ÜÇ FARKLI PALYATİF BAKIM HİZMET MODELİNİN KANSERLİ HASTA – HASTAYA BAKIM VEREN AİLE ÜYELERİ AÇISINDAN DEĞERLENDİRİLMESİ VE MALİYET- ETKİLİLİK ANALİZİ

Abstract

SAYGILI, Meltem. An Evaluation of Three Different Palliative Care Service Models in Terms of Patients with Cancer Diagnosis-Their Family Caregivers and Cost-Effectiveness Analysis, PhD Disertation, Ankara, 2016. The purpose of this study is to evaluate the cost effectiveness of the palliative care services received by cancer patients who need palliative care with three different service models. The study was conducted with 60 patients who got service at the Palliative Care Center, 59 patients who received usual care at the public hospital and 41 patients who got home health care services (total 160 patients) and 154 family members who provided care for them. In the study, the cost effectiveness results of the palliative care services provided in the Palliative Care Center and usual care at the public hospital were evaluated with social point of view. The cost effectiveness results of the palliative care services provided together with home health care services were evaluated with the patient’s perspective. For patients; recovery in their symptoms, the levels of patients’ life quality, levels of patients’ satisfaction with the services, they get were evaluated within the measurement of effectiveness. For the family members who provided care for the patients, family care satisfaction and family care burden were evaluated within the measurement of effectiveness. According to the results obtained, it was determined that more recovery was experienced in the symptom levels of the patients who received usual care at the public hospital when compared to the patients who received care at Palliative Care Centers (p<0,05). In the life quality evaluation, the worst scores in terms of general health situation, functional situation and symptom situation were measured with the patients receiving palliative care at the Palliative Care Center (p<0,05). The best general health situation level in terms of life quality was measured in the patients who were receiving home health care services and the best scores in the functional situation evaluation were obtained from the patients who were receiving usual care at the public hospital (p<0,05). The model which the patients and their familiy caregivers had the highest level of satisfaction with the service they got was the Palliative Care Center Model (p<0,00). The model in which the care burden of the families was the highest was the Palliative Care Center model but no statistically significant difference could be found between the palliative care models in terms of family care burden (p>0,05). When the QALY was evaluated according to the service models, the QALY value of the patients receiving service at the Palliative Care Center was calculated as -1,0±4,0 in average. The QALY value of the cancer patients receiving usual care at the public hospital was calculated as 1,5±4,8 in average. The QALY value of the patients receiving home health care services was calculated as 2,5±3,3 in average. As for the evaluation of the costs, the model in which the direct and indirect costs (out-of-pocket expenses) are the highest has been the “Palliative Care Center Model”. In the study, the models were compared calculating the “Incremental Cost Effectiveness Ratios” in terms of the gains in the cost effectiveness evaluation. According to the data obtained, receiving usual care at the public hospital was found more cost effective than receiving care at the Palliative Care Center when they were approached from the social perspective. When a comparison from the patient perspective was made, home health care services model was found more cost effective than the usual care at the public hospital model and the Palliative Care Center model. When the gains in terms of life quality (general health situation, functional situation and symptom level) were evaluated from the patient’s perspective, the most cost effective model became the home health care services model again. When the patient satisfaction level was evaluated from the patient perspective, the most cost effective method was found as the usual care at public hospital model. The most cost effective model in terms of the satisfaction levels and the care burdens of the families was found as home health care services model. The research results are expected to provide important evidence based information to health managers and decision makers in health planning and reimbursement policies.