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Westby M, Ijaz S, Savović J, McLeod H, Dawson S, Welsh T, Le Roux H, Walsh N, Bradley N. Virtual wards for people with frailty: what works, for whom, how and why-a rapid realist review. Age Ageing 2024; 53:afae039. [PMID: 38482985 PMCID: PMC10938537 DOI: 10.1093/ageing/afae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Virtual wards (VWs) deliver multidisciplinary care at home to people with frailty who are at high risk of a crisis or in crisis, aiming to mitigate the risk of acute hospital admission. Different VW models exist, and evidence of effectiveness is inconsistent. AIM We conducted a rapid realist review to identify different VW models and to develop explanations for how and why VWs could deliver effective frailty management. METHODS We searched published and grey literature to identify evidence on multidisciplinary VWs. Information on how and why VWs might 'work' was extracted and synthesised into context-mechanism-outcome configurations with input from clinicians and patient/public contributors. RESULTS We included 17 peer-reviewed and 11 grey literature documents. VWs could be short-term and acute (1-21 days), or longer-term and preventative (typically 3-7 months). Effective VW operation requires common standards agreements, information sharing processes, an appropriate multidisciplinary team that plans patient care remotely, and good co-ordination. VWs may enable delivery of frailty interventions through appropriate selection of patients, comprehensive assessment including medication review, integrated case management and proactive care. Important components for patients and caregivers are good communication with the VW, their experience of care at home, and feeling involved, safe and empowered to manage their condition. CONCLUSIONS Insights gained from this review could inform implementation or evaluation of VWs for frailty. A combination of acute and longer-term VWs may be needed within a whole system approach. Proactive care is recommended to avoid frailty-related crises.
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Affiliation(s)
- Maggie Westby
- The National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2NT, UK
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Sharea Ijaz
- The National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2NT, UK
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Jelena Savović
- The National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2NT, UK
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Hugh McLeod
- The National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2NT, UK
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Sarah Dawson
- The National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2NT, UK
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
| | - Tomas Welsh
- Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
- RICE – The Research Institute for the Care of Older People, Bath, UK
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Hein Le Roux
- Churchdown Surgery, Parton Rd, Churchdown, Gloucester GL3 2JH, UK
- NHS England and NHS Improvement South West, Somerset, UK
- One Gloucestershire Integrated Care System Quality Improvement, Gloucester, UK
| | - Nicola Walsh
- The National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol BS1 2NT, UK
- Centre for Health & Clinical Research, University of the West of England, Bristol BS16 1DD, UK
| | - Natasha Bradley
- School of Nursing and Midwifery, Queens University Belfast, Belfast BT7 1NN, UK
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Eines TF, Storm M, Grønvik CKU. Interprofessional collaboration in a community virtual ward: A focus group study. Scand J Caring Sci 2023; 37:677-686. [PMID: 36710599 DOI: 10.1111/scs.13152] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 01/05/2023] [Accepted: 01/14/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND The problem of a lack of nurses is expected to worsen in the future. With an ever-increasing number of elderly patients with multimorbidity and a shortage of healthcare professionals, primary care must innovatively organise their services to offer more sustainable healthcare services. Organising healthcare services in a community virtual ward has been found to improve the quality of life for vulnerable elderly populations. AIM The aim of the study was to explore healthcare professionals' experiences of interprofessional collaboration in care for patients with multimorbidity in a community virtual ward in the Norwegian context. METHODS Focus group interviews were conducted in this qualitative exploratory study. A purposive sample of 17 healthcare professionals working in a community virtual ward in Norway was interviewed. Data were analysed using thematic analysis. RESULTS The study results show that healthcare professionals recognise a need for patient involvement in the community virtual ward to offer more sustainable healthcare services at home. Furthermore, the results show how healthcare professionals experience the use of assessment tools and whiteboard meetings as useful tools for facilitating interprofessional collaboration. The study results also describe how interprofessional and holistic follow-up with patients with multimorbidity contributes to increased focus on health promotion in the community virtual ward. CONCLUSION We found that interprofessional collaboration in community virtual wards may be a sustainable way of organising healthcare services for patients with multimorbidity living at home. Interprofessional collaboration with a patient-centred and health promotion approach, seems to increase the quality of the follow-up for patients with multimorbidity living at home. Additionally, mutual interprofessional trust and respect seems to be essential for making use of the unique expertise of different professions in the follow-up for patients with multimorbidity. In the future, both the patient's voice and opinion of their next of kin should be considered in the development of more sustainable homecare services.
