The impact of an epilepsy nurse competency framework on the costs of supporting adults with epilepsy and intellectual disability: findings from the EpAID study.

Autor: Pennington M; Department of Health Services and Population Research, King's Health Economics, PO24, David Goldberg Centre, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK., Ring H; Department of Psychiatry, University of Cambridge, Cambridge, UK.; Department of Psychiatry, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.; NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, UK., Howlett J; MRC Biostatistics Unit, University of Cambridge, Institute of Public Health, Cambridge, UK., Smith C; Department of Psychiatry, University of Cambridge, Cambridge, UK., Redley M; Department of Psychiatry, University of Cambridge, Cambridge, UK.; NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, UK.; School of Health Sciences, University of East Anglia, Norwich, UK., Murphy C; King's Clinical Trials Unit, PO64 Institute of Psychiatry, King's College London, London, UK., Hook R; Department of Psychiatry, University of Cambridge, Cambridge, UK., Platt A; Department of Psychiatry, University of Cambridge, Cambridge, UK., Gilbert N; Department of Psychiatry, University of Cambridge, Cambridge, UK., Jones E; Department of Psychiatry, University of Cambridge, Cambridge, UK.; Department of Psychiatry, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK., Kelly J; King's Clinical Trials Unit, PO64 Institute of Psychiatry, King's College London, London, UK., Pullen A; Epilepsy Action, New Antsey House, Leeds, UK.; NHS Leeds West Clinical Commissioning Group, Leeds, UK., Mander A; NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, UK., Donaldson C; Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK., Rowe S; Finance and Contracts, NHS Wakefield Clinical Commissioning Group, Wakefield, UK., Wason J; MRC Biostatistics Unit, University of Cambridge, Institute of Public Health, Cambridge, UK., Irvine F; School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Jazyk: angličtina
Zdroj: Journal of intellectual disability research : JIDR [J Intellect Disabil Res] 2019 Dec; Vol. 63 (12), pp. 1391-1400. Date of Electronic Publication: 2019 Aug 08.
DOI: 10.1111/jir.12679
Abstrakt: Background: The development of a nurse-led approach to managing epilepsy in adults with an intellectual disability (ID) offers the potential of improved outcomes and lower costs of care. We undertook a cluster randomised trial to assess the impact on costs and outcomes of the provision of ID nurses working to a designated epilepsy nurse competency framework. Here, we report the impact of the intervention on costs.
Method: Across the United Kingdom, eight sites randomly allocated to the intervention recruited 184 participants and nine sites allocated to treatment as usual recruited 128 participants. Cost and outcome data were collected mainly by telephone interview at baseline and after 6 months. Total costs at 6 months were compared from the perspective of health and social services and society, with adjustments for pre-specified participant and cluster characteristics at baseline including costs. Missing data were imputed using multiple imputation. Uncertainty was quantified by bootstrapping.
Results: The intervention was associated with lower per participant costs from a health and social services perspective of -£357 (2014/2015 GBP) (95% confidence interval -£986, £294) and from a societal perspective of -£631 (95% confidence interval -£1473, £181). Results were not sensitive to the exclusion of accommodation costs.
Conclusions: Our findings suggest that the competency framework is unlikely to increase the cost of caring for people with epilepsy and ID and may reduce costs.
(© 2019 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)
Databáze: MEDLINE
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