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)

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