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A cost-effectiveness study of person-centered integrated heart failure and palliative home care: Based on a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature278465
Source
Palliat Med. 2016 Mar;30(3):296-302
Publication Type
Article
Date
Mar-2016
Author
Klas-Göran Sahlen
Kurt Boman
Margareta Brännström
Source
Palliat Med. 2016 Mar;30(3):296-302
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cost-Benefit Analysis
Delivery of Health Care, Integrated - economics - standards
Female
Health Care Costs
Heart Failure - therapy
Home Care Services - economics - organization & administration - standards
Humans
Male
Middle Aged
Palliative Care - economics - organization & administration - standards
Person-Centered Therapy - economics - organization & administration - standards
Quality of Life
Quality-Adjusted Life Years
Sweden
Abstract
Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion.
To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care.
A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients' responses to the EQ-5D quality of life instrument.
Patients with chronic and severe heart failure were randomly assigned to an intervention (n?=?36) or control (n?=?36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6?months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital.
EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs.
The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective.
PubMed ID
26603186 View in PubMed
Less detail

Critically examining diversity in end-of-life family caregiving: implications for equitable caregiver support and Canada's Compassionate Care Benefit.

https://arctichealth.org/en/permalink/ahliterature119283
Source
Int J Equity Health. 2012;11:65
Publication Type
Article
Date
2012
Author
Melissa Giesbrecht
Valorie A Crooks
Allison Williams
Olena Hankivsky
Author Affiliation
Department of Geography, Simon Fraser University, Burnaby, BC, Canada. mgiesbre@sfu.ca
Source
Int J Equity Health. 2012;11:65
Date
2012
Language
English
Publication Type
Article
Keywords
Canada
Caregivers - economics - organization & administration
Culture
Female
Financing, Government - economics - organization & administration
Health Care Surveys
Health Services Accessibility
Healthcare Disparities - economics - organization & administration - statistics & numerical data
Humans
Interviews as Topic
Male
Palliative Care - economics - organization & administration
Sex Factors
Socioeconomic Factors
Terminal Care - economics - organization & administration
Abstract
Family (i.e., unpaid) caregiving has long been thought of as a 'woman's issue', which ultimately results not only in gendered, but also financial and health inequities. Because of this, gender-based analyses have been prioritized in caregiving research. However, trends in current feminist scholarship demonstrate that gender intersects with other axes of difference, such as culture, socio-economic status, and geography to create diverse experiences. In this analysis we examine how formal front-line palliative care providers understand the role of such diversities in shaping Canadian family caregivers' experiences of end-of-life care. In doing so we consider the implications of these findings for a social benefit program aimed at supporting family caregivers, namely the Compassionate Care Benefit (CCB).
This analysis contributes to a utilization-focused evaluation of Canada's CCB, a social program that provides job security and limited income assistance to Canadian family caregivers who take a temporary leave from employment to provide care for a dying family member at end-of-life. Fifty semi-structured phone interviews with front-line palliative care providers from across Canada were conducted and thematic diversity analysis of the transcripts ensued.
Findings reveal that experiences of caregiving are not homogenous and access to services and supports are not universal across Canada. Five axes of difference were commonly raised by front-line palliative care providers when discussing important differences in family caregivers' experiences: culture, gender, geography, lifecourse stage, and material resources. Our findings reveal inequities with regard to accessing needed caregiver services and resources, including the CCB, based on these axes of difference.
We contend that without considering diversity, patterns in vulnerability and inequity are overlooked, and thus continually reinforced in health policy. Based on our findings, we demonstrate that re-framing categorizations of caregivers can expose specific vulnerabilities and inequities while identifying implications for the CCB program as it is currently administered. From a policy perspective, this analysis demonstrates why diversity needs to be acknowledged in policy circles, including in relation to the CCB, and seeks to counteract single dimensional approaches for understanding caregiver needs at end-of-life. Such findings illustrate how diversity analysis can dramatically enhance evaluative health policy research.
Notes
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PubMed ID
23116474 View in PubMed
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Evaluation of a hospital-based palliative support service with particular regard to financial outcome measures.

