Clinical trial NCT04121182: Prevention of pneumonIA in Nursing hOme
Official title: Prevention of pneumonIA in Nursing hOme
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Pneumonia
Keywords: Nursing home
Prevention
Lead sponsor: University Hospital, Toulouse
Sponsor class: OTHER
Collaborators: name: Ministry of Health, France
First posted: 2019-10-09
Enrollment: 3818
Sex: ALL
Minimum age (years): 60
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Seven thousand residents will be recruited by 280 nursing home in 2 major regions in France and followed for 1 year. At the end of the randomization, half of the institutions will benefit from an "on-line" training on the prevention and management of pulmonary disease in residents. Other institutions will continue their usual practice (routine care) and will not benefit from training during the study period.
Primary purpose: PREVENTION

Brief summary: Infections in nursing home are associated with high morbidity and mortality. Pulmonary infections are known to be the most problematic. In our INCUR observational study of 773 residents, 20.13% of residents had pneumonia during the year of follow-up. On average, the extra cost of pneumopathies was 4,467 euros / patient for the long-term care facility and 3,044 euros for the hospital.

Detailed description: The pneumopathies in nursing home are the main cause of hospitalization of residents. Depending on the series, 9 to 50% of residents with pneumonia should be transferred. This reflects the difficulties faced by nursing home care teams in these situations. The respiratory symptomatology of nursing home residents is difficult to grasp and the prescribed antibiotic therapy is often considered inappropriate (25% to 75% of cases). Prevention of resident pneumonia, such as vaccination against pneumococcus remains poorly practiced, influenza vaccination teams or vitamin D supplementation.

In addition to the risk of mortality, lung diseases are often the cause of a rapid functional decline. Preventing pneumonia in nursing homes is therefore an important issue in the prevention of dependence, the quality of life, the health care system (use of hospitalization and transfer to emergencies) and health expenditure. In this vulnerable population, a prevention intervention seems particularly relevant.

In this research project, the investigators hypothesize that a multi-domain prevention intervention for pneumonia carried out by nursing teams in nursing homes can reduce the incidence of pneumonia. They also believe that this action would reduce emergency transfers and health expenditures.

Eligibility criteria: Inclusion Criteria:

* Living in a nursing home for at least 30 days at the start of inclusions,
* Having received information concerning the study and having not expressed opposition to participate,
* For which an agreement in principle of the attending physician has been obtained.

Exclusion Criteria:

* Refusal of the resident (or of his legal representative) or of his treating physician after given information,
* Resident at the end of life (life expectancy evaluated within one month by the coordinating physician),
* Resident whose attending physician is already involved in the PIANO study under a resident of another nursing home.

Primary outcomes:
measure: The comparison of the incidence of lung disease number between the two groups
timeFrame: 1 year
measure: Number of Medical evidence of rattles or crepitates
timeFrame: 1 year
Secondary outcomes:
measure: Establish a differential cost-effectiveness ratio at 1 year of the care of the residents in nursing home
timeFrame: 1 year
measure: Evaluation of the time spent by the health care team to support the patient between two groups
timeFrame: 1 year
measure: Evaluating the incidence of all-cause hospitalizations
timeFrame: 1 year
measure: Evaluate the evolution of quality of care indicators in the nursing home
timeFrame: 1 year
measure: Functional decline of residents
timeFrame: 1year
Other outcomes:
Locations:
city: Toulouse
country: France
facility: University Hospital Toulouse
Study officials:
affiliation: University Hospital, Toulouse
name: Yves Rolland, MD
role: PRINCIPAL_INVESTIGATOR
References: