Exploring the expectations, needs and experiences of general practitioners and nurses towards a proactive and structured care programme for frail older patients: a mixed‐methods study

Bleijenberg, Nienke; Dam, Valerie H. ten; Steunenberg, Bas; Drubbel, Irene; Numans, Mattijs E.; Wit, Niek J. de; Schuurmans, Marieke J.

doi:10.1111/jan.12110

Cited by 38 publications

(103 citation statements)

References 31 publications

(48 reference statements)

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“…This theme was informed by nine studies [33,36,39,45,49,50,61,63,68] and includes examples of experiences and opinions which challenge or support the notion that frailty development is malleable. While health professionals showed confidence in prevention and management of frailty, they also acknowledged the difficulty of having the right tools to identify people who might benefit, and when intervention would be more useful.…”

Section: Resultsmentioning

confidence: 99%

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Stakeholders’ views and experiences of care and interventions for addressing frailty and pre-frailty: A meta-synthesis of qualitative evidence

et al. 2017

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Frailty is a common condition in older age and is a public health concern which requires integrated care and involves different stakeholders. This meta-synthesis focuses on experiences, understanding, and attitudes towards screening, care, intervention and prevention for frailty across frail and healthy older persons, caregivers, health and social care practitioners. Studies published since 2001 were identified through search of electronic databases; 81 eligible papers were identified and read in full, and 45 papers were finally included and synthesized. The synthesis was conducted with a meta-ethnographic approach. We identified four key themes: Uncertainty about malleability of frailty; Strategies to prevent or to respond to frailty; Capacity to care and person and family-centred service provision; Power and choice. A bottom-up approach which emphasises and works in synchrony with frail older people's and their families' values, goals, resources and optimisation strategies is necessary. A greater employment of psychological skills, enhancing communication abilities and tools to overcome disempowering attitudes should inform care organisation, resulting in more efficient and satisfactory use of services. Public health communication about prevention and management of frailty should be founded on a paradigm of resilience, balanced acceptance, and coping. Addressing stakeholders’ views about the preventability of frailty was seen as a salient need.

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Section: Resultsmentioning

confidence: 99%

“…Twentysix papers contributed to this theme [31–36,38–40,43,46,47,52–58,60,62,65,70–72,74]. This theme presents findings related to care providers’ capacity to care, taking a patient-centred and family-centred approach to care.…”

Section: Resultsmentioning

confidence: 99%

Stakeholders’ views and experiences of care and interventions for addressing frailty and pre-frailty: A meta-synthesis of qualitative evidence

et al. 2017

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“…Health care providers cite insufficient time and limited financial resources as barriers to proactive, goal based care, particularly for older adults with multiple morbidities (Bleijenberg et al, 2013). Discharge planners and community service providers reported that disabilities and deficits remain the central focus with insufficient attention to older adults’ goals when transitioning from hospital to home setting.…”

Section: Background and Significancementioning

confidence: 99%

Examining Life Goals of Community-Dwelling, Low-Income Older Adults

Howard¹,

Louvar²

2017

Research in Gerontological Nursing

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Self-care and self-management programs are touted as a means to age successfully. Yet, these programs pay little regard to a critical first step—the personal goals of older adults. The capacity to self-identify goals and pursue actions toward goal achievement transcends age. An examination of life goals identified by community-dwelling, low-income older adults indicates that functional performance mechanisms are valued. Maintenance of health and increased physical activity were the two most commonly identified personal goals within a sample of 161 community-dwelling older adults residing in subsidized housing. A third goal, increased socialization, aligns with relevant psychosocial factors and reflects the need to engage with others. The preferences of the older adult placed at the center of the care planning process strategically support goal attainment. Providing an opportunity to create and pursue self-selected life goals of older adults is worth consideration when developing and testing interventions designed to support successful aging. [Res Gerontol Nurs. 2017; 10(5):205–214.]

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“…Uit de evaluatie bleek dat ouderen die het programma ontvingen meer behoud van zelfredzaamheid hadden dan ouderen die het traditionele zorgaanbod ontvingen [7]. Bovendien werd het zorgprogramma positief ontvangen door ouderen en hun mantelzorgers, huisartsen en praktijkverpleegkundigen [8,9]. Mede hierdoor waren verschillende huisartsenpraktijken in de regio gemotiveerd om het programma in de praktijk te implementeren.…”

Section: Inleidingunclassified

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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Exploring the expectations, needs and experiences of general practitioners and nurses towards a proactive and structured care programme for frail older patients: a mixed‐methods study

Abstract: This explanatory mixed-methods study showed that general practitioners and practice nurses perceived the U-CARE programme as feasible in general practice. A transition was made from reactive, ad hoc care towards a proactive and preventive care approach.

Cited by 38 publications

References 31 publications

Stakeholders’ views and experiences of care and interventions for addressing frailty and pre-frailty: A meta-synthesis of qualitative evidence

Stakeholders’ views and experiences of care and interventions for addressing frailty and pre-frailty: A meta-synthesis of qualitative evidence

Examining Life Goals of Community-Dwelling, Low-Income Older Adults

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

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