The national implementation of 'Proactive Health Support' in Denmark since 2017: Expectations and challenges for the telephone-based self-management program

Fredens, Mia; Terkildsen, Morten Deleuran; Bollerup, Stina; Albæk, Jens; Nissen, Nina; Winther, Susanne; Grønkjær, Mette; Rasmussen, Maja Kjær; Benthien, Kirstine Skov; Toft, Ulla; Hjarnaa, Louise; Rasmussen, Knud; Nielsen, Charlotte

doi:10.1016/j.healthpol.2020.05.014

Cited by 6 publications

(10 citation statements)

References 14 publications

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“…14 Since the PaHS prediction model was used to select participants for a randomized controlled trial and the intervention might affect hospital admissions, we performed the analyses on information predating the trial and the preceding implementation period. 15 Therefore, the validated prediction period was from August 1st to October 31st, 2016.…”

Section: Materials and Methods Designmentioning

confidence: 99%

Predicting Individual Risk of Emergency Hospital Admissions – A Retrospective Validation Study

Benthien¹,

Jacobsen²,

Hjarnaa³

et al. 2021

RMHP

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Purpose: A high number of hospital admissions may indicate poor general health and less than optimal health care across sectors. To prevent hospital admissions, previous studies have focused on predicting readmissions relating to a defined index admission and specific condition, whereas generic models suited for community-dwelling persons are lacking. The aim of this study was to validate a generic model that predicted risk of emergency hospital admission within the following three months and to investigate regional variation. Materials and Methods: This study is an observational register-based validation study of a prediction model. The prediction model was based on a population of frail elderly, persons with non-communicable diseases, and persons with three emergency hospital admissions using information about diagnoses and hospital contacts. The prediction model consisted of two stages. In the first stage, covariate associations to admissions are estimated from observed data in one year. In the second stage, admissions are predicted in the coming three months based on observed estimations from the first stage. The validity of the model was calculated by comparing predicted and observed admissions from August 1st to October 31st, 2016. Results: The study included 112,026 persons. In nationwide data, area under the curve (AUC) was 0.7742 (95% CI 0.7698-0.7786), and the positive predictive value was 52% for the 99th percentile (the top 1%). AUC varied between regions from 0.6914 in Southern Denmark (95% CI 0.6779-0.7049) to 0.8224 (95% CI 0.8064-0.8384) in North Denmark. AUC was higher with nationwide data compared to regional. Conclusion:The model performed satisfactorily in predicting individual risk of emergency hospital admission.

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Section: Materials and Methods Designmentioning

confidence: 99%

Predicting Individual Risk of Emergency Hospital Admissions – A Retrospective Validation Study

Benthien¹,

Jacobsen²,

Hjarnaa³

et al. 2021

RMHP

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“…Further evaluation results are reported in other articles (Benthien et al, 2020(Benthien et al, , 2021(Benthien et al, , 2022Fredens et al, 2020;Winther, Fredens, Hansen, et al, 2020;Winther, Fredens, Skov Benthien, et al, 2020).…”

Section: Introductionmentioning

confidence: 94%

“…Understanding the factors influencing the early implementation of complex SMS interventions is essential for achieving successful outcomes (Pluye et al, 2005). This focus involves recognizing the importance of operationalizing the components of SMS interventions and understanding how they become workable and embedded in everyday healthcare practice (May et al, 2007) (Benthien et al, 2020), a cost-effectiveness analysis, a study of patients' experiences (Winther, Fredens, Skov Benthien, et al, 2020) and, a study on the implementation and organization of the intervention (Fredens et al, 2020). The RCT, which involved randomizing 6402 individuals, proved modest improvements in HRQoL and coping but no reduction in hospital admissions (Benthien et al, 2022).…”

Section: Studies Of Sms Interventions Conclude That This Type Of Inter-mentioning

confidence: 99%

“…• An initial face-to-face session with the same RN who will conduct the entire intervention • Telephone-based follow-up sessions et al, 2020, 2021). Unlike most SMS interventions, PaHS was not offered within a clinical setting such as hospital departments or rehabilitation centres (Fredens et al, 2020). The intervention was organized in specially established PaHS units independent of existing organizational units.…”

Section: Structurementioning

confidence: 99%

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Nurses' perspectives on challenges and facilitators when implementing a self‐management support intervention as an everyday healthcare practice: A qualitative study

