House Calls Research Articles

Integrating Geriatric House Call Practice into Paramedic Education: A Novel Educational Approach on Attitudes and Acceptance

Integrating Geriatric House Call Practice into Paramedic Education: A Novel Educational Approach on Attitudes and Acceptance

Environmental house calls can reduce symptoms of chemical intolerance: a demonstration of personalized exposure medicine.

The goals of this investigation were to 1) identify and measure exposures inside homes of individuals with chemical intolerance (CI), 2) provide guidance for reducing these exposures, and 3) determine whether our environmental house calls (EHCs) intervention could reduce both symptoms and measured levels of indoor air contaminants. CI is an international public health and clinical concern, but few resources are available to address patients' often disabling symptoms. Numerous studies show that levels of indoor air pollutants can be two to five (or more) times higher than outdoor levels. Fragranced consumer products, including cleaning supplies, air fresheners, and personal care products, are symptom triggers commonly reported by susceptible individuals. A team of professionals trained and led by a physician/industrial hygienist and a certified indoor air quality specialist conducted a series of 5 structured EHCs in 37 homes of patients reporting CI. We report three case studies demonstrating that an appropriately structured home intervention can teach occupants how to reduce indoor air exposures and associated symptoms. Symptom improvement, documented using the Quick Environmental Exposure and Sensitivity Inventory Symptom Star, corresponded with the reduction of indoor air volatile organic compounds, most notably fragrances. These results provide a deeper dive into 3 of the 37 cases described previously in Perales et al. (2022). We address the long-standing dilemma that worldwide reports of fragrance sensitivity have not previously been confirmed by human or animal challenge studies. Our ancient immune systems' 'first responders', mast cells, which evolved 500 million years ago, can be sensitized by synthetic organic chemicals whose production and use havegrown exponentially since World War II. We propose that these chemicals, which include now-ubiquitous fragrances, trigger mast cell degranulation and inflammatory mediator release in the olfactory-limbic tract, thus altering cerebral blood flow and impairing mood, memory, and concentration (often referred to as 'brain fog'). The time has come to translate these research findings into clinical and public health practice.

Socio-spatial inequalities in presence of primary care physicians and patients' ability to register: A simulated-patient survey in the Paris Region

ObjectivesWe studied the socio-spatial inequalities of three types of general practitioner (GP) density in the Paris metropolitan area: the density of GPs present (that is, practising) in the census block and of those registering new patients for office visits and, separately, for house calls. Study designAn exhaustive simulated patient survey enabled us to determine the number of GPs practising in the Paris metropolitan region accepting new patient registration for continuing care at their office and/or for house calls. MethodsWe measured at the level of a census block three types of GP densities: density of GPs present, density of GPs registering new patients at their office and density of GP registering new patients for house calls. We compared the association between the social deprivation level and each density measurement overall, then by stratifying for the population density of the census block. ResultsIn 2017–2018, we contacted 8171 physicians (87.6 % of the GPs in the region). Although more than 55 % of Ile-de-France census blocks had (at least) one practising GP, fewer than 40 % had one willing to register a new patient for ongoing office care, and fewer than 20 % for home care. Regardless of the GP density considered, it decreased as the census block's deprivation index rose. However, these inequalities were more marked for registration than for presence and in the most densely populated blocks. ConclusionsIn conclusion, the indicators of GPs' mere presence appear to minimise the socio-spatial disparities associated with access to registration.

Impact of the COVID-19 Pandemic on Home Medical Care Utilization in Japan: An Interrupted Time Series Analysis.

