Physician Availability in Long-Term Care and Resident Hospital Transfer: A Retrospective Cohort Study

Kobewka, Daniel; Kunkel, Elizabeth; Hsu, Amy T; Talarico, Robert; Tanuseputro, Peter

doi:10.1016/j.jamda.2019.06.004

Cited by 16 publications

(9 citation statements)

References 25 publications

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“…One study reported an improved quality of life [40], and there were mixed results across the three studies regarding ED transfers. Kobewka 2020 (Canada) [43] evaluated sameday physician access (n = 5,617) compared to physician visits the next day or later (n = 15,007) and resulted in lower hospitalizations and emergency department visits. Weatherall 2019 (Denmark) [44] evaluated assigning a dedicated primary care physician to a home (n = 339) compared to no dedicated primary care physician (n = 26,446), which resulted in a reduction in the probability a resident experienced a preventable hospitalization or a readmission.…”

Section: Main Findings-healthcare Services Deliverymentioning

confidence: 99%

Models of provider care in long-term care: A rapid scoping review

et al. 2021

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Introduction One of the current challenges in long-term care homes (LTCH) is to identify the optimal model of care, which may include specialty physicians, nursing staff, person support workers, among others. There is currently no consensus on the complement or scope of care delivered by these providers, nor is there a repository of studies that evaluate the various models of care. We conducted a rapid scoping review to identify and map what care provider models and interventions in LTCH have been evaluated to improve quality of life, quality of care, and health outcomes of residents. Methods We conducted this review over 10-weeks of English language, peer-reviewed studies published from 2010 onward. Search strategies for databases (e.g., MEDLINE) were run on July 9, 2020. Studies that evaluated models of provider care (e.g., direct patient care), or interventions delivered to facility, staff, and residents of LTCH were included. Study selection was performed independently, in duplicate. Mapping was performed by two reviewers, and data were extracted by one reviewer, with partial verification by a second reviewer. Results A total of 7,574 citations were screened based on the title/abstract, 836 were reviewed at full text, and 366 studies were included. Studies were classified according to two main categories: healthcare service delivery (n = 92) and implementation strategies (n = 274). The condition/ focus of the intervention was used to further classify the interventions into subcategories. The complex nature of the interventions may have led to a study being classified in more than one category/subcategory. Conclusion Many healthcare service interventions have been evaluated in the literature in the last decade. Well represented interventions (e.g., dementia care, exercise/mobility, optimal/appropriate medication) may present opportunities for future systematic reviews. Areas with less research (e.g., hearing care, vision care, foot care) have the potential to have an impact on balance, falls, subsequent acute care hospitalization.

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Section: Main Findings-healthcare Services Deliverymentioning

confidence: 99%

Models of provider care in long-term care: A rapid scoping review

et al. 2021

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“… 2 In one of the few surveys examining physician in LTC homes, a 1991 survey demonstrated that physicians with a nursing home practice spent ≤2 hours per week with residents, 3 and a more recent examination of same-day physician availability in Ontario, Canada, revealed that only around 30% of 161 surveyed homes had same day physician access. 4 The lack of on-site availability of PCPs may contribute to adverse health outcomes among residents 5 and dissatisfaction from residents and their families related to the frequency of interactions with their physician. 6 , 7 Finding physicians focused on care of LTC residents will no doubt become increasingly more challenging, with data from the United States demonstrating that these providers have decreased from 83% in 2008 to 59% in 2018.…”

Section: The Current Residential Long-term Care Contextmentioning

confidence: 99%

The Future Includes Nurse Practitioner Models of Care in the Long-Term Care Sector

McGilton

Bowers

2022

Journal of the American Medical Directors Association

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“…Some examples of the 'outside ED' interventions or strategies were: increasing after-hours primary care, 37 free access to primary care for the uninsured, 38 adjacent or co-located primary care clinic for lower acuity patients, 39 introduction of a patient-centred medical home that addresses primary care needs of patients, 40 implementation of GP cooperatives (out-of-hours primary healthcare in one centrally located practice), 41 urgent care collaborations between the GP and ED, 42 GP-led walk-in centres, 43 PCP blended fee for service, 44 hospital-integrated general practice for emergency care services, 45 integrated emergency posts where care is provided by both ED and GPs, 46 rural health clinics 47 and advanced access primary care with timely access. 48 Involvement of primary healthcare providers The type of PHCP involved in the interventions or strategies involving PHCPs were as follows: family physician (n=85, 31.7%), NP (n=69, 25.7%) or nurse given increased authority (n=43, 16%). There were also a number of dyads reported, including FP and NP (n=15, 5.6%), FP and nurse (n=2, 0.8%), or NP and nurse (n=8, 3%).…”

Section: Interventions and Strategies Involving Phcpsmentioning

confidence: 99%

Interventions and strategies involving primary healthcare professionals to manage emergency department overcrowding: a scoping review

et al. 2021

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ObjectivesTo conduct a scoping review to identify and summarise the existing literature on interventions involving primary healthcare professionals to manage emergency department (ED) overcrowding.DesignA scoping review.Data sourcesA comprehensive database search of Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley) and CINAHL (EBSCO) databases was conducted (inception until January 2020) using peer-reviewed search strategies, complemented by a search of grey literature sources.Eligibility criteriaInterventions and strategies involving primary healthcare professionals (PHCPs: general practitioners (GPs), nurse practitioners (NPs) or nurses with expanded role) to manage ED overcrowding.MethodsWe engaged and collaborated, with 13 patient partners during the design and conduct stages of this review. We conducted this review using the JBI guidelines. Two reviewers independently selected studies and extracted data. We conducted descriptive analysis of the included studies (frequencies and percentages).ResultsFrom 23 947 records identified, we included 268 studies published between 1981 and 2020. The majority (58%) of studies were conducted in North America and were predominantly cohort studies (42%). The reported interventions were either ‘within ED’ (48%) interventions (eg, PHCP-led ED triage or fast track) or ‘outside ED’ interventions (52%) (eg, after-hours GP clinic and GP cooperatives). PHCPs involved in the interventions were: GP (32%), NP (26%), nurses with expanded role (16%) and combinations of the PHCPs (42%). The ‘within ED’ and ‘outside ED’ interventions reported outcomes on patient flow and ED utilisation, respectively.ConclusionsWe identified many interventions involving PHCPs that predominantly reported a positive impact on ED utilisation/patient flow metrics. Future research needs to focus on conducting well-designed randomized controlled trials (RCTs) and systematic reviews to evaluate the effectiveness of specific interventions involving PHCPs to critically appraise and summarise evidence on this topic.

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Physician Availability in Long-Term Care and Resident Hospital Transfer: A Retrospective Cohort Study

Cited by 16 publications

References 25 publications

Models of provider care in long-term care: A rapid scoping review

Models of provider care in long-term care: A rapid scoping review

The Future Includes Nurse Practitioner Models of Care in the Long-Term Care Sector

Interventions and strategies involving primary healthcare professionals to manage emergency department overcrowding: a scoping review

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