Home-based Services Research Articles

Palliative Care in the Midst of Adversity: Insights from a Low-Income Country.

The integration of palliative care into conventional healthcare services has demonstrated significant benefits in alleviating serious health-related suffering (SHRS), reducing symptom burden, and lowering healthcare expenditure for patients and families. Despite Lebanon's initial steps towards palliative care development, its integration remains inadequate, particularly due to the country's socio-political and economic challenges. This paper examines the current landscape of palliative care services in Lebanon, including their geographical distribution and care models, while addressing the obstacles impeding their progress. Data on palliative care services were gathered from the presentations of stakeholders at the 2023 National Palliative Care Conference. Currently, three nonprofit organizations provide home-based palliative care primarily for end-of-life patients, while seven hospitals offer palliative care through inpatient consultation teams, three of which have specialized palliative care wards and two outpatient clinics. Hospital-based palliative care services are primarily located in the capital city Beirut and operate within private healthcare facilities. Notably, only home-based services are provided free of charge, while hospital-based care is not reimbursed, thus limiting access to palliative care for only those who can afford it. The political and economic instability, inadequate policies and insufficient reimbursement, shortage of trained expertise and essential medicines like morphine, and inconsistent health education are some of the challenges that Lebanon faces in developing palliative care. A multilevel coordinated response and advocacy are crucial to drive policy reforms, enhance education, promote public awareness, and improve clinical practice ensuring quality and equitable palliative care access to all.

Features and Differences in Core Symptom Clusters in Home-Based Hospice Patients With Advanced Cancer: A Network Analysis.

Patients with terminal-stage cancer frequently experience multiple symptoms simultaneously. Little is known about how core symptom clusters differ in advanced-cancer patients with different survival expectancies receiving hospice care. To identify the core symptom clusters of hospice-care cancer patients with different survival expectancies and compare the features of their symptom networks. In this retrospective study, secondary data analysis was conducted. Records of 6946 patients with advanced cancer who received home-based hospice care service in a hospice center from April 2001 to December 2020 were collected and analyzed using network analysis. This analysis included 6946 patients with advanced cancer receiving hospice care. In patients with survival expectancies of 0-6 months, loss of appetite was identified as the core symptom (rs = 4.03, rb = 5.21, rc = 2.63), and five symptom clusters were identified. Malnutrition was the core symptom in patients with survival expectancies of 6-12 months (rs = 2.83, rb = 2.43, rc = 0.93), and nine symptom clusters were identified. Wasting syndrome was the core symptom cluster in two groups. The network density of symptoms in patients with < 6 months of survival expectancy (91.99) was higher than in patients with 6-12 months (28.39). Nutrition impact symptoms are the core symptoms for home-hospice care cancer patients with a survival period of 1 year or below. Moreover, hospice cancer patients with short survival expectancies have greater inter-symptom impact.

Video consultations among registered nurses in public sector and associated factors

Abstract Background In digital health services, including services for older people, video consultations can enhance access to care while enabling interaction through audio and visual means. Registered nurses are pivotal in digital care delivery and there is a need for more understanding regarding the use of video consultations in nursing. This study aims to examine factors associated with nurses’ video consultations in the public sector. Methods The Finnish ‘Survey on information systems for registered nurses’ was delivered for registered nurses in March 2023. The respondents were asked whether their work had included video consultations in the past six months. Binary logistic regression was used to examine if career stage and digital skills (basic IT-skills, proficiency in data security, skills in digital working environments) were associated with nurses’ video consultations, adjusted for working unit and location of employment. Results The study included 2,525 public sector nurses (92.7% female, mean age 47.34, SD 10.47). Of them, twelve percent had used video consultations with patients. Most nurses used video consultations in outpatient units (63.3%), whereas they were less used among those working in acute care (3.3%), housing services (3.3%) and home-based services (8.2%). Early-career nurses had lower odds (OR .38, 95% CI .19-.73) of video consultations compared to mid-career nurses. Nurses who had good skills in working in digital environments (OR 2.07, 95% CI 1.26-3.39) had greater odds of video consultations than those with poorer skills. Conclusions The study suggests a limited adoption of video consultations among public sector nurses, particularly among early-career professionals. Increasing targeted support and training, and the availability of tools for various patient service needs in video consultations, are needed. By recognizing the importance of nurses’ digital skills, digital care delivery could be enhanced and potential public health benefits promoted. Key messages • Relatively few registered nurses used video consultations in the public sector. More research is needed to explore if their usage could be increased safely for patients, also in early nursing careers. • Proficiency in digital work environments is imperative for ensuring the quality of care in video consultations. Therefore, collaborative efforts are required to enhance professionals’ digital skills.

