Atendimento domiciliar do enfermeiro da Estratégia Saúde da Família na comunidade quilombola Sacopã: relato de experiência / Family Health Strategy nurse home care in the Sacopã quilombola community: experience report / Atención domiciliaria de la enfermería en la Estrategia de Salud Familiar en la comunidad quilombola Sacopã: informe de experiencia

A comunidade quilombola de Sacopã, cuja existência remonta a mais de 100 anos, está localizada na zona sul do Rio de Janeiro, na Lagoa Rodrigo de Freitas, e continua preservando cultura, ancestralidade e tradições do povo negro até os dias atuais. Neste estudo, tem-se como objetivo relatar a experiência das consultas do enfermeiro da Estratégia Saúde da Família (ESF) realizadas na comunidade quilombola Sacopã. Trata-se de um estudo do tipo relato de experiência, com abordagem qualitativa. As visitas domiciliares ocorreram nos dias 29 de setembro de 2021, no turno da tarde, e 6 de outubro de 2021, nos turnos da manhã e da tarde. O processo de enfermagem foi aplicado, incluindo triagem com aferição da pressão arterial e medição da glicemia capilar, renovação das prescrições de medicamentos, teste de sensibilidade plantar, agendamento de exames de colpocitologia e mamografias, avaliação dos registros de vacinação infantil, aconselhamento e educação em saúde. Essas ações visam atender às demandas da população quilombola e reparar os atrasos nas visitas domiciliares causados pela pandemia de covid-19. Vale ressaltar que realizar consultas de enfermagem no formato de atendimento domiciliar proporciona conforto, fortalece o vínculo entre a unidade de saúde e a comunidade, possibilita uma imersão na realidade local, aproxima os profissionais das famílias e reduz os custos de deslocamento, garantindo assim um cuidado holístico e abrangente aos usuários.

The Sacopã quilombola community, which has existed for over 100 years, is in the south of Rio de Janeiro, in Lagoa Rodrigo de Freitas, and continues to preserve culture, ancestry, and traditions of the black people to this day. This study aims to report the experience of consultations with the Family Health Strategy (FHS) nurse held in the Sacopã quilombola community. It is an experience report study with a qualitative approach. The home visits were conducted on September 29, 2021, in the afternoon shift, and on October 6, 2021, in the morning and afternoon shifts. The nursing process was applied, including screening with blood pressure and capillary blood glucose measurements, renewal of the drug prescriptions, plantar sensitivity tests, scheduling of Pap smears and mammograms, evaluation of children's vaccination records, counseling, and health education. These actions aim to meet the demands of the quilombola population and address the delays in home visits that occurred due to the COVID-19 pandemic. Note that conducting nursing consultations in a home care format provides comfort, strengthens the link between the health unit and the community, allows immersion in the local reality, brings professionals closer to families, and reduces travel costs, thus ensuring holistic and comprehensive care for users.

La comunidad quilombola de Sacopã que se remonta a más de cien años está ubicada en la zona sur de Río de Janeiro, en la Lagoa Rodrigo de Freitas, y viene preservando la cultura, ancestralidad y tradiciones del pueblo negro hasta la actualidad. Este estudio tuvo por objetivo informar la experiencia de consultas con la enfermería de la Estrategia de Salud Familiar (ESF) realizadas en la comunidad quilombola de Sacopã. Se trata de un estudio de tipo informe de experiencia, con enfoque cualitativo. Las visitas domiciliarias tuvieron lugar el 29 de septiembre de 2021, por la tarde, y el 6 de octubre de 2021, por la mañana y tarde. Se aplicó el proceso de enfermería, incluyendo el triaje con medición de la presión arterial y de la glucemia capilar, renovación de prescripciones de medicamentos, prueba de sensibilidad plantar, programación de exámenes de citología vaginal y mamografías, evaluación de los registros de vacunación infantil, asesoramiento y educación en salud. El objetivo de estas acciones fue atender las demandas de la población quilombola y compensar los retrasos en las visitas domiciliarias debido a la pandemia de la covid-19. Es importante destacar que la realización de las consultas de enfermería en atención domiciliaria proporciona comodidad, fortalece el vínculo entre la unidad de salud y la comunidad, permite una inmersión en la realidad local, acerca a los profesionales a las familias y reduce los costos de desplazamiento, garantizando así una atención holística y completa a los usuarios.

Cenário simulado no ensino da visita domiciliar no âmbito da atenção primária à saúde / Escenario de simulación para enseñar a realizar visitas domiciliarias como parte de la atención primaria de salud / Simulated setting in home visit teaching in the scope of primary health care

RESUMO Objetivo: relatar a experiência do uso da simulação, junto a estudantes de Enfermagem do primeiro ano da graduação, para o desenvolvimento das habilidades necessárias para a visita domiciliar. Descrição da experiência: a simulação em questão foi desenvolvida seguindo três etapas: briefing, cena e debriefing. A estratégia foi realizada na casa simulada, um laboratório que recria as condições do ambiente domiciliar. Nesse espaço, o estudante vivencia a prática da visita domiciliar, antecipando possíveis dificuldades ou desafios. Os estudantes participaram ativamente da simulação. O debriefing oportunizou que os estudantes expressassem seus sentimentos diante do cenário, visualizassem a atuação e refletissem sobre aspectos positivos relacionados ao desenvolvimento da atividade. Além disso, proporcionou uma autorreflexão sobre tópicos que podem ser aprimorados. Considerações finais: a estratégia viabilizou uma atmosfera de ensino mais realística e aplicada, propiciando, aos estudantes, o desenvolv imento de habilidades de obser vação, comunicação e entrevista. A vivência simulada da primeira visita domiciliar pode instrumentalizar os estudantes para que eles identifiquem melhor as necessidades e potencialidades presentes nos indivíduos, nas famílias ou no domicílio, assim como façam uma melhor integração entre os conteúdos teóricos e práticos.

