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Clinical Investigations in Critical Care |

Impact of a Disease Management Program Upon Caregivers of Chronically Critically Ill Patients*

Sara L. Douglas, PhD, CRNP; Barbara J. Daly, PhD, RN; Carol Genet Kelley, PhD, RN; Elizabeth O’Toole, MD; Hugo Montenegro, MD
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*From Case Western Reserve University, Cleveland, OH.

Correspondence to: Sara L. Douglas, PhD, CRNP, School of Nursing, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106-4904; e-mail: SLD4@case.edu



Chest. 2005;128(6):3925-3936. doi:10.1378/chest.128.6.3925
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Objectives: Few studies have examined the effects of caregiving on the caregivers of chronically critically ill (CCI) patients, and no one has examined the impact of a disease management program (DMP) on physical and psychological outcomes for the caregivers of CCI patients. The purposes of this study of caregivers of CCI patients were as follows: (1) to describe the characteristics of CCI patients and caregivers and to examine the frequency of depression, subjective burden, and physical health; (2) to examine factors related to depression after hospital discharge; and (3) to examine the effects of a DMP on the physical health, depression, and burden of caregivers 2 months post-hospital discharge.

Design: Prospective experimental design.

Setting and participants: Caregivers of 290 patients who had received > 3 days of mechanical ventilation while in the ICU of a university medical center.

Measurements: Sociodemographics, caregiver burden, physical health status, and depression were measured using established tools.

Results: Interviews of caregivers were conducted at hospital discharge and 2 months later. Seventy-three percent of patients survived, completed the study period, and required caregiving 2 months later. Caregivers of patients residing in an institution reported higher depression (p = 0.0001), higher burden (ie, disrupted schedule, p = 0.0001; lack of family support, p = 0.036), and greater health problem scores (p = 0.0001) than did caregivers of patients residing at home. The DMP did not have a statistically significant impact on any of the outcome variables. However, by 2 months, 54% of caregivers in the experimental group had no depression or mild depression compared with 34.5% of the control group.

Conclusion: Two months after hospital discharge, approximately 25% of caregivers were classified as depressed with 16.7% of the depressed group classified as moderately or severely depressed. The caregivers of CCI patients are at risk for post-hospital discharge depression, and the caregivers of institutionalized CCI patients are at highest risk of long-term negative effects from caregiving.

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