The COVID-19 pandemic affected healthcare utilization worldwide, but changes in home medical care utilization have not been fully revealed. This study aims to clarify the changes in the use of home medical care services in Japan due to the pandemic. Interrupted time series analysis of national medical claims data. Individuals with home medical care use occurring in Japan between April 2019 and March 2022. The declaration of a state of emergency (April 2020) by the Japanese government. The outcomes were the monthly uses of regular home visits, emergency house calls, terminal care, and in-home deaths. Terminal care was stratified by care setting (home or nursing home) and the type of home medical care facilities (enhanced home care support clinics and hospitals (HCSCs), conventional HCSCs, and general clinics and hospitals). Regular home visits showed no significant change, but emergency house calls exhibited an upward trend (1258 uses/month, 95% CI 43to2473). Both terminal care and in-home deaths experienced an immediate increase in level (1116 uses/month, 95% CI 549to1683; 1459 uses/month, 95% CI 612to2307), followed by a gradual increase in trend (141 uses/month, 95% CI 73to209; 215 uses/month, 95% CI 114to317). The immediate increase of terminal care occurred only for home patients. Enhanced HCSCs showed the most prominent increase in both level and trend, followed by conventional HCSCs, and general clinics and hospitals. The COVID-19 pandemic increased the use of emergency house calls and terminal care among home medical care in Japan, particularly for home patients and enhanced HCSCs. These findings suggest that the pandemic revitalized the importance of home medical care as a patient-centered care delivery model and highlight the need for strategic healthcare planning and home medical care resource allocation to anticipate future pandemics.

Reproducibility of Portable OCT and Comparison with Conventional OCT.

Optical coherence tomography (OCT) is an indispensable instrument in ophthalmology; however, some facilities lack permanent OCT devices. ACT100, a portable SD-OCT system, allows for medical examinations at hospitals that do not have OCT and house calls. We investigated the usefulness of ACT100 by examining the reproducibility of retinal thickness measurements in 35 healthy participants with normal eyes using ACT100 and Cirrus. Using two OCTs, the OCT imaging of both eyes of each subject was performed. Macular retinal thickness was evaluated using the average value in nine lesions of the Early Treatment Diabetic Retinopathy Study (ETDRS) circle. Both models captured images in all cases. In the right eye, mean retinal thickness was significantly lower than in the ACT100 group in all regions; however, the measured values correlated well. The intraclass correlation coefficients showed the same high reliability as the Cirrus. The coefficients of variation (CVs) of both models showed little variation and high stability; however, the CV of ACT100 was significantly higher. The left eye was almost identical. Macular retinal thickness measured using ACT100 showed slightly greater variability than that by Cirrus; the reproducibility was good and correlated well with that of Cirrus. This technique is a suitable alternative to conventional OCT.

White House Calls for Stakeholder Action on Overdose Deaths

White House Calls for Stakeholder Action on Overdose Deaths

Doctor' s bag for House Call for Adults - Proposals

House calls are an important part of medical practice in Switzerland and help reducing the need for emergency room visits. To ensure quality service, the content of the doctor' s bag must be adapted to home practice: Enough to deal with a variety of clinical situations, while sufficiently limited to remain portable. We offer here an updated doctor' s bag content, focusing on the resources needed for diagnosis and treatment. We distinguish between basic items and additional resources that can be used for extended care, particularly in regions with no local health resources.

The Motivation of Students and Their Exposure to Learning Loss After the Pandemic

This research seeks to illustrate how the COVID-19 epidemic has affected students' motivation, engagement, and learning. Students had learning difficulties during the pandemic, as demonstrated by their nonattendance in online courses and their inability to turn in homework on sites such as Google Classroom. Acknowledging these difficulties, the instructor made house calls to collect information for this study. By exposing 100 ninth-grade students to several, the researcher addressed learning loss. The study used a case study methodology and included both qualitative and quantitative data. Google Forms was used to conduct both closed- and open-ended surveys for data gathering. According to the results, just 20.6% of students reported having no learning loss during the pandemic, compared to 79.4% who reported having it. Students' trust in their learning experiences throughout the pandemic was divided into three categories: great certainty (33.4%), certainty (46%), and uncertainty (20.6%). Furthermore, based on their comments on Google Forms, the data revealed that 52.5% of students thought their learning experience was bad, 28.2% thought it was extremely weak, and 19.6% thought it was strong.

