Introduction
The current study focused on researching the effectiveness of telephone-based and online care versus nursing home visits in the population of post-acute care patients aged sixty-five and older. The problem is significant due to the lack of available personnel to perform nursing home duties as well as the fact that visits are time-consuming, especially when facilities are far from health care centers. The purpose of the research was to develop an intervention to increase the efficiency and quality of transitional post-acute care among elderly patients through the use of telephone-based and online services.
Sampling, Procedures, Timeframe, and Tools
The current research was a randomized controlled trial that enrolled 200 participants for both control and intervention groups. Potential research subjects were recruited from three hospitals specializing in acute care; relevant data on eligible participants were collected by nurses and physicians that supervised the patients’ recovery process. Importantly, an agreement on the inclusion of patients was obtained from the hospitals’ administration. Thirty-five medical professionals were recruited for participating in telephone-based and online interactions with patients as well as nursing home visits. All professionals who participated in the research gave informed consent and were provided with all necessary information on the project’s timeframe, its scope, aims, and relevant procedures. Altogether, the project took twenty-two months to complete, including the final analysis and the writing of the research article.
In order to randomly assign participants to either control or intervention groups, GraphPad was used. For the intervention group, participants were asked to use a telephone and web-based technologies for communicating with their healthcare providers. The control group of participants was instructed to use traditional face-to-face interactions with their nursing professionals in post-acute transitional care. Surveys and questionnaires were used for evaluating the effectiveness of either type of care and whether they were more or less successful in preventing adverse health outcomes. The whole sample of participants was involved in the process of data collection for ensuring an unbiased analysis. It was estimated that the research would need approximately $25,000 on medical personnel’s financial rewards, $5,000-$6,000 on data collection of patients, $15,000 on study implementation, and $5,000 on the analysis of collected data. After the research was completed, it was calculated that the financial reward of personnel cost $28,000, data collection needed $5,000, $10,000 was needed for study implementation, and $6 was spent on data analysis. The final spending was by $2,000 less than expected.
While the outline baseline characteristics were expected to be the most appropriate tool used in the randomized controlled trial, the researchers used subgroup analysis for looking for different patterns between intervention and control groups. However, due to the possible limitations of subgroup analysis, it was proposed to divide subgroup analysis “into preplanned and posthoc subgroup analysis” (Landewe, 2009, p. 2). A preplanned analysis was conducted first and implied the analysis of subgroups of particular relevance to a research. For instance, differences between male and female patient outcomes post-discharge were measured; also, the researcher identified disparities in patients’ access to telephone- and online-based communication. Pre-specified subgroup analysis can minimize the risk of non-adherence to intervention with significant positive effects of the analyzed subgroups (Desai, Pieper, & Mahaffey, 2014). Post-hoc subgroup analysis, on the other hand, is not specified prior to data examination and is therefore associated with the testing of an initial hypothesis. It is also important to mention that subgroup analysis was deemed appropriate for the current study because the primary efficacy endpoint of the intervention was achieved previously and thus there was an objective of examining its efficacy across the sampled population in a more detailed manner.
Results and Findings
In the population of post-acute care patients aged sixty-five and older, the effectiveness of telephone-based and online care showed similar and in some cases better health outcomes in comparison with traditional nursing home visits. In the first months after being discharged from a health care facility, the outcomes of both intervention and control groups did not differ. However, the quality of life and self-efficacy of patients who followed the online and telephone-based care continued to steadily increase while those patients who were visited by nurses based on standardized protocols reported an improvement, which eventually stopped and remained on the same level. The intervention group of patients reported higher independence and improved procedures of self-care that were based on the recommendations given by their nurses.
The preliminary evaluation of the sample of participants revealed similar levels of quality of life and well-being after being discharged from a hospital and preparing for a transition to post-acute care for both intervention and control groups. However, the preplanned subgroup analysis supported the hypothesis that telephone- and online-based care within the population of patients 65 and older could be as effective as nursing home visits. While the subgroup of patients visited in nursing homes exhibited high levels of confidence in their recovery due to the trust in standardized procedures of care, the subgroup that received telephone and online-based care also revealed a positive outlook on future recovery.
Surveys and questionnaires conducted for the purpose of examining participants’ perceptions of the quality of care they received were useful in determining specific trends that both subgroups followed. The researchers found that there was uncertainty on the part of the intervention group regarding the effectiveness of innovative models of care due to the lack of prior experiences with such procedures. Participants indicated that despite having a positive outlook, the lack of face-to-face interactions with their nurses could hinder the process of recovery since some information could be lost or forgotten. On the other hand, the control group that only received traditional care was worried that nursing home visits would not be enough for a comprehensive assessment of their health conditions because some issues could arise when nurses were not there and therefore were unable to give advice in a timely manner.
Discussion
The findings of the research show that telephone- and online-based care for post-acute patients aged 65 and older is a viable strategy that can enhance patient-nurse collaboration and facilitate the development of effective self-care practices that promote independence (Johnston, Rogerson, Macjauskiene, Blaževičienė, & Cholewka, 2014). While traditional nursing home visits were also shown to benefit patients because they relied on their health care providers completely, the findings suggested that self-efficacy and independence levels were lower in comparison to the intervention group. In addition, the results of the surveys and questionnaires conducted among study participants pointed to the trend of patients being worried about not getting the advice of their nurses at times when they needed it. However, the intervention group reported having fewer worries about it because they were able to call or email their nurses more regularly compared to the control group that was only visited in nursing homes. Overall, the study provided a solid background for future research targeted at the exploration of practices that enhance nurse-patient collaboration and make patients more independent during their post-acute care.
Limitations
During the research, it was revealed that thirty-five nurses were not enough to address the needs of two hundred patients. Therefore, the limited size of the personnel was the first disadvantage of the research. It is possible that both intervention and control groups would have reported better health outcomes if the sample size of nurses enrolled in the study had been larger. Generalization was another limitation to the study because the researchers were unable to study each patient’s case separately and looked at general trends within the subgroups to identify how the studied population was adhering to different methods of care (Polit & Beck, 2010). Such generalizations hinder the validity of the results and make researchers come to conclusions that lack specification and therefore can be interpreted differently depending on how reviewers perceive them.
Implications for Practice
Because the research gave a positive indication that telephone- and online-based care could be successfully used for the post-acute population of patients aged 65 and older, the implications for future practice were vast. Nurses should look into introducing such models of care in order to save time and improve collaboration and understanding between them and the patients they serve. The research also serves as an opportunity for patient education on how to use technologies for communicating with their health care providers and improving their independence when adhering to post-acute treatment. Healthcare facilities should consider telephone- and online-based care for cost-efficiency and to save the time of nurses who are usually burdened by a variety of tasks and assignments that take a lot of time and effort.
References
Desai, M., Pieper, K. S., & Mahaffey, K. (2014). Challenges and solutions to pre- and post-randomization subgroup analyses. Current Cardiology Reports, 16(10), 531-536.
Johnston, B., Rogerson, L., Macijauskiene, J., Blaževičienė, A., & Cholewka, P. (2014). An exploration of self-management support in the context of palliative nursing: A modified concept analysis. BMC Nursing, 13, 21-24.
Landewe, R. (2009). What should be reported in clinical trials. Rheumatoid Arthritis, 11, 394-402.
Polit, D., & Beck, C. (2010). Generalization in quantitative and qualitative research: Myths and strategies. International Journal of Nursing Studies, 41(11), 1451-1458.