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Home Care Services (home + care_services)
Selected AbstractsInquiry into the ideal function of the pharmacy in home care,GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2004Mitsuko Onda Background: The aim of this study is to analyze why home-care services provided by pharmacists have not been effectively utilized. Method: Questionnaires were submitted to home-care service users, physicians, visiting nurses and home-helpers and pharmacy directors. We studied whether gaps existed between users' needs, physicians' expectations of pharmacy services and pharmacists' awareness of the importance of pharmacy services. We also investigated whether a failure to recognize the importance of cooperation with pharmacists in home-care provision existed among physicians and nurses/home-helpers. Results: Users and physicians expect pharmacists to be more involved in counseling about home care and welfare services than home-visiting services. Pharmacists recognize home visiting services as being of greater importance than counseling about home care and welfare services. The results indicated that gaps existed between users' needs, the physicians' expectations and pharmacists' awareness of the importance of pharmacy services. In terms of cooperation with pharmacists, study results implied that: (i) nurses/home-helpers' awareness of pharmacists' home-visiting service is lower than that of physicians; (ii) physicians' expectations regarding pharmacists' participation in home care services is lower than that of nurses/home-helpers; (iii) over 70% of both groups recognize the necessity of pharmacists' home-visiting service. Conclusions: Pharmacists need to get more involved in counseling users about home care and welfare. Also, there should be a special focus on heightening nurses/home-helpers' awareness of pharmacists' home-visiting service and on raising physicians' expectations for pharmacists' participation in home care services to develop home-care related pharmacy services in Japan. [source] Alternative approaches to obtain optimal bid values in contingent valuation studies and to model protest zeros.HEALTH ECONOMICS, Issue 2 2001Estimating the determinants of individuals' willingness to pay for home care services in day case surgery Abstract The use of day case surgery has increased rapidly as an alternative to inpatient surgery. Little is known, however, about the value of day case surgery to patients. The aim of this paper was to develop a contingent valuation survey to investigate how individuals value the costs of shifting from inpatient to day case surgery based on home care services. Using the willingness to pay (WTP) approach, two kinds of sequential experiments are compared: the maximum likelihood recursion (MLR) method and the C-optimal sequential procedure. The goal of sequential experimentation is to find bid values that provide the maximum possible information about the parameters of the WTP distribution, especially when the sample size is small. The C-optimal sequential procedure is shown to be an improvement, in terms of the statistical precision in small samples, over the MLR method. In addition, the paper presents a double hurdle (DH) approach for modelling the determinants of individuals' WTP. Using data from a contingent valuation survey conducted in 1996 on patients selected from the Day Case Surgery Unit in a hospital in the region of Catalonia, we argue that participation in the market offered and the level of consumption, that is, people's WTP, should be treated as individual choices. The results show that income and sex are related to WTP. Also, in this study, a clear presence of starting-point bias, introduced by the bid offered, was found. It is concluded that the WTP technique is potentially useful in evaluating health care programmes, although it is important to note that the criteria used to find an optimal design (in our model to minimize the asymptotic variance of the estimator used) may be restrictive from an economic point of view. Copyright © 2001 John Wiley & Sons, Ltd. [source] Do Palliative Consultations Improve Patient Outcomes?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2008David Casarett MD OBJECTIVES: To determine whether inpatient palliative consultation services improve outcomes of care. DESIGN: Retrospective telephone surveys conducted with family members of veterans who received inpatient or outpatient care from a Department of Veterans Affairs (VA) medical facility in the last month of life. SETTING: Five VA Medical Centers or their affiliated nursing homes and outpatient clinics. PARTICIPANTS: Veterans had received inpatient or outpatient care from a participating VA in the last month of life. One family member completed each survey. MEASUREMENTS: The telephone survey assessed nine aspects of the care the patient received in his or her last month of life: the patient's well-being and dignity (4 items), adequacy of communication (5 items), respect for treatment preferences (2 items), emotional and spiritual support (3 items), management of symptoms (4 items), access to the inpatient facility of choice (1 item), care around the time of death (6 