1. Are Patients Admitted to the Virtual Ward Satisfied with the Intervention of the Community Matron in their Care Pathway?
Geraldine Rodgers
Dr. Maria Ponto

2. Plan of Presentation Aims & objectives with background
Literature review
Research design
Methods
Findings
Discussion
Conclusion

3. Aims and Objectives AIMS
Explore whether the intervention of the Community Matron
Improves patients satisfaction of care provided
Prevents admission and re-admission to hospital
OBJECTIVES
Identify whether patients are satisfied with the intervention of the Community Matron
Ascertain whether A&E attendances are reduced using the Combined Risk Model Algorithm
Compare A&E figures to a control sample of 10 patients who declined to be case managed by the Community Matron
Determine whether positive patient satisfaction scores provide a useful benchmark for the evaluation of the virtual ward

4. Background
2005
The National Service Framework for Long-term Conditions
Government Targets: Reduce Hospital admissions by 5% by 2008
Introduction of the Role of Community Matron for Long Term Conditions
Virtual Ward Project in Croydon - 10 Community Matrons
Algorithm: Combined Predictive Model - Evidence based forecast

5. Key Literature Review Community Matron: New clinical role
Few studies at the beginning of project - more studies at the later stage of project
Only three qualitative studies [ Brown (2008) Sargent (2007) , and Bowler (2009)]during this period.
Four studies based on quantitative projects [ Gravelle (2007), Wright (2007), Clegg(2008), & Leighton (2008)]
In each of the studies the Community Matron was the primary focus but not the virtual ward as was a new concept
No community matron study had used IPA

6. Methodology of data capture
Research Design
Qualitative approach
Semi structured interviews
Interpretative Phenomenological Analysis (IPA)
Methodology of data capture
Sampling methodology
Sample size
Population
Random selection (50)
11 patients
All registered Croydon patients
Top 3% selected by Combined Model Predictive Tool
Exclusion criteria
Patients under 18
Patients with cognitive impairment

7. Characteristics of the Study Participants
Sex
Male 7
Female 4
Age (years)
Range
Arithmetic mean 72
Ethnicity
Iranian 1
Afro-Caribbean 2
Sri Lankan
White British
Geographic coverage
Suburbs covered 10
Period of admission to the virtual ward (months)
8 - 37 20
Characteristics of the Study Participants

8. Analysis
Interpretative Phenomenological Analysis (IPA) used to analyse data for emergent themes derived from patient experiences
IPA is a phenomenological method founded by Smith (1997)

9. Findings – Primary Themes
Patient perception of community matron
Confidence gained
Reassurance
A&E attendance & avoidance
Feelings
Virtual ward experience

10. Data Analysis

11. Discussion 1 Patient perception of the community matron
All 11 participants were positive about the role 2
Confidence gained
9 participants said they gained confidence 3
Reassurance
7 participants referred to reassurance 4
A&E attendance & avoidance
7 monitored their admission avoidance 5
Feelings
10 commented on the phenomena of living with a long term condition 6
Virtual ward experience
All commented on a feeling of belonging / good service

12. Theme 4: A&E

13. Conclusions and Reflection
The role community matrons were valued and increased patient satisfaction is evident in this study
Admission avoidance & reduction was evident
IPA provided a definite strength to study –holistic perspective

14. References
Bowler, M. (2009) Exploring patient’s experience of a community matron service using storybooks. Nursing Times, 105(24): Brown, K., Stainer, K., Stewart, J., Clacy, R., and Parker, S. (2008) Older people with complex long-term conditions. Their views on the community matron service: a qualitative study. Quality in Primary Care: 16; Clegg, A. & Bee, A.(2008) Community matrons: patients’ and carers’ views of a new service. Nursing Standard vol 22(47) p Gravelle, H., Dusheiko, M., Sheaff, R et al. (2007) Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data. British Medical Journal.334, 7583,31 Great Britain. Department of Health. (2004) The NHS Improvement Plan: Putting People at the Heart of Public Services, London, Department of Health. The Stationery Office, London Great Britain. Department of Health. (2005a) Supporting people with long-term conditions: an NHS and social care model. The Stationery Office, London Great Britain. Department of Health. (2005b) Supporting people with long term conditions: liberating the talents of nurses who care for people with long term conditions. The Stationery Office, London Great Britain. Department of Health. (2005) National Service Framework for Long Term Conditions. The Stationery Office, London Great Britain. Department of Health. (2006) Caring for people with long term conditions: an education framework for community matrons and case managers. The Stationery Office, London.

15. References
 Great Britain. Department of Health. (2006) Your health, your care, your say: A new direction for community services – an overview. The Stationery Office, London
 Great Britain. Department of Health. (2007) NHS Next Stage Review: interim report. The Stationery Office, London
 Great Britain. Department of Health. (2008) Your health your way. A guide to long term conditions and self care. The Stationery Office, London
Great Britain. Department of Health. (2008) High quality care for all- NHS Next Stage Review- Final Report. The Stationery Office, London
Leighton, Y., Clegg, A. and Bee, A. (2008) evaluation of community matron services in a large metropolitan city in England. Quality in Primary Care.16: 83-9
Smith, J.A., Flowers, P., & Osborn, M. (1997) Interpretative phenomenological analysis & health psychology. In L Yardley(Ed).Material Discourses & Health. London: Routledge
Sargent , P; Pickard, P, Sheaff, S; & Boaden, R. (2007) Patient and carer perceptions of case management for long term conditions. Health and Social Care in the Community. 15(6),
Wright, K., Ryder, S., and Gousy, M. (2007) Community Matrons improve health : Patients’ perspectives'. British Journal of Community Nursing. 12(10)  
Self care: a national view in 2007 compared to London : DH, Web publication
(Accessed 4 July 2009)

16. Contact Information
Geraldine Rodgers; Nurse consultant for Adults & Older People Dr Maria Ponto : Principal Lecturer, Course Director, MSc Healthcare Education and Clinical Leadership . Visiting Professor to Kemi-Tornio University in Finland