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Fret B, Smetcoren AS, De Donder L, Verté D. Preventive Home Visits Among Frail Community-Dwelling Older Adults. The Added Value of Follow-Up Telephone Calls. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:444-457. [PMID: 38491960 DOI: 10.1080/19371918.2024.2325555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
People in need of care and support do not always find appropriate services. This paper aims to explore the content and added value of monthly follow-up telephone calls after preventive home visits. We used both monitoring data and qualitative semi-structured interviews (with older adults, formal and informal caregivers). Results indicate that a majority of older adults (N = 95) received a regular follow-up of four telephone calls. Social connection and involvement were mentioned by all three groups as positive aspects of the program. Although time-consuming, this paper draws attention to the added value of follow-up telephone calls after preventive home visits.
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Affiliation(s)
- Bram Fret
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - An-Sofie Smetcoren
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Liesbeth De Donder
- Society and Ageing Research Lab (SARLab), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Dominique Verté
- Department of Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Jerez-Barranco D, Gutiérrez-Rodríguez L, Morilla-Herrera JC, Cuevas Fernandez-Gallego M, Rojano-Perez R, Camuñez-Gomez MD, Sanchez-Del Campo JL, García-Mayor S. Components of case management in caring for patients with dementia: a mixed-methods study. BMC Nurs 2022; 21:163. [PMID: 35739550 PMCID: PMC9219194 DOI: 10.1186/s12912-022-00935-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Case management has shown improvements in some health outcomes for dementia patients and their families. However, despite its benefits the components of case management in order to provide effective patient and family care remain unknown at present. Thus, the aim of this study is to identify the specific components of case management in caring for patients with dementia and to determine the necessary intensity of its deployment to enhance outcomes for these patients and their caregivers. METHODS Mixed-methods study with a qualitative phase to characterise forms of service provision, according to the case management components involved, followed by a quantitative phase to analyse the correlations between different patterns of service provision, adverse events in patients and caregiver overload. This study will be based on the variables described in the RANGE.COM register. DISCUSSION This research is expected to achieve a reproducible, evaluable set of interventions that can be modelled to optimise case management effectiveness for patients with dementia. Interactions between patients with dementia, their family caregivers and case management healthcare services, the components of these interactions and their association with the conditions of the individuals concerned are issues of great interest in the field of case management, which is constantly evolving.
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Affiliation(s)
- Desirée Jerez-Barranco
- Faculty of Health Sciences, Department of Nursing (Spain), University of Málaga, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain
- Andalusian Health Service, District Costa del Sol, Málaga, Spain
| | - Laura Gutiérrez-Rodríguez
- Faculty of Health Sciences, Department of Nursing (Spain), University of Málaga, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain.
- Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain.
| | - Juan Carlos Morilla-Herrera
- Faculty of Health Sciences, Department of Nursing (Spain), University of Málaga, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain
- Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain
- Andalusian Health Service, District Málaga-Guadalhorce, Málaga, Spain
| | - Magdalena Cuevas Fernandez-Gallego
- Faculty of Health Sciences, Department of Nursing (Spain), University of Málaga, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain
- Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain
- Andalusian Health Service, District Málaga-Guadalhorce, Málaga, Spain
| | | | | | | | - Silvia García-Mayor
- Faculty of Health Sciences, Department of Nursing (Spain), University of Málaga, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain
- Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain
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Chambers D, Cantrell A, Booth A. Implementation of interventions to reduce preventable hospital admissions for cardiovascular or respiratory conditions: an evidence map and realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BackgroundIn 2012, a series of systematic reviews summarised the evidence regarding interventions to reduce preventable hospital admissions. Although intervention effects were dependent on context, the reviews revealed a consistent picture of reduction across different interventions targeting cardiovascular and respiratory conditions. The research reported here sought to provide an in-depth understanding of how interventions that have been shown to reduce admissions for these conditions may work, with a view to supporting their effective implementation in practice.ObjectivesTo map the available evidence on interventions used in the UK NHS to reduce preventable admissions for cardiovascular and respiratory conditions and to conduct a realist synthesis of implementation evidence related to these interventions.MethodsFor the mapping review, six databases were searched for studies published between 2010 and October 2017. Studies were included if they were conducted in the UK, the USA, Canada, Australia or New Zealand; recruited adults with a cardiovascular or respiratory condition; and evaluated or described an intervention that could reduce preventable admissions or re-admissions. A descriptive summary of key characteristics of the included studies was produced. The studies included in the mapping review helped to inform the sampling frame for the subsequent realist synthesis. The wider evidence base was also engaged through supplementary searching. Data extraction forms were developed using appropriate frameworks (an implementation framework, an intervention template and a realist logic template). Following identification of initial programme theories (from the theoretical literature, empirical studies and insights from the patient and public involvement group), the review team extracted data into evidence tables. Programme theories were examined against the individual intervention types and collectively as a set. The resultant hypotheses functioned as synthesised statements around which an explanatory narrative referenced to the underpinning evidence base was developed. Additional searches for mid-range and overarching theories were carried out using Google Scholar (Google Inc., Mountain View, CA, USA).ResultsA total of 569 publications were included in the mapping review. The largest group originated from the USA. The included studies from the UK showed a similar distribution to that of the map as a whole, but there was evidence of some country-specific features, such as the prominence of studies of telehealth. In the realist synthesis, it was found that interventions with strong evidence of effectiveness overall had not necessarily demonstrated