DemStepCare: Risikostratifizierte Unterstützung der ambulanten Demenzversorgung – Bewertung aus hausärztlicher Perspektive

Zusammenfassung

Ziel Das Innovationsfondsprojekt DemStepCare zielte darauf, die multiprofessionelle ambulante Versorgung durch Case Management, Risikostratifizierung und Krisenambulanz zu optimieren. Vorgestellt werden die Evaluationsergebnisse aus hausärztlicher Perspektive.

Methodik Zu drei Zeitpunkten erfolgte eine quantitative Befragung der Hausärzt*innen hinsichtlich Akzeptanz, Nutzenbewertung und Demenzsensibilität. Ergänzend wurden qualitative Interviews geführt.

Ergebnisse Es zeigte sich eine hohe Zufriedenheit mit dem Gesamtprojekt. Wahrgenommen wurden Mehrwerte und Entlastungsfaktoren und durch die Kooperation mit dem Case Management eine effektivere und stabilere Demenzversorgung. Die Hausärzt*innen gaben eine gestiegene subjektive Kompetenz bei Diagnostik und Krankheitsmanagement an.

Schlussfolgerung Die Befunde bestätigen aus hausärztlicher Sicht Nutzen und Effektivität von DemStepCare.

Abstract

Objective The innovation fund project DemStepCare aimed to optimize multi-professional care through case management, risk stratification, and crisis outpatient clinic. Here, the evaluation results from the perspective of the general practitioners are presented.

Methods A quantitative survey was carried out at three time points regarding acceptance, benefit assessment and sensitivity to dementia of the general practitioners. In addition, qualitative interviews were conducted.

Results Satisfaction with the overall project was high. Added value and relief factors were perceived and more effective and stable dementia care was achieved through collaboration with case management. Physicians reported increased subjective competence in diagnostics and disease management.

Conclusions The results confirm the benefit and effectiveness of DemStepCare from general practitioner's perspective.

Schlüsselwörter

Demenzversorgung - Demenzdiagnostik - Risikostratifizierung - Case Management - Krisenprävention

Keywords

dementia care - dementia diagnostics - risk stratification - case management - crisis intervention

