Systematic Care for Informal Caregivers of Dementia Patients: An Efficient Approach?

Study Description

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Brief Summary:

The objective is to ascertain the potential efficiency of a systematic care programme for caregivers of dementia patients. The research questions are:

• What are the costs and benefits of the Systematic Care Programme - Dementia (SCP-Dementia), as compared with usual care?
• What are the effects on the quality of life of patients and informal caregivers (spouse, relative), as compared with usual care?

Condition or disease	Intervention/treatment	Phase
Dementia, Vascular; Dementia; Alzheimer Disease; Lewy Body Disease	Behavioral: Diagnosis of caregivers' problems; Behavioral: Professional service: treatment of problems by counseling or practical support	Not Applicable

Detailed Description:

A major challenge for future health care is the care for dementia patients and their informal caregivers. In usual care, the problems of caregivers often remain invisible until a crisis occurs. This inhibition is partly the result of informal caregivers paying scant attention to their own problems. Another reason is that professionals may not know how to support informal caregivers pro-actively (Van Hout et al., 2000). Therefore the family support programme (Bengtson, 1985: Vernooij et al., 2000) has been transformed into a Systematic Care Programme (SCP-Dementia). The reasons for choosing and studying the efficiency of this programme are the potential to diagnose and treat problems systematically, to cover a wide range of individual problems, its flexibility in connecting interventions to these problems, its suitability for pro-activity and the positive effects of the programme found in our previous study (Vernooij et al., 2000). To study its efficiency a cluster randomised controlled trial design will be used. Randomisation will take place in each of three participating regions. Professionals in the ambulatory mental health care services (psychologists and social psychiatric nurses) will be randomly assigned to either the intervention group or the control group before the recruitment of patients and informal caregivers. The study population consists of pairs of patients and their informal caregivers visiting the ambulatory mental health care service for the first time. The intervention is the training in SCP-Dementia and its subsequent use. SCP-Dementia consists of an assessment of the caregiver's sense of competence and suggestions on how to deal with deficiencies in competence. The follow-up period is one year. The primary outcome is patients´ admissions to nursing homes or residential homes. The secondary outcome is quality of life. Caregivers´ quality of life is assessed by sense of competence (SCQ), depression (CES-D) and physical quality of life (EuroQol). Patients´ quality of life by behavioral problems is assessed by the NPI-Q and the QOL-AD-Scale. The difference in proposed effect was based on previous research in which 14% of the patients in the intervention group and 28% in the control group were institutionalized (Vernooij-Dassen, 1993;1995). To detect a 50% reduction in institutionalization rates with 80% power at the two sided significance level of 0.05, 132 patient-caregiver dyads would be needed for each of the intervention and control arm. We inflated this sample size by a design effect of 1.15 to 152 dyads per trial arm to allow for correlation of dyads within the same cluster (i.e. professional), assuming an average cluster size of four and an intracluster correlation coefficient of 0.05. Assuming a 25% dropout rate of patient-caregiver dyads, the study needed an final enrolment of 190 dyads in each trial arm. The economic evaluation is a cost-effectiveness analysis regarding a societal perspective. In the economic evaluation both costs and effects will be monetarized and consequently will result in a net benefit.

Study Design

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Study Type :	Interventional (Clinical Trial)
Actual Enrollment :	304 participants
Allocation:	Randomized
Intervention Model:	Factorial Assignment
Masking:	Single (Outcomes Assessor)
Primary Purpose:	Diagnostic
Official Title:	Systematic Care for Informal Caregivers of Dementia Patients: An Efficient Approach?
Study Start Date :	June 2005
Actual Primary Completion Date :	February 2006
Actual Study Completion Date :	February 2006

Arms and Interventions

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Outcome Measures

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Study Description Study Design Arms and Interventions Outcome Measures Eligibility Criteria Contacts and Locations More Information

Primary Outcome Measures :

1. Patients admissions to nursing homes or residential homes. This outcome is the most important input for the estimation of cost differences between the intervention group and controls. [ Time Frame: after one year follow-up period ]

Secondary Outcome Measures :

1. Secondary outcome for cost estimation is patient and caregiver related costs estimated by "Resource Utilisation in Dementia" (RUD), including time spent on caregiving, use of health care services by caregivers and patients and additional productivity.

Eligibility Criteria

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Ages Eligible for Study:	Child, Adult, Senior
Sexes Eligible for Study:	All
Accepts Healthy Volunteers:	Yes

Criteria

Inclusion Criteria:

• Pairs of patients and their informal caregivers visiting the ambulatory mental health care service for the first time and treated by the professionals participating in the study

Exclusion Criteria:

• Patients and caregivers not mastering the Dutch language

Contacts and Locations

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Locations

Netherlands
Radboud University Nijmegen Medical Centre
Nijmegen, Netherlands

Sponsors and Collaborators

Radboud University

ZonMw: The Netherlands Organisation for Health Research and Development

Investigators

Principal Investigator:	Myrra M Vernooij-Dassen, PhD	Coordinator Alzheimer Centre UMC Nijmegen

More Information

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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Spijker A, Verhey F, Graff M, Grol R, Adang E, Wollersheim H, Vernooij-Dassen M. Systematic care for caregivers of people with dementia in the ambulatory mental health service: designing a multicentre, cluster, randomized, controlled trial. BMC Geriatr. 2009 Jun 7;9:21. doi: 10.1186/1471-2318-9-21.

Responsible Party:	Prof.dr. M. Vernooij-Dassen, Scientific Institute for Quality of Healthcare (IQ Healthcare) and Alzheimer Centre Radboud University, Radboud University Nijmegen Medical Centre
ClinicalTrials.gov Identifier:	NCT00147693 History of Changes
Other Study ID Numbers:	SCAD; ZonMw grant no 945-04-152
First Posted:	September 7, 2005
Last Update Posted:	October 1, 2008
Last Verified:	September 2008

Keywords provided by Radboud University:

Dementia; Alzheimer Disease; Lewy-Body; Cost*; Community (dwelling)	Caregiver(s); Institutionalization; Quality of life; Randomized Control Trail; Vascular dementia

Additional relevant MeSH terms:

Dementia; Dementia, Vascular; Alzheimer Disease; Lewy Body Disease; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Tauopathies; Neurodegenerative Diseases; Neurocognitive Disorders; Mental Disorders	Parkinsonian Disorders; Basal Ganglia Diseases; Movement Disorders; Cerebrovascular Disorders; Intracranial Arteriosclerosis; Intracranial Arterial Diseases; Leukoencephalopathies; Arteriosclerosis; Arterial Occlusive Diseases; Vascular Diseases; Cardiovascular Diseases