A Pilot Study to Evaluate a New Hep-GRP Care Pathway to Improve Outcomes Among Canadian Older Adults with Liver Cirrhosis.

IF 1.6 Q4 GERIATRICS & GERONTOLOGY Canadian Geriatrics Journal Pub Date : 2024-03-01 DOI:10.5770/cgj.27.725

Julie Zhu, Frances Carr, Michael Sun, Peter Tian, Magnus McLeod, Sarah De Coutere

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Abstract

Background: Older adults with cirrhosis have complex medical needs that are not satisfied by organ specific management. Interdisciplinary approach may mitigate comorbidity and improve patient satisfaction.

Methods: A pilot study consisted of dual specialist interdisciplinary referral pathway and mixed virtual care delivery model are prospectively evaluated in older adults (65 years and older) with cirrhosis during the COVID-19 pandemic between September and December 2022. Participant attitudes towards telemedicine were surveyed.

Results: 68 participants with cirrhosis were consecutively assessed by hepatology. The mean age was 73 years. 39 (57%) screened positive for one or more geriatric syndrome(s). Comprehensive geriatric assessments were conducted via telemedicine in 18 participants, with additional referrals to physiotherapy and nutritional education. Compared to a historic cohort matched for age, sex, and Child-Pugh class, acute health service utilization measured by ER visits among those received dual specialist interdisciplinary consultation were lowered by 1.11 per patient at three-month follow up period (p = .0006, 95% CI 0.47-1.74). Majority participants (87.6%) preferred telemedicine or mixed method visits.

Conclusion: An interdisciplinary approach to older adults with cirrhosis will likely be beneficial, and routine screening for geriatric syndrome may lead to reduced acute health-care utilization in the short term. Telemedicine and virtual screening tools in seniors should be fully explored to improve access to care.

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一项试点研究，旨在评估新的 Hep-GRP 护理路径，以改善加拿大老年肝硬化患者的治疗效果。

背景：患有肝硬化的老年人有复杂的医疗需求，特定器官的管理无法满足他们的需求。跨学科方法可减轻并发症，提高患者满意度：方法：在 2022 年 9 月至 12 月 COVID-19 大流行期间，对患有肝硬化的老年人（65 岁及以上）进行了一项试点研究，其中包括双专科跨学科转诊路径和混合虚拟护理交付模式。还调查了参与者对远程医疗的态度：结果：68 名肝硬化患者接受了肝病科的连续评估。平均年龄为 73 岁。39人（57%）筛查出一种或多种老年综合征阳性。通过远程医疗对 18 名参与者进行了全面的老年病评估，并转介他们接受物理治疗和营养教育。与年龄、性别和 Child-Pugh 分级相匹配的历史队列相比，在三个月的随访期内，接受双专家跨学科会诊的患者人均急诊室就诊次数减少了 1.11 次（p = 0.0006，95% CI 0.47-1.74）。大多数参与者（87.6%）倾向于选择远程医疗或混合方法就诊：结论：对患有肝硬化的老年人采取跨学科的治疗方法可能是有益的，对老年综合征进行常规筛查可能会在短期内减少急性期医疗服务的使用。应充分探索针对老年人的远程医疗和虚拟筛查工具，以改善医疗服务的可及性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian Geriatrics Journal Nursing-Gerontology

CiteScore

5.20

自引率

0.00%

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期刊介绍： The Canadian Geriatrics Journal (CGJ) is a peer-reviewed publication that is a home for innovative aging research of a high quality aimed at improving the health and the care provided to older persons residing in Canada and outside our borders. While we gratefully accept submissions from researchers outside our country, we are committed to encouraging aging research by Canadians. The CGJ is targeted to family physicians with training or an interest in the care of older persons, specialists in geriatric medicine, geriatric psychiatrists, and members of other health disciplines with a focus on gerontology.