Emergency provider perspectives on facilitators and barriers to home and community services for older adults with serious life limiting illness: A qualitative study.
Emergency provider perspectives on facilitators and barriers to home and community services for older adults with serious life limiting illness: A qualitative study.
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DOI：
10.1371/journal.pone.0270961
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
老年人占急诊室就诊的很大比例，但那些患有严重生命限制性疾病的人可能从转诊到家庭和社区服务而不是住院中受益最多。我们的目标是记录紧急提供者的观点，促进者和障碍，以获得家庭和社区服务的老年人与严重的生命限制性疾病。我们对来自美国各地卫生系统的紧急服务提供者进行了访谈员管理的半结构化访谈，以获得提供者对获得家庭和社区服务的促进者和障碍的看法。我们完成了定性的主题分析，使用迭代过程来开发主题和子主题，以总结提供商的响应。我们采访了11个卫生系统的8名急诊护士和10名急诊医生。紧急服务提供者熟悉当地的家庭和社区服务。获得这些服务的促进者包括护理管理人员和社会工作者。障碍包括无法全职获得转诊服务、保险/付款以及急诊科的忙碌性质。最有帮助的报告服务是临终关怀，物理治疗，职业治疗和访问护理服务。以家庭为基础的姑息治疗和全职急诊科为基础的护理管理和社会工作是最希望的服务提供者。提供者表示支持改善家庭和社区服务，希望减少不必要的急诊和住院，并为患者提供更多的支持性护理选择。获得急诊提供者的观点强调了从急诊科为患有严重生命限制性疾病的老年人访问HCS的重要考虑因素。这项研究为未来的研究和改善直接从急诊科获得家庭和社区服务的举措提供了基础信息。
Older adults account for a large proportion of emergency department visits, but those with serious life-limiting illness may benefit most from referral to home and community services instead of hospitalization. We aim to document emergency provider perspectives on facilitators and barriers to accessing home and community services for older adults with serious life-limiting illness. We conducted interviewer-administered semi-structured interviews with emergency providers from health systems across the United States to obtain provider perspectives on facilitators and barriers to accessing home and community services. We completed qualitative thematic analysis using an iterative process to develop themes and subthemes to summarize provider responses. We interviewed 8 emergency nurses and 10 emergency physicians across 11 health systems. Emergency providers were familiar with local home and community services. Facilitators to accessing these services include care management and social workers. Barriers include services that are not accessible full-time to receive referrals, insurance/payment, and the busy nature of the emergency department. The most helpful reported services were hospice, physical therapy, occupational therapy, and visiting nursing services. Home-based palliative care and full-time emergency department-based care management and social work were the services most desired by providers. Providers expressed support for improving access to home and community services in the hopes of decreasing unnecessary emergency visits and inpatient admissions, and to provide patients with greater options for supportive care. Obtaining the perspective of emergency providers highlights important considerations to accessing HCS for older-adults with serious life-limiting illness from the emergency department. This study provides foundational information for futures studies and initiatives for improving access to home and community services directly from the emergency department.
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DOI：
10.3390/ijerph18158172
发表时间：
2021-08-02
影响因子：
--
作者：
Gualano MR;Sinigaglia T;Lo Moro G;Rousset S;Cremona A;Bert F;Siliquini R
通讯作者：
Siliquini R
影响因子：
4.7
作者：
Kiger, Michelle E.;Varpio, Lara
通讯作者：
Varpio, Lara
影响因子：
4.7
作者：
Grudzen, Corita R.;Richardson, Lynne D.;Morrison, R. Sean
通讯作者：
Morrison, R. Sean
影响因子：
2.9
作者：
Grudzen, Corita R.;Brody, Abraham A.;Zimny, Erin
通讯作者：
Zimny, Erin
DOI：
10.1001/jama.2018.8981
发表时间：
2018-07-17
期刊：
JAMA
影响因子：
--
作者：
Teno JM;Gozalo P;Trivedi AN;Bunker J;Lima J;Ogarek J;Mor V
通讯作者：
Mor V