Comprehensive geriatric assessment delivered by advanced nursing practitioners within primary care setting: a mixed-methods pilot feasibility randomised controlled trial

Journal article


Safari, R., Jackson, J. and Boole, L. 2023. Comprehensive geriatric assessment delivered by advanced nursing practitioners within primary care setting: a mixed-methods pilot feasibility randomised controlled trial. BMC Geriatrics . 23 (513), pp. 1-14. https://doi.org/10.1186/s12877-023-04218-0
AuthorsSafari, R., Jackson, J. and Boole, L.
Abstract

Background
Comprehensive Geriatric Assessment (CGA)is a widely accepted intervention for frailty and can be cost-effective within a primary care setting.

Objective
To explore the feasibility of identifying older adults with frailty and assess the subsequent implementation of a tailored CGA with care and support plan by Advanced Nursing Practitioners (ANPs).

Methods
A mixed-method parallel randomised controlled trial was conducted. Participants were recruited from two General Practice (GP) centres between January and June 2019. Older adults with confirmed frailty, as assessed by practice nurses, were randomised, using a web service, to the intervention or treatment-as-usual (TAU) groups for six months with an interim and a final review. Data were collected on feasibility, health service usage, function, quality of life, loneliness, and participants' experience and perception of the intervention. Non-parametric tests were used to analyse within and between-group differences. P-values were adjusted to account for type I error. Thematic analysis of qualitative data was conducted.

Results
One hundred sixty four older adults were invited to participate, of which 44.5% (n = 72) were randomised to either the TAU (n = 37) or intervention (n = 35) groups. All participants in the intervention group were given the baseline, interim and final reviews. Eight participants in each group were lost to post-intervention outcome assessment. The health service use (i.e. hospital admissions, GP/emergency calls and GP/Accident Emergency attendance) was slightly higher in the TAU group; however, none of the outcome data showed statistical significance between-group differences. The TAU group showed a deterioration in the total functional independence and its motor and cognition components post-intervention (p < .05), though the role limitation due to physical function and pain outcomes improved (p < .05). The qualitative findings indicate that participants appreciated the consistency of care provided by ANPs, experienced positive therapeutic relationship and were connected to wider services.

Discussion
Frailty identification and intervention delivery in the community by ANPs were feasible. The study shows that older adults with frailty living in the community might benefit from intervention delivered by ANPs. It is suggested to examine the cost-effectiveness of the intervention in sufficiently powered future research.

Trial registrations
The protocol is available at clinicaltirals.gov, ID: NCT03394534; 09/01/2018.

Keywordsgeriatric assessment; advanced nursing practitioners; primary care
Year2023
JournalBMC Geriatrics
Journal citation23 (513), pp. 1-14
PublisherBMC (Springer Nature)
ISSN 1471-2318
Digital Object Identifier (DOI)https://doi.org/10.1186/s12877-023-04218-0
Web address (URL)https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-023-04218-0
Output statusPublished
Publication dates
Online24 Aug 2023
Publication process dates
Deposited31 Aug 2023
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https://repository.derby.ac.uk/item/q04wx/comprehensive-geriatric-assessment-delivered-by-advanced-nursing-practitioners-within-primary-care-setting-a-mixed-methods-pilot-feasibility-randomised-controlled-trial

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