title: Effects of guided care on family caregivers.
abstract: 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.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. jwolff@jhsph.edu
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wolff
authors.forename: Erin R
authors.initials: ER
authors.lastname: Giovannetti
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Boyd
authors.forename: Lisa
authors.initials: L
authors.lastname: Reider
authors.forename: Sara
authors.initials: S
authors.lastname: Palmer
authors.forename: Daniel
authors.initials: D
authors.lastname: Scharfstein
authors.forename: Jill
authors.initials: J
authors.lastname: Marsteller
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Wegener
authors.forename: Katherine
authors.initials: K
authors.lastname: Frey
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Chad
authors.initials: C
authors.lastname: Boult
mesh_terms: 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