Glenn Arendts1, Pamela Deans2, Keith O'Brien3, Christopher Etherton-Beer4, Kirsten Howard5, Gill Lewin6, Moira Sim7. 1. Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia; University of Western Australia, Crawley, Western Australia, Australia. Electronic address: glenn.arendts@uwa.edu.au. 2. University of Western Australia, Crawley, Western Australia, Australia. 3. Collaborative Primary Health Care, Western Australia, Australia. 4. Harry Perkins Institute for Medical Research, Perth, Western Australia, Australia; University of Western Australia, Crawley, Western Australia, Australia. 5. University of Sydney, Camperdown, New South Wales, Australia. 6. Curtin University of Technology, Bentley, Western Australia, Australia. 7. Edith Cowan University, Joondalup, Western Australia, Australia.
Abstract
BACKGROUND: Optimising quality of life and reducing hospitalisation for people living in residential aged care facilities (RACF) are important health policy goals. METHODS: A cluster controlled clinical trial of nurse practitioner care in RACF. Six facilities were included: three randomly allocated to intervention where nurse practitioners working with general practitioners and using a best practice guide were responsible for care, and three control. Participants were followed up for a minimum of 12 months unless dead or transferred to another facility. RESULTS: We enrolled two hundred patients (101 intervention and 99 control) with a mean (SD) follow up of 604 (276) days. There were 98 ED visits by intervention participants, resulting in 56 hospitalisations, compared with 121 ED visits and 70 hospitalisations for controls (risk reduction = 8%, 95% CI = -1% -17%, p = 0.10). For the pre-specified secondary outcomes of transfers within the first 12 months of enrolment, the number of residents making at least one visit (46 in each study arm) and rate of ED attendance (0.66 visits per intervention resident versus 0.70 visits per control resident) was not affected by the intervention. After adjusting for dependency and comorbidity, the intervention group had non-significantly lower transfers (OR 0.7, 95% CI 0.3-1.5, p = 0.34). There was a reduction in the rate of decline in the quality of life of intervention compared to control residents. CONCLUSIONS:Nurse practitioner care coordination resulted in no statistically significant change in rates of ED transfer or health care utilisation, but better maintained resident quality of life.
RCT Entities:
BACKGROUND: Optimising quality of life and reducing hospitalisation for people living in residential aged care facilities (RACF) are important health policy goals. METHODS: A cluster controlled clinical trial of nurse practitioner care in RACF. Six facilities were included: three randomly allocated to intervention where nurse practitioners working with general practitioners and using a best practice guide were responsible for care, and three control. Participants were followed up for a minimum of 12 months unless dead or transferred to another facility. RESULTS: We enrolled two hundred patients (101 intervention and 99 control) with a mean (SD) follow up of 604 (276) days. There were 98 ED visits by intervention participants, resulting in 56 hospitalisations, compared with 121 ED visits and 70 hospitalisations for controls (risk reduction = 8%, 95% CI = -1% -17%, p = 0.10). For the pre-specified secondary outcomes of transfers within the first 12 months of enrolment, the number of residents making at least one visit (46 in each study arm) and rate of ED attendance (0.66 visits per intervention resident versus 0.70 visits per control resident) was not affected by the intervention. After adjusting for dependency and comorbidity, the intervention group had non-significantly lower transfers (OR 0.7, 95% CI 0.3-1.5, p = 0.34). There was a reduction in the rate of decline in the quality of life of intervention compared to control residents. CONCLUSIONS: Nurse practitioner care coordination resulted in no statistically significant change in rates of ED transfer or health care utilisation, but better maintained resident quality of life.
Authors: Suzanne M Dyer; Jenni Suen; Helena Williams; Maria C Inacio; Gillian Harvey; David Roder; Steve Wesselingh; Andrew Kellie; Maria Crotty; Gillian E Caughey Journal: BMC Geriatr Date: 2022-07-14 Impact factor: 4.070
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