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How much does abandonment of assistive technology cost Italy’s national health service?


How much does abandonment of assistive technology cost Italy’s national health service?
The growing need for assistive technology. World Health Organization estimates that today, more
than one billion people need assistive technology (AT). AT include any item, piece of equipment or
product, whether it is acquired commercially, modified or customized, that is used to increase,
maintain or improve the functional capabilities of individuals with disability. Although AT can be a
great help to people with disability and reduce or neutralize barriers to participation in society, most
people discard their devices after only a short time.
There is general agreement that one year after receiving an AT device about 30% of users have
abandoned it and hence the 30% rate has been used as a threshold for distinguishing between low
and high rates of AT abandonment. The low rate of use of AT results in the waste of private and
public resources and also means that there is no change in the extent to which disability affects
potential users’ lives, which is frustrating for them.
A survey of users of the National health service in Italy. To investigate the extent to which users of
units of local health services (ULHS) in Italy abandon AT devices and their reasons for doing so, we
contacted 3,791 ULHS users by telephone for interview. The telephone interview questionnaire
asked users about their experience with their AT device, whether they were still using it and, if
applicable, why they had abandoned it. Users were also asked how satisfied they were with their AT
device and with the service which had provided it.
AT abandonment in Italy. The survey revealed that 17.9% of respondents had stopped using their
assigned AT device within seven months of receiving it and 40% of this group said they had never
used the device (Fig. 1).
Figure 1. Percentages of AT in use and abandoned.
People who received a hearing device where more likely to abandon their device (22.4%) than
people who received a mobility device (14.4%) (Fig. 2).
Figure 2. Percentages of hearing and mobility devices which are abandoned.
The most commonly given reason for not using a hearing device was that the design of the device
was inappropriate (58%). Mobility devices were more likely than hearing devices to be abandoned
for personal, health-related reasons. Non-use of mobility devices was more likely to be attributed to
health factors than to technology- and service-related factors.
Although in theory devices might be abandoned because they have become obsolete, in practice the
brevity of the period for which they are used before abandonment makes this an unlikely
explanation. It is more likely that AT devices are abandoned for reasons related to the characteristics
of the device or because they fail to meet the user’s needs and expectations (i.e., there is a poor
match between person and technology). Slightly less than half of recorded ex-users (40%) reported
that they had never used the device issued to them and the remaining 60% had abandoned their
device within 7 months. These data suggest that devices are abandoned because they are not
appropriate to the needs of the user or do not meet the user’s expectations.
The waste of public resources. Money spent on AT devices which are not used is money wasted. In
2013, the ULHS which provided survey respondents with AT devices spent 18,787,797.37 euros on
AT; if we assume an abandonment rate of 17.9%, this amounts to a loss of around 3,363,015.73
euros. Given that the ULHS involved in the study serves about 900,000 people this could be
regarded as a substantial waste of public money.
Federici, S., Meloni, F., & Borsci, S. (2016). The Abandonment of Assistive Technology in Italy: A
Survey of Users of the National Health Service. European Journal of Physical and Rehabilitation
Medicine. [Epub ahead of print]. The online version of this article is located at
... Unfit AT may not be used and may be discarded. Existing literature shows that, in Western countries, AT abandonment rate is estimated to be one third after one year (Dijcks et al., 2006;Federici et al., 2016a). Wheelchairs represent an exception with an abandonment rate around 5% (Samuelsson and Wressle, 2008). ...
... AT abandonment represents a waste of 5 to 30% of their cost of acquisition which can represent significant amounts for funders (Federici et al., 2016a). Thus, many authors suggest that abandoned ATs could be sell at a lower cost by another person with similar needs (Gowran et al., 2020;Kniskern et al., 2008;Walsh et al., 2015). ...
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Assistive technologies (AT) are essential in the daily life of elderly and people with disabilities. However, a growing demand for AT around the world remains unmet. The second-hand market has the potential to meet some of these unmet needs while reducing the amount of AT disposed of in landfills. The French government has recently engaged in financially supporting AT reuse programs. The current research aims at developing framework tools for project initiators. It was based on the literature on waste management and AT reuse and on a detailed analysis of seven innovative French local AT reused programs. Using a qualitative approach, the work resulted in an evaluation grid and a matrix scorecard of indicators for the management of future AT reuse programs. The aim of this tool is to consolidate the development of AT reuse programs to promote their access to people with disabilities while reducing waste production.
