Effect of preventive primary care outreach on health related quality of life among older adults at risk of functional decline: randomised controlled trial
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1480 (Published 16 April 2010) Cite this as: BMJ 2010;340:c1480
- Jenny Ploeg, associate professor1,
- Kevin Brazil, professor2, director3,
- Brian Hutchison, professor emeritus4,
- Janusz Kaczorowski, associate professor5,
- Dawn M Dalby, assistant professor6,
- Charles H Goldsmith, professor emeritus78,
- William Furlong, research associate9
- 1School of Nursing, Faculty of Health Sciences, McMaster University, 1200 Main St W, Room HSc-3N28G Hamilton, ON, Canada L8N 3Z5
- 2Department of Clinical Epidemiology and Biostatistics, Division of Palliative Care, Department of Family Medicine, Faculty of Health Sciences, McMaster University
- 3St Joseph’s Health System Research Network, Hamilton, ON, Canada L8N 1G6
- 4Departments of Family Medicine and Clinical Epidemiology and Biostatistics and Centre for Health Economics and Policy Analysis, Faculty of Health Sciences, McMaster University
- 5Department of Family Practice, University of British Columbia, Child and Family Research Institute, Vancouver, BC, Canada V6T 1Z3
- 6Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, ON, Canada N2L 3C5
- 7Department of Clinical Epidemiology and Biostatistics, McMaster University
- 8Biostatistics Unit, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada L8N 4A6
- 9Health Utilities Group, Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University
- Correspondence to: J Ploeg ploegj{at}mcmaster.ca
- Accepted 22 December 2009
Abstract
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 $C16 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.
Trial registration Clinical trials NCT00134836.
Footnotes
We are indebted to the research team, family physicians, and patients who participated in this study. We also thank Gary Foster, who assisted with the data management and statistical analysis.
Contributors: All authors were involved in the study concept and design and in obtaining funding. JP, KB, and CHG were involved in acquisition of data. JP, KB, CHG, and WF analysed and interpreted the data. All authors drafted the manuscript and critically revised it for important intellectual content. JP and KB supervised the study and are the guarantors.
Funding: This study was supported by a grant from the Ontario Ministry of Health and Long Term Care, Primary Health Care Transition Fund. The views expressed in this paper are the views of the authors and do not necessarily reflect those of the Ontario Ministry of Health and Long Term Care. JP was supported by a Canadian Institutes of Health Research/St Joseph’s Healthcare Hamilton investigator award while conducting this study. The funding agency played no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript. The researchers were independent from the funders.
Competing interests: CHG was paid as a consultant to help in developing the Health Utilities Index Mark 3 quality of life measure. WF has a stock interest in Health Utilities, which distributes copyright Health Utilities Index instrumentation and provides methodological advice on the use of Health Utilities Index.
Ethics approval: The study was approved by the Hamilton Health Sciences/McMaster Faculty of Health Sciences Research Ethics Board. Participants gave written informed consent before taking part in the study.
Data sharing: No additional data available.
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