University of Oulu

Kari, H., Äijö-Jensen, N., Kortejärvi, H., Ronkainen, J., Yliperttula, M., Laaksonen, R., & Blom, M. (2022). Effectiveness and cost-effectiveness of a people-centred care model for community-living older people versus usual care ─ A randomised controlled trial. Research in Social and Administrative Pharmacy, 18(6), 3004–3012. https://doi.org/10.1016/j.sapharm.2021.07.025

Effectiveness and cost-effectiveness of a people-centred care model for community-living older people versus usual care : a randomised controlled trial

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Author: Kari, Heini1,2; Äijö-Jensen, Nelli1; Kortejärvi, Hanna3;
Organizations: 1Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
2Research Unit, The Social Insurance Institution of Finland, Helsinki, Finland
3Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
4Primary Health Care Centre, Tornio, Finland
5Center for Life Course Health Research, University of Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.4 MB)
Persistent link: http://urn.fi/urn:nbn:fi-fe2022030722254
Language: English
Published: Elsevier, 2022
Publish Date: 2022-03-07
Description:

Abstract

Background: There is a need for effective and cost-effective interprofessional care models that support older people to maintain their quality of life (QoL) and physical performance to live longer independently in their own homes.

Objectives: The objectives were to evaluate effectiveness, QoL and physical performance, and cost-utility of a people-centred care model (PCCM), including the contribution of clinically trained pharmacists, compared with that of usual care in primary care.

Methods: A randomised controlled trial (RCT) with a two-year follow-up was conducted. The participants were multimorbid community-living older people, aged ≥75 years. The intervention comprised an at-home patient interview, health review, pharmacist-led clinical medication review, an interprofessional team meeting, and nurse-led care coordination and health support. At the baseline and at the 1-year and 2-year follow-ups, QoL (SF-36, 36-Item Short-Form Health Survey) and physical performance (SPPB, Short Performance Physical Battery) were measured. Additionally, a physical dimension component summary in the SF-36 was calculated. The SF-36 data were transformed into SF-6D scores to calculate quality-adjusted life-years (QALYs). Healthcare resource use were collected and transformed into costs. A healthcare payer perspective was adopted. Incremental cost-effectiveness ratio (ICER) was calculated, and one-way sensitivity analysis was performed.

Results: No statistically or clinically significant differences were observed between the usual care (n = 126) and intervention group (n = 151) patients in their QoL; at the 2-year follow-up the mean difference was −0.02, (95 % CI -0.07; 0.04,p = 0.56). While the mean difference between the groups in physical performance at the 2-year follow-up was −1.02, (−1.94;-0.10,p = 0.03), between the physical component summary scores it was −7.3, (−15.2; 0.6,p = 0.07). The ICER was −73 638€/QALY, hence, the developed PCCM dominated usual care, since it was more effective and less costly.

Conclusions: The cost-utility analysis showed that the PCCM including pharmacist-led medication review dominated usual care. However, it had no effect on QoL and the effect towards physical performance remained unclear.

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Series: Research in social & administrative pharmacy
ISSN: 1551-7411
ISSN-E: 1934-8150
ISSN-L: 1551-7411
Volume: 18
Issue: 6
DOI: 10.1016/j.sapharm.2021.07.025
OADOI: https://oadoi.org/10.1016/j.sapharm.2021.07.025
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
3142 Public health care science, environmental and occupational health
Subjects:
Funding: This work was supported by funding from The Foundation of Vappu and Oskari Yli-Perttula (funding of the research project execution and researchers travel costs), Tornio city (funding of the research project execution), and The Association of Finnish Pharmacies (AFP) (One year funding of doctoral studies). The researchers were independent of the funders.
Dataset Reference: Supplementary data to this article can be found online at https://doi.org/10.1016/j.sapharm.2021.07.025
  https://doi.org/10.1016/j.sapharm.2021.07.025
Copyright information: © 2021 The Authors. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
  https://creativecommons.org/licenses/by/4.0/