Background
Methods
Participants
Intervention: the Health and Welfare Information Portal
Implementation of the Health and Welfare Information Portal
Frail older people and informal caregivers | Professionals | Employing organizations | |
---|---|---|---|
Recruitment strategies | Involvement in development | Involvement in development | Financial compensation |
Flyers about the program | Flyers about the program | Educational program for employees | |
Involvement of GP who asked for participation in screening | Starting with intrinsically motivated early adopters by inviting general practices affiliated with the university hospital to participate | ||
Involvement of informal caregiver | |||
Supporting strategies | Visit by a volunteer who instructs them in the use of the ZWIP | Interprofessional educational program (Continuing Medical Education credits available) | |
Internet and paper version of ZWIP | E-learning | ||
Telephonic helpdesk | Coaching of professionals conducting the screening | ||
Telephonic helpdesk | |||
Newsletter | |||
Tailoring of intervention to meet local circumstances | |||
Deviations from inclusion criteria, such as including younger frail older people, allowed to gain experience | |||
Financial compensation | |||
Incentives such as the general practice receiving a cake after including the first frail older person |
Quantitative evaluation
Qualitative evaluation
Analysis
Results
Participants
General practice 1 | General practice 2 | General practice 3 | General practice 4 | General practice 5 | General practice 6 | General practice 7 | |
---|---|---|---|---|---|---|---|
Patients ≥ 70 years, % | 11.1 | 9.4 | 3.0 | 9.9 | 7.5 | 5.7 | 7.3 |
Setting | Village | Village | City | City | Village | City | City |
Collaboration in MTM and PTAMs | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
Use of e-consulting | No | No | Yes | No | Yes | No | No |
Start of implementation | September 2010 | September 2010 | October 2010 | November 2010 | December 2010 | November 2010 | January 2011 |
Professionals filling out the questionnaire, n | |||||||
General Practitioners (n = 34) | 3 | 3 | 7 | 6 | 4 | 8 | 3 |
Professionals conducting screening (n = 22) | 2 | 2 | 5 | 5 | 2 | 3 | 3 |
Other professionals (n = 62)a
| 13 | 8 | 4 | 8 | 6 | 9 | 7 |
Outcomes of the implementation process
End of implementation: 1 July, 2011 | General practice 1 | General practice 2 | General practice 3 | General practice 4 | General practice 5 | General practice 6 | General practice 7 | Total |
---|---|---|---|---|---|---|---|---|
Number of older people screened, n | 705 | 365 | 284 | 426 | 200 | 621 | 169 | 2770 |
Number of older people screened who were frail, n (%) | 71 (10.1) | 80 (21.9) | 49 (17.3) | 116 (27.2) | 25 (12.5) | 213 (34.3) | 43 (25.4) | 597 (21.6) |
Number of frail older people participating in the ZWIP, n (%) | 61 (85.9) | 25 (31.3) | 11 (22.4) | 55 (47.4) | 8 (32.0) | 118 (55.4) | 12 (27.9) | 290 (48.6) |
Female, n (%) | 34 (55.7) | 15 (60.0) | 4 (36.8) | 40 (72.7) | 6 (75.0) | 73 (61.9) | 10 (83.3) | 182 (62.8) |
Age, mean (SD) | 81.8 (5.4) | 81.6 (4.8) | 79.2 (5.8) | 80.2 (6.2) | 82.5 (7.5) | 81.1 (5.6) | 82.8 (7.5) | 81.2 (5.7) |
Number of frail older people in the ZWIP who logged on to the ZWIP once, n (%) | 9 (14.8) | 2 (8.0) | 2 (18.2) | 8 (14.5) | 3 (37.5) | 18 (15.3) | 1 (8.3) | 43 (14.8) |
Number of frail older people in the ZWIP who logged on to the ZWIP more than once, n (%) | 25 (41.0) | 17 (68.0) | 5 (45.5) | 23 (41.8) | 5 (62.5) | 36 (30.5) | 6 (50.0) | 117 (40.3) |
Number of professionals participating in the ZWIP, n | 31 | 17 | 25 | 43 | 16 | 30 | 16 | 169f
|
Female, n (%) | 21 (67.7) | 12 (70.6) | 18 (72.0) | 33 (76.7) | 12 (75.0) | 23 (76.7) | 13 (81.3) | 126 (74.6) |
Occupation, n (%) | ||||||||
General practitioner | 6 (19.4) | 4 (23.5) | 9 (36.0) | 8 (18.6) | 5 (31.3) | 9 (30.0) | 3 (18.8) | 42 (24.9) |
