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

• DOI: 10.1093/ageing/afy091
• Publication Date: 2018-05-24T19:09:57Z
• Authors: J W Blom; W B Van den Hout; W P J Den Elzen; Y M Drewes; N Bleijenberg; I N Fabbricotti; A P D Jansen; G I J M Kempen; R Koopmans; W M Looman; R J F Melis; S F Metzelthin; E P Moll van Char...; M E Muntinga; M E Numans; F G H Ruikes; S L W Spoorenberg; T Stijnen; J J Suijker; N J De Wit; K Wynia; A W Wind; J Gussekloo
• Keywords: Radboudumc 18: Healthcare improvement science RIHS: Radboud Institute for Health Sciences; ELDERLY-PEOPLE; older people; primary care; 03 medical and health sciences; All institutes and research themes of the Radboud University Medical Center; 0302 clinical medicine; PROGRAM; EMC NIHES-05-63-02 Quality; INDEX; SCALE; Aged; FUNCTIONAL DECLINE; integrated care; general practice; old people; Integrated care; ADULTS; RANDOMIZED CONTROLLED-TRIAL; 610 Medical sciences; Medicine; Primary care; EXPERIENCES; 3. Good health; MODEL; Ageing; aged; ddc: 610; Radboudumc 1: Alzheimer`s disease DCMN: Donders Center for Medical Neuroscience; Older people; Geriatrics and Gerontology; INTERVENTIONS; Research Paper

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.