Transforming primary care for older Canadians living with frailty: mixed methods study protocol for a complex primary care intervention

• Published in: BMJ open Vol. 11; no. 5; p. e042911
• Main Authors: Stolee, Paul, Elliott, Jacobi, Giguere, Anik MC, Mallinson, Sara, Rockwood, Kenneth, Sims Gould, Joanie, Baker, Ross, Boscart, Veronique, Burns, Catherine, Byrne, Kerry, Carson, Judith, Cook, Richard J, Costa, Andrew P, Giosa, Justine, Grindrod, Kelly, Hajizadeh, Mohammad, Hanson, Heather M, Hastings, Stephanie, Heckman, George, Holroyd-Leduc, Jayna, Isaranuwatchai, Wanrudee, Kuspinar, Ayse, Meyer, Samantha, McMurray, Josephine, Puchyr, Phyllis, Puchyr, Peter, Theou, Olga, Witteman, Holly
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 13.05.2021; BMJ Publishing Group
• Series: Protocol
• Subjects: Aged; Aged, 80 and over; Aging; Canada; Caregivers; Clinical decision making; Continuity of care; Data collection; Decision making; Frailty; Frailty - therapy; Geriatric Medicine; Humans; Intervention; Mixed methods research; Older people; Patient Participation; Patients; Primary care; Primary Health Care; Provinces; Quality of Life; Canada; primary care; geriatric medicine; health services administration & management
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-042911

IntroductionOlder Canadians living with frailty are high users of healthcare services; however, the healthcare system is not well designed to meet the complex needs of many older adults. Older persons look to their primary care practitioners to assess their needs and coordinate their care. They may need care from a variety of providers and services, but often this care is not well coordinated. Older adults and their family caregivers are the experts in their own needs and preferences, but often do not have a chance to participate fully in treatment decisions or care planning. As a result, older adults may have health problems that are not properly assessed, managed or treated, resulting in poorer health outcomes and higher economic and social costs. We will be implementing enhanced primary healthcare approaches for older patients, including risk screening, patient engagement and shared decision making and care coordination. These interventions will be tailored to the needs and circumstances of the primary care study sites. In this article, we describe our study protocol for implementing and testing these approaches.Methods and analysisNine primary care sites in three Canadian provinces will participate in a multi-phase mixed methods study. In phase 1, baseline information will be collected through questionnaires and interviews with patients and healthcare providers (HCPs). In phase 2, HCPs and patients will be consulted to tailor the evidence-based interventions to site-specific needs and circumstances. In phase 3, sites will implement the tailored care model. Evaluation of the care model will include measures of patient and provider experience, a quality of life measure, qualitative interviews and economic evaluation.Ethics and disseminationThis study has received ethics clearance from the host academic institutions: University of Calgary (REB17-0617), University of Waterloo (ORE#22446) and Université Laval (#MP-13-2019-1500 and 2017-2018-12-MP). Results will be disseminated through traditional means, including peer-reviewed publications and conferences and through an extensive network of knowledge user partners.Trial registration numberNCT03442426;Pre-results.