IMPLICATIONS OF THE COVID-19 PANDEMIC ON ADULT DAY SERVICES

Abstract Covid-19 hit Adult Day Services (ADS) hard with sites across the country forced to close. As part of the ADS-Plus study, two focus groups were conducted to understand the impact of Covid-19 on ADS sites, their participants, and staff. Six sites across the country, represented by nine staff and administration (females=n, males=1) participated in focus groups. Focus groups were recorded, transcribed verbatim, and coded by the authors. Four themes emerged, (1) Ways to stay in touch with families; (2) Issues reopening; (3) Family concerns; and (4) Future of the ADS Industry. Sites stayed in touch with families through a variety of measures, including virtual daycare or activities via zoom, house calls, and help obtaining food. Upon reopening, there were multiple issues with getting the census back for both participants and staff. Families were reluctant to return due to fear of Covid-19, placing their family member in LTC due to decline in functioning or due to work, and using more home services. Staff were reluctant to return due to fear of Covid-19 and salary, some reporting they made more on unemployment. There was a decline in both physical and cognitive health of ADS participants, attributed to the lack of socialization. In looking towards the future, focus group participants felt that the old approach of doing ADS is not sustainable and that the industry needs to expand to include more home options. Also, funding of ADS needs to be addressed as many facilities are not able to keep up with increasing salaries.

Health improvement of the elderly in five Central Asian countries during COVID-19 based on difference game.

In 2020, COVID-19 became a global pandemic. Older people are less resistant to the novel coronavirus. In order to ensure the health of the elderly population, the governments of five Central Asian countries should provide home medical services for the elderly or provide "green channel" to medical services. This "green channel" means providing a special service and treatment for the elderly in the hospital to ensure that they can safely and easily access the medical services they need. In order to study the application scope of various modes, this article constructs three modes of differential game: no special care, home medical care and "green channel". And the equilibrium results are compared and analyzed. Research shows that when the additional medical costs associated with house calls or "green channel" gradually increase, the social benefits to both the elderly and the government gradually decrease, and eventually it is less than the social benefits under the no-special care model. The greater the credibility of the government under the "green channel" service model, the greater the social benefits of the government. However, the greater the credibility of the government under the home medical service model, the smaller the social benefits of the government.

Drepadom - a Homecare Protocol for Vaso-Occlusive Crisis for Sickle Cell Disease Patients

INTRODUCTION Vaso-occlusive crisis (VOC) is first cause of emergency room (ER) admissions and hospitalizations for sickle-cell disease (SCD) patients. Acute chest syndrome (ACS) is a complication that can occur during VOC and prolong hospitalization, and is the main cause of death in SCD patients. The PRESEV score (Bartolucci - eBioMed 2016), established by our team, allows physicians to evaluate the risk of developing ACS and is calculated upon arrival to the ER and has been validated by an international multicenter study in five different countries (PRESEV 2 - ASH 2020). During the Covid-19 pandemic, we set up a temporary system to monitor VOC patients at home using a telephone hotline and homecare services. The success of this system led to the establishment of DREPADOM, a home-care protocol for VOC management for patients with low risk of developing ACS, or who can be discharged early from the hospital, as standard care (DREPADOM - ASH 2021). Since 2021, Drepadom has been successfully running in seven hospitals in the Parisian region. DESCRIPTION OF SETTING Drepadom has two inclusion modes: 1/ Patients arriving at the ER for VOC with a PRESEV score ≤ 6 and not presenting any exclusion criteria; 2/ patients that are discharged early following hospitalization for VOC and/or ACS (after at least 3 days of hospitalization for patients with PRESEV > 6 upon ER arrival). The Drepadom homecare protocol is activated by a coordinator, who coordinates delivery of PO opioids and parenteral treatments, and a home oxygen concentrator, to the patients' home within four hours. Drepadom uses an online platform and mobile app (Link4Life), where the patient's medical record is shared to the homecare nurse who will perform house calls twice a day. During each visit, the nurse enters the patient's vitals into the app, which are monitored by an on-call SCD expert physician. The online platform also hosts a secure messaging service where nurses, doctors and coordinators can communicate in real-time regarding patient status and care, as well as an automatic alert system that is triggered when vitals fall outside of a predetermined range set by SCD experts. Patient safety is further ensured with a daily calls to the patient using a decision-making algorithm supervised by SCD experts, who arbitrate according to the evolution of the situation (stopping/continuing outpatient follow-up vs. rehospitalization). RESULTS Over a 30-month period we had 209 inclusions for 170 patients into DREPADOM. Of these, 105 were inclusions from the ER and 104 were early discharges (ED). SCD genotype distribution was 83.2% SS, 10.5% SC, and 5.8% S-bThalassemia and female to male ratio was 128:81. In both ER and ED groups, median age was 31 [27-40], 74% of patients were under hydroxyurea treatment and median homecare follow-up duration was 3 [2-4] days. No significant differences in population characteristics were found between the ER and ED groups. In the ER group, 96/105 patients (91.4%) were included with PRESEV ≤ 6. 9/105 (8.6%) patients were included with a PRESEV score >6 only in 2021 during the Covid-19 pandemic, when the ER was saturated. In the PRESEV ≤ 6 group, 9/96 (9.4%) patients were rehospitalized: 1 for ACS (PRESEV = 4), 4 for uncontrolled VOC pain, 2 for chest pain, 2 for fever/infection unrelated to VOC. In the PRESEV >6 group, 3/9 (33%) were hospitalized, one for ACS (PRESEV = 8), one for uncontrolled VOC pain and one for issues with veinous access. In the ED group, patients were hospitalized for a median of 4.5 [3-7] days before being discharged. 27 patients (26%) were included in a post-ACS context. 48/104 (46.2%) had a PRESEV ≤6, of which only 2/48 (4.2%) were rehospitalized for uncontrolled VOC pain. Of the 56/104 (53.8%) patients included with a PRESEV > 6, 8/56 (14.3%) were rehospitalized: 1 for ACS, 3 for uncontrolled VOC pain, 1 for chest pain, 1 for fever/infection unrelated to VOC, 1 for issues with veinous access, and 1 for morphine withdrawal symptoms. For both ER and ED groups, a total of 22/209 patients (11%) required rehospitalization (Figure 1), and no deaths or ICU were reported in either group. PERSPECTIVES Our results confirm that Drepadom is a successful and safe tool to reduce hospital stay for SCD patients.