Home-based care services for elderly dependent adults. A comparative analysis of Madrid and Stockholm

This article analyses the situation of the Home Care Service in the two European cities of Madrid and Stockholm. There are significant differences in the development of this service in these cities which can explained by their diverse welfare models. At the same time, they also show similar trends, such as an ageing population and new demands by the elderly. The text focuses on the evolution of the service in three different dimensions: governance, working conditions and the tendering/monitoring system. The analysis is based on qualitative research, showing the predominant discourses among the key actors involved in the design and provision of the service. The results reveal the urgent need to redefine this service to respond to the new demands of the elderly as well as the changing regulatory frameworks.

Translating acceptability to sustained delivery: Clinician and manager perspectives on implementing modified constraint-induced movement therapy in an early-supported discharge rehabilitation service.

Modified constraint-induced movement therapy (mCIMT) improves upper limb (UL) function after stroke. Despite up to one-third of stroke survivors being eligible, clinical uptake remains poor. To address this, a multi-modal behaviour change intervention was implemented across a large seven-site early-supported discharge (ESD) rehabilitation service. This study investigated the acceptability of mCIMT implementation within this ESD service and identified adaptations required for sustained delivery. This qualitative study was nested within a mixed-methods process evaluation of mCIMT implementation. Four focus groups (n= 24) comprising therapists (two groups), therapy assistants (one group), and allied health managers (one group) were conducted. Data were analysed using reflexive thematic analysis and mapped to the Theoretical Domains Framework (TDF). Consumers were not directly involved in this study; however, lived experience research partners have helped shape the larger mixed-methods implementation study. Four themes were generated and mapped to the TDF. Factors related to acceptability included interdisciplinary practice in sharing workloads (belief about capabilities), practice opportunities across a range of UL presentations (skills), clinician attitudes influencing patient engagement (optimism), time constraints (belief about consequences), and cognitive overload from multiple systems and processes (memory, attention, and decision-making processes). Factors facilitating sustained delivery included improving stroke survivor education (knowledge), sharing success stories across teams (reinforcement), manager facilitation (social/professional role and identity), and the perception that the ESD setting was optimal for mCIMT delivery (social influences). mCIMT was acceptable in the ESD service, with clinicians feeling a responsibility to provide it. Key adaptations for sustained delivery included ongoing training, resource adaptation, and enhanced patient and carer engagement. Successful implementation and sustained delivery of mCIMT in the ESD service could enhance UL function and reduce the burden of care for potentially hundreds of stroke survivors and their carers. Modified constraint-induced movement therapy (mCIMT) helps improve arm movement after a stroke. However, many stroke survivors do not get this therapy. To fix this, we started a program in a large home-based rehabilitation service. This study looked at how well mCIMT could fit into this service. We also wanted to know what changes were needed to make sure it was regularly provided. We held four group discussions with therapists, therapy assistants, and health managers. A total of 24 people took part. From these discussions, we found several important points. Therapists needed to work together as a team. They also needed to practice mCIMT to get better at delivering it. Therapists having a positive attitude would encourage more stroke survivors to take part. For long-term success, stroke survivors need better education about mCIMT. Managers need to encourage therapists to provide mCIMT. The rehabilitation service should also share their success stories about this therapy to encourage therapists to deliver it and stroke survivors to ask for it. Therapists enjoyed delivering mCIMT in the rehabilitation service. It worked better than other therapies to improve a stroke survivor's arm function. Because of this, they also felt it was their duty to offer mCIMT. Having ongoing training and better resources would help keep mCIMT going. If mCIMT can be provided regularly in this service, it could lead to better arm function and less care needed for many stroke survivors and their carers.

