Ina Zwingmann

Effectiveness and Safety of Dementia Care Management in Primary Care: A Randomized Clinical Trial.

Importance Dementia care management (DCM) can increase the quality of care for people with dementia. Methodologically rigorous clinical trials on DCM are lacking. Objective To test the effectiveness and safety of DCM in the treatment and care of people with dementia living at home and caregiver burden (when available). Design, Setting, and Participants This pragmatic, general practitioner–based, cluster-randomized intervention trial compared the intervention with care as usual at baseline and at 12-month follow-up. Simple 1:1 randomization of general practices in Germany was used. Analyses were intent to treat and per protocol. In total, 6838 patients were screened for dementia (eligibility: 70 years and older and living at home) from January 1, 2012, to March 31, 2016. Overall, 1167 (17.1%) were diagnosed as having dementia, and 634 (9.3%) provided written informed consent to participate. Interventions Dementia care management was provided for 6 months at the homes of patients with dementia. Dementia care management is a model of collaborative care, defined as a complex intervention aiming to provide optimal treatment and care for patients with dementia and support caregivers using a computer-assisted assessment determining a personalized array of intervention modules and subsequent success monitoring. Dementia care management was targeted at the individual patient level and was conducted by 6 study nurses with dementia care–specific qualifications. Main Outcomes and Measures Quality of life, caregiver burden, behavioral and psychological symptoms of dementia, pharmacotherapy with antidementia drugs, and use of potentially inappropriate medication. Results The mean age of 634 patients was 80 years. A total of 407 patients received the intended treatment and were available for primary outcome measurement. Of these patients, 248 (60.9%) were women, and 204 (50.1%) lived alone. Dementia care management significantly decreased behavioral and psychological symptoms of dementia (bu2009=u2009−7.45; 95% CI, −11.08 to −3.81; Pu2009<u2009.001) and caregiver burden (bu2009=u2009−0.50; 95% CI, −1.09 to 0.08; Pu2009=u2009.045) compared with care as usual. Patients with dementia receiving DCM had an increased chance of receiving antidementia drug treatment (DCM, 114 of 291 [39.2%] vs care as usual, 31 of 116 [26.7%]) after 12 months (odds ratio, 1.97; 95% CI, 0.99 to 3.94; Pu2009=u2009.03). Dementia care management significantly increased quality of life (bu2009=u20090.08; 95% CI, 0 to 0.17; Pu2009=u2009.03) for patients not living alone but did not increase quality of life overall. There was no effect on potentially inappropriate medication (odds ratio, 1.86; 95% CI, 0.62 to 3.62; Pu2009=u2009.97). Conclusions and Relevance Dementia care management provided by specifically trained nurses is an effective collaborative care model that improves relevant patient- and caregiver-related outcomes in dementia. Implementing DCM in different health care systems should become an active area of research. Trial Registration clinicaltrials.gov Identifier: NCT01401582

Healthcare utilization and costs in primary care patients with dementia: baseline results of the DelpHi-trial

The objectives of this cross-sectional analysis were to determine healthcare resource utilization and cost for community-dwelling patients with dementia (PWD) from a payer’s and societal perspective, and to analyze the associations between costs and sociodemographic and clinical variables. Analysis of healthcare costs from a payer’s perspective was based on a sample of 425 PWD, analysis of healthcare costs from societal perspective on a subsample of 254 PWD and their informal caregivers. Frequency of healthcare resource utilization was assessed by means of questionnaires. Informal care and productivity losses were assessed by using the Resource Utilization in Dementia questionnaire (RUD). Costs were monetarized using standardized unit costs. To analyze the associations, multiple linear regression models were used. Total annual costs per PWD valued 7016€ from a payer’s and 25,877€ from a societal perspective, meaning that societal cost is approximately three and a half times as much as payer’s expenditures. Costs valuated 5456 € for medical treatments, 1559 € for formal care, 18,327€ for informal care. Productivity losses valued 1297€ for PWD caregivers. Informal care could vary substantially (−21%; +33%) concerning different valuation methods. Medical care costs decreased significantly with progression of dementia and with age. Costs of care double over the stages of dementia. Formal care costs were significantly higher for PWD living alone and informal care costs significantly lower for PWD with an employed caregiver. For all cost categories, deficits in daily living activities were major cost drivers.

