Skip to main content
Top
Published in: BMC Health Services Research 1/2014

Open Access 01-12-2014 | Research article

A quasi-experimental study of the effects of an integrated care intervention for the frail elderly on informal caregivers’ satisfaction with care and support

Authors: Benjamin Janse, Robbert Huijsman, Isabelle Natalina Fabbricotti

Published in: BMC Health Services Research | Issue 1/2014

Login to get access

Abstract

Background

This study explored the effects of an integrated care model for the frail elderly on informal caregivers’ satisfaction with care and support services.

Methods

A 62-item instrument was developed and deployed in an evaluative before/after study using a quasi-experimental design and enrolling a control group. The definitive study population (n = 63) consisted mainly of female informal caregivers who did not live with the care recipient. Analysis of separate items involved group comparisons, using paired and unpaired tests, and regression analyses, with baseline measurements, control variables (sex, age and living together with care recipient) and the intervention as independent variables. Subsequently, the underlying factor structure of the theoretical dimensions was investigated using primary component analysis. Group comparisons and regression analyses were performed on the resulting scales.

Results

Satisfaction with the degree to which care was provided according to the need for care of the recipients increased, while satisfaction with the degree to which professionals provided help with administrative tasks, the understandability of the information provided and the degree to which informal caregivers knew which professionals to call, decreased. Primary component analysis yielded 6 scales for satisfaction with care and 5 scales for satisfaction with caregiver support, with sufficient reliability.

Conclusions

The results suggest that expectations regarding the effects of integrated care on informal caregiver satisfaction may not be realistic. However, the results must be seen in light of the small sample size and should therefore be considered as preliminary. Nonetheless, this study provides guidance for further research and integrated care interventions involving informal caregivers.

