title: Systematic care for caregivers of patients with dementia: a multicenter, cluster-randomized, controlled trial.
abstract: OBJECTIVE
  To evaluate the effectiveness of the Systematic Care Program for Dementia (SCPD) on patient institutionalization and to determine the predictors of institutionalization.
  
  
  METHODS
  Single-blind, multicenter, cluster-randomized, controlled trial.
  
  
  METHODS
  Six community mental health services (CMHSs) across the Netherlands.
  
  
  METHODS
  A total of 295 patient-caregiver dyads referred to a CMHS with suspected patient dementia.
  
  
  METHODS
  Training of health professionals in the SCPD and its subsequent use. The SCPD consists of a systematic assessment of caregiver problems and alerts health professionals in flexible, connecting, proactive interventions to them. The intensity of the SCPD depends on the judgment of the health professional, based on individual caregiver needs.
  
  
  METHODS
  Institutionalization in long-term care facilities at 12 months of follow-up.
  
  
  RESULTS
  No main intervention effect on institutionalization was found. However, a better sense of competence in the control group reduced the chance of institutionalization but not in the intervention group. The caregiver's sense of competence and depressive symptoms and the patient's behavioral problems and severity of dementia were the strongest predictors of institutionalization. The intensity of the program was low, even for dyads exposed to the SCPD.
  
  
  CONCLUSIONS
  Although no main effect was found, the results suggest that the SCPD might prevent a deterioration of the sense of competence in the intervention group. The intensity of a program is crucial and should be prescribed on the basis of evidence rather than left to the discretion of health professionals. Future controlled trials in daily clinical practice should use a process analysis to control for compliance.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Evidence Based Practice, Beek-Ubbergen, the Netherlands.
authors.forename: Anouk
authors.initials: A
authors.lastname: Spijker
authors.forename: Hub
authors.initials: H
authors.lastname: Wollersheim
authors.forename: Steven
authors.initials: S
authors.lastname: Teerenstra
authors.forename: Maud
authors.initials: M
authors.lastname: Graff
authors.forename: Eddy
authors.initials: E
authors.lastname: Adang
authors.forename: Frans
authors.initials: F
authors.lastname: Verhey
authors.forename: Myrra
authors.initials: M
authors.lastname: Vernooij-Dassen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003156:Community Mental Health Services / Q000379:methods; D017281:Cost of Illness; D003376:Counseling / Q000379:methods*; D003704:Dementia / Q000451:nursing* / Q000523:psychology; D003863:Depression / Q000628:therapy; D005260:Female; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged