scholarly journals Family involvement in transitional care from hospital to home and its impact on older patients, families, and health care providers

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Supavadee Thiengtham ◽  
Deborah D’Avolio ◽  
Mayuree Leethong-in
Keyword(s):  
Health Care ◽  
Family Involvement ◽  
Health Care Providers ◽  
Older Patients ◽  
Transitional Care ◽  
Care Providers ◽  
Hospital To Home

Patient Flow or the Patient’s Journey? Exploring Health Care Providers’ Experiences and Understandings of Implementing a Care Pathway to Improve the Quality of Transitional Care for Older People

2021 ◽  
pp. 104973232110038
Author(s):  
Cecilie Fromholt Olsen ◽  
Astrid Bergland ◽  
Jonas Debesay ◽  
Asta Bye ◽  
Anne Gudrun Langaas
Keyword(s):  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Transitional Care ◽  
Care Pathway ◽  
Patient Flow ◽  
Care Pathways ◽  
Care Providers ◽  
Patient Centered ◽  
Care For Older People

Internationally, the implementation of care pathways is a common strategy for making transitional care for older people more effective and patient-centered. Previous research highlights inherent tensions in care pathways, particularly in relation to their patient-centered aspects, which may cause dilemmas for health care providers. Health care providers’ understandings and experiences of this, however, remain unclear. Our aim was to explore health care providers’ experiences and understandings of implementing a care pathway to improve transitional care for older people. We conducted semistructured interviews with 20 health care providers and three key persons, along with participant observations of 22 meetings, in a Norwegian quality improvement collaborative. Through a thematic analysis, we identified an understanding of the care pathway as both patient flow and the patient’s journey and a dilemma between the two, and we discuss how the negotiation of conflicting institutional logics is a central part of care pathway implementation.

scholarly journals Crossing Knowledge Boundaries: Health Care Providers’ Perceptions and Experiences of What is Important to Achieve More Person-Centered Patient Pathways For Older People

2021 ◽  
Author(s):  
Cecilie Olsen ◽  
Astrid Bergland ◽  
Asta Bye ◽  
Jonas Debesay ◽  
Anne Langaas
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Older People ◽  
Health Care Providers ◽  
Transitional Care ◽  
Care Providers ◽  
Quality Improvement Collaborative ◽  
Patient Journey ◽  
Patient Pathways

Abstract Background: Improving the transitional care of older people, especially hospital-to-home transitions, is a salient concern worldwide. Older people’s patient pathways may be unpredictable and complex, posing significant challenges for health care providers (HCPs). In particular, appropriate follow-up in primary care after discharge is key. Current research in the field endorses person-centered care as crucial to improving the patient pathways of older people. The aim of this study was to explore HCPs’ perceptions and experiences of what is important to achieve more person-centered patient pathways for older people.Methods: This was a qualitative study. We performed individual semistructured interviews with 20 HCPs and three key persons who participated in a Norwegian quality improvement collaborative. In addition, participant observation of 22 meetings in the quality improvement collaborative was performed. Results: A thematic analysis resulted in five themes: 1) Finding common ground through the mapping of the patient journey; 2) the importance of understanding the whole patient pathway; 3) the significance of getting to know the older patient; 4) the key role of home care providers in the patient pathways of older people; and 5) ambiguity toward checklists and practice implementation. Conclusion: To understand the findings, it proved useful to see them in light of knowledge sharing and boundary crossing, which are central concepts in the literature on transitional care. HCPs in the collaborative shared and coproduced new knowledge of the patient pathways of older people based on a patient journey perspective. Mapping the patient journey and asking, “What matters to you?” facilitated the crossing of knowledge boundaries between the HCPs; hence, a new and more holistic view of the patient pathways of older people in the current context emerged. The centrality of getting to know the patient and the special role of providers working in home care services was a central finding. The study adds to existing knowledge by suggesting that the achievement of person-centered patient pathways for older people does not only depend on the crossing of knowledge boundaries among HCPs, but also between HCPs and older persons.

