Are people in residential care entitled to receive rehabilitation services following hip fracture? Views of the public from a citizens’ jury

Abstract

Background: Access to rehabilitation services for people living in residential care facilities is frequently limited. A randomised trial of a hospital outreach hip fracture rehabilitation program in residential care facilities has demonstrated improvements in mobility at four weeks and quality of life at 12 months but was not considered cost-effective by standard health economic metrics. The current study aimed to explore the general public's views on issues involved in the allocation of rehabilitation resources for residents of care facilities. Methods: A citizens' jury comprising 13 purposively sampled members of the general public, representative of the South Australian age, gender and household income profile. The jury considered the questions "Should there be an investment of physical rehabilitation services in residential care for older people following a hip fracture? If so, what is the best way of providing this service (considering funding, models of service delivery and equity)?" Deliberations were in the context of a statewide health reform program. The jury was conducted over two days with an experienced independent facilitator, addressing questions developed by a steering group of research academics and clinicians. Results: The mean age of the citizens' jury members was 43 (range 26 to 61). Eleven members voted for investment in outreach hospital rehabilitation services in residential aged care. All jurors agreed a number of strategies in addition to investment should be implemented, including health care planning and decision making, increased emphasis on hip fracture prevention, training of aged care staff in rehabilitation and routine provision of hospital discharge summaries to families. The jury further advocated for an increased focus on rehabilitation in residential care, potentially through accreditation criteria, increasing health literacy of residents and families, implementation of age friendly environment strategies and improving connections of care facilities with community, hospital and tertiary services.

The Efficacy of Rehabilitation Nursing Interventions on Patients with Open Lower Limb Fractures

“…The inclusion criteria were as follows: (1) detailed imaging data can be obtained; (2) age ≥18 years old; (3) meet the standards of surgical operation and anesthesia; (4) has no treatment contraindications and midway withdrawal; (5) normal coagulation function, cardiopulmonary, liver, and kidney functions; and (6) patients or family members were aware of the study and signed the consent [ 5 ].…”

Public perspectives on acquired brain injury rehabilitation and components of care: A Citizens’ Jury

“…A Citizens’ Jury was conducted and is reported in accordance with typically used guidelines 14,17,25,32,33 . Citizens’ Juries, as with juries in a court of law, are based on the premise that a random sample of the population may hear evidence on a topic and then undertake deliberations that are representative of the conscience, intelligence and preferences of the general public 17‐19,32,34 .…”

“…A Citizens' Jury was conducted and is reported in accordance with typically used guidelines. 14,17,25,32,33 Citizens' Juries, as with juries in a court of law, are based on the premise that a random sample of the population may hear evidence on a topic and then undertake deliberations that are representative of the conscience, intelligence and preferences of the general public. [17][18][19]32,34 Citizens' Juries consist of a sample of people recruited to represent our diverse community, who are convened to hear from a variety of expert 'witnesses' and who present a range of perspectives on a particular issue which, in this case, was identified through informal deliberative processes and literature review.…”

“…When adopted in a health‐care context, non‐expert participants consider the realities of health policy development, are exposed to the perspectives and experience of others and reach consensus on recommendations for action 18‐23 . Public deliberations, using non‐expert citizens as participants, can make explicit the barriers and facilitators to health‐care policy that are difficult to draw from experts in the field or published research 24,25 . As such, they balance the dominant interests and perspectives of clinicians and researchers with those of less powerful citizen stakeholders 7 …”

“…[18][19][20][21][22][23] Public deliberations, using non-expert citizens as participants, can make explicit the barriers and facilitators to health-care policy that are difficult to draw from experts in the field or published research. 24,25 As such, they balance the dominant interests and perspectives of clinicians and researchers with those of less powerful citizen stakeholders. 7 Rehabilitation services for people with moderate to severe brain injury in Australia are funded and implemented following government policy.…”