RESUMEN Objetivo: relatar la experiencia del uso de la simulación, con el propósito de desarrollar las habilidades necesarias para las visitas domiciliarias, con estudiantes de primer año de Enfermería. Descripción de la experiencia: la simulación en cuestión se desarrolló siguiendo tres pasos: briefing, escena y debriefing. La estrategia se llevó a cabo en la casa simulada, un laboratorio que recrea las condiciones del entorno doméstico, en el que el alumno experimenta la práctica de la visita al hogar, anticipando posibles dificultades o retos. Los estudiantes participaron activamente en la simulación. El debriefing dio a los alumnos la oportunidad de expresar sus sentimientos sobre el escenario, visualizar su actuación y permitió reflexionar sobre los aspectos positivos relacionados con el desarrollo de la actividad. Además, proporcionó una autorreflexión sobre los temas que se pueden mejorar. Consideraciones finales: la estrategia permitió un ambiente de enseñanza más realista y aplicado, proporcionando a los estudiantes el desarrollo de habilidades de observación, comunicación y entrevista. La experiencia simulada de la primera visita a domicilio puede permitir a los estudiantes identificar mejor las necesidades y el potencial presente en las personas, familias u hogares y una mejor integración de los contenidos teóricos y prácticos.

ABSTRACT Objective: to report the experience of simulation use in Nursing student attending the first year of the undergraduate course, for the development of the necessary skills to conduct home visits. Description of the experience: the simulation in question was developed following three stages: briefing, scene and debriefing. The strategy was conducted in a simulated house, a laboratory which recreated the home environment conditions. In this space, the students experience the Home Visit practice, anticipating possible difficulties or challenges. The students were active participants in the simulation. The debriefing allowed the students to express their feelings about the scenario, visualize performance and reflect on positive aspects related to development of the activity. In addition to that, it provided self-reflection on topics that can be improved. Final considerations: the strategy enabled a more realistic and applied teaching atmosphere, allowing the students to develop observation, communication and interview skills. The first Home Visit simulated experience can prepare the students to better identify the needs and potentialities present in individuals, families or in the home, as well as to better integrate the theoretical and practical contents.

[Willingness to Use and Appropriate Payable Cost for Visiting Nurse Service for the Elderly in the Community].

PURPOSE: This study aimed to measure willingness to use (WTU) and appropriate payable cost of visiting nurse service for the elderly and explore their impact factors. METHODS: The study included 752 participants selected from data that were completed in 2017 for the elderly aged over 60 nationwide. Logit and Tobit regression analysis were performed to confirm the influencing factors. RESULTS: The study found that 39.1% of the elderly in the community were WTU the visiting nurse service, and they reported that the cost per visit was 12,650 Korean Won. The factors influencing WTU were having less than moderate subjective health status (OR = 1.63, p = .011), being part of a social participating groups (OR = 1.50, p = .046), or participation in senior health promotion programs (SHPPs) (OR = 1.96, p =.003). The cost was also influenced by less than moderate subjective health status (ß = 4.37, p = .021), being part of a social participating groups (ß = 4.41, p = .028), or participation in SHPPs (ß = 4.87, p = .023). Additionally, elderly people living alone who were used as covariates were highly WTU (OR = 2.20, p = .029). CONCLUSION: This study provides evidence to predict demand for visiting nurse service and reflects consumer value in setting the service cost. This is the first study to derive cost from consumers' perspective regarding the service for the elderly. As it is the result of an open-ended survey, follow-up studies are needed to estimate more reliable and reasonable results.

Effects of home visits on quality of life among older adults: a systematic review protocol.

BACKGROUND: Home visiting services for older adults have been offered for decades to maintain and promote health and independent functioning, thus enhancing quality of life. Previous systematic reviews have provided a mixed picture of the benefits of home visiting programmes in older adults, primarily because of heterogeneity in study designs, targeted populations, and intervention strategies. These reviews may also become out of date; thus, an updated synthesis of relevant studies is warranted. Our objective is to perform a systematic review of recently published primary studies on the effectiveness of multi-professional home visits on quality of life among older adults. METHODS: We will perform a comprehensive search for studies investigating the effect of a multi-professional home visit approach on quality of life among older adults. We will conduct the literature search in selected electronic databases and relevant research websites from January 2010 onwards. We will include randomised controlled trials (RCTs), cluster randomised controlled trials (cluster RCTs), and observational studies that enrolled older adults without dementia over 60 years old, along with studies involving multi-professional preventive-promotive home visit approaches not related to recent hospital discharge. We will report our planned review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will retrieve and record relevant data in a standardised data extraction form and evaluate the quality of the included articles using the Cochrane risk of bias tool and the quality assessment tool for studies with diverse designs (QATSDD). Where appropriate, outcomes will be pooled for meta-analysis using a random-effects model. The main outcomes include quality of life, incidence of falls, depression, dementia, and emergency department admissions. DISCUSSION: This review may provide evidence for the effectiveness of home visits in improving older adults' quality of life. It will potentially benefit health care professionals, policymakers, and researchers by facilitating the design and delivery of interventions related to older generations and improve service delivery in future. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021234531 .

