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1.
Health Qual Life Outcomes ; 18(1): 68, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32160887

RESUMO

BACKGROUND: Recurrent chest pain episodes with no clear explanation may affect patients' psychological wellbeing and health-related quality of life (HRQoL) negatively. Despite the fact that a significant amount of patients with non-cardiac chest pain (NCCP) might have a history of Cardiac Disease (CD), there is today a lack of knowledge on how CD influences the association between psychological wellbeing and HRQoL in patients with NCCP. Therefore, the aim of this study is to describe HRQoL in patients with NCCP, with or without history of CD, and to explore the association between HRQoL and cardiac anxiety, depressive symptoms, fear of body sensations and somatization. METHODS: Five hundred fifty-two patients discharged with NCCP from four hospitals in Southeast Sweden completed the EQ-5D, Cardiac Anxiety Questionnaire, Patient Health Questionnaire-9, Body Sensations Questionnaire, and Patient Health Questionnaire-15. RESULTS: Fifty precent reported at least moderate problems regarding pain/discomfort and 25% reported at least moderate problems in the HRQoL dimensions mobility, usual activities, and anxiety/depression. Patients with NCCP and history of CD reported significantly lower HRQoL (p ≤ 0.05) compared to patients with NCCP without CD. In the total study population, cardiac anxiety, depressive symptoms, and somatization had weak significant negative associations (beta = 0.187-0.284, p < 0.001) with HRQoL. In patients with history of CD, the association between depressive symptoms and HRQoL was moderate (beta = - 0.339, p < 0.001), compared to weak association in patients without CD (beta = - 0.193, p < 0.001). On the other hand, the association between cardiac anxiety and HRQoL was weak in both patients with history of CD (beta = - 0.156, p = 0.05), and in those without (beta = - 0.229, p < 0.001). CONCLUSIONS: Patients with NCCP, in particular those with history of CD, reported low levels of HRQoL, which was associated with psychological distress. This should be considered when developing psychological interventions aiming to improve HRQoL in patients with NCCP.

2.
Scand J Public Health ; : 1403494819844354, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31826709

RESUMO

Aims: The aims of this study are to describe informal care activities and to estimate the societal cost of informal care of community-dwelling frail elderly people in Sweden. Methods: This study was performed within the frame of the TREEE project that included 408 frail elderly patients. At index hospitalisation (baseline), primary informal caregivers of the patients were provided with a questionnaire on informal care during a period of three months. Questions concerning other (secondary) informal caregivers were also included. A rough estimate of the total cost of informal care of frail elderly people in Sweden was obtained by combining data from this study with published data and official statistics. Results: In total, 176 informal caregivers responded, and 89% had provided informal care. The informal caregivers (primary and secondary) provided care for an average of 245 hours over three months. Taking care of the home was the dominating activity. In total, the mean cost of informal care was estimated to approximately 18,000 SEK (€1878) over three months, corresponding to an annual cost of approximately 72,000 SEK (€7477) per frail elderly person. The total annual societal costs of informal care of community dwelling frail elderly people aged 75 years and older in Sweden was estimated to be approximately 11,000 million SEK (€1150 million). Conclusions: The care of frail elderly people provided by informal caregivers is extensive and represents a great economic value. Although our calculations are associated with uncertainty, the size indicates that supporting informal caregivers should be a priority for society.

3.
PLoS One ; 14(9): e0219911, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31513601

RESUMO

INTRODUCTION: Individuals with functional impairments or chronic diseases are often in need of assistance in their daily lives. For these individuals it is essential to find novel, cost-effective solutions to meet their needs. Service dogs are dogs that are specially trained to assist individuals with functional impairments and may be able to improve these individuals' quality of life at a reasonable cost, i.e. be cost effective. Cost-effectiveness analyses are used to illustrate the cost of an intervention in relation to its effects and provide important input to decision-makers when setting priorities. AIM: The aim of this study is to assess the cost effectiveness of a certified physical service dog and a diabetes alert dog compared to a regular companion dog. METHOD: Costs, life years and quality-adjusted life years were estimated over a 10-year time horizon using a decision-analytic model built upon evidence from the"service and hearing dog project". The primary outcome was the incremental cost-effectiveness ratio expressed as cost per gained quality-adjusted life year. The analysis was conducted from a societal perspective. Costs and effects were discounted with 3% per annum and reported in USD. RESULTS: Compared to a regular companion dog, a physical service dog is cost saving [-6,000 USD] and gives the dog owner more quality-adjusted life years [0.28]. The diabetes alert dog is also cost effective in comparison with a regular companion dog [-4,500 USD, 0.06 QALYs]. CONCLUSION: This study indicates that a certified service dog is cost saving in comparison with a regular companion dog for individuals with functional impairments or chronic diseases. The uncertainty of the analysis implies that further studies are needed in order to confirm these results. Nevertheless, physical service dogs and diabetes alert dogs show potential to be a valuable support and decision analytic models are useful tools to provide this information.


