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Ozdemir H, Sagris D, Abdul-Rahim AH, Lip GYH, Shantsila E. Management of ischaemic stroke survivors in primary care setting: the road to holistic care. Intern Emerg Med 2024; 19:609-618. [PMID: 37875703 PMCID: PMC11039521 DOI: 10.1007/s11739-023-03445-y] [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: 05/18/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023]
Abstract
The management of ischaemic stroke survivors is multidisciplinary, necessitating the collaboration of numerous medical professionals and rehabilitation specialists. However, due to the lack of comprehensive and holistic follow-up, their post-discharge management may be suboptimal. Achieving this holistic, patient-centred follow-up requires coordination and interaction of subspecialties, which general practitioners can provide as the first point of contact in healthcare systems. This approach can improve the management of stroke survivors by preventing recurrent stroke through an integrated post-stroke care, including appropriate Antithrombotic therapy, assisting them to have a Better functional and physiological status, early recognition and intervention of Comorbidities, and lifestyles. For such work to succeed, close interdisciplinary collaboration between primary care physicians and other medical specialists is required in a holistic or integrated way.
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Affiliation(s)
- Hizir Ozdemir
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Dimitrios Sagris
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Azmil Husin Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Gregory Yoke Hong Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Eduard Shantsila
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK.
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Ingram L, Pitt R, Shrubsole K. Health professionals' practices and perspectives of post-stroke coordinated discharge planning: a national survey. BRAIN IMPAIR 2024; 25:IB23092. [PMID: 38566295 DOI: 10.1071/ib23092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/08/2024] [Indexed: 04/04/2024]
Abstract
Background It is best practice for stroke services to coordinate discharge care plans with primary/community care providers to ensure continuity of care. This study aimed to describe health professionals' practices in stroke discharge planning within Australia and the factors influencing whether discharge planning is coordinated between hospital and primary/community care providers. Methods A mixed-methods survey informed by the Theoretical Domains Framework was distributed nationally to stroke health professionals regarding post-stroke discharge planning practices and factors influencing coordinated discharge planning (CDP). Data were analysed using descriptive statistics and content analysis. Results Data from 42 participants working in hospital-based services were analysed. Participants reported that post-stroke CDP did not consistently occur across care providers. Three themes relating to perceived CDP needs were identified: (1) a need to improve coordination between care providers, (2) service-specific management of the discharge process, and (3) addressing the needs of the stroke survivor and family . The main perceived barriers were the socio-political context and health professionals' beliefs about capabilities . The main perceived facilitators were health professionals' social/professional role and identity, knowledge, and intentions . The organisation domain was perceived as both a barrier and facilitator to CDP. Conclusion Australian health professionals working in hospital-based services believe that CDP promotes optimal outcomes for stroke survivors, but experience implementation challenges. Efforts made by organisations to ensure workplace culture and resources support the CDP process through policies and procedures may improve practice. Tailored implementation strategies need to be designed and tested to address identified barriers.
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Affiliation(s)
- Lara Ingram
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rachelle Pitt
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; and Office of the Chief Allied Health Officer, Queensland Health, Qld, Australia
| | - Kirstine Shrubsole
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; and Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia; and Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Qld, Australia; and Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Vic., Australia
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Parker SM, Aslani P, Harris-Roxas B, Wright MC, Barr M, Doolan-Noble F, Javanparast S, Sharma A, Osborne RH, Cullen J, Harris E, Haigh F, Harris M. Community health navigator-assisted transition of care from hospital to community: protocol for a randomised controlled trial. BMJ Open 2024; 14:e077877. [PMID: 38309760 PMCID: PMC10840031 DOI: 10.1136/bmjopen-2023-077877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/12/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION The objective of this parallel group, randomised controlled trial is to evaluate a community health navigator (CHN) intervention provided to patients aged over 40 years and living with chronic health conditions to transition from hospital inpatient care to their homes. Unplanned hospital readmissions are costly for the health system and negatively impact patients. METHODS AND ANALYSIS Patients are randomised post hospital discharge to the CHN intervention or usual care. A comparison of outcomes between intervention and control groups will use multivariate regression techniques that adjust for age, sex and any independent variables that are significantly different between the two groups, using multiple imputation for missing values. Time-to-event analysis will examine the relationship between seeing a CHN following discharge from the index hospitalisation and reduced rehospitalisations in the subsequent 60 days and 6 months. Secondary outcomes include medication adherence, health literacy, quality of life, experience of healthcare and health service use (including the cost of care). We will also conduct a qualitative assessment of the implementation of the navigator role from the viewpoint of stakeholders including patients, health professionals and the navigators themselves. ETHICS APPROVAL Ethics approval was obtained from the Research Ethics and Governance Office, Sydney Local Health District, on 21 January 2022 (Protocol no. X21-0438 and 2021/ETH12171). The findings of the trial will be disseminated through peer-reviewed journals and national and international conference presentations. Data will be deposited in an institutional data repository at the end of the trial. This is subject to Ethics Committee approval, and the metadata will be made available on request. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN 12622000659707). ARTICLE SUMMARY The objective of this trial is to evaluate a CHN intervention provided to patients aged over 40 years and living with chronic health conditions to transition from hospital inpatient care to their homes.
