Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis
Blom, J. W.; Van den Hout, W. B.; Den Elzen, W. P. J.; Drewes, Y. M.; Bleijenberg, N.; Fabbricotti, I. N.; Jansen, A. P. D.; Kempen, G. I. J. M.; Koopmans, R.; Looman, W. M.; Melis, R. J. F.; Metzelthin, S. F.; van Charante, E. P. Moll; Muntinga, M. E.; Numans, M. E.; Ruikes, F. G. H.; Spoorenberg, S. L. W.; Stijnen, T.; Suijker, J. J.; De Wit, N. J.; Wynia, K.; Wind, A. W.; Gussekloo, J.
(2018) Age and Ageing, volume 47, issue 5, pp. 705 - 714
(Article)
Abstract
Purpose: to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: individual patient data (IPD)
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meta-analysis of eight clinically controlled trials. Setting: primary care sector. Interventions: combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main outcome: activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: quality of life (visual analogue scale 0-10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was -0.01 (95% confidence interval -0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion: compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective.
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Keywords: aged, primary care, integrated care, older people, Integrated care, Older people, Aged, Primary care, Geriatrics and Gerontology, Ageing
ISSN: 0002-0729
Publisher: Oxford University Press
Note: Funding Information: This work was supported by The Netherlands Organisation for Health Research and Development (ZonMw) (ZonMw No. 63300095101). The sponsor had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. Publisher Copyright: © 2017 The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
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