痴呆症护理和初级保健中遵循指南的作用：来自 DemTab 研究的横断面研究结果。
Dementia care and the role of guideline adherence in primary care: cross-sectional findings from the DemTab study.
机构信息
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117, Berlin, Germany.
Brandenburg Medical School Theodor Fontane, Department of Psychiatry, Psychotherapy and Psychosomatics, Neuruppin, Germany.
出版信息
BMC Geriatr. 2021 Dec 18;21(1):717. doi: 10.1186/s12877-021-02650-8.
BACKGROUND
General practitioners (GPs) play a key role in the care of people with dementia (PwD). However, the role of the German Dementia Guideline in primary care remains unclear. The main objective of the present study was to examine the role of guideline-based dementia care in general practices.
METHODS
A cross-sectional analysis of data obtained from the DemTab study was conducted. Descriptive analyses of sociodemographic and clinical characteristics for GPs (N = 28) and PwD (N = 91) were conducted. Adherence to the German Dementia Guideline of GPs was measured at the level of PwD. Linear Mixed Models were used to analyze the associations between adherence to the German Dementia Guideline and GP factors at individual (age, years of experience as a GP, frequency of utilization of guideline, perceived usefulness of guideline) and structural (type of practice, total number of patients seen by a participating GP, and total number of PwD seen by a participating GP) levels as well as between adherence to the German Dementia Guideline and PwD's quality of life.
RESULTS
Self-reported overall adherence of GPs was on average 71% (SD = 19.4, range: 25-100). Adherence to specific recommendations varied widely (from 19.2 to 95.3%) and the majority of GPs (79.1%) reported the guideline as only partially or somewhat helpful. Further, we found lower adherence to be significantly associated with higher numbers of patients (γ10 = - 5.58, CI = - 10.97, - 0.19, p = .04). No association between adherence to the guideline and PwD's quality of life was found (γ10 = -.86, CI = - 4.18, 2.47, p = .61).
CONCLUSION
The present study examined the role of adherence to the German Dementia Guideline recommendations in primary care. Overall, GPs reported high levels of adherence. However, major differences across guideline recommendations were found. Findings highlight the importance of guidelines for the provision of care. Dementia guidelines for GPs need to be better tailored and addressed. Further, structural changes such as more time for PwD may contribute to a sustainable change of dementia care in primary care.
TRIAL REGISTRATION
The DemTab trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413 ). Registered 01 April 2019.
背景
全科医生（GP）在痴呆症患者（PwD）的护理中起着关键作用。然而，德国痴呆症指南在初级保健中的作用仍不清楚。本研究的主要目的是研究基于指南的痴呆症护理在全科医生中的作用。
方法
对 DemTab 研究中获得的数据进行了横断面分析。对 28 名全科医生（GP）和 91 名 PwD 的社会人口统计学和临床特征进行了描述性分析。以 PwD 为水平测量 GP 对德国痴呆症指南的依从性。线性混合模型用于分析个体（年龄、作为 GP 的经验年限、指南使用频率、指南有用性感知）和结构（实践类型、由参与 GP 诊治的患者总数、以及由参与 GP 诊治的 PwD 总数）水平上的 GP 因素与德国痴呆症指南的依从性之间以及德国痴呆症指南的依从性与 PwD 生活质量之间的关系。
结果
GP 自我报告的总体依从率平均为 71%（SD=19.4，范围：25-100）。具体建议的依从性差异很大（从 19.2%到 95.3%），大多数 GP（79.1%）表示该指南仅部分或有些有用。进一步的研究发现，较低的依从性与更多的患者数量显著相关（γ10=-5.58，CI=-10.97，-0.19，p=0.04）。没有发现依从性与 PwD 生活质量之间的关联（γ10=-0.86，CI=-4.18，2.47，p=0.61）。
结论
本研究考察了德国痴呆症指南建议在初级保健中的作用。总体而言，GP 报告的依从率较高。然而，在指南建议方面存在很大差异。研究结果强调了指南在提供护理方面的重要性。针对 GP 的痴呆症指南需要进一步定制和解决。此外，为 PwD 提供更多时间等结构性变化可能有助于在初级保健中实现痴呆症护理的可持续性改变。
试验注册
DemTab 试验前瞻性地在 ISRCTN 注册中心注册（试验注册编号：ISRCTN8065535）。于 2019 年 4 月 1 日注册。
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