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Coyle P, Tripken J, Perera S, Juarez GA, Spencer-Brown L, Cameron K, Brach JS. Dissemination and implementation of evidence-based programs for people with chronic disease: the impact of the COVID-19 pandemic. Front Public Health 2024; 11:1276387. [PMID: 38274541 PMCID: PMC10808618 DOI: 10.3389/fpubh.2023.1276387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Background Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we describe the implementation of evidence-based chronic disease self-management education (CDSME) programs by the Administration for Community Living CDSME Grantees during 2016-2022 and we also explore the impact of the COVID-19 pandemic on implementation. Methods Grantees collected data before and after the implementation of the CDSME programs and contributed to the national data repository. Data components included workshop information, participant information, and organizational data. Results The cohort consisted of 175,973 individuals who participated in 34 CDSME programs across 45 states. Participants had a mean ± SD age of 66.1 ± 14.8 years, were primarily female (65.9%) and had a mean ± SD of 2.6 ± 2.3 chronic conditions. Compared to the pre-COVID-19 strata, those who participated during COVID-19 were on average 1.5 years younger and had slightly less comorbidities. For individuals who had pre and post program self-reported health, 65.3% stayed the same, 24.4% improved, and 10.3% worsened (p < 0.001) after participating in CDSME programs. Conclusion CDSME offers a variety of programs across a broad geographic area to a diverse set of older adults in the US, underscoring the expansive reach of this public health initiative. COVID-19 appears to have shifted participant reach toward a slightly younger and healthier population. Finally, these programs appear to be effective in improving participants' self-rated health. However, these results should be interpreted with caution, given limitations due to missing data and the observational nature of this study design.
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Affiliation(s)
- Peter Coyle
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer Tripken
- National Council on Aging Center for Healthy Aging, Arlington, VA, United States
| | - Subashan Perera
- Department of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gardenia A. Juarez
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Kathleen Cameron
- National Council on Aging Center for Healthy Aging, Arlington, VA, United States
| | - Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
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Kessler D, McCutcheon T, Rajachandrakumar R, Lees J, Deyell T, Levy M, Liddy C. Understanding barriers to participation in group chronic disease self-management (CDSM) programs: A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 115:107885. [PMID: 37473604 DOI: 10.1016/j.pec.2023.107885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/13/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To identify factors that influence enrollment in and attendance of chronic disease self-management (CDSM) group programs. METHODS A scoping review of peer-reviewed publications that reported on factors of enrollment or attendance in group CDSM programs for adults with any type of chronic condition. Screening was completed by two reviewers and data extraction was checked for accuracy. Data were summarized and key themes were identified in collaboration with the study team. RESULTS Following screening, 52 of 2774 articles were included. Attendance rates that varied from 10.4-98.5% (mean =72.5%). There is considerable overlap between enrollment and attendance factors. These included Competing Commitments, Logistics, Personal characteristics, Perception of illness/health status, Health service provision, and Group dynamics. CONCLUSIONS Varied and individualized factors can facilitate or impede enrollment or attendance in group CDSM programs. Consideration of these factors and tailoring of programs is needed to facilitate patient ability to take part. Participatory co-design is a growing approach to ensure programs meet individual and community needs. More research is needed to identify the specific impact of using codesign on enrollment and attendance in group CDSM programs. PRACTICE IMPLICATIONS Including community members and service users in design and implementation may enhance CDSM program access.
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Affiliation(s)
- Dorothy Kessler
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada.
| | - Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | | | - Jodie Lees
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Tracy Deyell
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Marisa Levy
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada
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Banstola A, Pokhrel S, Hayhoe B, Nicholls D, Harris M, Anokye N. Economic evaluations of interventional opportunities for the management of mental-physical multimorbidity: a systematic review. BMJ Open 2023; 13:e069270. [PMID: 36854591 PMCID: PMC9980364 DOI: 10.1136/bmjopen-2022-069270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
OBJECTIVES Economic evaluations of interventions for people with mental-physical multimorbidity, including a depressive disorder, are sparse. This study examines whether such interventions in adults are cost-effective. DESIGN A systematic review. DATA SOURCES MEDLINE, CINAHL Plus, PsycINFO, Cochrane CENTRAL, Scopus, Web of Science and NHS EED databases were searched until 5 March 2022. ELIGIBILITY CRITERIA We included studies involving people aged ≥18 with two or more chronic conditions (one being a depressive disorder). Economic evaluation studies that compared costs and outcomes of interventions were included, and those that assessed only costs or effects were excluded. DATA EXTRACTION AND SYNTHESIS Two authors independently assessed risk of bias in included studies using recommended checklists. A narrative analysis of the characteristics and results by type of intervention and levels of healthcare provision was conducted. RESULTS A total of 19 studies, all undertaken in high-income countries, met inclusion criteria. Four intervention types were reported: collaborative care, self-management, telephone-based and antidepressant treatment. Most (14 of 19) interventions were implemented at the organisational level and were potentially cost-effective, particularly, the collaborative care for people with depressive disorder and diabetes, comorbid major depression and cancer and depression and multiple long-term conditions. Cost-effectiveness ranged from £206 per quality-adjusted life year (QALY) for collaborative care programmes for older adults with diabetes and depression at primary care clinics (USA) to £79 723 per QALY for combining collaborative care with improved opportunistic screening for adults with depressive disorder and diabetes (England). Conclusions on cost-effectiveness were constrained by methodological aspects of the included studies: choice of perspectives, time horizon and costing methods. CONCLUSIONS Economic evaluations of interventions to manage multimorbidity with a depressive disorder are non-existent in low-income and middle-income countries. The design and reporting of future economic evaluations must improve to provide robust conclusions. PROSPERO REGISTRATION NUMBER CRD42022302036.
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Affiliation(s)
- Amrit Banstola
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - Subhash Pokhrel
- Department of Health Sciences, Brunel University London, Uxbridge, UK
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Dasha Nicholls
- Department of Brain Sciences, Imperial College London Faculty of Medicine, London, UK
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Nana Anokye
- Department of Health Sciences, Brunel University London, Uxbridge, UK
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4
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Johnson LJ, Schopp LH, Waggie F, Frantz JM. Challenges experienced by community health workers and their motivation to attend a self-management programme. Afr J Prim Health Care Fam Med 2022; 14:e1-e9. [PMID: 35144456 PMCID: PMC8831930 DOI: 10.4102/phcfm.v14i1.2911] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 10/27/2021] [Accepted: 11/04/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Community health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behaviours. AIM This study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programme. SETTING The study was conducted in a low socio-economic urban area of the Western Cape, South Africa. METHODS This study used a qualitative exploratory design using in-depth interviews to obtain rich data about the personal and professional challenges that CHWs experience on a daily basis. RESULTS Five themes emerged with regard to professional challenges (social conditions, mental health of patients, work environment, patient adherence and communication). This cadre identified ineffective self-management as a personal challenge and two themes emerged as motivation for participating in a self-management programme: empowerment and widening perspective. CONCLUSION The challenges raised by the CHWs have a direct impact on their role in communities. This study therefore highlights an urgent need for policymakers and leaders who plan training programmes to take intentional strategic action to address their health challenges and to consider utilising a self-management intervention model to improve their overall health status.
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Affiliation(s)
- Levona J Johnson
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Bellville.
