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1.
BMC Health Serv Res ; 24(1): 567, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38698483

RESUMO

BACKGROUND: There is a growing recognition of multidisciplinary practices as the most rational approach to providing better and more efficient healthcare services. Pharmacists are increasingly integrated into primary care teams, but there is no universal approach to implementing pharmacist services across healthcare settings. In Norway, most pharmacists work in pharmacies, with very few employed outside this traditional setting. The home care workforce is primarily made up of nurses, assistant nurses, and healthcare assistants. General practitioners (GPs) are not based in the same location as home care staff. This study utilized the Normalization Process Theory (NPT) to conduct a process evaluation of the integration of pharmacists in a Norwegian home care setting. Our aim was to identify barriers and facilitators to optimal utilization of pharmacist services within a multidisciplinary team. METHODS: Semi-structured interviews (n = 9) were conducted with home care unit leaders, ward managers, registered nurses, and pharmacists in Norway, in November 2022-February 2023. Constructs from the NPT were applied to qualitative data. RESULTS: Findings from this study pertain to the four constructs of the NPT. Healthcare professionals struggled to conceptualize the pharmacists' competencies and there were no collectively agreed-upon objectives of the intervention. Consequently, some participants questioned the necessity of pharmacist integration. Further, participants reported conflicting preferences regarding how to best utilize medication-optimizing services in everyday work. A lack of stakeholder empowerment was reported across all participants. Moreover, home care unit leaders and managers reported being uninformed of their roles and responsibilities related to the implementation process. However, the presence of pharmacists and their services were well received in the setting. Moreover, participants reported that pharmacists' contributions positively impacted the multidisciplinary practice. CONCLUSION: Introducing new work methods into clinical practice is a complex task that demands expertise in implementation. Using the NTP model helped pinpoint factors that affect how pharmacists' skills are utilized in a home care setting. Insights from this study can inform the development of tailored implementation strategies to improve pharmacist integration in a multidisciplinary team.


Assuntos
Serviços de Assistência Domiciliar , Entrevistas como Assunto , Equipe de Assistência ao Paciente , Farmacêuticos , Pesquisa Qualitativa , Humanos , Serviços de Assistência Domiciliar/organização & administração , Noruega , Equipe de Assistência ao Paciente/organização & administração , Masculino , Feminino , Papel Profissional , Atitude do Pessoal de Saúde , Adulto , Pessoa de Meia-Idade
4.
Home Healthc Now ; 42(3): 179-183, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38709584

RESUMO

Home healthcare agencies provide interdisciplinary care to millions of individuals annually. Care is typically led by registered nurses who often determine additional disciplines need to be included in the plan of care. We found that, although persons living with dementia represent about 30% of the home healthcare population, data from our home healthcare system showed that over a 1-year period with 36,443 home care episodes, only 29.6% had one or more social worker visits. Recognizing Alzheimer's disease-related dementia as a terminal condition and shifting toward a palliative care approach can be a challenge in home healthcare where care is focused on restorative care or rehabilitative goals with a primary focus on improvement in condition. The goal of this article is to present insights into nurse-led care coordination and teamwork and provide implications for practice.


Assuntos
Serviços de Assistência Domiciliar , Equipe de Assistência ao Paciente , Humanos , Serviços de Assistência Domiciliar/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Demência/enfermagem , Masculino , Feminino , Idoso , Enfermagem Domiciliar/organização & administração , Doença de Alzheimer/enfermagem
6.
Support Care Cancer ; 32(5): 299, 2024 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-38644420

