A Qualitative Study of Older Patients’ and Family Caregivers’ Perspectives of Transitional Care From Hospital to Home

2021 ◽  
pp. RTNP-D-20-00067
Author(s):  
İlknur Dolu ◽  
Mehmet İIlkin Naharcı ◽  
Patricia A. Logan ◽  
Piret Paal ◽  
Mojtaba Vaismoradi
Keyword(s):  
Family Caregivers ◽  
Older Patients ◽  
Transitional Care ◽  
Care Program ◽  
Healthcare Services ◽  
Structured Interviews ◽  
High Quality ◽  
Rehabilitation Model ◽  
Hospital To Home ◽  
Discharge From Hospital

Background and PurposeThe need for high-quality long-term healthcare services is increasing across the globe as the population ages. Strategies for improving transitional care from hospital to home are needed. This study aimed to explore the perspectives of patients aged 65 years and over and their family caregivers transitioning from hospital to home in an urban area of Turkey.MethodsThematic analysis of in-depth semi-structured interviews was conducted with older patients (n = 14), with at least one chronic disease and admitted to the hospital for a minimum of 3 days, and family caregivers (n = 11) who voluntarily participated.ResultsMain themes were “confused feelings of safety and stress”; “worried about being left alone”; and “disrupted healthcare journey.” The proactive rehabilitation model was used to elaborate on the study findings and interpret the perspectives and experiences of older patients and their family caregivers, which can be used for improving the quality of care after discharge from hospital.Implications for PracticeA high-quality transitional care program requires taking care of the feeling of safety in older patients and their family caregivers by the multidisciplinary team and their enhanced involvement in care initiatives after hospital discharge.

scholarly journals Improvement of transitional care from hospital to home for older patients, the TIGER study: protocol of a randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e037999
Author(s):  
Martina Rimmele ◽  
Jenny Wirth ◽  
Sabine Britting ◽  
Thomas Gehr ◽  
Margit Hermann ◽  
...  
Keyword(s):  
Older Patients ◽  
Transitional Care ◽  
Intervention Group ◽  
Care Quality ◽  
Care Plan ◽  
Control Group ◽  
Care Services ◽  
Continuous Care ◽  
Hospital To Home ◽  
Randomised Controlled

IntroductionIn Germany, an efficient and feasible transition from hospital to home for older patients, ensuring continuous care across healthcare settings, has not yet been applied and evaluated. Based on the transitional care model (TCM), this study aims to reduce preventable readmissions of patients ≥75 years of age with a transitional care intervention performed by geriatric-experienced care professionals. The study investigates whether the intervention ensures continuous care during transition and stabilises the care situation of patients at home.Methods and analysesRandomised controlled clinical trial, recruiting between 25 April 2018 and 31 December 2019 in one German hospital in the city of Regensburg. The intervention group is supported by care professionals in the transition process from hospital to home for up to 12 months. Based on TCM, the intervention includes an individual care plan according to a patient’s symptoms, risks, needs and values. The plan is advanced in the domestic situation via personal visits and telephone contacts. All necessary care actions regarding, for example, mobility, residence adjustments, or nutrition, are initiated to be executed by ambulant care services, and are monitored, evaluated and adapted if necessary. In supervising the care plan, the care professionals do not administer active care services themselves but coordinate them. Patients and their caregivers are actively engaged in the care planning and execution. In contrast, the control group receives only usual discharge planning in the hospital and usual ambulatory care.The primary outcome is the all-cause readmission rate assessed using health insurance data within a follow-up of up to 12 months after hospital discharge. Secondary outcomes include care quality, mobility, nutritional and wound situation, and health-related quality of life. They are assessed at baseline, after 1 month, 3 months, 6 months, and at the end of study visit. Additionally, the economic efficiency of the intervention will be evaluated.Ethics and disseminationEthics approval for the trial was obtained from the Ethics Committee of the Friedrich-Alexander-Universität Erlangen-Nürnberg. Results will be published in peer-reviewed, open-access scientific journals and disseminated at national and international research conferences and through public presentations in the geriatric and healthcare community.Trial registrationClinicalTrials.gov identifier: NCT03513159.

