Nurse-led implementation of the single assessment process in primary care: a descriptive feasibility study.
OBJECTIVE
to determine the resources required to carry out the single assessment process in primary care.


METHODS
prospective descriptive study.


METHODS
one urban primary care practice, Southampton.


METHODS
nine hundred and forty-four people aged 70+ years, registered with the practice, not living in a residential/nursing home, or terminally ill.


METHODS
participants were sent the six-item Sherbrooke questionnaire (case-finding tool). Non-responders were re-mailed after 4 weeks. All those scoring 4, 5 or 6 and a randomly selected half of those scoring 2 or 3 were offered overview assessment and comprehensive assessment as indicated by the Minimum Data Set for Home Care protocol. The nurse assessor identified unmet needs and agreed an action plan with participants. Another researcher conducted semi-structured interviews with a purposive sample of 26 participants to elicit their views of the process.


METHODS
response rates/scores of Sherbrooke questionnaire; numbers/characteristics of people requiring overview and comprehensive assessments; nature of resulting recommendations/referrals and impact on other agencies; resources required; views of service users.


RESULTS
eight hundred and sixty-three (91%) participants replied. Five hundred and seven (54%) scored 2+, triggering an overview assessment, which was offered to 307. One hundred and twenty-four participants (40%) accepted; 64 (52%) had unmet needs (median 8 each, range 2-18), resulting in 34 referrals within the practice including four case conferences, and 21 to community/secondary health services. Few participants with a Sherbrooke score of 2 required comprehensive assessment. Users perceived the process as acceptable and useful, but not always relevant to their current needs.


CONCLUSIONS
targeting those scoring 3+ on the Sherbrooke questionnaire (28% of sample) may improve the identification of patients who would benefit from further assessment. A contact approach rather than a case-finding one may improve the relevance of this process to older people.
Roberts
Helen C
HC
University of Southampton, Elderly Care Research Unit, University Department of Geriatric Medicine, Southampton, UK. hcr@soton.ac.uk
Hemsley
Zoe M
ZM
Thomas
Gwen
G
Meakins
Philip
P
Powell
Jackie
J
Robison
Judy
J
Gove
Ian
I
Turner
Gill
G
Sayer
Avan Aihie
AA
D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D015577:Geriatric Assessment; D006699:Home Care Services / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009730:Nursing Assessment; D011320:Primary Health Care; D011446:Prospective Studies; D012648:Self Care; D011795:Surveys and Questionnaires; D006113:United Kingdom