effectiveness in UK settings. This could be a barrier to using these interventions in the NHS. Facilitation of the implementation of interventions was often not reported or inadequately reported. Many of the interventions were diverse in the ways in which they were delivered. There was also considerable overlap in the content of interventions. The role of specialist nurses was highlighted in several studies. The five programme theories identified were supported to varying degrees by empirical literature, but all provided valuable insights.LimitationsThe research was conducted by a small team; time and resources limited the team’s ability to consult with a full range of stakeholders.ConclusionsOverall, implementation appears to be favoured by support for self-management by patients and their families/carers, support for services that signpost patients to consider alternatives to seeing their general practitioner when appropriate, recognition of possible reasons why patients seek admission, support for health-care professionals to diagnose and refer patients appropriately and support for workforce roles that promote continuity of care and co-ordination between services.Future workResearch should focus on understanding discrepancies between national and international evidence and the transferability of findings between different contexts; the design and evaluation of implementation strategies informed by theories about how the intervention being implemented might work; and qualitative research on decision-making around hospital referrals and admissions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Lambert AS, Legrand C, Cès S, Van Durme T, Macq J. Evaluating case management as a complex intervention: Lessons for the future. PLoS One 2019; 14:e0224286. [PMID: 31671116 PMCID: PMC6822731 DOI: 10.1371/journal.pone.0224286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022] Open
Abstract
The methodological challenges to effectiveness evaluation of complex interventions has been widely discussed. Bottom-up case management for frail older person was implemented in Belgium, and indeed, it was evaluated as a complex intervention. This paper presents the methodological approach we developed to respond to four main methodological challenges regarding the evaluation of case management: (1) the standardization of the interventions, (2) stratification of the frail older population that was used to test various modalities of case management with different risks groups, (3) the building of a control group, and (4) the use of multiple outcomes in evaluating case management. To address these challenges, we developed a mixed-methods approach that (1) used multiple embedded case studies to classify case management types according to their characteristics and implementation conditions; and (2) compared subgroups of beneficiaries with specific needs (defined by Principal Component Analysis prior to cluster analysis) and a control group receiving 'usual care', to evaluate the effectiveness of case management. The beneficiaries' subgroups were matched using propensity scores and compared using generalized pairwise comparison and the hurdle model with the control group. Our results suggest that the impact of case management on patient health and the services used varies according to specific needs and categories of case management. However, these equivocal results question our methodological approach. We suggest to reconsider the evaluation approach by moving away from a viewing case management as an intervention. Rather, it should be considered as a process of interconnected actions taking place within a complex system.
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Affiliation(s)
- Anne-Sophie Lambert
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle aux Champs, Brussels, Belgium
| | - Catherine Legrand
- Institute of Statistics, Biostatistics and Actuarial Sciences (ISBA-IMMAQ), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Sophie Cès
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle aux Champs, Brussels, Belgium
| | - Thérèse Van Durme
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle aux Champs, Brussels, Belgium
| | - Jean Macq
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos Chapelle aux Champs, Brussels, Belgium
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Lambert AS, Ces S, Malembaka EB, Van Durme T, Declercq A, Macq J. Evaluation of bottom-up interventions targeting community-dwelling frail older people in Belgium: methodological challenges and lessons for future comparative effectiveness studies. BMC Health Serv Res 2019; 19:416. [PMID: 31234857 PMCID: PMC6592000 DOI: 10.1186/s12913-019-4240-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/10/2019] [Indexed: 01/27/2023] Open
Abstract
Background Optimizing the organization of care for community-dwelling frail older people is an important issue in many Western countries. In Belgium, a series of complex, innovative, bottom-up interventions was recently designed and implemented to help frail older people live at home longer. As the effectiveness of these interventions may vary between different population groups according to their long-term care needs, they must be evaluated by comparison with a control group that has similar needs. Methods The goal was to identify target groups for these interventions and to establish control groups with similar needs and to explore, per group, the extent to which the utilization of long-term care is matched to needs. We merged two databases: a clinical prospective database and the routine administrative database for healthcare reimbursements. Through Principal Component Analysis followed by Clustering, the intervention group was first stratified into disability profiles. Per profile, comparable control groups for clinical variables were established, based on propensity scores. Using chi-squared tests and logistic regression analysis, long-term care utilization at baseline was then compared per profile and group studied. Results Stratification highlighted five disability profiles: people with low-level limitations; people with limitations in instrumental activities of daily life and low-level of cognitive impairment; people with functional limitations; people with functional and cognitive impairments; and people with functional, cognitive, and behavioral problems. These profiles made it possible to identify long-term care needs. For instance, at baseline, those who needed more assistance with hygiene tasks also received more personal nursing care (P < 0.05). However, there were some important discrepancies between the need for long-term care and its utilization: while 21% of patients who were totally dependent for hygiene tasks received no personal nursing care, personal nursing care was received by 33% of patients who could perform hygiene tasks. Conclusions The disability profiles provide information on long-term care needs but not on the extent to which those needs are met. To assess the effectiveness of interventions, controls at baseline should have similar disability profiles and comparable long-term care utilization. To allow for large comparative effectiveness studies, these dimensions should ideally be available in routine databases. Electronic supplementary material The online version of this article (10.1186/s12913-019-4240-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne-Sophie Lambert
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos chapelle aux champs 30 /B1.30.15.05, 1200, Brussels, Belgium.
