Home based management in multiple sclerosis: results of a randomised controlled trial. Issue 3 (1st September 2002)

• Record Type: Journal Article
• Authors: Pozzilli, C; Brunetti, M; Amicosante, A M V; Gasperini, C; Ristori, G; Palmisano, L; Battaglia, M
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 73:Issue 3(2002)
• Page Start: 250
• Page End: 255
• Publication Date: 2002-09-01
• Subjects: home based management -- multiple sclerosis -- quality of life -- costs; CDQ, clinical depression questionnaire -- EDSS, expanded disability status score -- FIM, functional independence measure -- FSS, fatigue severity scale -- MCS, mental component score -- MMSE, mini-mental state examination -- PCS, physical component score -- SF-36, 36 item short form health survey questionnaire -- STAI, state trait anxiety inventory -- STAXI, state trait anger expression inventory; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp.73.3.250
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Background: Home based medical care is a popular alternative to standard hospital care but there is uncertainty about its cost-effectiveness. Objectives: To compare the effectiveness and the costs of multidisciplinary home based care in multiple sclerosis with hospital care in a prospective randomised controlled trial with a one year follow up. Methods: 201 patients with clinically definite multiple sclerosis were studied. They were randomised in a ratio 2:1 to an intervention group (133) or a control group (68). They were assessed at baseline and one year after randomisation with validated measures of physical and psychological impairment and quality of life (SF-36 health survey). The costs to the National Health Service over the one year follow up were calculated by a cost minimisation analysis. Results: There were no differences in functional status between the home based care group and the hospital group. There was a significant difference between the two groups favouring home based management in four SF-36 health dimensions—general health, bodily pain, role-emotional, and social functioning (all p ≤ 0.001). The cost of home based care was slightly less (822 euros/patient/year) than hospital care, mainly as a result of a reduction in hospital admissions. Conclusions: Comprehensive planning of home based intervention implemented by an interdisciplinary team and designed specifically for people with multiple sclerosis may provide a cost-effective approach to management and improve the quality of life.