scholarly journals Continuity of care and multiple chronic conditions impact frequent use of outpatient services

2019 ◽  
Vol 26 (1) ◽  
pp. 318-327 ◽  
Author(s):  
Chi Wang ◽  
Hsiao-Ching Kuo ◽  
Su-Fen Cheng ◽  
Jui-Lan Hung ◽  
Jia-Hui Xiong ◽  
...  
Keyword(s):  
Continuity Of Care ◽  
Chronic Conditions ◽  
Quality Care ◽  
Outpatient Service ◽  
Emergency Department Visits ◽  
Multiple Chronic Conditions ◽  
Outpatient Services ◽  
Frequent Use ◽  
Catastrophic Illness ◽  
Care Index

This study investigated the association between care continuity and chronic conditions in relation to highly frequent use of outpatient service in order to find constructive suggestions to bring efficient, high-quality care for patients with multiple chronic conditions. The National Health Insurance database was used and 333,294 patients were identified from 2007 to 2009. The continuity of care index indicates the dispersion of a patient’s ambulatory visits among providers. Multivariate logistic regression was used to estimate adjusted odds ratios with 95 percent confidence intervals. Continuity of care index was significantly associated with age, sex, urbanization level, socioeconomic status, emergency department visits, hospitalization, psychological disorders, chronic diseases, and catastrophic illness card; those with low continuity of care index were likely to use outpatient care highly frequently. Improving continuity of care is fundamental, and the best way is to advance the practice of family medicine for primary care.

Nurses’ Experiences of Transitional Care in Multiple Chronic Conditions

2021 ◽  
pp. 108482232110021
Author(s):  
Alireza Nikbakht Nasrabadi ◽  
Leila Mardanian Dehkordi ◽  
Fariba Taleghani
Keyword(s):  
Patient Safety ◽  
Data Collection ◽  
Continuity Of Care ◽  
Chronic Conditions ◽  
Transitional Care ◽  
Major Elements ◽  
Study Data ◽  
Multiple Chronic Conditions ◽  
University Hospitals ◽  
Levels Of Care

Transitional care is a designed plan to ensure the continuity of care received by patients as they transfer between different locations or levels of care. The aim of this paper is to explore nurses’ experiences of transitional care in multiple chronic conditions. A qualitative method with a conventional content analysis approach was utilized. The study was conducted at university hospitals in 2 big cities (Isfahan and Tehran) of Iran. This study is performed from November 2018 to December 2019 using deep, semi-structured, and face-to-face interviews which are focused on nurses’ experiences of transitional care. Data collection continued until saturation was reached. Finally, 15 nurses take part in this study. Data collection and data analysis were conducted concurrently. Data were analyzed using Graneheim and Lundman’s techniques. Two main themes providing a descriptive summary of the major elements of transitional care identified: “threat to patient safety” and “Care breakdown”. Findings showed an exclusive image of unsafe transitional care which was done unplanned without appropriate delegating care to family and threat patient safety. There is still a gap in the transition from hospital to home. Nursing managers can address this issue by creating a culture of teamwork, training competent nurses by continuum education, and more supervision of nursing care. Policymakers can ensure continuity of care by developing policies and programs about transitional care.

scholarly journals Emergency Department Utilization among Underserved African American Older Adults in South Los Angeles

2019 ◽  
Vol 16 (7) ◽  
pp. 1175 ◽  
Author(s):  
Mohsen Bazargan ◽  
James Smith ◽  
Sharon Cobb ◽  
Lisa Barkley ◽  
Cheryl Wisseh ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
African American ◽  
Los Angeles ◽  
Continuity Of Care ◽  
Chronic Conditions ◽  
Male Gender ◽  
Multiple Chronic Conditions ◽  
South Los Angeles ◽  
Ed Visits

