Home-based Health Care Research Articles

191 Exploring Perspectives on Home-Based Health Care as an Alternative to Hospital Admission After Emergency Department Treatment

191 Exploring Perspectives on Home-Based Health Care as an Alternative to Hospital Admission After Emergency Department Treatment

Preliminary study of a new home healthcare monitoring to prevent the recurrence of stroke.

We tested a new model that involves monitoring physiological parameters and the use of a rehabilitation training system to improve team-based healthcare. The system consisted of unobtrusive monitoring, a highly efficient database, and interventions by health professionals. This report discusses the core technologies, especially those involved in monitoring, which have been developed. The unobtrusive blood pressure (BP) estimation system, electrocardiogram (ECG), Kinect-based rehabilitation training system, and web-based care system, including its database, were designed and tested separately. BP was estimated with a cuffless BP monitor Estimated BP values were sufficiently accurate compared with noninvasive beat-by-beat BP values. The ECG was monitored with textile electrodes mounted on pajamas, and this allowed accurate calculation of heart rates. The training system was tested with four hemiplegic patients and garnered a high acceptance rate. The core technologies operated well, and the proposed system may prove useful and effective for home-based healthcare. Further studies are needed to evaluate the total care system.

Technological Design Considerations for Home-based Health care

The aim of this paper is to investigate the technological feasibility of integrating e-health solutions as an aid to the health monitoring of patients in their own homes. The approach taken to this task is based on system engineering from which models are produced to indicate how home-based health care may be envisaged. The model outputs indicate that electronic health methods and its associated technologies offer a future where health care remains affordable.

A wireless potentiostat for mobile chemical sensing and biosensing

Wireless chemical sensors are used as analytical devices in homeland defence, home-based healthcare, food logistics and more generally for the Sensor Internet of Things (SIoT). Presented here is a battery-powered and highly portable credit-card size potentiostat that is suitable for performing mobile and wearable amperometric electrochemical measurements with seamless wireless data transfer to mobile computing devices. The mobile electrochemical analytical system has been evaluated in the laboratory with a model redox system – the reduction of hexacyanoferrate(III) – and also with commercially available enzymatic blood-glucose test-strips. The potentiostat communicates wirelessly with mobile devices such as tablets or Smartphones by near-field communication (NFC) or with personal computers by radio-frequency identification (RFID), and thus provides a solution to the ‘missing link’ in connectivity that often exists between low-cost mobile and wearable chemical sensors and ubiquitous mobile computing products. The mobile potentiostat has been evaluated in the laboratory with a set of proof-of-concept experiments, and its analytical performance compared with a commercial laboratory potentiostat (R2=0.9999). These first experimental results demonstrate the functionality of the wireless potentiostat and suggest that the device could be suitable for wearable and point-of-sample analytical measurements. We conclude that the wireless potentiostat could contribute significantly to the advancement of mobile chemical sensor research and adoption, in particular for wearable sensors in healthcare and sport physiology, for wound monitoring and in mobile point-of-sample diagnostics as well as more generally as a part of the Sensor Internet of Things.

A randomised clinical trial of the effectiveness of home-based health care with telemonitoring in patients with COPD

We studied the effect of telemonitoring in addition to usual care compared to usual care alone in patients with chronic obstructive pulmonary disease (COPD). A total of 110 patients with moderate to severe COPD were recruited from a specialist respiratory service in Northern Ireland. Patients had at least two of: emergency department admissions, hospital admissions or emergency general practitioner (GP) contacts in the 12 months before the study. Exclusion criteria were patients who had any respiratory disorder other than COPD, or were cognitively unable to learn the process of monitoring. Patients were randomised to receive six months of home telemonitoring with usual care, or six months of usual care. The primary outcome measure was disease-specific quality of life, as measured by the St George’s Respiratory Questionnaire for COPD patients (SGRQ-C). Of 100 patients completing the study, 48 patients were randomised to telemonitoring and 52 patients were randomised to the control group. The SGRQ-C scores improved significantly in the intervention group compared to usual care (P = 0.001). The HADS anxiety score was significantly higher in the telehealth group compared to the usual care group (P = 0.01). There were significantly more contacts with the Community Respiratory Team in the telemonitoring group compared to the control group (P = 0.029). There were no significant between group differences in EQ-5D scores, HADS depression scores, GP activity, emergency department visits, hospital admissions or exacerbations. The total cost to the health service of the intervention over the 6-month study period was £2039, giving an estimated ICER of £203,900. In selected patients with COPD, telemonitoring was effective in improving health-related quality of life and anxiety, but was not a cost-effective intervention.

The level of participation during the development of a mobile care data application for home-based healthcare in a developing context: An actor-network theory perspective

The context of this study is home-based healthcare in a South African resource-restricted community. The research case involved the design and development of a mobile care data application, created to assist community caregivers in their professional activities. The development principles of a suitable application for feature phones (limited functionality) in this context are not fully established, however. For the mobile care data application, a participatory design approach was employed. It was observed, conversely, that the level of participation of all stakeholders differed significantly. It was especially observed that the designer and end-users were less involved in the actual development of the prototype. These differences may have an influence on the end product/result. Actor-network theory may provide the mechanism to describe how the human and non-human actors formed relations as they participate in these processes. Considering the alignment of such networks, the coordination, devices and passages during the four translation moments provide valuable insights in the design and development of technology products. This paper will consider these elements in more depth. With a social embeddedness perspective the level of participation was high during the design of the proposed ICT solution with the active participation of the care givers from the developing context. The socio-economic factors of the developing context influenced the development of the mobile application with the complexities of the socio-technical context evident in the difficult translations between the participants

Internet Protocol Television for Personalized Home-Based Health Information: Design-Based Research on a Diabetes Education System

BackgroundThe use of Internet protocol television (IPTV) as a channel for consumer health information is a relatively under-explored area of medical Internet research. IPTV may afford new opportunities for health care service providers to provide health information and for consumers, patients, and caretakers to access health information. The technologies of Web 2.0 add a new and even less explored dimension to IPTV’s potential.ObjectiveOur research explored an application of Web 2.0 integrated with IPTV for personalized home-based health information in diabetes education, particularly for people with diabetes who are not strong computer and Internet users, and thus may miss out on Web-based resources. We wanted to establish whether this system could enable diabetes educators to deliver personalized health information directly to people with diabetes in their homes; and whether this system could encourage people with diabetes who make little use of Web-based health information to build their health literacy via the interface of a home television screen and remote control.MethodsThis project was undertaken as design-based research in two stages. Stage 1 comprised a feasibility study into the technical work required to integrate an existing Web 2.0 platform with an existing IPTV system, populated with content and implemented for user trials in a laboratory setting. Stage 2 comprised an evaluation of the system by consumers and providers of diabetes information.ResultsThe project succeeded in developing a Web 2.0 IPTV system for people with diabetes and low literacies and their diabetes educators. The performance of the system in the laboratory setting gave them the confidence to engage seriously in thinking about the actual and potential features and benefits of a more widely-implemented system. In their feedback they pointed out a range of critical usability and usefulness issues related to Web 2.0 affordances and learning fundamentals. They also described their experiences with the system in terms that bode well for its educational potential, and they suggested many constructive improvements to the system.ConclusionsThe integration of Web 2.0 and IPTV merits further technical development, business modeling, and health services and health outcomes research, as a solution to extend the reach and scale of home-based health care.

A Support Programme for Caregivers of Children with Heart Disease in Rural Namibia

The majority of children suffering from heart disease in Namibia receive treatment as outpatients, with their caregivers taking responsibility for their continuing care. To provide the care required by these children, the caregiver has to remain vigilant. Many of these children live in rural areas and their caregivers may have only a limited educational background, as well as limited financial resources, as they depend on subsistence agriculture for a living. The development of the support programme discussed in this article originated from the results of a qualitative, exploratory, phenomenological study that addressed the issue of how these caregivers managed this responsibility. The findings of this study revealed that the caregivers generally had poor coping experiences. Subsequently, these findings formed the basis for the proposal about a support programme for the rural caregivers of children with heart disease in Namibia. As part of the study, interventions for home-based health care were developed, implemented and evaluated in order to facilitate the caregiver’s coping with the demands of home care. The findings of an outcomes evaluation indicated that the caregivers’ knowledge of the child’s condition, as well as the skills for providing care at home and the information about community-based resources that could provide them with support to cope, increased. If the programme were to be extended to other families in similar contexts, the programme interventions could make a difference in terms of their coping with the demands of care. This paper describes the implementation process involved in a home-based health care programme intervention of the study, and the subsequent outcomes of the programme evaluation.

Privacy and information security risks in a technology platform for home-based chronic disease rehabilitation and education.

BackgroundPrivacy and information security are important for all healthcare services, including home-based services. We have designed and implemented a prototype technology platform for providing home-based healthcare services. It supports a personal electronic health diary and enables secure and reliable communication and interaction with peers and healthcare personnel. The platform runs on a small computer with a dedicated remote control. It is connected to the patient’s TV and to a broadband Internet. The platform has been tested with home-based rehabilitation and education programs for chronic obstructive pulmonary disease and diabetes. As part of our work, a risk assessment of privacy and security aspects has been performed, to reveal actual risks and to ensure adequate information security in this technical platform.MethodsRisk assessment was performed in an iterative manner during the development process. Thus, security solutions have been incorporated into the design from an early stage instead of being included as an add-on to a nearly completed system. We have adapted existing risk management methods to our own environment, thus creating our own method. Our method conforms to ISO’s standard for information security risk management.ResultsA total of approximately 50 threats and possible unwanted incidents were identified and analysed. Among the threats to the four information security aspects: confidentiality, integrity, availability, and quality; confidentiality threats were identified as most serious, with one threat given an unacceptable level of High risk. This is because health-related personal information is regarded as sensitive. Availability threats were analysed as low risk, as the aim of the home programmes is to provide education and rehabilitation services; not for use in acute situations or for continuous health monitoring.ConclusionsMost of the identified threats are applicable for healthcare services intended for patients or citizens in their own homes. Confidentiality risks in home are different from in a more controlled environment such as a hospital; and electronic equipment located in private homes and communicating via Internet, is more exposed to unauthorised access. By implementing the proposed measures, it has been possible to design a home-based service which ensures the necessary level of information security and privacy.

Social Costs and Benefits of Community Home Based Health Care (CHBHC) Delivery System in Roma Valley, Lesotho

This study investigated the costs and benefits of community home-based caregivers in Roma Valley Lesotho. It made use of a population that consists of health professionals at St. Joseph hospital, village chiefs and caregivers in the villages, from where a sample size of 20 interviewees was selected to respond to the interviews. The study revealed mixed feelings of costs and benefits from this unique health care system on the care givers, the care recipients and the relatives of the care recipients. While the care givers are happy that they contribute to their society, their services also present some costs to them and their family. They experience challenges, which include disputes with their families due to non-remunerated work that they do. Emerging from the findings, this study suggests formulation of a social policy that will govern the system and other government's political and material supports to sustain the programme.

Social Costs and Benefits of Community Home Based Health Care (CHBHC) Delivery System in Roma Valley, Lesotho

This study investigated the costs and benefits of community home-based caregivers in Roma Valley Lesotho. It made use of a population that consists of health professionals at St. Joseph hospital, village chiefs and caregivers in the villages, from where a sample size of 20 interviewees was selected to respond to the interviews. The study revealed mixed feelings of costs and benefits from this unique health care system on the care givers, the care recipients and the relatives of the care recipients. While the care givers are happy that they contribute to their society, their services also present some costs to them and their family. They experience challenges, which include disputes with their families due to non-remunerated work that they do. Emerging from the findings, this study suggests formulation of a social policy that will govern the system and other government's political and material supports to sustain the programme.