Practice nurse | 0 (0.0) | 1 (5.9) | 1 (4.0) | 1 (2.3) | 1 (6.3) | 6 (20.0) | 1 (6.3) | 13 (7.7) |
District nurse | 7 (22.6) | 1 (5.9) | 3 (12.0) | 8 (18.6) | 2 (12.5) | 0 (0.0) | 4 (25.0) | 24 (14.2) |
Pharmacist | 1 (3.2) | 1 (5.9) | 2 (8.0) | 6 (14.0) | 2 (12.5) | 1 (3.3) | 3 (18.8) | 15 (8.9) |
Physiotherapist | 7 (22.6) | 4 (23.5) | 3 (12.0) | 6 (14.0) | 3 (18.8) | 5 (16.7) | 2 (12.5) | 30 (17.8) |
(Gerontological) social worker | 1 (3.2) | 2 (11.8) | 3 (12.0) | 2 (4.7) | 0 (0.0) | 1 (3.3) | 1 (6.3) | 9 (5.3) |
Hospital-based specialist | 1 (3.2) | 0 (0.0) | 1 (4.0) | 2 (4.7) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 3 (1.8) |
Other | 8 (25.8) | 4 (23.5) | 3 (12.0) | 10 (43.3) | 3 (18.8) | 8 (26.7) | 2 (12.5) | 33 (19.5) |
Number of professionals in the ZWIP of a frail older person, mean (range) | 2.5 (0–5)a
| 4.1 (0–8)b
| 1.9 (0–4) | 1.8 (0–5) | 4.1 (2–6) | 2.6 (1–6)d
| 3.0 (1–5) | 2.6 (0–8)g
|
Number of professionals in the ZWIP who logged on to the ZWIP once, n (%) | 2 (6.5) | 1 (5.9) | 2 (8.0) | 7 (16.7)c
| 2 (12.5) | 3 (10.3)e
| 8 (50.0) | 25 (15.0)h
|
Number of professionals in the ZWIP who logged on to the ZWIP more than once, n (%) | 22 (71.0) | 14 (82.4) | 20 (80.0) | 26 (61.9)c
| 11 (68.8) | 23 (79.3)e
| 6 (37.5) | 116 (69.5)h
|
Number of messages sent in the ZWIP by professionals, mean (range) | 3.6 (0–24) | 5.7 (0–46) | 0.3 (0–5) | 1.3 (0–17)c
| 0.3 (0–3) | 0.9 (0–6)e
| 0.7 (0–9) | 1.9 (0–46)h
|
Number of messages sent in the ZWIP by frail older people and informal caregivers, mean (range) | 1.2 (0–21) | 3.2 (0–31) | 0.6 (0–2) | 0.9 (0–34) | 0.1 (0–1) | 0.1 (0–4) | 0.2 (0–1) | 0.8 (0–34) |
Number of frail older people in whose ZWIP ≥ 5 messages have been sent, n (%) | 7 (11.5) | 8 (32.0) | 2 (18.2) | 3 (5.5) | 0 (0.0) | 1 (0.8) | 0 (0.0) | 21 (7.2) |
Outcomes of the implementation process | “I have one patient who actually ended up with a ZWIP…and I never hear anything from him” General practitioner1 |
“But I think that everyone who participates in the ZWIP here in the municipality…they have asked me to become involved in their network….so it’s tens of people” Other professional1 | |
“Whereas this week I saw, with another man here in X, he communicates [over the ZWIP] with the general practitioner by himself” Professional conducting the screening1 | |
Appreciation of the implementation strategies | “But those other disciplines, you never or rarely talk to them, and in those three [educational] meetings that we had here it was very interesting to see that, yes, what everyone does, yes, what the added value is of everyone…so you put people in primary care, also due to this project, around the table” Other professional1 |
“Yes, it [the educational program] helped, but then it was too lengthy to send all eight general practitioners there” General practitioner2 | |
“Yes, I really felt [coaching] was very important, for example, starting up a ZWIP account for the first time…just to accompany her one time and to see, and how it is done, yes, that just works better than a paper manual” Professional conducting the screening1 | |
Barriers and facilitators to the ZWIP | “Or older people that say like, yes, I need to call the general practitioner so often, and that is so difficult because he is so difficult to reach, because then I need to tell him my blood sugar for example, and then I have to be on hold and then I finally have the medical assistant, and then there’s an emergency call and I have to wait again. And now I can just type it through a secure system, and then I’m done” Implementation team1 |
“I thought it was really good, you [the implementation team] just gave a lot of time and attention, and were very easy to contact and yes, that was very nice, and everyone was really enthusiastic” General practitioner3 | |
“But the advantage of the ZWIP is of course that it’s a secure network, but that you can choose your own time for responding” Other professional1 | |
