Unravelling complex primary-care programs to maintain independent living in older people: a systematic overview

Linda C. Smit*, Marieke J. Schuurmans, Jeanet W. Blom, Isabelle N. Fabbricotti, Aaltje P. D. Jansen, Gertrudis I. J. M. Kempen, Raymond Koopmans, Willemijn M. Looman, Rene J. F. Melis, Silke F. Metzelthin, Eric P. Moll Van Charante, Maaike E. Muntinga, Franca G. H. Ruikes, Sophie L. W. Spoorenberg, Jacqueline J. Suijker, Klaske Wynia, Jacobijn Gussekloo, Niek J. De Wit, Nienke Bleijenberg

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

16 Citations (Web of Science)

Abstract

Objectives: Complex interventions are criticized for being a "black box", which makes it difficult to determine why they succeed or fail. Recently, nine proactive primary-care programs aiming to prevent functional decline in older adults showed inconclusive effects. The aim of this study was to systematically unravel, compare, and synthesize the development and evaluation of nine primary-care programs within a controlled trial to further improve the development and evaluation of complex interventions. Study Design and Setting: A systematic overview of all written data on the nine proactive primary-care programs was conducted using a validated item list. The nine proactive primary-care programs involved 214 general practices throughout the Netherlands. Results: There was little or no focus on the (1) context surrounding the care program, (2) modeling of processes and outcomes, (3) intervention fidelity and adaptation, and (4) content and evaluation of training for interventionists. Conclusions: An in-depth analysis of the context, modeling of the processes and outcomes, measurement and reporting of intervention fidelity, and implementation of effective training for interventionists is needed to enhance the development and replication of future complex interventions. (C) 2018 The Authors. Published by Elsevier Inc.
Original languageEnglish
Pages (from-to)110-119
Number of pages10
JournalJournal of Clinical Epidemiology
Volume96
DOIs
Publication statusPublished - 1 Apr 2018

Keywords

  • Complex interventions
  • Primary-care programs
  • Improvement
  • Development
  • Evaluation
  • Systematic overview
  • RANDOMIZED CONTROLLED-TRIAL
  • HEALTH-SERVICES RESEARCH
  • INTEGRATED CARE
  • BEHAVIOR-CHANGE
  • IMPROVE HEALTH
  • TREATMENT FIDELITY
  • CONSORT EXTENSION
  • GENERAL-PRACTICE
  • INTERVENTIONS
  • FRAIL

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