Impact of community-based multidomain preventive health program on healthcare utilisation among elderly persons in Singapore: a propensity score matched and difference-in-differences study.

Autor:	Phng F; Health Services Research & Analytics, Ng Teng Fong General Hospital, Singapore francis_phng@nuhs.edu.sg., Yap AU; Ng Teng Fong General Hospital, Singapore.; Duke-NUS Medical School, Singapore., Teo W; Health Services Research & Analytics, Ng Teng Fong General Hospital, Singapore., Chong JHS; Community Operations, Ng Teng Fong General Hospital, Singapore., Wu CX; Health Services Research & Analytics, Ng Teng Fong General Hospital, Singapore., Tan EEK; Health Services Research & Analytics, Ng Teng Fong General Hospital, Singapore., Chin CH; Ng Teng Fong General Hospital, Singapore., Chee TG; Community Operations, Ng Teng Fong General Hospital, Singapore., Lee HH; Ng Teng Fong General Hospital, Singapore., Phan P; Johns Hopkins University, Baltimore, Maryland, USA., Chua AP; Department of Medicine, Ng Teng Fong General Hospital, Singapore.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2024 Oct 02; Vol. 14 (10), pp. e086327. Date of Electronic Publication: 2024 Oct 02.
DOI:	10.1136/bmjopen-2024-086327
Abstrakt:	Objectives: Ageing populations present substantial challenges for healthcare systems. Community-based health worker (CHW) interventions for promoting healthy ageing and preventing/managing non-communicable diseases have gained considerable attention in recent years. This study aimed to assess the impacts of a multidomain preventive health initiative delivered by CHWs, specifically the 'My Health Map (MHM)' programme, on participants' health service utilisation using a propensity score matching methodology. Design, Setting and Participants: The multidomain MHM programme, which was implemented in Bukit Batok township, encompassed screenings, vaccinations, chronic disease management, counselling and socio-environmental interventions. Individuals, aged ≥40 years old, who received care at Ng Teng Fong General Hospital and were enrolled in the MHM programme constituted the intervention group. Outcomes of the intervention group were compared with a 1:1 propensity-matched comparison group at enrolment and 1-year follow-up. The outcome measures were emergency department (ED) utilisation and hospital admissions. Statistical evaluations were performed using χ 2 /non-parametric tests and difference-in-difference (DiD) estimation with a bias-adjusted generalised estimating equation (α=0.05). Results: A comparable comparison group was formed with no significant differences in baseline characteristics between groups. Data from a total of 299 MHM participants (mean age 70.7 (SD 9.6); 62.5% women) and 299 matched comparisons (mean age 72.1 (SD 16.6); 61.5% women) were appraised. DiD analysis indicated a significant reduction in ED attendance (-16.7%, p<0.001) and hospital admission (-18.4%, p<0.001) among intervention participants than the comparison participants. Conclusions: The multidomain MHM programme proved effective in reducing ED attendances and hospital admissions in older adults. CHWs have the potential to serve as change agents in healthcare and should be systematically integrated into preventive health programmes. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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