Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden

Jan Marcusson, Magnus Nord, Maria M Johansson, Jenny Alwin, Lars-Åke Levin, Petra Dannapfel, Kristin Thomas, Bonnie Poksinska, Annette Sverker, Anna Olaison, Elisabet Cedersund, Susanne Kelfve, Andreas Motel-Klingebiel, Ingrid Hellström, Agneta Kullberg, Ylva Böttiger, Huan-Ji Dong, Anneli Peolsson, Malin Wass, Johan Lyth, Agneta Andersson, Jan Marcusson, Magnus Nord, Maria M Johansson, Jenny Alwin, Lars-Åke Levin, Petra Dannapfel, Kristin Thomas, Bonnie Poksinska, Annette Sverker, Anna Olaison, Elisabet Cedersund, Susanne Kelfve, Andreas Motel-Klingebiel, Ingrid Hellström, Agneta Kullberg, Ylva Böttiger, Huan-Ji Dong, Anneli Peolsson, Malin Wass, Johan Lyth, Agneta Andersson

Abstract

Introduction: The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.

Methods and analysis: In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.

Ethics and dissemination: Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019-2022 and are planned to be used for the development of future care models.

Trial registration number: NCT03180606.

Keywords: care frail elderly.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Overview of the project over time.
Figure 2
Figure 2
Overview of the intervention. PASTEL, Primary Care Assessment Tool for the Elderly.

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