Stijnen Mandy M N, Jansen Maria W J, Duimel-Peeters Inge G P, Vrijhoef Hubertus J M
Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
Public Health Service South-Limburg, P.O. Box 2022, 6160, HA, Geleen, The Netherlands.
BMC Fam Pract. 2014 Oct 25;15:173. doi: 10.1186/s12875-014-0173-x.
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.
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.
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.
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.
人口老龄化促使为老年人提供的新型护理模式不断发展，这些模式越来越多地融入现有的护理体系。在荷兰，针对可能身体虚弱的社区居家老年人（年龄≥75岁）制定了一项以初级保健为基础的预防性家访计划，该计划包括由执业护士在家访期间进行全面的老年医学评估，随后进行有针对性的跨学科护理并长期跟踪随访。设计了一项基于理论的过程评估，以检查：（1）家访计划按计划实施的程度；（2）全科医疗成功重新设计其护理服务的程度。
采用混合方法，重点关注实施的保真度（实施质量）、提供的剂量（完整性）、接受的剂量（接触和满意度）、覆盖范围（参与率）、招募情况和背景。24家全科医疗参与其中，其中13家实施了家访计划，11家为老年人提供常规护理。数据收集包括对执业护士、全科医生和老年人进行半结构化访谈；与执业护士举行反馈会议；由执业护士填写的结构化登记表；以及研究团队成员对招募程序和纳入与退出登记的叙述性描述。
实施的保真度可以接受，但时间限制和覆盖范围不足（即相对健康的老年人参与）对协议要素的完整实施产生了负面影响，如跨学科合作和对老年人的长期跟踪随访。执业护士、全科医生和老年人对家访计划评价积极。为全科医疗提供了用于组织主动老年护理的有用工具。
家访计划本身没有重大缺陷，但实施过程仍有改进空间。全科医疗获得了有用的工具，可将其护理服务从被动式重新设计为主动式护理，但所察觉到的障碍需要引起关注，以确保家访计划能够长期持续开展。
