Home Visits Research Articles

49 Effects of numeracy and literacy on glycemic control and self-perceived efficacy in youth with type 1 diabetes in Haiti

Abstract Background The management of type 1 diabetes (T1D) in low-resource settings remains a challenge in the context of unfavourable social determinants of health. The effects of literacy and numeracy on glycemic control and self-perceived efficacy in youth living with T1D in low-resource settings have been insufficiently investigated. Objectives We described literacy and numeracy in Haitian youth with T1D and their caregivers and we evaluated their association with hemoglobin A1c (HbA1c) and perceived diabetes management self-efficacy. Design/Methods We conducted a cross-sectional cohort study of youth with T1D treated at the Montrouis clinic in Haiti, between June to December 2017. Inclusion criteria were a diagnosis of T1D at age 0-25 years and at least one parent of Haitian ancestry. One principal caregiver of each youth was also included. Exclusion criteria were inability of informed consent and declined home visit. The study was approved by our Institution Research Ethics Board. Data collection included demographics, clinical data, numeracy questionnaire adapted to the population and the standardized self-efficacy 8-item Perceived Diabetes Self-Management Scale (PDSMS). We used univariate and multivariate linear regression models to evaluate predictors of HbA1c and PDSMS scores. Results We included 85 patients (60% female) and 73 caregivers. Median age at diagnosis and diabetes duration were 14.3 and 3.1 years, respectively. Over 90% of patients had suboptimal (HbA1c >7.0%), poor (HbA1c >9%) or very poor (HbA1c >12%) glycemic control. 76 patients (90.5%) self-reported being able to read, 78 (91.8%) to write and 84 (98.8%) to count. Mothers’ and fathers’ median education years were 7.0 and 11, respectively. 54 parents (74.0%) self-reported being able to read and write. Normalized to 100%, median patient numeracy score was 75.0% and the mean PDSMS score was 65.9%. In univariate models, lower HbA1c was predicted by younger age (p=0.013), but not by gender, diabetes duration, numeracy score, mother’s education or PDSMS score. Higher PDSMS score was predicted by higher numeracy scores (p=0.003), marginally by sex (p=0.057), but not by age, diabetes duration, or mother’s education; in a multivariate model adjusted for age, sex and diabetes duration, higher numeracy remained significant (p=0.006). Conclusion In youth with T1D in Haiti who have ubiquitously poor glycemic control and suboptimal family literacy and numeracy, numeracy is a predictor of self-perceived efficacy of T1D. Further public health interventions addressing numeracy in youth living with T1D in low-resource settings are advised.

Outcomes of the Together for Life Program in Community-Dwelling Older Adults Living Alone: A Pilot Study.

The current study developed and tested selected effects of the Together for Life (TFL) program for community-dwelling older adults using an embedded mixed methods design. Nine community volunteers participated in the training program, and 14 people aged ≥65 years, living alone, enrolled in the study. Home visits were conducted by home health nurses every 2 weeks, supplemented by weekly home visits and phone counseling provided by volunteers, for a duration of 20 weeks. This mixed methods study used quantitative and qualitative approaches. Quantitative data were gathered through a questionnaire survey to assess the intervention's effects on health-related quality of life (HRQOL), loneliness, and depression. The qualitative component focused on participants' evaluation of the program. Significant changes were noted in HRQOL scores with an effect size of 0.6 (p = 0.01). Results indicated the positive impact of the TFL program on HRQOL among older adults as their health status was continuously monitored by volunteers who provided care and home health nurses who assisted with health management during the coronavirus disease 2019 (COVID-19) pandemic. In a pandemic, personalized health management, such as regular health check-ins provided by home health nurses and home or phone visits provided by volunteers, is crucial for isolated older adults. This pilot program enhanced participants' HRQOL through continuous health monitoring, volunteer care, and nurse support, even during the COVID-19 pandemic. [Journal of Gerontological Nursing, xx(x), xx-xx.].

