Marieke Perry

Effects of educational interventions on primary dementia care: A systematic review.

To determine the effects of educational interventions about dementia, directed at primary care providers (PCPs).

Implementation of an innovative web-based conference table for community-dwelling frail older people, their informal caregivers and professionals: a process evaluation

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.

Evaluation of an eHealth Intervention in Chronic Care for Frail Older People: Why Adherence is the First Target

Background Older people suffering from frailty often receive fragmented chronic care from multiple professionals. According to the literature, there is an urgent need for coordination of care. Objective The objective of this study was to investigate the effectiveness of an online health community (OHC) intervention for older people with frailty aimed at facilitating multidisciplinary communication. Methods The design was a controlled before-after study with 12 months follow-up in 11 family practices in the eastern part of the Netherlands. Participants consisted of frail older people living in the community requiring multidisciplinary (long-term) care. The intervention used was the health and welfare portal (ZWIP): an OHC for frail elderly patients, their informal caregivers and professionals. ZWIP contains a secure messaging system supplemented by a shared electronic health record. Primary outcomes were scores on the Instrumental Activities of Daily Living scale (IADL), mental health, and social activity limitations. Results There were 290 patients in the intervention group and 392 in the control group. Of these, 76/290 (26.2%) in the intervention group actively used ZWIP. After 12 months follow-up, we observed no significant improvement on primary patient outcomes. ADL improved in the intervention group with a standardized score of 0.21 (P=.27); IADL improved with 0.50 points, P=.64. Conclusions Only a small percentage of frail elderly people in the study intensively used ZWIP, our newly developed and innovative eHealth tool. The use of this OHC did not significantly improve patient outcomes. This was most likely due to the limited use of the OHC, and a relatively short follow-up time. Increasing actual use of eHealth intervention seems a precondition for large-scale evaluation, and earlier adoption before frailty develops may improve later use and effectiveness of ZWIP.

Development and Validation of Quality Indicators for Dementia Diagnosis and Management in a Primary Care Setting

OBJECTIVES: To construct a set of quality indicators (QIs) for dementia diagnosis and management in a primary care setting.

An in‐home geriatric programme for vulnerable community‐dwelling older people improves the detection of dementia in primary care

Dementia is under‐diagnosed in primary care. This study investigated whether an in‐home geriatric assessment and management programme could improve the identification of patients with dementia in primary care.

Studywise minimization: a treatment allocation method that improves balance among treatment groups and makes allocation unpredictable.

OBJECTIVES In randomized controlled trials with many potential prognostic factors, serious imbalance among treatment groups regarding these factors can occur. Minimization methods can improve balance but increase the possibility of selection bias. We described and evaluated the performance of a new method of treatment allocation, called studywise minimization, that can avoid imbalance by chance and reduce selection bias. STUDY DESIGN AND SETTING The studywise minimization algorithm consists of three steps: (1) calculate the imbalance for all possible allocations, (2) list all allocations with minimum imbalance, and (3) randomly select one of the allocations with minimum imbalance. We carried out a simulation study to compare the performance of studywise minimization with three other allocation methods: randomization, biased-coin minimization, and deterministic minimization. Performance was measured, calculating maximal and average imbalance as a percentage of the group size. RESULTS Independent of trial size and number of prognostic factors, the risk of serious imbalance was the highest in randomization and absent in studywise minimization. The largest differences among the allocation methods regarding the risk of imbalance were found in small trials. CONCLUSION Studywise minimization is particularly useful in small trials, where it eliminates the risk of serious imbalances without generating the occurrence of selection bias.

Care-related goals of community-dwelling frail older adults.

ACKNOWLEDGMENTS The authors would like to thank the Brazilian Society of Geriatrics Gerontology, São Paulo, and all students from the disciplines of geriatrics and gerontology who actively took part in this project and contributed daily and voluntarily for the expansion and strengthening of geriatrics and gerontology in Brazil: Adriana I Un Huang, Aghata Teixeira Silva, Aline Vial Cobello, Ana Beatrice Torres Carvalho, Ana Carolina Araújo Oliveira, Ana Cristina da Silva Fernandes, Ana Paula de Oliveira Marques, Ana Paula de Souza Oliveira, Anne Grazielle Lima Bindá, Bárbara Araújo Oliveira, Blenda Sousa Carli Rodrigues, Bruna Danielle de Menezes, Carolina Burgarelli Testa, Caroline Monteiro Conceição, Cristiane Andrade da Costa, Christyanne Maria Rodrigues Barreto de Assis, Daniela Teles da Silva, Danielle Figueredo da Silva, Danielle Florêncio dos Santos, Darlene Mara dos Santos Tavares, Debora Lee Vianna Paulo, Denise Cristina de Oliveira Ferreira, Diego Adão F. Silva, Edna Corrêa Moreira, Elder Lanzani Freitas, Erika Kiyomi Yuyama, Fábia Helena Muniz, Fernanda Gasparini, Fernanda Santucci, Giovanna Arcaro de Lima, Gustavo Ferrão, Hugo Moura de Albuquerque Melo, João Augusto Hidalgo Barros Abomorad, Karen Christine Albuquerque Moreira, Karoline Bento Ribeiro, Leila Fortes, Lilian César Salgado Boaventura, Liliane Ramos Costa, Li Men Zhao, Lorena Rodrigues Netto, Lucas Certain, Lucı́lia Rocha Lopes, Maria de Fátima Nunes Marucci, Maria Lucia Buziqui Piruzeli, Maria Monique Silva Oliveira, Mariana Leme Gomes, Mariani Mendes Madisson, Marisa Accioly Rodrigues da Costa Domingues, Marcos Alexandre Frota, Marta Nagai Coelho, Mayra Jacuviske Venegas, Maysa Seabra Cendoroglo, Mirella Carla de Melo Mendonça, Natália Sanchez Oliveira, Natalia Waldmann Okai, Natasha Casteli Bonfim, Nayara Paula Fernandes Martins, Nelisa Sandrini Alves Maciel, Paula Caroline O. Souza, Paulo André de Lacerda Alves, Raphael Valadão Dadalto, Raquel Aparecida Casarotto, Rebeca Matos Velez de Andrade Lima, Renata Borges Facury, Renato Lı́rio Morelato, Ricardo Ramiris Silva Gasperazzo, Silmara Rondon, Simone da Silva Henriques, Tiffany Moukbel Chaim, Valdeci de Oliveira Santos Rigolin, Vanessa Bezerra de Lima, Wagner Vicente de Morais Silva, Wilson Jacob Filho. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: All authors contributed equally to the data collection, analyses, and conclusion of this study. Sponsor’s Role: This study had no sponsor support.

