Objective: To evaluate the impact of a provider initiated primary care outreach intervention compared with usual care among older adults at risk of functional decline.
Design: Randomised controlled trial.
Setting: Patients enrolled with 35 family physicians in five primary care networks in Hamilton, Ontario, Canada.
Participants: Patients were eligible if they were 75 years of age or older and were not receiving home care services. Of 3166 potentially eligible patients, 2662 (84%) completed the validated postal questionnaire used to determine risk of functional decline. Of 1724 patients who met the risk criteria, 769 (45%) agreed to participate and 719 were randomised.
Intervention: The 12 month intervention, provided by experienced home care nurses in 2004-6, consisted of a comprehensive initial assessment using the resident assessment instrument for home care; collaborative care planning with patients, their families, and family physicians; health promotion; and referral to community health and social support services.
Main outcome measures: Quality adjusted life years (QALYs), use and costs of health and social services, functional status, self rated health, and mortality.
Results: The mean difference in QALYs between intervention and control patients during the study period was not statistically significant (0.017, 95% confidence interval ?0.022 to 0.056; P=0.388). The mean difference in overall cost of prescription drugs and services between the intervention and control groups was not statistically significant, (-$C165 (£107; 118; $162), 95% confidence interval -$C16 545 to $$16 214; P=0.984). Changes over 12 months in functional status and self rated health were not significantly different between the intervention and control groups. Ten patients died in each group.
Conclusions: The results of this study do not support adoption of this preventive primary care intervention for this target population of high risk older adults.
Ploeg, Jenny; Brazil, Kevin; Hutchison, Brian; Kaczorowski, Janusz; Guthrie, Dawn M.; Goldsmith, Charles H.; and Furlong, William, "Effect of Preventive Primary Care Outreach on Health Related Quality of Life Among Older Adults at Risk of Functional Decline: Randomised Controlled Trial" (2010). Health Sciences Faculty Publications. 6.