People at Risk of, or with Cardiovascular Diseases’ Perspectives and Perceptions of Physiotherapist-Led Health Promotion in Cameroon: A Mixed-Methods Study

Cardiovascular diseases (CVDs) and their risk factors are a major cause of illness and death worldwide, especially in low- and middle-income countries like Cameroon. Physiotherapist-led health promotion (PLHP) has proven effective in improving health and reducing CVD risks. Understanding patient perspectives is crucial for designing effective, context-specific PLHP interventions. This study explored patients’ views, experiences, perceived usefulness, acceptability, and preferred methods of PLHP, through a sequential explanatory mixed-methods approach. The quantitative data highlights a significant burden of CVD conditions and risk factors among patients seen in physiotherapy services. Qualitatively, three themes were identified and included: (1) perspectives and experiences of people at risk or with CVDs (pwCVDs) on PLHP; (2) perceived usefulness and acceptability of PLHP; (3) preferred delivery methods of PLHP. Participants reported positive feedback on PLHP and physiotherapy services. Barriers to effective PLHP included high workloads for physiotherapists, limited service access in rural areas, and prohibitive costs. Despite these challenges, participants expressed strong confidence in physiotherapists’ competence, though they also called for improved regulation and ongoing professional development. PLHP components, especially physical treatment and dietary advice, were deemed highly useful and acceptable. Patients suggested various delivery methods, including peer support groups, home visits, and mass media interventions. This study highlights the need to improve the scope of practice, competence of physiotherapists, and accessibility of physiotherapy services in Cameroon for pwCVDs. It is necessary to adopt multidisciplinary approaches to achieve better outcomes for risk factors like diabetes and hypertension in context.

Digitized Home Visit Education Service: A Trained Teaching Learning Attendant Visits the Student, and a Qualified Special Educator Connects Online to Collaboratively Conduct Classes

Digitized Home Visit Education Service: A Trained Teaching Learning Attendant Visits the Student, and a Qualified Special Educator Connects Online to Collaboratively Conduct Classes

Development of Interprofessional Competencies Through the Process of Collaborative Clinical Reasoning: A Qualitative Study.

Effective interprofessional (IP) collaboration is essential for managing complex patient cases. Collaborative clinical reasoning (CCR) is an approach where IP teams collectively analyze and address complex clinical cases, facilitating a shared understanding of patient management. While simulation and case-based learning are established methods for fostering IP collaboration, the process by which students develop a shared mental model for patient management after a simulated home visit and how this approach promotes the development of IP competencies is unknown. Understanding this process is critical for advancing IP competences that are fundamental to case management practice. The purpose of this study was to explore students' perceptions of the CCR processes used to develop an integrated care plan following a simulated home visit. Home care and community-based practice settings. A qualitative descriptive approach was employed to explore PT and nursing student teams' perceptions of the CCR processes used to develop an integrated care plan following a simulated home visit. Written responses to five reflection questions were analyzed using conventional content analysis among n =87 physical therapy and nursing students. There were three overarching themes: clarifying roles; developing a mutual approach; embracing shared values. Students' perceptions reflected skills needed to develop IP competencies including CCR. More research is needed to explore how student teams resolve disputes and use interdisciplinary knowledge in the process of CCR. Findings highlight the importance of IP collaboration in clinical case management, emphasizing the need for case managers to facilitate clear role clarification, mutual approaches, and shared values among IP teams to enhance integrated care planning and improve patient outcomes. These insights can inform training and development programs for case managers on IP teams, promoting the adoption of CCR in practice.

Oral Health Assessment for Older Residents in Long-Term Care Facilities Using Video Recording by a Mobile Electronic Device.

Many older adults who require long-term care need oral health management. However, access to dental care is limited, and connecting older patients with dental professionals is a future challenge. Therefore, the development of a remote oral health assessment system is required. This study aimed to investigate the usefulness of video-based oral health assessments in older adults residing in facilities. This study comprised 60 older adults residing in facilities who consented to dental home visit treatment by the Department of Oral Function Management at Showa University Dental Hospital between July 2021 and December 2022. The Oral Health Assessment Tool (OHAT) was used to evaluate the oral health status at the facilities by one dentist. The concordance of the oral health assessments conducted by this dentist at the facilities (OHAT-B) was compared with those conducted by the same dentist (OHAT-V1) and two other dentists (OHAT-V2 and V3) using approximately 1 min video recordings of the oral cavity taken with a mobile electronic device. On the OHAT total score, the intraclass correlation coefficient (ICC [1.1]) for OHAT-B and V1 was 0.931; the ICC (2.1) was 0.889 when compared with V2 and 0.788 when compared with V3. Moreover, the comparison between V2 and V3 showed high agreement, with an ICC (2.1) of 0.750. This study revealed that the oral health assessment of older adults residing in facilities using video recordings of the oral cavity taken with a mobile electronic device may be possible, suggesting the possibility of remote oral health assessment.

