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Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People—the ISCOPE study

older people often experience complex problems. Because of multiple problems, care for older people in general practice needs to shift from a 'problem-based, disease-oriented' care aiming at improvement of outcomes per disease to a 'goal-oriented care', aiming at improvement of functioning and perso... Full description

Journal Title: Age and Ageing 2016, Vol.45 (1), p.30-41
Main Author: Blom, Jeanet
Other Authors: den Elzen, Wendy , van Houwelingen, Anne H , Heijmans, Margot , Stijnen, Theo , Van den Hout, Wilbert , Gussekloo, Jacobijn
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: England: Oxford Publishing Limited (England)
ID: ISSN: 0002-0729
Link: https://www.ncbi.nlm.nih.gov/pubmed/26764392
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4711660
title: Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People—the ISCOPE study
format: Article
creator:
  • Blom, Jeanet
  • den Elzen, Wendy
  • van Houwelingen, Anne H
  • Heijmans, Margot
  • Stijnen, Theo
  • Van den Hout, Wilbert
  • Gussekloo, Jacobijn
subjects:
  • Activities of Daily Living
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Care plans
  • Clinical outcomes
  • Clinical trials
  • Cost effectiveness
  • Cost-Benefit Analysis
  • Delivery of Health Care, Integrated - economics
  • Delivery of Health Care, Integrated - organization & administration
  • Effectiveness
  • Elderly people
  • Feasibility
  • Feasibility Studies
  • Female
  • General practice
  • General Practice - economics
  • General Practice - organization & administration
  • General practitioners
  • Geriatric Assessment
  • Geriatrics
  • Health Care Costs
  • Health costs
  • Health Services for the Aged - economics
  • Health Services for the Aged - organization & administration
  • Health Services Research
  • Humans
  • integrated care
  • Integrated services
  • Interventions
  • Male
  • Models, Organizational
  • Netherlands
  • Older people
  • Patient Care Planning - economics
  • Patient Care Planning - organization & administration
  • Patient Satisfaction
  • Primary care
  • proactive care
  • Quality of Life
  • Recovery of Function
  • Research Papers
  • Screening
  • Surveys and Questionnaires
  • Time Factors
  • Training
  • Treatment Outcome
ispartof: Age and Ageing, 2016, Vol.45 (1), p.30-41
description: older people often experience complex problems. Because of multiple problems, care for older people in general practice needs to shift from a 'problem-based, disease-oriented' care aiming at improvement of outcomes per disease to a 'goal-oriented care', aiming at improvement of functioning and personal quality of life, integrating all healthcare providers. Feasibility and cost-effectiveness of this proactive and integrated way of working are not yet established. cluster randomised trial. all persons aged ≥75 in 59 general practices (30 intervention, 29 control), with a combination of problems, as identified with a structured postal questionnaire with 21 questions on four health domains. for participants with problems on ≥3 domains, general practitioners (GPs) made an integrated care plan using a functional geriatric approach. Control practices: care as usual. (i) quality of life (QoL), (ii) activities of daily living, (iii) satisfaction with delivered health care and (iv) cost-effectiveness of the intervention at 1-year follow-up. Netherlands trial register, NTR1946. of the 11,476 registered eligible older persons, 7,285 (63%) participated in the screening. One thousand nine hundred and twenty-one (26%) had problems on ≥3 health domains. For 225 randomly chosen persons, a care plan was made. No beneficial effects were found on QoL, patients' functioning or healthcare use/costs. GPs experienced better overview of the care and stability, e.g. less unexpected demands, in the care. GPs prefer proactive integrated care. 'Horizontal' care using care plans for older people with complex problems can be a valuable tool in general practice. However, no direct beneficial effect was found for older persons.
language: eng
source:
identifier: ISSN: 0002-0729
fulltext: no_fulltext
issn:
  • 0002-0729
  • 1468-2834
url: Link


