Geriatric Assessment, Multimorbidity
Conditions
Keywords
Elderly, Health care organization, Primary care
Brief summary
Older patients account for around 10% of the population, of which 57% have a long-term illness, and 33% were admitted in the past year. Geriatric assessment (GA) is a multidimensional assessment of general health status that can help identifying deficiencies and followed by a personalized care plan. Assessment and management of elderly patients is a daily concern for the general practitioner (GP) but conflicting results have been reported so far relating to the clinical impact of GA when applied in the primary care setting. This study protocol aims to assess the effect on morbi-mortality of a complex intervention in patients aged ≥70 years with chronic conditions in primary care. It aims to demonstrate that a GA adapted to primary care, followed by a personalized care plan and combined with successful interprofessional collaboration can improve clinically relevant outcomes in elderly patients with chronic conditions such as one-year overall mortality, unplanned hospital admission, emergency visits, or institutionalization. The CEPIA study will also help addressing the issue of whether an improved benefit could be achieved from a systematic nurse-led or a case-by-case GP-led GA.
Interventions
OTHERhealth care organization
Nurse-led or GP-led Geriatric assessment combined with an educational seminar focused on GA and personalized care-plan as well as a dedicated hotline for general practitioners seeking a geriatric advice Interactive educational seminar Primary care
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
70 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients aged≥70 years with a long-term illness scheme or hospital admission the past 3 months * Visiting their preferred general practioner (GP) or another GP in the same practice * patient oral non opposition
Exclusion criteria
* Patient who does not speak French * Severe disease with a life expectancy \<12 months * Institutionalized patients * Patient insured under the French national health insurance system
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Primary composite endpoint combined with: - Percentage of all-cause mortality - Percentage of Unplanned hospital admission - Percentage of Emergency visits. - Percentage of Institutionalization | At 12 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Unplanned hospital admission | At 12 months | — |
| Percentage of Emergency visits | At 12 months | — |
| Percentage of Institutionalization | At 12 months | — |
| Quality of life (Duke profile score) | At Day 0 and 12 months | — |
| Autonomy by KATZ ALD score | At Day 0 and 12 months | — |
| Number of medication prescription (polypharmacy) | Up to 12 months | — |
| Percentage of all-cause mortality | At 12 months | — |
| Percentage of personalized care plan performed | Up to 12 months | — |
| Percentage of geriatric phone advices requested by GPs | Up to 12 months | — |
| Percentage of health care actions planned | Up to 12 months | — |
| Percentage of satisfied general practitioner with the intervention | 27months after the beginning of the study | self-assessment |
| Satisfaction of general practitioners and nurses after completion of intervention | 12 months after the beginning of the study | interview of general practionners and nurses by independant investigator |
| Percentage of Geriatric assessment performed | Up to 12 months | — |
Countries
France
Outcome results
None listed