Are frail elderly patients treated in a CGA unit more satisfied with their hospital care than those treated in conventional acute medical care?

Abstract

ObjectivesOur aim was to study whether the acute care of frail elderly patients directly admitted to a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit in terms of patient satisfaction.DesignTREEE (Is the TReatment of frail Elderly patients Effective in an Elderly care unit?) is a clinical, prospective, controlled, one-center intervention trial comparing acute treatment in CGA units and in conventional wards.SettingThis study was conducted in the NÄL-Uddevalla county hospital in western Sweden.ParticipantsIn this follow-up to the TREEE study, 229 frail patients, aged ≥75 years, in need of acute in-hospital treatment, were eligible. Of these patients, 139 patients were included in the analysis, 72 allocated to the CGA unit group and 67 to the conventional care group. Mean age was 85 years and 65% were female.InterventionDirect admittance to an acute elderly care unit with structured, systematic interdisciplinary CGA-based care, compared to conventional acute medical care via the emergency room.MeasurementsThe primary outcome was the satisfaction reported by the patients shortly after discharge from hospital. A four-item confidential questionnaire was used. Responses were given on a 4-graded scale.ResultsThe response rate was 61%. In unadjusted analyses, significantly more patients in the intervention group responded positively to the following three questions about the hospitalization: “Did you get the nursing from the ward staff that you needed?” (p=0.003), “Are you satisfied with the information you received on your diseases and medication?” (p=0.016), and “Are you satisfied with the planning before discharge from the hospital?” (p=0.032). After adjusted analyses by multiple regression, a significant difference in favor of the intervention remained for the first question (p=0.027).ConclusionAcute care in a CGA unit with direct admission was associated with higher levels of patient satisfaction compared with conventional acute care via the emergency room.

The impact of interventions on management of frailty in hospitalized frail older adults: a systematic review and meta-analysis

“…Seven studies were included in the systematic review [11,21,22,[29][30][31]; four of these studies [22,29,31] reported outcomes of the same clinical trial project. One of four studies [22] reported about frailty and the three other studies [22,29,31] published secondary outcomes relevant for the present systematic review. Table 1 showed that all of the included studies were randomized controlled trials.…”

“…All studies were poor in "Blinding of participants and personnel". [21] and all other studies demonstrated poor quality [11,22,[29][30][31] (Additional file 2).…”

“…The study by Ekerstad et al (2018) showed that the group receiving the intervention (CGA) was more satisfied with the program than the control group. The intervention group scored significantly higher on satisfaction with received information (p = 0.016) and satisfaction with planning before discharge (p = 0.023) [31] (Table 4).…”

Explaining experiences of community-dwelling older adults with a pro-active comprehensive geriatric assessment program – a thorough evaluation by interviews

“…Notwithstanding this complicated nature of satisfaction, satisfaction (with care) is still used as an outcome measure of CGA evaluation studies, e.g. by Ekerstad et al [29]. However, there is also a trend towards the evaluation of ‘experienced care’ instead of satisfaction [30].…”

Frailty in Myocardial Infarction Patients: A Paradigm Shift

“…The A study in Sweden concluded that "acute care in a CGA unit with direct admission was associated with higher levels of patient satisfaction compared with conventional acute care via the emergency room [16]. " Another study concerning the effectiveness of CGA in elderly patients with coronary heart disease highlights that this approach " adds substantial information to evaluate the clinical, psychological and functional aspects in elderly CHD patients " which further improves "living quality, positive mental attitude" as well as "reducing the hospital days and cost [17]."…”