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Thuiswonende ouderen in een kwetsbare positie: effecten van en interdisciplinair eerstelijn sz orgprogramma (Frail elderly people living at home: effects of an interdisciplinary primary care programme) [Dutch]
Metzelthin SF, van Rossum E, de Witte LP, Ambergen A, Hobma S, Sipers W, Daniels R, Habets H, Crasborn L, Kempen GIJM
Nederlands Tijdschrift voor Geneeskunde 2014 Apr;158(17):A7355
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To assess the added value of an interdisciplinary primary care programme for frail elderly people living at home with regard to reducing disability in activities of daily living and preventing functional decline or worsening thereof. DESIGN: A cluster randomised trial. METHOD: We sent a written survey, the Groningen Frailty Indicator (GFI), to 3,498 patients > 70 years from 12 general practitioner (GP) practices in the southern part of the Dutch province Limburg. GP practices in the control group (n = 6) delivered usual care, while the 6 intervention practices implemented the 'prevention of care' approach. Besides screening, this programme consists of a multidimensional assessment and interdisciplinary care based on a tailor-made treatment plan and regular evaluation and follow-up. The GP and practice nurse make up the core team in this approach and closely collaborate with occupational therapists and physiotherapists. The primary outcome measure was disability in activities of daily living. This primary outcome and various secondary outcomes such as social support, fear of falling and quality of life were assessed at baseline and after 6, 12 and 24 months of follow-up (trial registered with Current Controlled Trials, ISRCTN31954692). RESULTS: The response rate to the postal screening was 80%. Out of 1,101 elderly people who were willing to participate in the study, 393 (36%) were frail according to the GFI (score = 5). Finally, 346 frail elderly people were included of whom 270 completed the study. Multi-level analyses showed no significant differences between the two groups in any of the primary and secondary outcomes. CONCLUSION: No evidence for the effectiveness of the prevention of care approach was found. This study contributes to the emerging body of evidence that primary care of frail elderly people is a challenging task.

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