RESUMO

PURPOSE: To compare the details, oncologists include in discharge letters with what home care physicians need. Although discharge letters are important to share patients' information for home palliative care, few studies have compared the details, especially patients' emotions, regarding what oncologists include in discharge letters and home care physicians' needs. METHODS: This cross-sectional study was conducted by sending anonymous, self-administered questionnaires to 500 certified oncologists (OCs) and 500 directors of home care supporting clinics (HCs) in Japan between March and May 2023. The survey considered 20 potential items found in discharge letters, and compared rates of OCs including these items and HCs needs. RESULTS: Of 310 valid responses, 186 were from OCs (average age: 47.7; 29 females) and 124 from HCs (average age: 55.4; 9 females). Major items with lower inclusion rates for OCs included patients' emotions regarding medical conditions (58.4% in OCs vs. 92.6% in HCs, p < 0.001), families' emotions regarding medical conditions (60.0 vs. 92.6%, respectively, p < 0.001), patients' perceptions regarding medical conditions (84.9 vs. 94.3%, respectively, p = 0.011), families' perceptions regarding medical conditions (84.3 vs. 95.1%, respectively, p = 0.004), and potential late-onset treatment-related adverse events (79.3 vs. 92.6%, respectively, p = 0.002). Conversely, OCs included patients' activities of daily living more frequently (96.2 vs. 90.2%, respectively, p = 0.031). CONCLUSION: Transitioning to home-based palliative care may necessitate accurate information and consideration of patients' and families' perceptions and emotions regarding medical conditions in discharge letters for continuous provision of high-quality care.


Assuntos
Serviços de Assistência Domiciliar , Alta do Paciente , Humanos , Feminino , Masculino , Estudos Transversais , Pessoa de Meia-Idade , Serviços de Assistência Domiciliar/organização & administração , Inquéritos e Questionários , Japão , Oncologistas/psicologia , Cuidados Paliativos/métodos , Adulto , Idoso , Emoções
7.
Ann Ig ; 36(4): 405-413, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38647092

RESUMO

Background: During COVID-19 pandemic, health professionals have been working in an extreme uncertainty context. Affected patients needed to be cared at home as long as possible to avoid virus spreading and hospital resources saturation. The Veneto Regional Administration (North-east of Italy) released Regional guidelines about it. The Western Healthcare District of the Local Health Authority of the city of Vicenza (180,000 inhabitants) implemented a healthcare pathway following them. Aim of the study is to describe the results and outcomes of such implementation. Methods: In the implemented health care pathway, a new service called "Special Unit of continuity of care" (USCA) with physicians and nurses has been dedicated to the prise en charge at home of patients suffering from Sars-CoV-2. They were referred to the USCA by general practitioners or by hospital specialists, and managed through a daily clinical monitoring by regular home visits and phone calls, specialist consultations and therapy management. In order to prevent hospital admission, an oxygen concentrator when possible has been employed and managed at home by the members of the USCA when the oxygen saturation was below 93%. An observational retrospective study has been conducted using anonymized data from different databases: the USCA activity database (from 12/01/20 to 21/31/21), the hospital and Emergency Department discharge databases, and the "healthcare co-payments exemptions database". The latter database refers to the people excluded - because of their chronicity - from the co-payment of a list of medical exams and services. Descriptive and multivariate logistic regression analyses have been implemented. Results: 1,419 patients suffering from Sars-CoV-2 have been cared and managed by the USCA in the considered period of time (mean 11.4 days), of whom 787 (55.5%) with at least one chronic condition (described in the above quoted "healthcare co-payments exemption database") and 261 provided with oxygen concentrator. 275 (19.4%) needed a hospital admission, 39 (2.8%) in intensive unit; 53 died during hospitalization (3.8%). Out of the 261 patients utilizing oxygen concentrator, 103 have been admitted to hospital (39.5%), 7.3% in intensive unit and 8.0% died. In implemented multivariate analyses, the use of oxygen concentrator, proxy measure of the severity of the condition, is the major determinant for the risk of hospital admission (adj OR: 3.2, CI 2.3-4.3) and of dying within 30 days (adj OR: 2.8 CI 1.5-5.1). Among the 261 patients provided with oxygen concentrator, 158 (60,5%) have been managed at home without any admission to emergency department and/or hospitalization. Conclusions: In an uncertain context such as COVID-19 pandemic, the already-implemented home care model has been modified by integrating the USCA physicians and nurses and specialist care networks to prevent hospitalization and the sense of isolation and abandonment of people as much as possible. Almost 1,500 patients suffering from COVID-19 have been cared for at home over 13 months by such new service with complex and multidisciplinary activities. The risk of hospitalization and death appears determined by the severity of the pathology with high and significant OR 60% of patients with oxygen concentrators who, despite an initial high hyposaturation were not hospitalized, represent, partly, the group of patients who would have been requiring hospital care in the absence of a home care pathway in a standard situation.


