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Estrada YVR, Esteban ANP, Aldana MSCD, Niño EYD, Contreras JSR, Galvis MDPC, Pinzón VA, Arenas SAG. Efficacy of a Hospital Discharge Transition Plan in the care competence of patients with chronic conditions and their family caregivers: a clinical trial. Rev Lat Am Enfermagem 2024; 32:e4104. [PMID: 38655933 DOI: 10.1590/1518-8345.6620.4104] [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: 12/29/2022] [Accepted: 10/07/2023] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE to assess the efficacy of a Hospital Discharge Transition Plan in the care competence and in adherence to the therapy of dyads comprised by patients with non-communicable chronic diseases and their caregivers. METHOD a controlled and randomized clinical trial; the sample was comprised by 80 dyads of patients with chronic conditions and their caregivers, randomly allocated as follows: 40 to the control group and another 40 to the intervention group. The instruments to characterize the patient-caregiver dyad, the patients' and caregivers' care competence and the patients' adherence to the treatment scale were applied. The " CUIDEMOS educational intervention" was applied to the intervention group; in turn, the control group was provided usual care with the aid of a booklet, with phone follow-up via at month 1. RESULTS 52.5% of the patients and 81.3% of the caregivers were women. The patients' and caregivers' mean ages were 69.5±12.6 and 47.5±13.1 years old, respectively. The Hospital Discharge Transition Plan increased the scores in the "knowledge", "uniqueness", "instrumental", "enjoying", "anticipation" and "social relations" dimensions, as well as the global care competence of the patients and family caregivers; in addition to the following factors: medications, diet, stimulants control, weight control, stress management, and global adherence to the therapy by the patient. There were no statistically significant differences between the control and intervention groups. CONCLUSION the Hospital Discharge Transition Plan increased the patients' and family caregivers' care competence after the intervention, as well as the patients' adherence to the treatment. However, there were no differences between the control and intervention groups, possibly due to the similarity of the activities.
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Affiliation(s)
- Yuliana Valentina Rincón Estrada
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| | - Astrid Nathalia Páez Esteban
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| | - Maria Stella Campos de Aldana
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| | - Erika Yurley Durán Niño
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| | - Juan Sebastian Rincón Contreras
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| | - Maria Del Pilar Castillo Galvis
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| | - Valeria Arias Pinzón
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
| | - Sergio Andrés García Arenas
- Universidad de Santander, Facultad de Ciencias Médicas y de la Salud, Institución de Investigación Masira, Bucaramanga, Santander, Colombia
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The cost-effectiveness of a telephone-based intervention to support caregivers of older people discharged from hospital. BMC Geriatr 2019; 19:68. [PMID: 30832575 PMCID: PMC6399869 DOI: 10.1186/s12877-019-1085-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background A telephone intervention for caregivers of older people discharged from hospital was shown to improve preparedness to care, reduce caregiver strain and caregiver distress. No cost-effectiveness analysis has been published on this, or similar interventions. The study aims addressed here were to examine whether positive outcomes for caregivers resulting from the Further Enabling Care at Home (FECH) program changed the use and costs of health services by patients; and to assess cost-effectiveness. Methods A single-blind randomised controlled trial compared FECH to usual care. FECH involved a specially trained nurse addressing support needs of caregivers of older patients discharged from hospital. A minimum clinically important difference in preparedness to care was defined as an increase in Preparedness for Caregiving scale score of ≥ two points from baseline. Designated data collection was at: Time 1, within four days of discharge; Time 2, 15–21 days post-discharge; and Time 3, six weeks post-discharge. A last observation carried forward approach to loss to follow-up was used, with a sensitivity analysis including only those who completed all time points. Patient use of hospital, emergency department (ED) and ambulance services were captured for 12 weeks post-discharge using administrative data. Costs included nurse time supporting caregivers, resources used by the nurse, and time taken training the nurse to deliver FECH. Cost-effectiveness was assessed using decision trees for preparedness for caregiving. Results Sixty-two intervention dyads and 79 controls provided complete data. A significantly greater proportion of intervention group caregivers reported improved preparedness to care to Time 2 (36.4% v 20.9%, p = 0.029), though this was not sustained to Time 3. The intervention cost $AUD268.28 above usual care per caregiver. No significant differences were observed in health service use between groups. The incremental cost-effectiveness ratio for each additional caregiver reporting improved preparedness to care at Time 2 was $AUD1,730.84. Conclusions To our knowledge this is the first work to calculate the cost-effectiveness of a telephone-delivered intervention designed to support caregivers of older people post-discharge, and will support decision-making regarding implementation. Further research should examine different settings, and assess impacts on health service use with larger samples and a longer follow-up. Trial registration Australian and New Zealand Clinical Trial Registry: ACTRN12614001174673. Registered 07/11/2014.
