title: Nurse-led home visitation programme to improve health-related quality of life and reduce disability among potentially frail community-dwelling older people in general practice: a theory-based process evaluation.
abstract: BACKGROUND
  Population ageing fosters new models of care delivery for older people that are increasingly integrated into existing care systems. In the Netherlands, a primary-care based preventive home visitation programme has been developed for potentially frail community-dwelling older people (aged ≥75 years), consisting of a comprehensive geriatric assessment during a home visit by a practice nurse followed by targeted interdisciplinary care and follow-up over time. A theory-based process evaluation was designed to examine (1) the extent to which the home visitation programme was implemented as planned and (2) the extent to which general practices successfully redesigned their care delivery.
  
  
  METHODS
  Using a mixed-methods approach, the focus was on fidelity (quality of implementation), dose delivered (completeness), dose received (exposure and satisfaction), reach (participation rate), recruitment, and context. Twenty-four general practices participated, of which 13 implemented the home visitation programme and 11 delivered usual care to older people. Data collection consisted of semi-structured interviews with practice nurses (PNs), general practitioners (GPs), and older people; feedback meetings with PNs; structured registration forms filled-out by PNs; and narrative descriptions of the recruitment procedures and registration of inclusion and drop-outs by members of the research team.
  
  
  RESULTS
  Fidelity of implementation was acceptable, but time constraints and inadequate reach (i.e., the relatively healthy older people participated) negatively influenced complete delivery of protocol elements, such as interdisciplinary cooperation and follow-up of older people over time. The home visitation programme was judged positively by PNs, GPs, and older people. Useful tools were offered to general practices for organising proactive geriatric care.
  
  
  CONCLUSIONS
  The home visitation programme did not have major shortcomings in itself, but the delivery offered room for improvement. General practices received useful tools to redesign their care delivery from reactive towards proactive care, but perceived barriers require attention to allow for sustainability of the home visitation programme over time.
authors.affiliation: Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands. mandy.stijnen@maastrichtuniversity.nl.
authors.forename: Mandy M N
authors.initials: MM
authors.lastname: Stijnen
authors.affiliation: Public Health Service South-Limburg, P.O. Box 2022, 6160, HA, Geleen, The Netherlands. maria.jansen@ggdzl.nl.|Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands. maria.jansen@ggdzl.nl.
authors.forename: Maria W J
authors.initials: MW
authors.lastname: Jansen
authors.affiliation: Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands. inge.duimel@maastrichtuniversity.nl.|Department of Patient and Care, Maastricht University Medical Centre, P.O. Box 5800, 6202, MD, Maastricht, The Netherlands. inge.duimel@maastrichtuniversity.nl.
authors.forename: Inge G P
authors.initials: IG
authors.lastname: Duimel-Peeters
authors.affiliation: Tilburg School of Social and Behavioral Sciences, Scientific Centre for Care and Welfare (TRANZO), Tilburg University, P.O. Box 90153, 5000, LE, Tilburg, The Netherlands. H.J.M.Vrijhoef@uvt.nl.|Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore, 117597, Republic of Singapore. H.J.M.Vrijhoef@uvt.nl.
authors.forename: Hubertus J M
authors.initials: HJ
authors.lastname: Vrijhoef
mesh_terms: D000328:Adult; D057179:Advanced Practice Nursing / Q000379:methods*; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D005260:Female; D016330:Frail Elderly; D058006:General Practice / Q000379:methods*; D015577:Geriatric Assessment / Q000379:methods*; D005851:Geriatric Nursing / Q000379:methods*; D006304:Health Status; D006792:House Calls; D006801:Humans; D057187:Independent Living; D008297:Male; D008875:Middle Aged; D057184:Practice Patterns, Nurses'; D017064:Process Assessment, Health Care; D011788:Quality of Life; D055815:Young Adult