Investigating the economic case of a service to support carers of people with dementia: a cross-sectional survey-based feasibility study in England

TY - JOUR

T1 - Investigating the economic case of a service to support carers of people with dementia

T2 - a cross-sectional survey-based feasibility study in England

AU - Longo, Francesco

AU - Neves De Faria, Rita Isabel

AU - Parker, Gillian Mary

AU - Gridley, Kate

AU - Aspinal, Fiona Jane

AU - Van Den Berg, Bernard

AU - Weatherly, Helen Louise Ann

N1 - © 2019 John Wiley & Sons Ltd. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details.

PY - 2019/6/21

Y1 - 2019/6/21

N2 - Carers contribute essential support to enable people with dementia to continue living within the community. Admiral Nurses provide specialist dementia support for carers of people with dementia, including offering expert emotional support and guidance, and work to join up different parts of the health and social care system to address needs in a co-ordinated way. The cost-effectiveness of this service is not clear. We undertook a feasibility study to explore related outcomes and costs for these carers. A cross-sectional, clustered survey was undertaken in England in 2017, in areas with and without Admiral Nursing. The survey questionnaire included questions on the characteristics of the carers and the person with dementia, outcomes (care-related quality of life, self-efficacy and subjective wellbeing), use of health and social care services, out-of-pocket costs and time spent on informal care. We used different econometric techniques to compare the outcomes and the costs of the carers with and without Admiral Nursing services: linear regression, propensity score matching and instrumental variables analysis. These techniques allowed us to control for differences in observed and unobserved characteristics between the two groups of carers which determined outcomes and costs. We concluded that Admiral Nursing services might have a positive effect on carers’ care-related quality of life, self-efficacy and subjective wellbeing. Further, we found little difference in costs between carers using Admiral Nursing and those using usual care, or in the costs of the people with dementia they care for. Our findings provided an initial indication as to whether AN services could be good value for money. The key limitation of the study was the difficulty in controlling for unobserved characteristics because of the cross-sectional nature of our observational data. To diminish this limitation, our survey could be used in future studies following carers with and without Admiral Nursing services over time.

AB - Carers contribute essential support to enable people with dementia to continue living within the community. Admiral Nurses provide specialist dementia support for carers of people with dementia, including offering expert emotional support and guidance, and work to join up different parts of the health and social care system to address needs in a co-ordinated way. The cost-effectiveness of this service is not clear. We undertook a feasibility study to explore related outcomes and costs for these carers. A cross-sectional, clustered survey was undertaken in England in 2017, in areas with and without Admiral Nursing. The survey questionnaire included questions on the characteristics of the carers and the person with dementia, outcomes (care-related quality of life, self-efficacy and subjective wellbeing), use of health and social care services, out-of-pocket costs and time spent on informal care. We used different econometric techniques to compare the outcomes and the costs of the carers with and without Admiral Nursing services: linear regression, propensity score matching and instrumental variables analysis. These techniques allowed us to control for differences in observed and unobserved characteristics between the two groups of carers which determined outcomes and costs. We concluded that Admiral Nursing services might have a positive effect on carers’ care-related quality of life, self-efficacy and subjective wellbeing. Further, we found little difference in costs between carers using Admiral Nursing and those using usual care, or in the costs of the people with dementia they care for. Our findings provided an initial indication as to whether AN services could be good value for money. The key limitation of the study was the difficulty in controlling for unobserved characteristics because of the cross-sectional nature of our observational data. To diminish this limitation, our survey could be used in future studies following carers with and without Admiral Nursing services over time.

KW - Admiral Nursing

KW - carers

KW - costs

KW - economic evaluation

KW - outcomes

KW - social care

UR - http://www.scopus.com/inward/record.url?scp=85067893534&partnerID=8YFLogxK

U2 - 10.1111/hsc.12799

DO - 10.1111/hsc.12799

M3 - Article

SN - 0966-0410

VL - 27

SP - e734-e743

JO - Health and Social Care in the Community

JF - Health and Social Care in the Community

IS - 5

ER -