Aim: To examine the effect of implementing the Patient Complexity Instrument (PCI) in addition to usual-care on complexity detection, clinical-care time allocation, and referrals to supportive services compared to usual-assessment alone.Design: A parallel-group-blocked pragmatic randomised controlled trial.Methods: A mixed-method study conducted within a regional Australian community nursing service. Randomisation occurred at the initial client assessment following referral acceptance for community nursing support. Older people aged 65 years and over (client participants), referred to the service from 1st of July 2020 to 30th of September 2020, eligible for Commonwealth-Home-Support-Programme funding. A convenience sample of community nurses conducting client-assessments were recruited. The intervention group included usual-assessment plus the PCI and the control group was usual-assessment alone. Chi-square test independence compared complexity ratings (low, medium, high) between groups for the hypothesis that adding the PCI to usual-assessment, has no effect on nurses’ complexity detection compared to usual-assessment alone.Results: Compared to usual-assessment alone, adding the PCI did not change nurses’ level detected complexity rating. However, for older people initially assessed with low levels of complexity, the PCI indicated a need for additional clinical-care-time. The nurses feedback showed the PCI useful in prompting to identify other care factors such as level of engagement, psychosocial which were not identified by usual-assessment alone thus, enhanced complexity detection.Conclusion: The addition of PCI to nurses’ usual-assessment did not improve levels of complexity ratings. However, the PCI enhanced complexity detection by pinpointing areas of care requiring referrals for additional care and extra-time required. The ImPaCt trial demonstrated the PCI as a useful tool for enhancing care for older people receiving nursing supports in the community. The PCI is a beneficial guidance resource for those new to Community Nursing role caring for older people.Key words: district or community nurse, older people, ageing, care complexity, clinical decision-making, clinical judgement, quality of care, assessment, community aged-care.ImpactWhat problem did the study address?The trial addresses the limited evidence and use of standardised tools for detecting care complexity and greater dependence on nurses’ clinical judgment.What were the main findings?The trial highlighted that the PCI could enhance community-based care for complex older people, and serves as a valuable guide for elder care, especially for those new to the community nurse role.Where and on whom will the research have an impact?Informing quality of care and shaping practice guidelines and policy for assessing complex community-dwelling older people.Enhancing clinician decision-making, facilitating care discussion and tracking client health and psychosocial trajectories.Informing academic research for further development of the PCI and similar tools to streamline elder care coordination and handover.Reporting Method : The study adhered to the updated guidelines for reporting parallel group randomised trials. Reporting was conducted according to the CONSORT checklist (Schulz et al., 2010).Patient or Public Contribution: This study was focussed on the nurses’ perspective of client complexity and how this complexity is detected. During the protocol development phase, a presentation about the study was made to a consumer group from the lead researcher’s workplace. This presentation was well received with five consumers in attendance. The protocol was also presented to the Board of the lead researcher’s workplace. Four board members were in attendance and showed positive interest.

Aim Prevalence of potentially suboptimal prescribing and associated risk factors were investigated among older patients attending primary care via Aboriginal Community Controlled Health Services (ACCHSs). Methods Prescription medications were audited for 420 systematically selected patients aged ≥50 years at three ACCHSs in urban, rural, and remote settings. Polypharmacy, potentially inappropriate medications (PIMs), and anticholinergic burden (ACB) were estimated and associated risk factors explored with logistic regression. Results The prevalence of polypharmacy, use of PIMs, and ACB score ≥3, was 43%, 18%, and 12%, respectively. In multivariable logistic regression analyses, polypharmacy was less likely in rural (OR=0.43, 95% CI=0.24-0.77) compared to urban health service patients, and more likely in those with heart disease (OR=2.62, 95% CI=1.62-4.25), atrial fibrillation (OR=4.25, 95% CI=1.08-16.81), hypertension (OR=2.14, 95% CI=1.34-3.44), diabetes (OR=2.72, 95% CI=1.69-4.39), or depression (OR=1.91, 95% CI=1.19-3.06). PIMs were more frequent in females (OR=1.88, 95% CI=1.03-3.42), and less frequent in rural (OR=0.41, 95% CI=0.19-0.85) and remote (OR=0.58, 95% CI=0.29-1.18) patients. Factors associated with PIMs were kidney disease (OR=2.60, 95% CI=1.37-4.92), urinary incontinence (OR=3.00, 95% CI=1.02-8.83), depression (OR=2.67, 95% CI=1.50-4.77), heavy alcohol use (OR=2.83, 95% CI 1.39-5.75) and subjective cognitive concerns (OR=2.69, 95% CI=1.31-5.52). High anticholinergic burden was less common in rural (OR=0.10, 95% CI 0.03-0.34) and remote (OR=0.51, 95% CI 0.25-1.04) patients, and more common in those with kidney disease (OR=3.07, 95% CI 1.50-6.30), or depression (OR=3.32, 95% CI 1.70-6.47). Conclusion Associations between potentially suboptimal prescribing and depression or cognitive concerns highlights the importance of considered medication review and deprescribing for these patients.