items), access to home care services (4 items), and access to benefits and services after the patient's death (3 items). RESULTS: Interviews were completed with 524 respondents. In a multivariable linear regression model, after adjusting for the likelihood of receiving a palliative consultation (propensity score), palliative care patients had higher overall scores: 65 (95% confidence interval (CI)=62,66) versus 54 (95% CI=51,56; P<.001) and higher scores for almost all domains. Earlier consultations were independently associated with better overall scores (,=0.003; P=.006), a difference that was attributable primarily to improvements in communication and emotional support. CONCLUSION: Palliative consultations improve outcomes of care, and earlier consultations may confer additional benefit. [source] Quality and Outcomes of Heart Failure Care in Older Adults: Role of Multidisciplinary Disease-Management ProgramsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2002Ali Ahmed MD, FACP PURPOSE: To determine whether the management of heart failure by specialized multidisciplinary heart failure disease-management programs was associated with improved outcomes. BACKGROUND: The advent of angiotensin-converting enzyme inhibitors, beta-blockers, and spironolactone has revolutionized the management of heart failure. Randomized double-blind studies have demonstrated survival benefits of these drugs in heart failure patients. Nevertheless, in spite of these advances, heart failure continues to be a syndrome of poor outcomes.1,4 There is also evidence that a significant portion of heart failure patients does not receive this evidence-based therapy that reduces morbidity and mortality.5,7 Various disease-management programs have been proposed and tested to improve the quality of heart failure care. Most of these programs are specialized multidisciplinary heart failure clinics lead by cardiologists or heart failure specialists and conducted by nurses or nurse practitioners. Similar to the Department of Veterans Affairs (VA) multidisciplinary geriatric assessment clinics, these clinics also use many other services, including pharmacists, dietitians, physical therapists, and social workers. Some of these programs also have an affiliated home health service. Several observation studies, using mostly pre- and postcomparison designs, have demonstrated the effectiveness of these programs in the process of care, resource use, healthcare costs, and clinical outcomes in patients with heart failure.8 Risk of hospitalization was reduced by 50% to 85% in six of the studies.8 Subsequently, several randomized trials were conducted to determine the effectiveness of these programs. The purpose of this systematic review was to determine the effectiveness of these programs on mortality and hospitalization rates of heart failure patients. METHODS: Published articles on human randomized trials involving specialized heart failure disease-management programs in all languages were searched using Medline from 1966 to 1999 and other online databases using the following terms and Medical Subject Headings: case management (exp); comprehensive health care (exp); disease management (exp); health services research (exp); home care services (exp); clinical protocols (exp); patient care planning (exp); quality of health care (exp); nurse led clinics; special clinics; and heart failure, congestive (exp). In addition, a manual search of the bibliographies of searched articles was performed to identify articles otherwise missed in the above search. Personal communications were made with three authors to obtain further data on their studies. Using a data abstraction tool, two of the investigators separately abstracted data from the selected articles. Data from the selected studies were combined using the DerSimonian and Laird random effects model and the Mantel-Haenszel-Peto fixed effects model. Meta-Analyst 0.998 software (J. Lau, New England Medical Center, Boston, MA) was used to determine risk ratios (RRs) with 95% confidence intervals (CIs) of mortality and hospitalization for patients receiving care through these specialized programs compared with those receiving usual care. The Cochran Q test was used to test heterogeneity among the studies, and sensitivity analyses were performed to examine the effect of various covariates, such as duration of intervention, and other characteristics of the disease-management programs. RESULTS: The original search resulted in 416 published articles, of which 35 met preliminary selection criteria. Of these, 11 were randomized trials and were selected for the meta-analysis. Studies that were not randomized trials, did not involve heart failure patients or disease-management programs, or had missing outcomes were excluded. Of the 11 studies selected, nine involved specialized follow-up using multidisciplinary teams and the remaining two involved follow-up by primary care physicians and telephone. These studies involved 1,937 heart failure patients with a mean age of 74. The follow-up period ranged from no follow-up (one study) to 1 year (one study). Patients receiving care from specialized heart failure disease-management programs had a 13% lower risk