Demand-oriented care for people with dementia. Testing a methodology.

By the government policy, new legislation, and the rise of customer
organisations within the health care in the Netherlands, the last years the
emphasis has come to lie more and more on the active role of the customer in
the care attribution. Instead of offering 'supply-oriented care', institutions
try to offer 'demand-oriented' and sometimes 'demand-driven' health care. The
client perspective becomes normative for the aid offer and the organisation of
the health care. Among other things, care programmes are designed to realize
the 'demand-oriented' health care (Van Baalen, 2002).
In the region s-Hertogenbosch several care providers (nursing homes, home care
institution, general hospital and GGz) have taken the initiative to develop a
regional care programme for people with dementia. In a regional care programme
stands the whole care offer of the region for a specific target group in an
univocal manner defined. The basis for a care programme form the wishes and
needs of this specific target group. For this reason it is important to
inventory what the wishes and expectations are with respect to (quality of)
care of people with dementia and caregivers. This inventory forms the basis of
a PhD project. In this protocol the second phase of this project is described.
The first phase of the project has been performed in 2005-2006 and
implementation of it was approved by the Medical Ethical Testcommission for
institutions in the mental health care (METiGG, protocol 5,120) the results of
the first phase of the research (in which the term ' quality of care' from the
perspective of people with dementia at an early stage at issue was) has been
described in a separate report (Van Baalen, 2007).
At this second stage of the project the central objectives beside 'quality of
care' are 'needs' and 'quality of life'. In a concept model 'demand-oriented
care' these objectives are connected with each other. The idea has arisen that
a methodology which explores in a structured manner the needs of people with
dementia at an early stage and caregivers and the important aspects around
quality of care from the customer perspective can make a contribution to
forming demand-oriented care. Using this methodology ('Client Centred
Care-Dementia'- work name 'CCC-DEM') the care provider can clarify the care
needs of the customer and his caregiver in a systematic manner and it can be
useful in providing the care that qualitatively connects with what the customer
finds important.

The objective of this research is reviewing the effectiveness of a methodology
which aimes at giving content to demand-oriented care for people with dementia
and caregivers and at being a useful tool for professional carers to provide
demand-oriented care.

This research has a quasi-experimental design. It does not meet all the
requirements of experimental research because complete blindness of the
intervention (use methodology) is not possible. The intervention is
single-blind applied (only the one who applies the intervention applies knows
this, the test person not). There will be an experimental and a control group
which will be composed by means of randomisation. One pretest and two posttest
measures will be done.

The design shows schematically as follows:

Time t 0 t1 t 2

R Group I O X C M O experimental group
R Group II O Xa M O control group

O *observation*: data are collected
X experimental intervention (use methodology)
Xa regular care
t 0,1,2 time 0 (pretest), time 1 (6 weeks after t0) and time 2 (3 months after
t 0)
C measurement of compliance
M care that results from the outcome of the methodology or regular care
R randomisation, by randomisation respondents are assigned to the experimental
or control group

In the experimental group case managers the use a methodology with which the
needs of people with dementia and their caregivers can be clarified in a
systematic manner and it can be useful in providing the care that qualitatively
fits with what these people find important.

The control group receives regular care.

People with dementia at an early stage are asked to answer questions concerning
their perspective on the experienced quality of life, on the degree of
demand-oriented care, (un)met needs and the experienced quality of care. These
questions are conducted at 3 different times with people what will confiscate
in sum approximately 2.5 hour time (2x 1 hours and 1x 1/2 hours). The research
doesn't withhold any risks.