Influence of Adherence to a Systematic Care Program for Caregivers of Dementia Patients

Objective: To evaluate the influence of adherence to the Systematic Care Program for Dementia (SCPD) intervention protocol on patient and caregiver outcomes. Design: Data were drawn from the SCPD study-a single-blind, multicenter, cluster-randomized, controlled trial. Multivariate regression analyses were used to assess the influence of adherence on patient and caregiver outcomes. Setting: Six community mental health services (CMHSs) across the Netherlands. Participants: Forty-eight mental health professionals treating 125 patient-caregiver dyads who were referred to the CMHS because of suspected patient dementia. Intervention: Training of professionals in the SCPD and its subsequent use. The SCPD consists of a systematic assessment of caregiver problems and consequent interventions. Measurements: The dependent variables were caregiver's sense of competence, caregiver's depressive symptoms, caregiver's distress due to the patient's behavioral problems, and the severity of patient's behavioral problems. The main independent variables were adherence to the SCPD intervention protocol and the intensity of the SCPD interventions. The follow-up lasted 12 months. Results: Caregivers treated by adhering professionals had a better sense of competence than caregivers treated by nonadhering professionals at follow-up. No differences between intervention groups and controls were found for the other outcomes. Conclusion: Nonadherence to the intervention protocol might be a reason for the difference found in the sense of competence between the intervention groups. Furthermore, the intensity of the SCPD might have been too low. Moreover, it might be that overburdened caregivers found it difficult to make effective use of the help offered to them. A qualitative process analysis should be executed to explore more in-depth clarifications. (Am J Geriatr Psychiatry 2013; 21:26-36)