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Affiliation(s)
| | - Marianne Storm
- Molde University College, Molde, Norway
- Stavanger University, Stavanger, Norway
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Fulop NJ, Walton H, Crellin N, Georghiou T, Herlitz L, Litchfield I, Massou E, Sherlaw-Johnson C, Sidhu M, Tomini SM, Vindrola-Padros C, Ellins J, Morris S, Ng PL. A rapid mixed-methods evaluation of remote home monitoring models during the COVID-19 pandemic in England. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-151. [PMID: 37800997 DOI: 10.3310/fvqw4410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Background Remote home monitoring services were developed and implemented for patients with COVID-19 during the pandemic. Patients monitored blood oxygen saturation and other readings (e.g. temperature) at home and were escalated as necessary. Objective To evaluate effectiveness, costs, implementation, and staff and patient experiences (including disparities and mode) of COVID-19 remote home monitoring services in England during the COVID-19 pandemic (waves 1 and 2). Methods A rapid mixed-methods evaluation, conducted in two phases. Phase 1 (July-August 2020) comprised a rapid systematic review, implementation and economic analysis study (in eight sites). Phase 2 (January-June 2021) comprised a large-scale, multisite, mixed-methods study of effectiveness, costs, implementation and patient/staff experience, using national data sets, surveys (28 sites) and interviews (17 sites). Results Phase 1 Findings from the review and empirical study indicated that these services have been implemented worldwide and vary substantially. Empirical findings highlighted that communication, appropriate information and multiple modes of monitoring facilitated implementation; barriers included unclear referral processes, workforce availability and lack of administrative support. Phase 2 We received surveys from 292 staff (39% response rate) and 1069 patients/carers (18% response rate). We conducted interviews with 58 staff, 62 patients/carers and 5 national leads. Despite national roll-out, enrolment to services was lower than expected (average enrolment across 37 clinical commissioning groups judged to have completed data was 8.7%). There was large variability in implementation of services, influenced by patient (e.g. local population needs), workforce (e.g. workload), organisational (e.g. collaboration) and resource (e.g. software) factors. We found that for every 10% increase in enrolment to the programme, mortality was reduced by 2% (95% confidence interval: 4% reduction to 1% increase), admissions increased by 3% (-1% to 7%), in-hospital mortality fell by 3% (-8% to 3%) and lengths of stay increased by 1.8% (-1.2% to 4.9%). None of these results are statistically significant. We found slightly longer hospital lengths of stay associated with virtual ward services (adjusted incidence rate ratio 1.05, 95% confidence interval 1.01 to 1.09), and no statistically significant impact on subsequent COVID-19 readmissions (adjusted odds ratio 0.95, 95% confidence interval 0.89 to 1.02). Low patient enrolment rates and incomplete data may have affected chances of detecting possible impact. The mean running cost per patient varied for different types of service and mode; and was driven by the number and grade of staff. Staff, patients and carers generally reported positive experiences of services. Services were easy to deliver but staff needed additional training. Staff knowledge/confidence, NHS resources/workload, dynamics between multidisciplinary team members and patients' engagement with the service (e.g. using the oximeter to record and submit readings) influenced delivery. Patients and carers felt services and human contact received reassured them and were easy to engage with. Engagement was conditional on patient, support, resource and service factors. Many sites designed services to suit the needs of their local population. Despite adaptations, disparities were reported across some patient groups. For example, older adults and patients from ethnic minorities reported more difficulties engaging with the service. Tech-enabled models helped to manage large patient groups but did not completely replace phone calls. Limitations Limitations included data completeness, inability to link data on service use to outcomes at a patient level, low survey response rates and under-representation of some patient groups. Future work Further research should consider the long-term impact and cost-effectiveness of these services and the appropriateness of different models for different groups of patients. Conclusions We were not able to find quantitative evidence that COVID-19 remote home monitoring services have been effective. However, low enrolment rates, incomplete data and varied implementation reduced our chances of detecting any impact that may have existed. While services were viewed positively by staff and patients, barriers to implementation, delivery and engagement should be considered. Study registration This study is registered with the ISRCTN (14962466). Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (RSET: 16/138/17; BRACE: 16/138/31) and NHSEI and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 13. See the NIHR Journals Library website for further project information. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.
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Affiliation(s)
- Naomi J Fulop
- Department of Applied Health Research, University College London, UK
| | - Holly Walton
- Department of Applied Health Research, University College London, UK
| | | | | | - Lauren Herlitz
- Department of Applied Health Research, University College London, UK
| | - Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Efthalia Massou
- Department of Public Health and Primary Care, University of Cambridge, UK
| | | | - Manbinder Sidhu
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Sonila M Tomini
- Department of Applied Health Research, University College London, UK
| | | | - Jo Ellins
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Pei Li Ng
- Department of Applied Health Research, University College London, UK
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Norman G, Bennett P, Vardy ERLC. Virtual wards: a rapid evidence synthesis and implications for the care of older people. Age Ageing 2023; 52:afac319. [PMID: 36633298 PMCID: PMC9835137 DOI: 10.1093/ageing/afac319] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/11/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Virtual wards are being rapidly developed within the National Health Service in the UK, and frailty is one of the first clinical pathways. Virtual wards for older people and existing hospital at home services are closely related. METHODS In March 2022, we searched Medline, CINAHL, the Cochrane Database of Systematic Reviews and medRxiv for evidence syntheses which addressed clinical-effectiveness, cost-effectiveness, barriers and facilitators, or staff, patient or carer experience for virtual wards, hospital at home or remote monitoring alternatives to inpatient care. RESULTS We included 28 evidence syntheses mostly relating to hospital at home. There is low to moderate certainty evidence that clinical outcomes including mortality (example pooled RR 0.77, 95% CI 0.60-0.99) were probably equivalent or better for hospital at home. Subsequent residential care admissions are probably reduced (example pooled RR 0.35, 95% CI 0.22-0.57). Cost-effectiveness evidence demonstrated methodological issues which mean the results are uncertain. Evidence is lacking on cost implications for patients and carers. Barriers and facilitators operate at multiple levels (organisational, clinical and patient). Patient satisfaction may be improved by hospital at home relative to inpatient care. Evidence for carer experience is limited. CONCLUSIONS There is substantial evidence for the clinical effectiveness of hospital at home but less evidence for virtual wards. Guidance for virtual wards is lacking on key aspects including team characteristics, outcome selection and data protection. We recommend that research and evaluation is integrated into development of virtual ward models. The issue of carer strain is particularly relevant.
