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1.
Rev Infirm ; 68(254): 33-35, 2019 Oct.
Artículo en Francés | MEDLINE | ID: mdl-31587850

RESUMEN

Many rural areas, far from hospitals, are seeing a decline in the number of general practitioners, making it more difficult for patients in these regions to access care. However, there are relevant solutions, as illustrated by the Dousopal network in Normandy, which, teaming up with home care providers, contributes to organising palliative care support for all, in optimal conditions.


Asunto(s)
Cuidados Paliativos/organización & administración , Servicios de Salud Rural/organización & administración , Francia , Médicos Generales/provisión & distribución , Accesibilidad a los Servicios de Salud , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos
3.
Soins Pediatr Pueric ; 40(309): 10-13, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31331594

RESUMEN

In-home hospital care provides a good vantage point from which to understand the evolution of paediatric care. It is in fact in line with the main ambitions of paediatrics today, by ensuring that children can remain with their parents in their familiar environment. The model may seem ideal. There are however constraints, such as the risk of confinement for the children and their parents and the difficulty, for the caregivers, of entering a private space which has not been designed for healthcare ergonomics.


Asunto(s)
Servicios de Atención de Salud a Domicilio/organización & administración , Pediatría/organización & administración , Cuidadores , Niño , Humanos , Padres
4.
BMC Public Health ; 19(1): 912, 2019 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-31288792

RESUMEN

BACKGROUND: Childhood asthma is a significant health issue with 8.3% prevalence in the U.S. Its prevalence is particularly higher among low-income communities in the Texas-Mexico border region, as they often lack access to clinical care and health insurance. This study examines the impact of a home-based education led by Community Health Workers (CHWs) on health outcomes for asthmatic, predominantly Hispanic children in these communities. METHODS: The study was a quasi-experimental design to learn the effectiveness of the asthma home-based education by comparing changes of health outcomes between baseline and follow-up of intervention and control groups. This study enrolled 290 participants, consisting of 130 in the intervention group and 160 in the control group. The educational intervention led by the CHWs referenced the Asthma and Healthy Homes curriculum and contents of the Seven Principles of Healthy Homes. The multiple linear regression analysis was conducted to estimate the associations between the intervention and each health outcome. RESULTS: When comparing the intervention group with the control group, the intervention group showed a significantly greater decrease in asthma attacks than the control group (p = 0.049). Although all of the five Children's Health Survey for Asthma (CHSA) scores showed significant improvements between baseline and follow-up in both groups, we found that increases of CHSA scores in the intervention group were higher than the control group except for emotional health of children (EC) score. The multiple linear regression models demonstrated that the mean changes in asthma attacks (p = 0.036) and emotional health of families (EF) score (p = 0.038) were significantly better in the intervention group than the control group, adjusting for children's age of diagnosis, household income, use of steroids, family history of allergy, and type of insurance. CONCLUSIONS: This study concluded that the home-based education by CHWs effectively improve health outcomes among children in communities lacking access to medical resources. The findings suggest the importance of the home-based education program in promoting emotional and medical care for children and their families in low-income communities like those in the Texas-Mexico border region.


Asunto(s)
Asma/etnología , Hispanoamericanos/educación , Servicios de Atención de Salud a Domicilio/organización & administración , Educación del Paciente como Asunto/métodos , Adolescente , Niño , Preescolar , Agentes Comunitarios de Salud , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Lactante , Masculino , México , Áreas de Pobreza , Evaluación de Programas y Proyectos de Salud , Texas
5.
Soins ; 64(837): 49-51, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31345311

RESUMEN

Health professionals working in patients' homes are confronted with the isolation and vulnerability of the people they support. Prevention is therefore essential. It must integrate innovative solutions to improve users' quality of life and safety in their home.


