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1.
J Korean Med Sci ; 35(20): e158, 2020 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-32449323

RESUMO

BACKGROUND: Since the recently announced Community Care Policy, there has been an opinion that Korea needs to establish an alternative medical model such as physician home visits. This study aimed to assess the need and willingness to pay (WTP) for physician home visits among the community-dwelling Korean older population and to determine the most important factors that influence older adults to decide to use a physician home visit service. METHODS: A total of 797 people aged 60 years or older who were randomly selected from a nationwide dataset using a multi-stage stratified sampling method answered a questionnaire on the need and WTP for physician home visits. RESULTS: A total of 39.3% of participants reported that they would like a physician home visit when they need help. Among older adults who needed physician home visits (n = 313), the WTP amount for physician home visits was 21,982 ± 17,546 KRW. Logit and Tobit regression analyses showed that the higher valuated need and WTP for physician home visits was associated with a lower level of physical/psychosocial functioning measured by EuroQol-five dimensions score (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.27; P = 0.035) and a higher level of satisfaction when using community-based services such as public health centers (OR, 1.32; 95% CI, 1.02-1.72; P = 0.034), social welfare centers and Gyeong-ro-dang (OR, 1.61; 95% CI, 1.04-2.50; P = 0.033; ß = 8.39; standard error, 3.63; P = 0.021). CONCLUSION: This study provides evidence that the decision to pay for a physician home visit service is based upon the complex interactions among an individual's physical and psychosocial functioning, personal experiences of service utilization, and demographic factors. The value for physician home visits should be qualified based on the empirical data of WTP, which comes from a consumer-centered perspective.


Assuntos
Visita Domiciliar , Idoso , Tomada de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Médicos
3.
Lancet Psychiatry ; 7(5): 420-430, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32353277

RESUMO

BACKGROUND: Multisystemic therapy is a manualised treatment programme for young people aged 11-17 years who exhibit antisocial behaviour. To our knowledge, the Systemic Therapy for At Risk Teens (START) trial is the first large-scale randomised controlled trial of multisystemic therapy in the UK. Previous findings reported to 18 months after baseline (START-I study) did not indicate superiority of multisystemic therapy compared with management as usual. Here, we report outcomes of the trial to 60 months (START-II study). METHODS: In this pragmatic, randomised, controlled, superiority trial, young people (aged 11-17 years) with moderate-to-severe antisocial behaviour were recruited from social services, youth offending teams, schools, child and adolescent mental health services, and voluntary services across England, UK. Participants were eligible if they had at least three severity criteria indicating past difficulties across several settings and one of five general inclusion criteria for antisocial behaviour. Eligible families were randomly assigned (1:1), using stochastic minimisation and stratifying for treatment centre, sex, age at enrolment, and age at onset of antisocial behaviour, to management as usual or 3-5 months of multisystemic therapy followed by management as usual. Research assistants and investigators were masked to treatment allocation; the participants could not be masked. For this extension study, the primary outcome was the proportion of participants with offences with convictions in each group at 60 months after randomisation. This study is registered with ISRCTN, ISRCTN77132214, and is closed to accrual. FINDINGS: Between Feb 4, 2010, and Sept 1, 2012, 1076 young people and families were assessed for eligibility and 684 were randomly assigned to management as usual (n=342) or multisystemic therapy (n=342). By 60 months' of follow-up, 188 (55%) of 342 people in the multisystemic therapy group had at least one offence with a criminal conviction, compared with 180 (53%) of 341 in the management-as-usual group (odds ratio 1·13, 95% CI 0·82-1·56; p=0·44). INTERPRETATION: The results of the 5-year follow-up show no evidence of longer-term superiority for multisystemic therapy compared with management as usual. FUNDING: National Institute for Health Research Health Services and Delivery Research programme.


