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Choi JW, Yoo AJ. The Impact of Home-Based Primary Care on Outcomes Among Older Adults in South Korea. J Am Med Dir Assoc 2023; 24:985-990.e2. [PMID: 37060921 DOI: 10.1016/j.jamda.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVES Although Korea issued a law and developed benefits of National Health Insurance (NHI) to enable the provision of home-based primary care (HBPC) along with implementation of a pilot project for community care for older adults in August 2019, the outcomes of HBPC services were not surveyed in Korea. This study aimed to assess the outcomes of HBPC among older adults. DESIGN Analyses were conducted using data from the National Health Insurance Service in connection with administrative survey data. Difference-in-differences analysis was performed using a generalized estimating equation and Cox proportional hazards model. SETTING AND PARTICIPANTS Overall, 538 older adults who used HBPC services in a pilot project for community care and 2059 propensity score-matched older individuals who did not use HBPC services in Korea were included. METHODS The length of home stay, total costs of NHI, hospitalizations, and admission to long-term care (LTC) facilities were measured as outcomes, and the outcomes of the participants were compared to those of the control group. RESULTS The findings indicated an increase of 8.3 days (95% CI 2.1-14.5) in the length of home stay and a reduction of US$1241 (95% CI -2342 to -139) in total costs of NHI among older adults who used HBPC services compared to the control group. The odds ratio for rates of hospitalization among older adults who utilized HBPC services was 0.77 (95% CI 0.60-0.98) and the hazard ratio for the admission of LTC facilities was 0.12 (95% CI 0.04-0.32) in comparison to the control group. CONCLUSIONS AND IMPLICATIONS The HBPC intervention has resulted in an increased length of home stay and reduced total costs, hospitalizations, and admission to LTC facilities among Korean older adults. In the future, new HBPC models must be developed to provide interprofessional team-based HBPC services with a standardized protocol of service provision.
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Affiliation(s)
- Jae Woo Choi
- Community Care Research Center, Health Insurance Research Institute, National Health Insurance Service, Gangwon, Korea
| | - Ae Jung Yoo
- Community Care Research Center, Health Insurance Research Institute, National Health Insurance Service, Gangwon, Korea.
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Kling SMR, Garvert DW, Lessios AS, Yefimova M, Martin M, Sheffrin M, Winget M. Home-Based Primary Care for Older Adults: Matched Case-Control Evaluation of Program’s Impact on Healthcare Utilization. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2023. [DOI: 10.1177/10848223231151975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Home-based Primary Care (HBPC) is an alternative model for homebound older adults. Healthcare utilization in HBPC was evaluated with a matched case-control design. Medical providers and social workers provided in-home visits. Enrolled patients were matched to controls on age, prior hospitalizations, and frailty risk. Difference-in-differences in utilization of primary care, specialty, and hospital services between 1-year pre- and 1-year post-enrollment were evaluated with hierarchical linear models. Analyses included 117 HBPC cases and 328 controls. HBPC cases had a significant increase in primary care visits compared to controls (7.8 ± 0.6; p < .0001) but significantly decreased utilization of in-clinic primary care visits (−3.2 ± 0.6; p < .0001). In-clinic specialty visits and hospital services did not differ between cases and controls (all p’s ≥ .75). Homebound patients accessed high-touch primary and social care, which is typically unachievable in clinic settings; however, additional work is needed to optimize services and target in-home care to impact healthcare utilization.
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Affiliation(s)
| | | | | | - Maria Yefimova
- Stanford University School of Medicine, Stanford, CA, USA
- Stanford Health Care, Stanford, CA, USA
| | - Marina Martin
- Stanford University School of Medicine, Stanford, CA, USA
| | - Meera Sheffrin
- Stanford University School of Medicine, Stanford, CA, USA
| | - Marcy Winget
- Stanford University School of Medicine, Stanford, CA, USA
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3
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Shih CY, Chen YM, Huang SJ. Survival and characteristics of older adults receiving home-based medical care: A nationwide analysis in Taiwan. J Am Geriatr Soc 2023; 71:1526-1535. [PMID: 36705340 DOI: 10.1111/jgs.18232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 12/08/2022] [Accepted: 12/18/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND In Taiwan, the National Health Insurance Administration initiated the integrated home-based medical care (iHBMC) program in 2016 to improve accessibility to health care for homebound patients. This study aimed to describe the characteristics of older people receiving iHBMC services in Taiwan as well as the relationship between patient characteristics and survival. METHODS All older adults registered in the iHBMC application dataset were enrolled between March 1, 2016, and December 31, 2018. Data on social determinants of health (income level, residential area), functional status, consciousness status, nasogastric tube or urinary catheter placement, and major diseases were retrieved from the database. Data on the frequency of multidisciplinary team members' visits were collected. The survival rate was investigated using the Kaplan-Meier method. A Cox proportional hazards univariate regression was conducted to analyze factors influencing survival rates. RESULTS A total of 41,079 patients aged ≥65 years were enrolled in iHBMC services. The results showed that the one-year survival rates were 72.1%, 67.4%, and 14.7% in the home-based primary care (HBPC), home-based primary care plus (HBPC-Plus), and home-based palliative care (HBPalC), respectively. Nearly two-thirds of the HBPC-Plus patients underwent nasogastric tube placement. The Cox proportional hazards univariate regression analysis showed that a low urbanization level, a low income level, a low functional status, and an impaired consciousness status were significant predictors of poor survival after adjustment for confounding variables. CONCLUSIONS Older adults receiving iHBMC services had a high mortality rate. The high rate of feeding tube use indicated that education and support for both clinical practitioners and family caregivers regarding careful hand feeding are warranted. There was a relationship between low income levels and poor survival in rural areas. Further research on whether social care could impact prognosis should be considered.
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Affiliation(s)
- Chih-Yuan Shih
- Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Sheng-Jean Huang
- Department of Surgery, Medical College, National Taiwan University, Taipei, Taiwan
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4
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Yang G, Wan L, Dong H, Liang X, He Y. Utilisation willingness for institutional care by the disabled elderly and its influencing factors based on Andersen's model: a cross-sectional survey of Henan, China. BMJ Open 2022; 12:e064949. [PMID: 36600340 PMCID: PMC9743373 DOI: 10.1136/bmjopen-2022-064949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To explore the factors that influence institutional care for the disabled elderly in China and the key factors that influence individuals based on the Andersen model. DESIGN Cross-sectional survey. SETTING The research was conducted in 18 cities in Henan Province, China. MAIN OUTCOME MEASURES A multistage, stratified sampling design was employed. The χ2 test was used to compare the differences in basic information of the disabled elderly. A binary Logit model was used to examine the factors influencing the willingness to institutionalise elderly people with disabilities. The determinants of willingness to care in an institution were also explored in a stratified study by gender, age and region to identify the key differences affecting institutionalisation. The Andersen model was used as the theoretical framework to infer the impact strength of each model. RESULTS Of the 2810 disabled elderly people in Henan, China, 7.4% of the elderly had a willingness for institutional care. In the binary logistic regression analysis, whether living alone (OR (95% CI)=0.596 (0.388 to 0.916)), medical payment method (basic medical insurance for urban employees: OR (95% CI)=2.185 (1.091 to 4.377)), having mental illness (OR (95% CI)=2.078 (1.044 to 4.137)) had a statistically significant difference (p<0.05) on the impact on the willingness of the disabled elderly to receive institutional care. Validation of the fitted coefficients of the model revealed that the needs factor had the most significant effect on the enabling variable, while the predisposing factor had more minerally effect. CONCLUSIONS Several factors influence the willingness of the disabled elderly to institutionalise. Therefore, it is recommended that relevant authorities take targeted measures to focus on the disabled elderly to identify more precise elderly care services to deal with the ageing crisis.
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Affiliation(s)
- Guangmei Yang
- Department of Social Medicine and Health Care Management, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Leping Wan
- Department of Social Medicine and Health Care Management, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Haiying Dong
- Department of Social Medicine and Health Care Management, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaoxiao Liang
- Department of Social Medicine and Health Care Management, School of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yan He
- Department of Social Medicine and Health Care Management, School of Public Health, Zhengzhou University, Zhengzhou, China
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Auerbach DI, Levy DE, Maramaldi P, Dittus RS, Spetz J, Buerhaus PI, Donelan K. Optimal Staffing Models To Care For Frail Older Adults In Primary Care And Geriatrics Practices In The US. Health Aff (Millwood) 2021; 40:1368-1376. [PMID: 34495726 DOI: 10.1377/hlthaff.2021.00401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Different staffing configurations in primary and geriatric care practices could have implications for how best to deliver services that are essential for a growing population of older adults. Using data from a 2018 survey of physicians (MDs) and nurse practitioners (NPs) working in primary and geriatric care, we assessed whether different configurations were associated with better or worse performance on a number of standard process measures indicative of comprehensive, high-quality primary care. Practices with a large concentration of MDs had the highest estimated labor costs. Practices high in NPs and physician assistants (PAs) were most common in states that grant full scope of practice to NPs. The high-NP/PA configuration was associated with a 17-percentage-point greater probability of facilitating patient visits and a 26-percentage-point greater probability of providing the full bundle of primary care services compared with the high-MD model. Team-based configurations had a 27.7-percentage-point greater probability of providing the full bundle of primary care services. The complex needs of older adults may be best served by team-based practices with a broad provider mix that can provide a range of services in the office and the community.
