Community-based Care Facilities Research Articles

Identification of factors associated with hospitalization in an outpatient population with mental health conditions: a case-control study.

Addressing relevant determinants for preserved person-centered rehabilitation in mental health is still a major challenge. Little research focuses on factors associated with psychiatric hospitalization in exclusive outpatient settings. Some variables have been identified, but evidence across studies is inconsistent. This study aimed to identify and confirm factors associated with hospitalization in a specific outpatient population. A retrospective monocentric case-control study with 617 adult outpatients (216 cases and 401 controls) from a French community-based care facility was conducted. Participants had an index outpatient consultation between June 2021 and February 2023. All cases, who were patients with a psychiatric hospitalization from the day after the index outpatient consultation and up to 1 year later, have been included. Controls have been randomly selected from the same facility and did not experience a psychiatric hospitalization in the 12 months following the index outpatient consultation. Data collection was performed from electronic medical records. Sociodemographic, psychiatric diagnosis, historical issues, lifestyle, and follow-up-related variables were collected retrospectively. Uni- and bivariate analyses were performed, followed by a multivariable logistic regression. Visit to a psychiatric emergency within a year (adjusted odds ratio (aOR): 13.02, 95% confidence interval (CI): 7.32-23.97), drug treatment discontinuation within a year (aOR: 6.43, 95% CI: 3.52-12.03), history of mental healthcare without consent (aOR: 5.48, 95% CI: 3.10-10.06), medical follow-up discontinuation within a year (aOR: 3.17, 95% CI: 1.70-5.95), history of attempted suicide (aOR: 2.50, 95% CI: 1.48-4.30) and unskilled job (aOR: 0.26, 95% CI: 0.10-0.65) are the independent variables found associated with hospitalization for followed up outpatients. Public health policies and tools at the local and national levels should be adapted to target the identified individual determinants in order to prevent outpatients from being hospitalized.

Cost-Sharing Effects on Hospital Service Utilization Among Older People in Fukuoka Prefecture, Japan

Background: The cost-sharing impact on hospital service utilization of different services is a critical issue that has not been well addressed worldwide. This study aimed to investigate the cost-sharing effects based on income status on hospital service utilization of different services among elderly people in Japan and provide a comprehensive examination and discussion for the reasonability of a cost-sharing system. Methods: The data were extracted from the Latter-Stage Elderly Healthcare Insurance database in the fiscal year 2016. A total of 610 182 insured people aged ≥75 years old, with 155 773 hospitalization patients, were identified. Hospitalization rate, length of stay (LOS), and total hospitalization cost were used to test the statistical significance among patients categorized by income levels. Generalized linear models for total hospitalization cost were constructed based on bed types to further assess different hospital service utilization. Results: For medical chronic care and psychiatric beds, which both required long-term care treatment, much higher hospitalization rates were observed in the patients with low- and middle-income levels than patients with high-income level. The LOS and total hospitalization cost of the patients with low- and middle-income levels were significantly higher than the patients with high-income level treated in medical chronic care and psychiatric beds. For psychiatric beds, the total hospitalization cost for patients with low-income level was significantly higher than that for patients with highincome level.Conclusion: The cost-sharing policy in Japan, especially the cap for out-of-pocket needs further determination. The importance of community-based care services needs to be emphasized, and the collaboration between hospitals and community-based care facilities should be enhanced.

Senior citizens’ requirements of services provided by community-based care facilities: a China study

Purpose This study aims to identify senior citizens’ requirements related to “embedded retirement facilities (ERFs)”, which are small-scale, multi-functional and community-based care facilities for senior citizens in mainland China, and to discuss whether senior citizens’ perceptions are influenced by their backgrounds. Design/methodology/approach A questionnaire type of research was administrated to gain senior citizens’ rankings of services that should be provided by ERFs. Non-parametric statistical models were applied to analyse the collected data. Findings Results reveal that health care services for senior citizens are considered the most important. Requirements regarding rehabilitation and entertainment and daily life assistance are ranked second and third, respectively. Culture-related activities are the least important. Differences in the senior citizens’ background also influence their choices. Research limitations/implications This research is based on a questionnaire survey completed in northeast China. Opinions from other areas of mainland China will be collected in the future study. Furthermore, the key items identified in this research, which was completed by participants from the built environment discipline, can be further elaborated by combining interdisciplinary feedback. Practical implications This study explores services that are supposedly provided by ERFs. Findings will provide useful perceptions from senior citizens and will enable decision makers to prioritise services for senior citizens. Social implications Although senior citizens are the end users of ERFs, their needs are easily overlooked. This study calls attention to their needs from ERFs, and the results are likely to serve as references for stakeholders in building improved facilities. Originality/value ERFs have been provided in mainland China to cater to senior citizens’ needs since 2014. However, few studies have identified senior citizens’ requirements for provided services. The survey-based results of this work will serve as references for various stakeholders in making enhanced decisions.