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Yadav UN, Mistry SK, Ghimire S, Schneider CH, Rawal LB, Acharya SP, Harris-Roxas B, Harris MF. Recognizing the roles of primary health care in addressing non-communicable diseases in low- and middle-income countries: Lesson from COVID-19, implications for the future. J Glob Health 2021; 11:03120. [PMID: 34804511 PMCID: PMC8590826 DOI: 10.7189/jogh.11.03120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Uday Narayan Yadav
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia, Sydney, Australia.,Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.,Centre for Research Policy and Implementation (CRPIN), Biratnagar, Nepal
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.,BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.,ARCED Foundation, Dhaka, Bangladesh
| | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
| | - Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Lal Bahadur Rawal
- School of Health Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney Campus, Australia
| | | | - Ben Harris-Roxas
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Mark Fort Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
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Marshall LW, Carrillo CA, Reyes CE, Thorpe CL, Trejo L, Sarkisian C. Evaluation of Recruitment of Older Adults of Color into a Community-Based Chronic Disease Self-Management Wellness Pathway Program in Los Angeles County. Ethn Dis 2020; 30:735-744. [PMID: 33250620 DOI: 10.18865/ed.30.s2.735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Established relationships between researchers, stakeholders and potential participants are integral for recruitment of potential older adult participants and Evidence-Based Programs (EBPs) for chronic disease management have empirically been shown to help improve health and maintain healthy and active lives. To accelerate recruitment in EBPs and potential future research, we propose a Wellness Pathway allowing for delivery within multipurpose senior centers (MPCs) linked with medical facilities among lower-income urban older adults. The study aims were to: 1) assess the effectiveness of three MPC-delivered EBPs on disease management skills, health outcomes, and self-efficacy; and 2) assess the feasibility of the proposed Wellness Pathway for lower-income urban-dwelling older adults of color. Methods We administered surveys and conducted a pre-post analysis among participants enrolled in any 1 of 3 MPC-based EBPs (n=53). To assess feasibility of the pathway, we analyzed survey data and interviews (EBP participants, MPC staff, physicians, n=10). Results EBP participation was associated with greater disease management skills (increased time spent stretching and aerobic activity) but not improvements in self-efficacy or other health outcomes. Interviews revealed: 1) older adults valued EBPs and felt the Wellness Pathway feasible; 2) staff felt it feasible given adequate growth management; 3) physicians felt it feasible provided adequate medical facility integration. Conclusions MPC-based EBPs were associated with improvements in disease management skills among older adults; a proposed Wellness Pathway shows early evidence of feasibility and warrants further investigation. Future efforts to implement this model of recruiting older adults of color into EBPs should address barriers for implementation and sustainability.
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Affiliation(s)
- Lia W Marshall
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA.,Division of Geriatrics, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Carmen A Carrillo
- Department of Public Health University, Los Angeles County Department of Public Health, Los Angeles, CA
| | - Carmen E Reyes
- Division of Geriatrics, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | | | - Laura Trejo
- City of Los Angeles Department of Aging, Los Angeles, CA
| | - Catherine Sarkisian
- Division of Geriatrics, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA.,VA Greater Los Angeles Healthcare System Geriatric Research and Education Clinical Center (GRECC), Los Angeles, CA
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Measuring the Cost and Value of Quality Improvement Initiatives for Local Health Departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:164-171. [PMID: 28257401 DOI: 10.1097/phh.0000000000000552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To demonstrate an approach to measuring the cost and value of quality improvement (QI) implementation in local health departments (LHDs). DESIGN We conducted cost estimation for 4 LHD QI projects and return-on-investment (ROI) analysis for 2 selected LHD QI projects. SETTING AND PARTICIPANTS Four Nebraska LHDs varying in rurality and jurisdiction size. MAIN OUTCOME MEASURES Total costs, unit costs, incremental cost-effectiveness ratios, and ROI. RESULTS The 4 QI projects vary significantly in their cost estimates. Estimated ROI ratios for 2 QI projects predicted significant savings in health care utilization for respective program participants. A QI project focused on improving breastfeeding rates in WIC (women, infants, and children) clients had a predicted ROI ratio of 3230% and a QI project for improving participation in a Chronic Disease Self-Management Program would need only 34 new participants to have a positive ROI. CONCLUSIONS We demonstrated how data can be collected and analyzed for cost estimation and ROI analysis to quantify the economic value of QI for LHDs. Our ROI analysis shows that QI initiatives have great potential to enhance the value of LHDs' public health services. A better understanding of the costs and value of QI will enable LHDs to appropriately allocate and utilize their limited resources for suitable QI initiatives.
