Efficacy and cost-effectiveness of extended nursing roles in dementia care: Results of the cluster-randomized trial InDePendent

Abstract

Introduction: Extended nursing roles in dementia can improve treatment, care, and patient and caregiver outcomes. We tested the efficacy and cost-effectiveness in people living with dementia (PlwD) and caregivers.

Methods: We analyzed data from 417 PlwD within the multicenter, cluster-randomized InDePendent trial six months after baseline. Specifically, qualified nurses carried out advanced dementia care management individually tailored to each patient's and caregiver's needs. Outcomes included unmet needs (CANE), quality of life (QoL-AD, EQ-5D), caregiver burden (Zarit), and cost-effectiveness (FIMA, RUD).

Results: PlwD receiving the intervention had 74% lower unmet needs (0.26, CI^95%: 0.17 to 0.40, p < 0.001) and higher quality of life (0.04, CI^95%: 0.01 to 0.07, p = 0.017) than controls. There was a gain in quality-adjusted life years (0.01, CI^95%: -0.001 to 0.018) at slightly higher costs (1,425 EUR, CI^95%: 638 to 2,211). There was no effect on caregiver burden after six months.

Discussion: The results provide evidence for the efficacy and cost-effectiveness of extended nursing roles in dementia care, demonstrating that extended nursing roles reduce unmet needs and improve quality of life.

Trial registration: This trial was prospectively registered on ClinicalTrials.gov under the identifier NCT04741932 on February 2, 2021.

Highlights: The InDePendent intervention significantly reduced the number of unmet needs in PlwD and their caregiver according to CANE. Extended nursing roles can improve PlwD's health-related Quality of Life. Advanced dementia care management were likely to be cost-effective after six months.

Keywords: advanced nursing; cost‐effectiveness; dementia; primary care; randomized controlled trial; unmet needs.