Investigating the characteristics and needs of frequently admitting hospital patients : a cross-sectional study in the United Kingdom

Objectives: This study forms the user requirements phase of the OPTIMAL project, which, through a predictive model and supportive intervention, aims to decrease early hospital readmissions. This phase aims to investigate the needs and characteristics of patients who had been admitted to hospital ≥2 times in the past 12 months. Setting This was a cross-sectional study involving patients from Croydon University Hospital (CUH), London, UK. Participants: A total of 347 patients responded to a postal questionnaire, a response rate of 12.7%. To meet the inclusion criteria, participants needed to be aged ≥18 and have been admitted ≥2 times in the previous 12 months (August 2014–July 2015) to CUH. Primary and secondary outcomes: To profile patients identified as frequent admitters to assess gaps in care at discharge or post-discharge. Additionally, to understand the patients’ experience of admission, discharge and post-discharge care. Results: The range of admissions in the past 12 months was 2–30, with a mean of 2.8. At discharge 72.4% (n=231/347) were not given a contact for out-of-hours help. Regression analysis identified patient factors that were significantly associated with frequent admissions (>2 in 12 months), which included age (p=0.008), being in receipt of care (p=0.005) and admission due to a fall (p=0.01), but not receiving polypharmacy. Post-discharge, 41.8% (n=145/347) were concerned about being readmitted to the hospital. In the first 30 days after discharge, over half of patients (54.5% n=189/347) had no contact from a healthcare professional. Conclusion: Considering that social care needs were more of a determinant of admission risk than medical needs, rectifying the lack of integration, communication and the under-utilisation of existing patient services could prevent avoidable problems during the transition of care and help decrease the likelihood of hospital readmission

COPD care delivery pathways in five European Union countries : mapping and health care professionals' perceptions

Background: COPD is among the leading causes of chronic morbidity and mortality in the European Union with an estimated annual economic burden of €25.1 billion. Various care pathways for COPD exist across Europe leading to different responses to similar problems. Determining these differences and the similarities may improve health and the functioning of health services. Objective: The aim of this study was to compare COPD patients’ care pathway in five European Union countries including England, Ireland, the Netherlands, Greece, and Germany and to explore health care professionals’ (HCPs) perceptions about the current pathways. Methods: HCPs were interviewed in two stages using a qualitative, semistructured email interview and a face-to-face semistructured interview. Results: Lack of communication among different health care providers managing COPD and comorbidities was a common feature of the studied care pathways. General practitioners/family doctors are responsible for liaising between different teams/services, except in Greece where this is done through pulmonologists. Ireland and the UK are the only countries with services for patients at home to shorten unnecessary hospital stay. HCPs emphasized lack of communication, limited resources, and poor patient engagement as issues in the current pathways. Furthermore, no specified role exists for pharmacists and informal carers. Conclusion: Service and professional integration between care settings using a unified system targeting COPD and comorbidities is a priority. Better communication between health care providers, establishing a clear role for informal carers, and enhancing patients’ engagement could optimize current care pathways resulting in a better integrated system

COPD care delivery pathways in five European Union countries: mapping and health care professionals’ perceptions

Background: COPD is among the leading causes of chronic morbidity and mortality in the European Union with an estimated annual economic burden of €25.1 billion. Various care pathways for COPD exist across Europe leading to different responses to similar problems. Determining these differences and the similarities may improve health and the functioning of health services. Objective: The aim of this study was to compare COPD patients’ care pathway in five European Union countries including England, Ireland, the Netherlands, Greece, and Germany and to explore health care professionals’ (HCPs) perceptions about the current pathways. Methods: HCPs were interviewed in two stages using a qualitative, semistructured email interview and a face-to-face semistructured interview. Results: Lack of communication among different health care providers managing COPD and comorbidities was a common feature of the studied care pathways. General practitioners/family doctors are responsible for liaising between different teams/services, except in Greece where this is done through pulmonologists. Ireland and the UK are the only countries with services for patients at home to shorten unnecessary hospital stay. HCPs emphasized lack of communication, limited resources, and poor patient engagement as issues in the current pathways. Furthermore, no specified role exists for pharmacists and informal carers. Conclusion: Service and professional integration between care settings using a unified system targeting COPD and comorbidities is a priority. Better communication between health care providers, establishing a clear role for informal carers, and enhancing patients’ engagement could optimize current care pathways resulting in a better integrated system. Keywords: COPD, comorbidities, care delivery pathway, comparative analysi

Exploring the role of technology in optimising the care of patients with long term conditions

