Evidence for effectiveness of home care
CMAJ 1998;159:442-3
We agree with Dr. Aidan Byrne, who indicated in his letter "Where's the evidence for home care?" (CMAJ 1998;159[2]:135-6) that health care services should be provided on the basis of evidence for their effectiveness and their costs. However, the evidence (or lack thereof) on the cost-effectiveness of home care is not as clearcut as Byrne suggests.
In 1996, the Saskatchewan Health Services Utilization and Research Commission conducted a comprehensive and rigorous review of the literature on the cost-effectiveness of home care.1 This study was cited by Dr. Peter Coyte of the Institute for Clinical Evaluative Sciences, to whom Dr. Byrne refers for support for his position. We found that for institutional care (i.e., long-term or nursing home care), there was indeed a lack of evidence that home care is a cost-effective alternative. However, with reference to hospital care, we found that for specific services such as intravenous antibiotic therapy, there is no doubt: home care is a cost-effective alternative. For palliative care, intravenous therapy for pain management and intravenous rehydration therapy, the research indicates that home care may be cost-effective under specific conditions. In our report, we recognized that the research in these areas is not extensive and recommended that more be done.
Byrne argues that because of the lack of evidence that home care is cost-effective, the status quo should prevail. This seems a case of misplaced burden of proof. The logic of home care as a substitute for non-acute hospital care is compelling, despite the scarcity of substantiating studies. Should we not be at least as sceptical about the lack of evidence of the cost-effectiveness of much more expensive non-acute care in hospitals?
Bonnie Brossart, MA
Laurence Thompson, MA
Health Services Utilization and
Research Commission
Saskatoon, Sask.
 |
Send a letter to the editor Envoyez une lettre à la rédaction |
Reference
- The cost-effectiveness of home care — a rigorous review of the literature [background paper]. Saskatoon: Health Services Utilization and Research Commission; 1996.
