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Introduction: Care for the frail elderly is often provided by several professionals. Collaboration between them is essential, but remains difficult to achieve. Interprofessional education (IPE) can improve this collaboration. We developed a 9-hour IPE program for primary care professionals from 7 disciplines caring for the frail elderly, and aimed to establish whether the program improved professionals' interprofessional attitudes and attitudes toward collaboration, collaboration skills, and collaborative behavior. We also evaluated learners' reactions to the program. Methods: Before-after study, using the Interprofessional Attitudes Questionnaire (IAQ, score:1 to 7); Attitudes Toward Health Care Teams Scale (ATHCTS, score: 0 to 105); and Team Skills Scale (TSS, score:17 to 85). Additionally, semistructured interviews were conducted with 10 selected participants. Results: Participants' ( N = 80) overall interprofessional attitudes improved (IAQ baseline: 5.49; follow-up: 5.67, p = 0.001); attitudes toward geriatric teams did not change (ATHCTS baseline: 69.9; follow-up: 69.1, p = 0.32). Participants' self-reported team skills improved (TSS baseline: 45.7; follow-up: 48.1, p = 0.001). In the interviews, many interviewees reported increased collaboration with professionals of other disciplines due to the program. Interviewees considered the program's interprofessional nature and attending the program with local professionals important contributing factors to the experienced improvements in collaboration. However, they also noted that not all parts of the program had met the needs of all participating disciplines, due to differences in professional background and knowledge. Discussion: A brief IPE program can improve interprofessional attitudes, collaboration skills, and collaborative behavior. That such a program allows professionals to get acquainted with each other and each other's viewpoints appears to be as important as the educational content. [ABSTRACT FROM AUTHOR]

Introduction: Adequate communication between care and medical disciplines is an important prerequisite for safe patient care. Studies have shown that personal, social and organizational barriers might hinder communication in hospital care and long term care. Literature in primary care on these topics is scarce, but studies on implementation of collaborative services in primary healthcare indicate that communication is an important prerequisite for collaboration. This study aims to identify factors that facilitate or hinder patient related communication between General Practitioners (GPs) and Community Nurses (CNs), in order to find strategies to improve poor communication, if present. Six mono-disciplinary focus groups (13 GPs, 3 meetings; 18 CNs, 3 meetings) were organized, to create an atmosphere of equality and trust, knowing that hierarchical relationships could hinder open discussions. The interviews were tape-recorded and transcribed ad verbatim. Professionals were invited to discuss topics concerning individual attitudes and experiences, barriers and facilitators, prerequisites and current and future strategies for improvement. ATLAS.ti was used to code transcripts. Results: Despite the fact that GPs and CNs have regular contacts (mostly via telephone, less often in person), poor communication was frequently perceived. Trustful relations appeared to be the most important prerequisite for effective communication. Organizational factors (e.g. lack of shared care plans, no contact in person and lack of time) and professional specific factors (e.g. discipline specific language, perspective, education level and position) influenced development of trustful relationships. Significant suggestions for improvement of communication by both GPs and CNs were made, for example the importance of communication skills training and use of practical communication tools that structure information. Discussions: The results of this study are in line with earlier studies in hospital and long term care settings with regard to miscommunication between doctors and nurses. However, in this primary care study, causes seem to be more divers and disruptive. Medical and nursing professionals are not part of one team, but work from different organizations, with different interests, visions, procedures and methods of working. Conclusions: Different professional and organizational factors might hinder effective patient related communication between GPs and CNs. Inter-professional training programmes should address these factors and should be evaluated for their effect on quality of care. [ABSTRACT FROM AUTHOR]

Communication and coordination between primary healthcare professionals and informal caregivers involved in the care for frail older adults is suboptimal and could benefit from interprofessional digital communication tools. Implementation in daily practice however frequently fails. We aim to identify generic barriers and facilitators experienced by healthcare professionals and informal caregivers during implementation of interprofessional communication tools to improve their long-term use. Qualitative content analysis using individual semi-structured interviews was used for evaluating three different digital communication tools used by interprofessional primary care networks for frail older adults by 28 professionals and 10 caregivers. After transcription and open coding, categories and themes were identified. Barriers and facilitators were related to: tool characteristics, context of use, involvement of professionals and caregivers. The tool improved availability, approachability and users' involvement. The large number of digital systems professionals simultaneously use, and different work agreements hampered tool use. The tools facilitated care coordination, and professionals declared to be better informed about patients' current situations. Overall, interprofessional digital communication tools can facilitate communication in networks for primary elderly care. However, integration between digital systems is needed to reduce the number of tools. Organizations and policy makers have an important role in realizing the tools' long-term use. [ABSTRACT FROM AUTHOR]

