Home Administration Research Articles

Subcutaneous Daratumumab at Home Is a Safe and Effective Procedure for Frail Patients with Multiple Myeloma: A Myelhome Project Report

Background Treatment of Multiple Myeloma (MM) is often difficult due to patient (pts) frailty, bone lesions/fractures that can hinder transport and/or long distance from the hospital. The availability in the Viterbo province of a Domiciliary Hematologic Care Unit (DHCU) allowed to overcome these difficulties. Patients and methods Herein, the experience in 15 patients with MM treated as outpatients [10 at home (HC) and 5 in a Long Term Residential Accomodation (LTRA)] with subcutaneous (sc) daratumumab (dara) is reported, as part of the Myel-Home project. The initial 2 dara administrations, either intravenous or sc, were given in hospital to prevent side effects, while subsequent administrations were done as outpatients: the first dara administration as outpatient was done by nurse and physician, while subsequent ones by nurse only. Results: The main clinical features of pts at baseline of dara initiation are shown in the Table. Different reasons for outpatient management were: advanced age (> 80 years) in 3 pts, illness related symptoms in 8 pts, social conditions and/or long distance in 4 pts. Distance from DHCU to pts home was < 20 Km in 4 cases ( 27%), ≥ 20 < 40 Km in 10 (66%) and ≥ 40 Km in 1 (7%). Different lines of treatment and different schemes are reported in the Table: among 7 pts treated in 1 st line, 3 were transplant eligible and 4 transplant ineligible. On the whole, 110 administrations of sc-dara were performed by DHCU nurses as outpatient: during and/or immediately after home administration, only one pt had adverse events (grade 2 allergic reaction according WHO), leading to dara permanent discontinuation after the 2nd dose at home. Main adverse events during the course of domiciliary treatment were infections (pneumonia in 4 pts, sepsis in 2, cystitis in 1) and deep vein thrombosis in 1 pts. Moreover, 4/5 patients (80%) in LTRA had infections (which were fatal in 3 of them) compared to 3/10 pts (30%) in HC with only 1 related death. Two pts were not yet evaluable for response and one pt discontinued early: among the evaluable 12 pts, 1 achieved a stringent complete remission and 4 a very good partial remission, with an overall response rate of 42%, 5 pts had a stable disease and 2 pts a disease progression. At the last follow-up, 8 pts are alive (2 waiting for transplant procedure) and 7 pts died (3 from disease progression, 3 from infective complications and 1 from heart disease). Conclusions: Treatment at home with sc-dara in frail pts with MM is feasible and safe with improved quality of life, making possible a curative approach frontline as well as in advanced phases of disease also in subjects otherwise excluded by best available therapies or forced to long periods of hospitalization: it is worth of note that pts living in LTRA were at high risk of infective complications, thus limiting the advantages of a domiciliary management compared to pts living at our own house. In the next future, within the Myel-Home project, other monoclonal antibodies (belantamab-mafodotin and talquetamab) will be available for home administration.

2610. Home Administration of Intranasal Live Attenuated Influenza Vaccine: A Review of Current Evidence and Potential for Meeting Vaccination Targets

Abstract Background During the 2010–2021 influenza seasons, vaccination coverage was below the 70% target for the United States at 33.4–58.6% among children and 50.2% among adults.[1, 2] The live attenuated influenza vaccine (LAIV) is currently approved for healthcare professional administration (HCPA); however, self- and home-administered LAIVs may provide an additional, effective option for vaccine administration, which could expand seasonal influenza vaccine accessibility. LAIV is a quadrivalent influenza vaccine administered intranasally, with comparable effectiveness to the inactivated influenza vaccine.[3] Broadening vaccine availability to multiple vaccination sites has been shown to increase vaccination rates by up to 22%.[4] Here we summarize the current evidence on self- and home-administered LAIV efficacy and safety, and potential applications for increasing community influenza vaccination accessibility. Methods Publications evaluating the efficacy, safety, and practicality of self- and home-administered LAIV were identified from a literature search with the following search string: (live attenuated influenza vaccine OR LAIV) AND (home administration OR self administration OR self immuni*). Results In three studies comparing LAIV self- and home administration to HCPA (Table), home administration was preferred by 64, 74, and 96% of participants. Sample sizes ranged from 41 children to 4561 patients receiving LAIV, with participants aged between 2.6 and 64 years old. A trial of 4561 patients comparing LAIV self- and home administration to HCPA groups found similar effectiveness against influenza-like illness, immunogenicity, and adverse events post-vaccination. Conclusion Evidence suggests that self- and home-administered LAIV could be safely and effectively offered, and may be preferable for a subset of the population, which could expand seasonal influenza vaccine accessibility.