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titleEffectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People—the ISCOPE study
creatorBlom, Jeanet ; den Elzen, Wendy ; van Houwelingen, Anne H ; Heijmans, Margot ; Stijnen, Theo ; Van den Hout, Wilbert ; Gussekloo, Jacobijn
creatorcontribBlom, Jeanet ; den Elzen, Wendy ; van Houwelingen, Anne H ; Heijmans, Margot ; Stijnen, Theo ; Van den Hout, Wilbert ; Gussekloo, Jacobijn
descriptionolder people often experience complex problems. Because of multiple problems, care for older people in general practice needs to shift from a 'problem-based, disease-oriented' care aiming at improvement of outcomes per disease to a 'goal-oriented care', aiming at improvement of functioning and personal quality of life, integrating all healthcare providers. Feasibility and cost-effectiveness of this proactive and integrated way of working are not yet established. cluster randomised trial. all persons aged ≥75 in 59 general practices (30 intervention, 29 control), with a combination of problems, as identified with a structured postal questionnaire with 21 questions on four health domains. for participants with problems on ≥3 domains, general practitioners (GPs) made an integrated care plan using a functional geriatric approach. Control practices: care as usual. (i) quality of life (QoL), (ii) activities of daily living, (iii) satisfaction with delivered health care and (iv) cost-effectiveness of the intervention at 1-year follow-up. Netherlands trial register, NTR1946. of the 11,476 registered eligible older persons, 7,285 (63%) participated in the screening. One thousand nine hundred and twenty-one (26%) had problems on ≥3 health domains. For 225 randomly chosen persons, a care plan was made. No beneficial effects were found on QoL, patients' functioning or healthcare use/costs. GPs experienced better overview of the care and stability, e.g. less unexpected demands, in the care. GPs prefer proactive integrated care. 'Horizontal' care using care plans for older people with complex problems can be a valuable tool in general practice. However, no direct beneficial effect was found for older persons.
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subjectActivities of Daily Living ; Age Factors ; Aged ; Aged, 80 and over ; Care plans ; Clinical outcomes ; Clinical trials ; Cost effectiveness ; Cost-Benefit Analysis ; Delivery of Health Care, Integrated - economics ; Delivery of Health Care, Integrated - organization & administration ; Effectiveness ; Elderly people ; Feasibility ; Feasibility Studies ; Female ; General practice ; General Practice - economics ; General Practice - organization & administration ; General practitioners ; Geriatric Assessment ; Geriatrics ; Health Care Costs ; Health costs ; Health Services for the Aged - economics ; Health Services for the Aged - organization & administration ; Health Services Research ; Humans ; integrated care ; Integrated services ; Interventions ; Male ; Models, Organizational ; Netherlands ; Older people ; Patient Care Planning - economics ; Patient Care Planning - organization & administration ; Patient Satisfaction ; Primary care ; proactive care ; Quality of Life ; Recovery of Function ; Research Papers ; Screening ; Surveys and Questionnaires ; Time Factors ; Training ; Treatment Outcome
ispartofAge and Ageing, 2016, Vol.45 (1), p.30-41
rights
0The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society.
1Copyright Oxford Publishing Limited(England) Jan 2016
2The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society. 2016
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descriptionolder people often experience complex problems. Because of multiple problems, care for older people in general practice needs to shift from a 'problem-based, disease-oriented' care aiming at improvement of outcomes per disease to a 'goal-oriented care', aiming at improvement of functioning and personal quality of life, integrating all healthcare providers. Feasibility and cost-effectiveness of this proactive and integrated way of working are not yet established. cluster randomised trial. all persons aged ≥75 in 59 general practices (30 intervention, 29 control), with a combination of problems, as identified with a structured postal questionnaire with 21 questions on four health domains. for participants with problems on ≥3 domains, general practitioners (GPs) made an integrated care plan using a functional geriatric approach. Control practices: care as usual. (i) quality of life (QoL), (ii) activities of daily living, (iii) satisfaction with delivered health care and (iv) cost-effectiveness of the intervention at 1-year follow-up. Netherlands trial register, NTR1946. of the 11,476 registered eligible older persons, 7,285 (63%) participated in the screening. One thousand nine hundred and twenty-one (26%) had problems on ≥3 health domains. For 225 randomly chosen persons, a care plan was made. No beneficial effects were found on QoL, patients' functioning or healthcare use/costs. GPs experienced better overview of the care and stability, e.g. less unexpected demands, in the care. GPs prefer proactive integrated care. 'Horizontal' care using care plans for older people with complex problems can be a valuable tool in general practice. However, no direct beneficial effect was found for older persons.
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0Activities of Daily Living
1Age Factors
2Aged
3Aged, 80 and over
4Care plans
5Clinical outcomes
6Clinical trials
7Cost effectiveness
8Cost-Benefit Analysis
9Delivery of Health Care, Integrated - economics
10Delivery of Health Care, Integrated - organization & administration
11Effectiveness
12Elderly people
13Feasibility
14Feasibility Studies
15Female
16General practice
17General Practice - economics
18General Practice - organization & administration
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20Geriatric Assessment
21Geriatrics
22Health Care Costs
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24Health Services for the Aged - economics
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34Older people
35Patient Care Planning - economics
36Patient Care Planning - organization & administration
37Patient Satisfaction
38Primary care
39proactive care
40Quality of Life
41Recovery of Function
42Research Papers
43Screening
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45Time Factors
46Training
47Treatment Outcome
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titleEffectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People—the ISCOPE study
authorBlom, Jeanet ; den Elzen, Wendy ; van Houwelingen, Anne H ; Heijmans, Margot ; Stijnen, Theo ; Van den Hout, Wilbert ; Gussekloo, Jacobijn
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1Age Factors
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12Elderly people
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22Health Care Costs
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45Time Factors
46Training
47Treatment Outcome
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atitleEffectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People—the ISCOPE study
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abstractolder people often experience complex problems. Because of multiple problems, care for older people in general practice needs to shift from a 'problem-based, disease-oriented' care aiming at improvement of outcomes per disease to a 'goal-oriented care', aiming at improvement of functioning and personal quality of life, integrating all healthcare providers. Feasibility and cost-effectiveness of this proactive and integrated way of working are not yet established. cluster randomised trial. all persons aged ≥75 in 59 general practices (30 intervention, 29 control), with a combination of problems, as identified with a structured postal questionnaire with 21 questions on four health domains. for participants with problems on ≥3 domains, general practitioners (GPs) made an integrated care plan using a functional geriatric approach. Control practices: care as usual. (i) quality of life (QoL), (ii) activities of daily living, (iii) satisfaction with delivered health care and (iv) cost-effectiveness of the intervention at 1-year follow-up. Netherlands trial register, NTR1946. of the 11,476 registered eligible older persons, 7,285 (63%) participated in the screening. One thousand nine hundred and twenty-one (26%) had problems on ≥3 health domains. For 225 randomly chosen persons, a care plan was made. No beneficial effects were found on QoL, patients' functioning or healthcare use/costs. GPs experienced better overview of the care and stability, e.g. less unexpected demands, in the care. GPs prefer proactive integrated care. 'Horizontal' care using care plans for older people with complex problems can be a valuable tool in general practice. However, no direct beneficial effect was found for older persons.
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pubOxford Publishing Limited (England)
pmid26764392
doi10.1093/ageing/afv174
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