Impact of MidMed, a general practitioner-led modified comprehensive geriatric assessment for patients with frailty

Helen E Jones; Atul Anand; Iain Morrison; Simon Hurding; Sarah H Wild; Stewart W Mercer; Susan D Shenkin

doi:10.1093/ageing/afad006

Impact of MidMed, a general practitioner-led modified comprehensive geriatric assessment for patients with frailty

Age Ageing. 2023 Mar 1;52(3):afad006. doi: 10.1093/ageing/afad006.

Authors

Helen E Jones¹, Atul Anand^{2

3}, Iain Morrison⁴, Simon Hurding⁴, Sarah H Wild⁵, Stewart W Mercer^{5

6}, Susan D Shenkin^{6

3}

Affiliations

¹ NHS Lothian, Scotland, UK.
² Centre for Cardiovascular Science, University of Edinburgh, Scotland, UK.
³ Ageing and Health Research Group, Usher Institute, University of Edinburgh, Scotland, UK.
⁴ Newbattle Medical Practice, Dalkeith, Scotland, UK.
⁵ Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Scotland, UK.
⁶ Advanced Care Research Centre, Usher Institute University of Edinburgh, Scotland, UK.

Abstract

Introduction: the identification and management of frailty occurs mostly in primary care. Several different models of care exist. This study aimed to assess the impact of a new General Practitioner (GP)-led modified Comprehensive Geriatric Assessment (CGA) on service delivery, healthcare utilisation and patient outcomes.

Method: patients with moderate-severe frailty (electronic Frailty Index score > 0.24) in Newbattle Medical Practice, Scotland, were eligible for a novel intervention (MidMed) in which an additional GP performed a modified CGA and was directly accessible for appointments. The recruits to the intervention (MidMed) group were compared with those waiting to be enrolled (non-MidMed). Outcomes included unscheduled hospital admissions, primary care consultations, continuity of care (Usual Provider of Care (UPC) index), outpatient attendances and mortality. Adjusted rate ratios (aRR), for MidMed compared to non-MidMed, were estimated using regression models adjusting for demographics and healthcare utilisation histories.

Results: 510 patients were included: 290 MidMed (mean(SD) age 80.1(7.6)years; 59.6% female) and 220 non-MidMed (75.4(8.6)years; 57.7% female). Median follow-up was 396 days. aRR(95%CI) was 0.46(0.30-0.71) for >1 admission, 0.62(0.41-0.95) >1 Emergency Department (ED) attendance and 1.52(1.30-1.75) for use of primary care, with no difference in outpatient appointments or mortality. Continuity of care was better for the MidMed group (MidMed UPC 0.77(SD 0.19), non-MidMed 0.41(0.18), P < 0.001).

Conclusion: this GP-led service for frail patients was associated with lower risk of hospital readmission/ED reattendance, greater use of primary care and improved continuity of care. More detailed evaluation of novel primary care frailty services, over longer time-periods, including robust randomised controlled trials, are needed.

Keywords: Comprehensive Geriatric Assessment (CGA); frailty; general practice; older people.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Emergency Service, Hospital
Female
Frailty* / diagnosis
Frailty* / therapy
General Practitioners*
Geriatric Assessment
Hospitalization
Humans
Male
Patient Readmission