Care in the Community for Older Adults
Development of the CHESS-Lite Scale to Predict Mortality at the Point of Home Care Entry
Chi-Ling Joanna Sinn*, Dr. Jeff Poss, Dr. John Hirdes
University of Waterloo
The Changes in Health, End-stage disease, and Signs and Symptoms (CHESS) scale is an indicator of health instability and has been shown to predict mortality and health service use. In Ontario, home care patients receiving services for an extended period are assessed regularly with the interRAI Home Care from which the CHESS scale can be calculated. Moderate or high CHESS scores may identify patients who would benefit from increased or more intensive services, more frequent reassessment, and/or advanced care planning. The current study covers the development of a"CHESS-Lite" scale from the interRAI Contact Assessment that is used to assess all patients entering the home care system. A CHESS-Lite scale with comparable predictive power as the CHESS scale could identify patients who are clinically unstable and require earlier or quicker reassessment in the short-term. The sample included all Contact Assessments linked to home care referrals initiated between April 2014 and March 2015 (n=144,070). About 7% of referrals resulted in death within 90 days of assessment. Items in the CHESS scale and additional items in the Contact Assessment were tested in bivariate and multivariable logistic models. The final version of the CHESS-Lite scale consists of seven of the 11 CHESS variables and an additional self-rated health variable. The CHESS-Lite scale was a strong predictor of death within 90 days (c statistic=0.82). Compared to 1.1% of patients in CHESS-Lite 1 who died within 90 days, one-third (33.6%) and two-thirds (68.3%) of patients in CHESS-Lite 5 and 6 died within 90 days, respectively.
An Interprofessional and Collaborative Approach to Care for Seniors with Addictions
Marilyn White-Campbell*, Jessica Wilson
St Joseph’s Health Care Center Guelph
Older Adults with Substance Use Disorders have multiple co morbidities including chronic mental and physical health problems are often high users of health care and emergency services. The prevalence of SUD (1999-2009) in a geriatric inpatient population (1,788 admission) admitted over a ten-year period was 11.7%. Most commonly abused substance = alcohol totaling 73.3% of the identified substance use disorders. Other SUDs were also found including sedative-hypnotics, opiates, cannabis, and tobacco. The prevalence of other SUDs was as follows: sedative-hypnotic abuse/dependence 11%, opiate abuse/dependence 2.9%, cannabis abuse 1%, and tobacco use disorder 1.4%. (Dombrowski et al, 2016 )The Waterloo Wellington Geriatrics Network identified the need for specialized geriatric addiction services. Geriatric addictions service was established with intent to build capacity in the community and to address identified needs.
In this presentation we will discuss;
- Program development
- Referral Sources
- Timely Access to Care
- Emergency Department and Acute Care Diversions
- Successful transitions to long term care
“I would hope the people looking after me know about me”: Perspectives of Persons Living with Dementia and Their Caregivers on Person-Centred Care and Quality of Care
Bryan B. Franco*, George A. Heckman, Sherry Dupuis, Lisa Loiselle, Veronique Boscart, Linda Lee
University of Waterloo
Background: Person-centred care has become synonymous with high quality dementia care but persons living with dementia and their caregivers have historically been excluded from quality improvement and assurance efforts. We explored person-centred care within the context of quality of care from their perspectives.
Methods: We present results from qualitative content analysis of interviews with thirteen participants: 9 persons living with dementia and 8 caregivers.
Results: Participants generally defined person-centred care as: care you would expect at home and all participants agreed that person-centred care is important to high quality care. Three major themes about how person-centred care impacted quality of care were identified: 1) clinicians' ability to solicit what is important to patients, 2) effective and appropriate communication to patients, and 3) patients' ability to navigate health and community resources. Clinicians' ability to solicit what is important for patients was touted as the most important theme for person-centred care. Some participants emphasized the need to self-advocate to overcome barriers to person-centred and quality care.
Discussion: Persons living with dementia and their caregivers provide valuable insights into relationships between person-centred care and quality of care that can inform quality improvement and assurance efforts. Person-centred care, as understood from the perspectives of persons living with dementia and their caregivers, is influenced by proximal and distal factors at the point of care and the health system, respectively.
Conclusion: The perspectives of persons living with dementia and their caregivers are vital to clinicians and policymakers' goal of delivering high quality and person-centred dementia care.
The Impact of Home Care Services on Same Day Emergency Department Utilization
Aaron Jones*, Andrew Costa
Background: Home care patients are a large and expanding subpopulation of older adults characterized by high rates of emergency department (ED) utilization. The relationship between ED visits and home care services is poorly understood. This study examines the impact that home care services have on same day ED utilization.
Methods: A population-based longitudinal retrospective cohort was created of all adult home care patients in a large health region of Ontario. The cohort included all days that a patient was available for home care service from January 1st 2015 to December 31st 2015, minus holidays and weekends. Conditional logistic regression was utilized to explore the effect that different types of home care visits during the day have on ED visits after 5pm of the same day, controlling for temporally dependent risk factors.
Results: Patients were considerably more likely to visit the ED after 5pm on days that they had any type of nursing service [Long Stay OR 1.51 (1.39-1.63), Short Stay OR 1.48 (1.33-1.64)]. The effect was greater for non-urgent ED visits [Long Stay OR 1.91 (1.53-2.39), Short Stay OR 1.62 (1.31-2.00)]. No effect was seen for personal support, therapies, or care coordination.
Interpretation: Home care nursing services were positively associated with same day after-hours ED visits. The effect was persistent across patient groups and nursing service types, but absent for other home care service types. Clinical issues beyond the RN/RPN scope of practice and poor integration with primary care may be leading to higher ED utilization rates.
Assessment of practicing community pharmacists knowledge, attitudes and behaviour towards influenza vaccine hesitancy in Ontario - An exploratory study
Pullagura GR*, Waite N, Violette R, Houle SKD
University of Waterloo
Objective: The emergence of vaccine hesitancy (VH) as a barrier to vaccine uptake calls for research to better understand the challenge. The purpose of this study was to assess the Ontario community pharmacistsâ€™ knowledge, attitudes and behaviour towards influenza VH.
Methods: A cross-sectional survey was developed and refined in consultation with members of the Canadian Immunization Research Network (CIRN). The survey was distributed electronically to 5,610 community pharmacists practicing in Ontario.
Results: The survey was completed by 885 community pharmacists, yielding a response rate of 16%. Pharmacists reported encountering an average 16 vaccine-hesitants per-week during the 2015-16 influenza season. Pharmacists' self-graded knowledge on influenza: disease, vaccine and related issues across a 15-component question was consistently high. About four out-of-five pharmacists [78.3%(n=634)] recognize their role in engaging influenza vaccine-hesitants about receiving the vaccine as that of "very high" importance. They also consistently rated high confidence in addressing common vaccine concerns. However, close to two-thirds [61.6%(507)] of the pharmacists believed that 70% of all individuals getting the influenza vaccine have made their decision, prior to meeting their health professionals. Additionally, 66.3%(n=465) pharmacists stated that most individuals (70%) getting the influenza vaccine actively "ask" for the service. The pharmacists rated workflow, time and staffing as the most important barriers to effective immunization service delivery, while the quality of current immunization training and their confidence in ability to immunize were least limiting.
Conclusion: Results suggest that community pharmacists do encounter VH in their practice. Although they recognize the importance, possess the knowledge and ability to address influenza VH; pharmacy specific operational barriers prevent them from optimally engaging with patients in this space.