Follow-up Home Care Research Articles

Introducing a New Paradigm in Occupational Therapy for Mental Health in Bangladesh

Bangladesh is making strides in supporting mental health needs by incorporating occupational therapy into rehabilitation care. Despite challenges like social stigma and limited resources, a shift toward a socio-humanistic approach is underway. Occupational therapy practitioners have set up a mental health day treatment service to help individuals transition from hospitals to the community, focusing on daily living skills and meaningful activities. Integrating mental health day treatment service with government psychiatric hospitals and improving rehabilitation and home care follow-up can significantly enhance support for people with mental health needs in low-resource settings.

European Respiratory Society statement on long COVID follow-up.

Patients diagnosed with coronavirus disease 2019 (COVID-19) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection frequently experience symptom burden post-acute infection or post-hospitalisation. We aimed to identify optimal strategies for follow-up care that may positively impact the patient's quality of life (QoL). A European Respiratory Society (ERS) Task Force convened and prioritised eight clinical questions. A targeted search of the literature defined the timeline of “long COVID” as 1–6 months post-infection and identified clinical evidence in the follow-up of patients. Studies meeting the inclusion criteria report an association of characteristics of acute infection with persistent symptoms, thromboembolic events in the follow-up period, and evaluations of pulmonary physiology and imaging. Importantly, this statement reviews QoL consequences, symptom burden, disability and home care follow-up. Overall, the evidence for follow-up care for patients with long COVID is limited.

Effects of a Transitional Telehealth Program on Functional Status, Rehospitalization, and Satisfaction With Care in Thai Patients with Heart Failure

Limited functional status is a common health problem in patients living with heart failure (HF), which often requires rehospitalization.Home-based transitional telehealth programs (TTPs) focused on health monitoring, education, promotion of self-management, and multidisciplinary team consultation have been shown to improve functional status and satisfaction with care while reducing rehospitalization rates in this population. Nonetheless, these variables and outcomes have yet to be assessed in a Thai patient with HF. Thus, the aim of this study was to investigate the effectiveness of a TTP on functional status, rehospitalization, and satisfaction with care in Thai patients with HF. Eligible participants (N = 146) were randomly assigned to either the control or TTP group. The TTP included in-hospital discharge planning and 6-week telemonitoring via a mobile phone application to provide follow-up home care. Data on the outcome variables were collected at 6 and 8 weeks post-enrollment and analyzed by descriptive statistics, independent t-tests, repeated measures ANOVA, and Z-tests. Functional status and satisfaction with care scores in the TTP group were significantly higher than those of the control group, and rehospitalization rates in the TTP group were significantly lower than those of the control group at 6 and 8 weeks post-enrollment. Thus, the TTP effectively improved functional status, increased satisfaction with care, and reduced rehospitalization rates in Thai patients with HF. TTP implementation could be considered to improve the quality of transitional care in Thailand.

Patient experiences of in-hospital preparations for follow-up care at home.

To examine patient experiences of hospital-based discharge preparation for referral for follow-up home care services. To identify aspects of discharge preparation that will assist patients with their transition from hospital-based care to home-based follow-up care. To improve patients' transitions from hospital-based care to community-based home care, hospitals incorporate home care referral processes into discharge planning. This includes patient preparation for follow-up home care services. While there is evidence to support that such preparation needs to be more patient-centred to be effective, there is little knowledge of patient experiences of preparation that would guide improvements. Qualitative descriptive study. The study was carried out at a supra-regional hospital in Eastern Canada. Findings are based on thematic content analysis of 13 semi-structured interviews of patients requiring home care after hospitalisation on a medical or surgical unit. Most interviews were held within one week of discharge. Patient experiences were associated with patient attitudes and levels of engagement in preparation. Attitudes and levels of engagement were seen as related to one another. Those who 'didn't really think about it', had low engagement, while those with the attitude 'guide me', looked for partnership. Those who had an attitude of 'this is what I want', had a very high level of engagement. Previous experience with home care services influenced patients' level of trust in the health care system, and ultimately shaped their attitudes towards and levels of engagement in preparation. Patient preparation for follow-up home care can be improved by assessing their knowledge of and previous experiences with home care. Patients recognised as using a proactive approach may be highly vulnerable.