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Affiliation(s)
- Gill Norman
- Division of Nursing, Midwifery & Social Work; School of Health Sciences; Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- NIHR Applied Research Collaboration Greater Manchester, University of Manchester, Oxford Road, Manchester, UK
| | - Paula Bennett
- Health Innovation Manchester, City Labs, Nelson Street, Manchester, UK
| | - Emma R L C Vardy
- Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, UK
- Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester, UK
- NIHR Applied Research Collaboration Greater Manchester, University of Manchester, Oxford Road, Manchester, UK
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Bird M, Carter N, Lim A, Kazmie N, Fajardo C, Reaume S, McGillion MH. A Novel Hospital-to-Home System for Children With Medical Complexities: Usability Testing Study. JMIR Form Res 2022; 6:e34572. [PMID: 35969456 PMCID: PMC9419046 DOI: 10.2196/34572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Children with medical complexity (CMC) are a group of young people who have severe complex chronic conditions, substantial family-identified service needs, functional limitations, and high health care resource use. Technology-enabled hospital-to-home interventions designed to deliver comprehensive care in the home setting are needed to ease CMC family stress, provide proactive and comprehensive care to this fragile population, and avoid hospital admissions, where possible. Objective In this usability testing study, we aimed to assess areas of strength and opportunity within the DigiComp Kids system, a hospital-to-home intervention for CMC and their families and care providers. Methods Hospital-based clinicians, family members of medically complex children, and home-based clinicians participated in DigiComp Kids usability testing. Participants were recorded and tasked to think aloud while completing usability testing tasks. Participants were scored on the metrics of effectiveness, efficiency, and satisfaction, and the total usability score was calculated using the Single Usability Metric. Participants also provided insights into user experiences during the postusability testing interviews. Results A total of 15 participants (5 hospital-based clinicians, 6 family members, and 4 home-based clinicians) participated in DigiComp Kids usability testing. The participants were able to complete all assigned tasks independently. Error-free rates for tasks ranged from 58% to 100%; the average satisfaction rating across groups was ≥80%, as measured by the Single Ease Question. Task times of participants were variable compared with the task times of an expert DigiComp Kids user. Single Usability Metric scores ranged from 80.5% to 89.5%. In qualitative interviews, participants stressed the need to find the right fit between user needs and the effort required to use the system. Interviews also revealed that the value of the DigiComp Kids system was in its ability to create a digital bridge between hospital and home, enabling participants to foster and maintain connections across boundaries. Conclusions Usability testing revealed strong scores across the groups. Insights gained include the importance of tailoring the implementation of the system to match individual user needs, streamlining key system features, and consideration of the meaning attached to system use by participants to allow for insight into system adoption and sustainment.
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Affiliation(s)
- Marissa Bird
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Nancy Carter
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Audrey Lim
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Nadia Kazmie
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | | | - Shannon Reaume
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Michael H McGillion
- School of Nursing, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
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6
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Fjellså HMH, Husebø AML, Storm M. eHealth in Care Coordination for Older Adults Living at Home: A Scoping Review (Preprint). J Med Internet Res 2022; 24:e39584. [DOI: 10.2196/39584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
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Ward TJ, Mavilakandy A, Danns J, Tsaknis G, Reddy RV. Outcomes from a virtual ward delivering oxygen at home for patients recovering from COVID-19: a real world observational study. Clin Med (Lond) 2022; 22:197-202. [PMID: 38589080 DOI: 10.7861/clinmed.2021-0512] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a lack of data on the safety of providing oxygen at home to stable patients recovering from COVID-19. METHODS A retrospective analysis of patients discharged to a COVID-19 virtual ward (CVW) between January 2021 and March 2021 at a UK district general hospital was performed. Patients with improving clinical trajectories and oxygen requirements up to 4 L/minute were eligible. Outcomes measured were 30-day mortality and readmission rate. RESULTS From 02 January 2021 to 16 March 2021 (74 days), 147 patients discharged to the CVW were included: 71 received continuous or ambulatory oxygen, and 76 received pulse oximetry monitoring only. Five patients were readmitted within 30 days and two patients died. There were no significant differences between readmission and mortality rates between those discharged with or without oxygen. CONCLUSION Provision of oxygen at home for selected patients recovering from COVID-19 is safe with low risk of readmission and death.
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Affiliation(s)
- Thomas Jc Ward
- Kettering General Hospital NHS Foundation Trust, Kettering, UK and University of Leicester, Leicester, UK.
| | | | - Julie Danns
- Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | | | - Raja V Reddy
- Kettering General Hospital NHS Foundation Trust, Kettering, UK
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van der Lande ACMH, Treskes RW, Beeres SLMA, Schalij MJ. Continuum of Care: Positioning of the Virtual Hospital. Front Cardiovasc Med 2022; 8:779075. [PMID: 35369043 PMCID: PMC8965149 DOI: 10.3389/fcvm.2021.779075] [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: 09/17/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
IntroductionPatients with multiple chronic diseases suffer from reduced life expectancy. Care for these patients is often divided over multiple healthcare professionals. eHealth might help to integrate care for these patients and create a continuum. It is the primary purpose of this paper to describe an intervention that integrates first, second, and third line care in patients with multiple chronic conditions using remote monitoring, remote therapy and data automatization, all integrated in a virtual care center (VCC).MethodsPatients diagnosed with three or more chronic conditions are included and given smartphone compatible devices for remote monitoring and a tablet for video consultations. Patients will be followed-up by the VCC, consisting of nurses who will coordinate care, supervised by general practitioners and medical specialists. Data is reviewed on a daily basis and patients are contacted on a weekly basis. Review of data is automated by computer algorithms. Patients are contacted in case of outcome abnormalities in the data. Patients can contact the VCC at any time. Follow-up of the study is 1 year.ResultsThe primary outcome of this study is the median number of nights admitted to the hospital per patient compared to the hospitalization data 12 months before enrolment. Secondary outcomes include all-cause mortality, event free survival, quality of life and satisfaction with technology and care.ConclusionThis study presents the concept of a VCC that integrates first, second, and third line care into a virtual ward using remote monitoring and video consultation.
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Affiliation(s)
| | - Roderick W. Treskes
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Martin J. Schalij
- Executive Board, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Martin J. Schalij
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Arias-Casais N, Amuthavalli Thiyagarajan J, Rodrigues Perracini M, Park E, Van den Block L, Sumi Y, Sadana R, Banerjee A, Han ZA. What long-term care interventions have been published between 2010 and 2020? Results of a WHO scoping review identifying long-term care interventions for older people around the world. BMJ Open 2022; 12:e054492. [PMID: 35105637 PMCID: PMC8808408 DOI: 10.1136/bmjopen-2021-054492] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/20/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The global population is rapidly ageing. To tackle the increasing prevalence of older adults' chronic conditions, loss of intrinsic capacity and functional ability, long-term care interventions are required. The study aim was to identify long-term care interventions reported in scientific literature from 2010 to 2020 and categorise them in relation to WHO's public health framework of healthy ageing. DESIGN Scoping review conducted on PubMed, CINHAL, Cochrane and Google Advanced targeting studies reporting on long-term care interventions for older and frail adults. An internal validated Excel matrix was used for charting.Setting nursing homes, assisted care homes, long-term care facilities, home, residential houses for the elderly and at the community. INCLUSION CRITERIA Studies published in peer-reviewed journals between 1 January 2010 to 1 February 2020 on implemented interventions with outcome measures provided in the settings mentioned above for subjects older than 60 years old in English, Spanish, German, Portuguese or French. RESULTS 305 studies were included. Fifty clustered interventions were identified and organised into four WHO Healthy Ageing domains and 20 subdomains. All interventions delved from high-income settings; no interventions from low-resource settings were identified. The most frequently reported interventions were multimodal exercise (n=68 reports, person-centred assessment and care plan development (n=22), case management for continuum care (n=16), multicomponent interventions (n=15), psychoeducational interventions for caregivers (n=13) and interventions mitigating cognitive decline (n=13). CONCLUSION The identified interventions are diverse overarching multiple settings and areas seeking to prevent, treat and improve loss of functional ability and intrinsic capacity. Interventions from low-resource settings were not identified.