Asunto(s)
Servicios de Atención de Salud a Domicilio/organización & administración , Seguridad del Paciente , Difusión de Innovaciones , Humanos , Calidad de Vida , Aislamiento Social , Poblaciones Vulnerables
6.
BMC Health Serv Res ; 19(1): 398, 2019 Jun 20.
Artículo en Inglés | MEDLINE | ID: mdl-31221149

RESUMEN

BACKGROUND: A training opportunity in which ongoing education is encouraged is one of the determinants in recruiting and retaining nurses in home-visit nursing care agencies. We investigated the association between ensuring training opportunities through scheduled training programs and the change in the number of nurses in home-visit nursing agencies using nationwide panel data at the agency level. METHODS: We used nationwide registry panel data of home-visit nursing agencies from 2012 to 2015 in Japan. To investigate the association between planning training programs and the change in the number of nurses in the following year, we conducted fixed-effect panel data regression analysis. RESULTS: We identified 4760, 5160 and 5025 agencies in 2012, 2013, and 2014, respectively. Approximately 60-80% of the agencies planned training programs for all staff, both new and former, during the study period. The means and standard deviations of the percentage change in the number of full time equivalent (FTE) nurses in the following year were 4.2 (19.8), 5.7 (23.5), and 5.8 (25.1), respectively. Overall, we found no statistically significant association between scheduled training programs and the change in the number of FTE nurses in the following year. However, the associations varied by agency size. Results of analysis stratified by agency size suggested that the first and second quartile sized agencies (2.5-4.0 FTE nurses) with scheduled training programs for all employees were more likely to see a 9.0% (95% confidence interval [CI]: 4.5, 13.5) and 8.5% (95% CI: 2.4, 14.5) increase in the number of FTE nurses in the following year, respectively. Similarly, the first and second quartile sized agencies with scheduled training programs for new employees were more likely to see a 4.7% (95% CI: 2.1, 7.2) and 3.3% (95% CI: 0.4, 6.2) increase in the number of FTE nurses in the following year, respectively. CONCLUSIONS: Ensuring training opportunities through scheduled training programs for all staff, both new and former, in relatively small-sized home-visit nursing agencies might contribute to an increase in the number of nurses at each agency.


Asunto(s)
Servicios de Atención de Salud a Domicilio/organización & administración , Atención Domiciliaria de Salud/educación , Atención Domiciliaria de Salud/estadística & datos numéricos , Análisis de Datos , Humanos , Japón
7.
BMC Health Serv Res ; 19(1): 416, 2019 Jun 24.
Artículo en Inglés | MEDLINE | ID: mdl-31234857

RESUMEN

BACKGROUND: Optimizing the organization of care for community-dwelling frail older people is an important issue in many Western countries. In Belgium, a series of complex, innovative, bottom-up interventions was recently designed and implemented to help frail older people live at home longer. As the effectiveness of these interventions may vary between different population groups according to their long-term care needs, they must be evaluated by comparison with a control group that has similar needs. METHODS: The goal was to identify target groups for these interventions and to establish control groups with similar needs and to explore, per group, the extent to which the utilization of long-term care is matched to needs. We merged two databases: a clinical prospective database and the routine administrative database for healthcare reimbursements. Through Principal Component Analysis followed by Clustering, the intervention group was first stratified into disability profiles. Per profile, comparable control groups for clinical variables were established, based on propensity scores. Using chi-squared tests and logistic regression analysis, long-term care utilization at baseline was then compared per profile and group studied. RESULTS: Stratification highlighted five disability profiles: people with low-level limitations; people with limitations in instrumental activities of daily life and low-level of cognitive impairment; people with functional limitations; people with functional and cognitive impairments; and people with functional, cognitive, and behavioral problems. These profiles made it possible to identify long-term care needs. For instance, at baseline, those who needed more assistance with hygiene tasks also received more personal nursing care (P < 0.05). However, there were some important discrepancies between the need for long-term care and its utilization: while 21% of patients who were totally dependent for hygiene tasks received no personal nursing care, personal nursing care was received by 33% of patients who could perform hygiene tasks. CONCLUSIONS: The disability profiles provide information on long-term care needs but not on the extent to which those needs are met. To assess the effectiveness of interventions, controls at baseline should have similar disability profiles and comparable long-term care utilization. To allow for large comparative effectiveness studies, these dimensions should ideally be available in routine databases.


