scholarly journals Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management [intersec-CM]: study protocol for a randomised controlled trial

2019 ◽  
Author(s):  
Angela Nikelski ◽  
Armin Keller ◽  
Fanny Schumacher-Schönert ◽  
Terese Dehl ◽  
Jessica Laufer ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cognitive Impairment ◽  
Hospital Admission ◽  
Collaborative Care ◽  
Hospital Care ◽  
Care Management ◽  
Unmet Needs ◽  
Controlled Trial ◽  
Somatic Illness

Abstract BackgroundSectorization of health care systems causes inefficient treatment, especially for elderly people with cognitive impairments. The transition from hospital care to primary care is insufficiently coordinated, and communication between health care providers is often lacking. Consequences include a further deterioration of health, higher rates of hospital readmission, and institutionalization. Models of collaborative care have shown their efficacy in primary care by improving patient-related outcomes. The main goal of this trial is to test the effectiveness of a collaborative care model for people with cognitive impairment (PCI) and current hospital treatment due to a somatic illness to improve the continuity of treatment and care across the transition between the in-hospital and adjoining primary care sectors.Methods The trial is a longitudinal multisite randomized controlled trial with two arms (“care as usual” and “intersectoral care management”). Inclusion criteria at the time of hospital admission due to a somatic illness: age 70+, cognitive impairment (Mini Mental State Examination, MMSE ≤ 26), live at home, provide written informed consent. Each participant will have a baseline assessment at the hospital and two follow-up assessments at home (three and twelve months after discharge). The estimated sample size is n=398 participants together with (where available) their respective informal caregivers.In the intersectoral care management group, specialized care managers will develop, implement and monitor individualized treatment and care based on comprehensive assessments of the patients and informal caregivers for unmet needs at the hospital and in their homes. Primary outcomes are (1) activities of daily living, (2) readmission to the hospital, and (3) institutionalization. Secondary outcomes include (a) frailty, (b) delirium, (c) quality of life, (d) cognitive status, (e) behavioral and psychological symptoms of dementia, (f) utilization of services, and (g) informal caregiver burden.DiscussionIn the event of proving efficacy, this trial delivers proof of concept for implementation into routine care. Cost-effectiveness analyses as well as an independent process evaluation increase the likelihood of meeting this goal. The trial allows in-depth analysis of mediating and moderating effects for different health outcomes at the interface between hospital care and primary care. Highlighting treatment and care, the study will provide insights into unmet needs at the time of hospital admission, the opportunities and barriers to meeting those needs during the hospital stay and after discharge.Trial registration ClinicalTrials.gov Identifier: NCT03359408

scholarly journals Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management [intersec-CM]: study protocol for a randomised controlled trial

2019 ◽  
Author(s):  
Angela Nikelski ◽  
Armin Keller ◽  
Fanny Schumacher-Schönert ◽  
Terese Dehl ◽  
Jessica Laufer ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cognitive Impairment ◽  
Hospital Admission ◽  
Collaborative Care ◽  
Hospital Care ◽  
Care Management ◽  
Unmet Needs ◽  
Controlled Trial ◽  
Somatic Illness

Abstract Background Sectorization of health care systems causes inefficient treatment, especially for elderly people with cognitive impairments. The transition from hospital care to primary care is insufficiently coordinated, and communication between health care providers is often lacking. Consequences include a further deterioration of health, higher rates of hospital readmission, and institutionalization. Models of collaborative care have shown their efficacy in primary care by improving patient-related outcomes. The main goal of this trial is to test the effectiveness of a collaborative care model for people with cognitive impairment (PCI) and current hospital treatment due to a somatic illness to improve the continuity of treatment and care across the transition between the in-hospital and adjoining primary care sectors. Methods The trial is a longitudinal multisite randomized controlled trial with two arms (“care as usual” and “intersectoral care management”). Inclusion criteria at the time of hospital admission due to a somatic illness: age 70+, cognitive impairment (Mini Mental State Examination, MMSE ≤ 26), live at home, provide written informed consent. Each participant will have a baseline assessment at the hospital and two follow-up assessments at home (three and twelve months after discharge). The estimated sample size is n=398 participants together with (where available) their respective informal caregivers. In the intersectoral care management group, specialized care managers will develop, implement and monitor individualized treatment and care based on comprehensive assessments of the patients and informal caregivers for unmet needs at the hospital and in their homes. Primary outcomes are (1) activities of daily living, (2) readmission to the hospital, and (3) institutionalization. Secondary outcomes include (a) frailty, (b) delirium, (c) quality of life, (d) cognitive status, (e) behavioral and psychological symptoms of dementia, (f) utilization of services, and (g) informal caregiver burden. Discussion In the event of proving efficacy, this trial delivers proof of concept for implementation into routine care. Cost-effectiveness analyses as well as an independent process evaluation increase the likelihood of meeting this goal. The trial allows in-depth analysis of mediating and moderating effects for different health outcomes at the interface between hospital care and primary care. Highlighting treatment and care, the study will provide insights into unmet needs at the time of hospital admission, the opportunities and barriers to meeting those needs during the hospital stay and after discharge.

