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Quasi-experimental Study of the Effectiveness of an Integrated Service Delivery Network for the Frail Elderly*

  • André Tourigny (a1), Pierre J. Durand (a2), Lucie Bonin (a3), Réjean Hébert (a4) and Louis Rochette (a5)...

Abstract

The aim of this study was to examine the effectiveness of a new, integrated service delivery (ISD) network of health and social services for frail elderly living in a semi-urban community. A quasi-experimental study was conducted from 1997 to 2000, with measures taken before implementation (T0) and every 12 months after implementation for a 3-year period (T1, T2, T3); 482 people aged 75 years or older from 2 communities, 272 in the experimental and 210 in the control group, were followed. Analyses were conducted using parametric and non-parametric statistics, a generalized linear model, and Cox regression for survival analysis. A declining trend in institutionalization was observed and the desire to be institutionalized was lower in the study group. When absence of deterioration on follow-up was analysed in terms of the level of autonomy, the ISD network produced positive effects on the frailer clientele at T1, effects that tended to be maintained at T2. In regard to caregivers' burden, the ISD network seemed to have been effective, with caregivers' burden being less at T1 and T2. The ISD network did not have a marked effect on the utilization of services. The ISD network did, in fact, produce some effects that should be seen as important for the elderly population.

L'objectif de cette étude vise à évaluer l'efficacité d'un nouveau réseau de services intégré (RSI) pour les personnes âgées vulnérables en milieu semi-urbain. Une étude quasi-expérimentale avec mesures avant (T0) et après à chaque 12 mois (T1, T2, T3), de 1997 à 2000; auprès d'une cohorte initiale de 482 personnes dont 272 dans le groupe expérimental et 210 dans le groupe témoin. Les analyses ont été faites en employant des tests statistiques paramétriques et non-paramétriques, modèle linéaire généralisé et régression de Cox pour les analyses de survie. Une tendance à la baisse de l'hébergement a été observée et le désir d'être hébergé était plus faible dans le groupe expérimental. Quand le suivi sans détérioration était analysé en fonction de l'autonomie, le RSI avait des effets positifs à T1 et qui tendaient à se maintenir à T2 chez les personnes en plus grande perte d'autonomie. Le fardeau des aidants était moindre à T1 et T2 dans le groupe expérimental. Le RSI a eu peu d'effet sur l'utilisation des services de santé. Le RSI a effectivement produit des effets jugés importants pour une population âgée.

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Corresponding author

Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être adressées à : André Tourigny, MD MBA, Unité de recherche en gériatrie de l'Université Laval, Hôpital du St-Sacrement, 1050, chemin Ste-Foy, L2–34, Québec G1S 4L8. (andre.tourigny@cha.quebec.qc.ca)

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*

This study was carried out with the support of grants from the Conseil québécois de la recherche sociale, Fonds de la recherche en santé du Québec, and Fonds pour l'adaptation des services de santé.

Footnotes

References

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