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, Jeanet W.; Hout, Wilbert B. van den; Elzen, W.P.J. den; Drewes, Yvonne M.; Bleijenberg, Nienke; Fabbricotti, Isabelle; Jansen, A.P.D.; Kempen, Gertrudis I. J. M.; Koopmans, Raymond T.C.M.; Looman, Willemijn; Melis, René J.F.; Metzelthin, Silke; Charante, Eric P. Moll van; Muntinga, Maaike; Numans, Mattijs E.; Ruikes, Franca G H; Spoorenberg, Sophie; Stijnen, Theo; Suijker, Jacqueline J.; Wit, Niek J. de; Wynia, Klaske; Wind, Astrid de; Gussekloo, Jacobijn

doi:10.1093/ageing/afy091

Cited by 28 publications

(32 citation statements)

References 32 publications

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“…GPs are considered to be key actors in the implementation of promising initiatives targeting frail older persons [9]. Many integrated care initiatives have emerged and are implemented in the primary healthcare sector, but evidence of their effectiveness and cost-effectiveness remains mixed [3, 16–21]. Integrated primary care programs for frail older persons have shown no effect on the majority of outcomes, and evidence for their cost-effectiveness is limited [16].…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons

Vestjens

Cramm

Birnie

et al. 2019

Cost Eff Resour Alloc

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Background The article reports on the cost-effectiveness of the proactive, integrated primary care program Finding and Follow - up of Frail older persons (FFF) compared with usual primary care for community-dwelling frail older persons in the Netherlands. Methods This study had a matched quasi-experimental design (pretest and posttest). The economic evaluation was performed from a healthcare perspective with a time horizon of 12 months. The target population consisted of community-dwelling frail older persons aged ≥ 75 years in the FFF intervention group (11 general practitioner (GP) practices) and in the control group receiving usual care (4 GP practices). The effectiveness measures for the cost-effectiveness and cost-utility analyses were subjective well-being (Social Production Function Instrument for the Level of well-being short; SPF-ILs) and QALYs (EuroQol; EQ-5D-3L), respectively. Costs were assessed using resource use questionnaires. Differences in mean effectiveness between groups were assessed using univariate, multilevel and propensity score matched analyses, with and without imputation of missing values. Differences in costs were assessed using Mann–Whitney U -tests and independent samples t -tests. Bootstrapping was performed, and predicted incremental cost-effectiveness ratios (ICERs) and incremental cost-utility ratios (ICURs) were depicted on cost-effectiveness planes. Results The various analyses showed slightly different results with respect to differences in estimated costs and effects. Multilevel analyses showed a small but significant difference between the groups for well-being, in favor of the control group. No significant differences between groups in terms of QALYs were found. Imputed data showed that mean total costs were significantly higher in the intervention group at follow-up. Conclusion Proactive, integrated care for community-dwelling frail older persons as provided in the FFF program is most likely not a cost-effective initiative, compared with usual primary care in the Netherlands, in terms of well-being and QALYs over a 12-month period. Electronic supplementary material The online version of this article (10.1186/s12962-019-0181-8) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons

Vestjens

Cramm

Birnie

et al. 2019

Cost Eff Resour Alloc

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“…Despite the fact that patient participation is high on the public agenda, studies show that multidisciplinary teams often operate from a professional perspective, and studies into interprofessional collaboration mainly focus on the viewpoints of professionals [11][12][13] or on more quantitative patient outcomes [14][15][16][17]. Furthermore, as previous studies have stressed, increasing communication with informal caregivers is very important in order to actively involve them in the care of older patients with multimorbidities and complex care needs [18][19][20].…”

