Development of a home visitation programme for the early detection of health problems in potentially frail community-dwelling older people by general practices

Abstract

The integration within existing health care systems of preventive initiatives to maintain independent living among older people is increasingly emphasized. This article describes the development and refinement of the [G]OLD home visitation programme: an eight-step programme, including a comprehensive geriatric assessment, for the early detection of health and well-being problems among older people (C75 years) by general practices. A single group post-test study using a mixed model design is performed to evaluate (a) the feasibility of the home visitation programme in general practice, (b) the practical usefulness of the geriatric assessment instrument, and (c) programme implementation with respect to reinventions introduced by general practitioners (GPs) and practice nurses (PNs). Within 3 months time, 22 PNs of 18 participating general practices visited 240 community-dwelling older people (mean age = 82.0 years; SD 4.2) who had not been in contact with their general practice for more than 6 months. Mean time investment of the programme per older person was 118.1 min (SD 27.0) for GPs and PNs combined. Evaluation meetings revealed that GPs and PNs considered the home visitation programme to be feasible in daily practice. They judged the geriatric assessment to be useful, although minor adjustments are needed (e.g., layout, substitution of tests). PNs often failed to register follow-up actions for detected problems in a care and treatment plan. Future training for PNs should address this issue. No reinventions were introduced that threatened fidelity of implementation. The findings are used to improve the home visitation programme before its evaluation in a large-scale controlled trial.

Formulation of and adherence to a care plan for potentially frail community-dwelling older people by practice nurses in the Netherlands

“…Concerning the formulation of care plans, only 27.8% of the problems identified through CGA were included in a care plan, which is in agreement with our previous work [15] . It implies, as confirmed by the findings, that the formulation of care plans by PNs is not only influenced by the cut-off points of the CGA, but also by a complex interplay of patient-related and problem-specific factors.…”

“…Also consistent with our previous work [15] , we found that the main reason for not including the remaining 72.2% of the problems in the care plan was that the problem was already known and/or action had already been undertaken. Hence, it might be argued that the ability of the [G]OLD-instrument to identify new or unmet needs that require follow-up actions is limited.…”

Early detection of health problems in potentially frail community-dwelling older people by general practices - project [G]OLD: design of a longitudinal, quasi-experimental study

“…General practices (n = 21) who visited older people at home as part of our pilot study [30] were excluded from participation to prevent contamination of prior experience. We approached 188 general practices in the three regions for participation in this study.…”

“…Applying both models has led to the development of the [G]OLD-protocol, which is explained in more detail below. Our pilot study provided preliminary evidence of the feasibility of the [G]OLD-protocol for general practices [30]. …”

Using an Electronic Comprehensive Geriatric Assessment and Health Coaching to Prevent Frailty in Primary Care: The CARES Model

“…Mounting evidence suggests frailty may be modifiable and can be prevented and sometimes even reversed [5]. Emerging frailty guidelines recommend the early identification of frailty in "at risk" seniors to address modifiable variables and prevent deterioration before it occurs [6,7]. The recognition for frailty is important especially in the primary care setting [8][9][10].…”