• Literatur

• 1 Connolly A, Gaehl E, Martin H. et al. Underdiagnosis of dementia in primary care: variations in the observed prevalence and comparisons to the expected prevalence. Aging Ment Health 2011; 15: 978-984
• 2 Eichler T, Thyrian JR, Hertel J. et al. Rates of formal diagnosis in people screened positive for dementia in primary care: results of the DelpHi-Trial. J Alzheimers Dis 2014; 42: 451-458
• 3 Pentzek M, Wollny A, Wiese B. et al. Apart from nihilism and stigma: what influences general practitioners' accuracy in identifying incident dementia?. Am J Geriatr Psychiatry 2009; 17: 965-975
• 4 Mansfield E, Noble N, Sanson-Fisher R. et al. Primary Care Physicians' Perceived Barriers to Optimal Dementia Care: A Systematic Review. Gerontologist 2019; 59: e697-e708
• 5 Pentzek M, Vollmar HC, Wilm S. et al. Putting dementia awareness into general practice : The CADIF approach. Z Gerontol Geriatr 2017; 50: 44-47
• 6 Wangler J, Fellgiebel A, Jansky M. Hausärztliche Demenzdiagnostik – Einstellungen, Vorgehensweisen und Herausforderungen von Hausärzten in Rheinland-Pfalz. Dtsch Med Wochenschr 2018; 143: e165-e171
• 7 Wangler J, Jansky M. Factors influencing general practitioners' perception of and attitude towards dementia diagnostics and care-results of a survey among primary care physicians in Germany. Wien Med Wochenschr 2021; 171: 165-173
• 8 Lehmann J, Michalowsky B, Kaczynski A. et al. The Impact of Hospitalization on Readmission, Institutionalization, and Mortality of People with Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2018; 64: 735-749
• 9 Wolf D, Rhein C, Geschke K. et al. Preventable hospitalizations among older patients with cognitive impairments and dementia. Int Psychogeriatr 2019; 31: 383-391
• 10 Thyrian JR, Hertel J, Wucherer D. et al. Effectiveness and Safety of Dementia Care Management in Primary Care: A Randomized Clinical Trial. JAMA Psychiatry 2017; 74: 996-1004
• 11 Callahan CM, Boustani MA, Unverzagt FW. et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. JAMA 2006; 295: 2148-2157
• 12 Samus QM, Johnston D, Black BS. et al. A Multidimensional Home-Based Care Coordination Intervention for Elders with Memory Disorders: The Maximizing Independence at Home (MIND) Pilot Randomized Trial. Am J Geriatr Psychiatry 2014; 22: 398-414
• 13 Chien WT, Lee IYM. Randomized controlled trial of a dementia care programme for families of home-resided older people with dementia. J Adv Nurs 2011; 67: 774-787
• 14 Jansen APD, van Hout HPJ, Nijpels G. et al. Effectiveness of case management among older adults with early symptoms of dementia and their primary informal caregivers: A randomized clinical trial. Int J Nurs Stud 2011; 48: 933-943
• 15 Lam LCW, Lee JSW, Chung JCC. et al. A randomized controlled trial to examine the effectiveness of case management model for community dwelling older persons with mild dementia in Hong Kong. Int J Geriatr Psychiatry 2010; 25: 395-402
• 16 Xiao LD, De Bellis A, Kyriazopoulos H. et al. The Effect of a Personalized Dementia Care Intervention for Caregivers From Australian Minority Groups. Am J Alzheimers Dis Other Demen 2016; 31: 57-67
• 17 Bass DM, Judge KS, Maslow K. et al. Impact of the care coordination program “Partners in Dementia Care” on veterans' hospital admissions and emergency department visits. Alzheimers Dement (N Y) 2015; 1: 13-22
• 18 Delgadillo J, Ali S, Fleck K. et al. Stratified Care vs Stepped Care for Depression: A Cluster Randomized Clinical Trial. JAMA Psychiatry 2022; 79: 101-108
• 19 Hingorani AD, Windt DAvd, Riley RD. et al. Prognosis research strategy (PROGRESS) 4: Stratified medicine research. BMJ 2013; 346: e5793
• 20 Bablok I, Binder H, Stelzer D. et al. Primary dementia care based on the individual needs of the patient: study protocol of the cluster randomized controlled trial, DemStepCare. BMC Geriatr 2021; 21: 222
• 21 Wangler J, Geschke K, Wuttke-Linnemann A. et al. Prävention von demenzbedingten Versorgungskrisen im hausarztbasierten Setting – das Projekt DemStepCare als innovative Versorgungsform. Präv Gesundheitsf 2023; 18: 145-151
• 22 Wangler J, Jansky M. Dementia diagnostics in general practitioner care: Do general practitioners have reservations? The findings of a qualitative study in Germany. Wien Med Wochenschr 2020; 170: 230-237
• 23 Thyrian JR, Fiß T, Dreier A. et al. Life- and person-centred help in Mecklenburg-Western Pomerania, Germany (DelpHi): study protocol for a randomised controlled trial. Trials 2012; 13: 56
• 24 Mayring P. Qualitative Inhaltsanalyse: Grundlagen und Techniken / Philipp Mayring. Weinheim: Basel: Beltz; 2015
• 25 Thyrian JR, Eichler T, Pooch A. et al. Systematic, early identification of dementia and dementia care management are highly appreciated by general physicians in primary care – results within a cluster-randomized-controlled trial (DelpHi). J Multidiscip Healthc 2016; 9: 183-190
• 26 Wangler J, Jansky M. Innovationsfonds und Primärversorgung – Welche Erwartungen und Erfahrungen vertreten Hausärzt*innen in Bezug auf die Teilnahme an innovativen Versorgungsmodellen?. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2022; 65: 697-705
• 27 Fletcher B, Gheorghe A, Moore D. et al. Improving the recruitment activity of clinicians in randomised controlled trials: a systematic review. BMJ Open 2012; 2: e000496
• 28 Dreier-Wolfgramm A, Michalowsky B, Austrom MG. et al. Dementia care management in primary care : Current collaborative care models and the case for interprofessional education. Z Gerontol Geriatr 2017; 50: 68-77
• 29 Virnau L, Braesigk A, Deutsch T. et al. General practitioners' willingness to participate in research networks in Germany. Scand J Prim Health Care 2022; 40: 237-245