Continuity of community nursing ‘improves patient outcomes’

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According to American researchers, having the same community nurse for home visits may prevent readmission of patients with dementia.

They found that people with dementia receiving home care visits were less likely to be readmitted to hospital when nursing staff were consistent.

“While continuity of nursing care can benefit all home care patients, it can be particularly critical for people with dementia.”

Chenjuan Ma

The results of the new study, conducted by researchers at New York University’s Rory Meyers College of Nursing, are published in the journal Medical care.

The researchers set out to determine whether continuity of care, or the same nurse coming every home visit, could help prevent readmission of patients.

Using several years of data from a large US nonprofit home care agency, researchers studied 23,886 elderly people with dementia who received home health care after admission.

They measured continuity of care as a function of the number of nurses and visits during home care, with a higher score indicating better continuity of care.

About 24% of the elderly with dementia in the study were readmitted from home health care. Infections, respiratory problems and heart disease were the three most common reasons.

Researchers have found large variations in the continuity of nursing care during home visits for people with dementia.

For example, 8% had no continuity of care, with a visit from a different nurse each time, while 26% received all visits from a nurse.

Notably, the increased continuity of home health care resulted in a lower risk of readmission, even after researchers controlled for other clinical risk factors and the average number of hours of care per week.

Compared with those with high nursing continuity, people with dementia receiving low or moderate nursing continuity were 30 to 33% more likely to be readmitted.

The study authors said: “Consistency of nurses during home care visits to people with dementia is essential to prevent rehospitalizations. “

To improve the continuity of nursing care, the researchers recommended addressing the shortage of community nurses, improving the coordination of care and “embracing” telehealth.

A “hybrid” model of care of in-person visits and telehealth could also potentially help ensure greater continuity of care, the researchers noted.

Dr Chenjuan Ma, assistant professor and lead author of the study, said, “As the population ages and the elderly choose to ‘age in place’ for as long as possible, the demand for home care for people with dementia is expected to increase rapidly.

“While continuity of nursing care can benefit all home care patients, it can be particularly critical for people with dementia,” she said.

“Having the same caregiver can increase familiarity, build trust and reduce confusion for patients and their families. “


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