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What works in delivering effective enhanced primary care support in care homes?
- Author:
- CORDIS BRIGHT
- Publisher:
- Cordis Bright
- Publication year:
- 2018
- Pagination:
- 12
- Place of publication:
- London
Based on a review of the evidence, this briefing outlines the key elements to effective practice in delivering enhanced primary care and support in care homes to improve the quality of life and healthcare for residents. The briefing identifies some of the reasons for implementing enhanced primary care in care homes and the potential to improve outcomes. These include improved resident and care quality outcomes; beneficial impact on secondary care and community services; improved integration and partnership working; and cost benefits. It also outlines key supportive features and the barriers and limitations to delivering enhanced primary care in care homes. Three short case studies highlight three different models: a nurse-led model, a GP-led model, and a multi-disciplinary team model. (Edited publisher abstract)
Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis
- Authors:
- BLOM J.W., et al
- Journal article citation:
- Age and Ageing, 47(5), 2018, pp.705-714.
- Publisher:
- Oxford University Press
Purpose: To support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: Individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting: Primary care sector. Interventions: Combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main: Outcome activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: Quality of life (visual analogue scale 0–10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: Intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: Included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was −0.01 (95% confidence interval −0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion: Compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective. (Publisher abstract)
A research program on implementing integrated care for older adults with complex health needs (iCOACH): an international collaboration
- Authors:
- WODCHIS Walter P., et al
- Journal article citation:
- International Journal of Integrated Care, 18(2), 2018, p.11. Online only
- Publisher:
- International Foundation for Integrated Care
Health and social care systems across western developed nations are being challenged to meet the needs of an increasing number of people aging with multiple complex health and social needs. Community based primary health care (CBPHC) has been associated with more equitable access to services, better population level outcomes and lower system level costs. Itmay be well suited to the increasingly complex needs of populations; however the implementation of CBPHC models of care faces many challenges. This paper describes a program of research by an international, multi-university, multidisciplinary research team who are seeking to understand how to scale up and spread models of Integrated CBPHC (ICBPHC). The key question being addressed is “What are the steps to implementing innovative integrated community-based primary health care models that address the health and social needs of older adults with complex care needs?” and will be answered in three phases. In the first phase we identify and describe exemplar models of ICBPHC and their context in relation to relevant policies and performance across the three jurisdictions (New Zealand, Ontario and Québec, Canada). The second phase involves a series of theory-informed, mixed methods case studies from which we shall develop a conceptual framework that captures not only the attributes of successful innovative ICBPHC models, but also how these models are being implemented. In the third phase, we aim to translate our research into practice by identifying emerging models of ICBPHC in advance, and working alongside policymakers to inform the development and implementation of these models in each jurisdiction. The final output of the program will be a comprehensive guide to the design, implementation and scaling-up of innovative models of ICBPHC. (Edited publisher abstract)
Care transitions as street-level work: providers' perspectives on the dilemmas and discretions of older people’s transitions across acute, sub-acute and primary care
- Authors:
- FOSTER Michele, et al
- Journal article citation:
- Journal of Integrated Care, 25(3), 2017, pp.196-207.
- Publisher:
- Emerald
Purpose: Quality care transitions of older people across acute, sub-acute and primary care are critical to safety and cost, which is the reason interventions to improve practice are a priority. Yet, given the complexity of providers and services involved it is often difficult to know the types of tensions that arise in day-to-day transition work or how front-line workers will respond. To that end, this innovative study differs from the largely descriptive studies by conceptualising care transitions as street-level work in order to capture how transition practice takes shape within the complexities and dynamics of the local setting. The paper aims to discuss these issues. Design/methodology/approach: Data were collected from 23 hospital health professionals and community service providers across primary, sub-acute and acute care through focus groups. A thematic analysis and interrogation of themes using street-level concepts derived three key themes. Findings: The themes of risk logics and dilemmas of fragmentation make explicit both the local constraints and opportunities of care transitions and how these intersect to engender a particular logic of practice. By revealing the various discretionary tactics adopted by front-line providers, the third theme simultaneously highlights how discretionary spaces might represent both possibilities and problematics for balancing organisational and patient needs. Originality/value: The study contributes to the knowledge of street-level work in health settings and specifically, the nature of transition work. Importantly, it benefits policy and practice by uncovering mechanisms that could facilitate and impede quality transitions in discrete settings.
