1. Amongst older adults with high risk of hospitalisations in Sweden, a comprehensive geriatric assessment (CGA) in primary care reduced the need for hospital care days.
Evidence level rating: 1 (Excellent)
Increased healthcare needs amongst the aging population is recognized as major challenge across developed countries in the world. In this prospective match-controlled trial, data from 1,604 individuals aged 75 years or older from 19 different primary care practices in Sweden were used to evaluate the effectiveness of comprehensive geriatric assessment of older adults with a high risk of hospitalisation. Calculation of a risk score for unplanned hospitalisation admissions used a validated prediction model, which extracted data from the preceding 12 months of electronic medical records. Using various factors such as age, healthcare use, diagnoses from inpatient care and outpatient visits, the participants were risk stratified and the top 11% with the highest risk were included. The participants were equally distributed to an intervention and control group. During the run of the study, there were 17% (control) and 19% (intervention) dropouts caused by death. The mean age of the group was 83.2 years and 51% were female. By the end of the study, there were 451 participants in the intervention group and 470 in the control group with no significant differences in participant demographics. The intervention, CGA, was three-fold, the first of which included a thorough health and frailty assessment and medication review by a nurse. The second part was a team meeting with the nurse and physician where they grade frailty using the Clinical Frailty Scale. Finally, the third part involved creating a care plan for the participant based on the assessment and their individual needs. The control group received care as usual. The primary outcome measured a significant reduction in hospital care days in the intervention group (8.5 days vs 10.3 days) during the 2 years of follow-up. The relative risk reduction (RRR) was -22% (-35% to -4%, p=0.02). The number of outpatient visits to primary or secondary care did not differ significantly and mortality was similar between the two groups. Finally, a cost analysis found a reduction of healthcare cost in the intervention group as a result of decreased hospital care days. Overall, the study helped demonstrate that CGA performed in primary care can significantly reduce the need for hospital care amongst high risk older adults.
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