Asunto(s)
Anciano Frágil , Servicios de Atención de Salud a Domicilio/organización & administración , Vida Independiente , Anciano , Anciano de 80 o más Años , Bélgica , Investigación sobre la Eficacia Comparativa/métodos , Investigación sobre la Eficacia Comparativa/tendencias , Bases de Datos Factuales , Personas con Discapacidad/estadística & datos numéricos , Femenino , Predicción , Anciano Frágil/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud , Humanos , Cuidados a Largo Plazo , Masculino , Estudios Prospectivos
8.
Clin Interv Aging ; 14: 1045-1064, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31239654

RESUMEN

The proportion of older adults is increasing around the world and most wish to live in their home until they die. To achieve this, many will require services in the home to remain living independently. To maintain function (ie, strength, balance, and endurance), physical activity needs to be undertaken on a regular basis, and is essential as a person ages. Unfortunately, as people age there is a tendency to reduce activity levels, which often leads to loss of function and frailty, and the need for home care services. This updated systematic review includes a mix of study methodologies and meta-analysis, and investigated the effectiveness of physical activity/exercise interventions for older adults receiving home care services. Eighteen studies including ten randomized controlled trials meeting the selection criteria were identified. Many of the studies were multi-factorial interventions with the majority reporting aims beyond solely trying to improve the physical function of home care clients. The meta-analysis showed limited evidence for effectiveness of physical activity for older adults receiving home care services. Future exercise/physical activity studies working with home care populations should consider focusing solely on physical improvements, and need to include a process evaluation of the intervention to gain a better understanding of the association between adherence to the exercise program and other factors influencing effectiveness.


Asunto(s)
Servicios de Salud Comunitaria/métodos , Terapia por Ejercicio/métodos , Ejercicio/fisiología , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos
9.
Healthc Q ; 22(1): 30-35, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31244465

RESUMEN

Older adults and their families often struggle in navigating an increasingly fragmented healthcare system when it becomes increasingly difficult to receive care beyond their homes in the face of advanced illness, frailty and complex care needs. The provision of integrated home-based primary care has demonstrated improved patient and caregiver experiences and reduced healthcare costs when primary care providers collaborate in delivering care as part of larger interprofessional teams. In this trans-Canada portrait of five urban home-based primary care programs, their core features are highlighted to provide a roadmap on how to integrate this form of care into a Patient's Medical Home in partnership with acute and home-care providers.


Asunto(s)
Anciano Frágil , Servicios de Atención de Salud a Domicilio/organización & administración , Atención Primaria de Salud/organización & administración , Anciano , Anciano de 80 o más Años , Canadá , Cuidadores , Servicio de Urgencia en Hospital/estadística & datos numéricos , Visita Domiciliaria , Humanos , Grupo de Atención al Paciente/organización & administración , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/organización & administración , Atención Primaria de Salud/métodos
10.
Healthc Q ; 22(1): 36-41, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31244466

RESUMEN

Collaborative interprofessional primary care (PC) teams are widely seen as an essential attribute of high-performing PC systems (Aggarwal and Hutchinson 2012). Effective PC teams play a key role in the mobilization of healthcare resources and navigation of the health and social care system for their patients. In Ontario, the establishment of Family Health Teams has resulted in the implementation of unique programs that deliver services to palliative and elderly patients with a focus on keeping them at home and out of hospital. Case studies cited in this article highlight two innovative programs in Family Health Teams and provide perspectives on lessons for successful implementation.


Asunto(s)
Servicios de Atención de Salud a Domicilio/organización & administración , Cuidados Paliativos/organización & administración , Anciano , Anciano de 80 o más Años , Servicios de Salud Comunitaria/organización & administración , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Humanos , Ontario , Estudios de Casos Organizacionales , Cuidados Paliativos/estadística & datos numéricos , Grupo de Atención al Paciente/organización & administración , Cuidado Terminal/organización & administración
11.
J Clin Nurs ; 28(19-20): 3478-3491, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31162855

