Researchers trial groundbreaking primary care programme for older adults

A study led by McMaster University researchers found a primary care programme promoting the health of older adults was well received but lacked clinical benefits.

The research, which was published in the journal Annals of Family Medicine yesterday, focused on the findings which came from running the primary care programme, known as the Health Teams Advancing Patient Experience: Strengthening Quality (TAPESTRY), at six sites across Ontario from March 2018 to August 2019.

Designed to provide care to patients by using technology and sharing patients data, the programme’s trial recruited 599 patients aged 70 years and older. 

The first study that trialled the scheme, which took place in Hamilton, Ontario, found that patients who participated in the intervention walked more, had fewer hospitalisations, and saw their primary care team more often.

However, the study showed no significant differences for the primary health outcomes between patients receiving Health TAPESTRY compared to those receiving usual care. The program did not impact the number of hospitalisations or total physical activity. 

Commenting on this, Doug Oliver, Professor of the Department of Family Medicine and implementation lead of Health TAPESTRY, said: ‘In research, a randomised trial occurs in a tightly controlled manner, then if successful, is implemented flexibly according to local context and it is assumed that a randomised controlled trails (RCT) effectiveness is reproduced.

‘But this flexibility may lead to a dilution of effects when the approach is translated into practice.’

Additionally, David Price, Executive lead of Health TAPESTRY said: ‘Even though the six sites implemented the programme as intended, local contextual differences, such as patient populations, health care team characteristics, clinic workflow, and integration with other levels of the health care system likely led to the varying effectiveness of Health TAPESTRY.’

Authors of the study echo that the findings do not invalidate the initial RCT results, but rather highlight a real-world tension between proving efficacy in a controlled context and achieving scale-up as part of effective routine care.

Researchers note that the results reinforce the importance of trials conducted under less-controlled conditions and raise questions about future methods and limitations to such complex research in primary care settings.

Image: CDC