Effect of a Multidisciplinary Outpatient Model of Care on Health Outcomes in Older Patients with Multimorbidity: A Retrospective Case Control Study

Shakib, Sepehr; Dundon, Benjamin K.; Maddison, John; Thomas, Josephine; Stanners, Melinda; Caughey, Gillian E.; Clark, Robyn

doi:10.1371/journal.pone.0161382

Cited by 26 publications

(29 citation statements)

References 29 publications

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“…Building multidisciplinary workforce capacity to better deliver integrated care models and meet the needs of older people is a key recommendation of the WHO World Report on Ageing and Health 2 and consistent with emerging evidence for delivering integrated care for older people with complex health needs. 55 In this review, interventions were most commonly directed towards building capacity in nurses, physiotherapists, general practitioners and social workers to deliver integrated care. These discipline foci highlight the importance of addressing health and social care needs, dealing with whole of health and addressing multimorbidity, and in particular maintaining a strong focus on enabling physical and mental capacity which reflect key domains of intrinsic capacity.…”

Section: Discussionmentioning

confidence: 99%

Elements of integrated care approaches for older people: a review of reviews

et al. 2018

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ObjectiveThe World Health Organization (WHO) recently proposed an Integrated Care for Older People approach to guide health systems and services in better supporting functional ability of older people. A knowledge gap remains in the key elements of integrated care approaches used in health and social care delivery systems for older populations. The objective of this review was to identify and describe the key elements of integrated care models for elderly people reported in the literature.DesignReview of reviews using a systematic search method.MethodsA systematic search was performed in MEDLINE and the Cochrane database in June 2017. Reviews of interventions aimed at care integration at the clinical (micro), organisational/service (meso) or health system (macro) levels for people aged ≥60 years were included. Non-Cochrane reviews published before 2015 were excluded. Reviews were assessed for quality using the Assessment of Multiple Systematic Reviews (AMSTAR) 1 tool.ResultsFifteen reviews (11 systematic reviews, of which six were Cochrane reviews) were included, representing 219 primary studies. Three reviews (20%) included only randomised controlled trials (RCT), while 10 reviews (65%) included both RCTs and non-RCTs. The region where the largest number of primary studies originated was North America (n=89, 47.6%), followed by Europe (n=60, 32.1%) and Oceania (n=31, 16.6%). Eleven (73%) reviews focused on clinical ‘micro’ and organisational ‘meso’ care integration strategies. The most commonly reported elements of integrated care models were multidisciplinary teams, comprehensive assessment and case management. Nurses, physiotherapists, general practitioners and social workers were the most commonly reported service providers. Methodological quality was variable (AMSTAR scores: 1–11). Seven (47%) reviews were scored as high quality (AMSTAR score ≥8).ConclusionEvidence of elements of integrated care for older people focuses particularly on micro clinical care integration processes, while there is a relative lack of information regarding the meso organisational and macro system-level care integration strategies.

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Section: Discussionmentioning

confidence: 99%

Elements of integrated care approaches for older people: a review of reviews

et al. 2018

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“…The in-depth model of care of the MACS clinic is in accordance with previous publication [30]. The model brie y constitutes a general nursing assessment including blood pressure and weight measurement, pharmacy medication review, followed by a physician review.…”

Section: Settingmentioning

confidence: 99%

Evaluation of demographic, clinical characteristics, and the prescribing practice of guideline-directed medical therapy among chronic heart failure outpatients in multidisciplinary clinics in a large tertiary hospital: a retrospective audit of 1186 patients from 12 years