Assuntos
Análise Custo-Benefício , Reabilitação , Animais , Doença Crônica , Tomada de Decisões , Diabetes Mellitus , Cães , Cadeias de Markov , Reabilitação/economia , Reabilitação/métodos
4.
BMJ Open ; 9(5): e027847, 2019 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-31122995

RESUMO

INTRODUCTION: The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction. METHODS AND ANALYSIS: In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire. ETHICS AND DISSEMINATION: Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019-2022 and are planned to be used for the development of future care models. TRIAL REGISTRATION NUMBER: NCT03180606.

5.
BMC Health Serv Res ; 18(1): 497, 2018 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-29945630

RESUMO

BACKGROUND: Individuals with severe disability often require personal assistance and help from informal caregivers, in addition to conventional health care. The utilization of assistance dogs may decrease the need for health and social care and increase the independence of these individuals. Service and hearing dogs are trained to assist specific individuals and can be specialized to meet individual needs. The aim of this study was to describe and explore potential consequences for health-related quality of life, well-being and activity level, of having a certified service or hearing dog. METHODS: A longitudinal interventional study with a pre-post design was conducted. At inclusion, all participants in the study had a regular (untrained) companion dog. Data were collected before training of the dog started and three months after certification of the dog. Health-related quality of life was assessed with EQ-5D-3L, EQ-VAS and RAND-36. Well-being was measured with WHO-5 and self-esteem with the Rosenberg Self-Esteem Scale. In addition, questions were asked about physical activity and time spent away from home and on social activities. Subgroups were analyzed for physical service and diabetes alert dogs. RESULTS: Fifty-five owner-and-dog pairs completed the study (30 physical service dogs, 20 diabetes alert dogs, 2 epilepsy alert dogs, and 3 hearing dogs). Initially, study participants reported low health-related quality of life compared with the general population. At follow-up, health-related quality of life measured with the EQ-VAS, well-being and level of physical activity had improved significantly. In the subgroup analysis, physical service dog owners had lower health-related quality of life than diabetes alert dog owners. The improvement from baseline to follow-up measured with EQ-5D statistically differed between the subgroups. CONCLUSIONS: The target population for service and hearing dogs has an overall low health-related quality of life. Our study indicates that having a certified service or hearing dog may have positive impact on health-related quality of life, well-being and activity level. Service and hearing dogs are a potentially important "wagging tail aid" for this vulnerable population, able to alleviate strain, increase independence, and decrease the risk of social isolation. TRIAL REGISTRATION: The trial was retrospectively registered in http://clinicaltrial.gov , NCT03270592. September, 2017.


Assuntos
Pessoas com Deficiência , Cães , Exercício Físico , Adolescente , Adulto , Idoso , Animais , Diabetes Mellitus/reabilitação , Pessoas com Deficiência/reabilitação , Epilepsia/reabilitação , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Autoimagem , Comportamento Social , Suécia , Adulto Jovem
6.
J Am Med Dir Assoc ; 19(10): 871-878.e2, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29784592

RESUMO

OBJECTIVE: The objective of this study was to estimate the 3-month within-trial cost-effectiveness of comprehensive geriatric assessment (CGA) in acute medical care for frail elderly patients compared to usual medical care, by estimating health-related quality of life and costs from a societal perspective. DESIGN: Clinical, prospective, controlled, 1-center intervention trial with 2 parallel groups. INTERVENTION: Structured, systematic interdisciplinary CGA-based care in an acute elderly care unit. If the patient fulfilled the inclusion criteria, and there was a bed available at the CGA unit, the patient was included in the intervention group. If no bed was available at the CGA unit, the patient was included in the control group and admitted to a conventional acute medical care unit. SETTING AND PARTICIPANTS: A large county hospital in western Sweden. The trial included 408 frail elderly patients, 75 years or older, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n = 206) or control group (n = 202). Mean age of the patients was 85.7 years, and 56% were female. MEASURES: The primary outcome was the adjusted incremental cost-effectiveness ratio associated with the intervention compared to the control at the 3-month follow-up. RESULTS: We undertook cost-effectiveness analysis, adjusted by regression analyses, including hospital, primary, and municipal care costs and effects. The difference in the mean adjusted quality-adjusted life years gained between groups at 3 months was 0.0252 [95% confidence interval (CI): 0.0082-0.0422]. The incremental cost, that is, the difference between the groups, was -3226 US dollars (95% CI: -6167 to -285). CONCLUSION: The results indicate that the care in a CGA unit for acutely ill frail elderly patients is likely to be cost-effective compared to conventional care after 3 months.


