Supporting Older People’s Self-Management of Health Interprofessionally in Primary care: Developing and Evaluating a People-Centred Care Model Including Clinical Medication Reviews
Abstract
Introduction
Effective and cost-effective people-centred care models, which support older people to maintain their quality of life (QoL) and physical performance, are needed in primary care to help people live longer, and independently, in their own homes. The aim of the multi-method Care Plan 2100 study was to develop a people-centred care model (PCCM), including clinical medication reviews, for primary care to support care for multimorbid home-living older people. Additionally, the objectives were to evaluate effectiveness and cost-effectiveness of the PCCM, and to evaluate how critical older
people’s involvement is in identifying clinically significant drug-related problems (DRPs).
Materials and methods
Study I was a participatory action research study, in which an active involvement of healthcare professionals, i.e. participants, and researchers, was utilised to develop the PCCM in Tornio primary health care. Patients eligible to participate in the project were home-living multimorbid outpatients aged ≥ 75 years. Study II evaluated how critical patient involvement is in identifying clinically significant drug-related problems (DRPs) in pharmacist-led clinical medication reviews (n=161). In study III, the effectiveness, QoL and physical performance, of the PCCM (n=151) was compared with that of usual care (n=126) in a randomised controlled trial (RCT) with a two-year follow-up. Additionally, cost-effectiveness of the PCCM was compared to usual care using cost-utility analysis.
Results
The developed PCCM comprised: a self-management evaluation questionnaire sent before a home-visit; a person-centred patient interview at home together by a nurse and a pharmacist; a nurse-led health review and a pharmacist-led clinical medication review with recommendations; an interprofessional (a general practitioner, a pharmacist and a named nurse) case conference meeting; a care plan including health and medication plans; and health support and empowerment interventions delivered by the named nurse. Healthcare professionals appreciated the advantages of the new enhanced care model and skill-mix, and found that the PCCM enhanced holistic approach and continuity of care and interprofessional collaboration. Patient involvement was essential when identifying clinically significant DRPs. The researchers evaluated that of the most significant clinical DRPs identified through patient interviews only 6% could have been identified through reviewing the medication list only, and 16% through reviewing the medication list and certain patient details. No statistically significant differences were observed in the QoL or in the physical performance between the groups. However, the cost-utility analysis showed that the PCCM dominates usual care, hence, the mean total costs were lower and generated quality-adjusted life years (QALYs) higher in the intervention group than in the usual care group.
Conclusion
The developed PCCM including clinical medication reviews enhanced continuity of care and older people’s involvement in their own care in
primary care. No statistically significant differences were observed in the QoL or in the physical performance between the groups. However,
the cost-utility analysis showed that the PCCM dominates usual care.
Author
Heini Kari
Additional Information
- Peer-Reviewed: yes.
- Open Access: yes.
- Cite as: Kari, H. (2023). Iäkkäiden omahoidon tukeminen moniammatillisesti perusterveydenhuollossa: Lääkehoidon kokonaisarvioinnin sisältävän ihmiskeskeisen omahoitomallin kehittäminen ja arviointi. Dosis, 39(1), 124–140. https://dosis.fi/wp-content/uploads/2023/03/124-141_Dosis_123_Kari.pdf