scholarly journals Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management [intersec-CM]: study protocol for a randomised controlled trial

2019 ◽  
Author(s):  
Angela Nikelski ◽  
Armin Keller ◽  
Fanny Schumacher-Schönert ◽  
Terese Dehl ◽  
Jessica Laufer ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cognitive Impairment ◽  
Hospital Admission ◽  
Collaborative Care ◽  
Hospital Care ◽  
Care Management ◽  
Unmet Needs ◽  
Controlled Trial ◽  
Somatic Illness

Abstract Background Sectorization of health care systems causes inefficient treatment, especially for elderly people with cognitive impairments. The transition from hospital care to primary care is insufficiently coordinated, and communication between health care providers is often lacking. Consequences include a further deterioration of health, higher rates of hospital readmission, and institutionalization. Models of collaborative care have shown their efficacy in primary care by improving patient-related outcomes. The main goal of this trial is to test the effectiveness of a collaborative care model for people with cognitive impairment (PCI) and current hospital treatment due to a somatic illness to improve the continuity of treatment and care across the transition between the in-hospital and adjoining primary care sectors. Methods The trial is a longitudinal multisite randomized controlled trial with two arms (“care as usual” and “intersectoral care management”). Inclusion criteria at the time of hospital admission due to a somatic illness: age 70+, cognitive impairment (Mini Mental State Examination, MMSE ≤ 26), live at home, provide written informed consent. Each participant will have a baseline assessment at the hospital and two follow-up assessments at home (three and twelve months after discharge). The estimated sample size is n=398 participants together with (where available) their respective informal caregivers. In the intersectoral care management group, specialized care managers will develop, implement and monitor individualized treatment and care based on comprehensive assessments of the patients and informal caregivers for unmet needs at the hospital and in their homes. Primary outcomes are (1) activities of daily living, (2) readmission to the hospital, and (3) institutionalization. Secondary outcomes include (a) frailty, (b) delirium, (c) quality of life, (d) cognitive status, (e) behavioral and psychological symptoms of dementia, (f) utilization of services, and (g) informal caregiver burden. Discussion In the event of proving efficacy, this trial delivers proof of concept for implementation into routine care. Cost-effectiveness analyses as well as an independent process evaluation increase the likelihood of meeting this goal. The trial allows in-depth analysis of mediating and moderating effects for different health outcomes at the interface between hospital care and primary care. Highlighting treatment and care, the study will provide insights into unmet needs at the time of hospital admission, the opportunities and barriers to meeting those needs during the hospital stay and after discharge.

scholarly journals Intersectoral care management for older people with cognitive impairment during and after hospital stays [intersec-CM]: study protocol for a process evaluation within a randomised controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Terese Dehl ◽  
Ulf Sauerbrey ◽  
Adina Dreier-Wolfgramm ◽  
Angela Nikelski ◽  
Nino Chikhradze ◽  
...  
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
Randomised Controlled Trial ◽  
Older People ◽  
Process Evaluation ◽  
Complex Intervention ◽  
Care Management ◽  
Controlled Trial ◽  
Qualitative And Quantitative ◽  
Randomised Controlled

