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Treatment Fidelity of an Evidence-Based Nurse-Led Intervention in a Proactive Primary Care Program for Older People

Authors

  • Nienke Bleijenberg RN, PhD,

    Corresponding author
    1. Assistant Professor, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
    • Address correspondence to Nienke Bleijenberg, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; N.Bleijenberg@umcutrecht.nl

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  • Valerie H. ten Dam MD, PhD,

    1. General Practitioner, geriatrics specialist, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
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  • Irene Drubbel MD, PhD,

    1. Physician, general practitioner trainee, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
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  • Mattijs E. Numans MD, PhD,

    1. Professor of General Practice, Department Public Health and Primary Care of the Leiden University Medical Center, The Netherlands
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  • Niek J. de Wit MD, PhD,

    1. Professor of General Practice, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands
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  • Marieke J. Schuurmans RN, PhD

    1. Professor of Nursing Science, Department of Rehabilitation, Nursing Science and Sports Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
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  • The authors gratefully acknowledge all the participants and nurses that participated in this study. We thank Bas Steunenberg for his contribution to the focus group, and Heather Greysen for her careful reading and her comments.

ABSTRACT

Background

In a large randomized trial, Utrecht PROactive Frailty Intervention Trial (U-PROFIT), we evaluated the effectiveness of an integrated program on the preservation of daily functioning in older people in primary care that consisted of a frailty identification tool and a multicomponent nurse-led care program. Examination of treatment fidelity is critical to successful translation of evidence-based interventions into practice.

Aims

To assess treatment delivery, dose and content of nursing care delivered within the nurse-led care program, and to explore if the delivery may have influenced the trial results.

Methods

A mixed-methods study was conducted. Type and dose of nursing care were collected during the trial. Shortly after the trial, a focus group with nurses was conducted to explore reasons for the observed differences between the type and dose of nursing care delivered.

Results

A total of 835 older persons were included in the nurse-led care program. The mean age was 75 years, 64% were female and 53.5% were living alone. The most frequent self-reported conditions were loneliness (60.8%) and cognitive problems (59.4%). One-third of the patients with a geriatric condition received an additional assessment (e.g., Mini-Mental State Examination), and the majority of these patients received at least one nurse intervention (>85%). Most nursing care was delivered to patients at risk of falling and to those with urinary incontinence. Patients with nutrition problems seldom received nursing interventions. The nurses explained that differences in type and dose were influenced by the preference of the patient, the type of geriatric problem, and the time required to apply a nurse intervention.

Linking Evidence to Action

All intervention components were delivered; however, differences were observed in the type and dose of nursing care delivered across geriatric conditions. The findings better explain the treatment fidelity and suggest that there is room for improvement that may result in more beneficial patient outcomes.

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