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Objective: Effective health care for older people with complex health needs requires a diverse range of healthcare professionals working together. The Building Partnerships Framework of the New South Wales Agency for Clinical Innovation seeks to promote collaboration and integration among service providers. The aim of the present study was to inform implementation and evaluation of the Framework. Methods: Data from the 45 and Up Study was linked with deaths and service data from hospitalisations and the Medicare Benefits Schedule (MBS). Participants with a hospitalisation for conditions representing 'geriatric syndrome' were allocated to a complex needs group; the remainder were allocated to a comparison group. Hospital admissions and MBS services use were modelled using log-linear Poisson regression. Results: Multivariate analysis showed that the rate of hospitalisation in the 2 years following index admission for the complex needs group was 18% (95% confidence interval (CI) 1.12–1.24) greater than the comparison group and specialist physician attendance was 13% (95% CI 1.06 – 1.21) greater. The rate of general practitioner (GP) attendances was 2% (95% CI 0.97–1.07) greater in the complex needs group, but this was not statistically significant. Discussion: The greater rates of hospitalisation and specialist service use, the absence of a similar finding for GP services and the prominence of the role of primary care in service integration literature, policy and strategy underscore the importance of careful planning, consultation and inclusiveness in the development and implementation of integrated care policy. What is known about the topic?: Older people with complex health needs are significant consumers of primary and secondary health services and benefit from well-planned and coordinated care. What does this paper add?: The findings presented here indicate that although hospitals and specialist physicians provide a significantly greater volume of services to people with complex health needs, GPs do not. Within the limitations of the present study, these findings can contribute to integrated care policy and strategy development and implementation. What are the implications for practitioners?: Given the prominence of primary care in service integration literature, policy and strategy and the findings of the present study with regard to the relative level of GP involvement in the management of people with complex needs, careful policy implementation will be required to ensure GPs are able to contribute significantly to coordinated cooperation between health services. [ABSTRACT FROM AUTHOR]

Aim To determine if a model of home-based dietetic care improves dietary intake and weight status in a specific group of older adults post-hospitalisation. Methods The Department of Veterans' Affairs clients aged 65 years and over were recruited from hospitals in a regional area of New South Wales, Australia (n = 32 men, n = 36 women). Nutritional status was assessed at home at baseline (within two weeks post-discharge) and three months post-discharge using a diet history, a food frequency checklist and Mini Nutritional Assessment ( MNA). Personalised dietary advice was provided by a single dietitian according to participants' nutritional status. Results Mean body weight improved significantly ( P = 0.048), as well as mean MNA score (21.9 ± 3.5 vs 25.2 ± 3.1) ( P < 0.001). Mean energy, protein and micronutrient intakes were adequate at baseline and three months, except for vitamin D. At three months, the underweight group (body mass index ( BMI) < 23 kg/m2) had significantly higher mean protein intake per body weight (1.7 ± 0.4 g/kg) compared to those who were a desirable weight ( BMI 23-27 kg/m2) (1.4 ± 0.3 g/kg) or overweight ( BMI>27 kg/m2) (1.1 ± 0.3 g/kg) peers ( P < 0.001). There was significant improvement in energy intake contributed from oral nutrition supplements (+95.5 ± 388.2 kJ/day) and milk (+259.6 ± 659.8 kJ/day). Conclusions Dietetic intervention improved nutritional status 3 months after hospital discharge in older adults living in the community. [ABSTRACT FROM AUTHOR]