Transforming primary health care for frail elderly Canadians
This project, with support from researchers, collaborators, health care providers and older adults from across Canada, worked to transform primary health care for older Canadian adults living with frailty.
About the Project
Improving the health of older Canadians means identifying health problems early. It means providing timely support so that manageable concerns do not spiral out of control. And, above all, it means helping health care providers actively engage older patients and their family caregivers as partners in care. Patients want to make informed choices about their health and the care they receive, based on their personal values, preferences and goals, and informed by available evidence.
Nine primary care clinics in three provinces (Québec, Ontario, Alberta) used a quick screening tool to identify older patients who are at risk of becoming frail. This helped initiate referral to health care or support services where necessary. Innovative technology was used to streamline the referral process and help assist older adults in decision-making about their care.
The project team worked in partnership with a number of stakeholders including older adults, health care providers, health administrators and policy makers.
Please see below for more details on the project rationale, hypothesis and research design, as well as implementation resources.
Paul Stolee, PhD — University of Waterloo
Anik Giguère, PhD — Université Laval
Sara Mallinson, PhD — University of Calgary
Kenneth Rockwood, MD, FRCPC, FRCP — Nova Scotia Health Authority
Joanie Sims-Gould, PhD, BSc, MSW — University of British Columbia
G. Ross Baker, PhD — University of Toronto
Veronique Boscart, PhD — Conestoga College
Catherine Burns, PhD — University of Waterloo
Kerry Byrne, PhD — University of Waterloo
Andrew Costa, PhD — McMaster University
Jacobi Elliott, PhD — University of Waterloo
Dorothy Forbes, PhD — University of Alberta
Justine Giosa, MSc — University of Waterloo
Kelly Grindrod, PhD — University of Waterloo
Mohammad Hajizadeh, PhD — Dalhousie University
Heather Hanson, PhD — Alberta Health Services
George Heckman, MD — University of Waterloo
Jayna Holroyd-Leduc, PhD — University of Calgary
Wanrudee Isaranuwatchai, PhD — University of Toronto
Lucille Juneau — CEVQ
Edeltraut Kröger, PhD — CEVQ
Ayse Kuspinar, PhD — University of Waterloo
Samantha Meyer, PhD — University of Waterloo
Josephine McMurray, PhD — Wilfrid Laurier University
Marie-Josée Sirois, PhD — Université Laval
Olga Theou, PhD — Dalhousie University
Holly Witteman, PhD — Université Laval
Knowledge Users and Partners:
Céline Allard — CIUSSS
Carol Anderson — Continuing Care/Alberta Health Services
Carol Annett — VHA Home Healthcare
Jacques Bouchard — CIUSSS
Seigrid Deutschlander, PhD — Alberta Health Services
Nancy Drouin — CIUSSS
France Falardeau — CIUSSS
Susie Gregg, OT — CMHA
Sharon Harper — Health Canada
David Harvey, MSc — Alzheimer Society Ontario
Nadine Henningsen — Canadian Home Care Association
Michael Hillmer, PhD — Ontario Ministry of Health and Long-Term Care
Kenneth LeClair, MD — brainXchange
Christine Maika — Canadian Foundation for Healthcare Improvement
Duncan Robertson, MD — Alberta Health Services
Project Contact: Dr. Paul Stolee — firstname.lastname@example.org
Rationale: It is well known that older Canadians are high users of health care services. What is less well known is that the health care system is not well-designed to meet the needs of those who use it most. Older persons look to their primary care practitioners to assess their needs and coordinate their care. Unfortunately, the health concerns of older persons are often missed in too-short office visits. They may need care from a variety of providers and services, but this care is often not well coordinated. Older persons and their 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, they may have health problems that are not properly assessed, managed or treated resulting in poorer health and preventable and expensive emergency department visits and hospital stays.
Research Question and Hypothesis: Compared to usual care in primary care settings, does our proposed model improve health, social and economic outcomes for frail and at-risk older Canadians (aged 70+)? We hypothesize that older adults will benefit from screening, active engagement in care planning, and appropriate referrals to services earlier in their care trajectories. In addition to improving health outcomes and quality of life for patients, more proactive interventions can reduce costly emergency department visits and unplanned hospital admissions.
Research Design: Our project required active participation of health care providers, patients and caregivers. Within a quasi-experimental control group design, we utilized a mixed-methods approach. Our project was divided into the three phases following Sidani and Braden’s (2011) recommendations for complex health interventions: Phase 1) Tailoring the intervention; Phase 2) Implementing the intervention; and, Phase 3) Evaluating the intervention (each described in greater detail later in this section). Both qualitative (interviews, focus groups) and quantitative data (surveys) were collected and analyzed using appropriate methods.