Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Geriatrics
Published in: BMC Geriatrics 1/2016

Open Access 01-12-2016 | Research article

The effects of a pro-active integrated care intervention for frail community-dwelling older people: a quasi-experimental study with the GP-practice as single entry point

Authors: Wilhelmina Mijntje Looman, Isabelle Natalina Fabbricotti, Ruben de Kuyper, Robbert Huijsman

Published in: BMC Geriatrics | Issue 1/2016

Login to get access

Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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.

Trial registration

Current Controlled Trials ISRCTN05748494. Registration date: 14/03/2013.
Literature
1.
WHO. Global health and Ageing. National Institute on Aging, National Institutes of Health. 2011. NIH publication no. 11–7737.
2.
Friedman SM, Steinwachs DM, Rathouz PJ, Burton LC, Mukamel DB. Characteristics Predicting Nursing Home Admission in the Program of All-Inclusive Care for Elderly People. Gerontologist. 2005;45:157–66.CrossRefPubMed
3.
Wiles JL, Leibing A, Guberman N, Reeve J, Allen RES. The Meaning of “Ageing in Place” to Older People. Gerontologist. 2011;52:357–66.CrossRefPubMed
4.
Gobbens RJJ, Luijkx KG, Wijnen-Sponselee MTH, Schols JMGA. Towards a conceptual definition of frail community-dwelling older people. Nurs Outlook. 2010;58(2):76–86.CrossRefPubMed
5.
Schers HJ, Koopmans R, Olde RM. De rol van de huisarts bij kwetsbare ouderen. Een internetenquête onder huisartsen [The role of the GP for frail elderly. An internet survey among GPs]. Huisarts Wet. 2009;52(13):626–30.CrossRef
6.
Vedel I, De Stampa M, Bergman H, Ankri J, Cassou B, Blanchard F, et al. Healthcare professionals and managers’ participation in developing an intervention: A pre-intervention study in the elderly care context. Implement Sci. 2009;4:21.PubMedCentralCrossRefPubMed
7.
Kodner D. All together now: a conceptual exploration of integrated care. Healthc Q. 2009;13:6–15.CrossRefPubMed
8.
Boeckxstaens P, de Graaf P. Primary care and care for older persons: Position Paper of the European Forum for Primary Care. Qual Prim Care. 2011;19:369–89.PubMed
9.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol Med Sci. 2001;56:M146–56.CrossRef
10.
Gobbens RJJ, van Assen MALM. The prediction of quality of life by physical, psychological and social components of frailty in community-dwelling older people. Qual Life Res. 2014;23:2289–300.CrossRefPubMed
11.
Challis D, Chessum R, Chesterman J, Luckett R, Woods B. Community Care for the Frail Elderly: An Urban Experiment. Br J Soc Work. 1987;18((supp):13–42.
12.
13.
Ex C, Gorter K, Janssen U. Providing integrated health and social care for older persons in the Netherlands. National report. Utrecht: Verwey Jonker Institute; 2003.
14.
Gröne O, Garcia-Barbero M. Integrated care: a position paper of the WHO European Office for Integrated Health Care Services. International Journal of Integrated Care. 2001;1:e21.PubMedCentralPubMed
15.
Kodner DL, Kyriacou CK. Fully integrated care for frail elderly: two American models. International Journal of Integrated care. 2000;1, e08.PubMedCentralPubMed
16.
Bleijenberg N, Drubbel I, Schuurmans MJ, ten Dam VH, Zuithoff NPA, Numans ME, et al. The effectiveness of a proactive patient-centred primary care program on daily functioning of frail older patients: a cluster randomised controlled trial. In: Drubbel I, editor. Frailty screening in older patients in primary care using routine care data. Zutphen: CPI Koninklijke Wöhrmann BV; 2014. p. 125–54.
17.
Johri M, Beland F, Bergman H. International experiments in integrated care for the elderly: a synthesis of evidence. Int J Geriatr Psychiatry. 2003;18(3):222–35.CrossRefPubMed
18.
Fabbricotti IN. Zorgen voor zorgketens: integratie en fragmentatie in de ontwikkeling van zorgketens. [Taking care of integrated care: integration and fragmentation in the development of integrated care arrangements]. Rotterdam: Optima; 2007.
19.
Hébert R, Durand PJ, Dubuc N, Tourigny A, The PRISMA Group. PRISMA: a new model of integrated service delivery for the frail older people in Canada. International Journal of Integrated Care. 2003;3, e08.PubMedCentralPubMed
20.
21.
Kodner D, Spreeuwenberg C. Integrated care: meaning, logic, applications, and implications – a discussion paper. International Journal of Integrated Care. 2002;2:e12.PubMed
