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

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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 (≥75 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., lay-out, 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.

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References

  • Blokstra A, Baan CA, Boshuizen HC, Feenstra TL, Hoogenveen RT, Picavet HSJ, Smit HA, Wijga AH, Verschuren WMM (2007) Vergrijzing en toekomstige ziektelast. Prognose chronische ziektenprevalentie 2005–2025 [Impact of the ageing population on burden of disease. Projections of chronic disease prevalence for 2005–2025] RIVM rapport 260401004. RIVM, Bilthoven

    Google Scholar 

  • Bodenheimer T, Berry-Millett R (2009) Care management of patients with complex health care needs. Research synthesis report no. 19. Robert Wood Johnson Foundation, Princeton

  • Bodenheimer T, Wagner EH, Grumbach K (2002) Improving primary care for patients with chronic illness. J Am Med Assoc 288:1775–1779

    Article  Google Scholar 

  • Boult C, Karm L, Groves C (2008) Improving chronic care: the “Guided Care” model. Perm J 12:50–54

    Google Scholar 

  • Bouman A, Van Rossum E, Ambergen T, Kempen GIJM, Knipschild P (2008) Effects of a preventive home visiting program for older people with poor health status: a randomized clinical trial in the Netherlands. J Am Geriatr Soc 56:397–404

    Article  Google Scholar 

  • Boyd CM, Boult C, Shadmi E, Leff B, Brager R, Dunbar L, Wolff JL, Wegener S (2007) Guided care for multimorbid older adults. Gerontologist 47:697–704

    Article  Google Scholar 

  • Craig P, Dieppe P, Macintyre S, Mitchie S, Nazareth I, Petticrew M (2008) Developing and evaluating complex interventions: the new Medical Research Council guidance. Br Med J 337:a1655

    Article  Google Scholar 

  • Daniels R, Metzelthin S, Van Rossum E, De Witte L, Van den Heuvel W (2010) Interventions to prevent disability in frail community-dwelling older persons: an overview. Eur J Ageing 7:37–55

    Article  Google Scholar 

  • Dutch College of General Practitioners (2007) NHG-Standpunt Toekomstvisie Huisartsenzorg. Huisartsgeneeskunde voor ouderen [Statement of the NHG, Future of General Practitioner Care. General practice medicine for older people]. NHG, Utrecht

  • Elkan R, Kendrick D, Dewey M, Hewitt M, Robinson J, Blair M, Williams D, Brummell K (2001) Effectiveness of home based support for older people: systematic review and meta-analysis. Br Med J 323:719–725

    Article  Google Scholar 

  • Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  Google Scholar 

  • Gill TM (2005) Education, prevention, and the translation of research into practice. J Am Geriatr Soc 53:724–726

    Article  Google Scholar 

  • Guigoz Y, Vellas B, Garry PJ (1994) Mini Nutritional Assessment: a practical assessment tool for grading the nutritional state of elderly patients. Facts Res Gerontol 4(Suppl 2):15–60

    Google Scholar 

  • Health Council of the Netherlands (2008) Health care for the elderly with multimorbidity. Health Council of the Netherlands, The Hague

    Google Scholar 

  • Johnson RB, Onwuegbuzie AJ (2004) Mixed methods research: a research paradigm whose time has come. Educ Res 33:14–26

    Google Scholar 

  • Kempen GIJM, Brilman EI, Heyink JW, Ormel J (1995) Het meten van de algemene gezondheidstoestand met de MOS Short-Form General Health Survey (SF-20): een handleiding [Measurement of general health status with the MOS Short-Form General Health Survey (SF-20): a guideline]. Rijksuniversiteit Groningen, Noordelijk Centrum voor Gezondheidsvraagstukken, Groningen

    Google Scholar 

  • Kempen GIJM, Miedema I, Ormel J, Molenaar W (1996) The assessment of disability with the Groningen Activity Restriction Scale. Conceptual framework and psychometric properties. Soc Sci Med 33:1601–1610

    Article  Google Scholar 

  • Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    Article  Google Scholar 

  • Lucchetti G, Granero AL (2011) Use of comprehensive geriatric assessment in general practice: results from the ‘Senta Pua’ project in Brazil. Eur J Gen Pract 17:20–27

    Article  Google Scholar 

  • Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel index. Md State Med J 14:61–65

    Google Scholar 

  • Markle-Reid M, Browne G, Weir R, Gafni A, Roberts J, Henderson SR (2006) The effectiveness and efficiency of home-based nursing health promotion for older people: a review of the literature. Med Care Res Rev 63:531–569

    Article  Google Scholar 

  • Mathias S, Navak US, Isaacs B (1986) Balance in elderly patients: the “get-up and go” test. Arch Phys Med Rehabil 67:387–389

    Google Scholar 

  • Morgan R, Pendleton N, Clague JE, Horan MA (1997) Older people’s perceptions about symptoms. Br J Gen Pract 47(427–430):427

    Google Scholar 

  • Piccoliori G, Gerolimon E, Abholz H (2008) Geriatric assessment in general practice using a screening instrument: is it worth the effort? Results of a South Tyrol Study. Age Ageing 37:647–652

    Article  Google Scholar 

  • Pot AM, Van Dijck R, Deeg DJ (1995) Ervaren druk door informele zorg: constructie van een schaal [Perceived stress caused by informal caregiving: construction of a scale]. Tijdschr Gerontol Geriatr 26:214–219

