Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.
BMC Geriatr. 2022 Apr 7;22(1):291. doi: 10.1186/s12877-022-02943-6.
Older adults frequently experience fall-related injuries, including hip fractures. Following a hip fracture, patients receive care across a number of settings and from multiple different providers. Transitions between providers and across settings have been noted as a vulnerable time, with potentially negative impacts. Currently, there is limited research on how to improve experiences with transitions in care following a hip fracture for older adults from the perspectives of those with lived experienced. The purpose of this study was to explore service recommendations made by patients, caregivers, healthcare providers, and decision-makers for improving transitions in care for older adults with hip fracture.
This descriptive qualitative study was part of a larger longitudinal qualitative multiple case study. Participants included older adults with hip fracture, caregivers supporting an individual with hip fracture, healthcare providers, and decision-makers. In-depth, semi-structured interviews were conducted with all participants, with patients and caregivers having the opportunity to participate in follow-up interviews as they transitioned out of hospital. All interviews were audio-recorded, transcribed verbatim, and analyzed thematically.
A total of 47 participants took part in 65 interviews. We identified three main categories of recommendations: (1) hospital-based recommendations; (2) community-based recommendations; and (3) cross-sectoral based recommendations. Hospital-based recommendations focused on treating patients and families with respect, improving the consistency, frequency, and comprehensiveness of communication between hospital providers and between providers and families, and increasing staffing levels. Community-based recommendations included the early identification of at-risk individuals and providing preventative and educational programs. Cross-sectoral based recommendations were grounded in enhanced system navigation through communication and care navigators, particularly within primary and community care settings.
Our findings highlighted the central role primary care can play in providing targeted, integrated services for older adults with hip fracture. The recommendations outlined have the potential to improve experiences with care transitions for older adults with hip fracture, and thus, addressing and acting on them should be a priority.
老年人经常发生与跌倒相关的伤害，包括髋部骨折。髋部骨折后，患者在多个环境中接受来自多个不同提供者的护理。在提供者之间以及在环境之间的过渡被认为是一个脆弱的时期，可能会产生负面影响。目前，从有过实际经验的人的角度来看，关于如何改善老年人髋部骨折后护理过渡体验的研究有限。本研究的目的是探讨患者、照顾者、医疗保健提供者和决策者提出的改善髋部骨折老年人护理过渡的服务建议。
这是一项描述性定性研究，是一项更大的纵向定性多案例研究的一部分。参与者包括髋部骨折的老年人、支持髋部骨折患者的照顾者、医疗保健提供者和决策者。对所有参与者进行了深入的半结构化访谈，髋部骨折患者和照顾者有机会在他们从医院出院时参加随访访谈。所有访谈均进行录音、逐字记录，并进行主题分析。
共有 47 名参与者参加了 65 次访谈。我们确定了三类主要建议：（1）基于医院的建议；（2）基于社区的建议；（3）基于跨部门的建议。基于医院的建议侧重于尊重患者和家庭，提高医院提供者之间以及提供者与家庭之间沟通的一致性、频率和全面性，并增加人员配备水平。基于社区的建议包括早期识别高危人群，并提供预防和教育计划。基于跨部门的建议基于通过沟通和护理导航员增强系统导航，特别是在初级和社区护理环境中。
我们的研究结果强调了初级保健在为髋部骨折老年人提供有针对性、综合服务方面可以发挥的核心作用。概述的建议有可能改善髋部骨折老年人的护理过渡体验，因此，解决这些问题并采取行动应是当务之急。
