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Schmüdderich K, Dörner J, Fahsold A, Palm R, Roes M, Holle B. Current situation, strengths and problems in intra- and interprofessional collaboration in German nursing homes - A holistic multiple case study. BMC Geriatr 2024; 24:610. [PMID: 39020281 PMCID: PMC11253382 DOI: 10.1186/s12877-024-05182-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 06/26/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND The increasing care complexity of nursing home residents living with dementia requires new care models that strengthen professional collaboration. To contribute to the sustainable implementation of new care models, it is important that they are linked to the care reality. However, little is known about intra- and interprofessional organization and provision of care in German nursing homes. Therefore, the aim of this study was to explore the current care situation, problems and strengths regarding intra- and interprofessional collaboration in the care of residents living with dementia. METHODS We conducted a holistic multiple case study. The individual care units in which residents living with dementia are cared for were defined as cases. The context was built by the respective nursing homes and their regional affiliation to the federal state of North Rhine-Westphalia. We used qualitative face-to-face interviews, documents and context questionnaires for data collection. The different sources of evidence served to capture complementary perspectives and to validate the findings. First, the collected qualitative data were analyzed using deductive-inductive content analysis. Second, similarities and differences between the cases were identified to elaborate case-specific and cross-case patterns and themes. The reporting followed the EQUATOR reporting guideline for organizational case studies. RESULTS We included four care units comprising 21 professionals (nurses, physicians, social worker, physiotherapist, pharmacist) and 14 relatives of residents living with dementia. The analysis revealed four categories to describe current intra- and interprofessional collaboration in all cases: actors and their roles, service delivery, coordination and governance, and communication channel. Moreover, we identified three categories that relate to the strengths and problems of intra- and interprofessional collaboration in all cases: role understanding, teamwork, and communication and exchange. Although we examined similar care units, we found differences in the realization of professional collaboration and resulting problems and strengths that are connected to the organizational contexts and strategies used. CONCLUSIONS Even though professional collaboration follows given patterns; these patterns do differ context-specifically and are perceived as problematic and fragmentary. Therefore, the identified differences and problems in collaboration need to be addressed in future research to develop and successfully implement tailored innovative care models.
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Affiliation(s)
- Kathrin Schmüdderich
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer Str. 12, 58453, Witten, Germany.
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Jonas Dörner
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer Str. 12, 58453, Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Anne Fahsold
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer Str. 12, 58453, Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Rebecca Palm
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
- School VI Medicine and Health Sciences, Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer Str. 12, 58453, Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Bernhard Holle
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Stockumer Str. 12, 58453, Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
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Luna G, Kim M, Miller R, Parekh P, Kim ES, Park SY, Abdulbaseer U, Gonzalez C, Stiehl E. Interprofessional relationships and their impact on resident hospitalizations in nursing homes: A qualitative study. Appl Nurs Res 2023; 74:151747. [PMID: 38007247 DOI: 10.1016/j.apnr.2023.151747] [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: 09/14/2022] [Revised: 08/09/2023] [Accepted: 10/24/2023] [Indexed: 11/27/2023]
Abstract
AIM The aim of this study is to explore experiences and perspectives of nurses and providers (e.g., physicians, medical directors, fellows, and nurse practitioners) on reducing preventable hospitalizations of nursing home (NH) residents in relation to interprofessional relationship and hospitalization decision-making process. BACKGROUND Preventable NH resident hospitalization continues to be a pressing public health issue. Studies show that improved interprofessional relationship may help reduce hospitalization, yet research on communication processes and interactions among different NH staff remains limited. METHODS This is a qualitative descriptive study. Two focus groups were held with fourteen nurses and thirteen in-depth, qualitative interviews were conducted with providers from two Chicagoland NHs. Focus group sessions and interviews were transcribed, coded, and analyzed for common themes based on qualitative description method. RESULTS All study participants agreed that providers have the ultimate responsibility for hospitalization decisions. However, nurses believed they could influence those decisions, depending on provider characteristics, trust, and resident conditions. Nurses and providers differed in the way they experienced and conveyed emotions, and differed in key elements affecting hospitalization decisions such as structural or environmental factors (e.g., lacking staff and equipment at the facility, poor communication between the NH and hospitals) and interpersonal factors (e.g., characteristics of effective nurses or providers and the effective interactions between them). CONCLUSIONS Interpersonal factors, including perceived competence, respect, and trust, may influence NH hospitalization decisions and be targeted for reducing preventable hospitalizations of residents.
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Affiliation(s)
- Geraldine Luna
- Chicago Department of Public Health, 333 S State St #200, Chicago, IL 60604, United States of America.
| | - Mhinjine Kim
- University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL 60612, United States of America.
| | - Richard Miller
- University of Illinois Chicago, 2170 West Bowler Street, Chicago, IL 60612, United States of America.
| | - Pooja Parekh
- University of Illinois Chicago, 1355 S. Halsted St., Chicago, IL 60607, United States of America.
| | - Esther S Kim
- University of Illinois Chicago, 625 W Madison St., Chicago, IL 60661, United States of America.
| | - Sophia Yaejin Park
- University of Illinois Chicago, 1853 W Polk St, Chicago, IL 60612, United States of America.
| | - Ummesalmah Abdulbaseer
- University of Illinois Chicago, 1853 W Polk St, Chicago, IL 60612, United States of America.
| | - Cristina Gonzalez
- University of Illinois Chicago, 1853 W Polk St, Chicago, IL 60612, United States of America.
| | - Emily Stiehl
- University of Illinois Chicago, 1603 W. Taylor St., Chicago, IL 60612, United States of America.
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Mazur A, Tetzlaff B, Mallon T, Hesjedal-Streller B, Wei V, Scherer M, Köpke S, Balzer K, Steyer L, Friede T, Pfeiffer S, Hummers E, Müller C. Cluster randomised trial of a complex interprofessional intervention (interprof ACT) to reduce hospital admission of nursing home residents. Age Ageing 2023; 52:7078345. [PMID: 36934341 PMCID: PMC10024891 DOI: 10.1093/ageing/afad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Some hospital admissions of nursing home residents (NHRs) might be attributed to inadequate interprofessional collaboration. To improve general practitioner-nurse collaboration in nursing homes (NHs), we developed an intervention package (interprof ACT) in a previous study. OBJECTIVE To assess the impact of interprof ACT on the proportion of hospitalisation and other clinical parameters within 12 months from randomisation among NHRs. METHODS Multicentre, cluster randomised controlled trial in 34 German NHs. NHRs of the control group received usual care, whereas NHRs in the intervention group received interprof ACT. Eligible NHs had at least 40 long-term care residents. NHs were randomised 1:1 pairwise. Blinded assessors collected primary outcome data. RESULTS Seventeen NHs (320 NHRs) were assigned to interprof ACT and 17 NHs (323 NHRs) to usual care. In the intervention group, 136 (42.5%) NHRs were hospitalised at least once within 12 months from randomisation and 151 (46.7%) in the control group (odds ratio (OR): 0.82, 95% confidence interval (CI): [0.55; 1.22], P = 0.33). No differences were found for the average number of hospitalisations: 0.8 hospitalisations per NHR (rate ratio (RR) 0.90, 95% CI: [0.66, 1.25], P = 0.54). Average length of stay was 5.7 days for NHRs in the intervention group and 6.5 days in the control group (RR: 0.70, 95% CI: [0.45, 1.11], P = 0.13). Falls were the most common adverse event, but none was related to the study intervention. CONCLUSIONS The implementation of interprof ACT did not show a statistically significant and clinically relevant effect on hospital admission of NHRs.
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Affiliation(s)
| | - Britta Tetzlaff
- Address correspondence to: Britta Tetzlaff, Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany. Tel: +49 (40) 7410-57158; +49 (40) 7410-53681.
| | - Tina Mallon
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Berit Hesjedal-Streller
- Department of General Practice, University Medical Center Göttingen, Göttingen D-37073, Germany
| | - Vivien Wei
- Department of General Practice, University Medical Center Göttingen, Göttingen D-37073, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University of Cologne and University Hospital Cologne, Cologne D-50935, Germany
| | - Katrin Balzer
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck D-23538, Germany
| | - Linda Steyer
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck D-23538, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen D-37073, Germany
| | - Sebastian Pfeiffer
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen D-37073, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Göttingen D-37073, Germany
| | - Christiane Müller
- Department of General Practice, University Medical Center Göttingen, Göttingen D-37073, Germany
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Christensen LD, Huibers L, Bro F, Christensen MB, Mygind A. Interprofessional team-based collaboration between designated GPs and care home staff: a qualitative study in an urban Danish setting. BMC PRIMARY CARE 2023; 24:3. [PMID: 36600218 DOI: 10.1186/s12875-023-01966-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND Being a general practitioner for residents in many care homes may challenge communication with residents, relatives, and care home staff, and potentially lead to lower quality of care. Several countries have therefore introduced different solutions to reduce the number of general practitioners at each care home. In 2017, the designated general practitioner model was introduced at many Danish care homes. This study aimed to evaluate experiences from the interprofessional team-based collaboration between designated general practitioners and care home staff with regular contact with the designated general practitioners in an urban Danish setting. METHODS A qualitative design was applied using semi-structured interviews. Eight interviews (three group interviews and five individual interviews) were conducted with four designated general practitioners and seven care home staff members at four care homes in an urban setting of Central Denmark Region, Denmark. The interviews were transcribed verbatim, and data were analysed using content analysis with inspiration from the theory of relational coordination. The study followed the guidelines addressed in the COREQ (Consolidated Criteria for Reporting Qualitative Research) framework. RESULTS The initiation of the designated general practitioner model was experienced to contribute to more clear, precise, and timely communication between care homes and the general practitioner. An improved mutual acknowledgement of roles and competencies was experienced between designated general practitioners, care home nurses, and sometimes also social and health care assistants. The more frequent visits by the general practitioners at the care homes, as a result of the designated general practitioner model, resulted in more face-to-face communication between care home staff and designated general practitioners. Professional differences in the interpretation of the patient's needs were still present, which at times caused a frustrating compromise of own professional competencies. An important reason for the overall perception of improved collaboration was attributed to the more frequent dialogue in which the care homes staff and the designated general practitioners exchanged knowledge that could be applied in future patient encounters. CONCLUSION The designated general practitioner model implied an improved collaboration between general practitioners and care homes staff. Clear, precise, and timely communication between care homes and the general practitioners, as well as mutual trust and acknowledgement was experienced to be essential for the collaboration. An important reason for the overall perception of an improved collaboration was attributed to the more frequent dialogue (more frequent general practitioner visits at the care homes) in which the care homes staff and the designated general practitioners exchange knowledge which again could be applied in future patient encounters.
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Affiliation(s)
| | - Linda Huibers
- Research Unit for General Practice, Bartholins Alle 2, 8000, Aarhus C, Denmark
| | - Flemming Bro
- Research Unit for General Practice, Bartholins Alle 2, 8000, Aarhus C, Denmark.,Department of General Practice, Institute for Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice, Bartholins Alle 2, 8000, Aarhus C, Denmark.,Department of General Practice, Institute for Public Health, Aarhus University, Bartholins Alle 2, 8000, Aarhus, Denmark
| | - Anna Mygind
- Research Unit for General Practice, Bartholins Alle 2, 8000, Aarhus C, Denmark
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Ruaux S, Chadborn N. A qualitative exploratory study of training requirements for general practitioners attending older people resident in care homes. JOURNAL OF INTEGRATED CARE 2022. [DOI: 10.1108/jica-11-2021-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeOlder people who reside in care homes have varying access and quality of medical care; in the UK, this is provided by general practitioners (GPs). The authors aimed to explore the experiences of trainee GPs in delivering integrated care and discuss, with senior GPs, opportunities to improve training.Design/methodology/approachTwo trainees and thirteen senior GPs were recruited through professional networks and participated in semi-structured interviews. Transcriptions were analysed using thematic analysis, and the theory of negotiated order was used to interpret findings.FindingsTrainees received no specific training on working with care homes. Exposure to the care home setting was variable, and could be negligible, depending on the GP practice placement. Senior GPs expressed concerns about patient safety, due to practical challenges of the consultation and a sense of lack of control. Considering the theory of negotiated order, where GPs had trusting relationships with care home staff, the input of the staff could mitigate the sense of risk. Care plans could communicate needs and preferences within the team and may be a way of extending the negotiated order, for example giving care homes authority to implement end-of-life care when the GP is not present.Research limitations/implicationsThe authors identified a need for trainees to engage with the organisational aspect of the care home to deliver integrated care. Trusted relationships with staff led to improved consultations, care plans, and better management of risk.Originality/valueThis is the first study of learning needs for GP trainees to provide integrated care for older care home residents.
