Proactive primary care model for frail older people in New Zealand delays aged-residential care: A quasi-experiment

Thomas E Robinson; Michal L Boyd; Diana North; Jean Wignall; Martin Dawe; Jean McQueen; Rosemary A Frey; Deborah L Raphael; Ngaire Kerse

doi:10.1111/jgs.17064

Proactive primary care model for frail older people in New Zealand delays aged-residential care: A quasi-experiment

J Am Geriatr Soc. 2021 Jun;69(6):1617-1626. doi: 10.1111/jgs.17064. Epub 2021 Feb 24.

Authors

Thomas E Robinson^{1

2}, Michal L Boyd^{1

3}, Diana North¹, Jean Wignall¹, Martin Dawe¹, Jean McQueen¹, Rosemary A Frey³, Deborah L Raphael³, Ngaire Kerse^{2

4}

Affiliations

¹ Waitematā District Health Board, Auckland District Health Board, Auckland, New Zealand.
² School of Population Health, University of Auckland, Auckland, New Zealand.
³ School of Nursing, University of Auckland, Auckland, New Zealand.
⁴ General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.

PMID: 33629356
DOI: 10.1111/jgs.17064

Abstract

Background/objectives: To determine the effect of a proactive primary care program on acute hospitalization and aged-residential care placement for frail older people.

Design: Controlled before and after, and controlled after only quasi-experimental studies, with a comparison group created via propensity score matching. One-year follow-up.

Setting: Nine general practices in Auckland, New Zealand.

Participants: Community-dwelling people aged 75 and older identified as at increased risk of hospitalization. One thousand and eighty five patients are compared with 3750 comparison patients matched by propensity score based on known risks.

Intervention: Primary healthcare based, registered nurse-led, comprehensive geriatric assessment, goal-setting, care planning, and regular follow-up. Patients were also provided self-management education, health and social care navigation, and transitional care for hospital discharges. Practices received program support, workforce development, and mentoring of primary healthcare nurses by gerontology nurse specialists.

Measurements: Outcomes from routinely collected administrative data. Primary: aged-residential care placement.

Secondary outcomes: acute hospitalization, mortality, and other health service utilization.

Results: Aged-residential care placement (odds ratio [OR] 0.66, 95% confidence interval (CI) = 0.48-0.91) and mortality (OR 0.66, 95% CI = 0.49-0.88) were significantly lower over the first year in Kare patients compared with matched controls. There was no difference in acute hospitalization (+0.06 admissions per year, 95% CI = -0.01-0.13). Support service use (allied health therapists and assessment for social support) was increased, and emergency department use decreased.

Conclusion: The Kare participants had lower aged-residential care placement and mortality in the first year, but no decrease in acute hospitalization. Because the design is nonexperimental caution is required in interpreting these results.

Keywords: aged; comprehensive health care; geriatric assessment; patient care planning; primary health care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Female
Frail Elderly / statistics & numerical data*
Geriatric Assessment*
Hospitalization / statistics & numerical data
Humans
Independent Living*
Male
Mortality
New Zealand
Primary Care Nursing*
Primary Health Care / organization & administration*
Residential Facilities / statistics & numerical data