The effect of an educational intervention towards healthcare workers performing? preventive home visits to older people: A cluster randomised controlled trial with a long follow-up

Abstract

Aims: Preventive home visits aim at maintaining health, autonomy and functional ability among home-dwelling older people. The effect of preventive home visits on functional ability, healthcare utilisation and mortality has been investigated with ambiguous findings and overall short follow-up. The aim of this study was to investigate the effect of an intervention comprising an educational programme among preventive home visitors and general practitioners on mortality and nursing home admission over 12 years of follow-up among men and women aged 75 or 80 years at baseline. Methods: The intervention was carried out as a cluster randomised controlled trial including 34 municipalities. This study was based on questionnaire data from the trial and follow-up registry data. Outcomes were measured in four consecutive three-year follow-up periods starting in 1999 and analysed through Cox regression analyses. Results: In all periods, a non-significantly lower mortality rate was observed in intervention municipalities. In the first three-year period, there was a non-significantly higher nursing home admission rate in intervention municipalities. In the second three-year period, there was a non-significantly lower nursing home admission rate in intervention municipalities. Conclusions: No statistically significant effect of the intervention on mortality or nursing home admission was seen at long-term follow-up. The evaluation of preventive home visits needs to consider outcomes valued by the healthcare personnel involved and the older people themselves, such as empowerment and self-esteem, rather than relying on easily measured outcomes such as mortality and nursing home admission.