Apoio institucional na visita domiciliar da estratégia de saúde da família no município de Camaçari (BA) / Institutional support in house calls by the family health strategy in the municipality of Camaçari, Bahia / Apoyo institucional en la visita domiciliaria de la estrategia de salud familiar en el municipio de Camaçari/BA, Brasil

A visita domiciliar é uma potente ferramenta da gestão do cuidado que aproxima a Unidade de Saúde da Família do território de forma viva e dinâmica. O apoio institucional contribui junto às equipes para a qualificação e operacionalização desse importante instrumento que amplia o cuidado centrado no usuário. Este artigo é um estudo qualitativo, descritivo, do tipo relato de experiência, acerca do papel e da percepção do apoio institucional de uma região de saúde do município de Camaçari, Bahia, em uma visita domiciliar a uma família pertencente ao território adscrito de uma Unidade de Saúde da Família no mês de janeiro de 2020. Percebe-se que a presença do apoio institucional no processo de trabalho da equipe contribuiu na direcionalidade do caminho percorrido para o cuidado em saúde de uma família em situação de vulnerabilidade social, auxiliando na retomada do cuidado, possibilitando a interação entre família e equipe, assim como o fortalecimento da intersetorialidade entre saúde e desenvolvimento social. Evidencia-se com o relato que alguns desafios, sobretudo a reinvenção no contexto da pandemia do novo coronavírus, a importância de inserção de outros pontos da Rede de Atenção à Saúde, a ampliação da discussão sobre a promoção da saúde e a corresponsabilidade na produção do cuidado, precisam ser enfrentados com as equipes, de modo que resulte na ampliação da qualidade de vida dos usuários pertencentes ao domicílio e território.

House call is a powerful care management tool that brings the Family Health Unit closer to the territory in a lively and dynamic manner. Institutional support contributes with the teams to qualify and operationalize this important instrument that expands user-centered care. This paper is a qualitative, descriptive, experience repot study about the role and perception of the institutional support offered to a health region in the municipality of Camaçari, Bahia, Brazil, during a house call to a family belonging to the enrolled territory of a Family Health Unity in January 2020. The presence of institutional support in the team's work process contributed to direct the path chosen for the health care of a socially vulnerable family, helping to resume care, enable the family-team interaction, and strengthen the intersectoriality between health and social development. The report reveals that some challenges, especially the reinvention during the new coronavirus pandemic, the importance of implementing other Health Care Network posts, expansion of the debate on health promotion, and the co-responsibility in care production, must be faced with the teams, so that it results in enhancing the quality of life of users belonging to the home and territory.

La visita domiciliaria es una herramienta eficaz de gestión del cuidado que acerca la Unidad de Salud Familiar al territorio de forma viva y dinámica. El apoyo institucional contribuye con los equipos en la calificación y la puesta en marcha de este importante instrumento que expande la atención centrada en el usuario. Este artículo es un estudio cualitativo, descriptivo de tipo informe de experiencia sobre el rol y la percepción sobre el apoyo institucional de una región de salud en el Municipio de Camaçari, en Bahía (Brasil) en una visita domiciliaria a una familia perteneciente al territorio adscrito a una Unidad de Salud Familiar en enero de 2020. Se nota que la presencia del apoyo institucional en el proceso de trabajo del equipo contribuyó a orientar el camino recorrido para el cuidado de la salud de una familia en situación de vulnerabilidad social, ayudándola a retomar el cuidado, posibilitando la interacción entre la familia y el equipo, así como el fortalecimiento de la intersectorialidad entre salud y desarrollo social. Se desprende del informe que algunos desafíos, sobre todo la reinvención en el contexto de la pandemia del nuevo coronavirus, la importancia de insertar otros puntos en la Red de Asistencia Sanitaria, la ampliación de la discusión sobre promoción de la salud y la corresponsabilidad en la producción asistencial, necesitan promocionarse con los equipos, de manera que resulte en la ampliación de la calidad de vida de los usuarios pertenecientes al hogar y territorio.

Characteristics of Home-Visit Nursing Stations that Accept Children Requiring Long-Term Medical Care after Discharge from Neonatal Intensive Care Unit.

Many cultures are witnessing high-risk births due to the increasing trend of delayed childbearing. This has resulted in a higher proportion of children requiring long-term medical care (CLTM). The number of home-visit nursing stations available for pediatric patients should increase to provide care for CLTM at home. Through a questionnaire-based cross-sectional survey of 338 home-visit nursing station managers, this study aimed to identify the determinants of the acceptance of CLTM by analyzing the characteristics of the stations, managers, staff, and registered children, and the volume of home visits. Chi-squared tests and logistic regressions were applied to determine the independence of the variables of acceptance and analyze their significance, respectively. The response rate was 14.6%, the number of pediatric patients registered in the past was 914, and the average number of registered pediatrics was 2.7. The results indicate a correspondence between the increase in home visits by nursing staff and the number of CLTM accepted for home-visit nursing services after discharge from neonatal intensive care units. Additionally, stations whose managers have three or more years of pediatric care experience accept more CLTM, and their employees are better equipped to facilitate these acceptances. Nonetheless, the number of facilities with pediatric departments has declined; thus, nurses will face increasing difficulty gaining pediatric work experiences. Therefore, enhanced seminars and training on pediatric medical care for managers and nurses, as well as strengthened collaboration/coordination with pediatric wards, clinics, and multidisciplinary occupations should be implemented as countermeasures. Our findings illustrate issues and strategies for acceptance.

