Collaborative Dementia Care Management Improves Patient, Caregiver Outcomes

Relative to usual care, collaborative dementia care management is associated with improved neuropsychiatric symptoms in patients and lower caregiver burden, according to a new study published in JAMA Network Open.

People with dementia require comprehensive clinical support across multiple specialties, and general practitioners often do not have the tools and scaffolding to manage the complex post-diagnostic support these patients require. Collaborative dementia care management programs provide multiprofessional support in primary care for people living with dementia and their caregivers, and have been shown to be beneficial; however, long-term evidence for the clinical benefit and cost-effectiveness of these programs is lacking. To this aim, the current study sought to compare the patient, caregiver, and health system-relevant outcomes associated with collaborative dementia care management vs usual care.

Investigators conducted a secondary analysis of a 36-month follow-up trial from the DelpHi-MV GP-based cluster randomized clinical trials (NCT01401582), which examined the efficacy of collaborative dementia care management in primary dementia care. General practitioner practices from Germany were invited to participate and were randomized in a 1:1 ratio to receive either collaborative dementia care management or usual care. Patients were included in the analysis if they completed at least 2 of 3 annual assessments. Nurses conducted assessments at baseline and at 12, 24, and 36 months. The primary study outcomes included behavioral and psychological symptoms, mental health, and caregiver burden. The investigators also used data from medical records and the Resource Utilization in Dementia questionnaire, which is completed by caregivers and health services practitioners, to calculate cost-effectiveness from a public payer perspective in 2023 values.

A total of 308 participants were included in the clinical outcomes analysis, of whom 221 (71.8%) received collaborative dementia care management (mean [SD] age, 80.1 [5.3]

years; 64.3% women) and 87 (28.2%) received usual care (mean [SD] age, 79.2 [4.5] years; 57.5% women). The investigators included an additional 120 participants who died during the study period for the cost-effectiveness analyses, extending the number of participants to 428 (70.8% dementia care management; 29.2% usual care). Participants in the 2 treatment groups were generally similar in terms of baseline characteristics, with the exception of function impairment, which was significantly lower among the usual care group (P =.006).

Relative to usual care, patients who received collaborative dementia care management for 36 months had significantly lower Neuropsychiatric Inventory scores (adjusted mean difference [AMD], -10.26; 95% CI, -16.95 to -3.58; P =.003; Cohen d, -0.78), improved mental health scores on the 12-Item Short-Form Health Survey Mental Component Summary (AMD, 2.26; 95% CI, 0.31-4.21; P =.02; Cohen d, 0.26), and lower Berlin Inventory of Caregivers’ Burden in Dementia scores (AMD, -0.59; 95% CI, -0.81 to -0.37; P <.001; Cohen d, -0.71).

When evaluating cost-effectiveness, the incremental cost per quality-adjusted life year (QALY) over 36 months was not significantly elevated among the collaborative dementia care management group ($476; 95%CI, -$5927 to $6881; P =.87; Cohen d, 0.07), with a cost-effectiveness ratio of $3472 per QALY.

The investigators did not observe a significant difference between the groups in the use of antidementia drugs, overall health-related quality of life, physical health, or the use of potentially inappropriate mediation.

The current study results indicate that collaborative dementia care management is positively associated with improvements in behavioral and psychological symptoms, mental health, and caregiver burden over 36 months. Additionally, collaborative dementia care management is generally cost-effective. “The findings suggest that [collaborative dementia care management] is associated with improved patient, caregiver, and health system relevant outcomes over 36 months and that its translation into routine care should become a health policy priority,” the investigators concluded.

Study limitations include the imbalanced group distributions, the use of a screening instead of a diagnostic procedure to identify people with dementia, and restricted generalizability beyond patients with mild cognitive impairment in a primarily rural German setting.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor