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Integrated primary care for community-dwelling frail older persons

Traditional primary care in the Netherlands is ill equipped to meet the complex (healthcare) needs of frail older persons who live independently at home. Integrated care is advocated to improve the quality of care and patient outcomes. However, the added value of integrated primary care for community-dwelling frail older persons remains inconclusive, and important underlying mechanisms that drive (a lack of) effectiveness are often ignored. This thesis reports on a theory-guided evaluation of an integrated primary care approach for community-dwelling frail older persons, called Finding and Follow-up of Frail older persons (FFF)

Nursing home staff perceptions of well-being during the COVID-19 pandemic:A qualitative study

Aims: To explore how nursing home staff perceived their work environment during the COVID-19 pandemic and how this impacted their well-being. Design: A qualitative interview study. Methods: Interviews were held with twenty-two registered nurses and assistant nurses from five nursing homes in the Netherlands between April 2021 and July 2021. The interviews were analysed using qualitative content analysis. The Standards for Reporting Qualitative Research (SRQR) were followed. Results: Five themes emerged from the interviews and indicated that working during the COVID-19 pandemic impacted perceived well-being of nursing home staff. Three themes concerned experiences at work: eroding care, additional roles and workplace support. Specifically, the increased workload with additional tasks, the constant stream of new guidelines and constrictive personal protective equipment caused discomfort and anxiety. Two other themes concerned experiences outside of work: work-life interference and social interactions and status. The nurses reported that when they returned home after work, they were tired and worried about spreading the virus while facing limited social interactions and support. Conclusion: The social distancing measures due to the COVID-19 pandemic negatively impacted nursing home staff well-being by increasing demands in the absence of adequate resources. Implications for the Profession and/or Patient Care: The well-being needs of nurses should receive continued attention to ensure the sustainability of healthcare during future crises. Patient or Public Contribution: The nursing home managers participated in recommending the topics to be covered during interviews. Impact: What problem did the study address? The pressure of stressful working conditions on the well-being of nurses during the pandemic. What were the main findings? Nurses created strategies to cope with declining well-being. However, the available resources did not alleviate the increased demands caused by the pandemic. Where and on whom will the research have an impact? This study is important for healthcare organizations to understand how the COVID-19 pandemic affected nurses so that they may better prepare for future crises.</p

Evaluating an integrated primary care approach to improve well-being among frail community-living older people

Background: A major challenge in primary healthcare is the substantial increase in the proportion of frail community-dwelling older persons with long-term conditions and multiple complex needs. Consequently, a fundamental transformation of current models of primary care by means of implementing proactive integrated care is necessary. Therefore, an understanding of the effects of integrated primary care approaches and underlying mechanisms is essential. This article presents the design of a theory-based evaluation of an integrated primary care approach to improve well-being among frail community-living older adults, which is called "Finding and Follow-up of Frail older persons" (FFF). First, we present a theoretical model to facilitate a sound theory-guided evaluation of integrated primary care approaches for frail community-dwelling older people. The model incorporates interrelated elements of integrated primary care approaches (e.g. proactive case finding and self-management support). Efforts to improve primary care should integrate these promising components to assure productive patient-professional interactions and to improve well-being. Moreover, cognitive and behavioral components of healthcare professionals and patients are assumed to be important. Second, we present the design of the study to evaluate the FFF approach which consists of the following key components: (1) proactive case finding, (2) case management, (3) medication review, (4) self-management support, and (5) working in multidisciplinary care teams. Methods: The longitudinal evaluation study has a matched quasi-experimental design with one pretest and one posttest (12 month follow-up) and is conducted in the Netherlands between 2014 and 2017. Both quantitative and qualitative methods are used to evaluate effectiveness, processes, and cost-effectiveness. In total, 250 frail older persons (75 years and older) of 11 GP (general practitioner) practices that implemented the FFF approach are compared with 250 frail older patients of 4 GP practices providing care as usual. In addition, data are collected from healthcare professionals. Outcome measures are based on our theoretical model. Discussion: The proposed evaluation study will reveal insight into the (cost)effectiveness and underlying mechanisms of the proactive integrated primary care approach FFF. A major strength of the study is the comprehensive evaluation b

Quality of primary care delivery and productive interactions among community-living frail older persons and their general practitioners and practice nurses

Background Although there is evidence with respect to the effectiveness of Chronic Care Model (CCM)

A cross-sectional study investigating the relationships between self-management abilities, productive patient-professional interactions, and well-being of community-dwelling frail older people

Worldwide, the maintenance of well-being in ageing populations with associated frailty has become increasingly important

Cost-effectiveness of a proactive, integrated primary care approach for community-dwelling frail older persons

Background: The article reports on the cost-effectiveness of the proactive, integrated primary care program Finding and Follow-up of Frail older persons (FFF) compared with usual primary care for community-dwelling frail older persons in the Netherlands. Methods: This study had a matched quasi-experimental design (pretest and posttest). The economic evaluation was performed from a healthcare perspective with a time horizon of 12 months. The target population consisted of community-dwelling frail older persons aged ≥ 75 years in the FFF intervention group (11 general practitioner (GP) practices) and in the control group receiving usual care (4 GP practices). The effectiveness measures for the cost-effectiveness and cost-utility analyses were subjective well-being (Social Production Function Instrument for the Level of well-being short; SPF-ILs) and QALYs (EuroQol; EQ-5D-3L), respectively. Costs were assessed using resource use questionnaires. Differences in mean effectiveness between groups were assessed using univariate, multilevel and propensity score matched analyses, with and without imputation of missing values. Differences in costs were assessed using Mann-Whitney U-tests and independent samples t-tests. Bootstrapping was performed, and predicted incremental cost-effectiveness ratios (ICERs) and incremental cost-utility ratios (ICURs) were depicted on cost-effectiveness planes. Results: The various analyses showed slightly different results with respect to differences in estimated costs and effects. Multilevel analyses showed a small but significant difference between the groups for well-being, in favor of the control group. No significant differences between groups in terms of QALYs were found. Imputed data showed that mean total costs were significantly higher in the intervention group at follow-up. Conclusion: Proactive, integrated care for community-dwelling frail older persons as provided in the FFF program is most likely not a cost-effective initiative, compared with usual primary care in the Netherlands, in terms of well-being and QALYs over a 12-month period