Proactive and integrated primary care for frail older people: design and methodological challenges of the Utrecht primary care PROactive frailty intervention trial (U-PROFIT).
Proactive and integrated primary care for frail older people: design and methodological challenges of the Utrecht primary care PROactive frailty intervention trial (U-PROFIT).
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DOI：
10.1186/1471-2318-12-16
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发表时间：
2012-04-25
期刊：
影响因子：
4.1
通讯作者：
de Wit NJ
中科院分区：
文献类型：
--
作者：
Bleijenberg N;Drubbel I;Ten Dam VH;Numans ME;Schuurmans MJ;de Wit NJ
目前，针对体弱老年人的初级保健是被动的、耗时的，而且不能满足患者的需求。需要向主动和综合护理过渡，以便保持日常功能和良好的生活质量。为了实现这些目标，研究人员开发了两种干预措施，以加强对普通实践中虚弱的老年患者的护理：使用常规医疗保健数据的筛查和监测干预（U-PRIM）和护士主导的多学科干预计划（U-CARE）。U-PROFIT试验旨在评估这些干预措施的有效性。本文的目的是描述U-PROFIT试验设计，并讨论方法学问题和挑战。U-PRIM和U-CARE的有效性正在荷兰的58家全科诊所进行三组随机试验，预计将有大约5000名老年人参加。主要结果是对日常生活活动的影响，用Katz ADL指数来衡量。次要结局是生活质量、死亡率、疗养院入院、急诊科和非工作时间全科医生（GP）、手术就诊和护理人员负担。在日常临床实践中对虚弱的老年患者进行的大型实用试验中，将出现一些挑战和方法问题。患者的招募和保留以及干预措施的可行性是重要的问题。为了使结果具有广泛的普遍性，需要仔细选择设计和结果测量方法。考虑到这一点，U-PROFIT试验旨在为在初级保健中为体弱老年人提供护理的结构化和综合方法提供有力的证据。NTR2288
Currently, primary care for frail older people is reactive, time consuming and does not meet patients' needs. A transition is needed towards proactive and integrated care, so that daily functioning and a good quality of life can be preserved. To work towards these goals, two interventions were developed to enhance the care of frail older patients in general practice: a screening and monitoring intervention using routine healthcare data (U-PRIM) and a nurse-led multidisciplinary intervention program (U-CARE). The U-PROFIT trial was designed to evaluate the effectiveness of these interventions. The aim of this paper is to describe the U-PROFIT trial design and to discuss methodological issues and challenges. The effectiveness of U-PRIM and U-CARE is being tested in a three-armed, cluster randomized trial in 58 general practices in the Netherlands, with approximately 5000 elderly individuals expected to participate. The primary outcome is the effect on activities of daily living as measured with the Katz ADL index. Secondary outcomes are quality of life, mortality, nursing home admission, emergency department and out-of-hours General Practice (GP), surgery visits, and caregiver burden. In a large, pragmatic trial conducted in daily clinical practice with frail older patients, several challenges and methodological issues will occur. Recruitment and retention of patients and feasibility of the interventions are important issues. To enable broad generalizability of results, careful choices of the design and outcome measures are required. Taking this into account, the U-PROFIT trial aims to provide robust evidence for a structured and integrated approach to provide care for frail older people in primary care. NTR2288
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DOI：
10.1016/j.apmr.2006.04.005
发表时间：
2006-07-01
影响因子：
4.3
作者：
Faber, Marjan J.;Bosscher, Ruud J.;van Wieringen, Piet C.
通讯作者：
van Wieringen, Piet C.
影响因子：
4.2
作者：
Hoogerduijn, Jita G.;Schuurmans, Marieke J.;de Rooij, Sophia E.
通讯作者：
de Rooij, Sophia E.
DOI：
10.1111/j.1532-5415.2004.52174.x
发表时间：
2004-04-01
影响因子：
6.3
作者：
Ferrucci, L;Guralnik, JM;Walston, JD
通讯作者：
Walston, JD
DOI：
10.1093/gerona/63.3.321
发表时间：
2008-03-01
影响因子：
5.1
作者：
Boult, Chad;Reider, Lisa;Scharfstein, Daniel
通讯作者：
Scharfstein, Daniel
影响因子：
--
作者：
Boter, H;van Delden, JJM;Rinkel, GJE
通讯作者：
Rinkel, GJE