• Terry P Haines, Andrew J Palmer, Petra Tierney, Lei Si, and Andrew L Robinson.
• Monash University, Melbourne, VIC.
• Med. J. Aust. 2020 May 1; 212 (9): 409-415.

ObjectivesTo evaluate whether an alternative model of care in aged care facilities, including in-house general practitioners, influenced health outcomes for residents.DesignStepped wedge, cluster randomised controlled trial over 90 weeks (31 December 2012 - 21 September 2014), with a 54-week pre-trial retrospective data period (start: 19 December 2011) and a 54-week post-trial prospective data collection period (to 4 October 2015).Participants, SettingFifteen residential aged care facilities operated by Bupa Aged Care in metropolitan and regional cities in four Australian states.InterventionResidential aged care facilities sought to recruit general practitioners as staff members; care staff roles were redefined to allow registered nurses greater involvement in care plan development.Main (Primary) Outcome MeasuresNumbers of falls; numbers of unplanned transfers to hospital; polypharmacy.ResultsThe new model of care could be implemented in all facilities, but four could not recruit in-house GPs at any time during the trial period. Intention-to-treat analyses found no statistically significant effect of the intervention on the primary outcome measures. Contamination-adjusted intention-to-treat analyses identified that the presence of an in-house GP was associated with reductions in the numbers of unplanned hospital transfers (incidence rate ratio [IRR], 0.53; 95% CI, 0.43-0.66) and admissions (IRR, 0.52; 95% CI, 0.41-0.64) and of out-of-hours GP call-outs (IRR, 0.54; 95% CI, 0.36-0.80), but also with an increase in the number of reported falls (IRR, 1.37; 95% CI, 1.20-1.58).ConclusionsRecruiting GPs to work directly in residential aged care facilities is difficult, but may reduce the burden of unplanned presentations to hospitals and increase the reporting of adverse events.Trial RegistrationAustralia New Zealand Clinical Trial Registry, ACTRN12613000218796 (25 February 2013).© 2020 AMPCo Pty Ltd.

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