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Mabetha K, Soepnel LM, Mabena G, Motlhatlhedi M, Nyati L, Norris SA, Draper CE. Mobile Technology Use in Clinical Research Examining Challenges and Implications for Health Promotion in South Africa: Mixed Methods Study. JMIR Form Res 2024; 8:e48144. [PMID: 38588527 PMCID: PMC11036187 DOI: 10.2196/48144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The use of mobile technologies in fostering health promotion and healthy behaviors is becoming an increasingly common phenomenon in global health programs. Although mobile technologies have been effective in health promotion initiatives and follow-up research in higher-income countries and concerns have been raised within clinical practice and research in low- and middle-income settings, there is a lack of literature that has qualitatively explored the challenges that participants experience in terms of being contactable through mobile technologies. OBJECTIVE This study aims to explore the challenges that participants experience in terms of being contactable through mobile technologies in a trial conducted in Soweto, South Africa. METHODS A convergent parallel mixed methods research design was used. In the quantitative phase, 363 young women in the age cohorts 18 to 28 years were contacted telephonically between August 2019 and January 2022 to have a session delivered to them or to be booked for a session. Call attempts initiated by the study team were restricted to only 1 call attempt, and participants who were reached at the first call attempt were classified as contactable (189/363, 52.1%), whereas those whom the study team failed to contact were classified as hard to reach (174/363, 47.9%). Two outcomes of interest in the quantitative phase were "contactability of the participants" and "participants' mobile number changes," and these outcomes were analyzed at a univariate and bivariate level using descriptive statistics and a 2-way contingency table. In the qualitative phase, a subsample of young women (20 who were part of the trial for ≥12 months) participated in in-depth interviews and were recruited using a convenience sampling method. A reflexive thematic analysis approach was used to analyze the data using MAXQDA software (version 20; VERBI GmbH). RESULTS Of the 363 trial participants, 174 (47.9%) were hard to reach telephonically, whereas approximately 189 (52.1%) were easy to reach telephonically. Most participants (133/243, 54.7%) who were contactable did not change their mobile number. The highest percentage of mobile number changes was observed among participants who were hard to reach, with three-quarters of the participants (12/16, 75%) being reported to have changed their mobile number ≥2 times. Eight themes were generated following the analysis of the transcripts, which provided an in-depth account of the reasons why some participants were hard to reach. These included mobile technical issues, coverage issues, lack of ownership of personal cell phones, and unregistered number. CONCLUSIONS Remote data collection remains an important tool in public health research. It could, thus, serve as a hugely beneficial mechanism in connecting with participants while actively leveraging the established relationships with participants or community-based organizations to deliver health promotion and practice.
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Affiliation(s)
- Khuthala Mabetha
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Larske M Soepnel
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Gugulethu Mabena
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Molebogeng Motlhatlhedi
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Lukhanyo Nyati
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, United Kingdom
| | - Catherine E Draper
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Bressman E, Long JA, Burke RE, Ahn A, Honig K, Zee J, McGlaughlin N, Balachandran M, Asch DA, Morgan AU. Automated Text Message-Based Program and Use of Acute Health Care Resources After Hospital Discharge: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e243701. [PMID: 38564221 PMCID: PMC10988348 DOI: 10.1001/jamanetworkopen.2024.3701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/21/2024] [Indexed: 04/04/2024] Open
Abstract
Importance Postdischarge outreach from the primary care practice is an important component of transitional care support. The most common method of contact is via telephone call, but calls are labor intensive and therefore limited in scope. Objective To test whether a 30-day automated texting program to support primary care patients after hospital discharge reduces acute care revisits. Design, Setting, and Participants A 2-arm randomized clinical trial was conducted from March 29, 2022, through January 5, 2023, at 30 primary care practices within a single academic health system in Philadelphia, Pennsylvania. Patients were followed up for 60 days after discharge. Investigators were blinded to assignment, but patients and practice staff were not. Participants included established patients of the study practices who were aged 18 years or older, discharged from an acute care hospitalization, and considered medium to high risk for adverse health events by a health system risk score. All analyses were conducted using an intention-to-treat approach. Intervention Patients in the intervention group received automated check-in text messages from their primary care practice on a tapering schedule for 30 days following discharge. Any needs identified by the automated messaging platform were escalated to practice staff for follow-up via an electronic medical record inbox. Patients in the control group received a standard transitional care management telephone call from their practice within 2 business days of discharge. Main Outcomes and Measures The primary study outcome was any acute care revisit (readmission or emergency department visit) within 30 days of discharge. Results Of the 4736 participants, 2824 (59.6%) were female; the mean (SD) age was 65.4 (16.5) years. The mean (SD) length of index hospital stay was 5.5 (7.9) days. A total of 2352 patients were randomized to the intervention arm and 2384 were randomized to the control arm. There were 557 (23.4%) acute care revisits in the control group and 561 (23.9%) in the intervention group within 30 days of discharge (risk ratio, 1.02; 95% CI, 0.92-1.13). Among the patients in the intervention arm, 79.5% answered at least 1 message and 41.9% had at least 1 need identified. Conclusions and Relevance In this randomized clinical trial of a 30-day postdischarge automated texting program, there was no significant reduction in acute care revisits. Trial Registration ClinicalTrials.gov Identifier: NCT05245773.
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Affiliation(s)
- Eric Bressman
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Judith A. Long
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Robert E. Burke
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | - Aiden Ahn
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Katherine Honig
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jarcy Zee
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nancy McGlaughlin
- Penn Primary Care, University of Pennsylvania Health System, Philadelphia
| | - Mohan Balachandran
- Center for Health Care Innovation and Transformation, University of Pennsylvania Health System, Philadelphia
| | - David A. Asch
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Anna U. Morgan
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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Bruce C, Pinn-Kirkland T, Meyers A, Javaluyas E, Osborn J, Kelkar S, Bruchhaus L, McLaury K, Sauceda K, Carr K, Garcia C, Arabie LA, Williams T, Vozzella G, Nisar T, Schwartz RL, Sasangohar F. Investigating patient engagement associations between a postdischarge texting programme and patient experience, readmission and revisit rates outcomes. BMJ Open 2024; 14:e079775. [PMID: 38485169 PMCID: PMC10941103 DOI: 10.1136/bmjopen-2023-079775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES This study aimed (1) to examine the association between patient engagement with a bidirectional, semiautomated postdischarge texting programme and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey outcomes, readmissions and revisit rates in a large health system and (2) to describe operational and clinical flow considerations for implementing a postdischarge texting programme. SETTING The study involved 1 main academic hospital (beds: 2500+) and 6 community hospitals (beds: 190-400, averaging 300 beds per hospital) in Houston, Texas. METHODS Retrospective, observational cohort study between non-engaged patients (responded with 0-2 incoming text messages) and engaged patients (responded with 3+ incoming, patient-initiated text messages) between December 2022 and May 2023. We used the two-tailed t-test for continuous variables and χ2 test for categorical variables to compare the baseline characteristics between the two cohorts. For the binary outcomes, such as the revisit (1=yes, vs 0=no) and readmissions (1=yes vs 0=no), we constructed mixed effect logistic regression models with the random effects to account for repeated measurements from the hospitals. For the continuous outcome, such as the case mix index (CMI), a generalised linear quantile mixed effect model was built. All tests for significance were two tailed, using an alpha level of 0.05, and 95% CIs were provided. Significance tests were performed to evaluate the CMI and readmissions and revisit rates. RESULTS From 78 883 patients who were contacted over the course of this pilot implementation, 49 222 (62.4%) responded, with 39 442 (50%) responded with 3+ incoming text messages. The engaged cohort had higher HCAHPS scores in all domains compared with the non-engaged cohort. The engaged cohort used significantly fewer 30-day acute care resources, experiencing 29% fewer overall readmissions and 20% fewer revisit rates (23% less likely to revisit) and were 27% less likely to be readmitted. The results were statistically significant for all but two hospitals. CONCLUSIONS This study builds on the few postdischarge texting studies, and also builds on the patient engagement literature, finding that patient engagement with postdischarge texting can be associated with fewer acute care resources. To our knowledge, this is the only study that documented an association between a text-based postdischarge programme and HCAHPS scores, perhaps owing to the bidirectionality and ease with which patients could interact with nurses. Future research should explore the texting paradigms to evaluate their associated outcomes in a variety of postdischarge applications.
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Affiliation(s)
- Courtenay Bruce
- System Patient Experience, Houston Methodist, Houston, Texas, USA
| | - Theresa Pinn-Kirkland
- Houston Methodist Physicians Alliance for Quality, Houston Methodist, Houston, Texas, USA
| | - Adam Meyers
- Houston Methodist Physician Organization, Houston Methodist, Houston, Texas, USA
| | | | - John Osborn
- System Quality & Patient Safety, Houston Methodist, Houston, Texas, USA
| | - Sayali Kelkar
- System Quality & Patient Safety, Houston Methodist, Houston, Texas, USA
| | - Lindsey Bruchhaus
- Department of Guest Relations and Patient Experience, Houston Methodist The Woodlands, The Woodlands, Texas, USA
| | - Kristen McLaury
- Department of Guest Relations and Patient Experience, Houston Methodist The Woodlands, The Woodlands, Texas, USA
| | - Katherine Sauceda
- Department of Guest Relations and Patient Experience, Houston Methodist Sugar Land Hospital, Sugar Land, Texas, USA
| | - Karen Carr
- Department of Guest Relations and Patient Experience, Houston Methodist Sugar Land Hospital, Sugar Land, Texas, USA
| | - Claudia Garcia
- Department of Guest Relations and Patient Experience, Houston Methodist Baytown, Houston, Texas, USA
| | | | - Terrell Williams
- System Patient Experience, Houston Methodist, Houston, Texas, USA
| | - Gail Vozzella
- Department of Nursing, Houston Methodist, Houston, Texas, USA
| | - Tariq Nisar
- Center for Health Data Science & Analytics, Houston Methodist, Houston, Texas, USA
| | - Roberta L Schwartz
- Houston Methodist Academic Institute, Houston Methodist, Houston, Texas, USA
| | - Farzan Sasangohar
- Industrial and Systems Engineering, Texas A&M University System, College Station, Texas, USA
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Mohamedsharif A, Elfeaki M, Bushra R, Gemperli A. Effectiveness of hospital-to-home transitional care interventions and consultation for implementation in Sudan: a scoping review of systematic reviews. FRONTIERS IN HEALTH SERVICES 2023; 3:1288575. [PMID: 38162192 PMCID: PMC10755884 DOI: 10.3389/frhs.2023.1288575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
Background Hospital discharge is often associated with a lack of continuity resulting in fragmented care, particularly in low-income countries. As there is limited information about interventions in these countries and no study evaluating the effectiveness of hospital discharge interventions, we conducted a scoping review to identify effective hospital-to-home transitional care interventions and explore their applicability in a low-income country (Sudan). Methods Our scoping review of systematic reviews and meta-analyses classed interventions as effective, ineffective, undesirable, or uncertain, based on the quality of their evidence and their estimated effects on the following outcomes: readmission rates, mortality, costs, quality of life, and adverse outcomes) and certainty of evidence. Our authors from Sudan used the SUPPORT summary tool to determine if three effective interventions could be implemented in Sudan. Results Out of 3,276 articles that were identified, and 72 articles were reviewed, 10 articles has been included in the review. Seven interventions were classified as effective, one as ineffective, and none with undesirable effects. Eight interventions were classified as having an uncertain effect. The effective interventions were composed of home visits, information and communication technology (ICT), case manager models, multidisciplinary teams, and self-management support. Conclusions The finding of this study suggested that a combining two to four interventions can improve enhance hospital-to-home transitional care. Effective interventions are composed of home visits, ICT, case manager models, multidisciplinary teams, and self-management support. The implementation of these interventions in Sudan was found to be undermined by contextual factors such as inadequate human resources, telecommunication instability, and inequality in accessibility. These interventions could be tailored based on an in-depth understanding of the contextual factors in low-income countries that influence implementation. Systematic Review Registration https://osf.io/9eqvr/, doi: 10.17605/OSF.IO/9EQVR.
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Affiliation(s)
- Asma Mohamedsharif
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Mohammed Elfeaki
- Directorate of Quality, Development and Accreditation, Federal Ministry of Health, Khartoum, Sudan
| | - Rayan Bushra
- Department of General Medicine, Ibrahim Malik Teaching Hospital, Khartoum, Sudan
| | - Armin Gemperli
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center of Primary and Community Care, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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Jarab AS, Al-Qerem W, Alzoubi KH, Tharf M, Abu Heshmeh S, Al-Azayzih A, Mukattash TL, Akour A, Al Hamarneh YN. Patterns of drug-related problems and the services provided to optimize drug therapy in the community pharmacy setting. Saudi Pharm J 2023; 31:101746. [PMID: 37649677 PMCID: PMC10462881 DOI: 10.1016/j.jsps.2023.101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction Drug-related problems (DRPs) are events or circumstances involving drug therapy that actually or potentially interferes with desired health outcomes. Objectives To assess community pharmacists' knowledge and practice regarding DRP-reduction services, as well as the barriers and factors associated with decreased provision of these services. Methods This cross-sectional study utilized a validated questionnaire to assess pharmacists' knowledge, practice, and barriers to the provision of DRP-reduction services in the community pharmacy setting. Binary regression model was used to assess the variables associated with the practice of DRP-reduction services. Results A total of 412 pharmacists participated in the study. The pharmacists demonstrated strong knowledge but inadequate practice of DRP-reduction services. The most reported DRPs were inappropriate combination of drugs, or drugs and herbal medications, or drugs and dietary supplements (52.4%), patients' inability to understand instructions properly (46.1%), inappropriate drug according to guidelines (43.7%), and too high dose (40.3%). The most common barriers to these services were increased workload (60.5%), limited time (53.2%), and lack of good communication skills (49.8%). The presence of a counselling area in the pharmacy increased the practice of DRP-reduction services (OR: 3.532, 95%Cl: 2.010-5.590, P < 0.001), while increased weekly working hours (OR: 0.966, 95%Cl: 0.947-0.986), P < 0.01) and serving < 10 patients daily (OR = 0.208, 95%Cl: 0.072-0.601, P < 0.01) decreased it. Conclusions Community pharmacists' practice of DRP-reduction services showed a scope for improvement. Future pharmaceutical care initiatives should increase the number of personnel working in the pharmacy and provide them with opportunities for continued education and training in order to improve the provision of DRP services and optimize patients' outcomes.
