Wassenberg, G.L.J. (2012) Cost saving through care plans in general practice The influence of ISCOPE on the use and costs of primary health care for older people. thesis, Medicine.
Full text available on request.Abstract
Background: The Dutch population is ageing. In many older people, a decline in health is seen within different health domains. This decline can lead to disability, which is associated with high health care costs. The general practitioner (GP) plays a key role in the care for older people, but many problems are often unnoticed. To aim for a more proactive approach of primary care for the older population, the study Integrated Systematic Care for Older People (ISCOPE) was set up. A structural monitoring system was used to detect the deterioration in somatic, functional, mental or social health of individuals aged 75 years and over, followed by the execution of a care plan for those people with a combination of problems. The aim of the present study was to investigate the difference in costs of health care use from the participants one year before the start of ISCOPE compared to one year after the start of ISCOPE. Furthermore, we investigated within a group of participants with complex problems, whether a care plan influences the use and costs of health care. Methods: This economic evaluation was conducted within 10 general practices of the cluster randomized innovation trial ISCOPE. Within the 10 practices there were 2245 candidates of which 66% was willing to participate. 37% of the people willing to participate was visited at home (n=544). After 12 months, 460 participants were visited again whereby the baseline questions were repeated. Out of the 460 participants, 220 were having complex problems. For 59 of the 220 participants, an individual care plan was made (intervention group). To evaluate the use and costs of health care, we included GP care, home care, institutional admissions, day care and day treatment. Mean costs of health care per person were calculated within the different groups and compared to each other in order to calculate the mean differences per person between the groups, using paired samples and independent samples t-tests. Data were compared one year before the start of ISCOPE to one year after the start of ISCOPE. Results: The mean age of the participants was 81.4 years and 66.1% was female. In the group of all participants, mean costs of health care increased €2220 per person over one year (p<0.001). Main cost drivers are home care (nursing & household) and care home admissions. In the group of participants with complex problems, the mean costs of health care increased €1035 per person in the intervention group (p=0.594), while the costs in the usual care group increased €3604 (p=0.013). A mean difference of increase between the two groups of €2569 (p=0.282) was calculated. Conclusion: Mean total costs of health care increase yearly in the overall study population. However, the results suggest that a care plan can save an amount of €2500 per person yearly in the group of participants with complex problems.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider and Wiel, Dr. H. van der |
| Supervisor name: | Extern begeleider and Dr. J.W. Blom |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:38 |
| Last Modified: | 25 Jun 2020 10:38 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/27 |
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