Facilitating safe patient transition of care: A qualitative systematic review

Background: Failure to appropriately plan for a safe and effective transition to the next level of care leads to greater use of hospital and emergency services, often measured by rates of readmission. Despite a focus to develop programs to reduce readmissions, the 30-day all-cause readmission rate for Medicare patients in 2011 remained essentially unchanged. Purpose: The objective of this qualitative systematic review was to synthesize the evidence for interventions aimed at reducing readmissions through a transition of care program. Methods: We searched PubMed and Medline (OVID) with search terms including home care services, continuity of patient care, patient discharge, patient-centered care, health planning, and patient readmission. Selection criteria included quantitative studies, qualitative studies, and expert opinion articles in which a transition of care intervention, was implemented. The outcome of interest was readmission rates. Results: Thirty-three articles met inclusion criteria. The data were synthesized into two categories: primary studies in which the readmission rate was measured as an outcome, and studies that systematically reviewed interventions aimed at improving the discharge process. In all studies reviewed, a transitional care intervention resulted in a statistically significant reduction in readmission rate, or a rate trending lower, or the rate remained the same. Several studies evaluating an intervention occurring during and after hospitalization demonstrated significant results. Conclusion: There is value in reconfiguring discharge processes toward interventions that are more likely to reduce readmissions. The discharge process should incorporate a multidisciplinary, multicomponent transition of care intervention that involves hospital and home-care follow-up.

Self-care in Older Adults With Heart Failure

The aims of this integrative review were to examine the evidence specific to self-care in older adults, 65 years or older, with heart failure and to indicate best nursing practice interventions for use in this population. Self-care is a complex set of activities involving self-care maintenance and self-care management. Age-related and psychosocial factors impact older patients' ability to engage effectively in self-care practices. Although self-care processes are the focus of the investigation, few studies provide implications specific for the older adult population. Limited research on heart failure self-care in the older adult meets the age criterion of 65 years or older. A comprehensive search of the literature was performed using Medline, CINAHL, and the Cochrane Library, as well as an ancestry approach of reference lists of selected studies. Eligible studies were randomized controlled trial, qualitative, quantitative, and mixed-method design studies on older adults with heart failure related to self-care for the years 2002-2012. Three themes of self-care were noted in the selected studies: patient-related factors, patient education, and telemonitoring. The patient-related factors identified were barriers to self-care such as age-related symptoms, cognitive factors, and social issues. The interventions promoting self-care were patient education (self-care knowledge) and telemonitoring (augmenting symptom recognition). Patient education tailored to older adults may be beneficial. Telemonitoring is an appropriate self-care enhancement tool for selected older adults. More emphasis needs to be placed on interventions to assist older adults with heart failure in symptom recognition and early notification of healthcare providers. As the population ages, a need for evidence-based care for older adults with heart failure is warranted. Heart failure self-care interventions do not address the special considerations of the older heart failure patient. To determine the best approaches for promoting effective self-care, older adults with heart failure need to be studied as a cohort. Older adults with heart failure face many challenges engaging in self-care practices. These older adults need individualized self-care instructions and home care follow-up. Identifying special needs of the patient, such as sensory or cognitive impairment, is necessary when providing instructions and follow-up care for the older adult.

