Ways of improving older patients' involvement in their primary care

Wetzels R, Harmsen M, Van Weel C, Grol R, Wensing M

Published Online:

October 8, 2008

Stimulating the involvement of older patients in their primary care may enhance their health. Therefore we reviewed studies of interventions to improve older people's involvement in their care. There has been little research in this area involving older people as the main target of the research. Only three trials were identified. These evaluated the effects of written or face-to-face preparation for consultations with doctors. Interventions of a pre-visit booklet and a pre-visit session (either combined or pre-visit session alone) led to more questioning behaviour by older people and more self-reported active behaviour. Overall, there is sparse evidence about the effects of interventions for improving older patients' involvement in their primary care.

Abstract (click to read)

Background:

There is a growing expectation among patients that they should be involved in the delivery of medical care. Accumulating evidence from empirical studies shows that patients of average age who are encouraged to participate more actively in treatment decisions have more favourable health outcomes, in terms of both physiological and functional status, than those who do not. Interventions to encourage more active participation may be focused on different stages, including: the use of health care; preparation for contact with a care provider; contact with the care provider; or feedback about care. However, it is unclear whether the benefits of these interventions apply to the elderly as well.

Objectives:

To assess the effects of interventions in primary medical care that improve the involvement of older patients (>=65 years) in their health care.

Search strategy:

We searched: the Cochrane Consumers and Communication Review Group Specialised Register (May 2003); the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library issue 1, 2004; MEDLINE (Ovid) (1966 to June 2004); EMBASE (1988 to June 2004); PsycINFO (1872 to June 2004); DARE, The Cochrane Library issue 1, 2004; ERIC (1966 to June 2004); CINAHL (1982 to June 2004); Sociological Abstracts (1963 to June 2004); Dissertation Abstracts International (1861 to June 2004); and reference lists of articles.

Selection criteria:

Randomised controlled trials or quasi-randomised trials of interventions to improve the involvement of older patients (>= 65 years) in single consultations or episodes of primary medical care.

Data collection and analysis:

Two review authors independently assessed trial quality and extracted data. Results are presented narratively as meta-analysis was not possible.

Main results:

We identified three studies involving 433 patients. Overall, the quality of studies was not high, and there was moderate to high risk of bias. Interventions of a pre-visit booklet and a pre-visit session (either combined or pre-visit session alone) led to more questioning behaviour and more self-reported active behaviour in the intervention group (3 studies). One study (booklet and pre-visit session) showed no difference in consultation length and time engaged in talk between the intervention and control groups. The booklet and pre-visit session in one study was associated with more satisfaction with interpersonal aspects of care for the intervention group although no difference in overall satisfaction between intervention and control. There was no long-term follow up to see if effects were sustained. No studies measured outcomes relating to the use of health care, health status and wellbeing, or health behaviour.

Authors' conclusions:

Overall this review shows some positive effects of specific methods to improve the involvement of older people in primary care episodes. Because the evidence is limited, however, we can not recommend the use of the reviewed interventions in daily practice. There should be a balance between respecting patients' autonomy and stimulating their active participation in health care. Face-to-face coaching sessions, whether or not complemented with written materials, may be the way forward. As this is impractical for the whole population, it could be worthwhile to identify a subgroup of older patients who might benefit the most from enhanced involvement, ie. those who want to be involved, but lack the necessary skills. This group could be coached either individually or, more practically, in group sessions.

This record should be cited as:

Wetzels R, Harmsen M, Van Weel C, Grol R, Wensing M. Interventions for improving older patients' involvement in primary care episodes. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004273. DOI: 10.1002/14651858.CD004273.pub2

Assessed as up to date:

June 29, 2004

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Primary Review Group:

Consumers and Communication Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective are interventions in primary medical care that improve the involvement of older patients (>65 years) in their health care?

Bottom line:

Interventions of a pre-visit booklet and a pre-visit session (either combined or a pre-visit session alone) lead to more questioning behaviour by older people and more self-reported active behaviour than seen in controls.

Caveat:

Only 3 trials were evaluated, and there was no long-term follow-up to see if effects were sustained. No studies measured outcomes relating to the use of health care, health status and wellbeing, or health behaviour. As the evidence was limited, the authors could not recommend the use of the reviewed intervention in routine primary care.

Context:

Many patients believe that they should be more involved in the delivery of their medical care. Empirical studies suggest that patients of average age who are encouraged to participate more actively in treatment decisions have more favourable outcomes, in terms of both physiological and functional status, than those who do not.

Cochrane Systematic Review:

Wetzels R et al. Interventions for improving older patients’ involvement in primary care episodes. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004273. DOI: 10.1002/14651858.CD004273.pub2. This review contains 3 trials with a total of 433 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Consumer & communication strategies > Enabling consumers to know about their health & treatment

Consumer & communication strategies > Involving individual consumers in decision-making or communication about their health or treatment

Consumer & communication strategies > Promoting acquisition of skills and competencies

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Ways of improving older patients' involvement in their primary care

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