“All Hands on Deck”: Administrator Perspectives on Managing COVID-19 Outbreaks in U.S. Nursing Homes

Context: Managing COVID-19 outbreaks at U.S. nursing homes highlight the structural weaknesses of pre-pandemic long-term care emergency preparedness protocols. Objective: To understand how nursing home administrators managed staffing and facility operations during an active COVID-19 outbreak. Methods: This descriptive qualitative study conducted semi-structured interviews with administrators at 40 U.S. nursing homes from July 2020–December 2021. Interview questions focused on the impact of COVID-19 on nursing home operations and staffing, among other topics. Interview transcripts were qualitatively analysed to identify overarching themes using modified grounded theory and thematic analysis. Findings: Four major themes emerged from analysis. (1) Administrators described the rapidity of viral infection of staff and residents as overwhelming and long-lasting; (2) a COVID-19 outbreak had an immediate impact on staffing levels; (3) administrators implemented short-term compensatory strategies to manage staffing shortages during COVID-19 outbreaks; and (4) administrator and staff roles and responsibilities expanded in order to maintain facility operations during, and post-COVID-19 outbreak. Limitations: Findings may not be generalizable to all U.S. nursing homes and may not reflect current COVID-19 mitigation protocols and perspectives as interviews concluded in December 2021. Implications: U.S. nursing home administrators used crisis-management strategies to sustain facility operations during active COVID-19 outbreaks. This approach highlights on-going weaknesses in the long-term care infrastructure at U.S. nursing homes. Learning from administrator experiences during the COVID-19 pandemic is critical for the development of robust emergency preparedness plans and the improvement of state and federal resource coordination efforts to support U.S. nursing homes during future public health emergencies.

Examining the Director of Nursing Role in Long-Term Care: An Integrative Review

Aim. To identify and examine the structures and processes that support the director of nursing role in long-term care homes. Background. The director of nursing in long-term care homes is central to overseeing and supporting the workforce and delivery of safe, quality resident care. With ongoing health human resource challenges and an aging population requiring care from long-term care homes, it is important to understand what individual and organizational factors support the director of nursing leadership in these settings. Evaluation. This review was guided by Cooper’s five stages of the integrative review process. Donabedian’s structure-process-outcome framework was applied to synthesize the literature. Key Issue(s). Five individual-level structures (years of experience, level of education, demonstrated leadership capabilities, completed certification and/or established linkages with a professional association, and completed continuing education); three organizational-level structures (physical presence of leadership across the organization, a clear job description, and salary); and four processes (nursing home administrators and the director of nursing relationship, availability of onsite continuing education opportunities targeting directors of nursing and support for continuing education, cultivating relationships and enhancing networks beyond the long-term care home, and orientation to the role) were identified across 11 articles to support the director of nursing role in long-term care homes. Conclusion(s). The findings indicate that there are individual characteristics that support the director of nursing in their role. Notably, there are organizational structures and processes that can be modified at the practice and policy level to better recruit, retain, and support the performance of directors of nursing. Implications for Nursing Management. There are actionable steps that leaders and decision-makers can take to support nursing leadership across long-term care homes and directly address health human resource challenges.