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Affiliation(s)
- David I Auerbach
- David I. Auerbach is an external adjunct faculty member at the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, in Bozeman, Montana, and is senior director for research and cost trends at the Massachusetts Health Policy Commission, in Boston, Massachusetts
| | - Douglas E Levy
- Douglas E. Levy is an associate professor in the Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, in Boston
| | - Peter Maramaldi
- Peter Maramaldi is a professor in the School of Social Work, Simmons University, in Boston
| | - Robert S Dittus
- Robert S. Dittus is the Albert and Bernard Werthan Professor of Medicine at Vanderbilt University; chief innovation officer and senior vice president for the Vanderbilt Health Affiliated Network; and director of the Geriatric Research, Education, and Clinical Center at the Veterans Affairs Tennessee Valley Healthcare System, in Nashville, Tennessee
| | - Joanne Spetz
- Joanne Spetz is director and Brenda and Jeffrey L. Kang Presidential Chair in Healthcare Finance at the Philip R. Lee Institute for Health Policy Studies at the University of California San Francisco, in San Francisco, California
| | - Peter I Buerhaus
- Peter I. Buerhaus is a professor of nursing and director of the Center for Interdisciplinary Health Workforce Studies, both in the College of Nursing, Montana State University
| | - Karen Donelan
- Karen Donelan is the Stuart H. Altman Chair in U.S. Health Policy at the Heller School for Social Policy and Management, Brandeis University, in Waltham, Massachusetts. At the time this work was performed, she was a senior scientist at the Health Policy Research Center at the Mongan Institute, Massachusetts General Hospital, and an associate professor in the Department of Medicine at Harvard Medical School, in Boston
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Ezeokonkwo FC, Sekula KL, Theeke LA. Loneliness in Homebound Older Adults: Integrative Literature Review. J Gerontol Nurs 2021; 47:13-20. [PMID: 34309447 DOI: 10.3928/00989134-20210624-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Loneliness affects people of all ages at one point or another in their lives; however, older adults aged ≥65 years are disproportionally affected due to age-related losses. Most research on loneliness has focused on older adults in general. Older adults who are homebound tend to have more disabilities and associated complications than older adults in the general population and face unique challenges. The current review examined and synthesized knowledge about loneliness among older adults who are homebound using Whittemore and Knafl's analysis process. Fourteen studies published from 1999 to 2020 met the inclusion criteria. The analysis resulted in four themes: characteristics of loneliness in older adults who are homebound, risks for homebound in older adults, location of older adults who are homebound, and coping strategies and methods to reduce loneliness in this population. Implications for nursing practice and recommendations for future research are discussed. [Journal of Gerontological Nursing, 47(8), 13-20.].
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Zhou R, Cheng J, Wang S, Yao N. A qualitative study of home health care experiences among Chinese homebound adults. BMC Geriatr 2021; 21:309. [PMID: 33985442 PMCID: PMC8117649 DOI: 10.1186/s12877-021-02258-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home health care services (HHC) are emerging in China to meet increased healthcare needs among the homebound population, but there is a lack of research examining the efficiency and effectiveness of this new care model. This study aimed to investigate care recipients' experiences with HHC and areas for improvement in China. METHODS This research was a qualitative study based on semi-structured interviews. Qualitative data were collected from homebound adults living in Jinan, Zhangqiu, and Shanghai, China. A sample of 17 homebound participants aged 45 or older (mean age = 76) who have received home-based health care were recruited. Conceptual content analysis and Colaizzi's method was used to generate qualitative codes and identify themes. RESULTS The evaluations of participants' experiences with HHC yielded both positive and negative aspects. Positive experiences included: 1) the healthcare delivery method was convenient for homebound older adults; 2) health problems could be detected in a timely manner because clinicians visited regularly; 3) home care providers had better bedside manners and technical skills than did hospital-based providers; 4) medical insurance typically covered the cost of home care services. Areas that could potentially be improved included: 1) the scope of HHC services was too limited to meet all the needs of homebound older adults; 2) the visit time was too short; 3) healthcare providers' technical skills varied greatly. CONCLUSIONS Findings from this study suggested that the HHC model benefited Chinese older adults-primarily homebound adults-in terms of convenience and affordability. There are opportunities to expand the scope of home health care services and improve the quality of care. Policymakers should consider providing more resources and incentives to enhance HHC in China. Educational programs may be created to train more HHC providers and improve their technical skills.
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Affiliation(s)
- Rui Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, Jinan, 250012, Shandong, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Joyce Cheng
- University of Virginia, College of Arts and Sciences, Charlottesville, VA, USA
| | - Shuangshuang Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, Jinan, 250012, Shandong, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China.,Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA
| | - Nengliang Yao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Rd, Jinan, 250012, Shandong, China. .,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China. .,School of Medicine, University of Virginia, Charlottesville, VA, USA. .,Home Centered Care Institute, Schaumburg, Chicago, IL, USA.
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8
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Ramraj B, Logaraj M. Is home bound a major burden towards health access among the elderly population? A community based cross sectional study in the selected northern districts in Tamilnadu. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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9
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Cheng JM, Batten GP, Cornwell T, Yao N. A qualitative study of health-care experiences and challenges faced by ageing homebound adults. Health Expect 2020; 23:934-942. [PMID: 32476232 PMCID: PMC7495080 DOI: 10.1111/hex.13072] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The ageing of the global population is associated with an increasing prevalence of chronic diseases and functional impairments, resulting in a greater proportion of homebound individuals. OBJECTIVE To examine the health-care experiences of older homebound adults who have not previously received home-based primary care (HBPC). To explore their impressions of this method of care. DESIGN Cross-sectional qualitative study using semi-structured interviews. SETTING AND PARTICIPANTS 18 older homebound individuals in Central Virginia. RESULTS Our findings revealed that homebound individuals faced significant health challenges, including pain resulting from various comorbidities. They felt that their mobility was restricted by their physical conditions and transportation challenges. These were major barriers to social outings and health-care access. Participants left their homes infrequently and typically with assistance. Regarding office-based care, participants were concerned about long wait times and making timely appointments. Some thought that HBPC would be convenient and could result in better quality care; however, others believed that the structure of the health-care system and its focus on efficiency would not permit routine HBPC. DISCUSSION AND CONCLUSIONS Older homebound adults in this study faced high burdens of disease, a lack of mobility and difficulty accessing quality health care. Our observations may help researchers and clinicians better understand the health-care experiences and personal opinions of older homebound individuals, informing the development of effective and empathetic home-based care. Participant responses illuminated a need for education about HBPC. We must improve health-care delivery and develop comprehensive, patient-centered HBPC to meet the needs of homebound individuals.
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Affiliation(s)
- Joyce M. Cheng
- University of Virginia College of Arts and SciencesCharlottesvilleVAUnited States
- Shandong University School of Health Care Management (NHC Key Laboratory of Health Economics and Policy Research)JinanChina
| | - George P. Batten
- University of Virginia Cancer CenterCharlottesvilleVAUnited States
| | | | - Nengliang Yao
- Shandong University School of Health Care Management (NHC Key Laboratory of Health Economics and Policy Research)JinanChina
- Home Centered Care InstituteSchaumburgILUnited States
- University of Virginia School of MedicineCharlottesvilleVAUnited States
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10
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Fong J, Cashin A, Buckley T. Models of prescribing, scope of practice, and medicines prescribed, a survey of nurse practitioners. J Adv Nurs 2020; 76:2311-2322. [PMID: 32511776 DOI: 10.1111/jan.14444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/20/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to explore current Australian Nurse Practitioners (NPs) models of prescribing used and medicines prescribed within their scopes of practice. DESIGN Descriptive online electronic national survey. METHODS An online survey of Australian NPs was conducted in 2017. A total of 252 NP participants reported on their current prescribing practices. RESULTS Participants reported prescribing via three prescribing models with autonomous prescribing the most frequently used, followed by prescribing under supervision and prescribing under a structured arrangement. Participants reported prescribing 298 separate medications, representative of all major drug classifications from the Australian Medicines Handbook. CONCLUSIONS NPs appear to engage in several modes of prescribing as relevant to their context of practice with most NPs prescribing using all models of prescribing at different times. Findings also highlight the diversity of and breath of the medicines that NP prescribes and highlight the need for NPs to have broad capability in relation to the quality use of medicines, irrespective of specialty or location of practice. IMPACT Findings of this research add to the international literature on NP prescribing and through identification of models of prescribing and medicines prescribed inform future NP education and policy.
