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Trafikskadades erfarenheter av vård och kostnadseffektivt stöd
Umeå University, Faculty of Medicine, Department of Nursing.
2008 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to describe experiences of emergency treatment among people injured in traffic accidents, and to test and evaluate the effects of follow-up telephone calls from a nurse during the subsequent phase. The thesis is based on four sub-studies of motorists, bicyclists, and pedestrians who had fallen in traffic during the years 2002-2005. The participants were aged 18 to 70 years old and had minor (MAIS 1) or nonminor (MAIS 2+) injuries. Sub-study I was a qualitative study in which individual narrative interviews were conducted with nine persons who had sustained traffic injuries. The aim of this study was to describe the injured individuals’ experiences of pre-hospital and hospital care and subsequent rehabilitation. The interviews were analysed using content analysis, and the experiences of the interviewees were formulated into four themes: facing commotion, experiencing trust and security, lacking security and support, and struggling to return to everyday life. The results showed that a sensitive caregiver who provides comprehensible information facilitates both the emergency treatment and the subsequent period of care and rehabilitation.

Sub-study II was a cross-sectional study in which the participants (n=565) estimated their perceptions of the quality of care in the accident and emergency department (A&E) after an injury event. The Mini-KUPP (“Quality from the Patient’s Perspective”) questionnaire was used to estimate quality of care at the A&E. The questionnaire was posted to the subjects’ home addresses three weeks after the visit to the A&E. The results showed that the quality of care was scored on the top half of the scale by all three road user categories. In a multiple logistic regression analysis, significant connections emerged between good quality of care and a short waiting time, non-minor injuries (MAIS2+), higher age, and higher levels of education. The factor most closely associated with the perception of good quality of care was a short waiting time.

Sub-study III was a stratified and randomised intervention study including 568 injured persons. In addition to modern trauma care, the intervention group received follow-up via telephone, three weeks after the injury, by a nurse who provided advice and support during the rehabilitation period. The control group received modern trauma care but no follow-up. Both groups estimated their health-related quality of life two weeks (baseline) and six months after the injury. After six months, estimates of health-related quality of life were generally higher in the intervention group than in the control group. A sub-group analysis found that the differences were most pronounced for the group who had received adequate advice in connection with the telephone follow-up. Of the three road user categories, the motorists gained the greatest benefit from the telephone intervention, with milder problems with regard to pains/difficulties and essential activities.

Sub study IV was a health economic study. The calculations were built on the results from study III (n=568). A cost utility analysis was performed, including the costs for the intervention and the QALYs gained. The results showed that the telephone intervention was cost-effective. The total gain in the intervention group was 2.60 QALYs, while the car occupants gained 1.54 QALYs. The cost per QALY gained was 16 000 SEK overall and 8 500 SEK for car occupants.

Conclusion: A sensitive caregiver who also provides good information can instil security and trust in the patient. For the purposes of generally improving the quality of care in an A&E, the aim above all should be a short waiting time, but the treatment of minor injuries should also be improved. Access to a supportive nurse who is able to provide advice during the subsequent phase has the potential to improve health-related quality of life in a cost-effective way.

Place, publisher, year, edition, pages
Umeå: Omvårdnad , 2008. , 68 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1195
Keyword [en]
traffic injuries, quality of care, accident and emergency department (A&E), telephone intervention, health-related quality of life, cost-effectiveness, QALY, patient experience
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-1803ISBN: 978-91-7264-596-7 (print)OAI: oai:DiVA.org:umu-1803DiVA: diva2:142026
Public defence
2008-09-18, Aulan, Vårdvetarhuset, Umeå, 09:00 (English)
Opponent
Available from: 2008-09-03 Created: 2008-09-03 Last updated: 2012-07-05Bibliographically approved
List of papers
1. Injured in traffic: experiences of care and rehabilitation.
Open this publication in new window or tab >>Injured in traffic: experiences of care and rehabilitation.
2006 (English)In: Accident and Emergency Nursing, ISSN 0965-2302, Vol. 14, no 2, 104-110 p.Article in journal (Refereed) Published
Keyword
Accidents; Traffic, Adaptation; Psychological, Adult, Emotions, Female, Health Knowledge; Attitudes; Practice, Humans, Male, Middle Aged, Professional-Patient Relations, Qualitative Research, Recovery of Function, Social Support, Sweden, Trust, Wounds and Injuries/psychology/*therapy
Identifiers
urn:nbn:se:umu:diva-6765 (URN)doi:10.1016/j.aaen.2006.01.003 (DOI)16510284 (PubMedID)
Available from: 2008-10-07 Created: 2008-10-07 Last updated: 2009-05-08Bibliographically approved
2. Injured road users' experience of care in the emergency department
Open this publication in new window or tab >>Injured road users' experience of care in the emergency department
Show others...
2008 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 6, 726-734 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To describe the patients' perceptions of quality of care (QoC) in an emergency department (ED) and to analyse associations between patients' background characteristics and estimated QoC.

BACKGROUND: Each year 1.4 out of every 100 inhabitants are injured in the traffic environment and receive care at the ED. No study has yet analysed different injured road users' perceived QoC, or how important they rate different caring dimensions.

DESIGN: Cross-sectional study at the ED, in the University Hospital in Umeå, Sweden.

METHOD: A stratified consecutive sample of 166 car occupants, 200 cyclists and 199 pedestrians, aged 18-70 years, all injured in the traffic environment. Data were collected from medical records and from a mail survey using a short form of the Quality from the Patient's Perspective questionnaire, modified for ED use. The statistical methods used included Mann-Whitney's U-test, the Kruskal-Wallis test and multiple logistic regression.