Visita domiciliar pela Estratégia Saúde da Família: limites e possibilidades no contexto da violência urbana no Rio de Janeiro / Home visit by the Family Health Strategy: limits and possibilities in the context of urban violence in Rio de Janeiro / Visita domiciliar por la Estrategia Salud de la Familia: límites y posibilidades en el contexto de la violencia urbana en Río de Janeiro

A Estratégia Saúde da Família (ESF) se organiza sobre uma base territorial, considerando as características locais e possibilitando às equipes conhecer o perfil da clientela e as situações vivenciadas no seu cotidiano. Nos últimos anos, o município do Rio de Janeiro expandiu a ESF para territórios altamente vulneráveis e as equipes aproximaram-se de áreas onde a violência urbana está fortemente presente. O objetivo foi compreender se a Visita Domiciliar (VD) permanece como uma ferramenta possível para a ESF, em contextos de violência urbana. Foi realizado um estudo de natureza qualitativa, com aplicação de entrevistas com roteiro semiestruturado e análise de conteúdo. Os resultados apontam que a VD é, prioritariamente, destinada à busca de usuários com alguma limitação de acesso à unidade, restrição ao leito ou domicílio. Segundo o relato dos profissionais, situações frequentes como incursão policial, confronto armado entre a polícia e traficantes, a presença de caveirões e o som de tiros e bombas, são limitadores para a realização da VD. A qualidade da atenção prestada fica prejudicada e as atividades no território sofrem grandes prejuízos, trazendo medo e insegurança, inclusive aos profissionais. A ESF se consolida como um serviço próximo a territórios marcados pela violência urbana, enfrentando desafios diários para aplicação de suas ferramentas, em especial a VD.

The Family Health Strategy (ESF) is organized on a territorial basis, considering the local characteristics and enabling teams to know the profile of their clientele and situations experienced in their daily lives. In recent years, the municipality of Rio de Janeiro has expanded the ESF to highly vulnerable territories and has approached to areas where urban violence is strongly present. The objective was to understand if the Home Visit (VD) remains as a possible tool for ESF, in contexts of urban violence. A qualitative study was carried out, using interviews with semi structured script and content analysis. The results indicate that the VD is, primarily, aimed to search for users with some limitation of access, restriction to the bed or domicile. According to professionals reports, frequent situations such as police incursions, armed clashes between police and drug dealers, the presence of caveirões and the sound of shots and bombs, are limiting for the accomplishment of VD. The quality of care provided is impaired and activities in territory suffer great losses, bringing fear and insecurity, including to professionals. The ESF consolidates itself as a service close to territories marked by urban violence, facing daily challenges for application of its tools, especially the RV.

La Estrategia Salud de la Familia (ESF) está organizada sobre una base territorial, considerando las características locales y permitiendo a los equipos conocer el perfil de la clientela y las situaciones experimentadas en su vida diaria. En los últimos años, el municipio de Río de Janeiro ha expandido la ESF a territorios altamente vulnerables y los equipos se han acercado a áreas donde la violencia urbana está fuertemente presente. El objetivo era comprender si la Visita Domiciliaria (VD) sigue siendo una posible herramienta para la ESF en contextos de violencia urbana. Se realizó un estudio cualitativo, usando entrevistas con guiones semiestructurados y análisis de contenido. Los resultados indican que la VD está destinada principalmente a la búsqueda de usuarios con alguna limitación de acceso a la unidad, restricción de lecho o domicilio. Según el informe de los profesionales, las situaciones frecuentes como redadas policiales, enfrentamientos armados entre la policía y los traficantes, la presencia de caveirões y el sonido de disparos y bombas, son limitantes para la realización de la VD. La calidad de la atención se ve afectada y las actividades en el territorio sufren grandes daños, lo que genera temor e inseguridad, incluso para los profesionales. La ESF se consolida como un servicio cercano a los territorios marcados por la violencia urbana, enfrentando desafíos diarios para aplicar sus herramientas, especialmente la VD

Avaliação da visita domiciliar em programas na primeira infância: contribuições para a realidade brasileira / Evaluación de la visita domiciliaria en programas de primera infancia: contribuciones a la realidad brasileña / House call assessment in early childhood programs: contributions to the brazilian reality

RESUMO Introdução: este estudo consiste numa reflexão sobre a avaliação da visita domiciliar em programas na primeira infância. Objetivo: discutir as dimensões envolvidas em um modelo de avaliação para a realidade brasileira, além da percepção dos autores a respeito do tema. Método: essa reflexão foi estruturada nos seguintes tópicos: dimensões envolvidas na avaliação da visita domiciliar e o processo avaliativo nos programas brasileiros. Considerando a centralidade e relevância da visita domiciliar nos programas brasileiros com foco na Primeira Infância e a tendência de consolidação dessa tecnologia como forma de intervenção adequada a programas dessa natureza, propõe-se organizar quatro dimensões para a avaliação das visitas domiciliares: dosagem, conteúdo, relacionamento e responsividade do participante. Resultado: avaliar a tecnologia de intervenção dos programas voltados para a primeira infância, no caso a visita domiciliar, permite investigar os processos que ocorrem durante a entrega das visitas domiciliares e abrir a "caixa preta" da intervenção, sendo possível elucidar problemas operacionais e propor recomendações para corrigi-las. Conclusão: o modelo proposto possibilita aos supervisores e tomadores de decisão acompanhar de forma sistemática e ajustar as dimensões que impactam nos resultados dos programas de visita domiciliar voltados para a Primeira Infância.