The number of patients diagnosed with long term conditions in the UK is increasing with an expected number of 18 million patients by 2018, responsible for 69% of all spending on health and social care in England. These challenges cannot be solved solely by conventional approaches and other alternatives, such as cost-effective technological solutions, must be considered to increase patient's independence and quality of life, and produce cost savings for the authorities. This practice-based research explored the potential role of technologies in the care of patients with long term conditions, and aimed to evaluate the acceptance and effectiveness of a telehealth service provided to patients' with chronic obstructive pulomary disease and heart failure; to map and compare chronic obstructive pulmonary disease care pathways between different EU countries to better understand how technologies fit within the standard forms of care; to explore how m-health interventions can be developed and designed to support the care of cancer patients and survivors; and to provide data on UK cancer patients' ownership of and interest in m-health technologies. Mixed-mthod research approach was used in this study with a mixture of face-to-face and email semi-structured interviews, postal and online questionnaires, and data extraction from available databases. This approach was selected to harness the strengths of, both quantitative and qualitative methodologies. Seven nurses, working on telehealth for an average of 15 months were interviewed. Lack of resources and organisational support, patient selection criteria, and technological support were identified as barriers for effective implementation of telehealth. Telehealth reduced the number of both A&E and hospital admissions by 36% (P=0.03) and 28% (P=0.02), respectively. 27 patients responded to the postal questionnaire and were very satisfied with the service. They agreed that telehealth had improved their health, was a convenient form of healthcare delivery for them, and that it made them more involved in the decisions about their care or treatment. Five COPD-specialised HCPs were interviewed, and the COPD care pathway was compared between 5 EU countries including Germany, Greece, Ireland, Netherlands and England. Lack of communication among different healthcare providers managing COPD and co-morbities is a common feature of the studies care pathways. In all countries, the lifestyle management services provided were similar with no specific tools used to enhance patients' adherance, and no specified role/training existing for informal carers (partners, family & friends). Telehealth can play a role int he integrated care of long tem conditions by providing means communication allowing better communications between different healthcare providers managing LTCs and co-morbidities. Next, the role of m-health in cancer care was explored. A need for m-health platforms to support cancer patients and survivors was identified, and two m-health platforms were developed and designed using patient's centred approach and Waterfall system development model. MyAppPal and CanAdvice+ were designed to support colorectal cnacer srvivors set up on follow-up care plans and cancer patients receiving oral chemotheraphy at home, respectively. 12 colorectal cancer patients were interviewed and 69 patients responded to the postal questionnaire. Patients expereince with the support provided during follow up plan varied based on appointment type and location. They had problems remembering or accessing information as they moved away from their treatment, and reported needs for more specific and personalised information, more information on how to handle financial difficulties and social care, and more control over their hospital appointments. The usability scores of the developed apps were very positive, and they were seen as simple and attractive to use, and had very positive learnability and usability scores. Finally, 529 cancer patients completed surveys to assess their ownership of smart-technologies and interest in m-health apps. 90.5% of the patients had access to smartphone, tablet or both, and only patients' age significantly affected this ownership. Almost half of the patients showed an interest in the use of m-health apps, and two out of five were willing to download apps in were made available from the hospital. Five factors were found to significantly predict patients' willingness to use and download health applications, including age, health literacy, previous use of apps in general and health apps in particular, and previous use of smartphones/tablets to access related health information in the past six months. Ownership of smart-technologies and interest in m-health apps was independent from all other socio-economic factors. Technologies seem to be acceptable to patients with long term conditions, and can play an important role in improving their clinical outcomes if well designed, introduced, implemented and managed. Patients' perceptions of the usefulness and ease of use of these technologies seem to be a crucial factor in their acceptance of such interventions

Optimizing cancer care through mobile health

The survival rates for patients living with cancer are increasing, due to recent advances in detection, prevention and treatment. It has been estimated that there were 28 million cancer survivors around the world in 2012. In the UK, for patients diagnosed in 2007, it is predicted that more than half of them will survive their cancer for 5 years or more. A large majority of cancer survivors report unmet supportive care needs and distressing symptoms and adverse long-term consequences related to their cancer. Cancer management could be optimized to better meet patients demand through technology, including mobile health (m-Health). m-Health is defined as the use of mobile communications and network technologies for health care. m-Health can help both patients and health-care professionals and play an important part in managing and delivering cancer care including managing side effects, supporting drug adherence, providing cancer information, planning and follow up and detecting and diagnosing cancer. Health authorities have already published guidelines regulating m-Health to insure patient safety and improve the accountability of its applications

