Effects of guided care on family caregivers.
OBJECTIVE
Guided Care (GC) is a model of health care for multimorbid older adults that is provided by a registered nurse who works with the patients' primary care physician (PCP). The purpose of this study was to determine whether GC improves patients' primary caregivers' depressive symptoms, strain, productivity, and perceptions of the quality of care recipients' chronic illness care.


METHODS
A cluster-randomized controlled trial of GC was conducted within 14 PCP teams. The study sample included 196 primary caregivers who completed baseline and 18-month surveys and whose care recipients remained alive and enrolled in the GC study for 18 months. Caregiver outcomes included the following: depressive symptoms (Center for Epidemiological Studies-Depression scale), strain (Modified Caregiver Strain Index), the quality of care recipients' chronic illness care [Patient Assessment of Chronic Illness Care (PACIC)], and personal productivity (Work Productivity and Activity Impairment questionnaire, adapted for caregiving).


RESULTS
In multivariate regression models, between-group differences in depression, strain, work productivity, and regular activity productivity were not statistically significant after 18 months, but GC caregivers reported the overall quality of their recipients' chronic illness care to be significantly higher (adjusted beta = 0.40, 95% confidence interval : 0.14-0.67). Quality was significantly higher in 4 of 5 PACIC subscales, reflecting the dimensions of goal setting, coordination of care, decision support, and patient activation.


CONCLUSIONS
GC improved the quality of chronic illness care received by multimorbid care recipients but did not improve caregivers' depressive symptoms, affect, or productivity.
Wolff
Jennifer L
JL
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. jwolff@jhsph.edu
Giovannetti
Erin R
ER
Boyd
Cynthia M
CM
Reider
Lisa
L
Palmer
Sara
S
Scharfstein
Daniel
D
Marsteller
Jill
J
Wegener
Stephen T
ST
Frey
Katherine
K
Leff
Bruce
B
Frick
Kevin D
KD
Boult
Chad
C
D000328:Adult; D017028:Caregivers / Q000523:psychology*; D002908:Chronic Disease / Q000451:nursing / Q000628:therapy; D003863:Depression / Q000517:prevention & control; D055318:Evidence-Based Nursing; D005260:Female; D006801:Humans; D008873:Mid-Atlantic Region; D008875:Middle Aged; D024802:Nurse's Role; D010821:Physicians, Family; D012044:Regression Analysis; D013315:Stress, Psychological / Q000517:prevention & control