• Franca G H Ruikes, Sytse U Zuidema, Reinier P Akkermans, Willem J J Assendelft, Henk J Schers, and Raymond T C M Koopmans.
• From the Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen (FGHR, RPA, WJJA, HJS, RTCMK); the Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen (SUZ); and the Joachim and Anna Centre for Specialized Geriatric Care, Nijmegen, the Netherlands (RTCMK). Franca.Ruikes@Radboudumc.nl.
• J Am Board Fam Med. 2016 Mar 1; 29 (2): 209-17.

BackgroundThe increasing number of community-dwelling frail elderly people poses a challenge to general practice. We evaluated the effectiveness of a general practitioner-led extensive, multicomponent program integrating cure, care, and welfare for the prevention of functional decline.MethodsWe performed a cluster controlled trial in 12 general practices in Nijmegen, the Netherlands. Community-dwelling frail elderly people aged ≥70 years were identified with the EASY-Care two-step older persons screening instrument. In 6 general practices, 287 frail elderly received care according to the CareWell primary care program. This consisted of proactive care planning, case management, medication reviews, and multidisciplinary team meetings with a general practitioner, practice and/or community nurse, elderly care physician, and social worker. In another 6 general practices, 249 participants received care as usual. The primary outcome was independence in functioning during (instrumental) activities of daily living (Katz-15 index). Secondary outcomes were quality of life [EuroQol (EQ5D+C) instrument], mental health and health-related social functioning (36-item RAND Short Form survey instrument), institutionalization, hospitalization, and mortality. Outcomes were assessed at baseline and at 12 months, and were analyzed with linear mixed-model analyses.ResultsA total of 204 participants (71.1%) in the intervention group and 165 participants (66.3%) in the control group completed the study. No differences between groups regarding independence in functioning and secondary outcomes were found.ConclusionWe found no evidence for the effectiveness of a multifaceted integrated care program in the prevention of adverse outcomes in community-dwelling frail elderly people. Large-scale implementation of this program is not advocated.© Copyright 2016 by the American Board of Family Medicine.

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