PDF(Pubmed)
Abstract：
UNASSIGNED: The increasing number of people living with dementia and its burden on families and systems particularly in low- and middle-income countries require comprehensive and efficient post-diagnostic management. This study aimed to explore the acceptability and efficacy of a multi-professional case management and psychoeducation model (North Macedonia Interprofessional Dementia Care, or NOMAD) delivered by mobile teams for people with dementia and their caregivers in North Macedonia.
UNASSIGNED: We conducted a two-arm randomized controlled trial comparing the intervention with treatment as usual. Participants were recruited from 12 general practitioner (GP) offices in the Skopje region. The NOMAD intervention included the delivery of a personalized care plan over four home visits to dyads of people with dementia and their caregivers by a team including a dementia nurse and a social worker, in collaboration with GPs and dementia experts, and the introduction of a caregiver manual. We assessed caregivers\' depressive symptoms, burden, and quality of life and the neuropsychiatric symptoms, daily living activities, and service utilization of people with dementia at baseline and follow-up; we also assessed the acceptability of the intervention by analyzing case notes and attendance rates.
UNASSIGNED: One hundred and twenty dyads were recruited and randomized to either the control (n = 60) or the intervention group (n = 60). At follow-up, caregivers in the intervention group had, on average, scores that were 2.69 lower for depressive symptoms (95% CI [-4.75, -0.62], p = 0.012), and people with dementia had, on average, 11.32 fewer neuropsychiatric symptoms (95% CI [-19.74, -2.90], p = 0.009) and used, on average, 1.81 fewer healthcare services (95% CI [-2.61, -1.00], p < 0.001) compared to the control group. The completion of the home visits was 100%, but the intervention\'s acceptability was underpinned by relationship building, GP competencies, and resources to support families with dementia. There were no differences in the caregivers\' quality of life and burden levels or daily living activities in people with dementia. NOMAD is the first case management, non-pharmacological, and multi-professional intervention tested in North Macedonia.
UNASSIGNED: The trial showed that it is effective in reducing caregivers\' depressive symptoms and neuropsychiatric symptoms in people with dementia and the burden on health and social care services, and it is acceptable for families. Implementing NOMAD in practice will require building primary care capacity and recognizing dementia as a national priority.
UNASSIGNED: We conducted a two-arm randomized controlled trial comparing the intervention with treatment as usual. Participants were recruited from 12 general practitioner (GP) offices in the Skopje region. The NOMAD intervention included the delivery of a personalized care plan over four home visits to dyads of people with dementia and their caregivers by a team including a dementia nurse and a social worker, in collaboration with GPs and dementia experts, and the introduction of a caregiver manual. We assessed caregivers\' depressive symptoms, burden, and quality of life and the neuropsychiatric symptoms, daily living activities, and service utilization of people with dementia at baseline and follow-up; we also assessed the acceptability of the intervention by analyzing case notes and attendance rates.
UNASSIGNED: One hundred and twenty dyads were recruited and randomized to either the control (n = 60) or the intervention group (n = 60). At follow-up, caregivers in the intervention group had, on average, scores that were 2.69 lower for depressive symptoms (95% CI [-4.75, -0.62], p = 0.012), and people with dementia had, on average, 11.32 fewer neuropsychiatric symptoms (95% CI [-19.74, -2.90], p = 0.009) and used, on average, 1.81 fewer healthcare services (95% CI [-2.61, -1.00], p < 0.001) compared to the control group. The completion of the home visits was 100%, but the intervention\'s acceptability was underpinned by relationship building, GP competencies, and resources to support families with dementia. There were no differences in the caregivers\' quality of life and burden levels or daily living activities in people with dementia. NOMAD is the first case management, non-pharmacological, and multi-professional intervention tested in North Macedonia.
