Outcomes Of Community Care Research Articles

The prevalence of non-pharmacological interventions in older homecare recipients: an overview from six European countries

Key summary pointsAimTo investigate the prevalence of non-pharmacological interventions (NPIs) in older homecare recipients in six European countries.FindingsThe prevalence of NPIs varied considerably between homecare users in different European countries. Interventions with a potential positive impact on health outcomes show a relatively low prevalence.MessageFurther research into better implementation of potentially beneficial interventions in treatment guidelines might be needed, in order to optimize functioning and quality of life of older homecare recipients.

Changes in home care clients\u2019 characteristics and home care in five European countries from 2001 to 2014: comparison based on InterRAI - Home Care data

BackgroundPolicymakers advocate extended residence in private homes as people age, rather than relocation to long-term care facilities. Consequently, it is expected that older people living in their own homes will be frailer and have more complex health problems over time. Therefore, community care for aging people is becoming increasingly important to facilitate prevention of decline in physical and cognitive abilities and unnecessary hospital admission and transfer to a nursing home. The aim of this study was to examine changes in the characteristic of home care clients and home care provided in five European countries between 2001 and 2014 and to explore whether home care clients who are most in need of care receive the care required.MethodsThis descriptive study used data from two European research projects, Aged in Home Care (AdHOC; 2001–2002) and Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of Community Care (IBenC; 2014–2016). In both projects, the InterRAI-Home Care assessment tool was used to assess a random sample of home care clients 65 years and older in five European countries. These data facilitate a comparison of physical and cognitive health and the provided home care between countries and study periods.ResultsIn most participating countries, both cognitive (measured on the Cognitive Performance Scale) and functional ability (measured on the Activities of Daily Living Hierarchy scale) of home care clients deteriorated over a 10-year period. Home care provided increased between the studies. Home care clients who scored high on the physical and cognitive scales also received home care for a significantly higher duration than those who scored low.ConclusionOlder people in several European countries remain living in their own homes despite deteriorating physical and cognitive skills. Home care services to this group have increased. This indicates that the government policy of long-term residence at own home among older people, even in increased frailty, has been realised.

Meeting the challenges of measuring outcomes of home care programs: The Australian Community Outcomes Measurement (ACCOM) tool

ABSTRACT Measuring the impact of care delivered at home for frail older people is a complex task given many confounding variables that may impact on the ability of service providers to identify the direct impact of their programs on their clients’ well-being and quality of life. The recent publication of the 2018 Wellness and Reablement Report Outcomes indicated that organizations lack formal processes to measure the impact of their programs on service users. There are therefore limited data exits on measuring outcomes and the performance of the ACCOM tool in the real world. Knowledge of a strong causal relationship between services provided and outcomes enables confidence in assuming the care provided was largely responsible for the outcome achieved. This paper will reflect on the experiences of one service provider in Brisbane, in implementing the Australian Community Care Outcomes Measurement (ACCOM) tool to measure and demonstrate the impact of their programs.

The Prevalence and Persistence of Dizziness in Older European Home Care Recipients: A Prospective Cohort Study

ObjectivesThe prevalence of different geriatric syndromes in older home care (HC) recipients is yet to be determined. Dizziness is often regarded as a geriatric syndrome. The natural course of dizziness in older people is still unknown, because of a lack of longitudinal studies. The objective of this study was to investigate the prevalence and persistence of dizziness in HC recipients. DesignProspective cohort study. SettingHome care organizations in 6 European countries participating in the EU-funded Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Participants2616 community-dwelling long-term HC recipients aged 65 years or older. MethodsData were collected at baseline and 6 and 12 months by using the interRAI Home Care instrument (interRAI-HC). Dizziness status was assessed by the number of days people experienced dizziness in the last 3 days (0-3) and later dichotomized for analyses (present or not in the last 3 days). Dizziness persistence was defined as the odds for dizzy people at baseline to also report dizziness at subsequent follow-up moments, compared with people who were not dizzy at baseline. The pattern of dizziness was descriptively analyzed in recipients who completed all measurements. Generalized estimating equations analysis was used to determine the persistence of dizziness symptoms. ResultsThe prevalence of dizziness of 2616 eligible HC recipients at baseline was 25.1%, ranging from 16.2% (Belgium) to 39.7% (Italy). The majority of dizzy recipients at baseline also experienced dizziness after 6 and 12 months (79.1%). Dizziness persistence was high at 6 months [odds ratio (OR) 57.8, 95% confidence interval (CI) 43.1-77.5] and at 12 months (OR 30.2, 95% CI 22.3-41.1). Conclusions and ImplicationsDizziness in older HC recipients in Europe is common, and dizziness persistence is high. This warrants a more active approach in treating dizziness in older HC recipients.

