Key result
Frail older cardiac patients appreciated the continuity of care and post-discharge support from the transitional care intervention, though recovery experiences varied and some preferred their existing care networks.
Why the study?
Older cardiac patients face high risk of readmission and mortality, but transitional care interventions showed neutral outcomes; exploring patient experiences was intended to help interpret those results and inform future intervention design.
Qualitative interviews revealed that frail older cardiac patients appreciated the continuity of care from a nurse-coordinated transitional care intervention, though perceived recovery benefits varied and existing care networks influenced engagement.
Supports continuity-focused transitional care for frail cardiac patients while respecting preferences; extends RCT evidence with qualitative acceptability data.
BACKGROUND: Older cardiac patients are at high risk of readmission and mortality. Transitional care interventions (TCIs) might contribute to the prevention of adverse outcomes. The Cardiac Care Bridge program was a randomized nurse-coordinated TCI combining case management, disease management and home-based rehabilitation for hospitalized frail older cardiac patients. This qualitative study explored the experiences of patients' participating in this study, as part of a larger process evaluation as this might support interpretation of the neutral study outcomes. In addition, understanding these experiences could contribute to the design and application of future transitional care interventions for frail older cardiac patients. METHODS: A generic qualitative approach was used. Semi-structured interviews were performed with 16 patients ≥70 years who participated in the intervention group. Participants were selected by gender, diagnosis, living arrangement and hospital of inclusion. Data were analysed using thematic analysis. In addition, quantitative data about intervention delivery were analysed. RESULTS: Three themes emerged from the data: 1) appreciation of care continuity; 2) varying experiences with recovery and, 3) the influence of an existing care network. Participants felt supported by the transitional care intervention as they experienced post-discharge support and continuity of care. The perceived contribution of the program in participants' recovery varied. Some participants reported physical improvements while others felt impeded by comorbidities or frailty. The home visits by the community nurse were appreciated, although some participants did not recognize the added value. Participants with an existing healthcare provider network preferred to consult these providers instead of the providers who were involved in the transitional care intervention. CONCLUSION: Our results contribute to an explanation of the neutral study of a nurse-coordinated transitional care intervention. For future purpose, it is important to identify which patients might benefit most from TCIs. Furthermore, the intensity and content of TCIs could be more personalized by tailoring interventions to older cardiac patients' needs, considering their frailty, self-management skills and existing formal and informal caregiver networks.
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Jepma et al. (2021) studied Frail older cardiac patients (n=16). Nurse-coordinated transitional care intervention (Cardiac Care Bridge program) was evaluated on Patient experiences (qualitative themes). Frail older cardiac patients appreciated the continuity of care and post-discharge support from the transitional care intervention, though recovery experiences varied and some preferred their existing care networks.
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