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Aoun SM, Stegmann R, Slatyer S, Hill KD, Parsons R, Moorin R, Bronson M, Walsh D, Toye C. Hospital postdischarge intervention trialled with family caregivers of older people in Western Australia: potential translation into practice. BMJ Open 2018; 8:e022747. [PMID: 30413506 PMCID: PMC6231564 DOI: 10.1136/bmjopen-2018-022747] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 07/26/2018] [Accepted: 09/28/2018] [Indexed: 11/03/2022] Open
Abstract
There is lack of a suitable assessment tool that can be used routinely and systematically by hospital staff to address family caregivers' (FCs') support needs. This paper describes a novel approach to identifying and addressing FCs' needs following hospital discharge of the older person receiving care. SETTING AND PARTICIPANTS FC recruitment occurred on the patient's discharge from a tertiary hospital in Western Australia; 64 completed the study; 80% were female; mean age 63.2 years. INTERVENTION The Further Enabling Care at Home (FECH) programme was delivered over the telephone by a specially trained nurse and included: support to facilitate understanding of the patient's discharge letter; caregiver support needs assessment and prioritisation of urgent needs; and collaborative guidance, from the nurse, regarding accessing supports. RESULTS Sixty-four FCs completed the FECH programme. The top three support needs identified by the FCs were: knowing what to expect in the future (52%), knowing who to contact if they were concerned (52%) and practical help in the home (36%). The telephone-based outreach service worked well and was convenient for the nurse and the FCs, and saved on transport, time and money. Most of the FCs appreciated the systematic approach to identify and articulate their needs and were satisfied with the support they received, mainly navigation through the systems, problem solving, self-care strategies, explanation of illness, symptoms and medication and access to after-hours services. CONCLUSIONS In order to guide services which may consider adopting this systematic approach to supporting FCs and integrating it into their routine practice, this evaluation of the FECH programme has described the processes implemented and highlighted the factors that hindered or facilitated these processes to engage caregivers with appropriate services in a timely manner. Positive feedback indicated that the programme was a useful addition to hospital discharge planning. TRIAL REGISTRATION NUMBER ACTRN12614001174673; Results.
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Affiliation(s)
- Samar M Aoun
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
- The Perron Institute for Neurological and translational Science, Perth, Western Australia, Australia
| | - Roswitha Stegmann
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Susan Slatyer
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Richard Parsons
- School of Pharmacy, Curtin University, Perth, Western Australia, Australia
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Mary Bronson
- Medical Division, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Debbie Walsh
- Department of Social Work, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Christine Toye
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Wilson S, Toye C, Aoun S, Slatyer S, Moyle W, Beattie E. Effectiveness of psychosocial interventions in reducing grief experienced by family carers of people with dementia: a systematic review protocol. ACTA ACUST UNITED AC 2018; 14:30-41. [PMID: 27532647 DOI: 10.11124/jbisrir-2016-002485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW OBJECTIVE The objective is to examine the existing evidence regarding the effectiveness of psychosocial interventions to assist grief pre- and post-bereavement for family carers of people with dementia residing in the community or in a health or social care facility. REVIEW QUESTION What psychosocial interventions for family carers of people with dementia are most effective in reducing: (1) anticipatory grief, (2) post-death grief (bereavement), and (3) complicated grief?