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Affiliation(s)
- Natalia Arias-Casais
- ATLANTES Global Observatory for Palliative Care, University of Navarra, Pamplona, Spain
| | | | | | - Eunok Park
- College of Nursing, Jeju National University, Jeju, Republic of Korea
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yuka Sumi
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Ritu Sadana
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Zee-A Han
- Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Li Y, Chen M, Lin R, Li H. Perceptions and Expectations of Advanced Geriatric Nursing Role Development in Primary Health Care: A Qualitative Study Exploring Staff's Perspectives. J Multidiscip Healthc 2021; 14:3607-3619. [PMID: 35002250 PMCID: PMC8722692 DOI: 10.2147/jmdh.s343622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This qualitative study aimed to explore multidisciplinary members' perceptions and expectations of advanced geriatric nursing role development in primary health care. PATIENTS AND METHODS A multi-center, cross-sectional study based on semi-structured individual interviews was conducted with registered nurses, general physicians, and managers involved in the care of older people in primary health care between September 2020 and January 2021. Recruitment was purposive and the framework method was used to inductively analyze the data. The Consolidated Criteria for Reporting Qualitative research (COREQ) served to structure our manuscript. RESULTS In total, 29 registered nurses, 6 general physicians, and 10 managers from 8 health centers were interviewed. The relevant themes interpreted from the interview data were as follows: (1) the current roles of registered nurses in the care of older people; (2) the factors affect the advanced geriatric nursing role development; (3) expectations of the advanced geriatric nursing roles. CONCLUSION There is a need for appropriate educational programs, well-established laws, and regulations to support the sustainable development of advanced geriatric nursing roles. To build the expected role model, the nursing education program in the future should integrate gerontological nursing, public health nursing, and nursing management to maximize the role of gerontological nurse practitioners in primary health care.
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Affiliation(s)
- Yulian Li
- The School of Nursing, Fujian Medical University, Fuzhou City, Fujian Province, People’s Republic of China
| | - Meirong Chen
- Department of Nursing, Fujian Provincial Hospital, Fuzhou City, Fujian Province, People’s Republic of China
| | - Rong Lin
- The School of Nursing, Fujian Medical University, Fuzhou City, Fujian Province, People’s Republic of China
- Research Center for Nursing Theory and Practice, Fujian Provincial Hospital, Fuzhou City, Fujian Province, People’s Republic of China
| | - Hong Li
- The School of Nursing, Fujian Medical University, Fuzhou City, Fujian Province, People’s Republic of China
- Research Center for Nursing Theory and Practice, Fujian Provincial Hospital, Fuzhou City, Fujian Province, People’s Republic of China
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Henderson L, Bain H, Allan E, Kennedy C. Integrated health and social care in the community: A critical integrative review of the experiences and well-being needs of service users and their families. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1145-1168. [PMID: 33058359 DOI: 10.1111/hsc.13179] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 08/13/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
A need for people-centred health and social support systems is acknowledged as a global priority. Most nations face challenges in providing safe, effective, timely, affordable, coordinated care around the needs and preferences of people who access integrated health and social care (IHSC) services. Much of the current research in the field focuses on describing and evaluating specific models for delivering IHSC. Fewer studies focus on person-centred experiences, needs and preferences of people who use these services. However, current international guidance for integrated care sets a precedence of person-centred integrated care that meets the health and well-being needs of people who access IHSC services. This integrative literature review synthesises empirical literature from six databases (CINAHL; MEDLINE; AMED; TRIP; Web of Science and Science Direct; 2007-2019). This review aims to better understand the experiences and health and well-being needs of people who use IHSC services in a community setting. Twenty studies met the inclusion criteria and results were thematically analysed. Three overarching themes were identified, including relationships, promoting health and well-being and difficulty understanding systems. Findings of this review indicate that relationships hold significance in IHSC. People who access IHSC services felt that they were not always involved in planning their care and that there was a lack of clarity in navigating integrated systems; subsequently, this impacted upon their experiences of those services. However, service user and informal carer voices appear to be underrepresented in current literature and studies that included their views were found to be of low quality overall. Collectively, these findings support the need for further research that explores the person-centred experiences and needs of people who access IHSC.