Introduction: Care integration in primary elderly care is suboptimal. Validated instruments are needed to enable the implementation of integrated primary care. We aimed to assess construct validity of the Rainbow Model of Integrated Care measurement tool (RMIC-MT) for healthcare professionals working in an integrated primary elderly care setting in the Netherlands. Methods: In a cross-sectional study, the RMIC-MT, a 36-item questionnaire covering all domains of the Rainbow Model of Integrated Care (RMIC), was sent out to local networks of primary elderly care professionals. Confirmatory factor analysis with maximum likelihood estimation was used for the validation of the factor structure the RMIC-MT. Model fit was assessed by the chi-square test and fit indices. Results: The RMIC-MT was completed by 323 professionals, primarily general practitioners, community nurses, practice nurses, and case managers. Confirmatory factor analysis and corresponding fit indices showed moderate to good fit, thereby confirming a nine factor model with a total of 36 items. Conclusions: The RMIC-MT is promising for the primary elderly care setting in the Netherlands. It can be used for evaluating integrated care initiatives in a primary care setting, thereby contributing to implementation of integrated primary elderly care. [ABSTRACT FROM AUTHOR]

Background: Although frail older people can be more reluctant to become involved in clinical decision making, they do want professionals to take their concerns and wishes into account. Discussing goals can help professionals to achieve this. Objective: To describe the development of a two‐step method for discussing goals with frail older people in primary care and professionals' first experiences with it. Methods: The method consisted of (i) an open‐ended question: If there is one thing we can do for you to improve your situation, what would you like? if necessary, followed by (ii) a bubble diagram with goal subject categories. We reviewed the goals elaborated with the method and surveyed professionals' (primary care nurses and social workers) experiences, using questions concerning time investment, reasons for not formulating goals, and perceived value of the method. Results: One hundred and thirty‐seven community‐dwelling frail older people described 173 goals. These most frequently concerned mobility (n = 43; 24.9%), well‐being (n = 52; 30.1%) and social context (n = 57; 32.9%). Professionals (n = 18) were generally positive about the method, as it improved their knowledge about what the frail older person valued. Not all frail older people formulated goals; reasons for this included being perfectly comfortable, not being used to discussing goals or cognitive problems limiting their ability to formulate goals. Conclusions: This two‐step method for discussing goals can assist professionals in gaining insight into what a frail older person values. This can guide professionals and frail older people in choosing the most appropriate treatment option, thus increasing frail older people's involvement in decision making. [ABSTRACT FROM AUTHOR]

Introduction: Implementing integrated care in primary care settings is essential to establish a sustainable health care system for older adults living at home. Measuring integrated care performance facilitates implementation and improvement of integrated care services in daily practice, yet valid instruments are still lacking. Based on the Rainbow Model of Integrated Care (RMIC) a measurement tool (MT) has been validated for renal care patients and care providers. In the present study we aimed to validate the RMIC-MT for healthcare professionals working in an integrated primary elderly care setting. Theory/Methods: The RMIC-MT is a 36-item questionnaire, covering all aspects of integrated care according to the RMIC. Per integration domain professionals are asked to rate a set of questions. In a cross-sectional study, the RMIC-MT was sent to local networks of primary elderly care professionals in the Netherlands by email between February 2020 and February 2021. Confirmatory factor analysis (CFA) was used to build upon the previous results of the RMIC-MT for renal care by using the standard fit indices: root-mean-square error of approximation (RMSEA) (=0.06), standardized root-mean-square residual (SRMR) (=0.08), comparative fit index (CFI) (=0.90) and Tucker-Lewis index (TLI) (=0.90). Maximum likelihood was used to estimate the model parameters and goodness-of-fit indices. Results: 323 professionals filled out the RMIC-MT, the majority were general practitioners, community nurses, practice nurses and case managers. Median time needed to complete the RMIC-MT was 14 minutes. Some professionals did not complete the questionnaire because the questionnaire was too long or perceived as irrelevant. The model passed the goodness-to-fit test by confirmatory factor analysis: RMSEA=0.046, SRMR=0.055, CFI=0.895, TLI=0.882. The factor structure of 9 categories with a total of 36 items was thereby confirmed. Conclusions: We successfully validated the RMIC-MT for the primary elderly care setting. We adjusted the name of one category from 'triple aim' to 'outcome measurements'. Application of the RMIC-MT enables professional networks in this setting to evaluate and improve their care integration and contribute to better quality and more sustainable primary elderly care. Implications for applicability/transferability, sustainability, and limitations: The sample size was small but sufficient for the CFA. Recruitment was difficult which may reflect difficulties in future use in daily practice. The RMIC-MT was considered too long by some professionals. Developing a shorter version may be a promising strategy to increase completion in daily practice. RMIC-MT application can enable professionals to improve people-centered integrated primary care by using the feedback reports for improvement plans. Feasibility and added value of the tool should be studied after this small-scale implementation. Broader implementation of the RMIC-MT for elderly care should be investigated, including other contexts and countries. [ABSTRACT FROM AUTHOR]

