A nurse-led interdisciplinary primary care approach to prevent disability among community-dwelling frail older people: A large-scale process evaluation

Metzelthin, Silke; Daniëls, Ramon; Rossum, Erik van; Cox, Karen; Habets, Herbert; Witte, Luc de; Kempen, Gertrudis I. J. M.

doi:10.1016/j.ijnurstu.2012.12.016

Cited by 74 publications

(209 citation statements)

References 37 publications

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“…Outcome measures that are more person-and goal-centered (eg, goal-attainment scaling) might better measure the effectiveness of our intervention. 38 Second, it is widely recognized that complex interventions are often not delivered or adhered to as intended, [39][40][41] which we accept as part of the outcome given the pragmatic nature of our study. Moreover, the follow-up period of 12 months may be too short to establish effective multidisciplinary collaborations, a true transition toward integrated care, 41 and to achieve measurable effects on patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial

Ruikes

Zuidema

Akkermans

et al. 2016

The Journal of the American Board of Family Medicine

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Background:The increasing number of community-dwelling frail elderly people poses a challenge to general practice. We evaluated the effectiveness of a general practitioner-led extensive, multicomponent program integrating cure, care, and welfare for the prevention of functional decline.Methods: We performed a cluster controlled trial in 12 general practices in Nijmegen, the Netherlands. Community-dwelling frail elderly people aged >70 years were identified with the EASY-Care twostep older persons screening instrument. In 6 general practices, 287 frail elderly received care according to the CareWell primary care program. This consisted of proactive care planning, case management, medication reviews, and multidisciplinary team meetings with a general practitioner, practice and/or community nurse, elderly care physician, and social worker. In another 6 general practices, 249 participants received care as usual. The primary outcome was independence in functioning during (instrumental) activities of daily living (Katz-15 index). Secondary outcomes were quality of life [EuroQol (EQ5D؉C) instrument], mental health and health-related social functioning (36-item RAND Short

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Section: Discussionmentioning

confidence: 99%

Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial

Ruikes

Zuidema

Akkermans

et al. 2016

The Journal of the American Board of Family Medicine

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“…Of the 57 papers reporting primary research, the majority were from the UK (n = 29 106,113,114,122,124 ). As there was limited literature directly relevant to our target group, which we had anticipated, we included studies that offered opportunities for transferable learning, for example SM strategies for people living with dementia or diabetes care for older people.…”

Section: Description Of Studiesmentioning

confidence: 99%

Managing diabetes in people with dementia: a realist review

Bunn

Goodman

Jones

et al. 2017

Health Technol Assess

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BackgroundDementia and diabetes mellitus are common long-term conditions that coexist in a large number of older people. People living with dementia and diabetes may be at increased risk of complications such as hypoglycaemic episodes because they are less able to manage their diabetes.ObjectivesTo identify the key features or mechanisms of programmes that aim to improve the management of diabetes in people with dementia and to identify areas needing further research.DesignRealist review, using an iterative, stakeholder-driven, four-stage approach. This involved scoping the literature and conducting stakeholder interviews to develop initial programme theories, systematic searches of the evidence to test and develop the theories, and the validation of programme theories with a purposive sample of stakeholders.ParticipantsTwenty-six stakeholders (user/patient representatives, dementia care providers, clinicians specialising in dementia or diabetes and researchers) took part in interviews and 24 participated in a consensus conference.Data sourcesThe following databases were searched from 1990 to March 2016: MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Scopus, The Cochrane Library (including the Cochrane Database of Systematic Reviews), Database of Abstracts of Reviews of Effects, the Health Technology Assessment (HTA) database, NHS Economic Evaluation Database, AgeInfo (Centre for Policy on Ageing – UK), Social Care Online, the National Institute for Health Research (NIHR) portfolio database, NHS Evidence, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (Google Inc., Mountain View, CA, USA).ResultsWe included 89 papers. Ten papers focused directly on people living with dementia and diabetes, and the rest related to people with dementia or diabetes or other long-term conditions. We identified six context–mechanism–outcome (CMO) configurations that provide an explanatory account of how interventions might work to improve the management of diabetes in people living with dementia. This includes embedding positive attitudes towards people living with dementia, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. A general metamechanism that emerges concerns the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. A flexible service model for people with dementia and diabetes would enable this synergy in a way that would lead to the improved management of diabetes in people living with dementia.LimitationsThere is little evidence relating to the management of diabetes in people living with dementia, although including a wider literature provided opportunities for transferable learning. The outcomes in our CMOs are largely experiential rather than clinical. This reflects the evidence available. Outcomes such as increased engagement in self-management are potential surrogates for better clinical management of diabetes, but this is not proven.ConclusionsThis review suggests that there is a need to prioritise quality of life, independence and patient and carer priorities over a more biomedical, target-driven approach. Much current research, particularly that specific to people living with dementia and diabetes, identifies deficiencies in, and problems with, current systems. Although we have highlighted the need for personalised care, continuity and family-centred approaches, there is much evidence to suggest that this is not currently happening. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to the needs of people living with dementia and diabetes.Study registrationThis study is registered as PROSPERO CRD42015020625.FundingThe NIHR HTA programme.

