Samen op weg naar transitie: de implementatie van een zorgmodel voor kwetsbare ouderen vanuit de huisartsenpraktijk

Summary

Together toward transition.
Implementing a comprehensive care program for frail, older people in primary care
Maaike Muntinga

BACKGROUND: In this thesis, we evaluate the implementation process of the Geriatric Care Model, a comprehensive care model for frail, community-dwelling older people that was tested and implemented by means of a randomised controlled trial (the ACT-study). In addition, we explore the theoretical premises of the Geriatric Care Model by gaining insight in aspects of the caregiver-receiver interaction in the home environment and in the care needs at stake during this interaction. METHODS: Design and participants: Between 2010 and 2012, the ACT-study was carried out among 35 primary care practices in two regions in the Netherlands. Participants were 1147 frail, older people and their primary care givers. Geriatric Care Model: Every six months, practice nurses visited older people at home and carried out a comprehensive geriatric assessment. Geriatric expert teams managed practice nurses, organised training sessions and built local networks. Older people with complex care needs were discussed in multidisciplinary consultations. Data collection: Qualitative (semi-structured interviews with older people, practice nurses and geriatric team members, observations) and quantitative process data (questionnaires, geriatric assessment data, care plans) were collected alongside the trial and at the end of the intervention period.
FINDINGS: We found that the Geriatric Care Model was largely implemented as intended. When practice nurses deviated from protocol, they often aimed to tailor the intervention to the local situation. Our results suggest proactive comprehensive geriatric assessment has the potential to identify new or changed care needs related to pain management, and most of frail, older people’s unmet care needs existing in the psychosocial domain. In addition, we found that meeting older people’s relational needs may play an important role in establishing trusting care relationships, which influences whether frail, older people accept care that is pro-actively offered to them. Finally, we argue that questionnaires that measure client-centeredness of care from the perspective of frail, older people take into account the specific carerelated circumstances of this group.
CONCLUSION: Components of the Geriatric Care Model, such as proactive home visits and practice nurseled comprehensive geriatric assessments, may positively contribute to tailored care for frail, older people. When carrying out proactive home visits, practice nurses should meet the relational needs of frail, older people in order to promote older people’s adoption of care advice and interventions.

Keywords: Chronic care model, primary care, frail older people, home visits, implementation