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Affiliation(s)
- Jacqueline Fong
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Andrew Cashin
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Thomas Buckley
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Jones A, Bronskill SE, Seow H, Feeny D, Lapointe-Shaw L, Mowbray F, Costa AP. Physician Home Visit Patterns and Hospital Use Among Older Adults with Functional Impairments. J Am Geriatr Soc 2020; 68:2074-2081. [PMID: 32579727 DOI: 10.1111/jgs.16639] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/07/2020] [Accepted: 05/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Home-based primary care has been associated with reductions in hospital use among homebound older adults, but population-based studies on the general home visit patterns of primary care physicians are lacking. OBJECTIVE We examined the association between the provision of home visits by primary care physicians and subsequent use of hospital-based care among their older adult patients with extensive functional impairments. DESIGN Population-based retrospective cohort study. SETTING The setting was Ontario, Canada, from October 2014 to September 2016. PARTICIPANTS Older adults (aged ≥65 years) with extensive functional impairments receiving publicly funded home care. MEASUREMENTS We measured the provision of home visits by a patient's most responsible primary care physician during the year before a comprehensive home care assessment. Physician home visit patterns were measured as the proportion of the total outpatient visits in a year that were home visits, categorized with quartiles. Multivariable, multilevel negative binomial regression models examined the associations between physician-level home visit provision and patient emergency department visits and hospital admissions over the 6 months following the home care assessment. RESULTS There were 49,613 patients in the cohort who were linked to 8,096 unique primary care physicians. A total of 69.1% of physicians provided at least one home visit in a year, with the median proportion of home visits to total visits ranging from 0.057% to 3.19% across quartiles. Patients whose physicians were in the highest home visit provision quartile had lower rates of emergency department visits (incidence rate ratio [IRR] = 0.93; 95% confidence interval [CI] = 0.90-0.96) and hospital admissions (IRR = 0.89; 95% CI = 0.85-0.93) compared with patients whose physician did not do home visits. CONCLUSION Home care patients with extensive functional impairments whose physicians provided higher levels of home visits had fewer emergency department visits and hospital admissions. Expanding home visits by primary care physicians could reduce hospital use by older adults living with functional impairments in the community.
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Affiliation(s)
- Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hsien Seow
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - David Feeny
- Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Lauren Lapointe-Shaw
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada
| | - Fabrice Mowbray
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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12
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Bringing services to seniors rather than seniors to services: proof of concept. Int Psychogeriatr 2020; 32:435-436. [PMID: 32295669 DOI: 10.1017/s1041610219001972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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13
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Goroncy A, Makaroff K, Trybula M, Regan S, Pallerla H, Goodnow K, Schlaudecker J. Home Visits Improve Attitudes and Self-Efficacy: A Longitudinal Curriculum for Residents. J Am Geriatr Soc 2020; 68:852-858. [PMID: 32105356 DOI: 10.1111/jgs.16390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/21/2020] [Accepted: 01/29/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To develop a competency-based, adaptable home visit curricula and clinical framework for family medicine (FM) residents, and to examine resident attitudes, self-efficacy, and skills following implementation. DESIGN Quantitative analysis of resident survey responses and qualitative thematic analysis of written resident reflections. SETTING Urban FM residency program. PARTICIPANTS A total of 43 residents and 20 homebound patients in a home-based primary care program. INTERVENTION A home-based primary care practice and accompanying curriculum for FM residents was developed and implemented to improve learners' confidence and skills to perform home visits. MEASUREMENTS A 10-question survey with a 4-point Likert scale and open-ended responses. Written resident reflections following home visits. RESULTS Over 3 years, 43 unique respondents completed a total of 79 surveys evaluating attitudes, skills, and barriers to home care. Some residents may have completed the survey more than once at different stages in their training. Overall, 86% are interested in home visits in future practice, and 78% of survey responses indicated an increased likelihood to perform home visits with more training. Learners with two or more home visits reported significantly improved confidence. Themes across all resident reflections included social determinants of health, patient-physician relationship, patient-home assessment, patient autonomy/independence, and physician wellness/attitudes. Residents described how home visits encourage more holistic care to improve outcomes for patients who are homebound. CONCLUSION Our home visit curriculum provided new learning, an enhanced desire to practice home-based primary care, improved learner confidence, and could help residents meet the need of a growing population of adults who are homebound. J Am Geriatr Soc 68:852-858, 2020.
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Affiliation(s)
- Anna Goroncy
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio.,The Christ Hospital/University of Cincinnati Family Medicine Residency, Cincinnati, Ohio
| | - Katherine Makaroff
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Marcus Trybula
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Saundra Regan
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Harini Pallerla
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Keesha Goodnow
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jeffrey Schlaudecker
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio.,The Christ Hospital/University of Cincinnati Family Medicine Residency, Cincinnati, Ohio
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Kozikowski A, Shotwell J, Wool E, Slaboda JC, Abrashkin KA, Rhodes K, Smith KL, Pekmezaris R, Norman GJ. Care Team Perspectives and Acceptance of Telehealth in Scaling a Home-Based Primary Care Program: Qualitative Study. JMIR Aging 2019; 2:e12415. [PMID: 31518266 PMCID: PMC6716443 DOI: 10.2196/12415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 04/08/2019] [Accepted: 04/25/2019] [Indexed: 12/13/2022] Open
Abstract
Background Novel and sustainable approaches to optimizing home-based primary care (HBPC) programs are needed to meet the medical needs of a growing number of homebound older adults in the United States. Telehealth may be a viable option for scaling HBPC programs. Objective The purpose of this qualitative study was to gain insight into the perspectives of HBPC staff regarding adopting telehealth technology to increase the reach of HBPC to more homebound patients. Methods We collected qualitative data from HBPC staff (ie, physicians, registered nurses, nurse practitioners, care managers, social workers, and medical coordinators) at a practice in the New York metropolitan area through 16 semistructured interviews and three focus groups. Data were analyzed thematically using the template analysis approach with Self-Determination Theory concepts (ie, relatedness, competence, and autonomy) as an analytical lens. Results Four broad themes—pros and cons of scaling, technology impact on staff autonomy, technology impact on competence in providing care, and technology impact on the patient-caregiver-provider relationship—and multiple second-level themes emerged from the analysis. Staff acknowledged the need to scale the program without diminishing effective patient-centered care. Participants perceived alerts generated from patients and caregivers using telehealth as potentially increasing burden and necessitating a rapid response from an already busy staff while increasing ambiguity. However, they also noted that telehealth could increase efficiency and enable more informed care provision. Telehealth could enhance the patient-provider relationship by enabling caregivers to be an integral part of the patient’s care team. Staff members raised the concern that patients or caregivers might unnecessarily overutilize the technology, and that some home visits are more appropriate in person rather than via telehealth. Conclusions These findings suggest the importance of considering the perspectives of medical professionals regarding telehealth adoption. A proactive approach exploring the benefits and concerns professionals perceive in the adoption of health technology within the HBPC program will hopefully facilitate the optimal integration of telehealth innovations.
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Affiliation(s)
- Andrzej Kozikowski
- Center for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY, United States
| | - Jillian Shotwell
- Northwell Health Solutions, Northwell Health, Manhasset, NY, United States
| | - Eve Wool
- Northwell Health Solutions, Northwell Health, Manhasset, NY, United States
| | | | - Karen A Abrashkin
- Northwell Health Solutions, Northwell Health, Manhasset, NY, United States
| | - Karin Rhodes
- Northwell Health Solutions, Northwell Health, Manhasset, NY, United States
| | - Kristofer L Smith
- Northwell Health Solutions, Northwell Health, Manhasset, NY, United States
| | - Renee Pekmezaris
- Center for Health Innovations and Outcomes Research, Northwell Health, Manhasset, NY, United States
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15
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Abstract
Many barriers to primary healthcare accessibility in the United States exist including an increased opportunity cost associated with seeking primary care. New models of healthcare delivery aimed at addressing these problems are emerging. The potential impact that on-demand primary care physician house calls services can have on healthcare accessibility, patient care, and satisfaction by both patients and physicians is poorly characterized.We performed a retrospective observational analysis on data from 13,849 patients who utilized Heal, Inc, an application (app)-based, on-demand house calls platform between August 2016 and July 2017. We assessed house call wait time and visit duration, diagnoses by International Classification of Diseases, tenth revision, Inc (ICD10) codes, and house call outcomes by post-visit prescription and lab requests, and patient satisfaction survey.Patients who utilized this physician house call service had a bimodal age distribution peaking at age 1 year and 36 years. Same day acute sick exams (93.9% of pediatric (Ped) and 66.9% of adult requests) for fever and/or acute upper respiratory infection represented the most common use. The mean wait time for as soon as possible house calls were 96.1 minutes, with an overall mean house call duration of 27.1 minutes. A house call was primarily chosen over an Urgent Care Clinic or Doctor's office (46.2% and 41.6% of respondents, respectively), due to convenience or fastest appointment available (69.6% and 33.8% of respondents, respectively). Most survey respondents (94.2%) would schedule house calls again.On-demand physician house calls programs can expand access options to primary healthcare, primarily used by younger individuals with acute illness and preference for a smartphone app-based home visit.
