Community Care Program Research Articles

Predicting in-home time of community care professionals.

The aim of this study was to test whether the client homebound score (CHS), the case management intensity score (CMIS) and the client priority visit score (CPVS) could be used to predict in-home time of professional caregivers in the Aspen community care program. A random sample of 34 community care clients from the different geographical areas of the Aspen Regional Health Authority was selected and the home visits for each client were tracked for three months. Information such as client demographics, the client diagnostic category, number and in-home time of visits was collected. In addition, the CHS, the CMIS and the CPVS were measured for each client. Data were analyzed, using a robust variance estimator regression model. CMIS was found to be the best predictor of in-home time (coefficient 9.521, p > 0.001), followed by the CHS and the CPVS.

Institutional versus at-home long term care for functionally dependent older people.

An increasing number of functionally dependent older people require care and medical treatment. Increasingly governments are shifting resources into community care expecting both reduction in costs and improvement in the quality of care. However, it is difficult to establish the costs and benefits of institutional and the alternative at-home care. To assess the effects of institutional versus at-home care for functionally dependent older people on health outcomes, satisfaction (of functionally dependent older people, relatives and health care professionals), quality of care and costs. We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC) specialised register (1999), the Cochrane Controlled Trials Register (Issue 4 1999), MEDLINE (1966 to 1999), EMBASE (1980 to 1999), Best Evidence (1990 to 1999), Ageline (1982 to 1999), Cinahl (1982 to 1999), EconLit (1969 to 1999), PsycInfo (1887 to 1999), NTIS (1980 to 1999), Scisearch (1980 to 1999), Sigle (1980 to 1999), and reference lists of related systematic reviews and articles. We contacted authors working in the field in an attempt to identify unpublished studies. Randomised trials, controlled clinical trials, controlled before and after studies and interrupted time series studies where functionally dependent older people were assigned to either institutional or at-home care. Three reviewers independently extracted data and assessed study quality. No meta analysis was conducted as only one trial was identified. One study was included involving 112 people. This evaluated a community care programme (CCP) organising foster care versus nursing home care. No studies were found where functionally dependent older people returned to their own homes. The included trial was small and of poor methodological quality. No significant difference was found between the two groups when comparing functioning (ADL and IADL), mental status, attitudes to perceived health, life satisfaction or mortality. There is insufficient evidence to estimate the likely benefits, harms and costs of institutional or at-home care for functionally dependent older people.

The changing face of community and district nursing.

The Royal District Nursing Service (RDNS) of South Australia provides home- and community-based nursing care to people residing in the Adelaide Metropolitan area. The service is funded predominantly by the Home and Community Care Program. It provides community nursing services in the areas of wound management, palliative care, HIV/AIDS care, continence management, disability care, mental health and dementia care, and diabetes management. In 2000-01, the service made 439,700 visits to people's homes or saw them in a nurse-led nursing centre. In addition, the nursing staff had 84,000 contacts other than face to face that were related to client care. These contacts include the co-ordination of care with other service providers for new and existing clients of RDNS.

A Pilot Study on Home Visiting in Aspen Community Care Services

The aim of this study was to test a questionnaire for more detailed management information of a community care program in rural Alberta. A total of 24 community care clients and 486 home visits to these clients were assessed. The Client Homebound Score (CHS) and the Case Management Intensity Score (CMIS) were positively associated with time spent on home visits. These scores would be useful indicators for improved resource-based planning of home visiting.

Free Papers Looking at Community Care Programs

Australasian Journal on AgeingVolume 19, Issue s4 p. 41-43 Free Papers Looking at Community Care Programs Discharge planning: the link between hospital and home First published: 05 December 2008 https://doi.org/10.1111/j.1741-6612.2000.tb00267.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume19, Issues4November 2000Pages 41-43 RelatedInformation

Using Reflective Process in Community-based Participatory Action Research

Using principles of transformational leadership, the management team of a Community Care Program (CCP) in British Columbia, Canada involved its staff, clients, and community agency personnel in a participatory action research process to evaluate the CCP's in-home nursing and physio/occupational programs. An iterative reflective process was initiated by the management team and expanded to include all stakeholders. We used a descriptive design with multiple analytic methods. CCP clients, agency personnel, and physicians were surveyed for their perceptions of whether CCP staff practised according to their core program values. Findings revealed minor discrepancies between the CCP's espoused values and those they practised with clients and agency personnel. An important outcome of this study was demonstrating the power and effectiveness of active participation by professional staff, consumers, and agency partners in all aspects of change within a traditional bureaucratic system.

