Background

There is a need for effective and cost-effective interprofessional care models that support older people to maintain their quality of life (QoL) and physical performance to live longer independently in their own homes.

Objectives

The objectives were to evaluate effectiveness, QoL and physical performance, and cost-utility of a people-centred care model (PCCM), including the contribution of clinically trained pharmacists, compared with that of usual care in primary care.

Methods

A randomised controlled trial (RCT) with a two-year follow-up was conducted. The participants were multimorbid community-living older people, aged ≥75 years. The intervention comprised an at-home patient interview, health review, pharmacist-led clinical medication review, an interprofessional team meeting, and nurse-led care coordination and health support. At the baseline and at the 1-year and 2-year follow-ups, QoL (SF-36, 36-Item Short-Form Health Survey) and physical performance (SPPB, Short Performance Physical Battery) were measured. Additionally, a physical dimension component summary in the SF-36 was calculated. The SF-36 data were transformed into SF-6D scores to calculate quality-adjusted life-years (QALYs). Healthcare resource use were collected and transformed into costs. A healthcare payer perspective was adopted. Incremental cost-effectiveness ratio (ICER) was calculated, and one-way sensitivity analysis was performed.

Results

No statistically or clinically significant differences were observed between the usual care (n = 126) and intervention group (n = 151) patients in their QoL; at the 2-year follow-up the mean difference was −0.02, (95 % CI -0.07; 0.04,p = 0.56). While the mean difference between the groups in physical performance at the 2-year follow-up was −1.02, (−1.94;-0.10,p = 0.03), between the physical component summary scores it was −7.3, (−15.2; 0.6,p = 0.07). The ICER was −73 638€/QALY, hence, the developed PCCM dominated usual care, since it was more effective and less costly.

Conclusions

The cost-utility analysis showed that the PCCM including pharmacist-led medication review dominated usual care. However, it had no effect on QoL and the effect towards physical performance remained unclear.

中文翻译：

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以人为本的社区老年人护理模式与常规护理相比的有效性和成本效益 ─ 一项随机对照试验

背景

需要有效且具有成本效益的跨专业护理模式，以支持老年人维持其生活质量 (QoL) 和身体机能，从而在自己的家中独立生活更长时间。

目标

目的是评估以人为本的护理模式 (PCCM) 的有效性、生活质量和身体表现以及成本效用，包括受过临床培训的药剂师的贡献，与初级保健中的常规护理相比。

方法

进行了一项为期两年的随机对照试验（RCT）。参与者是多病社区生活的老年人，年龄≥75岁。干预措施包括家庭患者访谈、健康审查、药剂师主导的临床药物审查、跨专业团队会议以及护士主导的护理协调和健康支持。在基线和 1 年和 2 年的随访中，测量了生活质量（SF-36，36 项简短健康调查）和身体表现（SPPB，短期表现物理电池）。此外，还计算了 SF-36 中的物理尺寸组件汇总。将 SF-36 数据转换为 SF-6D 分数以计算质量调整生命年 (QALY)。医疗资源使用被收集并转化为成本。采用了医疗保健支付者的观点。

结果

常规护理（n = 126）和干预组（n = 151）患者的生活质量未观察到统计学或临床显着差异；在 2 年的随访中，平均差异为 -0.02，（95 % CI -0.07；0.04，p = 0.56）。虽然在 2 年的随访中，各组之间身体表现的平均差异为 -1.02，（-1.94；-0.10，p = 0.03），但身体成分总分之间的平均差异为 -7.3，（-15.2；0.6 ,p = 0.07)。ICER 为 -73 638 欧元/QALY，因此，发达的 PCCM 主导了常规护理，因为它更有效且成本更低。

结论

成本效用分析表明，包括药剂师主导的药物审查在内的 PCCM 主导了常规护理。然而，它对生活质量没有影响，对身体表现的影响仍不清楚。