Advanced Use of Point-of-care Technology Versus Usual Care During In-home-assessment by Acute Community Nurses in Older Adults for Reducing Acute Hospital Admissions
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 632
- Locations
- 1
- Primary Endpoint
- Admission ≤ 30-days
Study Overview
Brief Summary
Due to ageing-related physiological changes, diagnosing older adults is challenging. Delayed disease recognition lead to adverse health outcomes and increased hospitalisation, which is why there is a need to develop new procedures for timely diagnosis and treatment of older adults. Point-of-care technology, e.g. focused lung ultrasound scan and bedside analysis of blood samples (leucocytes with differential count, electrolytes and creatinine) carried out in the patients' home may support clinical decision-making, and potentially reduce acute hospital admissions.
The trial's overall aim is to investigate whether increased point-of-care technology, i.e. focused lung ultrasound scan and bedside blood analysis, used as in-home diagnostics in older adults with acute respiratory symptoms, can qualify the general practitioner's clinical decision-making for early treatment initiation and eventually reduce acute hospital admission.
Detailed Description
The trial is conducted in Kolding municipality in Denmark. Participants eligible for this study are people aged 65 years or older, referred to the Acute Community Health Care Service (ACHCS) in Kolding municipality for an in-home assessment.
Data collection:
In the control group, the Acute Community Nurses (ANC) will carry out usual care that involves a clinical inspection, measurements of vital signs (respiratory rate(breaths/min), saturation (%), blood pressure (mmHg), heart rate (beats/min), body temperature (celsius), and Glasgow Coma Scale), and point-of-care tests (POCT) for C-reactive protein (CRP) and haemoglobin.
In the intervention group, the ACN will carry out extended POCT besides usual care. Extended POCT covers a focused lung ultrasound scan (FLUS) and biochemical blood analyses. FLUS examination follows a standardized protocol (21). Biochemical analyses include sodium, potassium, creatinine, urea, and leucocytes with differential count.
In both control and intervention groups the ACN communicates the examination results to the participants' primary care physician (PCP) by telephone as well as an electronic written documentation. The findings will support the PCP in the clinical decision-making. The communication to the PCP is part of the usual care and is carried out in both groups.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Diagnostic
- Masking
- None
Eligibility Criteria
- Ages
- 65 Years to — (Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •referred to the ACHCS in Kolding Municipality for in-home assessment
- •functional decline defined as either subjective (not able to perform normal daily activities as usual) or objective functional decline (increased need of home care)
Exclusion Criteria
- •moderate to severe cognitive impairment
- •antibiotic treatment
Arms & Interventions
Control - Usual Care
Participants in the control-arm will undergo usual care. This covers clinical inspection, vital parameters (respiratory rate(breaths/min), saturation (%), blood pressure (mmHg), heart rate (beats/min), body temperature (celsius), and Glasgow Coma Scale) , and point-of-care blood-test for CRP and haemoglobin
Intervention - Advanced point-of-care technology
Participants in the intervention-arm will undergo usual care as well as advanced point-of-care technology.
Intervention: Advanced point-of-care technology (Other)
Outcomes
Primary Outcomes
Admission ≤ 30-days
Time Frame: 30 days
Proportion of Admissions during 30 days follow-up
Secondary Outcomes
- Re-referrals to the Acute Community Health Care Service(30 days)
- Acute admissions at day 0(Day 0)
- Complications during hospital admission(30 days)
- Treatment initiation or changes ≤ 30-day(30 days)
- Functional level(30 days)
- Mortality ≤ 30-days(30 days)
- Hospital-free days ≤ 30-days(30 days)
- Contact to the PCP ≤ 30-days(30 days)
- Treatment initiations or changes at day 0(Day 0)
- Length of hospital admission(30 days)