A pragmatic randomized controlled trial of a cardiac hospital-to-home transitional care program in a Singapore academic medical center

2020 ◽  
Vol 25 (2) ◽  
pp. 55-66
Author(s):  
Yanying Chen ◽  
Yi Jin Tan ◽  
Ya Sun ◽  
Cheng Zhan Chua ◽  
Jeffrey Kwang Sui Yoo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Transitional Care ◽  
Controlled Trial ◽  
Care Program ◽  
Emergency Department Visits ◽  
Pragmatic Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Hospital To Home

Background Rehospitalizations are common in healthcare. They are costly for hospitals and patients and a substantial percentage are preventable, partly because hospital-to-community transitions are often unmanaged or poorly managed. In this study, we conducted a pragmatic randomized, controlled trial to evaluate the effectiveness of a new nurse–practitioner-led transitional care program called CareHub, piloted in Singapore’s National University Hospital. Methods Study population included all eligible cardiac patients admitted between July 2016 and November 2016. Patients were followed for six months post-discharge. Primary outcomes other than emergency department visits were all cardiac-related: number of readmissions, specialist visits, emergency department visits, and total days readmitted. Secondary outcomes: variables related to quality of life and transitional care. Regression analyses were used to estimate the intent-to-treat effect of CareHub and explore treatment heterogeneity. Results CareHub reduced the mean number of unplanned readmissions by 0.23 (a 39% reduction relative to control mean of 0.60 unplanned readmissions, p < 0.05), mean number of all readmissions by 0.20 (31% reduction relative to control mean of 0.63 readmissions, p = 0.10), mean number of total unplanned days in hospital by 2.2 (56% reduction relative to control mean of 4.0 days, p < 0.05), mean number of total days in hospital by 2.0 (42% reduction relative to control mean of 4.3 days, p < 0.10). Treatment effects varied by pre-admission health and socio-economic status. Conclusion A carefully designed protocolized cardiac hospital-to-home transition program can reduce resource utilization while improving quality of life.

scholarly journals Dementia in People with a Turkish Migration Background: Experiences and Utilization of Healthcare Services

2020 ◽  
Vol 77 (2) ◽  
pp. 865-875
Author(s):  
Jessica Monsees ◽  
Tim Schmachtenberg ◽  
Wolfgang Hoffmann ◽  
Amy Kind ◽  
Andrea Gilmore-Bykovskyi ◽  
...  
Keyword(s):  
Family Caregivers ◽  
Help Seeking ◽  
Qualitative Content Analysis ◽  
Relevant Information ◽  
Healthcare Services ◽  
Migration Background ◽  
Structured Interviews ◽  
Migrant Populations ◽  
Turkish Culture ◽  
Willingness To Use

Background: As the proportion of older people with migration background (PwM) increases, the proportion of older PwM with dementia might also increase. Dementia is underdiagnosed in this group and a large proportion of PwM with dementia and family caregivers are not properly supported. Healthcare utilization is lower among older migrant populations. Thus, a better understanding of how PwM and family caregivers perceive their situation and how they experience healthcare services is needed to improve utilization of the healthcare system. Objective: Analyze how family caregivers of PwM with dementia experience their situation, why healthcare services are utilized less often, and what can be done to reverse this. Methods: Eight semi-structured interviews were conducted with people with Turkish migration background caring for PwM with dementia. Qualitative content analysis was used for data analysis. Results: Daily care was performed by one family member with the support of others. Healthcare services were used by most participants. Participants identified a need for better access to relevant information and incorporation of Turkish culture into healthcare services. Conclusion: PwM face similar challenges in taking care of persons with dementia as those without migration background. There is a willingness to use services, and services embracing Turkish culture would help to reduce hesitance and make affected people feel more comfortable, thereby increasing utilization and satisfaction. A limitation of this study is that participants were already connected to health services, which may not reflect the help-seeking behavior of those in the Turkish community who are not involved in healthcare.

‘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 Transition from hospital to home during COVID-19: A case report from an Australian transitional care program

2021 ◽  
Vol 2 (1) ◽  
pp. 1-19
Author(s):  
Claire Gough ◽  
Claire Hutchinson ◽  
Chris Barr ◽  
Anthony Maeder ◽  
Stacey George
Keyword(s):  
Older Adults ◽  
Case Report ◽  
Lived Experience ◽  
Social Isolation ◽  
Transitional Care ◽  
Care Program ◽  
Healthcare Services ◽  
Vulnerable Groups ◽  
Ageing Population ◽  
Transition Care