A Parent’s Multimodal Support to Bilingual Child’s Reading: A Case Study of Korean Immigrant Family

ABSTRACT Shared reading is a practice for promoting children’s literacy that parents may utilize at home. In particular, multimodal interactions between a parent and a child can play a role in fostering bilingual children’s reading experiences. This qualitative case study explores how a Korean bilingual mother multimodally supports her child’s shared reading practices. Data sources include an online survey, a monthly reading log, two home visit video observations, and a parent interview. Four multimodal cues are classified throughout the reading: pointing, hand gestures, nodding, and audio language. The three emerging themes of the parent’s nonverbal language in support of the child’s literacy practices include assisting in guessing vocabulary and meaning, drawing attention, and encouraging confidence. The implications of the study are discussed with regards to better promoting a home literacy environment, along with the open communication of relevant messages to parents and educators to offer more support for bilingual students.

Registered sex offenders’ experiences of home visits in England & Wales: are the police expected to integrate “risk” with “desistance”

Purpose In England and Wales, adult male registered sex offenders (RSOs) are risk assessed and managed using a tool known as the Active Risk Management System; a risk assessment designed specifically for police management of RSOs and carried out by a specialist group of police officers known as Management of Violent or Sexual Offenders (MOSOVO) at the RSO’s home, known as “the home visit”. The purpose of this paper is to explore RSOs views of the home visit and risk assessment and to make recommendations to MOSOVO to improve future home visit & risk assessment practice. Design/methodology/approach This study aimed to examine a sample of adult male RSOs’ views of the risk assessment and home visit process. Three police forces in England and Wales agreed to facilitate the sampling of 10 RSOs who varied in their level of risk, namely, low, medium, high and very high. Findings Three themes were developed from the analysis: anxiety and shame; perceptions of the first home visit; and the property search and observations. This paper discusses these experiences in light of the growing call for MOSOVOs to both manage risk and assist desistance and present recommendations for improving both the home visit and risk assessment practice. Originality/value To the best of the authors’ knowledge, this is the first study to understand and explore RSOs views of the home visit and risk assessment process.

Conceptual framework for the health and well-being of caregivers of HIV/AIDS orphans in North West Province, South Africa

BackgroundThe human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) is an epidemic that continues to increase the burden of care among caregivers of HIV/AIDS orphans. Research has confirmed that HIV/AIDS orphans’ caregivers perform their duties in an unconducive environment. Consequently, this negatively impacts their health leading to inability to discharge caregiving duties effectively. After carefully considering the caregivers’ predicament, the researchers found it imperative to develop a conceptual framework for the North West Province as this province lacks a conceptual framework that addresses the health and well-being of caregivers for orphaned children.MethodsAn exploratory, descriptive and contextual design was used in the study. The population for this study were HIV/AIDS orphans’ caregivers and ward-based professional nurses who also served as outreach team leaders. Non-probability purposive sampling technique was used to select participants for this study. Data was collected using individual semi-structured interviews, focus groups, and field notes. Six steps of thematic analysis were adopted to analyze collected data. The practice-orientated theory by Dickoff, James, and Wiedenbach guided the development of the conceptual framework. These six steps include the agent, recipient, context, procedure, dynamics, and terminus.ResultsThe study findings include home visits, health education, support during disclosure, routine monitoring of blood and growth, mobilization of support systems and resources, and utilization of government services.ConclusionThe conceptual framework seeks to improve the health and well-being of HIV/AIDS orphans caregivers so that they may provide high-quality care to the orphans. The framework guides outreach team leaders and nurses registered in primary health care institutions on the procedure to follow to improve and preserve the health of caregivers of children orphaned by HIV/AIDS.

