Effectiveness Of Home Care Research Articles

Community Palliative Care: What are the Best Models?

Palliative care seeks to address the physical, psychosocial and spiritual concerns of patients with a life limiting illness and their caregivers. Early referral to palliative care improves symptoms and is the standard of care. This paper evaluates the evidence for different models of community palliative care and looks at the effects of homecare, hospice programs and residential aged care facility (RACF) interventions on symptom management, home death rate and acute health service utilization. It also examines the impact of COVID-19, telehealth, integration and staffing models on the efficacy of community palliative care. Evidence suggests that community palliative care increases the rate of death at home and may improve satisfaction with care, but effect on symptoms and acute health care utilization are less certain. Enrolment in a hospice program may decrease hospitalizations and improve satisfaction. RACF staff training interventions to improve the quality of palliative care provided to residents show mixed results across all indicators. COVID-19 saw a relative increase in the demand for community palliative care, as people opted out of the hospital system. Models of community palliative care that facilitate integration, support primary health providers, and promote technological innovation are worthy of further research.

Effects of home care and e-mobile training/consultancy on women's postpartum symptoms and breastfeeding self-efficacy: a randomized clinical trial.

Most women experience breastfeeding problems and need changes due to postpartum physical symptoms and low breastfeeding self-efficacy. Postpartum home care and e-mobile training/consultancy has been introduced to address this issue. This study was conducted as a randomized controlled interventional study. The sample of the study consisted of 75 (home care group = 25, control group = 25, e-mobile training/consultancy group = 25) women who met the sample selection criteria, agreed to participate in the study, and were hospitalized in the postpartum ward of a City Hospital. Data were collected through the Personal Information Form, the Postpartum Physical Symptom Severity Scale and the Breastfeeding Self-Efficacy Scale (BSES). In all postpartum stages, a statistically significant difference was detected between the home care, e-mobile training/consultancy and control group women in terms of the Postpartum Physical Symptoms Severity Scale and BSES total mean scores (P < .05). Interviews showed that the home care group had the lowest Postpartum Physical Symptom Severity Scale total mean scores and the highest BSES total mean scores (P < .05). Postpartum home visits and e-mobile training/consultancy should be considered a routine part of postpartum care. It is effective in reducing postpartum physical symptoms and increasing breastfeeding self-efficacy. In line with the results of this study, the use of home care and e-mobile training/consultancy is recommended to decrease physical symptoms and increase breastfeeding self-efficacy.

Effectiveness of Home Care in Reducing Emergency Department Visits by End-Stage Palliative Care Patients in the Armed Forces Hospital – Southern Region, Saudi Arabia: A Retrospective Cohort Study

Objectives: To assess home healthcare services’ effectiveness in reducing emergency department visits (ED) and subsequent hospital readmission rates. Methods: A file-based hospital-based retrospective cohort study with an analytical component was conducted to compare palliative patients under home care services (Study Group) with a matched group of palliative patients who were not under home care services (Control Group). Demographic data, ED visits, and hospital readmission rates were calculated. Results: Both groups were diagnosis-, age-, and sex-matched. There was a highly significant difference regarding ED visits, as those in the Home Care (Study) group had significantly fewer ED visits and substantially fewer hospital admissions than patients in the non-home care (Control) group. Conclusions: Home Care services can effectively reduce ED visits and hospital admissions for end-stage palliative care patients. Keywords: Home Care, Palliative care, Emergency Department visits, Hospital admission

Variables determining higher health care effectiveness in patients with cardiovascular disease

