Enabling optimal care transitions for older people remains a key challenge facing policy‐makers a... more Enabling optimal care transitions for older people remains a key challenge facing policy‐makers and service providers. This qualitative Australian study aimed to provide a comprehensive picture of the factors/issues surrounding care transitions from the perspective of older people and their carers. It documents how supports and services are searched for and gained during the care transition process and the effect of this process on older people and their families. These findings have implications for service provision and policy relating to both assisting older people to age in place wherever possible and facilitating optimal care transitions when they are required.
Wound Practice & Research: Journal of the Australian Wound Management Association, Mar 1, 2016
Both practice and outcomes data sets are integral to any randomised controlled trial (RCT) design... more Both practice and outcomes data sets are integral to any randomised controlled trial (RCT) design and should be collected both before and after the intervention has been implemented to understand if a change has occurred as a result of the intervention. However, it is not unusual for only outcomes data to be collected. In this paper a mixed methods descriptive study, which was a discrete part of a moisturising RCT, is used to demonstrate the importance of collecting pre- and post-intervention practice data. This paper demonstrates how the descriptive study aimed to enhance the researchers' understanding of the outcomes of the moisturising RCT by determining how practice changed within the facilities in each arm of the study. In summary, this study was designed to ensure the results from the moisturising RCT could be accurately interpreted and it was a critical, but independent component of the moisturising study.
The objective of this study was to assess whether purchasing a personal alarm service makes a dif... more The objective of this study was to assess whether purchasing a personal alarm service makes a difference in a range of health outcomes for community dwelling older adults. The prospective cohort study involved 295 individuals for whom data on emergencies experienced at home were collected over a period of 12 months. Purchasers of alarms, compared to nonpurchasers, benefitted in terms of feeling more safe and secure and being more active around their home. Outcomes experienced after an emergency were similar for both groups with no differences found in terms of time spent on floor, or hospitalizations.
Purpose To systematically compare, via ranking and best worst tasks, the relative importance of k... more Purpose To systematically compare, via ranking and best worst tasks, the relative importance of key dimensions of quality of life for younger and older people. Methods A web-based survey was developed for administration to two Australia-wide community-based samples comprising younger people aged 18-64 years and older people aged 65 years and above. Respondents were asked to rank 12 quality of life dimensions. Respondents also completed a successive best worst task using the same 12 quality of life dimensions. Results The relative importance of the quality of life dimensions differed for younger and older person samples. For older people, the ability to be independent and to have control over their daily lives were particularly important for their overall quality of life whereas for younger people, mental health was considered most important. Conclusions Many interventions accessed by older people in geriatric medicine and aged care sectors have a broader impact upon quality of life beyond health status. The findings from this study indicate that a focus on broader aspects of quality of life may also be consistent with the preferences of older people themselves as to what constitutes quality of life from their perspective.
Objective: The primary objective of the study was to evaluate the reliability of a primary, gener... more Objective: The primary objective of the study was to evaluate the reliability of a primary, generic, home care assessment instrument across telephone, home visit and self‐complete modes of administration. Secondary objectives included: qualitative assessment of the utility of the instrument as judged by home care assessment staff and the identification of client groups for whom the self‐complete mode of assessment is inappropriate.
Archives of Gerontology and Geriatrics, Jul 1, 2018
Background: Optimising quality of life and reducing hospitalisation for people living in resident... more Background: Optimising quality of life and reducing hospitalisation for people living in residential aged care facilities (RACF) are important health policy goals. Methods: A cluster controlled clinical trial of nurse practitioner care in RACF. Six facilities were included: three randomly allocated to intervention where nurse practitioners working with general practitioners and using a best practice guide were responsible for care, and three control. Participants were followed up for a minimum of 12 months unless dead or transferred to another facility. Results: We enrolled two hundred patients (101 intervention and 99 control) with a mean (SD) follow up of 604 (276) days. There were 98 ED visits by intervention participants, resulting in 56 hospitalisations, compared with 121 ED visits and 70 hospitalisations for controls (risk reduction = 8%, 95% CI = −1% −17%, p = 0.10). For the pre-specified secondary outcomes of transfers within the first 12 months of enrolment, the number of residents making at least one visit (46 in each study arm) and rate of ED attendance (0.66 visits per intervention resident versus 0.70 visits per control resident) was not affected by the intervention. After adjusting for dependency and comorbidity, the intervention group had non-significantly lower transfers (OR 0.7, 95% CI 0.3-1.5, p = 0.34). There was a reduction in the rate of decline in the quality of life of intervention compared to control residents. Conclusions: Nurse practitioner care coordination resulted in no statistically significant change in rates of ED transfer or health care utilisation, but better maintained resident quality of life.