UNASSIGNED: The trial showed that it is effective in reducing caregivers\' depressive symptoms and neuropsychiatric symptoms in people with dementia and the burden on health and social care services, and it is acceptable for families. Implementing NOMAD in practice will require building primary care capacity and recognizing dementia as a national priority.
摘要：
越来越多的痴呆症患者及其对家庭和系统的负担，特别是在低收入和中等收入国家，需要全面有效的诊断后管理。本研究旨在探讨多专业病例管理和心理教育模式的可接受性和有效性（北马其顿跨专业痴呆症护理，或NOMAD）由移动团队为北马其顿的痴呆症患者及其护理人员提供服务。
■我们进行了一项双臂随机对照试验，将干预措施与常规治疗进行比较。参与者来自斯科普里地区的12个全科医生（GP）办公室。NOMAD干预措施包括通过包括痴呆症护士和社会工作者在内的团队对痴呆症患者及其护理人员的四次家访提供个性化护理计划。与全科医生和痴呆症专家合作，以及介绍护理人员手册。我们评估了护理人员的抑郁症状，负担，生活质量和神经精神症状，日常生活活动,和痴呆患者在基线和随访时的服务利用率;我们还通过分析病例记录和出诊率评估了干预措施的可接受性.
■招募了120个二元组，并随机分为对照组（n=60）或干预组（n=60）。在后续行动中,干预组的护理人员有，平均而言,抑郁症状得分低2.69分（95%CI[-4.75，-0.62]，p=0.012),痴呆症患者，平均而言,神经精神症状减少11.32（95%CI[-19.74，-2.90]，p=0.009)和使用，平均而言,医疗服务减少1.81（95%CI[-2.61，-1.00]，p<0.001）与对照组相比。完成了100%的家访,但是这种干预的可接受性是由建立关系所支撑的，GP能力，以及支持痴呆症家庭的资源。痴呆症患者的护理人员的生活质量和负担水平或日常生活活动没有差异。NOMAD是第一个案例管理，非药理学，以及在北马其顿进行的多专业干预测试。
■该试验表明，它可以有效减少痴呆症患者的看护者的抑郁症状和神经精神症状，并减轻健康和社会护理服务的负担，这是家庭可以接受的。在实践中实施NOMAD将需要建立初级保健能力，并将痴呆症视为国家优先事项。
■我们进行了一项双臂随机对照试验，将干预措施与常规治疗进行比较。参与者来自斯科普里地区的12个全科医生（GP）办公室。NOMAD干预措施包括通过包括痴呆症护士和社会工作者在内的团队对痴呆症患者及其护理人员的四次家访提供个性化护理计划。与全科医生和痴呆症专家合作，以及介绍护理人员手册。我们评估了护理人员的抑郁症状，负担，生活质量和神经精神症状，日常生活活动,和痴呆患者在基线和随访时的服务利用率;我们还通过分析病例记录和出诊率评估了干预措施的可接受性.
■招募了120个二元组，并随机分为对照组（n=60）或干预组（n=60）。在后续行动中,干预组的护理人员有，平均而言,抑郁症状得分低2.69分（95%CI[-4.75，-0.62]，p=0.012),痴呆症患者，平均而言,神经精神症状减少11.32（95%CI[-19.74，-2.90]，p=0.009)和使用，平均而言,医疗服务减少1.81（95%CI[-2.61，-1.00]，p<0.001）与对照组相比。完成了100%的家访,但是这种干预的可接受性是由建立关系所支撑的，GP能力，以及支持痴呆症家庭的资源。痴呆症患者的护理人员的生活质量和负担水平或日常生活活动没有差异。NOMAD是第一个案例管理，非药理学，以及在北马其顿进行的多专业干预测试。
■该试验表明，它可以有效减少痴呆症患者的看护者的抑郁症状和神经精神症状，并减轻健康和社会护理服务的负担，这是家庭可以接受的。在实践中实施NOMAD将需要建立初级保健能力，并将痴呆症视为国家优先事项。
