Comparing Frailty Care Pathways in Rural Primary Care: a Feasibility Study
试验速览
- 阶段
- 不适用
- 状态
- 撤回
- 试验地点
- 1
- 主要终点
- Frequency of health care use
研究概览
简要总结
Primary Care General Practitioners (GPs) are always looking at ways to improve the care of older people and ways to prevent older people from losing their independence. Pro-active provision of support often involves lifestyle advice and is a potentially important aspect of that, as it supports older people before acute care is needed. It's preventative caring, rather than reactive caring. But, implementing pro-active care is hampered by the high current workload of acute care, the uncertainty of 'what works' and whether patients are responsive to pro-active care plans. This project will explore different ways of providing pro-active support to older people who could be at risk of losing their independence and requiring frequent acute care. The benefits of pro-active care are arguably the greatest in these individuals.
详细描述
This is randomised control trial design with a cluster randomisation, whereby each cluster (a GP surgery) will have a different intervention. As it's a feasibility study, there will only be one cluster per intervention.
Participants will be recruited from 4 local primary care surgeries, and if participants take part, they will have 4 visits, and will be randomly allocation of an intervention arm, or a control arm receiving usual care.
At the start, the participant would have 2 visits of a maximum of 2 hours to the participant's local GP surgery to undergo a variety of tasks and assessments about the participant's well-being, health and physical functioning. That could lead to an 'action plan' that is implemented. The participant will have the 3rd visit after 3 months, and a final (fourth) visit after 12 months. During the 3rd and 4th visit the participant will repeat various tasks and assessments done in visit 1 and 2.
The project comprises different activities in the different GP surgeries. The project compares different approaches that each surgery takes. Generally, each surgery will assess relevant aspects that are associated with 'getting older' and provide support in the coming months. The specific approaches are based on the Comprehensive Geriatric Assessment, the World Health Organisation's recommendation and resources for the Integrated Care of Older People (ICOPE) model, the recommendations from the International Conference of Frailty and Sarcopenia Research (ICFSR) and the Functional Fitness test battery. All of these approaches would lead to an 'personal care plan' developed by the medical student, with actions that are specific to the participant's circumstances.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Triple (Participant, Investigator, Outcomes Assessor)
盲法说明
There will be different people assigned to the delivery and the intervention. The effectiveness of this will be established as part of the feasibility evaluation.
入排标准
- 年龄范围
- 60 Years 至 105 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •The study focuses on community-dwelling frail older people (≥ 60 years). Each GP surgery will complete the electronic Frailty Index (eFI) to stratify older people based on their level of frailty (non-frail, mildly frail, and frail). Participants will be stratified into four strata,
- •participants without complex care needs and with a relatively low frailty level (non-frail);
- •participants with some chronic conditions that could put them at risk in the future (mild frailty)
- •frail participants at risk of complex care needs (frailty)
- •participants with complex care needs (severe frailty).
- •Inclusion Criteria:
- •adults aged 60 years or older
- •mild frailty or frailty based on the eFI,
- •without severe cognitive impairment diagnoses,
- •not currently taking part in other research or in the previous 6 months,
- •willing to provide informed consent
排除标准
- •are terminally ill
- •have severe cognitive or psychological impairments,
- •have experienced a severe, disabling stroke within the previous 6 months
- •are unable to communicate in English.
- •are currently taking part in other research project, or was part of research in the previous 6 months.
- •have experienced a heart attack, or unstable angina within the previous 3 months.
- •already receive advice that includes exercise and diet by health professionals and were referred at discharge for condition-specific rehabilitation (e.g. pulmonary rehabilitation, stroke rehabilitation) within the previous 6 months
研究组 & 干预措施
Comprehensive Geriatric Assessment (CGA)
Participants in this arm will undertake a Comprehensive Geriatric Assessment, and will be implemented based on Comprehensive Geriatric Assessment Toolkit for Primary Care Practitioners from the British Geriatrics Society. A personalised action plan will be developed and implemented based on the CGA.
干预措施: Frailty care pathway for older people in a rural primary care setting (Other)
Integrated Care for Older PEople (ICOPE)
Participants in this arm will undertake the assessment recommended by the World Health Organisation, and will be implemented by the publicly available app. A personalised action plan will be developed and implemented based on the ICOPE.
干预措施: Frailty care pathway for older people in a rural primary care setting (Other)
Identification and Management of frailty and sarcopenia
Participants in this arm will undertake the assessment recommended by the International Conference on Frailty and Sarcopenia Research Clinical Practice Guidelines for Identification and Management of physical frailty (ICFSR). A personalised action plan will be developed and implemented based on the ICFSR.
干预措施: Frailty care pathway for older people in a rural primary care setting (Other)
Functional Fitness Battery (FFB)
Participants in this arm will undertake a Functional Fitness Battery, comprising physical assessments on the intrinsic capacity, lifestyle and nutritional status
干预措施: Frailty care pathway for older people in a rural primary care setting (Other)
Usual Care
Participants in this arm will not receive an intervention, but the usual care provided by the primary care provider.
结局指标
主要结局
Frequency of health care use
时间窗: 12 months
The number of hospital admissions and GP visits in the preceding 12 months
Recruitment rate (feasibility determination)
时间窗: 6 months
The recruitment rate reflects the recruitment method and number of eligible patients and general interest to take part.
Drop out rate (feasibility determination)
时间窗: 12 months
The drop out rate reflects the number of participants lost to follow up, response rates and adherence/compliance to the intervention.
electronic Frailty Index
时间窗: 12 months
This score reflects the number of accumulated deficits
次要结局
- Usual Walking Speed(12 months)
- Physical Activity Level(12 months)
- Grip Strength(12 months)