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Affiliation(s)
- Anan S. Jarab
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P.O. Box 130, Amman 11733, Jordan
| | - Karem H. Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Tharf
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Shrouq Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Ahmad Al-Azayzih
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Tareq L. Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Amal Akour
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, Al Ain, United Arab Emirates
| | - Yazid N Al Hamarneh
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Coombes J, Holland AJA, Ryder C, Finlay SM, Hunter K, Bennett-Brook K, Orcher P, Scarcella M, Briscoe K, Forbes D, Jacques M, Maze D, Porykali B, Bourke E, Kairuz Santos CA. Discharge interventions for First Nations people with a chronic condition or injury: a systematic review. BMC Health Serv Res 2023; 23:604. [PMID: 37296401 DOI: 10.1186/s12913-023-09567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander peoples have a unique place in Australia as the original inhabitants of the land. Similar to other First Nations people globally, they experience a disproportionate burden of injury and chronic health conditions. Discharge planning ensures ongoing care to avoid complications and achieve better health outcomes. Analysing discharge interventions that have been implemented and evaluated globally for First Nations people with an injury or chronic conditions can inform the implementation of strategies to ensure optimal ongoing care for Aboriginal and Torres Strait Islander people. METHODS A systematic review was conducted to analyse discharge interventions conducted globally among First Nations people who sustained an injury or suffered from a chronic condition. We included documents published in English between January 2010 and July 2022. We followed the reporting guidelines and criteria set in Preferred Reporting Items for Systematic Review (PRISMA). Two independent reviewers screened the articles and extracted data from eligible papers. A quality appraisal of the studies was conducted using the Mixed Methods Appraisal Tool and the CONSIDER statement. RESULTS Four quantitative and one qualitative study out of 4504 records met inclusion criteria. Three studies used interventions involving trained health professionals coordinating follow-up appointments, linkage with community care services and patient training. One study used 48-hour post discharge telephone follow-up and the other text messages with prompts to attend check-ups. The studies that included health professional coordination of follow-up, linkage with community care and patient education resulted in decreased readmissions, emergency presentations, hospital length of stay and unattended appointments. CONCLUSION Further research on the field is needed to inform the design and delivery of effective programs to ensure quality health aftercare for First Nations people. We observed that discharge interventions in line with the principal domains of First Nations models of care including First Nations health workforce, accessible health services, holistic care, and self-determination were associated with better health outcomes. REGISTRATION This study was prospectively registered in PROSPERO (ID CRD42021254718).
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Affiliation(s)
- Julieann Coombes
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Andrew J A Holland
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and, Hainsworth St, Westmead, NSW, 2145, Australia
| | - Courtney Ryder
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
- Indigenous Health College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Summer May Finlay
- School of Health and Society, Wollongong University, Wollongong, NSW, 2522, Australia
| | - Kate Hunter
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Keziah Bennett-Brook
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Phillip Orcher
- Agency for Clinical Innovations, 1 Reserve Rd, St Leonards, NSW, 2065, Australia
| | - Michele Scarcella
- The Sydney Children's Hospital Network (SCHN), Sydney, NSW, 2145, Australia
| | - Karl Briscoe
- National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP), 31-37 Townshend Street, Phillip ACT, 2606, Australia
| | - Dale Forbes
- Department Community and Justice NSW, Sydney, NSW, 2012, Australia
| | - Madeleine Jacques
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and, Hainsworth St, Westmead, NSW, 2145, Australia
| | - Deborah Maze
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and, Hainsworth St, Westmead, NSW, 2145, Australia
| | - Bobby Porykali
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Elizabeth Bourke
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Camila A Kairuz Santos
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia.
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Grischott T, Rachamin Y, Senn O, Hug P, Rosemann T, Neuner-Jehle S. Medication Review and Enhanced Information Transfer at Discharge of Older Patients with Polypharmacy: a Cluster-Randomized Controlled Trial in Swiss Hospitals. J Gen Intern Med 2023; 38:610-618. [PMID: 36045192 PMCID: PMC9432794 DOI: 10.1007/s11606-022-07728-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medication safety in patients with polypharmacy at transitions of care is a focus of the current Third WHO Global Patient Safety Challenge. Medication review and communication between health care professionals are key targets to reduce medication-related harm. OBJECTIVE To study whether a hospital discharge intervention combining medication review with enhanced information transfer between hospital and primary care physicians can delay hospital readmission and impact health care utilization or other health-related outcomes of older inpatients with polypharmacy. DESIGN Cluster-randomized controlled trial in 21 Swiss hospitals between January 2019 and September 2020, with 6 months follow-up. PARTICIPANTS Sixty-eight senior physicians and their blinded junior physicians included 609 patients ≥ 60 years taking ≥ 5 drugs. INTERVENTIONS Participating hospitals were randomized to either integrate a checklist-guided medication review and communication stimulus into their discharge processes, or follow usual discharge routines. MAIN MEASURES Primary outcome was time-to-first-readmission to any hospital within 6 months, analyzed using a shared frailty model. Secondary outcomes covered readmission rates, emergency department visits, other medical consultations, mortality, drug numbers, proportions of patients with potentially inappropriate medication, and the patients' quality of life. KEY RESULTS At admission, 609 patients (mean age 77.5 (SD 8.6) years, 49.4% female) took a mean of 9.6 (4.2) drugs per patient. Time-to-first-readmission did not differ significantly between study arms (adjusted hazard ratio 1.14 (intervention vs. control arm), 95% CI [0.75-1.71], p = 0.54), nor did the 30-day hospital readmission rates (6.7% [3.3-10.1%] vs. 7.0% [3.6-10.3%]). Overall, there were no clinically relevant differences between study arms at 1, 3, and 6 months after discharge. CONCLUSIONS The combination of a structured medication review with enhanced information transfer neither delayed hospital readmission nor improved other health-related outcomes of older inpatients with polypharmacy. Our results may help researchers in balancing practicality versus stringency of similar hospital discharge interventions. STUDY REGISTRATION ISRCTN18427377, https://doi.org/10.1186/ISRCTN18427377.
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Affiliation(s)
- Thomas Grischott
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland.
| | - Yael Rachamin
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
| | - Petra Hug
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
| | - Stefan Neuner-Jehle
- Institute of Primary Care, University of Zurich & University Hospital Zurich, Zurich, Switzerland
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Kassymova G, Sydsjö G, Wodlin NB, Nilsson L, Kjølhede P. Effect of nurse-led telephone follow-up on postoperative symptoms and analgesics consumption after benign hysterectomy: a randomized, single-blinded, four-arm, controlled multicenter trial. Arch Gynecol Obstet 2023; 307:459-471. [PMID: 36050542 PMCID: PMC9918564 DOI: 10.1007/s00404-022-06722-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/24/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The study aimed to determine if planned telephone follow-up, especially when adding structured, oriented coaching, reduces the intensity of postoperative symptoms and decreases analgesics consumption after benign hysterectomy. METHODS A randomized, single-blinded, four-armed, controlled multicenter trial of 525 women scheduled for hysterectomy was conducted in 5 hospitals in the southeast health region of Sweden. The women were allocated 1:1:1:1 into four follow-up models: (A) no telephone follow-up (control group); (B) one planned, structured, telephone follow-up the day after discharge; (C) as B but with additional telephone follow-up once weekly for 6 weeks; and (D) as C but with oriented coaching telephone follow-up on all occasions. Postoperative symptoms were assessed using the Swedish Postoperative Symptoms Questionnaire. Analgesic consumption was registered. Unplanned telephone contacts and visits were registered during the 6 weeks of follow-up. RESULTS In total, 487 women completed the study. Neither pain intensity, nor symptom sum score or analgesic consumption differed between the intervention groups. Altogether, 224 (46.0%) women had unplanned telephone contacts and 203 (41.7%) had unplanned visits. Independent of intervention, the women with unplanned telephone contacts had higher pain intensity and symptom sum scores, particularly if an unplanned telephone contact was followed by a visit, or an unplanned visit was preceded by an unplanned telephone contact. CONCLUSION Telephone follow-up did not seem to affect recovery regarding symptoms or analgesic consumption after benign hysterectomy in an enhanced recovery after surgery (ERAS) setting. Unplanned telephone contacts and visits were associated with more postoperative symptoms, especially pain. Trial registration The study is registered in ClinicalTrial.gov: NCT01526668 retrospectively from January 27; 2012. Date of enrolment of first patient: October 11; 2011.
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Affiliation(s)
- Gulnara Kassymova
- Department of Obstetrics and Gynecology in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, University Hospital, S-58245, Linköping, Sweden.
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynecology in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, University Hospital, S-58245 Linköping, Sweden
| | - Ninnie Borendal Wodlin
- Department of Obstetrics and Gynecology in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, University Hospital, S-58245 Linköping, Sweden
| | - Lena Nilsson
- Department of Anesthesiology and Intensive Care in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Preben Kjølhede
- Department of Obstetrics and Gynecology in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, University Hospital, S-58245 Linköping, Sweden
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9
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Bressman E, Long JA, Honig K, Zee J, McGlaughlin N, Jointer C, Asch DA, Burke RE, Morgan AU. Evaluation of an Automated Text Message-Based Program to Reduce Use of Acute Health Care Resources After Hospital Discharge. JAMA Netw Open 2022; 5:e2238293. [PMID: 36287564 PMCID: PMC9606844 DOI: 10.1001/jamanetworkopen.2022.38293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Posthospital contact with a primary care team is an established pillar of safe transitions. The prevailing model of telephone outreach is usually limited in scope and operationally burdensome. OBJECTIVE To determine whether a 30-day automated texting program to support primary care patients after hospital discharge is associated with reductions in the use of acute care resources. DESIGN, SETTING, AND PARTICIPANTS This cohort study used a difference-in-differences approach at 2 academic primary care practices in Philadelphia from January 27 through August 27, 2021. Established patients of the study practices who were 18 years or older, were discharged from an acute care hospitalization, and received the usual transitional care management telephone call were eligible for the study. At the intervention practice, 604 discharges were eligible and 430 (374 patients, of whom 46 had >1 discharge) were enrolled in the intervention. At the control practice, 953 patients met eligibility criteria. The study period, including before and after the intervention, ran from August 27, 2020, through August 27, 2021. EXPOSURE Patients received automated check-in text messages from their primary care practice on a tapering schedule during the 30 days after discharge. Any needs identified by the automated messaging platform were escalated to practice staff for follow-up via an electronic medical record inbox. MAIN OUTCOMES AND MEASURES The primary study outcome was any emergency department (ED) visit or readmission within 30 days of discharge. Secondary outcomes included any ED visit or any readmission within 30 days, analyzed separately, and 30- and 60-day mortality. Analyses were based on intention to treat. RESULTS A total of 1885 patients (mean [SD] age, 63.2 [17.3] years; 1101 women [58.4%]) representing 2617 discharges (447 before and 604 after the intervention at the intervention practice; 613 before and 953 after the intervention at the control practice) were included in the analysis. The adjusted odds ratio (aOR) for any use of acute care resources after implementation of the intervention was 0.59 (95% CI, 0.38-0.92). The aOR for an ED visit was 0.77 (95% CI, 0.45-1.30) and for a readmission was 0.45 (95% CI, 0.23-0.86). The aORs for death within 30 and 60 days of discharge at the intervention practice were 0.92 (95% CI, 0.23-3.61) and 0.63 (95% CI, 0.21-1.85), respectively. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that an automated texting program to support primary care patients after hospital discharge was associated with significant reductions in use of acute care resources. This patient-centered approach may serve as a model for improving postdischarge care.
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Affiliation(s)
- Eric Bressman
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Judith A. Long
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Katherine Honig
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jarcy Zee
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology, and Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nancy McGlaughlin
- Primary Care Service Line, University of Pennsylvania Health System, Philadelphia
| | - Carlondra Jointer
- Primary Care Service Line, University of Pennsylvania Health System, Philadelphia
| | - David A. Asch
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Center for Health Care Innovation, University of Pennsylvania Health System, Philadelphia
| | - Robert E. Burke
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Anna U. Morgan
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
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10
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Valenti V, Rossi R, Scarpi E, Ricci M, Pallotti MC, Dall'Agata M, Montalti S, Maltoni M. Nurse‐led telephone follow‐up for early palliative care patients with advanced cancer. J Clin Nurs 2022; 32:2846-2853. [PMID: 35871285 DOI: 10.1111/jocn.16403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVES To present our experience of a nursing telephone consultation service, describing patient and caregiver requests, and outlining ensuing nursing or medical interventions. BACKGROUND Recently, there has been an increase in the use of telephone consultation for cancer patients. However, there is still limited data on the characteristics of this type of service and on the nature of the interventions carried out. DESIGN AND METHODS In this observational retrospective study, we evaluated the phone calls made over a 6-month period by patients or caregivers to the early palliative care team of a cancer institute. Information regarding telephone calls (frequency, reason and management) was systematically collected by a nursing case manager. The study complies with the STROBE checklist File S1. RESULTS 171 patients used the service, for a total of 323 phone calls. The majority (80.8%) were from patients followed at the outpatient clinic and the most common requests were for pain management (38.4%) and for updates on the clinical situation (23.8%). Other frequent requests were for medication management (18.9%) and scheduling (18.3%). 210 of the 323 phone calls were handled by the nurse, while 22 were managed in collaboration with a physician. An 87.6% effectiveness in telephone management was observed. CONCLUSION The overall use of the phone service was higher for early palliative care patients. The majority of phone calls were effectively handled by the nursing case manager. RELEVANCE TO CLINICAL PRACTICE An effective and feasible nurse-led telephone follow-up of early palliative care patients with advanced cancer could improve their care experience. Specifically, it could impact on patients and families improving quality of life and symptom control securing access to timely care without travel or additional cost.It can also improve continuity of care, adherence to oncological treatments and minimise acute care visits.
