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General practice / Family practice
Protocol
Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden
  1. Jan Marcusson1,
  2. Magnus Nord2,
  3. Maria M Johansson1,
  4. Jenny Alwin3,
  5. Lars-Åke Levin3,
  6. Petra Dannapfel1,
  7. Kristin Thomas4,
  8. Bonnie Poksinska5,
  9. Annette Sverker6,
  10. Anna Olaison7,
  11. Elisabet Cedersund8,
  12. Susanne Kelfve7,
  13. Andreas Motel-Klingebiel7,
  14. Ingrid Hellström9,
  15. Agneta Kullberg7,
  16. Ylva Böttiger10,
  17. Huan-Ji Dong4,
  18. Anneli Peolsson11,
  19. Malin Wass12,
  20. Johan Lyth12,
  21. Agneta Andersson12
  1. 1 Acute Internal Medicine and Geriatrics and Departmentof Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
  2. 2 Family Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  3. 3 Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  4. 4 Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
  5. 5 Department of Management and Engineering, Linköping University, Linköping, Sweden
  6. 6 Rehabilitation Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
  7. 7 Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
  8. 8 Ageing and Social Change, Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
  9. 9 Department of Social and Welfare Studies, Faculty of Health Sciences, Norrköping University, Norrköping, Sweden
  10. 10 Clinical Pharmacology, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
  11. 11 Physiotherapy, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
  12. 12 Research and Development Unit in Region Östergötland, Linköping University, Linköping, Sweden
  1. Correspondence to Professor Jan Marcusson; jan.marcusson{at}liu.se

Abstract

Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.

Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.

Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.

Trial registration number NCT03180606.

  • care frail elderly

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-027847

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    Footnotes

    • Contributors All authors have made substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. They have participated in drafting or revising the work critically for important intellectual content. The gave final approval of the version to be published. JM: principal investigator, design, analysis and scientific writing. MN: clinical project leader, design, clinical site visits, data collection, analysis and scientific writing. YB: design, analysis and scientific writing. H-JD: design and analysis of the prediction model and scientific writing. MMJ and AP: clinicians and scientists responsible for rehabilitation, design of the postal questionnaire, data collection, analysis and scientific writing. JA and L-ÅL: design and health economic analysis, design of the postal questionnaire, data collection, analysis and scientific writing. PD, KT and BP: design and analysis of implementation studies, data collection, analysis and scientific writing. AS, AO and EC: design of interviews, analysis of the patient’s perspective and scientific writing. SK and AM-K: design of the postal questionnaire, analysis of well-being, network support, satisfaction and social inequality based on questionnaire and registry data, and scientific writing. IH and AK: design and analysis of professional perspective and scientific writing. JL: analysis and scientific writing. MW: project coordinator and scientific writing. AA: coinvestigator, analysis and scientific writing.

    • Funding This work was supported by the County Council of Östergötland and Linköping University from the strategic research fund for ‘Health Care and Welfare’ (Grant number 2016186-14). Contact person is Dean Johan Söderholm, Deans Office, Medical Faculty, Linköping University. This funding source had no role in the design of this study and will not have any role during its execution, analysis, interpretation of the data, or decision to submit results.

    • Competing interests None declared.

    • Ethics approval This study was subject to ethical evaluation and was approved by the regional ethical review board in Linköping (Dnr 2016/347-31).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.