Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study
Abstract Background The effectiveness of health care interventions is co-determined by contextual factors. Unknown is the extent of this impact on patient outcomes. Therefore, the aim of this study is to explore which characteristics of general practices are associated with patient outcomes in a pro...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-021-02539-6 |
| _version_ | 1819143425210974208 |
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| author | Linda C. Smit Niek J. De Wit Meggie L. Nieuwenhuizen Marieke J. Schuurmans Nienke Bleijenberg |
| author_facet | Linda C. Smit Niek J. De Wit Meggie L. Nieuwenhuizen Marieke J. Schuurmans Nienke Bleijenberg |
| author_sort | Linda C. Smit |
| collection | DOAJ |
| description | Abstract Background The effectiveness of health care interventions is co-determined by contextual factors. Unknown is the extent of this impact on patient outcomes. Therefore, the aim of this study is to explore which characteristics of general practices are associated with patient outcomes in a proactive primary care program, the U-PROFIT 2.0. Methods A longitudinal observational study was conducted from January 2016 till October 2017. Two questionnaires were send out, one to collect characteristics of general practices such as practice neighbourhood socio-economic status, general practice versus healthcare centre (involving multiple primary care professionals), and professional- frail older patient ratio per practice of general practitioners and practice nurses. Regarding delivering the program, the practice or district nurse who delivered the program, number of years since the start of the implementation, and choice of age threshold for frailty screening were collected. Patient outcomes collected by the second questionnaire and send to frail patients were daily functioning, hospital admissions, emergency department visits, and general practice out-of-hours consultations. Linear and generalized linear mixed models were used. Results A total of 827 frail older people were included at baseline. Delivery of the program by a district nurse compared to a practice nurse was significantly associated with a decrease in daily functioning on patient-level (β = 2.19; P = < 0.001). Duration since implementation of 3 years compared to 9 years was significantly associated with less out-of-hours consultations to a general practice (OR 0.11; P = 0.001). Applying frailty screening from the age of 75 compared to those targeted from the age of 60 showed a significant increase in emergency visits (OR 5.26; P = 0.03). Conclusion Three associations regarding the organizational context 1) the nurse who delivered the program, 2) the number of years the program was implemented and 3) the age threshold for defining a frail patient are significant and clinically relevant for frail patients that receive a proactive primary care program. In general, contextual factors need more attention when implementing complex primary care programs which can result in better balanced choices to enhance effective proactive care for older people living in the community. |
| first_indexed | 2024-12-22T12:26:02Z |
| format | Article |
| id | doaj.art-b95fdfc22e6b434ea79d6324a6d84945 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-22T12:26:02Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-b95fdfc22e6b434ea79d6324a6d849452022-12-21T18:25:49ZengBMCBMC Geriatrics1471-23182021-10-0121111210.1186/s12877-021-02539-6Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational studyLinda C. Smit0Niek J. De Wit1Meggie L. Nieuwenhuizen2Marieke J. Schuurmans3Nienke Bleijenberg4Research Centre for Healthy and Sustainable Living, University of Applied Sciences UtrechtDepartment of General Practice, Division Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtDepartment of General Practice, Division Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtEducation Center, UMC Utrecht Academy, University Medical Center UtrechtResearch Centre for Healthy and Sustainable Living, University of Applied Sciences UtrechtAbstract Background The effectiveness of health care interventions is co-determined by contextual factors. Unknown is the extent of this impact on patient outcomes. Therefore, the aim of this study is to explore which characteristics of general practices are associated with patient outcomes in a proactive primary care program, the U-PROFIT 2.0. Methods A longitudinal observational study was conducted from January 2016 till October 2017. Two questionnaires were send out, one to collect characteristics of general practices such as practice neighbourhood socio-economic status, general practice versus healthcare centre (involving multiple primary care professionals), and professional- frail older patient ratio per practice of general practitioners and practice nurses. Regarding delivering the program, the practice or district nurse who delivered the program, number of years since the start of the implementation, and choice of age threshold for frailty screening were collected. Patient outcomes collected by the second questionnaire and send to frail patients were daily functioning, hospital admissions, emergency department visits, and general practice out-of-hours consultations. Linear and generalized linear mixed models were used. Results A total of 827 frail older people were included at baseline. Delivery of the program by a district nurse compared to a practice nurse was significantly associated with a decrease in daily functioning on patient-level (β = 2.19; P = < 0.001). Duration since implementation of 3 years compared to 9 years was significantly associated with less out-of-hours consultations to a general practice (OR 0.11; P = 0.001). Applying frailty screening from the age of 75 compared to those targeted from the age of 60 showed a significant increase in emergency visits (OR 5.26; P = 0.03). Conclusion Three associations regarding the organizational context 1) the nurse who delivered the program, 2) the number of years the program was implemented and 3) the age threshold for defining a frail patient are significant and clinically relevant for frail patients that receive a proactive primary care program. In general, contextual factors need more attention when implementing complex primary care programs which can result in better balanced choices to enhance effective proactive care for older people living in the community.https://doi.org/10.1186/s12877-021-02539-6Primary careProactive care programImplementationOrganizational contextOlder people |
| spellingShingle | Linda C. Smit Niek J. De Wit Meggie L. Nieuwenhuizen Marieke J. Schuurmans Nienke Bleijenberg Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study BMC Geriatrics Primary care Proactive care program Implementation Organizational context Older people |
| title | Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study |
| title_full | Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study |
| title_fullStr | Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study |
| title_full_unstemmed | Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study |
| title_short | Impact of organizational context on patient outcomes in a proactive primary care program:a longitudinal observational study |
| title_sort | impact of organizational context on patient outcomes in a proactive primary care program a longitudinal observational study |
| topic | Primary care Proactive care program Implementation Organizational context Older people |
| url | https://doi.org/10.1186/s12877-021-02539-6 |
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