Martinez Laure, Lacour Noémie, Gonthier Régis, Bonnefoy Marc, Goethals Luc, Annweiler Cedric, Salles Nathalie, Jomard Nathalie, Bohatier Jérôme, Tardy Magali, Ojardias Etienne, Jugand Romain, Bongué Bienvenu, Celarier Thomas
Department of Clinical Gerontology, University Hospital of Saint-Etienne, Saint Etienne, France.
Department of Clinical Gerontology, Firminy Hospital, Firminy, France.
JMIR Res Protoc. 2020 Feb 13;9(2):e15423. doi: 10.2196/15423.
In France, emergency departments (EDs) are the fastest and most common means for general practitioners (GPs) to cope with the complex issues presented by elderly patients with multiple conditions. EDs are overburdened, and studies show that being treated in EDs can have a damaging effect on the health of elderly patients. Outpatient care or planned hospitalizations are possible solutions if appropriate geriatric medical advice is provided. In 2013, France's regional health authorities proposed creating direct telephone helplines, "geriatric hotlines," staffed by geriatric specialists to encourage interactions between GP clinics and hospitals. These hotlines are designed to improve health care pathways and the health status of the elderly.
This study aims to describe the health care pathways and health status of patients aged 75 years and older hospitalized in short-stay geriatric wards following referral from a geriatric hotline.
The study will be conducted over 24 months in seven French university hospital centers. It will include all patients aged 75 and older, living in their own homes or nursing homes, who are admitted to short-stay geriatric wards following hotline consultation. Two questionnaires will be filled out by medical staff at specific time points: (1) after conducting the telephone consultation and (2) on admitting the patient to a short-stay geriatric medical care. The primary endpoint will be mean hospitalization duration. The secondary endpoints will be intrahospital mortality rate, the characteristics of patients admitted via the hotline, and the types of questions asked and responses given via the hotline.
The study was funded by the National School for Social Security Loire department (École Nationale Supérieure de Sécurité Sociale) and the Conference for funders of prevention of autonomy loss for the elderly of the Loire department in November 2017. Institutional review board approval was obtained in April 2018. Data collection started in May 2018; the planned end date for data collection is May 2020. Data analysis will take place in the summer of 2020, and the first results are expected to be published in late 2020.
The results will reveal whether geriatric hotlines provide the most effective management of elderly patients, as indicated by shorter mean hospitalization durations. Shorter hospital durations could lead to a reduced risk of complications-geriatric syndromes-and the domino chain of geriatric conditions that follow. We will also describe different geriatric hotlines from different cities and compare how they function to improve the health care of the elderly and pave the way toward new advances, especially in the organization of the care path.
ClinicalTrials.gov NCT03959475; https://clinicaltrials.gov/ct2/show/NCT03959475.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15423.
在法国，急诊科是全科医生应对患有多种疾病的老年患者所呈现的复杂问题的最快且最常见的途径。急诊科负担过重，研究表明在急诊科接受治疗可能会对老年患者的健康产生不利影响。如果能提供适当的老年医学建议，门诊护理或计划性住院治疗是可行的解决方案。2013年，法国地方卫生当局提议设立由老年医学专家值守的直接电话求助热线“老年热线”，以促进全科医生诊所与医院之间的互动。这些热线旨在改善医疗保健途径以及老年人的健康状况。
本研究旨在描述在老年热线转诊后入住短期老年病房的75岁及以上患者的医疗保健途径和健康状况。
该研究将在法国的七个大学医院中心进行，为期24个月。研究对象将包括所有75岁及以上、居住在自己家中或养老院、在热线咨询后入住短期老年病房的患者。医护人员将在特定时间点填写两份问卷：(1) 在进行电话咨询后；(2) 在患者入住短期老年医疗护理病房时。主要终点将是平均住院时间。次要终点将是院内死亡率、通过热线入院患者的特征，以及通过热线提出的问题类型和给出的答复。
该研究由法国国家社会保障卢瓦尔省学校（École Nationale Supérieure de Sécurité Sociale）和卢瓦尔省老年人自主性丧失预防资助者会议于2017年11月资助。2018年4月获得了机构审查委员会的批准。数据收集于2018年5月开始；计划的数据收集截止日期为2020年5月。数据分析将于2020年夏季进行，预计首批结果将于2020年底公布。
结果将揭示老年热线是否能像平均住院时间缩短所表明的那样，为老年患者提供最有效的管理。缩短住院时间可能会降低并发症——老年综合征——以及随之而来的老年疾病多米诺链的风险。我们还将描述来自不同城市的不同老年热线，并比较它们在改善老年人医疗保健方面的运作方式，为新的进展铺平道路，尤其是在护理路径的组织方面。
ClinicalTrials.gov NCT03959475；https://clinicaltrials.gov/ct2/show/NCT03959475。
国际注册报告识别码（IRRID）：DERR1-10.2196/15423。
