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Randomized Controlled Trial
. 2013 Sep 10:347:f5264.
doi: 10.1136/bmj.f5264.

Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial

Silke F Metzelthin  1 , Erik van Rossum, Luc P de Witte, Antonius W Ambergen, Sjoerd O Hobma, Walther Sipers, Gertrudis I J M Kempen
Affiliations
Randomized Controlled Trial

Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial

Silke F Metzelthin et al. BMJ. .

Abstract

Objective: To evaluate whether an interdisciplinary primary care approach for community dwelling frail older people is more effective than usual care in reducing disability and preventing (further) functional decline.

Design: Cluster randomised controlled trial.

Setting: 12 general practices in the south of the Netherlands

Participants: 346 frail older people (score ≥ 5 on Groningen Frailty Indicator) were included; 270 (78%) completed the study.

Interventions: General practices were randomised to the intervention or control group. Practices in the control group delivered care as usual. Practices in the intervention group implemented the "Prevention of Care" (PoC) approach, in which frail older people received a multidimensional assessment and interdisciplinary care based on a tailor made treatment plan and regular evaluation and follow-up.

Main outcome measures: The primary outcome was disability, assessed at 24 months by means of the Groningen Activity Restriction Scale. Secondary outcomes were depressive symptomatology, social support interactions, fear of falling, and social participation. Outcomes were measured at baseline and at 6, 12, and 24 months' follow-up.

Results: 193 older people in the intervention group (six practices) received the PoC approach; 153 older people in the control group (six practices) received care as usual. Follow-up rates for patients were 91% (n=316) at six months, 86% (n=298) at 12 months, and 78% (n=270) at 24 months. Mixed model multilevel analyses showed no significant differences between the two groups with regard to disability (primary outcome) and secondary outcomes. Pre-planned subgroup analyses confirmed these results.

Conclusions: This study found no evidence for the effectiveness of the PoC approach. The study contributes to the emerging body of evidence that community based care in frail older people is a challenging task. More research in this field is needed.

Trial registration: Current Controlled Trials ISRCTN31954692.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: this research is funded by the Dutch National Care for the Elderly Programme by The Netherlands Organisation for Health Research and Development; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Six steps of Prevention of Care approach
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Fig 2 Flow of participants through trial. PoC=Prevention of Care
See this image and copyright information in PMC

References

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    1. Ploeg J, Brazil K, Hutchison B, Kaczorowski J, Dalby DM, Goldsmith CH, et al. Effect of preventive primary care outreach on health related quality of life among older adults at risk of functional decline: randomised controlled trial. BMJ 2010;340:c1480. - PMC - PubMed
    1. Keating N, Otfinowski P, Wenger C, Fast J, Derksen L. Understanding the caring capacity of informal networks of frail seniors: a case for care networks. Ageing Soc 2003;23:115-27.

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