Home-based Care Group Research Articles

Outcomes of Cancer Patients Who Seek Outpatient Visits Despite Post-chemotherapy Decline.

The medical needs of cancer patients are complex and increase with the disease's progression. However, Japan's aging population and increased medical needs have produced challenges like a shortage of hospital beds. Therefore, patients who have completed chemotherapy are recommended home-based care or referred to local palliative care facilities, especially when cancer treatment is no longer a viable option and outpatient visits become unfeasible. However, some patients still strive to continue outpatient visits, which could result in increased pain and possible urgent hospitalization. These patients may spend their final days in the hospital, which may not have been their desired outcome. Therefore, we examined the outcomes of patients who were recommended home-based care. The study population comprised 34 cancer patients undergoing treatment at the Oncology Outpatient Department of Edogawa Hospital who were recommended home-based care owing to their difficulty attending outpatient visits. Data regarding home-based care recommendations were obtained from the lists of medical social welfare interventions and hospitalized patients. Patients were classified based on whether they opted for home-based care and their caregivers' caregiving capacity. Survival was analyzed using the Kaplan-Meier curve and the log-rank test, and the groups were compared using Fisher's exact test. The median interval between the initial consultation with an oncologist and the date of recommendation for home-based care was six and a half months. Home-based care was mostly recommended because of the progression of cachexia (23 cases) and the worsening of symptoms (11 cases). The median survival for the groups with cachexia and worsening symptoms was 25 days and 35 days, respectively. Ten patients refused home-based care. Of them, six refused it because they wished to continue with outpatient visits. Of the home-based care group (24 patients), only one required an emergency room (ER) visit, while four of the non-home-based care group required ER visits. Regarding end-of-life care, 19 from the home-based care group and four from the non-home-based care group received end-of-life care at home. Additionally, one of the two patients who lived alone and two of the six patients whose caregivers were deemed to have insufficient caregiving capacity received end-of-life care at home. Of the remaining 24 patients, 22 received end-of-life care at home. The short survival period of the group with cachexia indicates that it would be beneficial for patients, their family members, and home-based care providers to facilitate earlier referral to home-based care. However, while home-based care is beneficial for patients who wish to spend their final days at home and for their family members, short-term and achievable goals, such as attending the next outpatient visit, may alleviate anxiety in cancer patients and enable them to live their daily lives without constant awareness of death. Additionally, while non-home-based care could lead to extended pain due to the lack of readily accessible medical personnel, ER visits, and hospital-based end-of-life care, home-based care can be mentally and physically strenuous for the primary caregiver. Therefore, comprehensive information about palliative care options should be provided early on during the outpatient visits of cancer patients who wish for home-based care for informed decision-making.

Assessment of a new home-based care pathway for children newly diagnosed with type 1 diabetes

AimTo compare the outcomes of home-based and conventional hospital-based care for children newly diagnosed with type 1 diabetes mellitus. MethodsA descriptive study was conducted of all children newly diagnosed with diabetes mellitus at the Timone Hospital in Marseille, France, between November 2017 and July 2019. The patients received either home-based or in-patient hospital care. The primary outcome was the length of initial hospital stay. The secondary outcome measures were glycemic control in the first year of treatment, families’ diabetes knowledge, the effect of diabetes on quality of life, and overall quality of care. ResultsA total of 85 patients were included, 37 in the home-based care group and 48 in the in-patient care group. The initial length of hospital stay was 6 days in the home-based care group versus 9 days in the in-patient care group. Levels of glycemic control, diabetes knowledge and quality of care were comparable in the two groups despite a higher rate of socioeconomic deprivation in the home-based care group. ConclusionHome-based care for children with diabetes is safe and effective. This new healthcare pathway provides good overall social care, especially for socioeconomically deprived families.

A Comparison of the Quality of Life of People With Epilepsy Receiving Home-Based and Clinic-Based Epilepsy Care Using the European Quality of Life Five-Dimension Three-Level (EQ-5D-3L) Scale.