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Lexow M, Wernecke K, Sultzer R, Bertsche T, Schiek S. Determine the impact of a structured pharmacist-led medication review - a controlled intervention study to optimise medication safety for residents in long-term care facilities. BMC Geriatr 2022; 22:307. [PMID: 35397527 PMCID: PMC8994296 DOI: 10.1186/s12877-022-03025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/11/2022] [Indexed: 01/04/2023] Open
Abstract
Abstract
Background
Medication reviews contribute to protecting long-term care (LTC) residents from drug related problems (DRPs). However, few controlled studies have examined the impact on patient-relevant outcomes so far.
Objective
We examined the impact of a one-time, pharmacist-led medication review on medication changes (primary endpoint) including discontinued medication, the number of chronic medications, hospital admissions, falls, and deaths (secondary endpoints).
Methods
A prospective, controlled intervention study was performed in three LTC facilities. In the intervention group (IG), after performing a medication review, a pharmacist gave recommendations for resolving DRPs to physicians, nurses and community pharmacists. The control group (CG) received usual care without a medication review. (i) We assessed the number of medication changes and the secondary endpoints in both groups before (t0) and after (t1, t2) the intervention. (ii) Additionally, the medication review was evaluated in the IG with regard to identified DRPs, the healthcare professional’s feedback on the forwarded pharmacist recommendations and whether DRPs were finally resolved.
Results
107 (IG) and 104 (CG) residents were enrolled. (i) More medication changes were identified in the IG than in the CG at t1 (p = 0.001). However, no significant difference was identified at t2 (p = 0.680). Mainly, medication was discontinued in those medication changes. Chronic medications increased in the CG (p = 0.005) at t2 while hospital admissions, falls, and deaths showed no differences. (ii) Overall, 1252 DRPs (median: 10; minimum-maximum: 2–39) were identified. Recommendations for 82% of relevant DRPs were forwarded to healthcare professionals, of which 61% were accepted or clarified. 22% were not accepted, 12% required further review and 6% remained without feedback. 51% of forwarded DRPs were finally resolved.
Conclusions
We found more medication changes in the IG compared to controls. Mostly, medication was discontinued. This suggests that our intervention was successful in discontinuing unnecessary medication. Other clinical outcomes such as falls, hospitalisations, and deaths were not improved due to the one-time intervention. The medication review further identified a high prevalence of DRPs in the IG, half of which were finally resolved.
Trial registration
German Clinical Trials Register, DRKS00026120 (www.drks.de, retrospectively registered 07/09/2021).
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Hammerschmidt J, Heier L, Ernstmann N. Enablement of nursing home residents in infection prevention during general practitioner visits: A qualitative study. PLoS One 2022; 17:e0266502. [PMID: 35390089 PMCID: PMC8989284 DOI: 10.1371/journal.pone.0266502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/22/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Hand hygiene measures are essential to protect nursing home residents against nosocomial infections. Evidence on the prevention of nosocomial infections for nursing home residents by general practitioners during their medical visits in nursing homes or how they enable nursing home residents to perform hand hygiene measures is lacking. This study aimed to explore hand hygiene behaviors of general practitioners in nursing homes, their attitudes toward infection prevention measures, and the enablement of nursing home residents in performing hand hygiene measures. Materials and methods Semi-structured interviews were conducted with general practitioners and nursing home residents in Germany. Interviews were audio-recorded and transcribed. Data were analyzed using thematic content analysis. Results Overall, 12 general practitioners and 12 nursing home residents participated in the study. The general practitioners expressed the fact that the possibilities for practicing hand hygiene differ in individual nursing homes. For nursing home residents, the availability of hand rub solutions was limited. Instructions for residents on hand disinfection from general practitioners was not described. Due to the lack of enablement, the residents’ knowledge on how to correctly perform hand hygiene was low, although some of the nursing home residents have experience with multidrug-resistant organisms. The nursing home residents varied in their needs for active participation and enablement during the general practitioners visit. Conclusion Nursing home residents require continuous enablement by their general practitioners to maintain adequate hand hygiene. Therefore, general practitioners should consider the different needs of nursing home residents to ensure adequate individual hand hygiene and safety for the residents. Existing guidelines for infection prevention and control do not adequately cover the nursing home care setting for the enablement of residents to enquire about hand hygiene.