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Affiliation(s)
- Vanessa Valenti
- Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori" Meldola Italy
| | - Romina Rossi
- Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori" Meldola Italy
| | - Emanuela Scarpi
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori" Meldola Italy
| | - Marianna Ricci
- Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori" Meldola Italy
| | - Maria Caterina Pallotti
- Palliative Care Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori" Meldola Italy
| | - Monia Dall'Agata
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori" Meldola Italy
| | - Sandra Montalti
- Nursing Administration, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori" Meldola Italy
| | - Marco Maltoni
- Medical Oncology Unit, Department of Specialized, Experimental and Diagnostic Medicine (DIMES) University of Bologna Bologna Italy
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11
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Billings KR, Bhushan B, Berkowitz RJ, Stake C, Lavin J. Outcomes of a postoperative day one call to families after adenotonsillectomy in children. Laryngoscope Investig Otolaryngol 2022; 7:1200-1205. [PMID: 36000061 PMCID: PMC9392385 DOI: 10.1002/lio2.845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To examine the outcomes of a postoperative day one (POD 1) phone call to families of ambulatory surgical patients, as a means of guiding clinical interventions and quality initiatives, with a focus on children undergoing adenotonsillectomy (T&A). Methods Retrospective analysis of outcomes of a POD 1 questionnaire completed in children <18 years of age undergoing T&A at a tertiary care children's hospital over a 3‐year period (August 14, 2018–August 31, 2021). Results Responses to the questionnaire were obtained for a total of 1428/3464 (41.2%) children undergoing T&A during the study period. There was no difference in gender, age at surgery, race, ethnicity, insurance product, or preoperative diagnosis for those whose caregiver responded to the questionnaire versus those who did not. Parent responses included 84 (5.9%) who reported problems or concerns postdischarge. These included 18 (1.3%) patients unable to take their pain medication, 9 (0.6%) refusing oral intake, 28 (2.0%) with postoperative emesis, 27 (1.9%) with fevers, and 6 (0.4%) with a change in breathing. A total of 75/122 (61.5%) who reported pain were taking their pain medication as directed. Nineteen (1.3%) patients were noted to have bleeding after surgery, including 4 (21.5%) with nosebleeds, and 12 (63.2%) with oral cavity bleeding requiring no interventions. Conclusions The POD 1 questionnaire identified patients with common concerns and complications after T&A. Although most of these concerns were infrequent, it afforded the clinical team the opportunity to provide additional education and instructions on care and management to caregivers after their child's surgical procedure.
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Affiliation(s)
- Kathleen R. Billings
- Division of Pediatric Otolaryngology‐Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
- Department of Otolaryngology‐Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Bharat Bhushan
- Division of Pediatric Otolaryngology‐Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
- Department of Otolaryngology‐Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Rachel J. Berkowitz
- Data Analytics and Reporting Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Christine Stake
- Department of Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Jennifer Lavin
- Division of Pediatric Otolaryngology‐Head and Neck Surgery Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
- Department of Otolaryngology‐Head and Neck Surgery Northwestern University Feinberg School of Medicine Chicago Illinois USA
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12
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Wake E, Brandenburg C, Heathcote K, Dale K, Campbell D, Cardona M. Follow-up of severely injured patients can be embedded in routine hospital care: results from a feasibility study. Hosp Pract (1995) 2022; 50:138-150. [PMID: 35297276 DOI: 10.1080/21548331.2022.2054633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Understanding the longitudinal patient experience outcomes following major trauma can promote successful recovery. A novel, hospital-led telephone follow-up program was implemented by a multi-disciplinary clinical trauma service team at a Level I trauma center. This process evaluation examined what factors promoted or impeded the program's implementation. METHODS A prospective convergent mixed methods process evaluation design was used. Quantitative data included patient and injury demographics and program feasibility data such number of telephone calls attempted/completed and call duration. Qualitative data consisted of semi-structured interviews with program participants (staff, patients, caregivers) who had participated in the program. Descriptive statistics and thematic analysis were applied to quantitative and qualitative data respectively. Data were collected concurrently and merged in the results to understand and describe the implementation and sustainability of the program. RESULTS 274 major trauma patients (ISS ≥ 12) were eligible for follow-up. A response rate of over 75% was achieved, with nurses responsible for most of the calls. Limited time and competing clinical demands were identified as barriers to the timely completion of the calls. Participants valued the pre-existing trauma service/patient relationship, and this facilitated program implementation. Clinicians were motivated to evaluate their patient's recovery, whilst patients felt 'cared for' and 'not forgotten' post-hospital discharge. Teamwork and leadership were highly valued by the clinical staff throughout the implementation period as ongoing source of motivation and support. Staff spontaneously developed the program to incorporate clinical follow up processes by providing guidance, advice and referrals to patients who indicated ongoing issues such as pain or emotional problems. CONCLUSION Telephone follow-up within a clinical trauma service team is feasible, accepted by staff and valued by patients and families. Despite time constraints, the successful implementation of this program is reliant on existing clinical/patient relationships, staff teamwork and leadership support.
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Affiliation(s)
- Elizabeth Wake
- Trauma Service, Gold Coast University Hospital, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Caitlin Brandenburg
- Emergency Department, Gold Coast University Hospital, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Kathy Heathcote
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Kate Dale
- Trauma Service, Gold Coast University Hospital, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Don Campbell
- Trauma Service, Gold Coast University Hospital, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Magnolia Cardona
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia.,Evidence Based Practice Professorial Unit, Gold Coast Hospital and Health Service, Queensland, Australia.,Institute for Evidence Based Health, Bond University, Gold Coast, Queensland, Australia
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13
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Can Teledentistry Replace Conventional Clinical Follow-Up Care for Minor Dental Surgery? A Prospective Randomized Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063444. [PMID: 35329133 PMCID: PMC8953526 DOI: 10.3390/ijerph19063444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: Born out of necessity, the implementation of digital processes experienced significant increase during the COVID-19 pandemic. Here, telemedicine offered a bridge to care and now an opportunity to reinvent virtual and hybrid care models, with the goal of improved healthcare access, outcomes, and affordability. The aim of this monocentric prospective, randomized trial was to compare conventional to telephone follow-up after minor dentoalveolar surgery on the basis of special aftercare questionnaires. (2) Methods: Sixty patients who underwent dentoalveolar surgery under local anesthesia were randomly assigned to both groups. After an average of four days, either telephone follow-up (test) or conventional personal aftercare (control) was performed. Based on the questionnaire, the following subject areas were evaluated: symptoms, complications, satisfaction with practitioner, travel, and waiting time, as well as the preferred form of follow-up care. (3) Results: There was no statistically significant difference regarding frequency of symptoms or complication rate. Patients who were assigned to the test group showed a clear tendency to prefer telephone follow-up (83.3%) to conventional aftercare (16.7%, p = 0.047). (4) Conclusions: The data suggest high acceptance of telephone-only follow-up after dentoalveolar surgery. The implementation of telemedicine could be a time- and money-saving alternative for both patients and healthcare professionals and provide healthcare access regardless of time and space.
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14
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Gingold DB, Liang Y, Stryckman B, Marcozzi D. The effect of a mobile integrated health program on health care cost and utilization. Health Serv Res 2021; 56:1146-1155. [PMID: 34402056 DOI: 10.1111/1475-6773.13773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To measure the effect of a mobile integrated health community paramedicine (MIH-CP) transitional care program on hospital utilization, emergency department visits, and charges. DATA SOURCES Retrospective secondary data from the electronic health record and regional health information exchange were used to analyze patients discharged from a large academic medical center and an affiliated community hospital in Baltimore, Maryland, May 2018-October 2019. STUDY DESIGN We performed an observational study comparing patients enrolled in an MIH-CP program to propensity-matched controls. Propensity scores were calculated using measures of demographics, clinical characteristics, social determinants of health, and prior health care utilization. The primary outcome is inpatient readmission within 30 days of discharge. Secondary outcomes include excess days in acute care 30 days after discharge and emergency department visits, observation hospitalizations, and total health care charges within 30 and 60 days of discharge. DATA COLLECTION Included patients were over 18 years old, discharged to home from internal/family medicine services, and live in eligible ZIP codes. The intervention group was enrolled in the MIH-CP program; controls met inclusion criteria but were not enrolled during the study period. PRINCIPAL FINDINGS The adjusted model showed no difference in 30-day inpatient readmission between 464 enrolled patients and propensity-matched controls (adjusted incidence rate ratio = 1.19, 95% confidence interval [CI] [0.89, 1.60]). There was a higher rate of observation hospitalizations within 30 days of index discharge for MIH-CP patients (adjusted incidence rate ratio = 1.78, 95% CI = [1.01, 3.14]). This difference did not persist at 60 days, and there were no differences in other secondary outcomes. CONCLUSIONS We found no significant difference in short-term health care utilization or charges between patients enrolled in an MIH-CP transitional care program and propensity-matched controls. This highlights the importance of well-controlled, robust evaluations of effectiveness in novel care-delivery systems.
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Affiliation(s)
- Daniel B Gingold
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, Division of Biostatistics and Bioinformatics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Benoit Stryckman
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David Marcozzi
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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15
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David SD, Roy N, Solomon H, Lundborg CS, Wärnberg MG. Measuring post-discharge socioeconomic and quality of life outcomes in trauma patients: a scoping review. J Patient Rep Outcomes 2021; 5:68. [PMID: 34370128 PMCID: PMC8353045 DOI: 10.1186/s41687-021-00346-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/20/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose Trauma is a global public health challenge. Measuring post-discharge socioeconomic and quality-of-life outcomes can help better understand and reduce the consequences of trauma. Methods We performed a scoping review to map the existing research on post-discharge outcomes for trauma patients, irrespective of the country or setting in which the study was performed. The scoping review was conducted by searching six databases – MEDLINE, EMBASE, the Cochrane Library, Global Index Medicus, BASE, and Web of Science – to identify all articles that report post-discharge socioeconomic or quality of life outcomes in trauma patients from 2009 to 2018. Results Seven hundred fifty-eight articles were included in this study, extracting 958 outcomes. Most studies (82%) were from high-income countries (HICs). More studies from low- and middle-income countries (LMICs) were cross-sectional (71%) compared with HIC settings (46%). There was a wide variety of different definitions, interpretations, and measurements used by various articles for similar outcomes. Quality of life, return to work, social support, cost, and participation were the main outcomes studied in post-discharge trauma patients. Conclusions The wide range of outcomes and outcome measures reported across different types of injuries and settings. This variability can be a barrier when comparing across different types of injuries and settings. Post-discharge trauma studies should move towards building evidence based on standardized measurement of outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00346-6.
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Affiliation(s)
- Siddarth Daniels David
- Health Systems and Policy, Department of Global Public Health Karolinska Institutet, Stockholm, Sweden. .,Doctors For You, Mumbai, India.
| | - Nobhojit Roy
- Health Systems and Policy, Department of Global Public Health Karolinska Institutet, Stockholm, Sweden.,WHO Collaborating Centre for Research in Surgical care delivery in LMICs, BARC Hospital, Mumbai, India
| | - Harris Solomon
- Department of Cultural Anthropology and the Duke Global Health Institute, Duke University, Durham, USA
| | - Cecilia Stålsby Lundborg
- Health Systems and Policy, Department of Global Public Health Karolinska Institutet, Stockholm, Sweden
| | - Martin Gerdin Wärnberg
- Health Systems and Policy, Department of Global Public Health Karolinska Institutet, Stockholm, Sweden.,Function, Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
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16
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Nagendrappa S, Vinod P, Pai NM, Ganjekar S, Desai G, Kishore MT, Thippeswamy H, Vaiphei K, Chandra PS. Perinatal Mental Health Care for Women With Severe Mental Illness During the COVID-19 Pandemic in India-Challenges and Potential Solutions Based on Two Case Reports. Front Glob Womens Health 2021; 2:648429. [PMID: 34816204 PMCID: PMC8593993 DOI: 10.3389/fgwh.2021.648429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/22/2021] [Indexed: 01/09/2023] Open
Abstract
The ongoing COVID-19 pandemic in India has created several challenges in the care of women with perinatal mental illness. Access to healthcare has been disrupted by lockdowns, travel restrictions, and the unavailability of outpatient services. This report aims to discuss the challenges faced by women with severe mental illnesses during the perinatal period with the help of two case reports. Accordingly, we have highlighted the role of COVID-19 infection as a traumatic event during childbirth and its role in triggering a psychotic episode in women with vulnerabilities; difficulties faced by women with postpartum psychosis in accessing perinatal psychiatry services; and the challenges of admission into an inpatient Mother-Baby Unit (MBU). Further, we have discussed potential solutions from the perspectives of Lower and Middle-income (LAMI) countries that need to be extended beyond the pandemic. They include offering video consultations, reviewing hospital policies, and evolving strategies to mitigate traumatic experiences for pregnant and postpartum women with severe mental illnesses in both obstetric and psychiatric care.
