Development of a Proactive Care Program (U-CARE) to Preserve Physical Functioning of Frail Older People in Primary Care

Purpose: Care for older patients in primary care is currently reactive, fragmented, and time consuming. An innovative structured and proactive primary care program (U-CARE) has been developed to preserve physical functioning and enhance quality of life of frail older people. This study describes in detail the development process of the U-CARE program to allow its replication. Methods: The framework of the Medical Research Council (MRC) for the development and evaluation of complex interventions was used as a theoretical guide for the design of the U-CARE program. An extended stepwise multimethod procedure was used to develop U-CARE. A team of researchers, general practitioners, registered practice nurses, experts, and an independent panel of older persons was involved in the development process to increase its feasibility in clinical practice. A systematic review of the literature and of relevant guidelines, combined with clinical practice experience and expert opinion, was used for the development of the intervention. Findings: Based on predefined potentially effective guiding components, the U-CARE program comprises three steps: a frailty assessment, a comprehensive geriatric assessment at home followed by a tailor-made care plan, and multiple follow-up visits. Evidence-based care plans were developed for 11 geriatric conditions. The feasibility in clinical practice was tested and approved by experienced registered practice nurses. Conclusions: Using the MRC Framework, a detailed description of the development process of the innovative U-CARE program is provided, which is often missing in reports of complex intervention trials. Based on our feasibility-pilot study, the general practitioners and the registered practice nurses indicated that the U-CARE intervention is feasible in clinical practice. Clinical Relevances: The U-CARE program consists of promising components and has the potential to improve the care of older patients.