RESUMEN Introducción: este estudio consiste en una reflexión sobre la evaluación de la visita domiciliaria en programas en la primera infancia. Objetivo: discutir las dimensiones involucradas en un modelo de evaluación para la realidad brasileña, además de la percepción de los autores acerca del tema. Método: esta reflexión fue estructurada en los siguientes tópicos: dimensiones involucradas en la evaluación de la visita domiciliaria y el proceso evaluativo en los programas brasileños. Considerando la centralidad y relevancia de la visita domiciliaria en los programas brasileños con foco en la Primera Infancia y la tendencia de consolidación de esta tecnología como forma de intervención adecuada a programas de esa naturaleza, se propone organizar cuatro dimensiones para la evaluación de las visitas domiciliarias: dosificación, contenido, relación y respuesta del participante. Resultado: evaluar la tecnología de intervención de los programas dirigidos a la primera infancia, en el caso la visita domiciliaria, permite investigar los procesos que ocurren durante la entrega de las visitas domiciliarias y abrir la "caja negra" de la intervención, siendo posible aclarar problemas operativos y proponer recomendaciones para corregirlos. Conclusión: el modelo propuesto posibilita a los supervisores y tomadores de decisiones acompañar de forma sistemática y ajustar las dimensiones que impactan en los resultados de los programas de visita domiciliariadirigidos para la Primera Infancia.

ABSTRACT Introduction: This study consists of a reflection on house call assessment in early childhood programs, which aimed to discuss the dimensions involved in an assessment model for the Brazilian reality, in addition to the authors' perception of the topic. Method: This reflection was structured around the following topics: dimensions involved in house call assessment and the assessment process in Brazilian programs. Considering the centrality and relevance of house calls in Brazilian programs focused on early childhood and the tendency to consolidate this technology as an intervention strategy suitable for programs of this nature, it is proposed to organize four dimensions for house call assessment: dosage, content, relationship, and participant responsiveness. Results: Assessing the intervention technology of programs aimed at early childhood, in this case house calls, allows us to inquire into the processes that occur during house calls and to open the 'black box' of intervention, making it possible to clarify operational issues and propose recommendations to fix them. Conclusion: The model proposed allows supervisors and decision makers to systematically monitor and adjust the dimensions that impact the results of house call programs aimed at early childhood.

Developing the Community Engaged Physician: Medical Students Reflect on a Household Visit Curriculum.

INTRODUCTION:  To educate students about social determinants of health, our medical school assigns interprofessional student teams to work longitudinally with underserved households to identify and address their health and social needs. To cultivate reflective practice--an essential component to training competent professionals through service-learning programs--students are asked to recognize their emotional responses to patient encounters. This project used reflective essays to identify the emotional responses of medical students to the start of their household visit experience and to assess their observations in relation to social determinants of health. METHODS:  Thematic analysis was used to examine patterns in reflective essays provided by 99 medical students. Two independent reviewers read the essays and created initial codes, which were developed into a common codebook by consensus. Codes were categorized into themes, including observations of the social determinants and emotional reactions to household visits. RESULTS: Through the provision of household-centered care, medical students recognize the roles that social determinants play in the health of patients, households, and communities. Furthermore, they are able to identify household and community level interventions to address these identified needs. A variety of emotional responses to household visits were identified, ranging from frustration and sadness to empathy and humility.  Conclusions: Medical students undergo an emotional evolution even at the start of their household visit experience; highlighting that early patient care responsibilities play an important role in their development from pre-professional students to doctors-in-training. Additionally, student observations of the social determinants suggest that household visits can provide an opportunity for the application of knowledge about identifying and addressing these barriers to care.

A Posthospitalization Home Visit Curriculum for Pediatric Patients.

Introduction: Home visits allow physicians to develop a deeper understanding of patients' homes and community, enhance physician-patient connectedness, and improve physician treatment plans for patients. We describe a unique pediatric posthospitalization home visit curriculum to train residents about the social determinants of health (SDH). Methods: Residents participated in an interactive presentation that discussed the logistics of making home visits and a background detailing SDH. During subsequent home visits, residents got to know the family and neighborhood on a deeper level. After each home visit, residents participated in a reflection session and considered the impact of SDH. Surveys were completed to capture data about residents' knowledge and attitudes regarding SDH and connectedness with the families. Families' perspectives were captured by phone surveys. Results: Of residents, 23 of 31 (74%) were able to make at least one home visit. After participating in the curriculum, residents reported increased confidence in understanding SDH (p = .048) and increased consideration of SDH when developing treatment plans (p = .007). All residents who made home visits predicted they would feel more confident in understanding how SDH impact patients they will care for in the future. Ninety percent of residents felt they made a stronger connection with the family. Eight families were surveyed, and all stated that the home visit had positive effects. Discussion: This curriculum teaches SDH while improving connections between physicians and patients.