RESUMEN

AIMS AND OBJECTIVES: To explore home care nurses' experiences of implementation and use of checklists developed for improving continuity of care for older patients (65+ years). BACKGROUND: The Norwegian Coordination Reform was implemented to improve coordination between hospitals and communities and facilitate a quicker return to home community after hospital discharge. To follow-up, national learning networks were initialised to improve pathways for chronically ill older patients, including the development and use of standardised checklists. DESIGN: An explorative qualitative design was chosen. METHODS: Three focus group interviews were conducted, including 18 registered nurses from eight municipalities in southern Norway. Systematic text condensation was used to analyse the interview texts. The COREQ checklist was followed. RESULTS: Three categories emerged from the analysis. (a) "The implementation process" included the experiences of a chaotic beginning, the importance of involvement, the leaders' role and resource allocation. (b) "Pros and cons of checklists in use" included the informants' experiences of checklists' usefulness for nurses and the patients. (c) "Competence needed" included the need for a comprehensive set of formal, experiential and social competences. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: The leaders' role, support and engagement are decisive for a successful implementation. To succeed and establish solid routines, allocating resources when implementing new laborious routines, such as checklists, is important. To improve holistic continuity of care to chronically ill older patients, checklists should be customisable to each patient's needs, be comprehensive enough to grasp the essence in what to be done at several time points, but at the same time brief enough to be operational. Checklists can be a useful tool for home care nurses, if customised to the individual municipality and the staffs' working routines. It is important that the staff have versatile and extensive competencies enabling them to use the checklists appropriately.


Asunto(s)
Lista de Verificación/métodos , Continuidad de la Atención al Paciente/normas , Servicios de Atención de Salud a Domicilio/organización & administración , Adulto , Femenino , Grupos Focales , Enfermería Holística/métodos , Humanos , Liderazgo , Masculino , Persona de Mediana Edad , Noruega , Investigación Cualitativa
12.
BMC Health Serv Res ; 19(1): 310, 2019 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-31092244

RESUMEN

BACKGROUND: Europe's ageing society leads to an increased demand for long-term care, thereby putting a strain on the sustainability of health care systems. The 'Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of Community Care' (IBenC) project aims to develop a new benchmark methodology based on quality of care and cost of care utilization to identify best practices in home care. The study's baseline data, methodology, and rationale are reported. METHODS: Home care organizations in Belgium, Finland, Germany, Iceland, Italy, and the Netherlands, home care clients of 65 years and over receiving home care, and professionals working in these organizations were included. Client data were collected according to a prospective longitudinal design with the interRAI Home Care instrument. Assessments were performed at baseline, after six and 12 months by trained (research) nurses. Characteristics of home care organizations and professionals were collected cross-sectionally with online surveys. RESULTS: Thirty-eight home care organizations, 2884 home care clients, and 1067 professionals were enrolled. Home care clients were mainly female (66.9%), on average 82.9 years (± 7.3). Extensive support in activities of daily living was needed for 41.6% of the sample, and 17.6% suffered cognitive decline. Care professionals were mainly female (93.4%), and over 45 years (52.8%). Considerable country differences were found. CONCLUSION: A unique, international, comprehensive database is established, containing in-depth information on home care organizations, their clients and staff members. The variety of data enables the development of a novel cost-quality benchmark method, based on interRAI-HC data. This benchmark can be used to explore relevant links between organizational efficiency and organizational and staff characteristics.


Asunto(s)
Actividades Cotidianas , Benchmarking , Servicios de Atención de Salud a Domicilio/normas , Cuidados a Largo Plazo/normas , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Europa (Continente) , Femenino , Encuestas de Atención de la Salud , Personal de Salud/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos , Cuidados a Largo Plazo/organización & administración , Masculino , Calidad de la Atención de Salud , Encuestas y Cuestionarios
13.
Bull Cancer ; 106(6): 527-537, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31122656

RESUMEN

BACKGROUND: The aim of this investigation was to study the effects of supervised combined intermittent aerobic, muscle strength and home-based walking training programs on cardiorespiratory fitness in women with breast cancer during adjuvant chemotherapy treatment. METHODS: Thirty-two women with breast cancer undertaking adjuvant chemotherapy participated in the study (trained group n=20 and control group n=12). The trained group carried out 6weeks of supervised intermittent cycling aerobic, muscle strength and home-based walking training programs. The self-selected walking speed (WS), walking distance covered (WD), heart rate (rHR), blood lactate ([La]b) concentration and rating of perceived exertion (RPE) were assessed in the two groups during the 6-min walking test before and after the training period. RESULTS: Compared to controls, a significant increase in the WS (P<0.01) and the WD (P<0.01) accompanied by a significant decrease in resting rHR (P<0.01), exercising HR6' (P<0.01), [La]b (P<0.05), HR6'/WS (P<0.01) and [La]b/WS ratios (P<0.01) was reported in the trained group. However, a significant decrease both in WD (P<0.01) and WS (P<0.01) has been observed in the controls. No significant difference was observed in resting HR, exercising HR6', [La]b, HR6'/WS, and [La]b/WS ratios were observed in the control group. A significant improvement was observed for RPE in training group (P<0.05). However, no difference was shown in controls. CONCLUSION: Combined training based on intermittent aerobic exercise, muscle strength and walking improve cardiorespiratory responses and reduce the perception of fatigue in women with breast cancer.


