A MULTI-STAKEHOLDER QUALITATIVE EVALUATION OF THE ED PLUS PROJECT RCT

A. Holmes¹, M. Conneely¹, R. Galvin¹, C. Fitzgerald¹, K. Robinson¹, A. Gallagher¹, P. Cotter²

¹University of Limerick, School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, Limerick, Ireland, ²Ireland East Hospital Group, St. Luke's Hospital Kilkenny, Kilkenny, Ireland

Background: Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. Health and Social Care Professionals are well placed to develop and lead integrated care intervention for older adults discharged from the ED (ED PLUS) to prevent and reduce these well reported adverse outcomes.

Purpose: This study aims to evaluate the experiences of older adult participants and health care providers (HCPs) involved in the intervention arm (ED PLUS) of a pilot feasibility RCT. The qualitative evaluation assessed the acceptability of the trial methods, evaluated the acceptability of the ED PLUS, identified modifications to ED PLUS and described participants' experiences of ED PLUS. This study will generate data and experience to inform the conduct and delivery of a future definite RCT.

Methods: A qualitative descriptive (QD) study design was adopted to allow in-depth examination of the views and experiences of this topic from the perspective of the individual. Nine older adults and ten health care providers (HCPs) who participated in intervention arm 2 of the ED Plus trial were invited to participate in the study. Audio-recorded, open-ended, semi-structured interviews via telephone were conducted to allow in-depth exploration of participants’ perspectives and experiences of the ED Plus intervention. All audio-recorded interviews were fully transcribed verbatim. NVivo software package (version 12) was employed to organize, store and retrieve data which was then collectively analysed using a reflexive approach to thematic analysis.

Results: In total 9 older adult service user and 6 HCPs consented to participate and were subsequently interviewed between December 2021 and July 2022. The following main themes were identified based on the data: 1) Impacts on Care Delivery identified including the impact of Covid 19 2) Team Work and Collaboration and 3) Model of Service Delivery. Facilitators and barriers to the service model were identified within all themes from both the service user and service provider's perspective.

Conclusions: Both health care providers and patients reported satisfaction with the model of delivery of care and the role of the physiotherapist acting as a key case worker, supporting the care transition from the ED to the home. The model of health service delivery aligns to national and international policies on healthy and successful ageing, particularly in relation to supporting older adults to live in their own homes and communities.

Implications: This evaluation of ED PLUS has provided valuable multi stakeholder insight and perspective on the beneficial effects on clinical outcomes and healthcare utilisation in older person's attending the ED in addition to highlighting the potential role that physiotherapists and other health and social care professionals may play in service development and transitional care delivery for this population. This preliminary evidence requires confirmation in a future definite, adequately powered RCT that incorporates long-term follow-up of important clinical and process outcomes.

Funding acknowledgements: This study was supported by the Health Research Board (HRB) of Ireland.

Keywords:
Older Person
Emergency Department Care
Admission avoidance

Topics:
Older people
Service delivery/emerging roles
Community based rehabilitation

Did this work require ethics approval? Yes

Institution: Health Service Executive Ireland

Committee: HSE Mid-Western Area Research Ethics Committee

Ethics number: 088/2020