Effectiveness of a Geriatric Care Model for frail older adults in primary care: Results from a stepped wedge cluster randomized trial

Hoogendijk, Emiel O.; Horst, Henriëtte E. van der; Ven, Peter M. van de; Twisk, Jos W. R.; Deeg, Dorly J. H.; Frijters, Dinnus; Leeuwen, Karen M van; Campen, Jos P. C. M. van; Nijpels, Giel; Jansen, A.P.D.; Hout, Hein van

doi:10.1016/j.ejim.2015.10.023

Cited by 62 publications

(66 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One trial was found that used the modified Katz‐15 scale as a secondary outcome. The effectiveness of a geriatric care model for frail older adults in primary care evaluated in that stepped‐wedge cluster‐randomized trial demonstrated a small intervention effect on IADLs after 18 months of follow‐up . Despite the fact that ADLs and IADLs are commonly used outcome measures, different instruments are used, making small changes over time difficult to detect .…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of a Proactive Primary Care Program on Preserving Daily Functioning of Older People: A Cluster Randomized Controlled Trial

Bleijenberg

Drubbel

Schuurmans

et al. 2016

J American Geriatrics Society

View full text Add to dashboard Cite

OBJECTIVES:To determine the effectiveness of a proactive primary care program on the daily functioning of older people in primary care. DESIGN: Single-blind, three-arm, cluster-randomized controlled trial with 1-year follow-up. SETTING: Primary care setting, 39 general practices in the Netherlands. PARTICIPANTS: Community-dwelling people aged 60 and older (N = 3,092). INTERVENTIONS: A frailty screening intervention using routine electronic medical record data to identify older people at risk of adverse events followed by usual care from a general practitioner; after the screening intervention, a nurse-led care program consisting of a comprehensive geriatric assessment, evidence-based care planning, care coordination, and follow-up; usual care. MEASUREMENTS: Primary outcome was daily functioning measured using the Katz-15 (6 activities of daily living (ADLs), 8 instrumental activities of daily living (IADLs), one mobility item (range 0-15)); higher scores indicate greater dependence. Secondary outcomes included quality of life, primary care consultations, hospital admissions, emergency department visits, nursing home admissions, and mortality. RESULTS: The participants in both intervention arms had less decline in daily functioning than those in the usual care arm at 12 months (mean Katz-15 score: screening arm, 1.87, 95% confidence interval (CI) = 1.77-1.97; screening and nurse-led care arm, 1.88, 95% CI = 1.80-1.96; control group, 2.03, 95% CI = 1.92-2.13; P = .03). No differences in quality of life were observed. CONCLUSION: Participants in both intervention groups had less decline than those in the control group at 1-year follow-up. Despite the statistically significant effect, the clinical relevance is uncertain at this point because of the small differences. Greater customizing of the intervention combined with prolonged follow-up may lead to morerobust results. J Am Geriatr Soc 64:1779-1788, 2016.Key words: primary care; daily functioning; randomized controlled trial; older people; nurse-led care program P roviding optimal care for the increasing number of older people with complex care needs is a major challenge in primary care. 1,2 The average primary care consultation rate for Dutch citizens increases from 4.3 to 6.2 per year between the ages of 60 and 75 to 10 or more per year after the age of 75. 3 The current approach in primary care is reactive and fragmented and does not meet the needs of older people as they experience a lack of overview and coordination when multiple care providers are involved. 4 These deficits result in unnecessary losses of daily functioning, suboptimal quality of life, and high healthcare expenditures. 5 A transition toward more-proactive primary care that focuses on maintaining independence and prevention of functional decline in older adults has been proposed, 6 but the critical components of a more-proactive primary care system remain unknown.The literature regarding the prevention of functional decline in older adults suggests a stepwise identification of people who are a...

show abstract

Section: Discussionmentioning

confidence: 99%

Effectiveness of a Proactive Primary Care Program on Preserving Daily Functioning of Older People: A Cluster Randomized Controlled Trial