Assuntos
Idoso Fragilizado , Avaliação Geriátrica , Serviços de Saúde para Idosos/economia , Unidades Hospitalares , Hospitalização , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Visita a Consultório Médico/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Prospectivos , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Suécia
7.
BMC Geriatr ; 18(1): 32, 2018 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-29386007

RESUMO

BACKGROUND: Older people with multi-morbidity are increasingly challenging for today's healthcare, and novel, cost-effective healthcare solutions are needed. The aim of this study was to assess the cost-effectiveness of comprehensive geriatric assessment (CGA) at an ambulatory geriatric unit for people ≥75 years with multi-morbidity. METHOD: The primary outcome was the incremental cost-effectiveness ratio (ICER) comparing costs and quality-adjusted life years (QALYs) of a CGA strategy with usual care in a Swedish setting. Outcomes were estimated over a lifelong time horizon using decision-analytic modelling based on data from the randomized AGe-FIT trial. The analysis employed a public health care sector perspective. Costs and QALYs were discounted by 3% per annum and are reported in 2016 euros. RESULTS: Compared with usual care CGA was associated with a per patient mean incremental cost of approximately 25,000 EUR and a gain of 0.54 QALYs resulting in an ICER of 46,000 EUR. The incremental costs were primarily caused by intervention costs and costs associated with increased survival, whereas the gain in QALYs was primarily a consequence of the fact that patients in the CGA group lived longer. CONCLUSION: CGA in an ambulatory setting for older people with multi-morbidity results in a cost per QALY of 46,000 EUR compared with usual care, a figure generally considered reasonable in a Swedish healthcare context. A rather simple reorganisation of care for older people with multi-morbidity may therefore cost effectively contribute to meet the needs of this complex patient population. TRIAL REGISTRATION: The trial was retrospectively registered in clinicaltrial.gov, NCT01446757 . September, 2011.


Assuntos
Assistência Ambulatorial/economia , Assistência Integral à Saúde/economia , Técnicas de Apoio para a Decisão , Avaliação Geriátrica/métodos , Anos de Vida Ajustados por Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Humanos , Masculino , Estudos Retrospectivos , Método Simples-Cego , Suécia
8.
Eur J Phys Rehabil Med ; 54(4): 507-517, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29072043

RESUMO

BACKGROUND: Spasticity is a common consequence of injury to the central nervous system negatively affecting patient's everyday activities. Treatment mainly consists of training and different drugs, often with side effects. There is a need for treatment options that can be performed by the patient in their home environment. AIM: The objective of this study was to assess the effectiveness of an assistive technology (AT), Mollii®, a garment with integrated electrodes for multifocal transcutaneous electrical stimulation intended for self-treatment of spasticity, in study participants with spasticity due to stroke or CP. DESIGN: The study was a randomized, controlled, double-blind study with a cross-over design. SETTING: Participants were recruited from two rehabilitation clinics. Treatments were performed in participants' homes and all follow-ups were performed in the two rehabilitation clinics. POPULATION: Thirty-one participants were included in the study and 27 completed the study. Four participants discontinued the study. Two declined participation before baseline and two withdrew due to problems handling the garment. METHODS: Participants used the AT with and without electrical stimulation (active/non-active period) for six weeks each, followed by six weeks without treatment. Goal Attainment Scaling (GAS), change in mobility, arm-hand ability, spasticity and pain were measured at baseline and after 6, 12 and 18 weeks. RESULTS: Fifteen of the 27 participants fulfilled the treatment protocol in terms of recommended use. Deviations were frequent. No statistically significant differences in outcome were found between the active and the non-active treatment periods. During the active period, an improvement was seen in the 10-meter comfortable gait test, time and steps. An improvement was seen in both the active and non-active periods for the GAS. CONCLUSIONS: Compliance was low, partly due to deviations related to the garment, complicating the interpretation of the results. Further research should focus on identifying the target population and concomitant rehabilitation strategies. CLINICAL REHABILITATION IMPACT: The evaluated concept of multifocal transcutaneous electrical stimulation (TES) represents an interesting addition to the existing repertoire of treatments to alleviate muscle spasticity. The evaluated concept allows TES to be self-administered by the patient in the home environment. A more elaborate design of training activities directly related to patient's own rehabilitation goals is recommended and may increase the value of the evaluated concept.