Asunto(s)
Neoplasias de la Mama/rehabilitación , Capacidad Cardiovascular , Ejercicio , Entrenamiento de Resistencia , Caminata , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclismo , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Quimioterapia Adyuvante , Ciclofosfamida/administración & dosificación , Docetaxel/administración & dosificación , Epirrubicina/administración & dosificación , Prueba de Esfuerzo , Femenino , Fluorouracilo/administración & dosificación , Frecuencia Cardíaca , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos , Lactatos/sangre , Persona de Mediana Edad , Esfuerzo Físico , Evaluación de Programas y Proyectos de Salud
14.
BMC Health Serv Res ; 19(1): 264, 2019 Apr 29.
Artículo en Inglés | MEDLINE | ID: mdl-31035973

RESUMEN

BACKGROUND: Translating evidence-based interventions from study conditions to actual practice necessarily requires adaptation. We implemented an evidence-based Hospital at Home (HaH) intervention and evaluated whether adaptations could avoid diminished benefit from "voltage drop" (decreased benefit when interventions are applied under more heterogeneous conditions than existing in studies) or "program drift." (decreased benefit arising from deviations from study protocols). METHODS: Patients were enrolled in HaH over a 6-month pilot period followed by nine quarters of implementation activity. The program retained core components of the original evidence-based HaH model, but adaptations were made at inception and throughout the implementation. These adaptations were coded as to who made them, what was modified, for whom the adaptations were made, and the nature of the adaptations. We collected information on length of stay (LOS), 30-day readmissions and emergency department (ED) visits, escalations to the hospital, and patient ratings of care. Outcomes were assessed by quarter of admission. Selected outcomes were tracked and fed back to the program leadership. We used logistic or linear regression with an independent variable included for the numerical quarter of enrollment after the initial 6-month pilot phase. Models controlled for season and for patient characteristics. RESULTS: Adaptations were made throughout the implementation period. The nature of adaptations was most commonly to add or to substitute new program elements. HaH services substituting for a hospital stay were received by 295 patients (a mean of 33, range 11-44, per quarter). A small effect of quarter from program inception was seen for escalations (OR 1.09, 95% CI 1.01 to 1.18, p = 0.03), but no effect was observed for LOS (- 0.007 days/quarter; SE 0.02, p = 0.75), 30 day ED visit (OR 0.93, 95% CI 0.86 to 1.01, p = 0.09), 30-day readmission (OR 1.00, 95% CI 0.93 to 1.08, p = 0.99), or patient rating of overall hospital care (OR for highest overall rating 0.99, 95% CI 0.93 to 1.05, p = 0.66). CONCLUSIONS: We made adaptations to HaH at inception and over the course of implementation. Our findings indicate that adaptations to evidence-based programs may avoid diminished benefits due to potential 'program drift' or 'voltage drop.' TRIAL REGISTRATION: Not applicable. This study is not a clinical trial by the International Committee of Medical Journal Editors (ICMJE) definition because it is an observational study "in which the assignment of the medical intervention is not at the discretion of the investigator."