Feasibility evaluation of a stepped procedure to identify community-dwelling frail older people in general practice. A mixed methods study

Abstract Background: Implementation of frailty identification methods in general practice has hardly been established. To achieve successful implementation, general practitioners (GPs) should be provided with an identification method that suits their needs. EASYcare-TOS is a new frailty identification method that uses a stepped approach and is specifically developed for use in general practice. The first step consists of the GPs frailty judgment based on his prior information on the patient. If the judgment is ‘uncertain’ or ‘frail,’ additional data are collected by a primary care nurse (PCN). The frailty decision is based on clinical reasoning by the GP, without applying predefined cut-offs in a numerical score. Objective: To evaluate the acceptability of EASYcare-TOS in daily general practice. Methods A mixed-methods study was conducted. Questionnaires were sent to all professionals (n = 25) who participated in the EASYcare-TOS validation study. Subsequently, semi-structured interviews with primary care professionals (n = 12) and patients (n = 9) were conducted. Results: Time investment was generally perceived as acceptable. Twenty-two professionals (88%) found a two-step model (very) useful in the identification instrument. Seventeen professionals (68%) valued making the final frailty decision by their own clinical reasoning. Patients appreciated the broad assessment and the advice given based on the assessment. According to 24 (96%) professionals, EASYcare-TOS improved the quality of patient care. GPs stated that implementation will ask for reconsidering allocation of tasks in general practices and adequate reimbursement. Conclusion: EASYcare-TOS is a new identification method that fits the needs of primary care professionals to a large extent and is acceptable in daily practice.

Which Frail Older Patients Use Online Health Communities and Why? A Mixed Methods Process Evaluation of Use of the Health and Welfare Portal

Background Frail older people often receive fragmented care from multiple providers. According to the literature, there is an urgent need for coordination of care. Online and eHealth tools are increasingly used to improve coordination. However, there are significant barriers to their implementation in frail older people. Objective Our aim was to (1) evaluate differences in use of a personal online health community (POHC) for frail older people in relation to personal characteristics, and (2) explore barriers and facilitators for use as experienced by older people and their informal caregivers, using the case of the Health and Welfare Information Portal (ZWIP). Methods This is a mixed methods study. For the quantitative analysis, we used POHC usage information (2 years follow-up) and baseline characteristics of frail older people. For the qualitative analysis, we used semistructured interviews with older people and their informal caregivers. Participants were recruited from 11 family practices in the east of the Netherlands and frail older people over 70 years. The ZWIP intervention is a personal online health community for frail older people, their informal caregivers, and their providers. ZWIP was developed at the Geriatrics Department of Radboud University Medical Center. We collected data on POHC use for 2 years as well as relevant patient characteristics. Interview topics were description of use, reasons for use and non-use, and user profiles. Results Of 622 frail patients in the intervention group, 290 were connected to ZWIP; 79 used ZWIP regularly (at least monthly). Main predictors for use were having an informal caregiver, having problems with activities of daily living, and having a large number of providers. Family practice level predictors were being located in a village, and whether the family practitioners had previously used electronic consultation and cared for a large percentage of frail older people. From 23 interviews, main reasons for use were perceiving ZWIP to be a good, quick, and easy way of communicating with providers and the presence of active health problems. Important reasons for non-use were lack of computer skills and preferring traditional means of consultation. Conclusions Only 27.2% (79/290) of frail older enrolled in the POHC intervention used the POHC frequently. For implementation of personal online health communities, older people with active health problems and a sizable number of health care providers should be targeted, and the informal caregiver, if present, should be involved in the implementation process. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 11165483; http://www.controlled-trials.com/isrctn/pf/11165483 (Archived by WebCite at http://www.webcitation.org/6U3fZovoU).

Longitudinal multiple case study on effectiveness of network-based dementia care towards more integration, quality of care, and collaboration in primary care

Introduction This study aimed to provide insight into the merits of DementiaNet, a network-based primary care innovation for community-dwelling dementia patients. Methods Longitudinal mixed methods multiple case study including 13 networks of primary care professionals as cases. Data collection comprised continuously-kept logs; yearly network maturity score (range 0–24), yearly quality of care assessment (quality indicators, 0–100), and in-depth interviews. Results Networks consisted of median nine professionals (range 5–22) covering medical, care and welfare disciplines. Their follow-up was 1–2 years. Average yearly increase was 2.03 (95%-CI:1.20–2.96) on network maturity and 8.45 (95%-CI:2.80–14.69) on quality indicator score. High primary care practice involvement and strong leadership proved essential in the transition towards more mature networks with better quality of care. Discussion Progress towards more mature networks favored quality of care improvements. DementiaNet appeared to be effective to realize transition towards network-based care, enhance multidisciplinary collaboration, and improve quality of dementia care.