Integrated care for frail older people: does it work?

Emiel Hoogendijk is postdoctoral researcher at the VU University Medical Center in Amsterdam, the Netherlands, where he works for the Longitudinal Aging Study Amsterdam. He discusses his Age & Ageing paper ‘How effective is integrated care for community-dwelling frail older people? The case of the Netherlands’

aaHow can we optimise quality of care for frail older people in the community? That is an important question, which is not easy to answer. Integrated care programs are often seen as the solution. These programs are characterised by a multidisciplinary approach, with personalised care based on comprehensive geriatric assessments. In many countries, these programs are implemented in primary care. However, the beneficial effects of these programs are not so clear. It is important to report on both successful and less successful initiatives in the field. By comparing effective and non-effective interventions we may identify elements which can make a difference for frail older people.

In the Netherlands, the government initiated in 2008 the Dutch National Care for the Elderly Programme with the aim to develop a more proactive and integrated healthcare system for frail older adults. In our recently published commentary in Age and Ageing we give an overview of the results of three recent clinical trials carried out as part of the Dutch National Care for the Elderly Programme. In all three studies, an integrated care program for frail older people was implemented in a real-life primary care setting.

General practitioners (GPs) and practice nurses involved were in general quite positive about the integrated care programs. GPs appreciated the fact that they had better insight into the health situation and care needs of their frail older patients. Practice nurses had the feeling that their clients benefited from integrated care. However, the formal evaluation of the integrated care programs did not show any difference in outcomes between frail older people who received integrated care and people who received usual primary care. This was the case for many outcome measures, including quality of life, hospital admissions and functional limitations. Also, integrated care was not cost-effective compared to usual primary care.

The results of the three recent studies from the Netherlands show us that it is very difficult to improve outcomes in community-dwelling frail older people using integrated care. Many questions have to be answered. For example: Are these results specific to the Netherlands or do they also apply to other countries with strong primary care systems? Would a more holistic approach (e.g. the involvement of non-medical professionals, such as social workers) give different results? Do we have to change the way we develop and evaluate clinical trials?  One thing is clear: the studies from the Netherlands gives us food for thought.

View the Age & Ageing paper ‘How effective is integrated care for community-dwelling frail older people? The case of the Netherlands’

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