“Yes, I think the application is quite easy to work with” Professional conducting the screening1 | |
“And in that way I keep thinking like, well, that study has actually come ten years too early… with a generation that’s not, that didn’t grow up with computers, I think that’s a pity” General practitioner1 | |
“And also, last year it was of course also that issue around the, er, National Electronic Health Record, that made people think like, yes, is everything really that reliable….” Professional conducting the screening2 | |
“Or the security token didn’t work or they had the wrong token or you know, those actually small things but those were really annoying for the general practitioners” Implementation team1 | |
“For in these kind of projects, and there’s no way to do it differently, you have parallel development lines, you have simultaneously the trajectories of the educational program that’s being developed, that should start, the information technology, but at a certain time the information technology is not just as ready, and then the information technology is, but the goals or the patient education materials aren’t ready yet. So, and that’s because we were under a lot of pressure with the time…” Implementation team2 | |
“And then I’m quite a bad one to persuade people [to participate]. Probably because I’m not one-hundred percent convinced myself” Professional conducting the screening3 | |
Recommendations for future implementation of the ZWIP | “You can use it for every disease or every target population…and indeed, also with dementia, in palliative phases of patients when patients are still active themselves…” Implementation team1 |
“Yes, those [non-frail older people] who don’t, those who are still quite vital, who do have that age. They would…those are people who are much quicker eh, could work with it before they, before they really…and I think they might be able to benefit from it” Professional conducting the screening1 | |
“You could stimulate its use in small groups…for once I was in a community centre…then, we just sat with X and some older people, and then really around a round table, just re-enacting it. And then you see that people understand it much quicker and can also see that you are actually communicating” Implementation team3 | |
“I think that a lot of registration systems that those people have, eh, we have a different kind of registration system and the ZWIP is another, I think that many things can be linked to each other” Professional conducting the screening2 |
Factors contributing to the implementation outcomes
Exposure to the implementation strategies
General practice 1 | General practice 2 | General practice 3 | General practice 4 | General practice 5 | General practice 6 | General practice 7 | Total | |
---|---|---|---|---|---|---|---|---|
Exposure of professionals
| n = 17 | n = 13 | n = 16 | n = 18 | n = 12 | n = 20 | n = 12 | n = 115n
|
Involvement of professionals in development | ||||||||
Aware of involvement, yes, n (%) | 15 (88.2) | 10 (76.9) | 10 (71.4)e
| 16 (88.9) | 8 (66.7) | 12 (60.0) | 9 (75.0) | 84 (75.0)o
|
Involved, yes, n (%) | 3 (17.6) | 3 (23.1) | 3 (20.0)f
| 3 (16.7) | 0 (0.0)a
| 1 (5.0) | 1 (8.3) | 15 (13.4)o
|
Flyers | ||||||||
Received, yes, n (%) | 11 (64.7) | 6 (46.2) | 9 (60.0)f
| 14 (77.8) | 8 (66.7) | 9 (47.4)k
| 5 (41.7) | 63 (56.3)o
|
Read, yes, n (%) | 11 (100.0)a
| 6 (100.0)c
| 9 (100.0)g
| 10 (76.9)h
| 8 (100.0)j
| 9 (100.0)g
| 5 (100.0)m
| 59 (95.2)p
|
Educational program | ||||||||
Participated, yes, n (%) | 13 (76.5) | 12 (92.3) | 9 (60.0)f
| 14 (77.8) | 11 (91.7) | 19 (95.0) | 12 (100.0) | 90 (79.6)q
|
Coaching for professionals conducting screening | ||||||||
Received, yes, n (%) | 8 (47.1) | 5 (38.5) | 11 (68.8) | 10 (55.6) | 3 (25.0) | 12 (60.0) | 4 (33.3) | 54 (47.0) |
Telephonic helpdesk | ||||||||
Contacted, yes, n (%) | 11 (64.7) | 5 (38.5) | 9 (56.3) | 11 (61.1) | 3 (25.0) | 9 (45.0) | 3 (25.0) | 53 (46.1) |
Newsletter | ||||||||
