The care of older persons can have negative impact on the caregiver. The objective of this population-based observational study is to identify problems experienced by informal caregivers, and the extent of related difficulties, in their care of older care-dependent recipients with and without cognitive impairment. Caregivers (n = 2,704) caring for a home-dwelling person aged ≥ 75 years responded to a questionnaire with 23 questions on problems and related difficulties by mail. Prevalence of self-reported problems and related difficulties was calculated. The impact of the problem was estimated by weighing the percentage of problems reported as being difficult against the prevalence of problems. The median number of problems was 12 (range 0-23), with 5 (range 0-23) reported as difficult. Informal caregivers experience a variety of problems, with the impossibility to engage in joint social activities having the highest impact. The impact of problems increased when the care recipient had a cognitive problem.
ObjectiveManagement of type 2 diabetes mellitus (T2DM) requires frequent monitoring of patients. Within a collective care group setting, doubts on the clinical effects of registration are a barrier for full adoption of T2DM registration in general practice. We explored whether full monitoring of biomedical and lifestyle-related target indicators within a care group approach is associated with lower HbA1clevels.DesignObservational, real-life cohort study.SettingPrimary care data registry from the Hadoks (EerstelijnsZorggroepHaaglanden) care group.ExposureThe care group provides general practitioners collectively with organisational support to facilitate structured T2DM primary care. Patients are offered quarterly medical and lifestyle-related consultation.Main outcome measureFull monitoring of each target indicator in patients with T2DM which includes minimally one measure of HbA1clevel, systolic blood pressure, LDL, BMI, smoking behaviour and physical exercise between January and December 2014; otherwise, patients were defined as ’incompletely monitored'. HbA1clevels of 8137 fully monitored and 3958 incompletely monitored patients were compared, adjusted for the confounders diabetes duration, age and gender. Since recommended HbA1cvalues depend on age, medication use and diabetes duration, analyses were stratified into three HbA1cprofile groups. Linear multilevel analyses enabled adjustment for general practice.ResultsCompared with incompletely monitored patients, fully monitored patients had significantly lower HbA1clevels (95% CI) in the first (−2.03 [−2.53 to −1.52] mmol/mol) (−0.19% [−0.23% to −0.14%]), second (−3.36 [−5.28 to −1.43] mmol/mol) (−0.31% [−0.48% to −0.13%]) and third HbA1cprofile group (−1.89 [−3.76 to −0.01] mmol/mol) (−0.17% [−0.34% to 0.00%]).Conclusions/interpretationThis study shows that in a care group setting, fully monitored patients had significantly lower HbA1clevels compared with incompletely monitored patients. Since this difference might have considerable clinical impact in terms of T2DM-related risks, this might help general practices in care group settings to overcome barriers on adequate registration and thus improve structured T2DM primary care. From population health management perspective, we recommend a systematic approach to adjust the structured care protocol for incompletely monitored subgroups.
This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
ObjectiveWhether care group participation by general practitioners improves delivery of diabetes care is unknown. Using ‘monitoring of biomedical and lifestyle target indicators as recommended by professional guidelines’ as an operationalisation for quality of care, we explored whether (1) in new practices monitoring as recommended improved a year after initial care group participation (aim 1); (2) new practices and experienced practices differed regarding monitoring (aim 2).DesignObservational, real-life cohort study.SettingPrimary care registry data from Eerstelijns Zorggroep Haaglanden (ELZHA) care group.ParticipantsAim 1:From six new practices (n=538 people with diabetes) that joined care group ELZHA in January 2014, two practices (n=211 people) were excluded because of missing baseline data; four practices (n=182 people) were included.Aim 2:From all six new practices (n=538 people), 295 individuals were included. From 145 experienced practices (n=21 465 people), 13 744 individuals were included.ExposureCare group participation includes support by staff nurses on protocolised diabetes care implementation and availability of a system providing individual monitoring information. ‘Monitoring as recommended’ represented minimally one annual registration of each biomedical (HbA1c, systolic blood pressure, low-density lipoprotein) and lifestyle-related target indicator (body mass index, smoking behaviour, physical exercise).Primary outcome measuresAim 1:In new practices, odds of people being monitored as recommended in 2014 were compared with baseline (2013).Aim 2:Odds of monitoring as recommended in new and experienced practices in 2014 were compared.ResultsAim 1:After 1-year care group participation, odds of being monitored as recommended increased threefold (OR 3.00, 95% CI 1.84 to 4.88, p<0.001).Aim 2:Compared with new practices, no significant differences in the odds of monitoring as recommended were found in experienced practices (OR 1.21, 95% CI 0.18 to 8.37, p=0.844).ConclusionsWe observed a sharp increase concerning biomedical and lifestyle monitoring as recommended after 1-year care group participation, and subsequently no significant difference between new and experienced practices—indicating that providing diabetes care within a collective approach rapidly improves registration of care.
This study explored the reliability and validity of a Dutch translation of the 10-item Filial Maturity Measure (FMM) in a sample of Dutch informal caregivers. The FMM was translated with a forward–backward method and completed by 93 informal caregivers (62 % response rate) with a need dependent parent. Dimensionality of the Dutch FMM was examined by principal component and internal consistency analyses. Criterion validity was examined by assessing correlations with filial love, filial autonomy and level of closeness between parent and child. Construct validity was tested by examining associations with the traits openness and agreeableness. In addition, the relationship with state and trait affectivity was explored. After removal of the item “I worry about turning out like my parent”, the original dimensional structure, internal consistency, criterion and construct validity were confirmed. Additional exploration of the relation between the FMM subscales and trait and state affectivity scales demonstrated that filial maturity is at most weakly associated with trait affectivity. Both FMM scales showed a positive partial correlation with negative state affectivity. The Dutch FMM appears to be a reliable and valid instrument for measuring filial maturity of informal caregivers who provide care to their need dependent parent. The (non-)functioning of one item pointed to the necessity to validate the FMM, but also questionnaires in general in different populations.
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