Coordinating Health, Extended Care, and Community Support Services

Under pressure to maximize the cost-effectiveness of programs, efforts to improve coordination have become increasingly central to the development of the broader health and welfare service delivery system in Australia in the past few years. This article reviews recent experience in two related fields: (1) the coordination of different community care services for older people and people with disabilities, funded by the Home and Community Care program; and (2) the attempt to enhance links between community and residential care services, hospitals, and other health care providers. Why coordination has emerged as such an important issue in the field of community care and, increasingly, across the entire system of what the Australian government now terms health and family services is discussed. A number of measures that have been introduced or are proposed to improve a coordination of services are briefly reviewed. These range from individualistic approaches based on information and referral, through schemes involving gatekeeping, case management and brokerage of services, to models involving the reconfiguration of organizational structures, linkages, and finances. These measures are not mutually exclusive and are increasingly likely to be applied in more complex mixed models of service coordination. It is argued that coordination at the level of direct-service provision is difficult if government policies that direct services lack coordination.

Assessing payback from NHS reactive research programmes.

Aims to assess retrospectively the payback from NHS reactive research programmes in the Northern and Yorkshire region. A questionnaire was sent to all recipients of regional reactive research programme funding (biomedical, health services research (HSR), and primary and community care programmes) between 1 April 1991 and 31 March 1996. The sample available for analysis involved 174 respondents covering 119 projects, with a total financial value of 2.2 million Pounds. The main outcome measures used were peer-reviewed publications, changes in individual practice, changes in NHS service delivery and organisation, and impact on the careers of researchers. Overall, 119 projects produced 230 peer-reviewed publications: this was achieved at an average cost of 10,673 Pounds, 6,386 Pounds and 22,310 Pounds per publication for the biomedical, HSR, and primary and community care programmes respectively. From the qualitative data analysis, important changes in individual practice and NHS service delivery were identified by respondents. The researchers in our sample appeared to have attracted over 6 million Pounds in R&D funding related to the initial regional grant. Although based on self-report, there is evidence to suggest that the return on investment from NHS R&D can be substantial, taking a broad view of benefits to the NHS and to researchers. The findings also confirm the need for more effective dissemination and implementation of research findings.

PMD2 The Effect of the Louisiana Medicaid Lock-in on Prescription Drug Utilization And Expenditures

In an effort to contain costs while assuring quality, the Louisiana Medicaid program expanded its existing Lock-in program (for high utilizers) in the summer and fall of 1995. Lock-in recipients may be locked-in to a primary care physician, a specialist, and/or a pharmacy. OBJECTIVE: The purpose of this research was to determine the impact of the lock-in on pharmacy provider consistency, and the utilization of prescription drugs and expenditures for prescription drugs. METHODS: To be included in this study, a recipient must have been continuously eligible for Medicaid during the study period, not have been a nursing home patient, not participated in the Community Care program (a gate-keeping program), and enrolled in the lock-in program. Two years of pharmacy claims data were used in the analysis. A t-test compared pharmacy provider consistency prior to and during the lock-in. Segmented regression was used to determine if there were significant differences in the slopes and the levels of pre-lock-in and post-lock-in trend lines for utilization and expenditure variables. RESULTS: A total of 1,490 recipients met the inclusion criteria. The study group was predominantly female and white with an average age of 47.56. Results demonstrated that post lock-in, recipients received significantly more prescriptions from a single pharmacy when compared to the pre-lock period. Significant reductions were also found in the utilization of number of different drugs (a surrogate for polypharmacy), utilization of Schedule II narcotics, and total pharmacy costs (adjusted for decline in per unit cost). There was also a slight reduction in number of maintenance medications, but the difference was not significant. CONCLUSION: The lock-in improved continuity of pharmacy care of enrolled Medicaid recipients. It also significantly decreased polypharmacy while having little effect on maintenance medications.

Intersite variation in the impact of intensive psychiatric community care on hospital use.

Differences among treatment facilities in effectiveness of intensive psychiatric community care (IPCC) for reducing hospital dependence are examined. Experimental data from nine VA hospitals showed IPCC to be most effective where former orientation to inpatient care was changing to improved accessibility of outpatient services. These hospitals appeared to have the greatest need for community care programs and to be most committed to shifting their system of service delivery.

Community Care Programme Introduced in the US

Community Care Programme Introduced in the US

What Does Community Care Research Tell Us About Community Care in Australia?

A critical appraisal of 21 studies of community care conducted in Australia between 1990 and 1995 provides the basis for assessing the account of community care that is presented in recent research. Several aspects of the policy and program context in which the Home and Community Care (HACC) Program operates give rise to great diversity in community care, and the design and methods of community care research are also diverse. Review of the coverage of the HACC client population in research, the range of services studied and outcomes investigated shows however, that findings fall short of giving a representative account of community care. The focus on outcomes relating to admission to residential care is especially seen to prescribe too narrow a view of the range of outcomes achieved by communnity care. The need to recognise a wider range of outcomes is identified as findamental to strengthening the contribution that research can make to the development of community care in Australia and in other countries.

Psychoanalytic observation in community and primary health care education

Summary This paper describes a psychoanalytic observation seminar that was set up as part of an MA in Community and Primary Health Care programme. The seminar was intended for senior professionals outside psychotherapy trainings, drawn from the health and social-care fields. The author outlines the way in which a conventional infant-observation model was adapted for this group, enabling the students to observe both individual subjects and also diverse primary-health and community-care settings. The advantages of such a learning experience are discussed; and also the inevitable anxieties stirred by it. Several examples of observations are provided, showing how students were helped to negotiate and explore challenging primary-health and community-care settings.