Assuntos
Comportamento do Adolescente , Comunicação , Transtorno da Conduta/reabilitação , Crime/estatística & dados numéricos , Terapia Familiar/métodos , Delinquência Juvenil/reabilitação , Poder Familiar , Apoio Social , Adaptação Psicológica , Adolescente , Terapia de Controle da Ira , Transtorno da Personalidade Antissocial , Criança , Inglaterra , Feminino , Visita Domiciliar , Humanos , Masculino , Relações Pais-Filho , Rede Social , Resultado do Tratamento
4.
Neurology ; 94(22): 959-969, 2020 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-32284362

RESUMO

The coronavirus 2019 (COVID-19) pandemic has potential to disproportionately and severely affect patients with neuromuscular disorders. In a short period of time, it has already caused reorganization of neuromuscular clinical care delivery and education, which will likely have lasting effects on the field. This article reviews (1) potential neuromuscular complications of COVID-19, (2) assessment and mitigation of COVID-19-related risk for patients with preexisting neuromuscular disease, (3) guidance for management of immunosuppressive and immunomodulatory therapies, (4) practical guidance regarding neuromuscular care delivery, telemedicine, and education, and (5) effect on neuromuscular research. We outline key unanswered clinical questions and highlight the need for team-based and interspecialty collaboration. Primary goals of clinical research during this time are to develop evidence-based best practices and to minimize morbidity and mortality related to COVID-19 for patients with neuromuscular disorders.


Assuntos
Infecções por Coronavirus/terapia , Imunossupressores/efeitos adversos , Doenças Neuromusculares/terapia , Pneumonia Viral/terapia , Antivirais/efeitos adversos , Cloroquina/efeitos adversos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde , Desprescrições , Progressão da Doença , Desenvolvimento de Medicamentos , Inibidores Enzimáticos/efeitos adversos , Síndrome de Guillain-Barré/etiologia , Visita Domiciliar , Humanos , Hidroxicloroquina/efeitos adversos , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/uso terapêutico , Imunossupressores/uso terapêutico , Infusões Subcutâneas , Macrolídeos/efeitos adversos , Doenças Musculares/etiologia , Miastenia Gravis/induzido quimicamente , Neurologia/educação , Doenças Neuromusculares/complicações , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Pesquisa , Comportamento de Redução do Risco , Autoadministração , Telemedicina , Vacinas Virais/uso terapêutico
5.
PLoS One ; 15(4): e0230211, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298289

RESUMO

BACKGROUND: Maternal depression is common among low-income women enrolled in home visiting programs, yet there is considerable variability in the extent to which it is identified and addressed. This study examines outcomes related to postpartum depression screening, receipt of evidence-based services, and reductions in depressive symptoms among clients of home visiting programs in the Health Resources and Services Administration's Maternal, Infant, and Early Childhood Home Visiting Program Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN), the first U.S. national application of the Institute for Healthcare Improvement's Breakthrough Series (BTS) Model in home visiting programs. METHODS AND FINDINGS: Fourteen home visiting programs in eight states, serving a geographically and racially diverse caseload of pregnant women and new mothers, took part in the HV CoIIN. Women in participating home visiting programs received the intervention strategies implemented by their program during participation in the collaborative. HV CoIIN strategies included specific policies and protocols for depression screening and home visitor response to screening results; home visitor training and supervision; delivery of prevention and treatment interventions; and tracking systems for screening, referral, and follow-up. HV CoIIN's proposed primary outcome was that 85% of women who accessed evidence-based services would experience a 25% reduction in depressive symptoms three months after accessing services. Secondary outcomes included an increased percentage of women who were screened for depression within three months of enrollment or birth, who verbally accepted a referral to evidence-based services, and who received one or more evidence-based service contacts. HV CoIIN resulted in improved symptoms among women who accessed services, from 51.1% to 59.9%. HV CoIIN also improved the percent of women screened for depression, from 83.6% to 96.3%, and those with positive depression screens who accessed evidence-based services, from 41.6% to 65.5%. Home visiting programs in this study were early adopters of quality improvement activities, which may limit the generalizability of these results to other home visiting programs. CONCLUSIONS: Home visiting programs can play an important role in closing gaps in maternal depression identification, referrals, service access, and symptom alleviation. Continuous quality improvement and BTS collaborative methods can be used to improve home visiting services in ways that advance national public health priorities and improve population health outcomes.