Assuntos
COVID-19 , Serviços de Assistência Domiciliar , Humanos , Itália/epidemiologia , COVID-19/epidemiologia , COVID-19/terapia , Estudos Retrospectivos , Serviços de Assistência Domiciliar/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Hospitalização/estatística & dados numéricos , Pandemias , Oxigenoterapia/estatística & dados numéricos
8.
BMC Health Serv Res ; 24(1): 528, 2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38664668

RESUMO

BACKGROUND: Quality in healthcare is a subject in need of continuous attention. Quality improvement (QI) programmes with the purpose of increasing service quality are therefore of priority for healthcare leaders and governments. This study explores the implementation process of two different QI programmes, one externally driven implementation and one internally driven, in Norwegian nursing homes and home care services. The aim for the study was to identify enablers and barriers for externally and internally driven implementation processes in nursing homes and homecare services, and furthermore to explore if identified enablers and barriers are different or similar across the different implementation processes. METHODS: This study is based on an exploratory qualitative methodology. The empirical data was collected through the 'Improving Quality and Safety in Primary Care - Implementing a Leadership Intervention in Nursing Homes and Homecare' (SAFE-LEAD) project. The SAFE-LEAD project is a multiple case study of two different QI programmes in primary care in Norway. A large externally driven implementation process was supplemented with a tracer project involving an internally driven implementation process to identify differences and similarities. The empirical data was inductively analysed in accordance with grounded theory. RESULTS: Enablers for both external and internal implementation processes were found to be technology and tools, dedication, and ownership. Other more implementation process specific enablers entailed continuous learning, simulation training, knowledge sharing, perceived relevance, dedication, ownership, technology and tools, a systematic approach and coordination. Only workload was identified as coincident barriers across both externally and internally implementation processes. Implementation process specific barriers included turnover, coping with given responsibilities, staff variety, challenges in coordination, technology and tools, standardizations not aligned with work, extensive documentation, lack of knowledge sharing. CONCLUSION: This study provides understanding that some enablers and barriers are present in both externally and internally driven implementation processes, while other are more implementation process specific. Dedication, engagement, technology and tools are coinciding enablers which can be drawn upon in different implementation processes, while workload acted as the main barrier in both externally and internally driven implementation processes. This means that some enablers and barriers can be expected in implementation of QI programmes in nursing homes and home care services, while others require contextual understanding of their setting and work.


Assuntos
Serviços de Assistência Domiciliar , Casas de Saúde , Pesquisa Qualitativa , Melhoria de Qualidade , Noruega , Humanos , Melhoria de Qualidade/organização & administração , Casas de Saúde/organização & administração , Casas de Saúde/normas , Serviços de Assistência Domiciliar/organização & administração , Liderança , Atenção Primária à Saúde/organização & administração
9.
BMC Health Serv Res ; 24(1): 520, 2024 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-38658937

RESUMO

BACKGROUND: Veterans who need post-acute home health care (HHC) are at risk for adverse outcomes and unmet social needs. Veterans' social needs could be identified and met by community-based HHC clinicians due to their unique perspective from the home environment, acuity of Veterans they serve, and access to Veterans receiving community care. To understand these needs, we explored clinician, Veteran, and care partner perspectives to understand Veterans' social needs during the transition from hospital to home with skilled HHC. METHODS: Qualitative data were collected through individual interviews with Veterans Health Administration (VHA) inpatient & community HHC clinicians, Veterans, and care partners who have significant roles facilitating Veterans' hospital to home with HHC transition. To inform implementation of a care coordination quality improvement intervention, participants were asked about VHA and HHC care coordination and Veterans' social needs during these transitions. Interviews were recorded, transcribed, and analyzed inductively using thematic analysis and results were organized deductively according to relevant transitional care domains (Discharge Planning, Transition to Home, and HHC Delivery). RESULTS: We conducted 35 interviews at 4 VHA Medical Centers located in Western, Midwestern, and Southern U.S. regions during March 2021 through July 2022. We organized results by the three care transition domains and related themes by VHA, HHC, or Veteran/care partner perspective. Our themes included (1) how social needs affected access to HHC, (2) the need for social needs screening during hospitalization, (3) delays in HHC for Veterans discharged from community hospitals, and (4) a need for closed-loop communication between VHA and HHC to report social needs. CONCLUSIONS: HHC is an underexplored space for Veterans social needs detection. While this research is preliminary, we recommend two steps forward from this work: (1) develop closed-loop communication and education pathways with HHC and (2) develop a partnership to integrate a social risk screener into HHC pathways.


