Impact of dementia care training on nurse care managers’ interactions with family caregivers
Tóm tắt
Nurse care managers (NCM) operate through care management programs to provide care for persons living with dementia (PLWD) and interact regularly with their family caregivers; however, most do not receive formal instruction in dementia care or caregiver support. CRESCENT (CaReEcoSystem primary Care Embedded demeNtia Treatment) is a telephone-based dementia care intervention adapted from the Care EcoSystem model designed to equip NCMs with these tools. For this study, we aimed to measure intervention fidelity and understand how dementia care training impacted NCMs’ provision of dementia care management services during interactions with caregivers of PLWD. We recruited 30 active NCMs; 15 were randomly assigned to receive training. For each nurse, we randomly selected 1–3 patients with a diagnosis of dementia in each nurse’s care during January-June 2021 for a total of 54 medical charts. To assess training uptake and fidelity, we identified documentation by NCMs of CRESCENT protocol implementation in the medical records. To understand how the training impacted the amount and types of dementia care management services provided in interactions with family caregivers, we compared attention to key dementia topic areas between trained NCMs (intervention) and untrained NCMs (control). Within the trained group only, community resources for PLWD, followed by safety, medication reconciliation, and advanced care planning topic areas were addressed most frequently (> 30%), while behavior management was addressed least frequently (12%). Trained NCMs were more likely to document addressing aspects of caregiver wellbeing (p = 0.03), community resources (p = 0.002), and identification of behavior (p = 0.03) and safety issues (p = 0.02) compared to those without training. There was no difference between groups in the amount of care coordination provided (p = 0.64). Results from this study demonstrate that focused dementia care training enriches care conversations in important topic areas for PLWD and family caregivers. Future research will clarify how best to sustain and optimize high quality dementia care in care management programs with special attention to the NCM-family caregiver relationship. NCT04556097.
Tài liệu tham khảo
Centers for Medicare & Medicaid Services. Accountable Care Organizations (ACOs) | CMS. www.cms.gov.2021. Available from: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO.
Hsu J, Price M, Vogeli C, Brand R, Chernew ME, Chaguturu SK, Weil E, Ferris TG. Bending The Spending Curve By Altering Care Delivery Patterns: The Role Of Care Management Within A Pioneer ACO. Health Aff (Millwood). 2017;36(5):876–884. https://doi.org/10.1377/hlthaff.2016.0922. PMID: 28461355.
Williams JN, Taber K, Huang W, Collins J, Cunningham R, McLaughlin K, Vogeli C, Wichmann L, Feldman CH. The impact of an Integrated Care Management Program on Acute Care Use and Outpatient appointment attendance among high-risk patients with Lupus. ACR Open Rheumatol. 2022;4(4):338–344. https://doi.org/10.1002/acr2.11391. Epub 2022 Jan 18. PMID: 35043589; PMCID: PMC8992467.
Taylor EF, Machta RM, Meyers DS, Genevro J, Peikes DN. Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers. Ann Fam Med. 2013;11(1):80–3. https://doi.org/10.1370/afm.1462. PMID: 23319510; PMCID: PMC3596023.
Richardson TJ, Lee SJ, Berg-Weger M, Grossberg GT. Caregiver health: health of caregivers of Alzheimer’s and other dementia patients. Curr Psychiatry Rep. 2013;15(7):367. https://doi.org/10.1007/s11920-013-0367-2. PMID: 23712718.
Dementia [Internet]. Who.int. [cited 2022 Sep 6]. Available from: https://www.who.int/news-room/fact-sheets/detail/dementia.
Bernstein A, Harrison KL, Dulaney S, Merrilees J, Bowhay A, Heunis J, Choi J, Feuer JE, Clark AM, Chiong W, Lee K, Braley TL, Bonasera SJ, Ritchie CS, Dohan D, Miller BL, Possin KL. The role of Care Navigators Working with People with Dementia and their caregivers. J Alzheimers Dis. 2019;71(1):45–55. https://doi.org/10.3233/JAD-180957. PMID: 31322558; PMCID: PMC7004209.
Kodner DL. Managing high-risk patients: the Mass General care management programme. Int J Integr Care. 2015;15:e017. https://doi.org/10.5334/ijic.2245. PMID: 26417211; PMCID: PMC4583073.
Evripidou M, Charalambous A, Middleton N, Papastavrou E. Nurses’ knowledge and attitudes about dementia care: systematic literature review. Perspect Psychiatr Care. 2019;55(1):48–60. https://doi.org/10.1111/ppc.12291. Epub 2018 May 15. PMID: 29766513.
Carroll C, Patterson M, Wood S, Booth A, Rick J, Balain S. A conceptual framework for implementation fidelity. Implement Sci. 2007;2:40. https://doi.org/10.1186/1748-5908-2-40. PMID: 18053122; PMCID: PMC2213686.