Assuntos
Espasticidade Muscular/etiologia , Espasticidade Muscular/reabilitação , Participação do Paciente/métodos , Qualidade de Vida , Estimulação Elétrica Nervosa Transcutânea/métodos , Paralisia Cerebral/complicações , Paralisia Cerebral/diagnóstico , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Masculino , Medição da Dor , Medidas de Resultados Relatados pelo Paciente , Medição de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento
9.
Clin Interv Aging ; 12: 1239-1249, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28848332

RESUMO

BACKGROUND: A high percentage of individuals treated in specialized acute care wards are frail and elderly. Our aim was to study whether the acute care of such patients in a comprehensive geriatric assessment (CGA) unit is superior to care in a conventional acute medical care unit when it comes to activities of daily living (ADLs), frailty, and use of municipal help services. PATIENTS AND METHODS: A clinical, prospective, controlled trial with two parallel groups was conducted in a large county hospital in West Sweden and included 408 frail elderly patients, age 75 or older (mean age 85.7 years; 56% female). Patients were assigned to the intervention group (n=206) or control group (n=202). Primary outcome was decline in functional activity ADLs assessed by the ADL Staircase 3 months after discharge from hospital. Secondary outcomes were degree of frailty and use of municipal help services. RESULTS: After adjustment by regression analyses, treatment in a CGA unit was independently associated with lower risk of decline in ADLs [odds ratio (OR) 0.093; 95% confidence interval (CI) 0.052-0.164; P<0.0001], and with a less prevalent increase in the degree of frailty (OR 0.229; 95% CI 0.131-0.400; P<0.0001). When ADLs were classified into three strata (independence, instrumental ADL-dependence, and personal ADL-dependence), changes to a more dependence-associated stratum were less prevalent in the intervention group (OR 0.194; 95% CI 0.085-0.444; P=0.0001). There was no significant difference between the groups in increased use of municipal help services (OR 0.682; 95% CI 0.395-1.178; P=0.170). CONCLUSION: Acute care of frail elderly patients in a CGA unit was independently associated with lesser loss of functional ability and lesser increase in frailty after 3 months.


Assuntos
Atividades Cotidianas , Idoso Fragilizado/estatística & dados numéricos , Avaliação Geriátrica/estatística & dados numéricos , Serviços de Saúde para Idosos , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Avaliação Geriátrica/métodos , Humanos , Masculino , Razão de Chances , Prevalência , Estudos Prospectivos , Suécia
10.
Clin Interv Aging ; 12: 1-9, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28031704

RESUMO

OBJECTIVE: The aim of this study was to investigate whether the acute care of frail elderly patients in a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit. DESIGN: This is a clinical, prospective, randomized, controlled, one-center intervention study. SETTING: This study was conducted in a large county hospital in western Sweden. PARTICIPANTS: The study included 408 frail elderly patients, aged ≥75 years, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n=206) or control group (n=202). Mean age of the patients was 85.7 years, and 56% were female. INTERVENTION: This organizational form of care is characterized by a structured, systematic interdisciplinary CGA-based care at an acute elderly care unit. MEASUREMENTS: The primary outcome was the change in health-related quality of life (HRQoL) 3 months after discharge from hospital, measured by the Health Utilities Index-3 (HUI-3). Secondary outcomes were all-cause mortality, rehospitalizations, and hospital care costs. RESULTS: After adjustment by regression analysis, patients in the intervention group were less likely to present with decline in HRQoL after 3 months for the following dimensions: vision (odds ratio [OR] =0.33, 95% confidence interval [CI] =0.14-0.79), ambulation (OR =0.19, 95% CI =0.1-0.37), dexterity (OR =0.38, 95% CI =0.19-0.75), emotion (OR =0.43, 95% CI =0.22-0.84), cognition (OR = 0.076, 95% CI =0.033-0.18) and pain (OR =0.28, 95% CI =0.15-0.50). Treatment in a CGA unit was independently associated with lower 3-month mortality adjusted by Cox regression analysis (hazard ratio [HR] =0.55, 95% CI =0.32-0.96), and the two groups did not differ significantly in terms of hospital care costs (P>0.05). CONCLUSION: Patients in an acute CGA unit were less likely to present with decline in HRQoL after 3 months, and the care in a CGA unit was also independently associated with lower mortality, at no higher cost.