Asunto(s)
Implementación de Plan de Salud/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Calidad de la Atención de Salud/organización & administración , Manejo de la Enfermedad , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Proyectos Piloto
15.
Epidemiol Health ; 41: e2019020, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31096747

RESUMEN

OBJECTIVES: To address and elucidate the impact of pharmacist-led home medicines review (HMR) services on identifying drug-related problems (DRPs) among the elderly population in home care settings. METHODS: A comprehensive systematic search was performed using electronic scientific databases such as PubMed, Scopus, Embase, and Web of Science for studies published between January 1, 2008 and December 31, 2018, pertaining to HMR services by pharmacists for identifying DRPs. RESULTS: In total, 4,292 studies were retrieved from the searches, of which 24 were excluded as duplicates. Titles and abstracts were screened for the remaining 4,268 studies, of which 4,239 were excluded due to the extraneous nature of the titles and/or abstracts. Subsequently, 29 full-text articles were assessed, and 19 were removed for lacking the outcome of interest and/or not satisfying the study's inclusion criteria. Finally, 10 studies were included in the review; however, publication bias was not assessed, which is a limitation of this study. In all studies, pharmacists identified a highly significant amount of DRPs through HMR services. The most common types of DRPs were potential drug-drug interactions, serious adverse drug reactions, need for an additional drug, inappropriate medication use, non-adherence, untreated indications, excessive doses, and usage of expired medications. CONCLUSIONS: HMR is a novel extended role played by pharmacists. The efficiency of such programs in identifying and resolving DRPs could minimize patients' health-related costs and burden, thereby enhancing the quality of life and well-being among the elderly.


Asunto(s)
Revisión de la Utilización de Medicamentos/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Farmacéuticos , Anciano , Humanos , Evaluación de Programas y Proyectos de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto
16.
Prof Case Manag ; 24(3): 114-129, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30946248

RESUMEN

PURPOSE/OBJECTIVES: The Centers for Medicare & Medicaid Services (CMS) announced that beginning in 2019, Medicare Advantage (MA) health plans may begin offering additional benefits for nonmedical home services. In 2019, this change impacts the Long-Term Services and Supports (LTSS) landscape dramatically. This 2-part article describes LTSS, its traditional demographic and health care footprint, the regulatory and accreditation landscape, quality measurement and outcomes, and the critical importance of maintaining care continuity for individuals receiving LTSS. The objectives are to: PRIMARY PRACTICE SETTING(S):: Applicable to all health care sectors where case management is practiced. FINDINGS/CONCLUSIONS: Historically, once Medicare recognizes a product or service, managed health plans and commercial insurance carriers follow suit. Professional case managers must become fluent in the language of LTSS, the implications of these CMS changes, and the impact on case management practice across the care continuum. IMPLICATIONS FOR PROFESSIONAL CASE MANAGEMENT PRACTICE: Professional case managers should understand LTSS, especially as it pertains to care transitions and continuity of health care services to our most vulnerable clients.


Asunto(s)
Manejo de Caso/organización & administración , Gestores de Casos/educación , Servicios de Atención de Salud a Domicilio/organización & administración , Cuidados a Largo Plazo/organización & administración , Medicaid/organización & administración , Medicare/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Manejo de Caso/normas , Curriculum , Educación Médica Continua , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos
18.
J Clin Nurs ; 28(17-18): 3149-3157, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30938869

RESUMEN

AIMS AND OBJECTIVES: To explore patients and carers' experience and perceptions of different modalities of long-term enteral feeding. BACKGROUND: With an ageing population in Singapore, there is a concomitant increase in number of patients with dysphagia and hence increase in prevalence of enteral feeding. It is essential to understand experiences of patients and home carers with long-term home enteral feeding and perceptions of different modalities to better provide support. DESIGN: A qualitative descriptive approach fulfilling the COREQ checklist criteria (See File S1). Nine patients who were receiving long-term enteral feeding and nine carers were recruited over the period of August to December 2017. One-to-one interviews were conducted and audio-recorded. An inductive content analysis approach, with open coding, creation of categories and abstraction of data, was adopted. RESULTS: Three themes were generated: (a) factors influencing choice of mode of enteral feeding; respondents narrated factors such as need to "conceal" illness, need to be independent and previous bad experience with alternative modality (b) identified informational, emotional and physical needs. Respondents reported the need for support in terms of information on the different modalities, and training on how to self-care or provide care and (c) individual perception and attitude towards life with enteral feeding. Most respondents portrayed a positive outlook to life, despite that they could no longer participate in communal eating. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: Understanding patients and carers' experience and perceptions will inform the development of strategies to empower future patients and carers in choice of modality for enteral feeding. Patients with percutaneous endoscopic gastrostomy (PEG) found it easier to integrate enteral tube feeding into daily lives. Carers played a pivotal role in choice of modality, as well as in care of patients on enteral feeding.


