Local, collaborative, stepped, and personalized care management for older people with chronic diseases – results from the randomized controlled LoChro-trial

BMC Geriatrics

Research

Jasmin Kiekert¹  Ines Himmelsbach¹  Christoph Maurer²  Bernhard Heimbach²  Elena Dreher²  Katharina Kohler²  Anne Göhner²  Jürgen Bengel³  Fabian Frank⁴  Katharina Laubner⁵  Jochen Seufert⁵  Andy Maun⁶  Claudia Salm⁶  Klaus Kaier⁷  Gloria Metzner⁸  Lukas Maximilian Horstmeier⁸  Erik Farin-Glattacker⁸  Sebastian Voigt-Radloff⁹  Eva Maria Bitzer^1,10  Lisa Lyssenko^1,10 

[1] Catholic University of Applied Sciences Freiburg, Karlstraße 63, 79104, Freiburg, Germany;Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany;Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, Engelbergerstr. 41, 79085, Freiburg, Germany;Department of Social Work, Protestant University of Applied Sciences Freiburg, Bugginger Straße 38, 79114, Freiburg, Germany;Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstraße 5, 79104, Freiburg, Germany;Division of Endocrinology and Diabetology, Department of Medicine II, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany;Institute of General Practice / Family Medicine, Medical Center – University of Freiburg, Faculty of Medicine, Elsässer Str. 2m, 79110, Freiburg, Germany;Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Zinkmattenstr. 6a, 79108, Freiburg, Germany;Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany;Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany;Center for Geriatric Medicine and Gerontology, University Medical Center Freiburg, Faculty of Medicine and Medical Center, University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany;University of Education Freiburg, Public Health and Health Education, Kunzenweg 21, 79117, Freiburg, Germany;

关键词: Collaborative care;    Care management;    Intervention;    Older adults;    Chronic diseases;    Multimorbidity;    Evaluation;    Randomized controlled trial;   

DOI  :  10.1186/s12877-023-03797-2

 received in 2022-07-26, accepted in 2023-02-03,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIn the aging population of Western societies, an increasing number of older adults have multiple chronic diseases. As multifaceted health problems imply the involvement of several healthcare professionals, multimorbid older people frequently face a fragmentation of health care. Addressing these challenges, we developed a local, collaborative, stepped, and personalized care management approach (LoChro-Care) and evaluated its effectiveness.MethodsA two-group, parallel randomized controlled trial was conducted comparing LoChro-Care recipients (IG) to participants with usual care (CG). Patients aged 65 + with chronic conditions were recruited at inpatient and outpatient departments of the Medical Center, University of Freiburg. Participants were allocated using block randomization (nIG = 261, nCG = 263). LoChro-Care comprised individualized care provided by chronic care managers with 7 to 13 contacts over 12 months. Questionnaires were given at 3 time points (T0: baseline, T1: after 12 months, T2: after 18 months). The primary outcome was the physical, psychological, and social health status represented by a composite score of functional health and depressive symptoms. Secondary outcomes were the participants’ evaluation of their health care situation, health-related quality of life (HRQL), and life-satisfaction (LS). The data were analyzed using linear mixed modelling.ResultsWe analyzed N = 491 participants (nIG = 244, nCG = 247), aged M = 76.78 years (SD = 6.35). For the composite endpoint, neither a significant difference between IG and CG (p = .88) nor a group-time interaction (p = .52; p = .88) could be observed. Participants in both groups showed a significant decline on the primary outcome between T0 and T2 (p < .001). Post hoc analyses revealed a decline in both functional health (p < .001) and depressive symptoms (p = .02). Both groups did not differ in their evaluation of their health care situation (p = .93), HRQL (p = .44) or LS (p = .32). Relevant confounding variables were female gender and multimorbidity.ConclusionSupporting patients’ self-management in coordinating their individual care network through LoChro-Care did not result in any significant effect on the primary and secondary outcomes. A decline of functional health and depressive symptoms was observed among all participants. Potential future intervention adaptations are discussed, such as a more active case management through direct referral to (in-)formal support, an earlier treatment initiation, and the consideration of specific sociodemographic factors in care management planning.Trial registrationGerman Clinical Trials Register (DRKS): DRKS00013904 (02.02.2018), https://drks.de/search/de/trial/DRKS00013904

【 授权许可】

CC BY   
© The Author(s) 2023

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