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Health economic analysis on intervention with psychosocial education for family caregivers to persons with dementia
S108
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
P250
Visualizing an elder-friendly emergency department: A focused ethnography using participatory photographic methods B. Parke a,∗ , C. Hoffman b , J. Anthony c , K. Dong d , G. Hodge e , M. Janik e , P. Marck f , A. Mcclelland g , A. Mcfadden e a Faculty Of Nursing, University of Alberta, Edmonton/AB, Canada b Clinical Performance Improvement, Edmonton/AB, Canada c Manager Physician Compensation Design Unit, Edmonton/AB, Canada d Emergency Medicine University Of Alberta, Edmonton/AB, Canada e Emergency Department Royal Alexandra Hospital, Edmonton/AB, Canada f School Of Nursing University Of British Columbia, Kelowna/BC, Canada g Faculty Of Nursing, Edmonton/AB, Canada Introduction.– Older adults have the highest emergency department visit rates, are more likely to be involved in unplanned transfers to hospital, request an ambulance more often, and on arrival be triaged to require significant acute care. The complexity of their needs poses multiple challenges to optimizing safe, and effective quality care during admission, assessment, and treatment in the emergency department. We identified barriers and facilitators to safe, quality emergency care. Text.– Method.– Focused ethnography with photographic research methods were used with purposive sampling. We interviewed older adults and caregivers (n = 20), conducted two focus groups with Registered Nurses (n = 4), and interdisciplinary team members (n = 7), and four Photo-walkabout sessions with photo-elicitation technique. Content analysis and coding techniques were conducted across four dimensions of an elder friendly hospital: care systems and processes, social climate, policies and procedures, and physical design. Results.– Four mediating factors impede and facilitate safety and quality: emergency mentality, chaotic atmosphere, built environment, and the role of the family caregiver. Central to these themes are communication, the role of triage, and actions taken in light of the atypical presentation of disease and illness found in older adults. Photographs illustrate the helpful and hurtful processes of coming to, being in and leaving the emergency department. Conclusion.– Unintentional harm to older emergency department patients can be mitigated with targeted education and high risk screening, elder-friendly emergency department care processes and policies and protocols. Adjustments to the built environment can improve safety and quality for older adults, caregivers, and the interdisciplinary care team. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.251 P251
Health economic analysis on intervention with psychosocial education for family caregivers to persons with dementia S. Elmståhl a , B. Dahlrup a,∗ , K. Steen Carlsson b , E. Nordell a Department Of Health Sciences, Lund University, Division of Geriatric Medicine, Skåne University Hospital, Malmö, Sweden b Swedish Institute Of Health Economics, Lund, Sweden
a
Introduction.– Psychosocial education has been shown to reduce burden and increase satisfaction for family caregiver, especially for next of kin to persons with dementia. There is however, a lack of knowledge on the health economical aspects of such an education. This is the first Nordic health-economical intervention-study on societal/community costs for dementia care after psychosocial education to caregivers compared to a control group.
