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
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Publication date
2018-09
Authors
Blom, J. W.
Van den Hout, W. B.
Den Elzen, W. P. J.
Drewes, Y. M.
Bleijenberg, Nienke
Fabbricotti, I. N.
Jansen, A. P. D.
Kempen, G. I. J. M.
Koopmans, R.
Looman, W. M.
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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) 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.
Keywords
aged, primary care, integrated care, older people, Integrated care, Older people, Aged, Primary care, Geriatrics and Gerontology, Ageing
Citation
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 M, 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, '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', Age and Ageing, vol. 47, no. 5, pp. 705-714. https://doi.org/10.1093/ageing/afy091