The House Call.

The House Call.

Home visiting and the housebound

Home visits by GPs, or ‘house calls’ as they were known, made up a large proportion of medical consultations until the 1960s, largely because of accessibility issues and slow transport options. Home visits now form a vastly smaller percentage of general practice workload reflecting, for example, increases in demand and a shortage of GPs. Many GPs now believe home visits should not be part of core contract work. Others fear such a change would communicate a lack of concern for the housebound. Such ambivalence is reflected in the GP training curriculum where home visits are no longer mandated, yet are simultaneously an expected competency for trainees. This article guides the trainee on how to complete a comprehensive home visit to illustrate the advantages they may offer. The latter part will explore further the differing opinions on home visits and proposals to address some of the dilemmas.

Medication of Postpartum Depression and Maternal Outcomes

<h3>Abstract</h3> We use data on over 420,000 first-time Dutch mothers to examine the effects of postpartum antidepressant use. Dutch general practitioners (GPs) must be available for house calls. We therefore instrument a woman’s receipt of antidepressants postpartum with local practitioners’ propensity to prescribe antidepressants to women 46 to 65. Ordinary least squares suggests negative effects of postpartum antidepressants but this is due to selection into treatment. Instrumental variables estimates indicate that the marginal treated patient is likely to continue taking antidepressants long term and is less likely to be employed in the year after birth, with little evidence of other effects.

Association between types of home healthcare and emergency house calls, hospitalization, and end-of-life care in Japan.