Perfil e indicadores da assistência de um serviço de atenção domiciliar em cuidados paliativos de um Hospital de Câncer / Service profile description and indicators of a home based palliative care team of a Cancer Hospital in Brasil

O objetivo deste trabalho é descrever o perfil de um serviço de atendimento domiciliar em cuidados paliativos e os resultados obtidos após o primeiro ano de funcionamento. Foi realizado um estudo transversal, observacional retrospectivo e foram analisados os dados referentes aos atendimentos realizados pelo Serviço de Atendimento Domiciliar em Cuidados Paliativos (SAD/CP) no primeiro ano de funcionamento. Observou-se que, de 72 pacientes elegíveis, 56,9% eram mulheres e a idade média foi de 67,74 anos. O Karnofsky Performance Status médio foi de 48,16 e o Índice de Prognóstico Paliativo médio foi de 3,23. A maioria dos pacientes faleceu na Unidade de Cuidados Paliativos (51,4%). Concluiu-se, assim, que os pacientes que morreram em casa receberam mais visitas da equipe de atendimento domiciliar e se deslocaram menos vezes para a urgência e emergência. Fadiga, dor e anorexia foram os sintomas mais frequentes. Ansiedade, depressão e sensação de bem-estar reduzido foram os sintomas mais intensos. (AU)

The aim of this study is to describe the profile of a home-based palliative care service (HBPCS) and the results after the first year of work. A cross-sectional observational retrospective study was conducted and data about the visits made by the home-based palliative care team were analyzed regarding the first year of work. From data of 72 elegible patients, 56,9% were women and the average age was 67.7 years. The average Karnosfsky Performance Status was 48.16, and the average Palliative Prognostic Index was 3,23. The majority of the patients died at the Palliative Care Unit (51.4%). The patients who died at home received more visits of HBPCS and had less visits to the emergency department. Fatigue, Pain and Anorexia were the most common symptoms. Anxiety, Depression and reduced Well-Being sensation were the most intense symptoms. (AU)

People with multimorbidity in outpatient care: patient-focused and needs-oriented healthcare management (MamBo) - protocol for a multiperspective evaluation study.

BACKGROUND: With demographic change, the number of noncommunicable diseases, chronic diseases and multimorbidity is increasing, and so is the demand for health services. This represents a further challenge for the healthcare system. An adequate and efficient treatment of multimorbid patients requires a well-structured, informed and cross-indicated treatment. Therefore, a new form of coordinated, managed and cross-sectoral care for multimorbid patients - the "MamBo" care model - has been developed. Along with the implementation of MamBo, a process and outcome evaluation will be carried out, which is described in this study protocol. The aim of the study is to evaluate the care model according to its implementation process and effectiveness. METHODS: The MamBo-care model will be evaluated in multi-perspective terms. Thus, a process and outcome evaluation with several data sources will be conducted: (1) Annual focus groups and individual interviews with those involved in the process. (2) Various primary data, including surveys of patients, physicians and practice staff at the time of enrolment and 1 year later to enable pre-post comparison. (3) Claim data from the health insurance of the MamBo population in comparison to a comparative population, formed by the propensity score matching method. (4) Process data of the care management. The analysis of qualitative data will be carried out by content analysis according to Mayring. For the analysis of the quantitative data, multivariate analyses are planned. DISCUSSION: A new form of coordinated care has been introduced to improve intersectoral care of multimorbid patients and reduce the workload on physicians. The effects of the MamBo care model are being investigated for patients, physicians and the cost units. The results will form the basis for the decision whether the care model should be transferred to standard care and what needs to be taken into account for implementation. TRIAL REGISTRATION: The study was retrospectively registered in the German Register for Clinical Studies (DRKS00014047) on June 28, 2019.

Eliminating Patient Identified Barriers to Decrease Medicaid Inpatient Admission Rates and Improve Quality of Care.

BACKGROUND AND OBJECTIVES: The goal of this study was to decrease admission and readmission rate for the 2296 Medicaid patients in our clinic. Our focus was to eliminate patient identified barriers to care that led to decreased quality of care. The identified barriers for our clinic included distance to care, poor same-day access, communication, and fragmented care. A team-based, collaborative approach using members from all aspects of patient care. METHODS: An initial survey identified which barriers to care our patients felt obstructed their care. With this data, along with a national literature review, our team used biweekly quality team meetings with LEAN methodology and Plan-Do-Study-Act cycles to create a 4-phase quality improvement project. A home-visit program to decrease distance to care, walk-in clinic to improve same-day access, strengthened collaboration with outside care managers and clinic staff to improve communication, and the introduction of an in-house phlebotomist to improve fragmented care were created and studied between June 2015 and December 2018. Admission rate, avoidable readmission rate, as well as other quality of care measurements were assessed with electronic medical record reports and through North Carolina Medicaid data reports. RESULTS: Overall Medicaid admissions decreased 32.7% from starting numbers, 40.2% below expected benchmarks. Avoidable readmissions decreased 41.8%, 53.8% below the expected benchmark. Improvements in same-day access numbers and lab completion rate were also seen. DISCUSSION: The team-based approach to eliminating patient-identified barriers decreased both admissions and avoidable readmissions for our Medicaid patients. It also improved quality-of-care measures. This approach has been shown to be beneficial at our clinic and can easily be replicated in other settings.

Role of House Calls in the Care of Patients With Pulmonary Disease.