Parajuli¹,

Shakib²,

Eng-Frost³

et al. 2020

Preprint

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BackgroundAdherence to guideline-directed medical therapy (GDMT) remains low particularly in elderly despite several approaches. Previous studies showed that heart failure (HF) patients who receive pharmacist-involved multidisciplinary care may have better clinical outcomes. We evaluated patient characteristics and the practice of receiving individual GDMT in chronic HF patients who attended multidisciplinary clinics.MethodsA retrospective audit of data of chronic HF patients presenting to two multidisciplinary outpatient clinics at a tertiary hospital between March 2005 and January 2017 was performed. Data were obtained from two clinics, a Multidisciplinary Ambulatory Consulting Service (MACS) clinic which uses a pharmacist-involved model of multidisciplinary care, and a General Cardiology Heart Failure Service (GCHFS) clinic which does not have the active involvement of a pharmacist.ResultsHF with mid-range ejection fraction (HFmrEF) subjects resembled the HF with preserved ejection fraction (HFpEF) patients in terms of age, heart rate (HR), systolic blood pressure (SBP) and having higher prevalence of polypharmacy whereas resembled with the HF with reduced ejection fraction (HFrEF) for the proportion of male distribution and prevalence of ischemic heart disease (IHD). Both the clinics had similar prescribing rates of GDMT and achieved maximal tolerated doses of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARB) in HFrEF, but significantly higher prescription of ACEIs/ARBs (70.5% v. 56.2%) was found in HFpEF patients in the MACS clinic. There was significantly lower rates of β-blockers and mineralocorticoid receptor antagonists (MRAs) prescription in HFrEF and HFpEF patients in both clinics. Use of digoxin in chronic atrial fibrillation (AF) was significantly higher in HFrEF patients (82.5% v. 58.5%), but number of people anticoagulated in presence of AF and prescription of diuretics were significantly lowered in MACS clinic in HFpEF patients. Age, anemia, chronic renal failure, SBP, HR and comorbidities were the significant predictors in a multivariate binary logistic regression for the utilization of GDMT.ConclusionsOur study concludes that pharmacist is an important member of a multidisciplinary team in the management of chronic heart failure. The other roles of the pharmacist within a multidisciplinary team, including continuity of care, medication compliance and prevention of adverse reactions need further research.

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“…Namely, the models were: Dutch Easy-care Study Geriatric Intervention Programme (DGIP) [17][18][19] ; Geriatric Resources for Assessment and Care of Elders (GRACE) 20,21 ; The Walcheren Integrated Care Model (WICM), [22][23][24][25][26] , On Lok Senior Health Services, Community Care Organization for Dependent Adults (ON LOK CCODA), [27][28][29] Program of All-inclusive Care for the Elderly (PACE), [28][29][30][31][32][33] Wisconsin Partnership Program (PACE-WPP), 34 prevention of care (PoC), 35,36 CO-ordination Personnes Age´es (COPA), 37 System of Integrated Care for Older Persons (SIPA), 38,39 The Silver Network project, 40 Rovereto, 41 Lanzeta, 42 Pone. 43…”

Section: Study Selectionmentioning

confidence: 99%

“…Reorganization of care for frail older people might not be sufficient to achieve effectiveness in terms of health outcomes and functional abilities. [22][23][24]26,46 The WICM study was assessed in 2016, by applying an economic evaluation. Effects were determined to health-related quality of life (EQ-5D questionnaire).…”

Section: Wicmmentioning

confidence: 99%

Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: A narrative review. Don’t we need a value-based approach?

Marino

Belvis

Tanzariello

et al. 2018

International Journal of Care Coordination

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Introduction: The management of patients with complex health and social needs is one of the main challenges for healthcare systems. Integrated care seems to respond to this issue, with collaborative working and integration efforts of the care system components professionals and service providers aimed at improving efficiency, appropriateness and person centeredness of care. We conducted a narrative review to analyse the available evidences published on effectiveness and cost-effectiveness of integrated care models targeted on the management of such elderly patients. Methods: MEDLINE, Scopus and EBSCO were searched. We reported this narrative review according to the PRISMA Checklist. For studies to be included, they had to: (i) refer to integrated care models through implemented experimental or demonstration projects; (ii) focus on frail elderly !65 years old, with complex health and social needs, not diseasespecific; (iii) evaluate effectiveness and/or cost and/or cost-effectiveness; (iv) report quantitative data (e.g. health outcomes, utilization outcomes, cost and cost-effectiveness). Results: Thirty articles were included, identifying 13 integrated care models. Common features were identified in case management, geriatric assessment and multidisciplinary team. Favourable impacts on healthcare facilities utilization rates, though with mixed results on costs, were found. The development of community-based and cost-effective integrated systems of care for the elderly is possible, thanks to the cooperation across care professionals and providers, to achieving a relevant impact on healthcare and efficient resource management. The elements of success or failure are not always unique and identifiable, but the potential clearly exists for these models to be successful and generalized on a large scale. Discussion: We found out a favourable impact of integrated care models/methods on health outcomes, care utilization and costs. The selected interventions are likely to be implemented at community level, focused on the patient management in terms of continuity of care. Thus, we propose a value-based framework for the evaluation of these services.

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Effect of a Multidisciplinary Outpatient Model of Care on Health Outcomes in Older Patients with Multimorbidity: A Retrospective Case Control Study

Cited by 26 publications

References 29 publications

Elements of integrated care approaches for older people: a review of reviews

Elements of integrated care approaches for older people: a review of reviews

Evaluation of demographic, clinical characteristics, and the prescribing practice of guideline-directed medical therapy among chronic heart failure outpatients in multidisciplinary clinics in a large tertiary hospital: a retrospective audit of 1186 patients from 12 years

Effectiveness and cost-effectiveness of integrated care models for elderly, complex patients: A narrative review. Don’t we need a value-based approach?

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