It ‘makes you feel more like a person than a patient’: patients’ experiences receiving home-based primary care (HBPC) in Ontario, Canada
- Authors:
- SMITH-CARRIER Tracy, et al
- Journal article citation:
- Health and Social Care in the Community, 25(2), 2017, pp.723-733.
- Publisher:
- Wiley
The lack of effective systems to appropriately manage the health and social care of frail older adults, especially among those who become homebound, is becoming all the more apparent. Home-based primary care (HBPC) is increasingly being promoted as a promising model that takes into account the accessibility needs of frail older adults, ensuring that they receive more appropriate primary and community care. There remains a paucity of literature exploring patients' experiences with HBPC programmes. The purpose of this study was to explore the experiences of patients accessing HBPC delivered by interprofessional teams, and their perspectives on the facilitators and barriers to this model of care in Ontario, Canada. Using certain grounded theory principles, we conducted an inductive qualitative content analysis of in-depth patient interviews (n = 26) undertaken in the winter of 2013 across seven programme sites exploring the lived experiences and perspectives of participants receiving HBPC. Themes emerged in relation to patients' perceptions regarding the preference for and necessity of HBPC, the promotion of better patient care afforded by the model in comparison to office-based care, and the benefits of and barriers to HBPC service provision. Underlying patterns also surfaced related to patients' feelings and emotions about their quality of life and satisfaction with HBPC services. The authors argue that HBPC is well positioned to serve frail homebound older adults, ensuring that patients receive appropriate primary and community care – which the office-based alternative provides little guarantee – and that they will be cared for, pointing to a model that may not only lead to greater patient satisfaction but also likely contributes to bettering the quality of life of a highly vulnerable population. (Edited publisher abstract)
Briefing: reducing hospital admissions by improving continuity of care in general practice
- Authors:
- DEENY Sarah, et al
- Publisher:
- Health Foundation
- Publication year:
- 2017
- Pagination:
- 10
- Place of publication:
- London
This briefing summarises research looking into the link between continuity of care and hospital admissions for older patients in England. It focuses specifically on admissions for conditions that could potentially be prevented through effective treatment in primary care. The study analysed data from over 230,000 anonymised patient records for older people aged 62 - 82 years. The results found there were fewer elective and emergency hospital admissions for certain conditions when patients saw the same GP more consistently. Patients seeing their usual GP two more times out of every 10 was associated with 6% fewer avoidable hospital admissions. The findings suggest improvements in continuity in primary care might help offset pressures on secondary care for older patients. It makes specific recommendations for general practices, commissioners and policy makers on ways to improve the continuity of care. (Edited publisher abstract)
Development and preliminary validation of an Observation List for detecting mental disorders and social Problems in the elderly in primary and home care (OLP)
- Authors:
- TAK Erwin C.P.M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(7), 2016, pp.755-764.
- Publisher:
- Wiley
Objective: Even though the prevalence of mental disorders and social problems is high among elderly patients, it is difficult to detect these in a primary (home) care setting. Goal was the development and preliminary validation of a short observation list to detect six problem areas: anxiety, depression, cognition, suspicion, loneliness, and somatisation. Methods: A draft list of indicators identified from a short review of the literature and the opinions of 22 experts was evaluated by general practitioners (GPs) and home care organisations for feasibility. It was then used by GPs and home care personnel to observe patients, who also completed validated tests for psychological disorders (General Health Questionnaire 12 item version (GHQ-12)), depression (Geriatric Depression Scale 15-item version (GDS-15)), anxiety and suspicion (Symptom Checklist-90 (SCL-90)), loneliness (University of California, Los Angeles (UCLA)), somatisation (Illness Attitude Scale (IAS)), and cognition (Mini-Mental State Examination (MMSE)). Results: GPs and home care personnel observed 180 patients (mean age 78.4 years; 66% female) and evaluated the draft list during a regular visit. Cronbach's α was 0.87 for the draft list and ≥0.80 for the draft problem areas (loneliness and suspicion excepted). Principal component analysis identified six components (cognition, depression + loneliness, somatisation, anxiety + suspicion, depression (other signs), and an ambiguous component). Convergent validity was shown for the indicators list as a whole (using the GHQ-12), and the subscales of depression, anxiety, loneliness, cognition, and somatisation. Using pre-set agreed criteria, the list was reduced to 14 final indicators divided over five problem areas. Conclusion: The Observation List for mental disorders and social Problems (OLP) proved to be preliminarily valid, reliable, and feasible for use in primary and home care settings. (Publisher abstract)