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Affiliation(s)
- Louise Henderson
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - Heather Bain
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - Elaine Allan
- School Nursing AHSCP & NHSG Strategic Lead CEL 13 School Nursing, NHS Grampian, Aberdeen, UK
- School Nursing, School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - Catriona Kennedy
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, UK
- The University of Limerick, Limerick, Ireland
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Wariri O, Okomo U, Cerami C, Okoh E, Oko F, Jah H, Bojang K, Susso B, Olatunji Y, Nkereuwem E, Akemokwe FM, Jobe M, Agboghoroma OF, Kebbeh B, Sowe G, Gilleh T, Jobe N, Usuf E, Clarke E, Brotherton H, Forrest K. Establishing and operating a 'virtual ward' system to provide care for patients with COVID-19 at home: experience from The Gambia. BMJ Glob Health 2021; 6:e005883. [PMID: 34140303 PMCID: PMC8212157 DOI: 10.1136/bmjgh-2021-005883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/22/2021] [Indexed: 12/20/2022] Open
Abstract
Health systems in sub-Saharan Africa have remained overstretched from dealing with endemic diseases, which limit their capacity to absorb additional stress from new and emerging infectious diseases. Against this backdrop, the rapidly evolving COVID-19 pandemic presented an additional challenge of insufficient hospital beds and human resource for health needed to deliver hospital-based COVID-19 care. Emerging evidence from high-income countries suggests that a 'virtual ward' (VW) system can provide adequate home-based care for selected patients with COVID-19, thereby reducing the need for admissions and mitigate additional stress on hospital beds. We established a VW at the Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, a biomedical research institution located in The Gambia, a low-income west African country, to care for members of staff and their families infected with COVID-19. In this practice paper, we share our experience focusing on the key components of the system, how it was set up and successfully operated to support patients with COVID-19 in non-hospital settings. We describe the composition of the multidisciplinary team operating the VW, how we developed clinical standard operating procedures, how clinical oversight is provided and the use of teleconsultation and data capture systems to successfully drive the process. We demonstrate that using a VW to provide an additional level of support for patients with COVID-19 at home is feasible in a low-income country in sub-Saharan Africa. We believe that other low-income or resource-constrained settings can adopt and contextualise the processes described in this practice paper to provide additional support for patients with COVID-19 in non-hospital settings.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Uduak Okomo
- Vaccines and Immunity Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Carla Cerami
- Nutrition Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Emmanuel Okoh
- Disease Control and Elimination, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Francis Oko
- Vaccines and Immunity Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Hawanatu Jah
- Disease Control and Elimination, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Kalifa Bojang
- Disease Control and Elimination, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Bubacarr Susso
- Clinical Services Department, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Yekini Olatunji
- Disease Control and Elimination, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Esin Nkereuwem
- Vaccines and Immunity Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Fatai Momodou Akemokwe
- Clinical Services Department, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Modou Jobe
- Nutrition Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Orighomisan Freda Agboghoroma
- Clinical Services Department, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Bunja Kebbeh
- Clinical Services Department, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Ghata Sowe
- Vaccines and Immunity Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Thomas Gilleh
- Data Management and Archives, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Naffie Jobe
- Directorate, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Effua Usuf
- Disease Control and Elimination, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Ed Clarke
- Vaccines and Immunity Theme, Medical Research Council Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Helen Brotherton
- Disease Control and Elimination, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Karen Forrest
- Clinical Services Department, Medical Research Council Unit The Gambia, at London School of Hygiene and Tropical Medicine, Banjul, Gambia
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Lewis C, O’Caoimh R, Patton D, O’Connor T, Moore Z, Nugent LE. Utilisation of a Suite of Screening Tools to Determine Adverse Healthcare Outcomes in an Older Frail Population Admitted to a Community Virtual Ward. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5601. [PMID: 34073916 PMCID: PMC8197352 DOI: 10.3390/ijerph18115601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022]
Abstract
Risk stratification to assess healthcare outcomes among older people is challenging due to the interplay of multiple syndromes and conditions. Different short risk-screening tools can assist but the most useful instruments to predict responses and outcomes following interventions are unknown. We examined the relationship between a suite of screening tools and risk of adverse outcomes (pre-determined clinical 'decline' i.e., becoming 'unstable' or 'deteriorating' at 60-90 days, and institutionalisation, hospitalisation and death at 120 days), among community dwellers (n = 88) after admission to a single-centre, Irish, Community Virtual Ward (CVW). The mean age of patients was 82.8 (±6.4) years. Most were severely frail, with mean Clinical Frailty Scale (CFS) scores of 6.8 ± 1.33. Several instruments were useful in predicting 'decline' and other healthcare outcomes. After adjustment for age and gender, higher frailty levels, odds ratio (OR) 3.29, (p = 0.002), impaired cognition (Mini Mental State Examination; OR 4.23, p < 0.001), lower mobility (modified FIM) (OR 3.08, p < 0.001) and reduced functional level (Barthel Index; OR 6.39, p < 0.001) were significantly associated with clinical 'decline' at 90 days. Prolonged (>30 s) TUG times (OR 1.27, p = 0.023) and higher CFS scores (OR 2.29, p = 0.045) were associated with institutionalisation. Only TUG scores were associated with hospitalisation and only CFS, MMSE and Barthel scores at baseline were associated with mortality. Utilisation of a multidimensional suite of risk-screening tools across a range of domains measuring frailty, mobility and cognition can help predict clinical 'decline' for an already frail older population. Their association with other outcomes was less useful. A better understanding of the utility of these instruments in vulnerable populations will provide a framework to inform the impact of interventions and assist in decision-making and anticipatory care planning for older patients in CVW models.
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Affiliation(s)
- Clare Lewis
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, 123 St Stephen’s Green, Saint Peter’s, D02 YN77 Dublin, Ireland; (D.P.); (T.O.); (Z.M.); (L.E.N.)
| | - Rónán O’Caoimh
- Clinical Sciences Institute, National University of Ireland Galway, Costello Road, H91 TK33 Galway City, Ireland;
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork City, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, 123 St Stephen’s Green, Saint Peter’s, D02 YN77 Dublin, Ireland; (D.P.); (T.O.); (Z.M.); (L.E.N.)
| | - Tom O’Connor
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, 123 St Stephen’s Green, Saint Peter’s, D02 YN77 Dublin, Ireland; (D.P.); (T.O.); (Z.M.); (L.E.N.)
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, 123 St Stephen’s Green, Saint Peter’s, D02 YN77 Dublin, Ireland; (D.P.); (T.O.); (Z.M.); (L.E.N.)
| | - Linda E. Nugent
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, 123 St Stephen’s Green, Saint Peter’s, D02 YN77 Dublin, Ireland; (D.P.); (T.O.); (Z.M.); (L.E.N.)