Abstract Background In the healthcare system in Germany, different institutions and actors play specific roles in the discharge and transition of patients from hospitals into primary care (Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen, Wettbewerb an der Schnittstelle zwischen ambulanter und stationärer Gesundheitsversorgung, 2012). However, there are shortcomings in these intersectoral transitions. Especially in older people with cognitive impairment (PCI), discharge management often lacks coordination and cooperation between healthcare providers. This frequently results in higher rates of unscheduled readmission. The project intersec-CM is a randomised controlled trial (RCT) that aims to explore up to what extent an intersectoral care management (ICM) can improve this transition. This ICM is delivered by nurses with special training in care management. The objective of this paper is to describe a mixed-methods process evaluation of the intersectoral care management intervention and the factors that facilitate and inhibit its implementation. Methods Different study designs for process evaluations from previous literature were collected and analysed according to the dimension implementation fidelity, satisfaction with the intervention, feasible transfer into routine care, optimum point of time, frequency and execution of the intervention, and context factors. Results The actor-network theory was chosen as the theoretic framework for the process evaluation. Based on this theory, a mixed-methods design was developed to combine and integrate qualitative and quantitative evaluation methods. The qualitative part includes semi-structured interviews using topic guides (phase 1) and later in-depth interviews with narrative portions (phase 3), which will be analysed by using the qualitative content analysis according to Kuckartz. The quantitative survey (phase 2) is conducted with standardised questionnaires. Discussion Challenges in data collection include the development of interview guidelines, which require different terminologies depending on every specific actor targeted in the intervention. Conducting the interviews, there is a risk of misunderstanding the older PCI by the interviewer and vice versa. However, the combination of qualitative and quantitative approaches as different techniques of process evaluation may help to capture, integrate and analyse data on different dimensions of the intervention. Conclusions The results of our process evaluation may serve as an implementation guideline for intersectoral care management in the German healthcare system. Furthermore, the approach to evaluate the process of a complex intervention in health care for older PCI may serve as a stimulus to broaden the evidence base also of other complex intervention studies to improve health care for this vulnerable group. The study was ethically approved by the Ethics Committee of the Ernst-Moritz-Arndt University of Greifswald. The study has been registered at the U.S. National Library of Medicine. Trial registration ClinicalTrials.gov NCT03359408. Registered on 2 December 2017. The approximate date when recruitment to the process evaluation of the study will be completed is 31 May 2021.

scholarly journals The situation of elderly with cognitive impairment living at home during lockdown in the Corona-pandemic in Germany

2020 ◽  
Author(s):  
Jochen René Thyrian ◽  
Friederike Kracht ◽  
Angela Nikelski ◽  
Melanie Boekholt ◽  
Fanny Schumacher-Schönert ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cognitive Impairment ◽  
Health Care Provision ◽  
Social Activities ◽  
Care Provision ◽  
Convenience Sample ◽  
Personal Impact ◽  
The Impact ◽  
At Home

Abstract Background: The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and living at home in Germany. Methods: This analysis is based on data of a telephone-based assessment in a convenience sample of n=141 people with known cognitive impairment in the primary care setting. Data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, change in the frequency of social activities due to the pandemic and perceived impact of the pandemic on health care related services were assessed during the time of lockdown. Results: The vast majority of participants are sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-5. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low symptoms of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or visiting birthdays have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies have been reported to have worsened due to the pandemic. Visits to general practitioners decreased. Conclusions: The study shows a small impact of the pandemic on psychological variables like depression, anxiety and loneliness in the short-term in Germany. There is a decrease in social activities as expected. The impact on health care provision is prominent. There is a need for qualitative, in-depth studies to further interpret the results.

THE ROAD AHEAD TO CURE AND PREVENT ALZHEIMER’S DISEASE: IMPLEMENTING PREVENTION INTO PRIMARY CARE

2015 ◽  
pp. 1-11
Author(s):  
B. Fougère ◽  
B. Vellas ◽  
J. Delrieu ◽  
A.J. Sinclair ◽  
A. Wimo ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cognitive Impairment ◽  
Primary Care Physicians ◽  
Large Scale ◽  
Objective Assessment ◽  
Epidemiological Studies ◽  
Cognitive Status ◽  
Cognitive Screening ◽  
Cognitive Complaint

Most old adults receive their health care from their primary care practitioner; as a consequence, as the population ages, the manifestations and complications of cognitive impairment and dementia impose a growing burden on providers of primary care. Current guidelines do not recommend routine cognitive screening for older persons by primary care physicians, although the vast majority recommend a cognitive status assessment and neurological examination for subjects with a cognitive complaint. Also, no clinical practice guidelines recommend interventions in older adults with cognitive impairment in primary care settings. However, primary care physicians need to conduct a review of risks and protective factors associated with cognitive decline and organize interventions to improve or maintain cognitive function. Recent epidemiological studies have indicated numerous associations between lifestyle-related risk factors and incidental cognitive impairment. The development of biomarkers could also help in diagnosis, prognosis, selection for clinical trials, and objective assessment of therapeutic responses. Interventions aimed at cognitive impairment prevention should be pragmatic and easy to implement on a large scale in different health care systems, without generating high additional costs or burden on participants, medical and social care teams.