To meet the increasing demand for home healthcare in Japan, as part of the national healthcare system, home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in 2006 and 2012 respectively. This study aimed to evaluate whether HCSCs has succeeded in providing 24-h home care services through the end of life. A retrospective cohort study was conducted using the national database in Japan. Participants were ≥ 65 years of age, had newly started regular home visits between July 2014 and September 2015, and used general clinics, conventional HCSCs, or enhanced HCSCs. Each patient was followed up for 6months after the first visit. The outcome measures were (i) emergency house call(s), (ii) hospitalization(s), and (iii) end-of-life care defined as in-home death. Multivariable logistic regression analyses were performed for statistical analysis. The analysis included 160,674 patients, including 13,477, 64,616, and 82,581 patients receiving regular home visits by general clinics, conventional HCSCs, and enhanced HCSCs respectively. Compared to general clinics, the use of conventional and enhanced HCSCs was associated with an increased likelihood of emergency house calls (adjusted odds ratio [aOR] and 95% confidence intervals [CIs] of 1.62 [1.56-1.69] and 1.86 [1.79-1.93], respectively) and a decreased likelihood of hospitalizations (aOR [95% CIs] of 0.86 [0.82-0.90] and 0.88 [0.84-0.92] respectively). Among 39,082 patients who died during the follow-up period, conventional and enhanced HCSCs had more in-home deaths (aOR [95% CIs] of 1.46 [1.33-1.59] and 1.60 [1.46-1.74], respectively) compared to general clinics. HCSCs (especially enhanced HCSCs) provided more emergency house calls, reduced hospitalization, and enabled expected deaths at home, suggesting that further promotion of HCSCs (especially enhanced HSCSs) would be advantageous.

Approaching the dermatologic care of people experiencing unsheltered homelessness through a volunteer street dermatology model

To the Editor: Although contemporary health care delivery models aim to tackle health care disparities, the most vulnerable patient populations continue to suffer from reduced access to care. A street-based approach presents a framework for clinical outreach to this truly underserved population that bears a disproportionate burden of disease.1Petrovich J.C. Hunt J.J. North C.S. Pollio D.E. Roark Murphy E. Comparing unsheltered and sheltered homeless: demographics, health services use and predictors of health services use.Community Ment Health J. 2020; 56: 271-279https://doi.org/10.1007/s10597-019-00470-0Crossref PubMed Scopus (9) Google Scholar Patients who would otherwise be unable to attend structured, charitable clinics can instead be evaluated in their own setting and on their own terms. Such “house-calls for the homeless” can bridge notable gaps in care, especially for essential yet difficult to access services like dermatology.2Stefanowicz M. Feldman B. Robinson J. House calls without walls: street medicine delivers primary care to unsheltered persons experiencing homelessness.Ann Fam Med. 2021; 19: 84https://doi.org/10.1370/afm.2639Crossref PubMed Scopus (3) Google Scholar The distinction between sheltered and unsheltered populations is not often made in medical literature, as previous studies involving people experiencing homelessness utilize shelter-based cohorts.3Koh K.A. Roncarati J.S. Racine M.W. O'Connell J.J. Gaeta J.M. Unsheltered vs. Sheltered adults experiencing homelessness: health care spending and utilization.J Gen Intern Med. 2022; 37: 2100-2102https://doi.org/10.1007/s11606-021-07153-1Crossref PubMed Scopus (1) Google Scholar In the absence of reliable shelter, people experiencing unsheltered homelessness (PEUH) are exposed to conditions that increase their risk of suboptimal dermatologic health leading to cellulitis and osteomyelitis.4Raoult D. Foucault C. Brouqui P. Infections in the homeless.Lancet Infect Dis. 2001; 1: 77-84https://doi.org/10.1016/S1473-3099(01)00062-7Abstract Full Text Full Text PDF PubMed Scopus (167) Google Scholar Street Dermatology is a model to provide direct dermatologic care for PEUH living near sidewalks, encampments, and overpasses. Many of these patients live in squalid conditions with both food and medical insecurity, and lack the means to coordinate formal health care visits. After registering with the state health department, ethical approval was obtained by the University of Miami Institutional Review Board (IRB) in conjunction with established volunteer street medicine providers. PEUH encountered face-to-face were offered basic medical care by a team of providers supervised by a physician. Although board-certified dermatologists were invited to participate in the outreach, most initial dermatologic input was provided via store-and-forward telemedicine (Fig 1). Skin conditions were documented among 160 PEUH encountered in Miami-Dade County from January to June 2022. A total of 125 dermatologic diagnoses (Table I) were made. We reviewed patient history, clinical presentation, and recommended treatment weekly. There was a wide distribution of dermatologic disease noted, with infectious (28.0%, n = 35), inflammatory (24.0%, n = 30), ulcers/erosion/wounds (12.8%, n = 16), UV-induced/neoplastic disorders (10.4%, n = 13), and pruritus (7.2%, n = 9) being prevalent. Patients received treatment and education about their condition including preventative measures. Patient information was stored on a secure, custom REDCap medical record.Table IDermatologic conditions encountered over a 6-month periodType of conditionNumber of diagnoses (% of total)Inflammatory30 (24.0) Acne4 (3.2) Pseudofolliculitis barbae1 (0.8) Dermatitis20 (16.0)Contact5 (4.0)Chronic dermatitis/Lichen simplex chronicus8 (6.4)Photodermatitis2 (1.6)Venous3 (2.4)Unspecified2 (1.6) Psoriasis2 (1.6) Seborrheic dermatitis2 (1.6) Lichen planus1 (0.8)Infectious35 (28.0) Tinea cruris1 (0.8) Tinea pedis10 (8.0) Tinea manuum1 (0.8) Onychomycosis10 (8.0) Verruca vulgaris4 (3.2) Erosio interdigitalis blastomycetica5 (4.0) Pityriasis versicolor1 (0.8) Scabies3 (2.4)Ulcerations/erosions/wounds16 (12.8) Erosions and wounds11 (8.8) Burn2 (1.6) Post-trauma scars3 (2.4)Nail disorders6 (4.8) Paronychia2 (1.6) Micronychia1 (0.8) Leukonychia1 (0.8) Beau’s lines1 (0.8) Clubbing1 (0.8)Pruritus10 (8.0) Prurigo nodularis1 (0.8)Cutaneous neoplasm or UV damage13 (10.4) Seborrheic keratosis6 (4.8) Actinic keratosis3 (2.4) Solar lentigo2 (1.6) Idiopathic guttate hypomelanosis1 (0.8) Melanoma1 (0.8)Miscellaneous10 (8.0) Arthropod assault4 (3.2) Acrochordon1 (0.8) Corns1 (0.8) Ichthyosis vulgaris1 (0.8) Xerosis2 (1.6) Terra firma-forme dermatosis1 (0.8)Unspecified, requiring dermatology evaluation5 (4.0)Total125 (100) Open table in a new tab Life-changing diagnoses were also made. For roughly 15 years, one patient had a slow growing, quarter-sized hyperpigmented lesion on his cheek. During street evaluation, the characteristics of his lesion raised concern for melanoma. He was immediately connected to our dermatology service where he received biopsies which confirmed the diagnosis of melanoma at a depth of 1 mm. Subsequently, surgery was coordinated. In this way, PEUH could now be connected to reliable, specialized care. This model’s reproducibility varies on a regional basis but can be adopted by a multidisciplinary team of medical providers, educators, and social workers.5Doohan N.C. Mishori R. Street medicine: creating a “classroom without walls” for teaching population health.Med Sci Educ. 2019; 30: 513-521https://doi.org/10.1007/s40670-019-00849-4Crossref PubMed Scopus (6) Google Scholar Notable drawbacks include unpredictability of follow-up care due to the inherently informal structure of our evaluations. Funding is dependent on charitable contributions and first-line treatments may be unavailable. Such outreach works for patients whose condition does not warrant urgent medical care but still requires timely management. Street Dermatology demonstrates the vital role our specialty can play in the care in one of the most underserved populations. None disclosed.