A qualitative exploration of policy interventions to improve the health-related quality of life of people living with HIV AIDS and co-morbidities of hypertension and/or diabetes in Ghana.

The intersection of infectious diseases, such as HIV, with chronic conditions like hypertension and diabetes poses a significant challenge in global health. While advancements in antiretroviral therapy have transformed HIV into a manageable chronic condition, a growing number of individuals with HIV now grapple with coexisting non-communicable diseases, impacting their Health-Related Quality of Life (HRQoL). Despite strides in HIV care, there is a notable policy gap that undermines efforts to address HIV-associated co-morbidities, particularly hypertension and diabetes, especially efforts to improve access, early detection, and ultimately HRQoL for individuals with HIV and co-morbidities. This study seeks to explore policy interventions aimed at improving the quality of life of HIV patients with hypertension or diabetes. The study utilized a qualitative descriptive design to explore the experiences and perspectives of healthcare professionals and support staff regarding policy interventions for managing HIV patients with hypertension and/or diabetes co-morbidities in three regions of Ghana. The research was conducted in the Upper West, Ashanti, and Greater Accra regions among 11 participants, chosen purposively from professions involved in HIV patient care to understand their views on the implementation of policy interventions to HRQoL for individuals with HIV and co-morbidities. In-depth interviews were conducted face-to-face and tape-recorded. Thematic analysis approach was used to analyze the data. The study involved 11 participants from three regions with varied years of experience. Implemented policies that potentially improve the HRQoL for individuals with HIV and co-morbidities involve support groups, home visits, provision of free drugs, and counselling. Barriers to policy implementation included non-adherence to medication, stigma, cost of non-communicable diseases (NCDs) medications, accessibility issues to NCDs services, lack of interest or understanding among implementers, and high staff turnover. Facilitators encompassed in-service training, guidelines in common platforms, knowledge sharing, external resources, regular check-ups, and motivational packages for patients. Individuals with HIV and comorbidities face complex challenges impacting their HRQoL, including emotional and financial dimensions. The study identifies critical policies and barriers, underscoring the need for tailored, patient-centered approaches. Facilitators like in-service training and regular check-ups offer actionable insights for effective policy implementation, emphasizing improved health outcomes for those with comorbid conditions. The study recommends integrated care approach and adherence support programs that address the unique challenges faced by people living with HIV.

Effectiveness of Play Therapy Programme in Promoting Early Child Development of under-5 Children visiting Tertiary Care Hospital in Rural Settings: Study Protocol of a Randomized Controlled Trial.

Background Good care and conscious, mindful parenting are the essential requirements of the early childhood period. Good care in early childhood consists of mindful handling of children’s needs like hunger, care in sickness, socio-emotional needs, safety, love and affection. Good care promotes children’s development and provides a favourable environment for learning. It’s a well-known fact that hospitalization is a stressful situation for child of any age. Play is an integral part of early childhood period which is virtually restricted in hospital settings. This study will try to explore the effectiveness of play therapy delivered in hospital settings, on early child development. Methods This will be a randomized control trial conducted in the Paediatrics department of a tertiary care hospital in Wardha, India. The sample size will be 360 children, 180 each in intervention and control arm. The hospitalized children from intervention arm will receive customized Play Therapy sessions from trained research assistants and will be followed up at scheduled home visits for one year from the date of enrolment. All children will be assessed for changes in cognitive, motor and socio-emotional development scores. The differences in development scores between intervention and control groups will be compared and effect sizes of changes will be calculated. Discussion Implementation of play stimulation activities have been reported as useful strategies for promoting child development and good recovery during hospitalization. This trial will attempt to explore the effectiveness of play therapy on changes in child development scores of children from intervention group compared to the control group. The customized play therapy program will be adapted to paediatric inpatient settings, and attempts will be made to improve the Play Therapy kit for hospitalized children. Registration Clinical Trial Registry of India Registration No.: C.T.R.I./2022/03/041355, dated 24/03/2022. Protocol Version: v6 Dated 04/10/2024.

