The Impact of Early Involvement in a Postdischarge Support Program for Ostomy Surgery Patients on Preventable Healthcare Utilization

Abstract

PURPOSE:To evaluate the impact of a postdischarge ostomy support program as an adjunct to nurse-led ostomy care on preventable healthcare utilization.DESIGN:A cross-sectional study.SUBJECTS AND SETTING:A postdischarge support program offered by an ostomy product's manufacturer provides persons living with an ostomy with patient-centered and easily accessible assistance. Individuals who underwent ostomy surgery within 18 months prior to the survey date were selected from an ostomy patient database maintained by the ostomy patient support program provider. Of 7026 surveys sent to program enrollees, 493 (7%) responded, compared with 225 (5%) out of 4149 surveys sent to individuals in a comparison group. The 2 groups were similar in demographics. A majority of the survey respondents were female (60% of program enrollees vs 55% of respondents in the comparison group). Among the program enrollees, 44% had colostomy, 43% had ileostomy, 10% had urostomy, and 4% had at least 2 types of ostomy surgery compared with 52%, 32%, 12%, and 4% of the respondents in a comparison group, respectively.METHODS:The study compared hospital readmission and emergency room (ER) visit rates attributable to ostomy complications between program enrollees and respondents in the comparison group. The event rates were measured in 2 study periods: within the first month of discharge and after the first month of discharge. Eligible individuals received an online survey that included the following domains: characteristics of ostomy surgery; readmissions and ER visits within the first month or after the first month of discharge, including reasons for preventable events; and level of health care access. Multivariate logistic regressions controlling for covariates were applied to investigate associations between program enrollment and ostomy-related readmission or ER visit rates.RESULTS:Logistic regression analyses showed that, when compared with respondents in the comparison group, program enrollees had a significantly lower likelihood of being readmitted and visiting the ER due to ostomy complications after the first month of hospital discharge and up to 18 months postdischarge (odds ratio [OR] = 0.45; 95% confidence interval [CI], 0.27-0.73; and OR = 0.37; 95% CI, 0.22-0.64, respectively).CONCLUSIONS:Findings suggest that enrolling patients in the postdischarge ostomy support program provides an effective approach to reducing preventable healthcare utilization.

Self-care of people with intestinal ostomy: beyond the procedural towards rehabilitation

“…For these people, in the first months of the ostomy process, several unknowns arose about self-care, clothing, food, and ostomy complications, which influenced the maintenance of their daily activities and resulted in self-prejudice and social isolation (1)(2)7,14,26) .…”

“…This will contribute to the planning of specialized assistance to achieve rehabilitation in order to make the person with intestinal ostomy as independent as possible, analyzing the conditions and limitations for self-care with the ostomy and handling of the waste output equipment, which represent a first aspect, but should not be considered as the only one or the most important (10) . The priority must be on actions to regain control of one's life, with an analysis of the limitations of aptitudes, which should be signaled by the person who experiences the illness and ostomy (1)(2)(3)(13)(14) .…”

Care in the Ostomates Programs: the multidisciplinary team’s perspective

“…Esta fase foi marcada por sentimento de insegurança, medo e dúvidas. O ensino do autocuidado pela equipe especializada intra-hospitalar foi primordial para o alcance da reabilitação, assim como a contrarreferência ao programa de saúde especializado para continuidade da assistência (2,(5)(6)(12)(13)(14)(15) .…”

“…Este suporte profissional foi importante para a autoconfiança e para que pudessem assumir os cuidados em domicílio, com maior independência. Por outro lado, aquelas pessoas que não conseguiam assumir o autocuidado, em geral, foi decorrente da não aceitação da condição de saúde ou do familiar que não possibilitava a oportunidade para assumi-lo, mantendo-o mais dependente dos profissionais ou do familiar cuidador, até com comportamento acomodado ou passivo (5)(6)(11)(12)(13)(14)(15)(16) .…”

Factors influencing health-related quality of life of those in the Netherlands living with an ostomy

“…Researchers have referred to the additional benefits of post-surgical support by specialist nurses. When individuals seek guidance or care, many organisations may also be available 24 hours a day, 7 days a week and will provide a personal contact at every call (Nagle et al, 2012;Rojanasarot, 2018).…”