Extended Use of Point-of-care Technology Versus Usual Care for In-home Assessment by Acute Community Nurses in Older Adults with Signs of Potential Acute Respiratory Disease: an Open-label Randomised Controlled Trial Protocol

Overview

Journal BMC Geriatr

Publisher Biomed Central

Specialty Geriatrics

Date 2024 Feb 16

PMID 38365595

Authors

Siri Aas Smedemark

Christian B Laursen

Dorte Ejg Jarbol

Flemming S Rosenvinge

Karen Andersen-Ranberg

Affiliations

Soon will be listed here.

Abstract

Background: Due to ageing-related physiological changes, diagnosing older adults is challenging. Delayed disease recognition may lead to adverse health outcomes and increased hospitalisation, necessitating the development of new initiatives for timely diagnosis and treatment of older adults. Point-of-care technology, such as focused lung ultrasound scan and bedside analysis of blood samples (leucocytes with differential count, electrolytes, and creatinine) conducted in the patients' home, may support clinical decision-making, and potentially reduce acute hospital admissions. We present the protocol for a randomized controlled trial, which aims at assessing the effect of focused lung ultrasound scan and bedside blood analysis during in-home assessments among older adults with signs of potential acute respiratory disease on hospital admissions.

Method: We will use a parallel open-label, individually randomised controlled trial design in an acute community healthcare setting. The trial will initiate on October 2022 and is expected to end one year later. The study population will include older adults (65 + year), with at least one of the following inclusion criteria: Cough, dyspnoea, fever, fall, or rapid functional decline. Expected study sample will comprise 632 participants. Participants in the control group will receive usual care, while the intervention group will undergo extended point-of-care technology (focused lung ultrasound scan and bedside venous blood analysis), in addition to usual care. The primary outcome is acute hospital admission within 30 days follow-up. Secondary outcomes include readmissions, mortality, length of hospital stay, hospital-free days, complications during hospital admission, treatment initiations or changes, functional level, re-referrals to the acute community healthcare service, and contacts to the primary care physician. A tertiary outcome is the diagnostic accuracy of Acute Community Nurses for conducting focused lung ultrasound compared with a specialist. Outcomes will be analysed as intention-to-treat.

Discussion: To our knowledge, this is the first randomised controlled trial examining the effect of extended use of point-of-care technology conducted in an in-home setting. We expect that the results may contribute to the development of new interventions aiming to improve timely diagnostics, treatment decisions, and reduce acute hospital admissions.

Trial Registration: www.

Clinicaltrials: org NCT05546073 (Date of registration: September 19th, 2022).

References

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

Barnett K, Mercer S, Norbury M, Watt G, Wyke S, Guthrie B . Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380(9836):37-43. DOI: 10.1016/S0140-6736(12)60240-2. View

Keeble E, Roberts H, Williams C, van Oppen J, Conroy S . Outcomes of hospital admissions among frail older people: a 2-year cohort study. Br J Gen Pract. 2019; 69(685):e555-e560. PMC: 6650131. DOI: 10.3399/bjgp19X704621. View

Struyf T, Boon H, van de Pol A, Tournoy J, Schuermans A, Verheij T . Diagnosing serious infections in older adults presenting to ambulatory care: a systematic review. Age Ageing. 2020; 50(2):405-414. DOI: 10.1093/ageing/afaa108. View

Auriemma C, Taylor S, Harhay M, Courtright K, Halpern S . Hospital-Free Days: A Pragmatic and Patient-centered Outcome for Trials among Critically and Seriously Ill Patients. Am J Respir Crit Care Med. 2021; 204(8):902-909. PMC: 8534616. DOI: 10.1164/rccm.202104-1063PP. View

Long L, Zhao H, Zhang Z, Wang G, Zhao H . Lung ultrasound for the diagnosis of pneumonia in adults: A meta-analysis. Medicine (Baltimore). 2017; 96(3):e5713. PMC: 5279077. DOI: 10.1097/MD.0000000000005713. View

Rodriguez-Contreras F, Calvo-Cebrian A, Diaz-Lazaro J, Cruz-Arnes M, Leon-Vazquez F, Del Carmen Lobon-Agundez M . Lung Ultrasound Performed by Primary Care Physicians for Clinically Suspected Community-Acquired Pneumonia: A Multicenter Prospective Study. Ann Fam Med. 2022; 20(3):227-236. PMC: 9199040. DOI: 10.1370/afm.2796. View

. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013; 310(20):2191-4. DOI: 10.1001/jama.2013.281053. View

Jackson M, Neuzil K, Thompson W, Shay D, Yu O, Hanson C . The burden of community-acquired pneumonia in seniors: results of a population-based study. Clin Infect Dis. 2004; 39(11):1642-50. PMC: 7108010. DOI: 10.1086/425615. View

10.

Harris P, Taylor R, Minor B, Elliott V, Fernandez M, ONeal L . The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019; 95:103208. PMC: 7254481. DOI: 10.1016/j.jbi.2019.103208. View

11.

Laursen C, Clive A, Hallifax R, Pietersen P, Asciak R, Davidsen J . European Respiratory Society statement on thoracic ultrasound. Eur Respir J. 2020; 57(3). DOI: 10.1183/13993003.01519-2020. View

12.

Christensen K, Doblhammer G, Rau R, Vaupel J . Ageing populations: the challenges ahead. Lancet. 2009; 374(9696):1196-208. PMC: 2810516. DOI: 10.1016/S0140-6736(09)61460-4. View

13.

Schols A, Dinant G, Hopstaken R, Price C, Kusters R, Cals J . International definition of a point-of-care test in family practice: a modified e-Delphi procedure. Fam Pract. 2018; 35(4):475-480. DOI: 10.1093/fampra/cmx134. View

14.

Boere T, Hopstaken R, Van Tulder M, Schellevis F, Verheij T, Hertogh C . Implementation and Use of Point-of-Care C-Reactive Protein Testing in Nursing Homes. J Am Med Dir Assoc. 2021; 23(6):968-975.e3. DOI: 10.1016/j.jamda.2021.09.010. View

15.

Florkowski C, Don-Wauchope A, Gimenez N, Rodriguez-Capote K, Wils J, Zemlin A . Point-of-care testing (POCT) and evidence-based laboratory medicine (EBLM) - does it leverage any advantage in clinical decision making?. Crit Rev Clin Lab Sci. 2017; 54(7-8):471-494. DOI: 10.1080/10408363.2017.1399336. View

16.

Fournaise A, Nissen S, Lauridsen J, Ryg J, Nickel C, Gudex C . Translation of the updated clinical frailty scale 2.0 into Danish and implications for cross-sectoral reliability. BMC Geriatr. 2021; 21(1):269. PMC: 8059120. DOI: 10.1186/s12877-021-02222-w. View

17.

Aubert C, Schnipper J, Fankhauser N, Marques-Vidal P, Stirnemann J, Auerbach A . Patterns of multimorbidity associated with 30-day readmission: a multinational study. BMC Public Health. 2019; 19(1):738. PMC: 6567629. DOI: 10.1186/s12889-019-7066-9. View

18.

Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein D, Mathis G, Kirkpatrick A . International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012; 38(4):577-91. DOI: 10.1007/s00134-012-2513-4. View

19.

Pietersen P, Konge L, Madsen K, Bendixen M, Maskell N, Rahman N . Development of and Gathering Validity Evidence for a Theoretical Test in Thoracic Ultrasound. Respiration. 2019; 98(3):221-229. DOI: 10.1159/000500146. View

20.

Larsen J, Jensen R, Pietersen P, Jacobsen N, Falster C, Nielsen A . Education in Focused Lung Ultrasound Using Gamified Immersive Virtual Reality: A Randomized Controlled Study. Ultrasound Med Biol. 2022; 49(3):841-852. DOI: 10.1016/j.ultrasmedbio.2022.11.011. View