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J Am Med Dir Assoc. 2015 Sep 1;16(9):800.e1-8. doi: 10.1016/j.jamda.2015.06.011. Epub 2015 Jul 10.

Community-dwelling patients with dementia and their informal caregivers with and without case management: 2-year outcomes of a pragmatic trial.

Author information

1
Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: j.l.macneil-vroomen@amc.uva.nl.
2
Faculty of Earth and Life Sciences, Department of Health Sciences and the EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands.
3
Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
4
Department of General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
5
Department of General Practice and Elderly Care Medicine and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry and the EMGO Institute for Health and Care Research, Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands.
6
Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
7
Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, The Netherlands.

Abstract

OBJECTIVE:

To evaluate outcomes for persons with dementia and primary informal caregivers of 2 types of implemented case management (intensive case management [ICMM] and linkage [LM] models) with no case management (control group).

DESIGN:

A pragmatic trial using a prospective, observational, controlled, cohort study.

SETTING:

Community care in the Netherlands.

PARTICIPANTS:

A total of 521 dyads.

INTERVENTION:

Case management provided within one care organization (ICMM), case management where multiple case management organizations are present within one region (LM), and a group with no access to case management (control).

MEASUREMENTS:

Neuropsychiatric problems in persons with dementia assessed by the Neuropsychiatric Inventory (NPI) and psychological health in informal caregivers as measured with the General Health Questionnaire (GHQ-12). Secondary outcomes included care and support needs, quality of life, and institutionalization. Comparability of groups at baseline was secured by inverse-propensity-score-weighted mixed models.

RESULTS:

No significant differences in changes in total NPI or GHQ-12 scores between the groups over 2 years were found. Secondary outcomes showed better quality-of-life scores for informal caregivers in the ICMM than the LM. Total needs, met and unmet care needs were significantly less in the ICMM compared with the control group.

CONCLUSION:

Neither case management type affected clinical outcomes of dyads meaningfully. The ICMM has positive impact on caregivers' quality of life and patient's number of needs compared with persons in LM and persons without access to case management respectively.

KEYWORDS:

Case management; dementia; informal caregivers; longitudinal study

PMID:
26170035
DOI:
10.1016/j.jamda.2015.06.011
[Indexed for MEDLINE]

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