Introduction: Rearrangements in primary care are needed to cope with aging populations, resulting in an increased prevalence of dementia and increasing health care costs. An essential strategy to establish a sustainable health care system for people with dementia is implementing integrated care in primary care settings. With DementiaNet, an integrated network-based approach, we facilitated collaboration between healthcare professionals from medical, care and social domains, and helped increasing their dementia expertise. Our aim is to evaluate the effects of the DementiaNet approach on quality of care, network collaboration and number of crisis admissions. Theory/Methods: In a longitudinal mixed methods multiple case study, 34 primary care networks participated; they adopted the DementiaNet approach in which a two-year tailor-made program was offered. Networks started between 2015 and 2020 and follow-up ended in 2021. Yearly, networks participated in data collection on their self-reported quality of care and crisis situations. Network collaboration was assessed yearly with scores on the eight integration domains of the Rainbow Model of Integrated Care based on semi-structured interviews with network leader(s). Descriptive statistics were used to identify changes in mean scores over time. Network characteristics and interview data was used to gain deeper understanding of the quantitative outcomes. Linear mixed models will be used to analyze the differences over time for quality of care and network collaboration. Results: Networks consisted on average of nine professionals (mainly a general practitioner, community nurse, practice nurse and case manager). Follow-up was 2-6 years. On average, quality of care of the networks increased for all measured indicators, of which the percentage of people discussed in a multidisciplinary meeting increased the most from 55% (range 0-100%) to 80% (range 48-100%). Advanced networks had less crisis situations compared to starting networks, 25% versus 30% (p=0.038) of their caseload of persons with dementia had a crisis situation. The quality of care was not associated with the number of crisis situations. Network collaboration increased as well over time and these results sustained or further improved after the two-year program ended. Conclusions: The DementiaNet approach improved quality of care and network collaboration and decreased the number of crisis situations of local primary dementia care networks. These effects sustained after the two-year program ended. Because of the improved collaboration, more advanced networks may be able to better communicate and act sooner in case of an oncoming crisis. Implications for applicability/transferability, sustainability, and limitations: Evaluation of a complex program such as DementiaNet requires an innovative design, flexibility and time. Previous studies did not find improvements after implementing integrated care, we showed that these improvements take at least two years to establish. Nevertheless, these effects were successfully sustained by the networks after the two years of support. Data is partly self-reported by network members. Despite the detailed data-collection protocols and definitions that were provided, the quality of the data may have suffered because of this strategy. Future research should focus on identifying if the DementiaNet approach is able to decrease healthcare costs. [ABSTRACT FROM AUTHOR]

Introduction: The rising incidence and policies to keep dementia patients in their own homes are increasingly putting pressure on primary care systems and budgets. The DementiaNet program stimulates development of primary care networks of medical, nursing and welfare professionals for community-dwelling dementia patients through practice facilitation. This study aimed to provide insight into the merits and drawbacks of this program, mechanisms and which contextual factors influenced them. Methods: In this longitudinal mixed methods multiple case study, primary care professionals with shared caseloads of dementia patients, were enrolled to form networks in the DementiaNet program. Data collection consisted of continuously kept logs, yearly structured interviews to rate the network maturity score (range 0-24), yearly quality of care assessment through a sum score of quality indicators (range 0-100), and in-depth interviews regarding experiences and perceived effects. Quantitative data were analyzed through mixed models; qualitative data with thematic analysis. Results were integrated by combined interpretation. Results: Thirteen networks were successfully initiated in the program, consisting of a median of 9 professionals. Overall, the networks showed an average yearly increase of 2.03 (95% CI 1.20-2.96) on network maturity and 8.45 (95% CI 2.80-14.69) on quality indicator sum scores. Mixed methods interpretation revealed patterns regarding network and contextual factors enabling the transition towards more mature networks and better quality of care. Discussion: Time trends in network maturity and quality of care indicators showed overall improvements. Several enabling factors for the transition to network-based care were identified including strong and adequate leadership (preferably with leaders from primary care practice), high involvement of motivated primary care physicians, high acquaintanceship with other network members, and network seize with a compact network that operates in a relatively small geographical area. Conclusions: Participation in the DementiaNet program was associated with increased network maturity and subsequent beneficial effects on quality of care. Adaptation towards a more mature network seemed to favour quality of care improvements. Lesson learned: The multiple case study design demonstrated its value in the evaluation of DementiaNet as example of a complex health care innovation by incorporating interactions and contextual dependency. Limitations: The main limitation of the study was the limited follow-up. The DementiaNet approach demands considerable changes in behaviour and practice from large numbers of actors; such adaptations require time and will be different per network. Indeed, networks work different in speed of change and improvement goals. Nonetheless, these initial results show improvements even over one and two year timeframes. Suggestions for future research: A succeeding study will be initiated to ensure longer followup of existing networks, while simultaneously expanding the number of networks. [ABSTRACT FROM AUTHOR]

