Background
The growing number of patients with chronic illness led to new models of carewhere patients and caregivers take a more active role.
We developed a project focused on patient empowerment and family coaching. Theaim was toincrease appropriateness, efficiencyand quality ofhome care services.
Methods
The study was designed during 2007 by Alta Val d’Elsa‘s (one of the four areas of Siena Health Unit – Tuscany, Italy) primary care nurses using auditing techniques. An epidemiological analysis was performed to assess healthcare needs of the population. Structured training programmes for different pathologies were developed. Sentinel events were established for every disease. Each patient was assigned to a nurse case manager available by phone when on duty and responsible for training and verifying learning. We identified two outcome indicators:the reduction of percentage of low-complexity home care nursing interventions (HCNI), considered at high risk of inappropriateness, and the growth of high-complexity HCNI. The complexity of all possible interventions was established by Local Health Unit management.
The project started in January 2008. A satisfaction survey (a one to ten scale, the higher the value, the better) was given to patients and caregivers.
Results
From 2008 through 2012, 20044 training activities were done for 3667 patients and caregivers. The overall number of interventions increased from 46 456 in 2007 to 52 767 in 2012.
The percentage of low-complexity HCNI decreased from 57.5% in 2007 to 51.4% in 2012 while in the other three areasof the Local Health Unit decreased from 61.2% in 2007 to 59.6% in 2012.
The number of high-complexity HCNI rose from 11 295 (24.3% of interventions) in 2007 to 17 662 in 2012 (33.5% of interventions); the mean percentage of high-complexity HCNI of the other three areas remained 21.3%. The level of satisfaction, evaluated only in 2008-09, was high: 9.35 for patients and 9.1 for caregivers.
Conclusions
Our findings suggest that structured educationprogrammes for patients and caregivers allow nurses to dedicate themselves to more complex and appropriate tasks and lead to an increase of number and quality of home care nursing interventions