Objectives: To determine if, how often and in what types of situations older people use personal ... more Objectives: To determine if, how often and in what types of situations older people use personal alarms and to explore the impact of personal alarm technology on older people's lives. Methods: This study was retrospective and involved a mailout survey to 2610 users of the Silver Chain CareLink Personal Alarm Service. Results: Clients wear their alarm consistently around their home and in the garden; however, use is low in the shower/bath and in bed at night. Clients reported positive impacts in terms of: gaining faster assistance in an emergency, extending the time they are able to remain living at home, increasing their sense of security, reducing anxiety about falling and increasing confidence in performing everyday activities. Conclusions: Personal alarms have many positive impacts on the lives of older people.
Study objectives: The objectives of this study were threefold. It estimated the prevalence of scr... more Study objectives: The objectives of this study were threefold. It estimated the prevalence of screening for depression among older individuals, as assessed at the commencement of homecare services or as part of a routine review, identified factors associated with a positive response to the depression screen; and, then examined the use of home-care services over a period of 12 months. Method: A prospective cohort of older home-care clients assessed once during October 2000 to June 2001 and followed for a maximum of 12 months to measure service use. Results: Almost 62% of the sample screened positive for depression. Contrary to previous studies, screening positive for depression was associated with lower service use. Conclusions: The prevalence of a positive depression screen was higher than has been previously reported. Further research is required to validate the screening tool with Australian elders.
Background Accurately assessing changes in the quality of life of older people living permanently... more Background Accurately assessing changes in the quality of life of older people living permanently in nursing homes is important. The multi-attribute utility instrument most commonly used and recommended to assess health-related quality of life in the nursing home population is the three-level EuroQol EQ-5D-3L. To date, there have been no studies using the Health Utilities Index Mark III (HUI3). The purpose of this study was to compare the level of agreement and sensitivity to change of the EQ-5D-3L and HUI3 in a nursing home population. Methods EQ-5D-3L and HUI3 scores were measured as part of a cluster randomised controlled trial of nurse led care coordination in a nursing home population in Perth, Western Australia at baseline and 6-month follow up. Results Both measures were completed for 199 residents at baseline and 177 at 6-month follow-up. Mean baseline utility scores for EQ-5D-3L (0.45; 95% CI 0.41-0.49) and HUI3 (0.15; 95% CI 0.10-0.20) were significantly different (Wilcoxon signed rank test, p<0.01) and agreement was poor to moderate between absolute scores from each instrument (intra-class correlation coefficient = 0.63). The EQ-5D-3L appeared more sensitive to change over the 6month period. Conclusion Our findings show that the EQ-5D-3L and HUI3 estimate different utility scores among nursing home residents. These differences should be taken into account, particularly when PLOS ONE |
The objective of the study was to examine the feasibility of using routinely available assessment... more The objective of the study was to examine the feasibility of using routinely available assessment, Minimum Data Set (MDS), socioeconomic , geographic and unit cost data to define a discrete number of clinically meaningful, costhomogeneous Home and Community Care (HACC) client groups. Participants included new and existing Western Australian (WA) HACC beneficiaries from 1 January to 31 September 2001. Seventy two HACC agencies from metropolitan and rural regions participated, which represented 29% of the sector. A total of 9,404 quarterly periods of care contributed to the exploratory classification analysis and 12,697 to the confirmatory analysis. The final structure contained nine terminal nodes, achieved an R 2 of 23.7%, and was robust to fluctuations in cost. Higher costs were associated with increased functional dependency and the need for clinical services. The classification is empirically grounded, simple and robust, and has a number of potential policy and practice applications. Further refinement is required to improve its suitability as a funding tool. Background to the study The HACC Program provides support services to assist frail older people and people with disabilities to remain living at home rather than in residential care (Commonwealth of Australia 2002). The Program receives large proportions of Commonwealth and state/territory community care budgets, with an estimated total annual