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Affiliation(s)
- Sachin Nagendrappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pratibha Vinod
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Naveen Manohar Pai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Geetha Desai
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - M. Thomas Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Harish Thippeswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kimneihat Vaiphei
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Prabha S. Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India,*Correspondence: Prabha S. Chandra
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17
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Kempen TGH, Bertilsson M, Hadziosmanovic N, Lindner KJ, Melhus H, Nielsen EI, Sulku J, Gillespie U. Effects of Hospital-Based Comprehensive Medication Reviews Including Postdischarge Follow-up on Older Patients' Use of Health Care: A Cluster Randomized Clinical Trial. JAMA Netw Open 2021; 4:e216303. [PMID: 33929523 PMCID: PMC8087955 DOI: 10.1001/jamanetworkopen.2021.6303] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/23/2021] [Indexed: 12/27/2022] Open
Abstract
Importance Suboptimal use of medications is a leading cause of health care-related harm. Medication reviews improve medication use, but evidence of the possible benefit of inpatient medication review for hard clinical outcomes after discharge is scarce. Objective To study the effects of hospital-based comprehensive medication reviews (CMRs), including postdischarge follow-up of older patients' use of health care resources, compared with only hospital-based reviews and usual care. Design, Setting, and Participants The Medication Reviews Bridging Healthcare trial is a cluster randomized crossover trial that was conducted in 8 wards with multiprofessional teams at 4 hospitals in Sweden from February 6, 2017, to October 19, 2018, with 12 months of follow-up completed December 6, 2019. The study was prespecified in the trial protocol. Outcome assessors were blinded to treatment allocation. In total, 2644 patients aged 65 years or older who had been admitted to 1 of the study wards for at least 1 day were included. Data from the modified intention-to-treat population were analyzed from December 10, 2019, to September 9, 2020. Interventions Each ward participated in the trial for 6 consecutive 8-week periods. The wards were randomized to provide 1 of 3 treatments during each period: CMR, CMR plus postdischarge follow-up, and usual care without a clinical pharmacist. Main Outcomes and Measures The primary outcome measure was the incidence of unplanned hospital visits (admissions plus emergency department visits) within 12 months. Secondary outcomes included medication-related admissions, visits with primary care clinicians, time to first unplanned hospital visit, mortality, and costs of hospital-based care. Results Of the 2644 participants, 7 withdrew after inclusion, leaving 2637 for analysis (1357 female [51.5%]; median age, 81 [interquartile range, 74-87] years; median number of medications, 9 [interquartile range, 5-13]). In the modified intention-to-treat analysis, 922 patients received CMR, 823 received CMR plus postdischarge follow-up, and 892 received usual care. The crude incidence rate of unplanned hospital visits was 1.77 per patient-year in the total study population. The primary outcome did not differ between the intervention groups and usual care (adjusted rate ratio, 1.04 [95% CI, 0.89-1.22] for CMR and 1.15 [95% CI, 0.98-1.34] for CMR plus postdischarge follow-up). However, CMR plus postdischarge follow-up was associated with an increased incidence of emergency department visits within 12 months (adjusted rate ratio, 1.29; 95% CI, 1.05-1.59) compared with usual care. There were no differences between treatment groups regarding other secondary outcomes. Conclusions and Relevance In this study of older hospitalized patients, CMR plus postdischarge follow-up did not decrease the incidence of unplanned hospital visits. The findings do not support the performance of hospital-based CMRs as conducted in this trial. Alternative forms of medication reviews that aim to improve older patients' health outcomes should be considered and subjected to randomized clinical trials. Trial Registration ClinicalTrials.gov Identifier: NCT02986425.
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Affiliation(s)
- Thomas G. H. Kempen
- Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | | | | | - Håkan Melhus
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Johanna Sulku
- Pharmacy Department, Region Gävleborg, Gävle, Sweden
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Ulrika Gillespie
- Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
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van Loon-van Gaalen M, van Winsen B, van der Linden MC, Gussekloo J, van der Mast RC. The effect of a telephone follow-up call for older patients, discharged home from the emergency department on health-related outcomes: a systematic review of controlled studies. Int J Emerg Med 2021; 14:13. [PMID: 33602115 PMCID: PMC7893958 DOI: 10.1186/s12245-021-00336-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/02/2021] [Indexed: 01/08/2023] Open
Abstract
Background Older patients discharged from the emergency department (ED) are at increased risk for adverse outcomes. Transitional care programs offer close surveillance after discharge, but are costly. Telephone follow-up (TFU) may be a low-cost and feasible alternative for transitional care programs, but its effects on health-related outcomes are not clear. Aim We systematically reviewed the literature to evaluate the effects of TFU by health care professionals after ED discharge to an unassisted living environment on health-related outcomes in older patients compared to controls. Methods We conducted a multiple electronic database search up until December 2019 for controlled studies examining the effects of TFU by health care professionals for patients aged ≥65 years, discharged to an unassisted living environment from a hospital ED. Two reviewers independently assessed eligibility and risk of bias. Results Of the 748 citations, two randomized controlled trials (including a total of 2120 patients) met review selection criteria. In both studies, intervention group patients received a scripted telephone intervention from a trained nurse and control patients received a patient satisfaction survey telephone call or usual care. No demonstrable benefits of TFU were found on ED return visits, hospitalization, acquisition of prescribed medication, and compliance with follow-up appointments. However, many eligible patients were not included, because they were not reached or refused to participate. Conclusions No benefits of a scripted TFU call from a nurse were found on health services utilization and discharge plan adherence by older patients after ED discharge. As the number of high-quality studies was limited, more research is needed to determine the effect and feasibility of TFU in different older populations. PROSPERO registration number CRD42019141403. Supplementary Information The online version contains supplementary material available at 10.1186/s12245-021-00336-x.
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Affiliation(s)
- Merel van Loon-van Gaalen
- Emergency Department, Haaglanden Medical Center, P.O. Box 432, 2501, CK, The Hague, The Netherlands.
| | - Britt van Winsen
- Emergency Department, Haaglanden Medical Center, P.O. Box 432, 2501, CK, The Hague, The Netherlands
| | | | - Jacobijn Gussekloo
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Roos C van der Mast
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.,Department of Psychiatry, CAPRI-University, Antwerp, Belgium
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Chocron R, Tamisier T, Feral-Pierssens AL, Juvin P. Establishing a written advice sheet to patients consulting for wound to emergency ward improves postemergency care. Turk J Emerg Med 2021; 21:6-13. [PMID: 33575509 PMCID: PMC7864124 DOI: 10.4103/2452-2473.301918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 04/16/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES: Sutures require follow-up visits for favorable evolution. To improve postemergency wound care, we decided to include a standardized advice sheet for patients based on current recommendations. The objective is to assess its effectiveness on outpatients' compliance after being discharged from the emergency department (ED). METHODS: We performed a prospective, pre–post design trial in an ED of a teaching hospital. We included for two consecutive months all patients aged ≥16 years old and consulting for wounds that needed suturing, and we excluded chronic wounds, burns, and hand wounds since they all need special care. During the 1st month, all patients received during ED visit usual verbal instructions concerning the postemergency care (Group A). During the 2nd month, all patients received usual verbal instructions and a standardized written advice sheet that detailed postemergency wound care (Group B). We organized telephone follow-up after the suture removal date and asked about dressing changes, appearance of infection signs, and respect of suture removal date. We compared patients;' characteristics in the two groups and performed a multivariable logistic regression using compliance to discharge instructions as our endpoint. RESULTS: For 2 months, 509 patients consulted for wounds. 119 (23.4%) patients were included in the study and followed. Baseline characteristics of patients did not differ between the two groups. Patients who received the advice sheet (Group B) had a better compliance in postemergency care (91.7% vs. 72.9%; P = 0.01). Moreover, there were significantly less dressing changes in Group B than in Group A (5.3 [2.2] vs. 12.9 [7.7]; P < 0.01) and suture removal date was more in agreement with recommendations in Group B (83.9% vs. 66.7%; P = 0.03). Occurrence of infection was not significantly different between groups (9.7% vs. 13.7%; P = 0.37). CONCLUSION: For the management of wound care, discharge hospital process including a written advice sheet improves outpatients' compliance and postemergency care.
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Affiliation(s)
- Richard Chocron
- Department of Emergency, Université de Paris, PARCC, INSERM, AP-HP, Georges Pompidou European Hospital, F-75015 Paris, France
| | - Thomas Tamisier
- Department of Emergency, AP-HP, Georges Pompidou European Hospital, F-75015 Paris, France
| | | | - Philippe Juvin
- Department of Emergency, Paris University, AP-HP, Georges Pompidou European Hospital, F-75015 Paris, France
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Pharmaceutical Discharge Management: Implementation in Swiss Hospitals Compared to International Guidelines. PHARMACY 2021; 9:pharmacy9010033. [PMID: 33562348 PMCID: PMC7931052 DOI: 10.3390/pharmacy9010033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 12/04/2022] Open
Abstract
Readmissions to the hospital are frequent after hospital discharge. Pharmacist-led interventions have been shown to reduce readmissions. The objective of this study was to describe pharmacist-led interventions to support patients’ medication management at hospital discharge in Switzerland and to compare them to international guidelines. We conducted a national online survey among chief hospital pharmacists focusing on medication management at hospital discharge. To put our findings in perspective, Cochrane reviews and guidelines were searched for summarised evidence and recommendations on interventions. Based on answers in the survey, hospitals with implemented models to support patients at discharge were selected for in-depth interviews. In semi-structured interviews, they were asked to describe pharmacists’ involvement in the patients’ pathway throughout the hospital stay. In Swiss hospitals (n = 44 survey participants), interventions to support patients at discharge were frequently implemented, mostly “patient education” (n = 40) and “communication to primary care provider” (n = 34). These interventions were commonly recommended in guidelines. Overall, pharmacists were rarely involved in the interventions on a regular basis. When pharmacists were involved, the services were provided by hospital pharmacies or collaborating community pharmacies. In conclusion, interventions recommended in guidelines were frequently implemented in Swiss hospitals, however pharmacists were rarely involved.
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21
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Nettleton J, Jelski J, Ahmad A. Reducing readmissions and improving patient experience following urological surgery, through early telephone follow-up. BMJ Open Qual 2021; 9:bmjoq-2018-000533. [PMID: 32303500 PMCID: PMC7199917 DOI: 10.1136/bmjoq-2018-000533] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/28/2019] [Accepted: 06/27/2019] [Indexed: 12/17/2022] Open
Abstract
Readmission from urological surgery is common, with a readmission rate for day case surgery of 3.7% and 26% for robot-assisted cystectomy. Readmission to secondary care and representation to primary care are both expensive and preventable. This project aimed to reduce both and also enhance the care of patients following urological surgery in a large tertiary referral centre, within the National Health Service. A retrospective telephone follow-up (TFU) survey was set up in the early postoperatively period to measure reattendance and readmission rates and perception of care received. Patients were also asked to suggest how improvement could be made. Quality improvement tools were used to optimise and review the methods and timing of TFU. TFU was initiated as a strategy to enhance care and reduce readmission rates. Phone calls were targeted to occur between 48 and 72 hours following discharge. During the intervention period, 484 phone calls were attempted with 343 being successful. Reattendance rates were reduced by 13% and patient satisfaction improved by 19.6%, following TFU. This intervention also generated additional income for the organisation and enhanced patient satisfaction in the early postoperative period.
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Affiliation(s)
- Jeremy Nettleton
- Department of Urology, North Bristol NHS Trust, Bristol Urological Institute, Bristol, UK
| | - Joseph Jelski
- Department of Urology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| | - Adnan Ahmad
- Department of Urology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
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Farzanegan B, Farzanegan R, Behgam Shadmehr M, Lajevardi S, Niakan Kalhori SR. Prediction of Patient's Adherence to the Post-Intubation Tracheal Stenosis Follow-up Plan in Iran: Application of two Data Mining Techniques. TANAFFOS 2020; 19:330-339. [PMID: 33959170 PMCID: PMC8088141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 08/01/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Timely diagnosis of post-intubation tracheal stenosis (PITS), which is one of the most serious complications of endotracheal intubation, may change its natural history. To prevent PITS, patients who are discharged from the intensive care unit (ICU) with more than 24 hours of intubation should be actively followed-up for three months after extubation. This study aimed to evaluate the abilities of artificial neural network (ANN) and decision tree (DT) methods in predicting the patients' adherence to the follow-up plan and revealing the knowledge behind PITS screening system development requirements. MATERIALS AND METHODS In this cohort study, conducted in 14 ICUs during 12 months in ten cities of Iran, the data of 203 intubated ICU-discharged patients were collected. Ten influential factors were defined for adherences to the PITS follow-up (P<0.05). A feed-forward multilayer perceptron algorithm was applied using a training set (two-thirds of the entire data) to develop a model for predicting the patients' adherence to the follow-up plan three months after extubation. The same data were used to develop a C5.0 DT in MATLAB 2010a. The remaining one-third of data was used for model testing, based on the holdout method. RESULTS The accuracy, sensitivity, and specificity of the developed ANN classifier were 83.30%, 72.70%, and 89.50%, respectively. The accuracy of the DT model with five nodes, 13 branches, and nine leaves (producing nine rules for active follow-up) was 75.36%. CONCLUSION The developed classifier might aid care providers to identify possible cases of non-adherence to the follow-up and care plans. Overall, active follow-up of these patients may prevent the adverse consequences of PITS after ICU discharge.
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Affiliation(s)
- Behrooz Farzanegan
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roya Farzanegan
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Behgam Shadmehr
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sharareh R. Niakan Kalhori
- Department of Health information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Aloy-Prósper A, Pellicer-Chover H, Balaguer-Martínez J, Llamas-Monteagudo O, Peñarrocha-Diago M. Patient compliance to postoperative instructions after third molar surgery comparing traditional verbally and written form versus the effect of a postoperative phone call follow-up a: A randomized clinical study. J Clin Exp Dent 2020; 12:e909-e915. [PMID: 33154791 PMCID: PMC7600202 DOI: 10.4317/jced.56680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/08/2020] [Indexed: 11/05/2022] Open
Abstract
Background The understanding and adherence to postoperative care instructions may be influenced by how they are presented by the professional interfering the recuperation process after surgery. The aim of this study was to evaluate the effect of a postoperative phone call follow-up compared with a traditional verbally and written instructions regarding compliance of postoperative recommendations after third molar surgery; and secondly, to discover the main points of non-compliance. Material and Methods A randomized clinical study was performed including patients that underwent surgical extraction of an impacted mandibular or maxillary third molar in the Oral Surgery Unit of the University of Valencia from January 2016 to January 2017. Patients were randomly assigned to one of three different test groups according to how the post-operative instructions were delivered: brief written instructions, written extended instructions or brief written instructions plus a phone call follow-up at 3-day postoperative period. Patients were interviewed about their adherence to the instructions one week after surgery. The significance level was set at p<0.05. Results The higher score of compliance was found to the phone call follow-up group (p=0.001). No statistically significant differences were found between brief written group and the group that received written extended instructions. In the phone call follow-up group all variables assessed to the compliance were fulfilled. To brief written and written extended instructions groups, the main points of non-compliance were hygiene and smoking (p<0.001, p=0.026, respectively), and tended towards significance for chlorhexidine rinses and antibiotic, analgesic and anti-inflammatories medication prescribed. Conclusions Telephone call follow-up can promote patient adherence to postoperative recommendations after third molar surgery. The main factors of non-compliance were not maintain a proper hygiene and not smoking, followed by not performing chlorhexidine rinses and not following medication prescribed. Key words:Compliance, postoperative instructions, postoperative recommendations, third molar surgery.
