title: The benefit of a geriatric nurse practitioner in a multidisciplinary diagnostic service for people with cognitive disorders.
abstract: BACKGROUND
  The aim of the study was to evaluate whether adding a geriatric nurse practitioner (GNP) to an outpatient diagnostic multidisciplinary facility for patients with cognitive disorders (Diagnostic Observation Center for PsychoGeriatry, DOC-PG) could improve quality of care. DOC-PG combines hospital diagnostics and care assessment from a community mental health team and provides the general practitioner (GP) with advice for treatment and management. In a previous study, we found that 28.7% of the advice made by this service was not followed up on by the GP.
  
  
  METHODS
  Two cohorts were studied: a group of patients with added GNP (n = 114) and a historical reference sample (n = 137). Both groups followed the same diagnostic protocol and care approach, but, in the GNP group, a care coordinator was added in order to communicate the advice from the DOC-PG to the GP. The primary outcome was the concordance rate of GPs regarding the advice. At the patient level, health-related quality of life (HRQoL) was assessed. Self-Rated Burden and care-related quality of life were measured at the informal caregiver level. Measures were conducted immediately after DOC-PG diagnosis and after 6 and 12 months. Univariate analyses, logistic regression analyses, and mixed model multilevel analyses were used to test differences between both groups.
  
  
  RESULTS
  Total concordance rates were significantly higher in the GNP group compared to the reference sample (82.1 and 71.3%, respectively; p < 0.001). No improvement in patient HRQoL was identified. Among the informal caregivers, a significant reduction of Self-Rated Burden was found in the GNP group at 12 months (adjusted mean difference -1.724, 95% CI -2.582 to -0.866; p < 0.001).
  
  
  CONCLUSIONS
  Adding a GNP to an outpatient diagnostic multidisciplinary facility for patients with cognitive disorders may improve the GP concordance rate of the advice from the DOC-PG and reduce subjective burden of the informal caregiver.
authors.affiliation: CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. bart.ament@maastrichtuniversity.nl.|Alzheimer Centre Limburg, MHeNS School for Mental Health and NeuroScience, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. bart.ament@maastrichtuniversity.nl.|Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. bart.ament@maastrichtuniversity.nl.
authors.forename: Bart H L
authors.initials: BH
authors.lastname: Ament
authors.affiliation: Alzheimer Centre Limburg, MHeNS School for Mental Health and NeuroScience, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. claire.wolfs@maastrichtuniversity.nl.
authors.forename: Claire A G
authors.initials: CA
authors.lastname: Wolfs
authors.affiliation: CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. g.kempen@maastrichtuniversity.nl.|Department of Health Services Research, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. g.kempen@maastrichtuniversity.nl.
authors.forename: Gertrudis I J M
authors.initials: GI
authors.lastname: Kempen
authors.affiliation: CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. ton.ambergen@maastrichtuniversity.nl.
authors.forename: Ton
authors.initials: T
authors.lastname: Ambergen
authors.affiliation: Alzheimer Centre Limburg, MHeNS School for Mental Health and NeuroScience, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. f.verhey@maastrichtuniversity.nl.
authors.forename: Frans R J
authors.initials: FR
authors.lastname: Verhey
authors.affiliation: Alzheimer Centre Limburg, MHeNS School for Mental Health and NeuroScience, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands. m.devugt@maastrichtuniversity.nl.
authors.forename: Marjolein E
authors.initials: ME
authors.lastname: De Vugt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis* / Q000451:nursing* / Q000523:psychology; D003142:Communication; D003153:Community Health Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D005260:Female; D058005:General Practitioners / Q000458:organization & administration; D015577:Geriatric Assessment; D005851:Geriatric Nursing / Q000458:organization & administration*; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009722:Nurse Practitioners / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life; D011795:Surveys and Questionnaires