Assuntos
Serviços de Assistência Domiciliar , Pesquisa Qualitativa , United States Department of Veterans Affairs , Veteranos , Humanos , Estados Unidos , Serviços de Assistência Domiciliar/organização & administração , Veteranos/psicologia , Masculino , Feminino , Cuidado Transicional/organização & administração , Alta do Paciente , Entrevistas como Assunto , Pessoa de Meia-Idade , Continuidade da Assistência ao Paciente , Apoio Social
10.
Rev Med Interne ; 45(4): 226-238, 2024 Apr.
Artigo em Francês | MEDLINE | ID: mdl-38632029

RESUMO

Patients hospitalised with acute venous thromboembolism (VTE), and notably patients with pulmonary embolism, often remain in hospital for extended periods due to the perceived risk of complications. However, several studies have shown that home treatment of selected patients is feasible and safe, with a low incidence of adverse events. This may offer clear benefits for patients' quality of life, hospital planning and cost to the health service. Nonetheless, there is a need for a VTE risk-stratification tool specifically addressing prognosis in patients with cancer. This may aid in the selection of low-risk patients with cancer and VTE who are suitable for outpatient treatment. Although several prognostic scores have been proposed, we suggest using a pragmatic clinical decision-making tool such as the Hestia criteria for selecting patients for home care in everyday clinical practice. Once patients have been discharged, it is mandatory to monitor patients regularly (we suggest after 3 days, 10 days, 1 month and 3 months, or more frequently if needed) with the involvement of a multidisciplinary team, so that appropriate and timely remedial action can be taken in case of warning signs of complications. If patients are selected carefully and monitored effectively, many patients who experience acute VTE can be cared for safely at home.


Assuntos
Serviços de Assistência Domiciliar , Neoplasias , Tromboembolia Venosa , Humanos , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/terapia , Tromboembolia Venosa/diagnóstico , Neoplasias/complicações , Neoplasias/terapia , Neoplasias/epidemiologia , Serviços de Assistência Domiciliar/normas , Serviços de Assistência Domiciliar/organização & administração , França/epidemiologia , Qualidade de Vida , Prognóstico
11.
Semin Oncol Nurs ; 40(2): 151616, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38431451

RESUMO

OBJECTIVES: Home-based pediatric cancer care requires addressing both physical and psychosocial care needs for children and their parents Currently, there is a notable gap in intervention programs that evaluate technology-based psychosocial empowerment for children and parents in home-based pediatric cancer care. The study protocol was to assess the efficiency of a technology-based psychosocial empowerment intervention for home-based care for children with cancer and their parents. METHODS: This study was planned as a single-blinded parallel-group randomized controlled experimental design. The study was intended to include 64 children and parents in the research sample. The HomeCare-Family EmPow is a technology-based intervention based on the Psychological Empowerment Theory. This 4-week program, delivered via the website, consists of four modules for parents and two for children. The descriptive form, Self-Efficacy Scale- for children and adolescents with cancer, State-Trait Anxiety Inventory, and Pediatric Cancer Coping Scale will be used in the data collection for children. The descriptive form, Self-Efficacy Scale, Problem-Solving Inventory, and Psychological Resilience Scale will be used for parents. Repeated measures analysis of variance and linear mixed-effects models will be applied for intragroup and intergroup comparisons. Outcome measures will be assessed before randomization, 1 week after the intervention, and 1 month after. RESULTS: The possible differences between the intervention and control groups will be evaluated after the implementation of the intervention. Our proposed hypotheses will report the findings. CONCLUSIONS: This research may provide a more comprehensive and evidence-based approach to pediatric cancer management at home-based pediatric cancer management by improving children's and parents' self-efficacy and coping by providing feasible, accessible, and innovative support. IMPLICATIONS FOR NURSING PRACTICE: The study outcomes are expected to enrich the understanding and management of the psychosocial well-being of children and their parents and empower them to cope with the treatment process more effectively during home-based care.


