Family Physician–Case Manager Collaboration and Needs of Patients With Dementia and Their Caregivers: A Systematic Mixed Studies Review

Abstract

PURPOSE Dementia case management (CM) in primary care is a complex intervention aimed at identifying the various needs of patients with dementia and their caregivers, as well as the organization and coordination of care. A key element of CM is the collaboration of family physicians with case managers. We conducted a systematic mixed-studies review to identify the needs of the patientcaregiver dyad and the effects of CM. METHODSWe searched MEDLINE, PsycINFO, and EMBASE up to October 2014, regardless of the study design. Our main outcomes were needs of patients and their caregivers and the effects of CM on these needs. We used narrative syntheses to develop a taxonomy of needs and to describe the effects of CM on those needs. We used meta-analysis to calculate the prevalence of needs and the standardized mean differences to evaluate the effects of CM on the needs identified.RESULTS Fifty-four studies were included. We identified needs of the patientcaregiver dyad and needs of the patient and caregiver individually. CM addressed the majority of the identified needs. Still, some very common needs (eg, early diagnosis) are overlooked while other needs (eg, education on the disease) are well addressed. Fully establishing the value of CM is difficult given the small number of studies of CM in primary care.CONCLUSIONS There is good evidence that case managers, in collaboration with family physicians, have a pivotal role in addressing the needs of the patientcaregiver dyad. 2016;14:166-177. doi: 10.1370/afm.1898. Ann Fam Med INTRODUCTIONT he proportion of people with dementia is growing dramatically. According to the US Alzheimer's Association, by 2030, 50% of Americans aged 65 years and older will be diagnosed with dementia. 1 In Canada in 2011, 747,000 Canadians lived with cognitive impairment.2 Today, the combined costs are $33 billion per year, 1 and they are projected to increase to $872 billion by 2038. 3,4 Worldwide, dementia is the main contributor to disability-adjusted life years (11.2%), representing a greater burden than cerebral vascular accident (9.5%), heart disease (5.0%), or cancer (2.4%). 5People with dementia need help with challenging changes in behavior, memory, physical disability, and mood. 6 The main source of help is family caregivers, who often suffer from the burdens of caregiving and from depression and health problems. 7 It has been shown that early intervention makes the greatest difference in management of symptoms. 1 The World Health Organization states that it would be challenging to intervene without effective involvement of primary care. 8 Dementia case management (CM) interventions are becoming a central component of primary health care organizations in North America and Europe. [9][10][11][12] According to the 167Case Management Society of America, case management is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communi...

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