Objective: Surgical wound dehiscence (SWD) increases the length of hospital stay and impacts on p... more Objective: Surgical wound dehiscence (SWD) increases the length of hospital stay and impacts on patient wellbeing and health-care costs. Globally, the health-care costs associated with SWD are poorly reported and those reported are frequently associated with surgical site infection (SSI), rather than dehiscence of non-microbial cause. This retrospective study describes and reports on the costs and time to healing associated with a number of surgical patients who were referred to a community nursing service for treatment of an SWD following discharge from a metropolitan hospital, in Perth, Western Australia. Method: Descriptive statistical analysis was carried out to describe the patient, wound and treatment characteristics. A costing analysis was conducted to investigate the cost of healing these wounds. Results: Among the 70 patients referred with a SWD, 55% were treated for an infected wound dehiscence which was a significant factor (p=0.001). Overall, the cost of treating the 70 patients with a SWD in a community nursing service was in excess of $56,000 Australian dollars (AUD) (£28,705) and did not include organisational overheads or travel costs for nurse visits. The management of infection contributed to 67% of the overall cost. Conclusion: SWD remains an unquantified aspect of wound care from a prevalence and fiscal point of view. Further work needs to be done in the identification of SWD and which patients may be ‘at risk’. Declaration of interest: The authors declare they have no competing interests.
Background: The objectives of this study were to determine whether older individuals who particip... more Background: The objectives of this study were to determine whether older individuals who participated in a reablement (restorative) program rather than immediately receiving conventional home care services had a reduced need for ongoing support and lower home care costs over the next 57 months (nearly 5 years). Materials and methods: Data linkage was used to examine retrospectively the service records of older individuals who had received a reablement service versus a conventional home care service to ascertain their use of home care services over time. Results: Individuals who had received a reablement service were less likely to use a personal care service throughout the follow-up period or any other type of home care over the next 3 years. This reduced use of home care services was associated with median cost savings per person of approximately AU $12,500 over nearly 5 years. Conclusion: The inclusion of reablement as the starting point for individuals referred for home care within Australia's reformed aged care system could increase the system's cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age.
Primary Intention: The Australian Journal of Wound Management, May 1, 2003
Silver Chain is the largest aged and community care provider in Western Australia and assists the... more Silver Chain is the largest aged and community care provider in Western Australia and assists the frail aged and disabled to remain in their own homes. Many of these individuals have compromised mobility and health status and without appropriate prevention are at significant risk of developing pressure ulcers. Like many other community organisations, Silver Chain did not have any standardised work processes for predicting the risk and reporting of pressure ulcers. As part of its commitment to providing high quality care, Silver Chain is currently undertaking a project to introduce the Australian Wound Management Association's (AWMA) Clinical Practice Guidelines for the Prediction and Prevention of Pressure Ulcers. This will be achieved by incorporating the guidelines into everyday work processes and accompanying the introduction of the new processes by a comprehensive staff education and training programme. The methodology and the tools developed by Prentice for the introduction and evaluation of the AWMA guidelines in Australian tertiary hospitals were adapted for use within a community setting. Baseline measurements of clinical and non-clinical staff knowledge and pressure ulcer prevalence were collected in December 2002. The results of the baseline study clearly demonstrated a need to improve staff knowledge of pressure ulcer prevention and the need to implement standardised quality processes to prevent pressure ulcers.
