Abstract
This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months. Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files. The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis. In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is required to study the value of integrated care on changes in health and the preservation of the positive effects on quality of life and health care use.
Highlights
With the ageing of the population, the number of frail elderly people is increasing rapidly and the need to find effective care arrangements for this elderly group has gained importance [1,2]
This study explored the short-term effects of a comprehensive integrated care intervention, the Walcheren Integrated Care Model, on the health, quality of life, health care use and satisfaction with care of frail elderly who were living independently
The main conclusion is that the Walcheren Integrated Care Model had only a small overall effect after three months
Summary
With the ageing of the population, the number of frail elderly people is increasing rapidly and the need to find effective care arrangements for this elderly group has gained importance [1,2]. The frail elderly suffer from age-related problems in the physical, psychological and social domains of daily functioning [1,3,4]. Problems in these three domains often influence each other, which may lead to accumulating problems [3,4]. Because the condition of the frail elderly declines gradually, timely detection is crucial as it may prevent further deterioration [5]. Research stresses the importance of detecting frailty, showing a strong relationship between frailty and quality of life [6] as well as severe problems such as disability, health care use and even death [4]
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