A Randomized Trial Exploring the Effect of a Telephone Call Follow-up on Care Plan Compliance Among Older Adults Discharged Home From the Emergency Department
A Randomized Trial Exploring the Effect of a Telephone Call Follow-up on Care Plan Compliance Among Older Adults Discharged Home From the Emergency Department
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DOI：
10.1111/acem.12308
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发表时间：
2014-02-01
影响因子：
4.4
通讯作者：
Busby-Whitehead, Jan
中科院分区：
文献类型：
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作者：
Biese, Kevin;LaMantia, Michael;Busby-Whitehead, Jan
目的急诊科（ED）老年出院患者难以理解出院计划，且不良结局风险高。作者调查了出院后护士电话干预是否会提高出院护理计划的依从性，特别是通过加快急诊科就诊后医生随访预约和/或依从药物改变。第二个目标是确定这种电话干预是否会减少急诊回访和/或指数急诊回访后35天内住院，并确定这种干预的潜在成本节约。方法：对65岁及以上从学术急诊科出院回家的患者进行为期10周的随机对照试验。在每位患者的指数急诊科就诊后1至3天，一名训练有素的护士召集干预组患者回顾出院说明并协助其遵守出院计划；安慰剂组患者会接到患者满意度调查电话，而对照组患者则不接到电话。所有三组的数据收集电话分别在索引ED就诊后5至8天和30至35天进行。对分类数据进行卡方检验或Fisher精确检验，Kruskal-Wallis检验在随访时间上的组间差异。结果共120例患者完成研究。患者中女性占60%，白人占72%，平均年龄75岁（标准差[SD] 7.58岁）。干预组患者比安慰剂组或对照组患者更有可能在ED就诊后5天内与医疗服务提供者进行随访（分别为54%、20%和37%；p=0.04）。各组在药物获取、用药适应证及剂量的理解方面均表现良好。与安慰剂组或对照组患者相比，干预组患者在指标ED就诊后35天内回访急诊科或医院的次数没有差异（分别为22%、33%和27%；p=0.41）。一项经济分析显示，该干预措施降低总成本的可能性约为70%。结论对老年急诊科出院患者进行电话随访，加快了患者与初级保健医生的随访。需要进一步的研究来确定这些结果是否转化为改善患者预后，减少急诊回访或住院次数，以及这种干预措施是否节省了成本。
ObjectivesOlder patients discharged from the emergency department (ED) have difficulty comprehending discharge plans and are at high risk of adverse outcomes. The authors investigated whether a postdischarge telephone call-mediated intervention by a nurse would improve discharge care plan adherence, specifically by expediting post-ED visit physician follow-up appointments and/or compliance with medication changes. The second objectives were to determine if this telephone call intervention would reduce return ED visits and/or hospitalizations within 35days of the index ED visit and to determine potential cost savings of this intervention.MethodsThis was a 10-week randomized, controlled trial among patients aged 65 and older discharged to home from an academic ED. At 1 to 3days after each patient's index ED visit, a trained nurse called intervention group patients to review discharge instructions and assist with discharge plan compliance; placebo call group patients received a patient satisfaction survey call, while the control group patients were not called. Data collection calls occurred at 5 to 8days and 30 to 35days after the index ED visits for all three groups. Chi-square or Fisher's exact tests were performed for categorical data and the Kruskal-Wallis test examined group differences in time to follow-up.ResultsA total of 120 patients completed the study. Patients were 60% female and 72% white, with a mean age of 75years (standard deviation [SD] 7.58years). Intervention patients were more likely to follow up with medical providers within 5days of their ED visits than either the placebo or the control group patients (54, 20, and 37%, respectively; p=0.04). All groups performed well in medication acquisition and comprehension of medication indications and dosage. There were no differences in return visits to the ED or hospital within 35days of the index ED visit for intervention patients, compared to placebo or control group patients (22, 33, and 27%, respectively; p=0.41). An economic analysis showed an estimated 70% chance that this intervention would reduce total costs.ConclusionsTelephone call follow-up of older patients discharged from the ED resulted in expedited follow-up for patients with their primary care physicians. Further study is warranted to determine if these results translate into improved patient outcomes, decreased return ED visits or hospital admissions, and cost savings resulting from this intervention.