22.
Béland F, Bergman H, Lebel P, Clarfield AM, Tousignant P, Contandriopoulos A-P, et al. A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial. J Gerontol Med Sci. 2006;61A:367–73.CrossRef
23.
Bernabei R, Landi F, Gambassi G, Sgadari A, Zuccala G, Mor V, et al. Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ. 1998;316:1348–51.PubMedCentralCrossRefPubMed
24.
25.
Eklund K, Wilhelmson K. Outcomes of coordinated and integrated interventions targeting frail elderly people: a systematic review of randomized controlled trails. Health Soc Care Community. 2009;17(5):447–58.CrossRefPubMed
26.
Eklund K, Wilhelmson K, Gustafsson H, Landahl S, Dahlin-Ivanoff S. One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial; “Continuum of care for frail older people”. BMC Geriatr. 2013;13:76.PubMedCentralCrossRefPubMed
27.
Gagnon AJ, Schein C, McVey L, Bergman H. Randomized controlled trial of nurse case management of frail older people. J Am Geriatr Soc. 1999;47:1118–24.CrossRefPubMed
28.
Hébert R, Raîche M, Dubois M-F, Gueye NR, Dubuc N, Tousignant M, et al. Impact of PRISMA, a coordination-type integrated service delivery system for frail older people in Quebec (Canada): a quasi-experimental study. J Gerontol Soc Sci. 2010;65B(1):107–18.CrossRef
29.
Leveille SG, Wagner EH, Davis C, Grothaus L, Wallace J, LoGerfo M, et al. Preventing disability and managing chronic illness in frail older adults: a randomized trial of a community-based partnership with primary care. J Am Geriatr Soc. 1998;46:1191–8.CrossRefPubMed
30.
Markle-Reid M, Weir R, Browne G, Roberts J, Gafni A, Henderson S. Health promotion for frail older home care clients. J Adv Nurs. 2006;54:381–95.CrossRefPubMed
31.
Melis RJ, van Eijken MIJ, Teerenstra S, van Achterberg T, Parker SG, Borm GF, et al. A randomized study of a multidisciplinary program to intervene on geriatric syndromes in vulnerable older people who live at home (Dutch EASYcare Study). J Gerontol Med Sci. 2008;63A(3):283–90.CrossRef
32.
Metzelthin SF, Van Rossum E, De Witte LP, Ambergen T, Sipers W, Hobma S, et al. Effectiveness of an interdisciplinary primary care approach to reduce disability in community-dwelling frail older people: a cluster randomised controlled trial. BMJ. 2013;347:f5264.PubMedCentralCrossRefPubMed
33.
Montgomery P, Fallis W. South Winnipeg Integrated Geriatric Program (SWING): a rapid-community response program for the frail elderly. Can J Aging. 2003;22:275–81.CrossRef
34.
Rockwood K, Stadnyk K, Carver D, MacPherson KM, Beanlands HE, Powell C, et al. A clinimetric evaluation of specialized geriatric care for rural dwelling, frail older people. J Am Geriatr Soc. 2000;48:1080–5.CrossRefPubMed
35.
Tourigny A, Durand PJ, Bonin L, Hébert R, Rouchette L. Quasi-experimental Study of the Effectiveness of an Integrated Service Delivery Network for the Frail Elderly. Can J Aging. 2004;23(3):229–43.CrossRef
36.
Van Hout HPJ, Jansen APD, van Marwijk HWJ, Pronk M, Frijters DF, Nijpels G. Prevention of Adverse Health Trajectories in a Vulnerable Elderly Population Through Nurse Home Visits: A Randomized Controlled Trial. J Gerontol Med Sci. 2010;65(7):734–42.CrossRef
37.
Fabbricotti IN, Janse B, Looman WM, de Kuijper R, van Wijngaarden JDH, Reiffers A. Integrated care for frail elderly compared to usual care: a study protocol of a quasi-experiment on the effects on the frail elderly, their caregivers, health professionals and health care costs. BMC Geriatr. 2013;13:31.PubMedCentralCrossRefPubMed
38.
Peters LL, Boter H, Buskens E, Slaets JPJ. Measurement properties of the Groningen Frailty Indicator in home-dwelling and institutionalized elderly people. J Am Med Dir Assoc. 2012;13(6):546–51.CrossRefPubMed
39.
Schuurmans H, Steverink N, Lindenberg S, Frieswijk N, Slaets JPJ. Old or frail: what tells us more? J Gerontol Med Sci. 2004;59A:962–5.CrossRef
40.
Boot JM, Knapen MJMH. Handboek Nederlandse gezondheidszorg. [Handbook Dutch Healthcare]. Utrecht: Het Spectrum; 2005.
41.
Smelt AFH, van der Weele GM, Blom JW, Gussekloo J, Assendelft WJ. How usual is usual care in pragmatic intervention studies in primary care? An overview of recent trials. Br J Gen Pract. 2010;60(576):e305–18.PubMedCentralCrossRefPubMed
42.
