PhD defence L. (Lotte) Vestjens

Integrated care is advocated to improve the quality of care and patient outcomes of frail older persons who live independently at home. This thesis reports on a theory-guided evaluation of a proactive, integrated primary care approach for community-dwelling frail older persons in the Dutch primary care setting; the Finding and Follow-up of Frail older persons (FFF) approach. This thesis research indicated that the FFF approach to the provision of integrated primary care to community-dwelling frail older persons holds promise for the improvement of care quality, a prominent goal of this approach. FFF implementation did not, however, impact well-being over the 1-year follow-up period, as expected. The added value of integrated care in terms of frail older persons’ well-being has not been demonstrated, which adds to the inconclusive body of evidence regarding the (cost-)effectiveness of these programs in the primary care setting. The use of a sound theoretical framework to evaluate (the complexities of) integrated primary care is key; it enables the construction of a cumulative understanding of underlying mechanisms, beyond the presence of the program’s components. Cognitions and behaviors of healthcare professionals and frail older persons are considered to be core mechanisms driving the (lack of) effects of integrated care. Populational aging and the implementation of policy reforms that promote aging in place necessitate a deeper understanding of the mechanisms underlying integrated primary care and facilitate sound evaluation of these complex programs in real-life settings.

Due to corona, the PhD defences do not take place publicly in the usual way in the Senate Hall of the Professor Andries Querido Room. The candidates will defend their dissertation either in a small group or online.