Early childhood education contingencies for sustaining learning during school closures: Lessons from preschool remote education home visits in Indonesia during the COVID-19 pandemic

Maintaining kindergarten education amid emergency situations is difficult. The COVID-19 pandemic highlighted the difficulties faced by early childhood education institutions in ensuring that children continue education despite school closures and prolonged social isolation. The transition from in-classroom learning to remote learning, which was mostly online for older age groups, was especially complicated for younger pupils due to their nature and limited family resources. In contrast, numerous kindergartens in Indonesia initiated home visit programs that enabled children to learn face-to-face with their teachers and peers during the school closure periods. The purpose of this study was to examine how the home visit program for early childhood education was implemented and how teachers and parents viewed this emergency alternative to online learning. A qualitative case study was employed as a method of inquiry. Nine parents and four teachers from a single kindergarten in South Tangerang, a suburb of Jakarta, participated in this study. The data revealed the home visit program’s implementation involved the following measures: dividing children into small groups, a teacher visiting each group’s assigned home once or twice per week for 45–90 min, enforcing health measures, and giving daily activities for students to complete with their parents. Teachers stated that the home visit program was helpful but had significant faults. Among the benefits were the following: It helped children comprehend learning materials, piqued their interest, and served as a possible alternative due to a family’s lack of resources such as electricity, internet connectivity and quota, educators’ competency in implementing online learning, and parents limited or unavailable devices. Meanwhile, some disadvantages of home visits included the following: Parents felt obligated to entertain their children’s teachers and peers, some students were unable to study due to distance, additional time and energy was spent on media preparation and learning activities, and the risk of exposure to COVID-19 was increased. In the future, unexpected health hazards or other situations may occur. These findings indicate the need for early childhood education institutions to be more prepared, develop a strategy and adjust their instructional approaches to respond rapidly to changing circumstances when required.

Engaging Indigenous communities in research to inform practice: The multisite implementation evaluation of Tribal home visiting.

Community engagement (CE) is widely acknowledged as a way to enhance the ethics, rigor, and impact of research. Additionally, CE is a demonstrated way to integrate Indigenous and colonial (western) research systems. For these reasons and others, designers of the Multi-site Implementation Evaluation of Tribal Home Visiting (MUSE) used a community-engaged approach to study the implementation of federally funded home-visiting programs across 17 Indigenous communities throughout the United States. This paper describes MUSE's community-engaged approach and its practical applications from the perspective of the MUSE study team. The paper highlights key outcomes attributable to CE, addresses barriers to CE, and details responses to these barriers and their impacts. Adding to the rich evidence base demonstrating the value of community-engaged approaches, MUSE demonstrates that in-depth CE is feasible and valuable in multisite studies done in partnership with Indigenous communities.

The Level of Perceived Stress and Affecting Factors due to Current Economic Crisis Among Undergraduates in Faculty of Health-Care Sciences, Eastern University Sri Lanka

Abstract In 2021, the Sri Lankan government officially declared the worst economic crisis in the country. The ongoing economic crisis in Sri Lanka has been affecting the whole sector of the country. The undergraduate students who stayed in hostels had to suffer a lot due to restrictions of family income. The parents face difficulties in affording all expenses required by their children as university students. As a result, students had to cut down their daily expenditures. Due to this crisis, the students had to be affected by various levels of stress leading to disruptions in both physical and mental health. It also caused poor academic performance. Some students had to quit their studies. Stress is an emotional feeling affecting all ages and it appears at any time of the life cycle. The purpose of this study was to identify the level of perceived stress and affecting factors due to the current economic crisis among undergraduates in the Faculty of Health-Care Sciences (FHCS), Eastern University Sri Lanka (EUSL). A cross-sectional descriptive study was conducted using a self-administered online questionnaire to gather information and a complete enumeration was done. The Perceived Stress Scale (PSS) instrument was used to assess the severity of the undergraduate perceived level of stress-related current economic crisis. Demographic variables and affecting factors due to the current economic crisis were considered. The overall mean stress score in the study population was 22.91(SD=5.386). The majority of undergraduates reported moderate stress 70.8% (N=240). A multiple linear regression analysis was applied, Pearson correlation was used, and all necessary tests were performed. There was a statistically significant, positive correlation between the level of perceived stress and their family income per month (p=0.000). The contributing factors correlated with perceived stress were unable to enjoy meeting people, unable to frequently visit home, unable to take meals from outside and instead of cooking, trying to save extra expenditure money, unable to frequent shopping for dresses, cosmetics, jewelry. The level of perceived stress reported by the majority of the students was moderate. Mainly their family income per month contributed to stress among them. Policymakers and the university administration have to consider more about the stress levels of the students and plan suitable programs like scholarships to manage stress.

