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Open Access Research article

Implementation of an innovative web-based conference table for community-dwelling frail older people, their informal caregivers and professionals: a process evaluation

Sarah HM Robben1*, Marieke Perry1, Mirjam Huisjes1, Leontien van Nieuwenhuijzen1, Henk J Schers2, Chris van Weel2, Marcel GM Olde Rikkert1, Theo van Achterberg3, Maud M Heinen3 and René JF Melis1

Author affiliations

1 Department of Geriatric Medicine, 925, Radboud University Nijmegen Medical Centre, P.O. Box 9101,, 6500 HB, Nijmegen, The Netherlands

2 Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, 117, Radboud University Nijmegen Medical Centre, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands

3 Scientific Institute for Quality of Healthcare, 114, Radboud University Nijmegen Medical Centre, P.O. Box 9101, , 6500 HB, Nijmegen, The Netherlands

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Citation and License

BMC Health Services Research 2012, 12:251  doi:10.1186/1472-6963-12-251

Published: 15 August 2012

Abstract

Background

Due to fragmentation of care, continuity of care is often limited in the care provided to frail older people. Further, frail older people are not always enabled to become involved in their own care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), a shared Electronic Health Record combined with a communication tool for community-dwelling frail older people and primary care professionals. This article describes the process evaluation of its implementation, and aims to establish (1) the outcomes of the implementation process, (2) which implementation strategies and barriers and facilitators contributed to these outcomes, and (3) how its future implementation could be improved.

Methods

Mixed methods study, consisting of (1) a survey among professionals (n = 118) and monitoring the use of the ZWIP by frail older people and professionals, followed by (2) semi-structured interviews with purposively selected professionals (n = 12).

Results

290 frail older people and 169 professionals participated in the ZWIP. At the end of the implementation period, 55% of frail older people and informal caregivers, and 84% of professionals had logged on to their ZWIP at least once. For professionals, the exposure to the implementation strategies was generally as planned, they considered the interprofessional educational program and the helpdesk very important strategies. However, frail older people’s exposure to the implementation strategies was less than intended. Facilitators for the ZWIP were the perceived need to enhance interprofessional collaboration and the ZWIP application being user-friendly. Barriers included the low computer-literacy of frail older people, a preference for personal communication and limited use of the ZWIP by other professionals and frail older people. Interviewees recommended using the ZWIP for other target populations as well and adding further strategies that may help frail older people to feel more comfortable with computers and the ZWIP.

Conclusions

This study describes the implementation process of an innovative e-health intervention for community-dwelling frail older people, informal caregivers and primary care professionals. As e-health is an important medium for overcoming fragmentation of healthcare and facilitating patient involvement, but its adoption in everyday practice remains a challenge, the positive results of this implementation are promising.

Keywords:
E-health; Implementation; Process evaluation; Frail older people; Primary care