Survival Analysis and Factors Associated With Mortality Among Elderly in a Home Care Program

Home care (HC) is directed at older people with high risk of mortality due to clinical, social, and functional vulnerability. The purpose of this study is to analyze the likelihood of survival in a 2-year follow-up of elderly in HC and determine associations between the patient outcome (death/survival) and baseline data. The medical records of 38 elderly in a HC program were analyzed with regard to sociodemographic and clinical data and by the Functional Independence Measure (FIM). After a 2-year period, the records were reanalyzed to determine the patient outcome (death/survival). To determine the mortality rate in the follow-up period, the Kaplan-Meier survival analysis model was used. The Chi square, Fisher exact tests, the Student t and Mann-Whitney tests were used to analyze associations between the baseline variables and program status. The probability of survival was 75.36% and 56.14%, after 1 and 2 years of HC follow-up, respectively. Age, gender, marital status and FIM had no influence on mortality. The elderly who died showed a shorter time of assistance in the HC program, greater number of comorbidities and skin diseases compared to the survivors. Frail and socially vulnerable elderly may benefit from early intervention that focuses on the maintenance of function and the control of clinical complications.

Haitians Get Creative in Effort to Rebuild Shattered System

Haitians Get Creative in Effort to Rebuild Shattered System

Cost-effectiveness of linezolid and vancomycin in the treatment of surgical site infections

ABSTRACTObjective: This decision-analytic study was intended to determine the expected cost-effectiveness of linezolid compared to vancomycin for treating surgical site infections (SSIs) caused by methicillin-resistant Staphyloccocus aureus (MRSA) from the perspective of a tertiary-care academic medical center.Research Design and Methods: This study is a cost-effectiveness analysis based on a modeling approach for the treatment of MRSA SSIs. Three clinical scenarios were considered in the decision analysis: (1) treatment with intravenous (IV) vancomycin during hospitalization and after discharge with home-care follow-up; (2) treatment with IV vancomycin during hospitalization, followed by oral linezolid after discharge; (3) treatment with oral linezolid during hospitalization and after discharge. Cost data was obtained from internal and external sources. Cure rate probabilities for MRSA SSIs were obtained from records at the medical center and from results of a randomized, multicenter trial. Healthcare costs for each scenario were obtained from the medical center, healthcare buying groups, and national databases. The robustness of the baseline cost-effectiveness determination was evaluated using sensitivity analyses over a broad range of costs and probabilities.Results: Treatment with oral linezolid during hospital­ization and after discharge (scenario 3) was associated with lower costs ($8923, $11 479, and $12 481, respectively) and greater effectiveness (0.867, 0.787, and 0.707, respectively) compared to the IV vancomycin/oral linezolid switch (scenario 2) and IV vancomycin (scenario 1), so it dominated the latter options in the base-case, incremental cost-effective­ness analysis ($10 292, $14 486, and $17 653 per MRSA SSI cure, respectively). Furthermore, the sensitivity analysis demonstrated that the IV vanco­mycin/oral linezolid (scenario 2) option would be the expected cost-effective choice only if the length of hospitalization for this scenario was less than 6 days or if the probability of cure with oral linezolid (scenario 3) was less than or equal to 0.72; otherwise, the oral linezolid option was dominant. A major limitation of this study is the utilization of probability estimates from both institutional and published research sources. Additionally, the success rates for linezolid were obtained from one relatively small randomized, open-label trial.Conclusions: Using decision-analytic modeling, treatment with oral linezolid during hospitalization and after discharge is expected to be the most cost-effective approach for treating SSIs caused by MRSA.

Patient Satisfaction With an Early Discharge Home Visit Program

In 1995, to meet the needs of mothers and newborns discharged early, a home care follow-up program using an advanced practice nurse was initiated at a Midwest academic medical center. Information about the program and elements of patient satisfaction, as measured from program inception, are presented in this article. The major correlates of satisfaction were nurse friendliness, technical skills, infant care teaching, and individualized care. Attending to these areas can facilitate existing program improvement and new program development.

