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 | Zendy

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

Open Access

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

Author(s) -

Jeanet W. Blom,

Wilbert B. van den Hout,

Wendy P. J. den Elzen,

Yvonne M. Drewes,

Nienke Bleijenberg,

Isabelle Fabbricotti,

A. P. D. Jansen,

Gertrudis I. J. M. Kempen,

R.T.C.M. Koopmans,

Willemijn Looman,

René J. F. Melis,

Silke Metzelthin,

Eric P. Moll van Charante,

Maaike Muntinga,

Mattijs E. Numans,

Franca G.H. Ruikes,

Sophie Spoorenberg,

Theo Stijnen,

Jacqueline J. Suijker,

Niek J. de Wit,

Klaske Wynia,

Annet Wind,

Jacobijn Gussekloo

Publication year - 2018

Publication title -

age and ageing

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 2.014

H-Index - 143

eISSN - 1468-2834

pISSN - 0002-0729

DOI - 10.1093/ageing/afy091

Subject(s) - medicine , quality of life (healthcare) , multidisciplinary approach , psychological intervention , interquartile range , subgroup analysis , intervention (counseling) , scale (ratio) , gerontology , meta analysis , quality adjusted life year , health care , cost effectiveness , nursing , social science , physics , risk analysis (engineering) , surgery , quantum mechanics , sociology , economics , economic growth

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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