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Parisa Aslani
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben Harris-Roxas
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael C Wright
- Health Economics Research and Evaluation, University of Technology, Sydney, New South Wales, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - F Doolan-Noble
- General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Sara Javanparast
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Anurag Sharma
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard H Osborne
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - John Cullen
- Aged Health, Rehabilitation and Chronic Care, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Haigh
- Centre for Health Equity Training, Research and Evaluation, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Mahera M, Rodda H, Monypenny N, Wembridge P. Evaluating an implementation of the Australian National Guidelines for the On-Screen Display of Discharge Summaries. AUST HEALTH REV 2023; 47:535-544. [PMID: 37550180 DOI: 10.1071/ah22248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 07/14/2023] [Indexed: 08/09/2023]
Abstract
Objective The objective of this study was to evaluate changes in the inclusion of pertinent information on electronic discharge summaries (eDS) after implementation of a revised template and electronic medical record (EMR) workflow. Methods A retrospective medical record audit of eDS at three metropolitan hospitals was undertaken for adult inpatient encounters in June 2021 (pre-intervention, n = 100) and June 2022 (post-intervention, n = 100). The eDS were evaluated against 16 components listed in the Australian National Guidelines for the On-Screen Display of Discharge Summaries. Nine components were further broken down to between two and 11 sub-components. Sub-analysis compared a hospital with full EMR to pooled results from hospitals with hybrid EMRs. Components and sub-components were evaluated for inclusion only; accuracy or relevance of the information was not assessed. Results Inclusion of three out of 16 components (presentation details: 47% vs 62%, problems and diagnosis: 61% vs 86% and recipient details: 82% vs 93%) and eight out of 36 sub-components (discharge destination, principal diagnosis, history of presenting complaint, infection risk, pressure injury, screening and/or diagnosis of delirium and GP phone number and address) was higher in the post-intervention group (all P < 0.05). Reduced eDS information inclusion in the post-intervention group was observed for discharge date and falls risk only (both P < 0.05). Reporting of falls history decreased at the hospital with full EMR (71% vs 20% P < 0.001) but not at hospitals utilising hybrid EMRs (24% vs 30% P = 0.5). Conclusion The intervention was associated with improved inclusion of pertinent information as described in the Australian National Guidelines for the On-Screen Display of Discharge Summaries.
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Affiliation(s)
- Masarrat Mahera
- Monash University Eastern Health Clinical School, Box Hill, Vic. 3128, Australia
| | - Hamish Rodda
- eHealth Department, Eastern Health, 8 Arnold Street, Box Hill, Vic. 3128, Australia; and Emergency Department, Eastern Health, 8 Arnold Street, Box Hill, Vic. 3128, Australia
| | - Nick Monypenny
- eHealth Department, Eastern Health, 8 Arnold Street, Box Hill, Vic. 3128, Australia
| | - Paul Wembridge
- Department of Quality, Planning and Innovation, Eastern Health, 8 Arnold Street, Box Hill, Vic. 3128, Australia; and Pharmacy Department, Eastern Health, 8 Arnold Street, Box Hill, Vic. 3128, Australia
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Gridley K, Baxter K, Birks Y, Newbould L, Allan S, Roland D, Malisauskaite G, Jones K. Social care causes of delayed transfer of care (DTOC) from hospital for older people: Unpicking the nuances of 'provider capacity' and 'patient choice'. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4982-e4991. [PMID: 35841589 PMCID: PMC10084034 DOI: 10.1111/hsc.13911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/19/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Unnecessarily prolonged stays in hospitals can have negative impacts on patients and present avoidable costs to health and social care systems. This paper presents the qualitative findings of a multi-methods study of the social care causes of delayed transfers of care (DTOC) for older people in England. The quantitative strand of this study found that DTOC are significantly affected by homecare supply. In this paper, we explore in depth how and why social care capacity factors lead to delays, from the perspectives of those working within the system. We examined the local transfer arrangements in six English local authority (LA) sites that were purposively sampled to include a range of DTOC performance and LA characteristics. Between March and December 2018, 52 professionals involved in arranging or facilitating discharge from hospitals in these sites provided qualitative data, primarily through semi-structured interviews. Topics included discharge teams and processes, strategic issues and perceived causes of delays. The thematic analysis uncovered the nuances behind the causes of DTOC previously categorised broadly as 'provider capacity' and 'patient choice'. In particular, our analysis highlights the lack of fit between available provision and the needs of people leaving hospital (theme 1); workforce inconsistencies (theme 2) and a myth of patient choice (theme 3). We are now at a turning point in the development of policy to reduce DTOC in the English system, with the full implications of a new national discharge to assess programme yet to be seen. Our research shows the significance of the alignment of service capacity, including the type and location of provision, with the needs and preferences of those leaving hospital. As the new system becomes established, attendance to such nuances behind blockages in the system will be more important than ever.