A sustainable and affordable support system for rural healthcare delivery

In developing countries, especially where a large proportion of the population still resides in rural areas, healthcare access and delivery are often poor, and can potentially benefit from innovative service models and supporting technologies. In these rural areas, the challenges of healthcare quality are many, ranging from poor infrastructure, low literacy, poverty, to inadequate monitoring of patients with chronic or serious diseases. The myriad of challenges requires innovative solutions that are affordable, robust and sustainable over time. Furthermore, due to special characteristics of such rural areas and their inhabitants, any healthcare solution should embed a decision support mechanism to prevent basic medical errors and negligence. In this article, we first discuss a healthcare delivery model (home-based healthcare) in displaced rural areas of South Africa, and then we propose a patient monitoring system for supporting the model using Unstructured Supplementary Service Data (USSD) technology. The proposed system is decision support driven in that it supports medical staff (nurses, doctors) to decide on the course of intervention or further treatment based on the vital signs of the patients that are tele-monitored on a regular basis. This patient monitoring system facilitates patient information flow from home-based care workers to a local clinic or hospital, where the information is presented on a desktop computer used by clinic nurses and doctors for monitoring the patients' health and ultimately speeding up decision making. The proposed system is tested through a prototype, which is applied in practice and generates data for evaluation.

Empowerment of the rural parents/caregivers of children with heart diseases in Namibia to facilitate coping with the demands of caring at home.

Aim:The purpose of this study was to describe how the parents/caregivers of children with heart diseases cope with the demands of caring for these children at home, with the purpose to develop a home-based health care programme to facilitate the parents/caregivers’ coping with the demands of care.Methods:A qualitative, exploratory, descriptive, and contextual study was conducted. Phenomenological data on the lived experiences of coping with the demands to care by the parents/caregivers and of living with the burden of the disease by the children were gathered and interpreted from a purposefully selected sample of 5 multiple cases of parents/caregivers and children with heart disease from the rural areas.Results:The findings have revealed poor coping with the demands of caring among the parents/caregivers, as characterized by the experiences of emotional challenges, disruptive social functioning and social relations, lack of support from the family and societal organizations, financial difficulties and of course the experiences of decreased vitality by the children. As a result, the need to empower the parents/caregivers for them to cope with providing a continuum care to their children who have heart disease was identified. The dynamics to mitigate the negative experiences were conceptualized. Therefore, the interventions of a home-based health care programme as an interface to facilitate the parents/caregivers to cope with the challenges caused by the demands to care were developed.Conclusions:The need for empowerment of these parents/caregivers can be met through the implementation of multi-component interventions, which draw together all the possible determinants factors and the coping methods to facilitate coping.

Socio-technical approach to community health: designing and developing a mobile care data application for home-based healthcare, in South Africa

Socio-technical interaction deals with the understanding of human behaviour in technology-mediated settings. In this research, home-based healthcare was selected as the case and the focus for the development of the practical application was on the needs of care givers. Service design methods were used to obtain a better understanding of the care givers’ needs where they were active participants in this process. The insights gained from the co-design, co-development and co-implementation approach contributed to the understanding of socio-technical design and development considerations applicable to the development of mobile health care applications for the benefit of South African Home-based Health care workers and the communities they serve.

Empowering mothers as household health workers

Description of the problem: Physical inaccessibility along with lack of awareness has been one of the main constraints to health service delivery in Arunachal Pradesh. Lack of adequate trained health manpower aggravates the situation. With the road density in 2001 of only 17.3 km per 100 sq km of area as against the national average of 82 km and 26.5% population living with had no road connectivity at all, [1] health infrastructure development has been slow and service delivery highly constrained. This has been aggravated by only 700 doctors and 900 nurses [2] , who too are unwilling to serve in remote areas. Methods: The Government of Arunachal Pradesh started the Public-Private Partnership (PPP) project as a part of NRHM in 2006 and outsourced the management of one Primary Health Centers in each of the 16 districts to Non-Governmental Organizations. The one at Sille in East Siang district is being managed by Future Generations Arunachal (FGA). With the premise that empowering the mothers to take care of their own health has the potential to dramatically improve the health status of the communities in inaccessible parts of Arunachal Pradesh, a pilot project entitled Mothers’ Training was carried out from May 2009 to April, 2011. The idea was to train one woman from each household in the catchment areas of the PHC. Each month, one woman from each of the six main villages in the catchment area was selected and was trained on basic home-based health care for a month. The training method consisted of one-hour talk on health issue everyday and involving the trainees in the works in the PHC the rest of the day. The outcome was measured with various health indicators in the PHC. Main findings : Dramatic improvements in health care indicators, especially those related to health behavior, were noted. Outpatient attendance dropped from 10543 in 2008 to 6838 in 2011. Similarly, total antenatal registration dropped from 269 in 2008 to 149 in 2011. However, percentage of pregnant women registering themselves in the ante-natal clinics in the first trimester increased from 39.4% in 2008 to 69.1% in 2011. There was also an increase in institutional deliveries from 33.8% in 2008 to 44.9% in 2011. In 2008, 5742 slides were collected for tests for malarial parasite whereas it was only 2122 in 2011. No death due to malaria has been reported whereas the disease was a major cause of mortality in the area earlier. Since posting of qualified personnel in the remote areas has been a major hurdle to health service delivery in Arunachal Pradesh, it is recommended that the existing health facilities like PHCs, CHCs and District Hospitals be used as community training centers on health so that they can participate in the health care delivery works of the government. This will not only improve the health status of the communities but also imbibe a sense of ownership in the health care process. Since the existing infrastructure and manpower will be utilized, this can be accomplished with minimal additional resource inputs. Conflict of Interest Statement : None Funding Source : Public-Private Partnership project funded by NRHM, Government of India and government of Arunachal Pradesh with additional funding by Future Generations, USA for Mothers’ Training program. [1] Arunachal Pradesh Public Works Department, Government of Arunachal Pradesh,1997. [2] There are 64 specialists, 512 allopathic doctors, 124 AYUSH doctors, 386 staff nurses and 548 ANMs as per the records in the Department of Health & Family Welfare, Government of Arunachal Pradesh.

