scholarly journals Integration between GPs andhospitals: lessons from a division-hospitalprogram

2000 ◽  
Vol 23 (4) ◽  
pp. 134 ◽  
Author(s):  
Jane Lloyd ◽  
Gawaine Powell Davies ◽  
Mark Harris
Keyword(s):  
General Practice ◽  
Community Services ◽  
Normal System ◽  
Post Discharge ◽  
Substantial Progress ◽  
Barriers To Service ◽  
Expected Benefits ◽  
Consumer Organisations ◽  
Internal Coherence ◽  
Effective Models

The aim of the study reported here was to evaluate current initiatives in GP-hospital integration and highlight areaswhere further research, development and evaluation are required. Seven pre-existing GP-hospital programs wereselected and given supplementary funding to allow for more effective evaluation. These local evaluations were thenincorporated into a national program on GP-hospital collaboration.We found that the seven projects made substantial progress towards their goals, and in the process highlighted importantaspects of successful collaboration. The collective evaluation of DHIP identified expected benefits of collaboration forpatients (improved access to services, reduced anxiety, and fewer post discharge complications), for GPs (increasedinvolvement in acute care and in hospital decision making), and for service organisations (stronger workingrelationships, increased capacity, and greater efficiency). Barriers to service integration were also identified, includingthe different cultures of Divisions and hospitals, their lack of internal coherence and the Commonwealth-state divide.The evaluation showed that much has been achieved in building the relationships and the capacity needed for GP-hospitalcollaboration, and that effective models exist. The current challenge is to extend successful models acrosshealth areas and make effective collaboration part of the normal system of care. Substantial progress towardsintegrated care relies on a shift from a focus on systems within general practice or hospital environments to a patientcentred approach. This will require general practice, hospitals, community services and consumer organisations toform long term partnerships and move beyond their currently disjointed view of acute and community care. Thedevelopment of practical indicators for integrated care will support the process and facilitate shared learning acrossCommonwealth and state divides.

scholarly journals Becoming a Carer for an Elderly Person after Discharge from an Acute Hospital Admission :

2004 ◽  
Author(s):  
Karen Grimmer ◽  
John Moss ◽  
Julie Falco
Keyword(s):  
Independent Living ◽  
Discharge Planning ◽  
Elderly Person ◽  
Community Setting ◽  
Community Services ◽  
Post Discharge ◽  
Acute Hospitals ◽  
Planning Processes ◽  
Discharge From Hospital ◽  
Patient Relationships

Objective: To describe the perceptions of people taking on a new or expanded caring role for an elderly patient recently hospitalised with a new or intensified health problem. Design: Observational study collecting qualitative data monthly for six months following patients’ discharge from hospital and attempted return to independent living in the community. Setting: Four South Australian acute hospitals (one metropolitan, three country). Subjects: 34 unpaid carers were nominated by 100 patients. 24 carers participated (17 elderly spouses, 3 younger family members, 4 neighbours and/ or friends). Results: The study highlighted carers’ perceptions of being unprepared for their new tasks, and their frustrations at the long-term and frequently significant changes to their lives brought about by assuming a caring role. Many carers felt their role had been imposed upon them without real choice, and that their own physical and emotional fitness for their new role had not been considered during discharge planning. Carers claimed to have been provided with little information about how to care for the patient, particularly when community services were seldom provided in the first week after discharge. Stresses developed in many of the carer-patient relationships, and patient and carer morale was often low for months post-discharge. Discussion: Carers indicated that their tasks could have been made easier by more timely, targeted education about their patient’s condition and their role in managing it. They would have liked greater inclusion in discharge planning processes whilst the patient was in hospital, and more timely and appropriate provision of post-discharge services that were patient- and carer-focused, and which addressed their ability to live independently in the community. Conclusion: Discharge planning systems should take greater account of the motivation and needs of carers, especially when this role is new or becoming expanded, and of the barriers they face in undertaking their role.

scholarly journals Assessing the engagement in a post-discharge phone Follow-Up project

ABOUTOPEN ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. 38-42
Author(s):  
Giuliana Pitacco ◽  
Ramiro Mendoza-Maldonado ◽  
Sandro Centonze
Keyword(s):  
Social Services ◽  
Third Sector ◽  
Pilot Project ◽  
Community Services ◽  
Post Discharge ◽  
Self Assessment ◽  
Rehabilitation Facility ◽  
Use Of Services ◽  
The City

Introduction: The article describes a post-discharge telephone Follow-Up pilot project that was activated in 2018 in the city of Trieste. Methods: The pilot project, in addition to the interception of possible situations of discomfort to be reported to social services and to ensure informative support to guide people to an optimal use of services, aimed to investigate the conditions, 1 and 3 months after discharge, of people not followed by the community services, in particular: a) maintenance of functional capacity; b) self-assessment of the patient with respect to health conditions and level of engagement; c) state of the relationships network; d) use of public, private and/or third sector health or welfare resources. Results and Conclusions: The Telephone Follow-Up has made it possible to experiment a “light” way of taking care of people discharged from a hospital or rehabilitation facility, to intercept situations of discomfort, reporting them to the Local District and social services and facilitating the appropriate use of local assistance services.