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Affiliation(s)
| | - Lina Heier
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany
| | - Nicole Ernstmann
- Institute for Patient Safety, University Hospital Bonn, Bonn, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Center for Health Communication and Health Services Research, University Hospital Bonn, Bonn, Germany
- * E-mail:
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Christensen LD, Vestergaard CH, Christensen MB, Huibers L. Health care utilization related to the introduction of designated GPs at care homes in Denmark: a register-based study. Scand J Prim Health Care 2022; 40:115-122. [PMID: 35361055 PMCID: PMC9090365 DOI: 10.1080/02813432.2022.2057031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/31/2022] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To investigate the correlation between having designated general practitioners (GPs) in residential care homes and the residents' number of contacts with primary care, number of hospital admissions and mortality. DESIGN A retrospective register-based longitudinal study. SETTING Forty-two care homes in Aarhus Municipality, Denmark. SUBJECTS A total of 2376 care home residents in the period from 1 September 2016 to 31 December 2018. MAIN OUTCOME MEASURES We used two models to calculate the incidence risk ratio (IRR) for primary care contacts, hospital admission or dying. Model 1 compared the residents' risk time before with their risk time after implementation of the designated GP model. Model 2 included only risk time after implementation and was based on calculations of successful (rate ≥60%) implementation. RESULTS Weighted by time at risk, the proportion of females across the two models ranged from 64% to 68%. The largest group was aged '85-94' years. In Model 1, the mere implementation of the model did not correlate with changes in primary care contacts, hospital admissions, or mortality. Contrarily, in Model 2, residents living in care homes with successful implementation had fewer email contacts (IRR = 0.81, 95%CI: 0.68;0.96), fewer telephone contacts (IRR = 0.78, 95%CI: 0.68;0.90) and fewer hospital admissions (IRR = 0.85, 95%CI: 0.73;0.99), but more home visits (IRR = 1.70, 95%CI: 1.29;2.25) than residents living in care homes with lower implementation rates. CONCLUSION The designated GP model seems promising, as a high implementation degree of the model correlated with a reduced the number of acute admissions, short-term admissions and readmissions. Future studies should focus on gaining deeper insight into the mechanisms of the designated GP model to further optimize the model.Key pointsA new care model was introduced in Denmark in 2017, designating dedicated GPs to residential care homes for the elderly.Successful implementation correlated with significantly fewer hospital admissions, specifically for acute admissions, but also with fewer short-term admissions and readmissions.The implementation of the model correlated significantly with fewer e-mail and telephone contacts and with more home visits.Future studies should gain more insight into the mechanisms of the designated GP model to further optimize the model.
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Affiliation(s)
| | | | - Morten Bondo Christensen
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Weber CE, Kortkamp C, Maurer I, Hummers E. Boundary work in response to professionals’ contextual constraints: Micro-strategies in interprofessional collaboration. ORGANIZATION STUDIES 2022. [DOI: 10.1177/01708406221074135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Boundary-work research has extensively explored how professionals engage in boundary work to protect or expand their professional boundaries in interprofessional collaboration (IPC). Yet professionals’ contextual constraints in everyday work, such as time pressure or legal restrictions, often result in competing interests of the professionals involved in IPC, prompting them to engage in boundary work to limit—instead of protect or expand—their boundaries. Our empirical analysis uses comprehensive qualitative data on IPC in Germany between self-employed general practitioners (GPs) and registered nurses employed in nursing homes in which GPs’ efficiency interests compete with nurses’ safeguarding interests, leading both professionals to engage in boundary-work efforts to limit their boundaries. Our findings provide a comprehensive understanding and framework of professionals’ boundary work, showing that individual GPs and nurses typically hold a portfolio of various defending and accommodating micro-strategies. Based on our first-order findings, we identify how different sources of power enable particular micro-strategies and explore how the choice of micro-strategies depends on different forms of trust in the collaborating partner. Lastly, we outline interactions of micro-strategies, illustrating how the outcomes of professionals’ bilateral boundary work depend on the sequence of these strategies.
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Affiliation(s)
| | | | | | - Eva Hummers
- University Medical Center Göttingen, Germany
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Nishiguchi S, Sugaya N, Saigusa Y, Inamori M. Effect of interprofessional collaboration among nursing home professionals on end-of-life care in nursing homes. Drug Discov Ther 2021; 15:93-100. [PMID: 33952776 DOI: 10.5582/ddt.2021.01030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As end-of-life (EOL) care in nursing homes is gradually increasing, interprofessional collaboration in EOL care in nursing homes is becoming important. However, a method for measuring interprofessional collaboration has not been established. Therefore, this study aimed to clarify the effect of interprofessional collaboration on EOL care in nursing homes. Questionnaires were mailed to the facility directors of 378 nursing homes in Kanagawa Prefecture, Japan, and distributed to nurses, care managers, and professional caregivers. Three professionals from each nursing home completed the same questionnaire, which included 9 items on EOL care: shared facility policy, residents' wishes, each professional's roles, person in charge of the facility, residents' conditions, mental status of residents' families, emergency codes, residents' key people, and sufficient discussion among professionals. Based on the professionals' responses, interprofessional collaboration was assessed. We used multivariable analysis, with interprofessional collaboration as an independent factor. The outcome was the amount of EOL care in the nursing home. A total of 180 (47.6%) nursing homes participated. Multivariable analysis showed that interprofessional collaboration (beta [β] coefficient 2.5, 95% confidence interval [CI] 0.45-4.48; p = 0.017), availability of EOL care bonuses (β coefficient 4.4, 95% CI 1.41-7.38; p = 0.004), physician support for emergency care during off time (β coefficient 5.4, 95% CI 1.86-8.94; p = 0.003), and EOL care conferences (β coefficient 4.1, 95% CI 1.19-6.99; p = 0.006) were significant factors associated with the amount of EOL care in the nursing homes. We found evidence in the adjusted model that interprofessional collaboration among facility professionals is effective for EOL care in nursing homes.
