Formal and informal care for community-dwelling frail elderly people over time: A comparison of integrated and usual care in the Netherlands

While integration has become a central tenet of community-based care for frail elderly people, little is known about its impact on formal and informal care and their dynamics over time. The aim of this study was therefore to examine how an integrated care intervention for community-dwelling frail elderly people affects the amount and type of formal and informal care over 12 months as compared to usual care. A quasi-experimental design with a control group was used. Data regarding formal and informal care were collected from frail elderly patients (n = 207) and informal caregivers (n = 74) with pre/post-questionnaires. Within- and between-group comparisons and multiple linear regression analyses were performed. The results showed marginal changes over time in the amount of formal and informal care in both integrated care and usual care. However, different associations between changes in formal and informal care were found in integrated and usual care. Most notably, informal caregivers provided more instrumental assistance over time if formal caregivers provided less personal care (and vice versa) in integrated care but not in usual care. These results suggest that integrated care does not necessarily change the contribution of formal or informal care, but changes the interaction between formal (personal care) and informal (instrumental) activities. Implications and recommendations for research and practice are discussed.

TRIAL REGISTRATION

Current Controlled Trials ISRNT05748494.

Delivering Integrated Care to the Frail Elderly: The Impact on Professionals' Objective Burden and Job Satisfaction

BACKGROUND

The impact of integrated working on professionals' objective burden and job satisfaction was examined. An evidence-based intervention targeting frail elderly patients was implemented in the Walcheren region of the Netherlands in 2010. The intervention involved the primary care practice as a single entry point, and included proactive frailty screening, a comprehensive assessment of patient needs, case management, multidisciplinary teams, care plans and protocols, task delegation and task specialisation, a shared information system, a geriatric care network and integrated funding.

METHODS

A quasi-experimental design with a control group was used. Data regarding objective burden involved the professionals' time investments over a 12-month period that were collected from patient medical records (n = 377) time registrations, transcripts of meetings and patient questionnaires. Data regarding job satisfaction were collected using questionnaires that were distributed to primary care and home-care professionals (n = 180) after the intervention's implementation. Within- and between-groups comparisons and regression analyses were performed.

RESULTS

Non-patient related time was significantly higher in the experimental group than in the control group, whereas patient-related time did not differ. Job satisfaction remained unaffected by the intervention.

CONCLUSION AND DISCUSSION

Integrated working is likely to increase objective burden as it requires professionals to perform additional activities that are largely unrelated to actual patient care. Implications for research and practice are discussed. [Current Controlled Trials ISRCTN05748494].

Do integrated care structures foster processes of integration? A quasi-experimental study in frail elderly care from the professional perspective

OBJECTIVE

This study explores the processes of integration that are assumed to underlie integrated care delivery.

DESIGN

A quasi-experimental design with a control group was used; a new instrument was developed to measure integration from the professional perspective.

SETTING AND PARTICIPANTS

Professionals from primary care practices and home-care organizations delivering care to the frail elderly in the Walcheren region of the Netherlands.

INTERVENTION

An integrated care intervention specifically targeting frail elderly patients was implemented.

MAIN OUTCOME MEASURES

Structural, cultural, social and strategic integration and satisfaction with integration.

RESULTS

The intervention significantly improved structural, cultural and social integration, agreement on goals, interests, power and resources and satisfaction with integration.

CONCLUSIONS

This study confirms that integrated care structures foster processes of integration among professionals.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN05748494.

The effects of an integrated care intervention for the frail elderly on informal caregivers: a quasi-experimental study

BACKGROUND

This study explored the effects of an integrated care model aimed at the frail elderly on the perceived health, objective burden, subjective burden and quality of life of informal caregivers.

METHODS

A quasi-experimental design with before/after measurement (with questionnaires) and a control group was used. The analysis encompassed within and between groups analyses and regression analyses with baseline measurements, control variables (gender, age, co-residence with care receiver, income, education, having a life partner, employment and the duration of caregiving) and the intervention as independent variables.

RESULTS

The intervention significantly contributed to the reduction of subjective burden and significantly contributed to the increased likelihood that informal caregivers assumed household tasks. No effects were observed on perceived, health, time investment and quality of life.

CONCLUSIONS

This study implies that integrated care models aimed at the frail elderly can benefit informal caregivers and that such interventions can be implemented without demanding additional time investments from informal caregivers. Recommendations for future interventions and research are provided.

TRIAL REGISTRATION

Current Controlled Trials http://ISRCTN05748494. Registration date: 14/03/2013.

A quasi-experimental study of the effects of an integrated care intervention for the frail elderly on informal caregivers' satisfaction with care and support

Background

This study explored the effects of an integrated care model for the frail elderly on informal caregivers’ satisfaction with care and support services.

Methods

A 62-item instrument was developed and deployed in an evaluative before/after study using a quasi-experimental design and enrolling a control group. The definitive study population (n = 63) consisted mainly of female informal caregivers who did not live with the care recipient. Analysis of separate items involved group comparisons, using paired and unpaired tests, and regression analyses, with baseline measurements, control variables (sex, age and living together with care recipient) and the intervention as independent variables. Subsequently, the underlying factor structure of the theoretical dimensions was investigated using primary component analysis. Group comparisons and regression analyses were performed on the resulting scales.

Results

Satisfaction with the degree to which care was provided according to the need for care of the recipients increased, while satisfaction with the degree to which professionals provided help with administrative tasks, the understandability of the information provided and the degree to which informal caregivers knew which professionals to call, decreased. Primary component analysis yielded 6 scales for satisfaction with care and 5 scales for satisfaction with caregiver support, with sufficient reliability.

