Effects of preventive home visits on older people's use and costs of health care services: A systematic review

Introduction: The aim of this study was to systematically review the evidence from randomized controlled trials (RCT) concerning effectiveness of preventive home visit (PHV) programs on older people's use and costs of health and social services. We also evaluated resultant costs-changes achieved with intervention in older people's functioning, quality-of-life (QOL) or mortality. Materials and methods: A systematic review of published RCTs reporting use and/or costs on PHVs on multimorbid older people was performed. The characteristics and methodological quality of studies were assessed. Results: Of the 3219 articles screened, 19 met the inclusion criteria. The methodological quality of the trials was principally moderate (n = 5) or good (n = 10). Of the studies, 12 evaluated the overall costs of health and social services. None of these studies was able to show significant differences in total costs between intervention and control groups. Six studies suggested that PHVs may decrease nursing home admissions and/or hospital days. Seven studies showed some favorable effect on physical functioning, QOL, or mortality, without increasing the total health care costs. Conclusions: Of the high number of studies investigating efficacy of PHVs on older people, only a few studies explore economic effects. PHVs do not provide overall savings to health care costs, but some interventions might offer some cost-neutral positive effects on functioning, QOL and/or mortality. More studies are needed to clarify the effective aspects of the programs and cost-effectiveness of the PHVs.måsjekke