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

Journal of Multidisciplinary Healthcare Dovepress open access to scientific and medical research Journal of Multidisciplinary Healthcare downloaded from https://www.dovepress.com/ by 180.31.230.217 on 07-Jun-2020 For personal use only. Open Access Full Text Article ORIGINAL RESEARCH 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 This article was published in the following Dove Press journal: Journal of Multidisciplinary Healthcare Gro Næss 1–3 Torgeir Bruun Wyller 1,4,5 Marit Kirkevold 1,3 1 Charm Research Centre for Habilitation and Rehabilitation Models & Services, Institute of Health and Society, University of Oslo, Oslo, Norway; 2Department of Nursing and Health Sciences, Faculty of Health and Sciences, University of SouthEastern Norway, Kongsberg, Norway; 3 Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway; 4Institute of Clinical Medicine, University of Oslo, Oslo, Norway; 5Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway 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 homedwelling 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 Introduction Correspondence: Gro Næss Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of SoutheasternNorway, PO Box 4, Kongsberg, Norway Tel +47 4 775 2986 Email The oldest home-dwelling older people often live with frailty, multimorbidity, and polypharmacy. They are therefore at risk of experiencing functional decline and worsening of symptoms and are at increased risk of adverse drug reactions.1,2 The complexity of older persons’ health situation requires more coordinated health care across health care levels and a better structured follow-up than is currently being submit your manuscript | www.dovepress.com Journal of Multidisciplinary Healthcare 2019:12 675–690 DovePress © 2019 Næss et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://doi.org/10.2147/JMDH.S212283 Powered by TCPDF (www.tcpdf.org) 675 Dovepress Journal of Multidisciplinary Healthcare downloaded from https://www.dovepress.com/ by 180.31.230.217 on 07-Jun-2020 For personal use only. Næss et al offered, especially in the transitional phase between hospital discharge and primary care, but also in more stable phases at home.3–7 General practitioners (GPs) are responsible for drug prescription and follow-up of prescribed medications. However, the frail older people visit their GPs less frequently than younger patients,7 with the consequence that such follow-up is left with the home care services. Several studies have shown that home care services frequently fail to discover health care needs and subtle changes in the health state of frail older people.8,9 Contributing factors might be the frequent changes in caregivers occurring within primary care10 and lack of adequate knowledge about geriatric nursing care.8,11,12 Structured follow-up and adequate documentation are necessary when caring for frail patients.13 Unfortunately, there is limited knowledge about which factors impact on structured assessment and follow-up of older people with multimorbidity and frailty by registered nurses (RNs) working in home care services. A list system ensures all Norwegian inhabitants their own GP. The GPs have a contract with their municipality, and most practices are organized as independent enterprises with a combination of public funding and fees for services. The GP is responsible for the overall medical treatment. The RNs working in home health care have the responsibility for updating information, such as the drug regime, in the patient’s home care journal. They also have the responsibility for observing how the patient responds to medications, observing any changes in the patient’s health condition, and reporting to the GP when necessary. RNs responsible for health care for this group of patients need to identify and document functional decline. Functional decline in the older people might be caused by interactions between aging and disease, interactions between diseases, or synergies between medical management of different diseases and aging. Such advanced geriatric health care might be difficult to achieve in primary care because the focus might be on covering primary needs such as personal hygiene, serving food, and delivery of medication rather than identifying early signs of further functional decline.14 Multimorbidity with comprehensive symptom burdens, advanced medical trea (...truncated)