Combining volunteers and primary care teamwork to support health goals and needs of older adults: a pragmatic randomized controlled trial
Lisa Dolovich, Doug Oliver, Larkin Lamarche, Lehana Thabane, Ruta Valaitis, Gina Agarwal, Tracey Carr, Gary Foster, Lauren Griffith, Dena Javadi, Monika Kastner, Dee Mangin, Alexandra Papaioannou, Jenny Ploeg, Parminder Raina, Julie Richardson, Cathy Risdon, Pasqualina Santaguida, Sharon Straus, David Price, Lisa Dolovich, Doug Oliver, Larkin Lamarche, Lehana Thabane, Ruta Valaitis, Gina Agarwal, Tracey Carr, Gary Foster, Lauren Griffith, Dena Javadi, Monika Kastner, Dee Mangin, Alexandra Papaioannou, Jenny Ploeg, Parminder Raina, Julie Richardson, Cathy Risdon, Pasqualina Santaguida, Sharon Straus, David Price
Abstract
Background: The Health TAPESTRY (Health Teams Advancing Patient Experience: STRengthening QualitY) intervention was designed to improve primary care teamwork and promote optimal aging. We evaluated the effectiveness of Health TAPESTRY in attaining goals of older adults (e.g., physical activity, productivity, social connection, medical status) and other outcomes.
Methods: We conducted a pragmatic randomized controlled trial between January and October 2015 in a primary care practice in Hamilton, Ontario. Older adults were randomized (1:1) to Health TAPESTRY (n = 158) or control (n = 154). Trained community volunteers gathered information on people's goals, needs and risks in their homes, using electronic forms. Interprofessional primary care teams reviewed summaries and addressed issues. Participants reported goal attainment (primary outcome), self-efficacy, quality of life, optimal aging, social support, empowerment, physical activity, falls, and access to and comprehensiveness of the health system. We determined use of health care resources through chart audit.
Results: There were no differences between groups in goal attainment or many other patient-reported outcome and experience assessments at 6 months. More primary care visits took place in the intervention versus control group over 6 months (mean ± standard deviation [SD] 4.93 ± 3.86 v. 3.50 ± 3.53; difference of 1.52 [95% confidence interval (CI) 0.84 to 2.19]). The odds of having 1 or more hospital admission were lower for the intervention group (odds ratio [OR] 0.44 [95% CI 0.20 to 0.95]).
Interpretation: Health TAPESTRY did not improve the primary outcome of goal attainment but showed signals of shifting care from reactive to active preventive care. Further evaluation will help in understanding effective components, costs and consequences of the intervention. Trial registration: ClinicalTrials.gov, no. NCT02283723.
Conflict of interest statement
Competing interests: Tracey Carr, Lisa Dolovich, Dee Mangin, David Price and Cathy Risdon report receiving grants from Health Canada and the Government of Ontario during the conduct of this study.
© 2019 Joule Inc. or its licensors.
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Source: PubMed