Consensus on Integrated Care for Older People Among Dutch Experts: A Delphi Study

Abstract

Introduction: In a previous rapid realist review (RRR), an initial programme theory (PT) was established giving insight into the interrelatedness of context items, mechanisms, programme-activities, and outcomes that influence integrated care programmes (ICPs) for community-dwelling frail older people. As ICPs need to be tailored to their local setting, the objective of this study is to assess consensus on the relevance of the items identified in the RRR for the Dutch setting, and refine the PT, where appropriate. Methods: A two-round e-Delphi study was carried out among Dutch experts to determine the relevance of 71 items. Results: Consensus on relevance was reached on 57 out of 71 items (80%). Items added to refine the PT included: increasing number of older people, decreasing access to hospital beds, well-designed ICP implementation processes, case management, having a clear portfolio of patients, the role of the government, aligning existing health and social care systems, management and monitoring of care activities, strong relationship between older person and healthcare providers (HCP), and providing continuous feedback to HCPs. Conclusion and discussion: The initial PT was refined for the Dutch setting. Items on which no consensus was found, need to be further investigated on the reason behind it.

Keywords

• integrated care
• older people
• delphi
• realist research