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Affiliation(s)
- Shannon Fortin Ensign
- Scripps Translational Science Institute, The Scripps Research Institute
- Department of Internal Medicine, Scripps Green Hospital, La Jolla, CA
| | - Katie Baca-Motes
- Scripps Translational Science Institute, The Scripps Research Institute
| | | | - Eric J. Topol
- Scripps Translational Science Institute, The Scripps Research Institute
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16
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Major-Monfried H, DeCherrie LV, Wajnberg A, Zhang M, Kelley AS, Ornstein KA. Managing Pain in Chronically Ill Homebound Patients Through Home-Based Primary and Palliative Care. Am J Hosp Palliat Care 2018; 36:333-338. [PMID: 30587000 DOI: 10.1177/1049909118820846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Many older adults are homebound due to chronic illness and suffer from significant symptoms, including pain. Home-based primary and palliative care (HBPC), which provides interdisciplinary medical and psychosocial care for this population, has been shown to significantly reduce symptom burden. However, little is known about how pain is managed in the homebound. OBJECTIVE: This article describes pain management for chronically, ill homebound adults in a model, urban HBPC program. DESIGN/MEASUREMENTS: This was a prospective observational cohort study of newly enrolled HBPC patients, who completed a baseline Edmonton Symptom Assessment System (ESAS) survey during the initial HBPC visit (N = 86). Baseline pain burden was captured by ESAS and pain severity was categorized as none, mild, or moderate-severe. All pain-related assessments and treatments over a 6-month period were categorized by medication type and titration, referrals to outside providers, procedures, and equipment. RESULTS: At baseline, 55% of the study population had no pain, 18% had mild pain, and 27% had moderate-severe pain. For those with moderate-severe pain at baseline (n = 23), prescriptions for pharmacological treatments for pain, such as opiates and acetaminophen, increased during the study period from 48% to 57% and 52% to 91%, respectively. Nonpharmacological interventions, including referrals to outside providers such as physical therapy, procedures, and equipment for pain management, were also common and 67% of the study population received a service referral during the follow-up period. CONCLUSIONS: Pharmacological and nonpharmacological treatments are widely used in the setting of HBPC to treat the pain of homebound, older adults.
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Affiliation(s)
- Hannah Major-Monfried
- 1 Department of Pediatrics, Columbia University Medical Center, New York City, NY, USA
| | - Linda V DeCherrie
- 2 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ania Wajnberg
- 3 Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Meng Zhang
- 3 Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Amy S Kelley
- 2 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Katherine A Ornstein
- 2 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.,3 Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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17
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Using Nurse Practitioner Co-Management to Reduce Hospitalizations and Readmissions Within a Home-Based Primary Care Program. J Healthc Qual 2018; 39:249-258. [PMID: 27631706 DOI: 10.1097/jhq.0000000000000059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurse practitioner (NP) co-management involves an NP and physician sharing responsibility for the care of a patient. This study evaluates the impact of NP co-management for clinically complex patients in a home-based primary care program on hospitalizations, 30-day hospital readmissions, and provider satisfaction. We compared preenrollment and postenrollment hospitalization and 30-day readmission rates of home-bound patients active in the Nurse Practitioner Co-Management Program within the Mount Sinai Visiting Doctors Program (MSVD) (n = 87) between January 1, 2012, and July 1, 2013. Data were collected from electronic medical records. An anonymous online survey was administered to all physicians active in the MSVD in July 2013 (n = 13).After enrollment in co-management, patients have lower annual hospitalization rates (1.26 vs. 2.27, p = .005) and fewer patients have 30-day readmissions (5.8% vs. 17.2%, p = .004). Eight of 13 physicians feel "much" or "somewhat" less burned out by their work after implementation of co-management. The high level of provider satisfaction and reductions in annual hospitalization and readmission rates among high-risk home-bound patients associated with NP co-management may yield not only benefits for patients, caregivers, and providers but also cost savings for institutions.
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18
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Kim CO, Jang SN. Home-Based Primary Care for Homebound Older Adults: Literature Review. Ann Geriatr Med Res 2018; 22:62-72. [PMID: 32743249 PMCID: PMC7387609 DOI: 10.4235/agmr.2018.22.2.62] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/18/2018] [Accepted: 05/28/2018] [Indexed: 11/27/2022] Open
Abstract
Home-based primary care (HBPC) refers to the type of home care services which provide interdisciplinary primary care services with a comprehensive and continuous manner. Currently, it is getting much attention due to possess potential of converting primary care services from outpatient clinic to home, especially for those who are medically isolated including homebound older adults. This study examined a number of HBPCs introduced in the literature since 1990s, and summarizes the key factors with the analytic framework of 5Ps: purpose, patients, people, process, patterns. The results of this study emphasize that contents of primary care for older population should be different from those of the general population. This paper may be interpreted as the practice guideline of the following policy questions: “How can we design the HBPC if it is introduced in the nearest future?” In the future, it is necessary to have a heated debate concerning what is the most desirable primary care system for older adults.
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Affiliation(s)
- Chang-O Kim
- Institute of Social Welfare, Sungkonghoe University, Seoul, Korea.,Clinical Research Center, Yangji Hospital, Seoul, Korea
| | - Soong-Nang Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
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19
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International practice settings, interventions and outcomes of nurse practitioners in geriatric care: A scoping review. Int J Nurs Stud 2018; 78:61-75. [DOI: 10.1016/j.ijnurstu.2017.09.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 07/28/2017] [Accepted: 09/13/2017] [Indexed: 01/15/2023]
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20
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Norman GJ, Orton K, Wade A, Morris AM, Slaboda JC. Operation and challenges of home-based medical practices in the US: findings from six aggregated case studies. BMC Health Serv Res 2018; 18:45. [PMID: 29374478 PMCID: PMC5787297 DOI: 10.1186/s12913-018-2855-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 01/17/2018] [Indexed: 11/15/2022] Open
Abstract
Background Home-based primary care (HBPC) is a multidisciplinary, ongoing care strategy that can provide cost-effective, in-home treatment to meet the needs of the approximately four million homebound, medically complex seniors in the U.S. Because there is no single model of HBPC that can be adopted across all types of health organizations and U.S. geographic regions, we conducted a six-site HBPC practice assessment to better understand different operation structures, common challenges, and approaches to delivering HBPC. Methods Six practices varying in size, care team composition and location agreed to participate. At each site we conducted unstructured interviews with key informants and directly observed practices and procedures in the field and back office. Results The aggregated case studies revealed important issues focused on team composition, patient characteristics, use of technology and urgent care delivery. Common challenges across the practices included provider retention and unmet community demand for home-based care services. Most practices, regardless of size, faced challenges around using electronic medical records (EMRs) and scheduling systems not designed for use in a mobile practice. Although many practices offered urgent care, practices varied in the methods used to provide care including the use of community paramedics and telehealth technology. Conclusions Learnings compiled from these observations can inform other HBPC practices as to potential best practices that can be implemented in an effort to improve efficiency and scalability of HBPC so that seniors with multiple chronic conditions can receive comprehensive primary care services in their homes.
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Affiliation(s)
- Gregory J Norman
- West Health Institute, 10350 North Torrey Pines Rd, La Jolla, CA, 92037, USA.
| | - Kristann Orton
- West Health Institute, 10350 North Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Amy Wade
- West Health Institute, 10350 North Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Andrea M Morris
- West Health Institute, 10350 North Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Jill C Slaboda
- West Health Institute, 10350 North Torrey Pines Rd, La Jolla, CA, 92037, USA
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21
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Soh LL, Low LL. Attitudes, perceptions and practice patterns of primary care practitioners towards house calls. J Prim Health Care 2018; 10:237-247. [DOI: 10.1071/hc18022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTION
Historically, doctors routinely delivered medical care to sick patients in their homes, with house calls accounting for 40% of all doctor–patient encounters in the 1940s. This proportion has dwindled to less than 1% today. Advantages of house calls include decreased mortality rates, admissions to long-term care in the general elderly population and increased patient appreciation. Therefore, we asked ‘Why do some primary care practitioners do house calls and what are the reasons that others do not?’.
AIM
This review aims to understand the attitudes, perceptions of Primary Care Practitioners (PCPs) towards house calls and their practice patterns.
METHODS
A search of PubMed and Embase was conducted for articles published before 31 December 2017. A total of 531 articles with 44 duplicates was generated. Of these, 13 were shortlisted along with three hand-searched articles for a total of 16 articles included in this review.
RESULTS
Primary care providers were aware of the role of house calls and their advantages in enabling comprehensive care for a patient. They saw making house calls as a responsibility with rewards that enhanced the doctor–patient relationship. However, opportunity cost, time, medical liability and miscellaneous reasons such as the lack of training precluded some PCPs from making more house calls.
DISCUSSION
Primary care practitioners recognise the importance of house calls, especially in the care of elderly patients, but there are many unaddressed issues such as opportunity cost and clinical inadequacy in the home setting that have caused a decline in house calls over the years.
