Journal Article

Combining volunteers and primary care teamwork to support health goals and needs of older adults: a pragmatic randomized controlled trial

Lamarche, Larkin, Papaioannou, Alexandra, Agarwal, Gina, Mangin, Dee, Richardson, Julie, Oliver, Doug, Javadi, Dena, Ploeg, Jenny, Valaitis, Ruta, Risdon, Cathy, Griffith, Lauren, Price, David, Straus, Sharon, Dolovich, Lisa, Carr, Tracey, Raina, Parminder, Thabane, Lehana, Santaguida, Pasqualina, Foster, Gary, Kastner, Monika

2019

Overview

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. 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. 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]). 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

• Publisher: Elsevier Inc,CMA Impact Inc,Joule Inc,CMA Impact, Inc
• Subject: Accidental Falls - prevention & control / Aged / Aged - psychology / Aging / Care and treatment / Chronic illnesses / Clinical trials / Elderly / Evidence-based medicine / Exercise / Family medicine / Geriatrics / Gerontology / Goals / Health Services for the Aged - organization & administration / Health Services Needs and Demand / Hospital admission and discharge / Humans / Integrative medicine / Internal Medicine / Intervention / Medical care utilization / Medical cooperation / Medical records / Methods / Older people / Patient Care Team / Patient Reported Outcome Measures / Patients / Physical fitness / Preventive Health Services / Primary care / Primary health care / Primary Health Care - organization & administration / Production management / Public health / Quality of Life / Self Efficacy / Social Support / Systematic review / Teams / Teamwork (Workplace) / Volunteers