Trial registration

Current Controlled Trials ISRCTN05748494. Date of registration: 14/03/2013.
Appendix
Available only for authorised users
Literature
1.
go back to reference Smale B, Epp T, Dupuis SL: Caregivers of persons with dementia: roles, experiences, supports and coping. A literature review. 2004, Waterloo, ON: Murray Alzheimer Research and Education Program, University of Waterloo Smale B, Epp T, Dupuis SL: Caregivers of persons with dementia: roles, experiences, supports and coping. A literature review. 2004, Waterloo, ON: Murray Alzheimer Research and Education Program, University of Waterloo
2.
go back to reference Carretero S, Garcés J, Ródenas F, Sanjosé V: The informal caregiver’s burden of dependent people: theory and empirical review. Arch Gerontol Geriatr. 2009, 49 (1): 74-79.CrossRefPubMed Carretero S, Garcés J, Ródenas F, Sanjosé V: The informal caregiver’s burden of dependent people: theory and empirical review. Arch Gerontol Geriatr. 2009, 49 (1): 74-79.CrossRefPubMed
3.
go back to reference Gobbens RJ, Luijkx KG, Wijnen-Sponselee MTH, Schols JMGA: Towards a conceptual definition of frail community-dwelling older people. Nurs Outlook. 2010, 58 (2): 76-86.CrossRefPubMed Gobbens RJ, Luijkx KG, Wijnen-Sponselee MTH, Schols JMGA: Towards a conceptual definition of frail community-dwelling older people. Nurs Outlook. 2010, 58 (2): 76-86.CrossRefPubMed
4.
go back to reference Reinhard SC, Given B, Petlick NH, Bemis A: Supporting family caregivers in providing care. Patient safety and quality: an evidence-based handbook for nurses. Edited by: Hughes RG. 2008, Rockville: Agency for Healthcare Research and Quality, 1. Reinhard SC, Given B, Petlick NH, Bemis A: Supporting family caregivers in providing care. Patient safety and quality: an evidence-based handbook for nurses. Edited by: Hughes RG. 2008, Rockville: Agency for Healthcare Research and Quality, 1.
5.
go back to reference Sussman T: The influence of service factors on spousal caregivers’ perceptions of community services. J Gerontol Soc Work. 2009, 52 (4): 406-422.CrossRefPubMed Sussman T: The influence of service factors on spousal caregivers’ perceptions of community services. J Gerontol Soc Work. 2009, 52 (4): 406-422.CrossRefPubMed
6.
go back to reference Stone RI, Farley P: The competing demands of employment and informal caregiving to disabled. Med Care. 1990, 28 (6): 513-526.CrossRefPubMed Stone RI, Farley P: The competing demands of employment and informal caregiving to disabled. Med Care. 1990, 28 (6): 513-526.CrossRefPubMed
7.
go back to reference Schulz R, Beach SR: Caregiving as a risk factor for mortality: the caregiver health effects study. JAMA. 1999, 282: 2215-2219.CrossRefPubMed Schulz R, Beach SR: Caregiving as a risk factor for mortality: the caregiver health effects study. JAMA. 1999, 282: 2215-2219.CrossRefPubMed
8.
go back to reference Deeken JF, Taylor KL, Mangan P, Yabroff KR, Ingham JM: A review of self-report instruments developed to measure burden, needs, and quality of life of informal caregivers. J Pain Symptom Manage. 2003, 26 (4): 922-953.CrossRefPubMed Deeken JF, Taylor KL, Mangan P, Yabroff KR, Ingham JM: A review of self-report instruments developed to measure burden, needs, and quality of life of informal caregivers. J Pain Symptom Manage. 2003, 26 (4): 922-953.CrossRefPubMed
9.
go back to reference Lopez-Hartmann M, Wens J, Verhoeven V, Remmen R: The effect of caregiver support interventions for caregivers of community-dwelling frail elderly: a systematic review. Int J Integrated Care. 2012, 12 (5): e133.CrossRef Lopez-Hartmann M, Wens J, Verhoeven V, Remmen R: The effect of caregiver support interventions for caregivers of community-dwelling frail elderly: a systematic review. Int J Integrated Care. 2012, 12 (5): e133.CrossRef
10.
go back to reference Hallberg IR, Kristensson J: Preventive home care of frail older people: a review of recent case management studies. J Clin Nurs. 2004, 13: 112-120.CrossRefPubMed Hallberg IR, Kristensson J: Preventive home care of frail older people: a review of recent case management studies. J Clin Nurs. 2004, 13: 112-120.CrossRefPubMed
11.
