Backhouse Amy, Ukoumunne Obioha C, Richards David A, McCabe Rose, Watkins Ross, Dickens Chris
University of Exeter Medical School, College House, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
National Institute for Health Research (NIHR) South West Peninsula Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Exeter, Devon, UK.
BMC Health Serv Res. 2017 Nov 13;17(1):717. doi: 10.1186/s12913-017-2677-2.
Interventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to evaluate the effectiveness of community-based care coordinating interventions on health outcomes and investigate whether specific components of interventions influence their effects.
We searched four databases from inception to April 2017: Medline, The Cochrane Library, EMBASE and PsycINFO. This was aided by a search of four grey literature databases, and backward and forward citation tracking of included papers. Title and abstract screening was followed by a full text screen by two independent reviewers, and quality was assessed using the CASP appraisal tool. We then conducted meta-analyses and subgroup analyses.
A total of 14 randomised controlled trials (RCTs) involving 10,372 participants were included in the review. Altogether we carried out 12 meta-analyses and 19 subgroup analyses. Meta-analyses found coordinating interventions showed a statistically significant improvement in both patient behaviour measured using the Neuropsychiatric Inventory (NPI) (mean difference (MD) = -9.5; 95% confidence interval (CI): -18.1 to -1.0; p = 0.03; number of studies (n) = 4; I = 88%) and caregiver burden (standardised mean difference (SMD) = -0.54; 95% CI: -1.01 to -0.07; p = 0.02; n = 5, I = 92%) compared to the control group. Subgroup analyses found interventions using a case manager with a nursing background showed a greater positive effect on caregiver quality of life than those that used case managers from other professional backgrounds (SMD = 0.94 versus 0.03, respectively; p < 0.001). Interventions that did not provide supervision for the case managers showed greater effectiveness for reducing the percentage of patients that are institutionalised compared to those that provided supervision (odds ratio (OR) = 0.27 versus 0.96 respectively; p = 0.02). There was little evidence of effects on other outcomes, or that other intervention components modify the intervention effects.
Results show that coordinating interventions in dementia care has a positive impact on some outcomes, namely patient behaviour and caregiver burden, but the evidence is inconsistent and results were not strong enough to draw definitive conclusions on general effectiveness. With the rising prevalence of dementia, effective complex interventions will be necessary to provide high quality and effective care for patients, and facilitate collaboration of health, social and third sector services.
旨在为社区痴呆症患者协调服务的干预措施在组成部分、组织和实施方面存在差异。在本综述中，我们旨在评估基于社区的护理协调干预措施对健康结果的有效性，并调查干预措施的特定组成部分是否会影响其效果。
我们检索了从创刊到2017年4月的四个数据库：医学索引数据库（Medline）、考克兰图书馆（The Cochrane Library）、荷兰医学文摘数据库（EMBASE）和心理学文摘数据库（PsycINFO）。通过检索四个灰色文献数据库以及对纳入论文进行前后向引文追踪来辅助检索。两名独立评审员先进行标题和摘要筛选，然后进行全文筛选，并使用CASP评估工具评估质量。随后我们进行了荟萃分析和亚组分析。
本综述共纳入14项随机对照试验（RCT），涉及10372名参与者。我们总共进行了12项荟萃分析和19项亚组分析。荟萃分析发现，与对照组相比，协调干预措施在使用神经精神科问卷（NPI）测量的患者行为（平均差（MD）=-9.5；95%置信区间（CI）：-18.1至-1.0；p=0.03；研究数量（n）=4；I²=88%）和照顾者负担（标准化平均差（SMD）=-0.54；95%CI：-1.01至-0.07；p=0.02；n=5，I²=92%）方面均显示出统计学上的显著改善。亚组分析发现，与使用其他专业背景的个案管理员的干预措施相比，使用具有护理背景的个案管理员的干预措施对照顾者生活质量的积极影响更大（SMD分别为0.94和0.03；p<0.001）。与提供监督的干预措施相比，不提供个案管理员监督的干预措施在降低患者住院率方面显示出更大的效果（优势比（OR）分别为0.27和0.96；p=0.02）。几乎没有证据表明对其他结果有影响，也没有证据表明其他干预组成部分会改变干预效果。
结果表明，痴呆症护理中的协调干预措施对某些结果有积极影响，即患者行为和照顾者负担，但证据并不一致，结果也不够有力，无法就总体有效性得出明确结论。随着痴呆症患病率的上升，需要有效的综合干预措施为患者提供高质量和有效的护理，并促进卫生、社会和第三部门服务的协作。
