Combining volunteers and primary care teamwork to support health goals and needs of older adults: a pragmatic randomized controlled trial

Dolovich, Lisa; Oliver, Doug; Lamarche, Larkin; Thabane, Lehana; Valaitis, Ruta; Agarwal, Gina; Carr, Tracey; Foster, Gary; Griffith, Lauren; Javadi, Dena; Kastner, Monika; Mangin, Dee; Παπαϊωάννου, Αλεξάνδρα; Ploeg, Jenny; Raina, Parminder; Richardson, Julie; Risdon, Cathy; Santaguida, Pasqualina; Straus, Sharon E.; Price, David

doi:10.1503/cmaj.181173

Cited by 45 publications

(70 citation statements)

References 51 publications

(44 reference statements)

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“…Volunteers were integrated into an intervention centred on clients' prioritised health goals and needs, unique e-Health technologies, activated interprofessional primary care teams and personalised community resources. This motivational, educational, self-directed program was based on the Health TAPESTRY approach initially developed and tested with older adults Dolovich et al, 2019;Oliver et al, 2018). rich and comprehensive data demonstrating the feasibility of bringing volunteers into primary care.…”

Section: Health Teams Advancing Patient Experience: Strengtheningmentioning

confidence: 99%

Exploration of volunteers as health connectors within a multicomponent primary care‐based program supporting self‐management of diabetes and hypertension

Dolovich

Gaber

Valaitis

et al. 2020

Health Soc Care Community

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Volunteers support health and social care worldwide, yet there is little research on integrating these unpaid community members into primary care. ‘Health Teams Advancing Patient Experience, Strengthening Quality through Health Connectors for Diabetes Management’ (Health TAPESTRY‐HC‐DM) integrates volunteer ‘health connectors’ into a community‐ and primary care‐based program supporting client self‐management in Hamilton, Canada. Volunteers supported clients through goal setting, motivation, education and connections to community resources and primary care. This study aimed to create and apply a volunteer program evaluation framework to explore: (a) volunteer training effectiveness (learning online content, in‐person training, self‐efficacy in role tasks, training overall); (b) feasibility of program implementation (process measures, reflections on client encounters, understanding of volunteer roles/responsibilities, client perspectives on volunteer program); and (c) effects of volunteering on volunteers (health outcomes, self‐efficacy, value of volunteering). A concurrent triangulation, mixed‐methods design was used. Data were collected in 2016, sources included: volunteer online training quizzes, focus groups, self‐efficacy survey, Veterans RAND 12‐Item (VR‐12) survey, in‐person training feedback forms and narratives of client visits; client interviews; and quantitative implementation data. Quantitative data analysis included descriptive statistics, paired samples t tests, and effect size (Cohen's d). Qualitative data used descriptive thematic analysis. Nineteen volunteers and 12 clients participated in this evaluation. Findings demonstrate the volunteer program evaluation framework in action. Online training increased knowledge. In‐person training received largely positive evaluations. Self‐efficacy was high post‐training and higher after volunteering. VR‐12 sub‐scale means increased descriptively. Volunteers understood themselves as healthcare system connectors, feeling fulfilled with their contributions and learning new skills. They identified barriers including not having the resources and skills of healthcare professionals. Clients found volunteers were a major program strength, appreciating their company and regular goals follow‐up. Using a volunteer program evaluation framework generated rich and comprehensive data demonstrating the feasibility of bringing volunteers into primary care.