Aim and Background: With the ongoing COVID-19 global pandemic, consideration for vulnerable groups, including our ageing population has been of great concern. Social isolation has been recommended to protect older adults with chronic diseases and reduce the spread of the virus, as well as to prevent healthcare services becoming overwhelmed. Yet social isolation presents its own health risks. Methods: In this paper, we provide commentary on the lived experience of returning home from hospital during the COVID-19 pandemic. This case report details the experience of an 83-year-old female, who was living and mobilising independently in her own home, prior to hospital admission following a fall and resultant head injury. Results: The participant returned home during the COVID-19 pandemic with a community transition care program which included assistance with cleaning tasks, shopping, and physiotherapy over a 45-day period. Conclusions: COVID-19 has illuminated the issue of social isolation and increased awareness of its negative health effects at a global level. As society eases restrictions and returns to a new ‘normal’, many older adults will remain socially isolated. Ongoing allied health intervention is required to ensure quality of life through the latter years and to support older adults through periods of social distancing. Keywords: transition care; COVID-19, social isolation, community participation    

scholarly journals Transitional nursing care for older inpatients: a person-centred research programme

2021 ◽  
Vol 11 (1) ◽  
pp. 1-3
Author(s):  
Cédric Mabire ◽  
◽  
Joanie Pellet ◽  
Keyword(s):  
Older Persons ◽  
Nursing Practice ◽  
Transitional Care ◽  
Medication Management ◽  
Research Programme ◽  
Healthcare Services ◽  
Western World ◽  
Levels Of Care ◽  
Transitions Theory ◽  
Hospital To Home

Across the Western world, healthcare services are contending with the challenge of ageing populations. Switzerland is no exception, and faces the need to adapt its healthcare system to the needs of older persons. A disease-oriented approach is ill suited to the varied abilities, preferences and degrees of resilience among older people, and person-centred care is better placed to respond effectively to this situation (Ekman et al., 2013). Our team at the Institute of Higher Education and Research in Healthcare (IUFRS) of the University of Lausanne has developed a research programme to improve the healthcare experiences of older persons during hospitalisation and transition to discharge. We have identified different models and theories that promote a better understanding of the factors that impact on older persons ’lives during these phases and of how to take them into account in nursing practice in order to encourage a person-centred approach. The transition of care from hospital to home is a vulnerable time in the continuum of care for older persons (Arbaje et al., 2014). Transitional care is defined by Coleman and Boult (2003, p 549) as a ‘set of actions designed to ensure the coordination and continuity of healthcare as patients transfer between different locations or different levels of care within the same location’. At the theoretical level, Meleis ’transitions theory (2000) provides a perspective for interpreting and planning comprehensive discharge for hospitalised older persons. In designing our research programme, this theory helped us to link the older person’s health problems (conditions of transition) in relation to hospitalisation (nature of transition), discharge preparation (nursing interventions) and the effects on the person (response models) (Mabire et al., 2015). From the transitions theory, Naylor et al. (2017) developed their transitional care model to guide nursing practice during this period. This model includes eight components: Patient engagement Caregiver engagement Complexity and medication management Patient education Caregiver education Patient and caregiver wellbeing Care continuity Accountability

scholarly journals The practice environment’s influence on patient participation in intermediate healthcare services – the perspectives of patients, relatives and healthcare professionals

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Linda Aimée Hartford Kvæl ◽  
Astrid Bergland
Keyword(s):  
Older People ◽  
Patient Participation ◽  
Older Patients ◽  
Healthcare Professionals ◽  
Healthcare Services ◽  
Practice Environment ◽  
Structured Interviews ◽  
Rehabilitation Care ◽  
Theoretical Approaches ◽  
Complex Relationships

Abstract Background Intermediate care (IC) bridges the clinical pathway of older patients transitioning from the hospital to home. Currently, there is a strong consensus that the practice environment is an important factor in helping older people overcome their limitations and regain function after illness or injury. Regardless of the arising attention related to person-centred care, the practice environment is yet to be recognised as a vital part of care, and a small extent of focus has been given the environmental dimensions of IC services. Thus, more research is required regarding the complex relationships between older people and the practice environment. This study explores the perspectives of older patients, their relatives and healthcare professionals related to the practice environment’s influence on patient participation among older people in the context of intermediate healthcare services. Methods Using purposive sampling and theoretical approaches, including frameworks of patient participation, the practices environment and person-centred care, semi-structured interviews were conducted with 15 older patients, 12 relatives and 18 healthcare professionals from three different IC institutions in Norway to discuss their experiences and preferences regarding patient participation. A thematic analysis was used to explore patterns across the interviews. Results Three main themes were identified: ‘location and access to physical facilities’, ‘symbolic expression of patients’ and professionals’ possibilities’ and ‘participating in meaningful activities’. The findings show that both the physical and the psychosocial environments influenced older patients’ various types of participation in IC services. Conclusions To optimise rehabilitation care for older people, the ward configuration should focus on supportive environments that facilitate patient participation and provide options for the patients and relatives to independently access the facilities, balancing the personal capabilities with the environmental demands. To foster patient participation, the practice environment should thus align with the model of person-centred rehabilitation.