Methods.– Three hundred and eight family caregivers from one municipality in Sweden, 153 in the intervention group (IG) who underwent psychosocial education and 155 controls, were assessed every 6:th month, for up to 5 years. The assessment included total annual societal cost for every specific unit e.g. home care service, nursing home costs, assisted living including personnel costs/staff costs. The generic EQ-5D quality of life instrument was used for analysis of caregiver quality of life. Results.– Overall, neither total costs differ between groups nor total costs weighted by the study period length and home help costs. Nursing home costs were lower in the IG 39 354 SEK (36 924–40 776) versus 41 354 (38 708–42 682, P < 0.01). Caregivers in the IG rated higher median EQ-5D (interquartile range, IQR): intervention 0.848 (0.725–1) and control 0.796 (0.725–1, Mann-Whitney P < 0.01). Findings remained for children caregivers after controlling for own age, gender, employment status, study group and patient demographics. Conclusion.– Psychosocial education of family caregivers with lower weighted levels of total costs for intervention with substantially improved quality of life as outcome, especially for children as caregivers, could be considered as cost-neutral or cost-effective. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.252 P252
The use of the BelRAI-system as software for comprehensive geriatric assessment in acute hospitals: Opportunities and threats N. Wellens a,∗ , E. Devriendt a , A. Declercq b , P. Moons a , J. Flamaing c , K. Milisen a a Centre For Health Services And Nursing Research, KU Leuven, Leuven, Belgium b Lucas-centre For Care Research And Consultancy, Policy Research Centre For Welfare, Public Health And The Family, KU Leuven, Leuven, Belgium c Department Of Geriatric Medicine, Leuven University Hospitals, Leuven, Belgium Introduction.– BelRAI is a software system including various comprehensive geriatric assessment instruments of the interRAI Suite enabling evidence-based care planning and data exchange. The aim was an in-depth evaluation of its use for hospitalized older persons. Methods.– Trained clinical staff (nurses, occupational therapists, social workers, and geriatricians) assessed 410 inpatients in routine clinical practice, in a cross-sectional multicenter study on four geriatric wards in three acute hospitals. The BelRAI-system was evaluated by focus groups, observations, and questionnaires. The Strengths, Weaknesses, Opportunities and Threats were mapped (SWOT-analysis) and validated by the participants. Results.– The primary strengths of the BelRAI-system were a structured overview of the patient’s condition early after admission and the promotion of multidisciplinary assessment. It was a first introduction to exchange of standardized data and a way to centralize (para)medical and nursing data. Furthermore, it is secured with strict privacy regulations. Weaknesses are the time-consuming process and the overlap with other tools. There is room for improvement regarding the user-friendliness and the efficiency of the software, which needs hospital-specific adaptations. Opportunities are a timely and systematic problem detection and continuity of care. An actual shortage of funding of personnel to coordinate the assessment process was the most important threat. Furthermore, a political decision regarding the nationwide implementation is needed. Conclusion.– The BelRAI web-based software system could improve the quality of care and data exchange. However, weaknesses and threats must and could be tackled before large-scale implementation is possible. Funding for the coordination of the assessment process is important.
8th Congress of the EUGMS / European Geriatric Medicine 3S (2012) S33–S143
P250
Visualizing an elder-friendly emergency department: A focused ethnography using participatory photographic methods B. Parke a,∗ , C. Hoffman b , J. Anthony c , K. Dong d , G. Hodge e , M. Janik e , P. Marck f , A. Mcclelland g , A. Mcfadden e a Faculty Of Nursing, University of Alberta, Edmonton/AB, Canada b Clinical Performance Improvement, Edmonton/AB, Canada c Manager Physician Compensation Design Unit, Edmonton/AB, Canada d Emergency Medicine University Of Alberta, Edmonton/AB, Canada e Emergency Department Royal Alexandra Hospital, Edmonton/AB, Canada f School Of Nursing University Of British Columbia, Kelowna/BC, Canada g Faculty Of Nursing, Edmonton/AB, Canada Introduction.– Older adults have the highest emergency department visit rates, are more likely to be involved in unplanned transfers to hospital, request an ambulance more often, and on arrival be triaged to require significant acute care. The complexity of their needs poses multiple challenges to optimizing safe, and effective quality care during admission, assessment, and treatment in the emergency department. We identified barriers and facilitators to safe, quality emergency care. Text.– Method.– Focused ethnography with photographic research methods were used with purposive sampling. We interviewed older adults and caregivers (n = 20), conducted two focus groups with Registered Nurses (n = 4), and interdisciplinary team members (n = 7), and four Photo-walkabout sessions with photo-elicitation technique. Content analysis and coding techniques were conducted across four dimensions of an elder friendly hospital: care systems and processes, social climate, policies and procedures, and physical design. Results.– Four mediating factors impede and facilitate safety and quality: emergency mentality, chaotic atmosphere, built environment, and the role of the family caregiver. Central to these themes are communication, the role of triage, and actions taken in light of the atypical presentation of disease and illness found in older adults. Photographs illustrate the helpful and hurtful processes of coming to, being in and leaving the emergency department. Conclusion.– Unintentional harm to older emergency department patients can be mitigated with targeted education and high risk screening, elder-friendly emergency department care processes and policies and protocols. Adjustments to the built environment can improve safety and quality for older adults, caregivers, and the interdisciplinary care team. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.251 P251
Health economic analysis on intervention with psychosocial education for family caregivers to persons with dementia S. Elmståhl a , B. Dahlrup a,∗ , K. Steen Carlsson b , E. Nordell a Department Of Health Sciences, Lund University, Division of Geriatric Medicine, Skåne University Hospital, Malmö, Sweden b Swedish Institute Of Health Economics, Lund, Sweden
a
Introduction.– Psychosocial education has been shown to reduce burden and increase satisfaction for family caregiver, especially for next of kin to persons with dementia. There is however, a lack of knowledge on the health economical aspects of such an education. This is the first Nordic health-economical intervention-study on societal/community costs for dementia care after psychosocial education to caregivers compared to a control group.
