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Nouvenne A, Ticinesi A, Siniscalchi C, Rendo M, Cerundolo N, Parise A, Castaldo G, Chiussi G, Carrassi R, Guerra A, Meschi T. The Multidisciplinary Mobile Unit (MMU) Program Bringing Hospital Specialist Geriatric Competencies at Home: A Feasible Alternative to Admission in Older Patients with Urgent Complaints. J Clin Med 2024; 13:2720. [PMID: 38731249 PMCID: PMC11084740 DOI: 10.3390/jcm13092720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/01/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Older patients are subject to a high number of Emergency Department (ED) visits and hospitalizations. Innovative strategies to manage geriatric urgencies in the community are thus needed. Methods: In this prospective observational study, we examined the case mix of a hospital-based domiciliary urgent care service tailored to older patients, called Multidisciplinary Mobile Unit (MMU), from January to September 2023. The service, activated by general practitioners or territorial specialists during workdays, provided domiciliary geriatric assessment, point-of-care diagnostics, including multi-site ultrasound and lab tests, and therapeutical measures, including intravenous treatment and insertion of invasive devices, with the goal of reaching on-site stabilization and avoiding ED referral. We collected data regarding multimorbidity, polypharmacy, and frailty according to the Clinical Frailty Scale (CFS), reasons for MMU activation, and diagnostic and therapeutical services provided. The assessed outcomes were immediate hospitalization after a visit, 30-day admission, and 30-day mortality. Results: Participants (n = 205, 102 M) were mostly aged (median age 83 years old), with multimorbidity and frailty (CFS median 6). The most frequent reasons for MMU activation were dyspnea (49%), cough (34%), and musculoskeletal pain (17%), while the commonest diagnostic test provided was thoracic ultrasound (81%). Only five patients (2.4%) were hospitalized immediately after MMU visit. The 30-day rate of hospitalization was 10.2%, with age, cancer, and abdominal pain as independent predictors on a stepwise binary logistic regression model. 30-day mortality was 4.9%. Conclusions: The MMU model is a feasible strategy to manage geriatric urgencies, especially involving the cardiorespiratory system, is associated with good outcomes and may prevent ED visits.
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Affiliation(s)
- Antonio Nouvenne
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (A.T.); (R.C.); (A.G.); (T.M.)
- Parma University Hospital—Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (N.C.); (A.P.); (G.C.); (G.C.)
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (A.T.); (R.C.); (A.G.); (T.M.)
- Parma University Hospital—Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (N.C.); (A.P.); (G.C.); (G.C.)
| | - Carmine Siniscalchi
- Parma University Hospital—Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (N.C.); (A.P.); (G.C.); (G.C.)
| | - Martina Rendo
- Primary Care Department, Parma District, Azienda Unità Sanitaria Locale di Parma, Strada del Quartiere 2/A, 43125 Parma, Italy;
| | - Nicoletta Cerundolo
- Parma University Hospital—Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (N.C.); (A.P.); (G.C.); (G.C.)
| | - Alberto Parise
- Parma University Hospital—Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (N.C.); (A.P.); (G.C.); (G.C.)
| | - Giampiero Castaldo
- Parma University Hospital—Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (N.C.); (A.P.); (G.C.); (G.C.)
| | - Giulia Chiussi
- Parma University Hospital—Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (N.C.); (A.P.); (G.C.); (G.C.)
| | - Richard Carrassi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (A.T.); (R.C.); (A.G.); (T.M.)
| | - Angela Guerra
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (A.T.); (R.C.); (A.G.); (T.M.)
- Parma University Hospital—Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (N.C.); (A.P.); (G.C.); (G.C.)
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (A.N.); (A.T.); (R.C.); (A.G.); (T.M.)
- Parma University Hospital—Azienda Ospedaliero-Universitaria di Parma, Via Antonio Gramsci 14, 43126 Parma, Italy; (N.C.); (A.P.); (G.C.); (G.C.)
