Who should have a pre-discharge home assessment visit after a stroke? A qualitative study of occupational therapists' views

Abstract

The number of patients who have a pre-discharge home assessment visit following a stroke has been reported to vary nationally. The purpose of this research was to explore the factors influencing occupational therapists' decisions to complete such visits. Method: Semi-structured interviews were completed with 20 senior occupational therapists working with stroke in-patients, from a range of urban and rural locations in the United Kingdom. The interviews explored their views about those patients for whom a pre-discharge home assessment visit would and would not be required. The interviews were analysed using thematic analysis. Findings: Three themes were identified: the patient's level of physical, cognitive, or perceptual impairment and its impact on performance in activities of daily living; factors relating to the patient's home environment, including the availability of support within the home environment; and other influences on occupational therapists. The presence of a cognitive impairment was a particularly important factor. Conclusions: Occupational therapists balanced aspects from each of these themes in order to determine whether a visit was needed or not. Although the level of impairment was important, the most dependent patients were not necessarily those believed to be the most likely to need a visit.

Effects, Barriers and Facilitators in Predischarge Home Assessments to Improve the Transition of Care from the Inpatient Care to Home in Adult Patients: An Integrative Review

“…Ten qualitative studies [3,9,[26][27][28][29][30][31][32][33] with a total of 245 participants (range: n = 4 [31] to n = 60 [26]) were included. All the studies used interview techniques, and one additionally used participant observation [32].…”

“…Three studies explored perceptions of patients, therapists and older adults in community dwellings with regard to the use of virtual reality (VR) applications in PDHA [9,28,29]. One study explored factors considered by the OTs when deciding about stroke patients' need for a predischarge home assessment visit [33]. One study focused on older adults' and carers' perception of and involvement in PDHA decisionmaking processes [27].…”

“…Qualitative studies reported on participants' views [3,26,[30][31][32] and on views of OTs [3,27,28,30,32,33], families [26,30], and older community-dwelling people [9].…”

“…Involvement in patient goals and meaningful activities in functional assessment. PDHAs were seen as a chance for both the patients and the therapists to gain a realistic view about the patient's function and limitations in the home environment [27,29,32,33]. The patients felt restrained by the time limitation during the self-assessment at home [27,31].…”

Pre‐discharge home visits: A qualitative exploration of the experience of occupational therapists and multidisciplinary stakeholders

“…A randomised control trial study (Clemson et al, 2016), while noting limitations related to contamination bias and outcome measure selection, did not recommend these visits be routinely used for discharge planning for acutely hospitalised medical patients, indicating a need for guidelines for hospital-based assessment and consultation (Clemson et al, 2016). Given this, the decision to conduct a pre-discharge home visit in many cases is governed by knowledge level, experience and clinical reasoning of the therapist (Welch & Lowes, 2005;Whitehead, Fellows, Sprigg, Walker & Drummond, 2014).…”