Assuntos
Serviços de Assistência Domiciliar , Neoplasias , Pais , Humanos , Criança , Neoplasias/psicologia , Neoplasias/terapia , Serviços de Assistência Domiciliar/organização & administração , Masculino , Feminino , Pais/psicologia , Adolescente , Adaptação Psicológica , Adulto , Ensaios Clínicos Controlados Aleatórios como Assunto , Pré-Escolar , Método Simples-Cego
12.
Z Gerontol Geriatr ; 56(8): 630-635, 2023 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-37938317

RESUMO

BACKGROUND: Little is known so far about the actual benefits of digital platforms that mediate volunteer helpers with households facing care responsibilities. OBJECTIVE: This article presents the initial results of a survey conducted among placement agencies as part of a multistage organized interview study. The key question is what benefits do agencies ascribe to the services in their own organization for the users and on a societal or sociospatial level. MATERIAL AND METHODS: For the purpose of conducting explorative guideline-based interviews, four placement agencies were selected. Of these, two use a matching platform and two do not. The data were analyzed using content analysis methods. RESULTS: The providers perceive advantages in efficiency, improvements in quality but also new possibilities for harnessing new helper clientele as important beneficial aspects of using digital placement platforms for their own organization. In terms of nurturing users' trust and acceptance, hybrid matching models appear to be particularly advantageous by deploying digital technologies and also enabling personal support in developing helping relationships. The findings also suggest that public welfare-oriented, quality-assured matching platforms can unfurl additional benefits at sociospatial and societal levels. CONCLUSION: Besides beneficial aspects for organizations and users it was also possible to reconstruct potential benefits in relation to local care networks.


Assuntos
Sistemas de Painéis , Serviços de Assistência Domiciliar , Humanos , Serviços de Assistência Domiciliar/organização & administração
13.
BMC Health Serv Res ; 22(1): 1389, 2022 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-36419109

RESUMO

BACKGROUND: To improve the care for patients with motor neuron disease an e-health innovation for continuous monitoring of disease progression and patients' well-being (ALS H&C) was implemented in 10 multidisciplinary rehabilitation settings. The first aim was to evaluate the implementation of ALS H&C by assessing several implementation outcomes, technology acceptance and usability of the innovation according to the end users. The secondary aim was to explore differences in these outcomes between the teams with sustainable and unsustainable implementation. METHODS: The chosen implementation strategy was a combination of the implementation process model by Grol & Wensing and a participatory action research approach. In three meetings with multidisciplinary project groups the innovation was introduced, the expected barriers/facilitators identified, and action plans to resolve each barrier developed. After a 3-month pilot phase, patients and their healthcare providers were asked to complete an online evaluation survey to assess implementation outcomes, based on Proctor's evaluation framework (i.e., acceptability, feasibility, fidelity, sustainability). Telemedicine technology acceptance was assessed according the technology acceptance model of Chau, and user experiences with the System Usability Scale (SUS). Implementation outcomes of teams with sustainable implementation (continuation after completion of the pilot phase) and unsustainable implementation (discontinuation after the pilot phase) were compared. RESULTS: The implementation outcomes from the patients' perspective (N = 71) were positive; they found ALS H&C to be an acceptable and feasible care concept. Patients' technology acceptance was high, with positive attitudes towards ALS H&C, and positive views on perceived technology control, usefulness, and ease of use. Patients rated their satisfaction with the (web) app on a scale from 1 (not satisfied at all) to 10 (very satisfied) with a 7.0 (median; IQR 1.0). Healthcare providers (N = 76) also found ALS H&C acceptable and appropriate as well, but were less positive about the feasibility and usability of ALS H&C (mean SUS 58.8 [SD 11.3]). ALS H&C has largely been implemented as intended and the implementation was sustainable in 7 teams. Teams who discontinued ALS H&C after the pilot phase (N = 2) had more fidelity issues. CONCLUSIONS: A participatory action research approach supported by theoretical approaches used in implementation science led to a sustainable implementation of ALS H&C in 7 of the participating teams. To improve implementation success, additional implementation strategies to increase feasibility, usability and fidelity are necessary. TRIAL REGISTRATION: Trial NL8542 registered at Netherlands Trial Register (trialregister.nl) on 15th April 2020.


