Comprehensive discharge follow-up in patients’ homes by GPs and district nurses of elderly patients

Rytter, Lars; Jakobsen, Helle; Rønholt, Finn; Hammer, Anna Viola; Andreasen, Anne Helms; Nissen, Aase; Kjellberg, Jakob

doi:10.3109/02813431003764466

Cited by 69 publications

(130 citation statements)

References 22 publications

Supporting

Mentioning

125

Contrasting

Unclassified

Order By: Relevance

“…[14,15] In comparison to standard treatment, none but a single Danish study found significantly fewer readmissions after an intermediate care intervention. [10] Another study focusing on implementation challenges, identified problems with recruiting and retaining qualified professionals, inadequate funding, lack of support and involvement from GPs, lack of knowledge about the intervention and lack of integration and coordination of services. [6] This theory-based stakeholder evaluation has shown that not all outcome assumptions of the ACCESS project were met, probably due to erroneous implementation.…”

Section: Discussionmentioning

confidence: 99%

“…While some studies have reported substantial challenges in the implementation process, [6] others have found significant decreases, not only in admission rates, costs and admission lengths, [7][8][9] but also in readmission rates. [10] A number of other studies, despite findings of increased costs, [11,12] report no significant impact on admission [1,2,13] and readmission rates. [14,15] The inconsistent findings may be due to the fact that the care of frail elderly citizens has multiple stakeholders, with different jurisdictions (e.g.…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Inappropriate admissions or inadequate discharges of frail elderly: Competing program theories and implementation challenges in an intermediate care intervention

Nørgaard

Skjøt‐Arkil²,

Nissen³

et al. 2017

JNEP

View full text Add to dashboard Cite

Intermediate care interventions are increasingly being implemented in the health services to avoid hospitalizing elderly frail patients with complex medical issues, often referred to as inappropriate or unwarranted admissions. This paper presents a theory-based stakeholder evaluation of an intervention involving hospitals, community care and general practitioners (GPs) in a Danish region with the overall objective to reduce the number of (inappropriate) hospital admissions for the frail elderly of 65 years or older. In a controlled study design elderly acutely ill patients were randomized to care and treatment either by a district nursing team or in an emergency department (ED) -both interventions with a 48-hour time limit. The district nursing teams were given access to various telemedicine solutions. In the programme theory analysis the stakeholders' normative theories, situation theories and causal theories were studied. Competing programme theories and barriers and facilitators were identified. Data were collected in interviews with stakeholders (managers, nurses, hospital physicians and GPs) and from the literature. The intervention included a regional hospital, four municipalities and 166 GPs servicing a mixed urban and rural region in Denmark. Four district nursing teams, eight GPs, three hospital physicians and two project managers were interviewed between January and March 2015. The stakeholder's programme theories were both concordant and competing; the GPs in particular were sceptical of the purported objective of reducing the number of inappropriate hospital admissions; they would rather see a reduction in the number of inappropriate hospital discharges. Our results indicate a compromised implementation process.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Inappropriate admissions or inadequate discharges of frail elderly: Competing program theories and implementation challenges in an intermediate care intervention

Nørgaard

Skjøt‐Arkil²,

Nissen³

et al. 2017

JNEP

View full text Add to dashboard Cite

show abstract

“…For a clinically relevant difference of 10% in re-admissions and an expected drop-out rate of 12% (based on [12]), a statistical significant level of 0.05 and a power of 80%, two groups of 80 patients are calculated to be necessary.…”

Section: Methodsmentioning

confidence: 99%

Study protocol: follow-up home visits with nutrition: a randomised controlled trial

et al. 2011

View full text Add to dashboard Cite

BackgroundGeriatric patients are at high risk of re-admission after discharge. Pre-existing nutritional risk amongst these patients is of primary concern, with former nutritional intervention studies being largely ineffective. None of these studies has included individual dietary counselling by a registered dietician or has considered competing medical conditions in the participants. A former randomised study has shown that comprehensive discharge follow-up in geriatric patients homes by general practitioners and district nurses was effective in reducing the re-admission risk in the intervention group compared to the control group. That study did not include a nutritional intervention. The purpose of this study is to assess the combined benefits of an intervention consisting of discharge follow-up in geriatric patients' home by a general practitioner and a registered dietician.Methods/designThis single-blind randomised controlled study, will recruit 160 hospitalised geriatric medical patients (65+ y) at nutritional risk. Participants will be randomly allocated to receive in their homes, either 12 weeks individualised nutritional counselling by a registered dietician complemented with follow-up by general practitioners or a 12 weeks follow-up by general practitioners alone.DiscussionThis trial is the first of its kind to provide individual nutritional intervention combined with follow-up by general practitioner as an intervention to reduce risk of re-admission after discharge among geriatric medical patients. The results will hopefully help to guide the development of more effective rehabilitation programs following hospital admissions, which may ultimately lead to reduced health care costs, and improvement in mobility, independence and quality of life for geriatric patients at nutritional risk.Trial RegistrationClinicalTrials.gov 2010 NCT01249716

show abstract

“…Hernández encontró que pacientes con insuficiencia cardiaca que tuvieron un control precoz tuvieron menos reingresos a los 30 días (p < 0,001) 59 . Rytter encontró que las visitas domiciliarias post alta reducen el riesgo de reingreso (p = 0,03), y mejoran la adherencia a la medicación (p = 0,05) en adultos mayores frági-les 60 . Townsend encontró una menor frecuencia de reingresos múltiples con este tipo de intervención 61 .…”

Section: Seguimientounclassified

Proceso de alta hospitalaria, revisión de la literatura

et al. 2014

View full text Add to dashboard Cite

show abstract

Comprehensive discharge follow-up in patients’ homes by GPs and district nurses of elderly patients

Cited by 69 publications

References 22 publications

Inappropriate admissions or inadequate discharges of frail elderly: Competing program theories and implementation challenges in an intermediate care intervention

Inappropriate admissions or inadequate discharges of frail elderly: Competing program theories and implementation challenges in an intermediate care intervention

Study protocol: follow-up home visits with nutrition: a randomised controlled trial

Proceso de alta hospitalaria, revisión de la literatura

Contact Info

Product

Resources

About