Team-based care intervention: views and perspectives from patients and healthcare professionals

Background

Blood pressure (BP) control is poor in European countries. Team-based care (TBC) intervention involving different healthcare professionals has the potential to improve BP control. Within a patient-centered approach, we evaluated patients' and healthcare professionals' opinion about a TBC intervention involving nurses, pharmacists, and physicians (MD).

Methods

As part of the TBC study, a pragmatic randomized controlled study to evaluate the impact of a TBC interprofessional intervention on BP control, we collected opinion of patients and team-based members (nurses, community pharmacists, and MD) at the end of study period using specific questionnaires. A mean TBC-satisfaction score was computed, assessing various aspects of the intervention, and ranged from 0 to 60, where a higher score represents a greater satisfaction.

Results

All patients (100%), pharmacists (100%), MD (92%) and nurses (80%) were satisfied with TBC intervention. Most patients considered that TBC can help improving BP control (92%), drug intake (71%), and lifestyle habits (84%). Furthermore, patients reported that TBC improved their relationship with nurses (66%), pharmacists (55%), and MD (50%). Patients also reported that their discussion with nurses (95%) and pharmacists (89%) helped improve medication intake. Healthcare professionals considered that TBC improve the quality of care (91%) and an added value for the management of chronic disease (79%). Mean TBC-satisfaction score was higher among MD [42 (SD: 9)] and pharmacists [45 (SD: 6)] compared with nurses [36 (SD: 9)].

Conclusions

Overall, patients and healthcare professionals were highly satisfied regarding TBC engaging different healthcare professionals in a primary care setting.

Key messages

TBC intervention seem to be well appreciated by patients and healthcare professionals. Favourable patients’ and healthcare professionals’ perspectives will help implementing TBC intervention.

Team-based Care for Improving Hypertension Management Among Outpatients

Background

Innovative models of care are needed to reduce poor blood pressure (BP) control in European countries. The TBC-HTA study evaluated the effects of an interprofessional team-based care (TBC) intervention, involving nurses, community pharmacists, and physicians, on BP control compared to usual care.

Methods

We conducted a pragmatic randomized controlled study in ambulatory clinics and community pharmacies in Lausanne and Geneva, Switzerland (ClinicalTrials.gov: NCT02511093). Uncontrolled treated hypertensive patients were randomized to TBC (N = 46) or usual care (UC: N = 43). The TBC intervention was led over 6 months. Nurses and pharmacists met patients every 6 weeks to measure BP, assess lifestyle and medication adherence, and provide health education. After each visit, they wrote a report with recommendations to the physician who could adjust antihypertensive therapy accordingly. The outcome was ambulatory BP measured at 6 and 12 months.

Results

A total of 60 men and 29 women [mean (SD) age: 61(12) year; mean (SD) number of antihypertensive drugs: 2 (1)] were included. At baseline, mean (SD) BP was 144(10)/90(8) and 147(12)/87(11) mmHg in the TBC and UC care groups. 76 patients were followed up to 12 months. At 6 months, the between-group difference in mean BP was -3/+2 mmHg [95% CI: -10 to + 5 / -2 to + 5]; BP control was 38% in the TBC group and 33% in the UC group, respectively. At 12 months, the between-group difference in mean BP was -8/-3 mmHg [95% CI: -14 to -1/-7 to + 1]; BP control was 34% in the TBC group and 20% in the UC group, respectively.

Conclusions

This TBC intervention helped long-term BP control among hypertensive outpatients in Switzerland. In line with recent European guidelines (ESC/ESH), this type of care should be more widely implemented.

Key messages

A TBC of hypertension helped control BP in a Swiss healthcare setting. Policymakers should evaluate how to implement such intervention.

In-home monitoring evaluation by home-dwelling older adults, caregivers and healthcare providers

Background

In Europe, population ageing is increasing the healthcare needs and costs. Both frailty and chronic diseases affecting older people reduce their ability to live independently. However, most older people prefer to age in their own homes. New development of in-home monitoring can play a role in staying independent, active and healthy. Our objective was to evaluate a new in-home monitoring system among home-dwelling older adults (OA), their family caregivers (FC), and their healthcare providers (HCP) for the support of home care.

Methods

The system continuously monitored OA’s daily activities (e.g., mobility, sleep habits, fridge visits, door events) at home by ambient sensor system (DomoCare®) and health-related events by wearable sensors (Fitbit®, ECG). In case of deviations in daily activities (e.g., changes in mobility), alerts were transmitted to HCP via email. Using specific questionnaires, the opinion of 13 OA, 13 FC, and 20 HCP were collected at the end of 12-month of follow-up focusing on their user experience and the impact of in-home monitoring on home care services.

Results

These preliminary results underlined that the majority of OA, FC, and HCP consider that in-home sensors can help staying at home, improving home care, reducing family stress, and preventing domestic accidents. The opinion tended to be more favourable toward ambient sensors (80%) than toward Fitbit® (67%) and ECG (64%). On average, OA (80%) and FC (73%) tended to be more enthusiast than HCP (63%). Some barriers reported by HCP were a fear of weakening of the relationship with OA and an excessive surveillance.

Conclusions

Overall, the opinion of OA, FC and HCP were positive related to in-home sensors, with HCP being more mixed about their use in clinical practice.

Key messages

In-home monitoring technologies seem to be generally well accepted. In-home monitoring technologies could be help facilitating home care of older people.

Low-calcium dialysate stimulates parathormone secretion and its long-term use worsens secondary hyperparathyroidism

The long-term clinical effects of the use of a low calcium concentration in the dialysate are largely unknown. For this reason, the influence of low-calcium dialysate on parathyroid hormone (PTH) secretion in hemodialysis patients and its long-term effect on the severity of secondary hyperparathyroidism were studied. In 35 hemodialysis patients, the dialysate calcium concentration was lowered from 1.75 to 1.25 mmol/L. Twelve months later, serum iPTH levels increased significantly from 18.6 to 33.2 pmol/L and so did alkaline phosphatase levels, from 210 to 330 IU/L, without significant changes in serum calcium or phosphorus levels. Hemodialysis with low-calcium dialysate (1.25 mmol/L) induced a net calcium loss in 10 patients, without modifications in ionized serum calcium levels. In addition, mean serum iPTH increased 20% over baseline levels, reaching the maximal level at 30 min after the start of hemodialysis with low-calcium dialysate. In contrast, mean serum iPTH levels drop dramatically at 30 min of hemodialysis with high-calcium dialysate (1.75 mmol/L). It was concluded that low-calcium dialysate worsens secondary hyperparathyroidism in hemodialysis patients, probably by inducing a negative calcium balance and causing repetitive stimulation of PTH secretion in each dialysis. The maintenance of normal serum calcium levels could be due to PTH-induced calcium mobilization from bone.

[Cirrhosis caused by amiodarone]

A woman who had been taking amiodarone--400 mg/day--for over nine years, developed cirrhosis. Electron microscopy showed phospholipid-laden lysosomal lamellar bodies containing myelin figures. A review is made about the reported cases of amiodarone-induced cirrhosis, including detailed histological findings. We conclude that periodical clinical and biochemical monitoring must be made in patients receiving treatment with amiodarone, and that the pathophysiologic mechanism responsible for the amiodarone toxicity still remains unclear.