Abstract
BackgroundDue to fragmentation of care, continuity of care is often limited in the care provided to frail older people. Further, frail older people are not always enabled to become involved in their own care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), a shared Electronic Health Record combined with a communication tool for community-dwelling frail older people and primary care professionals. This article describes the process evaluation of its implementation, and aims to establish (1) the outcomes of the implementation process, (2) which implementation strategies and barriers and facilitators contributed to these outcomes, and (3) how its future implementation could be improved.MethodsMixed methods study, consisting of (1) a survey among professionals (n = 118) and monitoring the use of the ZWIP by frail older people and professionals, followed by (2) semi-structured interviews with purposively selected professionals (n = 12).Results290 frail older people and 169 professionals participated in the ZWIP. At the end of the implementation period, 55% of frail older people and informal caregivers, and 84% of professionals had logged on to their ZWIP at least once. For professionals, the exposure to the implementation strategies was generally as planned, they considered the interprofessional educational program and the helpdesk very important strategies. However, frail older people’s exposure to the implementation strategies was less than intended. Facilitators for the ZWIP were the perceived need to enhance interprofessional collaboration and the ZWIP application being user-friendly. Barriers included the low computer-literacy of frail older people, a preference for personal communication and limited use of the ZWIP by other professionals and frail older people. Interviewees recommended using the ZWIP for other target populations as well and adding further strategies that may help frail older people to feel more comfortable with computers and the ZWIP.ConclusionsThis study describes the implementation process of an innovative e-health intervention for community-dwelling frail older people, informal caregivers and primary care professionals. As e-health is an important medium for overcoming fragmentation of healthcare and facilitating patient involvement, but its adoption in everyday practice remains a challenge, the positive results of this implementation are promising.
Highlights
Due to fragmentation of care, continuity of care is often limited in the care provided to frail older people
Interviewees recommended adapting the implementation strategies to make them more efficient, for example by shortening the educational programme, to use the ZWIP for other target populations as well, and to add new strategies that may help frail older people to feel more comfortable with computers and the ZWIP
This study has described the implementation of an innovative e-health intervention for community-dwelling frail older people, informal caregivers and primary care professionals, which had positive results
Summary
Due to fragmentation of care, continuity of care is often limited in the care provided to frail older people. The healthcare system is not designed to facilitate the incorporation of patient perspectives in decision making, which becomes even more difficult when care is delivered by an interprofessional team [4,5]. This is unfortunate, as involving patients in their care is mandatory and can improve patient outcomes [6,7]. The program aimed to facilitate shared decision-making and self-management by frail older people and informal caregivers, as well as to reduce fragmentation of care by improving collaboration among professionals involved
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