The effect of a gerontology nurse specialist for high needs older people in the community on healthcare utilisation: a controlled before-after study

Abstract

BackgroundNurse-led models of comprehensive geriatric assessment and care coordination can improve health management as well as reduce hospitalisations for high risk community dwelling older people. This study investigated the effect on healthcare utilisation of systematic case finding to identify high risk older people in the community with a subsequent comprehensive assessment and care coordination intervention by a Gerontology Nurse Specialist based in primary care.MethodsThis was a controlled before-after study design located within primary healthcare practices in Auckland, New Zealand. An intervention model was initiated within two primary healthcare practices and involved a screening tool to identify high risk older people with succeeding gerontology nurse specialist assessment and care coordination. The comparison group included older people who received usual care at three comparable primary healthcare practices. The primary outcome measure was acute hospital admissions. Secondary outcomes included hospital re-admissions, length of stay, emergency department presentations, residential care admissions, and community contacts.ResultsA total of 579 older people were posted the screening tool in the intervention group, with 517 completed screens (89% response rate) formulating the intervention group. A total of 101 older people were identified as high risk from these screens (20%). The comparison group comprised 883 older people. Comparing the intervention and comparison group, no statistical differences were found for hospital admissions, emergency department presentations, hospital re-admissions, length of stay, or residential care admission. Community physiotherapy showed a statistically significant increase for the intervention compared to the comparison group (p = 0.03). Non-significant findings revealed decreased risk of entering residential care and fewer frequent hospital re-admissions for the intervention group when compared with the comparison group.ConclusionsThis specialist nurse-led intervention involving comprehensive assessment and care coordination care did not appear superior to usual care, however, there is benefit to exploring a more robust randomised controlled trial design.Trial registrationRetrospectively registered on 18/09/2017 with the Australian New Zealand Clinical Trials Registry (ANZCTR). Registration number ACTRN12617001332314Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0717-3) contains supplementary material, which is available to authorized users.

Explaining experiences of community-dwelling older adults with a pro-active comprehensive geriatric assessment program – a thorough evaluation by interviews

“…Therefore, there seems to be a need for unscheduled availability of care workers working holistically and integrated within the standard health care of older adults. This was suggested by our participants and has been concluded in other research into the older adults’ perspective for improving standard care [51, 52].…”

The impact of community nurse‐led interventions on the need for hospital use among older adults: An integrative review

“…They were undertaken between 2011 and 2018 and sampled a combined total of 32,257 people aged 65 years or older from six countries: UK=3, France, New Zealand, Hong Kong, Sweden=1 each and Germany=2 (the same study reporting 1 and 3‐year outcomes in separate papers). Four studies were randomised controlled trials (RCTs) (Chow & Wong, 2014; Kirchberger et al, 2015; Meisinger et al, 2013; Sandberg et al, 2014), two were pre–post‐test quasi‐experiments (King et al, 2018; de Stampa et al, 2014), and there was one retrospective controlled case review (Chitnis et al, 2013), one retrospective case series (Cox et al, 2017), and one phenomenology (Grange, 2011). Seven of the studies were of nurse‐led services for older adults with chronic disease or who had suffered an acute myocardial infarction (Chow & Wong, 2014; Cox et al, 2017; King et al, 2018; Kirchberger et al, 2015; Meisinger et al, 2013; Sandberg et al, 2014; de Stampa et al, 2014), one was of end‐of‐life care delivered by Marie Curie nurses (Chitnis et al, 2013), and one explored the case management experiences of community matrons (Grange, 2011).…”

“…Both quasi‐experiments were robust but relied on opportunistic sampling rather than random sampling. One of these studies also reported significant differences in the mean age of participants across study groups, which may have influenced results (King et al, 2018). The retrospective controlled case review met all applicable JBI criteria although it was unclear how the authors dealt with confounding factors in their analyses.…”

“…Both quasi‐experiments reported no significant difference in hospital admissions between intervention and control groups (King et al, 2018; de Stampa et al, 2014). However, in the de Stampa et al, (2014) study, the intervention group who received nurse‐led intensive case management were significantly less likely to have at least one unplanned hospital admission than controls (OR = 0.39, 95% CI 0.16–0.98) and more likely to have planned admissions (OR = 3.59, 95% CI 1.02–12.70).…”

An exploration of how community‐dwelling older adults enhance their well‐being

“…Integrating well‐being to design public policy is proposed (Adler & Seligman, ; Jarden, Jarden, & Oades, ), and ways of achieving this require more thought and discussion. Nurses are well placed to contribute to this public policy debate, and gerontology nurses acknowledged as strong advocates for improving services and developing innovative approaches with and for older adults (King, I., Boyd, M.L., Raphael, D.L., & Jull, A., ).…”