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Mateos-Nozal J, Rodríguez-Domínguez M, San Román J, Candel FJ, Villarrubia N, Pérez-Panizo N, Segura E, Cuñarro JM, Ramírez-Arellano MVM, Rodríguez-Ramos R, Pariente-Rodríguez R, Villar LM, Ramos P, Cantón R, Cruz-Jentoft AJ, Galán JC. Factors Associated with SARS-CoV-2 Infection in Fully Vaccinated Nursing Home Residents and Workers. Viruses 2024; 16:186. [PMID: 38399962 PMCID: PMC10891794 DOI: 10.3390/v16020186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
Persons living or working in nursing homes faced a higher risk of SARS-CoV-2 infections during the pandemic, resulting in heightened morbidity and mortality among older adults despite robust vaccination efforts. This prospective study evaluated the humoral and cellular immunity in fully vaccinated residents and workers from two nursing homes in Madrid, Spain, from 2020 to 2021. Measurements of IgG levels were conducted in August 2020 (pre-vaccination) and June and September 2021 (post-vaccination), alongside assessments of neutralizing antibodies and cellular responses in September 2021 among the most vulnerable individuals. Follow-up extended until February 2022 to identify risk factors for SARS-CoV-2 infection or mortality, involving 267 residents (mean age 87.6 years, 81.3% women) and 302 workers (mean age 50.7 years, 82.1% women). Residents exhibited a significantly higher likelihood of experiencing COVID-19 before June 2021 compared with nursing staff (OR [95% CI], 7.2 [3.0 to 17.2], p < 0.01). Participants with a history of previous COVID-19 infection showed more significant increases in IgG levels in August 2020, June 2021 and September 2021, alongside an increased proportion of neutralizing antibodies in the most vulnerable individuals. However, IgG decay remained the same between June and September 2021 based on the previous COVID-19 status. During the Omicron variant wave, residents and staff showed a similar rate of SARS-CoV-2 infection. Notably, preceding clinical or immunological factors before receiving three vaccination doses did not demonstrate associations with COVID-19 infection or overall mortality in our participant cohort.
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Affiliation(s)
- Jesús Mateos-Nozal
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (N.P.-P.); (M.V.M.R.-A.); (A.J.C.-J.)
| | - Mario Rodríguez-Domínguez
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (M.R.-D.); (R.C.); (J.C.G.)
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | | | - Francisco Javier Candel
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital Clínico San Carlos, 28040 Madrid, Spain;
| | - Noelia Villarrubia
- Servicio de Inmunología, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain (R.R.-R.); (R.P.-R.); (L.M.V.)
| | - Nuria Pérez-Panizo
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (N.P.-P.); (M.V.M.R.-A.); (A.J.C.-J.)
| | - Esther Segura
- Residencia de Mayores Manoteras, 28050 Madrid, Spain;
| | | | | | - Rafael Rodríguez-Ramos
- Servicio de Inmunología, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain (R.R.-R.); (R.P.-R.); (L.M.V.)
| | - Roberto Pariente-Rodríguez
- Servicio de Inmunología, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain (R.R.-R.); (R.P.-R.); (L.M.V.)
| | - Luisa M. Villar
- Servicio de Inmunología, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain (R.R.-R.); (R.P.-R.); (L.M.V.)
| | | | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (M.R.-D.); (R.C.); (J.C.G.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Alfonso J. Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (N.P.-P.); (M.V.M.R.-A.); (A.J.C.-J.)
| | - Juan Carlos Galán
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (M.R.-D.); (R.C.); (J.C.G.)
- Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Mateos-Nozal J, Bermejo Boixareu C, Pérez-Panizo N, Hormigo Sánchez AI, Martínez Peromingo FJ. [Situation and activity of the liaison geriatrics units with nursing homes in the Community of Madrid]. Rev Esp Geriatr Gerontol 2023; 58:27-30. [PMID: 36446658 PMCID: PMC9701085 DOI: 10.1016/j.regg.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/06/2022] [Accepted: 11/03/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In June 2020, after the first wave of the COVID-19 pandemic, Hospital-Based Liaison Geriatrics units and Primary Care nursing care units were created in the Community of Madrid to improve health care for residents in a coordinated manner. OBJECTIVE To analyze the situation and the activity of the Hospital-Based Liaison Geriatrics units. MATERIAL AND METHODS A cross-sectional study was conducted using an electronic survey prepared and sent to the liaison geriatricians in March 2022, including the following sections: available resources, areas of health care, reasons for consultation, care interventions, research and teaching activity, profiles of residents attended and coordination with other health professionals at that time. A descriptive analysis of the data was performed. RESULTS 100% of the existing Liaison Geriatrics units responded, describing essential differences in human resources, hours of care and volume of patients attended. Regarding the care activity of these units, they highlighted the telematic consultation, and the face-to-face assessment during hospitalization and in the emergency department. The main reasons for assessment were decision-making, acute pathology and geriatric syndromes; and the in-hospital drug management or orthoprosthetic aids among the interventions. CONCLUSIONS Despite the heterogeneity in the resources of the different Liaison Geriatric units, there is a similarity in their care activity and the use of telemedicine. It is common to request an assessment for decision-making, acute pathology or geriatric syndromes and interventions for managing in-hospital drugs and tests, orthoprosthetic aids and coordination with other specialists. Liaison Geriatrics units must continue leading quality health care coordinated with nursing homes, as well as continuity of care for residents.