scholarly journals Optimizing hospital-to-home transitions for older persons in rural communities: a participatory, multimethod study protocol

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Mary T. Fox ◽  
Souraya Sidani ◽  
Jeffrey I. Butler ◽  
Mark W. Skinner ◽  
Marilyn Macdonald ◽  
...  
Keyword(s):  
Rural Communities ◽  
Focus Group ◽  
Older People ◽  
Family Caregivers ◽  
Transitional Care ◽  
Healthcare Providers ◽  
Group Discussions ◽  
People With Dementia ◽  
Hospital To Home ◽  
Purposive Sample

Abstract Background Transitional care involves time-limited interventions focusing on the continuity of care from hospital to home, to optimize patient functioning and management. Providing interventions, as part of transitional care, that optimize the functioning of older people with dementia is critical due to the small window of opportunity in which they can return to their baseline levels of functioning. Yet prior research on transitional care has not included interventions focused on functioning and did not target older people with dementia in rural communities, limiting the applicability of transitional care to this population. Accordingly, the goal of this study is to align hospital-to-home transitional care with the function-related needs of older people with dementia and their family-caregivers in rural communities. Methods In this multimethod study, two phases of activities are planned in rural Ontario and Nova Scotia. In phase I, a purposive sample of 15–20 people with dementia and 15–20 family-caregivers in each province will rate the acceptability of six evidence-based interventions and participate in semi-structured interviews to explore the interventions’ acceptability and, where relevant, how to improve their acceptability. Acceptable interventions will be further examined in phase II, in which a purposive sample of healthcare providers, stratified by employment location (hospital vs. homecare) and role (clinician vs. decision-maker), will (1) rate the acceptability of the interventions and (2) participate in semi-structured focus group discussions on the facilitators and barriers to delivering the interventions, and suggestions to enable their incorporation into rural transitional care. Two to three focus groups per stratum (8–10 healthcare providers per focus group) will be held for a total of 8–12 focus groups per province. Data analysis will involve qualitative content analysis of interview and focus group discussions and descriptive statistics of intervention acceptability ratings. Discussion Findings will (1) include a set of acceptable interventions for rural transitional care that promote older patients’ functioning and family-caregivers’ ability to support patients’ functioning, (2) identify resources needed to incorporate the interventions into rural transitional care, and (3) provide high-quality evidence to inform new transitional care practices and policies and guide future research.

scholarly journals 22 Coping with Medicines After Hospital Discharge; the Invisible Work of Older Patients and Their Care-Givers

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i7-i11
Author(s):  
J Tomlinson ◽  
H Smith ◽  
J Silcock ◽  
K Karban ◽  
B Fylan
Keyword(s):  
Older Patients ◽  
Structured Interviews ◽  
Medicines Management ◽  
Post Discharge ◽  
General Internal ◽  
Care Givers ◽  
Invisible Work ◽  
Ethical Approval ◽  
Discharge From Hospital ◽  
The Invisible

Abstract Introduction Older patients often experience medication-related problems following discharge from hospital. These can be categorised as issues with obtaining medication, taking medication, medication effects or problems with communication or care co-ordination (Nicosia et al., Journal of General Internal Medicine, 2019, https://doi.org/10.1007/s11606-019-05463-z). The aim of this study was to explore older adults’ experiences of post-discharge medicines management, including the strategies they use to safely manage their changed medicines. Methods Following ethical approval, patients aged 75 and above, with a change in their long term medicines, were recruited during admission to one of two hospitals in Yorkshire. Semi-structured interviews took place with the participants in their own homes, approximately two weeks after discharge. Interviews were audio recorded and transcribed. Data were analysed using the Framework method. Results Twenty-seven patients (mean age 85 years; 6 males) consented to be interviewed. They described multiple self-management and safety strategies used to support medicines management in the early post-discharge phase. The work done included adaptations (to routines, the home environment and action plans), scaffolding (where patients and their care-givers support the primary care system by providing additional documentation or prompts to ensure medicines were supplied on time and were correct) and error avoidance (seeking information, performing checks and balances). Conclusion Older patients experience gaps in their post-discharge medicines-related care which they had to bridge through implementing their own strategies or by enlisting support from others. This study shines a spotlight on to the invisible work that patients have to do in order to make post-discharge medicines management fit for purpose. Further work should consider those patients who are not able to carry out these tasks or who do not have any care-givers available for support and how this potential gap in care can be addressed.

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