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22
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Kneale L, Mikles S, Choi YK, Thompson H, Demiris G. Using scenarios and personas to enhance the effectiveness of heuristic usability evaluations for older adults and their care team. J Biomed Inform 2017; 73:43-50. [PMID: 28867476 DOI: 10.1016/j.jbi.2017.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/06/2017] [Accepted: 07/09/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Using heuristics to evaluate user experience is a common methodology for human-computer interaction studies. One challenge of this method is the inability to tailor results towards specific end-user needs. This manuscript reports on a method that uses validated scenarios and personas of older adults and care team members to enhance heuristics evaluations of the usability of commercially available personal health records for homebound older adults. MATERIALS AND METHODS Our work extends the Chisnell and Redish heuristic evaluation methodology by using a protocol that relies on multiple expert reviews of each system. It further standardizes the heuristic evaluation process through the incorporation of task-based scenarios. RESULTS We were able to use the modified version of the Chisnell and Redish heuristic evaluation methodology to identify potential usability challenges of two commercially available personal health record systems. This allowed us to: (1) identify potential usability challenges for specific types of users, (2) describe improvements that would be valuable to all end-users of the system, and (3) better understand how the interactions of different users may vary within a single personal health record. CONCLUSIONS The methodology described in this paper may help designers of consumer health information technology tools, such as personal health records, understand the needs of diverse end-user populations. Such methods may be particularly helpful when designing systems for populations that are difficult to recruit for end-user evaluations through traditional methods.
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Affiliation(s)
- Laura Kneale
- Biomedical and Health Informatics, University of Washington, Box 358047, 1959 NE Pacific Street, Seattle, WA 98195-7240, USA.
| | - Sean Mikles
- Biomedical and Health Informatics, University of Washington, Box 358047, 1959 NE Pacific Street, Seattle, WA 98195-7240, USA
| | - Yong K Choi
- Biomedical and Health Informatics, University of Washington, Box 358047, 1959 NE Pacific Street, Seattle, WA 98195-7240, USA
| | - Hilaire Thompson
- School of Nursing, University of Washington, Box 357260, 1959 NE Pacific Street, Seattle, WA 98195-7240, USA
| | - George Demiris
- Biomedical and Health Informatics, University of Washington, Box 358047, 1959 NE Pacific Street, Seattle, WA 98195-7240, USA; School of Nursing, University of Washington, Box 357260, 1959 NE Pacific Street, Seattle, WA 98195-7240, USA
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23
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How’s Your Health at Home: Frail Homebound Patients Reported Health Experience and Outcomes. Can J Aging 2017; 36:273-285. [PMID: 28558857 DOI: 10.1017/s0714980817000186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
RÉSUMÉPour notre sondage, nous avons utilisé une méthodologie mixte basée sur le Web (How’s Your Health – Frail) pour examiner la santé des adultes fragiles (78% âgés de 80 ans et plus) inscrits à un programme de soins primaires à domicile à Vancouver, au Canada. Soixante pour cent des répondants admissibles ont participé, représentant plus d’un quart (92/350, 26,2%) de tous les individus qui reçoivent le service. Malgré des niveaux élevés de co-morbidité et de dépendance fonctionnelle, 50% ont jugé leur santé aussi bonne, très bonne ou excellente. Les ratios de cotes ajustés pour l’auto-évaluation de sa santé positive étaient de 7,50, 95 pour cent d’intervalle de confiance (IC) [1,09, 51,81] et 4,85, 95% CI [1,02, 22,95] pour l’absence de symptômes gênants et le pouvoir de parler à la famille ou amis, respectivement. Des réponses narratives aux questions sur la fin de vie et la vie avec une maladie sont également décrites. Les résultats suggèrent que l’accent mis sur la gestion des symptômes, et le soutien des contacts sociaux, peut améliorer la santé des personnes âgées fragiles.
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24
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Obstacles to preventive care for individuals with disability. J Am Assoc Nurse Pract 2017; 29:282-293. [DOI: 10.1002/2327-6924.12449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 01/11/2017] [Indexed: 11/07/2022]
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25
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Smith-Carrier T, Sinha SK, Nowaczynski M, Akhtar S, Seddon G, Pham TNT. It 'makes you feel more like a person than a patient': patients' experiences receiving home-based primary care (HBPC) in Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:723-733. [PMID: 27287281 DOI: 10.1111/hsc.12362] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 06/06/2023]
Abstract
The lack of effective systems to appropriately manage the health and social care of frail older adults - especially among those who become homebound - is becoming all the more apparent. Home-based primary care (HBPC) is increasingly being promoted as a promising model that takes into account the accessibility needs of frail older adults, ensuring that they receive more appropriate primary and community care. There remains a paucity of literature exploring patients' experiences with HBPC programmes. The purpose of this study was to explore the experiences of patients accessing HBPC delivered by interprofessional teams, and their perspectives on the facilitators and barriers to this model of care in Ontario, Canada. Using certain grounded theory principles, we conducted an inductive qualitative content analysis of in-depth patient interviews (n = 26) undertaken in the winter of 2013 across seven programme sites exploring the lived experiences and perspectives of participants receiving HBPC. Themes emerged in relation to patients' perceptions regarding the preference for and necessity of HBPC, the promotion of better patient care afforded by the model in comparison to office-based care, and the benefits of and barriers to HBPC service provision. Underlying patterns also surfaced related to patients' feelings and emotions about their quality of life and satisfaction with HBPC services. We argue that HBPC is well positioned to serve frail homebound older adults, ensuring that patients receive appropriate primary and community care - which the office-based alternative provides little guarantee - and that they will be cared for, pointing to a model that may not only lead to greater patient satisfaction but also likely contributes to bettering the quality of life of a highly vulnerable population.
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Affiliation(s)
- Tracy Smith-Carrier
- School of Social Work, King's University College at Western University, London, Ontario, Canada
| | - Samir K Sinha
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Johns Hopkins University School of Medicine, Balitmore, Maryland, USA
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark Nowaczynski
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- House Calls: Interdisciplinary Healthcare for Homebound Seniors, SPRINT Senior Care, Toronto, Ontario, Canada
| | - Sabrina Akhtar
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Home-Based Care Program, Toronto Western Family Health Team, Toronto, Ontario, Canada
| | - Gayle Seddon
- Toronto Central Community Care Access Centre, Toronto, Ontario, Canada
| | - Thuy-Nga Tia Pham
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- South East Toronto Family Health Team, Toronto, Ontario, Canada
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26
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Sairenji T, Wilson SA, D'Amico F, Peterson LE. Training Family Medicine Residents to Perform Home Visits: A CERA Survey. J Grad Med Educ 2017; 9:90-96. [PMID: 28261401 PMCID: PMC5319637 DOI: 10.4300/jgme-d-16-00249.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Home visits have been shown to improve quality of care, save money, and improve outcomes. Primary care physicians are in an ideal position to provide these visits; of note, the Accreditation Council for Graduate Medical Education no longer requires home visits as a component of family medicine residency training. OBJECTIVE To investigate changes in home visit numbers and expectations, attitudes, and approaches to training among family medicine residency program directors. METHODS This research used the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2015. Questions addressed home visit practices, teaching and evaluation methods, common types of patient and visit categories, and barriers. RESULTS There were 252 responses from 455 possible respondents, representing a response rate of 55%. At most programs, residents performed 2 to 5 home visits by graduation in both 2014 (69% of programs, 174 of 252) and 2015 (68%, 172 of 252). The vast majority (68%, 172 of 252) of program directors expect less than one-third of their graduates to provide home visits after graduation. Scheduling difficulties, lack of faculty time, and lack of resident time were the top 3 barriers to residents performing home visits. CONCLUSIONS There appeared to be no decline in resident-performed home visits in family medicine residencies 1 year after they were no longer required. Family medicine program directors may recognize the value of home visits despite a lack of few formal curricula.
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Affiliation(s)
- Tomoko Sairenji
- Corresponding author: Tomoko Sairenji, MD, MS, University of Washington School of Medicine, Department of Family Medicine, E-304, 1959 NE Pacific Street, Seattle, WA 98195-6390, 206.543.9425, fax 206.543.3821,
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27
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Sutton BS, Pracht É, Williams AR, Alemi F, Williams AE, Levy C. Budget Impact Analysis of Veterans Affairs Medical Foster Homes versus Community Living Centers. Popul Health Manag 2017; 20:48-54. [DOI: 10.1089/pop.2015.0166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Bryce S. Sutton
- James A. Haley Veterans Affairs Hospital, Center of Innovation on Disability and Rehabilitation Research (CINDRR), Tampa, Florida
| | - Étienne Pracht
- Bay Pines Veterans Affairs Medical Center, Bay Pines, Florida
| | - Arthur R. Williams
- James A. Haley Veterans Affairs Hospital, Center of Innovation on Disability and Rehabilitation Research (CINDRR), Tampa, Florida
- George Mason University, Department of Health Administration and Policy, Fairfax, Virginia
| | - Farrokh Alemi
- District of Columbia Veterans Affairs Medical Center, Washington, DC
- George Mason University, Department of Health Administration and Policy, Fairfax, Virginia
| | | | - Cari Levy
- Denver Veterans Affairs Medical Center/University of Colorado Denver, Department of Medicine, Denver, Colorado
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28
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Zhang J, Abrashkin KA, Poku A, Smith KL. Be Prepared: Emergency and After-Hours Calls in a Program for Frail Community-Dwelling Older Adults. J Am Geriatr Soc 2016; 64:e231-e233. [DOI: 10.1111/jgs.14460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jenny Zhang
- Department of Internal Medicine; Hofstra-Northwell School of Medicine; Hempstead New York
| | - Karen A. Abrashkin
- Department of Internal Medicine; Hofstra-Northwell School of Medicine; Hempstead New York
| | - Asantewaa Poku
- Department of Internal Medicine; Hofstra-Northwell School of Medicine; Hempstead New York
| | - Kristofer L. Smith
- Department of Internal Medicine; Hofstra-Northwell School of Medicine; Hempstead New York
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Thomas JE, Jacobs RJ, Caballero J, Ownby RL, Lessmann EM, Mallare K, Adler M. Factors to assess depression in homebound older adults. Ment Health Clin 2016; 6:236-241. [PMID: 29955476 PMCID: PMC6007589 DOI: 10.9740/mhc.2016.09.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The number of homebound older adults is expected to increase as the elderly population grows. Many homebound older persons may be at high risk for depression, which has been associated with adverse health outcomes. The objective of this study was to identify selected factors that may predict depression in the homebound older population. Methods: Data from 340 homebound adults, aged 65 and older who were enrolled in Broward Meals on Wheels and who participated in a telephone survey were analyzed. Participants were asked to report demographic information, health status, medication-taking behaviors, mental health, and life satisfaction. Multiple regression analysis was used to identify predictors of depressed mood in this sample of older adults. Results: The majority of the sample (aged 65–95 years; mean, 77 years) were female (76.5%), white (77.1%), and living alone (52.6%). Multivariate modeling indicated that difficulty remembering the number of prescribed medications to be taken, feeling groggy after taking certain medications, poor self-reported health status, taking anxiety medications, and less satisfaction with life explained 34% (adjusted R2) of the variance in predicting depressed mood (F = 33.1, df = 5, P < .001). Discussion: Multiple factors related to medication use were identified that may contribute to higher levels of depressed mood in homebound older adults. These factors found in our study may be used to create a screening model to be used by pharmacists to identify homebound older adults who would benefit from further assessment for depression.
