The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components
Abstract Background Interventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to evaluate the effectiveness of community-based care coordinating interventions on health outcomes and investigate...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2017-11-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-017-2677-2 |
| _version_ | 1819015917400489984 |
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| author | Amy Backhouse Obioha C. Ukoumunne David A. Richards Rose McCabe Ross Watkins Chris Dickens |
| author_facet | Amy Backhouse Obioha C. Ukoumunne David A. Richards Rose McCabe Ross Watkins Chris Dickens |
| author_sort | Amy Backhouse |
| collection | DOAJ |
| description | Abstract Background Interventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to evaluate the effectiveness of community-based care coordinating interventions on health outcomes and investigate whether specific components of interventions influence their effects. Methods We searched four databases from inception to April 2017: Medline, The Cochrane Library, EMBASE and PsycINFO. This was aided by a search of four grey literature databases, and backward and forward citation tracking of included papers. Title and abstract screening was followed by a full text screen by two independent reviewers, and quality was assessed using the CASP appraisal tool. We then conducted meta-analyses and subgroup analyses. Results A total of 14 randomised controlled trials (RCTs) involving 10,372 participants were included in the review. Altogether we carried out 12 meta-analyses and 19 subgroup analyses. Meta-analyses found coordinating interventions showed a statistically significant improvement in both patient behaviour measured using the Neuropsychiatric Inventory (NPI) (mean difference (MD) = −9.5; 95% confidence interval (CI): −18.1 to −1.0; p = 0.03; number of studies (n) = 4; I2 = 88%) and caregiver burden (standardised mean difference (SMD) = −0.54; 95% CI: -1.01 to −0.07; p = 0.02; n = 5, I2 = 92%) compared to the control group. Subgroup analyses found interventions using a case manager with a nursing background showed a greater positive effect on caregiver quality of life than those that used case managers from other professional backgrounds (SMD = 0.94 versus 0.03, respectively; p < 0.001). Interventions that did not provide supervision for the case managers showed greater effectiveness for reducing the percentage of patients that are institutionalised compared to those that provided supervision (odds ratio (OR) = 0.27 versus 0.96 respectively; p = 0.02). There was little evidence of effects on other outcomes, or that other intervention components modify the intervention effects. Conclusion Results show that coordinating interventions in dementia care has a positive impact on some outcomes, namely patient behaviour and caregiver burden, but the evidence is inconsistent and results were not strong enough to draw definitive conclusions on general effectiveness. With the rising prevalence of dementia, effective complex interventions will be necessary to provide high quality and effective care for patients, and facilitate collaboration of health, social and third sector services. |
| first_indexed | 2024-12-21T02:39:21Z |
| format | Article |
| id | doaj.art-9778a68289624ea19423a66a804358c1 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-21T02:39:21Z |
| publishDate | 2017-11-01 |
| publisher | BMC |
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| series | BMC Health Services Research |
| spelling | doaj.art-9778a68289624ea19423a66a804358c12022-12-21T19:18:43ZengBMCBMC Health Services Research1472-69632017-11-0117111010.1186/s12913-017-2677-2The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention componentsAmy Backhouse0Obioha C. Ukoumunne1David A. Richards2Rose McCabe3Ross Watkins4Chris Dickens5University of Exeter Medical School, College House, St Luke’s CampusUniversity of Exeter Medical School, College House, St Luke’s CampusUniversity of Exeter Medical School, College House, St Luke’s CampusUniversity of Exeter Medical School, College House, St Luke’s CampusUniversity of Exeter Medical School, College House, St Luke’s CampusUniversity of Exeter Medical School, College House, St Luke’s CampusAbstract Background Interventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to evaluate the effectiveness of community-based care coordinating interventions on health outcomes and investigate whether specific components of interventions influence their effects. Methods We searched four databases from inception to April 2017: Medline, The Cochrane Library, EMBASE and PsycINFO. This was aided by a search of four grey literature databases, and backward and forward citation tracking of included papers. Title and abstract screening was followed by a full text screen by two independent reviewers, and quality was assessed using the CASP appraisal tool. We then conducted meta-analyses and subgroup analyses. Results A total of 14 randomised controlled trials (RCTs) involving 10,372 participants were included in the review. Altogether we carried out 12 meta-analyses and 19 subgroup analyses. Meta-analyses found coordinating interventions showed a statistically significant improvement in both patient behaviour measured using the Neuropsychiatric Inventory (NPI) (mean difference (MD) = −9.5; 95% confidence interval (CI): −18.1 to −1.0; p = 0.03; number of studies (n) = 4; I2 = 88%) and caregiver burden (standardised mean difference (SMD) = −0.54; 95% CI: -1.01 to −0.07; p = 0.02; n = 5, I2 = 92%) compared to the control group. Subgroup analyses found interventions using a case manager with a nursing background showed a greater positive effect on caregiver quality of life than those that used case managers from other professional backgrounds (SMD = 0.94 versus 0.03, respectively; p < 0.001). Interventions that did not provide supervision for the case managers showed greater effectiveness for reducing the percentage of patients that are institutionalised compared to those that provided supervision (odds ratio (OR) = 0.27 versus 0.96 respectively; p = 0.02). There was little evidence of effects on other outcomes, or that other intervention components modify the intervention effects. Conclusion Results show that coordinating interventions in dementia care has a positive impact on some outcomes, namely patient behaviour and caregiver burden, but the evidence is inconsistent and results were not strong enough to draw definitive conclusions on general effectiveness. With the rising prevalence of dementia, effective complex interventions will be necessary to provide high quality and effective care for patients, and facilitate collaboration of health, social and third sector services.http://link.springer.com/article/10.1186/s12913-017-2677-2DementiaHealth servicesDementia care coordinationCase managementSystematic reviewMeta-analysis |
| spellingShingle | Amy Backhouse Obioha C. Ukoumunne David A. Richards Rose McCabe Ross Watkins Chris Dickens The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components BMC Health Services Research Dementia Health services Dementia care coordination Case management Systematic review Meta-analysis |
| title | The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components |
| title_full | The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components |
| title_fullStr | The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components |
| title_full_unstemmed | The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components |
| title_short | The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components |
| title_sort | effectiveness of community based coordinating interventions in dementia care a meta analysis and subgroup analysis of intervention components |
| topic | Dementia Health services Dementia care coordination Case management Systematic review Meta-analysis |
| url | http://link.springer.com/article/10.1186/s12913-017-2677-2 |
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