Linking GPs with care homes: Harrogate and Rural District Clinical Commissioning Group
- Authors:
- NHS CONFEDERATION, HARROGATE AND RURAL DISTRICT CLINICAL COMMISSIONING GROUP
- Publisher:
- NHS Confederation
- Publication year:
- 2016
- Pagination:
- 2
- Place of publication:
- London
Case study which describes a scheme introduced by Harrogate and Rural District Clinical Commissioning Group (CCG) to link each of the 17 GP practices in the area to a local care home. The scheme was introduced in response to the fact that local care home residents had twice the number of GP visits as other patients of a similar age and that GPs had a small number of care home patients across a large number of facilities. Both GPs and care homes have provided positive feedback on the scheme and a 4 per cent reduction in emergency admissions for care home residents has been recorded. (Edited publisher abstract)
Post-traumatic stress syndrome in a large sample of older adults: determinants and quality of life
- Authors:
- LAMOUREUX-LAMARCHE Catherine, et al
- Journal article citation:
- Aging and Mental Health, 20(4), 2016, pp.401-406.
- Publisher:
- Taylor and Francis
Objectives: The aims of this study are to assess in a sample of older adults consulting in primary care practices the determinants and quality of life associated with post-traumatic stress syndrome (PTSS). Method: Data used came from a large sample of 1765 community-dwelling older adults who were waiting to receive health services in primary care clinics in the province of Quebec. PTSS was measured with the PTSS scale. Socio-demographic and clinical characteristics were used as potential determinants of PTSS. Quality of life was measured with the EuroQol-5D-3L (EQ-5D-3L) EQ-Visual Analog Scale and the Satisfaction With Your Life Scale. Multivariate logistic and linear regression models were used to study the presence of PTSS and different measures of health-related quality of life and quality of life as a function of study variables. Results: The six-month prevalence of PTSS was 11.0%. PTSS was associated with age, marital status, number of chronic disorders and the presence of an anxiety disorder. PTSS was also associated with the EQ-5D-3L and the Satisfaction with Your Life Scale. Conclusion: PTSS is prevalent in patients consulting in primary care practices. Primary care physicians should be aware that PTSS is also associated with a decrease in quality of life, which can further negatively impact health status. (Publisher abstract)
Which factors are associated with fear of falling in community-dwelling older people?
- Authors:
- KUMAR Arun, et al
- Journal article citation:
- Age and Ageing, 43(1), 2014, pp.76-84.
- Publisher:
- Oxford University Press
Background: Fear of falling (FOF) is common in older people and associated with serious physical and psychosocial consequences. Identifying those at risk of FOF can help target interventions to both prevent falls and reduce FOF. Objective: To identify factors associated with FOF. Study design: Cross-sectional study in 1,088 community-dwelling older people aged ≥65 years. Methods: Data were collected on socio-demographic characteristics, self-perceived health, exercise, risk factors for falls, FOF (Short FES-I), and functional measures. Logistic regression models of increasing complexity identified factors associated with FOF. Results: High FOF (Short FES-I ≥11) was reported by 19%. A simpler model (socio-demographic + falls risk factors) correctly classified as many observations (82%) as a more complex model (socio-demographic + falls risk factors + functional measures) with similar sensitivity and specificity values in both models. There were significantly raised odds of FOF in the simpler model with the following factors: unable to rise from a chair of knee height (OR: 7.39), lower household income (OR: 4.58), using a walking aid (OR: 4.32), difficulty in using public transport (OR: 4.02), poorer physical health (OR: 2.85), black/minority ethnic group (OR: 2.42), self-reported balance problems (OR: 2.17), lower educational level (OR: 2.01) and a higher BMI (OR: 1.06). Conclusions: A range of factors identify those with FOF. A simpler model performs as well as a more complex model containing functional assessments and could be used in primary care to identify those at risk of FOF, who could benefit from falls prevention interventions. (Publisher abstract)