Abstract
Introduction: Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, 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 (HSCPs) are ideally placed to develop and lead integrated care intervention for older adults discharged from the ED to prevent and reduce such adverse outcomes.
Aim: 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 aims to assess the acceptability of trial methods, evaluate the acceptability of and identify modifications required and describe participants' experiences of the ED PLUS model. This study will generate data and experience to inform the conduct and delivery of a future definite RCT.
Method: 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 ED PLUS. 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 following data analysis:
1) The ED PLUS model of care bridged the transition across care settings for older adults
2) The investment and collaboration of multiple stakeholders in the ED were key enablers of implementation
3) Organisational, logistical and personnel factors impeded the delivery of ED PLUS
4) Potential for service optimisation and expansion
Facilitators and barriers to the service model were identified within all themes from both the older adult and HCP perspective.
Conclusion: Both HCPs and older adults 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. This evaluation of ED PLUS has provided valuable multi stakeholder insight and perspective on the beneficial effects on clinical outcomes and healthcare utilisation of older adults attending the ED in addition to highlighting the potential role that physiotherapists and other HSCPs 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 outcomes.