gms | German Medical Science

51. Kongress für Allgemeinmedizin und Familienmedizin

Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)

21.09. - 23.09.2017, Düsseldorf

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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

Meeting Abstract

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  • J. Blom - Leiden University Medical Center, Leiden, Niederlande
  • W. van Den Hout - Leiden University Medical Center, Leiden, Niederlande
  • W. Den Elzen - Leiden University Medical Center, Leiden, Niederlande
  • Y. Drewes - Leiden University Medical Center, Leiden, Niederlande
  • N. Bleijenberg - University Medical Center Utrecht, Utrecht, Niederlande
  • I. Fabbricotti - Erasmus University Rotterdam, Rotterdam, Niederlande
  • D. Jansen - VU University Medical Center, Amsterdam, Niederlande
  • R. Kempen - Maastricht University, Maastricht, Niederlande
  • R. Koopmans - Radboud University, Nijmegen Medical Center, Nijmegen, Niederlande
  • W. Looman - Erasmus University Rotterdam, Rotterdam, Niederlande
  • R. Melis - Radboud University, Nijmegen Medical Center, Nijmegen, Niederlande
  • S. Metzelthin - Maastricht University, Maastricht, Niederlande
  • E. Moll van Charante - Amsterdam Medical Center, Amsterdam, Niederlande
  • M. Muntinga - VU University Medical Center, Amsterdam, Niederlande
  • M. Numans - Leiden University Medical Center, Leiden, Niederlande
  • F. Ruikes - Radboud University, Nijmegen Medical Center, Nijmegen, Niederlande
  • S. Spoorenberg - Leiden University Medical Center, Leiden, Niederlande; University Medical Center Groningen, Groningen, Niederlande
  • T. Stijnen - Leiden University Medical Center, Leiden, Niederlande
  • J. Suijker - Amsterdam Medical Center, Amsterdam, Niederlande
  • N. de Wit - University Medical Center Utrecht, Utrecht, Niederlande
  • K. Wynia - University Medical Center Groningen, Groningen, Niederlande
  • A. Wind - Leiden University Medical Center, Leiden, Niederlande
  • J. Gussekloo - Leiden University Medical Center, Leiden, Niederlande

51. Kongress für Allgemeinmedizin und Familienmedizin. Düsseldorf, 21.-23.09.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. Doc17degam160

doi: 10.3205/17degam160, urn:nbn:de:0183-17degam1600

Published: September 5, 2017

© 2017 Blom et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Background: Supporting older people with several healthcare needs in sustaining adequate functioning and independence puts a major challenge on the healthcare system. Proactive approaches are needed.

Objectice: This study summarizes the (cost-)effectiveness of eight proactive, multidisciplinary, integrated care programs for older people in primary care in The Netherlands.

Method: Individual Patient Data meta-analysis of 8 clinical controlled trials performed. Interventions: identification of older people with complex problems with a multidisciplinary, integrated care program for those identified in primary care. Primary outcome: ADL (change on Katz-15-scale, baseline to 12 months). Secondary outcomes: QoL (VAS 0-10), psychological (mental wellbeing scale RAND-36) and social wellbeing (single item, RAND-36), QALY (EQ-5D-3L), healthcare utilization and cost-effectiveness.

Results: In total, 8,678 participants were included, with 5,496 (63.3%) women and a median age of 80.5 years (Inter Quartile Range 75.3; 85.7). The pooled difference in change on the modified Katz-15-scale between the intervention and control groups was -0.01 (95% Confidence Interval (CI) -0.10;0.08). No significant differences were found for the other patient outcomes and in subgroup analyses. Intervention costs were on average € 527 per person and total health care costs were higher in the intervention group than in the control group (€ 911 per person, 95% CI: € 408; € 1414). The probability of the intervention group to be cost-effective compared to usual care was less than 5%. Design: Individual Patient Data meta-analysis of 8 clinical controlled trials performed.

Discussion: Strategies for identification of frail older people combined with a proactive, integrated care intervention was not (cost-)effective compared to usual care after 12 months.