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Affiliation(s)
- Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan.,Unit of Public Health and Preventive Medicine, Yokohama City University, Yokohama, Japan.,Department of Internal Medicine, Hayama Heart Center, Miura, Japan
| | - Nagisa Sugaya
- Unit of Public Health and Preventive Medicine, Yokohama City University, Yokohama, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Masahiko Inamori
- Department of Medical Education, Yokohama City University, Yokohama, Japan
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Brunkert T, Simon M, Ruppen W, Zúñiga F. A Contextual Analysis to Explore Barriers and Facilitators of Pain Management in Swiss Nursing Homes. J Nurs Scholarsh 2020; 52:14-22. [PMID: 31898860 DOI: 10.1111/jnu.12508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE As part of a contextual analysis, this study aimed to generate a comprehensive understanding of barriers and facilitators to pain management in nursing homes to identify potential leverage points for future implementation studies. DESIGN An explanatory sequential mixed-methods study embedded in a cross-sectional study in 20 Swiss nursing homes (data collection: July-December 2016). METHODS Quantitative data were collected via care worker questionnaire surveys comprising 20 items assessing perceptions of barriers to pain management. Descriptive statistics were computed. In the subsequent qualitative strand we conducted four focus group discussions with care workers (registered nurses, licensed practical nurses, and nursing aides) using a knowledge-mapping approach. Findings of both strands were merged and mapped onto domains of the Capability, Opportunity, and Motivation determine Behavior (COM-B) system, a model for behavior, to identify determinants for behavior change. FINDINGS Data from 343 completed care worker surveys (response rate 67.3%) and four focus groups with care workers were analyzed. Items rated most problematic were as follows: lack of availability of nonpharmacological treatment (60.9%), lack of application of nonpharmacological treatment (53.6%), reluctance of residents to report pain (51.1%), and lack of time for a comprehensive pain assessment (50.5%). Focus groups partly corroborated quantitative findings and complemented them with facilitators, such as close collaboration with physicians and further barriers (e.g., organizational factors such as high turnover and a lack of established routines in pain management). CONCLUSIONS Our approach using a behavioral model highlighted a need for implementation strategies that improve pain management knowledge and focus on motivational aspects to establish new routines and habits related to pain management among care workers. CLINICAL RELEVANCE Our findings suggest that future approaches to improve pain management in nursing homes should go beyond provision of education and training. To establish new practices or adapt existing ones, a more complex approach (e.g., introduction of external or internal facilitators) is necessary to influence motivation and ultimately change behavior.
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Affiliation(s)
- Thekla Brunkert
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Michael Simon
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland, and Inselspital Bern University Hospital, Nursing Research Unit, Bern, Switzerland
| | - Wilhelm Ruppen
- Department for Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Franziska Zúñiga
- Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
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Müller C, Hesjedal-Streller B, Fleischmann N, Tetzlaff B, Mallon T, Scherer M, Köpke S, Balzer K, Gärtner L, Maurer I, Friede T, König HH, Hummers E. Effects of strategies to improve general practitioner-nurse collaboration and communication in regard to hospital admissions of nursing home residents (interprof ACT): study protocol for a cluster randomised controlled trial. Trials 2020; 21:913. [PMID: 33153484 PMCID: PMC7643262 DOI: 10.1186/s13063-020-04736-x] [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: 05/13/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Germany, up to 50% of nursing home residents are admitted to a hospital at least once a year. It is often unclear whether this is beneficial or even harmful. Successful interprofessional collaboration and communication involving general practitioners (GPs) and nurses may improve medical care of nursing home residents. In the previous interprof study, the six-component intervention package interprof ACT was developed to facilitate collaboration of GPs and nurses in nursing homes. The aim of this study is to evaluate the effectiveness of the interprof ACT intervention. METHODS This multicentre, cluster randomised controlled trial compares nursing homes receiving the interprof ACT intervention package for a duration of 12 months (e.g. comprising appointment of mutual contact persons, shared goal setting, standardised GPs' home visits) with a control group (care as usual). A total of 34 nursing homes are randomised, and overall 680 residents recruited. The intervention package is presented in a kick-off meeting to GPs, nurses, residents/relatives or their representatives. Nursing home nurses act as change agents to support local adaption and implementation of the intervention measures. Primary outcome is the cumulative incidence of hospitalisation within 12 months. Secondary outcomes include admissions to hospital, days admitted to hospital, use of other medical services, prevalence of potentially inappropriate medication and quality of life. Additionally, health economic and a mixed methods process evaluation will be performed. DISCUSSION This study investigates a complex intervention tailored to local needs of nursing homes. Outcomes reflect the healthcare and health of nursing home residents, as well as the feasibility of the intervention package and its impact on interprofessional communication and collaboration. Because of its systematic development and its flexible nature, interprof ACT is expected to be viable for large-scale implementation in routine care services regardless of local organisational conditions and resources available for medical care for nursing home residents on a regular basis. Recommendations will be made for an improved organisation of primary care for nursing home residents. In addition, the results may provide important knowledge and data for the development and evaluation of further strategies to improve outpatient care for elderly care-receivers. TRIAL REGISTRATION ClinicalTrials.gov NCT03426475 . Initially registered on 7 February 2018.
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Affiliation(s)
- Christiane Müller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, D-37073, Göttingen, Germany.
| | - Berit Hesjedal-Streller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, D-37073, Göttingen, Germany
| | - Nina Fleischmann
- Nursing Science, Fulda University of Applied Sciences, Building 31, Room 122, Leipziger Straße 123, D-36037, Fulda, Germany
| | - Britta Tetzlaff
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Tina Mallon
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University Clinic Cologne, Gleueler Straße 176-178, D-50935, Köln, Germany
| | - Katrin Balzer
- Institute for Social Medicine and Epidemiology, Nursing Research Group, University of Lübeck, Ratzeburger Allee 160, Haus 50, D-23538, Lübeck, Germany
| | - Linda Gärtner
- Institute for Social Medicine and Epidemiology, Nursing Research Group, University of Lübeck, Ratzeburger Allee 160, Haus 50, D-23538, Lübeck, Germany
| | - Indre Maurer
- Chair of Organization and Corporate Development, Georg-August-University Göttingen, Platz der Göttinger Sieben 3, D-37073, Göttingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, D-37073, Göttingen, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, D-37073, Göttingen, Germany
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13
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Delegating home visits in general practice: a realist review on the impact on GP workload and patient care. Br J Gen Pract 2020; 70:e412-e420. [PMID: 32424046 PMCID: PMC7239043 DOI: 10.3399/bjgp20x710153] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/02/2020] [Indexed: 11/30/2022] Open
Abstract
Background UK general practice is being shaped by new ways of working. Traditional GP tasks are being delegated to other staff with the intention of reducing GPs’ workload and hospital admissions, and improving patients’ access to care. One such task is patient-requested home visits. However, it is unclear what impact delegated home visits may have, who might benefit, and under what circumstances. Aim To explore how the process of delegating home visits works, for whom, and in what contexts. Design and setting A review of secondary data on home visit delegation processes in UK primary care settings. Method A realist approach was taken to reviewing data, which aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes. A range of data has been used including news items, grey literature, and academic articles. Results Data were synthesised from 70 documents. GPs may believe that delegating home visits is a risky option unless they have trust and experience with the wider multidisciplinary team. Internal systems such as technological infrastructure might help or hinder the delegation process. Healthcare professionals carrying out delegated home visits might benefit from being integrated into general practice but may feel that their clinical autonomy is limited by the delegation process. Patients report short-term satisfaction when visited by a healthcare professional other than a GP. The impact this has on long-term health outcomes and cost is less clear. Conclusion The delegation of home visits may require a shift in patient expectation about who undertakes care. Professional expectations may also require a shift, having implications for the balance of staffing between primary and secondary care, and the training of healthcare professionals.
