Cost-utility analysis of case management for frail older people: effects of a randomised controlled trial

Sandberg, Magnus; Jakobsson, Ulf; Midlöv, Patrik; Kristensson, Jimmie

doi:10.1186/s13561-015-0051-9

Cited by 23 publications

(31 citation statements)

References 54 publications

(54 reference statements)

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“…The observed hospitalization rate (for all frailty types) in this study was much lower than that for several studies [19][20][21][22][23][24][25][26][27][28]. This nding reveals that elderly Malaysians are probably healthier than elderly in other countries.…”

Section: Discussioncontrasting

confidence: 75%

Out Of Pocket Payments For Health Care Among The Elderly With Cognitive Frailty In Malaysia

Alkhodary

Aljunid

Ismail³

et al. 2020

Preprint

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Abstract Background Recently, there is a concern on cognitive frailty, as a potent risk factors for dementia, functional disability, poor quality of life and mortality among elderly. Cognitive frailty is a reversible pathological transitional stage between healthy aging and disability; it is associated with increased health care utilization and co-morbidities. The study purpose was to identify socio-demographic characteristics, co-morbidities, and out-of-pocket payments for health care among elderly Malaysians with cognitive frailty. Methods The study included all participants of the third phase of Malaysian representative LRGS-TUA community based study. Multiple types of data were collected through a structured interviewed questionnaire including Fried’s test; Clinical dementia rating test; inpatient and outpatient health care utilization and amount paid. Results A total of 1,006 participants were interviewed, with 66.18% response rate. Only 730 respondents found satisfying the inclusion criteria of not having physical disability or psychiatric problem, not terminally ill, and no history of alcohol or drugs abuse. The prevalence of cognitive frailty was 4.5%. Males represented 66.6%. Hypertension, high cholesterol level, joint pain, diabetes mellitus, and vision problems, were the most common chronic diseases among cognitive frail elderly in Malaysia (69.7%, 66.7%, 48.5%, 39.4% and 39.4%, respectively). During last six months, cognitive frailty participants utilized outpatient care at governmental clinic, governmental hospitals, and private clinics (60.6%, 21.2%, and 21.2%, respectively). Out of the cognitive frail patients, only 3.0% were admitted to hospitals during last year. Around half (53%) of the study participants were spending less than RM100 per six months for health care out of their pockets, while 26%, 13%, 8% of the study participants were spending RM101 to RM200, RM201 to RM300, and > RM300 every six months out of their pockets for seeking of care, respectively. The mean total out-of-pocket payments for six months seeking of care for elderly Malaysian citizens with cognitive frailty was around RM84 (SD = 96.0) per six months. Conclusions Cognitive frailty is not a costly phenomena among elderly Malaysian citizens. Elderly Malaysians with cognitive frailty are probably characterized with good health and well controlled co-morbidities.

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Section: Discussioncontrasting

confidence: 75%

Out Of Pocket Payments For Health Care Among The Elderly With Cognitive Frailty In Malaysia

Alkhodary

Aljunid

Ismail³

et al. 2020

Preprint

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“…The objective burden—time spent on informal care—was considered from a societal perspective in five cost‐effectiveness analyses and one intervention found an effect in favour of the caregivers in the intervention group. Time spent on IADL by the caregivers decreased in this intervention that aimed specially at improving the functional status of frail older people (Sandberg et al ).…”

Section: Resultsmentioning

confidence: 99%

The (cost‐)effectiveness of preventive, integrated care for community‐dwelling frail older people: A systematic review

Looman

Huijsman

Fabbricotti

2018

Health Soc Care Community

123

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Integrated care is increasingly promoted as an effective and cost-effective way to organise care for community-dwelling frail older people with complex problems but the question remains whether high expectations are justified. Our study aims to systematically review the empirical evidence for the effectiveness and cost-effectiveness of preventive, integrated care for community-dwelling frail older people and close attention is paid to the elements and levels of integration of the interventions. We searched nine databases for eligible studies until May 2016 with a comparison group and reporting at least one outcome regarding effectiveness or cost-effectiveness. We identified 2,998 unique records and, after exclusions, selected 46 studies on 29 interventions. We assessed the quality of the included studies with the Effective Practice and Organization of Care risk-of-bias tool. The interventions were described following Rainbow Model of Integrated Care framework by Valentijn. Our systematic review reveals that the majority of the reported outcomes in the studies on preventive, integrated care show no effects. In terms of health outcomes, effectiveness is demonstrated most often for seldom-reported outcomes such as well-being. Outcomes regarding informal caregivers and professionals are rarely considered and negligible. Most promising are the care process outcomes that did improve for preventive, integrated care interventions as compared to usual care. Healthcare utilisation was the most reported outcome but we found mixed results. Evidence for cost-effectiveness is limited. High expectations should be tempered given this limited and fragmented evidence for the effectiveness and cost-effectiveness of preventive, integrated care for frail older people. Future research should focus on unravelling the heterogeneity of frailty and on exploring what outcomes among frail older people may realistically be expected.

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“…Similarly, in another study [ 48 ], a 1-year intervention ( n = 150 frail patients) was carried out by nurses and physiotherapists working as case managers, who undertook home visits at least once a month. Authors showed that there were no significant differences between the intervention group and control group for total cost or two measures of quality-adjusted life years.…”

Section: Discussionmentioning

confidence: 99%

Patient-centred access to health care: a framework analysis of the care interface for frail older adults

et al. 2018

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BackgroundThe objective of this study was to explore the issues surrounding access to health and social care services for frail older adults with Polish stakeholders, including healthy and frail/pre-frail older adults, health care providers, social care providers, and caregivers, in order to determine their views and perspectives on the current system and to present suggestions for the future development of a more accessible and person-centred health and social care system.MethodsFocus groups were used to gather qualitative data from stakeholders. Data were analysed using framework analysis according to five dimensions of accessibility to care: approachability, acceptability, availability and accommodation, affordability and appropriateness.ResultsGenerally services were approachable and acceptable, but unavailable. Poor availability related to high staff turnover, staff shortages and a lack of trained personnel. There were problems of long waiting times for specialist care and rehabilitation services, and geographically remote clinics. Critically, there were shortages of long-term inpatient care places, social care workers and caregivers. The cost of treatments created barriers to care and inequities in the system. Participants described a lack of integration between health and social care systems with differing priorities and disconnected budgets. They described an acute medical system that was inappropriate for patients with complex needs, alongside a low functioning social care system, where bureaucratisation caused delays in providing services to the vulnerable. An integrated system with a care coordinator to improve connections between services and patients was suggested.ConclusionsThere is an immediate need to improve access to health and social care systems for pre-frail and frail patients, as well as their caregivers. Health and social care services need to be integrated to reduce bureaucracy and increase the timeliness of treatment and care.

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Cost-utility analysis of case management for frail older people: effects of a randomised controlled trial

Cited by 23 publications

References 54 publications

Out Of Pocket Payments For Health Care Among The Elderly With Cognitive Frailty In Malaysia

Out Of Pocket Payments For Health Care Among The Elderly With Cognitive Frailty In Malaysia

The (cost‐)effectiveness of preventive, integrated care for community‐dwelling frail older people: A systematic review

Patient-centred access to health care: a framework analysis of the care interface for frail older adults

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