The Effect of Home Care Support Clinics on Hospital Readmission in Heart Failure Patients in Japan.

Heart failure is common and is associated with high rates of hospitalization. Home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in Japan in 2006 and 2012, respectively. This study aimed to examine the effect of post-discharge care by conventional or enhanced HCSCs on readmission, compared with general clinics. Retrospective cohort study using the Japanese nationwide health insurance claims database. Participants were ≥65 years of age, admitted for heart failure and discharged between July 2014 and August 2015 and received a home visit within a month following the discharge (n=12,393). The exposure was the type of medical facility that provides post-discharge home healthcare: general clinics, conventional HCSCs, and enhanced HCSCs. The primary outcome was all-cause readmission for 6 months after the first visit; the incidence of emergency house calls was a secondary outcome. We used a competing risk regression using the Fine and Gray method, in which death was regarded as a competing event. At 6 months, readmissions were lower in conventional (38%) or enhanced HCSCs (38%) than general clinics (43%). The adjusted subdistribution hazard ratio (sHR) of readmission was 0.87 (95% CI: 0.78-0.96) for conventional and 0.86 (0.78-0.96) for enhanced HCSCs. Emergency house calls increased with conventional (sHR: 1.77, 95% CI:1.57-2.00) and enhanced HCSCs (sHR: 1.93, 95% CI: 1.71-2.17). Older Japanese patients with heart failure receiving post-discharge home healthcare by conventional or enhanced HCSCs had lower readmission rates, possibly due to compensation with more emergency house calls. Conventional and enhanced HCSCs may be effective in reducing the risk of rehospitalization. Further studies are necessary to confirm the medical functions performed by HCSCs.