Background and objective Epilepsy is a chronic neurological condition that, both physically and psychologically, puts a person at risk for poorquality of life (QOL). People with epilepsy (PWE) may experience shame, fear, and rejection and feel discriminated against, hence avoiding social interactions. To avoid being labeled as having epilepsy, patients may conceal their disease and refuse medical attention, which can lead to treatmentdiscontinuation and significantly impact the quality of life. Epilepsy care in India has fallen back on primary care physicians because there are not enough neurologists available to treat the condition. Home-based care (HBC) may overcome many barriers by providingfree antiepileptic drugs (AEDs), eliminating the "distance to a health facility," and providing correctinformationthat mayimprove QOL. This study is therefore conducted to compare the QOL between people with epilepsy receiving home-based care (HBC) and routine clinic-based care (CBC). Methodology The people with epilepsy enrolled in this study were already part of a community-based randomized controlled trial conducted to compare the effect of regular home-based epilepsy care with routine clinic-based epilepsy care on antiepileptic adherence among urban and peri-urban areas of Ludhiana, Punjab, India (explained further in the study). Thepresent study is a cohort study where the two cohorts, one receiving home-based epilepsy care (n = 97) and the other receiving routine clinic-based epilepsy care (n = 76), were compared for QOL at two points in time, i.e., at baseline (at enrolment) and after 24 months of receiving epilepsy care, using the European Quality of Life Five-Dimension Three-Level (EQ-5D-3L) scale. Results The mean EQ-5D-3L index scores for the HBC group at baseline were 0.88 ± 0.15, and after 24 months, the scores increased to 0.94 ± 0.17. The baseline mean index scores for the CBC group were 0.89 ± 0.21, and after 24 months, the value increased to 0.90 ± 0.19. The mean difference in QOL in the HBC group showed a higher difference than in the CBC group (0.06 ± 0.1 versus 0.01 ± 0.1), but the difference was found to be statistically not significant (p = 0.067). As per the five dimensions of the EQ-5D-3L scale, i.e., mobility, self-care, usual activities, pain/discomfort, and anxiety/depression, there was a decrease in the number of PWE reporting problems among both groups after 24 months of epilepsy care.Sociodemographic and clinical variablessuch as level of education, working status, age at the onset of seizures, frequency of seizures, treatment regimen, presence of comorbidities, and adverse drug reactions significantly affect the QOL of people with epilepsy at p < 0.05. Conclusion The results of the study emphasize that epilepsy has a negative impact on QOL. The results showed a higher QOL among the people in the HBC group as compared to the CBC group, but the difference was not statistically significant. There was an improvement in QOL from baseline after dedicated care in both groups. The problems related to mobility, self-care, usual activities, pain/discomfort, and anxiety/depression have been significantly reduced in the HBC group. Having low levels of education, not having a job, starting to have seizures at a young age, having seizures more often, receiving more than one type of treatment, and the presence of other health problems and side effects are factorsassociated with poor QOL among peoplewith epilepsy.

Head Start in Low-Wealth, Rural Communities: Evidence from the Family Life Project

ABSTRACT This study utilized data from the Family Life Project (FLP) to examine Head Start children’s school readiness skills at the end of preschool in comparison to two other care groups: home-based care and other center-based care. The FLP study enrolled a birth-cohort of 1,292 children born in two historically low-wealth, rural regions of the U.S., with oversampling of children from low-wealth families and African American families. Propensity score weighting adjusted for differences in baseline child and family characteristics between the Head Start participants and children in the two alternative care groups. Research Findings: The results indicated that the Head Start group had higher literacy skills at the end of preschool in comparison to the home-based care group (β = 0.36), but no other reliable differences emerged between these groups in school readiness skills. No reliable differences emerged between the Head Start and other center-based care groups in school readiness skills. Practice and Policy: Implications for educational practice and policy were discussed in relation to Head Start programming in rural America, including potential targets for program improvement and strategies for program expansion.

Parents' acceptance and regret about end of life care for children who died due to malignancy.

PurposeTo analyse the preference of end of life care place in paediatric oncology patients, and to understand the end of life care needs and regrets among the care givers.MethodThis was an observational qualitative study. Parents of in-curable paediatric malignancy patients who died during the years 2016–2018 were interviewed using a pre-formed open-ended questionnaire. Fears during the last phase of child’s life, most disturbing symptoms, choice of end of life care plan, regret of care givers and reasons for such choices were noted and analysed.ResultTwenty six families were interviewed. A median of 3 months of discordance was noted between declaration of in-curability and acceptance of the same by the family. During terminal months, pain (84.62%) was described as the most bothersome symptom followed by respiratory distress (73.08%). Eighteen families (69%) opted for home-based terminal care, 8 (31%) for hospital-based terminal care. Regret of choice was noted in 62.5% families of the hospital-based care group (separation from home environment being the main reason) and 38.89% of the home-based care group (lack of access to health care personnel and pain medication being the main reasons).ConclusionHome-based care is the preferred option for end of life care by the care givers. Lack of community-based terminal care support system and availability of analgesics are the main areas to work on in India.

