A family nurse-led intervention for reducing health services’ utilization in individuals with chronic diseases : The ADVICE pilot study

Journal article


Savini, Serenella, Iovino, Paolo, Monaco, Dario, Marchini, Roberta, Di Giovanni, Tiziana, Donato, Giuseppe, Pulimeno, Ausilia, Matera, Carmela, Quintavalle, Giuseppe and Turci, Carlo. (2021). A family nurse-led intervention for reducing health services’ utilization in individuals with chronic diseases : The ADVICE pilot study. International Journal of Nursing Sciences. 8(3), pp. 264-270. https://doi.org/10.1016/j.ijnss.2021.05.001
AuthorsSavini, Serenella, Iovino, Paolo, Monaco, Dario, Marchini, Roberta, Di Giovanni, Tiziana, Donato, Giuseppe, Pulimeno, Ausilia, Matera, Carmela, Quintavalle, Giuseppe and Turci, Carlo
Abstract

Objectives
Intensive health services’ utilization is common in older individuals affected by chronic diseases. This study assessed whether a structured family nurse-led educational intervention would be effective in reducing health services’ use (readmissions and/or emergency service access) among older people affected by chronic conditions.

Methods
This is a non-randomized before-after pilot study. A sample of 78 patients was recruited from two general practices in Italy and 70 among them were followed for 8 months. Standard home care was provided during the first four months’ period (months 1–4), followed by the educational intervention until the end of the study (months 5–8). The intervention, based on the teach-back method, consisted of by-weekly 60-min home sessions targeting aspects of the disease and its treatment, potential complications, medication adherence, and health behaviours. Rates of health services’ use were collected immediately before (T0), and after the interventions (T1). Differences in utilization rates were examined by the McNemar’s test. Potential factors associated with the risk of health services’ use were explored with a Cox proportional hazard regression model.

Results
The sample (n = 78) was predominantly female (n = 50, 64.1%), and had a mean age of 76.2 (SD = 4.8) years. Diabetes mellitus was the most frequent disease (n = 27, 34.6%). McNemar’s test indicated a significant reduction in health services’ use at T1 (McNemar χ2 = 28.03, P < 0.001). Cox regressions indicated that time and patient education, as well as their interaction, were the only variables positively associated with the probability of health services’ use.

Conclusion
A teach-back intervention led by a family nurse practitioner has the potential to reduce health services’ use in older patients with chronic diseases.

Keywordsaged; chronic disease; facilities and services utilization; family nurse practitioners; patient readmission; home care services; health services
Year2021
JournalInternational Journal of Nursing Sciences
Journal citation8 (3), pp. 264-270
PublisherElsevier B.V.
Chinese Nursing Association
ISSN2352-0132
Digital Object Identifier (DOI)https://doi.org/10.1016/j.ijnss.2021.05.001
PubMed ID34307774
Scopus EID2-s2.0-85109076121
PubMed Central IDPMC8283711
Open accessPublished as ‘gold’ (paid) open access
Page range264-270
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online12 May 2021
Publication process dates
Accepted07 May 2021
Deposited24 Nov 2022
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