Stakeholders’ perceptions of a nurse-led telehealth case management intervention in primary care for patients with complex care needs: a qualitative descriptive study

Delahunty-Pike, Alannah; Lambert, Mireille; Schwarz, Charlotte; Howse, Dana; Bisson, Mathieu; Aubrey-Bassler, Kris; Burge, Fred; Chouinard, Maud-Christine; Doucet, Shelley; Luke, Alison; Macdonald, Marilyn; Zed, Joanna; Taylor, Jennifer; Hudon, Catherine

doi:10.1136/bmjopen-2023-073679

Cited by 2 publications

(13 citation statements)

References 30 publications

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“…This imbalance may reflect the priorities of care managers as well as the needs of their clients, both patients and other providers, given the limited time available in a monthly telephonic encounter. They may focus on domains of care that they can do something about, such as connecting patients to supportive services or providing coupons or other assistance to defray medication costs, and/or patients may be unwilling or less willing to disclose challenges until trust is developed [ 23 – 25 ]. We demonstrate a practical strategy for mining care managers’ notes for barriers to care and unmet social needs, bringing care managers into the process to reflect on the terms that they use to document different findings.…”

Section: Discussionmentioning

confidence: 99%

Finding social need-les in a haystack: ascertaining social needs of Medicare patients recorded in the notes of care managers

Shafer,

Davis,

Clark

2023

BMC Health Serv Res

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Background Unmet social needs may impair health and access to health care, and intervening on these holds particular promise in high-risk patient populations, such as those with multiple chronic conditions. Our objective was to identify social needs in a patient population at significant risk—Medicare enrollees with multiple chronic illnesses enrolled in care management services—and measure their prevalence prior to any systematic screening. Methods We partnered with Renova Health, an independent Medicare Chronic Care Management (CCM) provider with patients in 10 states during our study period (January 2017 through August 2020). Our data included over 3,000 Medicare CCM patients, representing nearly 20,000 encounters. We used a dictionary-based natural language processing approach to ascertain the prevalence of six domains of barriers to care (food insecurity, housing instability, utility hardship) and unmet social needs (health care affordability, need for supportive services, transportation) in notes taken during telephonic Medicare CCM patient encounters. Results Barriers to care, specifically need for supportive services (2.4%) and health care affordability (0.8%), were the most prevalent domains identified. Transportation as a barrier to care came up relatively less frequently in CCM encounters (0.1%). Unmet social needs were identified at a comparatively lower rate, with potential housing instability (0.3%) flagged most followed by potential utility hardship (0.2%) and food insecurity (0.1%). Conclusions There is substantial untapped opportunity to systematically screen for social determinants of health and unmet social needs in care management.

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Section: Discussionmentioning

confidence: 99%

Finding social need-les in a haystack: ascertaining social needs of Medicare patients recorded in the notes of care managers

Shafer,

Davis,

Clark

2023

BMC Health Serv Res

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“…Eight studies reported on history taking and patient data collection tasks completed by nurses (Ahmed et al, 2013;Ajay et al, 2016;Anger et al, 2020;Bove, 2010;Cook et al, 2007;Jindal et al, 2022;Kaplan-Dobbs et al, 2021;Rosenman et al, 2006). Nurses conducted a range of diagnostic activities in 45 studies (Ahmed et al, 2013;Ajay et al, 2016;Anger et al, 2020;Anson et al, 2022;Bajis et al, 2020;Barton et al, 2013;Bedelu et al, 2007;Billington et al, 2015;Brennan et al, 2011;Carlisle & Warren, 2013;Chang et al, 2007;Clarke et al, 2018;Cohen et al, 2009;Cook et al, 2007;Delahunty-Pike et al, 2023;Fox & McCorkle, 2018;Frieden et al, 2020;Gilliver et al, 2022;Grimsrud et al, 2014;Howland et al, 2020;Iversen et al, 2020;Jordan et al, 2011;Kompala et al, 2016;Kwak et al, 2021;Macduff et al, 2001;Mallow et al, 2018;McCombe et al, 2022;Momin et al, 2022;Moriyama et al, 2021;Neppelenbroek et al, 2023;Parham et al, 2010;Parham et al, 2023;Parker et al, 2022;…”

Section: Key Tasks Of Nurses Working In Nurse-led Models Of Carementioning

confidence: 99%

“…Nurses conducted a range of diagnostic activities in 45 studies (Ahmed et al, 2013;Ajay et al, 2016;Anger et al, 2020;Anson et al, 2022;Bajis et al, 2020;Barton et al, 2013;Bedelu et al, 2007;Billington et al, 2015;Brennan et al, 2011;Carlisle & Warren, 2013;Chang et al, 2007;Clarke et al, 2018;Cohen et al, 2009;Cook et al, 2007;Delahunty-Pike et al, 2023;Fox & McCorkle, 2018;Frieden et al, 2020;Gilliver et al, 2022;Grimsrud et al, 2014;Howland et al, 2020;Iversen et al, 2020;Jordan et al, 2011;Kompala et al, 2016;Kwak et al, 2021;Macduff et al, 2001;Mallow et al, 2018;McCombe et al, 2022;Momin et al, 2022;Moriyama et al, 2021;Neppelenbroek et al, 2023;Parham et al, 2010;Parham et al, 2023;Parker et al, 2022;Ramakrishnan et al, 2020;Rosenman et al, 2006;Roy et al, 2022;Shaw et al, 2013;Shumbusho et al, 2009;Smits et al, 2020;Some et al, 2016;Stone et al, 2010;Teo et al, 2024;…”