go back to reference Brotman SL, Yaffe MJ: Are physicians meeting the needs of family caregivers of the frail elderly?. Can Fam Physician. 1994, 40: 679-685.PubMedPubMedCentral Brotman SL, Yaffe MJ: Are physicians meeting the needs of family caregivers of the frail elderly?. Can Fam Physician. 1994, 40: 679-685.PubMedPubMedCentral
12.
go back to reference Brown LJ, Potter JF, Foster BG: Caregiver burden should be evaluated during geriatric assessment. J Am Geriatr Soc. 1990, 38: 455-460.CrossRefPubMed Brown LJ, Potter JF, Foster BG: Caregiver burden should be evaluated during geriatric assessment. J Am Geriatr Soc. 1990, 38: 455-460.CrossRefPubMed
13.
go back to reference Ducharme F, Lebel P, Bergman H: Vieillissement et soins, l’urgence d’offrir des services de santé intégrés aux familles du XXIe siècle [Aging and care: urgency to offer integrated health services to families of 21st century]. Ruptures: Revue Transdisciplinaire en Santé. 2001, 8 (2): 110-121. Ducharme F, Lebel P, Bergman H: Vieillissement et soins, l’urgence d’offrir des services de santé intégrés aux familles du XXIe siècle [Aging and care: urgency to offer integrated health services to families of 21st century]. Ruptures: Revue Transdisciplinaire en Santé. 2001, 8 (2): 110-121.
14.
go back to reference Rosenthal GE, Shannon SE: The use of patient perceptions in the evaluation of health-care delivery systems. Med Care. 1997, 35 (11): NS58-NS68.PubMed Rosenthal GE, Shannon SE: The use of patient perceptions in the evaluation of health-care delivery systems. Med Care. 1997, 35 (11): NS58-NS68.PubMed
15.
go back to reference Savard J, Leduc N, Lebel P, Béland F, Bergman H: Caregiver satisfaction with support services: influence of different types of services. J Aging Health. 2006, 18 (10): 3-27.CrossRefPubMed Savard J, Leduc N, Lebel P, Béland F, Bergman H: Caregiver satisfaction with support services: influence of different types of services. J Aging Health. 2006, 18 (10): 3-27.CrossRefPubMed
16.
go back to reference McAdam M: Frameworks of integrated care for the elderly: A systematic review. 2008, Ontario: Canadian Policy Research Networks, research report McAdam M: Frameworks of integrated care for the elderly: A systematic review. 2008, Ontario: Canadian Policy Research Networks, research report
17.
go back to reference Genet N, Boerma WG, Kringos DS, Bouman A, Francke AL, Fagerström C, Melchiorre MG, Greco C, Devillé W: Home care in Europe: a systematic literature review. BMC Health Serv Res. 2011, 11 (1): 207.CrossRefPubMedPubMedCentral Genet N, Boerma WG, Kringos DS, Bouman A, Francke AL, Fagerström C, Melchiorre MG, Greco C, Devillé W: Home care in Europe: a systematic literature review. BMC Health Serv Res. 2011, 11 (1): 207.CrossRefPubMedPubMedCentral
18.
go back to reference Béland F, Bergman H, Lebel P, Clarfield AM, Tousignant P, Contandriopoulos AP, Dallaire L: A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2006, 61 (4): 367-373.CrossRefPubMed Béland F, Bergman H, Lebel P, Clarfield AM, Tousignant P, Contandriopoulos AP, Dallaire L: A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2006, 61 (4): 367-373.CrossRefPubMed
19.
go back to reference Kodner D, Spreeuwenberg C: Integrated care: meaning, logic, applications and implications – a discussion paper. Int J Integrated Care. 2003, 2 (3): e12. Kodner D, Spreeuwenberg C: Integrated care: meaning, logic, applications and implications – a discussion paper. Int J Integrated Care. 2003, 2 (3): e12.
20.
go back to reference Kodner D: All together now: a conceptual exploration of integrated care. Healthc Q. 2009, 13 (Sp): 6-15.CrossRefPubMed Kodner D: All together now: a conceptual exploration of integrated care. Healthc Q. 2009, 13 (Sp): 6-15.CrossRefPubMed
21.
go back to reference Fabbricotti IN, Janse B, Looman WM, de Kuijper R, van Wijngaarden JDH, Reiffers A: Integrated care for frail elderly compared to usual care: a study protocol of a quasi-experiment on the effects on the frail elderly, their caregivers, health professionals and health care costs. BMC Geriatr. 2013, 13: 31.CrossRefPubMedPubMedCentral Fabbricotti IN, Janse B, Looman WM, de Kuijper R, van Wijngaarden JDH, Reiffers A: Integrated care for frail elderly compared to usual care: a study protocol of a quasi-experiment on the effects on the frail elderly, their caregivers, health professionals and health care costs. BMC Geriatr. 2013, 13: 31.CrossRefPubMedPubMedCentral