Home Based Care as an Approach to Improve the Efficiency of treatment for MDR Tuberculosis: A Quasi-Experimental Pilot Study.

Multi Drug Resistant Tuberculosis (MDR TB) has emerged as a significant public health problem in India. The prolonged treatment duration in MDR TB is a challenge in achieving treatment completion and poses a threat to TB control in the country. Home based care is an approach accepted by patients because it helps in ameliorating their understanding of TB, improving the compliance and reducing stigma in the community. To assess the outcome of Home-Based Care (HC) versus No Home-Based Care (NHC) on the treatment of MDR TB patients registered at two chest clinics in Eastern Delhi. A quasi-experimental study was done among diagnosed MDR TB patients receiving Category IV regimen under Revised National Tuberculosis Control Programme (RNTCP) from two government chest clinics in Eastern Delhi during May 2014 to May 2016. In the control arm, 50 MDR TB patients at one of the chest clinics were offered the standard Category IV regimen under RNTCP; while in the intervention arm, 50 MDR TB patients at the second chest clinic were provided home based care (counselling, support for completion of treatment, rehabilitation, and nutritional support) along with the standard treatment. The primary outcome assessed was outcome of treatment, while secondary outcomes included stigma faced due to the disease, and impact of disease on family and community life. The primary outcome data was available for 32 (64%) participants in the intervention arm, and 38 (76%) participants in control arm. The treatment was significantly more successful in the intervention arm (p<0.03). The data on secondary outcomes was available for all participants. Stigma due to disease was significantly lower in the intervention arm (p<0.01); also rejection faced by participants from family and community due to disease was significantly lower among the HC group (p<0.05). Home-based care in MDR TB treatment holds potential in improving treatment outcomes of patient.

Interventions for helping people adhere to compression treatments for venous leg ulceration.

Chronic venous ulcer healing is a complex clinical problem that requires intervention from skilled, costly, multidisciplinary wound-care teams. Compression therapy has been shown to help heal venous ulcers and to reduce recurrence. It is not known which interventions help people adhere to compression treatments. This review is an update of a previous Cochrane review. To assess the benefits and harms of interventions designed to help people adhere to venous leg ulcer compression therapy, to improve healing and prevent recurrence after healing. In June 2015, for this first update, we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We also searched trial registries, and reference lists of relevant publications for published and ongoing trials. There were no language or publication date restrictions. We included randomised controlled trials (RCTs) of interventions that aim to help people with venous leg ulcers adhere to compression treatments compared with usual care, or no intervention, or another active intervention. Our main outcomes were ulcer healing, ulcer recurrence, quality of life, pain, adherence to compression therapy and number of people with adverse events. Two review authors independently selected studies for inclusion, extracted data, assessed the risk of bias of each included trial, and assessed overall quality of evidence for the main outcomes in 'Summary of findings' tables. One randomised controlled trial was added to this update making a total of three. One ongoing study was also identified.One trial (67 participants) compared a community-based Leg Club® that provided mechanisms for peer-support, assistance with goal setting and social interaction with home-based care. There was no clear difference in healing rates at three months (12/28 people healed in Leg Club group versus 7/28 in home-based care group; risk ratio (RR) 1.71, 95% confidence interval (CI) 0.79 to 3.71); or six months (15/33 healed in Leg Club group versus 10/34 in home-based care group; RR 1.55, 95% CI 0.81 to 2.93); or in quality of life outcomes at six months (MD 0.85 points, 95% CI -0.13 to 1.83; 0 to 10 point scale). The Leg Club may lead to a small reduction in pain at six months, that may not be clinically significant (MD -12.75 points, 95% CI -24.79, -0.71; 0 to 100 point scale, 15 point reduction is usually considered the minimal clinically important difference) (low quality evidence downgraded for risk of selection bias and imprecision).Another trial (184 participants) compared a community-based, nurse-led self-management programme of six months' duration promoting physical activity (walking and leg exercises) and adherence to compression therapy via counselling and behaviour modification (Lively Legs®) with usual care in a wound clinic. At 18 months follow-up, there were no clear differences in healing rates (51/92 healed in Lively Legs group versus 41/92 in usual care group; RR 1.24 (95% CI 0.93 to 1.67)); rates of recurrence of venous leg ulcers (32/69 with recurrence in Lively Legs group versus 38/67 in usual care group; RR 0.82 (95% CI 0.59 to 1.14)); or adherence to compression therapy (42/92 people fully adherent in Lively Legs group versus 41/92 in usual care group; RR 1.02 (95% CI 0.74 to 1.41)). The evidence from this trial was also downgraded to low quality due to risk of selection bias and imprecision.A single study compared patient education delivered via video with education delivered by text (pamphlet). However, no outcomes relevant to this review were reported.We found no studies that investigated other interventions to promote adherence to compression therapy. It is unclear whether interventions designed to help people adhere to compression therapy improve venous ulcer healing and reduce recurrence. There is a lack of trials of interventions that promote adherence to compression therapy for venous ulcers.

