Extensivist: improving the delivery of enhanced health in older people's care homes.

Autor:	Ma N; Department of Ageing & Health, Guy's and St Thomas' NHS Foundation Trust, London, UK., Stanley G; Quay Health Solutions, London, UK., Miller D; Quay Health Solutions, London, UK., Ajagunna D; Guy's and St Thomas' NHS Foundation Trust, London, UK., Jones N; Guy's and St Thomas' NHS Foundation Trust, London, UK., Kinirons M; Department of Ageing & Health, Guy's and St Thomas' NHS Foundation Trust, London, UK., Dallmeyer R; Quay Health Solutions, London, UK., Kalsi T; Department of Ageing & Health, Guy's and St Thomas' NHS Foundation Trust, London, UK tania.1.kalsi@kcl.ac.uk.; CARICE, Faculty of Life Sciences & Medicine, King's College London, London, UK.
Jazyk:	angličtina
Zdroj:	BMJ open quality [BMJ Open Qual] 2024 Oct 02; Vol. 13 (4). Date of Electronic Publication: 2024 Oct 02.
DOI:	10.1136/bmjoq-2023-002705
Abstrakt:	Background: Older people living in care homes are often frail and clinically complex. The Enhanced Health in Care Homes (EHCH) framework supports organisational and clinical strategies to deliver good care, promoting proactive person-centred care by whole system collaboration. We evaluate the impact of a new role, the Extensivist, in the delivery of EHCH for older people living in care homes. Aims: To evaluate implementation processes and the clinical utility of the Extensivist in older people care homes in the London borough of Southwark. Methods: The Extensivist (Band 8a Advanced Nurse Specialist skilled in frail older people) was embedded within the care home general practitioners (GP) service for a 2-year pilot (2019-2021). Implementation processes were evaluated. Impact of the Extensivist role was evaluated by the number of Comprehensive Geriatric Assessment (CGA) completed, interventions and other clinical activity performed as well as qualitative case studies and semistructured feedback from care home workers and professionals. Results: The Extensivist feasibly delivered CGA and implemented intervention plans. The role iteratively developed to support wider aspects of care including advance care planning (ACP) and training. Challenges included building trust, the time-consuming nature of CGA, ACP and coordinated communication. Case studies and semistructured feedback indicated the role was considered valuable in the delivery of clinical care, supporting residents, families, care homes and GPs and as a resource for education for care home workers. Conclusions: The Extensivist is a valuable resource and a linchpin in the delivery of EHCH framework in care homes for older adults in Southwark. Further evaluations to assess reproducibility in other areas of the UK are warranted. Competing Interests: Competing interests: All authors were either involved clinically, operationally or involved in the project design/evaluation (including the Extensivist, himself). NM reported the study. GS conducted and reported the study. DM planned, conducted and reported study. DA planned, conducted and reported study. NJ conducted the study. MK planned and conducted study. RD planned and conducted study. TK conducted, reported and is contributor with responsibility for the overall content of study. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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