School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
BMJ Open. 2021 May 13;11(5):e042911. doi: 10.1136/bmjopen-2020-042911.
Older Canadians living with frailty are high users of healthcare services; however, the healthcare system is not well designed to meet the complex needs of many older adults. Older persons look to their primary care practitioners to assess their needs and coordinate their care. They may need care from a variety of providers and services, but often this care is not well coordinated. Older adults and their family caregivers are the experts in their own needs and preferences, but often do not have a chance to participate fully in treatment decisions or care planning. As a result, older adults may have health problems that are not properly assessed, managed or treated, resulting in poorer health outcomes and higher economic and social costs. We will be implementing enhanced primary healthcare approaches for older patients, including risk screening, patient engagement and shared decision making and care coordination. These interventions will be tailored to the needs and circumstances of the primary care study sites. In this article, we describe our study protocol for implementing and testing these approaches.
Nine primary care sites in three Canadian provinces will participate in a multi-phase mixed methods study. In phase 1, baseline information will be collected through questionnaires and interviews with patients and healthcare providers (HCPs). In phase 2, HCPs and patients will be consulted to tailor the evidence-based interventions to site-specific needs and circumstances. In phase 3, sites will implement the tailored care model. Evaluation of the care model will include measures of patient and provider experience, a quality of life measure, qualitative interviews and economic evaluation.
This study has received ethics clearance from the host academic institutions: University of Calgary (REB17-0617), University of Waterloo (ORE#22446) and Université Laval (#MP-13-2019-1500 and 2017-2018-12-MP). Results will be disseminated through traditional means, including peer-reviewed publications and conferences and through an extensive network of knowledge user partners.
NCT03442426;Pre-results.
患有虚弱症的加拿大老年人是医疗保健服务的高使用者；然而，医疗保健系统设计不佳，无法满足许多老年人的复杂需求。老年人希望他们的初级保健医生评估他们的需求并协调他们的护理。他们可能需要来自各种提供者和服务的护理，但通常这种护理协调不佳。老年人及其家庭照顾者是他们自己需求和偏好的专家，但他们往往没有机会充分参与治疗决策或护理计划。结果，老年人可能存在未得到适当评估、管理或治疗的健康问题，导致健康状况恶化，经济和社会成本更高。我们将为老年患者实施强化初级保健方法，包括风险筛查、患者参与、共同决策和护理协调。这些干预措施将根据初级保健研究地点的需求和情况进行调整。在本文中，我们描述了实施和测试这些方法的研究方案。
三个加拿大省份的九个初级保健地点将参与一项多阶段混合方法研究。在第 1 阶段，将通过问卷和患者和医疗保健提供者（HCP）的访谈收集基线信息。在第 2 阶段，将咨询 HCP 和患者，根据特定地点的需求和情况调整基于证据的干预措施。在第 3 阶段，将实施量身定制的护理模式。护理模式的评估将包括患者和提供者体验的衡量标准、生活质量衡量标准、定性访谈和经济评估。
这项研究已获得主办学术机构的伦理批准：卡尔加里大学（REB17-0617）、滑铁卢大学（ORE#22446）和拉瓦尔大学（#MP-13-2019-1500 和 2017-2018-12-MP）。结果将通过传统途径传播，包括同行评议的出版物和会议，以及通过广泛的知识用户合作伙伴网络。
NCT03442426；预结果。