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Affiliation(s)
- Jennifer E. Thomas
- Assistant Professor, School of Pharmacy, Husson University, Bangor, Maine
| | - Robin J. Jacobs
- Associate Professor, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | - Joshua Caballero
- (Corresponding author) Associate Professor, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida,
| | - Raymond L. Ownby
- Professor, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida
| | | | - Kayla Mallare
- Pharmacy Student, College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida
| | - Mark Adler
- Executive Director, Broward Meals on Wheels, Plantation, Florida
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Ghesquiere AR, Bazelais KN, Berman J, Greenberg RL, Kaplan D, Bruce ML. Associations Between Recent Bereavement and Psychological and Financial Burden in Homebound Older Adults. OMEGA-JOURNAL OF DEATH AND DYING 2016. [DOI: 10.1177/0030222815590709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Bereavement is common in older adults, but it remains unknown whether bereavement contributes to poor outcomes in the vulnerable population of older adults receiving home-based services. We examine whether recent bereavement was associated with worse physical or mental health, presence of abuse or neglect, and financial strain. Research Design Cross-sectional analyses of an assessment of functional and social vulnerabilities collected by the New York City Department for the Aging (DFTA), the largest Area Agency on Aging in New York. Assessments were completed on 5,576 New York City Department for the Aging long-term care program, recipients aged ≥60 who received services in 2012. Assessment also collected data on partner or child death in the last year. Results Logistic regression indicated that the recently bereaved were more likely than the nonbereaved to report both depression symptoms and financial strain. Conclusion Enhanced efforts to identify and address mental health and financial concerns in bereaved homebound older adults may be warranted.
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Affiliation(s)
- Angela R. Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College of the City University of New York, NY, USA
| | - Kisha N. Bazelais
- University of Miami, Student Counseling Center, Coral Gables, FL, USA
| | | | | | - Daniel Kaplan
- Department of Psychiatry, Weill Cornell Medical College, NY, USA
| | - Martha L. Bruce
- Department of Psychiatry, Weill Cornell Medical College, NY, USA
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Shafir A, Garrigues SK, Schenker Y, Leff B, Neil J, Ritchie C. Homebound Patient and Caregiver Perceptions of Quality of Care in Home-Based Primary Care: A Qualitative Study. J Am Geriatr Soc 2016; 64:1622-7. [PMID: 27384919 DOI: 10.1111/jgs.14244] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess patient and caregiver perceptions of what constitutes quality care in home-based primary care (HBPC). DESIGN Cross-sectional qualitative design; semistructured interview study. SETTING Academic home-based primary care program. PARTICIPANTS Homebound patients (n = 13) and 10 caregivers (n = 10) receiving HBPC. MEASUREMENTS Semistructured interviews explored experiences with a HBPC program and perceptions of quality care. Interviews were audio-recorded and transcribed. Qualitative content analysis was performed to identify major themes. RESULTS Five major themes emerged related to participant perceptions of quality care: access, affordability, competency, care coordination, goal attainment. Participants felt that reliable, consistent access provided "peace of mind" and reduced hospital and emergency department use. Insurance coverage of program costs and coordinated care provided by an interdisciplinary team were positively regarded. Interpersonal skills and technical abilities of providers influenced patient perception of provider competency. Assessing and helping patients attain care goals contributed to a perception of quality care. CONCLUSION Patients and caregivers associate high-quality HBPC with around-the-clock access to affordable interdisciplinary providers with strong interpersonal skills and technical competency. These results expand on prior research and are concordant with HBPC goals of around-the-clock access to multidisciplinary teams with the goals of reduced emergency department and hospital use. HBPC programs should be structured to optimize access, affordability, coordinated care, and goal ascertainment and alignment. Quality indicators should be created and validated with these patient and caregiver views of care quality in mind.
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Affiliation(s)
- Adi Shafir
- UPMC Internal Medicine Residency Program, Pittsburgh, Pennsylvania
| | - Sarah K Garrigues
- Division of Geriatrics, University of California at San Francisco, San Francisco, California
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jessica Neil
- University of California at San Francisco Internal Medicine Residency Program, San Francisco
| | - Christine Ritchie
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Jewish Home of San Francisco Center for Research on Aging, San Francisco, California
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Yang N, Ornstein KA, Reckrey JM. Association Between Symptom Burden and Time to Hospitalization, Nursing Home Placement, and Death Among the Chronically Ill Urban Homebound. J Pain Symptom Manage 2016; 52:73-80. [PMID: 27033155 PMCID: PMC5369236 DOI: 10.1016/j.jpainsymman.2016.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/10/2016] [Accepted: 02/13/2016] [Indexed: 10/22/2022]
Abstract
CONTEXT Homebound adults experience significant symptom burden. OBJECTIVES To examine demographic and clinical characteristics associated with high symptom burden in the homebound, and to examine associations between symptom burden and time to hospitalization, nursing home placement, and death. METHODS Three hundred eighteen patients newly enrolled in the Mount Sinai Visiting Doctors Program, an urban home-based primary care program, were studied. Patient sociodemographic characteristics, symptom burden (measured via the Edmonton Symptom Assessment Scale), and incidents of hospitalization, nursing home placement, and death were collected via medical chart review. Multivariate Cox proportional hazards models were used to analyze the effect of high symptom burden on time to first hospitalization, nursing home placement, and death. RESULTS Of the study sample, 45% had severe symptom burden (i.e., Edmonton Symptom Assessment Scale score >6 on at least one symptom). Patients with severe symptom burden were younger (82.0 vs. 85.5 years, P < 0.01), had more comorbid conditions (3.2 vs. 2.5 Charlson score, P < 0.01), higher prevalence of depression (43.4% vs. 12.0%, P < 0.01), lower prevalence of dementia (34.3% vs. 60.6%, P < 0.01), and used fewer hours of home health services (73.6 vs. 94.4 hours/wk, P < 0.01). Severe symptom burden was associated with a shorter time to first hospitalization (hazard ratio = 1.51, 95% CI 1.06-2.15) in adjusted models but had no association with time to nursing home placement or death. CONCLUSION The homebound with severe symptom burden represents a unique cohort of patients who are at increased risk of hospitalization. Tailored symptom management via home-based primary and palliative care programs may prevent unnecessary health care utilization in this population.
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Affiliation(s)
- Nancy Yang
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer M Reckrey
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Sairenji T, Jetty A, Peterson LE. Shifting Patterns of Physician Home Visits. J Prim Care Community Health 2015; 7:71-5. [PMID: 26574565 DOI: 10.1177/2150131915616366] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Home visits have been shown to improve quality of care and lower medical costs for complex elderly patients. We investigated trends in physician home visits and domiciliary care visits as well as physician characteristics associated with providing these services. DESIGN Longitudinal analysis of Medicare Part B claims data for a national sample of direct patient care physicians in 2006 and 2011. Descriptive statistics were used to characterize the physician sample and to determine numbers of home visits and domiciliary visits in total and by physician specialty. SETTING Patient homes, nursing homes, and domiciliary care facilities. PARTICIPANTS Direct patient care physicians (n = 22,186). MEASUREMENTS Physician demographics, specialty, practice characteristics (practice type, geographic location), number of home visits, and domiciliary visits in 2006 and 2011. RESULTS We found a small increase (n = 63,501) in total number of home visits made to Medicare beneficiaries between 2006 and 2011 performed by a decreasing percentage of physicians (5.1%, n = 18,165 in 2006; 4.5%, n = 15,296 in 2011). There was substantial growth in domiciliary care visit numbers (n = 218,514) and a small increase in percentage of physicians delivering these services (2.0% in 2006, 2.3% in 2011). Physicians who performed home visits were more likely to be older, in rural locations, specialists in primary care, and more likely to provide nursing home and domiciliary care compared with physicians who did not make any home visits (P < .05). CONCLUSION Home visits and domiciliary visits to Medicare beneficiaries are increasing. General internal medicine physicians provided the highest number of home and domiciliary care visits in 2006, and family physicians did so in 2011. Such delivery models show promise in lowering medical costs while providing high-quality patient care.
