Unravelling complex primary-care programs to maintain independent living in older people: a systematic overview

Smit, Linda; Schuurmans, Marieke J.; Blom, Jeanet W.; Fabbricotti, Isabelle; Jansen, A.P.D.; Kempen, Gertrudis I. J. M.; Koopmans, Raymond T.C.M.; Looman, Willemijn; Melis, René J. F.; Metzelthin, Silke; Charante, Eric P. Moll van; Muntinga, Maaike; Ruikes, Franca G H; Spoorenberg, Sophie; Suijker, Jacqueline J.; Wynia, Klaske; Gussekloo, Jacobijn; Wit, Niek J. de; Bleijenberg, Nienke

doi:10.1016/j.jclinepi.2017.12.013

Cited by 30 publications

(36 citation statements)

References 52 publications

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“…An explanation for this connection could be that GP need support in acting upon CGA recommendations [26]. Despite the overwhelming amount of literature about the importance of integration of care and the difficulty of implementing this collaborative way of working [48] there is still not enough attention to embedding in existing care or to the context in which outpatient programs are carried out [9].…”

Section: Discussionmentioning

confidence: 99%

“…Programs can differ in many aspects: overall program aim, domains focused on in the CGA, disciplines carrying out the CGA, as well as the level of influence over the recommendations given after the CGA and follow-up period. Studying the separate components of these programs, their implementation and how they fit together has been suggested [9] to optimally design programs that lead to improved patient outcomes [3, 10]).…”

Section: Introductionmentioning

confidence: 99%

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Explaining experiences of community-dwelling older adults with a pro-active comprehensive geriatric assessment program – a thorough evaluation by interviews

et al. 2019

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IntroductionPro-active assessment programs are increasingly used to improve care for older adults. These programs include comprehensive geriatric tailored to individual patient preferences. Evidence for the effects of these programs on patient outcomes is nevertheless scarce or ambiguous. Explaining these dissatisfying results is difficult due to the multi-component nature of the programs. The objective of the current study was to explore and explain the experience of older adults participating in a pro-active assessment program, to help to clarify the effects.MethodsSemi-structured in-depth interviews were held with 25 participants of a pro-active assessment program for frail community-dwelling adults aged 65+. This study was part of an evaluation study on the effects of the program. Transcripts were analysed with thematic analysis and cross-case analysis.ResultsThe participants’ mean age was 78.5 (SD 6.9) and 56% was female. The majority of the participants were satisfied with the program but based this on communication aspects, since only a few of them expressed real program benefits. Participant experiences could be clustered in six themes: (1) All participants expressed the need for a holistic view which was covered in the program, (2) the scope of the CGA was broader than expected or unclear, (3) the program delivered unexpected but valued help, (4) participants described a very low sense of ownership, (5) timing of the program implementation or the CGA was difficult and(6), participants and care workers had a different view on what to consider as a problem. These experiences could be explained by three program components: the degree of (the lack of) integration of the program within usual care, the pro-active screening method and the broader than expected, but appreciated multi-domain approach.ConclusionOlder adults’ need for a holistic view is covered by this outpatient assessment program. However, their engagement and the correct timing of the program are hampered by the pro-active recruitment and the limited integration of the program within existing care. Furthermore, satisfaction seems an insufficient guiding factor when evaluating CGA programs for older adults because it does not reflect the impact of the program.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-1025-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Explaining experiences of community-dwelling older adults with a pro-active comprehensive geriatric assessment program – a thorough evaluation by interviews

et al. 2019

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“…This study showed that the pathway complexity and contextual complexity of most interventions were unclear or unable to access. The limited reporting regarding the use of a logic model which describe the nature of the causal pathway between the intervention and its effect, and contextual factors which can influence the effectiveness of an intervention, was also observed by Smit et al 10 that examined complex primary healthcare interventions. 10 SNA could be of value in addressing the contextual complexity as the degree to which the effects of the intervention are dependent on the context or setting in which it is implemented.…”

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confidence: 92%

“…The limited reporting regarding the use of a logic model which describe the nature of the causal pathway between the intervention and its effect, and contextual factors which can influence the effectiveness of an intervention, was also observed by Smit et al 10 that examined complex primary healthcare interventions. 10 SNA could be of value in addressing the contextual complexity as the degree to which the effects of the intervention are dependent on the context or setting in which it is implemented. 26 The Consolidated Framework Open access for Implementation Research (CFIR) comprises 39 constructs organised across five major domains (eg, intervention, outer setting, inner setting, characteristics of individuals and process), all of which interact to influence implementation and implementation effectiveness.…”