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The projected incidence of cardiovascular disease and the aging population (deaths from cardiovascular disease increase after age 50) are expected to increase in the coming years. It is therefore imperative to improve health care for patients with CVD in primary care. Objective The aim of this study was to analyze the variables that influence the efficiency of health care delivery, which is synonymous with high quality of life, intensification of health behaviors, and high satisfaction of needs in patients with chronic cardiovascular disease. Methods The study was conducted on 157 patients with chronic cardiovascular disease who came to a follow-up appointment with a general practitioner. The WHOQOL-BREF Quality of Life Questionnaire, the Health Behavior Inventory Questionnaire (HBI), the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), and the Hospital Anxiety and Depression Scale-Modified Version (HADS-M) were used for the study. The Wilcoxon test and Fisher's exact test, as well as Spearman's rank correlation coefficient and logistic regression, were used for the analyzes. Results Analysis of patients revealed an association between home care effectiveness and the following variables (OR per unit): age (OR = 0.96, 95% CI: 0.92-0.99), educational level (OR = 1.45, 95% CI: 1.13-1.91), financial status (OR = 0.98, 95% CI: 0.20-0.89), assessment of physical well-being (OR = 2.60, 95% CI: 1.29-5.65), improvement in psychological well-being after a nurse visit (OR = 1.36, 95% CI: 0.00-0.17), and medication irregularity (OR = 0.30, 95% CI: 0.09-0.86). There was no association between effectiveness of care and duration of cardiovascular disease (p = 0.149), number of visits to a cardiology clinic (p = 0.414), number of visits to a PHC (p = 0.223), interventions by a family nurse practitioner (p = 0.075), and health care services provided by a physician such as ae.g., medical interview (p = 0.064), physical examination (p = 0.731), blood pressure measurement (p = 0.558). Conclusions Patients with CVD characterized by lower educational status, poorer financial status, poorer self-perception of physical well-being, expectation that the GP will provide information about disease progression, expectation that a social worker will provide information about the possibility of receiving social services, and the expectation that the family nurse would be more accessible when needed, as well as being characterized by irregular medication adherence and nonadherence to good eating habits, were much more likely to receive worse health care. Patients with cardiovascular disease can be well supported in primary care settings as long as the model of care is tailored to their specific needs. This includes care coordination within the health care team, home care, and support from general practice.

Variables Determining Higher Home Care Effectiveness in Patients with Chronic Cardiovascular Disease.

The aim of this cross-sectional study was to analyze the variables that influence the effectiveness of home care in patients with chronic cardiovascular disease and their informal caregivers. The study was conducted in 193 patients and their 161 informal caregivers. The study used the WHOQOL-BREF Quality of Life Questionnaire, the health behavior inventory questionnaire (HBI), the Camberwell assessment of need short appraisal schedule (CANSAS) and the hospital anxiety and depression scale–modified (HADS–M) version. Spearman’s rank correlation coefficient test and logistic regression were used for analyses. Analysis of patients revealed an association between home care effectiveness and the following variables (OR per unit): age (OR = 0.98, 95% CI: 0.95–0.99), educational level (OR = 1.45, 95% CI: 1.05–2.02), financial status (OR = 0.43, 95% CI: 0.21–0.83), medication irregularity (OR = 0.25, 95% CI: 0.07–0.72), presence of comorbidities (OR = 6.18, 95% CI: 1.83–23.78), health care services provided by a nurse (OR = 1.25, 95% CI: 1.03–1.64), and number of visits to a cardiology clinic (OR = 1.25, 95% CI: 1.02–1.59). There was no association between care effectiveness and sex (p = 0.28), place of residence (p = 0.757), duration of cardiovascular disease (p = 0.718), number of home visits (p = 0.154), nursing interventions (p = 0.16), and adherence to lifestyle change recommendations (p = 0.539) or proper dietary habits (p = 0.355). A greater chance of improved health care effectiveness was found in patients whose caregivers reported higher social (OR = 1.24, 95% CI: 1.09–1.44), psychological (OR = 1.68, 95% CI: 1.25–2.37), and physical (OR = 1.24, 95% CI: 1.05–1.49) quality of life. Patients with cardiovascular disease who were characterized by lower educational attainment, poorer financial status, fewer visits to cardiology clinics, lower utilization of medical services, poorer self-perception of mental and physical well-being, recent onset of disease symptoms, and irregular use of medications, were much more likely to have poorer health care effectiveness. Patients with cardiovascular disease and their caregivers can be well supported at home as long as the care model is tailored to the specific needs. This includes family care coordination in the health care team, home care, and general practice support.

Effects of Home Care on patients with hepatocellular carcinoma treated with sorafenib.