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14
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Marques ICP, Franco M. Cooperation networks in the area of health: systematic literature review. Scientometrics 2020. [DOI: 10.1007/s11192-019-03341-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Scheibl F, Fleming J, Buck J, Barclay S, Brayne C, Farquhar M. The experience of transitions in care in very old age: implications for general practice. Fam Pract 2019; 36:778-784. [PMID: 31219151 PMCID: PMC6859521 DOI: 10.1093/fampra/cmz014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It can be challenging for general practitioners to support their oldest old patients through the complex process of relocation. OBJECTIVE To provide a typology of the experiences of moving in very old age that is clinically useful for practitioners navigating very old people's relocation. METHODS Qualitative analysis of data from a mixed-methods UK population-based longitudinal study, Cambridge City over-75s Cohort (CC75C), from Year 21 follow-up onwards. Interviews with participants aged ≥95 years old and proxy informants (Year 21: 44/48, 92%, subsequent attrition all deaths). Thematic analysis of qualitative data available from 26/32 participants who moved before they died. RESULTS Individuals who moved voluntarily in with family experienced gratitude, and those who moved into sheltered house or care homes voluntarily had no regrets. One voluntary move into care was experienced with regret, loss and increased isolation as it severed life-long community ties. Regret and loss were key experiences for those making involuntary moves into care, but acceptance, relief and appreciation of increased company were also observed. The key experience of family members was trauma. Establishing connections with people or place ahead of moving, for example through previous respite care, eased moving. A checklist for practitioners based on the resulting typology of relocation is proposed. CONCLUSIONS Most of the sample moved into residential care. This study highlights the importance of connections to locality, people and place along with good family relationships as the key facilitators of a healthy transition into care for the oldest old. The proposed checklist may have clinical utility.
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Affiliation(s)
- Fiona Scheibl
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Jane Fleming
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Jackie Buck
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
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Omori M, Baker C, Jayasuriya J, Savvas S, Gardner A, Dow B, Scherer S. Maintenance of Professional Boundaries and Family Involvement in Residential Aged Care. QUALITATIVE HEALTH RESEARCH 2019; 29:1611-1622. [PMID: 30931823 DOI: 10.1177/1049732319839363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The importance of family's involvement in care planning has been stressed to cater individualized, person-centered care in residential aged care. However, in reality, there are numerous structural obstacles and barriers that limit opportunities for their involvement. The aim of this article is to explore what they are. The findings based on the 12 focus groups, six groups of care professionals and six groups of family/relatives, reveal that the narrow pathway of communication between staff and families, which is hierarchically structured, one-directional, and clinically driven, enables the former to maintain and control professional boundaries between formal and informal care-giving. Such communication style delimits an opportunity for families to engage in quality discussion about care planning for their loved ones with care staff. Communication within residential aged care facilities embodies complex dynamics of care expectations and responsibilities held by care staff and families.
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Affiliation(s)
- Maho Omori
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
| | - Courtney Baker
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
| | - Jude Jayasuriya
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
| | - Steven Savvas
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
- 2 Royal Freemasons Ltd, Melbourne, Victoria, Australia
- 3 The University of Melbourne, Parkville, Victoria, Australia
| | - Anastasia Gardner
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
| | - Briony Dow
- 1 National Ageing Research Institute, Parkville, Victoria, Australia
- 3 The University of Melbourne, Parkville, Victoria, Australia
| | - Sam Scherer
- 2 Royal Freemasons Ltd, Melbourne, Victoria, Australia
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Nishiguchi S, Sugaya N, Inamori M. End-of-life care conferences in Japanese nursing homes. Drug Discov Ther 2019; 13:47-51. [PMID: 30880322 DOI: 10.5582/ddt.2019.01002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
End-of-life (EOL) care conferences have an important role in promoting EOL care in nursing homes. However, the details of the conferences remain poorly understood. A Japanese prefecture-wide survey was conducted to investigate the factors involved in such conferences that contribute to an increase in the amount of EOL care. One hundred fifty-three nursing homes performed the conferences. The outcome was the amount of EOL care provided in nursing homes after adjusting for the facility beds in 2014. We investigated the factors of staff experience with EOL care, frequency of the conferences, years the conferences were conducted, review conferences after EOL care, and professional participants in the conferences. The multivariate analysis revealed significant associations between EOL care in nursing homes and nurses' experience with EOL care (adjusted β coefficient 2.9, 95% confidence interval (CI) 0.52 ~ 5.22, p = 0.017), more than 5 years of continuous conferences (adjusted β coefficient 3.8, 95% CI 0.46 ~ 7.05, p = 0.026), and family participation (adjusted βcoefficient ‒4.0, 95% CI ‒7.5 ~ ‒0.48, p = 0.026). In conclusion, the continuation of conferences and enrollment of the nurse with experience in EOL care may promote EOL care in nursing homes, while family enrollment in conferences may decrease EOL care in nursing homes. EOL care conferences in nursing homes should be continuously performed by staff, with an experienced nurse undertaking the task of information sharing before discussing EOL care with the patients' families.
