PC‐002: Case management for patients with dementia in primary care: Why it doesn't work—A mixed studies systematic review
Bibliographic record
Abstract
As the first contact of patients with cognitive deficiency happens in primary care it is important to strengthen it. Case management (CM) was designed to address it by providing a demand-directed care. However, the results of CM efficacy are varied across the studies. Recently conducted systematic reviews concluded that CM is unlikely to be cost-effective and lead to optimal use of healthcare resources. One of the causes that can hinder the efficacy of CM is the barriers to implementation. They can lead to little or no effect of the intervention (no implementation, no effect) while CM intervention can be effective. Our study hypothesis posits that the more barriers to implementation are addressed the more positive key outcomes are measured. A systematic mixed studies review allowed us to integrate the findings of studies (quantitative, qualitative and mixed methods) in order to evaluate the complex intervention of CM. Moreover, it is a way to answer a number of questions in the same review (e.g., identification of barriers and evaluation if they have been addressed). Literature search of publications in English or French was performed in MEDLINE, PsycInfo, EMBASE and the Cochrane library from 1995 to 2012. Five main groups of outcomes have been identified across 28 intervention studies: clinical outcomes, service use, caregiver outcomes, satisfaction and other outcomes (e.g., dementia detection rate, medication management). From predominantly qualitative studies barriers were grouped into 2 categories: barriers to intervention (restricted inclusion criteria, CM intensity, duration of intervention, lack of training in geriatrics) and barriers to implementation (lack of CM embedding, case manager location, short engagement period, collaboration/communication issues). Duration of intervention, intensity of CM, ineffective communication and collaboration, case manager location, and training in geriatrics are addressed more frequently. Less attention has been paid to lack of CM embedding, restricted inclusion criteria of participants and, short engagement period. Matching of the non-intervention (qualitative studies) with the intervention studies (quantitative studies measuring outcomes) demonstrates that studies with more addressed barriers to implementation produce more positive outcomes. Among the barriers effective communication/collaboration and duration of intervention are the most important to be addressed to gain more positive outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.020 | 0.073 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.010 |
| Bibliometrics | 0.013 | 0.013 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.004 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".