Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study

Graff, Maud; Adang, Eddy; Vernooij-Dassen, M.J.F.J.; Dekker, Joost; Jönsson, Linus; Thijssen, Marjolein; Hoefnagels, W.H.L.; Rikkert, Marcel G M Olde

doi:10.1136/bmj.39408.481898.be

Cited by 242 publications

(266 citation statements)

References 25 publications

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“…[164][165][265][266][267][268][269] Grade B, Level 2 + B End-of-life care for patients with dementia has been found to be extremely demanding of family caregivers. The burden experienced can be personal, emotional and economic and can result in significant levels of depression in the caregivers.…”

Section: Needs Of Caregiversmentioning

confidence: 99%

Systematic review of recent dementia practice guidelines

2014

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Level Type of Evidence + +High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias. +Well conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias. -Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias + +High quality systematic reviews of case control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal 2 + Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal -Case control or cohort studies with a high risk of confounding or bias and a significant risk that the relationship is not causal 3Non-analytic studies, e.g. case reports, case series 4 Expert opinion Levels of evidence and grades of recommendation Statement of IntentThese guidelines are not intended to serve as a standard of medical care. Standards of medical care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge advances and patterns of care evolve.The contents of this publication are guidelines to clinical practice, based on the best available evidence at the time of development. Adherence to these guidelines may not ensure a successful outcome in every case. These guidelines should neither be construed as including all proper methods of care, nor exclude other acceptable methods of care. Each physician is ultimately responsible for the management of his/her unique patient, in the light of the clinical data presented by the patient and the diagnostic and treatment options available. ForewordDementia represents a major public health concern in Singapore and worldwide. Being the most prevalent neurodegenerative disease, dementia is expected to affect 55,000 patients in Singapore by the year 2020. The commonest cause of dementia is Alzheimer's disease with vascular dementia being the next most important cause. Right from the stage of mild dementia up to the stages of severe dementia, this condition poses a significant health and socio-economic burden to patients, caregivers and the nation as a whole. Early diagnosis will allow appropriate use of pharmacological and non-pharmacological management. Along with disease stabilization, efforts to address caregiver burden, patient safety and medico legal concerns should form the principles of management. Clear practise guidelines will allow holistic and optimal care in dementia.I am pleased to present the revised clinical practise guidelines for dementia. In this regard the workgroup has performed a thorough review of the existing literature to recommend both pharmacological and nonpharmacological aspects of management for patients ranging from mild cognitive impairment to severe dementia. This revised guidelines also highlights issues related to the management of mild cognitive impairment, young onset dementia and e...

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Section: Needs Of Caregiversmentioning

confidence: 99%

Systematic review of recent dementia practice guidelines

2014

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“…5 After the recommendations from the consensus conference were finalized, the results of a single-blind randomized controlled trial of community-based occupational therapy for older patients with mild to moderate dementia and their primary caregiver were published. [6][7][8] The therapy comprised environmental modifications, compensatory strategies for the patient, and training of the caregiver to use effective supervision, problemsolving and coping strategies to sustain the autonomy and social participation of the patient and the caregiver. After 10 one-hour sessions over 5 weeks, statistically significant improvements were seen in the short term (3 months) in the daily functioning of patients in the intervention group.…”

Section: Nonpharmacologic Therapymentioning

confidence: 99%

Diagnosis and treatment of dementia: 5. Nonpharmacologic and pharmacologic therapy for mild to moderate dementia

Hogan¹,

Bailey²,

Black³

et al. 2008

Canadian Medical Association Journal

133

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“…In these trials, they have found occupational therapy to be cost-effective with adults with stroke or dementia, in reducing falls, and when provided as a preventive service (Godwin, Wasserman, & Ostwald, 2011;Graff et al, 2008;Hay et al, 2002;Steultjens, Dekker, Bouter, Jellema, et al, 2004). Most population-based research has focused on postacute care, hospital readmission, or geographic variation in outcomes related to inpatient rehabilitation services (Galloway et al, 2016;Reistetter et al, 2015).…”

mentioning

confidence: 99%

Therapy Caps and Variation in Cost of Outpatient Occupational Therapy by Provider, Insurance Status, and Geographic Region

Pergolotti

Reeve

Dusetzina

2018

The American Journal of Occupational Therapy

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OBJECTIVE. This article describes the cost of occupational therapy by provider, insurance status, and geographic region and the number of visits allowed and out-of-pocket costs under proposed therapy caps. METHOD. This retrospective, population-based study used Medicare Provider Utilization and Payment Data for occupational therapists billing in 2012 and 2013 (Ns = 3,662 and 3,820, respectively). We examined variations in outpatient occupational therapy services with descriptive statistics and the impact of therapy caps on occupational therapy visits and patient out-of-pocket costs. RESULTS. Differences in cost between occupational and physical therapists were minimal. The most frequently billed service was therapeutic exercises. Wisconsin had the most inflated outpatient costs in both years. Under the proposed therapy cap, patients could receive an evaluation plus 12–14 visits. DISCUSSION. Wide variation exists in potential patient out-of-pocket costs for occupational therapy services on the basis of insurance coverage and state. Patients without insurance pay a premium.

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Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study

Abstract: Objective To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint.

Cited by 242 publications

References 25 publications

Systematic review of recent dementia practice guidelines

Systematic review of recent dementia practice guidelines

Diagnosis and treatment of dementia: 5. Nonpharmacologic and pharmacologic therapy for mild to moderate dementia

Therapy Caps and Variation in Cost of Outpatient Occupational Therapy by Provider, Insurance Status, and Geographic Region

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