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Open Access Study protocol

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

Mandy MN Stijnen1*, Inge GP Duimel-Peeters12, Maria WJ Jansen3 and Hubertus JM Vrijhoef45

Author Affiliations

1 Department of General Practice, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands

2 Department of Patient & Care, Maastricht University Medical Centre, P.O. Box 5800, 6202 MD, Maastricht, The Netherlands

3 Public Health Service South-Limburg, School for Public Health and Primary Care (CAPHRI), P.O. Box 2022, 6160 HA, Geleen, The Netherlands

4 Tilburg University, Scientific Centre for Care and Welfare (TRANZO), Tilburg, The Netherlands

5 National University of Singapore, Saw Swee Hock School for Public Health, Singapore, Singapore

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BMC Geriatrics 2013, 13:7  doi:10.1186/1471-2318-13-7

Published: 18 January 2013

Abstract

Background

Due to the ageing of the population, the number of frail older people who suffer from multiple, complex health complaints increases and this ultimately threatens their ability to function independently. Many interventions for frail older people attempt to prevent or delay functional decline, but they show contradicting results. Recent studies emphasise the importance of embedding these interventions into existing primary care systems and tailoring care to older people’s needs and wishes. This article presents the design of an evaluation study, aiming to investigate the effects and feasibility of the early detection of health problems among community-dwelling older people and their subsequent referral to appropriate care and/or well-being facilities by general practices.

Methods/Design

A longitudinal, quasi-experimental study is designed comparing 13 intervention practices with 11 control practices. General practices select eligible community-dwelling older people (≥ 75 years). Practice nurses from intervention practices (1) visit older people at home for a comprehensive assessment of their health and well-being; (2) discuss results with the GP; (3) formulate – if required – a care and treatment plan together with the patient; (4) refer patient to care and/or well-being facilities; and (5) monitor and coordinate care and follow-up. Control practices provide usual care and match the intervention practices on the presence of different primary care professionals within the practice. Primary outcome measures are health-related quality of life and disability. Additionally, attitude towards ageing, care satisfaction, health care utilisation, nursing home admission and mortality are measured. Some outcomes are assessed by means of a postal questionnaire (at baseline and after 6, 12, and 18 months follow-up), others through continuous registration over the 18-month period. A profound process evaluation will provide insight into barriers and facilitators for implementing the intervention protocol within general practices from both the patient and caregiver perspective.

Discussion

The proposed approach requires redesigning care delivery within general practices for accomplishing appropriate care for older people. A quasi-experimental design is chosen to closely resemble a real-life situation, which is desirable for future implementation after this innovation proves to be successful. Results of the effect and process evaluation will become available in 2013.

Trial registration

The Netherlands National Trial Register NTR2737

Keywords:
Frailty; Older people; Comprehensive geriatric assessment; Home visit; General practice; Quasi-experimental design