Bleijenberg

Drubbel

Schuurmans

et al. 2016

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…The ACT trial, the PoC trial and the U-PROFIT trial found no effects of integrated care on a wide range of outcome measures [10,11,12]. No effects were found on "hard" outcomes, such as hospital admissions No effects on quality of life (SF-12), health-related quality of life, functional limitations, self-rated health, psychological well-being, social functioning and hospitalisations [10]. The intervention is not costeffective [13].…”

Section: Results From Three Recent Studies In the Netherlandsmentioning

confidence: 99%

“…It did not matter whether intention-to-treat or per protocol analyses were performed. It should be noted that both the ACT trial and the U-PROFIT trial found a small effect of the intervention on functional limitations (IADL or a combined ADL/IADL measure), but the effects were not statistically significant after correction for multiple comparisons (ACT) [10], or the effect size was very small and not clinically relevant (U-PROFIT) [12]. The interventions of the ACT trial and the PoC trial were not cost-effective compared with usual care [13,14].…”

Section: E O Hoogendijkmentioning

confidence: 99%

How effective is integrated care for community-dwelling frail older people? The case of the Netherlands

Hoogendijk¹

2016

Age Ageing

Self Cite

View full text Add to dashboard Cite

Integrated care programs have been developed to enhance the quality care for older adults in primary care. These programs usually consist of a multidisciplinary approach, with personalised care based on comprehensive geriatric assessments. However, there is limited evidence for the effectiveness of these programs in frail older people. In this article, we review the results of three recent intervention studies carried out as part of the Dutch National Care for the Elderly Programme. The results illustrate how difficult it is to improve outcomes in community-dwelling frail older adults by means of integrated care. Furthermore, we discuss the implications of these studies for future research into frailty interventions.

show abstract

“…Information on whether or how (frequently) a CGA was used to monitor changes in functioning and care needs of older individuals was limited in the papers. For two programs, papers explicitly mentioned that the nurse involved used a digital instrument to conduct the CGA (Hoogendijk et al, ; Muntinga et al, ; Van Hout et al, ).…”

Section: Resultsmentioning

confidence: 99%

Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review

Stoop

Lette

Gils

et al. 2019

Health Soc Care Community

Self Cite

View full text Add to dashboard Cite

In many integrated care programs, a comprehensive geriatric assessment (CGA) is conducted to identify older people's problems and care needs. Different ways for conducting a CGA are in place. However, it is still unclear which CGA instruments and procedures for conducting them are used in integrated care programs, and what distinguishes them from each other. Furthermore, it is yet unknown how and to what extent CGAs, as a component of integrated care programs, actually reflect the main principles of integrated care, being comprehensiveness, multidisciplinarity and person‐centredness. Therefore, the objectives of this study were to: (a) describe and compare different CGA instruments and procedures conducted within integrated care programs for older people living at home, and (b) describe how the principles of integrated care were applied in these CGAs. A scoping review of the scientific literature on CGAs in the context of integrated care was conducted for the period 2006–2018. Data were extracted on main characteristics of the identified CGA instruments and procedures, and on how principles of integrated care were applied in these CGAs. Twenty‐seven integrated care programs were included in this study, of which most were implemented in the Netherlands and the United States. Twenty‐one different CGAs were identified, of which the EASYcare instrument, RAI‐HC/RAI‐CHA and GRACE tool were used in multiple programs. The majority of CGAs seemed to reflect comprehensiveness, multidisciplinarity and person‐centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. This study highlights the high variability of CGA instruments and procedures used in integrated care programs. This overview of available CGAs and their characteristics may promote (inter‐)national exchange of CGAs, which could enable researchers and professionals in choosing from the wide range of existing CGAs, thereby preventing them from unnecessarily reinventing the wheel.

show abstract

Effectiveness of a Geriatric Care Model for frail older adults in primary care: Results from a stepped wedge cluster randomized trial

Cited by 62 publications

References 42 publications

Effectiveness of a Proactive Primary Care Program on Preserving Daily Functioning of Older People: A Cluster Randomized Controlled Trial

Effectiveness of a Proactive Primary Care Program on Preserving Daily Functioning of Older People: A Cluster Randomized Controlled Trial

How effective is integrated care for community-dwelling frail older people? The case of the Netherlands

Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review

Contact Info

Product

Resources

About