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8
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Park MJ, Green J, Jung HS, Park YS. Trajectories of change after a health-education program in Japan: decay of impact in anxiety, depression, and patient-physician communication. PeerJ 2019; 7:e7229. [PMID: 31341730 PMCID: PMC6637923 DOI: 10.7717/peerj.7229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/01/2019] [Indexed: 11/23/2022] Open
Abstract
Background Health education can benefit people with chronic diseases. However, in previous research those benefits were small, and reinforcement to maintain them was not effective. A possible explanation is that the benefits appeared to be small and reinforcement appeared to be ineffective because those analyses mixed data from two latent groups: one group of people who needed reinforcement and one group of people who did not. The hypothesis is that mixing the data from those two different groups caused the true effects to be “diluted.” Methods To test that hypothesis we used data from the Chronic Disease Self-Management Program in Japan, focusing on anxiety, depression, and patient-physician communication. To identify latent trajectories of change after the program, we used growth-mixture modeling. Then, to find out which baseline factors were associated with trajectory-group membership, we used logistic regression. Results Growth-mixture modeling revealed two trajectories—two groups that were defined by distinct patterns of change after the program. One of those patterns was improvement followed by backsliding: decay of impact. On anxiety and depression the decay of impact was large enough to be clinically important, and its prevalence was as high as 50%. Next, logistic regression analysis revealed that being in the decay-of-impact group could be predicted from multimorbidity, low self-efficacy, and high scores on anxiety or depression at baseline. In addition, one unexpected finding was an association between multimorbidity and better patient-physician communication. Conclusions These results support the hypothesis that previous findings (i.e., apparently small effect sizes and apparently ineffective reinforcement) actually reflect “dilution” of large effects, which was caused by mixing of data from distinct groups. Specifically, there was one group with decay of impact and one without. Thus, evaluations of health education should include analyses of trajectory-defined groups. These results show how the group of people who are most likely to need reinforcement can be identified even before the educational program begins. Extra attention and reinforcement can then be tailored. They can be focused specifically to benefit the people with the greatest need.
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Affiliation(s)
- Min Jeong Park
- Department of Nursing, College of Nursing, Konyang University, Daejeon, South Korea.,Department of Health Communication, University of Tokyo, Tokyo, Japan
| | - Joseph Green
- Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hun Sik Jung
- College of Global Business, Konyang University, Nonsan, South Korea
| | - Yoon Soo Park
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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van Grieken RA, van Tricht MJ, Koeter MWJ, van den Brink W, Schene AH. The use and helpfulness of self-management strategies for depression: The experiences of patients. PLoS One 2018; 13:e0206262. [PMID: 30359444 PMCID: PMC6201928 DOI: 10.1371/journal.pone.0206262] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/09/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To explore which of 50 self-management strategies are actually used and which are perceived as most helpful by patients in their day-to-day management of depression, in order to empower patients and promote active engagement in their own care. METHODS Retrospective study using an online self-report survey to assess the use and perceived helpfulness of 50 previously identified self-management strategies in 193 participants who recently recovered from a major depressive episode. RESULTS Forty-five of the 50 strategies were used by at least half of all participants and about one third of all participants perceived almost 50% of all strategies as (very) helpful. The most used strategies, such as 'finding strategies to create pleasurable distractions', 'engaging in leisure activities' or 'identifying the cause of the depression', were not always perceived as most helpful. In addition, the perceived most helpful strategies, such as 'completing treatment' and 'leaving the house regularly' were not always the most used ones. CONCLUSIONS Patients use and perceive a wide range of self-management strategies as helpful to recover from their depression. Patients use and perceive strategies about engagement in treatment and physical activities as being most helpful. These finding may contribute to the further development and implementation of self-management programs for the prevention or the rehabilitation of depression.
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Affiliation(s)
- Rosa A. van Grieken
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam J. van Tricht
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Maarten W. J. Koeter
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Aart H. Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, the Netherlands
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Dahl-Popolizio S, Doyle S, Wade S. The role of primary health care in achieving global healthcare goals: Highlighting the potential contribution of occupational therapy. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2018. [DOI: 10.1080/14473828.2018.1433770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Sue Doyle
- OT Lifestyle Solutions, Battle Ground HealthCare, Battle Ground, WA, USA
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11
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Rooks RN, Kapral CG, Mathis AL. Chronic Conditions May Be More Important Than Race or Ethnicity in Relation to Health Information Seeking and Use. J Aging Health 2017; 31:611-630. [PMID: 29254425 DOI: 10.1177/0898264317744643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This research examines health information (HI) seeking and use among middle-aged and older adults with chronic health conditions. METHOD We used logistic regression models to analyze HI seeking ( N = 7,822) and use (N = 4,541-4,547) among participants (aged 45+ years) with chronic conditions from the nationally-representative Health Tracking Household Survey. RESULTS Adults aged 45+ years with chronic conditions were significantly more likely to seek and use HI; however, these results varied based on the age and education. Compared with Whites, Latinos were less likely to seek HI but more likely to use HI to treat illness, and African Americans were more likely to use HI to maintain health. CONCLUSION Middle-aged and older adults with chronic conditions are prominent HI seekers and users. Proficient HI seeking and use may have the potential to enhance control over one's own health, maintain independence in the community, and reduce the impact of negative health consequences on the health care system.
