Department of Veterans' Affairs preventive care trial
Associate Professor Julie Byles, Emeritis Professor Richard Heller (University of Manachester), Associate Professor Nick Higginbotham, Professor Kichu Nair, Associate Professor Claire Jackson (The University of Queensland), Dr Jim Butler (Australian National University)
Completed in 2001, the Preventive Care Trial provides strong endorsement for the benefits of preventive health assessments for an older population.
Commenced in 1996, the Preventive Care Trial aimed to develop and evaluate a series of home based preventive health assessments with veterans and war widows aged 70 years and over living in the communities of 10 randomly selected regions of NSW and QLD. 1569 participants took part in a baseline survey and were randomly allocated to receive the home visit intervention (N=942) or usual care (N=627).
Home visit health data were collected from intervention veterans only over a three-year period from December 1997 to September 2000, during which a total of 3476 home visits and 3349 follow up phone calls were conducted. Data on hospital and nursing home admissions, utilisation of health and community services, falls and quality of life were collected over a 4-year period during annual telephone surveys with both intervention and control veterans.
Final survey data revealed no significant differences between control and intervention veterans in terms of the number of hospital or nursing home admissions, having a carer, or receiving home help or community services. However, final analysis of SF-36 quality of life and sub-group data showed that intervention veterans reported significantly higher quality of life than the control group from baseline to year four, with the greatest improvements evident in the final year. Moreover, veterans with stronger feelings of depression and poorer health at baseline reported greater improvements to quality of life than those veterans with better health at baseline after accounting for confounding factors.
Early in the trial, the most commonly reported health problems by intervention veterans were not having been vaccinated against pneumonia (83%) or tetanus (46%), not having received a recent test for diabetes (48%), not having had a hearing check in the past 2 years (63%), and having problems with one or both feet (45%). Over the course of the Trial within-group differences improved for intervention veterans for each of these problems. In addition, compared to control veterans, intervention participants recorded significantly higher rates of vaccination for pneumonia and tetanus, having a recent test for diabetes and being aware of the option to nominate an enduring guardian.
The Preventive Care Trial is the most rigorous study of health assessments of Australian elderly conducted to date. Outcome and process data collected as part of the Trial has helped to inform the introduction of a new Medicare Benefits Scheme item involving health assessments with people 75 years of age and over. The evidence base afforded by the Preventive Care Trial has provided practical, working knowledge for health assessments of the elderly. This includes training, development of tools and protocol manuals, interpretation of scales, identification of items which can be assessed by a health professional on behalf of the GP and which responses should flag further follow up and/or referral.