Prevention of emergency department visits among frail older patients in primary care – development and piloting a complex intervention

Frail old home-dwelling people such as those receiving home health care account for a significant proportion of emergency visits, which is costly and may not necessarily improve health for this sensitive patient group.

However, the rate of emergency visits differs across primary care (PC) practices, which may in part be influenced by the organisation of PC services.

This 3-year project explores if and how PC organization and collaboration between PC and other caregivers is related to the rate of emergency visits among old people with home health care.

The research follows a international framework for development of complex interventions since our results aim to be used to design and carry out such an intervention.We will link several Swedish registers and PC data to analyse PC facility risk differences for emergency visits.

In parallel, we will perform interviews with patients, family members and professionals in home health care and home care to identify triggering and contributing risk factors and perceived potential preventive measures.

This will be the basis for the development of the most promising PC model that reduces emergency visits for frail old people.

In a subsequent step, outside of this application, the model will be tested and optimized in a pilot-feasibility study at three PC practices in the region to be corroborated in a large cluster-randomized trial. Collectively, the outcomes of this project may lead to improved health and reduced health care use.