scholarly journals Acceptability of a nurse-led, person-centred, anticipatory care planning intervention for older people at risk of functional decline: A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251978
Author(s):  
Dagmar A. S. Corry ◽  
Julie Doherty ◽  
Gillian Carter ◽  
Frank Doyle ◽  
Tom Fahey ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Older People ◽  
Thematic Analysis ◽  
Functional Decline ◽  
Home Visits ◽  
Care Planning ◽  
Personal Factors ◽  
Healthcare Provision ◽  
Healthcare Needs

Background As the population of older adults increases, the complexity of care required to support those who choose to remain in the community amplifies. Anticipatory Care Planning (ACP), through earlier identification of healthcare needs, is evidenced to improve quality of life, decrease aggressive interventions, and prolong life. With patient acceptability of growing importance in the design, implementation, and evaluation of healthcare interventions, this study reports on the acceptability of a primary care based ACP intervention on the island of Ireland. Methods As part of the evaluation of a feasibility cluster randomized controlled trial (cRCT) testing an ACP intervention for older people at risk of functional decline, intervention participants [n = 34] were interviewed in their homes at 10-week follow-up to determine acceptability. The intervention consisted of home visits by specifically trained registered nurses who assessed participants’ health, discussed their health goals and plans, and devised an anticipatory care plan in collaboration with participants’ GPs and adjunct clinical pharmacist. Thematic analysis was employed to analyze interview data. The feasibility cRCT involved eight general practitioner (GP) practices as cluster sites, stratified by jurisdiction, four in Northern Ireland (NI) (two intervention, two control), and four in the Republic of Ireland (ROI) (two intervention, two control). Participants were assessed for risk of functional decline. A total of 34 patients received the intervention and 31 received usual care. Findings Thematic analysis resulted in five main themes: timing of intervention, understanding of ACP, personality & individual differences, loneliness & social isolation, and views on healthcare provision. These map across the Four Factor Model of Acceptability (‘4FMA’), a newly developed conceptual framework comprising four components: intervention factors, personal factors, social support factors, and healthcare provision factors. Conclusion Acceptability of this primary care based ACP intervention was high, with nurses’ home visits, GP anchorage, multidisciplinary working, personalized approach, and active listening regarded as beneficial. Appropriate timing, and patient health education emerged as vital.

scholarly journals Anticipatory Care Planning Intervention for Older Adults at Risk of Functional Decline: Study protocol for a Primary Care Cluster Feasibility Randomised Trial

2019 ◽  
Author(s):  
Kevin Brazil ◽  
David Scott ◽  
Emma Wallace ◽  
Mike Clarke ◽  
Tom Fahey ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
At Risk ◽  
Health Systems ◽  
Functional Decline ◽  
Randomised Trial ◽  
Care Planning ◽  
The Impact

Abstract Background The treatment and management of long-term health conditions is the greatest challenge facing health systems around the world today. Innovative approaches to patient care in the community such as Anticipatory Care Planning (ACP), which seek to help with the provision of high-quality comprehensive care to older adults at risk of functional decline, require evaluation. This study will evaluate one approach that will include primary care as the setting for Anticipatory Care Planning.Methods This study will help to determine the feasibility for a definitive randomised trial to evaluate the implementation and outcomes of an ACP intervention. The intervention will be delivered by specially trained registered nurses in a primary care setting with older adults identified as at risk of functional decline. The intervention will comprise of: a) information collection via patient assessment; b) facilitated informed dialogue between the patient, family carer, general practitioner and other healthcare practitioners; and, c) documentation of the agreed support plan and follow-up review dates. Through a structured consultation with patients and their family carers, the nurses will complete a mutually agreed personalized support plan.Discussion This study will determine the feasibility for a full trial protocol to evaluate the implementation and outcomes of an (ACP) intervention in primary care to assist older adults aged 70 years of age or older and assessed as at risk of functional decline. The study will be implemented in two jurisdictions on the island of Ireland which employ different health systems but which face similar health challenges. This study will allow us to examine important issues, such as the impact of two different healthcare systems on the health of older people and the influence of different legislative interpretations on undertaking cross jurisdictional research in Ireland.

scholarly journals Anticipatory Care Planning Intervention for Older Adults at Risk of Functional Decline: Study protocol for a Primary Care Cluster Feasibility Randomised Trial

2020 ◽  
Author(s):  
Kevin Brazil ◽  
David Scott ◽  
Emma Wallace ◽  
Mike Clarke ◽  
Tom Fahey ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
At Risk ◽  
Health Systems ◽  
Functional Decline ◽  
Randomised Trial ◽  
Care Planning ◽  
Planning Methods ◽  
The Impact ◽  
Support Plan

