Jackson Diana, McCrone Paul, Mosweu Iris, Siegert Richard, Turner-Stokes Lynne
King's College London, Faculty of Life Sciences & Medicine, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom.
King's College London, Institute of Psychiatry, Psychology & Neuroscience, Health Services and Population Research Department, London, United Kingdom.
PLoS One. 2014 Nov 17;9(11):e113056. doi: 10.1371/journal.pone.0113056. eCollection 2014.
Knowledge of the configuration and costs of community rehabilitation and support for people with long-term neurological conditions (LTNCs) is needed to inform future service development and resource allocation. In a multicentre prospective cohort study evaluating community service delivery during the year post-discharge from in-patient neuro-rehabilitation, a key objective was to determine service use, costs, and predictors of these costs.
Patients consecutively admitted over one year to all nine London specialised (Level 1) in-patient neuro-rehabilitation units were recruited on discharge. They or their carers completed postal/web-based questionnaires at discharge and six and twelve months later, providing demographic data and measures of impairment, disability, service needs and provision. This paper describes health and social care service use, informal care and associated costs. Regression models using non-parametric boot-strapping identified predictors of costs over time.
Overall, 152 patients provided consistent data. Mean formal service costs fell significantly from £13,290 (sd £19,369) during the first six months to £9,335 (sd £19,036) from six-twelve months, (t = 2.35, P<0.05), mainly due to declining health service use. At six months, informal care was received on average for 8.2 hours/day, mean cost £14,615 (sd 23,305), comprising 52% of overall care costs. By twelve months, it had increased to 8.8 hours per day, mean cost £15,468 (sd £25,534), accounting for 62% of overall care costs. Being younger and more disabled predicted higher formal care costs, explaining 32% and 30% of the variation in costs respectively at six and twelve months.
Community services for people with LTNCs carry substantial costs that shift from health to social care over time, increasing the burden on families. Prioritising rehabilitation services towards those in greatest need could limit access to others needing on-going support to promote their independence and reduce their reliance on families. This argues for greater investment in future rehabilitation services.
为指导未来的服务发展和资源分配，需要了解针对长期神经系统疾病（LTNCs）患者的社区康复及支持的配置和成本。在一项评估住院神经康复出院后一年内社区服务提供情况的多中心前瞻性队列研究中，一个关键目标是确定服务使用情况、成本以及这些成本的预测因素。
连续一年入住伦敦所有九个专科（一级）住院神经康复单元的患者在出院时被招募。他们或其护理人员在出院时以及出院后六个月和十二个月完成邮寄/基于网络的问卷，提供人口统计学数据以及损伤、残疾、服务需求和服务提供情况的测量数据。本文描述了健康和社会护理服务的使用、非正式护理及相关成本。使用非参数自举法的回归模型确定了随时间变化的成本预测因素。
总体而言，152名患者提供了一致的数据。正式服务的平均成本在前六个月从13290英镑（标准差19369英镑）显著降至六个月至十二个月期间的9335英镑（标准差19036英镑），（t = 2.35，P<0.05），主要原因是医疗服务使用量下降。在六个月时，平均每天接受非正式护理8.2小时，平均成本14615英镑（标准差23305英镑），占总护理成本的52%。到十二个月时，增加到每天8.8小时，平均成本15468英镑（标准差25534英镑），占总护理成本的62%。年龄较小和残疾程度较高预示着正式护理成本较高，分别解释了六个月和十二个月时成本变化的32%和30%。
为LTNCs患者提供的社区服务成本巨大，且随着时间推移从医疗护理转向社会护理，增加了家庭负担。将康复服务优先提供给最需要的人可能会限制其他需要持续支持以促进其独立性并减少对家庭依赖的人获得服务。这表明需要对未来的康复服务加大投资。