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confidence: 92%

Value of social network analysis for developing and evaluating complex healthcare interventions: a scoping review

et al. 2020

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ObjectivesMost complex healthcare interventions target a network of healthcare professionals. Social network analysis (SNA) is a powerful technique to study how social relationships within a network are established and evolve. We identified in which phases of complex healthcare intervention research SNA is used and the value of SNA for developing and evaluating complex healthcare interventions.MethodsA scoping review was conducted using the Arksey and O’Malley methodological framework. We included complex healthcare intervention studies using SNA to identify the study characteristics, level of complexity of the healthcare interventions, reported strengths and limitations, and reported implications of SNA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews 2018 was used to guide the reporting.ResultsAmong 2466 identified studies, 40 studies were selected for analysis. At first, the results showed that SNA seems underused in evaluating complex intervention research. Second, SNA was not used in the development phase of the included studies. Third, the reported implications in the evaluation and implementation phase reflect the value of SNA in addressing the implementation and population complexity. Fourth, pathway complexity and contextual complexity of the included interventions were unclear or unable to access. Fifth, the use of a mixed methods approach was reported as a strength, as the combination and integration of a quantitative and qualitative method clearly establishes the results.ConclusionSNA is a widely applicable method that can be used in different phases of complex intervention research. SNA can be of value to disentangle and address the level of complexity of complex healthcare interventions. Furthermore, the routine use of SNA within a mixed method approach could yield actionable insights that would be useful in the transactional context of complex interventions.

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“…This may be explained by differences in groups reached by the intervention, fidelity to the intervention and context of implementation. However, a recent study revealed that coordinated preventive care studies often do not report how such specific aspects of the intervention are carried out (Smit et al, ). Insight in these so‐called ‘process components’ could increase the understanding of underlying reasons for why some studies do find positive effects while another do not.…”

Section: Introductonmentioning

confidence: 99%

A coordinated preventive care approach for healthy ageing in five European cities: A mixed methods study of process evaluation components

Franse

Zhang

Grieken

et al. 2019

Journal of Advanced Nursing

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Aims To evaluate specific process components of the Urban Health Centres Europe (UHCE) approach; a coordinated preventive care approach aimed at healthy ageing by decreasing falls, polypharmacy, loneliness and frailty among older persons in community settings of five cities in the United Kingdom, Greece, Croatia, the Netherlands and Spain. Design Mixed methods evaluation of specific process components of the UHCE approach: reach of the target population, dose of the intervention actually delivered and received by participants and satisfaction and experience of main stakeholders involved in the approach. Methods The UHCE approach intervention consisted of a preventive assessment, shared decision‐making on a care plan and enrolment in one or more of four coordinated care‐pathways that targeted falls, polypharmacy, loneliness and frailty. Quantitative data from a questionnaire and quantitative/qualitative data from logbooks were collected among older persons involved in the approach. Qualitative data from focus groups were collected among older persons, informal caregivers and professionals involved in the approach. Quantitative data were analysed by means of descriptive statistics and multilevel logistic regression models. Qualitative data were analysed through thematic analysis. Results Having limited function was associated with non‐enrolment in falls and loneliness care‐pathways (both p < .01). The mean rating of the approach was 8.3/10 (SD 1.9). Feeling supported by a care professional and meeting people were main benefits for older persons. Mistrust towards unfamiliar care providers, lack of confidence to engage in care activities and health constraints were main barriers towards engagement in care. Conclusions Although the UHCE approach was received generally positively, health constraints and psychosocial barriers prevented older person's engagement in care. Impact Coordinated preventive care approaches for older community‐dwelling persons should address health constraints and psychosocial barriers that hinder older person's engagement in care. Trial registration: ISRCTN registry number is ISRCTN52788952. Date of registration is 13/03/2017.

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Unravelling complex primary-care programs to maintain independent living in older people: a systematic overview

Abstract: An in-depth analysis of the context, modeling of the processes and outcomes, measurement and reporting of intervention fidelity, and implementation of effective training for interventionists is needed to enhance the development and replication of future complex interventions.

Cited by 30 publications

References 52 publications

Explaining experiences of community-dwelling older adults with a pro-active comprehensive geriatric assessment program – a thorough evaluation by interviews

Explaining experiences of community-dwelling older adults with a pro-active comprehensive geriatric assessment program – a thorough evaluation by interviews

Value of social network analysis for developing and evaluating complex healthcare interventions: a scoping review

A coordinated preventive care approach for healthy ageing in five European cities: A mixed methods study of process evaluation components

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