Implementing Dementia Care Management into routine care: protocol for a cohort study in Siegen-Wittgenstein, Germany (RoutineDeCM).

INTRODUCTION: Dementia Care Management is an evidence-based model of care. It has proven its efficacy and cost-effectiveness and has been applied to different settings and different target groups. However, it is not available in routine care in Germany. The scientific evidence has influenced the National Dementia Strategy, in which one measure is to examine the possibility and requirements to implement it into routine care. The aim of this study is to implement Dementia Care Management into routine care in a selected region in Germany and evaluate the effect on participants. METHODS AND ANALYSIS: For the duration of 12 months, n=90 patients and their informal caregivers with cognitive impairment are recruited in different routine settings in primary care (general hospital, physicians' network, ambulatory nursing service, counselling service) by partners in primary care. They receive an adapted Dementia Care Management (DeCM) to the specific setting using participatory methods. DeCM is delivered by specifically qualified dementia care managers and consists of a comprehensive assessment of healthcare needs followed by algorithm-based and person-based support in healthcare planning, implementing and monitoring. The duration of the intervention is 6 months and data assessments are conducted prior to (baseline), at the end of (follow-up 1, FU1) and 6 months after the end of the intervention (follow-up 2, FU2). Primary outcomes are unmet needs at FU1 and FU2. Secondary outcomes are antidementia drug treatment, neuropsychiatric symptoms and caregiver burden at FU1 and FU2. Further outcomes are cognition, frailty and health-related quality of life. A separate process evaluation accompanies the implementation. ETHICS AND DISSEMINATION: The Ethics Committee of University Medicine Greifswald, Germany, has reviewed and approved the study (registration number BB110/22). All participants provide written informed consent prior to participation. The results will be disseminated in regional workshops, press, online media and talks. They will be submitted to international peer-reviewed scientific journals for publication and presented at scientific meetings and conferences. Furthermore, results will be discussed with the funder and presented to the steering committee of the National Dementia Strategy. TRIAL REGISTRATION NUMBER: NCT05529277.

[Contribution of professional nurses of ambulatory nursing services to home nursing care]. / Der Beitrag von Pflegefachpersonen ambulanter Pflegedienste in häuslichen Pflegesituationen.

The meaning and understanding of home care is a leading factor in health care both nationally and internationally. The implementation of the law on care insurance in Germany demonstrates the understanding of home care and shows changes in health care policy. This new context of health care delivery influences the nursing profession. New challenges arise and changes in nursing perspectives are necessary. The presented study focuses on the contribution of nurses in home care situations. Its aim is to illuminate and to understand the perspective of home care nurses. Grounded Theory approach is used. Altogether, nine participants are interviewed. The results show that nurses aim at keeping care recipients in a home care situation as long as possible. In order to achieve this, the contribution of nurses are not just limited to rediscountable benefits. Voluntary interventions such as managing housework and emotional support for care recipients are also being rendered. However, these actions depend on several factors, such as the relationship between the nurse and the care recipient, the home care situation or the professional attitude of the nurse. In this context, nurses have to develop strategies to deal with these various tasks. The discussion emphasizes the legislative framework of home care in Germany as well as factors that influenced the study.