of hospitalization than those receiving usual care (summary RR = 0.87; 95% CI = 0.79,0.96), but the Cochran Q test demonstrated significant heterogeneity among the studies (P = .003). Subgroup analysis of the nine studies using specialized follow-up by a multidisciplinary team showed similar results (summary RR = 0.77, 95% CI = 0.68,0.86; test of heterogeneity, P> .50). Seven of the nine studies did not show any significant association between intervention and reduced hospitalization, but the two studies that used follow up by primary care physicians and telephone failed to show any significant reduction in hospitalization (summary RR = 0.94, 95% CI = 0.75,1.19). In fact, one of the studies demonstrated a higher risk of hospitalization for patients receiving intervention (RR = 1.26, 95% CI = 1.04,1.52). Of the 11 studies, only six reported mortality as an outcome. None of these studies found any association between intervention and mortality (summary RR = 1.15, 95% CI = 0.96,1.37; test of heterogeneity, P> .15). Five of the studies used quality of life or functional status as outcomes, and, of them, only one demonstrated significant positive association. The results of the sensitivity analyses were negative for any significant association with duration of intervention or follow-up or year of study. Eight studies performed cost analyses and seven demonstrated cost-effectiveness of the intervention. CONCLUSIONS: The authors concluded that specialized disease-management programs were cost-effective, and heart failure patients cared for by these programs were more likely to undergo fewer hospitalizations, but the study did not provide any conclusive association between these programs and quality of care or mortality. The authors recommend that disease-management programs involve patient education and specialized follow-up by a multidisciplinary team including home health care. [source] Rapid Emergency Department Intervention for Older People Reduces Risk of Functional Decline: Results of a Multicenter Randomized TrialJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2001DrPH, Jane McCusker MD OBJECTIVES: To determine the effectiveness of a two-stage (screening and nursing assessment) intervention for older patients in the emergency department (ED) who are at increased risk of functional decline and other adverse outcomes. DESIGN: Controlled trial, randomized by day of ED visit, with follow-up at 1 and 4 months. SETTING: Four university-affiliated hospitals in Montreal. PARTICIPANTS: Patients age 65 and older expected to be released from the ED to the community with a score of 2 or more on the Identification of Seniors At Risk (ISAR) screening tool and their primary family caregivers. One hundred seventy-eight were randomized to the intervention, 210 to usual care. INTERVENTION: The intervention consisted of disclosure of results of the ISAR screen, a brief standardized nursing assessment in the ED, notification of the primary care physician and home care providers, and other referrals as needed. The control group received usual care, without disclosure of the screening result. MEASUREMENTS: Patient outcomes assessed at 4 months after enrollment included functional decline (increased dependence on the Older American Resources and Services activities of daily living scale or death) and depressive symptoms (as assessed by the short Geriatric Depression Scale). Caregiver outcomes, also assessed at baseline and 4 months, included the physical and mental summary scales of the Medical Outcomes Study Short Form-36. Patient and caregiver satisfaction with care were assessed 1 month after enrollment. RESULTS: The intervention increased the rate of referral to the primary care physician and to home care services. The intervention was associated with a significantly reduced rate of functional decline at 4 months, in both unadjusted (odds ratio (OR) = 0.60, 95% confidence interval (CI) = 0.36,0.99) and adjusted (OR = 0.53, 95% CI = 0.31,0.91) analyses. There was no intervention effect on patient depressive symptoms, caregiver outcomes, or satisfaction with care. CONCLUSION: A two-stage ED intervention, consisting of screening with the ISAR tool followed by a brief, standardized nursing assessment and referral to primary and home care services, significantly reduced the rate of subsequent functional decline. J Am Geriatr Soc 49:1272,1281, 2001. [source] Family Disruption and Support in Later Life: A Comparative Study Between the United Kingdom and ItalyJOURNAL OF SOCIAL ISSUES, Issue 4 2007Cecilia Tomassini Global population aging has led to considerable disquiet about future support for frail older people; however, the determinants are poorly understood. Moreover, most industrialized societies have witnessed considerable changes in family behavior (e.g., rises in divorce and declining fertility). Such trends may have adversely affected the support systems of older people; nonetheless, only recently has research begun to address this issue. Employing data from the longitudinal British Household Panel Survey (1991,2003) and the 1998 Indagine Multiscopo sulle Famiglie "Famiglia, soggetti sociali e condizione dell'infanzia," we investigated the association