Effects of general practitioner training and family support services on the care of home-dwelling dementia patients - Results of a controlled cluster-randomized study
1 Psychiatric University Clinic Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany
2 Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
3 Federal Association of the AOK, Rosenthalerstr. 31, 10178 Berlin, Germany
4 AOK Bavaria - Health insurer, Stromerstraße 5, 90443 Nürnberg, Germany
5 Pfizer Deutschland GmbH, Linkstrasse 10, 10785 Berlin, Germany
6 HealthEcon AG, Basel, Switzerland
7 Eisai GmbH, Frankfurt, Germany
BMC Health Services Research 2010, 10:314 doi:10.1186/1472-6963-10-314Published: 18 November 2010
More than 90% of dementia patients are cared for by their general practitioners, who are decisively involved in the diagnosis, therapy and recommendation of support services. Objective: To test whether special training of general practitioners alters the care of dementia patients through their systematic recommendation of caregiver counseling and support groups.
129 general practitioners enrolled 390 dementia patients and their informal caregivers in a prospective, three-arm cluster-randomized 2-year study. Arm A constituted usual care, in Arm B and C support groups and caregiver counseling (in Arm B one year after baseline, in Arm C at baseline) were recommended by the general practitioners. The general practitioners received arm-specific training. Diagnostic and therapeutic behavior of physicians was recorded at baseline. Informal caregivers were questioned in follow-up after 2 years about the utilization of support services.
The diagnostic behavior of the general practitioners conforms to relevant guidelines. The procedure in newly-diagnosed patients does not differ from previously diagnosed patients with the exception of the rate of referral to a specialist. About one-third of the newly-diagnosed dementia patients are given an anti-dementia drug. The utilization of support groups and counseling increased five- and fourfold, respectively. Utilization of other support services remained low (< 10%), with the exception of home nursing and institutional short-term nursing.
Trained general practitioners usually act in conformity with guidelines with respect to diagnosing dementia, and partly in conformity with the guidelines with respect to recommended drug therapy. Recommendations of support services for informal caregivers by the general practitioner are successful. They result in a marked increase in the utilization rate for the recommended services compared to offers which are not recommended by the general practitioner.