Migrant Workers in Home Care: Routes, Responsibilities, and Respect

We consider the increasingly common provision of home-based health care by migrant care workers. In particular, we explore the racial division of paid reproductive care and ideas about embodied work to show that although (im)migrants tend to fall to the bottom of the hierarchy of care work, the reasons are multifaceted and complex. We draw on interview data from a larger study of long-term home care in Ontario to explore the lived experience of care work by migrant workers, emphasizing their social agency. We organize our discussion around the themes of routes, responsibilities, and respect and emphasize the embodied and power-inflected care work relation. Through these themes we explore the different routes the migrants took into care work—how they found their jobs and what role those jobs play in their lives. Then we address the responsibilities of different home care jobs and the relational dynamic of how job responsibilities are actually practiced. Finally, the theme of respect examines how the workers try to treat their clients with dignity but sometimes the work relation is marked by racism and friction over what counts as “good” care. We show that care work is constructed and experienced through a complex interweaving of embodiment, labor market inequalities, and the province's regulatory mechanisms of care provision.

On participatory design of home-based healthcare

Participatory design (PD) activities in private homes challenge how we relate to the PD process, compared to PD in professional settings. Grounded in a project related to chronic dizziness among older people, we identified four challenges when performing PD with ill, weak users in their private homes. The challenges are (1) designing for, and negotiating knowledge about, the home, (2) ill, weak users and their participation in PD, (3) divergent interests of participants and (4) usable and sustainable post-project solutions. These challenges have to be carefully addressed, and we use them to reflect upon differences between a home-based PD process with non-workers, such as ours, and work-place projects, such as Utopia. Through this reflection, the paper contributes to a more general discussion on PD in non-work settings with weak users. Indeed, differences do exist between traditional PD projects in work settings, such as Utopia, and home-based PD with weak users especially in relation to knowledge about settings and how to reconcile differences in interests. The home as a place for (technology-assisted) treatment and PD must be carefully analyzed. Diverse interests and roles as well as possibilities for post-project solutions should be negotiated among all stakeholders.

At-home 2.0 – an educational framework for home-based healthcare

This paper intends to describe some of the primary social and cultural dynamics in South African home-based healthcare, using ethnographic case study material and design methodology. This constitutes a detailed narrative of the “care experience” in a poor community, emphasising the needs of and barriers to educational information, particularly concerning caregivers. In reaction to this context, a collaborative training model – AT-HOME 2.0 – emerges through design intervention. This is foreseen as a basic framework whereby caregivers (are encouraged to) develop educational content via information and communication technologies (e.g. mobile phones and social media). Such content can and may include experiences, suggestions, and guidelines that are relevant to the practice of caregiving. ATHOME 2.0 will conceptually – and in some cases practically – demonstrate how educational content may be generated, published, and disseminated in the sphere of home-based healthcare.

