Comparing Different Implementation Strategies for Collaborative Dementia Care Management in Terms of Patients' Characteristics, Unmet Needs, and the Impact on Quality of Life and Costs in Germany.

IF 2 Q2 ECONOMICS

PharmacoEconomics Open Pub Date : 2025-03-01 Epub Date: 2024-12-14 DOI:10.1007/s41669-024-00548-w

Moritz Platen, Wolfgang Hoffmann, Bernhard Michalowsky

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引用次数: 0

Abstract

Objective: To compare the implementation of collaborative dementia care management (cDCM) across two settings regarding patients' characteristics, unmet needs, and the impact on health-related quality of life (HRQoL) and costs.

Methods: This analysis was based on data from the DCM:IMPact study, implementing cDCM in a physician network (n = 22 practices) and two day care centers (DCC) for community-dwelling persons with dementia over 6 months in Germany. Participants completed comprehensive assessments at baseline and 6 months after, soliciting sociodemographic and clinical characteristics, unmet needs, HRQoL and healthcare resource utilization. Patient characteristics and unmet needs were analyzed descriptively, and the impact of cDCM on costs and HRQoL was assessed using multivariable regression models.

Results: At baseline, patients from the physician network (n = 46) exhibited more pronounced neuropsychiatric symptoms (NPI mean score 14 versus 10, p = 0.075), were more frequently diagnosed with dementia (76% versus 56%, p = 0.040), were less likely assigned a care level by the long-term care insurance (63% versus 91%, p ≤ 0.001) to access formal care services and had more unmet needs (12.8 versus 11.0, p ≤ 0.001), especially for social care services than DCC patients (n = 57). After 6 months, the adjusted means indicated that cDCM implemented in the physician network was more effective [EQ-5D-5L utility score; 0.061; 95% confidence interval (CI) - 0.032 to 0.153] and less costly (- 5950€; 95% CI - 8415€ to - 3485€) than cDCM implemented in DCC.

Conclusions: Patients and the healthcare system may benefit more when cDCM is implemented in physician networks. However, patient characteristics indicated two samples with specific conditions and various unmet needs using different ways of accessing healthcare, demonstrating the need for cDCM in both settings, which must be considered when implementing cDCM to integrate the respective sectors efficiently.

Trial registration: German Clinical Trials Register: DRKS00025074. Registered 16 April 2021-retrospectively registered.

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比较不同实施策略的合作痴呆护理管理的病人特点，未满足的需求，以及对生活质量和成本的影响在德国。

目的：比较两种情况下协同痴呆护理管理（cDCM）的实施情况，包括患者的特征、未满足的需求以及对健康相关生活质量（HRQoL）和成本的影响。方法：本分析基于DCM:IMPact研究的数据，该研究在德国的一个医生网络（n = 22个实践）和两个日托中心（DCC）实施了cDCM，用于治疗6个月以上的社区痴呆患者。参与者在基线和6个月后完成了全面的评估，包括社会人口学和临床特征、未满足的需求、HRQoL和医疗资源利用。对患者特征和未满足需求进行描述性分析，并使用多变量回归模型评估cDCM对成本和HRQoL的影响。结果:基线,病人的医生网络(n = 46)表现出更明显的神经精神症状(NPI意味着得分14和10,p = 0.075),是更频繁地诊断出患有痴呆(76%比56%,p = 0.040),不太可能分配一个保健水平的长期护理保险(63%比91%,p≤0.001)访问正式护理服务和有更多的未满足的需求(12.8和11.0,p≤0.001),特别是对社会关怀服务比DCC病人(n = 57)。6个月后，调整后的均值表明，在医生网络中实施cDCM更有效[EQ-5D-5L效用评分；0.061;95%置信区间(CI) - 0.032至0.153]，成本更低(- 5950欧元；95% CI - 8415€至- 3485€)比cDCM在DCC中实现。结论：当cDCM在医生网络中实施时，患者和医疗保健系统可能会受益更多。然而，患者特征表明，两个样本具有特定的条件和各种未满足的需求，使用不同的获得医疗保健的方式，这表明在这两种情况下都需要cDCM，在实施cDCM以有效整合各自部门时必须考虑到这一点。试验注册：德国临床试验注册：DRKS00025074。注册于2021年4月16日-回顾性注册。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

PharmacoEconomics Open Multiple-

CiteScore

3.50

自引率

0.00%

发文量

审稿时长

8 weeks

期刊介绍： PharmacoEconomics - Open focuses on applied research on the economic implications and health outcomes associated with drugs, devices and other healthcare interventions. The journal includes, but is not limited to, the following research areas:Economic analysis of healthcare interventionsHealth outcomes researchCost-of-illness studiesQuality-of-life studiesAdditional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in PharmacoEconomics -Open may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.All manuscripts are subject to peer review by international experts. Letters to the Editor are welcomed and will be considered for publication.