Community-Integrated Intermediary Care (CIIC) Service Model to Enhance Family-Based, Long-Term Care for Older People: Protocol for a Cluster Randomized Controlled Trial in Thailand

Abstract

Background Thailand is one of the most rapidly aging countries in Asia. Traditional family-based care, which has been the basis of most care for older people, is becoming unsustainable as families become smaller. In addition, women tend to be adversely affected as they still form the bulk of caregivers for older people, and many are likely to exit the labor market in order to provide care. Many family caregivers also have no or minimal training, and they may be called upon to provide quite complex care, increasing the proportion of older people receiving suboptimal care if they rely only on informal care that is provided by families and friends. Facing the increasing burden of noncommunicable diseases and age-related morbidity, Thai communities are increasingly in need of community-integrated care models for older persons that can link existing health systems and reduce the burden upon caring families. This need is common to many countries in the Association of Southeast Asian Nations (ASEAN). Objective In this study, we aimed to assess the effectiveness of a community-integrated intermediary care (CIIC) model to enhance family-based care for older people. Methods This paper describes a cluster randomized controlled trial comprised of 6 intervention clusters and 6 control clusters that aim to recruit 2000 participants in each arm. This research protocol has been approved by the World Health Organization Ethics Review Committee. The intervention clusters will receive an integrated model of care structured around (1) a community respite service, (2) the strengthening of family care capacity, and (3) an exercise program that aims to prevent entry into long-term care for older people. Control group clusters receive usual care (ie, the current system of long-term care common to all provinces in Thailand), consisting principally of a volunteer-assisted home care service. The trial will be conducted over a period of 2 years. The primary outcome is family caregiver burden measured at a 6-month follow-up, as measured by the Caregiver Burden Inventory. Secondary outcomes consist of biopsychosocial indicators including functional ability, as measured using an activity of daily living scale; depression, as measured by the Geriatric Depression Scale; and quality of life of older people, as measured by the EuroQol 5-dimensions 5-levels scale. Intention-to-treat analysis will be followed. Results The CIIC facility has been established. Community care prevention programs have been launched at the intervention clusters. Family caregivers are receiving training and assistance. However, the COVID-19 pandemic delayed the intervention. Conclusions Since ASEAN and many Asian countries share similar traditional family-based, long-term care systems, the proposed CIIC model and the protocol for its implementation and evaluation may benefit other countries wishing to adopt similar community-integrated care models for older people at risk of needing long-term care. Trial Registration Thai Clinical Trials Registry TCTR20190412004; http://www.thaiclinicaltrials.org/# International Registered Report Identifier (IRRID) DERR1-10.2196/20196

Caregiver Burden and Associated Factors for the Respite Care Needs among the Family Caregivers of Community Dwelling Senior Citizens in Chiang Mai, Northern Thailand

“…Those who were unable to understand about informed consent, who had cognitive impairment, or who did not consent, were excluded. Following CIIC study protocol, data were collected by trained research assistants via interviewer administered survey questionnaires from August to December 2019 [ 12 ]. Maehia city, Chiang Mai province, Northern Thailand was randomly selected as the intervention arm and 1509 older people, and 867 primary caregivers were recruited with their written informed consent.…”

“…The intermediary care service is a free of charge, formal care, short-stay service at the local community CIIC center, staffed by health care personnel. This respite care service aims to relieve Thai families of the caregiving burden by taking care of older people when their caregiver experiences symptoms of burnout or is temporarily unavailable [ 12 ].…”

Estimating Service Demand for Intermediary Care at a Community Integrated Intermediary Care Center among Family Caregivers of Older Adults Residing in Chiang Mai, Northern Thailand

“…Those who did not consent, who could not understand the explanation regarding informed consent, and with cognitive impairment or severe impairment in decision making abilities were excluded. The research assistants were trained in data collection and data were collected according to the CIIC study protocol via interviewer administered survey questionnaires in 2019 [ 12 ].…”

“…To address this issue, a cluster randomized control trial (Community Integrated Intermediary Care (CIIC) project), consisting of six control clusters and six intervention clusters, with a new respite care service, will be introduced among the intervention arms [ 12 ]. Intermediary or respite care is formal care which is neither day care nor long-term residential care, provided for short-term relief of burdened caregivers when they are not temporarily available or are suffering from burnout.…”

Thai Older People’s Willingness (Intention) to Participate in a Care Prevention, Community Group Exercise Program: An Assessment before Implementing an Intervention Trial in Chiang Mai, Northern Thailand

“…We conducted a pre-intervention survey. The study population in this survey is all the participants who enrolled into the intervention arm of the CIIC cluster randomized controlled trial, according to the CIIC protocol [19]. The inclusion criteria of study were defined.…”