Abstract
Introduction
Integrated care potentially improves coordination and health outcomes for older people with frailty. We aimed to assess the effectiveness of a new, proactive, multidisciplinary care service in improving the well-being and quality of life of older people with frailty.
Methods
A community-based non-randomised controlled trial. Participants (≥65 years, electronic Frailty Index ≥0.36) received either the new integrated care service plus usual care, or usual care alone. Data collection was at 3-time points: baseline, 2-4 weeks, and 10-14 weeks; the primary outcome was patient well-being at 2-4 weeks, measured using the Integrated Palliative care Outcome Scale, IPOS. The secondary outcome was quality of life, measured using EQ-5D-5L. Well-being and quality of life at 10-14 weeks were measured to test safety and duration of effect. Data were analysed with STATA v17.
Results
199 intervention and 54 control participants were recruited. At baseline, participants were similar in age, gender, body mass index, ethnicity, and living status. At 2-4 weeks, the intervention group had improved well-being (median IPOS reduction 5, versus control group increase 2, p<0.001) and improved quality of life (median EQ-5D index values increase 0.12 versus control 0.00, p<0.001); these were clinically significant. After adjusting for age, gender and living status, the intervention group had an average total IPOS score reduction of 6.34 (95% CI: -9.01: -4.26, p<0.05). Propensity score matching analysis based on functional status and deprivation score showed similar results (reduction in IPOS score in intervention group 7.88 (95% CI: -12.80: -2.96, p<0.001). At 10-14 weeks, the intervention group sustained well-being improvement (median IPOS score reduction of 4, versus control increase of 2, p<0.001) and improved quality of life (median EQ-5D index values increase 0.06 versus control -0.01, p<0.001).
Conclusion
The new integrated care service improves the overall well-being and quality of life of older people with frailty at 2-4 weeks; improvement was sustained at 3 months.
Ethics Approval
IRAS-250981 and NHS Research Ethics Committee 18/YH/0470
Comments
Interesting and positive results. What did the 'new integrated care' offered to the intervention group consist of?
Hi Sarah Mistry,
Thank you for your kind words. The 'new integrated care' consists of various individually-tailored assessments and interventions during a single appointment, taking approximately 3-5 hours.
Thanks
Thanks for your interest - we hope the paper will be published soon, and you are very welcome to reach out by email if you have more queries, as Blessing says.
What did the 'new integrated care' offer
If you look at 3.28 in the video, there is much more detail about what the 'new integrated care' offered.
best
Fliss
Absolutely brilliant, we are just about to start planning to set up a clinic in our GP practice with these sorts of aims. Our aim was more to target pre/mild frailty but this shows that it can even work with more severely frail patients.
My questions are:
How did you approach patients? Once identified via EFI were they just sent a letter/telephoned?
Did you have any issues with patients coming in to the centre for assessment. Our most common issue is transport.
How was follow up done? In person or were the questionnaires posted out?
Thank you so much this is going to be really helpful for us going forward!
Hi Aileen McCartney,
Thank you for your kind words.
These patients are referred to the 'new service' by their GP. The 'new service' in Hull was established to provide integrated, anticipatory, multidisciplinary care for older people living with frailty.
A member of the team visits the patient in their home prior to the centre's attendance to pre-assess and identify concerns that the patient wishes to discuss when they attend their assessment.
Participants were provided with a complimentary lunch and free transport to and from the centre.
The follow-up was done in person.
I wish you success in setting up the clinic. You can reach out to the study team: fliss.murtagh@hyms.ac.uk; blessing.ukoha-kalu@hyms.ac.uk if you need further information
thanks
Thanks for your interest - we hope the paper will be published soon, and you are very welcome to reach out by email if you have more queries, as Blessing says.