to care and reducing CG burden is warranted. These findings highlight the potential for such programs as adjuncts to dementia care offered in primary care practices. (PsycINFO Database Record
痴呆症护理主要在初级保健机构提供。本文描述了一个试点项目，旨在评估一项基于电话、以患者和照护者为中心、可及的协作式护理管理项目的有效性，该项目包括照护者教育和心理社会支持，以改善照护者和患者的结局。从退伍军人事务部（VA）医疗中心初级保健机构接受护理的患有痴呆症的老年退伍军人的照护者（n = 75）被随机分为接受痴呆症护理管理或常规护理（UC）。本研究感兴趣的是患者痴呆相关症状的频率和严重程度、与患者行为和神经精神症状相关的照护者痛苦（主要结局）以及照护者的应对和掌控能力（次要结局）。调整后的意向性治疗纵向模型表明，与接受常规护理的照护者相比，接受护理管理的照护者报告称，因患者痴呆相关症状（p = 0.05）和神经精神症状（p = 0.01）导致的痛苦显著减轻。此外，干预组的照护者在应对能力（p = 0.03）和照护掌控能力（p = 0.03）方面有显著更大的改善。随着时间的推移，在照护者负担、患者痴呆相关症状的频率或严重程度方面未发现显著的组间差异。研究结果表明，患有痴呆症的退伍军人的照护者可能受益于通过电话提供的护理管理项目，以改善与照护者相关的结局。有必要进一步研究针对患有痴呆症的退伍军人照护者的护理管理项目，以解决护理障碍并减轻照护者负担。这些发现凸显了此类项目作为初级保健机构提供的痴呆症护理辅助手段的潜力。（PsycINFO数据库记录）