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Affiliation(s)
- Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital.,Unit of Public Health and Preventive Medicine, Yokohama City University.,Department of Internal Medicine, Hayama Heart Center
| | - Nagisa Sugaya
- Unit of Public Health and Preventive Medicine, Yokohama City University
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18
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Krause O, Wiese B, Doyle IM, Kirsch C, Thürmann P, Wilm S, Sparenberg L, Stolz R, Freytag A, Bleidorn J, Junius-Walker U. Multidisciplinary intervention to improve medication safety in nursing home residents: protocol of a cluster randomised controlled trial (HIOPP-3-iTBX study). BMC Geriatr 2019; 19:24. [PMID: 30683060 PMCID: PMC6347799 DOI: 10.1186/s12877-019-1027-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/04/2019] [Indexed: 01/29/2023] Open
Abstract
Background Medication safety is an important health issue for nursing home residents (NHR). They usually experience polypharmacy and often take potentially inappropriate medications (PIM) and antipsychotics. This, coupled with a frail health state, makes NHR particularly vulnerable to adverse drug events (ADE). The value of systematic medication reviews and interprofessional co-operation for improving medication quality in NHR has been recognized. Yet the evidence of a positive effect on NHR’ health and wellbeing is inconclusive at this stage. This study investigates the effects of pharmacists’ medication reviews linked with measures to strengthen interprofessional co-operation on NHR’ medication quality, health status and health care use. Methods Pragmatic cluster randomised controlled trial in nursing homes in four regions of Germany. A total of 760 NHR will be recruited. Inclusion: NHR aged 65 years and over with an estimated life expectancy of at least six months. Intervention with four elements: i) introduction of a pharmacist’s medication review combined with a communication pathway to the prescribing general practitioners (GPs) and nursing home staff, ii) facilitation of change in the interprofessional cooperation, iii) educational training and iv) a “toolbox” to facilitate implementation in daily practice. Analysis: primary outcome - proportion of residents receiving PIM and ≥ 2 antipsychotics at six months follow-up. Secondary outcomes - cognitive function, falls, quality of life, medical emergency contacts, hospital admissions, and health care costs. Discussion The trial assesses the effects of a structured interprofessional medication management for NHR in Germany. It follows the participatory action research approach and closely involves the three professional groups (nursing staff, GPs, pharmacists) engaged in the medication management. A handbook based on the experiences of the trial in nursing homes will be produced for a rollout into routine practice in Germany. Trial registration Registered in the German register of clinical studies (DRKS, study ID DRKS00013588, primary register) and in the WHO International Clinical Trials Registry Platform (secondary register), both on 25th January 2018.
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Affiliation(s)
- Olaf Krause
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Birgitt Wiese
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Ina-Merle Doyle
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Claudia Kirsch
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Petra Thürmann
- Philipp Klee Institute for Clinical Pharmacology, University of Witten/Herdecke, Heusnerstraße 40, 42283, Wuppertal, Germany
| | - Stefan Wilm
- Institute for General Practice, Heinrich-Heine University Düsseldorf, Werdener Straße 4, 40227, Düsseldorf, Germany
| | - Lisa Sparenberg
- Institute for General Practice, University Medical Center Rostock, Doberaner Straße 142, 18057, Rostock, Germany
| | - Regina Stolz
- Institute for General Practice and Interprofessional Care, University Hospital and Faculty Tübingen, Osianderstraße 5, 72076, Tübingen, Germany
| | - Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Jutta Bleidorn
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Ulrike Junius-Walker
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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Previato GF, Baldissera VDA. Portraits of interprofessional collaborative practice in the primary health care teams. ACTA ACUST UNITED AC 2018; 39:e20170132. [PMID: 30088603 DOI: 10.1590/1983-1447.2018.2017-0132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 10/20/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To analyze the Interprofessional Collaborative Practice in Health from the perspective of professionals of the Primary Health Care teams. METHODOLOGY Participatory, qualitative, exploratory-descriptive study, performed in Basic Health Units of a municipality in the northwest of the Paraná, with 88 professionals of thw Primary Health Care teams. The data collection took place from February to April 2017, through the "Photovoice" data collection and analysis technique. RESULTS Two categories of analysis emerged: A picture of the process of constructing concepts of the Collaborative Interprofessional Health Practice; A picture of the configurations of the Collaborative Interprofessional Health Practice in the work process among the Primary Health Care teams. FINAL CONSIDERATIONS It was pointed out that Collaborative Interprofessional Practice is a new term and little explored in the Primary Health Care scenario, but the reflections about the photos allowed the assimilation, the thematic approximation and the collective construction of knowledge validated by the practice.
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Affiliation(s)
- Giselle Fernanda Previato
- Universidade Estadual de Maringá (UEM), Departamento de Pós-Graduação em Enfermagem. Maringá, Paraná, Brasil
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Pearson R, Mullan J, Ujvary E, Bonney A, Dijkmans-Hadley B. Australian general practitioner attitudes to residential aged care facility visiting. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e497-e504. [PMID: 29479778 DOI: 10.1111/hsc.12561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 06/08/2023]
Abstract
Demographic trends suggest that the sustainability of the general practitioner (GP) Residential Aged Care Facility (RACF) workforce, worldwide and in Australia, is under threat, compromising the ongoing care of chronically ill RACF residents. It is therefore important to ascertain current GP attitudes towards this work, to better understand and hypothesise means of reversing this trend. To this end, during 2014 the views of 26 GPs and GP Registrars working in rural and regional New South Wales, Australia, were captured during focus group discussions and one-on-one interviews. Analysis of the qualitative date revealed that GP attitudes towards RACF visiting fell into five key themes: pleasure, duty, remuneration and logistics, hesitation, and frustration. The data also revealed that the overriding emotion GPs felt about RACF visitation was frustration with the avoidable delays and inefficiencies associated with the work. Despite the pleasure GPs derived from their work in RACFs and their sense of obligation to be involved, their hesitation and frustration was compounded by the work's perceived poor remuneration. This research suggests that the barriers to GP participation in RACF visiting were managerial rather than attitudinal, and that a strategic focus upon improving administrative and logistical support is needed.
