Πέμπτη, 5 Ιανουαρίου 2017

Family Physician–Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review

ABSTRACT
PURPOSE Dementia case management (CM) in primary care is a complex intervention
aimed at identifying the various needs of patients with dementia and
their caregivers, as well as the organization and coordination of care. A key element
of CM is the collaboration of family physicians with case managers. We
conducted a systematic mixed-studies review to identify the needs of the patientcaregiver
dyad and the effects of CM.
METHODS We searched MEDLINE, PsycINFO, and EMBASE up to October 2014,
regardless of the study design. Our main outcomes were needs of patients and
their caregivers and the effects of CM on these needs. We used narrative syntheses
to develop a taxonomy of needs and to describe the effects of CM on those
needs. We used meta-analysis to calculate the prevalence of needs and the standardized
mean differences to evaluate the effects of CM on the needs identified.
RESULTS Fifty-four studies were included. We identified needs of the patientcaregiver
dyad and needs of the patient and caregiver individually. CM
addressed the majority of the identified needs. Still, some very common needs
(eg, early diagnosis) are overlooked while other needs (eg, education on the disease)
are well addressed. Fully establishing the value of CM is difficult given the
small number of studies of CM in primary care.
CONCLUSIONS There is good evidence that case managers, in collaboration with
family physicians, have a pivotal role in addressing the needs of the patientcaregiver
dyad.
Ann Fam Med 2016;14:166-177. doi: 10.1370/afm.1898.