Artikel
Effectiveness of local, collaborative, stepped and personalized care management for older people with chronic diseases
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Autoren
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Gloria Metzner
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Lukas M. Horstmeier
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Eva Maria Bitzer
- Pädagogische Hochschule Freiburg, Freiburg, Deutschland
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Elena Dreher
- Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Anne Göhner
- Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Ines Himmelsbach
- Katholische Hochschule Freiburg, Freiburg, Deutschland
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Klaus Kaier
- Institut für Medizinische Biometrie und Statistik, Medizinische Fakultät, Universitätsklinikum Freiburg, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Jasmin Kiekert
- Katholische Hochschule Freiburg, Freiburg, Deutschland
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Katharina Kohler
- Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Katharina Laubner
- Abteilung Endokrinologie und Diabetologie, Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Lisa Lyssenko
- Pädagogische Hochschule Freiburg, Freiburg, Deutschland
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Andy Maun
- Institut für Allgemeinmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Claudia Salm
- Institut für Allgemeinmedizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Jochen Seufert
- Abteilung Endokrinologie und Diabetologie, Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Sebastian Voigt-Radloff
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland; Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Erik Farin-Glattacker
- Sektion Versorgungsforschung und Rehabilitationsforschung, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| Veröffentlicht: | 30. September 2022 |
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Gliederung
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Background: During the past decades, life expectancy improved significantly in Western societies. Consequently, the number of elderly people with multiple coexisting chronic diseases, called multimorbidity, increased as well. In Germany, multimorbid elderly frequently face fragmented health care support due to the involvement of various separate healthcare professionals. In this study, LoChro-Care aimed to address this problem by implementing a local, collaborative, stepped and personalized care management approach.
Objective: The effectiveness of LoChro-Care was evaluated by contrasting the physical, psychological and social health status of the intervention group (IG) to participants receiving usual care (control group, CG).
Method: A longitudinal, randomized controlled trial was conducted at the University Medical Centre Freiburg (2018-2020), with 3 time points (t0 baseline, t1 after 12 months, t2 after 18 months). Provided by a chronic care manager, LoChro-Care comprised individualized stepped care with 7 to 13 contacts over 12 months. Physical, psychological and social health status was assessed as primary outcome by a composite score of functional health (WHODAS) and depressive symptoms (PHQ). The participants’ evaluation of their health care situation, health-related quality of life and life-satisfaction were secondary outcomes. Data were analysed using linear mixed modelling.
Results: We analysed N=491 participants (nIG=244, nCG=247), mean age 76.8 years (SD=6.4). Both groups showed a significant decline in their physical, psychological and social health status between t0 and t2 (p<.001). No significant difference between IG and CG (p=.88) and no group-time interaction (p=.52; p=.88) were observed. Post hoc analyses revealed a significant worsening of both functional health (WHODAS; p<.001) and depressive symptoms (PHQ; p=.02) over time. In addition, no significant difference between both groups could be observed for the participants’ evaluation of their health care situation (p=.93), health-related quality of life (p=.44) life satisfaction (p=.32).
Discussion: The results did not indicate neither a significant nor a positive effect of LoChro-Care on the physical, psychological and social health status of elderly people with multiple chronic diseases. Both groups, however, displayed an ongoing decline of functional health and wellbeing. Potential explanations for the lack of an intervention effect are a) the initiation of treatment was too late in disease progression to successfully support multimorbid patients, b) negative effects of the COVID-19 pandemic interfered with potentially positive LoChro-effects, or c) the diversity of the sample potentially interfered with the interventions’ effectiveness.
Practical implications: While collaborative care management approaches may have theoretical benefit, the specific and effective intervention elements need to be determined before implementation in routine care for each targeted population and intervention goal respectively.
Appeal for practice in one sentence: The rapid decline in the physical, psychological, and social health status among multimorbid patients underlines the importance of future research for more efficient care.
Funding: Sonstige Förderung; 01GL1703 A-C