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Cushen B, Madden A, Long D, Whelan Y, O'Brien ME, Carroll D, O'Flynn D, Forde M, Pye V, Grogan L, Casey M, Farrell K, Costello RW, Lewis C. Integrating hospital and community care: using a community virtual ward model to deliver combined specialist and generalist care to patients with severe chronic respiratory disease in their homes. Ir J Med Sci 2021; 191:615-621. [PMID: 33956325 PMCID: PMC8100740 DOI: 10.1007/s11845-021-02633-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/01/2021] [Indexed: 11/26/2022]
Abstract
Background Chronic respiratory diseases are responsible for significant patient morbidity, mortality, and healthcare use. Community virtual ward (CVW) models of care have been successfully implemented to manage patients with complex medical conditions. Aims To explore the feasibility and clinical outcomes of a CVW model of care in patients with chronic respiratory disease. Methods Patients known to specialist respiratory services with Chronic Obstructive Pulmonary Disease (COPD) and/or asthma were admitted to the CVW for disease optimisation and exacerbation management. Individualised management plans were delivered in the patients’ home by hospital-based respiratory and community nursing teams, incorporating remote technology to monitor vital signs. Symptoms and health status at admission and discharge were compared. Results Twenty patients were admitted. One-quarter of patients had asthma, 50% COPD, and 25% combined asthma/COPD. Patients had severe disease, mean (SD) FEV1 50(20) % predicted, and an average 6.4(5.7) exacerbations of disease in the previous 12 months. Patients received personalised disease and self-management education. All acute exacerbations (n = 11) were successfully treated in the community. The average length of CVW admission was 10(4) days. By discharge, 60% of COPD and 66% of asthma patients recorded improvements in symptoms score exceeding the minimal clinically important difference. Fifty percent had clinically meaningful improvements in health status. Conclusion A CVW model facilitates the delivery of combined specialist and generalist care to patients with chronic respiratory disease in the community and improves symptoms and health status. The principles of the model are transferable to other conditions to improve overall health and reduce emergency hospital care.
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Affiliation(s)
- Breda Cushen
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland.
| | - Aisling Madden
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Deirdre Long
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Yvonne Whelan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | | | - Deirdre Carroll
- Community Intervention Team, Community Healthcare Organisation Dublin North Central and County, Area 9 (CHO 9 DNCC), Dublin North City, Ireland
| | - Des O'Flynn
- Community Intervention Team, Community Healthcare Organisation Dublin North Central and County, Area 9 (CHO 9 DNCC), Dublin North City, Ireland
| | - Michelle Forde
- Community Intervention Team, Community Healthcare Organisation Dublin North Central and County, Area 9 (CHO 9 DNCC), Dublin North City, Ireland
| | - Virginia Pye
- Office of the Nursing and Midwifery Services Director, Health Service Executive, Dublin South City, Ireland
| | - Loretto Grogan
- Office of the Nursing and Midwifery Services Director, Health Service Executive, Dublin South City, Ireland
| | - Margaret Casey
- Office of the Nursing and Midwifery Services Director, Health Service Executive, Dublin South City, Ireland
| | | | - Richard W Costello
- Department of Respiratory Medicine, Beaumont Hospital, Dublin 9, Dublin, Ireland
| | - Clare Lewis
- Department of Health, Chief Nurse's Office, Dublin, Ireland
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15
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Ferry OR, Moloney EC, Spratt OT, Whiting GFM, Bennett CJ. A Virtual Ward Model of Care for Patients With COVID-19: Retrospective Single-Center Clinical Study. J Med Internet Res 2021; 23:e25518. [PMID: 33529157 PMCID: PMC7879714 DOI: 10.2196/25518] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/23/2020] [Accepted: 01/10/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 has necessitated the implementation of innovative health care models in preparation for an influx of patients. A virtual ward model delivers clinical care remotely to patients in isolation. We report on an Australian cohort of patients with COVID-19 treated in a virtual ward. OBJECTIVE The aim of this study was to describe and evaluate the safety and efficacy of a virtual ward model of care for an Australian cohort of patients with COVID-19. METHODS Retrospective clinical assessment was performed for 223 patients with confirmed COVID-19 treated in a virtual ward in Brisbane, Australia, from March 25 to May 15, 2020. Statistical analysis was performed for variables associated with the length of stay and hospitalization. RESULTS Of 223 patients, 205 (92%) recovered without the need for escalation to hospital care. The median length of stay in the virtual ward was 8 days (range 1-44 days). In total, 18 (8%) patients were referred to hospital, of which 6 (33.3%) were discharged after assessment at the emergency department. Furthermore, 12 (5.4%) patients were admitted to hospital, of which 4 (33.3%) required supplemental oxygen and 2 (16.7%) required mechanical ventilation. No deaths were recorded. Factors associated with escalation to hospital care were the following: hypertension (odds ratio [OR] 3.6, 95% CI 1.28-9.87; P=.01), sputum production (OR 5.2, 95% CI 1.74-15.49; P=.001), and arthralgia (OR 3.8, 95% CI 1.21-11.71; P=.02) at illness onset and a polymerase chain reaction cycle threshold of ≤20 on a diagnostic nasopharyngeal swab (OR 5.0, 95% CI 1.25-19.63; P=.02). CONCLUSIONS Our results suggest that a virtual ward model of care to treat patients with COVID-19 is safe and efficacious, and only a small number of patients would potentially require escalation to hospital care. Further studies are required to validate this model of care.
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Affiliation(s)
- Olivia R Ferry
- Metro North Hospital and Health Service, Brisbane, Australia
| | - Emma C Moloney
- Metro North Hospital and Health Service, Brisbane, Australia
| | - Owen T Spratt
- Metro North Hospital and Health Service, Brisbane, Australia
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Yu Z, Gallant AJ, Cassidy CE, Boulos L, Macdonald M, Stevens S. Case Management Models and Continuing Care: A Literature Review across nations, settings, approaches, and assessments. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2020. [DOI: 10.1177/1084822320954394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Older adults accessing continuing care often have multiple chronic conditions. Research suggests that case management is a promising approach to reduce health care expenditure and improve patient outcomes. To optimize healthcare delivery, an examination of existing case management models and their effectiveness is essential. This literature review was conducted using Joanna Briggs Institute (JBI) methods to explore case management models for older adults accessing continuing care services. Searches were conducted in PubMed and CINAHL from 2010 to 2018. A total of 37 articles were included in this review. Approaches to case management are diverse with respect to composition of care providers, method of care provision, and location of care. Findings from 27 quantitative studies demonstrated that nurse-led and interdisciplinary team case management models that include home visits can effectively reduce hospital admission/readmission while lowering costs. Mixed results were found on the impact of case management on patient satisfaction, ED visits, quality of life, length of stay, self-efficacy, social integration and caregiver burden. Among 10 qualitative studies, 3 facilitators for quality case management were identified that include receiving care at home, building trusting relationships, and improving self-efficacy. Based on these findings, we conclude that nurse-led and interdisciplinary team case management can effectively reduce hospital admission of frail older adults while lowering costs, particularly within home care settings.
