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

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 Charante, M. E. Muntinga, M. E. Numans, F. G. H. Ruikes, S. L. W. Spoorenberg, T. Stijnen, J. J. Suijker, N. J. De WitK. Wynia, A. W. Wind, J. Gussekloo, TOPICS-MDS Res Consortium

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

15 Citations (Web of Science)

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-3-level (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.
Original languageEnglish
Pages (from-to)705-714
Number of pages10
JournalAge and Ageing
Volume47
Issue number5
DOIs
Publication statusPublished - 1 Sep 2018

Keywords

  • aged
  • primary care
  • integrated care
  • older people
  • RANDOMIZED CONTROLLED-TRIAL
  • FUNCTIONAL DECLINE
  • ELDERLY-PEOPLE
  • ADULTS
  • PROGRAM
  • MODEL
  • INDEX
  • INTERVENTIONS
  • EXPERIENCES
  • SCALE

Cite this