Fighting for food aid—the struggle to assist groups affected by HIV/AIDS

Currently a colleague and I care for about 200 chronically sick children and adults from a small home-based care group in Malawi. Because they are among the most poor and least educated people in their society these people are vulnerable and more often than not infected with HIV/AIDS. They have no income to buy food or other daily needs and they are too weak to do subsistence farming. All too often such people in Malawi are the last to be supported by food donors such as the World Food Programme and their distribution agencies. At least this is the case in and around Salima district where I work as a volunteer nurse. In 2003 under the second Joint Emergency Food Programme to Malawi the people of Salima District were beneficiaries but our patients did not receive anything. I approached Save the Children UK the distribution agency at the time and due to my advocacy for my patients 150 client households (family members and other dependants living with the patient in the same hut or house) 50 orphans and other vulnerable households led by children each received a monthly food ration for November and December of: 50 kg maize 5 kg pulses 7.5 kg soya corn blend flour and 4 L cooking oil. (excerpt)

Home based management in multiple sclerosis: results of a randomised controlled trial

Background: Home based medical care is a popular alternative to standard hospital care but there is uncertainty about its cost-effectiveness. Objectives: To compare the effectiveness and the costs of multidisciplinary...

Pilot study of a home-based asthma health education program 1,2

Objective: Caring for a child with asthma can affect the parent’s coping and well-being and coping strategies. This study examined the influence of a home-based asthma health education program on parental coping and quality of life. Design: Randomized controlled non-blinded clinical trial. Setting: Northern community pediatrician’s office. Patients: Families whose children, under the age of 11, had chronic stable asthma, and who presented to the pediatrician’s office for continuing care; those with an acute exacerbation of asthma were excluded. Interventions: Families were randomly assigned to receive either a single two-hour, standardized home-based asthma health education session or a booklet representing conventional care. Main Outcome Measures: One and three-months following the intervention, assessments were obtained for coping measured by Hymovich’s Parent Perception Inventory (PPI), quality of life measured by the Pediatric Asthma Caregiver Quality of Life Questionnaire (PACQLQ) and change in asthma measured by the Caregiver Perception of Change (CPC) survey. Results: Forty families were recruited and randomized; baseline characteristics were similar between groups. At the final follow-up, reduction in parental need for asthma information ( p=0.04), reduction in parental concerns ( p=0.02) and increased use of coping strategies ( p=0.04) were observed in the home-based care group. Improvement was noted in the parent’s perception of their child’s asthma in the home-based asthma education group ( p=0.01). Quality of life as measured by the PACQLQ remained unchanged over the intervention period ( p>0.05). Conclusions: These results suggest the use of a one-time, flexible, home-based intervention to assist families caring for children with asthma should be considered and appears effective.

Home-based care for parents with AIDS: impact on children's psychological functioning

Objective: This study explored the concept of home-based care for people living with full-blown AIDS and the impact of this on their children's psychological functioning. There were 30 children in the study whose parents had full-blown AIDS. The comparison group comprised 30 children. The parents of the children in the comparison group reported that they did not have full-blown AIDS and were not registered as AIDS patients with their community home-based care group. Method: The children's psychological functioning and performance on cognitive tasks were examined, using the Impact of Event Scale — Revised, the Secondary Traumatic Stress Scale (STSS), the Stress Symptoms Checklist, the Child Behaviour Checklist (CBCL), the British Ability Scales and Daniel and Diack's Graded Spelling Test. Result: The results of the study showed that children whose parents had full-blown AIDS showed mental distress and low cognitive performance on numerical and spelling skills. Conclusion: The findings of the study seem to suggest that although the home-based care concept is a noble and global idea, it should be accompanied by psychological support mechanisms to mitigate the effects of traumatic stress that normally follow exposure to a traumatic event. Suggestions for further research on the topic are discussed.