Van Der Zee KI, Sanderman R. Het meten van de algemene gezondheidstoestand met de RAND-36: Een handleiding [The assessment of general health status with the RAND-36]. Groningen: Research Institute SHARE/University of Groningen, the Netherlands; 2012.
43.
Laan W, Zuithoff NPA, Drubbel I, Bleijenberg N, Numans ME, de Wit NJ, et al. Validity and reliability of the Katz-15 scale of measure unfavorable health outcomes in community-dwelling older people. J Nutr Health Aging. 2014;18(9):848–54.CrossRefPubMed
44.
Krabbe PF, Stouthard ME, Essink-Bot ML, Bonsel GJ. The effect of adding a cognitive dimension to the EuroQol multiattribute health-status classification system. J Clin Epidemiol. 1999;52(4):293–301.CrossRefPubMed
45.
Lamers LM, McDonnell J, Stalmeier PFM, Krabbe PFM, Busschbach JJV. The Dutch tariff: Results and arguments for an effective design for national EQ-5D valuation studies. Health Econ. 2006;15(10):1121–32.CrossRefPubMed
46.
Coast J, Flynn TN, Natarajan L, Sproston K, Lewis J, Louviere JL, et al. Valuing the ICECAP capability index for older people. Soc Sci Med. 2008;67:874–82.CrossRefPubMed
47.
Grewal I, Lewis J, Flynn TN, Brown J, Bond J, Coast J. Developing attributes for a generic quality of life measure for older people: preferences or capabilities? Soc Sci Med. 2006;62:1891–901.CrossRefPubMed
48.
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, New Jersey: Lawrence Erlbaum Associates; 1988.
49.
Looman WM, Fabbricotti IN, Huijsman R. The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care. International Journal of Integrated Care. 2014;14, e034.PubMedCentralPubMed
50.
Janse B, Huijsman R, Kuyper RDM, Fabbricotti IN. The effects of an integrated care intervention for the frail elderly on informal caregivers: a quasi-experimental design. BMC Geriatr. 2014;14:58.PubMedCentralCrossRefPubMed
51.
Nies H. Integrated Care: concepts and background. In: Nies H, Berman PC, editors. Integrating Services for Older People: a resource book for managers. Dublin: Ehma; 2004. p. 17–32.
52.
Gill TM, Baker DI, Gottschalk M, Peduzzi PN, Allore H, Byers A. A program to prevent functional decline in physically frail, elderly persons who live at home. N Engl J Med. 2002;347(14):1068–74.CrossRefPubMed
53.
Makai P, Brouwer WB, Koopmanschap MA, Nieboer AP. Capabilities and quality of life in Dutch psycho-geriatric nursing homes: an exploratory study using a proxy version of the ICECAP- O. Qual Life Res. 2012;21(5):801–12.PubMedCentralCrossRefPubMed
54.
Makai P, Looman WM, Adang E, Melis R, Stolk E, Fabbricotti IN. Cost-effectiveness of integrated care in frail elderly using the ICECAP-O and EQ-5D: does choice of instrument matter? Eur J Health Econ. 2015;16:437–50.CrossRefPubMed
55.
Lee TW, Ko IS, Lee KJ. Health promotion behaviors and quality of life among community-dwelling elderly in Korea: A cross-sectional survey. Int J Nurs Stud. 2006;43(3):293–300.CrossRefPubMed
56.
Grayson P, Lubin B, Van Whitlock R. Comparison of depression in the community-dwelling and assisted-living elderly. J Clin Psychol. 1995;51(1):19–21.CrossRef
Metadata
Title
The effects of a pro-active integrated care intervention for frail community-dwelling older people: a quasi-experimental study with the GP-practice as single entry point
Authors
Wilhelmina Mijntje Looman
Isabelle Natalina Fabbricotti
Ruben de Kuyper
Robbert Huijsman
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2016
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-016-0214-5

Other articles of this Issue 1/2016

BMC Geriatrics 1/2016 Go to the issue

Research Article

Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment

Research article

Who benefits from orthogeriatric treatment? Results from the Trondheim hip-fracture trial

Research Article

Estimation of prevalence of sarcopenia by using a new bioelectrical impedance analysis in Chinese community-dwelling elderly people

Research article

The effects of a life goal-setting technique in a preventive care program for frail community-dwelling older people: a cluster nonrandomized controlled trial

Research article

Cognitive impairment and dependence of patients with diabetes older than 65 years old in an urban area (DERIVA study)

Research article

The Klotho gene G-395A polymorphism and metabolic syndrome in very elderly people
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits