Looman Wilhelmina Mijntje, Fabbricotti Isabelle Natalina, de Kuyper Ruben, Huijsman Robbert
Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
BMC Geriatr. 2016 Feb 15;16:43. doi: 10.1186/s12877-016-0214-5.
This study explored the effectiveness of a pro-active, integrated care model for community-dwelling frail older people compared to care as usual by evaluating the effects on a comprehensive set of outcomes: health outcomes (experienced health, mental health and social functioning); functional abilities; and quality of life (general, health-related and well-being).
The design of this study was quasi-experimental. In this study, 184 frail older patients of three GP practices that implemented the Walcheren Integrated Care Model were compared with 193 frail older patients of five GP practices that provided care as usual. In the Walcheren Integrated Care Model, community-dwelling elderly were pro-actively screened for frailty from the GP practice using the Groningen Frailty Indicator, and care needs were assessed with the EASYcare instrument. The GP practice functioned as single entry point from which case management was provided, and the GP was the coordinator of care. The entire process was supported by multidisciplinary meetings, multidisciplinary protocols and web-based patient files. The outcomes of this study were obtained at baseline, after 3 months and after 12 months and analyzed with linear mixed models of repeated measures.
The Walcheren Integrated Care Model had a positive effect on love and friendship and a moderately positive effect on general quality of life. The ability to receive love and friendship and general quality of life decreased in the control group but was preserved in the experimental group. No significant differences were found on health outcomes such as experienced health, mental health, social functioning and functional abilities.
The results indicated that pro-active, integrated care can be beneficial for frail older people in terms of quality of life and love and friendship but not in terms of health outcomes and functional abilities. Recommendations for future research are to gain greater insight into what specific outcomes can be achieved with proactive and integrated care, considering the specific content of this care, and to allow for the heterogeneity of frail older people in evaluation research.
Current Controlled Trials ISRCTN05748494. Registration date: 14/03/2013.
本研究通过评估对一系列综合结果的影响，探讨了一种积极主动的综合护理模式对社区居住的体弱老年人的有效性，这些结果包括：健康结果（体验到的健康状况、心理健康和社会功能）；功能能力；以及生活质量（总体、与健康相关的和幸福感）。
本研究采用准实验设计。在本研究中，将实施瓦尔赫伦综合护理模式的三家全科医生诊所的184名体弱老年患者与五家提供常规护理的全科医生诊所的193名体弱老年患者进行了比较。在瓦尔赫伦综合护理模式中，使用格罗宁根衰弱指标从全科医生诊所对社区居住的老年人进行主动衰弱筛查，并使用EASYcare工具评估护理需求。全科医生诊所作为提供病例管理的单一入口点，全科医生是护理协调员。整个过程得到多学科会议、多学科协议和基于网络的患者档案的支持。本研究的结果在基线、3个月后和12个月后获得，并使用重复测量的线性混合模型进行分析。
瓦尔赫伦综合护理模式对爱和友谊有积极影响，对总体生活质量有中度积极影响。对照组中接受爱和友谊的能力及总体生活质量下降，但实验组中得以保持。在体验到的健康状况、心理健康、社会功能和功能能力等健康结果方面未发现显著差异。
结果表明，积极主动的综合护理在生活质量以及爱和友谊方面对体弱老年人有益，但在健康结果和功能能力方面并非如此。对未来研究的建议是，考虑到这种护理的具体内容，更深入地了解积极主动的综合护理可以实现哪些具体结果，并在评估研究中考虑体弱老年人的异质性。
当前对照试验ISRCTN05748494。注册日期：2013年3月14日。
