Extended use of point-of-care technology by acute community nurses during in-home assessment of older adults with potential acute respiratory conditions: a parallel-group, open-label, randomised controlled trial.

Abstract

Diagnosing acute respiratory conditions in adults older than 65 years is challenging due to age-related physiological changes, which increase diagnostic complexity and the risk of hospital admission. We investigated whether extended point-of-care technology (POCT), used at home by acute community nurses, reduced hospital admissions in older adults. In this parallel-group, open-label, randomised controlled trial, conducted in a primary care setting in Denmark, adults aged 65 years and older with potential respiratory symptoms were randomly assigned (1:1) using computer-generated allocation, with blocked randomisation (variable block sizes of two, four, and six) stratified by gender, to standard nurse-led care (clinical assessment, vital signs, and C-reactive protein and haemoglobin) or standard nurse-led care with extended POCT (additional blood tests, focused lung ultrasound, and tele-ultrasound). Participants and clinicians were not masked to assignment. The primary outcome was hospital admission within 30 days. Mortality was assessed as a prespecified safety outcome. Analyses were done on an intention-to-treat basis. The trial is registered with ClinicalTrials.gov, NCT05546073. Between Oct 14, 2022, and Nov 18, 2023, 623 participants were randomly assigned. 313 (50%) of 623 participants were assigned usual care and 310 (50%) were assigned the intervention. No difference was observed in hospital admissions within 30 days (112 [38%] participants in the usual care group vs 119 [40%] participants in the intervention group; risk ratio [RR] 1·06, 95% CI 0·86-1·30). 30-day mortality was lower in the intervention group (25 [8%] deaths in the usual care group vs 11 [4%] deaths in the intervention group; RR 0·44, 95% CI 0·22-0·88). No intervention-related harms were observed. Compared with standard nurse-led community care including basic POCT, extended POCT did not reduce hospital admissions among older adults with potential acute respiratory conditions. These findings suggest that the added value of extended diagnostic technology in community-based acute care might have little impact on admission decisions and warrant further evaluation focusing on clinical decision making and patient trajectories. Region of Southern Denmark, Karen Elise Jensen Foundation, AP Moeller Foundation, Hartmann Foundation, Gangsted Foundation, and Odense University Hospital Innovation Foundation.