Integrated Care With GP Participation for Older Persons in the Ambulatory Care Hub: a Prospective Cohort Study.

November 7, 2023 updated by: University of Limerick

Integrated Care With GP Participation for Older Persons in the Ambulatory Care Hub: a Prospective Cohort Study of Clinical and Process Outcomes.

Comprehensive Geriatric Assessment (CGA) demonstrates positive outcomes amoung community-dwelling older people living with frailty. However, there is currently no evidence of benefit for CGA with General Practitioner (GP) participation within the Irish Primary Care setting. This study aims to explore the clinical and process outcomes of older adults living with frailty who are screened by and referred to one of the three Ambulatory Care Hub's in the primary care setting in the Mid-West of Ireland by their GP, where they undergo a CGA .

Study Overview

Status

Recruiting

Conditions

Detailed Description

The growth of ageing population poses significant difficulties in the delivery of healthcare to older adults. As people age, they experience a decline in their intrinsic capacities which leads to an increasing prevalence of multi-morbidity which ultimately leads to older adults at increased risk of requiring emergency care and increased multidisciplinary health needs.

With functional decline and deterioration in an older persons' ability to self-care being a common consequence of hospitalisation, older people are placed at higher risk of requiring increased care needs after discharge from acute care and transfer between care settings proves a challenge for the provision of seamless quality care.

The World Health Organisation recommends health and social care professionals intervening at an early stage of this ageing process in order to prevent or delay the process of becoming frail through delivering effective interventions that are targeted at functional decline. Internationally, there is recognition for health and social care systems to reorient towards longitudinal, preventive, coordinated and integrated care models, reflecting the growth in multi-morbidity and the needs of older people's complex health and social care requirements. The World Health Organisation acknowledges this shift in healthcare delivery and launched the 'WHO Guidelines on Integrated Care for Older People' programme where it highlighted the need to develop and implement comprehensive community-based approaches at the primary healthcare level in the context of a needs assessment and integrated care plan.

CGA is an interdisciplinary diagnostic process which includes an assessment and holistic management plan that is based on the individual needs of the older person. As many older adults' first point of contact with the health service is through primary care, General Practitioners (GPs) play a crucial role in the coordination of the older person's care.

Frailty screening by the GP and comprehensive geriatric assessment within the primary care setting has demonstrated significant positive health outcomes in community-dwelling older people, demonstrating reduced rates of hospitalisation, reduced hospital re-admissions, reduced GP visits and an increase in social activities.

A primary care based multidisciplinary team aim to improve the delivery of care and clinical and process outcomes for community-dwelling older people through the delivery of CGA in the Ambulatory Care Hub (ACH). An ACH is a clinical site within the primary care setting, with access to diagnostics, specialised services and specialist care in order to support older people to live in their own homes for as long as possible.

This study aims to explore the clinical and process outcomes of older adults living with frailty who are screened by and referred to one of the three Ambulatory Care Hub's in the Mid-West of Ireland by their GP.

Study Type

Observational

Enrollment (Estimated)

300

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Ireland
    • Munster
      • Limerick, Munster, Ireland, V94 T9PX
        • Recruiting
        • School of Allied Health, University of Limerick.
        • Contact:
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

75 years and older (Older Adult)

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

All older adults aged ≥75 years who are referred to the ACH by their GP between February 2022 and January 2023 (inclusive) will be considered eligible for participation in the study, if they meet the inclusion criteria.

Description

Inclusion Criteria:

  • Referred to the ACH by their GP
  • Score between 4 and 6 on the Rockwood Clinical Frailty Scale
  • Reside within CHO 3 and the catchment area of the relevant ACH hub
  • Have been assessed in-person by the referrer
  • Has not had MDT input within the last three months

And any one of the following criteria:

  • Fall within the last month unrelated to acute cardiac or neurological cause & no previous falls assessment
  • Increased dependency or increased carer burden in the last month
  • A deterioration in swallow in the last month including symptoms of recurrent chest infections
  • Weight loss
  • Coughing when eating/drinking
  • Self-modifying diet secondary to difficulties or experienced an adverse drug reaction within the last month excluding allergic reaction.

