Randomized controlled trial of anticipatory and preventive multidisciplinary team care: for complex patients in a community-based primary care setting.
OBJECTIVE
T o examine whether quality of care (QOC) improves when nurse practitioners and pharmacists work with family physicians in community practice and focus their work on patients who are 50 years of age and older and considered to be at risk of experiencing adverse health outcomes.


METHODS
Randomized controlled trial.


METHODS
A family health network with 8 family physicians, 5 nurses, and 11 administrative personnel serving 10 000 patients in a rural area near Ottawa, Ont.


METHODS
Patients 50 years of age and older at risk of experiencing adverse health outcomes (N = 241).


METHODS
At-risk patients were randomly assigned to receive usual care from their family physicians or Anticipatory and Preventive Team Care (APTCare) from a collaborative team composed of their physicians, 1 of 3 nurse practitioners, and a pharmacist.


METHODS
Quality of care for chronic disease management (CDM) for diabetes, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease.


RESULTS
Controlling for baseline demographic characteristics, the APTCare approach improved CDM QOC by 9.2% (P < .001) compared with traditional care. The APTCare intervention also improved preventive care by 16.5% (P < .001). We did not observe significant differences in other secondary outcome measures (intermediate clinical outcomes, quality of life [Short-Form 36 and health-related quality of life scales], functional status [instrumental activities of daily living scale] and service usage).


CONCLUSIONS
Additional resources in the form of collaborative multidisciplinary care teams with intensive interventions in primary care can improve QOC for CDM in a population of older at-risk patients. The appropriateness of this intervention will depend on its cost-effectiveness. TRIAL REGISTRATION NUMBER NCT00238836 (CONSORT).
Hogg
William
W
University of Ottawa, Department of Family Medicine, 43 Bruyère St, Ottawa, ON K1N 5C8. whogg@uottawa.ca
Lemelin
Jacques
J
Dahrouge
Simone
S
Liddy
Clare
C
Armstrong
Catherine Deri
CD
Legault
Frances
F
Dalziel
Bill
B
Zhang
Wei
W
D000368:Aged; D002908:Chronic Disease / Q000628:therapy; D003153:Community Health Services / Q000379:methods*; D003157:Community Pharmacy Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D009726:Nurses; D009864:Ontario; D010348:Patient Care Team / Q000458:organization & administration*; D010595:Pharmacists; D010821:Physicians, Family; D011315:Preventive Medicine / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies