Project Summary 

Primary Care Services are the cornerstones for the system of the future.  Our vision was to extend a Family Health Network (FHN) into the home setting.  The Anticipatory and Preventative Team Care Study (APTCare) tested a new model of integrated service delivery for at-risk frail elderly patients: patients who had multiple chronic illnesses and required a more intensive level of care than the average patient.  The goal of the study was to deliver improved preventative and anticipatory care to these patients while still maintaining cost effectiveness.  To accomplish this, the project incorporated a telehealth monitoring component and a new role for NPs and pharmacists.

For more information contact:

aptcare@bruyere.org

Goals/objectives

The goal of the APTCare project was to demonstrate that APTCare (a multidisciplinary care model in which a nurse practitioner and a pharmacist are integrated into a family physician team) is an effective approach in the management of at-risk patients.  The principal objective of the study was to evaluate the impact of APTCare on the quality of care (QOC) for a population of at-risk patients with chronic diseases.  QOC scores were calculated for patients with any of the following four chronic conditions: Coronary artery disease (CAD), diabetes, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD) .

Secondary outcomes were also collected and included quality of life measures (SF-36), self perceived quality of life (HRQoL), activities of daily living (IADL), medication appropriateness (MAI), caregiver burden, prevention manoeuvres and emergency department and hospitalization data.

Qualitative and descriptive data was also gathered to:

(1) evaluate the acceptability of APTCare to patients, caregivers and care providers;

(2) identify the process of collaboration between care providers; and

(3) to document the processes undertaken in the study.

The telehealth component of the study was evaluated using patient and caregiver semi-structured in-depth interviews and surveys at the mid-point of the study; care provider surveys, focus groups and in-depth interviews; and a survey conducted per patient with the associate responsible for installation and support of the telehealth equipment. 

Phases / timeline

Phase I (April 2004 - October 2004) – Establish research team, develop intervention, recruit Nurse Practitioners and Pharmacist.  Train NPs in geriatric assessment and assist team in collaborative models.  Finalize data collection instruments.  Establish partnership with West Carleton Family Health Network.  Educate FHN physicians and staff about project, intervention and collaboration.

Phase II (November 2004 - March 2006) – Trial commences with recruitment of at risk patients.  Collection of baseline data and randomization of patients.  Geriatric assessment and care plan development.  Ongoing intervention by NPs and Pharmacist.

Phase III (March 2006) – Completion of study. 

Phase IV (March 2006 - July 2006) – Data analysis, dissemination and completion of project.

Funding body and amount

This project was funded by the Ontario Ministry of Health and Long-Term Care, Primary Health Care Transition Fund in the amount of $1,383,957.

Research questions

To determine whether incorporating nurse practitioners and a pharmacist into a primary care team targeted at patients with chronic diseases:

1. Improves the quality of care in these patients;

2. Improves the functional status and quality of life of these patients;

3. Is satisfactory to patients;

4. Is an acceptable collaborative model to health care providers;

5. Is cost-effective.

Methodology

• Randomized controlled trial of patients 50 years and older with chronic disease and at risk of requiring an emergency room visit.  Eligible patients are randomly allocated to the APTCare intervention or standard care provided by their family physician and practice nurse.
• Two hundred and forty-one patients were recruited and followed until the March 2006. 

Outcome and Key Results

• Being an APTCare patient was found to increase Quality of Care by approximately 10%.
• The patients in the intervention arm received more preventive manoeuvres, especially screening for colorectal cancer, hearing exam and eye exam, than those in the control arm.
• Patient perceived quality of life and health status were similar for both the intervention and control arm.
• The proportion of patients with ER visits and hospital admissions were similar for both arms.

Collaborators

West Carleton Family Health Network, Carp ON

119 Langstaff Dr.

Carp, ON  K0A 1L0

Tel.: 613-839-3271

Dr. William Hogg, Director, C.T. Lamont Centre

 
Dr. Jacques Lemelin, Professor & Chair of Research Committee, University of Ottawa Department of Family Medicine

Co-Investigators