Understanding the Use of Antiretroviral Drugs in the Aging Patient

2017 ◽  
Author(s):  
Brandon H. Samson ◽  
James D. Scott
Keyword(s):  
Health Care ◽  
Drug Interactions ◽  
Health Care Providers ◽  
Bone Health ◽  
Older Patients ◽  
Viral Suppression ◽  
Antiretroviral Drugs ◽  
Care Providers ◽  
Negative Effects ◽  
Positive Effects

The prevalence of HIV infection is increasing in the older population. Because of other comorbidities, older patients infected with HIV may be taking multiple medications, which increases the risk of drug–drug interactions. Treatment of HIV in aging patients is based on the consideration of adverse effects associated by antiretroviral therapy (ART) with regard to renal, hepatic, cardiovascular, metabolic, and bone health, as well as the potential for increased drug–drug interactions. Because ART is associated with both beneficial and deleterious effects, health care providers should weigh the negative effects against the positive effects of viral suppression. Health care providers should routinely review patients’ medication lists to search for significant drug–drug interactions and perform drug interaction checks using available resources.

scholarly journals P129: Safer transitions in the care of the elderly: identification of essential information in transitional care

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S110-S111
Author(s):  
S. Trivedi ◽  
S. Beckett ◽  
A. Dick ◽  
R. Hartmann ◽  
C. Roberts ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Transitional Care ◽  
Transitions Of Care ◽  
Free Text ◽  
Care Providers ◽  
Cross Sectional ◽  
Term Care ◽  
Essential Information ◽  
Patient Advocates

Introduction: When presenting to the Emergency Department (ED), the care of elderly patients residing in Long Term Care (LTC) can be complicated by threats to patient safety created by ineffective transitions of care. Though standardized inpatient handover tools exist, there has yet to be a universal tool adopted for transfers to the ED. In this study, we surveyed relevant stakeholders and identified what information is essential in the transitions of care for this vulnerable population. Methods: We performed a descriptive, cross sectional electronic survey that was distributed to physicians and nurses in ED and LTC settings, paramedics, and patient advocates in two Canadian cities. The survey was kept open for a one month period with weekly formal reminders sent. Questions were generated after performing a literature review which sought to assess the current landscape of transitional care in this population. These were either multiple choice or free text entry questions aimed at identifying what information is essential in transitional periods. Results: A total of 191 health care providers (HCP) and 22 patient advocates (PA) responded to the survey. Within the HCPs, 38% were paramedics, 38% worked in the ED, and 24% were in LTC. In this group, only 41% of respondents were aware of existing handover protocols. Of the proposed informational items in transitional care, 100% of the respondents within both groups indicated that items including reason for transfer and advanced care directives were essential. Other areas identified as necessary were past medical history and baseline functional status. Furthermore, the majority of PAs identified that items such as primary language, bowel and bladder incontinence and spiritual beliefs should be included. Conclusion: This survey demonstrated that there is a need for an improved handover culture to be established when caring for LTC patients in the ED. Education needs to be provided surrounding existing protocols to ensure that health care providers are aware of their existence. Furthermore, we identified what information is essential to transitional care of these patients according to HCPs and PAs. These findings will be used to generate a simple, one page handover form. The next iteration of this project will pilot this handover form in an attempt to create safer transitions to the ED in this at-risk population.

‘There was no preamble’: Comparing the Transition from Hospital to Home in Different Care Settings

2020 ◽  
pp. 1-11
Author(s):  
Marianne Saragosa ◽  
Lianne Jeffs ◽  
Shoshana Hahn-Goldberg ◽  
Howard Abrams ◽  
Christine Soong ◽  
...  
Keyword(s):  
Acute Care ◽  
Health Care Providers ◽  
Transitional Care ◽  
Informal Caregivers ◽  
Care Providers ◽  
Outpatient Services ◽  
Structured Interviews ◽  
Individualized Approach ◽  
Transition Points ◽  
Hospital To Home

ABSTRACT Our qualitative descriptive study compared how older patients and their informal caregivers experienced the care transition from acute care or rehabilitation to home. We recruited patients 65 years of age or older, or their informal caregivers, from in-patient units within acute care hospitals and rehabilitation facilities to participate in semi-structured interviews. We identified emergent themes via thematic analysis. In all, 16 patients and four patient caregivers participated. Across all care settings, caregivers were integral in facilitating the transition as well as experiencing variable discharge preparation, health care providers’ optimizing transitions, and missed care and medication discrepancies at transition points. Orthopedic and rehabilitation patients more commonly voiced prior transition experiences in discharge preparation, including having to unexpectedly coordinate and wait for outpatient services. Differing responses between acute care and orthopedic settings suggest that transitional care practices and policies favor an individualized approach that considers patients’ previous experiences, needs, and care expectations.