Implementing a telehealth service: nurses' perceptions and experiences

BACKGROUND: Telehealth is defined as the remote surveillance of a patient's health to aid early diagnosis and timely intervention. Understanding how the stakeholders perceive telehealth can influence its acceptability and diffusion. INTRODUCTION: A primary care trust (PCT) in south London has been providing telehealth services for chronic obstructive pulmonary disease (COPD) and heart-failure patients for the past 22 months. The aim of this study was to elicit practice nurses' perceptions of the telehealth service provided by this PCT. MATERIALS AND METHODS: A descriptive qualitative design was chosen to elicit practice nurses' perceptions. A semi-structured email interview was used to investigate their experiences of the service to date and their views about the future of the service. RESULTS: Seven nurses, working on telehealth for an average of 15 months and providing the service to 34 patients, were interviewed. Overall, the nurses described their experience with telehealth to be positive. Lack of resources, organisational support, patient selection criteria and technical support were identified as barriers to effective implementation of telehealth. Additional team members, more input and training, and expanded patient selection criteria were suggested by the nurses to enhance and ensure the success of telehealth. DISCUSSION AND CONCLUSIONS: The challenges and barriers to the implementation of telehealth identified by the practice nurses need to be addressed by health services to ensure its continuity and success

Telehealth: what do we know and what is the future?

Telehealth services use technology to provide personalised patient care while allowing them to live more independently at home: research has shown this to be beneficial in the management of chronic conditions. This presentation will outline patients' perceptions and consider future development

Evaluation of a Telehealth Service for COPD and HF patients: Clinical outcome and patients’ perceptions

NHS Croydon Health Services and NHS Croydon Clinical Commissioning Group have been providing telehealth services for the past 36 months. The aim of this study was to measure the impact of telehealth when implemented as a service within a standard patient care pathway. To measure the clinical outcomes, the number of A&E visits and hospital admissions, recorded on the NHS Secondary Uses Service database, were compared before and after the implementation of the telehealth service. The number of all events despite its cause and the number of events related to the patients’ diagnosed condition were collected. To elicit patients’ perceptions about the telehealth service, a cross sectional survey of patients registered on the triage manager database was used to explore their perceptions, concerns and general satisfaction with the telehealth service via a 4 point likert scale questionnaire. The data of 48 patients were collected and telehealth reduced the number of both A&E and hospital admission due to all causes by 13% (P¼0.42) and 22% (P¼0.048), respectively. When only the events directly related to the patient’s diagnosed condition were considered, a reduction by 36% (P¼0.03) and 28% (P¼0.02) was recorded for A&E visits and hospital admission respectively. 27 patients consented to participate in the survey. Overall, patients were very satisfied with telehealth services. Patients agreed that telehealth had improved their health, it was a convenient form of health care delivery for them and they were more involved in the decisions about their care or treatment. In addition, since being on telehealth, patients’ confidence in managing their health increased from somewhat confident to confident. Telehealth, when provided as a service within a standard care pathway, seems to decrease hospital admissions and A&E visits. Good patient satisfaction suggests that the current service is accepted and it could be further expanded to include a larger number of patients

Investigating the characteristics and needs of frequently admitting hospital patients

OBJECTIVES: This study forms the user requirements phase of the OPTIMAL project, which, through a predictive model and supportive intervention, aims to decrease early hospital readmissions. This phase aims to investigate the needs and characteristics of patients who had been admitted to hospital ≥2 times in the past 12 months. SETTING: This was a cross-sectional study involving patients from Croydon University Hospital (CUH), London, UK PARTICIPANTS: A total of 347 patients responded to a postal questionnaire, a response rate of 12.7%. To meet the inclusion criteria, participants needed to be aged ≥ 18 and have been admitted ≥2 times in the previous 12 months (August 2014-July 2015) to CUH. PRIMARY AND SECONDARY OUTCOMES: To profile patients identified as frequent admitters to assess gaps in care at discharge or post-discharge. Additionally, to understand the patients’ experience of admission, discharge and post-discharge care. RESULTS: The range of admissions in the past 12 months was 2-30, with a mean of 2.8. At discharge 72.4%, (n= 231/347) were not given a contact for out of hours help. Regression analysis identified patient factors that were significantly associated with frequent admissions (>2 in 12 months), which included age (p=0.008), being in receipt of care (p=0.005) and admission due to a fall (p=0.01), but not receiving polypharmacy. Post-discharge, 41.8% (n=145/347) were concerned about being readmitted to the hospital. In the first 30 days after discharge, over half of patients (54.5% n=189/347) had no contact from a health care professional. CONCLUSION: Considering that social care needs were more of a determinant of admission risk than medical needs, rectifying the lack of integration, communication and the under-utilisation of existing patient services could prevent avoidable problems during the transition of care and help decrease the likelihood of hospital readmission