Assuntos
Depressão Pós-Parto/terapia , Serviços de Assistência Domiciliar , Visita Domiciliar , Serviços de Saúde Materna , Melhoria de Qualidade , Adulto , Depressão Pós-Parto/epidemiologia , Feminino , Humanos , Gravidez , Estados Unidos/epidemiologia
6.
BMC Health Serv Res ; 20(1): 189, 2020 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-32143644

RESUMO

BACKGROUND: Perinatal depression is a prevalent public health concern. Although preventive interventions exist, there is limited literature on the acceptability and appropriateness of these interventions, especially those delivered by paraprofessionals. The Mothers and Babies Program (MB) is a group-based perinatal depression preventive intervention delivered prenatally. A cluster-randomized controlled trial examined the acceptability, appropriateness, and effectiveness of MB delivered by mental health professionals compared to paraprofessional staff from home visiting programs. METHODS: The full study enrolled 874 pregnant women. Fifty-three facilitators were trained and delivered the MB intervention to women in one of seven states in the United States. Semi-structured interviews were attempted with a randomly-selected subset of the full sample of pregnant women who received the MB intervention and with all facilitators. Specifically, interviews were conducted with 88 women who received the MB group intervention (45 in the paraprofessional-led arm and 43 in the mental health professional-led arm) and 46 women who facilitated the groups (27 home visiting staff and 19 mental health professionals). Interviews were conducted over the phone in English or Spanish and audio recorded. The recordings were translated into English, as needed, and transcribed. Thematic analysis was conducted using NVIVO to identify key themes related to intervention acceptability and appropriateness. Similarities and differences between study arms were explored. RESULTS: Clients and facilitators found the MB content and group format acceptable. Challenges included maintaining group attendance, transportation issues, and managing group discussion. Overall, facilitators found the intervention appropriate for pregnant clients with some challenges presented for clients in crisis situations, experiencing housing instability, and with literacy and learning challenges. Participants provided suggestions for improvement, both for the course content and implementation. There were no significant differences found between study arms. CONCLUSIONS: Overall, clients and facilitators enjoyed MB irrespective of study arm, and facilitators found the intervention appropriate for the population. These findings add to the qualitative literature on perinatal depression preventive interventions, specifically those delivered by paraprofessionals. TRIAL REGISTRATION: This trial is registered on ClinicalTrials.gov (Initial post: December 1, 2016; identifier: NCT02979444).


Assuntos
Depressão/prevenção & controle , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gestantes/psicologia , Psicoterapia de Grupo , Adulto , Atitude do Pessoal de Saúde , Feminino , Pesquisa sobre Serviços de Saúde , Visita Domiciliar , Humanos , Serviços de Saúde Mental , Mães/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa
7.
Am J Nurs ; 120(4): 58-59, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32218052
8.
Sr Care Pharm ; 35(2): 75-80, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32019642

RESUMO

This report describes a case of hypertensive crisis identified by two pharmacists conducting a patient home visit. A 72-year-old woman living in a rural town in Eastern Washington state was referred for a pharmacist home visit by her care coordinator, who had concerns of possible medication-related issues. The patient had a history of type 2 diabetes mellitus, hypertension, ischemic stroke, heart failure with preserved ejection fraction, hypothyroidism, and unspecified back pain. This patient also experienced additional challenges resulting from living in a rural and medically underserved community. During the home visit, the patient's chief complaint was recurrent, painful migraine headaches that she self-treated with nonsteroidal anti-inflammatory medication. Upon examination, the pharmacists found the patient's blood pressure to be 223/132 mm Hg and her self-monitoring log consistently showed blood pressure readings greater than 180/110 mm Hg with a pulse between 75 bpm to 80 bpm. The patient was referred to the emergency department after determining her blood pressure met criteria for hypertensive crisis despite her adherence to her current antihypertensive regimen. She was hospitalized for three days. After her hospitalization, she was referred to her primary care providers and her pharmacist for follow up. The pharmacist reconciled her current medication regimen and made guideline-directed adjustments to her antihypertensive medications. Six months after her hospitalization her blood pressure was within goal and associated headaches had resolved.


