Structured follow-up of frail home-dwelling older people in primary health care: is there a special need, and could a checklist be of any benefit? A qualitative study of experiences from registered nurses and their leaders

Abstract

Aim

To identify experiences and opinions about the need for a structured follow-up and to identify potential benefits and barriers to the use of a checklist (Sub Acute Functional decline in the Older people [SAFE]) when caring for frail home-dwelling older people.

Background

The complexity of older peoples’ health situation requires more coordinated health care across health care levels and a better structured follow-up than is currently being offered, especially in the transitional phase between hospital discharge and primary care, but also in more stable phases at home.

Design

This was a qualitative study using focus group interviews.

Methods

Data were collected during six focus group interviews in three districts in a municipality. Nineteen registered nurses (RNs) and seventeen leaders responsible for the follow-up of frail home-dwelling older people participated. Participants were representatives of the RNs in homecare and their leaders.

Results

Our results highlight that although most RNs and their leaders saw a number of significant benefits to conducting a structured assessment and follow-up of frail older people home care recipients, a number of barriers made this difficult to realize on a daily basis.

Conclusion

There is no common perception that a structured follow-up of frail home-dwelling older people in primary health care is an important and contributing factor to better quality of health care. Despite this, most RNs and leaders found that the use of a structured checklist such as SAFE was a benefit to achieving a structured follow-up of the frail older people. We identified several factors of importance to whether a structured follow-up with a checklist is conducted in home care.

Keywords:

• community health services
• home care
• frail elderly
• multimorbidity
• polypharmacy
• functional decline
• geriatric assessment
• methods

Supplementary material

Figure S1 (Continued)

Figure S1 (Continued)

Figure S1 Sub Acute Functional decline in the Elderly instrument (SAFE).

Note: An interdisciplinary team from Oslo University Hospital, University of Oslo (UiO) and districts in Oslo municipality, developed SAFE. As project manager and responsible for further development and validation of SAFE, Edith L. Roth Gjevjon (Oslo University Hospital) has granted permission to use SAFE (translated into English by the first author).

Acknowledgments

We would like to thank all informants for participating in the study. Furthermore, we thank Edith L. Roth Gjevjon for important input from her work with SAFE and the permission to translate and enclose SAFE.

Abbreviations

RN, registered nurse; GP, general practitioners; SAFE, Sub Acute Functional decline in elderly; EPR, electronic patient record, HC, home care.

Disclosure

The authors report no conflicts of interest in this work.