Should care managers for older adults be located in primary care? A randomized controlled trial.

ABSTRACT

OBJECTIVES: To determine the effect of a primary care-based care management initiative on residential care placement and death in a population of frail older adults referred for needs assessment in New Zealand. DESIGN: Randomized controlled trial with follow-up at 3, 6, 12, 18, and 24 months for residential care placement and mortality. SETTING: Fifty-five family physician practices in New Zealand that established a care management initiative for older adults assessed as being at high risk of residential care placement in 2004 to 2006. PARTICIPANTS: Three hundred fifty-one individuals (243 female, 108 male) aged 65 and older (mean 81) who were assessed as being at risk of permanent residential care placement. INTERVENTIONS: The care management program (Coordinator of Services for Elderly) consisted of a nominated health professional care manager geographically aligned to family physicians housed with the family physician or located nearby. MEASUREMENTS Rates of permanent residential care placement and mortality. RESULTS: The risk of permanent residential care placement or death was 0.36 for usual care (control group) and 0.26 for the care management initiative, a 10.2% absolute risk reduction, with the majority of the risk reduction seen in residential care placement (control group 0.25, intervention group 0.16). CONCLUSION: A family physician-aligned community care management approach reduces frail older adults' risk of mortality and permanent residential care placement.