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Age Ageing. 2016 Jan;45(1):30-41. doi: 10.1093/ageing/afv174.

Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People--the ISCOPE study.

Author information

1
Public Health and Primary Care, Leiden University Medical Center, Leiden2300 RC, The Netherlands.
2
Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands.
3
Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

BACKGROUND:

older people often experience complex problems. Because of multiple problems, care for older people in general practice needs to shift from a 'problem-based, disease-oriented' care aiming at improvement of outcomes per disease to a 'goal-oriented care', aiming at improvement of functioning and personal quality of life, integrating all healthcare providers. Feasibility and cost-effectiveness of this proactive and integrated way of working are not yet established.

DESIGN:

cluster randomised trial.

PARTICIPANTS:

all persons aged ≥75 in 59 general practices (30 intervention, 29 control), with a combination of problems, as identified with a structured postal questionnaire with 21 questions on four health domains.

INTERVENTION:

for participants with problems on ≥3 domains, general practitioners (GPs) made an integrated care plan using a functional geriatric approach. Control practices: care as usual.

OUTCOME MEASURES:

(i) quality of life (QoL), (ii) activities of daily living, (iii) satisfaction with delivered health care and (iv) cost-effectiveness of the intervention at 1-year follow-up.

TRIAL REGISTRATION:

Netherlands trial register, NTR1946.

RESULTS:

of the 11,476 registered eligible older persons, 7,285 (63%) participated in the screening. One thousand nine hundred and twenty-one (26%) had problems on ≥3 health domains. For 225 randomly chosen persons, a care plan was made. No beneficial effects were found on QoL, patients' functioning or healthcare use/costs. GPs experienced better overview of the care and stability, e.g. less unexpected demands, in the care.

CONCLUSIONS:

GPs prefer proactive integrated care. 'Horizontal' care using care plans for older people with complex problems can be a valuable tool in general practice. However, no direct beneficial effect was found for older persons.

KEYWORDS:

aged; integrated care; older people; primary care; proactive care

PMID:
26764392
PMCID:
PMC4711660
DOI:
10.1093/ageing/afv174
[Indexed for MEDLINE]
Free PMC Article

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