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Geriatrician-performed comprehensive geriatric care in older adults referred to a community rehabilitation unit: A randomized controlled trial

Published:February 03, 2018DOI:https://doi.org/10.1016/j.ejim.2018.01.022

      Highlights

      • Modified comprehensive geriatric care (CGC) model was evaluated in an RCT.
      • The CGC was performed by geriatrician in an outpatient rehabilitation unit.
      • The CGC had no effect on the utilization of the secondary healthcare.
      • The CGC reduced the primary healthcare use and improved the patient's quality of life.
      • A physician should be on site at an outpatient community rehabilitation unit.

      Abstract

      Background

      Older adults make increasing demands on all sectors of the healthcare system. We investigated the effect of geriatrician-performed comprehensive geriatric care (CGC) in older adults referred to a community rehabilitation unit.

      Design

      Randomized controlled trial.

      Setting

      Two Danish non-hospital based rehabilitation units.

      Participants

      Persons aged 65 or older admitted from home or hospital.

      Intervention

      CGC performed by a geriatrician at the rehabilitation unit.

      Outcomes

      Primary outcome was number of hospital admissions and emergency department (ED) visits. Secondary outcomes were number of ambulatory contacts, general practitioner (GP) contacts, activities of daily living (ADL) and overall quality of life (OQoL). Outcomes were measured within 90 days of admission to the rehabilitation units.

      Results

      368 persons were randomized: 185 to the intervention group (IG) vs 183 to the control group (CG). Groups were comparable at baseline. The number of hospital admissions and ED visits, ambulatory contacts and out of hour GP visits or phone calls did not differ between the groups. The number of daytime GP consultations and visits or phone and email consultations was lower in the IG (P < 0.001). There were no differences in the mean between the groups for ADL and OQoL, but more participants in the IG improved their OQoL (OR 1.63, 95% CI: 1.07–2.48, P = 0.023).

      Conclusion

      Geriatrician-performed CGC in older adults in a community rehabilitation unit had no effect on the secondary healthcare utilization, but may reduce primary healthcare utilization and improve OQoL during the 90-day follow-up period.

      Trial registration

      ClinicalTrials.gov NCT01506219.

      Abbreviations:

      ADL (activities of daily living), CCI (Charlson Comorbidity Index), CI (confidence interval), CGA (comprehensive geriatric assessment), CGC (comprehensive geriatric care), DL (Depression List), IG (intervention group), CG (control group), GP (general practitioner), HR (hazard ratio), ED (emergency department), IRR (incidence rate ratio), ITT (intention-to-treat), IQR (interquartile range), MBI (Modified Barthel-100 Index), MMSE (Mini-Mental State Examination), OR (odds ratio), OQoL (overall quality of life), RCT (randomized controlled trial), SD (standard deviation)

      Keywords

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