... In the scientific literature, however, not much is known about the impact and cost-effectiveness of AT. Although there are some studies [18,19], this has been a neglected field for many years. This is partly due to the fact that AT is not acknowledged as a major separate issue in most healthcare and welfare systems, but is also due to the complexity of evaluating the impact of AT. ...
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Purpose: This is a position paper describing the elements of an international framework for assistive technology provision that could guide the development of policies, systems and service delivery procedures across the world. It describes general requirements, quality criteria and possible approaches that may help to enhance the accessibility of affordable and high quality assistive technology solutions. Materials and methods: The paper is based on the experience of the authors, an analysis of the existing literature and the inputs from many colleagues in the field of assistive technology provision. It includes the results of discussions of an earlier version of the paper during an international conference on the topic in August 2017. Results and conclusion: The paper ends with the recommendation to develop an international standard for assistive technology provision. Such a standard can have a major impact on the accessibility of AT for people with disabilities. The paper outlines some the key elements to be included in a standard. • Implications for Rehabilitation • Assistive technology is a key element in rehabilitation, but many people have no access to affordable AT solutions. The recommendations in the paper aim to inform policies, systems and service delivery procedures on how to improve access to AT across the world.
Les chutes sont la cause de mortalité et de morbidité importante des personnes âgées. Ainsi, la problématique de leur prévention est une priorité dans les systèmes socio-sanitaire du monde entier. Cette problématique n’est pas récente car elle est un sujet de recherche depuis plus d’une trentaine d’années. Elle se justifie par le fait que plus de 50% des chutes des personnes âgées sont évitables. Les technologies d’assistance (TA) pour la mobilité occupent une place importante dans les stratégies de prévention. En effet, elles modifient l’environnement physique afin de faciliter ou restaurer le rendement occupationnel dans les activités de soins personnels, de travail et de loisirs. Mais ces prouesses ne sont réalisables que si ces assistances sont acceptées et bien utilisées par le patient. Pour cela, l’accompagnement par un tiers (professionnel et / ou familial) est essentiel en raison des difficultés d’apprentissage aux grands âges. Dans le cadre du dispositif UPSAVECOCAT du CHU de Limoges, l’abandon de ces technologies figurait parmi les facteurs de risque de chutes graves à domicile (OR : 17,41 ; IC à 95% = [2,59 ;117,02] ; p = 0,003), en plus du fait de vivre en zone urbaine (OR : 11,46 ; IC à 95% = [1,48 ;88,98] ; p = 0,020) et de la réalisation des activités de la vie quotidienne (OR : 34,04 ; IC à 95% = [1,59 ;727,86] ; p = 0,024). En effet, l’incidence de chutes graves à 6 mois est plus dans « le groupe d’utilisateurs » comparativement « au groupe d’abandonneurs » : respectivement 57% (IC à 95% : [46% ; 68%]), contre 21% (IC à 95% : [12% ; 33%]), avec p = 0,001. Les scores de qualité de vie et de bien-être sont également plus élevés auprès des utilisateurs, respectivement 0,15 (IC à 95% : [0,13 ; 0,17]) contre 0,11 (IC à 95% : [0,08 ; 0,14]) pour les « abandonneurs » avec p = 0,009 pour les QALYs, et 0,32 (IC à 95% : [0,30 ; 0,34]) contre 0,25 (IC à 95% : [0,23 ; 0,27]) avec p < 0,001 pour le bien-être. Le gain supplémentaire par QALY gagné, le plus élevé était de 81 125,00 euros et le plus faible 20 271,50 euros. Suivants les mêmes extrêmes, on trouve 46 428,57 euros et 11 583,71 euros pour le gain supplémentaire par bien-être gagné. L’utilisation des TAs pour la mobilité dans le cadre du projet UPSAV-ECOCAT était donc coût-utile.
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