Assuntos
Idoso Fragilizado , Serviços de Saúde para Idosos/organização & administração , Administração Hospitalar , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Cognição , Feminino , Avaliação Geriátrica , Serviços de Saúde para Idosos/estatística & dados numéricos , Humanos , Masculino , Razão de Chances , Alta do Paciente , Modelos de Riscos Proporcionais , Estudos Prospectivos , Suécia
11.
J Am Med Dir Assoc ; 17(3): 263-8, 2016 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-26805750

RESUMO

OBJECTIVE: To compare the effects of care based on comprehensive geriatric assessment (CGA) as a complement to usual care in an outpatient setting with those of usual care alone. The assessment was performed 36 months after study inclusion. DESIGN: Randomized, controlled, assessor-blinded, single-center trial. SETTING: A geriatric ambulatory unit in a municipality in the southeast of Sweden. PARTICIPANTS: Community-dwelling individuals aged ≥ 75 years who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion. Participants were randomized to the intervention group (IG) or control group (CG). INTERVENTION: Participants in the IG received CGA-based care for 24 to 31 months at the geriatric ambulatory unit in addition to usual care. OUTCOME MEASURES: Mortality, transfer to nursing home, days in hospital, and total costs of health and social care after 36 months. RESULTS: Mean age (SD) of participants was 82.5 (4.9) years. Participants in the IG (n = 208) lived 69 days longer than did those in the CG (n = 174); 27.9% (n = 58) of participants in the IG and 38.5% (n = 67) in the CG died (hazard ratio 1.49, 95% confidence interval 1.05-2.12, P = .026). The mean number of inpatient days was lower in the IG (15.1 [SD 18.4]) than in the CG (21.0 [SD 25.0], P = .01). Mean overall costs during the 36-month period did not differ between the IG and CG (USD 71,905 [SD 85,560] and USD 65,626 [SD 66,338], P = .43). CONCLUSIONS: CGA-based care resulted in longer survival and fewer days in hospital, without significantly higher cost, at 3 years after baseline. These findings add to the evidence of CGA's superiority over usual care in outpatient settings. As CGA-based care leads to important positive outcomes, this method should be used more extensively in the treatment of older people to meet their needs.


Assuntos
Assistência Ambulatorial/economia , Assistência Ambulatorial/normas , Avaliação Geriátrica/métodos , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo , Feminino , Idoso Fragilizado , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde/métodos , Método Simples-Cego , Suécia
12.
Scand J Public Health ; 43(8): 848-54, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26271493

RESUMO

AIMS: A number of value sets are available today for converting EQ-5D questionnaire responses to quality-adjusted life year-weights used in health economic evaluations. The aim of this study is to analyse the differences between the commonly used hypothetical UK value set and the newly introduced Swedish experience-based value set and to evaluate health economic implications of such differences on policy decisions. METHODS: Differences between the two value sets were studied using two methods: a comparison of health states and improvements as well as an empirical comparison. In the comparison of health states and improvements, the valuations of all EQ-5D states and all pure improvements were compared. In the empirical study, a database of 23,925 individuals was used to identify patient groups that could be affected by the implementation of the Swedish experience-based value set. RESULTS: The comparison of health states and possible improvements showed that only three health states were assigned a lower quality-adjusted life year-weight and most improvements were given smaller absolute values if the experience-based value set was used. The empirical comparison showed that severe conditions were assigned higher values when using the experience-based value set. CONCLUSIONS: The Swedish experience-based value set seems to render a higher estimated level of health-related quality of life in virtually all health conditions compared to the hypothetical UK value set. In extension, health-related quality of life enhancing interventions are likely to be given higher priority in decision-making situations where hypothetical values are used to construct quality-adjusted life year-weights. In situations where experience-based quality-adjusted life year-weights are used, life-prolonging interventions would be prioritised.


