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Efficacy of Adherence to Guideline-Based Dementia Management

This study suggests that close adherence to guideline-based systematic disease-management approaches can benefit some patients.

Does adherence to a guideline-based management program for dementia improve care and health outcomes? To find out, researchers tracked 408 patients with dementia and their caregivers, randomly assigning 238 patient-caregiver pairs to the guideline-based disease-management intervention group, which included computerized case records, case managers who provided home and phone follow-up for each patient-caregiver pair, and health care provider education. The rest received standard care. Participants were tracked for an average of 22 months and assessed for their caregivers’ adherence to the 23 prescribed guidelines, for receipt of community resources, and for patient and caregiver health and quality-of-life (QOL) measures.

Significantly more patients in the intervention group than in the control group received care according to the guidelines. Secondary measures that were significantly better in the intervention group than in the control group were: patient health-related QOL; overall quality of patient care; caregivers’ perception of their caregiving quality; social support; and assistance from community agencies. Although patient QOL was higher in the intervention group than in the control group, caregiver QOL was not. Providers in both groups (mostly primary care physicians) had similarly high levels of treatment knowledge and attitudes.

Comment: This was a well-conducted study. Generalizability is limited because all subjects were well-educated, predominantly white, and from Southern California. Moreover, it is perhaps unsurprising that educating care managers about interventions supported by guidelines led to care that reflected the guidelines. However, provider participation in the intervention (educational sessions) was low, raising the question of just what the critical factors for success really were. Perhaps the computer program used to monitor offered services acted as a reminder to follow the guidelines.

— Danny George, BA, MSc, and Peter J. Whitehouse, MD, PhD

Mr. George is pursuing a PhD at Oxford University, Oxford, U.K. Dr. Whitehouse is Director, Integrative Studies, University Memory and Aging Center, Case Western Reserve University, Cleveland.

Published in Journal Watch Neurology February 27, 2007

Citation(s):

Vickrey BG et al. The effect of a disease management intervention on quality and outcomes of dementia care: A randomized, controlled trial. Ann Intern Med 2006 Nov 21; 145:713-26.

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