Integrated Care of Older Patients with Frailty in Primary Care (ICOOP-Frail): a pilot randomized controlled trial and...

Frailty in older adults is associated with increased healthcare utilization and costs, yet evidence on the clinical effectiveness and cost-effectiveness of frailty management programs in primary care remains limited, particularly in Asian settings. This pilot randomized controlled trial (RCT) evaluated a structured, primary care-based frailty intervention in Korea to assess its feasibility, clinical impact, and economic outcomes.

We conducted a 6-month pilot RCT involving community-dwelling older adults recruited from four urban primary care clinics. Participants were randomized to either the intervention group, which received frailty screening with the validated Korean Frailty Index for Primary Care (KFI-PC) and monthly health coaching delivered by trained nurses and health coaches, or the control group receiving usual care. Outcomes included changes in frailty index scores and total healthcare costs. Between-group comparisons were assessed using independent t-tests, chi-squared tests, and cost-effectiveness analysis from a healthcare system perspective.

A total of 84 participants were analyzed (intervention, n = 39; control, n = 45). At 3 months, the intervention showed a greater reduction in the frailty index than usual care, but the between-group difference was not statistically significant (mean difference - 0.03, 95% CI - 0.064 to 0.004); at 6 months the difference remained non-significant. However, the Group × Time interaction was significant (F = 4.99, p = 0.009). Total 6-month costs were lower in the intervention group, indicating economic dominance.

This pilot RCT provides preliminary clinical evidence and demonstrates economic dominance of a structured, primary care-based frailty management program, supporting feasibility and the need for larger, longer trials. By integrating KFI-PC-based screening with telephone-based health coaching, the intervention reduced physician burden while addressing multidimensional needs of frail older adults. These findings support the feasibility of scaling frailty management in primary care, although further research is required to confirm long-term effectiveness and sustainability.

CRIS (KCT0005922), registered on February 22, 2021.