Abstract
Introduction:In a previous rapid realist review (RRR), an initial programme theory (PT) was established giving insight into the interrelatedness of context items, mechanisms, programme-activities, and outcomes that influence integrated care programmes (ICPs) for community-dwelling frail older people. As ICPs need to be tailored to their local setting, the objective of this study is to assess consensus on the relevance of the items identified in the RRR for the Dutch setting, and refine the PT, where appropriate.Methods:A two-round e-Delphi study was carried out among Dutch experts to determine the relevance of 71 items.Results:Consensus on relevance was reached on 57 out of 71 items (80%). Items added to refine the PT included: increasing number of older people, decreasing access to hospital beds, well-designed ICP implementation processes, case management, having a clear portfolio of patients, the role of the government, aligning existing health and social care systems, management and monitoring of care activities, strong relationship between older person and healthcare providers (HCP), and providing continuous feedback to HCPs.Conclusion and discussion:The initial PT was refined for the Dutch setting. Items on which no consensus was found, need to be further investigated on the reason behind it.
Highlights
In a previous rapid realist review (RRR), an initial programme theory (PT) was established giving insight into the interrelatedness of context items, mechanisms, programme-activities, and outcomes that influence integrated care programmes (ICPs) for community-dwelling frail older people
The term ‘modified’ refers to a Delphi study that consisted of two rounds, and where in round 1 Delphi panel experts were provided with items of the RRR, of which they are requested to assess their relevance for the Dutch setting [25, 26]
PARTICIPANTS A total of 35 people was approached to participate in the Delphi study, of which 21 people agreed (Figure 1)
Summary
In a previous rapid realist review (RRR), an initial programme theory (PT) was established giving insight into the interrelatedness of context items, mechanisms, programme-activities, and outcomes that influence integrated care programmes (ICPs) for community-dwelling frail older people. To address the diverse needs of older people for care and support, integrated care programmes (ICPs) are recommended. ICPs aim to provide a continuum of care for older people, where professionals in different domains cooperate and coordinate care taking into account the often complex care needs, and the individual preferences of older people within a broad range of (health and social) services over an extensive timeframe [4, 5]. General practitioners (GPs) and their specialised ‘primary care assistant practitioners’ are considered the main providers of complex care for older people. Primary care assistant practitioners are regarded as essential players in identifying care needs of patients, organizing care and coordinating primary care [12]
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