Number Of Care Visits Research Articles

IMPLEMENTING REABLEMENT IN COMMUNITY CARE: HOW DO WE SUCCEED?

Abstract In the Netherlands, reablement is high on the agenda for inclusion in future health care policy, resulting in more and more care providers wanting to implement reablement into their everyday practice. So far, it has been implemented, resourced and organized in multiple ways. To support the implementation on an (inter)national level, insight is needed into what preconditions and influencing factors are regarding the successful implementation of reablement. Within a qualitative exploratory research design, four focus group interviews were conducted with stakeholders from three Dutch care organizations that have been providing reablement services for at least 6 months prior. Care staff, as well as project leaders, managers, directors, policymakers, and health insurance company representatives, were represented in the interviews. Data were analyzed using the framework method guided by the Consolidated Framework for Implementation Research. In total, 34 stakeholders, distributed over the four focus group interviews, participated in the study. Facilitators included interdisciplinary collaboration, organizational support in terms of leadership engagement and implementation climate, innovation design, and adaptability of the innovation. Barriers included costs and funding of the innovation, time investment (i.e. reporting, number of care visits), and communication. Some factors were listed as both hindering and facilitating such as knowledge and beliefs of care staff, staff’s and clients’ self-efficacy to change, and motivation of clients and family caregivers. These results enhance the understanding of factors influencing the implementation of reablement in community care. The next step is to identify strategies to overcome the identified barriers.

Clozapine treatment and risk of severe COVID-19 infection.

ObjectiveTo investigate whether patients with clozapine treatment are at an increased risk of a more severe COVID‐19 infection as compared with patients on other antipsychotic drugs.MethodsIn this register‐based cohort study, all residents (age 18 or older) in the Stockholm Region with a psychotic disorder diagnosis and antipsychotic treatment were included (N = 8 233) and followed from 1 March 2020 to 14 January 2021. The exposure was defined as clozapine treatment and the outcome measures (indicating a more severe COVID‐19 infection) were: inpatient care, care within intensive care unit or death due to COVID‐19 infection. Differences in outcome rates between exposed (n = 966) and unexposed (other antipsychotics; n = 7 267) were examined using Cox proportional hazards models and expressed as hazard ratios (HR) with 95% confidence intervals (CI).ResultsNo statistically significant differences in outcome rates were found between the two groups of patients after adjusting for age, sex and residence in retirement homes. The adjusted HR for the exposed compared to the unexposed was 0.96 (95% CI: 0.54, 1.70) for inpatient care; 1.69 (0.48, 5.93) for care in intensive care unit (ICU); and 0.86 (0.26, 2.80) for death. Regarding inpatient care, additional adjusting for country of birth, living in socioeconomically vulnerable areas, number of care visits during the previous year, and comorbid medical illnesses did not alter the results.ConclusionsOur results may add support to the present guidelines, recommending sustained clozapine treatment during the current COVID‐19 pandemic with careful monitoring and readiness to alter drug doses as needed.

末期がん患者の在宅診療の取り組み―退院支援の標準化に関する研究―

Unitil now, most terminal cancer patients have received end-of-life care service in a hospital. How, recently, home health care services have received much attention instead of the hospital care. In this study, we investigated important factors affecting smooth transition to home health care from hospital care. We examined the records of 66 deceased subjects with terminal cancers who received medical care by staff of home heath care agency "Yunomori Tnapopo clininc" were included in this study. The categories evaluated were: 1) general condition, 2) breakdown of family caregivers, 3) rate of application for care insurance, 4) the percentage of cases with a discharge planning conference, 5) the time of death and, 6) frequency of visiting care in the first 1 week and the last 1 week. The 66 subjects consisted of 38 men (58%) and the average age of the group was 71.1 2.0. 1) Dementia was indicated in 20 (30%) patients and 23% of the patients were reliant on intravenous nutrition. Oxygen treatment was required for 45% of the patients. Some help for excretion was required by 70% of the patients. 2) 70% of a main care giver were woman and the average number of persons per household was 2.0. 3) 50% of the patients did not apply for care insurance. 4) Discharge planning conferences between the hospital and the clininc were held in only 21% of the case. 5) over 70% of the patients died outside duty hours (between 8AM and 6PM). 6) Although the average duration of stay at home was 62.5 days, 10% of the cases died or had to leave their home due to worsening condition during the first 2 weeks. Vsits by medical doctor in the last 1 week significantly increased in frequency compared to that in the last 1 week. (5.0 0.2 vs. 3.9 0.2, p<0.01). In addition, frequency of care visits by nurses increased significantly as well (3.2 0.2 vs. 2.4 0.2, p<0.01). Overall the number of care visits in the last 1 week was more than once a day. 1. A home-health care clinic which gives 24-hour care is necessary so that the patients receive end-of-life care as well as hospital care. 2. Earliest possible transfer to the home health care setting is needed so trhat the patients could have enough time to live in their hom with their family. On this account, it is most important to convene a conference co-organaized by the home health care adjusytment. In addition, the patients or their family need to apply to the munided office for care insurance. Medical staff should provide information and help them.

Birthweight Productivity of Prenatal Care

The ability of prenatal care to produce birthweight, through faster fetal growth, is examined within the Rosenzweig and Schultz framework. Prenatal care, measured by the time delay in initiating care and the number of care visits, adjusted for gestation, was specified in various functional forms, permitting an examination of its marginal returns. Maternal anthropometric characteristics, such as height and prepregnancy weight, were included as measures of limits on fetal growth. Race-specific regressions were performed. Prenatal care visits, but not delays, were found to significantly increase the rate of fetal growth for black mothers. Prenatal care did not significantly increase the rate of fetal growth for white mothers. Multicollinearity in the complex specifications and weak identification of the birthweight equation prevent strong conclusions as to whether the marginal returns to prenatal care are constant, decreasing, or increasing. Maternal anthropometrics were found to greatly increase the rate of fetal growth for all mothers, though more so for white than black mothers. Prenatal care appears to be but a modest tool in reducing the incidence of low birthweight due to retarded fetal growth.

Birthweight Productivity of Prenatal Care

The ability of prenatal care to produce birthweight, through faster fetal growth, is examined within the Rosenzweig and Schultz framework. Prenatal care, measured by the time delay in initiating care and the number of care visits, adjusted for gestation, was specified in various functional forms, permitting an examination of its marginal returns. Maternal anthropometric characteristics, such as height and prepregnancy weight, were included as measures of limits on fetal growth. Race‐specific regressions were performed. Prenatal care visits, but not delays, were found to significantly increase the rate of fetal growth for black mothers. Prenatal care did not significantly increase the rate of fetal growth for white mothers. Multicollinearity in the complex specifications and weak identification of the birthweight equation prevent strong conclusions as to whether the marginal returns to prenatal care are constant, decreasing, or increasing. Maternal anthropometrics were found to greatly increase the rate of fetal growth for all mothers, though more so for white than black mothers. Prenatal care appears to be but a modest tool in reducing the incidence of low birthweight due to retarded fetal growth.

An Innovative Approach to Home Health Education: The Critical Path to Self-Care for Adults with Diabetes

A retrospective chart audit of home health care clients with the primary diagnosis of insulin-dependent diabetes mellitus (IDDM) revealed that the average number of visits for care exceeded the average number of visits for teaching. Using Orem's Self-Care Deficit Theory of Nursing, a critical pathway was designed to extend the number of visits incorporating teaching and to sequence teaching so that the client/caregiver would not be overwhelmed with instruction at the beginning of care. Physiologic needs and safety are addressed first on the pathway, followed by health promotion and disease prevention. A flexible method for documentation minimizes variance.