Advance Care Planning for frail older adults: Findings on costs in a cluster randomised controlled trial
| Autor: | Juanita A. Haagsma, Ida J. Korfage, Kim de Nooijer, Suzanne Polinder, Bernard J. Hammes, Daniel Muliaditan, Anouk Overbeek, Judith Ac Rietjens, Agnes van der Heide, Pascalle Billekens |
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| Přispěvatelé: | Faculty of Medicine and Pharmacy, Family Medicine and Chronic Care, Medical Sociology, End-of-life Care Research Group, Public Health |
| Rok vydání: | 2019 |
| Předmět: |
Male
Patient Activation Advance care planning medicine.medical_specialty Health Services for the Aged Frail Elderly Frail Older Adults MEDLINE Affect (psychology) law.invention Random Allocation 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law patient activation Humans Medicine 030212 general & internal medicine Cluster randomised controlled trial advance care planning older adults Aged Netherlands Aged 80 and over Random allocation Frailty business.industry General Medicine Anesthesiology and Pain Medicine 030220 oncology & carcinogenesis Randomized Controlled Trial Costs and Cost Analysis Physical therapy Female Geriatrics and Gerontology business |
| Zdroj: | Palliative Medicine, 33(3), 291-300. SAGE Publications Ltd |
| ISSN: | 0269-2163 |
| DOI: | 10.1177/0269216318801751 |
| Popis: | Background: Advance Care Planning aims at improving alignment of care with patients’ preferences. This may affect costs of medical care. Aim: To determine the costs of an Advance Care Planning programme and its effects on the costs of medical care and on concordance of care with patients’ preferences. Design/settings/participants: In a cluster randomised trial, 16 residential care homes were randomly allocated to the intervention group, where frail, older participants were offered facilitated Advance Care Planning conversations or to the control group. We calculated variable costs of Advance Care Planning per participant including personnel and travel costs of facilitators. Furthermore, we assessed participants’ healthcare use during 12 months applying a broad perspective (including medical care, inpatient days in residential care homes, home care) and calculated costs of care per participant. Finally, we investigated whether treatment goals were in accordance with preferences. Analyses were conducted for 97 participants per group. Trial registration number: NTR4454. Results: Average variable Advance Care Planning costs were €76 per participant. The average costs of medical care were not significantly different between the intervention and control group (€2360 vs €2235, respectively, p = 0.36). Costs of inpatient days in residential care homes (€41,551 vs €46,533) and of home care (€14,091 vs €17,361) were not significantly different either. Concordance of care with preferences could not be assessed since treatment goals were often not recorded. Conclusion: The costs of an Advance Care Planning programme were limited. Advance Care Planning did not significantly affect the costs of medical care for frail older adults. |
| Databáze: | OpenAIRE |
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