Fredens,

Palmhøj Nielsen,

Grønkjær

et al. 2023

Journal of Advanced Nursing

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AimTo explore registered nurses' perspectives on challenges and facilitators to implementing a telephone‐based self‐management support (SMS) intervention (Proactive Health Support) as an everyday healthcare practice, during the early stages of implementation.DesignData were collected using a qualitative research design involving focus‐group interviews and participant observations.MethodsWe conducted participant observation following nine nurses and four focus group interviews with 14 nurses. Data were analysed using thematic analyses.ResultsProactive Health Support was implemented in units organized independently of the existing organizational units within healthcare services. This independent organization, along with the intervention's generic (non‐disease specific) design, empowered nurses to become autonomous practitioners capable of prioritizing the operationalization of SMS as an everyday healthcare practice. However, unlearning already embedded medical practices and establishing new nursing roles necessary to accommodate the intervention in practice was experienced a challenge. Education and supervision were identified as valuable tools for successful implementation.ConclusionOur study highlights the significance of organizational context and autonomy in successful SMS implementation. Balancing external factors like organizational context, priority and time is vital, but navigating the internal shift in professional practice is equally crucial. Role transition processes can constitute challenges demanding accommodation.Implications for the ProfessionFrom a nursing perspective, this study highlights that practising SMS requires substantial training and education. Generic SMS interventions can introduce higher levels of contingency due to their versatile nature. Thus, equipping nurses with competencies that enable them to navigate this unpredictability flexibly is crucial.ImpactPolicymakers and administrators should allocate resources and support implementation processes in ways that accommodate both internal and external conditions to facilitate nurses in delivering effective SMS.Reporting MethodThis study adheres to the SRQR guideline.Patient or Public ContributionNo patient or public contribution.

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“…The main components of the intervention are listed in Table 1. The PaHS research program consists of a development phase, an RCT study on the effect of the intervention including prediction model development, a cost‐effect analysis, an organizational analysis (Fredens et al., 2020) and a study on participants’ experiences of the intervention (Winther et al., 2020). The present paper reports of the latter study that is a qualitative study that sought to obtain the participants’ perspectives on PaHS by exploring their experiences of participating in the intervention and identifying what they found to be important and meaningful.…”

Section: Introductionmentioning

confidence: 99%

Exploring patient experiences of participating in a telephone‐based self‐management support intervention: Proactive Health Support (PaHS)

Winther

Fredens

Benthien

et al. 2020

Journal of Advanced Nursing

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Aim Proactive Health Support is a telephone‐based self‐management intervention that is carried out in Denmark by Registered Nurses who provide self‐management support to people at risk of hospital admission. We aimed to explore participants’ experiences of Proactive Health Support and to identify what the participants find important and meaningful during the intervention process. Design Qualitative design involving semi‐structured interview. Methods Using a phenomenological–hermeneutical framework, we conducted semi‐structured interviews with 62 participants in their own homes (32 women, 30 men; aged 20–81 years) in spring and fall 2018. Results The participants felt confident that they could discuss every matter with the nurses. Participants benefitted from accessibility to the nurses’ professional and medical competences and they felt relief that the nurses contacted them via the telephone due to their multiple health conditions. The participants felt that the nurses were available and helped them to navigate the healthcare system. Conclusion The participants valued the intervention because they benefitted from the nurses’ holistic approach. They described the nurses’ knowledge and professionalism in relation to their symptoms, treatments, and medicine as important and meaningful. Accordingly, the intervention seemed to promote feelings of independence and self‐management among the participants. Impact From a nursing perspective, the study highlights that it is possible to establish a close relationship and behavioural change among participants through regular telephone contact.

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The national implementation of 'Proactive Health Support' in Denmark since 2017: Expectations and challenges for the telephone-based self-management program

Cited by 6 publications

References 14 publications

Predicting Individual Risk of Emergency Hospital Admissions – A Retrospective Validation Study

Predicting Individual Risk of Emergency Hospital Admissions – A Retrospective Validation Study

Nurses' perspectives on challenges and facilitators when implementing a self‐management support intervention as an everyday healthcare practice: A qualitative study

Exploring patient experiences of participating in a telephone‐based self‐management support intervention: Proactive Health Support (PaHS)

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