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Affiliation(s)
- Jesús Mateos-Nozal
- Unidad de Geriatría de Atención a Residencias, Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, España.
| | | | - Nuria Pérez-Panizo
- Unidad de Geriatría de Atención a Residencias, Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, España
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Valk-Draad MP, Bohnet-Joschko S. Nursing Home-Sensitive Hospitalizations and the Relevance of Telemedicine: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12944. [PMID: 36232255 PMCID: PMC9566431 DOI: 10.3390/ijerph191912944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The aging of society is increasing the number of hospitalizations of nursing home residents. Telemedicine might help reduce the frequency of these potentially risk-associated hospitalizations. This scoping review looked for evidence of a change in the rate of hospitalization and, if mentioned, any cost savings and/or staff acceptance of the use of telemedicine in a nursing home setting. To identify available evidence, the electronic databases PubMed, Livivo, EBSCO and JSTOR were searched (without time or regional constraints) for comparative primary research studies on this topic in peer-reviewed journals. A total of 1127 articles were retrieved and 923 titles and abstracts were screened, with 16 studies published between 2001 and 2022 being included. Telemedicine consultation reduced the hospitalization of nursing home residents in 14/16 and care costs in 8/11 articles. Staff satisfaction was mentioned positively in five studies. Most studies used telemedicine involving medical diagnostic technologies (10), (electronic) health records (9), specialists (9) and specialized nursing staff (11). Few studies had a higher level of evidence: only one randomized clinical trial was included. There is the need for high credibility studies, using guidelines on protocol and reporting, to better understand the hindering and facilitating factors of telemedicine provision in the healthcare of nursing home residents.
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Ford JH, Jolles SA, Heller D, Langenstroer M, Crnich C. There and back again: the shape of telemedicine in U.S. nursing homes following COVID-19. BMC Geriatr 2022; 22:337. [PMID: 35436869 PMCID: PMC9015887 DOI: 10.1186/s12877-022-03046-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Telemedicine use in nursing homes (NHs) expanded during the COVID-19 pandemic. The objectives of this study were to characterize plans to continue telemedicine among newly adopting NHs and identify factors limiting its use after COVID-19. Methods Key informants from 9 Wisconsin NHs that adopted telemedicine during COVID-19 were recruited. Semi-structured interviews and surveys were employed to identify participant perceptions about the value of telemedicine, implementation challenges encountered, and plans and barriers to sustaining its delivery after COVID-19. Directed content analysis and a deductive thematic approach using the Systems Engineering Initiative for Patient Safety (SEIPS) model was used during analyses. Quantitative and qualitative data were integrated to identify participant views on the value of telemedicine and the tools and work system enhancements needed to make telemedicine easier and more effective. Results All participating NHs indicated a preference to continue telemedicine after COVID-19. Urgent assessments of resident change-in-condition and cognitively based sub-specialty consultations were identified as the encounter types most amenable to telemedicine. Reductions in resident off-site encounters and minimization of resident therapy interruptions were identified as major benefits of telemedicine. Twelve work system enhancements needed to better sustain telemedicine were identified, including improvements to: 1) equipment/IT infrastructure; 2) scheduling; 3) information exchange; and 4) telemedicine facilitators. Discussion NHs that adopted telemedicine during COVID-19 wish to continue its use. However, interventions that enhance the integration of telemedicine into NH and off-site clinic work systems require changes to existing regulations and reimbursement models to sustain its utilization after COVID-19. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03046-y.
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Affiliation(s)
- James H Ford
- Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin, 777 Highland Ave, Madison, WI, 53705, USA.
| | - Sally A Jolles
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Dee Heller
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | | | - Christopher Crnich
- University of Wisconsin School of Medicine & Public Health, Madison, WI, USA.,William S. Middleton VA Hospital, Madison, WI, USA
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Zimmerman S, Cesari M, Gaugler JE, Gleckman H, Grabowski DC, Katz PR, Konetzka RT, McGilton KS, Mor V, Saliba D, Shippee TP, Sloane PD, Stone RI, Werner RM. The Inevitability of Reimagining Long-Term Care. J Am Med Dir Assoc 2022; 23:187-189. [DOI: 10.1016/j.jamda.2021.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
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