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Paediatric home care: a systematic review of randomized trials on costs and effectiveness

Parker, G., Bhakta, P., Lovett, C., Olsen, R. and Paisley, S. (2006) Paediatric home care: a systematic review of randomized trials on costs and effectiveness. Journal of Health Services Research and Policy, 11 (2). pp. 110-119. ISSN 1355-8196

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Objective: To review systematically randomized trials (RCTs) on the effectiveness and costs of paediatric home care.

Methods: National Health Service (NHS) Centre for Reviews and Dissemination guidelines were followed. In all, 20 electronic and other sources were searched, using specially designed strategies. Economic studies and other selected designs were included, but only RCT findings – on service use, clinical outcomes, costs, and impact on the family – are reported here. Analysis is descriptive, with pooled standard mean differences used where meta-analysis was possible.

Results: About 1730 identified records up to August 2001 were potentially relevant. In all, 10 RCTs (24 papers) were finally included, covering five types of paediatric home care – for very low birth weight or medically 'fragile' infants, for asthma or diabetes, for technology-dependent children, for mental health, and generic home care. Paediatric home care may enhance physical and mental development for very low birth weight infants and may be cheaper but the evidence is not strong. Home care for diabetes or asthma may reduce parents' costs with some clinical but no social differences noticeable. No randomized trials for technologically dependent children were found. Home care for mental health may increase parental satisfaction with services and reduce some health service and residential care costs. Generic home care showed no clinical effects at early follow-up. Partial follow-up after five years suggested improved psychological adjustment. No cost data were available for this care model.

Conclusions: Despite recent expansion, research evidence from randomized trials for paediatric home care is slight, and methods used are weak in places. Paediatric home care poses practical and ethical questions that cannot be addressed by RCTs.

Item Type: Article
Institution: The University of York
Academic Units: The University of York > Social Policy Research Unit (York)
The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > Health Economics and Decision Science
Depositing User: York RAE Import
Date Deposited: 22 Apr 2009 17:37
Last Modified: 22 Apr 2009 17:37
Published Version: http://dx.doi.org/10.1258/135581906776318947
Status: Published
Publisher: Royal Society of Medicine
Identification Number: 10.1258/135581906776318947
URI: http://eprints.whiterose.ac.uk/id/eprint/6705

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