Section: Key Tasks Of Nurses Working In Nurse-led Models Of Careunclassified

“…Involvement of nurses in telehealth or e-health was described in 43 studies (Ahmed et al, 2013;Ajay et al, 2016;Anger et al, 2020;Anson et al, 2022;Bosworth et al, 2011;Bove, 2010;Carlisle & Warren, 2013;Chang et al, 2007;Clarke et al, 2018;Cook et al, 2007;Datta et al, 2010;de Moraes et al, 2022;Delahunty-Pike et al, 2023;Engel et al, 2015;Fox & McCorkle, 2018;Grisot et al, 2019;Hoffman et al, 2023;Howland et al, 2020;Hui et al, 2022;Hunkeler et al, 2000;Iversen et al, 2020;Jackson et al, 2017;Jeong et al, 2018;Jordan et al, 2011;Kwak et al, 2021;Mallow et al, 2018;Mammen et al, 2020;Momin et al, Rosenman et al, 2006;Schofield et al, 2005;Shaw et al, 2013;Stone et al, 2010;Teo et al, 2024;Turner et al, 2009;Wakefield et al, 2011;Walker et al, 2015;Williams et al, 2001), with nurses using devices (both telephone and videoconferencing) to counsel patients and gather medical information. This included interpreting electronic or patient reported data such as patient biometrics (Chang et al, 2007;Clarke et al,...…”

Section: E-health and Telehealth Servicesmentioning

confidence: 99%

“…Forty-five studies described the training provided to nurses prior to them participating in or implementing a nurse-led model of care, with a focus on the particular tasks(s), tools and/or health conditions they were to be involved in (Ahmed et al, 2013;Ajay et al, 2016;Anson et al, 2022;Asgary et al, 2020;Barton et al, 2013;Bedelu et al, 2007;Brennan et al, 2011;Carroll, 2021;Chin-Quee et al, 2020;Clarke et al, 2020;Cohen et al, 2009;Datta et al, 2010;Delahunty-Pike et al, 2023;Everitt-Penhale et al, 2019;Fairall et al, 2012;Fairall et al, 2016;Frieden et al, 2020;Howland et al, 2020;Hunkeler et al, 2000;Husain et al, 2022;Iversen et al, 2020;Jindal et al, 2022;Jordan et al, 2011 Thomas et al, 2023;Vierhile, 2017;Wartko et al, 2023;Zewdu et al, 2022). If nurses were deemed to have existing skills and qualifications, they were not required to undertake further training to deliver the nurse-led model (Billington et al, 2015;McKissick et al, 2017;Walker et al, 2015).…”

Section: Training For Nurse-led Model Of Carementioning

confidence: 99%

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Nurse and midwife involvement in task‐sharing and telehealth service delivery models in primary care: A scoping review

Moulton,

Botfield,

Subasinghe

et al. 2024

Journal of Clinical Nursing

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AimTo synthesise and map current evidence on nurse and midwife involvement in task‐sharing service delivery, including both face‐to‐face and telehealth models, in primary care.DesignThis scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews.Data Source/Review MethodsFive databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse‐led models.ResultsOne hundred peer‐reviewed articles (as 99 studies) were deemed eligible for inclusion. Task‐sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse‐led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost‐effective, and increase system efficiencies with supportive training, clinical set‐up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy.ConclusionNurse‐led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task‐sharing models with nurses to be feasible and effective.ImpactNurse‐led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost‐effective. Increased utilisation of nurse‐led models should be considered to address health system challenges and improve access to essential primary healthcare services globally.Reporting MethodThis review is reported against the PRISMA‐ScR criteria.Patient or Public ContributionNo patient or public contribution.Protocol registrationThe study protocol is published in BJGP Open (Moulton et al., 2022).

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Stakeholders’ perceptions of a nurse-led telehealth case management intervention in primary care for patients with complex care needs: a qualitative descriptive study

Cited by 2 publications

References 30 publications

Finding social need-les in a haystack: ascertaining social needs of Medicare patients recorded in the notes of care managers

Finding social need-les in a haystack: ascertaining social needs of Medicare patients recorded in the notes of care managers

Nurse and midwife involvement in task‐sharing and telehealth service delivery models in primary care: A scoping review

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