Supporting family dementia caregivers: testing the efficacy of dementia care management on multifaceted caregivers’ burden

ABSTRACT Objectives: Current research suggests that dementia care management (DCM) can decrease burden and associated health impairments of caregivers. The objective of this secondary analysis is to investigate the impact of DCM on multifaceted caregivers’ burden dimensions by differentiating between objective and subjective burden. Methods: A sample of n = 317 dyads of caregivers and community-dwelling people with dementia (PwD) participated in a general practitioner-based, cluster-randomized intervention trial (Identifier:NCT01401582) with two arms and comprehensive data assessment at baseline and 12-month follow-up. Data provided by the caregiver included an inventory with 88 items in 20 different dimensions. Results: Caregivers in the intervention ‘DCM’ group showed decreased caregiver burden, especially in caregivers’ objective burden due to caring (i.e. emotional support), caregivers’ subjective burden due to behavior change (i.e. cognition, aggression and resistance, depression, late symptoms) and caregivers’ subjective burden due to perceived conflicts between needs and responsibilities to care (i.e. financial losses) compared to caregivers in the control ‘care as usual’ group, which showed significant increased caregiver burden after 12 months. Conclusion: Our findings support evidence for the effectiveness of DCM to lower family dementia caregivers burden in multifaceted dimensions.

Dementia care management in primary care

BackgroundDementia is one of the most prevalent diseases in the older population. Various dementia care models have been developed to address patient’s healthcare needs. They can be described as “collaborative care” or “person-centered care”. Referring to the needs of the workforce working with persons with dementia, axa0key element is the use of interprofessional education (IPE).ObjectiveThe purpose of this article is to describe different international collaborative care models to define axa0minimum standard of healthcare professions for collaborative dementia care in primary care. This helps to identify requirements for IPE to optimize care of people with dementia and to support informal caregivers in the future.Material and methodsIn this article six dementia care models from 4 different countries (Germany, USA, UK and Netherlands) are described and compared regarding aims, interventions and healthcare professionals involved.ResultsCare teams are minimally comprised of general practitioners or primary care providers, nurses, and social workers. Additional healthcare disciplines may be involved for specific interventions. Mostly, care team members received specific training but such training did not necessarily incorporate the IPE approach. To ensure successful collaboration of professions, IPE training programs should at least consist of the following core topics: (1) early diagnosis, (2) postdiagnostic support, (3) advanced care planning for patients and caregivers and (4) effective collaborative care.ConclusionThe IPE programs for dementia should be expanded and must be widely implemented in order to assess the impact on collaborative practice. This study will provide the knowledge base for structuring IPE trainings developing educational agendas and adapting existing guidelines to improve collaborative dementia care in the future.ZusammenfassungHintergrundDemenz ist eine der häufigsten Erkrankungen im höheren Alter und erfordert innovative Konzepte zur Versorgung der Betroffenen. Um Gesundheitsberufe adäquat auf eine patientenzentrierte, interprofessionelle Demenzversorgung vorzubereiten hat sich das interprofessionelle Lernen (IPL) bewährt.Ziel der ArbeitZiel ist es, Versorgungskonzepte für Menschen mit Demenz zu beschreiben und einen Mindeststandard an Professionen zu definieren, die an der patientenzentrierten Demenzversorgung beteiligt werden sollten, sowie Erfordernisse an das IPL zu identifizieren.Material und MethodenSechs Versorgungskonzepte aus 4xa0Ländern (Deutschland, USA, Großbritannien, Niederlande) werden hinsichtlich ihrer Ziele, Interventionen und involvierten Gesundheitsfachberufe verglichen, um Rückschlüsse für das IPL zu ziehen.ErgebnisseHausärzte, Pflegefachpersonen und Sozialarbeiter sind in allen Ländern Teil des Versorgungsteams. Weitere Gesundheitsberufe werden für spezifische Interventionen einbezogen. Die Mitglieder des Versorgungsteams werden zumeist speziell qualifiziert, jedoch nicht im interprofessionellen Lernansatz. IPL Qualifikationen sollten mindestens folgende Themenbereiche umfassen: (1) frühe Diagnostik, (2) Versorgung nach Diagnosestellung, (3) effektives Versorgungsmanagement und (4) interprofessionelle Zusammenarbeit.DiskussionIPL sollte künftig für das Krankheitsbild Demenz ausgeweitet sowie weitreichend implementiert und evaluiert werden, um den Nutzen für die interprofessionelle Teamarbeit in der Praxis zu überprüfen. Dies ist die Basis, um länderspezifische IPL Bildungsprogramme zu entwickeln und bestehende Versorgungsleitlinien für eine verbesserte interprofessionelle Demenzversorgung im ambulanten Setting anzupassen.