| | - Sophie Ces
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos chapelle aux champs 30 /B1.30.15.05, 1200, Brussels, Belgium
| | - Espoir Bwenge Malembaka
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos chapelle aux champs 30 /B1.30.15.05, 1200, Brussels, Belgium.,Ecole Régionale de Santé Publique (ERSP), Faculty of Medicine, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Thérèse Van Durme
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos chapelle aux champs 30 /B1.30.15.05, 1200, Brussels, Belgium
| | - Anja Declercq
- LUCAS and Center for Sociological Research, KU Leuven, Leuven, Belgium
| | - Jean Macq
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Clos chapelle aux champs 30 /B1.30.15.05, 1200, Brussels, Belgium
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Exploring the Cost of ‘Ageing in Place’: Expenditures of Community-Dwelling Older Adults in Belgium. AGEING INTERNATIONAL 2018. [DOI: 10.1007/s12126-018-9341-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mello JDA, Macq J, Van Durme T, Cès S, Spruytte N, Van Audenhove C, Declercq A. The determinants of informal caregivers' burden in the care of frail older persons: a dynamic and role-related perspective. Aging Ment Health 2017; 21:838-843. [PMID: 27054404 DOI: 10.1080/13607863.2016.1168360] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
UNLABELLED Research into informal caregivers' burden does not distinguish between different stages of impairment. This study explored the determinants of burden from an in-depth perspective in order to identify which determinants apply to which phases of impairment. METHODS This was a cross-sectional study including frail older persons aged 65 and above. Instruments used were the interRAI Home Care, the Zarit-12 interview and an ad hoc economic questionnaire. A combination of variables from the Stress Process Model and Role Theory and a sub-group analysis enabled refined multivariate logistic analyses. RESULTS The study population consisted of 4175 older persons (average age: 81.4 ± 6.8, 67.8% female) and their informal caregivers. About 57% of them perceived burden. Depressive symptoms, behavioral problems, IADL impairment, previous admissions to nursing homes and risk of falls yielded significant odds ratios in relation to informal caregivers' burden for the whole sample. These determinants were taken from the Stress Process Model. When the population was stratified according to impairment, some factors were only significant for the population with severe impairment (behavioral problems OR:2.50; previous admissions to nursing homes OR:2.02) and not for the population with mild or moderate impairment. The informal caregiver being an adult child, which is a determinant from Role Theory, and cohabitation showed significant associations with burden in all strata. CONCLUSION Determinants of informal caregivers' burden varied according to stages of impairment. The results of this study can help professional caregivers gain a greater insight into which informal caregivers are most susceptible to perceive burden. ABBREVIATIONS NIHDI: National Institute for Health and Disability Insurance; ZBI12: Zarit Burden Interview - 12 items; InterRAI HC: interRAI Home Care instrument; ADL: Activities of Daily Living; ADLH: interRAI Activities of Daily Living Hierarchy scale; IADL: Instrumental Activities of Daily Living; IADLP: InterRAI Instrumental Activities of Daily Living Performance scale; CPS2: InterRAI Cognitive Performance scale 2; DRS: InterRAI Depression Rating scale.