Received, yes, n (%) | 10 (58.8) | 13 (100.0) | 11 (68.8) | 12 (66.7) | 7 (63.6)a
| 13 (72.2)l
| 7 (58.3) | 74 (66.1)o
|
Financial compensation | ||||||||
Aware of receiving it when applicable, yes, n (%) | 12 (75.0)b
| 12 (100.0)d
| 8 (61.5)h
| 12 (70.6)i
| 9 (75.0) | 11 (68.8)b
| 12 (100.0) | 77 (73.3)r
|
Exposure of frail older people and informal caregivers
| n = 61 | n = 25 | n = 11 | n = 55 | n = 8 | n = 118 | n = 12 | n = 290 |
Visit or call by a volunteer who explains the ZWIP | ||||||||
Number of older people or informal caregivers visited by volunteer, n | 5 | 8 | 1 | 1 | 2 | 28 | 1 | 62s
|
Telephonic helpdesk | ||||||||
Number of contacts of helpdesk with frail older people or informal caregivers, n | 16 | 8 | 1 | 9 | 2 | 12 | 3 | 54t
|
Appreciation of the implementation strategies
Implementation strategy | n = 115a
|
---|---|
Involvement of professionals in development | |
Involvement of GPs/professionals important; yes, n (%) | 95 (86.4)b
|
Flyers | |
Flyers important for deciding about participation, yes, n (%) | 35 (59.3)c
|
Estimated relevance to future users on a scale of 1–10, mean (SD) | 6.8 (1.6)d
|
Educational program | |
Necessary for being able to work with ZWIP; yes, n (%) | 63 (70.8)e
|
Estimated relevance to future users on a scale of 1–10, mean (SD) | 7.5 (1.6)f
|
Coaching | |
Able to work with ZWIP without coaching; no, n (%) | 14 (26.4)g
|
Estimated relevance to future users on a scale of 1–10, mean (SD) | 6.9 (1.7)h
|
E-coaching | |
Necessary for being able to work with ZWIP; yes, n (%) | 8 (38.1)i
|
Estimated relevance to future users on a scale of 1–10, mean (SD) | 6.7 (1.6)j
|
Telephonic helpdesk | |
Necessary for being able to work with ZWIP; yes, n (%) | 41 (77.4)g
|
Estimated relevance to future users on a scale of 1–10, mean (SD) | 7.3 (1.6)f
|
Newsletter | |
Newsletter important for staying up-to-date about the program; yes, n (%) | 35 (46.7)k
|
Estimated relevance to future users on a scale of 1–10, mean (SD) | 5.9 (1.5)d
|
Financial compensation | |
Financial compensation necessary for future professionals; yes, n (%) | 27 (56.3)l
|
Estimated relevance to future users on a scale of 1–10, mean (SD) | 6.7 (2.0)h
|
Possibility to adapt the ZWIP to meet local circumstances | |
Estimated relevance to future users on a scale of 1–10, mean (SD) | 8.0 (1.4)f
|
Barriers and facilitators
n = 105 | Disagree, n (%) | Neutral, n (%) | Agree, n (%) |
---|---|---|---|
The data included in the ZWIP are sufficiently safeguarded | 2 (2.0)a
| 48 (49.0)a
| 48 (49.0)a
|
The data included in the ZWIP are accurate | 5 (5.1)b
| 45 (45.5)b
| 49 (49.5)b
|
The data included in the ZWIP are not up-to-date | 32 (32.3)b
| 54 (54.5)b
| 13 (13.1)b
|
The data included in the ZWIP provide me insufficient information | 30 (30.3)b
| 51 (51.5)b
| 18 (18.2)b
|
The data included in the ZWIP are way too extensive | 38 (38.0)c
| 61 (61.0)c
| 1 (1.0)c
|
I feel that the ZWIP is very user-friendly | 11 (11.1)b
| 42 (42.4)b
| 46 (46.5)b
|
I feel that working with computers is uncomfortable | 81 (81.8)b
| 11 (11.1)b
| 7 (7.1)b
|
I feel that the instruction during the educational program was sufficient to be able to work with the ZWIP | 6 (6.3)d
| 17 (17.7)d
| 73 (76.0)d
|
Working with the ZWIP is too complicated | 45 (46.9)d
| 38 (39.6)d
| 13 (13.5)d
|
Working with the ZWIP ultimately saved me time | 46 (48.9)e
| 42 (44.7)e
| 6 (6.4)e
|
I feel that the ZWIP does not fit into my regular working pattern | 68 (68.7)b
| 20 (20.2)b
| 11 (11.1)b
|
Working with the ZWIP gives me the enough leeway to incorporate the goals of the frail older person in decisions about his/her care | 10 (10.9)f
| 41 (44.6)f
| 41 (44.6)f
|
Working with the ZWIP is difficult since other professionals involved do not use the ZWIP much | 8 (8.5)e
| 36 (38.5)e
| 50 (52.1)e
|
Working with the ZWIP is difficult since the frail older person and informal caregiver do not use the ZWIP much | 7 (7.4)e
| 31 (33.0)e
| 56 (59.6)e
|