Examining markers of safety in homecare using the international classification for patient safety

BACKGROUND

Homecare is a growth enterprise. The nature of the care provided in the home is growing in complexity. This growth has necessitated both examination and generation of evidence around patient safety in homecare. The purpose of this paper is to examine the findings of a recent scoping review of the homecare literature 2004-2011 using the World Health Organization International Classification for Patient Safety (ICPS), which was developed for use across all care settings, and discuss the utility of the ICPS in the home setting. The scoping review focused on Chronic Obstructive Pulmonary Disease (COPD), and Congestive Heart Failure (CHF); two chronic illnesses commonly managed at home and that represent frequent hospital readmissions. The scoping review identified seven safety markers for homecare: Medication mania; Home alone; A fixed agenda in a foreign language; Strangers in the home; The butcher, the baker, the candlestick maker; Out of pocket: the cost of caring at home; and My health for yours: declining caregiver health.

METHODS

The safety markers from the scoping review were mapped to the 10 ICPS high-level classes that comprise 48 concepts and address the continuum of health care: Incident Type, Patient Outcomes, Patient Characteristics, Incident Characteristics, Contributing Factors/Hazards, Organizational Outcomes, Detection, Mitigating Factors, Ameliorating Actions, and Actions Taken to Reduce Risk.

RESULTS

Safety markers identified in the scoping review of the homecare literature mapped to three of the ten ICPS classes: Incident Characteristics, Contributing Factors, and Patient Outcomes.

CONCLUSION

The ICPS does have applicability to the homecare setting, however there were aspects of safety that were overlooked. A notable example is that the health of the caregiver is inextricably linked to the wellbeing of the patient within the homecare setting. The current concepts within the ICPS classes do not capture this, nor do they capture how care responsibilities are shared among patients, caregivers, and providers.

The impact of caring for those with chronic obstructive pulmonary disease (COPD) on carers' psychological well-being: a narrative review

OBJECTIVE

To identify and summarise studies of the psychological well-being of informal carers of people with chronic obstructive pulmonary disease.

DESIGN

The review included studies if they reported the carers perspective of caregiving - studies that focused mostly on the person with chronic obstructive pulmonary disease were included only if the carers perspective of the caregiver role could be extracted.

DATA SOURCES

Electronic searches of MEDLINE, CINAHL, PsychInfo, Sociological Abstracts and The Cochrane Library were carried out between December 2008 and February 2009, with update searches undertaken in June 2011.

REVIEW METHODS

A narrative approach was adopted to evaluate studies according to their contribution and drew together evidence from a range of methodologies, including qualitative and quantitative studies.

RESULTS

Twenty studies were included in this review. Twelve studies focuses only on the caregiver (quantitative studies=7 and qualitative studies=5) and eight included caregivers and the person with chronic obstructive pulmonary disease (quantitative=6 and qualitative=2). Common methodological limitations of studies included in this review were a lack of non-caregiver age-matched comparison groups, focus on the experience of female carers, small sample sizes, and failure to follow-up caregivers longitudinally. Seven studies provided estimates of the prevalence of psychological distress among caregivers but no conclusions could be drawn from the current evidence base. The totality of the current evidence-base suggests that many factors are related to caregiver psychological distress, but it is not possible to gauge the prevalence of this at present.

CONCLUSION

Further studies are needed to clarify the prevalence of chronic obstructive pulmonary disease caregivers' psychological comorbidity and disease specific factors that predict poorer carer health outcomes. That work will enable appropriate interventions to be developed and evaluated.

Caregivers' perceived adequacy of support in end-stage lung disease: results of a population survey

BACKGROUND

End-stage lung disease (ESLD) is a frequent cause of death. What are the differences in the supports needed by caregivers of individuals with ESLD at end of life versus other life-limiting diagnoses?

METHODS

The South Australian Health Omnibus is an annual, random, face-to-face, cross-sectional survey. In 2002, 2003 and 2005-2007, respondents were asked a range of questions about end-of-life care; there were approximately 3000 survey participants annually (participation rate 77.9%). Responses were standardised for the whole population. The families and friends who cared for someone with ESLD were the focus of this analysis. In addition to describing caring, respondents reported additional support that would have been helpful.

RESULTS

Of 1504 deaths reported, 145 (9.6%) were due to ESLD. The ESLD cohort were older than those with other 'expected' causes of death (> 65 years of age; 92.6% versus 70.6%; p < 0.0001) and were less likely to access specialised palliative care services (38.4% versus 61.9%; p < 0.0001). For those with ESLD, the mean caring period was significantly longer at 25 months (standard deviation (SD) 24) than for 'other diagnoses' (15 months; SD 18; p < 0.0001). Domains where additional support would have been useful included physical care, information provision, and emotional and spiritual support.

CONCLUSIONS

Caregiver needs were similar regardless of the underlying diagnosis although access to palliative care specialist services occurred less often for ESLD patients. This was despite significantly longer periods of time for which care was provided.

