Improving Patient Activation among Older Veterans: Results from a Social Worker-Led Care Transitions Intervention.

Autor:	Koufacos NS; Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA., May J; Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA., Judon KM; Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA., Franzosa E; Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA.; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA., Dixon BE; Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA.; Department of Epidemiology, Indiana University, Fairbanks School of Public Health, Indianapolis, Indiana, USA.; Center for Biomedical Informatics, Regenstrief Institute, Center for Biomedical Informatics, Indianapolis, Indiana, USA., Schubert CC; Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA.; Department of Medicine, Indiana University, School of Medicine, Indianapolis, Indiana, USA., Schwartzkopf AL; Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA., Guerrero VM; Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA., Traylor M; Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA., Boockvar KS; Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA.; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Jazyk:	angličtina
Zdroj:	Journal of gerontological social work [J Gerontol Soc Work] 2022 Jan; Vol. 65 (1), pp. 63-77. Date of Electronic Publication: 2021 May 30.
DOI:	10.1080/01634372.2021.1932003
Abstrakt:	Older veterans enrolled in the Veterans Health Administration (VHA) often use both VHA and non-VHA providers for their care. This dual use, especially around an inpatient visit, can lead to fragmented care during the time of transition post-discharge. Interventions that target patient activation may be valuable ways to help veterans manage complex medication regimens and care plans from multiple providers. The Care Transitions Intervention (CTI) is an evidence-based model that helps older adults gain confidence and skills to achieve their health goals post-discharge. Our study examined the impact of CTI upon patient activation for veterans discharged from non-VHA hospitals. In total, 158 interventions were conducted for 87 veterans. From baseline to follow-up there was a significant 1.7-point increase in patient activation scores, from 5.4 to 7.1. This association was only found among those who completed the intervention. The most common barriers to completion were difficulty reaching the veteran by phone, patient declining the intervention, and rehospitalization during the 30 days post-discharge. Care transitions guided by social workers may be a promising way to improve patient activation. However, future research and practice should address barriers to completion and examine the impact of increased patient activation on health outcomes.
Databáze:	MEDLINE
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