Enabling optimal care transitions for older people remains a key challenge facing policy‐makers a... more Enabling optimal care transitions for older people remains a key challenge facing policy‐makers and service providers. This qualitative Australian study aimed to provide a comprehensive picture of the factors/issues surrounding care transitions from the perspective of older people and their carers. It documents how supports and services are searched for and gained during the care transition process and the effect of this process on older people and their families. These findings have implications for service provision and policy relating to both assisting older people to age in place wherever possible and facilitating optimal care transitions when they are required.
Wound Practice & Research: Journal of the Australian Wound Management Association, Mar 1, 2016
Both practice and outcomes data sets are integral to any randomised controlled trial (RCT) design... more Both practice and outcomes data sets are integral to any randomised controlled trial (RCT) design and should be collected both before and after the intervention has been implemented to understand if a change has occurred as a result of the intervention. However, it is not unusual for only outcomes data to be collected. In this paper a mixed methods descriptive study, which was a discrete part of a moisturising RCT, is used to demonstrate the importance of collecting pre- and post-intervention practice data. This paper demonstrates how the descriptive study aimed to enhance the researchers' understanding of the outcomes of the moisturising RCT by determining how practice changed within the facilities in each arm of the study. In summary, this study was designed to ensure the results from the moisturising RCT could be accurately interpreted and it was a critical, but independent component of the moisturising study.
The objective of this study was to assess whether purchasing a personal alarm service makes a dif... more The objective of this study was to assess whether purchasing a personal alarm service makes a difference in a range of health outcomes for community dwelling older adults. The prospective cohort study involved 295 individuals for whom data on emergencies experienced at home were collected over a period of 12 months. Purchasers of alarms, compared to nonpurchasers, benefitted in terms of feeling more safe and secure and being more active around their home. Outcomes experienced after an emergency were similar for both groups with no differences found in terms of time spent on floor, or hospitalizations.
Purpose To systematically compare, via ranking and best worst tasks, the relative importance of k... more Purpose To systematically compare, via ranking and best worst tasks, the relative importance of key dimensions of quality of life for younger and older people. Methods A web-based survey was developed for administration to two Australia-wide community-based samples comprising younger people aged 18-64 years and older people aged 65 years and above. Respondents were asked to rank 12 quality of life dimensions. Respondents also completed a successive best worst task using the same 12 quality of life dimensions. Results The relative importance of the quality of life dimensions differed for younger and older person samples. For older people, the ability to be independent and to have control over their daily lives were particularly important for their overall quality of life whereas for younger people, mental health was considered most important. Conclusions Many interventions accessed by older people in geriatric medicine and aged care sectors have a broader impact upon quality of life beyond health status. The findings from this study indicate that a focus on broader aspects of quality of life may also be consistent with the preferences of older people themselves as to what constitutes quality of life from their perspective.
Objective: The primary objective of the study was to evaluate the reliability of a primary, gener... more Objective: The primary objective of the study was to evaluate the reliability of a primary, generic, home care assessment instrument across telephone, home visit and self‐complete modes of administration. Secondary objectives included: qualitative assessment of the utility of the instrument as judged by home care assessment staff and the identification of client groups for whom the self‐complete mode of assessment is inappropriate.
Archives of Gerontology and Geriatrics, Jul 1, 2018
Background: Optimising quality of life and reducing hospitalisation for people living in resident... more Background: Optimising quality of life and reducing hospitalisation for people living in residential aged care facilities (RACF) are important health policy goals. Methods: A cluster controlled clinical trial of nurse practitioner care in RACF. Six facilities were included: three randomly allocated to intervention where nurse practitioners working with general practitioners and using a best practice guide were responsible for care, and three control. Participants were followed up for a minimum of 12 months unless dead or transferred to another facility. Results: We enrolled two hundred patients (101 intervention and 99 control) with a mean (SD) follow up of 604 (276) days. There were 98 ED visits by intervention participants, resulting in 56 hospitalisations, compared with 121 ED visits and 70 hospitalisations for controls (risk reduction = 8%, 95% CI = −1% −17%, p = 0.10). For the pre-specified secondary outcomes of transfers within the first 12 months of enrolment, the number of residents making at least one visit (46 in each study arm) and rate of ED attendance (0.66 visits per intervention resident versus 0.70 visits per control resident) was not affected by the intervention. After adjusting for dependency and comorbidity, the intervention group had non-significantly lower transfers (OR 0.7, 95% CI 0.3-1.5, p = 0.34). There was a reduction in the rate of decline in the quality of life of intervention compared to control residents. Conclusions: Nurse practitioner care coordination resulted in no statistically significant change in rates of ED transfer or health care utilisation, but better maintained resident quality of life.
