School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
BMC Geriatr. 2019 Mar 4;19(1):68. doi: 10.1186/s12877-019-1085-3.
A telephone intervention for caregivers of older people discharged from hospital was shown to improve preparedness to care, reduce caregiver strain and caregiver distress. No cost-effectiveness analysis has been published on this, or similar interventions. The study aims addressed here were to examine whether positive outcomes for caregivers resulting from the Further Enabling Care at Home (FECH) program changed the use and costs of health services by patients; and to assess cost-effectiveness.
A single-blind randomised controlled trial compared FECH to usual care. FECH involved a specially trained nurse addressing support needs of caregivers of older patients discharged from hospital. A minimum clinically important difference in preparedness to care was defined as an increase in Preparedness for Caregiving scale score of ≥ two points from baseline. Designated data collection was at: Time 1, within four days of discharge; Time 2, 15-21 days post-discharge; and Time 3, six weeks post-discharge. A last observation carried forward approach to loss to follow-up was used, with a sensitivity analysis including only those who completed all time points. Patient use of hospital, emergency department (ED) and ambulance services were captured for 12 weeks post-discharge using administrative data. Costs included nurse time supporting caregivers, resources used by the nurse, and time taken training the nurse to deliver FECH. Cost-effectiveness was assessed using decision trees for preparedness for caregiving.
Sixty-two intervention dyads and 79 controls provided complete data. A significantly greater proportion of intervention group caregivers reported improved preparedness to care to Time 2 (36.4% v 20.9%, p = 0.029), though this was not sustained to Time 3. The intervention cost $AUD268.28 above usual care per caregiver. No significant differences were observed in health service use between groups. The incremental cost-effectiveness ratio for each additional caregiver reporting improved preparedness to care at Time 2 was $AUD1,730.84.
To our knowledge this is the first work to calculate the cost-effectiveness of a telephone-delivered intervention designed to support caregivers of older people post-discharge, and will support decision-making regarding implementation. Further research should examine different settings, and assess impacts on health service use with larger samples and a longer follow-up.
Australian and New Zealand Clinical Trial Registry: ACTRN12614001174673 . Registered 07/11/2014.
对出院老年人的护理人员进行电话干预，可提高护理准备度，减轻护理人员压力和困扰。尚未对该干预或类似干预进行成本效益分析。本研究旨在探讨因 Further Enabling Care at Home（FECH）项目而使护理人员产生的积极结果是否改变了患者对卫生服务的使用和费用；并评估成本效益。
一项单盲随机对照试验将 FECH 与常规护理进行了比较。FECH 涉及到一名经过专门培训的护士，以满足出院老年患者护理人员的支持需求。准备护理的最低临床重要差异定义为准备护理量表评分从基线增加≥2 分。指定的数据收集时间为：时间 1，出院后 4 天内；时间 2，出院后 15-21 天；时间 3，出院后 6 周。对随访缺失采用最后观察值结转方法，敏感性分析包括仅完成所有时间点的患者。使用行政数据在出院后 12 周内捕获患者对医院、急诊部（ED）和救护车服务的使用情况。费用包括支持护理人员的护士时间、护士使用的资源以及培训护士提供 FECH 所花费的时间。使用决策树评估对护理准备的成本效益。
62 对干预组和 79 对照组提供了完整的数据。干预组护理人员报告准备护理的比例在时间 2 时显著更高（36.4%比 20.9%，p=0.029），但这一比例在时间 3 时没有持续。干预组的成本比常规护理组每位护理人员高 268.28 澳元。两组之间的卫生服务使用没有显著差异。每增加一名报告在时间 2 时准备护理有所改善的护理人员的增量成本效益比为 1730.84 澳元。
据我们所知，这是第一项计算旨在支持出院后老年人护理人员的电话干预的成本效益的工作，这将支持实施决策。应进一步研究不同的环境，并使用更大的样本和更长的随访时间来评估对卫生服务使用的影响。
澳大利亚和新西兰临床试验注册中心：ACTRN12614001174673。注册于 2014 年 7 月 11 日。
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