Impact of a disease management program upon caregivers of chronically critically ill patients.
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.
Douglas
Sara L
SL
School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106-4904, USA. SLD4@case.edu
Daly
Barbara J
BJ
Kelley
Carol Genet
CG
O'Toole
Elizabeth
E
Montenegro
Hugo
H
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