Article Domain Category: Medical Education.

This study measured the effect the experience of house calls might have on third-year medical students. Students were surveyed via an anonymous online survey at the start of their geriatrics clerkship, again at the end of their clerkship, and once more three months later. Empathy was measured using the Jefferson Scale of Empathy - Student version (JSE) and student attitudes towards the geriatrics population was measured using the UCLA Geriatrics Attitudes Scale (GAS). Data were analyzed using SPSS version 27.0. No changes in empathy were found when comparing students who completed house calls versus those who did not. However, students who trained in office settings were noted to have higher JSE scores at the three-month follow-up survey, students who worked in hospital settings had higher JSE scores at the completion of the clerkship, and student who worked in assisted living facilities had higher GAS scores at the completion of the clerkship. Teaching students ways to improve empathy can be challenging. The setting in which a student trains may be an area of focus for improving empathy among trainees and should be researched further.

HOW ARE MULTIPLE CHRONIC CONDITION COMBINATIONS DIFFERENTIALLY ASSOCIATED WITH HEALTH SERVICE USE?

Abstract A growing body of literature describes important advances in the study of chronic conditions, most notably a paradigm shift from the study of individual chronic conditions to the study of multiple chronic conditions (MCCs). Despite these advances, little research has explored MCC combinations, and almost no published research has explored how MCC combinations are related to health service utilization. Using data from the 2018 wave of the Health and Retirement Study, we categorized 16,447 older adults into one of 32 groups using self-reports of five prevalent chronic conditions: arthritis, diabetes, heart problems, hypertension, and respiratory problems. ANOVAs assessed associations between MCC combinations and two self-report measures of health service use: (1)number of medical visits, including emergency room visits, clinic visits, and house calls; and (2)total out-of-pocket costs for major medical expenses. Results show that older adults with more conditions had a greater number of medical visits (p&amp;lt; 0.0001). The pattern between total number of conditions and out-of-pocket costs is less clear, though still varied significantly (p&amp;lt; 0.01). Findings demonstrate variability in outcomes among MCC combinations with the same total number of conditions. Those in the Heart-Hypertension-Respiratory group averaged 9 medical visits while those in the Arthritis-Diabetes-Heart group averaged 16. Adults in the Diabetes-Heart group averaged $2,546 in out-of-pocket costs, which is nearly double the costs reported by the Diabetes-Hypertension group ($1,254). Findings highlight complex associations of MCC combinations with health service use, and can inform resource allocation, policy priorities, and care planning among providers serving older adults with MCCs.

Community long-term care services in Taiwan: a qualitative study based on provider’s perspectives

Purpose This qualitative study aims to explore the experiences of Taiwan’s community-based long-term care service stations. Design/methodology/approach Semi-structured interviews were conducted with eight managers selected from stations located in the counties with the highest proportion of elderly people. Findings The results are as follows: the main services offered by the stations include health promotion activities, congregate meal programs, respite care and making house calls; government subsidies constitute a major proportion of the service stations’ funds, followed by user payments and external donations; the adversities encountered include frequent policy revisions, the dwellers’ reluctance to participate in the activities, manpower shortages and subpar service quality; and the effects of the stations on the community include achieving aging in place, providing more options for life after retirement, mitigating caregivers’ burden, expanding the elderly’s social networks and strengthening their health literacy. Originality/value The results of this research can understand the benefits and difficulties of Tier C service centers in Taiwan. Also, the practical experiences provide some suggestions for policies and training. Future studies can focus on establishing systematized training programs and standardizing the service personnel’s competence.