Effect of preventive primary care outreach on health related quality of life among older adults at risk of functional decline: randomised controlled trial
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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 ( pound107; euro118; $162), 95% confidence interval -$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.
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