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Transitional care improves self-care, quality of life in patients with lupus
Providing transitional care for individuals with systemic lupus erythematosus reduced readmissions and improved not only patients’ quality of life, but also their ability to perform self-care, according to findings published in Arthritis Research & Therapy.
“Transitional care is a set of actions designed to ensure the coordination and continuity of health care when patients transfer between different settings (eg, from hospital to home),” Xia Xie, RN, BSN, of Sichuan University’s West China Hospital, and colleagues wrote. “Previous studies have shown that it is an effective model to improve self-care, reduce rehospitalization rates and enhance quality of life of patients with other chronic conditions, mainly heart failure and diabetes. ... Studies evaluating transition care in adult SLE are scarce, and the reproducibility and effectiveness of transitional care in adult patients with SLE remain unclear.”
To analyze the impact of transitional care on individuals’ self-care, quality of life and readmission rates among adults with SLE, Xie and colleagues conducted a single-center, single-blind, parallel-group randomized controlled study of patients at West China Hospital. The researchers recruited 136 adults with SLE who were admitted due to new or worsening symptoms and subsequently discharged home. The participants were randomly assigned into one of two groups, with half placed into a transitional care group and half receiving usual care.
Transitional care included four structural assessments and corresponding interventions, as well as four telephone follow-up sessions, over a 12-week period. All interventions were conducted by two experienced nurses trained in transitional care, supported by a physician and three nursing specialists. Usual care included brief instructions on medication and basic health advice upon discharge, the researchers wrote. The researchers conducted evaluations at baseline, before the patient was discharged, and at 3 months using the facility’s readmission rate, the Exercise of Self-Care Agency Scale and the Medical Outcomes Study Short Form 36-item Health Survey.
Among the participants, four members of the transitional care group and seven in the usual care cohort were lost to follow-up. In total, 64 patients in the transitional care and 61 in the usual care cohorts were included in the final analysis.
According to the researchers, patients in the transitional care group reported significantly greater improvement in self-care and quality of life compared with those who received the usual care. In addition, readmission rates for participants who received transitional care were significantly lower than those in the usual care group at 30, 60 and 90 days following discharge.
“This study is timely and contributes to the evidence that transitional care may improve self-care, reduce readmissions, and improve quality of life of adult patients with SLE,” Xie and colleagues wrote. “These findings might be highly relevant for policy makers and health care providers because of the increasing trend of patients with SLE and the heavy burden of the disease. In view of the feasibility and positive outcomes of the transitional care in our study, we assume that transitional care has potential for application in SLE patients from other settings. Further studies are needed in the future.” – by Jason Laday
Disclosure: Xie reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Systemic lupus erythematosus is a common chronic autoimmune disease. In recent decades, the survival rate of patients with SLE has improved because of advancements in diagnosis and treatment; however, nearly 60% of patients with SLE have persistently active disease or flare episodes each year. This is especially unfortunate because patients with active SLE usually experience more serious physical and psychosocial problems resulting in frequent admissions.
Previous studies have shown that approximately 16.5% of patients hospitalized for SLE are readmitted within 30 days because of the development of new or worsening symptoms, and approximately 35% are readmitted within one year after discharge. In total compared with those with other chronic illnesses, patients with SLE have the sixth highest hospital readmission rate in the U.S. Frequent hospitalizations contribute greatly to the burden an SLE patient must bear. Additionally, patients who are readmitted within 30 days are faced with significantly higher expenses and experience greater impacts on their quality of life.