Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.
Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.
J Alzheimers Dis. 2019;71(1):45-55. doi: 10.3233/JAD-180957.
Care navigation is an approach to personalized care management and care coordination that can help overcome barriers to care. Care navigation has not been extensively studied in dementia, where health care workforce innovations are needed as a result of increasing disease prevalence and resulting costs to the health care system.
To identify facilitators and barriers to care navigation in dementia and to assess dementia caregiver satisfaction with care navigation.
Methods include qualitative research (interviews, focus groups, observations) with "Care Team Navigators" (CTNs) who were part of a dementia care navigation program, the Care Ecosystem, and a quantitative survey with caregivers about their experiences with CTNs. Transcripts were analyzed to identify themes within the data.
CTNs identified the following facilitators to care navigation in dementia: working closely with caregivers; providing emotional support; tailoring education and resources; and coordinating with a clinical team around issues ranging from clinical questions to financial and legal decision-making. The barriers CTNS identified included burn-out, the progressive nature of the disease; coordinating with primary care providers; and identifying resources for dyads who are low-income, do not speak English, or live in rural areas. Caregivers across both sites highly rated CTNs, though satisfaction was higher among those in Nebraska and Iowa.
Innovative approaches to care delivery in dementia are crucial. Care navigation offers a feasible model to train unlicensed people to deliver care as a way to deliver larger-scale support for the growing population of adults living with dementia and their caregivers.
护理导航是一种个性化护理管理和护理协调方法，可以帮助克服护理障碍。由于痴呆症的患病率不断增加，给医疗保健系统带来了相应的成本，因此需要医疗保健劳动力的创新，而护理导航在痴呆症领域尚未得到广泛研究。
确定痴呆症护理导航的促进因素和障碍，并评估痴呆症护理者对护理导航的满意度。
采用定性研究方法（访谈、焦点小组、观察），对参与痴呆症护理导航计划（护理生态系统）的“护理团队导航员”（CTNs）进行研究，同时对护理者进行了关于他们与 CTNs 互动体验的定量调查。对转录本进行分析以确定数据中的主题。
CTNs 确定了痴呆症护理导航的以下促进因素：与护理者密切合作；提供情感支持；针对教育和资源进行个性化定制；围绕从临床问题到财务和法律决策等问题与临床团队协调。CTNs 确定的障碍包括倦怠、疾病的进行性特征、与初级保健提供者的协调以及为收入较低、不会说英语或居住在农村地区的双职工家庭识别资源。两个地点的护理者对 CTNs 的评价都很高，但内布拉斯加州和爱荷华州的护理者满意度更高。
在痴呆症中采用创新的护理提供方法至关重要。护理导航提供了一种可行的模式，可以培训非专业人员提供护理，为不断增长的痴呆症患者及其护理者群体提供更大规模的支持。