Partnering With Nursing Home Administrators to Improve Diabetes Care

Partnering With Nursing Home Administrators to Improve Diabetes Care

Changes in Antidementia Medications upon Admission to the Nursing Home: Who Decides and Why? Results From a National Survey of Nursing Home Administrators

ObjectiveLittle is known about who is involved and what factors influence changes in antidementia medications for older adults living in nursing homes. The study sought to describe factors associated with initiation and discontinuation of antidementia medications in nursing home residents with dementia. DesignNational survey of nursing homes with ≥30 beds; homes with dementia units were oversampled. Settings and ParticipantsNursing home administrators [eg, Directors of Nursing (DoNs)]. MethodsIn 2022, 1293 homes were surveyed (response rate: 26.6%, n = 340). Weighted analyses provided nationally representative results corrected for nonresponse (n = 14,455). ResultsDoNs reported that people always/almost always involved in antidementia medication decisions included nursing home prescriber (84.4%), nursing staff (33.2%), family (23.4%), resident (13.8%), community primary care provider (12.1%), and dementia specialist (5.8%). DoNs reported that antidementia medications were much more likely to be initiated if residents (55.8%) and family members (53.2%) wanted antidementia medications, a dementia specialist was involved (51.9%), resident had aggressive behaviors (44.8%), resisted care (31.6%), or had severe physical/cognitive impairment (22.3%). DoNs reported that antidementia medications were much more likely to be discontinued with dementia specialist involvement (46.5%), progression to severe impairment (39.2%), hospice involvement (31.5%), <6 months’ prognosis (28.5%), emergence of aggressive behaviors (25.2%), or resisting care (19.0%) and much less likely to be discontinued if residents (30.2%) and family (27.3%) were reluctant to discontinue. One in 6 homes reported that residents had no immediate family/caregivers usually or almost always/always. Conclusions and ImplicationsDoNs report that family/caregivers and dementia specialists have significant influence on antidementia medication decisions in nursing homes, but many residents lack their involvement. Real-world evidence on the risks and benefits of antidementia medications in nursing homes is needed to inform clinical guidance about appropriate use of antidementia medications in nursing homes.

THU071 Key Device Attributes For Injectable SRL Therapy In Acromegaly And NETs To Aid Clinical Decision Making