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Affiliation(s)
- Amparo Aloy-Prósper
- DDS, PhD. Assistant Professor of Oral Surgery, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Hilario Pellicer-Chover
- DDS, PhD. Collaborating Professor of the Master in Oral Surgery and Implant Dentistry, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - José Balaguer-Martínez
- DDS, MSc. Student of Master in Oral Surgery and Implant Dentistry, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Oscar Llamas-Monteagudo
- Master in Oral Surgery and Implant Dentistry, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Miguel Peñarrocha-Diago
- MD, PhD. Chairman of Oral Surgery, Stomatology Department, Faculty of Medicine and Dentistry, University of Valencia, Spain
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Ragesh G, Ganjekar S, Thippeswamy H, Desai G, Hamza A, Chandra PS. Feasibility, Acceptability and Usage Patterns of a 24-Hour Mobile Phone Helpline Service for Women Discharged from a Mother-Baby Psychiatry Unit (MBU) in India. Indian J Psychol Med 2020; 42:530-534. [PMID: 33354078 PMCID: PMC7735230 DOI: 10.1177/0253717620954148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND For women with perinatal mental illness, phone helplines may be a useful way of accessing help. This study assessed the feasibility, acceptability, limitations, and usage patterns of a helpline service for mothers discharged from a mother-baby psychiatry unit. METHODS Mothers discharged from a mother baby unit during an 18-month period were provided with a helpline number. A social worker answered the calls. Details of the calls, including the reasons and the interventions provided, were recorded. Feasibility and acceptability were assessed by calling all users and nonusers. Satisfaction with the helpline was recorded among users, and reasons for not calling were assessed among nonusers. RESULTS Among 113 mothers, 51 (45%) made 248 calls. Calls were regarding medication, sleep problems, planning pregnancies, symptom exacerbation, appointments, and suicidal ideation. Some calls were related to domestic violence (n = 13, 5.24%), and infant health and breastfeeding (n = 11, 4.44%). Seventy-six (67%, 44 callers and 32 noncallers) were contacted. The majority (41/44) of the callers found it useful: 91% said they got help, and 95% said they would recommend it to others. However, language difficulties (9%) and technical problems (5%) were reported. Among the noncallers, the majority reported having experienced no problem related to mental health or had contacted a doctor. However, of the noncallers, one woman died of suicide, did not have access to a phone, and the family did not choose to call. CONCLUSIONS Helpline phone service appears to be feasible and acceptable and can be adapted in other mother-baby psychiatry units in low and middle-income countries. However, in some women, the nonavailability of a phone may be a limiting factor.
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Affiliation(s)
- G Ragesh
- Dept. of Psychiatric Social Work, Institute of Mental Health and Neurosciences, Govt. Medical College campus, Kozhikode, Kerala, India
| | - Sundarnag Ganjekar
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Harish Thippeswamy
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Geetha Desai
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Ameer Hamza
- Retd Additional Professor, Dept. of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Prabha S Chandra
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Draaijer M, Lalla-Edward ST, Venter WDF, Vos A. Phone Calls to Retain Research Participants and Determinants of Reachability in an African Setting: Observational Study. JMIR Form Res 2020; 4:e19138. [PMID: 32996891 PMCID: PMC7557447 DOI: 10.2196/19138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 06/13/2020] [Accepted: 08/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background Long-term retention of research participants in studies is challenging. In research in sub-Saharan Africa, phone calls are the most frequently used method to distantly engage with participants. Objective We aimed to get insight into the effectiveness of phone calls to retain contact with participants and evaluated determinants of reachability. Methods A cross-sectional study was performed using the databases of two randomized controlled trials investigating different kinds of antiretroviral therapy in HIV-positive patients. One trial finished in 2018 (study 1), and the other finished in 2015 (study 2). A random sample size of 200 participants per study was obtained. There were up to 3 phone numbers available per participant collected during the studies. Participants received a maximum of 3 phone calls on every available number on different days and at different times. Voicemails were left, and emails sent wherever possible. We documented how many calls were answered, who answered, as well as after how many attempts participants were reached. To further increase our understanding of reachability, we conducted a short questionnaire assessing factors contributing to reachability. The study was approved by the Research Ethics Committee of the University of Witwatersrand, Johannesburg, South Africa (reference number M1811107). Results In our sample size of n=200 per study, study 1, with a median time of 11 months since the last visit at the research site, had a response rate of 70.5% (141/200) participants while study 2, with a median duration of 55 months since the last visit, had a response rate of 50.0% (100/200; P<.001). In study 1, 61.5% (123/200) of calls were answered directly by the participant while this was 36.0% (72/200) in study 2 (P=.003). The likelihood of reaching a participant decreased with time (odds ratio [OR] 0.73, 95% CI 0.63 to 0.84) for every year since the last face-to-face visit. Having more phone numbers per participant increased reachability (OR 2.32, 95% CI 1.24 to 4.36 for 2 phone numbers and OR 3.03, 95% CI 1.48 to 6.22 for 3 phone numbers compared with 1 number). A total of 141 of 241 reached participants responded to the questionnaire. Of the 93 participants who had changed phone numbers, 5% (50/93) had changed numbers because their phone was stolen. The most preferred method of being contacted was direct calling (128/141) with participants naming this method followed by WhatsApp (69/141). Conclusions Time since last visit and the number of phone numbers listed were the only determinants of reachability. Longer follow-up time is accompanied with a decrease in reachability by phone while more listed phone numbers increases the likelihood that someone can be reached. Trial Registration ClinicalTrials.gov NCT02671383; https://clinicaltrials.gov/ct2/show/NCT02671383 and ClinicalTrials.gov NCT02670772; https://clinicaltrials.gov/ct2/show/NCT02670772
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Affiliation(s)
- Melvin Draaijer
- Department of Global Health, VU Medical Center, Amsterdam University Medical Centers, Amsterdam, Netherlands.,Ezintsha (subdivision of Wits Reproductive Health and HIV Institute), University of Witwatersrand, Johannesburg, South Africa
| | - Samanta Tresha Lalla-Edward
- Ezintsha (subdivision of Wits Reproductive Health and HIV Institute), University of Witwatersrand, Johannesburg, South Africa
| | - Willem Daniel Francois Venter
- Ezintsha (subdivision of Wits Reproductive Health and HIV Institute), University of Witwatersrand, Johannesburg, South Africa
| | - Alinda Vos
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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A Systematic Literature Review of Concepts and Factors Related to Pro-Environmental Consumer Behaviour in Relation to Waste Management Through an Interdisciplinary Approach. SUSTAINABILITY 2020. [DOI: 10.3390/su12114452] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although there has been a steady increase in the number of studies on consumer behaviour in relation to sustainable development, there is limited focus on the product disposal phase. This systematic literature review intends to: (1) clarify how concepts related to pro-environmental consumer behaviour are understood and analysed in the academic literature on waste management; (2) discover any interplay between pro-environmental consumer behaviour and generic consumer behaviour, and the conditions and factors that favour it. A typical systematic literature review methodology was applied to the papers available on Web of Science, Science Direct and EBSCO (Elton Bryson Stephens Company) host between 1975 and 2019, leading to the selection of 699 final papers. The findings reveal that: (1) Although scholars tend to create a variety of pro-environmental consumer behaviour models depending on their specific field of inquiry, all approaches can be traced back to a limited number of reference theories; (2) The overall level of interplay between pro-environmental consumer behaviour and generic consumer behaviour is limited, nevertheless a favourable context or a supportive institutional-legal framework can significantly influence it; (3) A plethora of conditions and factors favour this type of interplay, involving social psychology, laws, economics, institutions and more; (4) Several critical issues appear in the analysed papers, especially some scholars’ assumptions to be able to identify all key factors. It follows the need for a more interdisciplinary approach, a deeper analysis of the effectiveness of the intervention measures at the governmental and institutional level, and a clear classification of factors and conditions (as proposed by this review).
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Rezamand F, Shahnazi H, Hassanzadeh A. The Effect of Continuous Care Model Implementation on the Quality of Life of Patients with Heart Failure: A Randomized Controlled Trial. Korean J Fam Med 2020; 42:107-115. [PMID: 32434300 PMCID: PMC8010439 DOI: 10.4082/kjfm.20.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/02/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Heart failure is an important chronic and progressive disease worldwide. Patients are faced with several stressors that decrease their quality of life (QoL). The present study aimed to determine the effectiveness of implementing a continuous care model on improving the QoL of patients with heart failure. METHODS In the present randomized controlled trial, 72 patients with heart failure admitted to Shahid Chamran Hospital of Isfahan (in Central Iran) were randomly divided into 36-individual two groups: the experimental (continuous care model) and control (normal care) groups. In the experimental group, the continuous care model was implemented for 3 months. Data were collected using the standard Minnesota Living with Heart Failure Questionnaire for patients with heart failure. Subsequently, the collected data were entered into the IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA) and analyzed using the Mann-Whitney U-test, chi-square test, and independent and paired t-test at a significance level of α≤0.05. RESULTS The results indicated that the mean scores of QoL before the implementation of continuous care model were 43.3±6.1 in the experimental group and 42.7±5.1 in the control group, indicating no statistically significant difference between the two groups. After the implementation of continuous care model, the mean score of QoL of the experimental group was significantly higher than that of the control group. CONCLUSION Considering the results obtained in the present study, model implementation could improve the overall scores of QoL in patients with chronic heart failure.
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Affiliation(s)
- Fatemeh Rezamand
- Student Research Committee, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Shahnazi
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akbar Hassanzadeh
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Biersteker TE, Boogers MJ, de Lind van Wijngaarden RA, Groenwold RH, Trines SA, van Alem AP, Kirchhof CJ, van Hof N, Klautz RJ, Schalij MJ, Treskes RW. Use of Smart Technology for the Early Diagnosis of Complications After Cardiac Surgery: The Box 2.0 Study Protocol. JMIR Res Protoc 2020; 9:e16326. [PMID: 32314974 PMCID: PMC7201318 DOI: 10.2196/16326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/19/2019] [Accepted: 02/26/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF), sternal wound infection, and cardiac decompensation are complications that can occur after cardiac surgery. Early detection of these complications is clinically relevant, as early treatment is associated with better clinical outcomes. Remote monitoring with the use of a smartphone (mobile health [mHealth]) might improve the early detection of complications after cardiac surgery. OBJECTIVE The primary aim of this study is to compare the detection rate of AF diagnosed with an mHealth solution to the detection rate of AF diagnosed with standard care. Secondary objectives include detection of sternal wound infection and cardiac decompensation, as well as assessment of quality of life, patient satisfaction, and cost-effectiveness. METHODS The Box 2.0 is a study with a prospective intervention group and a historical control group for comparison. Patients undergoing cardiac surgery at Leiden University Medical Center are eligible for enrollment. In this study, 365 historical patients will be used as controls and 365 other participants will be asked to receive either The Box 2.0 intervention consisting of seven home measurement devices along with a video consultation 2 weeks after discharge or standard cardiac care for 3 months. Patient information will be analyzed according to the intention-to-treat principle. The Box 2.0 devices include a blood pressure monitor, thermometer, weight scale, step count watch, single-lead electrocardiogram (ECG) device, 12-lead ECG device, and pulse oximeter. RESULTS The study started in November 2018. The primary outcome of this study is the detection rate of AF in both groups. Quality of life is measured with the five-level EuroQol five-dimension (EQ-5D-5L) questionnaire. Cost-effectiveness is calculated from a society perspective using prices from Dutch costing guidelines and quality of life data from the study. In the historical cohort, 93.9% (336/358) completed the EQ-5D-5L and patient satisfaction questionnaires 3 months after cardiac surgery. CONCLUSIONS The rationale and design of a study to investigate mHealth devices in postoperative cardiac surgery patients are presented. The first results are expected in September 2020. TRIAL REGISTRATION ClinicalTrials.gov NCT03690492; http://clinicaltrials.gov/show/NCT03690492. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16326.
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Affiliation(s)
- Tom E Biersteker
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Mark J Boogers
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Rolf Hh Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Serge A Trines
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Anouk P van Alem
- Department of Cardiology, Haaglanden Medisch Centrum, Den Haag, Netherlands
| | | | - Nicolette van Hof
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert Jm Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Roderick W Treskes
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
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Feasibility of Telephone Follow-Up after Critical Care Discharge. Med Sci (Basel) 2020; 8:medsci8010016. [PMID: 32183263 PMCID: PMC7151604 DOI: 10.3390/medsci8010016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Critical care has evolved from a primary focus on short-term survival, with greater attention being placed on longer-term health care outcomes. It is not known how best to implement follow-up after critical care discharge. Study aims were to (1) assess the uptake and feasibility of telephone follow-up after a critical care stay and (2) profile overall physical status and recovery during the sub-acute recovery period using a telephone follow-up assessment. Methods: Adults who had been admitted to critical care units of St. James’s Hospital, Dublin, for >72 h were followed up by telephone 3–9 months post discharge from critical care. The telephone assessment consisted of a battery of questionnaires (including the SF-36 questionnaire and the Clinical Frailty Scale) and examined quality of life, frailty, employment status, and feasibility of telephone follow-up. Results: Sixty five percent (n = 91) of eligible participants were reachable by telephone. Of these, 80% (n = 73) participated in data collection. Only 7% (n = 5) expressed a preference for face-to-face hospital-based follow-up as opposed to telephone follow-up. For the SF-36, scores were lower in a number of physical health domains as compared to population norms. Frailty increased in 43.2% (n = 32) of participants compared to pre-admission status. Two-thirds (n = 48) reported being >70% physically recovered. Conclusion: Results showed that telephone follow-up is a useful contact method for a typically hard-to-reach population. Deficits in physical health and frailty were noted in the sub-acute period after discharge from critical care.