Exploring the patients' and family members' perspectives on home-based palliative care.

Healthcare at home is considered a partial substitute for institutional long-term care, because patients and families with known poor prognoses prefer to stay home with their loved ones and are unable to pay for hospital care at the end of life in some countries. To explore patients' and family members' perspectives and experiences of receiving home-based palliative care services. This was a qualitative exploratory study conducted in Karachi, targeting patients and family members receiving home-based palliative care services. The data collection was done via interviews, and simultaneously, the interviewer recorded field notes, which were all carried out within the confines of the participants' homes. Moreover, the subjects were recruited through purposive sampling, resulting in a total of six patients and six family members. The final number of participants was determined based on data saturation. The inclusion criteria encompassed individuals of all genders, aged 18 and above, and residents of Karachi, Pakistan. Those who were not able to provide information, due to any reason, were excluded from the study. The study adhered strictly to ethical considerations. The study uncovered several significant themes that provide valuable insights, including caregivers' availability, patients' inclusiveness, improved dietary pattern, psychological wellbeing, and rapid recovery in home-based care. Furthermore, the study identified themes on providing home-based palliative care, like family members' education and keeping back-ups for unforeseen situations. In contrast, the themes identified as home-based care preference over hospital care were: experienced compromised care, hospital anxiety, restricted to the available resources and higher hospital living expenses for patients and family members. The study underscored the importance of adopting a patient-centric approach. It has become evident that the comfort and familiarity of one's home environment provide a conducive backdrop for holistic healing and wellbeing.

SURVEY ON CAREGIVERS' BURDEN OF CARE PATIENTS WITH CHRONIC STROKE AND CONSIDERATIONS ON THE ROLE OF THEPHYSIOTHERAPIST

Background: Therole of caregivers in the rehabilitation process is crucial, yet the impact of caregiving on their well-beingis not fully understood.This study aims to analyze the psycho-physical load on caregivers of chronic stroke patients, evaluate the variables affecting their health, and assess the significance of physiotherapists in improving patient rehabilitation outcomes. Materials: A sample of 30 chronic strokepatients and their caregivers involving home-based rehabilitation services was examined over eight weeks. The study utilized various scales such as the Short Form Health Survey 36 (SF-36), Barthel Index, Stroke Impact Scale 3.0, Modified Rankin Scale, and Caregiver Burden Inventory to assess the health status of patients and the burden on caregivers before and after the intervention. Results: The study found significant improvements in patient health metrics (SF-36, Barthel Index, Stroke Impact Scale, Modified Rankin Scale) post-rehabilitation. Similarly, a notable reduction in caregiver burden was observed, highlighting the effectiveness of targeted physiotherapy interventions in alleviating the psycho-physical stress on caregivers.

Study of Anxiety Among Older People in Kazakhstan and Factors Affecting This Indicator