Background and AimTreatment with sorafenib causes diverse side effects, which limits adherence. This work assesses whether Home Care, a psychosocial nursing intervention, prolongs the duration of treatment in patients with advanced hepatocellular carcinoma (HCC) and if it influences health‐related quality of life (HRQL).Methods and ResultsThis is a cohort study using data from patients receiving sorafenib in the prospective Bern HCC Cohort at the University Hospital. Duration of treatment, overall survival, and HRQL using the Functional Assessment of Cancer Therapy‐Hepatobiliary questionnaire were compared in the two groups. A total of 173 patients were eligible for the analysis. Among them, 141 were in the Home Care program, and 32 were not. Patients with Home Care had a significantly longer duration of treatment (265 days vs 152 days, P = 0.003) and a better functional well‐being (17.7 vs 12.5, P = 0.015).ConclusionPsychosocial interventions such as Home Care are a valid method in improving adherence to sorafenib and can therefore be recommended.

Economic Evaluation of Home Care for Stroke Patients Compared to Hospital Care: A Systematic Review

Context: Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries. Objectives: The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients. Data Sources: A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Data Extraction: To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used. Results: Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care. Conclusions: Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (mRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.

Economic Evaluation of Home Care for Stroke Patients Compared to Hospital Care: A Systematic Review

Context: Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries. Objectives: The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients. Data Sources: A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Data Extraction: To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used. Results: Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care. Conclusions: Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (MRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.

The effect of home care based on the Neuman systems model on symptomatic relief and quality of life in patients undergoing hemodialysis.

Chronic renal failure (CRF) is an important common health problem with high morbidity and mortality rate in the world and in Turkey. This study was conducted to determine the effect of home care based on the Neuman Systems Model on relief of physical and psychological symptoms and quality of life in patients undergoing hemodialysis. This study was conducted as a pretest-posttest randomized controlled trial. The sample of the study was composed of 160 hemodialysis patients. The patients were randomly and sequentially assigned to experimental and control groups as 80 hemodialysis patients. After the intervention, it was determined that the symptoms levels of the patients in the experimental group reduced and their quality of life increased. The care provided based on the Neuman Systems Model reduced the symptoms of the patients having hemodialysis treatment and enhanced their quality of life. Care given using a model is important in improving the quality of life of hemodialysis patients.

Home Care for the Elderly under the Epidemic of Novel Coronavirus Pneumonia

Objective: To explore the effects of home care in the elderly patients under the epidemic of COVID-19. Methods: According to the hospital deployment and guidance documents, a series of actions were worked out, including the home care service process and contingency plan, training of the knowledge of novel coronavirus pneumonia (NCP), providing psychological intervention for nurses, providing home care for elderly patients at home and education about home prevention of COVID-19 for the elderly family. Results: From January 19 to March 31, 2020, the home visiting nurses provided home care service for 93 elderly patients at home, representing a 20% increase over the same period last year. The home care service included retention / replacement of gastric tube, retention / replacement of urinary tube, pressure ulcer care, sputum suction care, maintenance of peripherally inserted central catheters and venous blood collection for 127 times. The home visiting nurses were in good physical condition without any bad mood. Conclusion: Under the epidemic of COVID-19, more home-based elderly patients had home care service needs. Home care could not only take advantage under the epidemic situation, but also meet the medical needs of elderly patients at home, and effectively alleviate the burden of epidemic prevention and reduce the risk of cross infection. Home care could play a great role in prevention and control of the COVID-19 epidemic.

Effect of Home Care on Husband’s Support During the Postpartum Period

Effect of Home Care on Husband’s Support During the Postpartum Period

Health Professionals’ perceptions and Experiences of Family Caregivers: A Pilot Qualitative Study Carried Out at the Diabetes Centre of the National Public Health Institute of Cote d’Ivoire

Introduction: Despite a growing interest in proximology about the relationship between family caregivers of people with non communicable disease such as diabetes and health professionals, little is known about this issue in Côte d’Ivoire. While researchers are focused on diabetic patient, they frequently omit health professionals’ experiences with family caregivers. This paper aims to report a study on the perception of health professionals of family caregivers of diabetic patient and identify the facilitating factors to improve their implication in the care process. Material and Method: This qualitative research using semi structured interviews was conducted between February and April 2018, among the health workers (n=17) of the Diabetes Centre of the Public Health Institute of Côte d’Ivoire. Data were analyzed using a content and thematic analysis of the transcripts. Results: The health professional expressed in general a good perception of caregivers despite conflicts. According to them, information and education on diabetes, improvement of the organizational practices, recruitment of a social worker, recognition of the caregivers’ expertise and work, organization of discussion group and creation of an association of family caregivers of people with diabetes are facilitating factors to improve caregivers’ implication. Conclusion: This study revealed that there is a need for greater awareness among health professionals concerning the expectations and needs of caregivers. Health professionals also need to be trained in family caregivers/patient/ health professional relationship in order to understand this relational issue and set up essential partnership that conditions the quality, continuity and effectiveness of home care.