Assuntos
Nível de Saúde , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Inquéritos e Questionários , Política de Saúde , Humanos , Formulação de Políticas , Reprodutibilidade dos Testes , Fatores Socioeconômicos , Suécia , Reino Unido
13.
J Am Med Dir Assoc ; 16(6): 497-503, 2015 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-25703450

RESUMO

OBJECTIVES: To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care. DESIGN: Assessor-blinded, single-center randomized controlled trial. SETTING: AGU in an acute hospital in southeastern Sweden. PARTICIPANTS: Community-dwelling individuals aged 75 years or older who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion and randomized to the intervention group (IG; n = 208) or control group (CG; n = 174). Mean age (SD) was 82.5 (4.9) years. INTERVENTION: Participants in the IG received CGA-based care at the AGU in addition to usual care. OUTCOME MEASURES: The primary outcome was number of hospitalizations. Secondary outcomes were days in hospital and nursing home, mortality, cost of public health and social care, participant' sense of security in care, and health-related quality of life (HRQoL). RESULTS: Baseline characteristics did not differ between groups. The number of hospitalizations did not differ between the IG (2.1) and CG (2.4), but the number of inpatient days was lower in the IG (11.1 vs 15.2; P = .035). The IG showed trends of reduced mortality (hazard ratio 1.51; 95% confidence interval [CI] 0.988-2.310; P = .057) and an increased sense of security in care interaction. No difference in HRQoL was observed. Costs for the IG and CG were 33,371 £ (39,947 £) and 30,490 £ (31,568 £; P = .432). CONCLUSIONS AND RELEVANCE: This study of CGA-based care was performed in an ambulatory care setting, in contrast to the greater part of studies of the effects of CGA, which have been conducted in hospital settings. This study confirms the superiority of this type of care to elderly people in terms of days in hospital and sense of security in care interaction and that a shift to more accessible care for older people with multimorbidity is possible without increasing costs. This study can aid the planning of future interventions for older people. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01446757.


Assuntos
Assistência Ambulatorial/organização & administração , Avaliação Geriátrica , Hospitalização/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Análise Custo-Benefício , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Entrevistas como Assunto , Masculino , Equipe de Assistência ao Paciente/organização & administração , Qualidade de Vida , Método Simples-Cego , Suécia/epidemiologia
14.
Scand J Public Health ; 42(7): 643-8, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25114065

RESUMO

BACKGROUND: The aim of this study was to survey minor home help services provided by Swedish municipalities with the main purpose to prevent fall injuries. METHODS: If minor home help services were presented on the homepage of a municipality, an initial telephone contact was taken. Thereafter a questionnaire was administered, including questions about target groups, aim with the services, tasks included, costs and restrictions for users, budget, and experienced gains with the services. Municipalities not providing minor home help services were asked about the reason therefore and if the municipality had previously provided the services Results: The questionnaire response rate was 92%. In 191 of Sweden's 290 municipalities services were provided by, or in cooperation with, the municipality. Reasons for not providing the services were mainly financial and lack of demand. Services were more often provided in larger cities and in municipalities located in populous regions. In some municipalities services were performed by persons with functional disabilities or unemployed persons. CONCLUSIONS: Both providers and users expressed satisfaction with the services aspects expressed were that services lead to greater sense of safety and social gains the effect of the services in terms of fall prevention is yet to be proved with only a small fall-preventive effect services are probably cost-effective improved quality of life, sense of safety, and being able to offer meaningful work to otherwise unemployed persons are important aspects that might in themselves motivate the provision of minor home help services.


Assuntos
Acidentes por Quedas/prevenção & controle , Cidades , Fraturas Ósseas/prevenção & controle , Serviços de Assistência Domiciliar/organização & administração , Acidentes por Quedas/economia , Idoso , Idoso de 80 Anos ou mais , Cidades/economia , Efeitos Psicossociais da Doença , Feminino , Fraturas Ósseas/economia , Pesquisas sobre Serviços de Saúde , Serviços de Assistência Domiciliar/economia , Humanos , Masculino , Suécia
15.
BMC Health Serv Res ; 13: 403, 2013 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-24107009

