Local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro): study protocol of a randomised comparative effectiveness trial.

Autor: Frank F; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Hauptstraße 5, 79104, Freiburg, Germany. fabian.frank@uniklinik-freiburg.de.; Department of Social Work, Protestant University of Applied Sciences Freiburg, 79114, Freiburg, Germany. fabian.frank@uniklinik-freiburg.de., Bjerregaard F; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Hauptstraße 5, 79104, Freiburg, Germany.; Center for Geriatric Medicine and Gerontology, Medical Center - University of Freiburg, Lehenerstraße 88, 79106, Freiburg, Germany., Bengel J; Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwig-University of Freiburg, Engelbergerstraße 41, 79085, Freiburg, Germany., Bitzer EM; Department of Public Health and Health Education, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany., Heimbach B; Center for Geriatric Medicine and Gerontology, Medical Center - University of Freiburg, Lehenerstraße 88, 79106, Freiburg, Germany., Kaier K; Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany., Kiekert J; Institute for Applied Research, Catholic University of Applied Sciences Freiburg, Karlstraße 63, 79104, Freiburg, Germany., Krämer L; Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwig-University of Freiburg, Engelbergerstraße 41, 79085, Freiburg, Germany., Kricheldorff C; Institute for Applied Research, Catholic University of Applied Sciences Freiburg, Karlstraße 63, 79104, Freiburg, Germany., Laubner K; Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany., Maun A; Department of Medicine, Division of General Practice, Medical Center - University of Freiburg, Elsässerstraße 2m, 79110, Freiburg, Germany., Metzner G; Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Hugstetterstraße 49, 79106, Freiburg, Germany., Niebling W; Department of Medicine, Division of General Practice, Medical Center - University of Freiburg, Elsässerstraße 2m, 79110, Freiburg, Germany., Salm C; Department of Medicine, Division of General Practice, Medical Center - University of Freiburg, Elsässerstraße 2m, 79110, Freiburg, Germany., Schütter S; Department of Public Health and Health Education, University of Education Freiburg, Kunzenweg 21, 79117, Freiburg, Germany., Seufert J; Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany., Farin E; Section of Health Care Research and Rehabilitation Research, Medical Center - University of Freiburg, Hugstetterstraße 49, 79106, Freiburg, Germany., Voigt-Radloff S; Center for Geriatric Medicine and Gerontology, Medical Center - University of Freiburg, Lehenerstraße 88, 79106, Freiburg, Germany.; Institute of Evidence in Medicine, Medical Center - University of Freiburg, Breisacher Straße 153, 79110, Freiburg, Germany.
Jazyk: angličtina
Zdroj: BMC geriatrics [BMC Geriatr] 2019 Mar 04; Vol. 19 (1), pp. 64. Date of Electronic Publication: 2019 Mar 04.
DOI: 10.1186/s12877-019-1088-0
Abstrakt: Background: Multimorbid older adults suffering from a long-term health condition like depression, diabetes mellitus type 2, dementia or frailty are at high risk of losing their autonomy. Disability and multimorbidity in the older population are associated with social inequality and lead to soaring costs. Our local, collaborative, stepped and personalised care management for older people with chronic diseases (LoChro-Care) aims at improving outcomes for older multimorbid patients with chronic conditions whose social and medical care must be improved.
Methods: The study will evaluate the effects of LoChro-Care on functional health, depressive symptoms and satisfaction with care, resource utilisation as well as health costs in older persons with long-term conditions. The trial will compare the effectiveness of LoChro-Care and usual care in a cross-sectoral setting from hospital to community care. We will recruit 606 older adults (65+) admitted to local hospital inpatient or outpatient departments who are at risk of loss of independence. Half of them will be randomised to receive the LoChro-Care intervention, comprising seven to 16 contacts with chronic care managers (CCM) within 12 months. The hypothesis that LoChro-Care will result in better patient-centred outcomes will be tested through mixed-method process and outcome evaluation and valid measures completed at baseline and at 12 and 18 months. Cost-effectiveness analyses from the healthcare perspective will include incremental cost-effectiveness ratios.
Discussion: The trial will provide evidence about the effectiveness of local, collaborative, stepped and personalised care management for multimorbid patients with more than one functional impairment or chronic condition. Positive results will be a first step towards the implementation of a systematic cross-sectoral chronic care management to facilitate the appropriate use of available medical and nursing services and to enhance self-management of older people.
Trial Registration: German Clinical Trials Register (DRKS): DRKS00013904 ; Trial registration date: 02. February 2018.
Databáze: MEDLINE
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