Journal of Multidisciplinary Healthcare (Aug 2019)
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
Gro Næss,1–3 Torgeir Bruun Wyller,1,4,5 Marit Kirkevold1,31Charm 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 South- Eastern Norway, Kongsberg, Norway; 3Department 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, NorwayCorrespondence: Gro NæssDepartment of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of Southeastern-Norway, PO Box 4, Kongsberg, NorwayTel +47 4 775 2986Email [email protected]: 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
