Anticipatory & Preventive Team Care (APTCare): At Risk Patients of Family Health Networks
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ClinicalTrials.gov Identifier: NCT00238836
Recruitment Status : Unknown
Verified June 2005 by C. T. Lamont Primary Care Research Centre. Recruitment status was: Active, not recruiting
The University of Ottawa and Élisabeth Bruyère Research Institute are conducting a study of preventive care for frail patients at risk of functional decline. At risk patients are assigned by chance to continue receiving their standard care from their family physician or receive additional care from a nurse practitioners and a pharmacist. In collaboration with the family physician, they develop an individualized care plan, a treatment and management road plan, for each patient, which they implement over the study period of one approximately year. The objective of the study is to compare the effectiveness of the model of care that includes the nurse practitioners and pharmacist against standard care in preventing functional decline, to determine the acceptability of this model of care to patients, their caregivers and the medical team, and to evaluate the cost implication of the program.
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Ages Eligible for Study:
50 Years and older (Adult, Senior)
Sexes Eligible for Study:
Accepts Healthy Volunteers:
50 years and over
'At Risk' by having one or more of the following: a. Visits to emergency dept within the past 6 months; b. Admission to hospital for a medical problem in past 6 months; c. High service use profiles; d. Polypharmacy; e. Other high risk factors
Capable of giving informed consent
Able to use the Care Companion technology
Cognitive impairment such that they cannot give informed consent
Unable or unwilling to use the telehomecare equipment
Unlikely to tolerate the intensive intervention
Language or cultural barriers
Being acutely ill or having an unstable condition on entry to the study