Introduction Crisis admissions of persons with dementia are more prevalent due to the rising number of people with dementia living longer at home. Better collaboration between primary care professionals could prevent crisis situations. Therefore, the DementiaNet program focuses on a transition towards integrated care by supporting interdisciplinary networks of primary care professionals from the medical, care and social services to improve their collaboration. This study aims to determine the effect of the DementiaNet program on the number of crisis admissions. Theory/Methods DementiaNet networks started from 2015 onwards. This 2-year program is based on the Rainbow Model of Integrated Care and consists of coaching and support to help the networks go from ad hoc collaboration to a structured collaboration. Collaboration, network leadership, interdisciplinary education and quality improvement cycles are key elements to help networks improve their quality of care for the persons with dementia and their caregivers. Yearly, networks collect patient data on five quality of care indicators, and on admission to a hospital or nursing home due to a crisis. The data collection took place between 2015 and 2020. We compared the number of crisis admissions of advanced networks (>2 years active) with the number of crisis admissions of starting networks (<2 years active) by using an independent T-test. Logistic regression was used to determine the relation between quality of care and the number of crisis admissions. Result 34 networks with on average 9 professions (frequently: general practitioner, practice nurse, community nurse and case manager) were included. The networks collected data of 1689 patient years of which 479 patient years had a crisis. Preliminary results show that advanced networks had less crisis admissions than starting networks, 0.25 versus 0.30 respectively (p=0.038, CI=0.003 - 0.091). The quality of care was not associated with the number of crisis situations. Discussions In advanced networks, less crisis admissions took place; Surprisingly, this effect was not mediated by quality of care. A possible explanation is that better collaboration leads to less crisis admissions due to earlier intervention by professionals. Conclusions The Dementia program was able to facilitate a transition towards better interdisciplinary collaboration within networks of primary dementia care professionals. In advanced networks less crisis admissions occurred than in starting networks. The quality of care was not associated with the number of crisis admissions. Lessons learned A complex intervention, such as DementiaNet, is able to realize a transition towards network-based care and enhance interdisciplinary collaboration to reduce the number of crisis admissions. Limitations The dataset consists of patient years rather than patients, data was collected yearly and we were not able to adjust for the same persons present in the dataset several years in a row. Ideally, we would like to include patient trajectories in further research. Suggestions for future research Further research in a larger database could contribute to unravelling the complex relations between network maturity, quality of care and crisis admissions in primary dementia care. [ABSTRACT FROM AUTHOR]

The complex care needs of frail older persons living at home is a major challenge for health care systems worldwide. One possible solution is to employ a primary care physician (PCP) with additional geriatric expertise. In the Netherlands, elderly care physicians (ECPs), who traditionally work in nursing homes, are increasingly encouraged to utilize their expertise within primary care. However, little is known about how PCPs and ECPs collaborate. Therefore, we aimed to unravel the nature of the current PCP-ECP collaboration in primary care for frail older persons, and to identify key concepts for success. A qualitative multiple case study with semistructured interviews. A selection of 22 participants from 7 "established collaboration practices" within the primary care setting in the Netherlands, including at least 1 ECP, 1 PCP, and 1 other health care professional for every included established collaboration practice. Transcripts of individual interviews were analyzed using largely double and independent open and axial coding, and formulation of themes and subthemes. Data analysis revealed 4 key concepts for success: (1) clarification of roles and expectations (ie, patient-centered care and embedding in existing care networks), (2) trust, respect, and familiarity as drivers for collaboration (ie, mutual trust through knowing each other and having shared goals); (3) framework for regular communication (ie, structural meetings and a shared vision); and (4) government, payer, and organization support (ie, financial support and emphasis on the collaboration's urgency by organizations and national policy makers). For a successful generalist-specialist collaboration, health care professionals need to invest in building relationships and mutual trust, and incorporating their efforts in the existing care networks to guarantee patient-centeredness. When provided with reimbursement and appreciation, this collaboration is a promising change in general practice to improve the care and outcomes of frail older persons. [ABSTRACT FROM AUTHOR]