Who Should Deliver Primary Care in Long-term Care Facilities to Optimize Resident Outcomes? A Systematic Review.

Journal of the American Medical Directors Association
Robert Oliver BarkerBarbara Hanratty

Abstract

Across the world, health care for residents in long-term care facilities (LTCFs) is provided by a range of different professionals, and there is no consensus on which professional group(s) deliver the best outcomes for residents. The objective of this review is to investigate how the health outcomes of older adults in LTCFs vary according to which professional group(s) provides first-line medical care. A systematic review and narrative synthesis were performed. Medline, Embase, the Cochrane Central Register of Controlled Trials, and Scopus were searched for studies from high-income countries, of any design, published after 2000. Quality was assessed using the Cochrane Risk of Bias and ROBINS-I tools. The exposure of interest was the professional group(s) involved in the delivery of first-line primary care. Older adults living in LTCFs. The principal outcomes were unplanned transfer to hospital, prescribing quality, and mortality. Searches identified 10,532 citations after removing duplicates. Twenty-six publications (across 24 studies) met the inclusion criteria. A narrative synthesis was conducted of the 20 experimental and 4 observational studies, involving approximately 98,000 residents. Seven studies were set in the USA, 6 ...Continue Reading

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