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“…a P verschil: tweezijdig significantieniveau (.05) gebaseerd op een independent-samples T-test uitvoeren van een complexe interventie zoals een proactief zorgprogramma niet altijd wordt uitgevoerd als gepland. Bovendien kost het veel tijd voordat het volledig is geïmplementeerd [23]. Het blijkt in de praktijk zeer complex een grootschalig programma in korte tijd volledig te implementeren en uit te voeren.…”

Section: Vergelijking Met De Literatuurunclassified

Implementatie van een proactief zorgprogramma voor kwetsbare ouderen in de huisartsenpraktijk: van onderzoek naar praktijk

Bleijenberg

Jonge

Brand

et al. 2016

Tijdschr Gerontol Geriatr

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SamenvattingAchtergrond Multimorbiditeit, functionele beperkingen en kwetsbaarheid bij thuiswonende ouderen leiden tot een toenemende zorgcomplexiteit in de eerstelijn. Een proactieve, integrale aanpak is hierbij noodzakelijk. In de periode oktober 2014-oktober 2015 is een evidence-based proactief zorgprogramma voor kwetsbare ouderen geïmplementeerd in de regio Noord-West Veluwe en Zeewolde. In deze studie is de haalbaarheid van de implementatie geëvalueerd. De focus lag op de verbinding en samenwerking tussen het medische en sociale domein. Methoden Met een mixed-methods design zijn verschillende procesindicatoren geanalyseerd. Data waren afkomstig van routine zorggegevens uit de huisartsenpraktijk, vragenlijsten en interviews met ouderen. De vragenlijsten gaven inzicht in verwachtingen en ervaringen ten aanzien van het programma en waren op baseline en na zes maanden follow-up afgenomen bij huisartsen, praktijkondersteuners ouderenzorg (POH's-OZ) en na 12 maanden bij andere professionals uit verschillende domeinen (stakeholders). Interviews met ouderen en hun mantelzorgers brachten de ervaringen in kaart. Regionale werkgroepen waren opgezet waarin verschillende professionals participeerden om de verbinding tussen de domeinen te realiseren. Resultaten Het proactieve zorgprogramma is geïmplementeerd in 42 huisartsenpraktijken die zorg verlenen aan 7904 75-plussers. In totaal vulden 101 zorgverleners en 44 stakeholders de vragenlijst in. Voorafgaand aan de implementatie bleek zowel bij zorgverleners als bij de stakeholders behoefte aan meer structuur, samenwerking en coördinatie in de zorgverlening aan kwetsbare ouderen. De implementatie van het proactieve zorgprogramma verbeterde significant de structuur in de organisatie van zorg en transparantie over verwijsmogelijkheden met respectievelijk 34 % (p ≤ .001) en 27 % (p = .009). Zowel zorgverleners als stakeholders gaven na afloop van de implementatie aan kwetsbare ouderen beter in beeld te hebben dan voor de implementatie (p = .005). Ongeveer de helft van de deelnemers vond na afloop dat de regionale afstemming is verbeterd. Kwetsbare ouderen en hun mantelzorgers waren tevreden met de insteek, opzet en uitvoering van de nieuwe proactieve zorg. De POH's-OZ gaven aan dat de screeningsvragenlijst te lang was en veel tijd kostte. Ook is niet voor alle ouderen die kwetsbaar waren een zorgplan opgesteld. Conclusie De implementatie van het proactieve zorgprogramma bleek haalbaar. Een sterke verbinding en domein overstijgende samenwerking is gerealiseerd. Het programma kon eenvoudig aangepast worden aan de actualiteit en de lokale context. AbstractBackground Multimorbidity, functional impairment and frailty among community-dwelling older people are causing increasing complexity in primary care. A proactive integrated primary care approach is therefore essential. Between October 2014-2015, an evidence-based proactive care program for frail older people was implemented in the region Noord-West Veluwe en Zeewolde, the Netherlands. This study evaluated the feasibility of t...

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A nurse-led interdisciplinary primary care approach to prevent disability among community-dwelling frail older people: A large-scale process evaluation

Cited by 74 publications

References 37 publications

Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial

Multicomponent Program to Reduce Functional Decline in Frail Elderly People: A Cluster Controlled Trial

Managing diabetes in people with dementia: a realist review

Implementatie van een proactief zorgprogramma voor kwetsbare ouderen in de huisartsenpraktijk: van onderzoek naar praktijk

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