Abstract Disclosure: W.W. de Herder: Research Investigator; Self; Novartis Pharmaceuticals. Speaker; Self; Novartis Pharmaceuticals, Ipsen. S. Melmed: Consulting Fee; Self; Ionis Pharmaceuticals Inc., Ipsen, Novo Nordisk. Grant Recipient; Self; Pfizer Global R&amp;D. C. Follin: None. W. Geilvoet: None. J.O. Jorgensen: Consulting Fee; Self; Novo Nordisk, Pfizer Global R&amp;D. T. Kolarova: Grant Recipient; Self; Ipsen, ITM, AAA, Novartis Pharmaceuticals. M. Marks: None. W. Martin: Speaker; Self; Ipsen, AAA. K. Geerlings-Grootscholten: None. Background: Adherence, effectiveness and safety of SRL injections are similar for self- vs healthcare setting administration but patient preferences and device satisfaction vary. Device ease of use is associated with more favourable outcomes for other injectable hormones. Aim: To define key injectable SRL device attributes associated with optimal injection experience by people living with NETs/acromegaly and HCPs, identifying differences at 95% confidence. Methods: The survey (Jun-Nov ‘22) included active current users (≥6 months) of an SRL device for NETs/acromegaly, and for HCPs currently treating patients with NETs/acromegaly. There were 263 respondents from Australia, Canada, Chile, Denmark, Ireland, Mexico, Norway, Spain, UK, and USA: 201 patients (P), 10 caregivers (C) and 52 HCPs. In the P/C group (n=211), 157 people lived with NET and 54 with acromegaly; 74% were female. The HCP group (n=52) comprised 29 physicians, 20 nurses and 3 others (research nurse, clinical manager, patient leader) treating acromegaly (n=22), NET (n=15), or both (n=15). Results: P/C treatment duration ranged from 0.5-&amp;gt;15y (≥3y in 61%); 49% had experience with &amp;gt;1 SRL device type. Most HCPs (62%) were prescribers, 48% administered SRL injections, 83% had experience with &amp;gt;1 SRL device type. In the P/C group, NET patients were significantly more likely to have injections administered by an HCP in a hospital setting (54% vs 26% with acromegaly, p=0.05). Home administration was more common among acromegaly P/C (57%; 26% self-injected, 22% by caregiver, 9% by HCP) vs NET P/C (30%; 10%, 9% and 11%, respectively). Top 3 key device attributes preferred by the P/C group were: 1) confidence that the correct amount of drug is delivered (76%); 2) quick administration with minimal pain/discomfort (68%); 3) device safety (needle-safety system, low risk of contamination; 53%).The top 3 in the HCP group was: 1) quick administration with minimal pain/discomfort (69%); 2) correct use is easy to learn, confidence in handling the device (63%); 3) confidence that the correct amount of drug is delivered (62%). Ease of learning and confidence on correct use was significantly more likely to be selected as important by HCPs than P/C (63% vs 44%, p=0.05); ‘shorter/finer needles’ was significantly more likely to be selected by P/C than HCPs (48% vs 25%; p=0.05). ‘Easy to store and transport’ was significantly more likely to be selected by people living with acromegaly vs NET (59% vs 35%, p=0.05). Conclusions: Patient opinions are important to define key device attributes impacting the injection experience. Home administration is more common in acromegaly vs NET, as reflected in P/C device attribute preferences. Identified differences in key device attributes preferred by patients and HCPs inform the decision on which SRL device best fits individual patient needs. Developed with COR2ED, supported by an independent educational grant from Ipsen. Presentation: Thursday, June 15, 2023

Technology Acceptance Models from Different Viewpoints of Caregiver, Receiver, and Care Facility Administrator: Lessons from Long-Term Implementation Using Baby-Like Interactive Robot for Nursing Home Residents with Dementia

The introduction of companion robots into nursing homes has positive effects on older people with dementia (PwD) but increases the physical and psychological burden on the nursing staff, such as learning how to use them, fear of breakdowns, and concern about hygiene, and the concerns of the nursing home administrator, such as increased turnover and reduced quality of care due to this. To solve this problem, it is necessary to investigate the acceptability of robots from the viewpoints of all stakeholders: PwD as receivers, nursing staff as caregivers, and nursing home administrator as a care facility administrator. However, there is still missing hypothesis about how their acceptability is structured and involved with each other. This study proposes three technology acceptance model (TAMs) from the perspectives of PwD, nursing staff, and nursing home administrator. The models are conceptualized based on the qualitative and quantitative analysis of the results of our two experiments involving a baby-like interactive robot to stimulate PwD in the same nursing home (one with low acceptance of all stakeholders and the other with their high acceptance) in addition to the comparison with other companion robots. Based on the proposed models, we discuss an integrated TAM for the acceptance of companion robots in long-term care facilities. We also discuss the possibility of applying our approach, which examines the perspectives of various stakeholders on technology acceptance, to other areas such as health care and education, the ethical consideration of introducing a baby-like robot and some limitations.

P372 Safety of home administration of cipaglucosidase alfa + miglustat in late-onset Pompe disease: results from multiple clinical trials

P372 Safety of home administration of cipaglucosidase alfa + miglustat in late-onset Pompe disease: results from multiple clinical trials

"It's Not a Sprint, It's a Marathon": Stages of Managing a Nursing Home Throughout the Pandemic.