https://arctichealth.org/en/permalink/ahliterature21611
Source
Palliat Med. 1998 Jan;12(1):41-9
Publication Type
Article
Date
Jan-1998
Author
B. Axelsson
S B Christensen
Author Affiliation
Department of General Surgery, Ostersund Hospital, Sweden.
Source
Palliat Med. 1998 Jan;12(1):41-9
Date
Jan-1998
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Health Resources - utilization
Home Care Services, Hospital-Based - economics - organization & administration
Hospital Costs
Hospitalization
Humans
Male
Middle Aged
Neoplasms - economics - therapy
Palliative Care - economics - organization & administration
Sweden
Terminal Care - economics - organization & administration
Abstract
The object of this study was a financial assessment of a hospital-based palliative support service, to be made by comparing the study group with a matched historical control group and a group of contemporary reference patients. The staff consisted of one full-time nurse supported by a surgeon one half-day per week. The patients in the study group utilized fewer institutional days than the control group, according to such parameters as duration of terminal hospitalization (P
PubMed ID
9616458 View in PubMed
Less detail

Perceived barriers and facilitators in providing palliative care for people with severe dementia: the healthcare professionals' experiences.

https://arctichealth.org/en/permalink/ahliterature296528
Source
BMC Health Serv Res. 2018 Sep 12; 18(1):709
Publication Type
Journal Article
Date
Sep-12-2018
Author
May Helen Midtbust
Rigmor Einang Alnes
Eva Gjengedal
Else Lykkeslet
Author Affiliation
Faculty of Medicine and Health Sciences, Department for Health Sciences in Aalesund, Norwegian University of Science and Technology, Box 1517, NO 6025, Aalesund, Norway. mmi@ntnu.no.
Source
BMC Health Serv Res. 2018 Sep 12; 18(1):709
Date
Sep-12-2018
Language
English
Publication Type
Journal Article
Keywords
Aged
Attitude of Health Personnel
Continuity of Patient Care - economics - organization & administration
Dementia - nursing
Focus Groups
Health Personnel - psychology
Health Resources
Health Services Accessibility - standards
Humans
Norway
Nursing Homes - economics - organization & administration
Palliative Care - economics - organization & administration
Qualitative Research
Abstract
Dementia has become a major public health issue worldwide due to its rapidly increasing prevalence and an increasing number of dementia-related deaths in long-term care facilities. The aim of this study was to examine health professionals' experiences of potential barriers and facilitators in providing palliative care for people with severe dementia in long-term care facilities.
This was a qualitative descriptive study. The data were collected from four focus groups and 20 individual in-depth interviews with healthcare professionals from four Norwegian nursing homes. The data were analysed by thematic text analysis, as described by Braun and Clarke.
The major findings indicate that healthcare professionals experience a lack of continuity as the main barrier to facilitating palliative care. Time pressure and increased efficiency requirements especially affect the weakest and bedridden residents with dementia. The healthcare professionals feel conflicted between wanting to spend more time caring for each individual resident and feeling pressure to help everyone. Although resources are scarce, dying residents are always given priority by healthcare professionals, either by the hiring of extra personnel or the reorganization of tasks in a way that facilitates someone staying with the terminal resident. Advanced care planning was highlighted as a facilitator in providing palliative care, but the extensive use of temporary staff among nurses and doctors and the relocation between the sheltered and long-term wards threaten the continuity in planning and providing palliative care.
The findings indicate that healthcare professionals experienced several structural barriers that prevented the provision of palliative care to people with severe dementia in long-term care facilities. Increasing demands for economic rationality lead to a lack of continuity of care. Organizational changes, such as measures to increase the competence and the proportion of permanent employees and the prevention of burdensome end-of-life transitions, should be implemented to improve continuity and quality of care.
PubMed ID
30208872 View in PubMed
Less detail

Socioeconomic position and place of death of cancer patients.

