Effectiveness of Preventive Primary Care Outreach Interventions with Older Persons: Meta-analysis of Randomized Controlled Trials

Background: Preventive primary care outreach interventions with older persons have the potential to decrease mortality and institutionalization. Methods - We conducted a meta-analysis to assess the effect of preventive primary care outreach interventions on mortality, admissions to long-term care, admissions to acute care hospital, living in the community and use of homemaking and meals on wheels. Data Sources - Studies were identified by searching MEDLINE, CINAHL, AgeLine, Cochrane Controlled Trials Register, and EMBASE, and by reviewing reference lists of retrieved articles. Study Selection - Studies were included if patients were 65 years and over and lived in the community; the intervention was primary preventive care outreach defined as proactive, provider initiated care that is above and beyond usual care and provided in a primary care setting; the study was a randomized controlled trial; and at least one patient outcome (as above) was assessed. Data Extraction - Independent data extraction was conducted by two investigators. Data Synthesis - Using a random effects approach, summary odds ratios were estimated for each outcome. Results - Nineteen randomized trials with 14,911 patients were reviewed. Preventive primary care outreach interventions were associated with a reduction of mortality (Summary Odds Ratio [OR] 0.83, 95% confidence interval [CI] 0.75 to 0.91) and an increased likelihood of living in the community (Summary OR 1.23, 95% CI 1.06 to 1.43). Conclusions - Preventive primary care outreach interventions with older persons can be expected to reduce the risk of dying by 17% and to increase the likelihood of living in the community by 23%.