scholarly journals Improving Health Care Management in Primary Care for Homeless People: A Literature Review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Jego ◽  
J Abcaya ◽  
C Calvet-montredon ◽  
S Gentile
Keyword(s):  
Social Support ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
General Population ◽  
Literature Review ◽  
Care Management ◽  
Multidisciplinary Approach ◽  
Homeless People ◽  
Primary Health

Abstract Background Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. However, they face multiple difficulties in accessing primary health care and receive less preventive health care than the general population. Methods We performed a literature review that included articles which described and evaluated primary care programs for homeless people. We searched into the MEDLINE, PsycINFO, COCHRANE library, and Cairn.info databases primary articles published between 1 January 2012 and 15 December 2016. We also performed a grey literature search, and we added relative articles as we read the references of the selected articles. We described the main characteristics of the primary care programs presented in the selected articles. Then we classified these characteristics in main categories, as a descriptive thematic analysis. Secondarily, we synthetized the main results about the evaluation of each intervention or organization. Results Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. Conclusions Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model. Key messages To improve the health care management of homeless people it seems necessary to priorize multidisciplinary approach, integrated care, involve community health and answer their specific needs. It is necessary to evaluate more non-tailored primary care programs that collaborate with tailored structures.

scholarly journals Effectiveness of Village Health Worker–Delivered Smoking Cessation Counseling in Vietnam

2018 ◽  
Vol 21 (11) ◽  
pp. 1524-1530 ◽  
Author(s):  
Nan Jiang ◽  
Nina Siman ◽  
Charles M Cleland ◽  
Nancy Van Devanter ◽  
Trang Nguyen ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Controlled Trial ◽  
Evidence Based ◽  
Care Providers ◽  
Water Pipe ◽  
Randomized Controlled ◽  
Provider Advice ◽  
Village Health

Abstract Introduction Smoking prevalence is high in Vietnam, yet tobacco dependence treatment (TDT) is not widely available. Methods We conducted a quasiexperimental study that compared the effectiveness of health care provider advice and assistance (ARM 1) versus ARM 1 plus village health worker (VHW) counseling (ARM 2) on abstinence at 6-month follow-up. This study was embedded in a larger two-arm cluster randomized controlled trial conducted in 26 community health centers (CHCs) in Vietnam. Subjects (N = 1318) were adult patients who visited any participating CHC during the parent randomized controlled trial intervention period and were self-identified as current tobacco users (cigarettes and/or water pipe). Results At 6-month follow-up, abstinences rates in ARM 2 were significantly higher than those in ARM 1 (25.7% vs. 10.5%; p < .001). In multivariate analyses, smokers in ARM 2 were almost three times more likely to quit compared with those in ARM 1 (adjusted odds ratio [AOR] = 2.96, 95% confidence interval [CI] = 1.78% to 4.92%). Compared to cigarette-only smokers, water pipe–only smokers (AOR = 0.4, 95% CI = 0.26% to 0.62%) and dual users (AOR = 0.62, 95% CI = 0.45% to 0.86%) were less likely to achieve abstinence; however, the addition of VHW counseling (ARM 2) was associated with higher quit rates compared with ARM 1 alone for all smoker types. Conclusion A team approach in TDT programs that offer a referral system for health care providers to refer smokers to VHW-led cessation counseling is a promising and potentially scalable model for increasing access to evidence-based TDT and increasing quit rates in low middle-income countries (LMICs). TDT programs may need to adapt interventions to improve outcomes for water pipe users. Implications The study fills literature gaps on effective models for TDT in LMICs. The addition of VHW-led cessation counseling, available through a referral from primary care providers in CHCs in Vietnam, to health care provider’s brief cessation advice, increased 6-month biochemically validated abstinence rates compared to provider advice alone. The study also demonstrated the potential effectiveness of VHW counseling on reducing water pipe use. For LMICs, TDT programs in primary care settings with a referral system to VHW-led cessation counseling might be a promising and potentially scalable model for increasing access to evidence-based treatment.

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