Conclusions

The results suggest that expectations regarding the effects of integrated care on informal caregiver satisfaction may not be realistic. However, the results must be seen in light of the small sample size and should therefore be considered as preliminary. Nonetheless, this study provides guidance for further research and integrated care interventions involving informal caregivers.

Trial registration

Current Controlled Trials ISRCTN05748494. Date of registration: 14/03/2013.

Integrated care for frail elderly compared to usual care: a study protocol of a quasi-experiment on the effects on the frail elderly, their caregivers, health professionals and health care costs

BACKGROUND

Frail elderly persons living at home are at risk for mental, psychological, and physical deterioration. These problems often remain undetected. If care is given, it lacks the quality and continuity required for their multiple and changing problems. The aim of this project is to improve the quality and efficacy of care given to frail elderly living independently by implementing and evaluating a preventive integrated care model for the frail elderly.

METHODS/DESIGN

The design is quasi-experimental. Effects will be measured by conducting a before and after study with control group. The experimental group will consist of 220 elderly of 8 GPs (General Practitioners) who will provide care according to the integrated model (The Walcheren Integrated Care Model). The control group will consist of 220 elderly of 6 GPs who will give care as usual. The study will include an evaluation of process and outcome measures for the frail elderly, their caregivers and health professionals as well as a cost-effectiveness analysis. A concurrent mixed methods design will be used. The study population will consist of elderly 75 years or older who live independently and score a 4 or higher on the Groningen Frailty Indicator, their caregivers and health professionals. Data will be collected prospectively at three points in time: T0, T1 (3 months after inclusion), and T2 (12 months after inclusion). Similarities between the two groups and changes over time will be assessed with t-tests and chi-square tests. For each measure regression analyses will be performed with the T2-score as the dependent variable and the T0-score, the research group and demographic variables as independent variables.

DISCUSSION

A potential obstacle for this study will be the willingness of the elderly and their caregivers to participate. To increase willingness, the request to participate will be sent via the elders' own GP. Interviewers will be from their local region and gifts will be given. A successful implementation of the integrated model is also necessary. The involved parties are members of a steering group and have contractually committed themselves to the project.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN05748494.

The effects of integrated care on professionals: a systematic review

Background and aim

Traditional care is increasingly being replaced by integrated care models, which often implies changes for health professionals involved. However, although literature on integrated care is abundant, the primary focus is rarely on professionals. Consequently, it is not clear if and how they are affected by integrated care interventions. The aim of this study, therefore, is to provide a systematic review of the literature on the effect of integrated care on professionals.

Methods

We included empirical peer-reviewed journal articles in English and Dutch that have been published between 1970 and 2010 and report effects of integrated care interventions on professionals. Four databases were searched using a variety of terms for integrated care, effects and professionals. Articles were reviewed by two researchers. References of included studies were checked for additional relevant articles. This process resulted in 56 articles. Outcomes of effects were categorized into several broad themes knowledge and skills, communication, relationships and satisfaction. Additional categories of effects are expected after further analysis of the results.

Preliminary results and conclusions

Studies primarily focus on interventions within and between primary care and hospital care, involving mostly general practitioners, nurses and specialists. Interventions in these studies were heterogeneous. Integrated care interventions increase clinical knowledge and skills of professionals involved, as well as their knowledge of other professional’s roles and other services. These interventions also improve communication and relationships between professionals. They do not seem to affect the satisfaction of professionals with the care that is given, although it does increase their satisfaction with other services involved. A preliminary conclusion is that integrated care, indeed, does not leave professionals unaffected and that this influence seems primarily positive.

The poster presentation will further elaborate on these effects for professionals, the interventions used in relation to these effects, as well as the research methods and the scientific weight of these effects. Additional categories of effects will be described.

Are Bacteria Omnipresent on Phanerochaete chrysosporium Burdsall?

Cultures of Phanerochaete chrysosporium were examined for the presence of bacteria as previously described (F. Seigle-Murandi, P. Guiraud, C. Falsen, and K.-E. Eriksson, Appl. Environ. Microbiol. 62:2477-2481, 1996). Under no conditions could bacteria be isolated from cultures of P. chrysosporium. With PCR primers corresponding to small-subunit rRNA genes, no bacterium-like product could be amplified from cultures of the widely used P. chrysosporium strain BKM-F-1767. Thus, we could find no evidence of bacteria in association with P. chrysosporium BKM-F-1767.

Relatedness of Thermomyces lanuginosus strains producing a thermostable xylanase

Properties of an endo-beta-xylanase produced by a locally isolated Thermomyces lanuginosus strain SSBP was compared to seven other T. lanuginosus strains isolated from different geographical regions. Strain SSBP produced the highest xylanase activity of 59600 nkat ml(-1) when cultivated on corn cobs (maize) medium, whereas the seven other strains produced xylanase activities ranging from 6000 to 32000 nkat ml(-1). No cellulase activity was produced by the strains. Despite the variability in the production of xylanase, little difference in the other characteristics of the strains could be found. The optimal temperature and pH for xylanase production by the strains was either 40 or 50 degrees C and between pH 6 and 7, respectively. Optimal xylanase activity of the strains was observed at 70 degrees C and at pH 6 or 6.5. Culture supernatant analysis by SDS-PAGE and isoelectric focusing PAGE of all strains revealed the presence of a single 24.7 kDa and pI 3.9 xylanase. Phylogenetic analysis by PCR amplification and sequencing of the internal transcribed spacer of nuclear rRNA repeat units and 5.8S rDNA revealed no strain diversity. However, random amplified polymorphic DNA analysis pointed to greater diversity and with one primer (5'-GCCCGACGCG-3'), a relationship was established between xylanase levels and the RAPD pattern.