Exclusion Criteria:

Patients will be excluded if they:

  • Present with an acute neurological or cardiovascular event
  • Are more appropriate to an alternative care pathway or service e.g. primary care or geriatric medicine clinic
  • Present with injuries, unless the injury has already been appropriately managed,
  • Are experiencing an acute medical illness requiring treatment in an acute hospital setting
  • If care is being provided by other health care professionals at the time of referral and it is apparent that they are working to meet goals aligned with the current service
  • They require investigation or treatment not available in the relevant ICPOP hub (unless these investigations are already being arranged elsewhere)
  • They have had MDT input in the last three months
  • Have confirmed or suspected Covid-19 infection
  • Or other exclusions at the discretion of the integrated care team based on clinical expertise and available resource.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Incidence of functional decline
Time Frame: 30-days
The number of participants who experience functional decline or do not as measured by the Barthel Index (BI). Functional decline is defined as a net decrease in the number of activities of daily living performed independently as measured by the self-reported BI. The sum of all of the 10 subscales of the BI ranges from 0-20 points where a higher score indicates increased independence.
30-days
Incidence of functional decline
Time Frame: 6-months
The number of participants who experience functional decline or do not as measured by the Barthel Index (BI). Functional decline is defined as a net decrease in the number of activities of daily living performed independently as measured by the self-reported BI. The sum of all of the 10 subscales of the BI ranges from 0-20 points where a higher score indicates increased independence.
6-months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Primary healthcare use (within and outside of ACH healthcare utilisation)
Time Frame: 30-days
Number of services that participants were in receipt of following index visit at the ACH including; GP visits, Public Health Nurse visits, Health and Social Care Professional use, formal homecare support. This will be categorised by healthcare use linked to the ACH and outside of the ACH.
30-days
Primary healthcare use (within and outside of ACH healthcare utilisation)
Time Frame: 6-months
Number of services that participants were in receipt of following index visit at the ACH including; GP visits, Public Health Nurse visits, Health and Social Care Professional use, formal homecare support. This will be categorised by healthcare use linked to the ACH and outside of the ACH.
6-months
Secondary healthcare use
Time Frame: 30-days
Number of secondary healthcare services that participants were in receipt of including; Outpatient services, ED presentation and unplanned hospital admission.
30-days
Secondary healthcare use
Time Frame: 6-months
Number of secondary healthcare services that participants were in receipt of including; Outpatient services, ED presentation and unplanned hospital admission.
6-months
Quality of integrated care from the perspective of participants
Time Frame: 30-days
Participants evaluate the quality of integrated care across a number of domains using the Patient Assessment of Integrated Elderly Care Questionnaire. The sum of all subscales may range from 0-100, where a higher score reflects better perceived quality of care.
30-days
Health related quality of life (HRQOL)
Time Frame: 30-days
Participants will rate their HRQOL using the EuroQoL-5D-5L where the sum of 5 subscales may range from 5-25 where 5 points indicates the lowest possible HRQOL and 25 indicates the highest. The participant must also rate their health on a vertical visual analogue scale, where the endpoints are labelled 'The best health you can imagine' and 'The worst health you can imagine' on a scale of 0-100.
30-days
Health related quality of life (HRQOL)
Time Frame: 6-months
Participants will rate their HRQOL using the EuroQoL-5D-5L where the sum of 5 subscales may range from 5-25 where 5 points indicates the lowest possible HRQOL and 25 indicates the highest. The participant must also rate their health on a vertical visual analogue scale, where the endpoints are labelled 'The best health you can imagine' and 'The worst health you can imagine' on a scale of 0-100.
6-months
Mortality
Time Frame: 30-days
The number of participants who died following their index visit at the ACH
30-days
Mortality
Time Frame: 6-months
The number of participants who died following their index visit at the ACH
6-months
Nursing home admission
Time Frame: 30-days
Number of participants who were admitted to a nursing home or residential care facility following their index visit to the ACH
30-days
Nursing home admission
Time Frame: 6-months
Number of participants who were admitted to a nursing home or residential care facility following their index visit to the ACH
6-months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Limerick

Investigators

  • Study Director: Rose Galvin, University of Limerick

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

February 2, 2022

Primary Completion (Estimated)

December 30, 2023

Study Completion (Estimated)

February 28, 2024

Study Registration Dates

First Submitted

August 11, 2022

First Submitted That Met QC Criteria

September 1, 2022

First Posted (Actual)

September 2, 2022

Study Record Updates

Last Update Posted (Actual)

November 8, 2023

Last Update Submitted That Met QC Criteria

November 7, 2023

Last Verified

November 1, 2023

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 116/2021

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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