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Affiliation(s)
| | - J Macq
- b Université Catholique de Louvain , Institut de Recherche Santé et Société (IRSS) , Woluwe-Saint-Lambert, Belgium
| | - T Van Durme
- b Université Catholique de Louvain , Institut de Recherche Santé et Société (IRSS) , Woluwe-Saint-Lambert, Belgium
| | - S Cès
- b Université Catholique de Louvain , Institut de Recherche Santé et Société (IRSS) , Woluwe-Saint-Lambert, Belgium
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de Almeida Mello J, Declercq A, Cès S, Van Durme T, Van Audenhove C, Macq J. Exploring Home Care Interventions for Frail Older People in Belgium: A Comparative Effectiveness Study. J Am Geriatr Soc 2016; 64:2251-2256. [PMID: 27676585 DOI: 10.1111/jgs.14410] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To examine the effects of home care interventions for frail older people in delaying permanent institutionalization during 6 months of follow-up. DESIGN Longitudinal quasi-experimental research study, part of a larger study called Protocol 3. SETTING Community care in Belgium. PARTICIPANTS Frail older adults who received interventions (n = 4,607) and a comparison group of older adults who did not (n = 3,633). Organizations delivering the interventions included participants provided they were aged 65 and older, frail, and at risk of institutionalization. A comparison group was established consisting of frail older adults not receiving any interventions. INTERVENTION Home care interventions were identified as single component (occupational therapy (OT), psychological support, night care, day care) or multicomponent. The latter included case management (CM) in combination with OT and psychological support or physiotherapy, with rehabilitation services, or with OT alone. MEASUREMENTS The interRAI Home Care (HC) was completed at baseline and every 6 months. Data from a national database were used to establish a comparison group. Relative risks of institutionalization and death were calculated using Poisson regression for each type of intervention. RESULTS A subgroup analysis revealed that 1,999 older people had mild impairment, and 2,608 had moderate to severe impairment. Interventions providing only OT and interventions providing CM with rehabilitation services were effective in both subpopulations. CONCLUSION This research broadens the understanding of the effects of different types of community care interventions on the delay of institutionalization of frail older people. This information can help policy-makers to plan interventions to avoid early institutionalization.
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Affiliation(s)
| | | | - Sophie Cès
- Institute of Public Health, Université Catholique de Louvain, Institut de Recherche Santé et Société, Woluwe-Saint-Lambert, Belgium
| | - Thérèse Van Durme
- Institute of Public Health, Université Catholique de Louvain, Institut de Recherche Santé et Société, Woluwe-Saint-Lambert, Belgium
| | | | - Jean Macq
- Institute of Public Health, Université Catholique de Louvain, Institut de Recherche Santé et Société, Woluwe-Saint-Lambert, Belgium
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Van Durme T, Schmitz O, Cès S, Anthierens S, Remmen R, Maggi P, Delye S, Mello JDA, Declercq A, Aujoulat I, Macq J. Erratum to: A comprehensive grid to evaluate case management's expected effectiveness for community-dwelling frail older people: results from a multiple, embedded case study. BMC Geriatr 2015; 15:104. [PMID: 26289669 PMCID: PMC4545911 DOI: 10.1186/s12877-015-0084-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 11/21/2022] Open
Affiliation(s)
- Thérèse Van Durme
- IRSS, Institute of Health and Society, Université catholique de Louvain clos Chapelle-aux-Champs, 30.13 B-1200, Brussels, Belgium.
| | - Olivier Schmitz
- IRSS, Institute of Health and Society, Université catholique de Louvain clos Chapelle-aux-Champs, 30.13 B-1200, Brussels, Belgium.
| | - Sophie Cès
- IRSS, Institute of Health and Society, Université catholique de Louvain clos Chapelle-aux-Champs, 30.13 B-1200, Brussels, Belgium.
| | - Sibyl Anthierens
- Faculty of Medicine and Health Care Sciences, Universiteit Antwerpen Universiteitsplein, 1 B-2610, Wilrijk, Belgium.
| | - Roy Remmen
- Faculty of Medicine and Health Care Sciences, Universiteit Antwerpen Universiteitsplein, 1 B-2610, Wilrijk, Belgium.
| | - Patrick Maggi
- Faculty of Public Health Université de Liège Avenue de l'hôpital, 3 B-4000, Liège, Belgium.
| | - Sam Delye
- Faculty of Public Health Université de Liège Avenue de l'hôpital, 3 B-4000, Liège, Belgium.
| | - Johanna De Almeida Mello
- LUCAS, Centre for Care Research and Consultancy KU Leuven (University of Leuven), Kapucijnenvoer 39, B-3000, Leuven, Belgium.
| | - Anja Declercq
- LUCAS, Centre for Care Research and Consultancy KU Leuven (University of Leuven), Kapucijnenvoer 39, B-3000, Leuven, Belgium.
| | - Isabelle Aujoulat
- IRSS, Institute of Health and Society, Université catholique de Louvain clos Chapelle-aux-Champs, 30.13 B-1200, Brussels, Belgium.
| | - Jean Macq
- IRSS, Institute of Health and Society, Université catholique de Louvain clos Chapelle-aux-Champs, 30.13 B-1200, Brussels, Belgium.
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