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Affiliation(s)
- Kate Gridley
- Social Policy Research UnitUniversity of YorkYorkUK
| | - Kate Baxter
- Social Policy Research UnitUniversity of YorkYorkUK
| | - Yvonne Birks
- Social Policy Research UnitUniversity of YorkYorkUK
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Hall J, Kroll T, van Wijck F, Bassil-Morozow H. Co-creating Digital Stories With UK-Based Stroke Survivors With the Aim of Synthesizing Collective Lessons From Individual Experiences of Interacting With Healthcare Professionals. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:877442. [PMID: 36189023 PMCID: PMC9397888 DOI: 10.3389/fresc.2022.877442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022]
Abstract
Background Stroke survivor narratives can provide valuable insight into experiences of healthcare and beyond. There is need to further understand collective lessons from stroke survivor narratives, yet prior studies utilizing digital storytelling tend to not synthesize lessons from individual experiences. This study aims to develop a novel method to co-create digital stories with stroke survivors that will aim to synthesize and portray important collective lessons from individual stroke survivors' experiences of interacting with healthcare professionals. Methods This study follows-up a qualitative study conducted with 30 stroke survivors exploring factors that help or hinder survivors to positively reconfigure their identity post-stroke. Five co-creation workshops were conducted with a subset of UK-based stroke survivors from this previous study. Participants were invited to join through: online workshops, an online bulletin board, and as an advisor. A four-stage workshop framework was developed through the integration of UK Design Council's Double Diamond method, digital storytelling strategies and the Behavior Change Wheel (BCW) framework for developing behavioral change interventions. Findings Six online workshop participants (three male, three female; aged 33–63; time since stroke 2–16 years) co-created digital stories that share six collective lessons aimed at increasing empathy and encouraging behavior change in healthcare professionals (HCPs) working with stroke survivors. Online bulletin board participants (n = 1) and advisors (n = 5) supported the co-creation process. Collective lessons identified were: (1) Stroke has a variety of symptoms that must all be considered; (2) Stroke can affect anyone of any age and not just the elderly; (3) Assumptions should not be made about a survivor's lifestyle or habits; (4) It is important to acknowledge the person behind the stroke and ensure that they are communicated with and listened to; (5) Stroke survivors can often feel unprepared for the reality of life after stroke; (6) Adapting to life after stroke is a long-term process requiring long-term support. Conclusion Stroke survivor stories highlighted preconceptions, attitudes and behaviors embedded within healthcare that negatively impacted their experiences and recovery. The novel methodology employed in this study enabled these stories to be synthesized into collective lessons to bring about improvements in these behaviors in future.
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Affiliation(s)
- Joseph Hall
- Department of Media and Journalism, Glasgow School for Business and Society, Glasgow Caledonian University, Glasgow, United Kingdom
- *Correspondence: Joseph Hall
| | - Thilo Kroll
- UCD Centre for Education, Research and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin (UCD), Dublin, Ireland
| | - Frederike van Wijck
- Research Centre for Health, School for Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Helena Bassil-Morozow
- Department of Media and Journalism, Glasgow School for Business and Society, Glasgow Caledonian University, Glasgow, United Kingdom
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