A new multimodal geriatric discharge-planning intervention to prevent emergency visits and rehospitalizations of older adults: the optimization of medication in AGEd multicenter randomized controlled trial.

OBJECTIVES: To determine whether a new multimodal comprehensive discharge-planning intervention would reduce emergency rehospitalizations or emergency department (ED) visits for very old inpatients. DESIGN: Six-month prospective, randomized (Zelen design), parallel-group, open-label trial. SETTING: Six acute geriatric units (AGUs) in Paris and its surroundings. PARTICIPANTS: Six hundred sixty-five consecutive inpatients aged 70 and older (intervention group (IG) n = 317; control group (CG) n = 348). INTERVENTION: Intervention-dedicated geriatricians different from those in the study centers implemented the intervention, which targeted three risk factors for preventable readmissions and consisted of three components: comprehensive chronic medication review, education on self-management of disease, and detailed transition-of-care communication with outpatient health professionals. MEASUREMENTS: Emergency hospitalization or ED visit 3 and 6 months after discharge, as assessed by telephone calls to the participant, the caregiver, and the general practitioner and confirmed with the hospital administrative database. RESULTS: Twenty-three percent of IG participants were readmitted to hospital or had an ED visit 3 months after discharge, compared with 30.5% of CG participants (P = .03); at 6 months, the proportions were 35.3% and 40.8%, respectively (P = .15). Event-free survival was significantly higher in the IG at 3 months (hazard ratio (HR) = 0.72, 95% confidence interval (CI) = 0.53-0.97, P = .03) but not at 6 months (HR = 0.81, 95% CI = 0.64-1.04, P = .10). CONCLUSION: This intervention was effective in reducing rehospitalizations and ED visits for very elderly participants 3 but not 6 months after their discharge from the AGU. Future research should investigate the effect of this intervention of transitional care in a larger population and in usual acute and subacute geriatric care.

[Proposals for comprehensive approach to patient education for the care of type 2 diabetic patients]. / Propositions pour une approche compréhensive de l'éducation thérapeutique du patient diabétique de type 2.

The diagnosis of type 2 diabetes is generally put within the context of a medical check-up at a person more or less predisposed to the disease. From the patient's point of view the reality of the disease is thus at this moment at least abstracted, and can go from banalisation to dramatization. This aspect is going to influence how the patient is going to get involved in the approach of care and thus in the therapeutic educational process. We suggest being interested in this difficulty through three fundamental questions of the experience of the patient: the question of the identical break, the question of the sense and the question of self-efficacy. Because never definitively resolved, these questions will accompany the reflection of the patient and caregiver all along the route of care. By illustrating here a posture of care which legitimizes such a glance on the experience of the carrier of the disease, we defend an approach of the therapeutic education of the patient integrated into the care.