between family disruptions due to divorce, separation, or death and three key dimensions of informal support: (i) frequency of contact with unrelated friends (among all respondents aged 65 years and over); (ii) co-residence with children (among unmarried mothers aged 65 years and over); and (iii) regular or frequent help received from children (e.g., household assistance including care) among parents aged 65 years and over. In addition, we conducted a comparative investigation of the relationship between family disruptions and the use of home care services (i.e., health visitor or district nurse; home help; meals-on-wheels) among parents aged 65 years and over. Our findings suggest that in a culture like the U.K.'s, where relations between kin are primarily influenced by individualistic values, support in later life appears to be primarily related to need, whereas in societies with a strong familistic culture (like Italy's), support is received irrespective of the older person's individual characteristics. [source] Instrument Development of the Confidence in Home Care Services Questionnaire for Use With Elders and Caregivers of Mexican DescentPUBLIC HEALTH NURSING, Issue 3 2006Janice D. Crist ABSTRACT Mexican American elders use home care services less than non-Hispanic white elders, and a larger study is testing whether lack of confidence in home care services, measured by the Community Service Attitude Inventory, is a factor. In order to further develop the questionnaire for use with Mexican American elders and caregivers, qualitative interviews were conducted with Mexican American elders (n=5), Mexican American caregivers (n=5), and home care providers (n=5). Content analysis of interviews supported 2 dimensions: confidence and fear/worry. The research team developed 29 items from the dimensions. Testing of the items (n=15) suggested content validity and two additional items. The revised questionnaire was translated and tested for language equivalence in Spanish and English, assisted by a local community advisory council (n=9). Through collaboration, bicultural/bilingual teams and community partners refined 1 instrument that can be used to measure one of many barriers to equity in health care services with vulnerable populations. Thematic findings may be incorporated into nurses' interventions as they offer home care services to families. [source] Cost Analyses of Home Care and Nursing Home Services in the Southern Taiwan AreaPUBLIC HEALTH NURSING, Issue 5 2000Lian Chiu Sc.D. This study compares the cost of long-term care provided at patient homes with that of long-term care provided in nursing homes in southern Taiwan. Caring for a patient with a high degree of dependence at home is more expensive than caring for a patient in a nursing home facility when family costs and provider costs are considered together. This phenomenon is not demonstrated for patients with medium degrees of dependence. To be cost-effective, home care services should target patients with medium physical disability, and nursing home care should focus on patients with high levels of dependence. [source] Do phase 1 patients have greater needs for palliative care compared with other cancer patients?CANCER, Issue 2 2009Esmé Finlay MD Abstract BACKGROUND: Phase 1 oncology trial participants often are excluded from hospice. However, it is not known whether they would benefit from hospice services. The objectives of the current study were to define the palliative care needs of these patients and to determine whether their needs are greater than those of other cancer patients. METHODS: Two hundred ninety-seven patients who were undergoing cancer therapy and 69 patients who were enrolled in phase 1 trials at 7 oncology clinics in an urban cancer network were recruited and consented to participate in interviews. Interviewers assessed the prevalence and severity of 10 symptoms using the Global Distress Index of the Memorial Symptom Assessment Scale and patients' perceived need for 4 services typically provided through hospice: a chaplain, counselor, home health aide, and visiting nurse. RESULTS: Patients in the 2 groups had a similar symptom burden. However, after adjusting for Eastern Cooperative Oncology Group performance status scores, phase 1 patients were more likely to have 5 of the 10 symptoms and reported greater severity for 6 of the 10 symptoms. Compared with other patients, phase 1 patients were less likely to say they needed a home health aide (4 of 69 patients [6%] vs 198 of 297 patients [67%]), a chaplain (7 of 69 patients [10%] vs 134 of 297 patients [45%]), or a counselor (11 of 69 patients [16%] vs 160 of 297 patients [54%]; chi-square test: P < .001 for all). They were equally likely to say they needed a visiting nurse (30 of 69 patients [44%] vs 142 of 297 patients [48%]; chi-square test: P = .516). CONCLUSIONS: Compared with other patients who had cancer, patients who were participating in phase 1 trials were less likely to want several home care services, although they experienced a greater symptom burden. Further research will be needed to define the palliative care needs of this population. Cancer 2009. © 2009 American Cancer Society. [source] | ||||||||||