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Section: Health Teams Advancing Patient Experience: Strengtheningmentioning

confidence: 99%

Exploration of volunteers as health connectors within a multicomponent primary care‐based program supporting self‐management of diabetes and hypertension

Dolovich

Gaber

Valaitis

et al. 2020

Health Soc Care Community

Self Cite

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“…In an initial randomized controlled trial (RCT) that assessed effectiveness and cost-effectiveness, we found null results for the pre-specified primary outcome of goal attainment, but statistically significant improvements in pre-specified secondary outcomes related to health and health services use (23). Specifically, we found that more minutes of walking per week and less time spent sitting per week were reported in the Health TAPESTRY group compared to the control group (24,25). We also found statistically significant differences in health service use with reduced hospitalizations and increased primary health care visits (including both family physicians and other health care providers) (25), suggesting that Health TAPESTRY may be shifting care from a reactive to a proactive approach.…”

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confidence: 63%

Health TAPESTRY Ontario: Protocol for a Randomized Controlled Trial to Test Replicability and Implementation

Mangin

Lamarche

Bomze

et al. 2019

Preprint

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Background: Health TAPESTRY (Health Teams Advancing Patient Experience: STRengthening qualitY) aims to help people stay healthier for longer where they live by providing person-focused care through the integration of four key program components: 1) trained volunteers who visit clients in their homes, 2) an interprofessional primary health care team, 3) use of technology to collect and share information, and 4) improved connections to community health and social services. The initial randomized controlled trial of Health TAPESTRY found promising results in terms of health care use and patient outcomes, indicating a shift from reactive to preventive care. The trial was based on one clinical academic centre, thus limiting generalizability. The study objectives are: 1) to test replicability of the established effectiveness of Health TAPESTRY on physical activity and hospitalizations, 2) to test the feasibility of, and understand the contributing factors to, the implementation of Health TAPESTRY in six diverse communities across Ontario, Canada, and 3) to determine the value for money of implementing Health TAPESTRY. Methods: This planned study is a pragmatic parallel randomized controlled trial with a delayed intervention for control participants at six months. This trial will simultaneously assess effectiveness and implementation in a real world setting (Type II hybrid) in six diverse communities across Ontario. Participants 70 years of age and older will be randomized into the Health TAPESTRY intervention or the control group (usual care). Intervention clients will receive an individualized plan of care from an interprofessional care team. The plan will be based on a client’s goals and current health risks identified through volunteer visits. The study’s outcomes are mapped onto the RE-AIM framework, with levels of physical activity and number of hospitalizations as the co-primary outcomes. The main analysis will be a comparison at six months. Discussion: It is important to evaluate the effectiveness and implementation of Health TAPESTRY in multiple communities prior to scaling or widespread adoption. Trial registration: ClinicalTrials.gov: NCT03397836 (posted January 12, 2018). https://clinicaltrials.gov/ct2/results?cond=&term=NCT03397836&cntry=&state=&city=&dist=

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“…I n linked research, Dolovich and colleagues present the results of a pragmatic randomized controlled trial examining the Health TAPESTRY (Health Teams Advancing Patient Experience: Strengthening Quality) intervention. 1 This interventiondescribed in detail in a published protocol 2 -is an approach that integrates volunteers with professionals on primary care teams to improve outcomes for older patients living at home. The HEALTH Tapestry intervention is novel because it integrates multiple elements, which have been developed individually and evaluated previously.…”

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confidence: 99%

“…3 The linked research addresses a clear challenge for health systems globally that are experiencing a rising prevalence of multimorbidity and aging populations. 1 All health systems currently face the need to shift from single-condition care pathways to innovative approaches that can address multimorbidity. The study is also patient focused, as it aims to facilitate goal-setting for patients.…”

mentioning

confidence: 99%

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Managing multimorbidity in primary care

Smith

2019

CMAJ

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Combining volunteers and primary care teamwork to support health goals and needs of older adults: a pragmatic randomized controlled trial

Cited by 45 publications

References 51 publications

Exploration of volunteers as health connectors within a multicomponent primary care‐based program supporting self‐management of diabetes and hypertension

Exploration of volunteers as health connectors within a multicomponent primary care‐based program supporting self‐management of diabetes and hypertension

Health TAPESTRY Ontario: Protocol for a Randomized Controlled Trial to Test Replicability and Implementation

Managing multimorbidity in primary care

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