Section: Introduction Contextmentioning

confidence: 99%

Professional Care Networks of Frail Older People: An Explorative Survey Study from the Patient Perspective

et al. 2020

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Key pointsPatient participation is high on the public agenda, but multidisciplinary teams who offer care to frail older people find it hard to incorporate patients views in their way of working. Our study focused on the care network of the older patient, and more specific on the role of the informal caregiver. In many networks, the informal caregiver was not or only moderately connected with professional actors. Elderly care networks can be rather vulnerable because the power (knowledge, contacts) lies entirely with the patient. Our study suggests that it would be relatively easy to develop materials to enable professionals to map the patient care network, which could then be used as the basis of conversations about the organisation of care, Background: Frail older people living in the community require multidisciplinary care. Despite the fact that patient participation is high on the public agenda, studies into multidisciplinary care mainly focus on the viewpoints of professionals. Little is known about frail older patients' experiences with care delivered by multidisciplinary teams and their perception of collaboration between professional and informal caregivers. Objective: To gain more insight into the experiences of frail older patients with integrated multidisciplinary care by mapping the care networks of this patient group and their perception of the interconnection between professional and informal caregivers. Methods: Survey study to facilitate a care network analysis. Due to the vulnerable health status of the respondents, questionnaires were completed during interviews. Analysis was performed using an iterative process, using both visual and metric techniques. Participants: 44 older persons, considered 'frail' by their general practitioner. Setting: Four general practices in The Netherlands. Results: The networks of the participants consisted of an average of 15 actors connected by 54 ties. General practitioners were the most common actors in the networks, and were well connected to medical specialists and in-home care providers. The participants did not always perceive a connection between their general practitioner and their informal caregiver. The network analyses resulted in the identification of three subtypes: simple star (n = 16), complex star (n = 16), and sub-group networks (n = 12). Conclusions: Our findings indicate that the elderly often do not experience the integration of multidisciplinary care as such. This is a real opportunity for MTs to improve their care and to make the patients' experiences better in line with what they are aiming: allowing patients to live at home as healthy and independently as possible for as long as possible. We showed that informal caregivers often form communication bridges between patients and professionals. Having a better knowledge of the patient perspective enables the gaps in professional care networks of frail older people to be filled and facilitates the anticipation of crisis situations.

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“…These outpatient assessment programs have been extensively researched, however studies have shown inconsistent effects on clinical outcomes [3] and scarcely any effects on functional dependency [7]. This inconsistency in findings can be explained through the heterogeneity of these multi-component programs [8].…”

Section: Introductionmentioning

confidence: 99%

Explaining experiences of community-dwelling older adults with a pro-active comprehensive geriatric assessment program – a thorough evaluation by interviews

et al. 2019

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IntroductionPro-active assessment programs are increasingly used to improve care for older adults. These programs include comprehensive geriatric tailored to individual patient preferences. Evidence for the effects of these programs on patient outcomes is nevertheless scarce or ambiguous. Explaining these dissatisfying results is difficult due to the multi-component nature of the programs. The objective of the current study was to explore and explain the experience of older adults participating in a pro-active assessment program, to help to clarify the effects.MethodsSemi-structured in-depth interviews were held with 25 participants of a pro-active assessment program for frail community-dwelling adults aged 65+. This study was part of an evaluation study on the effects of the program. Transcripts were analysed with thematic analysis and cross-case analysis.ResultsThe participants’ mean age was 78.5 (SD 6.9) and 56% was female. The majority of the participants were satisfied with the program but based this on communication aspects, since only a few of them expressed real program benefits. Participant experiences could be clustered in six themes: (1) All participants expressed the need for a holistic view which was covered in the program, (2) the scope of the CGA was broader than expected or unclear, (3) the program delivered unexpected but valued help, (4) participants described a very low sense of ownership, (5) timing of the program implementation or the CGA was difficult and(6), participants and care workers had a different view on what to consider as a problem. These experiences could be explained by three program components: the degree of (the lack of) integration of the program within usual care, the pro-active screening method and the broader than expected, but appreciated multi-domain approach.ConclusionOlder adults’ need for a holistic view is covered by this outpatient assessment program. However, their engagement and the correct timing of the program are hampered by the pro-active recruitment and the limited integration of the program within existing care. Furthermore, satisfaction seems an insufficient guiding factor when evaluating CGA programs for older adults because it does not reflect the impact of the program.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-1025-7) contains supplementary material, which is available to authorized users.

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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

Cited by 28 publications

References 32 publications

Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons

Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons

Professional Care Networks of Frail Older People: An Explorative Survey Study from the Patient Perspective

Explaining experiences of community-dwelling older adults with a pro-active comprehensive geriatric assessment program – a thorough evaluation by interviews

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