Affiliation:
1. Ingram School of Nursing, Faculty of Medicine and Health Sciences McGill University Montréal Québec Canada
2. Département des sciences infirmières Université du Québec en Outaouais Saint‐Jérôme Québec Canada
3. Maisonneuve‐Rosemont Hospital Site CIUSSS de l'Est‐de‐l'Île‐de‐Montréal du Québec Montréal Québec Canada
4. Direction des soins infirmiers et de la santé physique Centre intégré universitaire de santé et des services sociaux de la Capitale Nationale Quebec City Québec Canada
5. Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences McGill University Montréal Québec Canada
Abstract
AbstractRationaleHome care allows patients with functional limitations to receive services at home and prevent health decline. Home care can reduce hospitalization and emergency department (ED) transfers. Integrating primary healthcare nurse practitioners (PHCNPs) in home care increases the supply of services, but little is known about their influence on patients' ability to remain at home.Aims and ObjectivesEvaluate the influence of PHCNPs' interventions on hospitalizations and ED transfers in patients receiving care from interprofessional home care teams with PHCNPs.MethodThe retrospective cohort study employed multiple logistic regression and Cox modelling techniques to assess the influence of PHCNP interventions on hospitalizations and ED transfers. Descriptive and bivariate analyses examined sample characteristics and variable associations. Four purposively selected sites in Québec, Canada, were included. Data were collected from electronic health records of all patients (n = 343) receiving home care from these teams.ResultsThe characteristics of the sites, sample, and PHCNP interventions were described. Planned interventions led to a 5.8% decrease in hospitalizations and ED transfers (adjusted odds ratio [OR]: 0.058, p = 0.039), while unplanned interventions resulted in a 1.5‐fold increase in this outcome (adjusted OR: 1.518, p < 0.001). The risk of hospitalization and ED transfers increased by 10.7 times with unplanned interventions (adjusted OR: 10.651, p = 0.002). Furthermore, imaging was associated with a 2‐fold increased risk (adjusted OR: 1.954, p = 0.021), consultations with a 1.8‐fold increased risk (adjusted OR: 1.849, p = 0.034), and laboratory test‐related interventions after 30 or more days reduced the risk by 68.0% (adjusted OR: 0.320, p < 0.001).ConclusionsPHCNPs in interprofessional home care teams show promise in reducing hospitalizations and ED transfers through planned visits. These findings provide valuable insights that can contribute to enhancing home care services for a population with limited access to healthcare and high healthcare needs. Further research is needed in other jurisdictions.
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