Asunto(s)
Cuidadores/psicología , Trastornos de Deglución/enfermería , Nutrición Enteral/psicología , Enfermeras de Salud Comunitaria/psicología , Adulto , Trastornos de Deglución/psicología , Nutrición Enteral/enfermería , Femenino , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Singapur
19.
BMC Health Serv Res ; 19(1): 224, 2019 Apr 11.
Artículo en Inglés | MEDLINE | ID: mdl-30975144

RESUMEN

BACKGROUND: Researchers have shown that hospitalisation can decrease older persons' ability to manage life at home after hospital discharge. Inadequate practices of discharge can be associated with adverse outcomes and an increased risk of readmission. This review systematically summarises qualitative findings portraying older persons' experiences adapting to daily life at home after hospital discharge. METHODS: A metasummary of qualitative findings using Sandelowski and Barroso's method. Data from 13 studies are included, following specific selection criteria, and categorised into four main themes. RESULTS: Four main themes emerged from the material: (1) Experiencing an insecure and unsafe transition, (2) settling into a new situation at home, (3) what would I do without my informal caregiver? and (4) experience of a paternalistic medical model. CONCLUSIONS: The results emphasise the importance of assessment and planning, information and education, preparation of the home environment, the involvement of the older person and caregivers and supporting self-management in the discharge and follow-up care processes at home. Better communication between older persons, hospital providers and home care providers is needed to improve the coordination of care and facilitate recovery at home. The organisational structure may need to be redefined and reorganised to secure continuity of care and the wellbeing of older persons in transitional care situations.


Asunto(s)
Actividades Cotidianas/psicología , Adaptación Psicológica , Actitud Frente a la Salud , Anciano , Anciano de 80 o más Años , Cuidadores/psicología , Comunicación , Continuidad de la Atención al Paciente/organización & administración , Continuidad de la Atención al Paciente/normas , Femenino , Servicios de Atención de Salud a Domicilio/organización & administración , Servicios de Atención de Salud a Domicilio/normas , Hospitalización , Hospitales , Humanos , Masculino , Alta del Paciente , Participación del Paciente , Relaciones Profesional-Paciente , Autocuidado/normas , Cuidado de Transición/organización & administración , Cuidado de Transición/normas
20.
Artículo en Inglés | MEDLINE | ID: mdl-30987053

RESUMEN

The role of informal caregivers was included in the Assumptions of the Long-Term Senior Policy in Poland for 2014-2020. The document acknowledged the necessity of diagnosing the needs of informal caregivers of elderly people and to implement systemic solutions that would enable the provision of assistance for them. In response, this study aimed to describe the situation of caregivers of patients receiving versus patients not receiving Long-Term Home Nursing Care (LTHNC; i.e., a formal program including regular visits by a nurse specializing in home care) in terms of caregiver socio-demographic characteristics, health self-assessment, work overload, satisfaction derived from being a caregiver, and the quality of perceived support. A cross-sectional study was conducted using the Carers of Older People in Europe (COPE) Index in 2015 in the north-eastern part of Poland involving 170 caregivers of patients supported with LTHNC and 86 caregivers of patients staying at home and not receiving LTHNC. We found that caregivers for patients receiving LTHNC were significantly less overloaded with care work than caregivers for patients without LTHNC support (p < 0.001). LTHNC support was also related to the level of satisfaction with providing care: Caregivers for patients receiving LTHNC were significantly more satisfied with performing their role and felt greater support than caregivers for patients without LTHNC (p < 0.001). Our study provides evidence for a positive relationship between LTHNC and the situation of informal caregivers of dependent elderly people at home. A formal program of visits by a nurse specializing in long-term home care may facilitate the provision by caregivers of better informal care to patients staying at home.


Asunto(s)
Cuidadores/psicología , Servicios de Atención de Salud a Domicilio/organización & administración , Atención Domiciliaria de Salud/organización & administración , Satisfacción Personal , Apoyo Social , Estrés Psicológico , Carga de Trabajo , Anciano , Anciano de 80 o más Años , Estudios Transversales , Europa (Continente) , Femenino , Humanos , Cuidados a Largo Plazo , Masculino , Persona de Mediana Edad , Polonia
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