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Clinical Trial
. 2008 May;23(5):536-42.
doi: 10.1007/s11606-008-0529-9. Epub 2008 Feb 12.

A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults

Cynthia M Boyd  1 , Efrat Shadmi, Leslie Jackson Conwell, Michael Griswold, Bruce Leff, Rosemarie Brager, Martha Sylvia, Chad Boult
Affiliations
Clinical Trial

A pilot test of the effect of guided care on the quality of primary care experiences for multimorbid older adults

Cynthia M Boyd et al. J Gen Intern Med. 2008 May.

Abstract

Objective: Improving health care of multimorbid older adults is a critical public health challenge. The objective of this study is to evaluate the effect of a pilot intervention to enhance the quality of primary care experiences for chronically ill older persons (Guided Care).

Design: Nonrandomized prospective clinical trial.

Patients/participants: Older, chronically ill, community-dwelling patients (N = 150) of 4 General Internists in 1 urban community practice setting who were members of a capitated health plan and identified as being at high risk of heavy use of health services in the coming year by claims-based predictive modeling.

Interventions: Guided Care, an enhancement to primary care that incorporates the operative principles of chronic care innovations, was delivered by a specially trained, practice-based registered nurse working closely with 2 primary care physicians. Each patient received a geriatric assessment, a comprehensive care plan, evidence-based primary care with proactive follow-up of chronic conditions, coordination of the efforts of health professionals across all health care settings, and facilitated access to community resources.

Measurements and main results: Quality of primary care experiences (physician-patient communication, interpersonal treatment, knowledge of patient, integration of care, and trust in physician) was assessed using the Primary Care Assessment Survey (PCAS) at baseline and 6 months later. At baseline, the patients assigned to receive Guided Care were similar to those assigned to receive usual care in their demographics and disability levels, but they had higher risk scores and were less likely to be married. Thirty-one of the 75 subjects assigned to the Guided Care group received the intervention. At 6 months, intention-to-treat analyses adjusting for age, gender, and risk score suggest that Guided Care may improve the quality of physician-patient communication. In per-protocol analyses, receipt of Guided Care was associated with more favorable change than usual care from baseline to follow-up in all 5 PCAS domains, but only physician-patient communication showed a statistically significant improvement.

Conclusions: In this pilot study, Guided Care appeared to improve the quality of primary care experiences for high-risk, chronically ill older adults. A larger cluster-randomized controlled trial of Guided Care is underway.

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Figures

Figure 1
Figure 1
Flow diagram of participants’ response rates to surveys percentages are based on all patients identified as high-risk in control and Guided Care groups (out of 75).
Figure 2
Figure 2
Differences between Guided Care (GC) and control groups’ 6-month change in PCAS scores (95% confidence interval) from baseline to follow-up after adjusting for baseline age, gender, and baseline adjusted clinical groups score; intention-to-treat (ITT) analysis. Higher values reflect greater increases in GC scores versus control scores. PCAS = Primary Care Assessment Survey
See this image and copyright information in PMC

References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1056/NEJMsa022615', 'is_inner': False, 'url': 'https://doi.org/10.1056/nejmsa022615'}, {'type': 'PubMed', 'value': '12826639', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/12826639/'}]}
    2. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635–45. - PubMed
    1. None
    2. Anderson G, Horvath J. Chronic Conditions: Making the Case for Ongoing Care. Baltimore, MD: Partnership for Solutions; 2002.
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '10304291', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/10304291/'}]}
    2. Gruenberg L, Tompkins C, Porell F. The health status and utilization patterns of the elderly: implications for setting Medicare payments to HMOs. Adv Health Econ Health Serv Res. 1989;10:41–73. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1046/j.1532-5415.2001.49076.x', 'is_inner': False, 'url': 'https://doi.org/10.1046/j.1532-5415.2001.49076.x'}, {'type': 'PubMed', 'value': '11347776', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/11347776/'}]}
    2. Boult C, Boult LB, Morishita L, Dowd B, Kane RL, Urdangarin CF. A randomized clinical trial of outpatient geriatric evaluation and management. J Am Geriatr Soc. 2001;49:351–9. - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '10078887', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/10078887/'}]}
    2. Reuben DB, Frank JC, Hirsch SH, McGuigan KA, Maly RC. A randomized clinical trial of outpatient comprehensive geriatric assessment coupled with an intervention to increase adherence to recommendations. J Am Geriatr Soc. 1999;47:269–76. - PubMed

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