Tihana Matosevic

The economic evidence for advance care planning: Systematic review of evidence:

Background: Advance care planning is a process of discussion and review concerning future care in the event of losing capacity. Aimed at improving the appropriateness and quality of care, it is also often considered a means of making better use of healthcare resources at the end of life. Aim: To review and summarise economic evidence on advance care planning. Design: A systematic review of the academic literature. Data sources: We searched for English language, peer-reviewed journal articles, 1990–2014, using relevant research databases: PubMed, ProQuest, CINAHL Plus with Full Text; EconLit, PsycINFO, SocINDEX with Full Text and International Bibliography of the Social Sciences. Empirical studies using statistical methods in which advance care planning and costs are variables were included. Results: There are no published cost-effectiveness studies. Included studies focus on healthcare savings, usually associated with reduced demand for hospital care. Advance care planning appears to be associated with healthcare savings for some people in some circumstances, such as people living with dementia in the community, people in nursing homes or in areas with high end-of-life care spending. There is no evidence that advance care planning is likely to be more expensive. Conclusion: There is need for clearer articulation of the likely mechanisms by which advance care planning can lead to reduced care costs or improved cost-effectiveness, particularly for people who retain capacity. There is also a need to consider wider costs, including the costs of advance care planning facilitation or interventions and the costs of substitute health, social and informal care. Economic outcomes need to be considered in the context of quality benefits.

The REFINEMENT Glossary of Terms: An International Terminology for Mental Health Systems Assessment

Comparing mental health systems across countries is difficult because of the lack of an agreed upon terminology covering services and related financing issues. Within the European Union project REFINEMENT, international mental health care experts applied an innovative mixed “top-down” and “bottom-up” approach following a multistep design thinking strategy to compile a glossary on mental health systems, using local services as pilots. The final REFINEMENT glossary consisted of 432 terms related to service provision, service utilisation, quality of care and financing. The aim of this study was to describe the iterative process and methodology of developing this glossary.

Long-term care for older people and EU Law: the position in England and Scotland

To what extent, if at all, is the current legal position on long-term care for older people in England and Scotland potentially inconsistent with the UKs obligations in EU law? The implications of EU law for UK healthcare provision have been tracked by the literature, exploited by litigation (Case C–372/04 Watts [2006] ECR I–4325, BetterCare [2002] CAT 7), and covered in EU legislation (Directive 2011/24/EU). However, long-term care for older people involves not only healthcare but also social care. Drawing on significant new empirical data gathered in early 2010 for a European Commission report (European Commission 2011), this article is the first to consider in detail how EU law might apply to the social care aspects of long-term care for older people in England and Scotland. It concludes that EU law is an important element of the long-term care policy context.

Promoting mental wellbeing among older people: technology-based interventions

This systematic review explored the effectiveness of technology-based interventions in promoting the mental health and wellbeing of people aged 65 and over. Data were collected as part of a wider review commissioned by the National Institute for Health and Care Excellence (NICE) in England on the effectiveness of different actions to promote the mental wellbeing and independence of older people. All studies identified through this review were subject to a detailed critical appraisal of quality, looking at internal and external validity. Twenty-one papers covering evaluations of technological interventions were identified. They examined the psychosocial effects of technologies for education, exposure to, and/or training to use, computers and the internet, telephone/internet communication and computer gaming. Few studies took the form of randomized controlled trials, with little comparability in outcome measures, resulting in an inconsistent evidence base with moderate strength and quality. However, three out of six studies with high or moderate quality ratings (all focused on computer/internet training) reported statistically significant positive effects on psychosocial outcomes, including increased life satisfaction and experienced social support, as well as reduced depression levels among intervention recipients. The review results highlight the need for more methodologically rigorous studies evaluating the effects of technology-based interventions on mental wellbeing. Well-performed technology-based interventions to promote various aspects of mental wellbeing, as identified in this review, can serve as best practice examples in this emerging field.

O-33 What do we know about the economic case?

Background Advance care planning is emphasised in UK policy on end of life care, featuring in the end of life care strategies for England, Wales, Scotland and Northern Ireland, and in a range of associated quality markers and targets. Aimed at improving the appropriateness and quality of care, advance care planning is also often considered a means of controlling health spending at the end of life. Aim We aimed to review and summarise economic evidence on advance care planning. Methods A systematic review of academic literature since 1990. Results There are no published cost-effectiveness studies. We identified 18 relevant studies. These vary considerably in terms of intervention, study design, sample, setting and so forth. They are focused primarily on health care savings, usually associated with reduced hospital care. Discussion In this presentation, I discuss the published studies, consider the research challenges facing those who undertake economic evaluation of advance care planning or advance care planning initiatives and offer some thoughts on ways forward. Conclusion It is important to develop further evidence on the economic implications of advance care planning, not just to contain costs but to allocate resources in ways that are efficient and equitable and ensure the most appropriate investment in end of life care services.