Journal name: Patient Preference and Adherence Article Designation: Original Research Year: 2018 Volume: 12 Patient Preference and Adherence Dovepress Running head verso: Ekerstad et al Running head recto: Comparison of acute treatment in CGA units and in conventional wards open access to scientific and medical research DOI: http://dx.doi.org/10.2147/PPA.S154658 Open Access Full Text Article ORIGINAL RESEARCH Are frail elderly patients treated in a CGA unit more satisfied with their hospital care than those treated in conventional acute medical care? Niklas Ekerstad1,2 Objectives: Our aim was to study whether the acute care of frail elderly patients directly Göran Östberg3 admitted to a comprehensive geriatric assessment (CGA) unit is superior to the care in a con- Maria Johansson3 ventional acute medical care unit in terms of patient satisfaction. Björn W Karlson3,4 Design: TREEE (Is the TReatment of frail Elderly patients Effective in an Elderly care unit?) is a clinical, prospective, controlled, one-center intervention trial comparing acute treatment in 1Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, CGA units and in conventional wards. Trollhättan-Uddevalla-Vänersborg, Setting: This study was conducted in the NÄL-Uddevalla county hospital in western Sweden. 2 Department of Medical and Health Participants: In this follow-up to the TREEE study, 229 frail patients, aged $75 years, in need Sciences, Division of Health Care Analysis, Linköping University, of acute in-hospital treatment, were eligible. Of these patients, 139 patients were included in 3 For personal use only. Linköping, Division of Internal and the analysis, 72 allocated to the CGA unit group and 67 to the conventional care group. Mean Acute Medicine, NU Hospital Group, age was 85 years and 65% were female. Trollhättan-Uddevalla-Vänersborg, 4Department of Molecular and Clinical Intervention: Direct admittance to an acute elderly care unit with structured, systematic Medicine, Institute of Medicine, interdisciplinary CGA-based care, compared to conventional acute medical care via the emer- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden gency room. Measurements: The primary outcome was the satisfaction reported by the patients shortly after discharge from hospital. A four-item confidential questionnaire was used. Responses were given on a 4-graded scale. Results: The response rate was 61%. In unadjusted analyses, significantly more patients in the intervention group responded positively to the following three questions about the hospitalization: “Did you get the nursing from the ward staff that you needed?” ( p=0.003), “Are you satisfied with the information you received on your diseases and medication?” ( p=0.016), and “Are Patient Preference and Adherence downloaded from https://www.dovepress.com/ by 54.70.40.11 on 31-Dec-2018 you satisfied with the planning before discharge from the hospital?” ( p=0.032). After adjusted analyses by multiple regression, a significant difference in favor of the intervention remained for the first question ( p=0.027). Conclusion: Acute care in a CGA unit with direct admission was associated with higher levels of patient satisfaction compared with conventional acute care via the emergency room. Keywords: frailty, elderly, comprehensive geriatric assessment, acute care, patient satisfaction, direct admission Correspondence: Niklas Ekerstad Introduction Department of Cardiology, Background NU (NAL-Uddevalla) Hospital Frailty is a biological syndrome reflecting vulnerability to stressors and reduced Group, Lärketorpsvägen, 46100 Trollhättan, Sweden physiological reserves.1 It is associated with functional decline, activity limitations, Tel +46 736 249 652 prolonged recovery, and a high risk of being institutionalized and dying.2–5 Among older Fax +46 104 357 129 Email [email protected] persons, the prevalence of frailty is estimated to be 10%–60%, depending on the frailty submit your manuscript | www.dovepress.com Patient Preference and Adherence 2018:12 233–240 233 Dovepress © 2018 Ekerstad et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you http://dx.doi.org/10.2147/PPA.S154658 hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Powered by TCPDF (www.tcpdf.org) 1 / 1 Ekerstad et al Dovepress assessment instrument used and the population studied.6,7 admitted to a CGA unit is superior to conventional acute Most of these patients have multiple chronic diseases and medical care in terms of patient satisfaction. We hypothesized recurring episodes of acute illness. that a higher proportion of patients cared for in a CGA unit Frail elderly individuals constitute a high percentage of would report satisfaction compared with patients treated in emergency patients in every hospital. The current organiza- a conventional care unit. tion of acute care is often poorly adapted to the specific needs of these patients. To meet these needs, in 2008, the NU (NÄL- Patients and methods Uddevalla) hospital group in the Västra Götaland Region of Study design and setting Sweden introduced two acute elderly care comprehensive This study on patient satisfaction used data from the TREEE 8 geriatric assessment (CGA) units (MÄVAs). The basic aims study, a clinical, prospective, controlled intervention trial were to optimize the clinical treatment and thereby utilize with two parallel groups performed at the NU hospital group health care resources in the best way. This form of care is between March 2013 and July 2015. Details of TREEE have characterized by direct admission and a structured, systematic been described earlier.14 The total primary population of the multi- and interdisciplinary CGA and care performed in the NU health care system is 280,000 inhabitants. The TREEE ward, including an early rehabilitation strategy involving study was approved by the Independent Ethics Committee at physicians, occupational therapists, physiotherapists, and the Sahlgrenska University Hospital in Gothenburg (8883-12, nurses as active team members. 20121212) and registered at the Swedish National Database Previous clinical studies have indicated that frail elderly of Research and Development (identifier: 113021). Written 9–14 patients could benefit from a CGA. informed consent was obtained from the patients or from Patient satisfaction is an important patient-reported a member of their next of kin. All data were computerized experience measure, and it can also be seen as an outcome and handled in accordance with legislation and Good in itself and as an integrated part of the results of every type Clinical Practice. of health care organization. It has been described as crucial For personal use only. 15,16 for the evaluation of health care quality. In accordance Selection of participants with the consumer model, satisfaction can be regarded as a TREEE included patients aged $75 years, in need of in- difference between expectations and assessed performance.17 hospital treatment, and who fulfilled the foundation of frailty On the other hand, it has been argued that it might be prob- in accordance with the recently validated FRESH (FRail lematic to treat elderly patients as consumers.18 Patient Elderly Support researcH group) screening instrument,22 satisfaction can also be defined as measuring the needs that is, two or more of the following criteria: tiredness from and wants,19 and it influences patient compliance as well as a short walk, general fatigue, frequent falls/anticipation of continuity of care.20,21 falls, dependence in shopping, and three or more visits to the emergency ward during the last 12 months. Patients were Importance excluded if they were clearly suited for care in a conven- Patient Preference and Adherence downloaded from https://www.dovepress.com/ by 54.70.40.11 on 31-Dec-2018 In acute care settings, there is, however, a lack of knowledge tional acute medical care unit due to the type or severity of regarding the effects of CGA on health-related quality of the acute illness. life (HRQoL) and even more so on patient satisfaction. When the ambulance nurse, or the primary care physician, In the TREEE study (Is the TReatment of frail Elderly had identified a patient who could fulfill the inclusion criteria, patients Effective in an Elderly care unit?), the results on a MÄVA doctor was contacted via telephone. If he/she HRQoL, activities of daily living (ADLs), mortality, and agreed, and there was a bed available at MÄVA, the patient re-hospitalizations were favorable for the CGA units as was allocated to the intervention group and admitted directly 14 described previously. to MÄVA. If bed was not available, the patient was allocated In severely frail elderly patients with poor prognosis to the control group and admitted to a conventional acute who need emergency care, the satisfaction with the received medical care unit through the emergency room. hospital care may be particularly important. In the TREEE study, 408 patients were included between March 2013 and July 2015. For practical and