A nurse-led interdisciplinary primary care approach to prevent disability among community-dwelling frail older people: A large-scale process evaluation
Section snippets
Background
Frail older people often suffer from a combination of acute and chronic diseases (multimorbidity) and functional impairments leading towards disability and dependency on long-term care (Fried et al., 2004). In general, older people prefer to stay at home for as long as possible (Henderson and Caplan, 2008). However, community-based care is challenging, due to the complex healthcare needs of frail older people, which have to be addressed by various healthcare professionals (Markle-Reid and
Study design
Between February 2010 and December 2011 the PoC approach was evaluated in a large-scale process evaluation among six GP practices in the south of the Netherlands. Several process evaluation components from Baranowski and Stables (i.e. reach, dose delivered, fidelity, dose received (exposure and satisfaction), and barriers) were chosen as theoretical base for the process evaluation (Baranowski and Stables, 2000, Linnan and Steckler, 2002, Saunders et al., 2005). Table 1 shows an overview of
Reach
On behalf of the six GP practices, 1825 screening lists were sent to community-dwelling frail older people (≥70 years) (see Fig. 1). The response rate was 80.9% (n = 1477). Of those, who have signed the consent form (n = 569) 37.6% (n = 214) were frail according to the GFI score ≥ 5. Finally, 194 frail older people were included in the study. Of these, 44.8% (n = 87) were male and 46.4% (n = 90) lived alone (versus living together, n = 104). Most people (60.3%, n = 117) had no or lower than average education
Discussion
The aim of the process evaluation was to provide insight into the extent to which the interdisciplinary care approach PoC is implemented as planned. Furthermore, healthcare professionals’ and frail older people's experiences regarding its feasibility were evaluated. From the perspective of the healthcare professionals, the PoC approach provided a useful structure for the delivery of geriatric primary care and increased the attention to preventive treatment. Frail older people were satisfied, as
Conclusion
To prevent disability in community-dwelling frail older people, complex interventions conducted by an interdisciplinary primary care team are needed, involving individualized assessment, tailor-made interventions and long-term follow-up. With regard to integrated care, nurses are recommended as case managers to plan, organize and monitor the care process and to facilitate cooperation between professionals. The PoC approach is appreciated by healthcare professionals and frail older people and
Acknowledgements
The authors would like to thank participating older people and healthcare professionals, the members of the research group: Walther Sipers (Orbis Medical Centre) Lilo Crasborn (MCC Omnes), Simone Denis (MCC Omnes), Marlou Wolters (MCC Omnes), Jill Bindels (Maastricht University) and their research assistants: Floor Koomen, Ine Hesdahl and Astrid Dello.
References (56)
- et al.
Complex interventions to improve physical function and maintain independent living in elderly people: a systematic review and meta-analysis
The Lancet
(2008) - et al.
Goal-setting for behavior change in primary care: an exploration and status
Patient Education and Counseling
(2009) - et al.
Effects of motiavtional interviewing intervention on self-management psychological and glycemic outcomes in type 2 diabetes: a randomized controlled trial
International Journal of Nursing Studies
(2012) - et al.
From best evidence to best practice: effective implementation of change in patients’ care
The Lancet
(2003) - et al.
Home sweet home? Community care for older people in Australia
Journal of American Medical Directors Association
(2008) - et al.
Program of All-Inclusive Care (PACE): past, present and future
Journal of the American Medical Directors Association
(2009) - et al.
Small-scale, homelike facilities in dementia care: a process evaluation into the experiences of family caregivers and nursing staff
International Journal of Nursing Studies
(2012) - et al.
Old people at home; their unreported needs
The Lancet
(1964) - et al.
What forsters or prevents interprofessional teamworking in primary and community care?. A literature review
International Journal of Nursing Studies
(2008) - et al.
Process evaluations of the 5-a-day projects
Health Education and Behavior
(2000)
Improving Primary Care. Strategies and Tools for Better Practice
Analysis in Qualitative Research
Effects of a home visiting program for older people with poor health status: a randomized, clinical trial in the Netherlands
Journal of the American Geriatrics Society
School for Public Health Primary Care
Interventions to prevent disability in frail community-dwelling older persons: an overview European
Journal of Ageing
A disability prevention programme for community-dwelling frail older persons
Clinical Rehabilitation
The predictive validity of three self-report screening instruments for identifying frail older people in the community
BMC Public Health
Frailty: an emerging concept for general practice
British Journal of General Practice
Eerste nurse practitioners met differentiatie huisartsenzorg
Tijdschrift voor Verpleegkundige
Measurement characteristics of the engagement in meaningful activities survey in an age-diverse sample
American Journal of Occupational Therapy
The meaningful activity participation assessment: a measure of engagement in personally valued activities international
Journal of Aging and Human Development
Decision-making and nurse case management: a philosophical perspective
Advances in Nursing Science
Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
Frailty in older adults: evidence for a phenotype
Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
How can we increase translation of research into practice?. Types of evidence needed
The Annual Review of Public Health
Assessing delivery of the five ‘As’ for patient-centred counseling
Health Promotion International
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