Datapoints: Psychotropic Drug Use Among Elderly Patients in Home Care in the United States

Back to table of contents Previous article Next article ColumnsFull AccessDatapoints: Psychotropic Drug Use Among Elderly Patients in Home Care in the United StatesVishal Bali, M.S., Satabdi Chatterjee, M.S., and Rajender R. Aparasu, Ph.D.Vishal BaliSearch for more papers by this author, M.S., Satabdi ChatterjeeSearch for more papers by this author, M.S., and Rajender R. AparasuSearch for more papers by this author, Ph.D.Published Online:1 Jan 2012https://doi.org/10.1176/appi.ps.2012000p6AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail An estimated 1.5 million persons in the United States receive home-based care involving a range of therapeutic and medical services (1). Most patients who receive home-based health care are elderly, with various levels of functional impairment. Although psychotropic medications are extensively used in the elderly population, limited data exist on the psychotropic needs of elderly home health patients.Psychotropic medication use was examined among elderly home health care patients age 65 and older by using the 2007 National Home and Hospice Care Survey (NHHCS), a national survey of U.S. home health and hospice agencies (2). Patient data for the NHHCS were obtained from interviews with designated agency staff members, who provided information from medical and medication administration records. Descriptive statistics, including 95% confidence intervals (CIs), were used to examine prevalence patterns of psychotropic drug use.More than a half million of the elderly home health care patients received at least one psychotropic agent—.54 million patients (CI=.50–.58) or 53.52% of the elderly patients (CI=50.60–56.44). As shown in Figure 1, antidepressants were the most frequently prescribed psychotropic agents (33.51%, CI=30.71–36.31), followed by sedatives-hypnotics-anxiolytics (30.65%, CI=27.96–33.34), mood stabilizers (9.87%, CI=8.15–11.59), and antipsychotics (7.55%, CI=6.08–9.03). Selective serotonin reuptake inhibitors (SSRIs) were the most frequently prescribed antidepressants (21.83%, CI=19.39–24.28), and benzodiazepines constituted a majority of the sedatives-hypnotics-anxiolytics prescribed (21.30%, CI=18.93–23.68).This study found that the overall prevalence of psychotropic use among elderly home health care patients was 54%, nearly 10 percentage points less than psychotropic use in nursing homes (63%) (3). The high prevalence of psychotropic use among home health care patients was mainly driven by the use of SSRIs and benzodiazepines. Given the inappropriate use of psychotropic agents among elderly patients and the poor health status of those receiving home health care, there is a need to monitor use of psychotropic drugs in this vulnerable population.The authors are affiliated with the Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Houston, TX 77030 (e-mail: [email protected]edu). Amy M. Kilbourne, Ph.D., M.P.H., and Tami L. Mark, Ph.D., are editors of this column.Acknowledgments and disclosuresThe authors report no competing interests.References1 Caffrey C , Sengupta M , Moss A , et al.: Home Health Care and Discharged Hospice Care Patients: United States, 2000 and 2007. National Health Statistics Reports, 38. Hyattsville, Md, National Center for Health Statistics, 2011 Google Scholar2 2007 National Home and Hospice Care Survey and National Home Health Aide Survey. Atlanta, Ga, Centers for Disease Control and Prevention, 2007. Available at www.cdc.gov/nchs/data/nhhcsd/NHHCS_NHHAS_web_documentation.pdf Google Scholar3 Bhattacharjee S , Karkare SU , Kamble P , et al.: Psychotropic drug utilization among elderly nursing home residents in the United States. Psychiatric Services 61:655, 2010 Link, Google ScholarFigures and TablesFigure 1 Psychotropic medication use among elderly home health care patients in 2007 FiguresReferencesCited byDetailsCited ByEuropean Geriatric Medicine, Vol. 8, No. 1 Volume 63Issue 1 January 2012Pages 6-6 Metrics Acknowledgments and disclosuresThe authors report no competing interests.PDF download History Published online 1 January 2012 Published in print 1 January 2012

Impact of a Multidisciplinary, Home-Based Health Care Program Versus Usual Care for Privately Insured Cardiac Patients

Impact of a Multidisciplinary, Home-Based Health Care Program Versus Usual Care for Privately Insured Cardiac Patients