To qualitatively examine the impact of COVID-19 on nursing homes over the course of the pandemic from the perspective of nursing home administrators. In-depth, semi-structured interviews with nursing home administrators, repeated 3 months apart for a total of 4 each from July 2020 through December2021. Administrators from a total of 40 nursing homes from 8 health care markets across the United States. Interviews were conducted virtually or via phone. The research team identified overarching themes using applied thematic analysis, and iteratively coded transcribed interviews. Nursing home administrators across the United States reported challenges of managing nursing homes during a pandemic. We found their experiences could generally be categorized into 4 stages, not necessarily coinciding with surge levels of the virus. The initial stage was characterized by fear and confusion. The second stage, by a "new normal," a term administrators used to report feeling better prepared for an outbreak and how residents, staff, and families began to adjust to life with COVID. Administrators started using the phrase "a light at the end of the tunnel" to describe the third stage, characterized by the hope associated with the availability of vaccinations. The fourth stage was marked by "caregiver fatigue" as nursing homes experienced numerous breakthrough cases. Some challenges, like staffing issues and uncertainty about the future, were reported throughout the pandemic, as was a continued mission to keep residents safe. As the ability of nursing homes to provide safe, effective care faces unprecedented and continued challenges, the insights reported here from longitudinal perspectives of nursing home administrators may help policy makers develop solutions to encourage high-quality care. Knowing how the needs for resources and support vary across the progression of these stages has the potential to be helpful in addressing these challenges.

Feasibility of home administration of nebulised interferon ß-1a (SNG001) for COVID-19: a remote study.

Effective therapeutics given early to high-risk ambulatory patients with coronavirus disease 2019 (COVID-19) could improve outcomes and reduce overall healthcare burden. However, conducting site visits in non-hospitalised patients, who should remain isolated, is problematic. To evaluate the feasibility of a purely remote (virtual) study in non-hospitalised patients with COVID-19; and the efficacy and safety of nebulised recombinant interferon-β1a (SNG001) in this setting. Randomised, double-blind, parallel-group study, which was conducted remotely. Eligible patients aged ≥65 years (or ≥50 years with risk factors) with COVID-19 and not requiring hospital admission were recruited remotely. They were randomised to SNG001 or placebo once-daily via nebuliser for 14 days. The main outcomes were assessments of feasibility and safety, which were all conducted remotely. Of 114 patients treated, 111 (97.4%) completed 28 days of follow-up. Overall compliance to study medication was high, with ≥13 doses taken by 89.7% and 92.9% of treated patients in the placebo and SNG001 groups, respectively. Over the course of the study, only two patients were hospitalised, both in the placebo group; otherwise there were no notable differences between treatments for the efficacy parameters. No patients withdrew owing to an adverse event, and a similar proportion of patients experienced on-treatment adverse events in the two treatment groups (64.3% and 67.2% with SNG001 and placebo, respectively); most were mild or moderate and not treatment-related. This study demonstrated that it is feasible to conduct a purely virtual study in community-based patients with COVID-19, when the study included detailed daily assessments and with medication administered via nebuliser.

Impact of approval of home use of misoprostol in England on access to medical abortion: An interrupted time series analysis.

In 2018, the Department of Health and Social Care in England approved the use of misoprostol at home for early medical abortions, following administration of mifepristone at clinic. The objective of the present study was to assess the impact of the approval of home administration of misoprostol in England on access to medical abortion, assessed through proxy measures of the proportion of all abortions that were medical and gestational age. This study uses the clinical data from the British Pregnancy Advisory Service on abortions in England in years 2018-2019, containing demographic and procedure characteristics of patients. We conducted an interrupted time series analysis to establish the differences before and after the approval in access to medical abortion, measured by the proportion of all abortions that were medical, and gestational age. The analysis also examined whether these changes were equitable, with focus on area-level deprivation. The analysis of the data (145 529 abortions) suggested that there was an increase in the proportion of medical abortions and decrease in gestational age of abortions after the approval. Compared with the situation if former trends had continued, the actual proportion of early medical abortions was 4.2% higher in December 2019, and the mean gestational age 3.4 days lower. We found that the acceleration of existing trends in increase in proportion of medical abortions and decrease in gestational age were larger in the most deprived quintiles and in those reporting a disability, but not equal across ethnic groups, with Black and Black British women experiencing little change in trajectories post-approval. The approval of home use of misoprostol as part of an early medical abortion regimen in England was associated with material and equitable improvements in abortion access. Pre-approval trends toward greater uptake of medical abortion and declining gestational age were accelerated post-approval and were greatest in the most deprived areas of England, but not across all racial/ethnic groups. The present findings strongly support the continuation or introduction of home management of medical abortions.