&lt;b&gt;Aim:&lt;/b&gt; The purpose of this research was to study of anxiety among older people in Kazakhstan and factors affecting this indicator.&lt;br /&gt; &lt;b&gt;Methods:&lt;/b&gt; A cross-sectional survey was conducted with 221 randomly selected elderly people from different regions of Kazakhstan. The survey covered questions of socio-demographic type and also used the GAD-7 (Generalized Anxiety Disorder-7).&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; The majority of participants showed low levels of anxiety on the test. Nevertheless, a significant proportion of older adults experienced mild and moderate anxiety, accounting for 33% and 23.1%, respectively. The analysis showed that age (OR = 0,852, 95% CI: 0,779-0,931, p &amp;lt; 0,001), gender (OR = 8,167, 95% CI: 3,232-20,642, p &amp;lt; 0,001), level of education (OR=9,928, CI 95%: 3,760 - 26,212, p &amp;lt; 0,001) and living conditions (OR=0,167, 95% CI: 0,060-0,467, p = 0,001) have a statistically significant impact on the anxiety level of this population group.&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt;&lt;b&gt; &lt;/b&gt;The results of the analysis confirm the importance of developing and implementing a set of measures aimed at improving the quality of life of older people, taking into account the individual characteristics and needs of each person. The following measures can be suggested to improve the quality of life of older persons: organize social activity and community involvement programs through clubs and activities; establish accessible health and social service centers where older persons can receive qualified care; use technology, such as mobile applications and smart devices, to facilitate daily life, including telemedicine and home-based services.

The Role of Dosage and Family Profiles in a Child Welfare Home Visiting Program

Abstract Background Among the different modalities of family support, home visiting programs have proved to be one of the most effective secondary prevention models for families involved in child welfare services. Despite the promising outcomes and the extensive available literature, further research is needed to investigate target population characteristics and implementation factors that may explain the heterogeneity in the outcomes of these programs for families receiving child welfare services. Objective This longitudinal study explored the role of dosage and family characteristics related to the effectiveness of the Family Intervention Program (FIP), which is a home-based Spanish child welfare service for supporting families at psychosocial risk. Method To this end, a quasi-experimental design was followed, including a time-series evaluation of the 289 families receiving the FIP. In order to examine the impact of the FIP, the evolution of child well-being (CWB) was evaluated with Child Well-Being Scales every 6 months. Results The results showed that the highest average CWB score was observed after 39 months of intervention, observing no improvements in CWB from that point. Similarly, the results showed that the FIP was more effective for single parent families at higher socioeconomic levels. Conclusions This article provides new knowledge for the understanding of home visiting programs success, concluding that the programs are not equally effective for all family profiles, and that it is necessary to adjust each program to the specific characteristics of the target population.

Improving access to tuberculosis preventive treatment for children in Ethiopia: designing a home-based contact management intervention for the CHIP-TB trial through formative research

BackgroundTuberculosis (TB) preventive treatment (TPT) is a long-standing recommendation for children exposed to TB but remains poorly implemented. Home-based contact management may increase access and coverage of TPT among children exposed to TB in their households.MethodsSixty in-depth interviews were conducted with key informants including program managers, TB providers (known as TB focal persons), health extension workers and caregivers whose children had recently engaged with TB prevention services in Oromia, Ethiopia in 2021 to understand the barriers and facilitators to providing home-based TB prevention services for children aged < 15 years. Thematic content analysis was conducted including systematically coding each interview.ResultsHome-based services were considered a family-centered intervention, addressing the time and financial constraints of clients. Stakeholders proposed a task-shared intervention between health extension workers and facility-based TB focal persons. They recommended that TB services be integrated into other home-based services, including HIV, nutrition, and vaccination services to reduce workload on the already overstretched health extension workers. Community awareness was considered essential to improve acceptability of home-based services and TPT in general among community members.ConclusionsDecentralization of TPT should be supported by task-sharing initiation and follow up between health extension workers and facility-based TB focal persons and integration of home-based services. Active community engagement through several existing mechanisms can help improve acceptability for both home-based interventions and TPT promotion overall for children.Trial registrationThe results presented here were from formative research related to the CHIP-TB Trial (Identifier NCT04369326) registered on April 30, 2020. This qualitative study was separately registered at NCT04494516 on 27 July 2020.

