7th European Public Health Conference: Thursday 20 November 2014 13:40-15:10
37
Effectiveness, cost-effectiveness and sustainability of integrated care models for elderly complex patients: a systematic review Marta Marino M Marino, M Tanzariello, S Bucci, AG de Belvis, W Ricciardi, S Boccia Department of Public Health, Hygiene Section, Catholic University ‘‘Sacro Cuore’’, Rome, Italy Contact:
[email protected]
Background Integrated care models respond to the complexities of long terms conditions, in particular the increasing prevalence of multiple morbidity and poly-pharmacy. The integration of care across primary, intermediate and secondary care providers could help reducing duplication or gaps in services, emphasize the continuity and coordination of care, improve the efficiency of care for both health professionals and patients. For complex patients (eg. elderly) were experienced in most European countries. This study is aimed at evaluating their effectiveness, cost-effectiveness and sustainability. Methods We conducted a systematic review on Pubmed, CINAHL Plus, Cochrane Central Register of Controlled Trials, EconLit, NHS Economic Evaluation Database and Scopus using a Boolean search by the following mesh terms and free text word: Delivery of Health Care, Integrated care, Comorbidity, Complex patient, Elderly, Frail Elderly, Program Evaluation, Cost Analysis, Effectiveness. Two review authors independently screened all titles and abstracts to assess which studies met the inclusion criteria. Gray literature and references analysis were also performed. The quality of the selected article were evaluated by using EPOC quality criteria. Results From 139 selected papers, 8 were included. Among them two are Randomized controlled trials (RCTs), two are controlled before and after studies (CBAs), one is a longitudinal cohort design (LCD), one is a case study (CS), one is an interrupted time series (ITS) and one is an economic evaluation (EE). No article concerning programs on mental illness, alcohol and drugs were included. Preliminary results show a reduction of the number of hospitalizations and of length of stay. No differences in mortality rates and disability rates were found. Conclusions The main goals of integrated care should be patient experience improvement, reduction of duplication of time, tests and information, delivery of excellent care by all healthcare organizations involved in providing care, accountability and responsibility for each health care professional/provider. Policy
38
European Journal of Public Health, Vol. 24, Supplement 2, 2014
makers should develop integrated care programs, focused on elderly with comorbidities, to achieve significant impact on hospitalization and efficient resource management. Key messages Chronic diseases, polimorbidity and population ageing are a major public health concern witch is challenging the actual health care organization schemes. Despite the diffusion of different approaches, the efforts in research and practice should emphasize on what really works in terms of impact on clinical, health, economic and organizational outcomes.
