Stijnen Mandy M N, Jansen Maria W J, Vrijhoef Hubertus J M, Duimel-Peeters Inge G P
Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
Public Health Service South-Limburg, School for Public Health and Primary Care (CAPHRI), P.O. Box 2022, 6160 HA Geleen, The Netherlands.
Eur J Ageing. 2012 Nov 7;10(1):49-60. doi: 10.1007/s10433-012-0251-7. eCollection 2013 Mar.
The integration within existing health care systems of preventive initiatives to maintain independent living among older people is increasingly emphasized. This article describes the development and refinement of the [G]OLD home visitation programme: an eight-step programme, including a comprehensive geriatric assessment, for the early detection of health and well-being problems among older people (≥75 years) by general practices. A single group post-test study using a mixed model design is performed to evaluate (a) the feasibility of the home visitation programme in general practice, (b) the practical usefulness of the geriatric assessment instrument, and (c) programme implementation with respect to reinventions introduced by general practitioners (GPs) and practice nurses (PNs). Within 3 months time, 22 PNs of 18 participating general practices visited 240 community-dwelling older people (mean age = 82.0 years; SD 4.2) who had not been in contact with their general practice for more than 6 months. Mean time investment of the programme per older person was 118.1 min (SD 27.0) for GPs and PNs combined. Evaluation meetings revealed that GPs and PNs considered the home visitation programme to be feasible in daily practice. They judged the geriatric assessment to be useful, although minor adjustments are needed (e.g., lay-out, substitution of tests). PNs often failed to register follow-up actions for detected problems in a care and treatment plan. Future training for PNs should address this issue. No reinventions were introduced that threatened fidelity of implementation. The findings are used to improve the home visitation programme before its evaluation in a large-scale controlled trial.
在现有医疗保健系统中整合预防性举措以维持老年人独立生活的做法日益受到重视。本文描述了[G]OLD家访计划的开发与完善：这是一个包含综合老年评估的八步计划，由全科医疗用于早期发现75岁及以上老年人的健康和幸福问题。采用混合模型设计进行单组后测研究，以评估：(a)家访计划在全科医疗中的可行性；(b)老年评估工具的实际实用性；以及(c)关于全科医生（GP）和执业护士（PN）引入的改进措施的计划实施情况。在3个月内，18家参与的全科医疗中的22名PN对240名社区居住的老年人（平均年龄 = 82.0岁；标准差4.2）进行了家访，这些老年人与他们的全科医疗已有6个月以上未接触。该计划每位老年人的平均时间投入，全科医生和执业护士合计为118.1分钟（标准差27.0）。评估会议表明，全科医生和执业护士认为家访计划在日常实践中可行。他们认为老年评估有用，不过需要进行一些小调整（例如，布局、测试替代）。执业护士常常未能在护理和治疗计划中为已发现的问题记录后续行动。未来对执业护士的培训应解决这一问题。没有引入会威胁实施保真度的改进措施。这些研究结果将用于在大规模对照试验评估之前改进家访计划。