As the population ages, and more patients with chronic pulmonary diseases become frail and functionally impaired, the prevalence of homebound patients grows. Homebound patients have higher disease burden, inpatient utilization rates, and mortality than nonhomebound patients. Vulnerable homebound patients with pulmonary disease benefit from pulmonary expertise to evaluate and optimize their complex medication regimens; evaluate equipment such as nebulizers, home oxygen, ventilators, and suction machines; and coordinate services. We review the need and benefits of house calls for these patients, and illustrate these needs with cases. We also explore the logistics of making house calls part of pulmonary practice, including supplies needed, safety in the home, and reimbursement. Reimbursement has grown for house calls, and we review how to bill for visits, advance care planning, and care management that is often required when caring for patients with advanced illness. In addition, house calls can often be beneficial for patients who may be identified as high risk and are part of value-based agreements with payers.

Features of U.S. Primary Care Physicians and Their Practices Associated with Advance Care Planning Conversations.

INTRODUCTION: Primary care practices are essential settings for Advance Care Planning (ACP) conversations with patients. We hypothesized that such conversations occur more routinely in Advanced Primary Care/Patient Centered Medical Home (APCP/PCMH) Practices using practice transformation strategies. METHODS: We analyzed characteristics of physician respondents and their practices associated with ACP discussions in older and sicker patients using US data from the 2015 Commonwealth Fund International Survey of Primary Care Physicians in 10 Nations. The primary outcome was how routinely these ACP conversations are reported. We developed an index of APCP/PCMH features as a practice covariable. RESULTS: Respondents (N = 1001) were predominantly male (60%) and ≥45 years old (74%). Multivariable analyses showed that suburban practice location was associated with fewer ACP conversations; working in a practice commonly seeing patients with multiple chronic conditions or who have palliative care needs, and working in a practice from which home visits are made, were associated with more ACP conversations. Physicians compensated in part by capitation were more likely to report ACP conversations. No association was found between a single item asking if the practice was an APCP/PCMH and having ACP conversations. However, higher scores on an index of APCP/PCMH features were associated with more ACP conversations. CONCLUSIONS: In this sample of US primary care physicians, the types of patients seen, practice location, and physician compensation influenced whether physicians routinely discuss ACP with patients who are older and sicker. Practices demonstrating more features of APCP/PCMH models of primary care are also associated with ACP discussions.

Estratégias de avaliação da visita domiciliar: uma revisão de escopo / Estrategias de evaluación de visitas domiciliarias: una revisión del alcance / Home visit assessment strategies: a scope review

Resumo Objetivo Explorar a literatura relacionada às estratégias de avaliação da visita domiciliar nos programas de visitação para a primeira infância. Métodos Revisão de escopo baseada na metodologia proposta pelo Instituto Joanna Briggs. Foram analisadas as seguintes bases: PubMed, Web of Science, Scopus, CINAHL, Embase, Biblioteca Virtual da Saúde e acrescentados estudos de outras fontes. Após revisão por dois revisores independente quanto aos critérios de inclusão, foram selecionados 19 estudos para compor a amostra. Resultados Os programas de visita domiciliar para a primeira infância utilizam a análise dos cadernos de anotação do visitador, a entrevista com participantes e a aplicação de instrumentos de medida como estratégias para avaliar a visita. Conclusão A revisão trouxe uma gama de abordagens que podem ser adotadas segundo o objetivo de cada programa e a disponibilidade de recursos. Carecem de estratégias efetividade comprovadas, além de instrumentos e métodos validados.

Resumen Objetivo investigar la literatura relacionada con las estrategias de evaluación de visitas domiciliarias en los programas de visitas en la primera infancia. Métodos revisión del alcance basada en la metodología propuesta por el Instituto Joanna Briggs. Se analizaron las siguientes bases: PubMed, Web of Science, Scopus, CINAHL, Embase, Biblioteca Virtual da Saúde y estudios de otras fuentes. Luego de la revisión realizada por dos revisores independientes sobre los criterios de inclusión, se seleccionaron 19 estudios para componer la muestra. Resultados los programas de visitas domiciliarias en la primera infancia utilizan un análisis de las notas del visitador, la entrevista con participantes y la aplicación de instrumentos de medida como estrategias para evaluar las visitas. Conclusión la revisión trajo una gama de enfoques que pueden ser adoptados según el objetivo de cada programa y la disponibilidad de recursos. Carecen de estrategias de efectividad comprobadas, además de instrumentos y métodos validados.

Abstract Objective To explore the literature related to home visit assessment strategies in early childhood visiting programs. Methods A scope review based on the methodology proposed by the Joanna Briggs Institute, which used PubMed, Web of Science, Scopus, CINAHL, Embase, Virtual Health Library for search. There was addition of studies from other sources. After review by two independent reviewers of the inclusion criteria, 19 studies were selected to compose the sample. Results Home visiting programs for early childhood use analysis of visitor notebooks, interview with participants, and application of measurement tools as strategies to assess the visit. Conclusion The review has brought a range of approaches that can be adopted according to the purpose of each program and availability of resources. They lack proven effectiveness strategies, as well as validated tools and methods.

Ten Things Every Geriatrician Should Know About House Calls.

