居家痴呆症患者及其非专业照护者的病例管理:范围综述。

Case management for people with dementia living at home and their informal caregivers: A scoping review.

机构信息

Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.

出版信息

Health Soc Care Community. 2022 Jul;30(4):1233-1253. doi: 10.1111/hsc.13647. Epub 2021 Nov 15.

Abstract

Case management is a complex intervention aimed at addressing a variety of health needs of people in their social environment. Case management for people with dementia is often poorly defined and insufficiently described. The crucial process steps are often not well understood. We aim to map and compare the key components, processes and contextual factors of case management programmes for dementia and to explore aspects of the interventions' generalisability. Our search covered the databases PubMed, CINAHL, Cochrane and GeroLit, as well as policy papers from international organisations. We included qualitative, quantitative and mixed-methods studies in the English or German language that was published between 1999 and 2020. The programmes were analysed according to programme characteristics, case management intervention and the structural and processing conditions. We identified 67 studies dealing with 25 programmes. Approximately half of the programmes were investigated in randomised controlled trials, two programmes used a mixed-methods design and the remaining were the subject of pre-post cohort studies. Participants in the studies were predominantly dyads of people with dementia and their informal caregivers. About half of the programmes reported a theoretical framework. All the programmes were derived from case management approaches or referred to such approaches. Despite huge differences in implementation, all the programmes covered the case management steps. In 14 out of 25 programmes, case management was carried out without additional intervention, the other programmes provided mainly education and training for informal caregivers. Costs of the case management interventions were stated in more than half of the programmes.The effectiveness and generalisability of dementia-specific case management interventions could be enhanced if the framework introduced in the review was used in the future by policy, practice and research.

摘要

个案管理是一种复杂的干预措施,旨在满足处于社会环境中的人们的各种健康需求。针对痴呆症患者的个案管理通常定义不明确,描述不足。关键的流程步骤往往理解得不够透彻。我们旨在绘制和比较痴呆症个案管理计划的关键组成部分、流程和背景因素,并探讨干预措施的普遍性的各个方面。我们的检索涵盖了 PubMed、CINAHL、Cochrane 和 GeroLit 数据库以及国际组织的政策文件。我们纳入了 1999 年至 2020 年间以英文或德文发表的定性、定量和混合方法研究,这些研究涉及痴呆症个案管理计划和结构及处理条件。我们根据方案特征、个案管理干预以及结构和处理条件分析了方案。我们确定了 67 项研究,涉及 25 个方案。大约一半的方案是在随机对照试验中进行调查的,两项方案采用了混合方法设计,其余方案则是基于前后队列研究。研究中的参与者主要是痴呆症患者及其非专业照顾者组成的二人组。大约一半的方案报告了一个理论框架。所有的方案都源自个案管理方法或参考了这些方法。尽管实施情况存在巨大差异,但所有的方案都涵盖了个案管理步骤。在 25 个方案中的 14 个方案中,个案管理是在没有额外干预的情况下进行的,其他方案主要为非专业照顾者提供教育和培训。超过一半的方案都说明了个案管理干预的成本。如果未来政策、实践和研究能够采用本综述中提出的框架,那么针对痴呆症的个案管理干预措施的有效性和普遍性可能会得到提高。

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