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Real-life implementation of guidelines on the hospital-to-home transition for older patients: a cohort study in general practice
- Authors:
- HURTAUD Aline, et al
- Journal article citation:
- Age and Ageing, 49(1), 2020, p.46–51.
- Publisher:
- Oxford University Press
Background: hospital discharge is a critical event for older patients. The French guidelines recommended the swift transmission of a discharge summary to the general practitioner (GP) and a primary care consultation within 7 days. The relevance and feasibility of these guidelines have not previously been assessed. Objective: to perform a real-life assessment of compliance with French guidelines on the transmission of discharge summaries and post-discharge medical reviews and to examine these factors’ association with 30-day readmissions. Design: a prospective multicentre cohort study. Setting: primary care (general practice) in France. Subjects: a sample of GPs and the same number of patients aged 75 or over having consulted within 30 days of hospital discharge. Methods: the main endpoints were the proportion of discharge summaries available and the proportion of patients consulting their GP within 7 days. The 30-day readmission rate was also measured. Factors associated with these endpoints were assessed in univariate and multivariate analyses. Results: seventy-one GPs (mean ± standard deviation age: 49 ± 11; males: 62%) and 71 patients (mean age: 84 ± 5; males: 52%; living at home: 94%; cognitive disorders: 22%) were included. Forty-six patients (65%, [95% confidence interval [CI]]: 53–76) consulted their GP within 7 days of hospital discharge. At the time of the consultation, 27 GPs (38% [95% CI]: 27–50) had not received the corresponding hospital discharge summary. Discharge summary availability was associated with a lower risk of 30-day readmission (adjusted odds ratio [95% CI] = 0.25 [0.07–0.91]). Conclusions: compliance with the French guidelines on hospital-to-home transitions is insufficient. (Edited publisher abstract)
Pressure gauge
- Author:
- GILBERT Helen
- Journal article citation:
- Care and Health Magazine, 11.5.04, 2004, pp.27-29.
- Publisher:
- Care and Health
Community hospitals are often seen as a safety valve for acute services, providing rehabilitation of patients who have had surgery or have been treated for serious illness in a district general hospital. Looks at how the new GP contract could jeopardise their existence.
How a rapid response can keep beds free
- Author:
- VALIOS Natalie
- Journal article citation:
- Community Care, 31.8.00, 2000, pp.28-29.
- Publisher:
- Reed Business Information
Reports on how a rapid response team in the north west of England has freed hospital beds and saved money by giving GPs a better option than referring patients to hospital.
Motivation to take part in integrated care: an assessment of follow-up home visits to elderly persons
- Authors:
- HJELMA Ulf, HENDRIKSEN Carsten, HANSEN Kirsten
- Journal article citation:
- International Journal of Integrated Care, 11(3), 2011, Online only
- Publisher:
- International Foundation for Integrated Care
Follow-up home visits by general practitioner and district nurse (within a week after discharge from hospital) can reduce hospital readmissions and improve the overall wellbeing of older people following hospital discharge. However, they can be difficult to implement because of a number of organizational obstacles, including co-ordination between the organizations involved in the process. Using inter-organisational network theory, this study examines the motivation and rationale of local care providers to invest time and effort in cross-sectoral follow-up home visits in Copenhagen, Denmark. Two focus groups and seven in-depth interviews were carried out with hospital staff, general practitioners, and district nurses. Care providers were motivated to collaborate by a number of factors. The focus of collaboration needs to be clearly defined and agreed upon, there needs to be a high degree of equality between the professionals involved, and there has to be a will to co-operate based on a shared understanding of values and learning potentials. The study concludes that motivational factors need to be addressed in future collaborative programmes in order to fully exploit the potential health benefits.
Support for carers of older people: independence and well-being 5
- Author:
- AUDIT COMMISSION
- Publisher:
- Audit Commission
- Publication year:
- 2004
- Pagination:
- 71p.
- Place of publication:
- London
This study looked at the extent to which carers’ expectations are being realised. It has involved consultations with a range of national organisations, including Carers UK and the King’s Fund, about issues currently facing carers and current policy developments. It went on to look at the support and services for carers of older people in six different areas of England, covered by county councils, unitary authorities and inner and outer London boroughs. Carers could expect primary care staff to identify them as carers and make suitable reference in their notes (and that of the person they care for), saying that they are a ‘carer’. They should also expect councils to identify them as carers when a referral has been made to them, from whatever source. They should be able to expect clear, concise, relevant information about their rights and the benefits and support they can get, without asking for it, or at the very least, to be able to find it without looking too hard – from both local and national sources. With the introduction of the Carers Grant, they would be provided with breaks. Carers who are working or who want to return to work should expect to receive some help. Carers should expect that any assessments of the person they care for would be done in consultation with them as the carer. They should then be offered an assessment of their needs on top of this. As a result, they could expect to ‘become real partners in the provision of care to the person they are looking after…’ as the national strategy clearly sets out. As partners, carers should be able to expect that they are not only included in consultations with social services whenever any contact is made with the person they care for, but in consultations at the hospital discharge process and at the GP practice – provided the person they care for has given permission.
Community health services
- Author:
- ASSOCIATION OF COMMUNITY HEALTH COUNCILS FOR ENGLAND AND WALES
- Publisher:
- Association of Community Health Councils for England and Wales
- Publication year:
- 1994
- Pagination:
- 55p.,diags.
- Place of publication:
- London
Briefing paper reviewing the wide range of community services which are a crucial part of primary care in the NHS. Looks at their historical base and development, how they have been affected by the recent reforms, and the type of service patients expect to receive in the future.
Review of the special care (early hospital discharge) scheme
- Authors:
- EVANS E., FARNSWORTH Simon, HOWARD Mavis
- Publisher:
- Gloucestershire. Social Services Department
- Publication year:
- 1987
- Pagination:
- 64p., tables, diags.
- Place of publication:
- Gloucester
Report discussing the results of research into the current operation of this scheme, including cost-effectiveness, client profiles, consumer views, the perspectives of hospital social workers, hospital staff general practitioners and the opinions of home care staff.
Third report for session 1995-96: selected investigations completed October 1995 to March 1996; presented to Parliament pursuant to section 14(4) of the Health Service Commissioners Act 1993
- Author:
- HEALTH SERVICE COMMISSIONER
- Publisher:
- HMSO
- Publication year:
- 1996
- Pagination:
- 227p.
- Place of publication:
- London
Selection of reports of completed investigations into complaints about the health service. Includes reports on: the discharge of an older person to residential care; discharge from hospital; discharge to a local authority residential home; delay in seeing a doctor and quality of care; failure to ensure the safety of a confused patient; handling of complaints; failure by staff to respond to a relatives concerns; and nursing care and communication.