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Koskiniemi S, Sund R, Liukka M, Härkänen M. Readmissions after appointments with nurse prescribers: A register-based study. J Clin Nurs 2023; 32:7783-7790. [PMID: 37485967 DOI: 10.1111/jocn.16837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/16/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Increasing number of nurse prescribers could be part of a solution to the shortage of physicians, improve access to treatment and curb the rise in healthcare costs; however, readmissions after nurse prescribers' appointments are under-researched. AIMS To describe and compare clients' initial appointments with nurse prescribers and physicians. In addition, client readmissions within 60 days in the target organisation after nurse prescribers' and physicians' appointments were investigated. DESIGN Retrospective register-based follow-up study. METHODS Data included client appointments (n = 3986) with nurse prescribers and physicians, and clients' readmissions (n = 9038) from 1 January 2018 to 31 December 2019 from one hospital district in Finland. Data were analysed statistically using frequencies, percentages, rate ratios and cross-tabulation. STROBE checklist was used. RESULTS Initial appointments including trimethoprim, pivmecillinam, phenoxymethyl penicillin, chloramphenicol, fusidic acid and cephalexin prescriptions with nurse prescribers (n = 36) were 2131, and physicians (n = 140) 1855. On average, client readmissions (within 60 days) per initial appointment were 2.10 after appointments with nurse prescribers and 2.46 after physicians. After initial appointments, including phenoxymethyl penicillin prescriptions, with nurse prescribers, clients had more readmissions in all age groups than after initial appointments with physicians. However, in all, after initial appointments with physicians, clients had a higher proportion of readmissions. CONCLUSION Clients have fewer readmissions after appointments with nurse prescribers than physicians, including the same prescriptions. Nurse prescribers' skills may not have been fully utilised. Physicians treated many patients whose diseases nurse prescribers might have been able to treat based on the nurse prescribers' rights. However, physician clients may have more demanding service requirements.
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Affiliation(s)
- Saija Koskiniemi
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Reijo Sund
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mari Liukka
- Wellbeing Services County of Ostrobothnia, Vaasa, Finland
| | - Marja Härkänen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Cruzado-Álvarez C, Pérez-Cabeza AI, Robles-Mezcua A, Robles-Mezcua M, García-Pinilla JM. Analysis of the activity of the telephone nursing consultation on demand for patients with heart failure. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:137-140. [PMID: 36822471 DOI: 10.1016/j.enfcle.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/19/2022] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Analyzing the most frequent reasons for telephone demand in the heart failure nurse's consultation and to evaluate the response resolution capacity after the call. METHOD Descriptive, retrospective study of all telephone calls recorded between June 2020 and April 2021 in a specific nursing consultation for heart failure care. The main sociodemographic and clinical variables, reason for calling and action carried out by the nurse were extracted from the electronic medical records. For its subsequent descriptive análisis. RESULTS 643 calls were analyzed, 354 (55.1%) were made by the patients. The most frequent reason for calling was to consult symptoms 45.8% (n = 162). 71.6% (n = 116) of the consultations were resolved by adjusting the pharmacological treatment by telephone, 24.7% (n = 40) required a face-to-face visit in the nurse's consultation, 22 (13.6%) needed emergency care. 5 due to worsening heart failure. The patients who consulted for symptoms had a worse functional class (p = 0.007) and had been referred from hospitalization (p = 0.023). CONCLUSIONS The telephone consultation was shown to be useful for patients with heart failure, being mainly demanded by users who present symptoms of worsening of their disease.
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Affiliation(s)
- Concepción Cruzado-Álvarez
- Enfermera, Unidad de Insuficiencia Cardiaca, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
| | - Alejandro Isidoro Pérez-Cabeza
- Facultativo Especialista de Área en Cardiología, Unidad de Insuficiencia Cardiaca, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Ainhoa Robles-Mezcua
- Facultativo Especialista de Área en Cardiología, Unidad de Insuficiencia Cardiaca, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - María Robles-Mezcua
- Enfermera, Unidad de Insuficiencia Cardiaca, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - José Manuel García-Pinilla
- Facultativo Especialista de Área en Cardiología, Unidad de Insuficiencia Cardiaca, Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Alcoberro L, Moliner P, Vime J, Jiménez-Marrero S, Garay A, Yun S, Pons-Riverola A, Ramos-Polo R, Ras-Jiménez M, Tajes M, Hidalgo E, Calero E, Ruiz M, José-Bazán N, Ferre C, Delso C, Alcober L, Enjuanes C, Comin-Colet J. Breaking the 30-day barrier: Long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure. PLoS One 2023; 18:e0279815. [PMID: 36749763 PMCID: PMC9904494 DOI: 10.1371/journal.pone.0279815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 12/15/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND AIMS Heart failure (HF) programs successfully reduce 30-day readmissions. However, conflicting data exist about its sustained effects afterwards and its impact on mortality. We evaluated whether the impact of a new nurse-led coordinated transitional HF program extends to longer periods of time, including 90 and 180 days after discharge. METHODS AND RESULTS We designed a natural experiment to undertake a pragmatical evaluation of the implementation of the program. We compared outcomes between patients discharged with HF as primary diagnosis in Period #1 (pre-program; Jan 2017-Aug 2017) and those discharged during Period #2 (HF program; Sept 2017-Jan 2019). Primary endpoint was the composite of all-cause death or all-cause hospitalization 90 and 180 days after discharge. 440 patients were enrolled: 123 in Period #1 and 317 in Period #2. Mean age was 75±9 years. There were more females in Period #2 (p = 0.025), with no other significant differences between periods. The primary endpoint was significantly reduced in the HF program group, at 90 [adjusted OR 0.31 (0.18-0.53), p <0.001] and at 180 days [adjusted OR 0.18 (CI 0.11-0.32), p <0.001]. Such a decrease was due to a reduction in cardiovascular (CV) and HF hospitalization. All-cause death was reduced when a double check discharge planning was implanted compared to usual care [0 (0%) vs. 7 (3.8%), p = 0.022]. CONCLUSION A new nurse-led coordinated transitional bundle of interventions model reduces the composite endpoint of all-cause death and all-cause hospitalization both at 90 and 180 days after a discharge for HF, also in high-risk populations. Such a decrease is driven by a reduction of CV and HF hospitalization. Reduction of all-cause mortality was also observed when the full model including a more exhaustive discharge planning process was implemented.
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Affiliation(s)
- Lidia Alcoberro
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Pedro Moliner
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- * E-mail: (PM); (JC-C)
| | - Joan Vime
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Santiago Jiménez-Marrero
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Alberto Garay
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Yun
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Internal Medicine, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Alexandra Pons-Riverola
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Raúl Ramos-Polo
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Mar Ras-Jiménez
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Internal Medicine, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Tajes
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Encarna Hidalgo
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Esther Calero
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Ruiz
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria José-Bazán
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Carles Ferre
- Emergency Department Short-Stay Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Delso
- Institut Catala de la Salut, SAP Delta Primary Care Service, El Prat de Llobregat, Barcelona, Spain
| | - Laia Alcober
- Institut Catala de la Salut, SAP Delta Primary Care Service, El Prat de Llobregat, Barcelona, Spain
| | - Cristina Enjuanes
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Comin-Colet
- Bellvitge Biomedical Research Institute (IDIBELL), Bio-Heart Cardiovascular Diseases Research Group, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Cardiology, Community Heart Failure Unit, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Institut Catala de la Salut, SAP Delta Primary Care Service, El Prat de Llobregat, Barcelona, Spain
- * E-mail: (PM); (JC-C)
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