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Randomized Controlled Trial
. 2009 Dec;55(12):e76-85.

Randomized controlled trial of anticipatory and preventive multidisciplinary team care: for complex patients in a community-based primary care setting

William Hogg  1 , Jacques Lemelin, Simone Dahrouge, Clare Liddy, Catherine Deri Armstrong, Frances Legault, Bill Dalziel, Wei Zhang
Affiliations
Randomized Controlled Trial

Randomized controlled trial of anticipatory and preventive multidisciplinary team care: for complex patients in a community-based primary care setting

William Hogg et al. Can Fam Physician. 2009 Dec.

Abstract
in English, French

Objective: T o examine whether quality of care (QOC) improves when nurse practitioners and pharmacists work with family physicians in community practice and focus their work on patients who are 50 years of age and older and considered to be at risk of experiencing adverse health outcomes.

Design: Randomized controlled trial.

Setting: A family health network with 8 family physicians, 5 nurses, and 11 administrative personnel serving 10 000 patients in a rural area near Ottawa, Ont.

Participants: Patients 50 years of age and older at risk of experiencing adverse health outcomes (N = 241).

Interventions: At-risk patients were randomly assigned to receive usual care from their family physicians or Anticipatory and Preventive Team Care (APTCare) from a collaborative team composed of their physicians, 1 of 3 nurse practitioners, and a pharmacist.

Main outcome measures: Quality of care for chronic disease management (CDM) for diabetes, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease.

Results: Controlling for baseline demographic characteristics, the APTCare approach improved CDM QOC by 9.2% (P < .001) compared with traditional care. The APTCare intervention also improved preventive care by 16.5% (P < .001). We did not observe significant differences in other secondary outcome measures (intermediate clinical outcomes, quality of life [Short-Form 36 and health-related quality of life scales], functional status [instrumental activities of daily living scale] and service usage).

Conclusion: Additional resources in the form of collaborative multidisciplinary care teams with intensive interventions in primary care can improve QOC for CDM in a population of older at-risk patients. The appropriateness of this intervention will depend on its cost-effectiveness. TRIAL REGISTRATION NUMBER NCT00238836 (CONSORT).

OBJECTIF: Déterminer si la qualité des soins (QDS) est meilleure quand les infirmières cliniciennes et les pharmaciens travaillent avec les médecins de famille et concentrent leurs efforts sur les patients de 50 ans et plus susceptibles de présenter des issues de santé défavorables.

TYPE D’ÉTUDE: Essai clinique randomisé.

CONTEXTE: Un réseau de santé familiale comprenant 8 médecins de famille, 5 infirmières et 11 membres du personnel administratif desservant 10 000 patients d’une région rurale voisine d’Ottawa, Ontario.

PARTICIPANTS: Patients de 50 ans et plus présentant des issues de santé défavorables (N = 241).

INTERVENTIONS: Les patients à risque élevé ont été choisis de façon aléatoire pour recevoir les soins habituels de leur médecin de famille ou ceux d’une Anticipatory and Preventive multidisciplinary Team Care (APTCare) prodigués en collaboration par une équipe comprenant leur médecin, une à trois infirmières cliniciennes et un pharmacien.

PRINCIPAUX PARAMÈTRES ÉTUDIÉS: Qualité des soins dans la gestion des maladies chroniques (GMC): diabète, maladie coronarienne et maladie pulmonaire obstructive chronique.

RÉSULTATS: Compte tenu des caractéristiques démographiques initiales, l’approche de l’APTCare a amélioré la QDS dans la GMC de 9,2 % (P < .001) par rapport aux soins traditionnels. Elle a aussi amélioré les soins préventifs de 16,5 % (P < .001). Nous n’avons pas observé de différence significative pour les autres issues secondaires étudiées (issues cliniques intermédiaires, qualité de vie [questionnaire généraliste sf-36 et échelles d’évaluation de la qualité de vie reliées à la santé], état fonctionnel [échelle des activités instrumentales de la vie quotidienne] et utilisation des services).

CONCLUSION: L ’addition de ressources sous forme d’équipes multidisciplinaires collaborant et intervenant de façon intensive au niveau des soins primaires peut améliorer la QDS dans la GMC chez une population de patients âgés à risque. L’opportunité d’une telle intervention dépendra de son rapport coût-bénéfice.

NUMÉRO D’ENREGISTREMENT DE L’ÉTUDE NCT00238836 (CONSORT)

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References

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