The effect of a long-term condition management programme on hospital presentations: A retrospective three group study.

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Authors
Mason, Sara
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Degree
Master of Nursing
Grantor
Eastern Institute of Technology
Date
2017
Supervisors
Munday, Karen
Maclaren, Olivia
Type
Masters Thesis
Ngā Upoko Tukutuku (Māori subject headings)
Keyword
Hawke's Bay (N.Z.)
New Zealand
respiratory disease
long-term conditions
chronic illnesses
Pulmonary Long-term Management (PLTM) Community Nursing Service
Trajectory of Long Term Care Model (TLC)
Māori health
Citation
Mason, S. (2017). The effect of a long-term condition management programme on hospital presentations: A retrospective three group study. (Unpublished document submitted in partial fulfilment of the requirements for the degree of Master of Nursing). Eastern Institute of Technology (EIT), New Zealand.
Abstract
BACKGROUND The Trajectory of Long Term Care Model (TLC) provides a framework for directing appropriate care to patients depending on where they are in the trajectory of their illness. It recognises that patients with long-term conditions (LTC) frequently move between different levels of healthcare services and escalates care depending on need. The Pulmonary Long-term Management (PLTM) Community Nursing Service developed a service based on the TLC model. The aim of this study was to ascertain if any reductions could be seen in emergency presentations or hospital admissions for patients who had participated in the PLTM service. METHODS This study applied a quasi-experimental, retrospective design using a total of 287 participants. Presentations and admissions to hospital were analysed for both respiratory disease and overall LTC. To explore the differences between the groups (one-hour intervention, ten-week intervention, and non-participation group) general linear models were generated for emergency presentations and hospital admissions within LTC or respiratory disease. If a significant difference between the groups were detected, then pairwise comparisons were performed using Bonferroni corrections. RESULTS When examining LTCs the ten-week intervention showed 75.7% less emergency room presentations compared to the non-participation group (p=0.006) and a 58.9% less hospital admissions compared to the non-participant group (p=0.008). Interestingly, no significant differences were found between the one-hour intervention group and the ten-week intervention group for emergency room presentations (p=0.677), admissions to hospital with LTCs (p=1.0), emergency presentations with respiratory disease (p=1.0) or admissions to hospital with respiratory disease (p=1.0). CONCLUSIONS Statistically significant reductions in hospital utilisation were seen when examining LTCs but not respiratory disease. This is noteworthy given that this study also found an average of three LTC per participant. This study could have significant implications for LTC management strategies especially given the difficulties seen in enrolment, participation and retention in LTC management programmes. Continuing inequities in health provide an argument for improved access to alternative choices in LTC management.
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