title: Impact of a disease management program upon caregivers of chronically critically ill patients.
abstract: OBJECTIVE
  Few studies have examined the effects of caregiving on the caregivers of chronically critically ill (CCI) patients, and no one has examined the impact of a disease management program (DMP) on physical and psychological outcomes for the caregivers of CCI patients. The purposes of this study of caregivers of CCI patients were as follows: (1) to describe the characteristics of CCI patients and caregivers and to examine the frequency of depression, subjective burden, and physical health; (2) to examine factors related to depression after hospital discharge; and (3) to examine the effects of a DMP on the physical health, depression, and burden of caregivers 2 months post-hospital discharge.
  
  
  METHODS
  Prospective experimental design.
  
  
  METHODS
  Caregivers of 290 patients who had received > 3 days of mechanical ventilation while in the ICU of a university medical center.
  
  
  METHODS
  Sociodemographics, caregiver burden, physical health status, and depression were measured using established tools.
  
  
  RESULTS
  Interviews of caregivers were conducted at hospital discharge and 2 months later. Seventy-three percent of patients survived, completed the study period, and required caregiving 2 months later. Caregivers of patients residing in an institution reported higher depression (p = 0.0001), higher burden (ie, disrupted schedule, p = 0.0001; lack of family support, p = 0.036), and greater health problem scores (p = 0.0001) than did caregivers of patients residing at home. The DMP did not have a statistically significant impact on any of the outcome variables. However, by 2 months, 54% of caregivers in the experimental group had no depression or mild depression compared with 34.5% of the control group.
  
  
  CONCLUSIONS
  Two months after hospital discharge, approximately 25% of caregivers were classified as depressed with 16.7% of the depressed group classified as moderately or severely depressed. The caregivers of CCI patients are at risk for post-hospital discharge depression, and the caregivers of institutionalized CCI patients are at highest risk of long-term negative effects from caregiving.
authors.affiliation: School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106-4904, USA. SLD4@case.edu
authors.forename: Sara L
authors.initials: SL
authors.lastname: Douglas
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Daly
authors.forename: Carol Genet
authors.initials: CG
authors.lastname: Kelley
authors.forename: Elizabeth
authors.initials: E
authors.lastname: O'Toole
authors.forename: Hugo
authors.initials: H
authors.lastname: Montenegro
mesh_terms: D000328:Adult; D000359:Aftercare / Q000523:psychology; D000368:Aged; D000704:Analysis of Variance; D017028:Caregivers / Q000523:psychology*; D002908:Chronic Disease; D016001:Confidence Intervals; D003266:Continuity of Patient Care; D017281:Cost of Illness; D016638:Critical Illness / Q000628:therapy*; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006701:Home Nursing / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011336:Probability; D011446:Prospective Studies; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology; D015996:Survival Rate