Treatment strategies or settings exist for two of the three groups of difficult patients-those with severe mental illness (unwilling care avoiders) and those with the least severe psychiatric symptoms but the most difficult behaviors (demanding care claimers). The remaining group (ambivalent care seekers), which consists of those who seek care but exhibit ambivalent behaviors that could be interpreted as both difficult and ill, is not supported sufficiently by effective treatment strategies. Further development and research into effective interventions is suggested for this group.

No abstract

BackgroundCase management programmes for home-dwelling people with dementia and their informal carers exist in multiple forms and shapes. The aim of this research was to identify the essential components of case management for people with dementia as well as the preconditions for an effective delivery of case management services.MethodThe method used to carry out the research was a modified four-phase Delphi design. First, a list of potentially essential components and preconditions for the provision of case management was drawn up on the basis of a literature review and a subsequent focus group interview. The list was then validated by experts in a first Delphi survey round, following which the researchers translated the list items into 75 statements. In the second Delphi survey, the experts rated the statements; in the third Delphi round, they rated 18 statements on which no consensus had been reached in the second round.ResultsThe experts were able to build consensus on 61 of the 75 statements. Essential components of case management for people with dementia are: information, support and counselling, coordination of the care provided and, to a lesser extent, practical help. A patient-centred approach was found to be one of the key aspects of providing case management services. Essential preconditions are: vision, care relationship, structured methodology, integration of case management into the health care chain, and the case manager's level of training and expertise.ConclusionsWe recommend that, based on the essential components and preconditions referred to above, quality criteria be developed for the provision of case management for people with dementia. Furthermore, we suggest the conduct of additional research to assess the effectiveness of case management in people with dementia.

Treatment strategies or settings exist for two of the three groups of difficult patients-those with severe mental illness (unwilling care avoiders) and those with the least severe psychiatric symptoms but the most difficult behaviors (demanding care claimers). The remaining group (ambivalent care seekers), which consists of those who seek care but exhibit ambivalent behaviors that could be interpreted as both difficult and ill, is not supported sufficiently by effective treatment strategies. Further development and research into effective interventions is suggested for this group.