Differences in social support of caregivers living with partners suffering from COPD or dementia

BACKGROUND

Future patients with chronic diseases will probably remain longer in their homes. To enable family caregivers to meet these challenges, public services and informal support are essential.

OBJECTIVES

This study compared social support between home-dwelling caregivers of partners with chronic obstructive pulmonary disease or dementia.

METHODS

A cross-sectional study of 206 caregivers. Professional aid was quantified by the services utilised. Informal support from family and friends was rated by the number of helping persons and the degree of social withdrawal. The Medical Outcomes Study Social Support Survey Form captured perceived social support.

RESULTS

For both diseases, increased severity correlated with more utilisation of professional aid. The chronic obstructive pulmonary disease group perceived more social support, reported less social withdrawal and higher numbers of helping persons. Ill partners' aggressive behaviour reduced perceived support. The use of professional aid was negatively associated with the ill partner's level of self-care, and positively correlated with social withdrawal. Professional aid was more utilised by the dementia group and by men.

CONCLUSIONS

Differences in caregivers' needs for social support were related to their partner's disease.

IMPLICATIONS FOR PRACTICE

Counteracting social withdrawal, considering type of illness and gender differences may increase the quality of informal care.

Care challenges for informal caregivers of chronically ill lung patients: Results from a questionnaire survey

Aims: The article aims to answer who the informal caregivers of patients with chronic obstructive pulmonary disease (COPD) are, what kind of help they provide, and how they experience providing help to the patient. Method: Data from a questionnaire survey to next of kin of COPD patients carried through in Norway in December 2009 and January 2010 is explored. Result: About 70% of the patients have one or more informal caregivers, and a majority of the caregivers is the patient’s spouse, most often a wife. The help provided is, to a large extent, practical help like housework, garden work, and shopping. Another important support is to accompany the patient to health care. About 45% of the caregivers are part of the work force. Rather few of the respondents experience the caregiving as so demanding that they have chosen to work part-time or quit working. The most demanding part of being an informal caregiver is an overall worrying for the patient. Conclusions: Paid sick leaves for caregivers that are employed, and hospital-at-home programmes that provide education and surveillance to the patient and his/her family through different phases of the illness, are policy means that both can help the informal caregivers to manage daily life and reduce the pressure on the formal healthcare and long-term care services in the future.

Personality features, caring burden and mental health of cohabitants of partners with chronic obstructive pulmonary disease or dementia

OBJECTIVES

The interplay between personality, mental health and type of disease in explaining caring burden was studied in home-dwelling cohabitants of partners with chronic obstructive pulmonary disease (COPD) or dementia.

METHODS

A cross-sectional study including 206 participants with 80% response rate. Neuroticism was assessed by Eysenck Personality Questionnaire (EPQ) and externality by Locus of Control of Behaviour. The Relative Stress Scale evaluated caring burden. Mental health was determined by the General Health Quality (GHQ-28) questionnaire.

RESULTS

Neuroticism and type of illness played a major role in explaining caring burden and mental health. In the COPD and dementia groups, 30.5% and 58.4%, respectively, were above the cut-off point for psychiatric caseness on the GHQ. Both groups had low scores for depression and high scores for social dysfunction, anxiety, insomnia and somatisation. Compared to the dementia group, the COPD group had lower scores and fairly stable levels on all subscales of the GHQ. Females had higher scores on somatic symptoms, anxiety and insomnia; they also reported higher scores on neuroticism and externality.

CONCLUSION

Differences in personality and illness explained both caring burden and mental health among caregivers. To mitigate the caring burden and mental health problems among home-dwelling caregivers, public health services need to take into account the personality and gender of the caregiver, and also the disease of the ill partner.

The functional and psychological impact of hand osteoarthritis

OBJECTIVES

Studies suggest that hand osteoarthritis (OA) can result in impairment of hand function and participation restriction. The objective of the current study was to investigate the impact of functional impairments caused by hand OA on everyday life.

METHODS

Semi-structured interviews with primary care (n = 15; mean age 62.4 years; M : F ratio 1 : 4) and secondary care (n = 14; mean age 63.6 years; M : F ratio 1 : 13) patients aged 50 years and over were conducted. Data were analysed using thematic analysis and the constant comparison method.

RESULTS

Individuals reported impact across day-to-day activities. Perceptions of dependence and independence were important. They reported embarrassment due to the appearance of their hands and their inability to carry out 'normal' tasks. Work status had been affected for two of the participants. Negative emotional responses were captured. Participants utilized cognitive, behavioural and avoidance forms of coping.

CONCLUSION

We have captured the impact of functional impairment on everyday life and related psychological effects. With a retirement age increasing, the study raises the potential issue of future employment restriction for those with hand OA. Individuals utilising 'temporal' comparison as a form of coping may be less well adjusted to their hand problem, which could have implications for future management.