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Comprehensive geriatric assessment in primary care: a systematic review

Comprehensive geriatric assessment in primary care: a systematic review
Comprehensive geriatric assessment in primary care: a systematic review
Background: Comprehensive Geriatric Assessment (CGA) involves the multidimensional assessment and management of an older person. It is well described in hospital and home-based settings. A novel approach could be to perform CGA within the primary care practice, the initial community located healthcare setting for patients, improving accessibility to a co-located multidisciplinary team. 
Aim: to appraise the evidence on CGA implemented within the primary care practice. 
Methods: the review followed PRISMA recommendations. Eligible studies reported CGA on persons aged >65 in a primary care practice. Studies focusing on a single condition were excluded. Searches were run in five databases; reference lists and publications were screened. Two researchers independently screened for eligibility and assessed study quality. All study outcomes were reviewed.
Results: authors screened 9003 titles, 145 abstracts and 97 full texts. Four studies were included. Limited study bias was observed. Studies were heterogeneous in design and reported outcomes. CGAs were led by a geriatrician (n=3) or nurse practitioner (n=1), with varied length and extent of follow up (12-48 months). Post-intervention hospital admission rates showed mixed results, with improved adherence to medication modifications. No improvement in survival or functional outcomes was observed. Interventions were widely accepted and potentially cost-effective. 
Discussion:the four studies demonstrated that CGA was acceptable and provided variable outcome benefit. Further research is needed to identify the most effective strategy for implementing CGA in primary care. Particular questions include identification of patients suitable for CGA within primary care CGA, a consensus list of outcome measures, and the role of different healthcare professionals in delivering CGA.
Comprehensive geriatric assessment, older people, primary care
1594-0667
Garrard, James W.
b0a5434d-4ece-458d-8547-e029fc8c4c48
Cox, Natalie J.
68866b83-ab69-48c3-a5fc-c1627813c828
Dodds, Richard M.
7f81e664-f9c8-47ea-b5fd-ee7eab2439d4
Roberts, Helen
5ea688b1-ef7a-4173-9da0-26290e18f253
Aihie Sayer, Avan
fb4c2053-6d51-4fc1-9489-c3cb431b0ffb
Garrard, James W.
b0a5434d-4ece-458d-8547-e029fc8c4c48
Cox, Natalie J.
68866b83-ab69-48c3-a5fc-c1627813c828
Dodds, Richard M.
7f81e664-f9c8-47ea-b5fd-ee7eab2439d4
Roberts, Helen
5ea688b1-ef7a-4173-9da0-26290e18f253
Aihie Sayer, Avan
fb4c2053-6d51-4fc1-9489-c3cb431b0ffb

Garrard, James W., Cox, Natalie J., Dodds, Richard M., Roberts, Helen and Aihie Sayer, Avan (2019) Comprehensive geriatric assessment in primary care: a systematic review. Aging Clinical and Experimental Research. (doi:10.1007/s40520-019-01183-w).

Record type: Article

Abstract

Background: Comprehensive Geriatric Assessment (CGA) involves the multidimensional assessment and management of an older person. It is well described in hospital and home-based settings. A novel approach could be to perform CGA within the primary care practice, the initial community located healthcare setting for patients, improving accessibility to a co-located multidisciplinary team. 
Aim: to appraise the evidence on CGA implemented within the primary care practice. 
Methods: the review followed PRISMA recommendations. Eligible studies reported CGA on persons aged >65 in a primary care practice. Studies focusing on a single condition were excluded. Searches were run in five databases; reference lists and publications were screened. Two researchers independently screened for eligibility and assessed study quality. All study outcomes were reviewed.
Results: authors screened 9003 titles, 145 abstracts and 97 full texts. Four studies were included. Limited study bias was observed. Studies were heterogeneous in design and reported outcomes. CGAs were led by a geriatrician (n=3) or nurse practitioner (n=1), with varied length and extent of follow up (12-48 months). Post-intervention hospital admission rates showed mixed results, with improved adherence to medication modifications. No improvement in survival or functional outcomes was observed. Interventions were widely accepted and potentially cost-effective. 
Discussion:the four studies demonstrated that CGA was acceptable and provided variable outcome benefit. Further research is needed to identify the most effective strategy for implementing CGA in primary care. Particular questions include identification of patients suitable for CGA within primary care CGA, a consensus list of outcome measures, and the role of different healthcare professionals in delivering CGA.

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Accepted/In Press date: 23 March 2019
e-pub ahead of print date: 9 April 2019
Keywords: Comprehensive geriatric assessment, older people, primary care

Identifiers

Local EPrints ID: 430202
URI: https://eprints.soton.ac.uk/id/eprint/430202
ISSN: 1594-0667
PURE UUID: 11a37ebb-ddc1-43af-b0e7-11f5c02bd538
ORCID for Helen Roberts: ORCID iD orcid.org/0000-0002-5291-1880

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Date deposited: 16 Apr 2019 16:30
Last modified: 20 Jul 2019 01:02

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Contributors

Author: James W. Garrard
Author: Natalie J. Cox
Author: Richard M. Dodds
Author: Helen Roberts ORCID iD

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