Proactive and integrated primary care for frail older people: design and methodological challenges of the Utrecht primary care PROactive frailty intervention trial (U-PROFIT)

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

doi:10.1186/1471-2318-12-16

Cited by 41 publications

(39 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the U-PROFIT trial, we are currently examining the effect of this two-step screening strategy on the quality of life and daily functioning of frail older people [40]. …”

Section: Discussionmentioning

confidence: 99%

Identifying frailty: do the Frailty Index and Groningen Frailty Indicator cover different clinical perspectives? a cross-sectional study

et al. 2013

Self Cite

View full text Add to dashboard Cite

BackgroundEarly identification of frailty is important for proactive primary care. Currently, however, there is no consensus on which measure to use. Therefore, we examined whether a Frailty Index (FI), based on ICPC-coded primary care data, and the Groningen Frailty Indicator (GFI) questionnaire identify the same older people as frail.MethodsWe conducted a cross-sectional, observational study of 1,580 patients aged ≥ 60 years in a Dutch primary care center. Patients received a GFI questionnaire and were surveyed on their baseline characteristics. Frailty-screening software calculated their FI score. The GFI and FI scores were compared as continuous and dichotomised measures.ResultsFI data were available for 1549 patients (98%). 663 patients (42%) returned their GFI questionnaire. Complete GFI and FI scores were available for 638 patients (40.4%), mean age 73.4 years, 52.8% female. There was a positive correlation between the GFI and the FI (Pearson’s correlation coefficient 0.544). Using dichotomised scores, 84.3% of patients with a low FI score also had a low GFI score. In patients with a high FI score, 55.1% also had a high GFI score. A continuous FI score accurately predicted a dichotomised GFI score (AUC 0.78, 95% CI 0.74 to 0.82). Being widowed or divorced was an independent predictor of both a high GFI score in patients with a low FI score, and a high FI score in patients with a low GFI score.ConclusionsThe FI and the GFI moderately overlap in identifying frailty in community-dwelling older patients. To provide optimal proactive primary care, we suggest an initial FI screening in routine healthcare data, followed by a GFI questionnaire for patients with a high FI score or otherwise at high risk as the preferred two-step frailty screening process in primary care.

show abstract

“…In the U-PROFIT trial, we are currently examining the effect of this two-step screening strategy on the quality of life and daily functioning of frail older people [40]. …”

Section: Discussionmentioning

confidence: 99%

Identifying frailty: do the Frailty Index and Groningen Frailty Indicator cover different clinical perspectives? a cross-sectional study

et al. 2013

Self Cite

View full text Add to dashboard Cite

show abstract

“…In the PoC trial, a postal questionnaire was used to identify frail older people: the Groningen Frailty Indicator [7]. The U-PROFIT trial made use of Electronic Medical Records to select older people with frailty [8,9]. The central element of all interventions was tailored care based on comprehensive geriatric assessments.…”

Section: Results From Three Recent Studies In the Netherlandsmentioning

confidence: 99%

How effective is integrated care for community-dwelling frail older people? The case of the Netherlands

Hoogendijk¹

2016

Age Ageing

View full text Add to dashboard Cite

Integrated care programs have been developed to enhance the quality care for older adults in primary care. These programs usually consist of a multidisciplinary approach, with personalised care based on comprehensive geriatric assessments. However, there is limited evidence for the effectiveness of these programs in frail older people. In this article, we review the results of three recent intervention studies carried out as part of the Dutch National Care for the Elderly Programme. The results illustrate how difficult it is to improve outcomes in community-dwelling frail older adults by means of integrated care. Furthermore, we discuss the implications of these studies for future research into frailty interventions.

show abstract

“…Because the intervention was aimed at the general practice level, a cluster‐randomized design was used to prevent contamination between the comparison groups. The study protocol has been described in detail . Written informed consent was obtained from all participants.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of a Proactive Primary Care Program on Preserving Daily Functioning of Older People: A Cluster Randomized Controlled Trial

Bleijenberg

Drubbel

Schuurmans

et al. 2016

J American Geriatrics Society

Self Cite

View full text Add to dashboard Cite

OBJECTIVES:To determine the effectiveness of a proactive primary care program on the daily functioning of older people in primary care. DESIGN: Single-blind, three-arm, cluster-randomized controlled trial with 1-year follow-up. SETTING: Primary care setting, 39 general practices in the Netherlands. PARTICIPANTS: Community-dwelling people aged 60 and older (N = 3,092). INTERVENTIONS: A frailty screening intervention using routine electronic medical record data to identify older people at risk of adverse events followed by usual care from a general practitioner; after the screening intervention, a nurse-led care program consisting of a comprehensive geriatric assessment, evidence-based care planning, care coordination, and follow-up; usual care. MEASUREMENTS: Primary outcome was daily functioning measured using the Katz-15 (6 activities of daily living (ADLs), 8 instrumental activities of daily living (IADLs), one mobility item (range 0-15)); higher scores indicate greater dependence. Secondary outcomes included quality of life, primary care consultations, hospital admissions, emergency department visits, nursing home admissions, and mortality. RESULTS: The participants in both intervention arms had less decline in daily functioning than those in the usual care arm at 12 months (mean Katz-15 score: screening arm, 1.87, 95% confidence interval (CI) = 1.77-1.97; screening and nurse-led care arm, 1.88, 95% CI = 1.80-1.96; control group, 2.03, 95% CI = 1.92-2.13; P = .03). No differences in quality of life were observed. CONCLUSION: Participants in both intervention groups had less decline than those in the control group at 1-year follow-up. Despite the statistically significant effect, the clinical relevance is uncertain at this point because of the small differences. Greater customizing of the intervention combined with prolonged follow-up may lead to morerobust results. J Am Geriatr Soc 64:1779-1788, 2016.Key words: primary care; daily functioning; randomized controlled trial; older people; nurse-led care program P roviding optimal care for the increasing number of older people with complex care needs is a major challenge in primary care. 1,2 The average primary care consultation rate for Dutch citizens increases from 4.3 to 6.2 per year between the ages of 60 and 75 to 10 or more per year after the age of 75. 3 The current approach in primary care is reactive and fragmented and does not meet the needs of older people as they experience a lack of overview and coordination when multiple care providers are involved. 4 These deficits result in unnecessary losses of daily functioning, suboptimal quality of life, and high healthcare expenditures. 5 A transition toward more-proactive primary care that focuses on maintaining independence and prevention of functional decline in older adults has been proposed, 6 but the critical components of a more-proactive primary care system remain unknown.The literature regarding the prevention of functional decline in older adults suggests a stepwise identification of people who are a...

show abstract

Proactive and integrated primary care for frail older people: design and methodological challenges of the Utrecht primary care PROactive frailty intervention trial (U-PROFIT)

Cited by 41 publications

References 43 publications

Identifying frailty: do the Frailty Index and Groningen Frailty Indicator cover different clinical perspectives? a cross-sectional study

Identifying frailty: do the Frailty Index and Groningen Frailty Indicator cover different clinical perspectives? a cross-sectional study

How effective is integrated care for community-dwelling frail older people? The case of the Netherlands

Effectiveness of a Proactive Primary Care Program on Preserving Daily Functioning of Older People: A Cluster Randomized Controlled Trial

Contact Info

Product

Resources

About