In-reach specialist nursing teams for residential care homes: uptake of services, impact on care provision and cost-effectiveness

Szczepura, Ala; Nelson, Sara; Wild, Deidre

doi:10.1186/1472-6963-8-269

Cited by 63 publications

(56 citation statements)

References 59 publications

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“…Alternative approaches include specialist in-reach teams to support care-home staff, which have been associated with reductions in admission to hospital through provision of care at the care home. 30 None of our case vignettes included the use of advancecare planning, reflecting the cases they were derived from. However, targeted advance-care-planning interventions reduce admissions to hospital among care-home residents and were associated with reductions in mortality in one study.…”

Section: Themes Common To Various Scenariosmentioning

confidence: 99%

Appropriateness of unscheduled hospital admissions from care homes

Harrison

McKay²,

Grant

et al. 2016

Clinical Medicine

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Section: Themes Common To Various Scenariosmentioning

confidence: 99%

Appropriateness of unscheduled hospital admissions from care homes

Harrison

McKay²,

Grant

et al. 2016

Clinical Medicine

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“…45 For residents in care homes who are not close to death, specialist in-reach nursing teams in the UK have been employed to try to avert hospital admissions. 50 An evaluation of the impact of the nursing team in four residential homes included the convening of an expert panel, who judged that 197 admissions were avoided for 131 residents. However, the cost savings from the intervention were only modest, which may limit its wider adoption.…”

Section: Transitions For Care-home Residentsmentioning

confidence: 99%

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

Hanratty

Lowson

Grande

et al. 2014

Health Services and Delivery Research

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BackgroundThe end of life may be a time of high service utilisation for older adults. Transitions between care settings occur frequently, but may produce little improvement in symptom control or quality of life for patients. Ensuring that patients experience co-ordinated care, and moves occur because of individual needs rather than system imperatives, is crucial to patients’ well-being and to containing health-care costs.ObjectiveThe aim of this study was to understand the experiences, influences and consequences of transitions between settings for older adults at the end of life. Three conditions were the focus of study, chosen to represent differing disease trajectories.SettingEngland.ParticipantsThirty patients aged over 75 years, in their last year of life, diagnosed with heart failure, lung cancer and stroke; 118 caregivers of decedents aged 66–98 years, who had died with heart failure, lung cancer, stroke, chronic obstructive pulmonary disease or selected other cancers; and 43 providers and commissioners of services in primary care, hospital, hospice, social care and ambulance services.Design and methodsThis was a mixed-methods study, composed of four parts: (1) in-depth interviews with older adults; (2) qualitative interviews and structured questionnaire with bereaved carers of older adult decedents; (3) telephone interviews with care commissioners and providers using case scenarios derived from the interviews with carers; and (4) analysis of linked Hospital Episode Statistics (HES) and mortality data relating to hospital admissions for heart failure and lung cancer in England 2001–10.ResultsTransitions between care settings in the last year of life were a common component of end-of-life care across all the data sets that made up this study, and many moves were made shortly before death. Patients’ and carers’ experiences of transitions were of a disjointed system in which organisational processes were prioritised over individual needs. In many cases, the family carer was the co-ordinator and provider of care at home, excluded from participation in institutional care but lacking the information and support to extend their role with confidence. The general practitioner (GP) was a valued, central figure in end-of-life care across settings, though other disciplines were critical of GPs’ expertise and adherence to guidelines. Out-of-hours services and care homes were identified by many as contributors to unnecessary transitions. Good relationships and communication between professionals in different settings and sectors was recognised by families as one of the most important influences on transitions but this was rarely acknowledged by staff.ConclusionsDevelopment of a shared understanding of professional and carer roles in end-of-life transitions may be one of the most effective ways of improving patients’ experiences. Patients and carers manage many aspects of end-of-life care for themselves. Identifying ways to extend their skills and strengthen their voices, particularly in hospital settings, would be welcomed and may reduce unnecessary end-of-life transitions. Why the experiences of carers appear to have changed little, despite the implementation of a range of relevant policies, is an important question that has not been answered. Recommendations for future research include the relationship between policy interventions and the experiences of end-of-life carers; identification of ways to harmonise understanding of the carers’ role and strengthen their voice, particularly in hospital settings; identification of ways to reduce the influence of interprofessional tensions in end-of-life care; and development of interventions to enhance patients’ experiences across transitions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…16 Also, the home care reduces the number of hospitalizations and the costs associated with them, reducing the demand for tertiary healthcare services. [17][18][19] However, for a quality care at home, it is necessary that the individual and the family are prepared to assume the responsibility for the care. Some studies emphasized that the family members often perform the care with knowledge and skill acquired with right or wrong experiences and the healthcare team has been negligent about the guidance on what the patient and the family need.…”

Section: Home Carementioning

confidence: 99%

“…13 A new home care service proposed in a study, which visits more often, has shown that this continuous follow-up allows to identify, at a significantly higher level, the nursing care needs, beyond the identified by the existing nursing services. 17 Among the nursing actions identified by the subjects, those related to affective level, such as attention and affection in how they feel cared for, stood out. 20 However, sometimes the patient is surrounded by stigma with this care, because the receptivity and expectations.…”

mentioning

confidence: 99%

Cuidado de enfermagem no domicílio ao paciente com insuficiência cardíaca: revisão integrativa Nursing care at home patient with heart failure: integrative review

Silva

Rabelo

2016

R. pesq. cuid. fundam. online

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Objetivo: Analisar a produção científica acerca do cuidado de enfermagem no domicílio ao paciente com insuficiência cardíaca. Método: O levantamento dos artigos ocorreu pela consulta à periódicos de enfermagem, com publicações disponíveis online e na íntegra, indexadas nas bases de dados LILACS e MEDLINE. Foram identificados 599 artigos, dos quais 17 compuseram a amostra do estudo. Resultados: Os textos originaram as seguintes categorias: cuidado domiciliar, equipe de saúde no cuidado domiciliar e propostas para melhor qualidade do atendimento. Conclusão: Considera-se importante o despertar para a necessidade de maiores investimentos e pesquisas nesta área, que mostrou-se uma proposta bastante positiva de cuidado humanizado, pois possibilita ao paciente estar no conforto do seu lar, contando com o apoio da sua família, além de incentivar o autocuidado e possibilitar maior autonomia. Descritores: Literatura de Revisão como Assunto; Cuidados de Enfermagem; Insuficiência Cardíaca.

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In-reach specialist nursing teams for residential care homes: uptake of services, impact on care provision and cost-effectiveness

Cited by 63 publications

References 59 publications

Appropriateness of unscheduled hospital admissions from care homes

Appropriateness of unscheduled hospital admissions from care homes

Transitions at the end of life for older adults – patient, carer and professional perspectives: a mixed-methods study

Cuidado de enfermagem no domicílio ao paciente com insuficiência cardíaca: revisão integrativa Nursing care at home patient with heart failure: integrative review

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