Objectives: Using the Andersen’s Behavioral Model of Health Services Use, we explored social, behavioral, and health factors that are associated with emergency department (ED) utilization among underserved African American (AA) older adults in one of the most economically disadvantaged urban areas in South Los Angeles, California. Methods: This cross-sectional study recruited a convenience sample of 609 non-institutionalized AA older adults (age ≥ 65 years) from South Los Angeles, California. Participants were interviewed for demographic factors, self-rated health, chronic medication conditions (CMCs), pain, depressive symptoms, access to care, and continuity of care. Outcomes included 1 or 2+ ED visits in the last 12 months. Polynomial regression was used for data analysis. Results: Almost 41% of participants were treated at an ED during the last 12 months. In all, 27% of participants attended an ED once and 14% two or more times. Half of those with 6+ chronic conditions reported being treated at an ED once; one quarter at least twice. Factors that predicted no ED visit were male gender (OR = 0.50, 95% CI = 0.29–0.85), higher continuity of medical care (OR = 1.55, 95% CI = 1.04–2.31), individuals with two CMCs or less (OR = 2.61 (1.03–6.59), second tertile of pain severity (OR = 2.80, 95% CI = 1.36–5.73). Factors that predicted only one ED visit were male gender (OR = 0.45, 95% CI = 0.25–0.82), higher continuity of medical care (OR = 1.39, 95% CI = 1.01–2.15) and second tertile of pain severity (OR = 2.42, 95% CI = 1.13–5.19). Conclusions: This study documented that a lack of continuity of care for individuals with multiple chronic conditions leads to a higher rate of ED presentations. The results are significant given that ED visits may contribute to health disparities among AA older adults. Future research should examine whether case management decreases ED utilization among underserved AA older adults with multiple chronic conditions and/or severe pain. To explore the generalizability of these findings, the study should be repeated in other settings.

scholarly journals Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs

2007 ◽  
Vol 22 (S3) ◽  
pp. 391-395 ◽  
Author(s):  
Christine Vogeli ◽  
Alexandra E. Shields ◽  
Todd A. Lee ◽  
Teresa B. Gibson ◽  
William D. Marder ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Care Management ◽  
Quality Care ◽  
Multiple Chronic Conditions ◽  
Health Consequences

scholarly journals Assessment of Continuity of Care among Patients with Multiple Chronic Conditions in Italy

PLoS ONE ◽  
2016 ◽  
Vol 11 (5) ◽  
pp. e0154940 ◽  
Author(s):  
Francesco Napolitano ◽  
Paola Napolitano ◽  
Luca Garofalo ◽  
Marianna Recupito ◽  
Italo F. Angelillo
Keyword(s):  
Continuity Of Care ◽  
Chronic Conditions ◽  
Multiple Chronic Conditions

scholarly journals Frequent use of emergency departments and chronic conditions in ageing societies: a retrospective analysis based in Italy

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Enrico di Bella ◽  
Luca Gandullia ◽  
Lucia Leporatti ◽  
Walter Locatelli ◽  
Marcello Montefiori ◽  
...  
Keyword(s):  
Emergency Departments ◽  
Chronic Conditions ◽  
Age Groups ◽  
Warning System ◽  
Multiple Chronic Conditions ◽  
Frequent Users ◽  
Administrative Dataset ◽  
Frequent Use ◽  
Demographic Risk ◽  
Demographic Risk Factors

Abstract Background Most western countries are facing relevant demographic changes, and the percentage of older people is destined to rise in the next decades. This fact is likely to affect the sustainability of healthcare systems significantly, mainly due to the connected issue of chronicity. Methods In this paper, using an extensive and comprehensive administrative dataset, we analyse the phenomenon of frequent use of emergency departments (ED) in the oldest region in Europe (i.e. Liguria) over 4 years (2013–2016). Two alternative approaches are used to define categories of ED users based on the intensity and frequency of accesses and splitting patients into different age groups. Results Results allow identifying clinical and socio-demographic risk-factors connected to different levels of ED utilisation and highlight the influential role played by chronic conditions (particularly mental disorders, respiratory diseases) and by multiple chronic conditions. Conclusions The study aims at representing an informative tool to support policy-makers in setting proper policies addressed, on the one side, towards the potentially preventable frequent users and, on the other, towards those accessing due to complex medical conditions. The results can help in building a warning system to help general practitioners in the identification of potential frequent users and to develop preventive policies.