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Bringing Healthy Aging to Scale: A Randomized Trial of a Quality Improvement Intervention to Increase Adoption of Evidence-Based Health Promotion Programs by Community Partners. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 23:e17-e24. [DOI: 10.1097/phh.0000000000000503] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Oksman E, Linna M, Hörhammer I, Lammintakanen J, Talja M. Cost-effectiveness analysis for a tele-based health coaching program for chronic disease in primary care. BMC Health Serv Res 2017; 17:138. [PMID: 28202032 PMCID: PMC5312514 DOI: 10.1186/s12913-017-2088-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 02/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background The burden of chronic disease and multimorbidity is rapidly increasing. Self-management support interventions are effective in reduce cost, especially when targeted at a single disease group; however, economical evidence of such complex interventions remains scarce. The objective of this study was to evaluate a cost-effectiveness analysis of a tele-based health-coaching intervention among patients with type 2 diabetes (T2D), coronary artery disease (CAD) and congestive heart failure (CHF). Methods A total of 1570 patients were blindly randomized to intervention (n = 970) and control (n = 470) groups. The intervention group received monthly individual health coaching by telephone from a specially trained nurse for 12-months in addition to routine social and healthcare. Patients in the control group received routine social and health care. Quality of life was assessed at the beginning of the intervention and follow-up measurements were made after 12 months health coaching. The cost included all direct health-care costs supplemented with home care and nursing home-care costs in social care. Utility was based on a Health Related Quality of Life (HRQoL) measurement (15D instrument), and cost effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). Results The cost-effectiveness of health coaching was highest in the T2D group (ICER €20,000 per Quality-Adjusted Life Years [QALY]). The ICER for the CAD group was more modest (€40,278 per QALY), and in the CHF group, costs increased with no marked effect on QoL. Probabilistic sensitivity analysis indicated that at the societal willingness to pay threshold of €50,000 per QALY, the probability of health coaching being cost effective was 55% in the whole study group. Conclusions The cost effectiveness of health coaching may vary substantially across patient groups, and thus interventions should be targeted at selected subgroups of chronically ill. Based on the results of this study, health coaching improved the QoL of T2D and CAD patients with moderate costs. However, the results are grounded on a short follow-up period, and more evidence is needed to evaluate the long-term outcomes of health-coaching programs. Trial registration NCT00552903 [Prospectively registered, registration date 1st November 2007, last updated 3rd February 2009].
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Affiliation(s)
- Erja Oksman
- Päijät-Häme Social and Health Care District, Keskussairaalankatu 7, 15 850, Lahti, Finland.
| | - Miika Linna
- Healthcare Engineering, Management and Architecture Institute, Aalto University, Espoo, Finland
| | - Iiris Hörhammer
- Healthcare Engineering, Management and Architecture Institute, Aalto University, Espoo, Finland
| | - Johanna Lammintakanen
- Department of Social and Health Management, University of Eastern Finland, Joensuu, Finland
| | - Martti Talja
- Päijät-Häme Social and Health Care District, Keskussairaalankatu 7, 15 850, Lahti, Finland
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Ory MG, Smith ML. Research, practice, and policy perspectives on evidence-based programing for older adults. Front Public Health 2015; 3:136. [PMID: 25973417 PMCID: PMC4411719 DOI: 10.3389/fpubh.2015.00136] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 01/17/2023] Open
Affiliation(s)
- Marcia G Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center, School of Public Health , College Station, TX , USA
| | - Matthew Lee Smith
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia , Athens, GA , USA
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