https://arctichealth.org/en/permalink/ahliterature263305
Source
BMJ Support Palliat Care. 2012 Jun;2(2):133-9
Publication Type
Article
Date
Jun-2012
Author
Mette Asbjoern Neergaard
Anders Bonde Jensen
Ineta Sokolowski
Frede Olesen
Peter Vedsted
Source
BMJ Support Palliat Care. 2012 Jun;2(2):133-9
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Cause of Death
Cross-Sectional Studies
Death
Delivery of Health Care - utilization
Denmark - epidemiology
Female
Humans
Income
Male
Middle Aged
Neoplasms - economics - mortality
Palliative Care - economics - organization & administration
Registries
Socioeconomic Factors
Young Adult
Abstract
Most terminally ill patients and relatives prefer care and death to occur at home. However, in many cases patients die in hospital and the question arises whether social inequity in palliative care exists. The aim of this study was to analyse associations between dying at home and demographic and socioeconomic characteristics adjusted for healthcare utilisation among Danish cancer patients.
Population-based, cross-sectional register study in Aarhus County, Denmark. 599 deceased adults who died from cancer from 1 March to 30 November 2006 in a well-defined geographical area were identified. Based on unique personal identifier numbers, socioeconomic data and healthcare utilisation from different registers were retrieved and analysed.
Multivariate analysis showed that dying at home was negatively associated with, first, being either 50-59 (prevalence ratio (PR): 0.67 (95% CI 0.45 to 0.99)) or 70-79 years of age (PR: 0.83 (95% CI 0.70 to 0.99)) compared with being 80 years or above; second, a middle personal income compared with a high income (PR: 0.86 (95% CI 0.75 to 1.00)); and, third, being employed or having a leadership position compared with being unemployed/student/receiving social security (PR: 0.72 (95% CI 0.53 to 0.98)).
The found socioeconomic differences in whether death occurred at home or at institutions indicate that age, income and social class must be taken into account when palliative care services engage in fulfilling preferences of dying at home. This may lead to more equality in the possibility of dying at home, despite differences in socioeconomic level.
PubMed ID
24654054 View in PubMed
Less detail

Utilization and costs of the introduction of system-wide palliative care in Alberta, 1993-2000.

https://arctichealth.org/en/permalink/ahliterature171912
Source
Palliat Med. 2005 Oct;19(7):513-20
Publication Type
Article
Date
Oct-2005
Author
Konrad Fassbender
Robin Fainsinger
Carleen Brenneis
Pam Brown
Ted Braun
Philip Jacobs
Author Affiliation
Alberta Cancer Board Palliative Care Research Initiative, Edmonton. konrad.fassbender@ualberta.ca
Source
Palliat Med. 2005 Oct;19(7):513-20
Date
Oct-2005
Language
English
Publication Type
Article
Keywords
Aged
Alberta
Delivery of Health Care, Integrated - economics - organization & administration
Female
Health Care Costs
Humans
Male
Neoplasms - economics - therapy
Palliative Care - economics - organization & administration - utilization
Terminal Care - economics
Abstract
De-institutionalization of health care services provided to terminally ill cancer patients is a cost-effective strategy that underpins health care reforms in Canada. The objective of this study therefore is to evaluate the economic implications associated with Canadian innovations in the delivery of palliative care services.
We identified 16,282 adults who died of cancer between 1993 and 2000 in two Canadian cities with newly introduced palliative care programs. Linkage of administrative databases was used to measure healthcare resource utilization. We sought to describe the utilization of palliative care services and its consequences for overall health care system costs.
Use of palliative services increased from 45 to 81% of cancer patients during the study period. Identifiable public health care services cost dollars 28093Cdn/patient (19033US dollars, 11,508GBl, 17,778 euro) for terminally ill cancer patients in their last year of life. Acute care accounted for two-thirds (67%) of these costs; physician (10%), residential hospice care (8%), nursing homes (6%), home care (6%) and prescription medications (3%) comprise the remainder. Increased costs associated with the introduction of palliative care programs were offset by cost savings realized when terminally ill cancer patients spent less time in hospital. Palliative home care and residential hospice care accounted for the bulk of this substitution effect. Cost neutrality was observed from the public perspective.
These results demonstrate that the introduction of comprehensive and community-based palliative care services resulted in increased palliative care service delivery and cost neutrality, primarily achieved through a decreased use of acute care beds.
PubMed ID
16295282 View in PubMed
Less detail

[Wrong conclusion on hospital-based home care services, SBU!].

https://arctichealth.org/en/permalink/ahliterature196880
Source
Lakartidningen. 2000 Aug 9;97(32-33):3519
Publication Type
Article
Date
Aug-9-2000

7 records – page 1 of 1.