Isolation and loneliness: pilot of a coffee morning hosted in a general practice

2020 ◽  
Vol 31 (10) ◽  
pp. 428-433
Author(s):  
Louise Johnson ◽  
Sheila Hardy
Keyword(s):  
General Practice ◽  
Risk Factor ◽  
Pilot Study ◽  
Social Isolation ◽  
Sense Of Community ◽  
Community Services ◽  
Older Population ◽  
Number Of Patients ◽  
The Uk ◽  
Fixed Period

Social isolation and loneliness are a significant and growing problem in the older population in the UK. Louise Johnson and Sheila Hardy performed a pilot study to see whether it was feasible to host a coffee morning for isolated patients in general practice Aim: The aim of this pilot study was to find out whether it was feasible to host a regular coffee morning in a GP practice to reduce isolation and loneliness. Background: Social isolation and loneliness are a significant and growing problem in the older population in the UK and have been identified as a risk factor for all cause morbidity and mortality. Method: A weekly coffee morning was held over 8 weeks. Feedback was gained via a participant questionnaire. Results: In total, 25 people attended the sessions. Just under half felt they had learnt about the healthcare roles in the practice and 80% learnt how to be healthier. Four-fifths were made aware of services and support in the community and 21 felt an increased sense of community. It was difficult for staff to commit due to work responsibilities. Conclusion: It is feasible to hold a coffee morning for isolated patients within a GP practice. Feedback from patients was positive. A programme of coffee mornings over a fixed period that encourage engagement in community services would increase the number of patients benefitting.

Performance of General Hospitals in Delivering Adjuvant Chemotherapy to Breast Cancer Patients

1988 ◽  
Vol 74 (4) ◽  
pp. 377-386 ◽  
Author(s):  
◽  
R. Fossati ◽  
C. Confalonieri ◽  
G. Apolone ◽  
A. Nicolucci ◽  
...  
Keyword(s):  
Breast Cancer ◽  
General Practice ◽  
Adjuvant Chemotherapy ◽  
Task Force ◽  
Mode Of Delivery ◽  
Breast Cancer Patients ◽  
General Hospitals ◽  
National Breast ◽  
Treatment Indications ◽  
Expected Benefits

Indications for and modes of delivery of adjuvant chemotherapy in early breast cancer were assessed in a group of 353 patients followed within a cohort of 1110 newly diagnosed cases in 54 Italian general hospitals. Among node-positive patients 79 % pre- and 44 % postmenopausal women had the treatment. Only a few node-negative women (10 % pre- and 5 % post-menopausal) were treated. The multidrug combination CMF was by far the most commonly employed (89 %) in its two types: cCMF (the classic combination where cyclophosphamide is given orally on days 1–14 and the two other drugs i.v. on days 1 and 8 every 28 days for either 6 or 12 cycles) to 33 % women and nCMF (the more recent combination where all three drugs are given i.v. on day 1 every 21 days for 12 cycles) to 63 %. The mode of delivery of treatment was consistent with the Italian National Breast Cancer Task Force (F.O.N. Ca. M.) recommendations for the cCMF combination, but the lack of clear guidelines on the use of nCMF led to wide variations in the total number of cycles administered. At present, however, it is hard to establish whether this will have any impact on patients’ outcome. Overall the study suggests that adjuvant chemotherapy for breast cancer has entered general practice and can be satisfactorily delivered at the community level. However, better guidelines need to specify more precisely the treatment indications (i.e. subgroups with greater expected benefits), regimen type (is nCMF still experimental or already standard?) and treatment duration, in view of the present uncertainty about what should be the standard for general practice. The paper finally discusses the feasibility of the treatment comparing general hospitals’ performance with that achieved in controlled clinical trials of adjuvant chemotherapy.

Setting up and Auditing Guideline- and Evidence-Based Cardiac Rehabilitation

2005 ◽  
Vol 4 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Richard Mayou ◽  
Jenny Welstand ◽  
Sally Tyndel
Keyword(s):  
Primary Care ◽  
Clinical Information ◽  
Postal Questionnaire ◽  
Community Services ◽  
Self Report ◽  
Post Discharge ◽  
Rehabilitation Team ◽  
Delivery Of Care ◽  
Quality Guidelines ◽  
Individualised Care

