The effects of aftercare on chronic patients and frail elderly patients when discharged from hospital: a systematic review

Abstract

The purpose of this systematic review was an assessment of the efficacy of aftercare in chronic patients and the frail elderly when discharged from hospital, as regards quality of life, compliance, costs, medical consumption and quality of care. In pursuit of this goal, 17 publications on the effects of aftercare after discharge from hospital were examined. A systematic assessment of methodological quality by two blinded independent reviewers resulted in a consensus score (0-100 points), based on four categories: the study population, description of the interventions, measurement of the outcome and the analysis and presentation of the data. Only three of the 17 studies scored more than 50 points, indicating that most of the studies were of poor methodological quality. The most prevalent methodological problems were that co-interventions were not avoided, a placebo group was lacking, the assessment was not blinded and the analysis was not made on the basis of the intention-to-treat principle. The majority of the studies did not report clear beneficial effects in favour of the intervention group. The positive effects reported were limited to costs and quality of care.

From hospital to home care: a randomized controlled trial of a Pain Education Programme for cancer patients with chronic pain

“…In reviewing the results of the study, district nurses play only a minor role in the treatment of cancer pain. These results are in agreement with a review article evaluating the beneficial effects of aftercare in chronic patients, in which it was found that a majority of the studies reported no clear beneficial effects (Bours et al. 1998).…”

Evaluating non-randomised intervention studies

“…Almost three-quarters of the tools (73%) were 'new' (or did not state the origin of the tool) and the remainder were modifications of a single existing tool. The most commonly modified tools were Chalmers and colleagues 51 and the Maastricht Criteria list, 67 the latter having been published several times by different authors, [68][69][70][71][72][73] but originating in 1989. 74,75 Most (182) of the identified tools aimed to assess more than one study design.…”

“…78,79 The Jadad 46 and McMaster 80 tools did not include items in five of the six domains. In contrast, nine of the 23 tools aimed at more than one study design 73,87,[97][98][99][100][101][102][103] and with specific items according to design, plus two of the four tools designed for cohort studies, 64,66 were included in the top 60 tools. I n t e r p r e t a t i o n # 1 2 P r e s e n t a t i o n…”

Interventions to prevent disability in frail community-dwelling older persons: an overview

“…Prevention of disability in frail older persons is seen as a priority for research in geriatrics (Ferrucci et al 2004) and can lead to the maintenance of quality of life and reduced health care costs (Cutler 2001). Several systematic reviews are available, which focus on specific categories of interventions for frail older persons, e.g., comprehensive geriatric assessment (Wieland 2003), after-care (Bours et al 1998), or respite care (Mason et al 2007). No overview is available, however, which provides an extensive overview of the content of the full range of existing programmes for community-living frail older persons that are aimed at the prevention of disability.…”