Integrating Care Across Disciplines

Blachman, Nina L.; Blaum, Caroline S.

doi:10.1016/j.cger.2016.01.010

Cited by 9 publications

(9 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3,[9][10][11][12][13][14] These approaches build on growing evidence that highlights the importance of team-based care delivery in ensuring that care practices are patient-centred, safer, timelier and more effective. [15][16][17][18][19] Despite the emergence of interprofessional teams as an effective approach to caring for older people, [20][21][22][23] little is known about how HCPs, including those outside the traditional roles of prescribing, distribution and administration of medication, individually recognize and respond to polypharmacy within their clinical practice. Central to the success of a collaborative interprofessional polypharmacy mandate is an understanding of how each HCP understands their individual and collective roles and responsibilities in managing polypharmacy.…”

Section: B Farrellmentioning

confidence: 99%

Health care providers’ roles and responsibilities in management of polypharmacy: Results of a modified Delphi

et al. 2018

View full text Add to dashboard Cite

Background: Little is known about the roles that allow interprofessional teams to effectively manage older patients experiencing polypharmacy. Objectives: to identify and examine the consensus on salient interprofessional roles, responsibilities and competencies required in managing polypharmacy. Methods: Four focus groups with 35 team members practising in geriatrics were generated to inform survey development. the sessions generated 63 competencies, roles or responsibilities, which were categorized into 4 domains defined by the canadian Interprofessional Health collaborative. the resulting survey was administered nationally to geriatric health care professionals who were asked to rate the importance of each item in managing polypharmacy; we sought agreement within and across professions using a confirmatory 2-round Delphi method. Results: round 1 was completed by 98 survey respondents and round 2 by 72. there was high intra-professional and interprofessional consensus regarding the importance of competencies among physicians, nurses and pharmacists; though pharmacists rated fewer competencies as important. Less consensus was observed among other health care professionals or they indicated the nonimportance of competencies despite focus group discussion to the contrary. Discussion: Although there is a strong consensus of polypharmacy management competencies across team members who have been more traditionally involved in medication management, there continue to be health care providers with differing understandings of competencies that may contribute to reduced reliance on medication. Lower importance ratings suggest pharmacists may not acknowledge or recognize their own potential roles in interprofessional polypharmacy management. Conclusion: Further exploration to understand the underutilization of professional expertise in managing polypharmacy will contribute to refining role clarity and translating competencies in practical settings, as well as guiding educators regarding curricular content.

show abstract

Section: B Farrellmentioning

confidence: 99%

Health care providers’ roles and responsibilities in management of polypharmacy: Results of a modified Delphi

et al. 2018

View full text Add to dashboard Cite

show abstract

“…That trend may be poised to change in response to a new wave of wide-ranging and imaginative research that is examining all aspects of end-of-life care in heart failure, with special emphasis on patients' priorities [86][87][88][89][90][91][92][93].…”

Section: Ethical Considerations In End-stage Heart Failure Patientsmentioning

confidence: 99%

Advanced heart failure: an appraisal of the potential of levosimendan in this end-stage scenario and some related ethical considerations

Fruhwald

Pollesello

Fruhwald

2016

Expert Review of Cardiovascular Therapy

View full text Add to dashboard Cite

The later stages of heart failure are characterized by a steady decline in quality of life. Clinical priorities should be to maintain functional capacity and quality of life. In the absence of sufficient organs for transplantation, options include left ventricular assist devices and inotropic support. Areas covered: We examined data published in the last two decades on the use of inotropes and inodilators in advanced heart failure. Expert commentary: In the literature, use of conventional inotropes, including adrenergic agonists and phosphodiesterase inhibitors, appears to be suboptimal for achieving the clinical priorities of late-stage heart failure. Evidence suggests instead that the calcium-sensitizing inodilator levosimendan, administered intermittently, delivers improvements in functional capacity and quality of life and does so with no adverse impact on life expectancy. At a terminal or near-terminal stage of heart failure, the therapeutic philosophy should shift towards meeting patients' existential priorities rather than traditional heart failure-centric targets.

show abstract

“…The variables included in the HOME Score were identified in our previous studies10 22 where we identified risk factors for all-cause readmission, possibly medication-related readmission and unlikely medication-related readmission within 30 days of discharge, in patients 65 years and older. We chose to solely include variables known already at admission since research suggests that the successful reduction of possibly medication-related readmission demands the implementation of actions during the hospital stay30 as well as at discharge12 and in transitions of care 14. In order to do this, patients at increased risk of possibly medication-related readmission need to be identified already at admission.…”

Section: Discussionmentioning

confidence: 99%

“…According to previous research, preventive measures should aim to improve medication use as well as transitions of care11 12 and are best performed by combining several minor activities into concepts 12 13. These activities should preferably include interdisciplinary actions during the hospital stay and at discharge12 as well as collaboration between hospital, primary and municipal care in transitions of care 14…”

Section: Introductionmentioning

confidence: 99%

Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment tool

et al. 2023

View full text Add to dashboard Cite

ObjectiveDeveloping and validating a risk assessment tool aiming to identify older adults (≥65 years) at increased risk of possibly medication-related readmission to hospital within 30 days of discharge.DesignRetrospective cohort study.SettingThe risk score was developed using data from a hospital in southern Sweden and validated using data from four hospitals in the mid-eastern part of Sweden.ParticipantsThe development cohort (n=720) was admitted to hospital during 2017, whereas the validation cohort (n=892) was admitted during 2017–2018.MeasuresThe risk assessment tool aims to predict possibly medication-related readmission to hospital within 30 days of discharge. Variables known at first admission and individually associated with possibly medication-related readmission were used in development. The included variables were assigned points, and Youden’s index was used to decide a threshold score. The risk score was calculated for all individuals in both cohorts. Area under the receiver operating characteristic (ROC) curve (c-index) was used to measure the discrimination of the developed risk score. Sensitivity, specificity and positive and negative predictive values were calculated using cross-tabulation.ResultsThe developed risk assessment tool, the Hospitalisations, Own home, Medications, and Emergency admission (HOME) Score, had a c-index of 0.69 in the development cohort and 0.65 in the validation cohort. It showed sensitivity 76%, specificity 54%, positive predictive value 29% and negative predictive value 90% at the threshold score in the development cohort.ConclusionThe HOME Score can be used to identify older adults at increased risk of possibly medication-related readmission within 30 days of discharge. The tool is easy to use and includes variables available in electronic health records at admission, thus making it possible to implement risk-reducing activities during the hospital stay as well as at discharge and in transitions of care. Further studies are needed to investigate the clinical usefulness of the HOME Score as well as the benefits of implemented activities.

show abstract

Integrating Care Across Disciplines

Cited by 9 publications

References 31 publications

Health care providers’ roles and responsibilities in management of polypharmacy: Results of a modified Delphi

Health care providers’ roles and responsibilities in management of polypharmacy: Results of a modified Delphi

Advanced heart failure: an appraisal of the potential of levosimendan in this end-stage scenario and some related ethical considerations

Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment tool

Contact Info

Product

Resources

About