Assuntos
Diabetes Mellitus Tipo 2 , Visita Domiciliar , Idoso , Anti-Hipertensivos , Feminino , Humanos , Farmacêuticos , Washington
9.
BMC Public Health ; 20(1): 136, 2020 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-32000744

RESUMO

BACKGROUND: This study tests whether home visitation to prevent child maltreatment can be improved by adding manualized program components, targeting four key risk factors for child maltreatment: low parental self-efficacy, high levels of perceived stress, parental anger, and post-traumatic stress symptoms. Home visitation is widely implemented, but effects on child maltreatment risk tend to be modest at best. Home visitation tends to be rather flexible (i.e., professionals decide how to support each family). We will test whether adding manualized program components increases program effectiveness, by ensuring that key risk factors are addressed, while maintaining flexibility. In addition, we will test whether any component effects on reduced child maltreatment risk can be explained (i.e., is mediated) by ameliorated risk factors. Lastly, we will test whether the components are more effective for some mothers (e.g., those at highest child maltreatment risk) than for others. METHODS: We will conduct a randomized controlled trial among 398 mothers enrolled in a Dutch home visiting program targeting families at risk for child maltreatment. Mothers in the experimental group will receive the manualized components in two consecutive home visits, while mothers in the control group will receive regular home visits (care as usual). Mothers will fill out questionnaires at four time points: before and after each of the two home visits. Outcome variables include the four targeted risk factors parental self-efficacy, perceived stress, parental anger, and (recognition of) post-traumatic stress symptoms, as well as parenting practices (e.g., rejection and affection), and risk for child maltreatment. DISCUSSION: This study aims to determine whether adding manualized program components to a flexible home visiting program increases program effectiveness on risk for child maltreatment. In addition, our test of whether the effects of the components on risk for child maltreatment is explained (i.e., mediated) by amelioration of the targeted risk factors, may contribute to our understanding of the role of these risk factors in child maltreatment. Our tests of which mothers benefit most from adding the components may help move the field towards evidence-based personalized family support. TRIAL REGISTRATION: This trial has been retrospectively registered in the Netherlands Trial Register (NL8005).


Assuntos
Maus-Tratos Infantis/prevenção & controle , Educação Infantil/psicologia , Promoção da Saúde/métodos , Visita Domiciliar , Mães/psicologia , Gestão de Riscos/métodos , Estresse Psicológico/prevenção & controle , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Países Baixos , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Inquéritos e Questionários
11.
N Engl J Med ; 382(8): 717-726, 2020 02 20.
Artigo em Inglês | MEDLINE | ID: mdl-32074419

RESUMO

BACKGROUND: The burden of hypertension is escalating, and control rates are poor in low- and middle-income countries. Cardiovascular mortality is high in rural areas. METHODS: We conducted a cluster-randomized, controlled trial in rural districts in Bangladesh, Pakistan, and Sri Lanka. A total of 30 communities were randomly assigned to either a multicomponent intervention (intervention group) or usual care (control group). The intervention involved home visits by trained government community health workers for blood-pressure monitoring and counseling, training of physicians, and care coordination in the public sector. A total of 2645 adults with hypertension were enrolled. The primary outcome was reduction in systolic blood pressure at 24 months. Follow-up at 24 months was completed for more than 90% of the participants. RESULTS: At baseline, the mean systolic blood pressure was 146.7 mm Hg in the intervention group and 144.7 mm Hg in the control group. At 24 months, the mean systolic blood pressure fell by 9.0 mm Hg in the intervention group and by 3.9 mm Hg in the control group; the mean reduction was 5.2 mm Hg greater with the intervention (95% confidence interval [CI], 3.2 to 7.1; P<0.001). The mean reduction in diastolic blood pressure was 2.8 mm Hg greater in the intervention group than in the control group (95% CI, 1.7 to 3.9). Blood-pressure control (<140/90 mm Hg) was achieved in 53.2% of the participants in the intervention group, as compared with 43.7% of those in the control group (relative risk, 1.22; 95% CI, 1.10 to 1.35). All-cause mortality was 2.9% in the intervention group and 4.3% in the control group. CONCLUSIONS: In rural communities in Bangladesh, Pakistan, and Sri Lanka, a multicomponent intervention that was centered on proactive home visits by trained government community health workers who were linked with existing public health care infrastructure led to a greater reduction in blood pressure than usual care among adults with hypertension. (Funded by the Joint Global Health Trials scheme; COBRA-BPS ClinicalTrials.gov number, NCT02657746.).


