Department of Health Organisation, Policy and Economics, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
Department of Health Organisation, Policy and Economics, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK.
BMJ Open. 2020 Feb 6;10(2):e033186. doi: 10.1136/bmjopen-2019-033186.
Improving outcomes for older people with long-term conditions and multimorbidity is a priority. Current policy commits to substantial expansion of social prescribing to community assets, such as charity, voluntary or community groups. We use longitudinal data to add to the limited evidence on whether this is associated with better quality of life or lower costs of care.
Prospective 18-month cohort survey of self-reported participation in community assets and quality of life linked to administrative care records. Effects of starting and stopping participation estimated using double-robust estimation.
Participation in community asset facilities. Costs of primary and secondary care.
4377 older people with long-term conditions.
Participation in community assets.
Quality-adjusted life years (QALYs), healthcare costs and social value estimated using net benefits.
Starting to participate in community assets was associated with a 0.017 (95% CI 0.002 to 0.032) gain in QALYs after 6 months, 0.030 (95% CI 0.005 to 0.054) after 12 months and 0.056 (95% CI 0.017 to 0.094) after 18 months. Cumulative effects on care costs were negative in each time period: £-96 (95% CI £-512 to £321) at 6 months; £-283 (95% CI £-926 to £359) at 12 months; and £-453 (95% CI £-1366 to £461) at 18 months. The net benefit of starting to participate was £1956 (95% CI £209 to £3703) per participant at 18 months. Stopping participation was associated with larger negative impacts of -0.102 (95% CI -0.173 to -0.031) QALYs and £1335.33 (95% CI £112.85 to £2557.81) higher costs after 18 months.
Participation in community assets by older people with long-term conditions is associated with improved quality of life and reduced costs of care. Sustaining that participation is important because there are considerable health changes associated with stopping. The results support the inclusion of community assets as part of an integrated care model for older patients.
改善患有长期疾病和多种疾病的老年人的预后是当务之急。当前的政策承诺将社会处方大量扩展到社区资产，如慈善、志愿或社区团体。我们使用纵向数据来补充关于这是否与更高的生活质量或更低的护理成本相关的有限证据。
对自我报告的参与社区资产和生活质量与行政护理记录相关的 18 个月前瞻性队列调查。使用双重稳健估计来估计开始和停止参与的效果。
参与社区资产。初级和二级保健费用。
4377 名患有长期疾病的老年人。
参与社区资产。
使用净效益估计质量调整生命年（QALY）、医疗保健成本和社会价值。
开始参与社区资产在 6 个月后 QALY 增加 0.017（95%置信区间 0.002 至 0.032），12 个月后增加 0.030（95%置信区间 0.005 至 0.054），18 个月后增加 0.056（95%置信区间 0.017 至 0.094）。在每个时间段内，对护理成本的累积影响均为负：6 个月时为-96 英镑（95%置信区间-512 至-321）；12 个月时为-283 英镑（95%置信区间-926 至-359）；18 个月时为-453 英镑（95%置信区间-1366 至-461）。在 18 个月时，开始参与的净效益为每位参与者 1956 英镑（95%置信区间 209 至 3703）。停止参与与 -0.102（95%置信区间-0.173 至-0.031）QALY 和 1335.33 英镑（95%置信区间 112.85 至 2557.81）更高的成本相关，在 18 个月后更大的负面影响。
患有长期疾病的老年人参与社区资产与生活质量的提高和护理成本的降低有关。维持这种参与很重要，因为停止参与会带来相当大的健康变化。结果支持将社区资产纳入老年患者综合护理模式。
