Cost-effectiveness of a multicomponent primary care program targeting frail elderly people

Ruikes, Franca G H; Adang, Eddy; Assendelft, W. J. J.; Schers, Henk; Koopmans, Raymond T.C.M.; Zuidema, Sytse U.

doi:10.1186/s12875-018-0735-4

Cited by 16 publications

(34 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 50 However, results should be interpreted with caution as omission of other services (such as medication reviews) within a multimodal intervention can impact costings, and there are instances where interventions have not been found to be more-cost effective than usual care. 64 The approach of streamlining and reorganising existing services rather than creating entirely new systems may be preferred.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of combined exercise and nutrition interventions in prefrail or frail older hospitalised patients: a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

ObjectivesTo determine the effectiveness of combined exercise-nutrition interventions in prefrail/frail hospitalised older adults on frailty, frailty-related indicators, quality of life (QoL), falls and its cost-effectiveness.DesignRandomised controlled trials (RCTs) of combined exercise-nutrition interventions on hospitalised prefrail/frail older adults ≥65 years were collated from MEDLINE, Emcare, CINAHL, Ageline, Scopus, Cochrane and PEDro on 10 October 2019. The methodological quality was appraised, and data were summarised descriptively or by meta-analysis using a fixed effects model. The standardised mean difference (SMD) or difference of means (MD) with 95% CIs was calculated.ResultsTwenty articles from 11 RCTs experimenting exercise-nutrition interventions on hospitalised older adults were included. Seven articles were suitable for the meta-analyses. One study had low risk of bias and found improvements in physical performance and frailty-related biomarkers. Exercise interventions were mostly supervised by a physiotherapist, focusing on strength, ranging 2–5 times/week, of 20–90 min duration. Most nutrition interventions involved counselling and supplementation but had dietitian supervision in only three studies. The meta-analyses suggest that participants who received exercise-nutrition intervention had greater reduction in frailty scores (n=3, SMD 0.25; 95% CI 0.03 to 0.46; p=0.02) and improvement in short physical performance battery (SPPB) scores (n=3, MD 0.48; 95% CI 0.12 to 0.84; p=0.008) compared with standard care. Only the chair-stand test (n=3) out of the three SPPB components was significantly improved (MD 0.26; 95% CI 0.09 to 0.43; p=0.003). Patients were more independent in activities of daily living in intervention groups, but high heterogeneity was observed (I2=96%, p<0.001). The pooled effect for handgrip (n=3)±knee extension muscle strength (n=4) was not statistically significant. Nutritional status, cognition, biomarkers, QoL, falls and cost-effectiveness were summarised descriptively due to insufficient data.ConclusionsThere is evidence, albeit weak, showing that exercise-nutrition interventions are effective to improve frailty and frailty-related indicators in hospitalised older adults.

show abstract

Section: Discussionmentioning

confidence: 99%

Effectiveness of combined exercise and nutrition interventions in prefrail or frail older hospitalised patients: a systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Given the confluence of an aging population and downward trend in the number of geriatrics‐trained clinicians, 15 healthcare systems must identify innovative approaches to stewarding clinical expertise while providing high‐quality care to the most vulnerable older adults and middle‐aged adults with complex comorbidity. Our study illustrates the organizational resources GeriPACTs need to support their work and the potential value added for geriatric primary care patients, but further research is warranted to (1) demonstrate GeriPACTʼs cost effectiveness 25 and establish a business case for reimbursement models in the private sector 15,26,41 ; (2) identify the patients most likely to benefit from GeriPACT and the extent to which GeriPACT can “effectively decompress primary care by removing Veterans who require more attention from the primary care patient mix” 1 ; and (3) understand patient experience and satisfaction with such delivery models.…”

Section: Discussionmentioning

confidence: 99%

Using the PACT Resources Framework to Understand the Needs of Geriatric Primary Care Teams