Methods.– Three hundred and eight family caregivers from one municipality in Sweden, 153 in the intervention group (IG) who underwent psychosocial education and 155 controls, were assessed every 6:th month, for up to 5 years. The assessment included total annual societal cost for every specific unit e.g. home care service, nursing home costs, assisted living including personnel costs/staff costs. The generic EQ-5D quality of life instrument was used for analysis of caregiver quality of life. Results.– Overall, neither total costs differ between groups nor total costs weighted by the study period length and home help costs. Nursing home costs were lower in the IG 39 354 SEK (36 924–40 776) versus 41 354 (38 708–42 682, P < 0.01). Caregivers in the IG rated higher median EQ-5D (interquartile range, IQR): intervention 0.848 (0.725–1) and control 0.796 (0.725–1, Mann-Whitney P < 0.01). Findings remained for children caregivers after controlling for own age, gender, employment status, study group and patient demographics. Conclusion.– Psychosocial education of family caregivers with lower weighted levels of total costs for intervention with substantially improved quality of life as outcome, especially for children as caregivers, could be considered as cost-neutral or cost-effective. Disclosure.– No significant relationships. http://dx.doi.org/10.1016/j.eurger.2012.07.252 P252
The use of the BelRAI-system as software for comprehensive geriatric assessment in acute hospitals: Opportunities and threats N. Wellens a,∗ , E. Devriendt a , A. Declercq b , P. Moons a , J. Flamaing c , K. Milisen a a Centre For Health Services And Nursing Research, KU Leuven, Leuven, Belgium b Lucas-centre For Care Research And Consultancy, Policy Research Centre For Welfare, Public Health And The Family, KU Leuven, Leuven, Belgium c Department Of Geriatric Medicine, Leuven University Hospitals, Leuven, Belgium Introduction.– BelRAI is a software system including various comprehensive geriatric assessment instruments of the interRAI Suite enabling evidence-based care planning and data exchange. The aim was an in-depth evaluation of its use for hospitalized older persons. Methods.– Trained clinical staff (nurses, occupational therapists, social workers, and geriatricians) assessed 410 inpatients in routine clinical practice, in a cross-sectional multicenter study on four geriatric wards in three acute hospitals. The BelRAI-system was evaluated by focus groups, observations, and questionnaires. The Strengths, Weaknesses, Opportunities and Threats were mapped (SWOT-analysis) and validated by the participants. Results.– The primary strengths of the BelRAI-system were a structured overview of the patient’s condition early after admission and the promotion of multidisciplinary assessment. It was a first introduction to exchange of standardized data and a way to centralize (para)medical and nursing data. Furthermore, it is secured with strict privacy regulations. Weaknesses are the time-consuming process and the overlap with other tools. There is room for improvement regarding the user-friendliness and the efficiency of the software, which needs hospital-specific adaptations. Opportunities are a timely and systematic problem detection and continuity of care. An actual shortage of funding of personnel to coordinate the assessment process was the most important threat. Furthermore, a political decision regarding the nationwide implementation is needed. Conclusion.– The BelRAI web-based software system could improve the quality of care and data exchange. However, weaknesses and threats must and could be tackled before large-scale implementation is possible. Funding for the coordination of the assessment process is important.