Possibilities and power during early Head Start Home visits: Comparing family- and home visitor-opened decision-making.

Decision-making by families and professionals about how to support children's development is an integral aspect of home visits. This study investigated home visit decision-making in a US program for families experiencing poverty, Early Head Start (EHS), through the following questions: What types of decisions do home visitors and families make about children's development during EHS home visits? How and to what extent do home visitors and families participate during these decisions? A convergent mixed methods research design was implemented to investigate participation through frequency counts and discourse analysis of home visit transcripts. Home visitor participants were four women, three white and one Black. Twelve families participated (12 mothers, 2 fathers). Parents identified as white (n=8), Black (n=3), and multiracial (n=3; Black and white). One parent was a bilingual Arabic and English speaker. A total of 66 decisions about children's development were identified, with 49 decisions initiated by home visitors and 17 initiated by families. Although families talked more and took on active roles when they initiated (i.e., opened) decisions, home visitors predominantly controlled decision-making. Quantitative and qualitative participation differed only in the beginning of family-opened decisions, and home visitors gradually took more control.

Access to primary healthcare services among adults with disabilities in Brazil.

To investigate perspectives of people with disabilities in Brazil regarding the access to primary healthcare. In-depth interviews were conducted with 44 individuals with disabilities in Pernambuco, Distrito Federal, and São Paulo between March 2020 and November 2021. These interviews were transcribed, coded, and analysed thematically, using the Levesque framework to identify healthcare access barriers. Participants expressed a solid understanding of their healthcare needs and existing obstacles. However, individuals with hearing and visual impairments experience challenges because of communication barriers. In Pernambuco, the Community Health Agent was often the initial point of contact for primary care services. Public transportation lacked accessibility, from buses to driver attitudes, posing difficulties for people with disabilities. More accessible transportation and improved urban infrastructure could enhance service access. High medication costs were reported due to limited healthcare unit availability. Communication accessibility issues, inadequate audio-visual resources and equipment were also identified as barriers. Attitudinal barriers among healthcare professionals and subpar home visit services further hinder access. To address these challenges and improve the well-being of individuals with disabilities in Brazil, comprehensive action is essential. This includes leadership, governance, and resource allocation reforms to meet healthcare needs. Initiatives like disability-focused training for service providers, enhanced transportation options, improved information accessibility, and increased support from community healthcare workers can collectively enhance the lives of people with disabilities.

Teaching Across Culture: Insights from Teachers of Indigenous Elementary Pupils at Gigaquit, Surigao Del Norte: A Narrative Inquiry

This qualitative study delved into the experiences of Mamanwa Tribe teachers educating indigenous elementary students in Gigaquit, Surigao del Norte. Utilizing narrative inquiry and categorical-content analysis, the study highlighted two key themes: the considerable challenges faced by these teachers (such as language barriers and student absenteeism) and the strategies they employed to overcome them (including home visits and parental communication). The findings underscore the necessity for a multi-faceted approach from educational authorities to address these challenges and provide support for teachers in indigenous communities. Recommendations include increased scholarship opportunities and encouragement for indigenous learners to enter the teaching profession, thereby strengthening the ranks of indigenous educators.

Child-father and child-mother attachment relationships in naturalistic settings.

