Enhancing health systems sustainability by providing cost ... · medication adherence and...

Siok-Swan Tan [email protected]

Professor Hein Raat, MD, PhD [email protected]

Marta Pisano González. PhD [email protected]

An Boone [email protected] EF

FIC

HR

ON

IC

Enhancing health systems sustainability

by providing cost-efficiency data of

evidenced based interventions for

chronic management in stratified

populations based on clinical socio-

economic determinants of health

INTERVENTION

N=90

Participants

≥ 55 years

With T2DM and/or CHD

Intervention

Mindfulness, community engagement & ICT support

3-7 workshops;

2.0hrs each;

once a week for 3-7 weeks;

the number of participants will be 30

2 leaders lead series of workshops

N=400

Participants

≥ 18 years

With chronic condition/s

With a low socio-economic position (SEP)

Intervention

The Chronic Disease Self-management Programme

6 workshops;

2.5hrs each;

once a week for 6 weeks;

the number of participants will be 15-20

2 leaders lead series of workshops

APPCARE Final event, Bruxelles May 23rd 2019

� Project co-funding from the

European Union’s Third Health programme (2014-2020; 738127)

� Duration: 3 years (2017 – 2020)

� Coordination: FICYT + Regional Ministry of Health of Asturias, Spain

� 5 European study sites: � the region of Occitanie in France

� province of Genoa in Italy

� principality of Asturias in Spain

� the region of London in the United Kingdom

� region of Rotterdam in the Netherlands

APPCARE Final event Bruxelles May 23rd 2019

Context

Context


CDSMP

Chronic Disease Self-Management Program

� Stanford University / SMRC: Kate Lorig

� Implemented all over the world

� Evidence-based� increase in self-management

� better health outcomes

� improved access to services


CDSMP


2 trainers

20 partipants

6 sessions1 session/week

2,5 hours/week

Conceptual elements

� Integral approach

� Community based

� Peer-to-peer education

� Multi-sector approach

Albert Bandura


CDSMP Self

efficacy

Problemsolving

Confidencebuilding

Decision making

Action plan

- Identify and stratify citizens with a low SEP

- Implement the CDSMP intervention in all study sites

- Evaluate the effects of the CDSMP intervention

- Define policy recommendations and guidelines for scaling-up

WorkPackages


Identifying citizens with a low SEP

�2500 citizens with a low SEP

(500/country)


EUROSTAT NUT-3 level geographical areas in Asturias, Spain

MPI Domains Selfy_MPI

ADL (Katz) Activities of Daily Living Barthel-ADL

IADL (Lawton) Instrumental ADL IADL

Exton-Smith Scale Mobility-Pressure sore risk Barthel-Mobility

Mini Nutritional Ass. Nutritional status Mini Nutritional Ass.

SPMSQ Cognitivity TYM test

CIRS Comorbility

# drugs Polypharmacy # drugs

Cohabitation Social variables SFES


Stratifying citizens with a low SEP

18 months

25-30 workshops

Implementing the CDSMP intervention


� At all 5 sites, a least 32 trainers were trained

� A total of 69 trainings have been provided, reaching more than 800 citizens with a low SEP so far

Implementing the CDSMP intervention


Firstly

• The evaluation framework was firstly described in the initial project proposal.

Secondly

• Then, an expert-panel prioritized the outcomes and proposed instruments in a national workshop.

Thirdly

• After this, a group of experts in evaluating the intervention from Stanford University gave its opinion on the proposed outcomes and instruments

Finally

• Finally, the instruments were debated by the project partners and a consensus was reached.

14APPCARE Final event Bruxelles May 23rd 2019

Effect evaluation

Effect evaluation

Q1

• What are the effects of the CDSMP intervention for the target population in terms of self-management in healthy lifestyle, depression, sleep and fatigue, medication adherence and health-related quality of life (HR-QoL)?

Q2

• What are the effects of the CDSMP intervention on the health literacy, communication with healthcare professionals and prevalence of perceived medical errors?

Q3

• What are the societal cost savings of the CDSMP intervention in terms of reduced healthcare utilization and productivity losses among the target population?

Q4• To what extent is the target population satisfied with the CDSMP

intervention?


Effect evaluation

Q1

• What are the effects of the CDSMP intervention for the target population in terms of self-management in healthy lifestyle, depression, sleep and fatigue, medication adherence and health-related quality of life ?

Q2


Q3



intervention?


Effect evaluation

Q1


Q2


Q3



intervention?


Effect evaluation

Q1


Q2


Q3



intervention?


Effect evaluation

Q1


Q2


Q3



intervention?


Outcomes Instruments

Healthy lifestyle (Physical exercise, Healthy eating, Sedentary

behaviour, Smoking, Alcohol use)

Exercise Behaviour scale, International Physical Activity Questionnaire

(IPAQ), AUDIT-C

Depression Patient Health Questionnaire depression scale (PHQ-8)

Sleep and fatigue Visual analog scale (0-10)

Adherence to medications Short Medication Adherence Questionnaire (SMAQ)

Self-efficacy Chronic Disease Self-Efficacy instrument (CDSE-6)

Health-related quality of life (HRQoL) 12-item short-form (SF-12), Euroqol (EQ-5D-5L)

Health literacy Health Literacy Questionnaire (HLQ)

Communication with healthcare providers 3 items Communication with healthcare providers

Prevalence of experienced medical errors American Association of Retired Persons (AARP) ‘survey beyond 50.09’

questionnaire

Healthcare utilization (Doctor appointments, Use of hospital emergency

rooms, Hospital admissions)

SMRC Health Care Utilization questionnaire

Productivity losses (Lost productivity at paid and unpaid work) Productivity Costs Questionnaire (PCQ)

Satisfaction with the CDSMP intervention Visual analog scale (0-10)

Experience of the specific elements (Problem solving, Decision making,

Confidence building)

5 point Likert scale (disagree-agree)

Questionnaire

� Pre-post design

� Two questionnaires� Before the start of the intervention (baseline; T0)

� 6 months later (follow up; T6)

� Socio-demographics: age, gender, country of birth, educational level and employment situation

Defining policy recommendations and guidelines for scaling-up

Chronic disease challenge:

CDSMP intervention, feasible and (cost-)effective approach?


Thank you for your attention!

[email protected]

APPCARE Final event, Bruxelles May 23rd 2019

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