22.
go back to reference Braun K, Rose C: Testing the impact of a case management program on caregiver appraisal. J Gerontol Soc Work. 1994, 21 (3/4): 51-69.CrossRef Braun K, Rose C: Testing the impact of a case management program on caregiver appraisal. J Gerontol Soc Work. 1994, 21 (3/4): 51-69.CrossRef
23.
go back to reference Eklund K: Outcomes of coordinated and integrated interventions targeting frail elderly people: a systematic review of randomized controlled trials. Health Soc Care Community. 2009, 17 (5): 447-458.CrossRefPubMed Eklund K: Outcomes of coordinated and integrated interventions targeting frail elderly people: a systematic review of randomized controlled trials. Health Soc Care Community. 2009, 17 (5): 447-458.CrossRefPubMed
24.
go back to reference Montgomery PR, Fallis WM: South Winnipeg Integrated Geriatric Program (SWING): a rapid community-response program for the frail elderly. Can J Aging. 2003, 22: 275-281.CrossRef Montgomery PR, Fallis WM: South Winnipeg Integrated Geriatric Program (SWING): a rapid community-response program for the frail elderly. Can J Aging. 2003, 22: 275-281.CrossRef
25.
go back to reference Boot JMD: Organisatie van de gezondheidszorg [In Dutch]. 2010, Assen: Uitgeverij van Gorcum Boot JMD: Organisatie van de gezondheidszorg [In Dutch]. 2010, Assen: Uitgeverij van Gorcum
26.
go back to reference Kane RL, Maciejewski M, Finch M: The relationship of patient satisfaction with care and clinical outcomes. Med Care. 1997, 35 (7): 714-730.CrossRefPubMed Kane RL, Maciejewski M, Finch M: The relationship of patient satisfaction with care and clinical outcomes. Med Care. 1997, 35 (7): 714-730.CrossRefPubMed
27.
go back to reference Malone-Beach E, Zarit S, Spore D: Caregiver’s perceptions of case management and community-based services: barriers to service use. J Appl Gerontol. 1992, 11: 146-159.CrossRef Malone-Beach E, Zarit S, Spore D: Caregiver’s perceptions of case management and community-based services: barriers to service use. J Appl Gerontol. 1992, 11: 146-159.CrossRef
28.
go back to reference Bull MJ, Hansen HE, Gross CR: Differences in family caregiver outcomes by their level of involvement in discharge planning. Appl Nurs Res. 2000, 13 (2): 76-82.CrossRefPubMed Bull MJ, Hansen HE, Gross CR: Differences in family caregiver outcomes by their level of involvement in discharge planning. Appl Nurs Res. 2000, 13 (2): 76-82.CrossRefPubMed
29.
go back to reference Cox C: Discharge planning for dementia patients: factors influencing caregiver decisions and satisfaction. Health Soc Work. 1996, 21: 97-104.PubMed Cox C: Discharge planning for dementia patients: factors influencing caregiver decisions and satisfaction. Health Soc Work. 1996, 21: 97-104.PubMed
30.
go back to reference Zwygart-Stauffacher M, Lindquist R, Savik K: Developments of health care delivery systems that are sensitive to the needs of stroke survivors and their caregivers. Nurs Adm Q. 2000, 24 (3): 33-42.CrossRefPubMed Zwygart-Stauffacher M, Lindquist R, Savik K: Developments of health care delivery systems that are sensitive to the needs of stroke survivors and their caregivers. Nurs Adm Q. 2000, 24 (3): 33-42.CrossRefPubMed
31.
go back to reference Given B, Given C: Family caregiver burden from cancer care. Cancer nursing: a comprehensive textbook. 1996, New York: Harcourt Brace, 93-104. 2 Given B, Given C: Family caregiver burden from cancer care. Cancer nursing: a comprehensive textbook. 1996, New York: Harcourt Brace, 93-104. 2
32.
go back to reference Congdon JG: Managing the incongruities: the hospital discharge experience for elderly patients, their families, and nurses. Appl Nurs Res. 1994, 7: 125-131.CrossRefPubMed Congdon JG: Managing the incongruities: the hospital discharge experience for elderly patients, their families, and nurses. Appl Nurs Res. 1994, 7: 125-131.CrossRefPubMed
33.
go back to reference Jewell S: Elderly patients’ participation in discharge decision-making. Br J Nurs. 1996, 5: 1065-1071.CrossRefPubMed Jewell S: Elderly patients’ participation in discharge decision-making. Br J Nurs. 1996, 5: 1065-1071.CrossRefPubMed