Assuntos
Esclerose Lateral Amiotrófica , Serviços de Assistência Domiciliar , Telemedicina , Humanos , Esclerose Lateral Amiotrófica/terapia , Tutoria/métodos , Tecnologia , Telemedicina/organização & administração , Serviços de Assistência Domiciliar/organização & administração , Monitorização Fisiológica/métodos , Aceitação pelo Paciente de Cuidados de Saúde
15.
BMC Pregnancy Childbirth ; 22(1): 107, 2022 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-35130858

RESUMO

BACKGROUND: Rwanda implemented post-natal care home visits by maternal community health workers (M-CHWs) in charge of maternal and newborn health care in 2010 as a component of a home-based maternal and neonatal health care package (HB-MNHCP), this being a complementary strategy to facility-based postnatal care to improve survival. The country has not met its Sustainable Development Goal (SDG) 3 target of less than 70 maternal mortalities per 100,000 live births and less than 12 neonatal deaths per 1,000 live births. This study therefore aimed to establish the knowledge of the health providers, providing HB-MNHC services as part of their antenatal, delivery and postnatal care program, specifically the M-CHWs services. METHODS: The cross-sectional descriptive study included 79 purposively sampled health care providers who were directly involved in the various components of the HB-MNHCP, namely: professional nurses, midwives, M-CHW, social workers, supervisors and data managers. The Kibogora, Muhima and Nyamata District Hospitals and two rural, semi-urban and urban health facility were included. Data was collected using questionnaires from April to July 2018. This study followed the STROBE checklist form: Cross -sectional studies. RESULTS: Overall, 88.6% (n=70/79) of participants knew about the M-CHW three home visits scheduled during pregnancy, 73.4% (n=58/79) about the three postnatal home visits after birth when the weight was normal, and 64.6% (n=51/79) about the five PNC home visits for low birth weights. Most (97.5%, n=77/79) knew that the mother and newborn should be screened during the same M-CHW home visits, and 87.2% (n= 68/79) were aware of the seven postnatal core competencies of delivering key maternal and newborn interventions during PNC home visits. CONCLUSIONS: There were varying levels of knowledge among the HB-MNHCP staff, indicating the need for ongoing monitoring and training to ensure that the correct information is provided to the mothers throughout the antenatal and postnatal periods. While most of the M-CHWs appear to have had the correct knowledge, their executing of some activities needs to be monitored to ensure that they provide the required services, as this is an important step in lowering the maternal and infant mortality and enabling Rwanda to meet its SDG 3. Home visits by the M-CHWs could increase referrals and reduce maternal and newborn mortality.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Visita Domiciliar , Cuidado Pós-Natal , Adulto , Agentes Comunitários de Saúde/normas , Estudos Transversais , Feminino , Serviços de Assistência Domiciliar/organização & administração , Humanos , Lactente , Masculino , Serviços de Saúde Materno-Infantil/organização & administração , Ruanda
16.
J Am Geriatr Soc ; 70(1): 243-250, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34585735

RESUMO

BACKGROUND: The Department of Veterans Affairs (VA)'s home-based primary care (HBPC) program provides coordinated, interdisciplinary care to seriously ill and disabled veterans, but few evaluations have considered end-of-life (EOL) care in this population. The aim of this study was to describe veterans' use of community-based hospice services while enrolled in HBPC and their associations with bereaved families' perceptions of care. METHODS: This study was a retrospective analysis of electronic medical record and bereaved family survey (BFS) data for veterans who died while enrolled in VA's HBPC program between October 2013 and September 2019. Seven regional VA networks called Veteran Integrated Service Networks participated in BFS data collection. The final sample included 3967 veterans who were receiving HBPC services at the time of death and whose next-of-kin completed a BFS. The primary outcome was the BFS global rating of care received in the last 30 days of life. Adjusted proportions for all BFS outcomes were examined and compared between those who received community-based hospice services and those who did not. RESULTS: Overall, 52.6% of BFS respondents reported that the care received by HBPC-enrolled veterans in the last 30 days of life was excellent using the BFS global rating. Among families of HBPC-enrolled veterans who received community-based hospice services, the BFS global rating was roughly eight percentage points higher than those who did not (55.7 vs. 47.0%, p < 0.001). On 12 of the 14 secondary BFS outcomes, veterans who received hospice scored higher than those who did not. CONCLUSIONS: Receipt of hospice services while enrolled in HBPC was associated with higher ratings of EOL care by bereaved family members. Integration of community hospice partners for qualifying veterans who are enrolled in the HBPC program represents a potential opportunity to improve the overall experience of EOL care for veterans and their families.