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Musich S, Wang SS, Hawkins K, Yeh CS. Homebound older adults: Prevalence, characteristics, health care utilization and quality of care. Geriatr Nurs 2015; 36:445-50. [DOI: 10.1016/j.gerinurse.2015.06.013] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 06/19/2015] [Accepted: 06/29/2015] [Indexed: 11/25/2022]
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Morsch P, Pereira GN, Navarro JHDN, Trevisan MD, Lopes DGC, Bós ÂJG. [Clinical characteristics and social determinants in a sample of non-homebound elderly]. CAD SAUDE PUBLICA 2015; 31:1025-34. [PMID: 26083177 DOI: 10.1590/01021-311x00053014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 12/15/2014] [Indexed: 11/22/2022] Open
Abstract
This study aimed to assess social and clinical factors associated with the fact that older adults (≥ 60 years) go out of their homes. The study interviewed 5,898 older adults identified through home visits, randomly selected in 59 cities in the State of Rio Grande do Sul, Brazil. Multivariate logistic regression was used to assess the association between the outcome and independent variables. Factors associated with going out were being men, younger and married, presence of arthrosis, ease in performing specific activities, and good self-rated health. Heart disease was a negative factor for going out. Given the importance of social activity for quality of life and the World Health Organization policy for active aging, it is extremely important to consider clinical conditions that allow the older adults to remain active in the community. Studies like this can help to adjust public policies for the elderly, especially acting on modifiable clinical and functional conditions.
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Affiliation(s)
- Patricia Morsch
- Instituto de Geriatria e Gerontologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil
| | - Gustavo Nunes Pereira
- Instituto de Geriatria e Gerontologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil
| | | | - Margarete Diprat Trevisan
- Instituto de Geriatria e Gerontologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil
| | - Diene Gomes Colvara Lopes
- Instituto de Geriatria e Gerontologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil
| | - Ângelo José Gonçalves Bós
- Instituto de Geriatria e Gerontologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil
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Nazir A, Khan B, Counsell S, Henderson M, Gao S, Boustani M. Impact of an inpatient geriatric consultative service on outcomes for cognitively impaired patients. J Hosp Med 2015; 10:275-80. [PMID: 25641773 PMCID: PMC4411200 DOI: 10.1002/jhm.2326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/21/2014] [Accepted: 12/07/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Impact of geriatric consultative services (GCS) on hospital readmission and mortality outcomes for cognitively impaired (CI) patients is not known. OBJECTIVE Evaluate impact of GCS on hospital readmission and mortality among CI inpatients. DESIGN Secondary data analysis of a prospective trial of a computerized decision support system between July 1, 2006 and May 30, 2008. SETTING Study conducted at Eskenazi hospital, Indianapolis, Indiana, a 340-bed, public hospital with over 2300 yearly admissions of patients ages 65 years or older. PATIENTS There were 415 inpatients aged 65 years and older with CI enrolled from July 2006 to March 2008. MEASUREMENTS Thirty-day and 1-year mortality and hospital readmission following the index admission. Cox proportional hazard models were used to determine the association between receiving GCS, readmission, or mortality while adjusting for demographics, discharge destination, delirium, Charlson Comorbidity Index, and prior hospitalizations. The propensity score method was used to adjust for the nonrandom assignment of GCS. RESULTS Patients receiving GCS were older (79 years old, 8.1 standard deviation [SD] vs 76 years old, 7.8 SD; P < 0.001) with higher incidence of delirium (49% vs 29%; P < 0.001). No significant differences were found between the groups for hospital readmission (hazard ratio [HR] = 1.19; 95% confidence interval = 0.89-1.59) and mortality at 12 months of index admission (HR = 0.91; 95% confidence interval = 0.59-1.40). However, a significant increase in readmissions was observed for the GCS group (HR = 1.75; 95% confidence interval = 1.06-2.88) at 30 days postdischarge. CONCLUSION One-year postdischarge outcomes of CI patients who received GCS were not different from patients who did not receive the service. New models of care are needed to improve postdischarge readmission and mortality among hospitalized patients with CI.
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Affiliation(s)
- Arif Nazir
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Babar Khan
- Indiana University School of Medicine, Indianapolis, Indiana
- Indiana University Center for Aging Research, Indianapolis, Indiana
- Regenstrief Institute, Inc. Indianapolis, Indiana
| | - Steven Counsell
- Indiana University School of Medicine, Indianapolis, Indiana
- Indiana University Center for Aging Research, Indianapolis, Indiana
| | - Macey Henderson
- Richard M. Fairbanks School of Public Health, Indianapolis, Indiana
| | - Sujuan Gao
- Indiana University School of Medicine, Indianapolis, Indiana
- Indiana University Center for Aging Research, Indianapolis, Indiana
| | - Malaz Boustani
- Indiana University School of Medicine, Indianapolis, Indiana
- Indiana University Center for Aging Research, Indianapolis, Indiana
- Regenstrief Institute, Inc. Indianapolis, Indiana
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Home visits by care providers – Influences on health outcomes for caregivers of homebound older adults with dementia. Geriatr Nurs 2015; 36:25-9. [DOI: 10.1016/j.gerinurse.2014.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 01/22/2023]
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Leff B, Carlson CM, Saliba D, Ritchie C. The Invisible Homebound: Setting Quality-Of-Care Standards For Home-Based Primary And Palliative Care. Health Aff (Millwood) 2015; 34:21-9. [DOI: 10.1377/hlthaff.2014.1008] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Bruce Leff
- Bruce Leff ( ) is a professor of medicine at the Johns Hopkins University School of Medicine, in Baltimore, Maryland
| | - Charlotte M. Carlson
- Charlotte M. Carlson is an associate medical director at On Lok Senior Health Services, in San Francisco, California
| | - Debra Saliba
- Debra Saliba is director of the University of California, Los Angeles, Borun Center and a research physician in the Veterans Affairs Greater Los Angeles Healthcare System
| | - Christine Ritchie
- Christine Ritchie is a professor in the Department of Medicine at the University of California, San Francisco
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Stall N, Nowaczynski M, Sinha SK. Systematic review of outcomes from home-based primary care programs for homebound older adults. J Am Geriatr Soc 2014; 62:2243-51. [PMID: 25371236 DOI: 10.1111/jgs.13088] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the effect of home-based primary care for homebound older adults on individual, caregiver, and systems outcomes. DESIGN A systematic review of home-based primary care interventions for community-dwelling older adults (aged ≥65) using the Cochrane, PubMed, and MEDLINE databases from the earliest available date through March 15, 2014. Studies were included if the house calls visitor was the ongoing primary care provider and if the intervention measured emergency department visits, hospitalizations, hospital beds days of care, long-term care admissions, or long-term care bed days of care. SETTING Home-based primary care programs. PARTICIPANTS Homebound community-dwelling older adults (N = 46,154). MEASUREMENTS Emergency department visits, hospitalizations, hospital bed days of care, long-term care admissions, long-term care bed days of care, costs, program design, and individual and caregiver quality of life and satisfaction with care. RESULTS Of 357 abstracts identified, nine met criteria for review. The nine interventions were all based in North America, with five emerging from the Veterans Affairs system. Eight of nine programs demonstrated substantial effects on at least one inclusion outcome, with seven programs affecting two outcomes. Six interventions shared three core program components: interprofessional care teams, regular interprofessional care meetings, and after-hours support. CONCLUSION Specifically designed home-based primary care programs may substantially affect individual, caregiver and systems outcomes. Adherence to the core program components identified in this review could guide the development and spread of these programs.
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Affiliation(s)
- Nathan Stall
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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LaMantia MA, Boustani MA, Jhanji S, Maina M, Nazir A, Messina FC, Frame A, Alder C, Chodosh J. Redesigning acute care for cognitively impaired older adults: Optimizing health care services. DEMENTIA 2014; 15:913-30. [PMID: 25128821 DOI: 10.1177/1471301214547089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE OF THE STUDY Cognitive impairment (CI) is one of several factors known to influence hospitalization, hospital length of stay, and rehospitalization among older adults. Redesigning care delivery systems sensitive to the influence of CI may reduce acute care utilization while improving care quality. To develop a foundation of fundamental needs for health care redesign, we conducted focus groups with inpatient and outpatient providers to identify barriers, facilitators, and suggestions for improvements in care delivery for patients with CI. DESIGN AND METHODS Focus group sessions were conducted with providers to identify their approach to caring for cognitively impaired hospitalized adults; obstacles and facilitators to providing this care; and suggestions for improving the care process. Using a thematic analysis, two reviewers analyzed these transcripts to develop codes and themes. RESULTS Seven themes emerged from the focus group transcripts. These were: (1) reflections on serving the cognitively impaired population; (2) descriptions of perceived barriers to care; (3) strategies that improve or facilitate caring for hospitalized older adults; (4) the importance of fostering a hospital friendly to the needs of older adults; (5) the need for educating staff, patients, and caregivers; (6) the central role of good communication; and (7) steps needed to provide more effective care. IMPLICATIONS Providing effective acute care services to older adults with CI is an important challenge in health care reform. An understanding derived from the perspective of multiple professional disciplines is an important first step. Future research will build on this preliminary study in developing new acute care models for patients with CI.
