Methodological challenges of complex proactive primary care programs for older people

Methodological challenges of complex proactive primary care programs for older people

The clinical practice is continuously changing as a result of an ageing population and the increase of multimorbidity and frailty. Preventive integrated care programs are increasingly promoted as the leading concept to enable older people to live independently at home. Nevertheless, it appears that these complex interventions fail to demonstrate a beneficial improvement in the care for older people and the question arises whether this is due to an inadequate design or implementation of the intervention. This dissertations focus on the impact of context in which complex proactive primary care programs are developed, evaluated and implemented from the perspectives of three levels; individual, team and organizational level. On the individual level, we conclude that training of professionals is crucial in developing and sustaining complex primary care programs. On team level, team networks can provide useful information regarding the characteristics of each professional, their social relationships and how the team works or collaborates, which can tailor the efforts in implementing an innovation. On the organizational level, researchers should be aware of the difficulties in addressing context and the possibility that adaptations in a complex care innovation are made by organisations themselves based on organizational constraints without considering the potential impact on patient outcomes. Future intervention research should incorporate contextual factors as intermediate outcomes and emphasize on training professionals. Different methodological approaches in intervention research, considering the impact of context will help reduce research waste and realize effective proactive primary care programs for older people.