Abstract Background The treatment and management of long-term health conditions is the greatest challenge facing health systems around the world today. Innovative approaches to patient care in the community such as Anticipatory Care Planning (ACP), which seek to help with the provision of high-quality comprehensive care to older adults at risk of functional decline, require evaluation. This study will evaluate one approach that will include primary care as the setting for Anticipatory Care Planning. Methods This study will help to determine the feasibility for a definitive randomised trial to evaluate the implementation and outcomes of an ACP intervention. The intervention will be delivered by specially trained registered nurses in a primary care setting with older adults identified as at risk of functional decline. The intervention will comprise of: a) information collection via patient assessment; b) facilitated informed dialogue between the patient, family carer, general practitioner and other healthcare practitioners; and, c) documentation of the agreed support plan and follow-up review dates. Through a structured consultation with patients and their family carers, the nurses will complete a mutually agreed personalized support plan. Discussion This study will determine the feasibility for a full trial protocol to evaluate the implementation and outcomes of an (ACP) intervention in primary care to assist older adults aged 70 years of age or older and assessed as at risk of functional decline. The study will be implemented in two jurisdictions on the island of Ireland which employ different health systems but which face similar health challenges. This study will allow us to examine important issues, such as the impact of two different healthcare systems on the health of older people and the influence of different legislative interpretations on undertaking cross jurisdictional research in Ireland.

scholarly journals Preventing unwanted situations and gaining trust: a qualitative study of older people and families’ experiences with advance care planning in the daily practice of primary care

2019 ◽  
Vol 37 (4) ◽  
pp. 519-524
Author(s):  
Jolien J Glaudemans ◽  
Dick L Willems ◽  
Jan Wind ◽  
Bregje D Onwuteaka Philipsen
Keyword(s):  
Primary Care ◽  
Older People ◽  
Advance Care Planning ◽  
Daily Practice ◽  
Care Planning ◽  
Theory Approach ◽  
Face To Face ◽  
Future Care ◽  
Advance Care

Abstract Background Using advance care planning (ACP) to anticipate future decisions can increase compliance with people’s end-of-life wishes, decrease inappropriate life-sustaining treatment and reduce stress, anxiety and depression. Despite this, only a minority of older people engage in ACP, partly because care professionals lack knowledge of approaches towards ACP with older people and their families. Objective To explore older people’s and their families’ experiences with ACP in primary care. Methods We conducted qualitative, semi-structured, face-to-face interviews with 22 older people (aged >70 years, v/m: 11/11), with experience in ACP, and eight of their family members (aged 40–79 years, f/m: 7/1). Transcripts were inductively analysed using a grounded theory approach. Results We distinguished three main themes. (i) Openness and trust: Respondents were more open to ACP if they wanted to prevent specific future situations and less open if they lacked trust or had negative thoughts regarding general practitioners’ (GPs’) time for and interest in ACP. Engaging in ACP appeared to increase trust. (ii) Timing and topics: ACP was not initiated too early. Quality of ACP seemed to improve if respondents’ views on their current life and future, a few specific future care scenarios and expectations and responsibilities regarding ACP were discussed. (iii) Roles of family: Quality of ACP appeared to improve if family was involved in ACP. Conclusions Quality and accessibility of ACP may improve if GPs and nurses involve family, explain GPs’ interest in ACP and discuss future situations older people may want to prevent, and views on their current life and future.

Worning: Tooth Wear Ahead

2016 ◽  
Vol 5 (3) ◽  
pp. 38-42
Author(s):  
Lucy Slater ◽  
Andrew Eder ◽  
Nairn Wilson
Keyword(s):  
At Risk ◽  
Periodontal Disease ◽  
Early Identification ◽  
Tooth Wear ◽  
Care Planning ◽  
National Guidelines ◽  
Healthcare Provision ◽  
Preventive Approach

While caries, periodontal disease and tooth wear are all largely preventable, current national guidelines on a preventive approach to oral healthcare provision are limited to advice on the prevention of caries and periodontal disease. Unfortunately, there is not yet a large enough body of evidence to develop guidelines on the prevention of tooth wear. As with caries, it is important to distinguish between ‘active’ and ‘arrested’ wear both in assessment and care planning. The aim of this article is to highlight the growing importance of early identification of patients who may be at risk of pathological tooth wear, provide an overview of known tooth wear markers, and suggest the development of a system to assess susceptibility to tooth wear.

Anticipatory care planning for older adults: a trans-jurisdictional feasibility study

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711197
Author(s):  
Dagmar Corry ◽  
Julie Doherty ◽  
Adrienne McCann ◽  
Frank Doyle ◽  
Christopher Cardwell ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Primary Care ◽  
Action Plan ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Care Planning ◽  
Healthcare Needs ◽  
The Uk