Predicting place of death of patients with advanced cancer receiving home-based palliative care services in Iran

BackgroundWhile home is frequently expressed as the favorite place of death (PoD) among terminally ill cancer patients, various factors affect the fulfillment of this wish. The determinants of the PoD of cancer patients in countries without healthcare system-integrated palliative and supportive care have not been studied before. This study aimed at identifying the predictors of the PoD of patients who suffer from advanced cancer by developing a reliable predictive model among who received home-based palliative care in Iran as a representative of the countries with isolated provision of palliative care services.MethodsIn a cross-sectional study, electronic records of 4083 advanced cancer patients enrolled in the Iranian Cancer Control Center (MACSA) palliative homecare program, who died between February 2018 and February 2020 were retrieved. Multivariable binary logistic regression analysis as well as subgroup analyses (location, sex, marital status, and tumor topography) was performed to identify the predictors of PoD.ResultsOf the 2398 cases included (mean age (SD) = 64.17 (14.45) year, 1269 (%52.9) male), 1216 (50.7%) patients died at home. Older age, presence and intensity of medical homecare in the last two weeks and registration in the Tehran site of the program were associated with dying at home (P < 0.05). Gynecological or hematological cancers, presence and intensity of the calls received from the remote palliative care unit in the last two weeks were predictors of death at the hospital (p < 0.05). The model was internally and externally validated (AUC = 0.723 (95% CI = 0.702–0.745; P < 0.001) and AUC = 0.697 (95% CI = 0.631–0.763; P < 0.001) respectively).ConclusionOur model highlights the demographic, illness-related and environmental determinants of the PoD in communities with patchy provision of palliative care. It also urges policymakers and service providers to identify and take the local determinant of the place of death into account to match the goals of palliative and supportive services with the patient preferences.

“I Figured It Might Be Because We Are Rural”: A Qualitative Study of Barriers and Opportunities Related to Home-Based Personal Assistance Services

Personal care assistance (PCA) provides vital support so rural disabled people and older adults can live in their communities. Currently, the state of home and community-based services in the United States is dire, with major shortfalls in access and utilization of these services. Moreover, little is known about the experiences of people living in rural areas who need paid, in-home assistance with activities of daily living. Because rural areas are often underserved and under-resourced, this study aimed to understand the experiences of rural users of personal care assistance services to inform the development of a training for rural people. Between February and November of 2021, 38 semi-structured qualitative interviews were conducted with 40 self-identified rural-dwelling people across the United States who use paid PCAs. Interview topics included finding, hiring, and training workers; worker qualities; and how living in a rural place impacted PCA services. Using thematic coding, results highlight how rurality intersected with participants’ daily experiences. Respondents identified 3 barriers to getting PCA services: (1) lack of transportation and travel distance, (2) worker shortages, and (3) fewer local community services; and one facilitator of obtaining PCA services: strong community connection. Additionally, some aspects of rural culture—such as valuing a slower pace of life, independence, and rugged individualism—presented both barriers and opportunities for rural PCA recipients. As the home care worker shortage crisis in the United States is expected to worsen in coming decades, rural people needing PCA services face unique circumstances related to place and culture.

Factors Associated With Intended Utilization of Home-Based Long-Term Care Among Older Adults in China: The Moderating Effect of Community Support.

Guided by Andersen's behavioral model, the objectives of this study were to (a) examine the associations between individual factors and the intended utilization of home-based long-term care (LTC) services among older adults in China and (b) explore the influence of community support, if any, on these associations. Using a multistage random sampling approach, we recruited 1,064 older adults in Chengdu, China. Hierarchical regression was employed to investigate the direct effects of individual predictors and community support on the intended use of home-based LTC services. The moderating effect of community support was examined using the Hayes Process. Two predisposing (i.e., being old and unmarried), 4 enabling (i.e., living alone, having fewer children, and receiving less family and peer support), and 6 need factors (i.e., having more chronic illnesses; decreased performance in instrumental activities of daily living; higher levels of depression, anxiety, loneliness; and a lower self-image of aging), and low community support were significantly associated with increased intended utilization of home-based LTC. In addition, community support moderated the effects of family support (B = -0.20, p < .001), peer support (B = -0.20, p < .001), self-image of aging (B = -0.39, p < .001), depression (B = -0.34, p < .001), and loneliness (B = -0.48, p < .001) on the intended utilization of home-based LTC services. Policy-makers and practitioners should consider delivering tailored services for older adults and involve the community in the context of enhancing home-based LTC services.

