Aim. To report the expectations and experiences of general practitioners and
practice nurses regarding the U-CARE programme, to gain a better understanding
of the barriers and facilitators in providing proactive, structured care to frail
older people and to determine whether implementation is feasible.
Background. Care for older patients with complex care needs in primary care is
fragmented, reactive and time consuming. A structured, proactive care
programme was developed to improve physical functioning and quality of life in
frail older patients.
Design. An explanatory mixed-methods study nested in a cluster-randomized
trial.
Methods. The barriers to and needs for the provision of structured, proactive
care, and expectations regarding the U-CARE programme were assessed with prequestionnaires
sent to all participating general practitioners (n = 32) and practice
nurses (n = 21) in October 2010. Postquestionnaires measured experiences with
the programme after 5 months. Twelve months later, focus group meetings were
conducted.
Results. Practice nurses and general practitioners reported that it was difficult to
provide proactive and structured care to older patients with multi-morbidity,
different cultural backgrounds and low socioeconomic status. Barriers were a lack
of time and financial compensation. Most general practitioners and practice
nurses indicated that the programme added value for the coordination of care and
allowed them to provide structured care.
Conclusion. This explanatory mixed-methods study showed that general
practitioners and practice nurses perceived the U-CARE programme as feasible in general practice. A transition was made from reactive, ad hoc care towards a
proactive and preventive care approach