HOspitals and patients WoRking in Unity (HOW R U?): telephone peer support to improve older patients’ quality of life after emergency department discharge in Melbourne, Australia—a multicentre prospective feasibility study

Abstract

ObjectivesTo ascertain the feasibility and acceptability of the HOW R U? programme, a novel volunteer-peer postdischarge support programme for older patients after discharge from the emergency department (ED).DesignA multicentre prospective mixed-methods feasibility study.SettingTwo tertiary hospital EDs in metropolitan Melbourne, Australia.ParticipantsA convenience sample of 39 discharged ED patients aged 70 years or over, with symptoms of social isolation, loneliness and/or depression.InterventionThe HOW R U? intervention comprised weekly social support telephone calls delivered by volunteer peers for 3 months following ED discharge.Primary and secondary outcome measuresThe primary outcomes were feasibility of study processes, intervention acceptability to participants and retention in the programme. Secondary outcomes were changes in loneliness level (UCLA-3—3-item Loneliness Scale), mood (5-item Geriatric Depression Scale) and health-related quality of life (EQ-5D-5L and EQ-VAS) postintervention.ResultsRecruitment was feasible, with 30% of eligible patients successfully recruited. Seventeen volunteer peers provided telephone support to patient participants, in addition to their usual hospital volunteer role. HOW R U? was well received, with 87% retention in the patient group, and no attrition in the volunteer group.The median age of patients was 84 years, 64% were female, and 82% lived alone. Sixty-eight per cent of patients experienced reductions in depressive symptoms, and 53% experiencing reduced feelings of loneliness, and these differences were statistically significant Patient feedback was positive and volunteers reported great satisfaction with their new role.ConclusionHOW R U? was feasible in terms of recruitment and retention and was acceptable to both patients and volunteers. The overall results support the potential for further research in this area and provide data to support the design of a definitive trial to confirm the observed effects.Trial registration numberANZCTRN12615000715572; Results.

The effect of a telephone follow-up call for older patients, discharged home from the emergency department on health-related outcomes: a systematic review of controlled studies

“…This was also reported in a study, investigating the effect of telephone support calls by volunteers on feelings of loneliness and depression by older patients, discharged home from the ED. [ 31 ] Patients may have refused participation, because they did not want to be involved in a study, but they may also judge TFU as unnecessary interference. Although less time-consuming than other transitional care programs, TFU still requires sufficient staff to approach all eligible patients [ 21 ].…”

“…Not including patients on other weekdays may undoubtedly have led to missing eligible patients who presented outside this inclusion window. The substantial number of eligible patients that was not reached or refused participation underlines the efforts that are needed to make FTU feasible in daily practice [ 26 , 27 , 31 ].…”

Volunteer contributions in the emergency department: A scoping review

“…8,9,[58][59][60][61][62][63] Ten programs were specifically aimed at decreasing the amount of time healthcare providers spent completing non-clinical tasks, such as provision of comfort items and assistance with meals, hydration, mobility and transportation once they were ready for ED discharge. 15,[49][50][51][52][53][54][55][56][57] The majority (n=52; 59.8%) of described programs had general volunteers in the ED, while 35 (40.2%) had volunteers targeting a specific patient population, including pediatrics, 17,42,[64][65][66][67][68][69][70][71][72][73][74][75][76] geriatrics, 25,[38][39][49][50][51][52]77 patients with mental health and addiction issues 18,[22][23][24]35,40,…”

“…12 programs used quantitative methods, including a number of randomized clinical trials, 18,19,24,26,37,40,42,50,52,53,77,79 four programs used qualitative methods 12,13,20,25 and two programs did not specify the type of evaluation used 23,31 . Of those that reported a focus on particular outcomes, patient satisfaction, 12,13,20,31 follow-up and referral rates, 25,40,79 ED and hospital costs and length of stay, 19,42,77 subsequent ED visits, 26,37 medical complications, 50,52 mental health , 18,23,24 and malnutrition 53 in the hospital were all reported to be positively affected by volunteers in the ED. Many of the evaluations of programs took the form of surveys and questionnaires from the perspectives of patients and hospital staff.…”

Stepped-Wedge Cluster Randomised Trial of Social Prescribing of Forest Therapy for Quality of Life and Biopsychosocial Wellbeing in Community-Living Australian Adults with Mental Illness: Protocol

“…Regardless of this somewhat mixed evidence, SP is gaining momentum in other countries, for example Canada [23], USA [24], and Australia [8,25,26]. Thus far in Australia a small number of analogous programs have been implemented, for example the 'How-R-U' telephone support and referral program for elderly people discharged from hospital [27], 'Reclink' community-referral sport programs for at-risk youth [28], NGO Caritas' faith-based community capacity-building programs [29], Feros Aged and Disability Care Services implementing diet, exercise, and socialisation activities [30], and most recently State and Federal government-funded programs in response to COVID-19 including the Victorian 'Community Activation and Social Isolation Initiative' which provides social support and welfare services via local government [31] and the 'HeadtoHelp' hub which provides all-ages access to mental health services [32].…”