Assuntos
Serviços de Assistência Domiciliar/normas , Cuidados Paliativos na Terminalidade da Vida/normas , Veteranos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Família , Feminino , Serviços de Assistência Domiciliar/organização & administração , Humanos , Masculino , Estudos Retrospectivos , Inquéritos e Questionários , Estados Unidos
17.
J Am Geriatr Soc ; 70(1): 218-227, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34618918

RESUMO

BACKGROUND: Home health clinicians report a need for family caregiver assistance during the majority of skilled home health care episodes. Since 2018, the Medicare Conditions of Participation has required home health agencies to provide training to family caregivers. However, little is known regarding current practices of family caregiver assessment and training during home health care. METHODS: Qualitative research relying on semistructured key informant interviews with registered nurses and physical therapists (n = 19), hereafter "clinicians," from four home health agencies. Interviews were recorded and transcribed, then analyzed using directed content analysis to identify relevant themes and concepts. RESULTS: Three agencies were not-for-profit and one was for-profit; three were urban and one was rural; two operated on a local scale, one on a regional scale, and one on a national scale. Key informants had an average of 9.3 years of experience in home health care and an average age of 45.0 years. Clinicians described a cyclic process of family caregiver training including four major phases: initial assessment, education, reassessment, and adjustment. Initial assessment was informal and holistic; education was delivered via demonstration and teach-back; reassessment was used to evaluate caregiver progress and inform adjustments to the care plan. Clinicians noted that their perceptions regarding the success of family caregiver training efforts influenced decisions relating to clinical practice, including the number of visits provided and whether to discharge the patient. CONCLUSIONS: Caregiver training is currently integrated into clinician workflows in home health care and helps determine visit intensity and discharge timing, but clinicians face a lack of structured assessment instruments or training materials. Efforts by policymakers and home health agencies to facilitate clinicians' training efforts could positively affect the cost and quality of Medicare-funded home health care.


Assuntos
Cuidadores/educação , Serviços de Assistência Domiciliar/organização & administração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Enfermeiras e Enfermeiros , Fisioterapeutas , Pesquisa Qualitativa
18.
JAMA Intern Med ; 182(1): 26-32, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34779818

RESUMO

Importance: Older adults who live alone are at risk for poor health outcomes. Whether social support mitigates the risk of living alone, particularly when facing a sudden change in health, has not been adequately reported. Objective: To assess if identifiable support buffers the vulnerability of a health shock while living alone. Design, Setting, and Participants: In this longitudinal, prospective, nationally representative cohort study from the Health and Retirement Study (enrollment March 2006 to April 2015), 4772 community-dwelling older adults 65 years or older who lived alone in the community and could complete activities of daily living (ADLs) and instrumental ADLs independently were followed up biennially through April 2018. Statistical analysis was completed from May 2020 to March 2021. Exposures: Identifiable support (ie, can the participant identify a relative/friend who could help with personal care if needed), health shock (ie, hospitalization, new diagnosis of cancer, stroke, heart attack), and interaction (multiplicative and additive) between the 2 exposures. Main Outcomes and Measures: The primary outcomes were incident ADL dependency, prolonged nursing home stay (≥30 days), and death. Results: Of 4772 older adults (median [IQR] age, 73 [68-81] years; 3398 [71%] women) who lived alone, at baseline, 1813 (38%) could not identify support, and 3013 (63%) experienced a health shock during the study. Support was associated with a lower risk of a prolonged nursing home stay at 2 years (predicted probability, 6.7% vs 5.2%; P = .002). Absent a health shock, support was not associated with a prolonged nursing home stay (predicted probability over 2 years, 1.9% vs 1.4%; P = .21). However, in the presence of a health shock, support was associated with a lower risk of a prolonged nursing home stay (predicted probability over 2 years, 14.2% vs 10.9%; P = .002). Support was not associated with incident ADL dependence or death. Conclusions and Relevance: In this longitudinal cohort study among older adults who live alone, identifiable support was associated with a lower risk of a prolonged nursing home stay in the setting of a health shock.