Balancing between dual belongings when organised into interdisciplinary teams, with the trust model as the context: A qualitative study

BackgroundHome-based healthcare services are facing challenges and pressures of increasing needs due to an ageing population, rising workload for an overburdened workforce, and limited financial resources. The trust model is an approach to address the challenges, by organizing the home-based healthcare services into smaller, autonomous interdisciplinary teams. The aim is to involve users and next of kin in decision-making and trusting frontline workers’ professional judgement, thus making the services more flexible and individually tailored. This study explores frontline workers’ practices and experiences of working within interdisciplinary teams according to the trust model’s goals.MethodsObservations, individual-, and focus groups interviews were conducted within home-based healthcare service in a Norwegian municipality. The participants were leaders and frontline workers at different levels of the home-based healthcare services, including registered nurses, auxiliary nurses, occupational therapists, physiotherapists, and other unskilled healthcare personnel. Data was analysed thematically.ResultsThe results are presented in terms of themes: ‘We all want the best for service users’, ‘Belonging to an interdisciplinary team’ and ‘Maintaining belonging to those with similar work tasks and responsibilities’. The results show a diversity among the participants’ experiences of working within interdisciplinary teams. It demonstrates a dilemma between creating belonging to and forming identities within the interdisciplinary team, and at the same time, the importance of maintaining belonging and identity with those in the same profession or with the same tasks and responsibilities.ConclusionThis study suggests that the frontline workers need for dual belonging seems to be underestimated within the trust model, and by acknowledging this, organisations and policymakers can create environments that support both. Which in turn can enhance the possibility to deliver flexible and individually tailored services for service users.

Frailty Assessment and Its Impact on Loneliness among Older Adults Receiving Home-Based Healthcare during the COVID-19 Pandemic.

The purpose of this study was to identify the effect of frailty on loneliness among older adults receiving home care, in correlation to their socioeconomic and homebound statuses. This cross-sectional study recruited 218 individuals aged ≥65 years receiving home-based health services from the "Help at Home" program in the Region of Evrytania, Greece through an open invitation from the municipality authorities from March to June 2022. The Tilburg Frailty Indicator (TFI) was used for the evaluation of frailty, the UCLA Loneliness Scale version 3 was used for loneliness, and social isolation was accessed through five questions (living alone, frequency of interaction with children, relatives, friends, and participation in social organizations). The mean age of the participants was 81.48 ± 9.06, 61.9% were female, 54.1% experienced high levels of loneliness (UCLA-3 mean 45.76 ± 11.10 [range 20-68]), and 46.3% of the participants were found to be socially isolated. Also, 58.3% of the individuals were identified as frail (TFI mean 5.95 ± 3.07) [TFI range 0-13], with 57.3% experiencing physical frailty, 43.6% experiencing psychological frailty, and 27.1% experiencing social frailty. An analysis of covariance (ANCOVA) using UCLA-3 as the dependent variable revealed that loneliness across all domains of TFI was significantly higher in participants with frailty (total frailty [Yes] 49.27 vs. [No] 40,87 p < 0.001) (physical frailty [Yes] = 48.99 vs. [No] = 41.42, p < 0.001, psychological: 48.60 vs. 43.57 p < 0.001, and social: 53.38 vs. 42.94 p < 0.001), particularly compared to non-frail individuals, even after adjusting for potential confounding effects (covariates: gender, age, marital status, family status, living status, educational level, annual income, chronic diseases, homebound status, and social isolation). Our findings indicate that frail older adults experienced higher levels of loneliness, suggesting that frailty and loneliness are independently associated among older adults who receive home-based healthcare.

