A new model of care and in-house general practitioners for residential aged care facilities: a stepped wedge, cluster randomised trial

<strong>Objectives:</strong> To evaluate whether an alternative model of care in aged care facilities, including in-house general practitioners, influenced health outcomes for residents.<p></p> <p><strong>Design:</strong> Stepped wedge, cluster randomised controlled trial over 90 weeks (31 December 2012 - 21 September 2014), with a 54-week pre-trial retrospective data period (start: 19 December 2011) and a 54-week post-trial prospective data collection period (to 4 October 2015).</p> <p><strong>Participants, setting:</strong> Fifteen residential aged care facilities operated by Bupa Aged Care in metropolitan and regional cities in four Australian states.</p> <p><strong>Intervention:</strong> Residential aged care facilities sought to recruit general practitioners as staff members; care staff roles were redefined to allow registered nurses greater involvement in care plan development.</p> <p><strong>Main (primary) outcome measures:</strong> Numbers of falls; numbers of unplanned transfers to hospital; polypharmacy.</p> <p><strong>Results:</strong> The new model of care could be implemented in all facilities, but four could not recruit in-house GPs at any time during the trial period. Intention-to-treat analyses found no statistically significant effect of the intervention on the primary outcome measures. Contamination-adjusted intention-to-treat analyses identified that the presence of an in-house GP was associated with reductions in the numbers of unplanned hospital transfers (incidence rate ratio [IRR], 0.53; 95% CI, 0.43-0.66) and admissions (IRR, 0.52; 95% CI, 0.41-0.64) and of out-of-hours GP call-outs (IRR, 0.54; 95% CI, 0.36-0.80), but also with an increase in the number of reported falls (IRR, 1.37; 95% CI, 1.20-1.58).</p> <p><strong>Conclusions:</strong> Recruiting GPs to work directly in residential aged care facilities is difficult, but may reduce the burden of unplanned presentations to hospitals and increase the reporting of adverse events.</p>