Efficiency Provision Process Assistive Devices for Donning and Doffing Compression Hosiery (#HASHTEK)

OBJECTIVE:

1. To optimize the process of providing assistive devices for donning and doffing compression hosiery, resulting in a better quality of life (QoL) for users of compression stockings, less burden on informal caregivers and homecare and substantial savings in healthcare costs.
2. To evaluate effects and cost-effectiveness.

METHOD:

A cluster randomized controlled trial, controlled trial with a 1:1 allocation of participants in the intervention and in the control group. Participants in both groups are recruited through the participating fitter of compression hosiery. The recruiters in the intervention group work together with occupational therapists according to the developed optimized method for the providing process. The new method and associated tools will be developed in year 1 in 6 co-creation meetings with all stakeholders.

The new method follows the steps described in the RiFA and will be defined in a protocol. After development, the protocol is used by half of the participating suppliers of compression hosiery and the occupational therapists with whom they collaborate. For this purpose, a vocational training will be developed and provided in the project, and the protocol and associated tools will be made available digitally.

CARE AS USUAL:

Earlier research has provided insight into bottlenecks in the current method of providing devices for donning and doffing compression hosiery. Currently, the process is not standardized; not everyone who would benefit is entering the process, professionals do not have sufficient knowledge about the assistive devices, the cooperation between client, supplier and care professional often does not go well, the match between the device, client and environment is often not sufficient, reimbursement is not adequate and the evaluation is limited.

ECONOMIC EVALUATION:

According to Dutch guidelines as a combination of CEA and CUA from a societal perspective. In the CEA, the ICER is expressed as the incremental costs per improvement on the success rate. Primary outcome measure CUA: incremental costs per extra QUALY based on the EQ-5D-5L. Costs healthcare, compression stockings user and family, as well as other costs (e.g. productivity) outside the healthcare sector will be included. All relevant data are collected with a tailored cost questionnaire.

DISEASES:

The study population involves a heterogeneous group of individuals with various diseases such as chronic venous insufficiency, lymphedema, venous ulcer cruris, thrombosis.

HYPOTHESIS:

It is hypothesized that an optimized provision process with more involvement of users/wearers of compression stockings, and better selection of assistive devices and training, positively contributes to compliance, satisfaction, independence, autonomy, participation and QoL of compression hosiery users/wearers. In addition, an optimized provision process is expected to be cost-effective. In the short term, this will lead to higher costs for services and assistive devices (e.g., additional use of occupational therapy for selection of the devices, instruction and training, possibly provision of more expensive devices and careful evaluation), but the costs of home care (and indirect costs for informal care) and the treatment of complications will decrease.