Older people’s experience and related factors while receiving home-based long-term care services: a qualitative study

BackgroundHome-based care may cover anything from 24-hour support for people with a disability, to short-term post-discharge care, or to periodic assistance with simple tasks such as domestic aid for frail older people. The process can be complex and time-consuming and requires coordination between the individual, their family caregivers, and healthcare providers. Receiving care at home can also lead to social isolation as older people may have limited opportunities for social interaction. This study aimed to investigate older people’s experience and related factors while receiving home-based long-term care services.MethodsA qualitative study was used. Face-to-face individual interviews were conducted with people who were receiving nursing care in their homes (N = 17) and analyzed through thematic analysis.ResultsAnalysis of interview data resulted in the identification of three major themes that captured participants’ personal experiences regarding long-term care in the home: (1) Challenges faced by older people receiving long-term care at home; (2) The impact of home care services on people’s social well-being; and (3) Older people’s contradictory emotions regarding care delivery.ConclusionsFindings of the study revealed that the most important and challenging factors in home care from the perspective of older people were social well-being, religious needs, and physical needs. They considered the nurses who provided these services as family members and the most significant helpers in their daily activities. Participants expressed a desire for more services in the future.

LEGAL REQUIREMENTS OF HOME-BASED CHILDCARE CENTRES IN MALAYSIA; ARE CHILDCARE PROVIDERS AWARE?

Home-based childcare (HBCC) services are among the childcare services available in Malaysia, as ensconsced in the Child Care Centre Act 1984. In Malaysia, HBCC providers are only allowed to care for a minimum of four and a maximum of 10 children. However, this definition does not include small home-based childcare services or childminders who care for less than four children. Employing the qualitative method of content analysis, this study discusses the laws and regulations governing HBCC in Malaysia, particularly the legal requirements that need to be fulfilled. This is further supported by interviews conducted with childcare providers who look after children at their home to examine their level of understanding of the legal requirements under Malaysian childcare laws and regulations. Findings indicate, among others, that the HBCC operators are unaware of the need to register with the Social Welfare Department. The adherence to the legal requirements for this HBCC should not be taken lightly, as it is crucial to ensure the safety and well-being of children. Consequently, greater efforts are required to ensure the children's health and safety because the current procedures rely solely on the experience and expertise of the childcare providers. This paper contributes to the extent of knowledge of HBCC in Malaysia especially towards policy makers, child care operators and parents by exploring the experiences of HBCC childcare providers. It is proposed that continuous improvements need to be made to the laws and regulations on HBCC in ensuring high quality services of HBCC.

Support services for informal carers: a register-based case–control study of Norwegian care recipients

This article aims to describe support services for informal carers and identify the characteristics of the care recipient and municipality that are associated with the allocation of these services. Care recipients were selected from the Norwegian Registry for Primary Health Care on 31 December 2019. Cases received care benefits (N = 9,816), respite care in institutions (N = 2,594) or respite care at home (N = 7,346); controls received home-based services only (N = 193,402). Municipal data were retrieved from the Municipality-State-Reporting register. Child and adolescent care recipients most often received support services, but allocation to this age group differed extensively between municipalities. Greater cognitive disability and cohabiting increased the odds of support services.

Discharging patients home from the intensive care unit: A new trend.

Discharging patients directly to home from the intensive care unit (ICU) is becoming a new trend. This review examines the feasibility, benefits, challenges, and considerations of directly discharging ICU patients. By analyzing available evidence and healthcare professionals' experiences, the review explores the potential impacts on patient outcomes and healthcare systems. The practice of direct discharge from the ICU presents both opportunities and complexities. While it can potentially reduce costs, enhance patient comfort, and mitigate complications linked to extended hospitalization, it necessitates meticulous patient selection and robust post-discharge support mechanisms. Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition. Through critical evaluation of existing literature, this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery. The insights provided contribute evidence-based recommendations for refining the direct discharge approach, fostering improved patient outcomes, heightened satisfaction, and streamlined healthcare processes. Ultimately, the review seeks to balance patient-centered care and effective resource utilization within ICU discharge strategies.

Health2Home – Mapping home-based diagnostic imaging services around the world: A market research

Health2Home – Mapping home-based diagnostic imaging services around the world: A market research