Development of a Psychoeducational Intervention for Community-Based Care Facilities to Substance Use Disorders in Mexico

In Mexico, there are over 2000 community-based care facilities (CRAMAAs), which use derivations of the 12-step program. Only 24% of the personnel working at these facilities have some kind of substance use disorder (SUD) care training, and manualized or evidence-based interventions for patient care are not used. The objective of this study was to describe the development of a psychoeducational intervention for SUD care at CRAMAAs. This development encompassed four stages: expert meetings, needs assessment, content development, and content validation. The intervention comprises 12 group sessions provided by a facilitator who does not require specific knowledge of SUD. Each session is structured according to five instructional events described by Gagne and to principles of adult education. The characteristics of this psychoeducational intervention allow to extend its use to public professional scenarios, whether residential or outpatient. The development of this kind of interventions reduces the gap between science and clinical practice in real treatment scenarios.

Developing a novel health and well-being service: The value of utilising the restorative benefits of nature in the UK

Research from a number of sources attests to the value that people place on many of the attributes of the countryside, particularly tranquillity and peacefulness. The use of natural settings has been shown to be effective in assisting the restorative process. Some would go further to argue for the development of the practice of active engagement in social and therapeutic horticulture and agriculture as a form of therapy, particularly in regard to the benefits to health, well-being, and improved recovery times. This phenomenon is utilised in the development of a novel service (CaRE – Care and Rural Enterprise) based on collaboration between rural micro-businesses and a UK university, reflecting a national government agenda of linking business with higher education. The approach to this new service development is one of action research, which has been used particularly by health and social care practitioners who wish to improve their practices by a cycle of gradual learning and improvement and the encouragement of reflection. Modern health care provision has come to emphasise delivery of value for patients as consumers, often placing them at the centre of stakeholder networks. This paper reviews the progress of a novel respite care service that linked social provision to rural entrepreneurial activity, and charts development from what was envisaged initially as private-sector niche opportunities in health and recuperative care, evolving into social care in the rural environment. The study resulted in the initiation and development of the CaRE service providing a network of rural community-based care facilities.

Conducting Research in Community-Based Care Facilities: Ethical and Regulatory Implications

Successful research in community-based care settings requires collaboration between facility staff and researchers. The ethical conduct of research involves respect for persons, beneficence, and justice. Research must comply with specific federal regulations and state laws. Interviews with 15 community-based care facility administrators revealed differences in understanding how research is regulated and the influence that research might have when a facility provides access to researchers. A Facility Bill of Rights describes principles related to the ethical conduct of research and questions to consider when deciding whether to provide researchers with access to a facility.

Local Resistance to Community-Based Care Facilities

Abstract The purpose of this paper is to describe the major issues related to the resistance to community based care facilities that occurs in urban areas. Information for the paper was gathered through interviews with representatives of four community based residential treatment facilities and interviews with local and state officials involved in community care controversies. The following critical variables were found to be significant in understanding community resistance and overcoming it: (1) overconcentration resulting in “group home ghettoes;” (2) client characteristics perceived by local residents as being threatening to the safety or aesthetics of the neighborhood; (3) type of neighborhood, e.g., socio-economic level, ethnic composition, and land use; (4) type of opposition and resistance used by local groups, including the circulation of petitions and flyers, law suits, the organization of residents' associations to oppose, refusal of local government to grant necessary permits, testimony before...

Local resistance to community-based care facilities

Local resistance to community-based care facilities