34.
go back to reference Wiles J: Informal caregivers’ experiences of formal support in a changing context. Health Soc Care Community. 2003, 11 (3): 189-207.CrossRefPubMed Wiles J: Informal caregivers’ experiences of formal support in a changing context. Health Soc Care Community. 2003, 11 (3): 189-207.CrossRefPubMed
35.
go back to reference Haug MR: Elderly patients, caregivers, and physicians: theory and research on health care triads. J Health Soc Behav. 1994, 35: 1-12.CrossRefPubMed Haug MR: Elderly patients, caregivers, and physicians: theory and research on health care triads. J Health Soc Behav. 1994, 35: 1-12.CrossRefPubMed
36.
go back to reference Levy-Storms L, Miller-Martinez D: Family caregiver involvement and satisfaction with institutional care during the 1st year after admission. J Appl Gerontol. 2005, 24 (2): 160-174.CrossRef Levy-Storms L, Miller-Martinez D: Family caregiver involvement and satisfaction with institutional care during the 1st year after admission. J Appl Gerontol. 2005, 24 (2): 160-174.CrossRef
37.
go back to reference Grant G, Ramcharan P, McGrath M, Nolan M, Keady J: Rewards and gratifications among family caregivers: towards a refined model of caring and coping. J Intellect Disabil Res. 1998, 42: 58-71.CrossRefPubMed Grant G, Ramcharan P, McGrath M, Nolan M, Keady J: Rewards and gratifications among family caregivers: towards a refined model of caring and coping. J Intellect Disabil Res. 1998, 42: 58-71.CrossRefPubMed
38.
go back to reference Schulz R, Martire LM: Family caregiving of persons with dementia: prevalence, health effects, and support strategies. Am J Geriatr Psychiatry. 2004, 12 (3): 240-249.CrossRefPubMed Schulz R, Martire LM: Family caregiving of persons with dementia: prevalence, health effects, and support strategies. Am J Geriatr Psychiatry. 2004, 12 (3): 240-249.CrossRefPubMed
39.
go back to reference Seddon D, Jones K, Boyle M: Carer experiences after a relative goes into nursing or residential care. Qual Ageing–Pol Res Pract. 2002, 3 (3): 16-26.CrossRef Seddon D, Jones K, Boyle M: Carer experiences after a relative goes into nursing or residential care. Qual Ageing–Pol Res Pract. 2002, 3 (3): 16-26.CrossRef
40.
go back to reference Bass DM, Noelker LS, McCarthy CA: The influence of formal and informal helpers on primary caregivers’ perceptions of quality of care. J Appl Gerontol. 1999, 18 (2): 177-199.CrossRef Bass DM, Noelker LS, McCarthy CA: The influence of formal and informal helpers on primary caregivers’ perceptions of quality of care. J Appl Gerontol. 1999, 18 (2): 177-199.CrossRef
41.
go back to reference Larsen DL, Attkisson CC, Hargreaves WA, Nguyen TD: Assessment of client/patient satisfaction: development of a general scale. Eval Program Plann. 1979, 2: 197-207.CrossRefPubMed Larsen DL, Attkisson CC, Hargreaves WA, Nguyen TD: Assessment of client/patient satisfaction: development of a general scale. Eval Program Plann. 1979, 2: 197-207.CrossRefPubMed
42.
go back to reference Challis D, Clarkson P, Williamson J, Hughes J, Venables D, Burns A, Weinberg A: The value of specialist clinical assessment of older people prior to entry to care homes. Age Ageing. 2004, 33 (1): 25-34.CrossRefPubMed Challis D, Clarkson P, Williamson J, Hughes J, Venables D, Burns A, Weinberg A: The value of specialist clinical assessment of older people prior to entry to care homes. Age Ageing. 2004, 33 (1): 25-34.CrossRefPubMed
43.
go back to reference Cramm JM, Strating MM, Nieboer AP: Validation of the caregivers’ Satisfaction with Stroke Care Questionnaire: C-SASC hospital scale. J Neurol. 2011, 258 (6): 1008-1012.CrossRefPubMed Cramm JM, Strating MM, Nieboer AP: Validation of the caregivers’ Satisfaction with Stroke Care Questionnaire: C-SASC hospital scale. J Neurol. 2011, 258 (6): 1008-1012.CrossRefPubMed
44.
go back to reference Boter H, de Haan RJ, Rinkel GJ: Clinimetric evaluation of a Satisfaction-with-Stroke-Care questionnaire. J Neurol. 2003, 250 (5): 534-541.CrossRefPubMed Boter H, de Haan RJ, Rinkel GJ: Clinimetric evaluation of a Satisfaction-with-Stroke-Care questionnaire. J Neurol. 2003, 250 (5): 534-541.CrossRefPubMed
46.
