No evidence that integrated care program effective at reducing decline in frail elderly patients

Researchers at the Radboud University Nijmegen Medical Center in the Netherlands found no evidence for the effectiveness of a multifaceted, integrated primary care program they had devised, intended to reduce functional decline in frail elderly patients, according to data published in the Journal of the American Board of Family Medicine.

“In addition to the need for coordinated and integrated care, the need for medication intervention programs aimed at the management of polypharmacy (ie, the [over]use of multiple medications) is widely recognized,” Franca G.H. Ruikes, MD, and colleagues wrote. “In Dutch primary care this has led to a well-supported belief that community-based geriatric care needs to be multifaceted, combining structured multidisciplinary collaboration between professionals from cure, care and welfare domains; proactive care planning; case management; and medication review.”

To that end, the researchers designed the CareWell program, combining those elements with the goal of preventing functional decline, institutionalization and hospitalization among community-dwelling frail elders. To test its effectiveness, the researchers conducted a cluster-controlled trial in 12 general practices in Nijmegen, the Netherlands, recruiting frail elderly people aged 70 years and older.

In six general practices, 287 patients received care according to the CareWell model, including proactive care planning, case management, medication reviews and multidisciplinary team meetings with a general practitioner, nurses, an elderly care physician and a social worker. In the other six practices, 249 patients received the usual care. Primary outcome was independence during daily living, using the Katz-15 index. Secondary outcomes were quality of life, mental health and health-related social functioning.

In all, 204 patients in the CareWell program, and 165 in the control group, completed the 12-month follow-up. According to the researchers, after correcting for clustering, relevant covariates and the Katz-15 score at baseline, there were no differences between the groups regarding independence in functioning and secondary outcomes. No differences in residential and nursing home admissions, hospital admissions and mortality were found.

“We found no beneficial effects of our CareWell primary care program among community-dwelling frail elderly people in Dutch primary care,” Ruikes and colleagues wrote. “Current evidence is insufficient to advocate large-scale implementation of this multicomponent integrated primary care program.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.

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