Deutscher Kongress für Versorgungsforschung

ZusammenfassungBeim 16.xa0Deutschen Kongress für Versorgungsforschung (DKVF), der vom 4.–6.xa0Oktober 2017 in der Urania Berlin stattfand, wurde ein neuer Besucherrekord erreicht: 859xa0Akteure aus der Versorgungsforschung, Versorgungspraxis und Gesundheitspolitik kamen an den 3xa0Kongresstagen in Berlin zusammen, um aktuelle Ergebnisse aus der Versorgungsforschung zu diskutieren und sich über neue Entwicklungen zu informieren. Denn das Gesundheitswesen in Deutschland steht vor großen Herausforderungen – die Deutschen werden älter, das Krankheitsgeschehen komplexer und gleichzeitig sinkt die Zahl von Fachkräften in der Krankenversorgung.Wie eine gute regionale Versorgung funktionieren kann, wurde an den 3xa0Kongresstagen in 95xa0Sitzungen anhand von 322xa0Vorträgen und 239xa0Postern präsentiert. Topthemen waren dabei innovative sektorenübergreifende Versorgungskonzepte, Patientensicherheit, neue Formen der Arbeitsteilung im Gesundheitswesen, Entwicklungen und Anwendungen im Bereich Telemedizin und E‑Health sowie die Projekte des Innovationsfonds und der Strukturausschreibungen des Bundesministeriums für Bildung und Forschung.Eine Quintessenz des diesjährigen DKVF ist, dass die Versorgungsforschung ein wichtiger Partner der Patienten, der Gesundheitspolitik und der Selbstverwaltung ist. Die Experten stellen fest, dass zukünftige Versorgung regional und sektorenübergreifend ist sowie alle Gesundheitsberufe miteinbeziehen muss, und sie formulieren eine Vielzahl von Forderungen an die neue Legislaturperiode.AbstractThe German congress for healthcare research reached axa0new historic record of 859 participants from healthcare research, practice, and policy who visited the congress from 4–6xa0October 2017 to discuss developments, results, and innovations in healthcare research.The German healthcare system will face key challenges over the coming years. As the German population is getting older and disease incidence will become more complex, the number of healthcare professionals will simultaneously decrease.The experts provided solutions and innovations in 322 lectures and in 239 poster presentations.Hot topics included innovative and cross-sectoral healthcare concepts, patient safety, new forms of division of labor, telemedicine, eHealth as well as projects of the innovation fund and the Federal Ministry for Education and Research.Healthcare experts state that healthcare research is axa0key partner of patients, health policy, and self-government. The experts declare that future healthcare should be regional, cross-sectoral, and should include all healthcare professions. They formulate several demands on health policy for the new legislative period.The German congress for healthcare research reached axa0new historic record of 859 participants from healthcare research, practice, and policy who visited the congress from 4-6xa0October 2017 to discuss developments, results, and innovations in healthcare research.The German healthcare system will face key challenges over the coming years. As the German population is getting older and disease incidence will become more complex, the number of healthcare professionals will simultaneously decrease.The experts provided solutions and innovations in 322 lectures and in 239 poster presentations.Hot topics included innovative and cross-sectoral healthcare concepts, patient safety, new forms of division of labor, telemedicine, eHealth as well as projects of the innovation fund and the Federal Ministry for Education and Research.Healthcare experts state that healthcare research is axa0key partner of patients, health policy, and self-government. The experts declare that future healthcare should be regional, cross-sectoral, and should include all healthcare professions. They formulate several demands on health policy for the new legislative period.

