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Title: Nurse-led home visitation programme to improve health-related quality of life and reduce disability among potentially frail community-dwelling older people in general practice: A theory-based process evaluation
Authors: Stijnen M.M.N.
Jansen M.W.J.
Duimel-Peeters I.G.P.
Vrijhoef H.J.M. 
Keywords: adult
advanced practice nursing
frail elderly
general practice
geriatric assessment
geriatric nursing
health care quality
health personnel attitude
health status
independent living
middle aged
nursing practice
professional practice
quality of life
very elderly
young adult
Advanced Practice Nursing
Aged, 80 and over
Attitude of Health Personnel
Frail Elderly
General Practice
Geriatric Assessment
Geriatric Nursing
Health Status
House Calls
Independent Living
Middle Aged
Practice Patterns, Nurses'
Process Assessment (Health Care)
Quality of Life
Young Adult
Issue Date: 2014
Publisher: BioMed Central Ltd.
Citation: Stijnen M.M.N., Jansen M.W.J., Duimel-Peeters I.G.P., Vrijhoef H.J.M. (2014). Nurse-led home visitation programme to improve health-related quality of life and reduce disability among potentially frail community-dwelling older people in general practice: A theory-based process evaluation. BMC Family Practice 15 (1) : 173. ScholarBank@NUS Repository.
Abstract: Background: Population ageing fosters new models of care delivery for older people that are increasingly integrated into existing care systems. In the Netherlands, a primary-care based preventive home visitation programme has been developed for potentially frail community-dwelling older people (aged ?75 years), consisting of a comprehensive geriatric assessment during a home visit by a practice nurse followed by targeted interdisciplinary care and follow-up over time. A theory-based process evaluation was designed to examine (1) the extent to which the home visitation programme was implemented as planned and (2) the extent to which general practices successfully redesigned their care delivery. Methods: Using a mixed-methods approach, the focus was on fidelity (quality of implementation), dose delivered (completeness), dose received (exposure and satisfaction), reach (participation rate), recruitment, and context. Twenty-four general practices participated, of which 13 implemented the home visitation programme and 11 delivered usual care to older people. Data collection consisted of semi-structured interviews with practice nurses (PNs), general practitioners (GPs), and older people; feedback meetings with PNs; structured registration forms filled-out by PNs; and narrative descriptions of the recruitment procedures and registration of inclusion and drop-outs by members of the research team. Results: Fidelity of implementation was acceptable, but time constraints and inadequate reach (i.e., the relatively healthy older people participated) negatively influenced complete delivery of protocol elements, such as interdisciplinary cooperation and follow-up of older people over time. The home visitation programme was judged positively by PNs, GPs, and older people. Useful tools were offered to general practices for organising proactive geriatric care. Conclusions: The home visitation programme did not have major shortcomings in itself, but the delivery offered room for improvement. General practices received useful tools to redesign their care delivery from reactive towards proactive care, but perceived barriers require attention to allow for sustainability of the home visitation programme over time. © 2014 Stijnen et al.
Source Title: BMC Family Practice
ISSN: 14712296
DOI: 10.1186/s12875-014-0173-x
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