Background: Rehabilitation is available to only a minority of post-myocardial infarction (MI) patients and is of variable quality. Guidelines now recommend individualised care delivered by hospital, primary care and community services, but there is little evidence of the feasibility, acceptability or effectiveness of this approach. Aims: To demonstrate the feasibility of guideline-based rehabilitation, to audit delivery and outcome and to identify problems. Methods: A four-phase stepped programme for post-MI patients was developed based on individualised in-hospital care and aftercare from a menu of options. Delivery involved co-ordination between hospital services, primary care and community services. Self-report audit data were collected in hospital and at 3 months post-discharge by postal questionnaire and telephone calls. Clinical information was recorded from hospital, telephone and outpatient contacts. Delivery of care to patients receiving interventions was recorded. Results: It was possible to negotiate individualized plans for all patients and to monitor progress for 3 months after discharge. The rehabilitation team achieved high rates of delivery of agreed interventions, considerably better than delivery by primary care. Problems largely related to difficulties and failures in communication. Patients with major social or psychological difficulties were the most difficult to treat. Conclusion: Guideline-based rehabilitation is feasible, but there is a need to improve the coordination of delivery of later steps of care and also to refine specialist interventions.

Social prescribing: A new medicine?

2016 ◽  
Vol 10 (2) ◽  
pp. 90-95 ◽  
Author(s):  
Patrick Hutt
Keyword(s):  
Social Support ◽  
Primary Care ◽  
General Practice ◽  
Health System ◽  
Local Community ◽  
Evidence Base ◽  
Community Services ◽  
Social Prescribing

The concept behind social prescribing is to link patients in primary care with local community services. Social prescribing is increasingly being championed as a key component of a GP’s therapeutic toolkit; it was referenced in the General Practice Forward View 2016 as an example of providing social support for patients and integrating care across the wider health system. This article sets out to describe what constitutes social prescribing, to highlight examples of services that exist, and to discuss the existing evidence base for social prescribing.

Education and training needs of nurses in general practice

2004 ◽  
Vol 10 (1) ◽  
pp. 21 ◽  
Author(s):  
Liz Meadley ◽  
Jane Conway ◽  
Margaret McMillan
Keyword(s):  
General Practice ◽  
Clinical Skills ◽  
Medical Practitioner ◽  
Education And Training ◽  
Post Discharge ◽  
Practice Nurses ◽  
Professional Development Needs ◽  
And Training

Practice nurses have been identified as key personnel in management of patients either in the prevention of hospitalisation or follow-up post-discharge from acute settings. There is an increase in numbers of practice nurses (PNs) in Australia, but the role of nurses who work in general practice is poorly understood. There is considerable variation in the activities of PNs, which can include functions as diverse as receptionist duties, performing a range of clinical skills at the direction of the medical practitioner, and conducting independent patient assessment and education. This paper reports on an investigation of PNs? perceptions of their ongoing professional development needs, and identifies issues in providing education and training to nurses who work with general practitioners (GPs).

scholarly journals Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review

2019 ◽  
Vol 16 (14) ◽  
pp. 2457 ◽  
Author(s):  
Coffey ◽  
Leahy-Warren ◽  
Savage ◽  
Hegarty ◽  
Cornally ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Care ◽  
Discharge Planning ◽  
Acute Care Hospital ◽  
Early Discharge ◽  
Community Services ◽  
Care Hospital ◽  
Post Discharge ◽  
Term Care ◽  
At Home

Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.

scholarly journals Development and implementation of a discharge pathway protocol for detained offenders with intellectual disabilities

2017 ◽  
Vol 8 (3) ◽  
pp. 144-154 ◽  
Author(s):  
John L. Taylor ◽  
Susan Breckon ◽  
Christopher Rosenbrier ◽  
Polly Cocker
Keyword(s):  
Intellectual Disabilities ◽  
Discharge Planning ◽  
Community Services ◽  
Outcome Data ◽  
Post Discharge ◽  
Readmission Rates ◽  
Content Type ◽  
Lengths Of Stay ◽  
The Right ◽  
The Impact

Purpose Building the Right Support, a national plan for people with intellectual disabilities (ID) in England aims to avoid lengthy stays in hospital for such people. Discharge planning is understood to be helpful in facilitating successful transition from hospital to community services, however, there is little guidance available to help those working with detained patients with ID and offending histories to consider how to affect safe and effective discharges. The paper aims to discuss these issues. Design/methodology/approach In this paper, the development and implementation of a multi-faceted and systemic approach to discharge preparation and planning is described. The impact of this intervention on a range of outcomes was assessed and the views of stakeholders on the process were sought. Findings Initial outcome data provide support for the effectiveness of this intervention in terms of increased rates of discharge, reduced lengths of stay and low readmission rates. Stakeholders viewed the intervention as positive and beneficial in achieving timely discharge and effective post-discharge support. Practical implications People with ID are more likely to be detained in hospital and spend more time in hospital following admission. A planned, coordinated and well managed approach to discharge planning can be helpful in facilitating timely and successful discharges with low risks of readmission. Originality/value This is the first attempt to describe and evaluate a discharge planning intervention for detained offenders with ID. The intervention described appears to be a promising approach but further evaluation across a range of service settings is required.

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