Effectiveness of a Geriatric Care Model for frail older adults in primary care: Results from a stepped wedge cluster randomized trial

• Primary care-based comprehensive care may improve outcomes in frail older adults.
• We investigated effects of the Geriatric Care Model (GCM) on quality of life and other outcomes.
• The GCM combines tailored care based on geriatric assessments with management by geriatric expert teams.
• We found no significant differences between the intervention group and usual care.
• The GCM adds very little to usual primary care for this population.

BackgroundPrimary care-based comprehensive care programs have the potential to improve outcomes in frail older adults. We evaluated the impact of the Geriatric Care Model (GCM) on the quality of life of community-dwelling frail older adults.MethodsA 24-month stepped wedge cluster randomized controlled trial was conducted between May 2010 and March 2013 in 35 primary care practices in the Netherlands, and included 1147 frail older adults. The intervention consisted of a geriatric in-home assessment by a practice nurse, followed by a tailored care plan. Reassessment occurred every six months. Nurses worked together with primary care physicians and were supervised and trained by geriatric expert teams. Complex patients were reviewed in multidisciplinary consultations. The primary outcome was quality of life (SF-12). Secondary outcomes were health-related quality of life, functional limitations, self-rated health, psychological wellbeing, social functioning and hospitalizations.ResultsIntention-to-treat analyses based on multilevel modeling showed no significant differences between the intervention group and usual care regarding SF-12 and most secondary outcomes. Only for IADL limitations we found a small intervention effect in patients who received the intervention for 18 months (B = − 0.25, 95%CI = − 0.43 to − 0.06, p = 0.007), but this effect was not statistically significant after correction for multiple comparisons.ConclusionThe GCM did not show beneficial effects on quality of life in frail older adults in primary care, compared to usual care. This study strengthens the idea that comprehensive care programs add very little to usual primary care for this population.Trial registrationThe Netherlands National Trial Register NTR2160.