Possin KL, Merrilees JJ, Dulaney S, Bonasera SJ, Chiong W, Lee K, Hooper SM, Allen IE, Braley T, Bernstein A, Rosa TD, Harrison K, Begert-Hellings H, Kornak J, Kahn JG, Naasan G, Lanata S, Clark AM, Chodos A, Gearhart R, Ritchie C, Miller BL. Effect of Collaborative Dementia Care via Telephone and Internet on Quality of Life, Caregiver Well-being, and Health Care Use: The Care Ecosystem Randomized Clinical Trial. JAMA Intern Med. 2019;179(12):1658-1667. https://doi.org/10.1001/jamainternmed.2019.4101. PMID: 31566651; PMCID: PMC6777227.
Lee L, Hillier LM, Harvey D. Integrating community services into primary care: improving the quality of dementia care. Neurodegener Dis Manag. 2014;4(1):11–21. https://doi.org/10.2217/nmt.13.72. PMID: 24640975.
Thyrian JR, Eichler T, Hertel J, Wucherer D, Dreier A, Michalowsky B, Killimann I, Teipel S, Hoffmann W. Burden of Behavioral and Psychiatric Symptoms in People Screened Positive for Dementia in Primary Care: Results of the DelpHi-Study. J Alzheimers Dis. 2015;46(2):451-9. https://doi.org/10.3233/JAD-143114. PMID: 25765916.
Feast A, Orrell M, Charlesworth G, Melunsky N, Poland F, Moniz-Cook E. Behavioural and psychological symptoms in dementia and the challenges for family carers: systematic review. Br J Psychiatry. 2016;208(5):429–34. https://doi.org/10.1192/bjp.bp.114.153684.
Tulsky JA. Beyond advance directives: importance of communication skills at the end of life. JAMA. 2005;294(3):359 – 65. https://doi.org/10.1001/jama.294.3.359. PMID: 16030281.
Etters L, Goodall D, Harrison BE. Caregiver burden among dementia patient caregivers: a review of the literature. J Am Acad Nurse Pract. 2008;20(8):423-8. https://doi.org/10.1111/j.1745-7599.2008.00342.x. PMID: 18786017.
Merrilees JJ, Bernstein A, Dulaney S, Heunis J, Walker R, Rah E, Choi J, Gawlas K, Carroll S, Ong P, Feuer J, Braley T, Clark AM, Lee K, Chiong W, Bonasera SJ, Miller BL, Possin KL. The Care Ecosystem: promoting self-efficacy among dementia family caregivers. Dement (London). 2020;19(6):1955–73. https://doi.org/10.1177/1471301218814121. Epub 2018 Nov 29. PMID: 30497302; PMCID: PMC6541533.
Possin KL, Merrilees J, Bonasera SJ, Bernstein A, Chiong W, Lee K, Wilson L, Hooper SM, Dulaney S, Braley T, Laohavanich S, Feuer JE, Clark AM, Schaffer MW, Schenk AK, Heunis J, Ong P, Cook KM, Bowhay AD, Gearhart R, Chodos A, Naasan G, Bindman AB, Dohan D, Ritchie C, Miller BL. Development of an adaptive, personalized, and scalable dementia care program: Early findings from the Care Ecosystem. PLoS Med. 2017;14:e1002260. doi: 10.1371/journal.pmed.1002260. PubMed Central PMCID: PMC5360211.
Heintz H, Monette P, Epstein-Lubow G, Smith L, Rowlett S, Forester BP. Emerging Collaborative Care Models for Dementia Care in the primary care setting: a narrative review. Am J Geriatr Psychiatry. 2020;28(3):320–330. https://doi.org/10.1016/j.jagp.2019.07.015. Epub 2019 Aug 2. PMID: 31466897.
Su HF, Koo M, Lee WL, Sung HC, Lee RP, Liu WI. A dementia care training using mobile e-learning with mentoring support for home care workers: a controlled study. BMC Geriatr. 2021 Feb 16;21(1):126. doi: https://doi.org/10.1186/s12877-021-02075-3. PMID: 33593287; PMCID: PMC7885550.
Lee L, Hillier LM, Patel T, Weston WW. A Decade of Dementia Care Training: Learning Needs of Primary Care Clinicians. J Contin Educ Health Prof. 2020;40(2):131–140. https://doi.org/10.1097/CEH.0000000000000288. PMID: 32175933.
Gkioka M, Schneider J, Kruse A, Tsolaki M, Moraitou D, Teichmann B. Evaluation and effectiveness of Dementia Staff Training Programs in General Hospital Settings: a narrative synthesis with Holton’s three-level Model Applied. J Alzheimers Dis. 2020;78(3):1089–108. https://doi.org/10.3233/JAD-200741. PMID: 33104033; PMCID: PMC7739966.