Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial.

<h4>Objective</h4>To evaluate the effectiveness of a nurse-led hospital-to-home transitional care intervention versus usual care on mental functioning (primary outcome), physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service u...

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Autores principales:	Maureen Markle-Reid, Carrie McAiney, Kathryn Fisher, Rebecca Ganann, Alain P Gauthier, Gail Heald-Taylor, Janet E McElhaney, Fran McMillan, Penelope Petrie, Jenny Ploeg, Diana J Urajnik, Carly Whitmore
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f32d79b29fe344a4bf67dea72e889c98
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spelling	oai:doaj.org-article:f32d79b29fe344a4bf67dea72e889c982021-12-02T20:04:50ZEffectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial.1932-620310.1371/journal.pone.0254573https://doaj.org/article/f32d79b29fe344a4bf67dea72e889c982021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0254573https://doaj.org/toc/1932-6203<h4>Objective</h4>To evaluate the effectiveness of a nurse-led hospital-to-home transitional care intervention versus usual care on mental functioning (primary outcome), physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use costs in older adults with multimorbidity (≥ 2 comorbidities) and depressive symptoms.<h4>Design and setting</h4>Pragmatic multi-site randomized controlled trial conducted in three communities in Ontario, Canada. Participants were allocated into two groups of intervention and usual care (control).<h4>Participants</h4>127 older adults (≥ 65 years) discharged from hospital to the community with multimorbidity and depressive symptoms.<h4>Intervention</h4>This evidence-based, patient-centred intervention consisted of individually tailored care delivery by a Registered Nurse comprising in-home visits, telephone follow-up and system navigation support over 6-months.<h4>Outcome measures</h4>The primary outcome was the change in mental functioning, from baseline to 6-months. Secondary outcomes were the change in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use cost, from baseline to 6-months. Intention-to-treat analysis was performed using ANCOVA modeling.<h4>Results</h4>Of 127 enrolled participants (63-intervention, 64-control), 85% had six or more chronic conditions. 28 participants were lost to follow-up, leaving 99 (47 -intervention, 52-control) participants for the complete case analysis. No significant group differences were seen for the baseline to six-month change in mental functioning or other secondary outcomes. Older adults in the intervention group reported receiving more information about health and social services (p = 0.03) compared with the usual care group.<h4>Conclusions</h4>Although no significant group differences were seen for the primary or secondary outcomes, the intervention resulted in improvements in one aspect of patient experience (information about health and social services). The study sample fell below the target sample (enrolled 127, targeted 216), which can account for the non-significant findings. Further research on the impact of the intervention and factors that contribute to the results is recommended.<h4>Trial registration</h4>clinicaltrials.gov Identifier: NCT03157999.Maureen Markle-ReidCarrie McAineyKathryn FisherRebecca GanannAlain P GauthierGail Heald-TaylorJanet E McElhaneyFran McMillanPenelope PetrieJenny PloegDiana J UrajnikCarly WhitmorePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 7, p e0254573 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Maureen Markle-Reid Carrie McAiney Kathryn Fisher Rebecca Ganann Alain P Gauthier Gail Heald-Taylor Janet E McElhaney Fran McMillan Penelope Petrie Jenny Ploeg Diana J Urajnik Carly Whitmore Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial.
description	<h4>Objective</h4>To evaluate the effectiveness of a nurse-led hospital-to-home transitional care intervention versus usual care on mental functioning (primary outcome), physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use costs in older adults with multimorbidity (≥ 2 comorbidities) and depressive symptoms.<h4>Design and setting</h4>Pragmatic multi-site randomized controlled trial conducted in three communities in Ontario, Canada. Participants were allocated into two groups of intervention and usual care (control).<h4>Participants</h4>127 older adults (≥ 65 years) discharged from hospital to the community with multimorbidity and depressive symptoms.<h4>Intervention</h4>This evidence-based, patient-centred intervention consisted of individually tailored care delivery by a Registered Nurse comprising in-home visits, telephone follow-up and system navigation support over 6-months.<h4>Outcome measures</h4>The primary outcome was the change in mental functioning, from baseline to 6-months. Secondary outcomes were the change in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use cost, from baseline to 6-months. Intention-to-treat analysis was performed using ANCOVA modeling.<h4>Results</h4>Of 127 enrolled participants (63-intervention, 64-control), 85% had six or more chronic conditions. 28 participants were lost to follow-up, leaving 99 (47 -intervention, 52-control) participants for the complete case analysis. No significant group differences were seen for the baseline to six-month change in mental functioning or other secondary outcomes. Older adults in the intervention group reported receiving more information about health and social services (p = 0.03) compared with the usual care group.<h4>Conclusions</h4>Although no significant group differences were seen for the primary or secondary outcomes, the intervention resulted in improvements in one aspect of patient experience (information about health and social services). The study sample fell below the target sample (enrolled 127, targeted 216), which can account for the non-significant findings. Further research on the impact of the intervention and factors that contribute to the results is recommended.<h4>Trial registration</h4>clinicaltrials.gov Identifier: NCT03157999.
format	article
author	Maureen Markle-Reid Carrie McAiney Kathryn Fisher Rebecca Ganann Alain P Gauthier Gail Heald-Taylor Janet E McElhaney Fran McMillan Penelope Petrie Jenny Ploeg Diana J Urajnik Carly Whitmore
author_facet	Maureen Markle-Reid Carrie McAiney Kathryn Fisher Rebecca Ganann Alain P Gauthier Gail Heald-Taylor Janet E McElhaney Fran McMillan Penelope Petrie Jenny Ploeg Diana J Urajnik Carly Whitmore
author_sort	Maureen Markle-Reid
title	Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial.
title_short	Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial.
title_full	Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial.
title_fullStr	Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial.
title_full_unstemmed	Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial.
title_sort	effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: a pragmatic randomized controlled trial.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/f32d79b29fe344a4bf67dea72e889c98
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Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial.

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