Life In The Slower Lane

Here is a 10-point summary of the Cochrane Review:

Full Review Title:

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

Authors: Putrik P, Grobler L, Lalor A, et al.

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

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🔟 Key Summary Points

1. Purpose of the Review:To assess the effectiveness, safety, and cost-effectiveness of alternative models for delivering or coordinating primary or secondary healthcare (or both) for residents of aged care facilities (ACFs), compared to usual care.
2. Scope of Evidence:The review included 40 randomised controlled trials (21,787 participants) from 15 countries. Models examined included care co-ordination, hospital in-reach, nurse practitioner-led models, GP co-location, multidisciplinary teams, and telehealth.
3. Emergency Department (ED) Visits:Little or no difference was found in the proportion of residents with at least one ED visit (RR 1.01; 95% CI 0.84 to 1.20; 7 trials, 1276 participants; low-certainty evidence) .
4. Unplanned Hospital Admissions:Reduced admissions were seen in alternative models (RR 0.74; 95% CI 0.56 to 0.99; 8 trials, 1263 participants; low-certainty evidence) .
5. Adverse Events (Falls, Infections, Pressure Ulcers):Effects were uncertain, with very low-certainty evidence for falls (RR 1.15; 95% CI 0.83 to 1.60; 3 trials) and similarly low certainty across other adverse events.
6. Adherence to Guidelines:Evidence from one small study (n = 65) suggested improved antidepressant prescribing (RR 5.29; 95% CI 1.08 to 26.00), but certainty was very low, limiting confidence .
7. Health-Related Quality of Life (HRQoL):No meaningful difference was detected between intervention and usual care (MD -0.016; 95% CI -0.036 to 0.004; 12 trials, 4016 participants; low-certainty evidence) .
8. Mortality:Probably no difference in mortality (RR 1.03; 95% CI 0.92 to 1.16; 24 trials, 3881 participants; moderate-certainty evidence) .
9. Cost-Effectiveness:Data from five economic evaluations (all focused on care co-ordination) were too heterogeneous to pool; overall, cost-effectiveness remains uncertain due to very low-certainty evidence .
10. Authors’ Conclusions:Alternative models of care may reduce hospitalisations but likely have little to no effect on other outcomes (e.g., ED visits, mortality, quality of life), and cost-effectiveness remains unclear. Improved reporting on “usual care” and clearer intervention descriptions are needed in future studies .

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