What constitutes brilliant aged care? : a qualitative study of practices that exceed expectation

Aim: This study aimed to explore what constitutes brilliant aged care. Background: Although many aged care services do not offer the care that older people and carers need and want, some perform better. Rather than focus on problems with aged care, this study examined brilliant aged care—practices that exceeded expectation. Design: The methodology for this study was informed by grounded theory, under-pinned by constructionism to socially construct meaning. Methods: This study invited nominations for a Brilliant Award via a survey, and inter-views with the nominees via web conference. After receiving survey responses from 10 nominators, interviews were conducted with 12 nominees. Data were analysed using reflexive thematic analysis and documented according to COREQ guidelines to optimise rigour and transparency. Results: According to participants, brilliant aged care involved being relationally at-tuned to older people, a deep understanding of the older person, recognition of aged care as more than a job, innovative practices and permission to reprioritise. Conclusions: This study suggests that, in aged care, brilliance happens. It emphasises the importance of meaningful connections and relationships in aged care, where thoughtful acts acknowledge an older person's value and humanity as well as creativity and innovation. Relevance to Clinical Practice: For those who manage and deliver aged care, the findings suggest that small practice changes can make a positive difference to older people. Brilliant aged care can involve acts of empathy; enthusiasm for aged care; innovative practices, even those that are small scale; and reprioritising workplace tasks to spend time with older people. For policymakers, this study highlights the need to recognise and raise the profile of the pockets of brilliance within the aged care sector. This might be achieved via awards and other initiatives that serve to celebrate and learn from brilliance in its myriad forms. Patient or Public Contribution: The nominees, who included carers, were invited to participate in workshops with other carers and older people to co-design a model of brilliant aged care, during which workshop participants discussed and critiqued the findings constructed from the data

Medication non-adherence in inflammatory bowel diseases is associated with disability

Background/Aims Medication non-adherence is common in inflammatory bowel diseases (IBD). The short-term consequences of non-adherence include increased disease relapse but the long-term impact upon patients in terms of daily functional impairment are less well characterized. Identifying negative outcomes, such as disability, may encourage adherence. Methods Consecutive ambulatory IBD subjects completed the Medication Adherence Rating Scale (MARS; non-adherence defined as ≤16), Inflammatory Bowel Diseases Disability Index (IBD-DI; disability: <3.5) and Beliefs about Medicines Questionnaire (high necessity/concerns: ≥16). The primary outcome was the association between medication non-adherence and disability. Secondary outcomes were the predictors of these outcomes. Results A total of 173 subjects on IBD maintenance medications were recruited (98 Crohn’s disease, 75 ulcerative colitis: median IBD-DI, –5.0; interquartile range [IQR], –14.0 to 4.0 and median MARS, 19.0; IQR, 18 to 20) of whom 24% were non-adherent. Disability correlated significantly with medication non-adherence (r=0.38, P<0.0001). Median IBD-DI for non-adherers was significantly lower than adherers (–16.0 vs. –2.0, P<0.0001). Predictors of disability included female sex (P=0.002), previous hospitalization (P=0.023), management in a referral hospital clinic (P=0.008) and medication concerns (P<0.0001). Non-adherence was independently associated with difficulty managing bowel movements (odds ratio [OR], 3.71; 95% confidence interval [CI], 1.50–9.16, P=0.005), rectal bleeding (OR, 2.69; 95% CI, 1.14–6.36; P=0.024) and arthralgia/arthritis (OR, 2.56; 95% CI, 1.11–5.92; P=0.028). Conclusions Medication non-adherence was associated with significantly increased disability in IBD. Female gender, higher disease severity and medication concerns were additional predictors of disability

Developing core sets for persons following amputation based on the International Classification of Functioning, Disability and Health as a way to specify functioning

