In-home supportive services for individuals with cerebral palsy in California

Health service use among adults with cerebral palsy: a mixed-methods systematic review

AIM

To determine the proportion of adults with cerebral palsy (CP) using health services and frequency of use, and to explore experiences and perceptions of health services for this population.

METHOD

A mixed-methods systematic review was conducted using the Joanna Briggs Institute methodology. Five databases were searched to September 2020. Observational and qualitative studies were included. Two reviewers screened titles, abstracts, and full texts; extracted data; and assessed the quality of included studies. Separate meta-analyses were used to pool the proportion of adults using each service and frequency of use. A meta-aggregation approach was used to synthesize qualitative data. Quantitative and qualitative findings were integrated using the Andersen and Newman Model of health care utilization.

RESULTS

Fifty-seven studies (31 quantitative, 26 qualitative) of 14 300 adults with CP were included. The proportion of adults using services ranged from 7% (95% confidence interval [CI]: 2-13%) for urologists to 84% (95% CI: 78-90%) for general practitioners. Incidence of visits ranged from 67 (95% CI: 37-123) hospital admissions to 404 (95% CI: 175-934) general practitioner visits per 100 person-years. Qualitative themes highlighted issues regarding accessibility, caregivers' involvement, health workers' expertise, unmet ageing needs, transition, and health system challenges.

INTERPRETATION

Adults with CP used a wide range of health services but faced context-specific challenges in accessing required care. Appropriate service delivery models for adults with CP are required. This review emphasizes a need to develop an appropriate service model for adults with CP to meet their needs.

Determinants of hospital-based health service utilisation in cerebral palsy: a systematic review

OBJECTIVE

To systematically review and synthesize evidence of determinants associated with hospital-based health service utilisation among individuals with cerebral palsy (CP).

DATA SOURCES

Electronic databases MEDLINE, Embase, APA Psycinfo were searched from January 2000 to April 2020.

STUDY SELECTION

Observational studies were included that described people with CP, reported quantitative measures of hospital-based health service utilisation (inpatient, outpatient, emergency department), and based in high-income countries. We excluded studies that included only subsets of people with CP, or those that only reported therapy service utilisation.

DATA EXTRACTION

After initial screen, two reviewers reviewed full texts for inclusion and performed data extraction and risk of bias assessment using the Newcastle Ottawa scale. Determinants of health service utilisation were identified and categorised using the Andersen Behavioural Model.

DATA SYNTHESIS

Seventeen studies met inclusion criteria. Study quality was high. Twenty-six determinants were reported across eight Andersen Model characteristics. Individual predisposing factors such as sex showed no difference in health service utilisation; inpatient admissions decreased with increasing age during childhood and was lower in adults. Increased health service utilisation was associated with "individual need" including severe gross motor disability, epilepsy, developmental/ intellectual disability and gastrostomy-use across inpatient, outpatient and emergency department settings. There was little information reported on socio-demographic and health system contextual determinants.

CONCLUSIONS

CP health service utilisation was associated with age, severity and comorbidities. Improved understanding of determinants of health service utilisation can support health service access for people with CP.

Children and adolescents with cerebral palsy in the perspective of familial caregivers

ABSTRACT Objective: to analyze family caregivers’ perceptions on care delivered to children and adolescents presented with cerebral palsy. Methods: a quantitative, qualitative study developed with 50 family caregivers of children and adolescents diagnosed with cerebral palsy. Data collection was carried out by means of an interview with semi-open questions whose answers were analyzed based on the Content Analysis. Results: family members’ accounts on care delivered to children and adolescents with cerebral palsy are mostly connected with positive feelings, such as love, happiness, privilege and overcoming. However, for a significant share of these family members, their own quality of life depends on the cared subject’s health condition, blurring the distinction between their own needs and those of the cared subjects. Conclusions: health professionals need to recognize the importance of caregivers’ health promotion as a major condition to keep caring. In this dimension, they may contribute by helping caregivers identify their own health needs.

Home-based versus center-based care in children with cerebral palsy: a cost-effectiveness analysis

The rehabilitation services for children with cerebral palsy are provided in two forms: home-based care and center-based care. The aim of this research was to evaluate the cost-effectiveness of the home-based accordance with the center-based care for kids with cerebral palsy. In this cost-effectiveness research, 56 children under 12 years old were assigned randomly to two rehabilitation programs: (1) clinic-based rehabilitation services (CBRS); and (2) home-based rehabilitation services (HBRS). Data were collected by two questionnaires: a strong life quality survey of children with cerebral palsy (CP QOL-Child) and medical and non-medical costs' checklists. Finally, the incremental expense-efficacy rate (ICER) was used to determine the further expenses of one unit of the quality of life gained by CBRS compared with HBRS. The mean costs per patients for the home-based care group were less than the ones for the clinic-based care unit (US$ 660.3 vs. US$ 933.8). The costs of the rehabilitation services and transportation were the main costs in the two patients' groups. The quality of life for cases in the home-based care group was better than the one of the clinic-based care team. The results showed that the home-based care method was more cost-effective than the centre-based care approach in children with cerebral palsy. The incremental cost-effectiveness ratio was calculated at about US$ 2.6. The conclusion was that home-based care centers were more cost-effective than the centre-based care centers for children with cerebral palsy. Therefore, it was suggested that the health policy makers pay more attention to developing home-based care strategy in physically challenged children.