Assuntos
Atividades Cotidianas , Serviços de Assistência Domiciliar/organização & administração , Vida Independente/estatística & dados numéricos , Assistência de Longa Duração/métodos , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores Socioeconômicos
19.
J Gerontol B Psychol Sci Soc Sci ; 77(2): 435-445, 2022 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-34752616

RESUMO

OBJECTIVES: We assess gender moderation in the association between partner care arrangements and individuals' well-being, and the extent to which gender differences vary across European care contexts. METHODS: We use 2015 data from the Survey of Health, Ageing and Retirement in Europe for 3,465 couples aged 50+, where at least 1 partner receives care. We assess gender differences in individuals' life satisfaction and depressive symptoms across 5 partner care arrangements: solo-; shared formal; shared informal; outsourced formal; and outsourced informal care. We explore heterogeneity in the gendered associations across 4 care contexts: Northern, Western, Southern, and Eastern Europe. RESULTS: Sharing care with formal providers is associated with lower well-being among women than men, with a significant well-being "penalty" among Southern European women with partners in shared formal care. Outsourcing partner care to informal providers is associated with higher well-being than other care arrangements for men across care contexts, but with lower well-being for women in Southern Europe. DISCUSSION: Policies to support caregivers' well-being need to be sensitive to the coordination of formal and informal caregiving support for men and women in their respective care contexts.


Assuntos
Sobrecarga do Cuidador , Cuidadores , Serviços de Assistência Domiciliar , Assistência ao Paciente , Qualidade de Vida , Fatores Sexuais , Idoso , Sobrecarga do Cuidador/epidemiologia , Sobrecarga do Cuidador/prevenção & controle , Sobrecarga do Cuidador/psicologia , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Europa (Continente)/epidemiologia , Feminino , Serviços de Assistência Domiciliar/organização & administração , Serviços de Assistência Domiciliar/normas , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Masculino , Avaliação das Necessidades , Assistência ao Paciente/métodos , Assistência ao Paciente/psicologia , Satisfação Pessoal
20.
PLoS One ; 16(12): e0262085, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34972170

RESUMO

OBJECTIVE: To assess the determinants of ED use in paediatric patients enrolled in an Integrated Paediatric Home Care (IPHC) program. METHODS: A retrospective study was conducted using administrative databases on a cohort of patients enrolled in an IPHC program between January 1st, 2012, and December 31st, 2017, in Northern Italy. ED visits that occurred during the IPHC program were considered. Data were collected considering sociodemographic, clinical and organizational variables. A multivariable stepwise logistic regression analysis was performed. The dependent variable to identify possible associations was ED visit. RESULTS: A total of 463 ED visits occurred in 465 children, with an incidence rate of 1. The risk of ED visits significantly increased among children involved in the IPHC program after hospital discharge (OR 1.94). Additionally, the risk of ED visits increased significantly as the duration of IPHC increased (OR 5.80 between 101 and 200 days, to OR 7.84 between 201 and 300 days, OR 12.54 between 301 and 400 days and OR 18.67 to more than 400 days). CONCLUSION: The overall results represent a practical perspective to contribute improving both the service quality of IPHC and reducing low acuity and improper ED use.


Assuntos
Serviço Hospitalar de Emergência , Serviços de Assistência Domiciliar/organização & administração , Pediatria/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Incidência , Lactente , Recém-Nascido , Itália/epidemiologia , Masculino , Análise Multivariada , Qualidade da Assistência à Saúde , Análise de Regressão , Estudos Retrospectivos , Risco
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