Spoorenberg Sophie L W, Wynia Klaske, Uittenbroek Ronald J, Kremer Hubertus P H, Reijneveld Sijmen A
University of Groningen, University Medical Center Groningen, Department of Health Sciences, Community and Occupational Medicine, Groningen, Groningen, The Netherlands.
University of Groningen, University Medical Center Groningen, Department of Neurology, Groningen, Groningen, The Netherlands.
PLoS One. 2018 Jan 19;13(1):e0190751. doi: 10.1371/journal.pone.0190751. eCollection 2018.
To evaluate the effects of the population-based, person-centred and integrated care service 'Embrace' at twelve months on three domains comprising health, wellbeing and self-management among community-living older people.
Embrace supports older adults to age in place. A multidisciplinary team provides care and support, with intensity depending on the older adults' risk profile. A randomised controlled trial was conducted in fifteen general practices in the Netherlands. Older adults (≥75 years) were included and stratified into three risk profiles: Robust, Frail and Complex care needs, and randomised to Embrace or care as usual (CAU). Outcomes were recorded in three domains. The EuroQol-5D-3L and visual analogue scale, INTERMED for the Elderly Self-Assessment, Groningen Frailty Indicator and Katz-15 were used for the domain 'Health.' The Groningen Well-being Indicator and two quality of life questions measured 'Wellbeing.' The Self-Management Ability Scale and Partners in Health scale for older adults (PIH-OA) were used for 'Self-management.' Primary and secondary outcome measurements differed per risk profile. Data were analysed with multilevel mixed-model techniques using intention-to-treat and complete case analyses, for the whole sample and per risk profile.
1456 eligible older adults participated (49%) and were randomized to Embrace (n(T0) = 747, n(T1) = 570, mean age 80.6 years (SD 4.5), 54.2% female) and CAU (n(T0) = 709, n(T1) = 561, mean age 80.8 years (SD 4.7), 55.6% female). Embrace participants showed a greater-but clinically irrelevant-improvement in self-management (PIH-OA Knowledge subscale effect size [ES] = 0.14), and a greater-but clinically relevant-deterioration in health (ADL ES = 0.10; physical ADL ES = 0.13) compared to CAU. No differences in change in wellbeing were observed. This picture was also found in the risk profiles. Complete case analyses showed comparable results.
This study found no clear benefits to receiving person-centred and integrated care for twelve months for the domains of health, wellbeing and self-management in community-living older adults.
评估以人群为基础、以人为本的综合护理服务“Embrace”在十二个月时对社区居住老年人健康、幸福感和自我管理这三个领域的影响。
“Embrace”支持老年人居家养老。一个多学科团队提供护理和支持，强度根据老年人的风险状况而定。在荷兰的15家全科诊所进行了一项随机对照试验。纳入年龄≥75岁的老年人，并将其分为三种风险状况：健康、虚弱和有复杂护理需求，然后随机分为接受“Embrace”服务组或常规护理（CAU）组。在三个领域记录结果。使用欧洲五维健康量表-3L和视觉模拟量表、老年人自我评估的INTERMED、格罗宁根衰弱指标和卡茨15项量表来评估“健康”领域。使用格罗宁根幸福感指标和两个生活质量问题来测量“幸福感”。使用自我管理能力量表和老年人健康伙伴量表（PIH-OA）来评估“自我管理”领域。主要和次要结局测量因风险状况而异。使用意向性分析和完整病例分析，采用多水平混合模型技术对整个样本和每个风险状况的数据进行分析。
1456名符合条件的老年人参与研究（参与率49%），并被随机分为“Embrace”组（T0时n = 747，T1时n = 570，平均年龄80.6岁（标准差4.5），女性占54.2%）和CAU组（T0时n = 709，T1时n = 561，平均年龄80.8岁（标准差4.7），女性占55.6%）。与CAU组相比,“Embrace”组参与者在自我管理方面有更大但临床意义不大的改善（PIH-OA知识子量表效应量[ES]=0.14），在健康方面有更大但具有临床意义的恶化（日常生活活动能力ES = 0.10；身体日常生活活动能力ES = 0.13）。在幸福感变化方面未观察到差异。在各风险状况中也发现了类似情况。完整病例分析显示了类似结果。
本研究发现，对于社区居住的老年人，在健康、幸福感和自我管理领域接受为期十二个月的以人为本的综合护理没有明显益处。
