Department of Primary Care and Population Health, University College London, London, UK.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Br J Gen Pract. 2020 May 28;70(695):e434-e441. doi: 10.3399/bjgp20X710165. Print 2020 Jun.
Global policy recommendations suggest a task-shifted model of post-diagnostic dementia care, moving towards primary and community-based care. It is unclear how this may best be delivered.
To assess the effectiveness and cost-effectiveness of primary care-based models of post-diagnostic dementia care.
A systematic review of trials and economic evaluations of post-diagnostic dementia care interventions where primary care was substantially involved in care plan decision making.
Searches were undertaken of MEDLINE, PsychINFO, EMBASE, Web of Science, and CINAHL (from inception to March 2019). Two authors independently critically appraised studies and inductively classified interventions into types of care models. Random effects meta-analysis or narrative synthesis was conducted for each model where appropriate.
From 4506 unique references and 357 full texts, 23 papers were included from 10 trials of nine interventions, delivered in four countries. Four types of care models were identified. Primary care provider (PCP)-led care ( = 1) led to better caregiver mental health and reduced hospital and memory clinic costs compared with memory clinics. PCP-led care with specialist consulting support ( = 2) did not have additional effects on clinical outcomes or costs over usual primary care. PCP-case management partnership models ( = 6) offered the most promise, with impact on neuropsychiatric symptoms, caregiver burden, distress and mastery, and healthcare costs. Integrated primary care memory clinics ( = 1) had limited evidence for improved quality of life and cost-effectiveness compared with memory clinics.
Partnership models may impact on some clinical outcomes and healthcare costs. More rigorous evaluation of promising primary care-led care models is needed.
全球政策建议提出了一种转移后诊断痴呆症护理任务的模式，转向以初级保健和社区为基础的护理。目前尚不清楚如何最好地提供这种护理。
评估以初级保健为基础的后诊断痴呆症护理模式的有效性和成本效益。
系统评价了涉及初级保健在护理计划决策中大量参与的后诊断痴呆症护理干预措施的试验和经济评估。
对 MEDLINE、PsychINFO、EMBASE、Web of Science 和 CINAHL（从成立到 2019 年 3 月）进行了检索。两位作者独立地批判性地评价了研究，并将干预措施归纳为不同类型的护理模式。在适当的情况下，对每种模式进行了随机效应荟萃分析或叙述性综合。
从 4506 个独特的参考文献和 357 篇全文中，从 10 项试验的 9 项干预措施中确定了 23 篇论文，这些干预措施在四个国家进行。确定了四种护理模式。与记忆诊所相比，初级保健提供者（PCP）主导的护理（=1）可改善照顾者的心理健康，并降低医院和记忆诊所的成本。在常规初级保健的基础上增加专科医生咨询支持的 PCP 主导护理（=2）对临床结果或成本没有额外影响。PCP-病例管理伙伴关系模式（=6）最有希望，对神经精神症状、照顾者负担、痛苦和掌握以及医疗保健成本有影响。与记忆诊所相比，综合初级保健记忆诊所（=1）在改善生活质量和成本效益方面的证据有限。
伙伴关系模式可能会对一些临床结果和医疗保健成本产生影响。需要对有前途的以初级保健为基础的护理模式进行更严格的评估。
