Life In The Slower Lane

Here is the structured PICO analysis for the seventh article you uploaded:

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Full Title (verbatim and exact):

“Models for delivery and co-ordination of primary or secondary health care (or both) to older adults living in aged care facilities”

Putrik P, Grobler L, Lalor A, Ramsay H, Gorelik A, Karnon J, Parker D, Morgan M, Buchbinder R, O’Connor D

Cochrane Database of Systematic Reviews 2024, Issue 3, Art. No.: CD013880

DOI: https://doi.org/10.1002/14651858.CD013880.pub2

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Type of Article:

Systematic review of randomised controlled trials, including cost-effectiveness analyses

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PICO Analysis:

Population:

• Older adults living in aged care facilities (ACFs) (including nursing homes and long-term care homes)
• 40 included trials with 21,787 participants from 15 countries
• Residents had varying conditions (e.g. dementia, frailty, infections, post-hip fracture, pressure ulcers)

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Intervention:

• Alternative models of delivering or co-ordinating primary or secondary care in ACFsThese included:
  • Multidisciplinary care teams (e.g. nurse practitioners, GPs, geriatricians)
  • In-reach hospital services
  • Discharge planning and care pathways
  • Telehealth
  • Continuity models (e.g. GP embedded in ACF)
  • Nurse-led care or task-shifting models

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Comparator:

• Usual care as defined in each trial (not standardised; often poorly described)

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Outcome:

1. Person-centred outcomes:

• Health-related quality of life (HRQoL):
  • Little or no effect (MD –0.016 on EQ-5D, low-certainty evidence)
• Mortality:
  • Probably little or no difference (RR 1.03, 95% CI 0.92–1.16, moderate-certainty evidence) 

2. Process outcomes:

• Emergency department (ED) visits:
  • Little or no difference (RR 1.01, 95% CI 0.84–1.20; low-certainty evidence)
• Unplanned hospital admissions:
  • May be reduced (RR 0.74, 95% CI 0.56–0.99; low-certainty evidence)
• Adverse events (e.g. falls, infections):
  • Effect uncertain (RR 1.15, 95% CI 0.83–1.60; very low-certainty evidence)
• Adherence to guideline-recommended care (e.g. antidepressant use):
  • Evidence highly uncertain; based on small, heterogeneous studies 

3. Health system outcomes:

• Cost-effectiveness:
  • Unclear – economic evaluations (n=5) were too heterogeneous to pool
  • Certainty of evidence rated very low
• Resource use and hospitalisation duration:
  • Inconclusive; some signals of decreased hospitalisation, but findings inconsistent 

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Summary Conclusion:

Alternative models of care may reduce unplanned hospital admissions for residents in aged care facilities, but likely have little or no effect on ED visits, mortality, or HRQoL. The evidence for cost-effectiveness and adverse events is uncertain. Findings suggest potential process improvements, but high variability and low study quality temper confidence.

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