Effectiveness of preventive primary care outreach interventions aimed at older people: meta-analysis of randomized controlled trials.

abstract

OBJECTIVE: To determine the effectiveness of preventive primary care outreach interventions aimed at older people. Knowing whether such interventions are effective could help busy family physicians make choices about which preventive care services to provide. DATA SOURCES: We searched MEDLINE, CINAHL, AgeLine, Cochrane Controlled Trials Register, and EMBASE databases and reviewed the reference lists of retrieved articles. STUDY SELECTION: We included studies of preventive primary care interventions aimed at patients 65 years and older if the studies were randomized controlled trials and if any of the following outcomes was reported: mortality, living in the community, admission to acute care hospitals, and admission to long-term care. We defined preventive primary care outreach as proactive, provider-initiated care, which can be provided by nurses, physicians, other professionals, or volunteers, that is in addition to usual care and is provided in primary care settings. Such care can be provided through home visits, office visits, telephone contacts, or a combination of these methods. SYNTHESIS: We assessed the quality of studies and extracted descriptive information on study populations, interventions, and outcomes for 19 trials involving 14,911 patients. Summary odds ratios were estimated for each outcome using a random effects model. CONCLUSION: This review showed that studies of preventive primary care outreach interventions aimed at older people were associated with a 17% reduction of mortality and a 23% increased likelihood of continuing to live in the community.