Compared Efficacy of Nurse-led and GP-led Geriatric Assessment in PrImary Care

Study Overview
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Brief Summary
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Older patients account for around 10% of the population, of which 57% have a long-term illness, and 33% were admitted in the past year. Geriatric assessment (GA) is a multidimensional assessment of general health status that can help identifying deficiencies and followed by a personalized care plan. Assessment and management of elderly patients is a daily concern for the general practitioner (GP) but conflicting results have been reported so far relating to the clinical impact of GA when applied in the primary care setting. This study protocol aims to assess the effect on morbi-mortality of a complex intervention in patients aged ≥70 years with chronic conditions in primary care. It aims to demonstrate that a GA adapted to primary care, followed by a personalized care plan and combined with successful interprofessional collaboration can improve clinically relevant outcomes in elderly patients with chronic conditions such as one-year overall mortality, unplanned hospital admission, emergency visits, or institutionalization. The CEPIA study will also help addressing the issue of whether an improved benefit could be achieved from a systematic nurse-led or a case-by-case GP-led GA.

Official Title
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Compared Efficacy of Nurse-led and GP-led Geriatric Assessment in PrImary Care: A Pragmatic Three-arm Cluster Randomized Controlled Trial

Conditions
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Multimorbidity, Geriatric Assessment

Intervention / Treatment
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* Other: health care organization


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients aged≥70 years with a long-term illness scheme or hospital admission the past 3 months Visiting their preferred general practioner (GP) or another GP in the same practice patient oral non opposition Exclusion Criteria: Patient who does not speak French Severe disease with a life expectancy <12 months Institutionalized patients Patient insured under the French national health insurance system

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Systematic nurse-led GA<br>Interactive educational seminar for GPs and nurses, and focused on geriatric assessment in primary care combined with Systematic nurse-led GA and dedicated hotline for GPs seeking geriatric advice | Other: health care organization<br>* Nurse-led or GP-led Geriatric assessment combined with an educational seminar focused on GA and personalized care-plan as well as a dedicated hotline for general practitioners seeking a geriatric advice Interactive educational seminar Primary care<br>* Other names: Nurse-led or GP-led Geriatric assessment combined with an educational seminar;|
| Experimental: GP-led GA on a case-by-case basis, as decided by the GP<br>Interactive educational seminar for GPs, and focused on Geriatric assessment in primary care combined with a GP-led GA on a case-by-case basis, as decided by the GP, and a dedicated hotline for GPs seeking geriatric advice | Other: health care organization<br>* Nurse-led or GP-led Geriatric assessment combined with an educational seminar focused on GA and personalized care-plan as well as a dedicated hotline for general practitioners seeking a geriatric advice Interactive educational seminar Primary care<br>* Other names: Nurse-led or GP-led Geriatric assessment combined with an educational seminar;|
| No Intervention: No intervention<br>No educational seminar Usual care | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Primary composite endpoint combined with: - Percentage of all-cause mortality - Percentage of Unplanned hospital admission - Percentage of Emergency visits. - Percentage of Institutionalization |  | At 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of all-cause mortality |  | At 12 months | 
| Percentage of Unplanned hospital admission |  | At 12 months | 
| Percentage of Emergency visits |  | At 12 months | 
| Percentage of Institutionalization |  | At 12 months | 
| Quality of life (Duke profile score) |  | At Day 0 and 12 months | 
| Autonomy by KATZ ALD score |  | At Day 0 and 12 months | 
| Number of medication prescription (polypharmacy) |  | Up to 12 months | 
| Percentage of Geriatric assessment performed |  | Up to 12 months | 
| Percentage of personalized care plan performed |  | Up to 12 months | 
| Percentage of geriatric phone advices requested by GPs |  | Up to 12 months | 
| Percentage of health care actions planned |  | Up to 12 months | 
| Percentage of satisfied general practitioner with the intervention | self-assessment | 27months after the beginning of the study | 
| Satisfaction of general practitioners and nurses after completion of intervention | interview of general practionners and nurses by independant investigator | 12 months after the beginning of the study | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Elderly, Health care organization, Primary care