Assuntos
Anti-Hipertensivos/uso terapêutico , Agentes Comunitários de Saúde , Visita Domiciliar , Hipertensão/terapia , Educação de Pacientes como Assunto , Idoso , Ásia Ocidental , Pressão Sanguínea , Determinação da Pressão Arterial , Lista de Checagem , Países em Desenvolvimento , Educação Médica Continuada , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prática de Saúde Pública , População Rural
12.
PLoS One ; 15(1): e0218682, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31999700

RESUMO

INTRODUCTION: As South Africa embarks on the implementation of the community health care worker (CHW) 2018 policy, quantifying the resource requirements to effectively manage the programme across different geographical communities is essential. This study was conducted to quantify and compare costs associated with travel and service delivery demands on CHWs between area types in two districts. METHODS: This economic analysis adopted a provider perspective to cost CHW services between January and November 2016. A total of 221 CHWs completed diaries for 10 days to document their activities. Quintile regression and the Kruskall Wallis test were used to test for differences in time and activities across urban and rural sites. RESULTS: While travel time across rural and urban settings within each district did differ it was not the most significant predictor of differences in time utilization. Time on activities showed more significant differences with overall median time by unit of activity being 15% longer in rural than urban areas in Sedibeng and 10% longer in uMzinyathi respectively. Most CHW time was spent conducting home visits (57% in rural,66% in peri-urban/urban). Median time per home visit in uMzinyathi was 50% longer in deep-rural areas than urban areas and 20% longer in rural than urban areas in Sedibeng. Referrals and number of home visits per capita (0.4 visits in rural and 0.7 in urban/peri-urban areas) were low in both districts. Expenditure on the programme translated to under 4% of PHC expenditure per capita and remains under 5% if despite the new national minimum wage (R3,500/$245). CONCLUSION: Because home visits take longer and CHWs spend a lower share of time on visits, a higher number is required in rural and deep rural areas (33% and 66% respectively) than in urban areas. Effective budget planning will therefore need to recognize the different geographical needs.


Assuntos
Serviços de Saúde Comunitária , Agentes Comunitários de Saúde , Infecções por HIV/epidemiologia , Fatores Socioeconômicos , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Infecções por HIV/prevenção & controle , Recursos em Saúde , Visita Domiciliar , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , População Rural/estatística & dados numéricos , África do Sul/epidemiologia
14.
BMC Health Serv Res ; 20(1): 39, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31941489

RESUMO

BACKGROUND: Medication mismanagement is a major cause of both hospital admission and nursing home placement of frail older adults. Medication reviews by community pharmacists aim to maximise therapeutic benefit but also minimise harm. Pharmacist-led medication reviews have been the focus of several systematic reviews, but none have focussed on the home setting. REVIEW METHODS: To determine the effectiveness of pharmacist home visits for individuals at risk of medication-related problems we undertook a systematic review and meta-analysis of randomised controlled trials (RCTs). Thirteen databases were searched from inception to December 2018. Forward and backward citation of included studies was also performed. Articles were screened for inclusion independently by two reviewers. Randomised controlled studies of home visits by pharmacists for individuals at risk of medication-related problems were eligible for inclusion. Data extraction and quality appraisal were performed by one reviewer and checked by a second. Random-effects meta-analyses were performed where sufficient data allowed and narrative synthesis summarised all remaining data. RESULTS: Twelve RCTs (reported in 15 articles), involving 3410 participants, were included in the review. The frequency, content and purpose of the home visit varied considerably. The data from eight trials were suitable for meta-analysis of the effects on hospital admissions and mortality, and from three trials for the effects on quality of life. Overall there was no evidence of reduction in hospital admissions (risk ratio (RR) of 1.01 (95%CI 0.86 to 1.20, I2 = 69.0%, p = 0.89; 8 studies, 2314 participants)), or mortality (RR of 1.01 (95%CI 0.81 to 1.26, I2 = 0%, p = 0.94; 8 studies, 2314 participants)). There was no consistent evidence of an effect on quality of life, medication adherence or knowledge. CONCLUSION: A systematic review of twelve RCTs assessing the impact of pharmacist home visits for individuals at risk of medication related problems found no evidence of effect on hospital admission or mortality rates, and limited evidence of effect on quality of life. Future studies should focus on using more robust methods to assess relevant outcomes.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Visita Domiciliar , Farmacêuticos , Idoso , Pesquisa sobre Serviços de Saúde , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco
15.
N Engl J Med ; 382(2): 152-162, 2020 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-31914242