Home Care Intervention to Improve Nutritional Status of Severe Acute Malnourished (SAM) Children in Yogyakarta, Indonesia

This study aims to evaluate effects of home care to improve nutritional status of acute malnourished children. Quasi-experimental with pretest-posttest control group design was carried out. The study was used 22 health centers in Yogyakarta. Samples were selected in intensive, strengthening and independent phases. Data collected included anthropometric measurement, and socio-demographic characteristics. Data were analyzed using chi square, t-test and linier mixed effect model. After three months, significant escalations were found in the anthropometric indicator among experimental groups. Then, the proportion of wasting in the experimental group was reduced to 56.7% (P=0.0001), whereas proportion of wasting in the control group showed no reduction (P=0.317). Three month of home care program was be able to improve the nutritional status of children.

Influence of home care in hospital on the post-discharged quality life of preterm infants

Objective To explore the effect of home care in hospital on the improvement of the post-discharged quality of life in preterm infants. Methods Seventy-four preterm infants who were hospitalized in NICU of Kunming Children's Hospital from August of 2015 to July of 2016 were included and divided into the control group and the invention group at random. Thirty-seven preterm infants were included into each group. The preterm infants in the control group accepted the conventional treatment and nursing in hospital. Besides the conventional treatment and nursing, the parents of the preterm infants in the intervention group accepted the preterm infant nursing which simulated the home environment when the infants were in hospital. Using the follow-up investigation method, the weight increasing, the rate of re-visiting the doctor of the preterm infants in the two groups were observed when they were discharged. Results One month after discharge the weight increasing of the preterm infants in the intervention group was (0.987±0.231) kg, which was significantly higher compared to the control group (0.760±0.179) kg (t=15.22, P<0.05) . One month after discharge the rate of re-visiting the doctor in the intervention group was 1, which was significantly fewer compared to the control group (χ2=8.86, P<0.05) . Conclusions Home care in hospital increases the parents' ability of taking care of preterm infants effectively, improves the health level and the development of preterm infants in NICU when they were discharged. Key words: Infant, preterm; Quality of life; Home care in hospital

Application of home care in total hip replacement patients with minimally invasive OCM approach

Objective To explore the nursing effect of home care in patients with minimally invasive total hip arthroplasty(THA) in patients with minimally invasive surgery, and to provide comprehensive and seamless care for patients. Methods A total of 79 patients with THA were divided into observation group (38 cases)and control group(41 cases). The observation group received home care, including health education, telephone follow-up, home visits and other nursing measures. Control group followed the routine nursing education. Activity of Daily Living Scale(ADL), Functional Independence Measure(FIM) and Harris scores were compared between the two groups of patients when discharged and three months after discharge. Results In the observation group and the control group, the ADL, FIM and Harris scores were gradually increased at 3 months after discharge which had no difference when discharge(P>0.05). The ADL, FIM and Harris scores of the observation group were significantly higher than that in the control group at 3 months after discharge(P<0.01). Conclusions Implementation of home care can improve patients′ ability of daily life, the whole hip joint function recovery and hip function independence, thus it makes their quality of life better, achieving the goal of comprehensive rehabilitation. Key words: Elderly; Total hip arthroplasty; Rehabilitation; Quality of life; Home care

