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Dementia Care Management

DOI: 10.3238/zfa.2015.0031-0037

Neue Wege in der ambulanten Demenzversorgung – ein Fallbeispiel

german translation / full article

Tilly Eichler, Jochen René Thyrian, Adina Dreier, Bernhard Michalowsky, Diana Wucherer, Stefan Teipel, Wolfgang Hoffmann

Keywords: Family Practitioner Based Outpatient Dementia Care Dementia Care Management Integrated Care DelpHi-MV

Going New Ways in Ambulant Dementia Care – a Case Study

Summary: DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) is a family practitioner-based cluster-randomized controlled intervention trial. The intervention aims to provide optimum care for community-dwelling people with dementia and their caregivers. Procedures contain integration of multi-professional and multimodal strategies to individualize and optimize treatment of dementia within the framework of the established health care and social service system. The intervention is conducted by Dementia Care Managers (DCM) – nurses with dementia-specific training – at the patients’ homes. The DCM collect baseline data regarding each patient’s specific medical, nursing, pharmaceutical, psychosocial, and legal situation to identify unmet needs in order to address these needs in close cooperation with the treating family physician. Enrolment into the study started in January 2012. More than 130 family practitioners and more than 600 patients are already included into the study (December 2014). The aim of this paper is to describe the DelpHi-Intervention, illustrated by a case study.


(State: 16.01.2015)

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