scholarly journals Falls prevention at GP practices: a description of daily practice

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wytske M. A. Meekes ◽  
Chantal J. Leemrijse ◽  
Yvette M. Weesie ◽  
Ien A. M. van de Goor ◽  
Gé A. Donker ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Preventive Care ◽  
Fall Risk ◽  
Older Patients ◽  
Daily Practice ◽  
Falls Prevention ◽  
Care Providers ◽  
Mobility Limitations

Abstract Background General practitioners (GPs) can be considered the designated professionals to identify high fall risk and to guide older people to fall preventive care. Currently it is not exactly known how GPs treat this risk. This study aims to investigate GPs’ daily practice regarding fall preventive care for frail older patients. Methods Sixty-five GPs from 32 Dutch practices participated in this study for a period of 12 months. When a GP entered specific International Classification of Primary Care-codes related to frailty and/or high fall risk in their Electronic Health Records, a pop-up appeared asking “Is this patient frail?”. If the GP confirmed this, the GP completed a short questionnaire about patient’s fall history and fear of falling (FOF), and the fall preventive care provided. Results The GPs completed questionnaires regarding 1394 frail older patients aged ≥75. Of 20% of these patients, the GPs did not know whether they had experienced a fall or not. The GPs did not know whether a FOF existed in even more patients (29%). Of the patients with a fall history and/or a FOF (N = 726), 37% (N = 271) received fall preventive care. Two main reasons for not offering fall preventive care to these patients were: I) the patient finds treatment too intensive or too much of a hassle (37%), and II) the GP identified a high fall risk but the patient did not acknowledge this (14%). When patients were treated for high fall risk, the GP and the physiotherapist were the most frequently involved health care providers. The involved health care providers most often treated mobility limitations, cardiovascular risk factors, and FOF. Conclusions The results from this study show that GPs were frequently not aware of their frail patient’s fall history and/or FOF and that the majority of the frail older patients with a fall history and/or FOF did not receive fall preventive care. Developing systematic screening strategies for the primary care setting enhancing the identification of high fall risk and the provision of fall preventive care may improve patients’ quality of life and reduce health care costs.

scholarly journals Older Patients in Emergency Departments. Challenges from the health care providers’ perspective

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Deutschbein ◽  
M Möckel ◽  
L Schenk
Keyword(s):  
Health Care ◽  
Adverse Events ◽  
Health Care Providers ◽  
Demographic Change ◽  
Health Care Professionals ◽  
Emergency Departments ◽  
Older Patients ◽  
Care Providers ◽  
Complex Needs ◽  
Prolonged Length

Abstract Background Patients aged 65 and above are the fastest growing patient population in Europe. This is one of greatest challenges for almost all health services providers, including acute hospitals and their Emergency Departments (ED). As of today, older patients represent up to 30% of all ED patients, it is estimated. However, it is largely unclear to what degree EDs are currently prepared for older patients and how they need to adjust. This study analyses the present situation from the perspective of health care professionals caring for older ED patients. Methods The study was embedded in a mixed methods design using qualitative expert interviews. N = 25 semi-structured, guided interviews were conducted with professional health care providers from 7 Berlin EDs (physicians, nurses), and adjacent health care sectors such as nursing homes, rehabilitation clinics, and medical practices. Interviewees were asked about their daily experiences with older ED patients and their ideas of health care deficits and potentials. Data was analyzed using content analysis and hermeneutics. Results Health care providers assess the ED care situation for older patients and the necessity of adjustments in different ways but mostly as deficient. EDs are described as not elderly-friendly and partly as hazardous: older patients are at risk of adverse events such as developing a delirium. Risk factors are prolonged length of stay, the busy and noisy ED setting, and falls hazards. In general, ED staffing is not adequate to care for older patients with complex needs. Conclusions Considering demographic change, German Eds need to concentrate on the growing number of oder patients and their specific needs. Further research and development of specific care concepts for older ED patients is strongly needed. Potential adjustments of ED structures and care concepts also need to involve patients’ experiences and subjective needs. However, data on the patient perspective is still missing. Key messages Older patients and demographic change represent great challenges for EDs. Care concepts need to be developed to meet older patients needs and to avoid risks of adverse events.

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