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

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...

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Detalles Bibliográficos
Autores principales: 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, Moll van Charante, E P, 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Research Paper
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108387/
http://dx.doi.org/10.1093/ageing/afy091
Descripción
Sumario: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) 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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