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Van Haren RM, Correa AM, Sepesi B, Rice DC, Hofstetter WL, Roth JA, Swisher SG, Walsh GL, Vaporciyan AA, Mehran RJ, Antonoff MB. Hospital readmissions after pulmonary resection: post-discharge nursing telephone assessment identifies high risk patients. J Thorac Dis 2020; 12:184-190. [PMID: 32274083 PMCID: PMC7139035 DOI: 10.21037/jtd.2020.02.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We previously reported that post-discharge nursing telephone assessments identified a frequent number of patient complaints. Our aim was to determine if telephone assessments can identify patients at risk for emergency room (ER) visits or hospital readmissions. Methods A single-institution, retrospective review was performed on all patients undergoing pulmonary resection over a 12-month period. Standardized nursing telephone calls were conducted and records were reviewed to determine postoperative issues. ER visits and readmissions within 30 and 90 days were recorded. Results In total, 521 patients underwent pulmonary resection and 245 (47%) were reached for telephone assessment. ER visits within 30/90 days were 8.1% (n=42) and 12.1% (n=63). Readmissions within 30/90 days were 3.1% (n=16) and 6% (n=31). For those reached by telephone assessment, patients with major issue demonstrated increased 30-day ER visits: 22.6% (n=7) vs. 8.0% (n=17), P=0.019. For all patients, those with 90-day ER visit and/or readmission were more likely to have pulmonary complications during initial admission (43.8% vs. 21.2%, P<0.001). Among patients who were reached by telephone, independent predictors of ER visit or readmission within 30 days were: major issue identified on telephone assessment (P=0.007), discharge with chest tube (<0.001), and reintubation postoperatively (P=0.047). Conclusions Standardized nursing telephone assessments were able to identify a high-risk population more likely to need ER visit or readmission. However, telephone assessments did not decrease ER visits or readmissions. Improved post-discharge protocols are needed for these high-risk patients in order to ensure patient safety, optimize patient experience, and limit unnecessary resource utilization.
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Affiliation(s)
- Robert M Van Haren
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine. Cincinnati, OH, USA
| | - Arlene M Correa
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jack A Roth
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Schofield T, Bhatia RS, Yin C, Hahn-Goldberg S, Okrainec K. Patient experiences using a novel tool to improve care transitions in patients with heart failure: a qualitative analysis. BMJ Open 2019; 9:e026822. [PMID: 31239302 PMCID: PMC6597626 DOI: 10.1136/bmjopen-2018-026822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the utility of a novel discharge tool adapted for heart failure (HF) on patient experience. DESIGN Semistructured interviews assessed the utility of a novel discharge tool adapted for HF; patient-oriented discharge summary (PODS-HF) at 72 hours and 30 days after leaving hospital. Interviews were recorded and transcribed verbatim. Three investigators used directed content analysis to determine themes and subthemes from the narrative data. SETTING The cardiology ward of an urban academic institution in Canada. PARTICIPANTS 13 patients and caregivers completed 24 interviews. Eligible patients were >18 years and admitted with a diagnosis of HF. RESULTS Analysis revealed six interconnected themes: (1) Utility of discharge instructions: how patients perceive and use written and verbal instructions. Patients receiving PODS-HF identified value in the patient-centred summarised content. (2) Adherence: strategies used by patients to enhance adherence to medications, diet and lifestyle changes. PODS-HF provides a strong visual reminder, particularly early postdischarge. (3) Adaptation: how patients incorporate changes into 'new norms'. This was more evident by 30 days, and those using PODS-HF had less unscheduled visits and readmissions. (4) Relationships with healthcare providers: patients' perceptions of the roles of family physicians and specialists in follow-up care. (5) Role of family and caregivers: the pivotal role of caregivers in supporting adherence and adaptation. (6) Follow-up phone calls: the utility of follow-up calls, particularly early after discharge as a means of providing clarification, reassurance and education. CONCLUSION PODS-HF is a useful tool that increases patients' confidence to self-manage and facilitates adherence by providing relevant written information to reference after discharge.
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Affiliation(s)
- Toni Schofield
- Department of Cardiology, Toronto General Hospital, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
| | - Cindy Yin
- Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
| | | | - Karen Okrainec
- Department of Medicine, University Hospital Network, Toronto, Ontario, Canada
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Vernon D, Brown JE, Griffiths E, Nevill AM, Pinkney M. Reducing readmission rates through a discharge follow-up service. Future Healthc J 2019; 6:114-117. [PMID: 31363517 PMCID: PMC6616175 DOI: 10.7861/futurehosp.6-2-114] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Approximately 15% of elderly patients are readmitted within 28 days of discharge. This costs the NHS and patients. Previous studies show telephone contact with patients -post-discharge can reduce readmission rates. This service -evaluation used a cohort design and compared 30-day emergency readmission rate in patients identified to receive a community nurse follow-up with patients where no attempt was made. 756 patients across seven hospital wards were -identified; 303 were identified for the intervention and 453 in a -comparison group. Hospital admission and readmission data was extracted over 6 months. Where an attempt to contact a patient was made post-discharge, the readmission rate was 9.24% compared to 15.67% where no attempt to -contact was made (p=0.011). After adjustment for -confounding using logistic regression, there was evidence of reduced readmissions in the 'attempt to contact' group odds ratio = 1.93 (95% c-onfidence interval = 1.06-3.52, p=0.033). Of the patients who community nurses attempted to contact, 288 were contacted, and 202 received a home visit with general practitioner -referral and medications advice being the most common -interventions initiated. This service evaluation shows that a simple intervention where community nurses attempt to contact and visit geriatric patients after discharge causes a significant reduction in 30-day hospital readmissions.
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Odeh M, Scullin C, Fleming G, Scott MG, Horne R, McElnay JC. Ensuring continuity of patient care across the healthcare interface: Telephone follow-up post-hospitalization. Br J Clin Pharmacol 2019; 85:616-625. [PMID: 30675742 DOI: 10.1111/bcp.13839] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/20/2018] [Accepted: 12/09/2018] [Indexed: 01/14/2023] Open
Abstract
AIMS To implement pharmacist-led, postdischarge telephone follow-up (TFU) intervention and to evaluate its impact on rehospitalization parameters in polypharmacy patients, via comparison with a well-matched control group. METHOD Pragmatic, prospective, quasi-experimental study. Intervention patients were matched by propensity score techniques with a control group. Guided by results from a pilot study, clinical pharmacists implemented TFU intervention, added to routine integrated medicines management service. RESULTS Using an intention to treat approach, reductions in 30- and 90-day readmission rates for intervention patients compared with controls were 9.9% [odds ratio = 0.57; 95% confidence interval (CI): 0.36-0.90; P < 0.001] and 15.2% (odds ratio = 0.53; 95% CI: 0.36-0.79; P = 0.021) respectively. Marginal mean time to readmission was 70.9 days (95% CI: 66.9-74.9) for intervention group compared with 60.1 days (95% CI: 55.4-64.7) for controls. Mean length of hospital stay compared with control was (8.3 days vs. 6.7 days; P < 0.001). Benefit: cost ratio for 30-day readmissions was 29.62, and 23.58 for 90-day interval. Per protocol analyses gave more marked improvements. In intervention patients, mean concern scale score, using Beliefs about Medicine Questionnaire, was reduced 3.2 (95% CI: -4.22 to -2.27; P < 0.001). Mean difference in Medication Adherence Report Scale was 1.4 (22.7 vs. 24.1; P < 0.001). Most patients (83.8%) reported having better control of their medicines after the intervention. CONCLUSIONS Pharmacist-led postdischarge structured TFU intervention can reduce 30- and 90-day readmission rates. Positive impacts were noted on time to readmission, length of hospital stay upon readmission, healthcare costs, patient beliefs about medicines, patient self-reported adherence and satisfaction.
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Affiliation(s)
- Mohanad Odeh
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK.,Faculty of Pharmaceutical Sciences, Hashemite University, Jordan
| | - Claire Scullin
- Medicines Optimisation Innovation Centre (MOIC), Antrim, UK
| | - Glenda Fleming
- Medicines Optimisation Innovation Centre (MOIC), Antrim, UK
| | | | - Robert Horne
- School of Pharmacy, University College London, London, WC1N 1AX, UK
| | - James C McElnay
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, BT9 7BL, UK
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Qiao S, Tang L, Zhang W, Tian S, Liu M, Yang L, Ye Z. Nurse-led follow-up to outpatients with cancer pain treated with opioids at home-telephone calls plus WeChat versus telephone calls only: a quasi-experimental study. Patient Prefer Adherence 2019; 13:923-931. [PMID: 31239650 PMCID: PMC6559775 DOI: 10.2147/ppa.s203900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/30/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Recently, cancer pain management has come increasingly to be provided in outpatient settings, requiring health-care providers and outpatients to take on responsibilities. Pain is among the most distressing symptoms of cancer. Objectives: To compare the effectiveness of nurse-led telephone calls plus WeChat versus telephone calls only for the pain management of outpatients with cancer. Methods: 231 outpatients with cancer pain were classified into two groups (group 1, N=125; group 2, N=106). Group 1 was followed up with weekly telephone calls for eight weeks, and group 2 with weekly telephone calls combined with the booklets through WeChat for eight weeks. Differences between groups in pain level, side effects, medication adherence, and satisfaction with pain management were analyzed, and statistical differences were tested usingan independent-sample t-test and a chi-squared test. Results: Group 2 had a significantly lower rest pain (p<0.01), and lower move pain but there was no statistical difference between the two groups. Among patients in group 2, constipation, nausea and vomiting, and dizziness were less (p<0.01), while medication adherence (p<0.05) and pain management satisfaction were higher (p<0.01) than patients in group 1. Conclusion: Nurse-led follow-up telephone calls combined with WeChat significantly reduced opioid-related health problems, such as pain intensity, side effects and medication adherence.
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Affiliation(s)
- Shina Qiao
- Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Leiwen Tang
- Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Weibo Zhang
- Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Suming Tian
- Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Minjun Liu
- Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Lili Yang
- Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Zhihong Ye
- Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
- Correspondence: Zhihong YeAffiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3rd Qingchun Road East, Hangzhou, People’s Republic of ChinaTel +86 136 0661 2119Email
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Finlayson K, Chang AM, Courtney MD, Edwards HE, Parker AW, Hamilton K, Pham TDX, O’Brien J. Transitional care interventions reduce unplanned hospital readmissions in high-risk older adults. BMC Health Serv Res 2018; 18:956. [PMID: 30541530 PMCID: PMC6291980 DOI: 10.1186/s12913-018-3771-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute hospital services account for the largest proportion of health care system budgets, and older adults are the most frequent users. As a result, older people who have been recently discharged from hospital may be at greater risk of readmission. This study aims to evaluate the comparative effectiveness of transitional care interventions on unplanned hospital readmissions within 28 days, 12 weeks and 24 weeks following hospital discharge. METHOD The present study was a randomised controlled trial (ACTRN12608000202369). The trial involved 222 participants who were recruited from medical wards in two metropolitan hospitals in Australia. Participants were eligible for inclusion if they were aged 65 years and over, admitted with a medical diagnosis and had at least one risk factor for readmission. Participants were randomised to one of four groups: standard care, exercise program only, Nurse Home visit and Telephone follow-up (N-HaT), or Exercise program and Nurse Home visit and Telephone follow-up (ExN-HaT). Socio-demographics, health and functional ability were assessed at baseline, 28 days, 12 weeks and 24 weeks. The primary outcome measure was unplanned hospital readmission which was defined as any hospital admission for an unforeseen or unplanned cause. RESULTS Participants in the ExN-HaT or the N-HaT groups were 3.6 times and 2.6 times respectively significantly less likely to have an unplanned readmission 28 days following discharge (ExN-HaT group HR 0.28, 95% CI 0.09-0.87, p = 0.029; N-HaT group HR 0.38, 95% CI 0.13-1.07, p = 0.067). Participants in the ExN-HaT or the N-HaT groups were 2.13 and 2.63 times respectively less likely to have an unplanned readmission in the 12 weeks after discharge (ExN-HaT group HR 0.47, 95% CI 0.23-0.97, p = 0.014; N-HaT group HR 0.38, 95% CI 0.18-0.82, p = 0.040). At 24 weeks after discharge, there were no significant differences between groups. CONCLUSION Multifaceted transitional care interventions across hospital and community settings are beneficial, with lower hospital readmission rates observed in those receiving more transitional intervention components, although only in first 12 weeks. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry ( ACTRN12608000202369 ).
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Affiliation(s)
- Kathleen Finlayson
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Anne M. Chang
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | | | - Helen E. Edwards
- Faculty of Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Anthony W. Parker
- School of Exercise and Nutrition Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Kyra Hamilton
- School of Applied Psychology, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Thu Dinh Xuan Pham
- School of Cultural and Professional Learning, Faculty of Education, Queensland University of Technology, Brisbane, Australia
| | - Jane O’Brien
- School of Health Sciences, University of Tasmania, Launceston, Australia
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Penney LS, Nahid M, Leykum LK, Lanham HJ, Noël PH, Finley EP, Pugh J. Interventions to reduce readmissions: can complex adaptive system theory explain the heterogeneity in effectiveness? A systematic review. BMC Health Serv Res 2018; 18:894. [PMID: 30477576 PMCID: PMC6260570 DOI: 10.1186/s12913-018-3712-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 11/14/2018] [Indexed: 11/13/2022] Open
Abstract
Background Successfully transitioning patients from hospital to home is a complex, often uncertain task. Despite significant efforts to improve the effectiveness of care transitions, they remain a challenge across health care systems. The lens of complex adaptive systems (CAS) provides a theoretical approach for studying care transition interventions, with potential implications for intervention effectiveness. The aim of this study is to examine whether care transition interventions that are congruent with the complexity of the processes and conditions they are trying to improve will have better outcomes. Methods We identified a convenience sample of high-quality care transition intervention studies included in a care transition synthesis report by Kansagara and colleagues. After excluding studies that did not meet our criteria, we scored each study based on (1) the presence or absence of 5 CAS characteristics (learning, interconnections, self-organization, co-evolution, and emergence), as well as system-level interdependencies (resources and processes) in the intervention design, and (2) scored study readmission-related outcomes for effectiveness. Results Forty-four of the 154 reviewed articles met our inclusion criteria; these studies reported on 46 interventions. Nearly all the interventions involved a change in interconnections between people compared with care as usual (96% of interventions), and added resources (98%) and processes (98%). Most contained elements impacting learning (67%) and self-organization (69%). No intervention reflected either co-evolution or emergence. Almost 40% of interventions were rated as effective in terms of impact on hospital readmissions. Chi square testing for an association between outcomes and CAS characteristics was not significant for learning or self-organization, however interventions rated as effective were significantly more likely to have both of these characteristics (78%) than interventions rated as having no effect (32%, p = 0.005). Conclusions Interventions with components that influenced learning and self-organization were associated with a significant improvement in hospital readmissions-related outcomes. Learning alone might be necessary but not be sufficient for improving transitions. However, building self-organization into the intervention might help people effectively respond to problems and adapt in uncertain situations to reduce the likelihood of readmission. Electronic supplementary material The online version of this article (10.1186/s12913-018-3712-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren S Penney
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA. .,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | - Musarrat Nahid
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Luci K Leykum
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, 2110 Speedway Stop B6500, Austin, TX, 78712-1277, USA
| | - Holly Jordan Lanham
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,Department of Information, Risk and Operations Management, McCombs School of Business, The University of Texas at Austin, 2110 Speedway Stop B6500, Austin, TX, 78712-1277, USA.,Department of Family & Community Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Polly H Noël
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Family & Community Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Erin P Finley
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,Department of Psychiatry, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Jacqueline Pugh
- South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, 78229, USA.,Department of Medicine, The University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
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Iwanoff C, Giannopoulos M, Salamon C. Follow-up postoperative calls to reduce common postoperative complaints among urogynecology patients. Int Urogynecol J 2018; 30:1667-1672. [PMID: 30413866 DOI: 10.1007/s00192-018-3809-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 10/25/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of our study was to identify the most common reasons why postoperative urogynecology patients called their surgeon within the first 6 weeks of surgery. We hypothesize that implementing a follow-up postoperative call (FPC) policy would decrease the number of patient-initiated calls within this postoperative period. METHODS This is a prospective before-and-after cohort study that was conducted in two phases. The initial phase identified the most common reasons why patients call within 6 weeks of their inpatient or outpatient urogynecological surgery. In the second phase, an intervention was implemented where each postoperative patient was called within 48 to 72 h of discharge: the intervention group. The primary outcome was the number of phone calls initiated by patients during the 6-week postoperative period. RESULTS There were 226 patients in the control group and 233 patients in the intervention group. Significantly fewer calls were initiated by patients in the intervention group, both groups having a median of 1 call per person, range 0-8 in the control group and 0-10 in the intervention group (p = 0.04). The five most common complaints were as follows: pain (20.4%), medication management (17.4%), disability paperwork (15.5%), and laboratory results (11.5%). There was a significant reduction in calls concerning constipation, laboratory/pathology results, and disability insurance claims after implementing the FPC policy. CONCLUSIONS The implementation of the FPC policy resulted in fewer patient-initiated calls. As such, there were significant reductions in postoperative complaints of constipation, vaginal bleeding, incomplete bladder emptying, and inquiries into laboratory results and disability paperwork.