    Google Scholar 

  • Rebchook GM, Kegeles SM, Huebner D, TRIP Research Team (2006) Translating research into practice: the dissemination and initial implementation of an evidence–based HIV prevention program. AIDS Educ Prev 18:119–136

    Article  Google Scholar 

  • Rogers EM (2003) Diffusion of innovations, 5th edn. Free Press, New York

    Google Scholar 

  • Rubenstein LZ (2007) New insights from the Danish preventive home visit trial. Eur J Ageing 4:141–143

    Article  Google Scholar 

  • Sheikh JA, Yesavage JA (1986) Geriatric depression scale (GDS): recent findings and development of a shorter version. In: Brink TL (ed) Clinical gerontology: a guide to assessment and intervention. Howarth Press, New York

    Google Scholar 

  • Shulman K, Shedletsky R, Silver IL (1986) The challenge of time: clock-drawing and cognitive function in the elderly. Int J Geriatr Psychiatry 1:135–140

    Article  Google Scholar 

  • Starfield B, Shi L, Macinko J (2005) Contribution of primary care to health systems and health. Milbank Q 83:457–502

    Article  Google Scholar 

  • Steverink N, Lindenberg S, Slaets JPJ (2005) How to understand and improve older people’s self-management of wellbeing. Eur J Ageing 2:235–244

    Article  Google Scholar 

  • Van Alphen SP, Engelen GJ, Kuin Y, Hoijtink H, Derksen JJ (2004) Constructie van een schaal voor de signalering van persoonlijkheidsstoornissen bij ouderen [Construction of a scale to detect personality disorders in older people]. Tijdschr Gerontol Geriatr 35:186–195

    Google Scholar 

  • Van der Zee KI, Sanderman R (1993) Het meten van de algemene gezondheidstoestand met de RAND-36: een handleiding [Measurement of general health status with the RAND-36: a guideline]. Rijksuniversiteit Groningen, Noordelijk Centrum voor Gezondheidsvraagstukken, Groningen

    Google Scholar 

  • Van Haastregt JCM, Diederiks JPM, Van Rossum E, De Witte LP, Crebolder HFJM (2000) Effects of preventive home visits to elderly people living in the community: systematic review. Br Med J 320:754–758

    Article  Google Scholar 

  • Van Hout HPJ, Jansen APD, Van Marwijk HWJ, Nijpel G (2010) Prevention of adverse health trajectories in a vulnerable elderly population through nurse home visits: randomized controlled trial [ISRCTN05358495]. J Gerontol A Biol Sci Med Sci 65:734–742

    Article  Google Scholar 

  • Van Sonsbeek JLA (1988) Methodological and substantial aspects of the OECD indicator of functional limitations. Maandbericht Gezondheid (CBS) 88:4–17

    Google Scholar 

  • Vass M, Avlund K, Siersma V, Hendriksen C (2009) A feasible model for prevention of functional decline in older home-dwelling people—the GP role. A municipality-randomized intervention trial. Fam Pract 26:56–64

    Article  Google Scholar 

  • Walters K, Iliffe S, Orrell M (2001) An exploration of help-seeking behaviour in older people with unmet needs. Fam Pract 18:277–282

    Article  Google Scholar 

  • Warnier RMJ (2008) TRAZAG. Transmuraal Zorg Assessment Geriatrie [TRAZAG. Transmural Care Assessment Geriatrics]. Academic Hospital Maastricht/MUMC+, Maastricht

    Google Scholar 

  • Warnier RMJ, Debie T, Beusmans G (2007) Complexe zorg voor ouderen. Beoordelingsinstrument voor de praktijkverpleegkundige [Complex care for older people. Assessment instrument for the practice nurse]. Tijdschr Prakt 2:50–53

    Article  Google Scholar 

  • World Health Organization (2000) Obesity: preventing and managing the global epidemic. World Health Organization, Geneva

    Google Scholar 

  • Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO (1982) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 17:1982–1983

    Article  Google Scholar 

  • Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  Google Scholar 

Download references

Acknowledgments

The development of project [G]OLD was supported by a grant from the Province of Limburg, the municipality of Maastricht, and the Foundation Beyaert Robuust Limburg, all in the Netherlands. Drs. M. Frederix and Drs. I. Wijnands (GP organization Maastricht-Heuvelland, "RHZ") organized expert panel meetings for the development of the [G]OLD-instrument and organized the evaluation meetings with GPs and PNs. The Public Health Service South-Limburg, the GP organizations in the regions Maastricht-Heuvelland ("RHZ") and Parkstad ("HOZL"), the municipality of Maastricht, the Foundation Beyaert Robuust Limburg, and the Dutch organization who looks after the interests of those who require care ("Huis voor de Zorg") collaborated in setting up the [G]OLD home visitation programme. We would like to thank all general practices in this study for their participation and useful input in improving the [G]OLD home visitation programme. Also, we are grateful to Lenneke van Eerd (student assistant, Maastricht University) for all the data entry work.

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Correspondence to Mandy M. N. Stijnen.

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Stijnen, M.M.N., Jansen, M.W.J., Vrijhoef, H.J.M. et al. Development of a home visitation programme for the early detection of health problems in potentially frail community-dwelling older people by general practices. Eur J Ageing 10, 49–60 (2013). https://doi.org/10.1007/s10433-012-0251-7

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