Table 7 Results from RCTs and controlled studies
From: A systematic review of integrated working between care homes and health care services
Study ID | Outcome | Main results at follow up (+) = positive effect, (-) = negative effect, (0) = no significant effect |
|---|---|---|
Crotty 2004 RCT | Appropriate prescribing (medication appropriateness index) | Follow up at 3 months (NB - two control groups - one external and one within the facility (results presented for external control grp only)) |
| Â | Â | Change MAI score (+) Mean score (95% CI)Intervention 4.10 (2.11-6.10), Control 0.41 (-0.42-1.23), Difference p = 0.004 |
| Â | Nursing home behaviour problem | Change NHBPS (0), Mean score (95% CI)Intervention 3.9 (-2.7-10.5), Control 1.2 (-9.1-11.6), P = 0.440 |
| Â | Mortality | Mortality (0) No differences between groups (p = 0.304) |
Goodman 2007 (non randomised controlled study) | Bowel related problems | Follow up at 6 months Normal bowel patterns (+) Intervention - significant increase in normal bowel patters, control grp - little change |
| Â | Medication and continence related product use | Prescription of laxatives (0) Increase in both groups but no statistically significant differences between groups p = 0.159 |
| Â | Dependency (Barthel index) | Dependency (+) Mean change score p = 0.002 Intervention -0.02 (SD 3.1), Control -1.84 (SD 3.7) |
| Â | Bowel related hospital admission | 1 admission in intervention grp, none in control (n = 120) |
King 2001 (non randomised controlled study) | Â | Follow up at 1 month. Data collected on 184 residents (75 reviewed, 109 not reviewed). |
| Â | Medication prescribed | Changes in medication prescribed - mean (SD) (0) Intervention -0.35 (2.56), Control -0.03 (1.90) P = 0.37 |
| Â | Medication administered | Changes in medication administered - mean (SD) (0) Intervention -0.44 (2.45), Control 0.12 (1.84), P = 0.16 |
| Â | Weekly Cost ($) - authors say study underpowered for this outcome | Weekly cost (0) Intervention -0.29 (10.80), Control 0.43 (12.16), P = 0.75 |
| Â | Mortality (adjusted for length of time in home) | Mortality (0) Adjusted mortality data showed 6% of reviewed residents died compared to 15% of those not reviewed p = 0.07 |
Kane 2004 (controlled study) - evaluating EverCare | Â | Follow up at 18 months 2 control groups a) other residents in same homes not enrolled in Evercare b) residents in homes in same geographical area that did not participate n Evercare Assessments at 6,12, 18 months (within 30 days) |
| Â | Mortality | Mortality Evercare rate significantly less than for control-in group but was slightly higher than control-out group (non significant) |
| Â | Preventable hospitalizations | Rates of preventable admissions lower in Evercare than for either control but only significant when compared to control-out. No differences in hospitalization rates overall. (0) |
| Â | Functional change | No significant differences in ADLs between Evercare and either control. (0) |
Llewellyn-Jones 1999 RCT | Geriatric depression scale (score of ≥ 10 defined as depressed) | Follow up after 9.5 months Depression Unadjusted MD (0) -0.76 (-2.09, 0.57) |
| Â | Â | Adjusted difference in change score (+) Multiple linear regression analysis Intervention group 1.87 improvement on scale compared to control group (95% CI 0.76, 2.97) p = 0.0011 |
Opie 2002 RCT (poor study design) | Frequency & severity of disruptive behaviours (Behaviour Assessment Graphical System and counts of certain behaviours) | Follow up at one month Frequency of disruptive behaviour (0) ANOVA revealed no statistically significant changes BAGS scores (0) No significant between group differences |
| Â | Assessment of change by senior nursing home staff - rated on 4 point scale(interviewed one month after completion of trial) | Assessment by staff No data reported on between group differences. Staff reported that the frequency of target behaviours had decreased in at least one behavioural category for 75% residents and that severity had decreased in at least one category for 60%. |
Schmidt 1998 RCT | Proportion of pts with any psychotropic drug (from lists of residents prescriptions) | Follow up at 12 months Any psychotropic drug use (0) RR 0.97 (95% CI 0.92, 1.03) |
Involves pharmacists | Proportion of residents with two or more drug classes (polymedicine) | Two or more drug classes (0) RR 1.02 (0.92, 1.13) |
| Â | Proportion of residents with therapeutic duplication (two or more drugs in same class) | Two or more drugs in same class RR 0.92 (0.76, 1.10) |
| Â | Number of drugs prescribed | Number of drugs prescribed (mean) 2.08% versus 2.20% Significant increase in average number of drugs prescribed in control before to after. No change in experimental homes. |
| Â | Proportion of residents with non recommended drugs (as defined by Swedish guidelines) | Non recommended hypnotics (+) RR 0.45 (0.35, 0.58) Non recommended anxiolytics (0) RR 0.96 (0.79, 1.16) Non recommended antidepressant (0) RR 0.67 (0.44, 1.03) Acceptable hypnotics (+) RR 1.46 (1.13, 1.89) |
| Â | Proportion of residents with acceptable drugs (as defined by Swedish guidelines) | Acceptable anxiolytics (0) RR 1.19 (0.97, 1.45) Acceptable antidepressant (-) RR 1.34 (1.07, 1.68) |
Vu 2007 (Pseudo RCT) | Percentage healed | Follow up at 20 weeks Healed (0) - but baseline wound severity greater in intervention group Intervention 61.7%, control 52.5% p = 0.074 |
Involves pharmacists | Mean time to healing | Time to healing (mean days) (0) Intervention 82.0 (69.1-94.9), Control 101.1 (84.5-117.6), P = 0.095 |
| Â | Total pain relief (Brief pain inventory) | Pain relief - BPI score = 0 (+) Intervention 38.6%, control 24.4% p = 0.017 |
| Â | Costs | Mean treatment costs (+) Reduction in mean treatment costs of 357.7 Australian dollars when training costs included p = 0.004 |