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Affiliation(s)
- Ziwa Yu
- Dalhousie University, Halifax, Canada
| | | | | | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Halifax, NS, Canada
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Lewis C, O'Caoimh R, Patton D, O'Connor T, Moore Z, Nugent LE. Risk Prediction for Adverse Outcomes for Frail Older Persons with Complex Healthcare and Social Care Needs Admitted to a Community Virtual Ward Model. Clin Interv Aging 2020; 15:915-926. [PMID: 32606633 PMCID: PMC7320026 DOI: 10.2147/cia.s236895] [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: 10/31/2019] [Accepted: 05/02/2020] [Indexed: 01/01/2023] Open
Abstract
Purpose Population ageing is challenging healthcare systems with limited resources, necessitating the development of new care models to address the needs of older, frail community-dwellers. Community Virtual Wards (CVW) reduce adverse events in these patients. We examined the effect of an established CVW on pre-defined health trajectories (between “stable”, “deteriorating”, and “unstable” states) and characteristics that increased the likelihood of adverse healthcare outcomes (hospitalization, institutionalization and death). Patients and Methods We collected prospective data on frail patients admitted to a CVW in a single centre in Ireland. Relationships between risk scores, health states and adverse outcomes at 30, 60 and 90 days after admission were examined using multinomial regression analysis. Results In total, 88 community-dwellers, mean (±SD) age of 82.8 ±6.4 years, were included. Most were severely frail on the Rockwood Clinical Frailty Scale (mean 6.8/9 ±1.33). Reaching stability (“stable” state) within 30 days was a predictor for stability at 60 and 90 days and remaining at home. Stability was also associated with fewer care episodes (<2) (p=<0.001), a requirement for fewer healthcare professionals (HCP) (<7) (p<0.001) and lower risk of delirium (p<0.001). By contrast, being “unstable” at 60 days increased the numbers of HCP referrals (>7) and was predictive of more acute episodes (>2) and institutionalization or death (p<0.001). Predictors of adverse outcomes of either institutionalization or death included frailty status, function, mobility, nutrition, pressure ulcer risk and cognition. Conclusion A CVW model can provide a framework for monitoring and case management to support older people to remain at home or identify those at risk of institutional care. The use of defined health states helped to stratify those at lower or higher risk in an already high-risk frail population. Level of frailty, function, mobility, nutrition, pressure ulcer risks and cognition were predictive of remaining at home and reaching a level of stability or instability/deterioration and institutional care.
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Affiliation(s)
- Clare Lewis
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Rónán O'Caoimh
- Clinical Sciences Institute, National University of Ireland Galway, Galway City H91 TK33, Ireland.,Mercy University Hospital, Cork City T12 WE28, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Tom O'Connor
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Linda E Nugent
- School of Nursing and Midwifery, Royal College of Surgeons Ireland, Dublin, Ireland
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Desmarais P, Herrmann N, Alam F, Choi S, Avramescu S. Future Directions for Geriatric Anesthesiology. Anesthesiol Clin 2019; 37:581-592. [PMID: 31337487 DOI: 10.1016/j.anclin.2019.05.002] [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: 01/24/2023]
Abstract
"With a rapidly aging world population, it is critical for physicians of every specialty to adapt the ways they provide medical and perioperative care to patients. Older adults represent the largest population of health care users, and they have very different needs and preferences compared with their younger counterparts. In this article, the authors discuss some of the current gaps in geriatric anesthesia and perioperative care, as they elaborate on what can be expected in the near future at different levels of the health care system: the patient, the environment, and the anesthesia specialty."
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Affiliation(s)
- Philippe Desmarais
- Cognitive & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room A455, Toronto, Ontario M4N 3M5, Canada; L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Nathan Herrmann
- Department of Psychiatry, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room FG19, Toronto, Ontario M4N 3M5, Canada
| | - Fahad Alam
- Department of Anesthesia, University of Toronto, 123 Edward Street, Toronto, Ontario M5G 1E2, Canada; Department of Anesthesia, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M3200, Toronto, Ontario M4N 3M5, Canada
| | - Stephen Choi
- Department of Anesthesia, University of Toronto, 123 Edward Street, Toronto, Ontario M5G 1E2, Canada; Department of Anesthesia, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M3200, Toronto, Ontario M4N 3M5, Canada
| | - Sinziana Avramescu
- Department of Anesthesia, University of Toronto, 123 Edward Street, Toronto, Ontario M5G 1E2, Canada; Department of Anesthesia, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M3200, Toronto, Ontario M4N 3M5, Canada; Department of Anesthesia, Humber River Hospital, 1235 Wilson Avenue, Toronto, Ontario M3M 0B2, Canada.
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Jarrín OF, Pouladi FA, Madigan EA. International priorities for home care education, research, practice, and management: Qualitative content analysis. NURSE EDUCATION TODAY 2019; 73:83-87. [PMID: 30550942 PMCID: PMC6713276 DOI: 10.1016/j.nedt.2018.11.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/29/2018] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Despite growing demand for home care nursing, there is a growing home care workforce shortage, due in part to hospital-centric nursing curricula that lead students to undervalue of home care and community practice setting (Van Iersel et al., 2018a, 2018b). OBJECTIVES Articulate an international vision for the future of home care education, research, practice, and management shared by experienced home care nurses working in leadership roles. DESIGN Qualitative content analysis. SETTINGS AND PARTICIPANTS The sample included 50 home care professionals from 17 countries. METHODS Home care nurse leaders (in education, research, practice, and management roles) were recruited through professional international nursing networks to participate in a structured online survey about priorities for the future of home care in 2014. Responses were open coded by two independent researchers. Preliminary categories and sub-themes were developed by the research team and revised after a modified member-checking process that included presentation and discussion of preliminary findings at three international nursing meetings in 2015 and 2016. RESULTS Four major themes emerged reflecting international priorities for the future of home care education, research, practice, and management: 1) Build the evidence base for home care; 2) Design better systems of care; 3) Develop leaders at all levels; and 4) Address payment and policy issues. CONCLUSIONS Collectively, the findings provide a major call to action for nurse educators to re-design existing pre- and post-licensure educational programs to meet the growing demand for home care nurses. Innovations in education that focus on filling gaps in the evidence-base for community nursing practice, and improving access to continuing education and evidence-based resources for practicing home care nurses and nurse managers should be prioritized.
