The course of readmission in frail older cardiac patients

Abstract

Aim The aim of this study is to explore patients’ and (in)formal caregivers’ perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program. Design This study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles. Methods Five cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi‐structured interviews were held with patients (n = 4), informal caregivers (n = 5), physical therapists (n = 4), and community nurses (n = 5) between April and June 2019. Patients’ medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six‐step analysis of Strauss & Corbin have been used. Results Three main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients’ health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers’ perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3). Conclusion Early detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients’ care needs and expectations should be prioritized to stimulate participation. Impact (In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients’ care needs and expectations.

The Experience of Chronic Illness Transitional Care: A Qualitative Systematic Review

“…All seven selected studies used a qualitative design. The studies were conducted between 2012 and 2021 in five countries: Australia (Allen et al, 2018; Reedy-Cooper et al, 2020), Canada (Backman et al, 2018), the Netherlands (Rijpkema et al, 2021), Norway (Halding et al, 2018), and the United States (Swan et al, 2020). All studies investigated transitional care with at least one chronic illness.…”

“…Across the studies, the number of participants was 123 (92 patients, 31 caregivers). A total of four studies included family caregivers as study participants (Allen et al, 2018; Backman et al, 2018; Dolu et al, 2021; Rijpkema et al, 2021); the rest included only patients with chronic illnesses. The mean age of patients ranged from 61 to 83 years old.…”

“…Transitional care was classified into stages as predischarge, hospital-to-home bridge, and postdischarge. Care plans included discharge assessment, discharge planning, self-management education, medication adherence checks, follow-up care, telemonitoring, and nurses’ home-visit services (Allen et al, 2018; Backman et al, 2018; Dolu et al, 2021; Rijpkema et al, 2021).…”

“…In four studies, patients and caregivers demonstrated psychological stress during transitional care (Backman et al, 2018; Dolu et al, 2021; Halding et al, 2018; Rijpkema et al, 2021). Generally, patients indicated they feared and worried that their ongoing symptoms may exacerbate their chronic illness(es) (Dolu et al, 2021; Halding et al, 2018).…”

“…In the same study, another patient indicated they feared transitioning to home: “I returned [home], my blood pressure rose again, as I suffer from high blood pressure; I am scared of it” (p. 176). One source of this stress was the fact home is less structured than hospitals and that patients would need to be independent without healthcare providers nearby (Rijpkema et al, 2021). Another source of stress was transportation, including the cost of public transportation versus taxis, distance to hospitals, and the mobility challenge of moving an older patient (Backman et al, 2018; Dolu et al, 2021).…”