The occurrence and extent of anxiety and distress among Dutch travellers after encountering an animal associated injury

BackgroundPrompt administration of post-exposure prophylaxis (PEP) is crucial to prevent a fatal rabies infection after an animal associated injury (AAI), preferably within 24 h. PEP, especially in case of a type III injury for which rabies immune globulin (RIG) is needed, is difficult to obtain abroad. This, along with the fear of potentially having contracted a lethal disease, might be an important source for anxiety and distress. We investigated the occurrence and extent of self-reported anxiety and distress at different timepoints among Dutch travellers after encountering an AAI, and the involved factors.MethodsA retrospective quantitative observational study was conducted including insured Dutch travellers who actively contacted Eurocross Assistance after encountering an AAI abroad. An online questionnaire was designed to measure anxiety and distress levels, using the HADS (Hospital Anxiety and Depression Scale) and distress thermometer at three time points: departure from home (T1), post-AAI (T2), and treatment administration (T3). Statistical analyses included T-tests, Chi-square tests, and ANCOVA analyses.ResultsWe showed a significant increase in mean anxiety and distress scores at T2, and a significant decrease at T3. Women were more often anxious and distressed. Between T1 and T2, PrEP, and being aware of the risks were positively associated with anxiety levels, and PrEP and WHO region Africa with distress levels. Between T2 and T3, anxiety levels remained higher for monkey-induced injury, thoracic injuries, and WHO region Southeast Asia. PEP-delay between 24–48 h resulted in decreased distress levels at this time period, while type II injury elevated distress levels.ConclusionsThis study showed significant anxiety and distress levels after an AAI among the vast majority of travellers, which is detrimental to their health-related quality of life (HR-QOL). This highlights the importance of proper pre-travel information. In the context of rabies prevention, these results suggest that pre-travel advice and policy makers should also take aspects of HR-QOL into consideration.

Pemberian Terapi Kelompok pada Lansia di Panti Werdha Kota Salatiga

The increasing number of older people in Indonesia impacts the care process. Culturally, the eldest in Indonesia are cared for by other family members. On the other hand, several older people live in nursing homes during their old age. While in the nursing home, the eldest are cared for by health workers or nursing home administrators physically, psychologically, and spiritually to maintain or improve their quality of life. However, the elderly living in three retirement homes in Salatiga City are at risk of non-communicable diseases such as hypertension (70%) and high cholesterol (23%), loneliness, and sleeplessness (41%). The purpose of the community service is to provide group activities therapy to older people living in nursing homes. The activities included cognitive exercises (drawing, writing) and psychomotor (brain gymnastics and song movements). The service results showed that the eldest expression was happy and eager to follow the activities. The involvement of students also reduces the loneliness of the eldest, who have not received visits from their families for a long time. Group therapy activities can train cognitive and psychomotor skills and reduce feelings of loneliness in the elderly.

Providing High-Quality Care During a Pandemic: Nursing Home Administrator Perspectives.