Continuity of Care, Systems Integration and Patient Transitions: Central or Local Psychiatric Beds? The VELO-Project

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
L.H.R. Myklebust ◽  
S. Bjorbekkmo ◽  
A. Nymann ◽  
S. Molvik ◽  
R. Olstad ◽  
...  
Keyword(s):  
Mental Health ◽  
Continuity Of Care ◽  
Service Use ◽  
Mental Health Problems ◽  
Outpatient Service ◽  
Systems Integration ◽  
Integrated System ◽  
Outpatient Services ◽  
Individual Level ◽  
Care Systems

Background:Although scientifically controversial, continuity of care for patients with serious mental illness has long been a key-concept in the evaluation of deinstitutionalized mental health services. It is associated with systems integration, and particularly relevant in transitions from in- to outpatient status at the individual level. The theme is highlighted in a close to natural experiment that was part of the VELO-project, were two neighboring mental health service-systems diverge concerning their organization of in- and outpatient services.Aim:To investigate the significance of systems integration of inpatient and outpatient services on continuity of care for individual patients.Method:244 inpatients from the services case-registry (2005) were followed concerning their pattern of both inpatient and outpatient service use. The results were controlled for length of hospitalization, diagnosis and demographical variables.Results:Overall for inpatients, the low-integrated system shows significantly less outpatient activity than the high-integrated system. This pattern is not associated with differences in general service profile of the systems, and holds up for patients suffering from schizophrenia and anxiety, but not for affective disorders.Discussion:The results may be explained by differences in geographical and managerial organization of the two systems.Conclusion:High level of systems integration is important in reducing the risk of discontinuity of care for patients suffering from severe mental health problems. Level of integration may interact with differences in vulnerability for transitions of individual patients.

scholarly journals Optimising medication management for polymedicated home-dwelling older adults with multiple chronic conditions: a mixed-methods study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030030
Author(s):  
Filipa Pereira ◽  
Pauline Roux ◽  
Marie Santiago-Delefosse ◽  
Armin von Gunten ◽  
Boris Wernli ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Mixed Methods ◽  
Chronic Conditions ◽  
Management Practices ◽  
Medication Management ◽  
Emergency Department Visits ◽  
Mixed Methods Study ◽  
Multiple Chronic Conditions ◽  
At Home

IntroductionOptimal medication management is one of the basic conditions necessary for home-dwelling older adults living with multiple chronic conditions (OAMCC) to be able to remain at home and preserve their quality of life. Currently, the reasons for such high numbers of emergency department visits and the very significant rate of hospitalisations for OAMCC, due to medication-related problems (MRPs), is poorly explored. This study aims to reveal the current state of the medication management practices of polymedicated, home-dwelling OAMCC and to make proposals for improving clinical and medication pathways through an innovative and integrated model for supporting medication management and preventing adverse health outcomes.Methods and analysisA mixed-methods study will address the medication management of polymedicated, home-dwelling OAMCC. Its explanatory sequential design will involve two major phases conducted sequentially over time. The quantitative phase will consist of retrospectively exploiting the last 5 years of electronic patient records from a local hospital (N ≈ 50 000) in order to identify the different profiles—made up of patient-related, medication-related and environment-related factors—of the polymedicated, home-dwelling OAMCC at risk of hospitalisation, emergency department visits, hospital readmission (notably for MRPs), institutionalisation or early death. The qualitative study will involve: (a) obtaining and understanding the medication management practices and experiences of the identified profiles extracted from the hospital data of OAMCC who will be interviewed at home (N ≈ 30); (b) collecting and analysing the perspectives of the formal and informal caregivers involved in medication management at home in order to cross-reference perspectives about this important dimension of care at home. Finally, the mixed-methods findings will enable the development of an innovative, integrated model of medication management based on the Agency for Clinical Innovation framework and Bodenheimer and Sinsky’s quadruple aim.Ethics and disseminationEthical approval has been obtained from the Human Research Ethics Committee of the Canton Vaud (2018-02196). Findings will be disseminated in peer-reviewed journals, professional conferences and other knowledge transfer activities with primary healthcare providers, hospital care units, informal caregivers’ and patients’ associations.

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