Versorgungsmanagement bei Demenz in der Primärversorgung: Aktuelle kooperative Versorgungsmodelle und der Vorteil von interprofessionellem Lernen

BackgroundDementia is one of the most prevalent diseases in the older population. Various dementia care models have been developed to address patient’s healthcare needs. They can be described as “collaborative care” or “person-centered care”. Referring to the needs of the workforce working with persons with dementia, axa0key element is the use of interprofessional education (IPE).ObjectiveThe purpose of this article is to describe different international collaborative care models to define axa0minimum standard of healthcare professions for collaborative dementia care in primary care. This helps to identify requirements for IPE to optimize care of people with dementia and to support informal caregivers in the future.Material and methodsIn this article six dementia care models from 4 different countries (Germany, USA, UK and Netherlands) are described and compared regarding aims, interventions and healthcare professionals involved.ResultsCare teams are minimally comprised of general practitioners or primary care providers, nurses, and social workers. Additional healthcare disciplines may be involved for specific interventions. Mostly, care team members received specific training but such training did not necessarily incorporate the IPE approach. To ensure successful collaboration of professions, IPE training programs should at least consist of the following core topics: (1) early diagnosis, (2) postdiagnostic support, (3) advanced care planning for patients and caregivers and (4) effective collaborative care.ConclusionThe IPE programs for dementia should be expanded and must be widely implemented in order to assess the impact on collaborative practice. This study will provide the knowledge base for structuring IPE trainings developing educational agendas and adapting existing guidelines to improve collaborative dementia care in the future.ZusammenfassungHintergrundDemenz ist eine der häufigsten Erkrankungen im höheren Alter und erfordert innovative Konzepte zur Versorgung der Betroffenen. Um Gesundheitsberufe adäquat auf eine patientenzentrierte, interprofessionelle Demenzversorgung vorzubereiten hat sich das interprofessionelle Lernen (IPL) bewährt.Ziel der ArbeitZiel ist es, Versorgungskonzepte für Menschen mit Demenz zu beschreiben und einen Mindeststandard an Professionen zu definieren, die an der patientenzentrierten Demenzversorgung beteiligt werden sollten, sowie Erfordernisse an das IPL zu identifizieren.Material und MethodenSechs Versorgungskonzepte aus 4xa0Ländern (Deutschland, USA, Großbritannien, Niederlande) werden hinsichtlich ihrer Ziele, Interventionen und involvierten Gesundheitsfachberufe verglichen, um Rückschlüsse für das IPL zu ziehen.ErgebnisseHausärzte, Pflegefachpersonen und Sozialarbeiter sind in allen Ländern Teil des Versorgungsteams. Weitere Gesundheitsberufe werden für spezifische Interventionen einbezogen. Die Mitglieder des Versorgungsteams werden zumeist speziell qualifiziert, jedoch nicht im interprofessionellen Lernansatz. IPL Qualifikationen sollten mindestens folgende Themenbereiche umfassen: (1) frühe Diagnostik, (2) Versorgung nach Diagnosestellung, (3) effektives Versorgungsmanagement und (4) interprofessionelle Zusammenarbeit.DiskussionIPL sollte künftig für das Krankheitsbild Demenz ausgeweitet sowie weitreichend implementiert und evaluiert werden, um den Nutzen für die interprofessionelle Teamarbeit in der Praxis zu überprüfen. Dies ist die Basis, um länderspezifische IPL Bildungsprogramme zu entwickeln und bestehende Versorgungsleitlinien für eine verbesserte interprofessionelle Demenzversorgung im ambulanten Setting anzupassen.

Dementia care management in primary care@@@Versorgungsmanagement bei Demenz in der Primärversorgung: Current collaborative care models and the case for interprofessional education@@@Aktuelle kooperative Versorgungsmodelle und der Vorteil von interprofessionellem Lernen