Solimeo

Steffen

Gardner

et al. 2020

J American Geriatrics Society

View full text Add to dashboard Cite

OBJECTIVES To identify the perceived organizational resources required by healthcare workers to deliver geriatric primary care in a geriatric patient aligned care team (GeriPACT). DESIGN Cross‐sectional observational study using deductive analyses of qualitative interviews conducted with GeriPACT team members. SETTING GeriPACTs practicing at eight geographically dispersed Department of Veterans Affairs (VA) healthcare systems. PARTICIPANTS GeriPACT clinicians, nurses, clerical associates, clinical pharmacists, and social workers (n = 67). MEASUREMENTS Semistructured qualitative interviews conducted in person, transcribed, and then analyzed using the PACT Resources Framework. RESULTS Using the PACT Resources Framework, we identified facility‐, clinic‐, and team‐level resources critical for GeriPACT implementation. Resources within each level reflect how the needs of older adults with complex comorbidity intersect with general population primary care medical home practice. GeriPACT implementation is facilitated by attention to patient characteristics such as cognitive impairment, ambulatory limitations, or social support services in staffing and resourcing teams. CONCLUSION Models of geriatric primary care such as GeriPACT must be implemented with an eye toward the most effective use of our most limited resource‐trained geriatricians. In contrast to much of the literature on medical home teams serving a general adult population, interviews with GeriPACT members emphasize how patient needs inform all aspects of practice design including universal accessibility, near real‐time response to patient needs, and ongoing interdisciplinary care coordination. Examination of GeriPACT implementation resources through the lens of traditional primary care teams illustrates the importance of tailoring primary care design to the needs of older adults with complex comorbidity.

show abstract

“…There is a range of studied CGA interventions, from an intense geriatrician-led ambulatory unit intervention [ 32 , 33 , 39 ] to a more limited CGA with a team consisting of GP, a nurse and a social worker [ 15 , 20 , 40 ]. We decided to use a doctor-nurse team and a CGA tool with a relatively small set of items aiming for a differentiated and individualized intervention [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…In spite of a great number of intervention studies, there is insufficient evidence for effectiveness of CGA in primary care regarding reduced mortality or inpatient care [ 11 , 17 ]. There is also limited economic evaluation that suggests that CGA may save on hospital costs [ 19 , 20 ]. One of the highlighted challenges in these studies is the identification of older adults in primary care that would benefit most from CGA interventions [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Costs and effects of comprehensive geriatric assessment in primary care for older adults with high risk for hospitalisation

et al. 2021

View full text Add to dashboard Cite

Background The healthcare system needs effective strategies to identify the most vulnerable group of older patients, assess their needs and plan their care proactively. To evaluate the effectiveness of comprehensive geriatric assessment (CGA) of older adults with a high risk of hospitalisation we conducted a prospective, pragmatic, matched-control multicentre trial at 19 primary care practices in Sweden. Methods We identified 1604 individuals aged 75 years and older using a new, validated algorithm that calculates a risk score for hospitalisation from electronic medical records. After a nine-month run-in period for CGA in the intervention group, 74% of the available 646 participants had accepted and received CGA, and 662 participants remained in the control group. Participants at intervention practices were invited to CGA performed by a nurse together with a physician. The CGA was adapted to the primary care context. The participants thereafter received actions according to individual needs during a two-year follow-up period. Participants at control practices received care as usual. The primary outcome was hospital care days. Secondary outcomes were number of hospital care episodes, number of outpatient visits, health care costs and mortality. Outcomes were analysed according to intention to treat and adjusted for age, gender and risk score. We used generalised linear mixed models to compare the intervention group and control group regarding all outcomes. Results Mean age was 83.2 years, 51% of the 1308 participants were female. Relative risk reduction for hospital care days was − 22% (− 35% to − 4%, p = 0.02) during the two-year follow-up. Relative risk reduction for hospital care episodes was − 17% (− 30% to − 2%, p = 0.03). There were no significant differences in outpatient visits or mortality. Health care costs were significantly lower in the intervention group, adjusted mean difference was € − 4324 (€ − 7962 to − 686, p = 0.02). Conclusions and relevance Our findings indicate that CGA in primary care can reduce the need for hospital care days in a high-risk population of older adults. This could be of great importance in order to manage increasing prevalence of frailty and multimorbidity. Trial registration clinicaltrials.gov Identifier: NCT03180606, first posted 08/06/2017.

show abstract

Cost-effectiveness of a multicomponent primary care program targeting frail elderly people

Cited by 16 publications

References 46 publications

Effectiveness of combined exercise and nutrition interventions in prefrail or frail older hospitalised patients: a systematic review and meta-analysis

Effectiveness of combined exercise and nutrition interventions in prefrail or frail older hospitalised patients: a systematic review and meta-analysis

Using the PACT Resources Framework to Understand the Needs of Geriatric Primary Care Teams

Costs and effects of comprehensive geriatric assessment in primary care for older adults with high risk for hospitalisation

Contact Info

Product

Resources

About