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
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BACKGROUND: To evaluate the effects of nurse-led multifactorial care to prevent disability in community-living older people.METHODS: In a cluster randomized trail, 11 practices (n = 1,209 participants) were randomized to the intervention group, and 13 practices (n = 1,074 participants) were randomized to the control group. Participants aged ≥ 70 years were at increased risk of functional decline based on a score ≥ 2 points on the Identification of Seniors at Risk- Primary Care, ISAR-PC. Participants in the intervention group received a systematic comprehensive geriatric assessment, and individually tailored multifactorial interventions coordinated by a trained community-care registered nurse (CCRN) with multiple follow-up home visits. The primary outcome was the participant's disability as measured by the modified Katz activities of daily living (ADL) index score (range 0-15) at one year follow-up. Secondary outcomes were health-related quality of life, hospitalization, and mortality.RESULTS: At baseline, the median age was 82.7 years (IQR 77.0-87.1), the median modified Katz-ADL index score was 2 (IQR 1-5) points in the intervention group and 3 (IQR 1-5) points in the control group. The follow-up rate was 76.8% (n = 1753) after one year and was similar in both trial groups. The adjusted intervention effect on disability was -0.07 (95% confidence interval -0.22 to 0.07; p = 0.33). No intervention effects were found for the secondary outcomes.CONCLUSIONS: We found no evidence that a one-year individualized multifactorial intervention program with nurse-led care coordination was better than the current primary care in community-living older people at increased risk of functional decline in The Netherlands.TRIAL REGISTRATION: Netherlands Trial Register NTR2653.
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