Effectiveness of a health and social care integration programme for home-dwelling frail older persons in Argentina

Abstract

Introduction The evidence of effectiveness of integrated care initiatives for home-dwelling frail older persons is still inconclusive. There is a need for more studies, especially in developing countries. Our objective was to assess the effectiveness of a health and social care integration programme versus the best standard of care to date in this population. Methods Quasi-experimental study performed in patients' homes in Buenos Aires, Argentina. The intervention arm had a health and social care counsellor that systematically reviewed the social and biological situation following a structured process, evaluating: functionality, nutrition, mobility, pain, cognition, medication reconciliation and adherence, need for care, quality of care, and environmental safety. The control group received the best standard of care to date, with access to the same health or social care services, but without the counsellor and related processes. The main outcome was the adjusted hazard ratio for hospitalizations after one year using a Cox-proportional hazards model. Results We recruited 121 persons in each group. The crude hazard ratio for hospital admissions, comparing the intervention to the control group was 0.622 (95% CI: 0.427–0.904; p = 0.013). The adjusted hazard ratio (aHR) was 0.503 (95% CI: 0.340–0.746; p = 0.001). The aHR for death was 0.993 (95% CI: 0.492–2.002; p = 0.984). The absolute difference in the quality of life was 16.59 points (95% CI: 12.03–21.14; p < 0.001). Discussion The integration programme had lower hospital admissions and better quality of life than the usual care. There was no significant difference in death rates.

How can we define social care and what are the levels of true integration in integrated care? A narrative review

“…The top 3 countries reporting health and social care initiatives in the literature are the UK ( n = 13), followed by the USA ( n = 7) and the Netherlands ( n = 4). Studies focussed on providing social care for older adults ( n = 13) (Terracciano et al ., 2021; Aredes et al ., 2021; Pruitt et al ., 2018; Perman et al ., 2021; Mateo-Abad et al ., 2020; Vestjens et al ., 2019; Spoorenberg et al ., 2019; Elston et al ., 2019; Wong et al ., 2020; Sadarangani et al ., 2019; Tong et al ., 2020; Doheny et al ., 2020; Janse et al ., 2016), followed by initiatives targeting social care for multimorbidity ( n = 14) (Melvin and Gipson, 2019; Collins et al ., 2017; Moretti, 2017; Davenport, 2021; Zarnegar et al ., 2017; Eastwood et al ., 2019; Talbot et al ., 2020; de Vries McClintock et al ., 2016; Ismail et al ., 2020; White et al ., 2021) and corresponding social needs (Aboutanos et al ., 2019; Cammy, 2017; Van Dijk et al ., 2016; Pauley et al ., 2016), initiatives addressing fragmentation of systems more broadly ( n = 3) (Bussu and Marshall, 2020; Murphy et al ., 2017; Alexander et al ., 2018) and initiatives aimed at community outreach in the context of integrated care ( n = 3) (Moon et al ., 2021; Chng et al ., 2021; Sohanpal et al ., 2017).…”

“…Key characteristics of “social care” within this category of initiatives include social care assessments and personalised plans to target older adults' social needs. Six initiatives (Perman et al ., 2021; Terracciano et al ., 2021; Aredes et al ., 2021; Vestjens et al ., 2019; Doheny et al ., 2020; Janse et al ., 2016) provided practical support (e.g. paid carers, home carers, home nurse and domestic helpers) and home space adaptation as part of their social care package.…”

“…Key characteristics of "social care" within this category of initiatives include social care assessments and personalised plans to target older adults' social needs. Six initiatives (Perman et al, 2021;Terracciano et al, 2021;Aredes et al, 2021;Vestjens et al, 2019; Social care targeting multimorbidity and corresponding social risks factors. In total, 14 selected initiatives aimed at targeting health and social multimorbidity and corresponding risk factors (n 5 14).…”

“…Of the 33 initiatives reported in the reviewed literature, 11 were jointly led, by either a combination of tertiary education (universities and research centres) organisations and primary health networks or public health systems (hospitals and community/day health centres) and/or non-for-profit organisations (Terracciano et al ., 2021; Moretti, 2017; Bussu and Marshall, 2020; Van Dijk et al ., 2016; Spoorenberg et al ., 2019; Ismail et al ., 2020; White et al ., 2021; Aboutanos et al ., 2019; Zarnegar et al ., 2017; Sohanpal et al ., 2017; Alexander et al ., 2018). In total, 20 initiatives were led by primary health network or hospital systems (Aredes et al ., 2021; Pruitt et al ., 2018; Collins et al ., 2017; Davenport, 2021; Perman et al ., 2021; Moon et al ., 2021; Mateo-Abad et al ., 2020; Eastwood et al ., 2020; de Vries McClintock et al ., 2016; Talbot et al ., 2020; Vestjens et al ., 2019; Elston et al ., 2019; Melvin and Gipson, 2019; Wong et al ., 2020; Sadarangani et al ., 2019; Tong et al ., 2020; Doheny et al ., 2020; Chng et al ., 2021; Janse et al ., 2016; Murphy et al ., 2017), and only one initiative did not report a leading organisation/s (Pauley et al ., 2016).…”

“…In total, 27 initiatives reporting having health and social care staff integrated in practice, with a strong role description and mapping, along with clear integrated governance (Aredes et al ., 2021; Terracciano et al ., 2021; Pruitt et al ., 2018; Cammy, 2017; Moretti, 2017; Bussu and Marshall, 2020; Perman et al ., 2021; Pauley et al ., 2016; Moon et al ., 2021; Mateo-Abad et al ., 2020; Eastwood et al ., 2020; Talbot et al ., 2020; Vestjens et al ., 2019; Spoorenberg et al ., 2019; Elston et al ., 2019; Ismail et al ., 2020; Wong et al ., 2020; Sadarangani et al ., 2019; Tong et al ., 2020; Doheny et al ., 2020; White et al ., 2021; Aboutanos et al ., 2019; Chng et al ., 2021; Janse et al ., 2016; Murphy et al ., 2017; Sohanpal et al ., 2017; Alexander et al ., 2018).…”