BackgroundAs the population of older adults’ increases, the complexity of care required to support those who choose to remain in the community has also increased. Anticipatory Care Planning (ACP) through earlier identification of healthcare needs is evidenced to improve quality of life, decrease the number of aggressive futile interventions, and even to prolong life.AimTo determine the feasibility of a cluster randomised trial to evaluate the implementation and outcomes of Anticipatory Care Planning (ACP) in primary care to assist older adults identified as at risk for functional decline by developing a personalised support plan.MethodGP practices were randomised into control/intervention groups stratified by jurisdiction [Northern Ireland (UK) and the Republic of Ireland (RoI)], and by setting (urban and rural). Participants were included if they were a) aged ≥70 years, b) 2 or more chronic medical conditions, c) 4 or more prescribed medications. The Anticipatory Care Plan consisted of home visits where the study nurse discussed patients’ goals and plans. An action plan was put in place following consultation with patient’s GPs and study Pharmacist.ResultsEight primary care practices participated; four in the UK and four in the RoI. Sample n = 64. Data was collected pertaining to patient quality of life, mental health, healthcare utilisation, costs, perception of person-centred care, and the use of potentially inappropriate medication.ConclusionUnique insights relating to the trans-jurisdictional delivery of healthcare services in the UK and RoI were observed which has implications on service delivery for older adults.

scholarly journals Feasibility and effects of preventive home visits for at-risk older people: Design of a randomized controlled trial

2009 ◽  
Vol 9 (1) ◽  
Author(s):  
Malcolm P Cutchin ◽  
Susan Coppola ◽  
Vibeke Talley ◽  
Judie Svihula ◽  
Diane Catellier ◽  
...  
Keyword(s):  
At Risk ◽  
Randomized Controlled Trial ◽  
Older People ◽  
Controlled Trial ◽  
Home Visits ◽  
Preventive Home Visits ◽  
Randomized Controlled

scholarly journals Usual primary care of older people in New Zealand: association between practice characteristics and practice activities

2017 ◽  
Vol 9 (1) ◽  
pp. 78 ◽  
Author(s):  
Leah Palapar ◽  
Laura Wilkinson-Meyers ◽  
Thomas Lumley ◽  
Ngaire Kerse
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Older People ◽  
Older Patients ◽  
Home Visits ◽  
Assessment Tools ◽  
Future Research ◽  
Practice Characteristics ◽  
Care Practices ◽  
Primary Care Practices

ABSTRACT INTRODUCTION Information on the processes used by primary care practices to help identify older patients in need of assistance are limited in New Zealand. AIM To describe the processes used to promote early problem detection in older patients in primary care and the practice characteristics associated with the use of these proactive processes. METHODS Sixty practices were randomly selected from all primary care practices in three regions (52% response rate) and surveyed in 2010 to identify characteristics of practices performing the following activities: using assessment tools; auditing the practice; conducting specific clinics; providing home visits; and providing active patient follow-up. Practice level variables were examined. RESULTS Only 4 (7%) of 57 practices did not perform any of the activities. We found the following associations in the many comparisons done: no activities and greater level of deprivation of practice address (p = 0.048); more activities in main urban centres (p = 0.034); more main urban centre practices doing home visits (p = 0.001); less Canterbury practices conducting specific clinics for frail older patients (p = 0.010); and more Capital and Coast practices following-up patients who do not renew their prescriptions (p = 0.019). DISCUSSION There are proactive processes in place in most New Zealand practices interested in a trial about care of older people. Future research should determine whether different types of practices or the activities that they undertake make a difference to older primary care patients’ outcomes.

scholarly journals Remote primary care consultations for people living with dementia during the COVID-19 pandemic: experiences of people living with dementia and their carers

2021 ◽  
pp. BJGP.2020.1094 ◽  
Author(s):  
Remco Tuijt ◽  
Greta Rait ◽  
Rachael Frost ◽  
Jane Wilcock ◽  
Jill Manthorpe ◽  
...  
Keyword(s):  
Primary Care ◽  
Best Practice ◽  
Qualitative Interviews ◽  
Healthcare Services ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
Healthcare Settings ◽  
Healthcare Needs ◽  
Remote Healthcare ◽  
Remote Consultations

Background: COVID-19 has accelerated remote healthcare provision in primary care, with changes potentially permanent. The implementation of remote provision of healthcare needs to hear from vulnerable populations, such as people living with dementia. Aim: To understand the remote healthcare experiences of patients living with dementia and their family carers during the COVID-19 pandemic. Design and setting: Qualitative interviews with community-based patients living with dementia and their carers during early months (May-August 2020) of the COVID-19 pandemic in England. Methods: Semi-structured interviews were conducted remotely by telephone or video call with 30 patients living with dementia and 31 carers. Data were analysed using thematic analysis. Results: Three main themes were derived relating to: 1) proactive care at the onset of COVID-19 restrictions, 2) avoidance of healthcare settings and services, and 3) difficulties with remote healthcare encounters. People living with dementia and their carers felt check-up calls were reassuring but limited in scope and content. Some avoided healthcare services, wishing to minimise COVID-19 risk, reduce NHS burden, or encountering technological barriers. Difficulties in remote consultations included lack of prompts to remember problems, dealing with new emerging problems, rescheduling/missed calls, and inclusion of the person with dementia’s voice. Conclusion: While remote consultations could be effective, pro-active calls could be more structured around needs, and consideration should be given to replace non-verbal prompts to describe problems, particularly for new health concerns. In continuing remote consultations, it is important to facilitate engagement with patients living with dementia and their carers to ensure best practice.

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