An overview of the most recent projects evaluated by the Socio-Medical Sciences research group is provided below.
An important condition for independent living is having a well-functioning social network to provide support. An Integrated Neighbourhood Approach (INA) creates a supportive environment for the frail older people, offering them tailored care in their local context that allows them to improve self-management abilities and well-being. The point of departure of INA is reinforcing networks between welfare, health care, informal care and community members in neighbourhoods, optimizing current services, and involving the (frail) older people. Such a demand driven approach offers older people tailored care -including care-related services such as housing - in their local context to enhance self-management abilities and well-being. The focus is on “de-medicalization” and recognition of mutual dependence between welfare, health care, and informal care. Thus, for INA to be successful the partners in primary, secondary, and tertiary care as well as informal networks need to work well together - from signalling problems to prevention, cure, care, promotion of welfare, and independent living. Early recognition of complaints and encouraging effective self-management may positively influence well-being. It requires the older people to ‘star’ in the ‘production’ of their own well-being as a form of empowerment. Informal caregivers play a central role in their social networks and are important to supporting independent living. Evidence suggests that caring for a frail older people person is an arduous task that may cause financial difficulties, emotional strain, or physical problems. A supportive network for older people may alleviate such negative aspects of caregiving, which in turn helps sustain informal caregivers’ support.
While INA may improve outcomes, evidence regarding the (cost-) effectiveness of such programmes is lacking. The purpose of our research is to investigate how an INA can contribute to outcomes of the frail older people and its cost-effectiveness. The first central study question is: To what extent does INA contribute to (a) continuous, demand-driven, coordinated care and support for the independently- living frail older people and the well-being of their informal caregivers; (b) improvement of their well-being and self-management abilities; and (c) reinforcement of their neighbourhood networks. The second central research question is: is the INA a cost-effective method to support the frail, independently- living older people?
Disease management programmes have emerged to level off the rising trend in chronic diseases, and to postpone or even prevent complications and co-morbidities and most of all increase the quality of life of chronic patients. Although evidence on the effectiveness of disease management is in part available, many questions still remain. Therefore, ZonMw has developed a programme aimed at the development of regional disease-management experiments and enhancement of knowledge on disease-management in chronic disease care. In order to assess what kinds of interventions are best suited for improvement of quality of care the black box of disease-management programmes needs to be opened. Evaluation studies that focus on outcomes, process, cost and the interrelation of these three are needed.
The aim of this study is to evaluate a range of current disease-management projects by capturing them in a common conceptual framework and by using similar structure, process and outcome measures. This strategy will enable sound comparison of the results of the different projects. The study will lead to both a better understanding of the mechanisms of disease management (components) and will add to our knowledge about the feasibility and cost-effectiveness of a disease-management approach to improve health care. The guiding research questions are as follows:
- Can we develop and apply a common framework to describe and compare the components of each disease management programme and each patient population?
- What are the effects of disease management interventions on the primary outcomes at the patient, professional and organisational level?
- What interventions are actually performed within the context of the ‘disease management in chronic diseases’ programme?
- What are the total costs (including implementation costs and all downstream healthcare costs) associated with the interventions and how are they financed and reimbursed?
- How do these costs relate to the effects described under (2)?
- What are crucial success and failure factors that influence the effect of disease-management interventions, and how is this spread to other settings?
The number of older people is rising rapidly; even more so among immigrants. Most immigrants live in large cities, with Turks, Surinamese, and Moroccans comprising the largest groups in the Netherlands. Poor health, chronic diseases, and functional limitations are much more prevalent among these immigrant populations than among natives. Health behaviours, such as smoking, eating habits, and physical activity, play a crucial role in these health problems and differ between immigrants and natives. For example, in the Netherlands, the prevalence of overweight is much higher among immigrants and the prevalence of smoking is especially high among Turks. These differences in health and health behaviour can be attributed only partly to differences in socio-economic status.
Sociocultural differences make it especially difficult for healthcare organisations to reach older immigrants effectively. Immigrant-sensitive healthcare interventions are needed, requiring insight into underlying sociocultural mechanisms explaining differences in health and health behaviour between older natives and immigrants. These insights will likely have important implications for preventive and curative healthcare delivery. Another sociocultural mechanism that may explain health differences between older Dutch natives and immigrant community-dwellers is the perception of ageing among older immigrants (e.g. beliefs about the health impacts of ageing, personal management of one's ageing experience). Perceptions of ageing are known to affect health and health behaviour and are expected to vary among cultures.
Inadequate understanding of the role of sociocultural mechanisms in health and health behaviour compromises the design and implementation of effective healthcare delivery and health promotion strategies for older immigrants. To improve (preventive) healthcare delivery quality and effectiveness for older immigrants, and to deliver care tailored to their needs, research on the sociocultural mechanisms leading to their poorer health and health behaviours is needed. Thus, this study aims to:
- Validate instruments assessing perceptions of ageing and social influence on health behaviours among older Dutch natives and immigrants (Turks, Surinamese, and Moroccans).
- Identify differences in perceptions of ageing between older Dutch natives and immigrants.
- Identify differences in the influence of the social environment on health behaviour between older Dutch natives and immigrants.
- Identify differences in health and health behaviours between older Dutch natives and immigrants.
- Identify and compare the relationships between the influences of the social environment and perceptions of ageing on health and health behaviours between older Dutch natives and immigrants over time.
The primary care approach Finding and Follow-up of the Frail (FFF) aims to target frail community-living older persons. The main objectives of the FFF approach are: (1) the early case finding of independently-living frail older people, (2) the establishment of an integrated primary care system for these older persons (consisting of collaboration among professionals with different occupational backgrounds led by a GP), (3) preventing (repeated) hospital and nursing home admissions, and (4) enhancement of quality of life, self-management abilities, and support systems for older persons. The multidisciplinary setting enables the development of the role of the elderly care physician and geriatric nurse within the primary care setting, a new approach in the Netherlands. The FFF approach combines successful features of integrated care, case management, and patient-centred care.
With this evaluation we aim to investigate:
- the effectiveness of the FFF approach regarding health-related quality of life (primary outcome) and several secondary outcomes in a primary care setting;
- the implementation, receipt, and setting of the FFF approach in order to facilitate the interpretation of the results;
- the cost-effectiveness of the primary care approach.