BackgroundDementia is one of the most prevalent diseases in the older population. Various dementia care models have been developed to address patient’s healthcare needs. They can be described as “collaborative care” or “person-centered care”. Referring to the needs of the workforce working with persons with dementia, axa0key element is the use of interprofessional education (IPE).ObjectiveThe purpose of this article is to describe different international collaborative care models to define axa0minimum standard of healthcare professions for collaborative dementia care in primary care. This helps to identify requirements for IPE to optimize care of people with dementia and to support informal caregivers in the future.Material and methodsIn this article six dementia care models from 4 different countries (Germany, USA, UK and Netherlands) are described and compared regarding aims, interventions and healthcare professionals involved.ResultsCare teams are minimally comprised of general practitioners or primary care providers, nurses, and social workers. Additional healthcare disciplines may be involved for specific interventions. Mostly, care team members received specific training but such training did not necessarily incorporate the IPE approach. To ensure successful collaboration of professions, IPE training programs should at least consist of the following core topics: (1) early diagnosis, (2) postdiagnostic support, (3) advanced care planning for patients and caregivers and (4) effective collaborative care.ConclusionThe IPE programs for dementia should be expanded and must be widely implemented in order to assess the impact on collaborative practice. This study will provide the knowledge base for structuring IPE trainings developing educational agendas and adapting existing guidelines to improve collaborative dementia care in the future.ZusammenfassungHintergrundDemenz ist eine der häufigsten Erkrankungen im höheren Alter und erfordert innovative Konzepte zur Versorgung der Betroffenen. Um Gesundheitsberufe adäquat auf eine patientenzentrierte, interprofessionelle Demenzversorgung vorzubereiten hat sich das interprofessionelle Lernen (IPL) bewährt.Ziel der ArbeitZiel ist es, Versorgungskonzepte für Menschen mit Demenz zu beschreiben und einen Mindeststandard an Professionen zu definieren, die an der patientenzentrierten Demenzversorgung beteiligt werden sollten, sowie Erfordernisse an das IPL zu identifizieren.Material und MethodenSechs Versorgungskonzepte aus 4xa0Ländern (Deutschland, USA, Großbritannien, Niederlande) werden hinsichtlich ihrer Ziele, Interventionen und involvierten Gesundheitsfachberufe verglichen, um Rückschlüsse für das IPL zu ziehen.ErgebnisseHausärzte, Pflegefachpersonen und Sozialarbeiter sind in allen Ländern Teil des Versorgungsteams. Weitere Gesundheitsberufe werden für spezifische Interventionen einbezogen. Die Mitglieder des Versorgungsteams werden zumeist speziell qualifiziert, jedoch nicht im interprofessionellen Lernansatz. IPL Qualifikationen sollten mindestens folgende Themenbereiche umfassen: (1) frühe Diagnostik, (2) Versorgung nach Diagnosestellung, (3) effektives Versorgungsmanagement und (4) interprofessionelle Zusammenarbeit.DiskussionIPL sollte künftig für das Krankheitsbild Demenz ausgeweitet sowie weitreichend implementiert und evaluiert werden, um den Nutzen für die interprofessionelle Teamarbeit in der Praxis zu überprüfen. Dies ist die Basis, um länderspezifische IPL Bildungsprogramme zu entwickeln und bestehende Versorgungsleitlinien für eine verbesserte interprofessionelle Demenzversorgung im ambulanten Setting anzupassen.

REDUCING AND PREVENTING CAREGIVERS’ BURDEN: THE EFFICACY OF DEMENTIA CARE MANAGEMENT FOR INFORMAL DEMENTIA CAREGIVERS

Impairment (MCI) and even prior to MCI. How best to measure early functional changes, and whether self-report or informantreport are differentially sensitive remains under debate. In the present study we examined the utility of selfand informant-reported functional abilities in predicting risk of transitioning from normal cognition to MCI or transition from MCI to dementia. Methods:Participants of this study were part of a longitudinal, observational research cohort at the University of California, Davis Alzheimer’s Disease Center (ADC). Older adult participants had been diagnosed with normal cognition or MCI at study baseline, had an informant who could complete informant-based ratings, and had at least one follow-up visit (average of 3-4 years). Participants and informants each completed the Everyday Cognition (ECog) scale, a questionnaire-based instrument designed to measure early and mild everyday functional changes across six cognitively-relevant domains (Everyday Memory, Language, Visuospatial abilities, Planning, Organization and Divided Attention). Risk of progression to MCI or dementia by baseline ECog scores (and demographic data) was evaluated using Cox proportional hazard models. Results: Both selfand informant-reported functional limitations on the ECog (Total score) were associated with a significant increase in risk of diagnostic progression to MCI (HR1⁄42.3, CI 1⁄4 1.4-3.6 and HR1⁄42.0, CI 1⁄4 1.3-3.2, respectively). When examining risk of progression from MCI to dementia, again both selfand informant-reported baseline Total ECog (HR 1⁄41.8, 1.2-2.8 and HR1⁄44.2, 3.0-5.8, respectively) were significant predictors although informant-report was much more strongly associated with conversion. Even when controlling for baseline cognitive abilities, results both for predicting MCI and dementia remained similar. Conclusions: Findings indicate that early cognitively-based functional limitations have prognostic value and help identify older adults at risk for developing MCI or dementia. Both selfand informant-reported everyday function are useful in predicting the development of MCI, whereas later in the disease (the transition from MCI to dementia) informant-reported everyday function is most strongly predictive.