RESULTS: The perceived QoC and the subjective importance of the corresponding QoC dimensions were rated at the 'better' half of the rating scale, with no differences between the different road user categories. The most prominent factors associated with a positive perceived QoC rating were a short waiting time, moderate or serious injuries and high age as well as high educational level of the injury victim. For the subjective importance, a short waiting time was rated as the most important but slight differences were seen, related to education and sex.

CONCLUSION: The association patterns between the areas of perceived reality and subjective importance indicated that expectations were higher than perceived QoC, suggesting that patients expected somewhat higher QoC than they received.

RELEVANCE TO CLINICAL PRACTICE: Information on factors causing long waiting times, adapted to patients' age, sex and educational level, may reduce dissatisfaction among long waiting patients, especially among those with minor injuries.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2008
Keyword
emergency department, patient's experience, Quality from the Patient's Perspective questionnaire, quality of care, traffic injury
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-21770 (URN)10.1111/j.1365-2702.2006.01873.x (DOI)000253121300004 ()17419790 (PubMedID)
Note

Published Online: 5 Apr 2007

Available from: 2009-04-20 Created: 2009-04-20 Last updated: 2017-12-13Bibliographically approved
3. Injured road users' health-related quality of life after telephone intervention: a randomised controlled trial.
Open this publication in new window or tab >>Injured road users' health-related quality of life after telephone intervention: a randomised controlled trial.
2009 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 1, 108-116 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate whether nursing intervention via telephone follow-up can affect health-related quality of life among road users in the postinjury phase.

Background: Injuries in the traffic environment often cause both physical impairment and psychological trauma. Therefore, it is important to investigate whether nursing via telephone follow-up after discharge could affect health-related quality of life among injured road users.

Design: A randomised controlled study.

Method: Between April 2003–April 2005, car occupants, cyclists and pedestrians, aged 18–70 years, all injured in the traffic environment, were randomly assigned to an intervention (n = 288) or control group (n = 280). All patients were initially managed by one emergency department with the intervention group being followed up by nurse led telephone follow-up three weeks after discharge, while the control group did not receive any telephone follow-up. Data were collected from a mail survey using the non-disease-specific health-related quality of life instrument EQ5D, at baseline and after six months.

Results: In general, the intervention group rated significantly higher health-related quality of life than the control group. This difference was most pronounced in the group of those provided with advice as part of telephone follow-up and significantly for the general health status. Car occupants gained most advantage from the nursing telephone follow-up, with significantly lower problems in the dimensions of pain/discomfort and usual activities.

Conclusion: Nursing intervention via telephone follow-up was effective at increasing the health-related quality of life of injured road users. Early identification of the concerns of the injured and specific advice provided by the intervening nurse seems to be of greatest weight. Thus, more research is needed regarding the usefulness of early support and the advantage of this from a health economic perspective.

Relevance to clinical practice: There is a need for changes in attitudes and working routines to identify individuals with low health-related quality of life and to give more extensive support from this point of view.

Place, publisher, year, edition, pages
Oxford: Blackwell Scientific, 2009
Keyword
health-related quality of life, nurses, nursing, patient experience, telephone intervention, traffic injury
Identifiers
urn:nbn:se:umu:diva-18514 (URN)10.1111/j.1365-2702.2008.02436.x (DOI)19120736 (PubMedID)
Available from: 2009-02-12 Created: 2009-02-12 Last updated: 2017-12-14Bibliographically approved
4. A cost-utility analysis of nursing intervention via telephone follow-up for injured road users
Open this publication in new window or tab >>A cost-utility analysis of nursing intervention via telephone follow-up for injured road users
2009 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 9, 98- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Traffic injuries can cause physical, psychological, and economical impairment, and affected individuals may also experience shortcomings in their post-accident care and treatment. In an earlier randomised controlled study of nursing intervention via telephone follow-up, self-ratings of health-related quality of life were generally higher in the intervention group than in the control group. OBJECTIVE: To evaluate the cost-effectiveness of nursing intervention via telephone follow-up by examining costs and quality-adjusted life years (QALYs). METHODS: A randomised controlled study was conducted between April 2003 and April 2005. Car occupants, cyclists, and pedestrians aged between 18 and 70 years and attending the Emergency Department of Umeå University Hospital in Sweden after an injury event in the traffic environment were randomly assigned to an intervention (n = 288) or control group (n = 280). The intervention group received routine care supplemented by nursing via telephone follow-up during half a year, while the control group received routine care only. Data were collected from a mail survey using the non-disease-specific health-related quality of life instrument EQ5D, and a cost-effectiveness analysis was performed including the costs of the intervention and the QALYs gained. RESULTS: Overall, the intervention group gained 2.60 QALYs (260 individuals with an average gain of 0.01 QALYs). The car occupants gained 1.54 QALYs (76 individuals, average of 0.02). Thus, the cost per QALY gained was 16 000 Swedish Crown (SEK) overall and 8 500 SEK for car occupants. CONCLUSION: Nursing intervention by telephone follow-up after an injury event, is a cost effective method giving improved QALY to a very low cost, especially for those with minor injuries. 

Place, publisher, year, edition, pages
BioMed Central, 2009
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-30579 (URN)10.1186/1472-6963-9-98 (DOI)000267743000001 ()19515265 (PubMedID)
Note

Funding: This research was supported by the Swedish Association for Cancer and Traffic Victims.

Available from: 2010-01-08 Created: 2010-01-08 Last updated: 2017-12-12Bibliographically approved

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