To evaluate the effectiveness of the Describe, Investigate, Create, Evaluate (DICE) method™ to improve the care for NPS in AD at the memory clinic.
We enrolled sixty community-dwelling people with mild cognitive impairment or AD dementia and NPS across six Dutch memory clinics with their caregivers. The first wave underwent care as usual (n = 36) and the second wave underwent the DICE method (n = 24). Outcomes were quality of life (QoL), caregiver burden, NPS severity, NPS-related distress, competence managing NPS, and psychotropic drug use. Reliable change index was calculated to identify responders to the intervention. A cost-effectiveness analysis was performed and semi-structured interviews with a subsample of the intervention group (n = 12).
The DICE method did not improve any outcomes over time compared to care as usual. Half of the participants of the intervention group (52%) were identified as responders and showed more NPS and NPS-related distress at baseline compared to non-responders. Interviews revealed substantial heterogeneity among participants regarding NPS-related distress, caregiver burden, and availability of social support. The intervention did not lead to significant gains in quality-adjusted life years and well-being years nor clear savings in health care and societal costs.
The DICE method showed no benefits at group-level, but individuals with high levels of NPS and NPS-related distress may benefit from this intervention.
目的:为了评估描述的有效性,调查,创建,评估(DICE)方法™以改善记忆诊所对AD中NPS的护理。
方法:我们在6个荷兰记忆诊所与他们的照顾者一起招募了60名患有轻度认知障碍或AD痴呆和NPS的社区居民。第一波照常接受护理(n=36),第二波接受DICE方法(n=24)。结果是生活质量(QoL),照顾者的负担,NPS严重性,与核动力源有关的痛苦,能力管理NPS,和精神药物的使用。计算可靠的变化指数以识别干预的响应者。对干预组(n=12)的子样本进行了成本效益分析和半结构化访谈。
结果:与常规护理相比,DICE方法没有改善任何结局。干预组的一半参与者(52%)被确定为反应者,与无反应者相比,基线时显示出更多的NPS和NPS相关的痛苦。访谈显示,在与NPS相关的困扰方面,参与者之间存在很大的异质性,照顾者的负担,和社会支持的可用性。干预措施并未导致质量调整后的生命年和福祉年的显着提高,也没有明显节省医疗保健和社会成本。
结论:DICE方法在组水平上没有益处,但NPS水平高和NPS相关痛苦的个体可能会从这种干预中获益.