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Table 3 Second Pilot : Exploring the potential for quality of care improvement of preventive home visits among elderly persons.

From: Design and pilot results of a single blind randomized controlled trial of systematic demand-led home visits by nurses to frail elderly persons in primary care [ISRCTN05358495]

Objective: To identify the need and possible benefit of home visits for frail patients, PCPs and nurses.
Method: The setting was a health center of 5400 patients with 3 PCPs and a practice nurse. Possible frailty was determined by the PCPs among their 75+ patients in the following cases: beginning dementia, active carcinoma, two or more medications for organ indication, treatments by two or more medical specialists, being 85+ and not contacted the PCP over the last three years, uncertainty regarding the ability to manage oneself, and all other persons the PCP felt it necessary to pay attention to. The nurses visited the patients and used an elaborate geriatric assessment protocol to identify psychosocial and medical problems. The nurses and the PCPs designed a care plan. The experiences of all participants were gathered by semi-structured interviews.
Results: The participants (PCPs, nurses, patients) evaluated this approach positively. The PCPs gained better insight in medical and care situation of their elderly patients and experienced less work pressure. The nurses experienced better quality of care. The patients felt safer and more independent. The PCP also selected a number of healthy persons.
Conclusion: Home visits by nurses were regarded by all to have potential for quality of care improvement. Point of concern was the inadequate selection of frail patients by the PCPs. Also, the assessment protocol used by the nurses provided no triggers on when actions should follow.
  1. PCP = Primary Care Physician