RESUMO

BACKGROUND: There is widespread interest in programs aiming to reduce spending and improve health care quality among "superutilizers," patients with very high use of health care services. The "hotspotting" program created by the Camden Coalition of Healthcare Providers (hereafter, the Coalition) has received national attention as a promising superutilizer intervention and has been expanded to cities around the country. In the months after hospital discharge, a team of nurses, social workers, and community health workers visits enrolled patients to coordinate outpatient care and link them with social services. METHODS: We randomly assigned 800 hospitalized patients with medically and socially complex conditions, all with at least one additional hospitalization in the preceding 6 months, to the Coalition's care-transition program or to usual care. The primary outcome was hospital readmission within 180 days after discharge. RESULTS: The 180-day readmission rate was 62.3% in the intervention group and 61.7% in the control group. The adjusted between-group difference was not significant (0.82 percentage points; 95% confidence interval, -5.97 to 7.61). In contrast, a comparison of the intervention-group admissions during the 6 months before and after enrollment misleadingly suggested a 38-percentage-point decline in admissions related to the intervention because the comparison did not account for the similar decline in the control group. CONCLUSIONS: In this randomized, controlled trial involving patients with very high use of health care services, readmission rates were not lower among patients randomly assigned to the Coalition's program than among those who received usual care. (Funded by the National Institute on Aging and others; ClinicalTrials.gov number, NCT02090426; American Economic Association registry number, AEARCTR-0000329.).


Assuntos
Doença Crônica/terapia , Hospitalização/estatística & dados numéricos , Administração dos Cuidados ao Paciente/métodos , Readmissão do Paciente/estatística & dados numéricos , Adulto , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Custos de Cuidados de Saúde , Visita Domiciliar , Humanos , Modelos Lineares , Pessoa de Meia-Idade , New Jersey , Administração dos Cuidados ao Paciente/organização & administração , Sumários de Alta do Paciente Hospitalar , Estudos Prospectivos , Fatores Socioeconômicos , Estados Unidos
16.
Nurs Educ Perspect ; 41(2): 126-127, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30601451

RESUMO

Given the complex needs of the aging population, nurse educators must prepare future registered nurses to help older adults remain safe and healthy in their homes. This article describes partnerships between a school of nursing and low-income senior housing providers to develop new, high-impact community-based learning experiences. Baccalaureate nursing students conducted home visits in low-income senior housing communities and engaged in a research study to quantify activities conducted by students and the impact the home visits had on client personal health goal attainment.


Assuntos
Enfermagem em Saúde Comunitária/educação , Promoção da Saúde/métodos , Visita Domiciliar , Estudantes de Enfermagem/psicologia , Idoso , Relações Comunidade-Instituição , Bacharelado em Enfermagem/organização & administração , Instituição de Longa Permanência para Idosos/organização & administração , Humanos , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem
17.
Matern Child Health J ; 24(1): 73-81, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31712949

RESUMO

INTRODUCTION: Pediatric primary care and home visiting programs seek to reduce health disparities and promote coordinated health care use. It is unclear whether these services impact high-cost, emergency department (ED) utilization. We evaluated the association of well-child care (WCC) and home visiting with ED visit frequency for children < 1 year with an established medical home. METHODS: Retrospective cohort study using linked administrative data for infants ≥ 34 weeks' gestation from 2010 to 2014, within a multisite, academic primary care system. Latent class analysis characterized longitudinal patterns of WCC. Multivariable negative binomial regression models tested the independent association between WCC patterns and home visiting enrollment with ED visits. RESULTS: Among 10,363 infants, three WCC latent classes were identified: "Adherent" (83.4% of the cohort), "Intermediate" (9.7%), and "Decreasing adherence" (7.0%). Sixty-one percent of the sample had ≥ 1 ED visit in the first 12 months of life, and 73% of all ED visits were triaged as non-urgent. There was a significant interaction effect between WCC pattern and insurance status. Among Medicaid-insured infants, "Intermediate" and "Decreasing adherence" WCC patterns were associated with a lower incident rate of ED visits compared with the "Adherent" pattern (incident rate ratios (IRR) 0.88, p = 0.03 and 0.79, p < 0.001 respectively); this effect was not observed among privately-insured infants. Home visiting enrollment was independently associated with a higher rate of ED visits (IRR 1.24, p < 0.001). DISCUSSION: Among infants with an established medical home, adherence to recommended WCC and home visiting enrollment was associated with greater ED use for non-urgent conditions.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Visita Domiciliar/estatística & dados numéricos , Assistência Centrada no Paciente , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Criança , Cuidado da Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Medicaid/estatística & dados numéricos , Gravidez , Estudos Retrospectivos , Estados Unidos
18.
Res Nurs Health ; 43(1): 122-133, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31793678

