title: Systematic care for caregivers of people with dementia in the ambulatory mental health service: designing a multicentre, cluster, randomized, controlled trial.
abstract: BACKGROUND
  Care for people with dementia and their informal caregivers is a challenging aim in healthcare. There is an urgent need for cost-effective support programs that prevent informal caregivers of people with dementia from becoming overburdened, which might result in a delay or decrease of patient institutionalization. For this reason, we have developed the Systematic Care Program for Dementia (SCPD). The SCPD consists of an assessment of caregiver's sense of competence and suggestions on how to deal with competence deficiencies. The efficiency of the SCPD will be evaluated in our study.
  
  
  METHODS
  In our ongoing, cluster, randomized, single-blind, controlled trial, the participants in six mental health services in four regions of the Netherlands have been randomized per service. Professionals of the ambulatory mental health services (psychologists and social psychiatric nurses) have been randomly allocated to either the intervention group or the control group. The study population consists of community-dwelling people with dementia and their informal caregivers (patient-caregiver dyads) coming into the health service. The dyads have been clustered to the professionals. The primary outcome measure is the patient's admission to a nursing home or home for the elderly at 12 months of follow-up. This measure is the most important variable for estimating cost differences between the intervention group and the control group. The secondary outcome measure is the quality of the patient's and caregiver's lives.
  
  
  CONCLUSIONS
  A novelty in the SCPD is the pro-active and systematic approach. The focus on the caregiver's sense of competence is relevant to economical healthcare, since this sense of competence is an important determinant of delay of institutionalization of people with dementia. The SCPD might be able to facilitate this with a relatively small cost investment for caregivers' support, which could result in a major decrease in costs in the management of dementia. Implementation on a national level will be started if the SCPD proves to be efficient.
  
  
  BACKGROUND
  NCT00147693.
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. a.spijker@inter.nl.net
authors.forename: Anouk
authors.initials: A
authors.lastname: Spijker
authors.forename: Frans
authors.initials: F
authors.lastname: Verhey
authors.forename: Maud
authors.initials: M
authors.lastname: Graff
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
authors.forename: Eddy
authors.initials: E
authors.lastname: Adang
authors.forename: Hub
authors.initials: H
authors.lastname: Wollersheim
authors.forename: Myrra
authors.initials: M
authors.lastname: Vernooij-Dassen
mesh_terms: D000553:Ambulatory Care / Q000145:classification / Q000379:methods* / Q000592:standards*; D017028:Caregivers / Q000145:classification / Q000523:psychology / Q000592:standards*; D016000:Cluster Analysis; D003704:Dementia / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008605:Mental Health Services / Q000145:classification / Q000592:standards*; D011361:Professional Competence / Q000592:standards; D016037:Single-Blind Method