Programa de altas precoces y asistencia domiciliaria en pacientes con exacerbación de enfermedad pulmonar obstructiva crónica y asma

To shorten hospital stays of patients with exacerbated chronic obstructive pulmonary disease (COPD) or asthma by way of a home care program and to assess whether the program increased the number of readmissions. Patients admitted due to COPD exacerbation or asthma who did not need critical care and were discharged before the fourth day. A registered nurse experienced with respiratory disease patients and in regular contact with the pneumologist who supervised the program made follow-up home care visits to give instructions and check compliance with treatment. Sixty-nine patients enrolled in the program, 53 with COPD and 16 with asthma. A mean 7.2 home care visits per patient were made. The mean hospital stay was 3.69 ( 0.5 days for patients receiving home care and 7.89 ( 5 days for those who received no home care (p < 0.005). Severity of COPD in terms of age, FEV1 and PaO2 was similar in both groups, as follows: FEV1 was 39.4 12% and PaO2 66.3 7,7% for patients receiving home care; FEV1 was 40.6 ( 12% and PaO2 was 64.3 ( 7% for those receiving no home care (ns). The mean hospital stay overall for both groups was 7.4 (4.9 days; the mean hospital stay for the same diseases in the same previous the year before the study was 8.3 ( 5.5 (p < 0.05). The rate of readmissions for new exacerbations within 30 days of discharge was 4.3% (3/69) in the group receiving home care and 7.2% (29/401) among patients receiving only hospital care (ns.). A questionnaire survey at the end of the program showed satisfaction to be very high. A program of home care provided by a registered nurse experienced with respiratory diseases allows mean hospital stay to be reduced without increasing the number of readmissions within 30 days, with high patient satisfaction.

Teaching New Mothers: Priorities of Nurses Postpartum Women

To identify the most important content areas to include when teaching postpartum women, either in the hospital or at home, from the perspective of both nurses and postpartum women. Descriptive design using scaled response surveys. Data for nurses were collected through mailed surveys. Data for new mothers were collected in the hospital within 24 hours after delivery and through mailed surveys. Seventy-one registered nurses who provided in-hospital maternity nursing care; 53 registered nurses who provided postpartum follow-up home care visits; and 103 low-risk postpartum women. Perceived importance of teaching topics related to care of mothers and their newborns. Comparisons between responses of nurses and new mothers were analyzed. Statistically significant differences were noted between the perceptions of nurses and new mothers regarding the priority of teaching content for new mothers. Nurses give priority to teaching about infant care, whereas new mothers give priority to their own care. These data suggest that new mothers may have opinions that differ from those of nurses as to what is important to learn about caring for themselves and for their newborns during the early postpartum period.

Postpartum home visits: extending the continuum of care from hospital to home.

Crucial maternal, newborn, and family healthcare needs arise during the early postpartum period, providing the opportunity for home care nurses to extend the continuum of care from hospital to home. This study identifies common early postpartum problems discovered on home health visits and describes the related interventions of home health nurses. Correlational analysis revealed that young mothers, first-time mothers, breastfeeding mothers, and single mothers are priority candidates for follow-up home care.

Clinical nurse specialists: creating new programs for neonatal home care.

Specialty home care programs are making headlines in nursing. Clinical nurse specialists are taking the lead in designing and directing follow-up home care for infants in neonatal intensive care units. The article describes a home care program in a Texas community that utilizes neonatal intensive care unit nursing staff as the home care providers for these infants.

The Connection Delivery Model

Cross-training nursing personnel to provide follow-up home care to patients with congestive heart failure has resulted in a dramatic drop in readmissions. Significant reduction in length of stay and cost for readmissions has prompted this hospital to expand this type of service to other patient populations. An added benefit is high job satisfaction among nurses.

Removable Partial Overdentures for the Irradiated Patient

Patients who have received radiotherapy to the head and neck area must avoid dental extractions and seek simplicity in treatment and home care follow-up. For partially edentulous patients, removable partial overdenture therapy can fulfill these goals while maintaining the high level of function and aesthetics desired by patients.

The cost-effectiveness of multiple sclerosis rehabilitation: a model.

Many patients with multiple sclerosis (MS) who have fixed, chronic neurologic deficits are kept at home with the help of community support systems, which cannot improve the physical independence of the MS patients they serve. We have found that active, intensive, multidisciplinary rehabilitation effectively improves functional performance, even though it cannot alter the underlying disorder. Inpatient rehabilitation with follow-up home care may actually be less expensive than any other current health care alternative.