Effects of home care on patients with pulmonary alveolar proteinosis

Objective To explore the effects of home care on pulmonary alveolar proteinosis patients. Methods The 24 cases of pulmonary alveolar proteinosis (PAP) patients were divided into observation group and the control group on average. The patients of observation group received after discharge home care including health education, outpatient visits, telephone follow-up and on-site visits while the patients of control group had no this kind of interventions. Dyspnea index, six-minute walk test, pulmonary function tests and body mass index were compared between two groups after discharge. Results The dyspnea evaluation scores were (1.31±1.07), (1.29±0.62) and (1.21±0.83) at 4, 8, 12 weeks after discharged in the observation group and all were better than that of the control group (t=6.438, 6.897, 8.572; P 0.05). Conclusions The implementation of home care can improve the PAP patients′ six-minute walk test distance and lung function, and reduce the patients with dyspnea index. Key words: Rehabilitation; Home care; Aerosol inhalation; Pulmonary alveolar proteinosis

Effect of home care nursing on elderly hypertensive patients in community

Objective To explore the effect of home care nursing on elderly hypertensive patients in community services .Methods Totals of 76 cases of elderly hypertensive patients were randomly divided into the experimental group and the control group , with 38 patients each .Six-month of home care nursing was adopted in the experimental group , and conventional community nursing was adopted in the control group .The therapeutic effect was compared between the two groups .Results After the intervention ,the systolic pressures and diastolic pressures of patients in the experimental group were （123.13 ±4.01）, （82.75 ±4.56） mmHg, respectively, which were significantly lower than the systolic pressures （ 146.00 ±6.32 ） mmHg and diastolic pressures （90.71 ±6.72）mmHg of patients in the control group （t =10.627, 3.332, respectively; P 〈0.05）.The medication compliance in the experimental group was increased from 21 patients to 36 patients, while there was no change in the control group.The difference was significant （χ2 =10.287, P〈0.05）.Conclusions Home care nursing model can reduce blood pressure more effectively and enhance the treatment effect .It is worthy of popularizing among the elderly hypertensive patients . Key words: Community health care nursing; Elderly patients; Hypertension; Home care

Early implementation of home care and 30 day readmissions in >65 years Veneto region patients discharged for heart failure and with disability

Early implementation of home care and 30 day readmissions in >65 years Veneto region patients discharged for heart failure and with disability. The effectiveness of Home care (HC) on preventing rehospitalizations in patients discharged for heart failure (HF) are uncertain. The aim of the study was to measure the impact of HC on early rehospitalizations of patients discharged for HF and with disabilities. Cohort retrospective study on >65 years patients, discharged at home and with a Barthel index <50. Variables considered were: previous hospitalizations for ischaemic cardiopathy ad/or chronic obstructive pulmonary disease, number of hospital admissions in the previous year, length of index hospitalization; outcomes considered were: hospital readmissions and days of hospitalizations 30 days from hospital discharge in patients with or without a home care visit within two days from hospital discharge. Of the 5.094 patients (60%>85 years), 14.8% received a HC visit within 2 days from discharge (43.7% from a nurse); 18.3% of patients (933) were readmitted within one month. In multivariate analyses an HC access within 2 days did not reduce the risk for readmission (although with better results in younger males but not in older women). An early HC visit reduced the days of hospital stay in males of all ages (65-74 years IRR 0.53 CI 95% 0.37-0.75; 75-84 years IRR 0.71 CI95% 0.60-0.83; 85+ years IRR 0.79 CI 95% 0.67-0.93) while in >75 years females there was a significant increase. An early HC visit (within two days from discharge) may have positive effects on males, but not in older women, possibly for the coexistence of socio-economic factors.

Better at home? Benefits of case management for children with complex needs

Care at home for children with complex health needs is recommended in health policy and advocated by professionals and voluntary organisations. Measuring benefits for the child and family is difficult and burden is known to be high for the family, especially when support for home care is inadequate. Case examples are used in this article to demonstrate the clinical and cost effectiveness of home care for children following acquired brain injury in the context of case management of an intensive package of support for each child. A first step to more widespread adoption of case-managed home care packages is to share examples of best practice that can demonstrate good outcomes and cost effectiveness.

Home care for older people

Older people receive home care either by choice or because alternative means of care are not available. The reasons for home care have an economic and cultural component; most of it is provided on a voluntary basis, regardless of the culture of the older person. Good home care, however, should not be left entirely to volunteers, but should be supported by the state through legislation and social policies, especially in the area of primary care and health promotion, as should end-of-life care. By these means some of the negative effects of home care on the recipient and the carer can be reduced.