Compared Efficacy of Nurse-led and GP-led Geriatric Assessment in PrImary Care

NCT02664454 | Completed

• 1 other identifier: K140707
• Study Type: interventional
• Target: 750
• Locations: 1 country
• Sites: 1

Brief Summary

Older patients account for around 10% of the population, of which 57% have a long-term illness, and 33% were admitted in the past year. Geriatric assessment (GA) is a multidimensional assessment of general health status that can help identifying deficiencies and followed by a personalized care plan. Assessment and management of elderly patients is a daily concern for the general practitioner (GP) but conflicting results have been reported so far relating to the clinical impact of GA when applied in the primary care setting. This study protocol aims to assess the effect on morbi-mortality of a complex intervention in patients aged ≥70 years with chronic conditions in primary care. It aims to demonstrate that a GA adapted to primary care, followed by a personalized care plan and combined with successful interprofessional collaboration can improve clinically relevant outcomes in elderly patients with chronic conditions such as one-year overall mortality, unplanned hospital admission, emergency visits, or institutionalization. The CEPIA study will also help addressing the issue of whether an improved benefit could be achieved from a systematic nurse-led or a case-by-case GP-led GA.

Conditions

Multimorbidity; Geriatric Assessment

Keywords

Elderly; Health care organization; Primary care

Outcome Measures

Primary Outcomes (1)

• Primary composite endpoint combined with: - Percentage of all-cause mortality - Percentage of Unplanned hospital admission - Percentage of Emergency visits. - Percentage of Institutionalization

  At 12 months

Secondary Outcomes (13)

• Percentage of all-cause mortality

  At 12 months

• Percentage of Unplanned hospital admission

  At 12 months

• Percentage of Emergency visits

  At 12 months

• Percentage of Institutionalization

  At 12 months

• Quality of life (Duke profile score)

  At Day 0 and 12 months

Study Arms (3)

Systematic nurse-led GA

EXPERIMENTAL

Interactive educational seminar for GPs and nurses, and focused on geriatric assessment in primary care combined with Systematic nurse-led GA and dedicated hotline for GPs seeking geriatric advice

Other: health care organization

GP-led GA on a case-by-case basis, as decided by the GP

EXPERIMENTAL

Interactive educational seminar for GPs, and focused on Geriatric assessment in primary care combined with a GP-led GA on a case-by-case basis, as decided by the GP, and a dedicated hotline for GPs seeking geriatric advice

Other: health care organization

No intervention

NO INTERVENTION

No educational seminar Usual care

Interventions

health care organization OTHER

Nurse-led or GP-led Geriatric assessment combined with an educational seminar focused on GA and personalized care-plan as well as a dedicated hotline for general practitioners seeking a geriatric advice Interactive educational seminar Primary care

Also known as: Nurse-led or GP-led Geriatric assessment combined with an educational seminar

GP-led GA on a case-by-case basis, as decided by the GP; Systematic nurse-led GA

Eligibility Criteria

• Age: 70 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• Patients aged≥70 years with a long-term illness scheme or hospital admission the past 3 months
• Visiting their preferred general practioner (GP) or another GP in the same practice
• patient oral non opposition

You may not qualify if:

• Patient who does not speak French
• Severe disease with a life expectancy \<12 months
• Institutionalized patients
• Patient insured under the French national health insurance system

Sponsors & Collaborators

• Assistance Publique - Hôpitaux de Paris: lead

Study Sites (1)

Faculté de Médecine, Université Paris Est Créteil (UPEC)

Créteil, 94010, France

Location

Related Publications (10)

• Bouman A, van Rossum E, Nelemans P, Kempen GI, Knipschild P. Effects of intensive home visiting programs for older people with poor health status: a systematic review. BMC Health Serv Res. 2008 Apr 3;8:74. doi: 10.1186/1472-6963-8-74.

  PMID: 18387184 RESULT

• Kuo HK, Scandrett KG, Dave J, Mitchell SL. The influence of outpatient comprehensive geriatric assessment on survival: a meta-analysis. Arch Gerontol Geriatr. 2004 Nov-Dec;39(3):245-54. doi: 10.1016/j.archger.2004.03.009.

  PMID: 15381343 RESULT

• Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993 Oct 23;342(8878):1032-6. doi: 10.1016/0140-6736(93)92884-v.

  PMID: 8105269 RESULT

• Stuck AE, Egger M, Hammer A, Minder CE, Beck JC. Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. JAMA. 2002 Feb 27;287(8):1022-8. doi: 10.1001/jama.287.8.1022.

  PMID: 11866651 RESULT

• Frese T, Deutsch T, Keyser M, Sandholzer H. In-home preventive comprehensive geriatric assessment (CGA) reduces mortality--a randomized controlled trial. Arch Gerontol Geriatr. 2012 Nov-Dec;55(3):639-44. doi: 10.1016/j.archger.2012.06.012. Epub 2012 Jul 11.

  PMID: 22790107 RESULT

• Ellis G, Whitehead MA, O'Neill D, Langhorne P, Robinson D. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD006211. doi: 10.1002/14651858.CD006211.pub2.

  PMID: 21735403 RESULT

• Li CM, Chen CY, Li CY, Wang WD, Wu SC. The effectiveness of a comprehensive geriatric assessment intervention program for frailty in community-dwelling older people: a randomized, controlled trial. Arch Gerontol Geriatr. 2010 Feb;50 Suppl 1:S39-42. doi: 10.1016/S0167-4943(10)70011-X.

  PMID: 20171455 RESULT

• Orcel V, Ferrat E, Moscova L, Vigneron L, Michau B, Cittee J, Adeline F, Audureau E, Hagege M. Barriers to and facilitators of comprehensive geriatric assessment in primary care in France: a qualitative study exploring physicians' and nurses' experiences. BMC Prim Care. 2025 Dec 30;26(1):414. doi: 10.1186/s12875-025-03085-5.

  PMID: 41469541 DERIVED

• Orcel V, Banh L, Bastuji-Garin S, Renard V, Boutin E, Gouja A, Caillet P, Paillaud E, Audureau E, Ferrat E. Effectiveness of comprehensive geriatric assessment adapted to primary care when provided by a nurse or a general practitioner: the CEpiA cluster-randomised trial. BMC Med. 2024 Sep 27;22(1):414. doi: 10.1186/s12916-024-03613-7.

  PMID: 39334117 DERIVED

• Ferrat E, Bastuji-Garin S, Paillaud E, Caillet P, Clerc P, Moscova L, Gouja A, Renard V, Attali C, Breton JL, Audureau E. Efficacy of nurse-led and general practitioner-led comprehensive geriatric assessment in primary care: protocol of a pragmatic three-arm cluster randomised controlled trial (CEpiA study). BMJ Open. 2018 Apr 12;8(4):e020597. doi: 10.1136/bmjopen-2017-020597.

  PMID: 29654038 DERIVED

Study Officials

• Emilie Ferrat, MCU-MG

  Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit)

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 22, 2016
• First Posted: January 27, 2016
• Study Start: May 24, 2016
• Primary Completion: August 24, 2018
• Study Completion: August 24, 2018
• Last Updated: May 16, 2024

Record last verified: 2024-05

Locations

FR (1)