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Affiliation(s)
- Russell Pearson
- Discipline of Graduate Medicine, University of Wollongong, NSW, Australia
| | - Judy Mullan
- Discipline of Graduate Medicine, University of Wollongong, NSW, Australia
| | - Eniko Ujvary
- Discipline of Graduate Medicine, University of Wollongong, NSW, Australia
| | - Andrew Bonney
- Discipline of Graduate Medicine, University of Wollongong, NSW, Australia
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Pasyar N, Rambod M, Gholamzadeh S, Sharif F. Correlation between Nurse /Manager Professional Collaborative Behaviors and Nurses’ Job Satisfaction. IRAN JOURNAL OF NURSING 2018. [DOI: 10.29252/ijn.31.112.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Müller CA, Fleischmann N, Cavazzini C, Heim S, Seide S, Geister C, Tetzlaff B, Hoell A, Werle J, Weyerer S, Scherer M, Hummers E. Interprofessional collaboration in nursing homes (interprof): development and piloting of measures to improve interprofessional collaboration and communication: a qualitative multicentre study. BMC FAMILY PRACTICE 2018; 19:14. [PMID: 29325541 PMCID: PMC5765653 DOI: 10.1186/s12875-017-0678-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 12/08/2017] [Indexed: 08/23/2023]
Abstract
BACKGROUND Given both the increase of nursing home residents forecast and challenges of current interprofessional interactions, we developed and tested measures to improve collaboration and communication between nurses and general practitioners (GPs) in this setting. Our multicentre study has been funded by the German Federal Ministry of Education and Research (FK 01GY1124). METHODS The measures were developed iteratively in a continuous process, which is the focus of this article. In part 1 "exploration of the situation", interviews were conducted with GPs, nurses, nursing home residents and their relatives focusing on interprofessional interactions and medical care. They were analysed qualitatively. Based on these results, in part 2 "development of measures to improve collaboration", ideas for improvement were developed in nine focus groups with GPs and nurses. These ideas were revisited in a final expert workshop. We analysed the focus groups and expert workshop using mind mapping methods, and finally drew up the compilation of measures. In an exploratory pilot study "study part 3" four nursing homes chose the measures they wanted to adopt. These were tested for three months. Feasibility and acceptance of the measures were evaluated via guideline interviews with the stakeholders which were analysed by content analyses. RESULTS Six measures were generated: meetings to establish common goals, main contact person, standardised pro re nata medication, introduction of name badges, improved availability of nurse/GP and standardised scheduling/ procedure for nursing home visits. In the pilot study, the measures were implemented in four nursing homes. GPs and nurses reviewed five measures as feasible and acceptable, only the designation of a "main contact person" was not considered as an improvement. CONCLUSIONS Six measures to improve collaboration and communication could be compiled in a multistep qualitative process respecting the perspectives of involved stakeholders. Five of the six measures were positively assessed in an exploratory pilot study. They could easily be transferred into the daily routine of other nursing homes, as no special models have to exist in advance. Impact of the measures on patient oriented outcomes should be examined in further research. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Christiane A Müller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany.
| | - Nina Fleischmann
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Christoph Cavazzini
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Susanne Heim
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Svenja Seide
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Christina Geister
- Faculty V - Health, Religious Education and Social Affairs, University of Applied Sciences and Arts, Blumhardtstraße 2, 30625, Hannover, Germany
| | - Britta Tetzlaff
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Andreas Hoell
- Psychiatric Epidemiology and Demographic Change, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, 68159, Mannheim, Germany
| | - Jochen Werle
- Psychiatric Epidemiology and Demographic Change, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, 68159, Mannheim, Germany
| | - Siegfried Weyerer
- Psychiatric Epidemiology and Demographic Change, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, 68159, Mannheim, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073, Göttingen, Germany
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Do not confuse multidisciplinary task management in nursing homes with interprofessional care! Prim Health Care Res Dev 2017. [PMID: 28625197 DOI: 10.1017/s146342361700024x] [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] [Indexed: 11/05/2022] Open
Abstract
Problem statement Little is known about how interprofessional healthcare providers in nursing homes work together. We know that interprofessional teamwork evolves from trial and error learning and so interprofessional collaboration has to be actively taught. This study aims to gain insights in the perception of professionals towards interprofessional collaboration in nursing homes and the factors that have an impact on interprofessional collaboration. Approach A qualitative descriptive methodology using focus group interviews and additional semi-structured interviews was performed. In total three focus group sessions with healthcare providers from different disciplines were held and additionally nine semi-structured interviews were executed. A thematic analysis was performed. The transcripts were read to immerse in the data and initial ideas were noted. Both open coding (identification of primary themes) and axial coding (analysis of relationships among themes) were conducted and re-focussed into potential themes. Findings Four main themes emerge from the analysis: context, collaboration, care and experience. From the findings it seems that healthcare teams in nursing homes work as 'separated groups'. A lot of collaboration is perceived, but no common vision or responsibility sharing is found. The role description of the different disciplines does not always seem clear or is not always explicit. CONCLUSION In usual care the perceived interactions between professionals are called collaboration. Obviously physicians and all healthcare professionals do not work interprofessionally according to definitions from the literature. This study provided evidence of the awareness that interprofessional collaboration in usual care is situational and fragmentary organised.
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Fleischmann N, Geister C, Hoell A, Hummers-Pradier E, Mueller CA. Interprofessional collaboration in nursing homes (interprof): A grounded theory study of nurse experiences of general practitioner visits. Appl Nurs Res 2017; 35:118-125. [PMID: 28532718 DOI: 10.1016/j.apnr.2017.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/02/2016] [Accepted: 02/01/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Nina Fleischmann
- Department of General Practice, University Medical Center Goettingen, Humboldtallee 38, 37073 Goettingen, Germany.
| | - Christina Geister
- University of Applied Sciences and Arts, Faculty V - Health, Religious Education, Social Affairs, Blumhardtstraße 2, 30625 Hannover, Germany.
| | - Andreas Hoell
- Psychiatric Epidemiology and Demographic Change, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, 68159, Mannheim, Germany
| | - Eva Hummers-Pradier
- Department of General Practice, University Medical Center Goettingen, Humboldtallee 38, 37073 Goettingen, Germany.
| | - Christiane A Mueller
- Department of General Practice, University Medical Center Goettingen, Humboldtallee 38, 37073 Goettingen, Germany.
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