Proactive primary care model for frail older people in New Zealand delays aged‐residential care: A quasi‐experiment

Abstract

Background/Objectives To determine the effect of a proactive primary care program on acute hospitalization and aged‐residential care placement for frail older people. Design Controlled before and after, and controlled after only quasi‐experimental studies, with a comparison group created via propensity score matching. One‐year follow‐up. Setting Nine general practices in Auckland, New Zealand. Participants Community‐dwelling people aged 75 and older identified as at increased risk of hospitalization. One thousand and eighty five patients are compared with 3750 comparison patients matched by propensity score based on known risks. Intervention Primary healthcare based, registered nurse‐led, comprehensive geriatric assessment, goal‐setting, care planning, and regular follow‐up. Patients were also provided self‐management education, health and social care navigation, and transitional care for hospital discharges. Practices received program support, workforce development, and mentoring of primary healthcare nurses by gerontology nurse specialists. Measurements Outcomes from routinely collected administrative data. Primary: aged‐residential care placement. Secondary outcomes: acute hospitalization, mortality, and other health service utilization. Results Aged‐residential care placement (odds ratio [OR] 0.66, 95% confidence interval (CI) = 0.48‐0.91) and mortality (OR 0.66, 95% CI = 0.49–0.88) were significantly lower over the first year in Kare patients compared with matched controls. There was no difference in acute hospitalization (+0.06 admissions per year, 95% CI = −0.01–0.13). Support service use (allied health therapists and assessment for social support) was increased, and emergency department use decreased. Conclusion The Kare participants had lower aged‐residential care placement and mortality in the first year, but no decrease in acute hospitalization. Because the design is nonexperimental caution is required in interpreting these results.

Legal advice and care-effective use of care and case management: limits, risks and need for change

“…Author details 1 University of Greifswald, Greifswald, Germany. 2 Bucerius Law School, Hamburg, Germany.…”

“…Management of the often complex care of geriatric patients by care and case managers or other coordinating functions has often positive effects on both the health situation of patients and on the [ 1 ] burden [ 2 ] of relatives [ 3 ]. Through care and case management, tasks in the health care system are better assigned to the right places and at the right times, which for example, also leads to a reduction in the workload of general practitioners [ 4 , 5 ].…”

‘Hearing silences’: Exploring culturally safe transitional care: A qualitative study among Turkish‐speaking migrant frail older adults

“…Therefore, frail older patients are recognized as an emerging public health priority (Kojima et al, 2019). In this context, high rates of rehospitalization of frail older adults (Anani et al, 2020; Cheong et al, 2020; Simo et al, 2021) further highlight the fact that existing transitional care models and programs are inadequate to meet the transitional care needs of frail older adults, thus requiring the development of new, innovative, patient‐focused and socio‐culturally appropriate models (Robinson et al, 2021).…”

GP-led adapted comprehensive geriatric assessment for frail older people: a multi-methods evaluation of the ‘Living Well Assessment’ quality improvement project in Scotland

“…Barriers to implementation need further investigation (19). Research on community-based CGA shows wide variation in who conducts the assessment, including geriatric specialists (19,20), nurses, physiotherapists and social workers (19,21,22). There are very few studies that have evaluated CGA delivered by general practitioners (GPs) (19).…”