Figure 1
Diagram of the patients included. Flow of participants for control and intervention group, per site.
Table 1
Baseline characteristics of the groups (intervention & control).
| Total | miss | Intervention | Control | p-value | |
|---|---|---|---|---|---|
| Sample size | 856 | 475 | 381 | ||
| Age | 77.6 (7.7) | 0 | 77.3 (7.7) | 78.1 (7.6) | 0.127 |
| Gender (Female) | 437 (51%) | 3 | 252 (53%) | 185 (49%) | 0.182 |
| Education | 19 | 0.044 | |||
| Lower than primary | 129 (15%) | 63 (14%) | 66 (17%) | ||
| Primary school | 360 (43%) | 187 (41%) | 173 (46%) | ||
| Secondary school | 146 (17%) | 84 (18%) | 62 (16%) | ||
| High school | 130 (16%) | 73 (16%) | 57 (15%) | ||
| College/University | 72 (9%) | 50 (11%) | 22 (6%) | ||
| Mobile use (Yes) | 509 (60%) | 5 | 287 (61%) | 222 (58%) | 0.501 |
| Personal Computer use (Yes) | 229 (27%) | 8 | 147 (31%) | 81 (21%) | 0.001 |
| Tobacco use | 15 | 0.069 | |||
| Never | 473 (56%) | 247 (54%) | 226 (60%) | ||
| Former | 318 (38%) | 181 (39%) | 137 (36%) | ||
| Current smoker | 50 (6%) | 34 (7%) | 16 (4%) | ||
| Body Mass Index | 29.5 (5.7) | 1 | 30 (5.9) | 29 (5.4) | 0.004 |
| HbA1c | 6.9 (1.1) | 400 | 6.9 (1.2) | 6.8 (1) | 0.553 |
| Creatinine | 1.1 (0.5) | 207 | 1.1 (0.5) | 1.07 (0.5) | 0.217 |
| Barthel index, median (Q1, Q3) | 100 (80,100) | 31 | 95 (80,100) | 100 (80,100) | 0.030 |
| Geriatric Depression Scale | 4.1 (3.7) | 6 | 4.1 (3.7) | 4.1 (3.7) | 0.800 |
| Age-adjusted CCI | 7.7 (2.9) | 19 | 7.8 (3.1) | 7.6 (2.7) | 0.356 |
| Comorbidity | |||||
| Myocardial infarct | 160 (19%) | 6 | 102 (22%) | 58 (15%) | 0.028 |
| Congestive heart failure | 528 (62%) | 8 | 307 (65%) | 221 (59%) | 0.087 |
| Peripheral vascular disease | 324 (38%) | 9 | 175 (37%) | 149 (39%) | 0.542 |
| Cerebrovascular disease | 208 (25%) | 9 | 113 (24%) | 95 (25%) | 0.728 |
| Dementia | 91 (11%) | 7 | 51 (11%) | 40 (11%) | 1.000 |
| Chronic pulmonary disease | 464 (54%) | 1 | 266 (56%) | 198 (52%) | 0.286 |
| Rheumatic disease | 87 (10%) | 6 | 45 (9%) | 42 (11%) | 0.507 |
| Peptic ulcer disease | 57 (7%) | 7 | 30 (6%) | 27 (7%) | 0.715 |
| Mild liver disease | 88 (10%) | 4 | 44 (9%) | 44 (12%) | 0.312 |
| Diabetes without complication | 432 (51%) | 3 | 243 (51%) | 189 (50%) | 0.736 |
| Diabetes with complication | 193 (23%) | 4 | 102 (21%) | 91 (24%) | 0.422 |
| Hemiplegia or paraplegia | 46 (5%) | 3 | 29 (6%) | 17 (4%) | 0.379 |
| Renal disease | 202 (24%) | 9 | 111 (24%) | 91 (24%) | 0.893 |
| Any malignancy | 90 (11%) | 15 | 58 (12%) | 32 (9%) | 0.106 |
| Moderate or severe liver disease | 79 (9%) | 7 | 46 (10%) | 33 (9%) | 0.724 |
| Metastatic solid tumour | 12 (1%) | 17 | 11 (2%) | 1 (0.3%) | 0.025 |
[i] Categorical data presented as frequencies and percentages (%) and continuous data as means and standard deviation, unless otherwise stated; CCI, Charlson Comorbidity Index; Comorbidity data show the incidence of comorbidity; miss, frequency of missing values; (Q1, Q3), Quartile 1 and 3; HbA1c and Creatinine only obtained for the patients reviewed to control specific diseases.
