Key result
Adherence to an integrated care program for frail older patients was 69% for successful hospital referral and 54% for completed follow-up visits, strongly influenced by organisational factors.
Why the study?
The influence of patient-specific and organisational factors on adherence to program guidelines in an integrated care program targeting older patients was not well understood.
What patient-specific and organisational factors influence adherence to an integrated care program for frail older patients post-discharge?
Cohort (n=1,659)
Yes
What patient-specific and organisational factors influence adherence to an integrated care program for frail older patients post-discharge?
Adherence to post-discharge integrated care programs for frail older patients is low and primarily driven by organisational barriers rather than patient-specific factors, highlighting challenges in vertical integration of care.
Organisational factors drove low adherence to post-discharge follow-up; leaves open whether targeting hospitals and municipalities improves vertical integration.
Introduction: This article explores the influence of patient-specific and organisational factors on adherence to program guidelines in an integrated care program targeting older patients.Methods: The integrated care program aimed to offer post-discharge follow-up visits by a municipality nurse and the general practitioner to frail older patients after discharge from hospital. Adherence was measured as step 1) successful referral from the hospital and step 2) completed post-discharge follow-up visit. We followed a cohort of 1,659 patients who were selected to receive a post-discharge follow-up visit in 2014. We obtained unique data from hospitals, municipalities and from administrative registers.Results: We found substantial lack of adherence in both steps of the program: 69% adherence in step 1 and 54% adherence in step 2. In step 1, adherence was related to hospital, and receiving municipal home care prior to admission. In step 2, level of adherence varied according to municipality, the type of general practitioner and the patient’s gender.Conclusion: We found that adherence was strongly related to organisational factors. Adherence differed significantly at all organisational levels (hospital, municipality, general practice), thus indicating challenges in the vertical integration of care. Gender influenced adherence as the only patient-related factor.
No takes yet. Share an insight, caveat, or question.
Lehn et al. (2019) conducted a cohort in frail older patients after discharge from hospital (n=1,659). Patient-specific and organisational factors was evaluated on Adherence to program guidelines (step 1: successful referral; step 2: completed post-discharge follow-up visit). Adherence to an integrated care program for frail older patients was 69% for successful hospital referral and 54% for completed follow-up visits, strongly influenced by organisational factors.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: