south west essex community services are patients admitted to the virtual ward satisfied with the...
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South West Essex Community Services
Are Patients Admitted to the Virtual Ward Satisfied with the Intervention of the Community Matron in their Care Pathway?
Geraldine Rodgers
Dr. Maria Ponto
South West Essex Community Services
Plan of Presentation
Aims & objectives with background
Literature review
Research design
Methods
Findings
Discussion
Conclusion
South West Essex Community Services
Aims and Objectives
Explore whether the intervention of the Community Matron Improves patients satisfaction of care provided
Prevents admission and re-admission to hospital
AIMS
Identify whether patients are satisfied with the intervention of the Community Matron
Ascertain whether A&E attendances are reduced using the Combined Risk Model Algorithm
Compare A&E figures to a control sample of 10 patients who declined to be case managed by the Community Matron
Determine whether positive patient satisfaction scores provide a useful benchmark for the evaluation of the virtual ward
OBJECTIVES
South West Essex Community Services
Background
Introduction of the Role of Community Matron for Long Term Conditions
Virtual Ward Project in Croydon - 10 Community Matrons
Algorithm: Combined Predictive Model - Evidence based forecast
2005
The National Service Framework for Long-term
Conditions
Government Targets: Reduce Hospital
admissions by 5% by 2008
South West Essex Community Services
Key Literature Review Community Matron: New clinical role
• Few studies at the beginning of project - more studies at the later stage of project
Only three qualitative studies [ Brown (2008) Sargent (2007) , and Bowler (2009)]during this period.
Four studies based on quantitative projects [ Gravelle (2007), Wright (2007), Clegg(2008), & Leighton (2008)]
In each of the studies the Community Matron was the primary focus but not the virtual ward as was a new concept
No community matron study had used IPA
South West Essex Community Services
Research Design
Semi structured interviews
Interpretative Phenomenological Analysis (IPA)
Qualitative approach
Patients under 18
Patients with cognitive impairment
Methodology of data capture
Sampling methodology
Sample size
Population
Exclusion criteria
Random selection (50)
All registered Croydon patients
11 patients
Top 3% selected by Combined Model Predictive Tool
South West Essex Community Services
Characteristics of the Study Participants
Sex
Male 7
Female 4
Age (years)
Range 53 - 89
Arithmetic mean 72
Ethnicity
Iranian 1
Afro-Caribbean 2
Sri Lankan 1
White British 7
Geographic coverage
Suburbs covered 10
Period of admission to the virtual ward (months)
Range 8 - 37
Arithmetic mean 20
Ch
ara
cteristic
s o
f the
Stu
dy
Pa
rticipa
nts
South West Essex Community Services
Analysis
Interpretative Phenomenological Analysis (IPA) used to analyse data for emergent themes derived from patient experiences
IPA is a phenomenological method founded by Smith (1997)
South West Essex Community Services
Findings – Primary Themes
1. Patient perception of community matron
2. Confidence gained
3. Reassurance
4. A&E attendance & avoidance
5. Feelings
6. Virtual ward experience
South West Essex Community Services
Data Analysis
South West Essex Community Services
1 Patient perception of the community matron
All 11 participants were positive about the role
2 Confidence gained 9 participants said they gained confidence
3 Reassurance 7 participants referred to reassurance
4 A&E attendance & avoidance
7 monitored their admission avoidance
5 Feelings 10 commented on the phenomena of living with a long term condition
6 Virtual ward experience All commented on a feeling of belonging / good service
Discussion
South West Essex Community Services
Theme 4: A&EComparison of Algorithm Scores between Admission Date and Most
Recent Iteration
0
10
20
30
40
50
60
70
80
90
100
1 2 3 4 5 6 7 8 9 10 11
Patient
% S
co
re
At Admission
Current
South West Essex Community Services
Conclusions and Reflection
• The role community matrons were valued and increased patient satisfaction is evident in this study
• Admission avoidance & reduction was evident
• IPA provided a definite strength to study –holistic perspective
South West Essex Community Services
References
Bowler, M. (2009) Exploring patient’s experience of a community matron service using storybooks. Nursing Times, 105(24): 19-21
Brown, K., Stainer, K., Stewart, J., Clacy, R., and Parker, S. (2008) Older people with complex long-term conditions. Their views on the community matron service: a qualitative study. Quality in Primary Care: 16; 409-417
Clegg, A. & Bee, A.(2008) Community matrons: patients’ and carers’ views of a new service. Nursing Standard vol 22(47) p 35-39
Gravelle, H., Dusheiko, M., Sheaff, R et al. (2007) Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data. British Medical Journal.334, 7583,31
Great Britain. Department of Health. (2004) The NHS Improvement Plan: Putting People at the Heart of Public Services, London, Department of Health. The Stationery Office, London
Great Britain. Department of Health. (2005a) Supporting people with long-term conditions: an NHS and social care model. The Stationery Office, London
Great Britain. Department of Health. (2005b) Supporting people with long term conditions: liberating the talents of nurses who care for people with long term conditions. The Stationery Office, London
Great Britain. Department of Health. (2005) National Service Framework for Long Term Conditions. The Stationery Office, London
Great Britain. Department of Health. (2006) Caring for people with long term conditions: an education framework for community matrons and case managers. The Stationery Office, London.
South West Essex Community Services
References Great Britain. Department of Health. (2006) Your health, your care, your say: A new direction for community services – an overview. The Stationery Office, London
Great Britain. Department of Health. (2007) NHS Next Stage Review: interim report. The Stationery Office, London
Great Britain. Department of Health. (2008) Your health your way. A guide to long term conditions and self care. The Stationery Office, London
Great Britain. Department of Health. (2008) High quality care for all- NHS Next Stage Review- Final Report. The Stationery Office, London
Leighton, Y., Clegg, A. and Bee, A. (2008) evaluation of community matron services in a large metropolitan city in England. Quality in Primary Care.16: 83-9
Smith, J.A., Flowers, P., & Osborn, M. (1997) Interpretative phenomenological analysis & health psychology. In L Yardley(Ed).Material Discourses & Health. London: Routledge
Sargent , P; Pickard, P, Sheaff, S; & Boaden, R. (2007) Patient and carer perceptions of case management for long term conditions. Health and Social Care in the Community. 15(6), 511- 519
Wright, K., Ryder, S., and Gousy, M. (2007) Community Matrons improve health : Patients’ perspectives'. British Journal of Community Nursing. 12(10) 453-459
Self care: a national view in 2007 compared to 2004-05. London : DH, Web publication
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance (Accessed 4 July 2009)
South West Essex Community Services
Contact Information
Geraldine Rodgers; Nurse consultant for Adults & Older People
Dr Maria Ponto : Principal Lecturer, Course Director, MSc Healthcare Education and Clinical Leadership . Visiting Professor to Kemi-Tornio University in Finland