Objectives: To determine if, how often and in what types of situations older people use personal ... more Objectives: To determine if, how often and in what types of situations older people use personal alarms and to explore the impact of personal alarm technology on older people's lives. Methods: This study was retrospective and involved a mailout survey to 2610 users of the Silver Chain CareLink Personal Alarm Service. Results: Clients wear their alarm consistently around their home and in the garden; however, use is low in the shower/bath and in bed at night. Clients reported positive impacts in terms of: gaining faster assistance in an emergency, extending the time they are able to remain living at home, increasing their sense of security, reducing anxiety about falling and increasing confidence in performing everyday activities. Conclusions: Personal alarms have many positive impacts on the lives of older people.
Study objectives: The objectives of this study were threefold. It estimated the prevalence of scr... more Study objectives: The objectives of this study were threefold. It estimated the prevalence of screening for depression among older individuals, as assessed at the commencement of homecare services or as part of a routine review, identified factors associated with a positive response to the depression screen; and, then examined the use of home-care services over a period of 12 months. Method: A prospective cohort of older home-care clients assessed once during October 2000 to June 2001 and followed for a maximum of 12 months to measure service use. Results: Almost 62% of the sample screened positive for depression. Contrary to previous studies, screening positive for depression was associated with lower service use. Conclusions: The prevalence of a positive depression screen was higher than has been previously reported. Further research is required to validate the screening tool with Australian elders.
Background Accurately assessing changes in the quality of life of older people living permanently... more Background Accurately assessing changes in the quality of life of older people living permanently in nursing homes is important. The multi-attribute utility instrument most commonly used and recommended to assess health-related quality of life in the nursing home population is the three-level EuroQol EQ-5D-3L. To date, there have been no studies using the Health Utilities Index Mark III (HUI3). The purpose of this study was to compare the level of agreement and sensitivity to change of the EQ-5D-3L and HUI3 in a nursing home population. Methods EQ-5D-3L and HUI3 scores were measured as part of a cluster randomised controlled trial of nurse led care coordination in a nursing home population in Perth, Western Australia at baseline and 6-month follow up. Results Both measures were completed for 199 residents at baseline and 177 at 6-month follow-up. Mean baseline utility scores for EQ-5D-3L (0.45; 95% CI 0.41-0.49) and HUI3 (0.15; 95% CI 0.10-0.20) were significantly different (Wilcoxon signed rank test, p<0.01) and agreement was poor to moderate between absolute scores from each instrument (intra-class correlation coefficient = 0.63). The EQ-5D-3L appeared more sensitive to change over the 6month period. Conclusion Our findings show that the EQ-5D-3L and HUI3 estimate different utility scores among nursing home residents. These differences should be taken into account, particularly when PLOS ONE |
The objective of the study was to examine the feasibility of using routinely available assessment... more The objective of the study was to examine the feasibility of using routinely available assessment, Minimum Data Set (MDS), socioeconomic , geographic and unit cost data to define a discrete number of clinically meaningful, costhomogeneous Home and Community Care (HACC) client groups. Participants included new and existing Western Australian (WA) HACC beneficiaries from 1 January to 31 September 2001. Seventy two HACC agencies from metropolitan and rural regions participated, which represented 29% of the sector. A total of 9,404 quarterly periods of care contributed to the exploratory classification analysis and 12,697 to the confirmatory analysis. The final structure contained nine terminal nodes, achieved an R 2 of 23.7%, and was robust to fluctuations in cost. Higher costs were associated with increased functional dependency and the need for clinical services. The classification is empirically grounded, simple and robust, and has a number of potential policy and practice applications. Further refinement is required to improve its suitability as a funding tool. Background to the study The HACC Program provides support services to assist frail older people and people with disabilities to remain living at home rather than in residential care (Commonwealth of Australia 2002). The Program receives large proportions of Commonwealth and state/territory community care budgets, with an estimated total annual
Objective: Surgical wound dehiscence (SWD) increases the length of hospital stay and impacts on p... more Objective: Surgical wound dehiscence (SWD) increases the length of hospital stay and impacts on patient wellbeing and health-care costs. Globally, the health-care costs associated with SWD are poorly reported and those reported are frequently associated with surgical site infection (SSI), rather than dehiscence of non-microbial cause. This retrospective study describes and reports on the costs and time to healing associated with a number of surgical patients who were referred to a community nursing service for treatment of an SWD following discharge from a metropolitan hospital, in Perth, Western Australia. Method: Descriptive statistical analysis was carried out to describe the patient, wound and treatment characteristics. A costing analysis was conducted to investigate the cost of healing these wounds. Results: Among the 70 patients referred with a SWD, 55% were treated for an infected wound dehiscence which was a significant factor (p=0.001). Overall, the cost of treating the 70 patients with a SWD in a community nursing service was in excess of $56,000 Australian dollars (AUD) (£28,705) and did not include organisational overheads or travel costs for nurse visits. The management of infection contributed to 67% of the overall cost. Conclusion: SWD remains an unquantified aspect of wound care from a prevalence and fiscal point of view. Further work needs to be done in the identification of SWD and which patients may be ‘at risk’. Declaration of interest: The authors declare they have no competing interests.
Background: The objectives of this study were to determine whether older individuals who particip... more Background: The objectives of this study were to determine whether older individuals who participated in a reablement (restorative) program rather than immediately receiving conventional home care services had a reduced need for ongoing support and lower home care costs over the next 57 months (nearly 5 years). Materials and methods: Data linkage was used to examine retrospectively the service records of older individuals who had received a reablement service versus a conventional home care service to ascertain their use of home care services over time. Results: Individuals who had received a reablement service were less likely to use a personal care service throughout the follow-up period or any other type of home care over the next 3 years. This reduced use of home care services was associated with median cost savings per person of approximately AU $12,500 over nearly 5 years. Conclusion: The inclusion of reablement as the starting point for individuals referred for home care within Australia's reformed aged care system could increase the system's cost effectiveness and ensure that all older Australians have the opportunity to maximize their independence as they age.
Primary Intention: The Australian Journal of Wound Management, May 1, 2003
Silver Chain is the largest aged and community care provider in Western Australia and assists the... more Silver Chain is the largest aged and community care provider in Western Australia and assists the frail aged and disabled to remain in their own homes. Many of these individuals have compromised mobility and health status and without appropriate prevention are at significant risk of developing pressure ulcers. Like many other community organisations, Silver Chain did not have any standardised work processes for predicting the risk and reporting of pressure ulcers. As part of its commitment to providing high quality care, Silver Chain is currently undertaking a project to introduce the Australian Wound Management Association's (AWMA) Clinical Practice Guidelines for the Prediction and Prevention of Pressure Ulcers. This will be achieved by incorporating the guidelines into everyday work processes and accompanying the introduction of the new processes by a comprehensive staff education and training programme. The methodology and the tools developed by Prentice for the introduction and evaluation of the AWMA guidelines in Australian tertiary hospitals were adapted for use within a community setting. Baseline measurements of clinical and non-clinical staff knowledge and pressure ulcer prevalence were collected in December 2002. The results of the baseline study clearly demonstrated a need to improve staff knowledge of pressure ulcer prevention and the need to implement standardised quality processes to prevent pressure ulcers.
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Papers by Gill Lewin