Figure 2
Use of health services. Data presented as mean rates of contacts per month. Mean values for all subjects (All), intervention group (INT) and control group (CON) are shown. Comparisons between the intervention and control groups were conducted by unadjusted and adjusted differences (adjusted by age, gender and age-adjusted Charlson Comorbidity Index). GP, General Practitioner; ER, Emergency rooms; * statistically significant difference (p < 0.05); + statistically significant difference (p < 0.05) only for unadjusted comparison.
Table 2
Basal and final results and differences between groups (intervention and control).
| Total | Differences per time point | Adjusted difference | ||||
|---|---|---|---|---|---|---|
| Intervention | Control | p-value | CareWell Effect | p-value | ||
| Clinical data | ||||||
| Body Mass Index (BMI) | 0.099 | |||||
| N | 620 | 335 | 285 | |||
| Basal | 29.9 (5.4) | 30.4 (5.8) | 29.4 (4.9) | 0.016 | – | |
| Final | 29.5 (5.4) | 29.9 (5.6)* | 28.9 (5) | 0.038 | –0.3 (–0.8,0.2) | |
| Oxygen saturation (%) | 0.639 | |||||
| N | 546 | 261 | 285 | |||
| Basal | 95.8 (2.4) | 95.4 (2.6) | 96.2 (2.2) | <0.001 | – | |
| Final | 96.1 (2.3) | 95.9 (2.1)* | 96.2 (2.4) | 0.114 | 0.1 (–0.4,0.5) | |
| Blood glucose (mg/dl) | 0.677 | |||||
| N | 546 | 261 | 285 | |||
| Basal | 129.9 (45.9) | 131.7 (50.8) | 128.3 (41) | 0.401 | – | |
| Final | 118.8 (50) | 111 (48.7)* | 123.2 (50.3) | 0.012 | –0.6 (–12.7,11.5) | |
| HbA1c (%) | 0.131 | |||||
| N | 364 | 177 | 187 | |||
| Basal | 6.8 (1) | 6.9 (1.1) | 6.8 (1) | 0.236 | – | |
| Final | 6.8 (1.2) | 6.6 (1.1) | 6.8 (1.2) | 0.227 | –0.4 (–0.8,–0.04) | |
| Creatinine (mg/dl) | 0.182 | |||||
| N | 364 | 177 | 187 | |||
| Basal | 1.1 (0.4) | 1.1 (0.5) | 1.1 (0.4) | 0.252 | – | |
| Final | 1.2 (0.6) | 1.2 (0.6)* | 1.1 (0.5)* | 0.220 | –0.1 (–0.1,0.02) | |
| Geriatric Depression Scale | 0.233 | |||||
| N | 757 | 403 | 354 | |||
| Basal | 3.9 (3.7) | 3.9 (3.7) | 4 (3.7) | 0.607 | – | |
| Final | 4 (3.8) | 3.7 (3.7) | 4.2 (3.8) | 0.089 | –0.6 (–1.6,0.3) | |
| Physical functional status | ||||||
| Barthel index | 0.889 | |||||
| N | 757 | 403 | 354 | |||
| Basal | 87.8 (20.3) | 86.7 (22) | 89.2 (18.2) | 0.085 | – | |
| Final | 86.7 (21.4) | 85.4 (22.9)* | 88.1 (19.6)* | 0.085 | –1.1 (–3.2,1) | |
[i] Data presented as mean, standard deviation or their corresponding 95% confidence interval; N, sample size used in the analysis (only included pilot sites which has the follow-up for the corresponding parameter); * indicates if there are pre-post differences within each arm (intervention or control); CareWell effect, indicates the difference between the intervention over the control group, by the interaction coefficient between the care group and the follow-up period. The effect coefficient was estimated considering follow-up of 12 months, and the mixed-effect models were adjusted using age, gender, and age-adjusted Charlson Comorbidity Index.
Figure 3
Patient’s satisfaction assessed by PIRU questionnaire: a) for intervention group and b) for control group. Data represents percentage of each category; color intensity indicates the level of satisfaction; the lighter the gray, the more satisfied are the participants; the darkest color indicates: “Don’t Know/not sure” for questions 1, 9 and 14; pre-post comparisons were performed for each group; * statistically significant difference (p < 0.05).