Nurse-led implementation of the single assessment process in primary care: a descriptive feasibility study

Objective: to determine the resources required to carry out the single assessment process in primary care. Design: prospective descriptive study. Setting: one urban primary care practice, Southampton. Participants: nine hundred and forty-four people aged 70+ years, registered with the practice, not living in a residential/ nursing home, or terminally ill. Intervention: participants were sent the six-item Sherbrooke questionnaire (case-finding tool). Non-responders were remailed after 4 weeks. All those scoring 4, 5 or 6 and a randomly selected half of those scoring 2 or 3 were offered overview assessment and comprehensive assessment as indicated by the Minimum Data Set for Home Care protocol. The nurse assessor identified unmet needs and agreed an action plan with participants. Another researcher conducted semi-structured interviews with a purposive sample of 26 participants to elicit their views of the process. Main outcome measures: response rates/ scores of Sherbrooke questionnaire; numbers/ characteristics of people requiring overview and comprehensive assessments; nature of resulting recommendations/ referrals and impact on other agencies; resources required; views of service users. Results: eight hundred and sixty-three ( 91%) participants replied. Five hundred and seven ( 54%) scored 2+, triggering an overview assessment, which was offered to 307. One hundred and twenty- four participants ( 40%) accepted; 64 ( 52%) had unmet needs ( median 8 each, range 2 - 18), resulting in 34 referrals within the practice including four case conferences, and 21 to community/ secondary health services. Few participants with a Sherbrooke score of 2 required comprehensive assessment. Users perceived the process as acceptable and useful, but not always relevant to their current needs. Conclusion: targeting those scoring 3+ on the Sherbrooke questionnaire ( 28% of sample) may improve the identification of patients who would benefit from further assessment. A contact approach rather than a case- finding one may improve the relevance of this process to older people.