Amputation is a common late stage sequel of peripheral vascular disease and diabetes or a sequel of accidental trauma, civil unrest and landmines. The functional impairments affect many facets of life including but not limited to: Mobility; activities of daily living; body image and sexuality. Classification, measurement and comparison of the consequences of amputations has been impeded by the limited availability of internationally, multiculturally standardized instruments in the amputee setting. The introduction of the International Classification of Functioning, Disability and Health (ICF) by the World Health Assembly in May 2001 provides a globally accepted framework and classification system to describe, assess and compare function and disability. In order to facilitate the use of the ICF in everyday clinical practice and research, ICF core sets have been developed that focus on specific aspects of function typically associated with a particular disability. The objective of this paper is to outline the development process for the ICF core sets for persons following amputation. The ICF core sets are designed to translate the benefits of the ICF into clinical routine. The ICF core sets will be defined at a Consensus conference which will integrate evidence from preparatory studies, namely: (a) a systematic literature review regarding the outcome measures of clinical trails and observational studies, (b) semi-structured patient interviews, (c) international experts participating in an internet-based survey, and (d) cross-sectional, multi-center studies for clinical applicability. To validate the ICF core sets field-testing will follow. Invitation for participation: The development of ICF Core Sets is an inclusive and open process. Anyone who wishes to actively participate in this process is invited to do so

Retrospective analysis of telemonitoring in Wollondilly, Australia

Purpose: The purpose of this paper is to analyse early findings from telemonitoring data for chronic obstructive pulmonary disease patients, residing in Wollondilly Shire, New South Wales, Australia. The Shire has 19 small scattered and isolated rural communities, which experience undersupply of healthcare providers. Findings are to be used for further research to support wider implementation of telemonitoring by general practitioners (GPs). Design/methodology/approach: Local patients with multiple chronic obstructive pulmonary disease hospital admissions were allocated home telemonitoring equipment, entering readings according to their GP management plan. Demographic, biometric and self-assessment readings were retrospectively collected, from July 2015 to April 2016. Findings: Data for 18 patients aged 44-87, with equal gender representation was analysed. There was a total of 24,545 data points from 2,932 readings. Over half showed high clinical risk; 93 occasions required GP escalation, 23 per cent for respiratory conditions, in 14 patients. Nine were hospitalised, 51 per cent for respiratory conditions. Practical implications: Home telemonitoring of chronic obstructive pulmonary disease was found to be a promising patient management approach, providing accurate, reliable health indicators. Its use empowered patients to improve symptom control and health outcomes. Originality/value: Experience in Australian general practice with telemonitoring is limited. High protocol compliance occurred, risk indicators were obtained and the value of home telemonitoring was confirmed

Learnings from implementing telemonitoring : the LITE study

Purpose: A recent study on the implementation of telemonitoring has provided an opportunity to explore how telemonitoring could be further developed to enhance better patient, carer and clinician experiences for patients living with chronic disease. The purpose of this paper is to identify the challenges and lessons of the telemonitoring implementation and to identify strategies to inform future implementation. Design/methodology/approach: A qualitative study was conducted with a purposive sample using semi-structured interviews to explore their views about the issues identified in the research aims. Interview themes were informed by current literature and the findings from local studies. Interviews were recorded, transcribed verbatim and analyzed thematically. Findings: A total of 16 participants were interviewed. Overall the recruitment of 56 percent were from identified potential participants. Five core themes were identified, linking different aspects of the telemonitoring implementation: impact of telemonitoring; implementation and management lessons; program risks; program main changes from beginning; and future strategies and recommendations. Originality/value: This study will inform the wider roll out of telemonitoring across the region with the goal of ensuring future interventions achieve better clinical outcomes, patient, carer experience and deliver better value

Additional file 1: of Understanding consumer and clinician preferences and decision making for rehabilitation following arthroplasty in the private sector

Appendix 1; Appendix 2; Appendix 3. Interview templates. (DOCX 17 kb

Understanding the general practice of telemonitoring integrated care : a qualitative perspective

Developed in partnership with GPs, a new telehealth model of care using remote monitoring, known as telemonitoring (TM), was introduced in South Western Sydney (SWS) in 2015, transmitting clinical readings taken at home to telehealth coordinators. This study explored the experiences, beliefs and attitudes of general practice staff to identify barriers to and facilitators of the SWS TM model. Responses were collected from a purposive sample of 10 participants via semistructured interviews (n = 9 interview sessions) and the resulting transcripts were analysed thematically. Four themes were identified: Lack of understanding and involvement; patient-centred care and empowerment; clinical practice and process factors; and system-wide communication and collaboration. Participants recognised some actual and potential benefits of TM, but barriers to TM were identified across all themes. Feedback provided by participants has informed the ongoing formulation of a more 'GP-led' model of TM