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. 2018 Jan 22;18(1):22.
doi: 10.1186/s12877-018-0717-3.

The effect of a gerontology nurse specialist for high needs older people in the community on healthcare utilisation: a controlled before-after study

A I I King  1   2 , M L Boyd  3 , D L Raphael  3 , A Jull  3
Affiliations

The effect of a gerontology nurse specialist for high needs older people in the community on healthcare utilisation: a controlled before-after study

A I I King et al. BMC Geriatr. .

Abstract

Background: Nurse-led models of comprehensive geriatric assessment and care coordination can improve health management as well as reduce hospitalisations for high risk community dwelling older people. This study investigated the effect on healthcare utilisation of systematic case finding to identify high risk older people in the community with a subsequent comprehensive assessment and care coordination intervention by a Gerontology Nurse Specialist based in primary care.

Methods: This was a controlled before-after study design located within primary healthcare practices in Auckland, New Zealand. An intervention model was initiated within two primary healthcare practices and involved a screening tool to identify high risk older people with succeeding gerontology nurse specialist assessment and care coordination. The comparison group included older people who received usual care at three comparable primary healthcare practices. The primary outcome measure was acute hospital admissions. Secondary outcomes included hospital re-admissions, length of stay, emergency department presentations, residential care admissions, and community contacts.

Results: A total of 579 older people were posted the screening tool in the intervention group, with 517 completed screens (89% response rate) formulating the intervention group. A total of 101 older people were identified as high risk from these screens (20%). The comparison group comprised 883 older people. Comparing the intervention and comparison group, no statistical differences were found for hospital admissions, emergency department presentations, hospital re-admissions, length of stay, or residential care admission. Community physiotherapy showed a statistically significant increase for the intervention compared to the comparison group (p = 0.03). Non-significant findings revealed decreased risk of entering residential care and fewer frequent hospital re-admissions for the intervention group when compared with the comparison group.

Conclusions: This specialist nurse-led intervention involving comprehensive assessment and care coordination care did not appear superior to usual care, however, there is benefit to exploring a more robust randomised controlled trial design.

Trial registration: Retrospectively registered on 18/09/2017 with the Australian New Zealand Clinical Trials Registry (ANZCTR). Registration number ACTRN12617001332314.

Keywords: Care coordination; Case finding; Comprehensive geriatric assessment; Gerontology nurse specialist; Older people; Primary care.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval was granted by the Northern X Regional New Zealand Health and Disability Ethics Committee (reference number: NTX/12/EXP/123). Written consent was gained from all individual older participants who received a CGA from the GNS. For all participants in both groups, the primary healthcare practices provided written consent for hospital utilisation data to be extracted from an electronic records system.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram illustrating participant enrolment and progression throughout the study. This file contains the Fig. 1 flow diagram
See this image and copyright information in PMC

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