Prevalence of Low-Value Care and Its Associations with Patient-Centered Outcomes in Dementia

Abstract

Background: Low-value care (LvC) is defined as care unlikely to provide a benefit to the patient regarding the patient’s preferences, potential harms, costs, or available alternatives. Avoiding LvC and promoting recommended evidence-based treatments, referred to as high-value care (HvC), could improve patient-reported outcomes for people living with dementia (PwD). Objective: This study aims to determine the prevalence of LvC and HvC in dementia and the associations of LvC and HvC with patients’ quality of life and hospitalization. Methods: The analysis was based on data of the DelpHi trial and included 516 PwD. Dementia-specific guidelines, the “Choosing Wisely” campaign and the PRISCUS list were used to indicate LvC and HvC treatments, resulting in 347 LvC and HvC related recommendations. Of these, 77 recommendations (51 for LvC, 26 for HvC) were measured within the DelpHi-trial and finally used for this analysis. The association of LvC and HvC treatments with PwD health-related quality of life (HRQoL) and hospitalization was assessed using multiple regression models. Results: LvC was highly prevalent in PwD (31%). PwD receiving LvC had a significantly lower quality of life (b = –0.07; 95%CI –0.14––0.01) and were significantly more likely to be hospitalized (OR = 2.06; 95%CI 1.26–3.39). Different HvC treatments were associated with both positive and negative changes in HRQoL. Conclusion: LvC could cause adverse outcomes and should be identified as early as possible and tried to be replaced. Future research should examine innovative models of care or treatment pathways supporting the identification and replacement of LvC in dementia.

Association Between Low- and High-Value Medication and Hospital Referrals by General Practitioners in Patients Living with Dementia

“…Our findings emphasize that HvM is not the simple opposite of LvM. Platen et al also highlighted this issue [19], demonstrating on a data basis of patients living with dementia in Germany primary care that, in contrast to LvC, recommended HvM not guarantee a positive patient-reported outcome. Their study revealed that guideline-based prescription of memantine significantly increases the health-related quality of life.…”

“…A study by Platen et al demonstrates that LvM is highly present in routine care. Also, PwD receiving LvM were significantly more hospitalized and had lower quality of life [ 19 ]. However, results concerning the impact of recommended HvM remained uncertain.…”

Associations Between Low-Value Medication in Dementia and Healthcare Costs

“…Moreover, a preceding study revealed that at least 31% of the PwD received low-value care, particularly Lvm associated with reduced quality of life and increased hospitalization [ 16 ]. In addition, 93% of PwD were affected by at least one drug-related problem and associated additional costs, suggesting that Lvm could also amplify adverse downstream effects for both PwD and payers [ 17 ].…”

Tasks and Activities of an Effective Collaborative Dementia Care Management Program in German Primary Care

“…This finding could explain that less educated people may need more educational interventions to address specific unmet needs in their dementia care and increase adherence to the given treatment and care plan. Previous analyses [ 41 ] also revealed that PwD with polypharmacy (more than five drugs regularly taken) more likely suffer from drug-related problems and receive potentially inappropriate medication and low-value care [ 42, 43 ]. This, in turn, can result in higher hospitalization rates, lower quality of life (QoL), and thus a more increased need for interventions to address this variety of unmet needs [ 41 ].…”

“…Previous analyses [ 41 ] also revealed that PwD with polypharmacy (more than five drugs regularly taken) more likely suffer from drug-related problems and receive potentially inappropriate medication and low-value care [ 42, 43 ]. This, in turn, can result in higher hospitalization rates, lower quality of life (QoL), and thus a more increased need for interventions to address this variety of unmet needs [ 41 ]. Our analysis confirmed these findings, demonstrating that PwD with higher rates of medical drug use often requires more interventions than those with a lower number of medications.…”