Nursing home administrators are responsible for promoting quality improvement (QI), a challenging task during a pandemic. In the current study, a convenience sample of 28 administrators of non-profit nursing homes was recruited for interviews regarding leadership during the coronavirus disease 2019 pandemic. The purpose was to elicit administrator insights into sustainable QI initiatives and factors contributing to QI success during a pandemic. Open-ended interview items focused on QI initiatives, pandemic-related advice to new administrators, and ways external parties can contribute to QI during a pandemic. Administrators highlighted QI initiatives in social connections, infection control, and innovative activities. Advice to new administrators included team development, maintaining a positive attitude, and extensive communication. Administrators recommended that external parties respect infection control measures, seek alternatives to restrictive regulations, and commend staff. Nurses may be better able to lead or assist in implementing nursing home QI initiatives informed by findings from this study. [Journal of Gerontological Nursing, 49(8), 14-18.].

Examination of Staffing Shortages at US Nursing Homes During the COVID-19 Pandemic

Staffing shortages have been widely reported in US nursing homes during the COVID-19 pandemic, but traditional quantitative research analyses have found mixed evidence of staffing shortfalls. To examine whether nursing home administrator perspectives can provide context for conflicting aggregate staffing reports in US nursing homes during the COVID-19 pandemic. In a qualitative study, convergent mixed-methods analysis integrating qualitative and quantitative data sets was used. Semistructured qualitative interviews were conducted between July 14, 2020, and December 16, 2021. Publicly available national Payroll Based Journal data were retrieved from January 1, 2020, to September 30, 2022, on 40 US nursing homes in 8 health care markets that varied by region and nursing home use patterns. Staffing and resident measures were derived from Payroll Based Journal data and compared with national trends for 15 436 US nursing homes. Nursing home administrators were recruited for interviews. Of the 40 administrators who consented to participate, 4 were lost to follow-up. Four repeated, semistructured qualitative interviews with participants were conducted. Interview questions focused on the changes noted during the COVID-19 pandemic in nursing homes. Thematic description of nursing home administrator compensatory strategies to provide context for quantitative analyses on nursing home staffing levels during the COVID-19 pandemic. A total of 156 interviews were completed with 40 nursing home administrators. Administrators reported experiencing staff shortages during the COVID-19 pandemic and using compensatory strategies, such as overtime, cross-training, staff-to-resident ratio adjustments, use of agency staff, and curtailing admissions, to maintain operations and comply with minimum staffing regulations. Payroll Based Journal data measures graphed from January 1, 2020, to September 30, 2022, supported administrator reports showing that study facilities had reductions in staff hours, increased use of agency staff, and decreased resident census. Findings were similar to national trends. In this qualitative, convergent mixed-methods study, nursing home administrators reported the major staffing strain they experienced at their facilities and the strategies they used to offset staffing shortages. Their experiences provide context to quantitative analyses on aggregate nursing home census data. The short-term compensatory measures administrators used to comply with regulations and maintain operations may be detrimental to the long-term stability of this workforce.

Occupational Therapy Practitioners’ Implementation of Home Programs for Individuals Post Burn: An Initial Cross-Sectional Survey

Occupational therapy practitioners who care for individuals post burn often prescribe home programs to facilitate continued progress toward occupational therapy goals. This study identified the components included in home programs, how practitioners create and prescribe home programs, and perceived supports and barriers to adherence in this population. Thirty-nine practitioners employed at American Burn Association-verified centers completed an online survey. Results suggest that home programs are primarily designed to address range of motion with less emphasis on function. The highest-ranked barriers to adherence were pain and lack of motivation while the highest-ranked supports were client motivation and family/caregiver support. Practitioners reported using handouts and demonstration frequently for delivery, with infrequent use of technology. Recommendations for incorporating evidence-based strategies into home program creation and administration are included.

Typology of Dementia-Specific Care Units: A Nationwide Survey Study in Germany.