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Affiliation(s)
- Sally Wilson
- 1School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University 2Western Australian Group for Evidence Informed Healthcare Practice: a Collaborating Centre of the Joanna Briggs Institute, Curtin University, Perth, Western Australia 3Menzies Health Institute, Griffith University 4School of Nursing and Dementia Collaborative Research Centre: Carers and Consumers, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Toye C, Parsons R, Slatyer S, Aoun SM, Moorin R, Osseiran-Moisson R, Hill KD. Outcomes for family carers of a nurse-delivered hospital discharge intervention for older people (the Further Enabling Care at Home Program): Single blind randomised controlled trial. Int J Nurs Stud 2016; 64:32-41. [PMID: 27684320 DOI: 10.1016/j.ijnurstu.2016.09.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/07/2016] [Accepted: 09/18/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hospital discharge of older people receiving care at home offers a salient opportunity to identify and address their family caregivers' self-identified support needs. OBJECTIVES This study tested the hypothesis that the extent to which family caregivers of older people discharged home from hospital felt prepared to provide care at home would be positively influenced by their inclusion in the new Further Enabling Care at Home program. DESIGN This single-blind randomised controlled trial compared outcomes from usual care alone with those from usual care plus the new program. The program, delivered by a specially trained nurse over the telephone, included: support to facilitate understanding of the patient's discharge letter; caregiver support needs assessment; caregiver prioritisation of urgent needs; and collaborative guidance, from the nurse, regarding accessing supports. SETTING AND PARTICIPANTS Dyads were recruited from the medical assessment unit of a Western Australian metropolitan public hospital. Each dyad comprised a patient aged 70 years or older plus an English speaking family caregiver. METHODS The primary outcome was the caregiver's self-reported preparedness to provide care for the patient. Data collection time points were designated as: Time 1, within four days of discharge; Time 2, 15-21days after discharge; Time 3, six weeks after discharge. Other measures included caregivers' ratings of: their health, patients' symptoms and independence, caregiver strain, family well-being, caregiver stress, and positive appraisals of caregiving. Data were collected by telephone. RESULTS Complete data sets were obtained from 62 intervention group caregivers and 79 controls. Groups were equivalent at baseline. Needs prioritised most often by caregivers were: to know whom to contact and what to expect in the future and to access practical help at home. Support guidance included how to: access help, information, and resources; develop crisis plans; obtain referrals and services; and organise legal requirements. Compared to controls, preparedness to care improved in the intervention group from Time 1 to Time 2 (effect size=0.52; p=0.006) and from Time 1 to Time 3 (effect size=0.43; p=0.019). These improvements corresponded to a change of approximately 2 points on the Preparedness for Caregiving instrument. Small but significant positive impacts were also observed in other outcomes, including caregiver strain. CONCLUSIONS These unequivocal findings provide a basis for considering the Furthering Enabling Care at Home program's implementation in this and other similar settings. Further testing is required to determine the generalisability of results.
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Affiliation(s)
- Christine Toye
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia; Centre for Nursing Research, Sir Charles Gairdner Hospital, The Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands Western Australia, 6009, Australia.
| | - Richard Parsons
- School of Pharmacy, Curtin University, GPO Box U1987 Perth, Western Australia 6845, Australia.
| | - Susan Slatyer
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia; Centre for Nursing Research, Sir Charles Gairdner Hospital, The Harry Perkins Institute of Medical Research, 6 Verdun Street, Nedlands Western Australia, 6009, Australia.
| | - Samar M Aoun
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Rachael Moorin
- School of Public Health, Curtin University, GPO Box U1987 Perth, Western Australia, 6845, Australia.
| | - Rebecca Osseiran-Moisson
- School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987 Perth, Western Australia 6845, Australia.
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