Effect of a stroke-specific follow-up care model on the quality of life of stroke patients and caregivers: A controlled trial

Objective: To evaluate the effectiveness of a stroke-specific follow-up care model on quality of life for stroke patients, being discharged home, and their caregivers. Design: A non-randomized, controlled trial, comparing an intervention group with a control group (usual care). Subjects: Stroke patients and their caregivers. Methods: Intervention involved 5 home visits by a stroke care coordinator over a period of 18 months, using a structured assessment tool. Outcome measures were conducted at baseline (TO) and every 6 months thereafter (T6, T12 and T18) in the domains of quality of life (primary), activities of daily living, social activities, depression, anxiety and caregiver strain. Results: The intervention group (n=62) had significantly increased its social activities after 18 months, whereas the control group (n=55) showed significantly decreased levels of social activities. In the first 6 months, levels of depression decreased significantly in caregivers of the intervention group. No differences were found for quality of life and the other outcome measures. Conclusion: The intervention was not effective in improving quality of life, but was effective in improving levels of social activities. The intervention may have focussed too much on screening for stroke-related problems and not as much on adequate follow-up care and referral

Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: a case study

Background Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups. Methods An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals. The Context + Mechanism = Outcome Model was used to study the relationship between context factors, mechanisms and outcomes. Dutch integrated care involves care groups, bundled payments, patient involvement, health professional cooperation and task substitution, evidence-based care protocols and a shared clinical information system. Community involvement is not (yet) part of Dutch integrated care. Results Barriers to the implementation of integrated care included insufficient integration between the patient databases, decreased earnings for some health professionals, patients’ insufficient medical and policy-making expertise, resistance by general practitioner assistants due to perceived competition, too much care provided by practice nurses instead of general practitioners and the funding system incentivising the provision of care exactly as described in the care protocols. Facilitators included performance monitoring via the care chain information system, increased earnings for some health professionals, increased focus on self-management, innovators in primary and secondary care, diabetes nurses acting as integrators and financial incentives for guideline adherence. Economic and political context and health IT-related barriers were discussed as the most problematic areas of integrated care implementation. The implementation of integrated care led to improved communication and cooperation but also to insufficient and unnecessary care provision and deteriorated preconditions for person-centred care. Conclusions Dutch integrated diabetes care is still a work in progress, in the academic and the practice setting. This makes it difficult to establish whether overall quality of care has improved. Future efforts should focus on areas that this study found to be problematic or to not have received enough attention yet. Increased efforts are needed to improve the interoperability of the patient databases and to keep the negative consequences of the bundled payment system in check. Moreover, patient and community involvement should be incorporated

CheckLijst voor het opsporen van cognitieve en emotionele gevolgen na een beroerte (CLCE-24)

Achtergrond en doel: Eerstelijns zorgverleners geven aan dat ondersteuning nodig is voor het onderkennen en signaleren van cognitieve en emotionele stoornissen na een beroerte. Deze studie beschrijft een nieuw signaleringsinstrument, de CheckLijst voor Cognitieve en Emotionele problemen na een beroerte (CLCE-24). Methode: Bij een groep patie¨nten (N = 69) werd 6 maanden na de beroerte voorafgaand aan het uitgebreid neuropsychologisch onderzoek (waaronder de MMSE en CAMCOG) de CLCE-24 afgenomen. Resultaten: De CLCE-24 werd positief ontvangen door zowel de patie¨nt, de naaste als de interviewer (psycholoog). De gemiddelde afnameduur was 11.1 minuten (5-35 minuten). Tachtig procent van de patie¨nten rapporteerde klachten; 73% cognitieve klachten en 51% emotionele klachten. Patie¨nten met ten minste e´e´n cognitieve klacht scoorden lager op de MMSE (t = 2.52; p=0.01) en de CAMCOG (t = 2.45; p= 0.02) dan patie¨nten zonder klachten. Conclusie: De CLCE-24 is een bruikbaar instrument om cognitieve en emotionele klachten na een beroerte op te sporen, waarna verwijzing naar bijvoorbeeld een neuropsycholoog en/of revalidatiearts kan plaatsvinden. Verder onderzoek moet o.a. gericht zijn op betrouwbaarheid tussen beoordelaars en op implementatie in de zorgkete

Multidisciplinary care for stroke patients living in the community: A systematic review

Objective: A systematic review of randomized controlled trials was performed to evaluate the effectiveness of multidisciplinary care for stroke patients living in the community. Data sources: Databases PubMed, EMBASE, CINAHL and the Cochrane Library from January 1980 until July 2012. Study selection: Randomized controlled trials focused on multidisciplinary interventions for stroke patients living at home after hospitalization or inpatient rehabilitation were selected. The outcome domains were activities of daily living, social participation and quality of life. A total of 14 studies were included. Data extraction: Two authors independently extracted the data and independently assessed the quality of reporting of the included studies using the Consolidated Standards of Reporting Trials (CONSORT) statement 2010. Data synthesis: None of the studies showed favourable effects of the intervention on activities of daily living and none assessed social participation. Furthermore, two studies reported favourable effects of the intervention in terms of quality of life. These concerned an intervention combining assessment with follow-up care and a rehabilitation intervention. Conclusion: There is little evidence for the effectiveness of multidisciplinary care for stroke patients being discharged home. Additional research should provide more insight into potentially effective multidisciplinary care for community-living stroke patients