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Affiliation(s)
- Christopher Iwanoff
- FPMRS, Atlantic Health System, 435 South Street, Suite 370, Morristown, NJ, 07960, USA.
| | - Maria Giannopoulos
- Obstetrics and Gynecology, Atlantic Health System, 100 Madison Ave, Morristown, NJ, USA
| | - Charbel Salamon
- FPMRS, Atlantic Health System, 435 South Street, Suite 370, Morristown, NJ, 07960, USA
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Yang H, Dervin G, Madden S, Fayad A, Beaulé P, Gagné S, Crossan ML, Wheeler K, Afagh M, Zhang T, Taljaard M. Postoperative Home Monitoring After Joint Replacement: Retrospective Outcome Study Comparing Cases With Matched Historical Controls. JMIR Perioper Med 2018; 1:e10169. [PMID: 33401365 PMCID: PMC7728407 DOI: 10.2196/10169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 09/15/2018] [Accepted: 09/24/2018] [Indexed: 02/01/2023] Open
Abstract
Background A retrospective cohort study was conducted in patients undergoing postoperative home monitoring (POHM) following elective primary hip or knee replacements. Objective The objectives of our study were to compare the cost per patient, readmissions rate, emergency room visits, and mortality within 30 days to the historical standard of care using descriptive analysis. Methods After Research Ethics Board approval, patients who were enrolled and had completed a POHM study were individually matched to historical controls by age, American Society of Anesthesiology class, and procedure at a ratio 1:2. Results A total of 54 patients in the study group and 107 in the control group were eligible for the analysis. Compared with the historical standard of care, the average cost per case was Can $5826.32 (SD 1418.89) in the POHM group and Can $9198.58 (SD 1513.59) for controls. After 30 days, there were 2 emergency room visits (3.7%) and 0 readmissions in the POHM group, whereas there were 8 emergency room visits (7.5%) and 2 readmissions (1.9%) in the control group. No mortalities occurred in either group. Conclusions The POHM study offers an early hospital discharge pathway for elective hip and knee procedures at a 38% reduction of the standard of care cost. The multidisciplinary transitional POHM team may provide a reliable forum to minimize readmissions, and emergency room visits within 30 days postoperatively. Trial Registration ClinicalTrials.gov NCT02143232; https://clinicaltrials.gov/ct2/show/NCT02143232 (Archived by WebCite at http://www.webcitation.org/73WQ9QR6P)
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Affiliation(s)
- Homer Yang
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, Western University, London, ON, Canada
| | - Geoff Dervin
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Susan Madden
- Department of Nursing, The Ottawa Hospital, Ottawa, ON, Canada
| | - Ashraf Fayad
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, Western University, London, ON, Canada
| | - Paul Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Sylvain Gagné
- Department of Anesthesia and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mary Lou Crossan
- Department of Anesthesia and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kathryn Wheeler
- Department of Anesthesia and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Melody Afagh
- Department of Anesthesia and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tinghua Zhang
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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Jayakody A, Passmore E, Oldmeadow C, Bryant J, Carey M, Simons E, Cashmore A, Maher L, Hennessey K, Bunfield J, Terare M, Milat A, Sanson-Fisher R. The impact of telephone follow up on adverse events for Aboriginal people with chronic disease in new South Wales, Australia: a retrospective cohort study. Int J Equity Health 2018; 17:60. [PMID: 29776360 PMCID: PMC5960116 DOI: 10.1186/s12939-018-0776-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic diseases are more prevalent and occur at a much younger age in Aboriginal people in Australia compared with non-Aboriginal people. Aboriginal people also have higher rates of unplanned hospital readmissions and emergency department presentations. There is a paucity of research on the effectiveness of follow up programs after discharge from hospital in Aboriginal populations. This study aimed to assess the impact of a telephone follow up program, 48 Hour Follow Up, on rates of unplanned hospital readmissions, unplanned emergency department presentations and mortality within 28 days of discharge among Aboriginal people with chronic disease. METHODS A retrospective cohort of eligible Aboriginal people with chronic diseases was obtained through linkage of routinely-collected health datasets for the period May 2009 to December 2014. The primary outcome was unplanned hospital readmissions within 28 days of separation from any acute New South Wales public hospital. Secondary outcomes were mortality, unplanned emergency department presentations, and at least one adverse event (unplanned hospital readmission, unplanned emergency department presentation or mortality) within 28 days of separation. Logistic regression models were used to assess outcomes among Aboriginal patients who received 48 Hour Follow Up compared with eligible Aboriginal patients who did not receive 48 Hour Follow Up. RESULTS The final study cohort included 18,659 patients with 49,721 separations, of which 8469 separations (17.0, 95% confidence interval (CI): 16.7-17.4) were recorded as having received 48 Hour Follow Up. After adjusting for potential confounders, there were no significant differences in rates of unplanned readmission or mortality within 28 days between people who received or did not receive 48 Hour Follow Up. Conversely, the odds of an unplanned emergency department presentation (Odds ratio (OR) = 0.92; 95% CI: 0.85, 0.99; P = 0.0312) and at least one adverse event (OR = 0.91; 95% CI: 0.85,0.98; P = 0.0136) within 28 days were significantly lower for separations where the patient received 48 Hour Follow Up compared with those that did not receive follow up. CONCLUSIONS Receipt of 48 Hour Follow Up was associated with both a reduction in emergency department presentations and at least one adverse event within 28 days of discharge, suggesting there may be merit in providing post-discharge telephone follow up to Aboriginal people with chronic disease.
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Affiliation(s)
- Amanda Jayakody
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, 2308, NSW, Australia. .,Hunter Medical Research Institute, New Lambton Heights, 2305, NSW, Australia. .,Evidence and Evaluation, Centre for Epidemiology and Evidence, NSW Ministry of Health LMB 961, North Sydney, Sydney, NSW, 2059, Australia.
| | - Erin Passmore
- Evidence and Evaluation, Centre for Epidemiology and Evidence, NSW Ministry of Health LMB 961, North Sydney, Sydney, NSW, 2059, Australia
| | - Christopher Oldmeadow
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,CREDITSS-Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, HMRI Building, New Lambton Heights, 2305, NSW, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, 2305, NSW, Australia
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, 2305, NSW, Australia
| | - Eunice Simons
- NSW Agency for Clinical Innovation, Level 4, Sage Building, 67 Albert Ave, Chatswood, Sydney, NSW, 2067, Australia
| | - Aaron Cashmore
- Evidence and Evaluation, Centre for Epidemiology and Evidence, NSW Ministry of Health LMB 961, North Sydney, Sydney, NSW, 2059, Australia.,School of Public Health and Community Medicine, University of NSW, Sydney, 2033, Australia
| | - Louise Maher
- Evidence and Evaluation, Centre for Epidemiology and Evidence, NSW Ministry of Health LMB 961, North Sydney, Sydney, NSW, 2059, Australia
| | - Kiel Hennessey
- NSW Agency for Clinical Innovation, Level 4, Sage Building, 67 Albert Ave, Chatswood, Sydney, NSW, 2067, Australia
| | - Jacinta Bunfield
- Centre for Aboriginal Health, NSW Ministry of Health LMB 961, North Sydney, Sydney, NSW, 2059, Australia
| | - Maurice Terare
- Centre for Aboriginal Health, NSW Ministry of Health LMB 961, North Sydney, Sydney, NSW, 2059, Australia
| | - Andrew Milat
- Evidence and Evaluation, Centre for Epidemiology and Evidence, NSW Ministry of Health LMB 961, North Sydney, Sydney, NSW, 2059, Australia.,Sydney Medical School, University of Sydney, Edward Ford Building A27, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, 2308, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, 2305, NSW, Australia
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Rehm KP, Brittan MS, Stephens JR, Mummidi P, Steiner MJ, Gay JC, Ayubi SA, Gujral N, Mittal V, Dunn K, Chiang V, Hall M, Blaine K, O'Neill M, McBride S, Rogers J, Berry JG. Issues Identified by Postdischarge Contact after Pediatric Hospitalization: A Multisite Study. J Hosp Med 2018; 13:236-242. [PMID: 29394301 DOI: 10.12788/jhm.2934] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many hospitals are considering contacting hospitalized patients soon after discharge to help with issues that arise. OBJECTIVE To (1) describe the prevalence of contactidentified postdischarge issues (PDI) and (2) assess characteristics of children with the highest likelihood of having a PDI. DESIGN, SETTING, PATIENTS A retrospective analysis of hospital-initiated follow-up contact for 12,986 children discharged from January 2012 to July 2015 from 4 US children's hospitals. Contact was made within 14 days of discharge by hospital staff via telephone call, text message, or e-mail. Standardized questions were asked about issues with medications, appointments, and other PDIs. For each hospital, patient characteristics were compared with the likelihood of PDI by using logistic regression. RESULTS Median (interquartile range) age of children at admission was 4.0 years (0-11); 59.9% were nonHispanic white, and 51.0% used Medicaid. The most common reasons for admission were bronchiolitis (6.3%), pneumonia (6.2%), asthma (5.1%), and seizure (4.9%). Twenty-five percent of hospitalized children (n=3263) reported a PDI at contact (hospital range: 16.0%-62.8%). Most (76.3%) PDIs were related to follow-up appointments (eg, difficulty getting one); 20.8% of PDIs were related to medications (eg, problems filling a prescription). Patient characteristics associated with the likelihood of PDI varied across hospitals. Older age (age 10-18 years vs <1 year) was significantly (P<.001) associated with an increased likelihood of PDI in 3 of 4 hospitals. CONCLUSIONS PDIs were identified often through hospital-initiated follow-up contact. Most PDIs were related to appointments. Hospitals caring for children may find this information useful as they strive to optimize their processes for follow-up contact after discharge.
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Affiliation(s)
- Kris P Rehm
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Mark S Brittan
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John R Stephens
- North Carolina Children's Hospital, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Pradeep Mummidi
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Michael J Steiner
- North Carolina Children's Hospital, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - James C Gay
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Nitin Gujral
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Vandna Mittal
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kelly Dunn
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Vincent Chiang
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Matt Hall
- Children's Hospital Association, Overland Park, Kansas, USA
| | - Kevin Blaine
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Sarah McBride
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jayne Rogers
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jay G Berry
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Abstract
BACKGROUND Availability of surgical site infection (SSI) surveillance rates challenges clinicians, healthcare administrators and leaders and the public. The purpose of this report is to demonstrate the consequences patient self-assessment strategies have on SSI reporting rates. METHODS We performed SSI surveillance among patients undergoing general surgery procedures, including telephone follow-up 30 days after surgery. Additionally we undertook a separate validation study in which we compared patient self-assessments of SSI with surgeon assessment. Finally, we performed a meta-analysis of similar validation studies of patient self-assessment strategies. RESULTS There were 22/266 in-hospital SSIs diagnosed (8.3%), and additional 16 cases were detected through the 30-day follow-up. In total, the SSI rate was 16.8% (95% CI 10.1-18.5). In the validation survey, we found patient telephone surveillance to have a sensitivity of 66% (95% CI 40-93%) and a specificity of 90% (95% CI 86-94%). The meta-analysis included five additional studies. The overall sensitivity was 83.3% (95% CI 79-88%), and the overall specificity was 97.4% (95% CI 97-98%). Simulation of the meta-analysis results divulged that when the true infection rate is 1%, reported rates would be 4%; a true rate of 50%, the reported rates would be 43%. CONCLUSION Patient self-assessment strategies in order to fulfill 30-day SSI surveillance misestimate SSI rates and lead to an erroneous overall appreciation of inter-institutional variation. Self-assessment strategies overestimate SSIs rate of institutions with high-quality performance and underestimate rates of poor performance. We propose such strategies be abandoned. Alternative strategies of patient follow-up strategies should be evaluated in order to provide valid and reliable information regarding institutional performance in preventing patient harm.
