Health-economic evaluations of person-centred care

Abstract

Person-centred care aims at making the individual partake in the healthcare decisionmaking and at supporting individual health management. This stands in contrast to usual care, which typically has more focus on the particular disease at hand, rather than on the person behind the disease. Interventions in which care is delivered according to the person- centred care approach belong to a larger group of interventions, usually referred to as complex interventions. It is well-known that evaluating such interventions frequently entails methodological challenges. The overall objective of this thesis was to contribute to the field of evaluation of complex interventions, by adding to the emerging, but still rather scarce, knowledge concerning the effects and the cost-effectiveness of personcentred care interventions. An essential part of this endeavor was to examine the effects achieved by person-centred care by applying a range of different outcome measures and methods. The thesis is comprised of four articles, all of which employed data from randomized controlled trials of person-centred care interventions conducted at the University of Gothenburg Centre for Person-Centred Care. In study I the effects of a person-centred care intervention for patients with acute coronary syndrome was estimated. In studies II and III, the cost-effectiveness of person-centred care provided to patients with (i) acute coronary syndrome and (ii) chronic obstructive pulmonary disease and/or chronic heart failure, compared with usual care, was estimated. In study IV, the outcomes observed among patients with acute coronary syndrome receiving person-centred care, or usual care, were projected to a post-trial point in time. A Markov-type health-economic model was constructed and the corresponding long-term cost-effectiveness of person-centred care was calculated. Overall, the results obtained in these studies suggest that personcentred care is both more effective and less costly than usual care, both in the short and in the long-term perspective.