Clinical trial NCT03180606: Enhanced Primary Care for Elderly
Official title: Enhanced Primary Care for Elderly: A Multicenter Pragmatic Clinical Trial Where Older People With Great Needs Are Predicted and Given Personalized Primary Care
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Frail Elderly Syndrome
Keywords: Elderly
Frail
Primary care
Lead sponsor: Region Östergötland
Sponsor class: OTHER
First posted: 2017-06-08
Enrollment: 1304
Sex: ALL
Minimum age (years): 75
Maximum age (years): 110
Standard ages: OLDER_ADULT
Observational model: CASE_CONTROL
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: People 75 years and older in the county of Östergötland with a high risk of being fragile and in need of hospital care. This risk group of 1600 out of 24000 is detected by a digital/statistical method depending on previous health care consumption and specific diagnoses

Brief summary: The present health care situation for the elderly in many countries is insufficient and not designed according to the health care needs of the aged population. In a pragmatic multicenter primary care setting (n= 1600), the investigators use an evidence based prediction model to find elderly (75+) with high risk for complex medical care or hospitalization and apply a differentiated and directed medical and social care to this risk group, in comparison to usual care. The intervention will include all the latest evidence based tools in the care of elderly (multi-professional team, social support, medical care home-visits, telephone support, general practitioner visits, etc). The project has high potential impact on the development of future care of elderly.

In addition to the intervention study, several academic sub-studies focusing on patient's perspective, professional roles, equality, implementation and governance management of health care will be performed.

Detailed description: The current project is a multidisciplinary research project covering several aspects of a shift in elderly care, with outcome measures not only related to primary medical or functional measures. The analyses will widen the view to overall societal costs and effects of changes in key institutions of social security as well as to hidden mechanisms in the governance system of care and health care of elderly.

The primary aim of the present study is to investigate the extent to which a differentiated (personalized) and targeted primary care intervention provided to a statistically predicted risk population of elderly, results in care that is more effective and of higher quality than that of a control group receiving standard care. In a pragmatic multicenter primary care setting (n= 1600), an evidence based prediction model to find elderly (75+) with high risk for complex medical care or hospitalization is used followed by a differentiated and directed medical and social care to this risk group, in comparison to usual care. The intervention will include all the latest evidence based tools in the care of elderly (multi-professional team, social support, medical care home-visits, telephone support, general practitioner visits, etc).

The investigators also aim to study the care model in a broader sense; experiences of the elderly, their social networks and diversity. Finally, the project will also investigate how the health care system, from specific health care professionals (primary care nurses, doctors, para-medical staff) to management levels and politicians influence the implementation of the present and future care models. One specific subproject focuses on the mechanisms behind the inability of steak holders/politicians and top administrative executives to find efficient governance principals for elderly care and health care, despite already available knowledge sources.

Eligibility criteria: Inclusion Criteria:

* Age 75 years and older living in county of Östergötland

Exclusion Criteria:

* No exclusion criteria

Primary outcomes:
measure: Hospital care days
timeFrame: January 1st 2018 - December 31st 2019
Secondary outcomes:
measure: Hospital care occasions
timeFrame: January 1st 2018 - December 31st 2019
measure: Health related quality of life
timeFrame: January 1st 2018 - December 31st 2019
measure: Costs for health care
timeFrame: January 1st 2018 - December 31st 2019
measure: Mortality
timeFrame: January 1st 2018 - December 31st 2019
Other outcomes:
Locations:
city: Linköping
country: Sweden
facility: Region Östergötland/Linköping University
state: Östergötland
city: Linköping
country: Sweden
facility: Primary Care of Östergötland
state: Östergötland
Study officials:
affiliation: Linkoeping University
name: Jan Marcusson, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Marcusson J, Nord M, Johansson MM, Alwin J, Levin LA, Dannapfel P, Thomas K, Poksinska B, Sverker A, Olaison A, Cedersund E, Kelfve S, Motel-Klingebiel A, Hellstrom I, Kullberg A, Bottiger Y, Dong HJ, Peolsson A, Wass M, Lyth J, Andersson A. Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden. BMJ Open. 2019 May 22;9(5):e027847. doi: 10.1136/bmjopen-2018-027847.
citation: Kammerlind AS, Peolsson A, Johansson MM. Dizziness in older persons at high risk of future hospitalization: prevalence, differences between those with and without dizziness, and effect of a proactive primary care intervention. BMC Geriatr. 2022 Apr 10;22(1):315. doi: 10.1186/s12877-022-02910-1.
citation: Nord M, Lyth J, Alwin J, Marcusson J. Costs and effects of comprehensive geriatric assessment in primary care for older adults with high risk for hospitalisation. BMC Geriatr. 2021 Apr 21;21(1):263. doi: 10.1186/s12877-021-02166-1.