Experiences of frail older cardiac patients with a nurse-coordinated transitional care intervention - a qualitative study

Table 2 Intervention delivery in interviewed participants

Patient	Clinical phase			Discharge phase	Post-discharge phase
Patient	CGA	Geriatric consultation	Geriatric consultation indicated?^a	Handover	Number of home visits CN^b	First home visit CN within median of 3 days	Medication verification	Evaluation of care plan	Lifestyle discussed	Number of home visits PT^c	Joint intake CN/PT
1	Yes	No	Yes	Face to face	4	No	Yes	No	Yes	4	Yes
2	Yes	No	Yes	Face to face	4	Yes	Yes	No	No	9	No
3	Yes	No	Yes	Face to face	4	Yes	Yes	No	Yes	9	No
4	Yes	No	Yes	Telephone	3	No	Yes	Yes	Yes	6	Yes
5	Yes	No	Yes	Face to face	5	No	Yes	Yes	Yes	7	No
6	Yes	No	Yes	Unknown	4	Yes	Yes	Yes	Yes	9	No
7	Yes	No	Yes	Telephone	4	Yes	Yes	Yes	Yes	9	No
8	Yes	No	Yes	Unknown	5	No	Yes	Yes	Yes	8	No
9	Yes	No	No	Face to face	4	Yes	Yes	No	Yes	9	Yes
10	Yes	No	No	Telephone	3	No	Yes	No	No	9	No
11	Yes	No	No	Face to face	4	Yes	Yes	Yes	Yes	1	NA
12	Yes	No	No	Face to face	4	Yes	Yes	Yes	No	0	NA
13	Yes	No	No	Face to face	4	Yes	Yes	Yes	Yes	4	No
14	Yes	No	No	Telephone	5	Yes	Yes	Yes	Yes	7	No
15	Yes	Yes	Yes	Face to face	5	Yes	Yes	No	Yes	7	No
16	Yes	No	Yes	Face to face	3	Yes	Yes	No	Yes	2	No

Abbreviations: CGA comprehensive geriatric assessment, CN community nurse, NA not applicable, PT physical therapist
^a Geriatric team consultation was indicated in case of ≥5 geriatric problems of which ≥1 problem had to be within the psychological domain. ^b Four home visits, according to the intervention protocol. An extra home visit was performed on indication, assessed by the CN. ^c Max. nine home-based rehabilitation session, according to the intervention protocol

ISSN: 1472-6963