RESUMO

BACKGROUND: Non-cardiac chest pain (NCCP) is a common complaint. Our aim was to present a detailed description of the costs of patients with NCCP compared to patients with acute myocardial infarction (AMI) and Angina Pectoris (AP) from a societal perspective. METHODS: Data on healthcare utilization and annual societal costs, including direct healthcare costs and indirect costs due to productivity loss, were collected from different databases. The participants consisted of 199 patients from a general hospital in Sweden (99 with NCCP, 51 with AMI, 49 with AP), mean age of 67 years, 59% men. RESULTS: NCCP, AMI, and AP patients had on average 54, 50 and 65 primary care contacts and 3, 4, and 4 hospital admissions during a period of 2 years. Length of hospital stay was 6, 11 and 11 days. On average, 14%, 18%, and 25% of NCCP, AMI and AP patients were on sick-leave annually, and about 12% in each group received a disability pension. The mean annual societal costs of NCCP, AMI and AP patients were €10,068, €15,989 and €14,737. CONCLUSIONS: Although the annual societal cost of NCCP patients was lower than in AMI and AP patients, the cost was still considerable (€10,068). Taken into account the high prevalence of NCCP, the cumulative annual national cost of these patients could be more than the double of AMI and AP if all patients incurred the same costs as in this study. Targeted interventions are important in order to support patients with NCCP and minimize healthcare utilization and costs.


Assuntos
Dor no Peito/economia , Assistência à Saúde/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Isquemia Miocárdica/economia , Idoso , Angina Pectoris/economia , Angina Pectoris/terapia , Dor no Peito/terapia , Assistência à Saúde/economia , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/economia , Infarto do Miocárdio/terapia , Isquemia Miocárdica/terapia , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Licença Médica/economia , Licença Médica/estatística & dados numéricos , Suécia/epidemiologia
16.
Disabil Rehabil ; 35(18): 1519-26, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23311670

RESUMO

PURPOSE: The aim of this study was to examine relatives' perception of an assistive technology intervention aimed at persons with dementia (PwDs) and their relatives, and to examine whether, and how, experiences of the intervention process differed between relatives valuing the intervention to be of high, and relatives perceiving it to be of low significance. METHOD: A total of 47 relatives of PwDs within the Swedish Technology and Dementia project were interviewed telephonically using a modified version of the Patient perspective on Care and Rehabilitation process instrument. A total of 46 participants were divided into two groups depending on whether they valued the intervention to be of great significance (GS group; N = 33) or of some/no significance (SNS group; N = 13). RESULTS: Several aspects of the intervention were perceived as highly important, e.g. being shown consideration and respect, and having somewhere to turn. The results indicate that relatives in the GS group perceived certain aspects of the intervention process as highly fulfilled to a larger extent than did relatives in the SNS group. CONCLUSIONS: This study illustrates how process evaluations can be used to increase the understanding and to identify improvement aspects of interventions. IMPLICATIONS FOR REHABILITATION: Process evaluation is a good method for understanding how interventions can be improved - a keystone for quality work. Based on relatives' ratings, a high fulfilment of the AT intervention process was associated with the perception of a significant outcome of the intervention.


Assuntos
Cuidadores/psicologia , Demência/reabilitação , Avaliação de Processos em Cuidados de Saúde/métodos , Equipamentos de Autoajuda , Adulto , Idoso , Demência/psicologia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Avaliação de Resultados da Assistência ao Paciente , Percepção , Qualidade de Vida , Suécia
17.
Int J Geriatr Psychiatry ; 25(3): 240-8, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19579261

RESUMO

OBJECTIVE: The aim of this study was to examine what family caregivers of persons with dementia perceive as important types of support/services in relation to experienced negative impact (NI) due to the caregiver situation, and to investigate if caregivers receive the support/services perceived as important. METHOD: The study was based on the Swedish part of the EUROFAMCARE project and included 110 caregivers of persons with dementia. Data were collected primarily through structured telephone interviews. The caregivers were divided into two groups, a higher NI group and a lower NI group, based on the NI scale from the COPE index. RESULTS: Getting information and having someone to talk to were perceived as very important types of support/services by the highest proportion of caregivers in both groups. Data indicated only one significant difference; a higher proportion of caregivers in the higher NI group reported being able to participate in activities outside of caring as very important. There was also an indication that a higher proportion of caregivers in the lower NI group perceived information about the disease as very important. Support/services perceived as important by the caregivers were received both to a high and a low degree. CONCLUSION: The results from this study suggest that there is almost no difference between groups of caregivers experiencing higher and lower NI regarding their perception of what are important types of support/services. The caregivers rated different types of support/services within the areas of information, relief and counselling as very important.


Assuntos
Cuidadores/psicologia , Demência/enfermagem , Família , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Assistência à Saúde/normas , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Suécia
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