This study examines paternal and maternal sensitivity as predictors of toddlers' attachment security in two naturalistic contexts. Seventy-three mostly White middle-class families participated between 2015 and 2019 when children (49.3% girls) were approximately 29.48 months old. Each child-parent dyad completed a home and playground visit. Findings revealed paternal and maternal sensitivity were significantly associated at home and marginally at the playground. Paternal sensitivity was only predictive of security to the father at the playground, showing a medium effect, while small effects of maternal sensitivity on security to the mother were found in both contexts. Cross-parent contributions to security were small and limited to the playground. The need to consider the greater ecology of child-parent relationships and suggestions for larger-scale research are discussed.

Telehealth in Home Visiting for New Mothers: Are Outcomes Different if the First Visits Are in Person?

Home visiting programs for new parents have a broad range of goals, including improvements in maternal and child health, reductions in child maltreatment, and improvements in child development. Before 2020, few home visits were conducted through phone or video encounters, i.e., telehealth home visiting (teleHV). However, rapid adoption of teleHV was required by the coronavirus disease 2019 (COVID-19) pandemic. To understand how conducting initial visits via teleHV was associated with outcomes, we performed a secondary data analysis to make use of the natural experiment created by COVID-19. Utilizing data from the Nurse-Family Partnership, a US national evidence-based model, we compared outcomes for families whose initial home visits were in person (enrolled 10/2019 to 1/2020; n = 7066) to those whose first visits were through teleHV (enrolled 4/2020 to 12/2020; n = 14,587). TeleHV at intake was associated with a higher likelihood of elevated depressive symptoms at 12 months (OR = 1.37; 95% CI 1.07, 1.76), a lower likelihood of retention to child’s age 12 months (OR = 0.67; 95% CI 0.58, 0.78), a higher likelihood of early drop from the program (OR = 1.77; 95% CI 1.48, 2.12), and fewer screening assessments completed (b = − 0.06; 95% CI − 0.07, − 0.04). No differences were detected between groups for the likelihood of breastfeeding at child’s age 6 months, elevated intimate partner violence (IPV) risk, 90% of attempted visits completed, or time to attrition. COVID-19 may have led families in different groups to have different experiences during key points of child development; however, as both groups’ involvement in the program occurred primarily during the pandemic, they were both subject to comparable influences. These findings suggest that in-person visits have some advantages in the first months of program involvement.

Readmission and mortality before and after introduction of orthogeriatric home visits: A retrospective cohort study in hip fracture patients

IntroductionOrthogeriatric collaboration in hip fracture patients during admission is well established, however, orthogeriatric involvement after discharge is not common. The aim of this study was to explore the association of orthogeriatric home visits with 30-day and 120-day readmission and mortality in ≥ 65-year-old patients surgically treated for hip fractures. Materials and MethodsA cohort of patients who underwent acute hip fracture surgery in an usual care period from January 2018 to December 2018 was compared with a cohort of patients in an intervention period from June 2020 to June 2021. During the intervention period, patients were offered orthogeriatric home visits at day 2 and 9 after discharge. The home visits were performed by orthogeriatric nurses, in close collaboration with geriatricians and orthopedic surgeons based in the local hospital. Readmission was defined as ≥ 12 h hospital stay, regardless of reason. For the main analysis, we applied Cox-regression models adjusted for age, sex, New Mobility Score, Cumulated Ambulation Score regained, cognitive function, Charlson Comorbidity Index, complications, medication, discharge destination and emergency department visits. ResultsIn total, 292 patients were included during the usual care period, and 308 patients during the intervention period. Thirty- and 120-day readmission rates were 27.7 % and 41.4 % in the usual care cohort vs. 21.8 % and 35.1 % in the home visit cohort. Adjusted Hazard Ratios for readmission in the intervention cohort after 30 and 120 days were 0.67 (CI95 %: 0.48–0.93) and 0.71 (CI95 %: 0.54–0.93) respectively. Thirty- and 120-day mortality rates were 7.2 % and 20.9 % in the usual care cohort versus 5.8 % and 13.3 % in the intervention cohort. Adjusted Hazard Ratios for mortality in the intervention cohort after 30 and 120 days were 0.68 (CI95 %: 0.35–1.31) and 0.56 (CI95 %: 0.37–0.84) respectively. ConclusionsIn a period where hip fracture patients were offered two home visits after discharge, we observed lower 30- and 120- day readmission, and lower 120-day mortality, calling for more studies with a randomized design.