Some care home residents may have died because of blanket DNR orders, says regulator

SummaryDespite evidence from 6 major clinical trials that warfarin effectively prevents strokes in atrial fibrillation, clinicians and health care managers may remain reluctant to support anticoagulant prophylaxis because of its perceived costs. Yet, doing nothing also has a price. To assess this, we carried out a pharmacoe-conomic analysis of warfarin use in atrial fibrillation. The course of the disease, including the occurrence of cerebral and systemic emboli, intracranial and other major bleeding events, was modeled and a meta-analysis of the clinical trials and other relevant literature was carried out to estimate the required probabilities with and without warfarin use. The cost of managing each event, including acute and subsequent care, home care equipment and MD costs, was derived by estimating the cost per resource unit, the proportion consuming each resource and the volume of use. Unit costs and volumes of use were determined from established US government databases, all charges were adjusted using cost-to-charge ratios, and a 3% discount rate was applied to costs incurred beyond the first year. The proportions of patients consuming each resource were estimated by fitting a joint distribution to the clinical trial data, stroke outcome data from a recent Swedish study and aggregate ICD-9 specific, Massachusetts discharge data. If nothing is done, 3.2% more patients will suffer serious emboli annually and the expected annual cost of managing a patient will increase by DM 2,544 (1996 German Marks), from DM 4,366 to DM 6,910. Extensive multiway sensitivity analyses revealed that the higher price of doing nothing persists except for very extreme combinations of inputs unsupported by literature or clinical standards. The price of doing nothing is thus so high, both in health and economic terms, that cost-consciousness as well as clinical considerations mandate warfarin prophylaxis in atrial fibrillation.

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Developing an Appropriate Investment Appraisal Model for Strategic Decision Making in the Care Home Sector

10.15396/eres2002_158 ◽

2002 ◽

Keyword(s):

Decision Making ◽

Care Home ◽

Strategic Decision ◽

Strategic Decision Making ◽

Investment Appraisal

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An Autoethnograpy on Life Worlds of My Mother in An Elderly Care Home

Korean Association for Qualitative Inquiry ◽

10.30940/jqi.2020.6.1.347 ◽

2020 ◽

Vol 6 (1) ◽

pp. 347-393

Author(s):

Yeung Ja Yang

Keyword(s):

Elderly Care ◽

Care Home

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Urinary tract infections (UTIs); a leaflet for older adults, and carers: the development of a UTI leaflet for older adults and their carers

British Journal of General Practice ◽

10.3399/bjgp18x696833 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X696833 ◽

Cited By ~ 1

Author(s):

Leah Ffion Jones ◽

Emily Cooper ◽

Cliodna McNulty

Keyword(s):

Older Adults ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Care Home ◽

Asymptomatic Bacteriuria ◽

Theoretical Domains Framework ◽

Antibiotic Use ◽

Primary Care Providers ◽

Care Providers ◽

Tract Infections

BackgroundEscherichia coli bacteraemia rates are rising with highest rates in older adults. Mandatory surveillance identifies previous Urinary Tract Infections (UTI) and catheterisation as risk factors.AimTo help control bacteraemias in older frail patients by developing a patient leaflet around the prevention and self-care of UTIs informed by the Theoretical Domains Framework.MethodFocus groups or interviews were held with care home staff, residents and relatives, GP staff and an out of hours service, public panels and stakeholders. Questions explored diagnosis, management, prevention of UTIs and antibiotic use in older adults. The leaflet was modified iteratively. Discussions were transcribed and analysed using Nvivo.ResultsCarers of older adults reported their important role in identifying when older adults might have a UTI, as they usually flag symptoms to nurses or primary care providers. Information on UTIs needs to be presented so residents can follow; larger text and coloured sections were suggested. Carers were optimistic that the leaflet could impact on the way UTIs are managed. Older adults and relatives liked that it provided new information to them. Staff welcomed that diagnostic guidance for UTIs was being developed in parallel; promoting consistent messages. Participants welcomed and helped to word sections on describing asymptomatic bacteriuria simply, preventing UTIs, causes of confusion and when to contact a doctor or nurseConclusionA final UTI leaflet for older adults has been developed informed by the TDF. See the TARGET website www.RCGP.org.uk/targetantibiotics/

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GPs’ experience of safeguarding in care homes: what do they see and what do they do?

British Journal of General Practice ◽

10.3399/bjgp20x711269 ◽

2020 ◽

Vol 70 (suppl 1) ◽

pp. bjgp20X711269

Author(s):

Elisabeth Alton ◽

Caroline White

Keyword(s):

Online Survey ◽

Qualitative Data ◽

Care Home ◽

Health Needs ◽

Care Homes ◽

Electronic Records ◽

Multiple Relationships ◽

Home Context ◽

Emerging Themes ◽

Multiple Health

BackgroundAbuse of older people in care homes is an on-going problem. GPs, as the most frequent practitioner group visiting care homes, have an important role in detecting and reporting abuse. However, there is little research about GPs’ experiences of working in care homes and how they work to safeguard residents.AimTo explore the challenges experienced by GPs working in this unique environment and how these impact on safeguarding.MethodAn online survey collected qualitative data about GPs’ experiences as visiting professionals to care homes, with an emphasis on safeguarding. A thematic analysis identified key themes.ResultsIn total, 58 completed surveys were returned, with a range of practitioner experience represented (1–30 years). Approximately 70% were GP partners, with the remainder salaried and locum doctors. Over one third reported they had witnessed signs of definite or possible abuse within care homes. Emerging themes related to the complex care home context, in which residents had multiple health needs and GPs had to build multiple relationships with managers, carers, families, and residents. Difficulties in accessing information were reported; residents could not always provide information, GPs had to rely on others for information, and rarely had access to electronic records.ConclusionGP work in care homes is a complex and skilled role, in which GPs encounter evidence of poor care and abuse. Key themes in respect of barriers and facilitators of good care were highlighted. The reliance on others for information and the need to build relationships with staff/managers may raise tensions in respect of safeguarding practice.

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