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Affiliation(s)
- Michael A LaMantia
- Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Malaz A Boustani
- Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shola Jhanji
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Mungai Maina
- Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Arif Nazir
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Frank C Messina
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amie Frame
- Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA
| | | | - Joshua Chodosh
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Eric De Jonge K, Jamshed N, Gilden D, Kubisiak J, Bruce SR, Taler G. Effects of Home‐Based Primary Care on Medicare Costs in High‐Risk Elders. J Am Geriatr Soc 2014; 62:1825-31. [DOI: 10.1111/jgs.12974] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K. Eric De Jonge
- Section of Geriatrics MedStar Washington Hospital Center Washington District of Columbia
| | - Namirah Jamshed
- Section of Geriatrics MedStar Washington Hospital Center Washington District of Columbia
| | | | | | - Stephanie R. Bruce
- Section of Geriatrics MedStar Washington Hospital Center Washington District of Columbia
| | - George Taler
- Section of Geriatrics MedStar Washington Hospital Center Washington District of Columbia
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Mahon GM. Home care, need for increased physician involvement in the 21st century. J Am Med Dir Assoc 2014; 15:538-40. [PMID: 24930090 DOI: 10.1016/j.jamda.2014.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 04/25/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Gerald M Mahon
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO.
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Stall N, Nowaczynski M, Sinha SK. Back to the future: home-based primary care for older homebound Canadians: part 1: where we are now. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:237-240. [PMID: 23486788 PMCID: PMC3596195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Stall N, Nowaczynski M, Sinha SK. Back to the future: home-based primary care for older homebound Canadians: part 2: where we are going. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2013; 59:243-245. [PMID: 23486789 PMCID: PMC3596196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Rosenberg T. Acute Hospital Use, Nursing Home Placement, and Mortality in a Frail Community-Dwelling Cohort Managed with Primary Integrated Interdisciplinary Elder Care at Home. J Am Geriatr Soc 2012; 60:1340-6. [DOI: 10.1111/j.1532-5415.2012.03965.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ted Rosenberg
- Department of Family Medicine; University of British Columbia and Island Medical Program; University of Victoria; Victoria; British Columbia; Canada
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Riggs JS, Madigan EA. Describing Variation in Home Health Care Episodes for Patients With Heart Failure. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2012. [DOI: 10.1177/1084822311425958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This cohort study used Outcome and Assessment Information Set (OASIS) data to describe home health care episode variation for patients ( N = 103 869) with heart failure (HF), according to prior site of care. The most common episode is admission followed by discharge home, occurring for 63% of patients in the hospital, and 58% of patients at home, prior to home health care admission. Hospitalization with no return to home health care comprised the next most frequent pattern, occurring most often (16%) for patients with skilled nursing facility as prior site of care, and least often (11%) for patients at home prior to admission. Home health care episodes vary for patients with HF according to prior site of care, perhaps a reflection of variation in patients’ care needs (restorative, maintenance, palliative).
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Affiliation(s)
- Jennifer S. Riggs
- University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA
| | - Elizabeth A. Madigan
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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Johnston D, Samus QM, Morrison A, Leoutsakos JS, Hicks K, Handel S, Rye R, Robbins B, Rabins PV, Lyketsos CG, Black BS. Identification of community-residing individuals with dementia and their unmet needs for care. Int J Geriatr Psychiatry 2011; 26:292-8. [PMID: 20658473 PMCID: PMC3039061 DOI: 10.1002/gps.2527] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 03/05/2010] [Indexed: 11/10/2022]
Abstract
BACKGROUND Innovative approaches to the widespread delivery of evidence-based dementia care are needed. The aims of this study were to determine whether a telephone screening method could efficiently identify individuals in the community in need of care for dementia and to develop a multidimensional needs assessment tool for identifying the type and frequency of unmet needs related to memory disorders in the home setting. METHODS This was a cross-sectional evaluation of 292 community-residing individuals aged 70 and older in Maryland. Participants were given a brief cognitive telephone screen. A subsample (n=43) received a comprehensive in-home assessment for dementia and dementia-related needs. Cognitive, functional, behavioral, and clinical factors were assessed. The Johns Hopkins Dementia Care Needs Assessment (JHDCNA) was used to identify unmet needs related to dementia. RESULTS Telephone screening for the sample took 350 h, and 27% screened positive for dementia. Virtually all participants with dementia who received an in-home assessment had at least one unmet need, with the most frequent unmet needs being for a dementia workup, general medical care, environmental safety, assistance with ADL impairments, and access to meaningful activities. Caregivers, when present, also had a number of unmet needs, with the most common being caregiver education about dementia, knowledge of community resources, and caregiver mental health care. CONCLUSIONS Effective and efficient means for identifying community-residing individuals with dementia are needed so that dementia care interventions can be provided to address unmet care needs of patients and their caregivers.
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Affiliation(s)
- D Johnston
- Division of Geriatric Psychiatry & Neuropsychiatry, The Johns Hopkins University School of Medicine, 550 North Broadway/Suite 308, Baltimore, Maryland, USA.
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Qiu WQ, Dean M, Liu T, George L, Gann M, Cohen J, Bruce ML. Physical and mental health of homebound older adults: an overlooked population. J Am Geriatr Soc 2010; 58:2423-8. [PMID: 21070195 DOI: 10.1111/j.1532-5415.2010.03161.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There are currently more than 38.9 million people aged 65 an older in the United States. Up to 3.6 million of these people are considered housebound and in need of home-based care. Although homebound status is not defined specifically, with a broad range of disability levels, it is evident that people who are homebound suffer from a multitude of medical and psychiatric illnesses. This review examines the current literature to identify the specific physical and psychiatric factors most responsible for older adults becoming and remaining housebound. Homebound older adults suffer from metabolic, cardiovascular, cerebrovascular, and musculoskeletal diseases, as well as from cognitive impairment, dementia, and depression, at higher rates than the general elderly population. The information in this review will explain the specific types of care the homebound population needs and discuss the care that could help ease their suffering and delay their entry into a nursing home or hospital.
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Affiliation(s)
- Wei Qiao Qiu
- Department of Psychiatry, Boston University Medical Campus, Boston, Massachusetts 02118, USA.
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Lucke JC, Brown W, Tooth L, Loxton D, Byles J, Spallek M, Powers J, Hockey R, Pachana NA, Dobson A. Health across generations: findings from the Australian Longitudinal Study on Women's Health. Biol Res Nurs 2010; 12:162-70. [PMID: 20798160 DOI: 10.1177/1099800410373804] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Interpretation of changes in health and health care utilization patterns across the life span depends on an understanding of the effects of age, period, and cohort. The purpose of this article is to illustrate differences among three generations of women in demographic factors, health risk factors, and health status indicators from 1996 to 2008. The article examines data from the Australian Longitudinal Study on Women's Health, a broad-ranging project funded by the Australian Government Department of Health and Ageing (DoHA) and involving three age groups of women (born in the periods 1973-1978, 1946-1951, and 1921-1926) who were first surveyed in 1996 and will be surveyed every 3 years until at least 2015. Patterns in selected demographic factors (marital status and level of educational qualification), health risk factors (smoking, alcohol consumption, physical activity, and body mass index [BMI]), and health status indicators (asthma, hypertension, diabetes and depression; physical functioning and mental health scores from the SF-36) were examined to illustrate examples of biological age, generational differences, or period effects that affect all age groups and generations simultaneously. The results can be used to inform the development of responsive and effective models for both prevention and management of chronic disease, including health and aged-care systems that will meet the needs of different generations of women across their life span.
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Affiliation(s)
- Jayne C Lucke
- The University of Queensland, School of Population Health, QLD, Australia.
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Challenges associated with the recognition and treatment of depression in older recipients of home care services. Int Psychogeriatr 2010; 22:514-22. [PMID: 20149271 DOI: 10.1017/s1041610209991797] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Home care for older adults is a common phenomenon worldwide because it allows older adults to remain in their home environment. Research has shown that depression is frequently found in older recipients of home care services. Nonetheless, it is often poorly recognized and treated. Untreated or poorly treated depression in older home care recipients has been associated with a variety of negative outcomes, including increased morbidity and mortality, greater likelihood of nursing home institutionalization and higher caregiver distress. METHODS The present review outlines some of the challenges associated with appropriate recognition and treatment of depression in older home care recipients. RESULTS Our review demonstrates that more aggressive management of depressive symptoms and the employment of an interdiciplinary team can result in beneficial outcomes. CONCLUSIONS Further research is needed, especially in the area of psychotherapeutic interventions as these should be flexible enough to meet the unique and evolving needs of this frail population of older adults.
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