Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People--the ISCOPE study.
Age Ageing
; 45(1): 30-41, 2016 Jan.
Article
em En
| MEDLINE
| ID: mdl-26764392
BACKGROUND: older people often experience complex problems. Because of multiple problems, care for older people in general practice needs to shift from a 'problem-based, disease-oriented' care aiming at improvement of outcomes per disease to a 'goal-oriented care', aiming at improvement of functioning and personal quality of life, integrating all healthcare providers. Feasibility and cost-effectiveness of this proactive and integrated way of working are not yet established. DESIGN: cluster randomised trial. PARTICIPANTS: all persons aged ≥75 in 59 general practices (30 intervention, 29 control), with a combination of problems, as identified with a structured postal questionnaire with 21 questions on four health domains. INTERVENTION: for participants with problems on ≥3 domains, general practitioners (GPs) made an integrated care plan using a functional geriatric approach. Control practices: care as usual. OUTCOME MEASURES: (i) quality of life (QoL), (ii) activities of daily living, (iii) satisfaction with delivered health care and (iv) cost-effectiveness of the intervention at 1-year follow-up. TRIAL REGISTRATION: Netherlands trial register, NTR1946. RESULTS: of the 11,476 registered eligible older persons, 7,285 (63%) participated in the screening. One thousand nine hundred and twenty-one (26%) had problems on ≥3 health domains. For 225 randomly chosen persons, a care plan was made. No beneficial effects were found on QoL, patients' functioning or healthcare use/costs. GPs experienced better overview of the care and stability, e.g. less unexpected demands, in the care. CONCLUSIONS: GPs prefer proactive integrated care. 'Horizontal' care using care plans for older people with complex problems can be a valuable tool in general practice. However, no direct beneficial effect was found for older persons.
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Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Planejamento de Assistência ao Paciente
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Custos de Cuidados de Saúde
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Modelos Organizacionais
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Prestação Integrada de Cuidados de Saúde
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Medicina Geral
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Serviços de Saúde para Idosos
Tipo de estudo:
Clinical_trials
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Evaluation_studies
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Guideline
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Health_economic_evaluation
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Prognostic_studies
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Qualitative_research
Limite:
Aged
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Aged80
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Female
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Humans
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Male
País/Região como assunto:
Europa
Idioma:
En
Revista:
Age Ageing
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
Holanda