Zorg op maat voor ouderen in de eerstelijnszorg

Summary

Personalized primary care for older people: evaluation of a nurse-led multicomponent care program
Nienke Bleijenberg

AIM: Providing optimal care for the increasing number of frail older people is a major challenge in primary care. The current approach in care is rather reactive and does not always meet the needs of older patients, resulting in unnecessary loss of daily functioning, suboptimal quality of life and high healthcare expenditures. In the Utrecht Proactive Frailty Intervention Trial (U-PROFIT), in Dutch: called ‘Ouderenzorgproject Midden Utrecht’ (Om U), we designed and evaluated a strategy entailing proactive patient-centred primary care of frail older people. This strategy consists of a frailty screening intervention based on routine patient data collected in general practice, combined with a nurseled personalized intervention comprising frailty screening, comprehensive geriatric assessment and evidencebased care planning.
METHOD: In this RCT, we provided a detailed description of the development of this nurseled care program. Furthermore, we evaluated the effectiveness of this care program on the preservation of daily functioning of frail older people as measured with the modified Katz-15 ADL/IADL scale.
FINDINGS: We observed that after a follow-up period of 1 year, both the screening intervention itself as well as the screening intervention subsequently followed by the nurseled care program resulted in a significantly better preservation of daily functioning as compared to the control group. Older people with a higher level of education benefitted from this intervention, as illustrated by an improvement in their level of daily functioning. The proactive primary care strategy was highly appreciated by nurses and general practitioners (GPs). Hence, the program was considered to be valuable for the implementation and coordination of personalized proactive care. Older patients were perceived to become more ‘visible’ in general practice through this care program. Interviews with a subsample of older persons showed that this proactive strategy was well appreciated when the relationship, timing of the intervention, and nurses’ roles were tailored to their needs. CONCLUSION: In conclusion, the U-PROFIT trial demonstrated that a proactive primary care strategy comprising a frailty screening subsequently followed by a multicomponent nurseled care intervention resulted in lesser decline of daily functioning in frail older people. This strategy can be easily implemented in daily care and is well appreciated by patients, nurses and GPs working in primary care. Future research is, however, needed to determine the optimal treatment intensity for specific subgroups of older patients as well as to achieve maximum benefits of this type of care program.

Keywords: Older people, primary care, complex interventions, randomized controlled trial, experiences, nurses, general practitioners