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Affiliation(s)
- Olga F Jarrín
- School of Nursing, Rutgers, The State University of New Jersey, and Institute for Health, Health Care Policy, and Aging Research, 112 Paterson Street, New Brunswick, NJ 08901, United States of America.
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Fullam J, Cusack E, Nugent LE. Research excellence across clinical healthcare: a novel research capacity building programme for nurses and midwives in a large Irish region. J Res Nurs 2018; 23:692-706. [PMID: 34394491 DOI: 10.1177/1744987118806543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: A lack of support and research skills development has contributed to low research output by clinically based nurses and midwives in Ireland, including those in specialised and advanced roles. A novel research capacity building (RCB) programme was developed to address existing barriers. The programme was developed and implemented using Cooke's principles of RCB. Nurses and midwives participated from acute hospital, community, public health, mental health, older adult, intellectual disability, addiction and palliative care settings. Aims: This paper provides an evaluation of the Research Excellence Across Clinical Healthcare (REACH) programme from 2013-2016. Methods: Document analysis was used to evaluate RCB activities and outputs. Data were extracted from programme reports, conference proceedings, paper references, and workshop and conference sign-in/evaluation forms. Results: Individuals (n = 17) and small research groups (n = 4) were supported. Increased research capacity was demonstrated through dissemination of research in peer-reviewed journals, posters and oral presentations at national and international conferences. Sustainability was demonstrated by progression of participants to PhD (n = 3) and research projects that remain ongoing (n = 5). Skills development was facilitated by the organisation of workshops and conferences. Conclusions: A programme that provides academic support and mentorship in the clinical environment along with skills development can build research capacity. Future research should involve follow-up to determine any long-term effects.
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Affiliation(s)
- James Fullam
- Postdoctoral Research Fellow, NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, UK
| | - Eithne Cusack
- Director of Nursing and Midwifery Planning and Development, Quality and Clinical Care Directorate, Health Service Executive Dublin North, Ireland
| | - Linda E Nugent
- Lecturer & Programme Director, RCSI School of Nursing & Midwifery, Royal College of Surgeons in Ireland, Ireland
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Johnson S, Bacsu J. Understanding complex care for older adults within Canadian home care: a systematic literature review. Home Health Care Serv Q 2018; 37:232-246. [PMID: 29578846 DOI: 10.1080/01621424.2018.1456996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In the context of an aging population, both the need for home care services and its complexity of care have increased in many high-income countries. Yet, the definition of what constitutes complex care is largely elusive. This systematic review examined the conceptual definition of complex care within the home care environment using several social and health science databases for research published from 2000 to 2017. Of the 25 articles and reports identified, only 16 addressed complex care specifically and included older adults, aging, and/or home care. The results showed that complex care for older adults is primarily defined from a biomedical approach focusing on chronic disease and management and less commonly from the perspective of the social determinants of health. Future studies should consider the importance of the continuum of care needs from both the biomedical and the social determinants to adequately plan and provide care for older adults.
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Affiliation(s)
- Shanthi Johnson
- a Faculty of Kinesiology and Health Studies and Saskatchewan Population Health and Evaluation Research Unit , University of Regina , Regina , Canada
| | - Juanita Bacsu
- a Faculty of Kinesiology and Health Studies and Saskatchewan Population Health and Evaluation Research Unit , University of Regina , Regina , Canada
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Gené Huguet L, Navarro González M, Kostov B, Ortega Carmona M, Colungo Francia C, Carpallo Nieto M, Hervás Docón A, Vilarrasa Sauquet R, García Prado R, Sisó-Almirall A. Pre Frail 80: Multifactorial Intervention to Prevent Progression of Pre-Frailty to Frailty in the Elderly. J Nutr Health Aging 2018; 22:1266-1274. [PMID: 30498836 DOI: 10.1007/s12603-018-1089-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Preventing or delaying frailty has important benefits in the elderly, and in health and social services. Studies have demonstrated the effectiveness of multifactorial interventions in the frail elderly, but there are fewer studies on community-dwelling pre-frail individuals. Identifying pre-frail individuals susceptible to intervention could prevent or delay frailty and its consequences and associated disability and might reverse the state from pre-frail to robust. To evaluate a multifactorial, interdisciplinary primary care intervention in community-dwelling pre-frail elderly patients aged ≥ 80 years. DESIGN Randomized clinical trial in a Barcelona primary healthcare centre. SETTING We included 200 community-dwelling subjects aged ≥ 80 years meeting the Fried pre-frailty criteria. Participants were randomized to intervention and control groups. INTERVENTION The intervention group received a 6-month interdisciplinary intervention based on physical exercise, Mediterranean diet advice, assessment of inadequate prescribing in polypharmacy patients and social assessment, while the control group received standard primary healthcare treatment. RESULTS 173 pre-frail participants (86.5%) completed the study; mean age 84.5 years, 64.5% female. At twelve months, frailty was lower in the intervention group (RR 2.90; 95%CI 1.45 to 8.69). Reversion to robustness was greater in the intervention group (14.1% vs.1.1%, p <0.001). Functional and nutritional status, adherence to Mediterranean diet, quality of life, and functional mobility were improved in the intervention group (p ≤0.001). CONCLUSION A multifactorial, interdisciplinary primary healthcare intervention focused on physical exercise, nutrition, review of polypharmacy and social assessment prevented frailty in pre-frail elderly patients, and improved functional capacity, quality of life and adherence to the Mediterranean diet.
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Affiliation(s)
- L Gené Huguet
- L. Gené Huguet Specialist family physician, Centro de Salud Borrell, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain,
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