Long-Term Care for Tracheotomised Patients With or Without Invasive Ventilation. Lessons Learned from a Scoping Review of International Concepts.

Susanne Stark,Michael Ewers

doi:10.5334/ijic.5429

Abstract

Introduction:Patients with long-term tracheostomies, with or without mechanical ventilation have complex and comprehensive healthcare needs. The number of patients is increasing internationally. Evidence suggests poor healthcare quality and outcomes, especially in Germany. Against this background, we searched for international concepts tailoring healthcare to these special needs, their key characteristics and results from their evaluations.Methods:A scoping review was performed in 2018 based on a systematic search of scientific databases and grey literature without restrictions to publication type. Key information was charted and thematically analysed based on the taxonomy of integrated care. Evaluations were analysed descriptively.Results:Seventy-nine publications related to 25 programmes from five countries were included. Healthcare concepts are usually regionally adapted and tertiary sector-based with a cross-sectoral approach. Care coordination responsibility is usually assigned to advanced nurse practitioners, embedded in multi-professional programme teams. Interventions consist of specialised needs-based clinical services combined with care coordination, homecare support and education. Evaluation of concepts is scarce, but existing results indicate beneficial effects on patient-related outcomes, care coordination, healthcare utilisation and costs.Conclusions:The concepts available in the literature are often poorly described and rarely evaluated. Research is needed on their impact on healthcare quality and outcomes. However, several key characteristics were identified, which should be considered when developing and implementing integrated and needs-based approaches for the patient group in Germany and beyond.

Highlights

Patients with long-term tracheostomies, with or without mechanical ventilation have complex and comprehensive healthcare needs
Demographic and epidemiological changes aligned with advances in medical technology and the medicalisation of healthcare are leading to a steady increase of this and other patient groups with a long-term dependency on healthcare technology [1, 3, 4]
According to the aim of this method to systematically search, collate and map existing knowledge on a broad field of conceptual practice, research, evidence and gaps [27], we summarised and mapped the so far scarcely researched field of healthcare approaches relevant to the patient group

Summary

Introduction

Patients with long-term tracheostomies, with or without mechanical ventilation have complex and comprehensive healthcare needs. E vidence suggests poor healthcare quality and outcomes, especially in Germany Against this background, we searched for international concepts tailoring healthcare to these special needs, their key characteristics and results from their evaluations. Demographic and epidemiological changes aligned with advances in medical technology and the medicalisation of healthcare are leading to a steady increase of this and other patient groups with a long-term dependency on healthcare technology [1, 3, 4] The complexity of their needs often requires the support of ongoing multifaceted, highly specialised professional health and social services spanning different sectors, settings and care levels [5, 6]. This often proves challenging – as the following outline of the German and international situation highlights

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Discussion

Conclusion