Heavy psychiatric service users and the community care programme

Heavy psychiatric service users and the community care programme

Structural Advocacy: A Process In Progress

In February 1996, the Royal District Nursing Service Homeless Persons Program (RDNS HPP) released the report of the findings of a research project called The HACC Program: Improving Access For Homeless People. At the same time, and consistent with the recommendations within the report, the Home and Community Care (HACC) program released a draft policy statement identifying homeless people as a special needs group. Is such policy the result of a number of randomly unrelated activities, or are there identifiable activities which must take place in order to achieve policy change?

Would a National Information System Promote the Development of Canadian Home and Community Care Policy? An Examination of the Australian Experience

The Australian Home and Community Care (AHCC) program is examined for its applicability to the Canadian situation. First, the basic ingredients of the program are outlined. Particular attention is given to the capabilities of the national information system developed to monitor funding and delivery patterns, services provided and users' profiles. Second, similarities and differences between Canadian and Australian systems of federalism are assessed for their effects on home care policy. Finally, changes in the distribution of Australian health care resources since the introduction of HACC are assessed. The paper concludes that the policy and planning potential of a national information system could provide data that are critical to the debate about changing health care priorities.

COMMUNITY‐BASED SERVICES AND THE FRAGMENTATION OF PROVISION: A CASE STUDY OF HOME AND COMMUNITY CARE SERVICES IN A SUBURBAN COMMUNITY

Although the use of non‐government organisations to provide assistance has long been part of Australian welfare history, the principles of community‐based provision have only recently been adopted as part of the mainstream philosphy of service provision. This article examines the association between the expansion of community‐based provision and the fragmentation of service provision using information drawn from a study of the provision of long‐term care for a group of primarily elderly people through the Home and Community Care Program (HACC) and related provisions in a suburban community. The account focuses on the structure of formal service provisions, identifying organisational features which directly affect the operation of the system of local services, fragmenting the assistance made available. First, the organisations providing care are all of relatively recent origin and their operation continues to reflect many of the characteristics associated with their initial establishment. Second, the organisations involved are essentially hybrid bodies, being the product of both national/State programs and local initiatives. A number of tensions and conflicts arising from this characteristic are discussed. Third, service providing agencies tend to be highly specialised, with the consequence that the main division of labour is between, rather than within, organisations. Finally, the system of funding and administration has tended to orient agencies vertically, towards the source of funding, limiting their flexibility and capacity to develop horizontal patterns of cooperation with other services in the local area. Overall, the emergent system of services appears to be characterised by a large number of small organisations organised under a range of different auspice bodies, struggling to preserve their own autonomy and to operate within an insecure and continually changing policy environment. Recognising that reforms are likely, a number of broad alternatives to privatisation arc canvassed in the final section of the article.

Clinical Psychology in Ireland: A National Survey

The results of a 1993 survey of 111 clinical psychologists practising in Ireland are presented in this paper. Fifty-five percent of respondents were female and 45% were male with a mean age of 39 years and 7 months. A third of the group had a two year masters degree in clinical psychology; a third had on-the-job training; and a third had a diploma, doctorate or one-year masters degree in clinical psychology. Respondents had a mean of 13 years clinical experience and an average of 3 previous jobs in clinical psychology. Half the sample were employed in voluntary organizations and just over a quarter were employed by health boards in the special hospitals or community care programmes. Thirty-one percent worked in child and family specialty, 30% in mental handicap and 23% in adult mental health. Forty-one percent were senior grade, 23% were basic grade and 19% identified themselves as service directors or consultants. Eighty-seven percent worked full-time and adopted complex roles involving up to 11 differen...

The need for quality assurance for a better compliance and increased quality of life in chronic schizophrenic patients

In many places in the world community care facilities for chronic schizophrenic patients are insufficient, leading to a series of complications which can even be fatal. The lack of facilities contributes to a decrease in patients' compliance. The establishing of a good community care programme for the whole disease period will also considerably increase the efficacy of relapse prevention and give the patient an acceptable quality of life, and hopefully increase the patient's compliance. There is urgent need for therapy standards to be assured and monitored according to strict evaluation criteria to produce a better interplay between the schizophrenic patient and psychiatric staff.

Psychiatric emergencies in people with a mental handicap

With the implementation of community care and resettlement programmes, the extent, frequency and the management of emergencies in the mentally handicapped population have attracted a good deal of attention. Among the issues of importance are crisis in the community and unnecessary and repeated hospital admission; inappropriate emergency referrals leading to abuse of services; the need for emergency services and the importance of short term admission facilities (Nolan et al, 1992). While the number of psychiatric emergencies in people with mental handicap is not large, the trend towards living in the community has brought the need to monitor such referrals.