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Anticipatory & Preventive Team Care (APTCare): At Risk Patients of Family Health Networks

The recruitment status of this study is unknown. The completion date has passed and the status has not been verified in more than two years.
Verified June 2005 by C. T. Lamont Primary Care Research Centre.
Recruitment status was:  Active, not recruiting
Ontario Ministry of Health and Long Term Care
University of Ottawa
Information provided by:
C. T. Lamont Primary Care Research Centre Identifier:
First received: October 12, 2005
Last updated: October 12, 2006
Last verified: June 2005
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.

Condition Intervention Phase
Chronic Obstructive Pulmonary Disease
Congestive Heart Failure
Behavioral: Self-management of chronic illness
Phase 2
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Prevention

Further study details as provided by C. T. Lamont Primary Care Research Centre:

Estimated Enrollment: 240
Estimated Study Completion Date: March 2006

Ages Eligible for Study:   50 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • 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

Exclusion Criteria:

  • 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
  Contacts and Locations
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Please refer to this study by its identifier: NCT00238836

Canada, Ontario
West Carleton Family Health Network
Carp, Ontario, Canada, K0A 1L0
Sponsors and Collaborators
C. T. Lamont Primary Care Research Centre
Ontario Ministry of Health and Long Term Care
University of Ottawa
Principal Investigator: William Hogg, MD C. T. Lamont Primary Care Research Centre
Principal Investigator: Jacques Lemelin, MD University of Ottawa