Are Patients Admitted to the Virtual Ward Satisfied with the Intervention of the Community Matron in their Care Pathway?

1. Are Patients Admitted to the Virtual Ward Satisfied with the Intervention of the Community Matron in their Care Pathway? Geraldine Rodgers Dr. Maria Ponto

2. Plan of Presentation • Aims & objectives with background • Literature review • Research design • Methods • Findings • Discussion • Conclusion

3. AIMS Aims and Objectives Explore whether the intervention of the Community Matron • Improves patients satisfaction of care provided • Prevents admission and re-admission to hospital OBJECTIVES • Identify whether patients are satisfied with the intervention of the Community Matron • Ascertain whether A&E attendances are reduced using the Combined Risk Model Algorithm • Compare A&E figures to a control sample of 10 patients who declined to be case managed by the Community Matron • Determine whether positive patient satisfaction scores provide a useful benchmark for the evaluation of the virtual ward

4. 2005 Background Introduction of the Role of Community Matron for Long Term Conditions Virtual Ward Project in Croydon - 10 Community Matrons Algorithm: Combined Predictive Model - Evidence based forecast The National Service Framework for Long-term Conditions Government Targets: Reduce Hospital admissions by 5% by 2008

5. Key Literature Review • Community Matron: New clinical role • Few studies at the beginning of project - more studies at the later stage of project • Only three qualitative studies [ Brown (2008) Sargent (2007) , and Bowler (2009)]during this period. • Four studies based on quantitative projects [ Gravelle(2007), Wright (2007), Clegg(2008), & Leighton (2008)] • In each of the studies the Community Matron was the primary focus but not the virtual ward as was a new concept • No community matron study had used IPA

6. Qualitative approach Research Design • Semi structured interviews • Interpretative Phenomenological Analysis (IPA) Methodology of data capture Sampling methodology Sample size Population Random selection (50) 11 patients All registered Croydon patients Top 3% selected by Combined Model Predictive Tool Exclusion criteria • Patients under 18 • Patients with cognitive impairment

7. Characteristics of the Study Participants Characteristics of the Study Participants

8. Analysis Interpretative Phenomenological Analysis (IPA) used to analyse data for emergent themes derived from patient experiences IPA is a phenomenological method founded by Smith (1997)

9. Findings – Primary Themes Patient perception of community matron Confidence gained Reassurance A&E attendance & avoidance Feelings Virtual ward experience

10. Data Analysis

11. Discussion

12. Theme 4: A&E

13. Conclusions and Reflection • The role community matrons were valued and increased patient satisfaction is evident in this study • Admission avoidance & reduction was evident • IPA provided a definite strength to study –holistic perspective

14. References  Bowler, M. (2009) Exploring patient’s experience of a community matron service using storybooks. Nursing Times, 105(24): 19-21 Brown, K., Stainer, K., Stewart, J., Clacy, R., and Parker, S. (2008) Older people with complex long-term conditions. Their views on the community matron service: a qualitative study. Quality in Primary Care: 16; 409-417 Clegg, A. & Bee, A.(2008) Community matrons: patients’ and carers’ views of a new service. Nursing Standard vol 22(47) p 35-39 Gravelle, H., Dusheiko, M., Sheaff, R et al. (2007) Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data. British Medical Journal.334, 7583,31 Great Britain. Department of Health. (2004) The NHS Improvement Plan: Putting People at the Heart of Public Services, London, Department of Health.The Stationery Office, London  Great Britain. Department of Health. (2005a) Supporting people with long-term conditions: an NHS and social care model. The Stationery Office, London  Great Britain. Department of Health. (2005b) Supporting people with long term conditions: liberating the talents of nurses who care for people with long term conditions. The Stationery Office, London  Great Britain. Department of Health. (2005) National Service Framework for Long Term Conditions. The Stationery Office, London  Great Britain. Department of Health. (2006) Caring for people with long term conditions: an education framework for community matrons and case managers. The Stationery Office, London.

15. References  Great Britain. Department of Health. (2006) Your health, your care, your say: A new direction for community services – an overview. The Stationery Office, London  Great Britain. Department of Health. (2007) NHS Next Stage Review: interim report. The Stationery Office, London  Great Britain. Department of Health. (2008) Your health your way. A guide to long term conditions and self care. The Stationery Office, London Great Britain. Department of Health. (2008) High quality care for all- NHS Next Stage Review- Final Report. The Stationery Office, London Leighton, Y., Clegg, A. and Bee, A. (2008) evaluation of community matron services in a large metropolitan city in England. Quality in Primary Care.16: 83-9 Smith, J.A., Flowers, P., & Osborn, M. (1997) Interpretative phenomenological analysis & health psychology. In L Yardley(Ed).Material Discourses & Health. London: Routledge Sargent , P; Pickard, P, Sheaff, S; & Boaden, R. (2007) Patient and carer perceptions of case management for long term conditions. Health and Social Care in the Community. 15(6), 511- 519 Wright, K., Ryder, S., and Gousy, M. (2007) Community Matrons improve health : Patients’ perspectives'. British Journal of Community Nursing. 12(10) 453-459 Self care: a national view in 2007 compared to 2004-05. London : DH, Web publication http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance (Accessed 4 July 2009)

16. Contact Information Geraldine Rodgers; Nurse consultant for Adults & Older People Geraldine.rodgers@swessex.nhs.uk ldine.rodgers@swessex.nhs.uk Dr Maria Ponto : Principal Lecturer, Course Director,  MSc Healthcare Education and Clinical Leadership . Visiting Professor to Kemi-Tornio University in Finland M.Ponto@sgul.kingston.ac.uk