Effects of home visits by home nurses to elderly people with health problems: design of a randomised clinical trial in the Netherlands [ISRCTN92017183].
BACKGROUND
Preventive home visits to elderly people by public health nurses aim to maintain or improve the functional status of elderly and reduce the use of institutional care services. A number of trials that investigated the effects of home visits show positive results, but others do not. The outcomes can depend on differences in characteristics of the intervention programme, but also on the selection of the target population. A risk group approach seems promising, but further evidence is needed. We decided to carry out a study to investigate the effects in a population of elderly with (perceived) poor health rather than the general population. Also, we test whether nurses who are qualified at a lower professional level (home nurses instead of public health nurses) are able to obtain convincing effects. The results of this study will contribute to the discussion on effective public health strategies for the aged.


METHODS
The study is carried out as a parallel group randomised trial. To screen eligible participants, we sent a postal questionnaire to 4901 elderly people (70-84 years) living at home in a town in the south of the Netherlands. After applying inclusion criteria (e.g., self-reported poor health status) and exclusion criteria (e.g., those who already receive home nursing care), we selected 330 participants. They entered the randomisation procedure; 160 were allocated to the intervention group and 170 to the control group. The intervention consists of (at least) 8 systematic home visits over an 18 months period. Experienced home nurses from the local home care organisation carry out the visits. The control group receives usual care. Effects on health status are measured by means of postal questionnaires after 12 months, 18 months (the end of the intervention period) and after 24 months (the end of 6-months follow-up), and face-to-face interviews after 18 months. Data on mortality and service use are continuously registered during 24 months. A cost-benefit analysis is included. The design and setting of the study, the selection of eligible participants and the study interventions are described in this article. Other included items are: the primary and secondary outcome measures, the statistical analysis and the economic evaluation.
Nicolaides-Bouman
Ans
A
Dept. of Epidemiology, Faculty of Health Sciences, Maastricht University, The Netherlands. ans.nicolaides@epid.unimaas.nl
van Rossum
Erik
E
Kempen
Gertrudis I J M
GI
Knipschild
Paul
P
D000368:Aged; D000369:Aged, 80 and over; D003152:Community Health Nursing / Q000458:organization & administration / Q000592:standards*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D015577:Geriatric Assessment; D006304:Health Status; D006760:Hospitalization; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009026:Mortality; D009426:Netherlands / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D011314:Preventive Health Services / Q000458:organization & administration / Q000600:supply & distribution*; D011795:Surveys and Questionnaires; D013997:Time Factors