go back to reference Triemstra M, Winters S, Kool RB, Wiegers TA: Measuring client experiences in long-term care in the Netherlands: a pilot study with the Consumer Quality Index Long-term Care. BMC Health Serv Res. 2010, 10 (1): 95.CrossRefPubMedPubMedCentral Triemstra M, Winters S, Kool RB, Wiegers TA: Measuring client experiences in long-term care in the Netherlands: a pilot study with the Consumer Quality Index Long-term Care. BMC Health Serv Res. 2010, 10 (1): 95.CrossRefPubMedPubMedCentral
47.
go back to reference Wiegers TA, Stubbe JH, Triemstra M: Development of the CQ-index Nursing Homes and Homecare: quality of life for residents, representatives and clients. 2007, Utrecht: Nivel, 2007-Research report Wiegers TA, Stubbe JH, Triemstra M: Development of the CQ-index Nursing Homes and Homecare: quality of life for residents, representatives and clients. 2007, Utrecht: Nivel, 2007-Research report
48.
go back to reference Tabachnick BG, Fidell LS, Osterlind SJ: Using multivariate statistics. 2007, Boston: Pearson/Allyn & Bacon, 5 Tabachnick BG, Fidell LS, Osterlind SJ: Using multivariate statistics. 2007, Boston: Pearson/Allyn & Bacon, 5
49.
go back to reference Bergman H, Béland F, Lebel P, Contandriopoulos AP, Tousignant P, Brunelle Y, Kaufman T, Leibovich E, Rodriguez R, Clarfield M: Care for Canada's frail elderly population: fragmentation or integration?. Can Med Assoc J. 1997, 157 (8): 1116-1121. Bergman H, Béland F, Lebel P, Contandriopoulos AP, Tousignant P, Brunelle Y, Kaufman T, Leibovich E, Rodriguez R, Clarfield M: Care for Canada's frail elderly population: fragmentation or integration?. Can Med Assoc J. 1997, 157 (8): 1116-1121.
50.
go back to reference Winslow BW: Family caregivers’ experiences with community services: a qualitative analysis. Public Health Nurs. 2003, 20 (5): 341-348.CrossRefPubMed Winslow BW: Family caregivers’ experiences with community services: a qualitative analysis. Public Health Nurs. 2003, 20 (5): 341-348.CrossRefPubMed
51.
go back to reference Fabbricotti IN: Taking care of integrated care: integration and fragmentation in the development of integrated care arrangements. PhD thesis. 2007, Erasmus University Rotterdam, Institute of Health Policy and Management Fabbricotti IN: Taking care of integrated care: integration and fragmentation in the development of integrated care arrangements. PhD thesis. 2007, Erasmus University Rotterdam, Institute of Health Policy and Management
52.
go back to reference Lagakos SW: The challenge of subgroup analyses – reporting without distorting. N Engl J Med. 2006, 354 (16): 1667-1669.CrossRefPubMed Lagakos SW: The challenge of subgroup analyses – reporting without distorting. N Engl J Med. 2006, 354 (16): 1667-1669.CrossRefPubMed
53.
go back to reference Durand PJ, Krueger PD, Chambers LW, Grek A, Charles C: Predictors of caregivers’ dissatisfaction with community long-term care services for seniors: results from the Canadian Study of Health and Aging. Can J Public Health. 1995, 86: 325-332.PubMed Durand PJ, Krueger PD, Chambers LW, Grek A, Charles C: Predictors of caregivers’ dissatisfaction with community long-term care services for seniors: results from the Canadian Study of Health and Aging. Can J Public Health. 1995, 86: 325-332.PubMed
54.
go back to reference Weissert WG, Elston JM, Bolda EJ, Zelman WN, Mutran E, Magnum AB: Adult day care: findings from a national survey. 1990, Baltimore: John Hopkins University Press Weissert WG, Elston JM, Bolda EJ, Zelman WN, Mutran E, Magnum AB: Adult day care: findings from a national survey. 1990, Baltimore: John Hopkins University Press
55.
go back to reference Fields A: Discovering statistics using SPSS. 2009, London: SAGE Publications, 3 Fields A: Discovering statistics using SPSS. 2009, London: SAGE Publications, 3
Metadata
Title
A quasi-experimental study of the effects of an integrated care intervention for the frail elderly on informal caregivers’ satisfaction with care and support
Authors
Benjamin Janse
Robbert Huijsman
Isabelle Natalina Fabbricotti
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2014
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-14-140

Other articles of this Issue 1/2014

BMC Health Services Research 1/2014 Go to the issue