The results of this thesis shed new light on two important issues for evidence-based general practice care for older people: 1) the feasibility of the (proactive) identification of older people... Show moreThe results of this thesis shed new light on two important issues for evidence-based general practice care for older people: 1) the feasibility of the (proactive) identification of older people with complex problems and 2) the effectiveness of proactive integrated care for older people with complex problems in general practice. We investigated five measures to identify older people with complex problems, i.e. a profile of laboratory measurements, handgrip and quadriceps muscle strength, Fried's frailty phenotype criteria, the clinical intuition of the GP, and the ISCOPE screening questionnaire. These measures each identified a complex group of older people, but none of these measures can be recommended as the most feasible for general practice. In the ISCOPE study, a proactive integrated care plan had no direct effect on functional decline and quality of life of older people with complex problems. This lack of effect might be attributed to the study design or to the intervention itself. Although this effect could not be demonstrated, in our opinion integrated care still remains the best type of care available for this age-group. We believe this is confirmed by the level of satisfaction of both older people and GPs who were included in the intervention group. Show less
This thesis describes the PROMODE-study, which investigated in a pragmatic way whether a pro-active approach in primary care by screening for depressive symptoms, followed by an intervention offer... Show moreThis thesis describes the PROMODE-study, which investigated in a pragmatic way whether a pro-active approach in primary care by screening for depressive symptoms, followed by an intervention offer to persons of 75 years and over who screened positive, is (cost)effective to detect and relieve suffering from depressive symptoms at old age. We compared two screening methods regarding yield and costs. Furthermore, we found that scores of the 15-item Geriatric Depression Scale were higher when this screening questionnaire was self-administered than when interviewer-administered. In our intervention study, a cluster-randomised controlled trial, we found that the stepped-care intervention program was not (cost)effective compared with usual care in general practice, possibly due to a low uptake of the offered course being the main part of the intervention. In a qualitative study we explored the limiting and motivating factors for accepting course participation. This revealed that most persons were not (yet) prepared to accept the unsolicited intervention offer, although perceived needs to relieve depressive symptoms seemed to largely match the elements of the course. It is discussed that a more selective approach, aimed at high risk-groups and focussing on need for and readiness to accept help, might increase efficiency of a combined screening-intervention program. Show less