Home-based primary care (HBPC) is experiencing a reemergence to meet the needs of homebound older adults. This brief review based on existing literature and expert opinion discusses 10 key facts about HBPC that every geriatrician should know: (1) the team-based nature of HBPC is key to its success; (2) preparations and after-hour access for house calls are required; (3) home safety for the clinician and patient must be considered; (4) being homebound is an independent mortality risk factor with a high symptom burden; (5) home care medicine presents unique benefits and challenges; (6) a systems-based approach to care is essential; (7) HBPC is a sustainable model within value-based care proven by the Department of Veterans Affairs and the Independence at Home Medicare Demonstration Project; (8) HBPC has an educational mission; (9) national organizations for HBPC include American Academy of Home Care Medicine and Home Centered Care Institute; and (10) practicing HBPC is a privilege. HBPC is a dynamic and unique practice model that will continue to grow in the future. J Am Geriatr Soc 67:139-144, 2019.

The interaction of socioeconomic status with place of death: a qualitative analysis of physician experiences.

BACKGROUND: Home is a preferred place of death for many people; however, access to a home death may not be equitable. The impact of socioeconomic status on one's ability to die at home has been documented, yet there remains little literature exploring mechanisms that contribute to this disparity. By exploring the experiences and insights of physicians who provide end-of-life care in the home, this study aims to identify the factors perceived to influence patients' likelihood of home death and describe the mechanisms by which they interact with socioeconomic status. METHODS: In this exploratory qualitative study, we conducted interviews with 9 physicians who provide home-based care at a specialized palliative care centre. Participants were asked about their experiences caring for patients at the end of life, focusing on factors believed to impact likelihood of home death with an emphasis on socioeconomic status, and opportunities for intervention. We relied on participants' perceptions of SES, rather than objective measures. We used an inductive content analysis to identify and describe factors that physicians perceive to influence a patient's likelihood of dying at home. RESULTS: Factors identified by physicians were organized into three categories: patient characteristics, physical environment and support network. Patient preference for home death was seen as a necessary factor. If this was established, participants suggested that having a strong support network to supplement professional care was critical to achieving home death. Finally, safe and sustainable housing were also felt to improve likelihood of home death. Higher SES was perceived to increase the likelihood of a desired home death by affording access to more resources within each of the categories. This included better health and health care understanding, a higher capacity for advocacy, a more stable home environment, and more caregiver support. CONCLUSIONS: SES was not perceived to be an isolated factor impacting likelihood of home death, but rather a means to address shortfalls in the three identified categories. Identifying the factors that influence ability is the first step in ensuring home death is accessible to all patients who desire it, regardless of socioeconomic status.

Description of public health nursing nutrition assessment and interventions for home-visited women.

OBJECTIVE(S): The purpose of this manuscript was to describe: Public Health Nurse (PHN) home-visited, female client Nutrition Knowledge (K), Behavior (B), and Status (S); the number and types of nutrition interventions PHNs used with these clients; and the types of clients receiving nutrition interventions. DESIGN AND SAMPLE: This descriptive study used PHN-generated Omaha System, electronic health record data from January 2012 to July 2015. The analytic sample contains 558 women who received home visits in a rural Midwestern U.S. county that employed universal nutrition assessment for clients. MEASUREMENTS: Omaha System data included nutrition KBS scores (from 1 = low to 5 = high) and nutrition interventions delivered. Analyses included descriptive, bivariate, and multivariate analyses (means, frequencies, chi-squares, general linear models). RESULTS: PHNs assessed nutrition KBS scores for 84.1% of clients; average Nutrition Knowledge was 3.4 (SD = 0.7), Behavior 3.7 (SD = 0.8), and Status 4.3 (SD = 1.0). PHNs provided 0-36 nutrition interventions per client. Nutrition intervention patterns were detected by the type of visit clients received. CONCLUSIONS: Results suggest home-visited women have room to improve Nutrition KBS and PHNs utilize myriad nutrition interventions. Results also point to opportunities to improve home-visited client care by providing more nutrition interventions, especially to those not receiving interventions, and revising standard care plans to reflect important Case Management nutrition interventions.

Patient-reported impact of after-hours house-call services on the utilization of emergency department services in Australia.

Objectives: This paper explores, from the patients' perspective, the likely impact of the Australian after-hours house-call (AHHC) medical services on emergency department (ED) presentations. This has become imperative given the significant cost difference between patient presentations to either the AHHC or ED and their practical implications for health care funding. Design, setting and participants: A cross-sectional, self-reported survey of all 10 838 patients in Australia known to have patronized AHHC services over the last week of January 2016. Main outcome measure: The study used a validated, self-completion questionnaire, dispatched through a mixture of online and postal methods. Results: A total of 1228 questionnaires were returned, of which 1211 included all relevant sections of the survey (11.2% response rate). Four hundred and eighty-six patients (40.1%) indicated that they would have gone to the ED on the same day or night of their illness had the AHHC not been available, with the elderly (≥65) and children (<16) accounting for nearly two-thirds of these (64.6%). Following their AHHC consultations, 103 (8.5%) patients eventually attended the ED, meaning that the service prevented 383 patients from attending the ED, a decrease of 78.8%. Stratification based on location showed that this impact was seen across all states and territories in Australia where AHHC services exist, ranging from a reduction of 73.9% in Western Australia to 85.0% in Tasmania. Similarly, the impact cuts across all patient demographics, including age ranges, gender and social divides. Conclusions: Based on our respondents' reports, AHHC services appear to be associated with a reduction in ED visits in Australia, with the impact cutting across all regions and patient demographics.