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  • 1
    Online Resource
    Online Resource
    Effects of a transitional care programme on medication adherence in an older cardiac population: A randomized clinical trial
    Wiley ; 2022
    In:  British Journal of Clinical Pharmacology Vol. 88, No. 3 ( 2022-03), p. 965-982
    Details
    In: British Journal of Clinical Pharmacology, Wiley, Vol. 88, No. 3 ( 2022-03), p. 965-982
    Abstract: Medication non‐adherence post‐discharge is common among patients, especially those suffering from chronic medical conditions, and contributes to hospital admissions and mortality. This study aimed to evaluate the effect of the Cardiac Care Bridge (CCB) intervention on medication adherence post‐discharge. Methods We performed a secondary analysis of the CCB randomized single‐blind trial, a study in patients ≥70 years, at high risk of functional loss and admitted to cardiology departments in six hospitals. In this multi‐component intervention study, community nurses performed medication reconciliation and observed medication‐related problems (MRPs) during post‐discharge home visits, and pharmacists provided recommendations to resolve MRPs. Adherence to high‐risk medications was measured using the proportion of days covered (PDC), using pharmacy refill data. Furthermore, MRPs were assessed in the intervention group. Results For 198 (64.7%) of 306 CCB patients, data were available on adherence (mean age: 82 years; 58.9% of patients used a multidose drug dispensing [MDD] system). The mean PDC before admission was 92.3% in the intervention group ( n  = 99) and 88.5% in the control group ( n  = 99), decreasing to 85.2% and 84.1% post‐discharge, respectively (unadjusted difference: −2.6% (95% CI −9.8 to 4.6, P  = .473); adjusted difference −3.3 (95% CI −10.3 to 3.7, P  = .353)). Post‐hoc analysis indicated that a modest beneficial intervention effect may be restricted to MDD non‐users ( P interaction  = .085). In total, 77.0% of the patients had at least one MRP post‐discharge. Conclusions Our findings indicate that a multi‐component intervention, including several components targeting medication adherence in older cardiac patients discharged from hospital back home, did not benefit their medication adherence levels. A modest positive effect on adherence may potentially exist in those patients not using an MDD system. This finding needs replication.
    Type of Medium: Online Resource
    ISSN: 0306-5251 , 1365-2125
    URL: Issue
    URL: Article
    DOI: 10.1111/bcp.v88.3
    DOI: 10.1111/bcp.15044
    RVK:
    XA 33650
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 1498142-7
    SSG: 15,3
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  • 2
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    The course of readmission in frail older cardiac patients
    Wiley ; 2021
    In:  Journal of Advanced Nursing Vol. 77, No. 6 ( 2021-06), p. 2807-2818
    Details
    In: Journal of Advanced Nursing, Wiley, Vol. 77, No. 6 ( 2021-06), p. 2807-2818
    Abstract: The aim of this study is to explore patients’ and (in)formal caregivers’ perspectives on their role(s) and contributing factors in the course of unplanned hospital readmission of older cardiac patients in the Cardiac Care Bridge (CCB) program. Design This study is a qualitative multiple case study alongside the CCB randomized trial, based on grounded theory principles. Methods Five cases within the intervention group, with an unplanned hospital readmission within six months after randomization, were selected. In each case, semi‐structured interviews were held with patients ( n  = 4), informal caregivers ( n  = 5), physical therapists ( n  = 4), and community nurses ( n  = 5) between April and June 2019. Patients’ medical records were collected to reconstruct care processes before the readmission. Thematic analysis and the six‐step analysis of Strauss & Corbin have been used. Results Three main themes emerged. Patients experienced acute episodes of physical deterioration before unplanned hospital readmission. The involvement of (in)formal caregivers in adequate observation of patients’ health status is vital to prevent rehospitalization (theme 1). Patients and (in)formal caregivers’ perception of care needs did not always match, which resulted in hampering care support (theme 2). CCB caregivers experienced difficulties in providing care in some cases, resulting in limited care provision in addition to the existing care services (theme 3). Conclusion Early detection of deteriorating health status that leads to readmission was often lacking, due to the acuteness of the deterioration. Empowerment of patients and their informal caregivers in the recognition of early signs of deterioration and adequate collaboration between caregivers could support early detection. Patients’ care needs and expectations should be prioritized to stimulate participation. Impact (In)formal caregivers may be able to prevent unplanned hospital readmission of older cardiac patients by ensuring: (1) early detection of health deterioration, (2) empowerment of patient and informal caregivers, and (3) clear understanding of patients’ care needs and expectations.
    Type of Medium: Online Resource
    ISSN: 0309-2402 , 1365-2648
    URL: Issue
    URL: Article
    DOI: 10.1111/jan.v77.6
    DOI: 10.1111/jan.14828
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2009963-0
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  • 3
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    Online Resource
    The Cardiac Care Bridge randomized trial in high‐risk older cardiac patients: A mixed‐methods process evaluation
    Wiley ; 2021
    In:  Journal of Advanced Nursing Vol. 77, No. 5 ( 2021-05), p. 2498-2510
    Details
    In: Journal of Advanced Nursing, Wiley, Vol. 77, No. 5 ( 2021-05), p. 2498-2510
    Abstract: To evaluate healthcare professionals' performance and treatment fidelity in the Cardiac Care Bridge (CCB) nurse‐coordinated transitional care intervention in older cardiac patients to understand and interpret the study results. Design A mixed‐methods process evaluation based on the Medical Research Council Process Evaluation framework. Methods Quantitative data on intervention key elements were collected from 153 logbooks of all intervention patients. Qualitative data were collected using semi‐structured interviews with 19 CCB professionals (cardiac nurses, community nurses and primary care physical therapists), from June 2017 until October 2018. Qualitative data‐analysis is based on thematic analysis and integrated with quantitative key element outcomes. The analysis was blinded to trial outcomes. Fidelity was defined as the level of intervention adherence. Results The overall intervention fidelity was 67%, ranging from severely low fidelity in the consultation of in‐hospital geriatric teams (17%) to maximum fidelity in the comprehensive geriatric assessment (100%). Main themes of influence in the intervention performance that emerged from the interviews are interdisciplinary collaboration, organizational preconditions, confidence in the programme, time management and patient characteristics. In addition to practical issues, the patient's frailty status and limited motivation were barriers to the intervention. Conclusion Although involved healthcare professionals expressed their confidence in the intervention, the fidelity rate was suboptimal. This could have influenced the non‐significant effect of the CCB intervention on the primary composite outcome of readmission and mortality 6 months after randomization. Feasibility of intervention key elements should be reconsidered in relation to experienced barriers and the population. Impact In addition to insight in effectiveness, insight in intervention fidelity and performance is necessary to understand the mechanism of impact. This study demonstrates that the suboptimal fidelity was subject to a complex interplay of organizational, professionals' and patients' issues. The results support intervention redesign and inform future development of transitional care interventions in older cardiac patients.
    Type of Medium: Online Resource
    ISSN: 0309-2402 , 1365-2648
    URL: Issue
    URL: Article
    DOI: 10.1111/jan.v77.5
    DOI: 10.1111/jan.14786
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2009963-0
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