Dementia-specific care units vary in their organizational characteristics and are difficult to compare in empirical studies. Based on a representative sample of care units in German nursing homes, we present a typology of organizational characteristics focusing on dementia-specific care structures. We also examine the relationships between organizational types and the provision of nonpharmacological interventions for people with dementia. Data were collected in a Germany-wide survey of a stratified randomized sample of 134 care units using a standardized questionnaire administered during telephone interviews with nursing home administrators or their representatives. The typology was developed based on a factor analysis of mixed data and a hierarchical cluster analysis. We identified 4 types of care units: Dementia Care Units (DCUs; n = 40), Dementia Special Care Units (DSCUs; n = 17), Usual Separated Care Units (n = 58), and Usual Incorporated Care Units (n = 19). All care unit types clearly differed in their organizational characteristics. The specialization of DSCUs was agreed upon with cost bearers and included admission criteria, higher costs, and better staff conditions. Dementia Care Units without specialization did not have these characteristics. Three of seven nonpharmacological interventions were associated with the DSCUs and two with DCUs, but not with the other care unit types. Researchers can use the typology to define and describe care units in empirical studies and improve the understanding and comparability of the context. A clear definition of care units also improves international comparisons.

Decentralized Clinical Trials: Potentials for Equity in Digital Health.

The COVID-19 pandemic has rapidly increased the possibilities for conducting Decentralized Clinical Trials (DCT). This paper addresses the potential for conducting DCT in Denmark and discusses how this potential can improve equity in digital healthcare. From stakeholder interviews, we learned that DCT has the potential to be implemented, as DCT guidelines are in place in Denmark. DCT can potentially improve equal access and inclusion of diverse populations, home administration of medication, retention and compliance, and monitoring of patients and side effects. While DCT has potential in a Danish context, the challenges regarding DCT need to be considered carefully, particularly concerning equity in digital health.

Open label single arm study to assess the implementation of home based daratumumab administration in patients being treated for multiple myeloma.

TPS1609 Background: Multiple myeloma (MM) is an incurable hematologic malignancy that has a high burden of care for patients and their caregivers. Over the last two decades, the treatment landscape for MM has changed dramatically. However, treatment burden with frequent visits to offices and the hospital is high. We need innovative care delivery models to alleviate these burdens. Chemotherapy at home remains uncommon in the US, though models for its use exist globally. In these models, home-based chemotherapy is safe, preferred by patients, and can be administered at lower cost. Herein, we propose a home-based subcutaneous daratumumab and hyaluronidase-fihj (dara) program for patients with MM. We hypothesize that this program will be feasible, reduce patient treatment and financial burden, and improve quality of life. Methods: We designed an open label single arm study to assess the implementation of home administration of dara. The primary objective is to evaluate (n=20) treatment satisfaction of patients, using the Cancer Therapy Satisfaction Questionnaire (CTSQ), when they receive care at home as compared to the standard of care (SOC). Secondary outcomes include evaluating adherence to home delivery, quality of life (EORTC QLQ-30), financial burden (COST survey), safety of home administration, and barriers to home administration. At the end of the study, we will conduct semi-structured interviews to assess patient experience with home administration of chemotherapy. Patients will be eligible for study participation if they have a diagnosis of multiple myeloma, are in the monthly phase of dara treatment and are treated with either monotherapy or in combination with oral agents. All participants who are interested and eligible will be on study for 8 cycles of dara (2 cycles of dara in the infusion center (IC) followed by 4 cycles at home and then 2 cycles in the IC). During the home administration phase, 1-3 days prior, patients will go to a local lab or have at home labs. On day of at home dara, the drug will be mixed and packaged by our pharmacy, and then delivered at room temperature to the patient’s home by our home infusion courier. The patient will take pre-medications 1-3 hours prior to nurse arrival. The nurse arrives, confirm pre-medications were taken. Pre-treatment vitals and post treatment vitals will be obtained. Drug will be administered as per label instructions. At the beginning of each cycle, patient reported outcome surveys and quality of life surveys will be collected. During the home administration phase, details on barriers to maintaining adherence (i.e. issues with storage, delivery, disposal of medication) will be collected. The study opened for enrollment on November 8th, 2022. As of February 1stth 2023, 9 patients have consented and 5 patients are on-treatment. Clinical trial information: NCT05511428 .