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Yiadom MYAB, Domenico H, Byrne D, Hasselblad MM, Gatto CL, Kripalani S, Choma N, Tucker S, Wang L, Bhatia MC, Morrison J, Harrell FE, Hartert T, Bernard G. Randomised controlled pragmatic clinical trial evaluating the effectiveness of a discharge follow-up phone call on 30-day hospital readmissions: balancing pragmatic and explanatory design considerations. BMJ Open 2018; 8:e019600. [PMID: 29444787 PMCID: PMC5829894 DOI: 10.1136/bmjopen-2017-019600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Hospital readmissions within 30 days are a healthcare quality problem associated with increased costs and poor health outcomes. Identifying interventions to improve patients' successful transition from inpatient to outpatient care is a continued challenge. METHODS AND ANALYSIS This is a single-centre pragmatic randomised and controlled clinical trial examining the effectiveness of a discharge follow-up phone call to reduce 30-day inpatient readmissions. Our primary endpoint is inpatient readmission within 30 days of hospital discharge censored for death analysed with an intention-to-treat approach. Secondary endpoints included observation status readmission within 30 days, time to readmission, all-cause emergency department revisits within 30 days, patient satisfaction (measured as mean Hospital Consumer Assessment of Healthcare Providers and Systems scores) and 30-day mortality. Exploratory endpoints include the need for assistance with discharge plan implementation among those randomised to the intervention arm and reached by the study nurse, and the number of call attempts to achieve successful intervention delivery. Consistent with the Learning Healthcare System model for clinical research, timeliness is a critical quality for studies to most effectively inform hospital clinical practice. We are challenged to apply pragmatic design elements in order to maintain a high-quality practicable study providing timely results. This type of prospective pragmatic trial empowers the advancement of hospital-wide evidence-based practice directly affecting patients. ETHICS AND DISSEMINATION Study results will inform the structure, objective and function of future iterations of the hospital's discharge follow-up phone call programme and be submitted for publication in the literature. TRIAL REGISTRATION NUMBER NCT03050918; Pre-results.
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Affiliation(s)
- Maame Yaa A B Yiadom
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Henry Domenico
- Department of Quality, Safety and Risk Prevention, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel Byrne
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | | | - Cheryl L Gatto
- Learning Health Care Platform, Vanderbilt Institute for Clinical and Translational Research, Nashville, Tennessee, USA
| | - Sunil Kripalani
- Center for Clinical Quality and Implementation Science Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Neesha Choma
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sarah Tucker
- Medicine Patient Services, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Li Wang
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Monisha C Bhatia
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Frank E Harrell
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Tina Hartert
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gordon Bernard
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Parrish AB, O’Neill SM, Crain SR, Russell TA, Sonthalia DK, Nguyen VT, Aboulian A. An Enhanced Recovery After Surgery (ERAS) Protocol for Ambulatory Anorectal Surgery Reduced Postoperative Pain and Unplanned Returns to Care After Discharge. World J Surg 2018; 42:1929-1938. [DOI: 10.1007/s00268-017-4414-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Planning for the Discharge, not for Patient Self-Management at Home - An Observational and Interview Study of Hospital Discharge. Int J Integr Care 2017; 17:1. [PMID: 29588634 PMCID: PMC5854016 DOI: 10.5334/ijic.3003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction and objective Despite recent interest in care transitions, little is known about how patients are prepared for the self-management tasks following the hospitalization. The objective of the study was to explore how discharge information is prepared and provided to patients in the transition from hospital to home. Method The discharge process at three hospitals in Sweden was observed over 12 days spread over ten weeks. In total, 30 discharge encounters were observed followed by interviews with patients and professionals. Data were analysed using qualitative content analysis. Results Much time, effort and resources were used to prepare the discharge; home-going teams and registered nurses planned the practical and social aspects of the discharge and the physicians compiled a plain-language discharge letter. Less focus was given on the actual discharge information to the patients. The discharge encounters lasted for a median of 4:46 minutes and the information had a retrospective focus with information on the hospitalization period, though omitting self-management tasks and life-style advice. Conclusion The discharge letter constitutes the basis for all patient information at discharge. The focus of the discharge encounter needs to be extended beyond mere information to include patient understanding, motivation and skills for self-management at home.
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Yang S. Impact of pharmacist-led medication management in care transitions. BMC Health Serv Res 2017; 17:722. [PMID: 29132369 PMCID: PMC5684763 DOI: 10.1186/s12913-017-2684-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/07/2017] [Indexed: 11/26/2022] Open
Abstract
Background When patients are discharged from hospital to home, it is a highlighted vulnerable period for which medication - related problems are prevalent. Researchers have proposed a telephone follow-up intervention as a means to reduce hospital readmissions. However, the outcome of the intervention with the engagement of pharmacists in managing patients’ medicines after discharge has not been well explored. The objectives of this study were (1) to determine whether a pharmacist telephone follow-up intervention focusing on patients’ medicines management support is associated with a reduction in 30-day readmission rates and (2) to describe the number and types of pharmacist interventions in care transitions. Methods This was a case-cohort study conducted in two acute hospitals in the UK. Pharmacists performed a telephone follow-up intervention to discharged patients to provide medicines management support. Patients who received pharmacist telephone follow-up calls within 14 days of discharge formed the intervention group. A subset of medical patient population discharged in the month of May 2013 formed the comparison group. During a series of two-telephone follow-up, pharmacists identified post-discharge pharmaceutical problems and provided patient-tailored interventions accordingly. The impact of pharmacist interventions was assessed using a risk assessment matrix tool by two senior pharmacists. Overall 30-day readmission rates in the intervention group were measured and compared with the comparison group using a chi-square test. Results Between 5th and 25th June 2013, a total of 62 medical patients participated in the study. Pharmacists provided 192 interventions as a result of pharmacist telephone follow-up intervention. The most prevalent type of interventions was the provision of drug information (n=40), followed by screening patient adherence (n=30) and advising on adverse drug reactions (n=27). The impact of interventions was assessed, and 49.3% of the identified risks intervened by pharmacists were associated with moderate risk. The 30-day readmission rates in the intervention group were 11.3% compared to 9.0% in the control group (p = 0.376); this was not statistically significant. Conclusions A pharmacist TFU intervention did not show a benefit in 30-day hospital readmissions. However, a pharmacist TFU intervention was an effective method to solve or avoid critical pharmaceutical problems. A future study using a larger scale trial is warranted.
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Affiliation(s)
- Seungwon Yang
- Department of Practice and Pharmacy, UCL School of Pharmacy, London, UK.
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Michel B, Hemery M, Rybarczyk-Vigouret MC, Wehrlé P, Beck M. Drug-dispensing problems community pharmacists face when patients are discharged from hospitals: a study about 537 prescriptions in Alsace. Int J Qual Health Care 2017; 28:779-784. [PMID: 27655792 DOI: 10.1093/intqhc/mzw111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 08/13/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives To identify both type and frequency of the challenges community pharmacists face when dispensing drugs from hospital discharge prescriptions, to describe the measures undertaken to resolve the issues at stake and to list their consequences. Design We carried out an observational study in the community pharmacies of the French region of Alsace and asked the community pharmacy staff to review 537 hospital discharge prescriptions in 2013 using anonymous data collection forms. Setting and Participants Nineteen community pharmacies. Main outcome measures Number of patients informed about their medication (at hospital and/or community pharmacy), type and frequency of issues encountered during drug dispensing, type and frequency of measures undertaken to resolve the issues, type and frequency of the consequences regarding drug dispensing. Results Community pharmacists faced 165 challenges from 145 hospital discharge prescriptions (i.e. 27.5% out of 528 analysed prescriptions), mostly correlated to the quality of the prescriptions (n = 100, 60.6%) or to logistical matters (n = 54, 32.7%). A mere 36.8% of the patients received information pertaining to their medication while being hospitalized. Of note, 40.5% of the prescriptions were delivered to pharmacies within 2 days following the patients' discharge. In order to resolve the different issues preventing drugs from being dispensed (n = 33/145 prescriptions), pharmacists sought information, mainly from patients, colleagues and hospital prescribers. The pharmacists were able to dispense all the drugs prescribed in 138 out of 145 cases (95.2%). Conclusions This study highlighted the challenges encountered by community pharmacists and their significant contribution to the continuity of care upon patients being discharged from hospitals.
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Affiliation(s)
- Bruno Michel
- OMEDIT Alsace, Agence Régionale de Santé d'Alsace, 67084 Strasbourg Cedex, France.,Service de Pharmacie, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Laboratoire HuManiS-EA 7308, Faculté de Pharmacie, Université de Strasbourg, 67098 Strasbourg Cedex, France
| | - Marie Hemery
- OMEDIT Alsace, Agence Régionale de Santé d'Alsace, 67084 Strasbourg Cedex, France
| | | | - Pascal Wehrlé
- EA 3452 Equipe pharmacie galénique et pharmacotechnie, Faculté de Pharmacie de Strasbourg, 67401 Illkirch Cedex, France
| | - Morgane Beck
- OMEDIT Alsace, Agence Régionale de Santé d'Alsace, 67084 Strasbourg Cedex, France
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Evaluation of the Effectiveness of a Phone Based Care Coordination Pilot on Hospital Utilisation and Costs for Patients With Chest Pain. Heart Lung Circ 2017; 27:147-153. [PMID: 28511924 DOI: 10.1016/j.hlc.2017.03.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND A small percentage of the population represents a disproportionate number of attendances at emergency departments (ED). "Frequent presenters" to ED with chest pain do not always fit into established pathways for acute myocardial events. With accelerated "rule out" protocols, patients are often discharged from the ED after short lengths of stay. This research will evaluate the effectiveness of a phone based care-coordination pilot designed to meet the needs of patients attending ED with cardiac and non-cardiac chest pain. METHODS A longitudinal, single-arm interventional study with retrospectively recruited control group. Ninety-five patients were enrolled as the intervention group; 97 patients were retrospectively identified as controls. These patients had re-presented with chest pain within 6 months of a cardiac event, or attended hospital within 12 months two or more times with chest pain and/or complex needs. Intervention group patients were holistically assessed then phone-coached to support self-management of chest pain over 6 months. Following descriptive and univariate analysis, multivariate analysis was conducted to adjust for noted differences between the intervention and control groups. RESULTS Thirty-day representation to ED was significantly less for the intervention group (14.1%) compared to controls (27.7%). After adjusting for baseline differences, intervention patients were more than two-fold less likely to re-present compared to controls (OR=0.42, 95%CI: 0.19-0.96). After adjustment for baseline differences, the savings in subsequent inpatient costs was $1588 per person, as a result of intervention, patients were less likely to have inpatient readmissions (16.3%) compared to controls (20.2%), although this was not statistically significant (p=0.588). CONCLUSION A phone based care-coordination pilot with targeted interventions has the potential to reduce ED presentations and hospital readmissions among patients representing with chest pain.
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Sutiono AB, Faried A, McAllister S, Ganefianty A, Sarjono K, Arifin MZ, Derrett S. The Bandung neurosurgery patient outcomes project, Indonesia (Part II): Patient pathways and feasibility and acceptability of telephone follow-up. Int J Health Plann Manage 2017; 33:e49-e56. [PMID: 28252219 DOI: 10.1002/hpm.2406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/19/2017] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Support of neurosurgery patients following discharge from hospital is important. Currently, little is known about patients' in low- and middle-income countries before and after their hospital treatment. This companion paper reports patients' pathways before and after hospital admission and the feasibility of following up this ill-patient population by telephone. METHODS Eligible patients were aged ≥18 years admitted to the Neurosurgery Department in Dr. Hasan Sadikin Hospital-a regional referral hospital in Bandung City, Indonesia. Clinical data were collected on admission by clinicians. In-person interviews were undertaken with a clinical research nurse 1 to 2 days pre-discharge, and telephone follow-up interviews at 1, 2, and 3 months post-discharge. Information was also collected on pathways prior to admission and following discharge. The number of contact attempts for each patient interview was documented, as was the overall acceptability of undertaking a telephone interview. RESULTS Of 178 patients discharged from hospital, 12 later died. Of the remaining 166 patients, 95% were able to be followed up to 3 months. Two-thirds of patients had been referred from another hospital. Patients came from, and were discharged to, locations throughout the West Java region. At the 1-month interview, 84% participants reported that they had had a follow-up consultation with a health professional-mostly with a neurosurgeon. CONCLUSION This study has shown that, with a neurosurgery nurse delegated to the role, it is feasible to conduct follow-up telephone interviews with patients after discharge from a neurosurgery ward and that in fact such follow-up was appreciated by patients.
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Affiliation(s)
- Agung Budi Sutiono
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Ahmad Faried
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Susan McAllister
- Centre for International Health, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Amelia Ganefianty
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Kalih Sarjono
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Muhammad Zafrullah Arifin
- Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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Okhovat F, Abdeyazdan Z, Namnabati M. Effect of Implementation of Continuous Care Model on Mothers' Anxiety of the Children Discharged from the Pediatric Surgical Unit. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2017; 22:37-40. [PMID: 28382056 PMCID: PMC5364750 DOI: 10.4103/ijnmr.ijnmr_63_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction: Child's hospitalization for surgery is a source of anxiety for the child and the family that persists for a long time after discharge. Therefore, it is necessary to provide appropriate solutions in this regard. This study aimed to investigate the effect of implementation of continuous care model on anxiety in mothers of children discharged from pediatric units of educational hospitals of Isfahan University of Medical Sciences in 2016. Materials and Methods: In this quasi-experimental study, 64 mothers of children hospitalized in surgical units were categorized in two groups (experimental and control). The intervention was a continuous care model including orientation, sensitization, follow up, and evaluation stages. We used Spielberg's Anxiety Questionnaire to assess mothers’ anxiety before, 1 week, and 1 month after the intervention. Data were analyzed using descriptive statistics, (t-test and analysis of variance) using the Statistical Package for the Social Sciences version 16. Results: The results of the study showed that the mean anxiety scores of the experimental group were 58.9, 36, and 31.4, respectively, before, 1 week, and 1 month after the intervention (P < 0.001). These scores were 57.5, 55.8, and 49.7, respectively, for the control group. t-test results showed that the mean anxiety scores of the experimental group were significantly less than that of the control group at 1 week and 1 month after the intervention. Conclusions: Based on the results, use of the continuous care model led to a decrease in mothers’ anxiety during their children's discharge from the pediatric surgery units. Therefore, we suggest the implementation of this model in pediatric units.
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Affiliation(s)
- Forogh Okhovat
- Student Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Abdeyazdan
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahboobeh Namnabati
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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