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The Gerontologist Advance Access published online on August 26, 2009
The Gerontologist, doi:10.1093/geront/gnp124
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Effects of Guided Care on Family Caregivers

Jennifer L. Wolff, PhD1,2,3, Erin R. Giovannetti2, Cynthia M. Boyd, MD, MPH2,3, Lisa Reider, MHS2, Sara Palmer, PhD3, Daniel Scharfstein, ScD2,3, Jill Marsteller, MPP, PhD2, Stephen T. Wegener, PhD2,3, Katherine Frey, MPH2, Bruce Leff, MD2,3, Kevin D. Frick, PhD2 and Chad Boult, MD, MPH, MBA2,3

2 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
3 Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland

1 Address correspondence to Jennifer L. Wolff, PhD, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 692, Baltimore, MD 21205. E-mail: jwolff{at}jhsph.edu


  Abstract

Purpose: 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. Design and 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. Implications: GC improved the quality of chronic illness care received by multimorbid care recipients but did not improve caregivers' depressive symptoms, affect, or productivity.

Keywords: Caregiving, Chronic disease, Nursing, Primary care, Guided Care

Received May 13, 2009; Accepted July 29, 2009

Decision Editor: William J. McAuley, PhD


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