RESUMO

Community-based home visiting programs using community health workers (CHWs) have become popular modes of delivering health care services, especially in settings where health workers are overburdened and resources are limited. Yet, little is known about the processes that shape effective implementation in low-resource settings, and whether these processes adhere to home visitors' training. This study used the newly-developed Home Visit Communication Skills Inventory (HCSI) to explore the delivery of a CHW program in rural South Africa. Routine home visits from CHWs to their maternal care clients were audio-recorded with consent, and later transcribed and translated into English. The HCSI, devised and piloted using existing frameworks and program-specific training components, consisted of 21 items covering domains related to active listening, active delivery, and active connecting, and was used to score English transcripts of the home visits. The HCSI was used to generate general frequencies and aggregate scores for each CHW. Eighty-four home visits by 14 CHWs showed a diverse application of communication skills. Active listening and active delivery were common, with fewer instances of active connecting observed. Practices disaggregated by CHW showcased varying strengths by an individual. In reviewing visit characteristics, longer average visit duration was significantly correlated with the presence of multiple types of active connecting skills. While technical skills were widely observed, fewer CHWs engaged in more complex "connecting" skills. The HCSI is a feasible, low-cost, and practical way to describe home visit fidelity among CHWs. Audio-based checklists can be used to describe fidelity to a model in the absence of additional supervisory resources.


Assuntos
Comunicação , Agentes Comunitários de Saúde/normas , Visita Domiciliar , Relações Enfermeiro-Paciente , Cuidado Pós-Natal/normas , Guias de Prática Clínica como Assunto , Serviços de Saúde Rural/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Rural , África do Sul
19.
Scand J Public Health ; 48(3): 308-315, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-29199915

RESUMO

Aims: It is important for district nurses and other health professionals in primary care to gain more insight into the patterns and quality of drug use in community-dwelling older people, particularly in 75-year-olds, who have been the target of preventive home visits. This study aimed to examine the extent and quality of drug use in community-dwelling older people and to compare drug use in 75-year-olds with that of older age groups. Methods: Data from 2013 on people aged ≥75 years were obtained from the Swedish Prescribed Drug Register. Those living in the community (671,940/739,734 people aged ≥75 years) were included in the study. Quality of drug use was assessed by using a selection of indicators issued by the Swedish National Board of Health and Welfare. Results: The prevalence of polypharmacy and of many drug groups increased with age, as did several indicators of inappropriate drug use. However some drug groups, as well as inappropriate drugs, were prevalent in 75-year-olds and declined with age, for example diabetes drugs, drugs with major anticholinergic effects and nonsteroidal anti-inflammatory drugs. Conclusions: The substantial use of some drugs as early as 75 years of age confirms the value of including drug use as a topic in preventive home visits to 75-year-olds. The finding that polypharmacy and many measures of inappropriate drug use increased with age in community-dwelling older people also underscores the importance of district nurses' role in continuing to promote safe medication management at higher ages.


Assuntos
Tratamento Farmacológico/estatística & dados numéricos , Vida Independente , Polimedicação , Idoso , Idoso de 80 Anos ou mais , Tratamento Farmacológico/enfermagem , Feminino , Visita Domiciliar , Humanos , Masculino , Enfermeiros de Saúde Comunitária , Sistema de Registros , Suécia
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