title: [Implementation of a proactive integrated primary care program for frail older people: from science to evidence-based practice].
abstract: BACKGROUND
  Multimorbidity, functional impairment and frailty among community-dwelling older people are causing increasing complexity in primary care. A proactive integrated primary care approach is therefore essential. Between October 2014-2015, an evidence-based proactive care program for frail older people was implemented in the region Noord-West Veluwe en Zeewolde, the Netherlands. This study evaluated the feasibility of the implementation, having a strong focus on the collaboration between the medical and social domain.
  
  
  METHODS
  Using a mixed-methods design we evaluated several process indicators. Data were obtained from electronic routine medical record data within primary care, questionnaires, and interviews with older adults. The questionnaires provided information regarding the expectations and experiences towards the program and were sent to health care professionals at baseline and six months follow-up. Stakeholders from various domains were asked to fill in the questionnaire at baseline and twelve months follow-up. Interviews were conducted to explore the experiences of older adults with the program. Regional work groups were set up in each municipality to enhance the interdisciplinary and domain transcending collaboration.
  
  
  RESULTS
  The proactive primary care program was implemented in 42 general practices who provided care to 7904 older adults aged 75 years or older. A total of 101 health care professionals and 44 stakeholders filled in the questionnaires. The need for better structure and interdisciplinary cooperation seemed widespread among the participants. The implementation resulted in a positive significant change in the demand for a better regional healthcare-framework (34% p ≤ .001) among health care professionals, and the needs for transparency regarding the possibilities for referral improved (27% , p = .009). Half of the participants reported that the regional collaboration has been improved after the implementation. Health care professionals and stakeholders gained increased attention and awareness of frail elderly in their area compared to before the implementation. Older people and their caregivers were positive about the proactive approach. The nurses reported that the screenings questionnaire was too lengthy and therefore time consuming.
  
  
  CONCLUSIONS
  The implementation of the proactive primary care approach in daily practice was feasible. A strong interdisciplinary collaboration was realized. The program was easily adapted to the local context.
authors.affiliation: Divisie Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde, afdeling verplegingswetenschap, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Postbus 35500 Str. 6.131, 3508 GA, Utrecht, Nederland. n.bleijenberg@umcutrecht.nl.
authors.forename: Nienke
authors.initials: N
authors.lastname: Bleijenberg
authors.affiliation: Huisartsen Coöperatie Medicamus, Harderwijk, Nederland.
authors.forename: Artine
authors.initials: A
authors.lastname: de Jonge
authors.affiliation: Geneeskundestudenten, Universiteit Utrecht, Utrecht, Nederland.
authors.forename: Morris P
authors.initials: MP
authors.lastname: Brand
authors.affiliation: Geneeskundestudenten, Universiteit Utrecht, Utrecht, Nederland.
authors.forename: Caitriona
authors.initials: C
authors.lastname: O'Flynn
authors.affiliation: Divisie Julius Centrum voor Gezondheidswetenschappen en Eerstelijns Geneeskunde, afdeling verplegingswetenschap, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, Postbus 35500 Str. 6.131, 3508 GA, Utrecht, Nederland.
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: Schuurmans
authors.affiliation: divisie Julius Centrum voor Gezondheitswetenschapen en Eestelijns Geneeskunde, afdeling huisartsgeneeskunde, Universitair Medisch Centrum Utrecht, Utrecht, Nederland.
authors.forename: Niek J
authors.initials: NJ
authors.lastname: de Wit
mesh_terms: D000369:Aged, 80 and over; D003695:Delivery of Health Care; D019317:Evidence-Based Medicine; D005260:Female; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D009426:Netherlands; D011320:Primary Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires
keywords: Frail older people; M﻿ultidisciplinary; Proactive primary care program; Process evaluation