Development of a novel benchmark method to identify and characterize best practices in home care across six European countries: design, baseline, and rationale of the IBenC project

BackgroundEurope’s ageing society leads to an increased demand for long-term care, thereby putting a strain on the sustainability of health care systems. The ‘Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of Community Care’ (IBenC) project aims to develop a new benchmark methodology based on quality of care and cost of care utilization to identify best practices in home care. The study’s baseline data, methodology, and rationale are reported.MethodsHome care organizations in Belgium, Finland, Germany, Iceland, Italy, and the Netherlands, home care clients of 65 years and over receiving home care, and professionals working in these organizations were included. Client data were collected according to a prospective longitudinal design with the interRAI Home Care instrument. Assessments were performed at baseline, after six and 12 months by trained (research) nurses. Characteristics of home care organizations and professionals were collected cross-sectionally with online surveys.ResultsThirty-eight home care organizations, 2884 home care clients, and 1067 professionals were enrolled. Home care clients were mainly female (66.9%), on average 82.9 years (± 7.3). Extensive support in activities of daily living was needed for 41.6% of the sample, and 17.6% suffered cognitive decline. Care professionals were mainly female (93.4%), and over 45 years (52.8%). Considerable country differences were found.ConclusionA unique, international, comprehensive database is established, containing in-depth information on home care organizations, their clients and staff members. The variety of data enables the development of a novel cost-quality benchmark method, based on interRAI-HC data. This benchmark can be used to explore relevant links between organizational efficiency and organizational and staff characteristics.

Polypharmacy in Home Care in Europe: Cross-Sectional Data from the IBenC Study.

Home care (HC) patients are characterized by a high level of complexity, which is reflected by the prevalence of multimorbidity and the correlated high drug consumption. This study assesses prevalence and factors associated with polypharmacy in a sample of HC patients in Europe. We conducted a cross-sectional analysis on 1873 HC patients from six European countries participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Data were collected using the interResident Assessment Instrument (interRAI) instrument for HC. Polypharmacy status was categorized into three groups: non-polypharmacy (0-4 drugs), polypharmacy (5-9 drugs), and excessive polypharmacy (≥10 drugs). Multinomial logistic regressions were used to identify variables associated with polypharmacy and excessive polypharmacy. Polypharmacy was observed in 730 (39.0%) HC patients and excessive polypharmacy in 433 (23.1%). As compared with non-polypharmacy, excessive polypharmacy was directly associated with chronic disease but also with female sex (odds ratio [OR] 1.58; 95% confidence interval [CI] 1.17-2.13), pain (OR 1.51; 95% CI 1.15-1.98), dyspnea (OR 1.37; 95% CI 1.01-1.89), and falls (OR 1.55; 95% CI 1.01-2.40). An inverse association with excessive polypharmacy was shown for age (OR 0.69; 95% CI 0.56-0.83). Polypharmacy and excessive polypharmacy are common among HC patients in Europe. Factors associated with polypharmacy status include not only co-morbidity but also specific symptoms and age.

Interactions between drugs and geriatric syndromes in nursing home and home care: results from Shelter and IBenC projects.

Drugs may interact with geriatric syndromes by playing a role in the continuation, recurrence or worsening of these conditions. Aim of this study is to assess the prevalence of interactions between drugs and three common geriatric syndromes (delirium, falls and urinary incontinence) among older adults in nursing home and home care in Europe. We performed a cross-sectional multicenter study among 4023 nursing home residents participating in the Services and Health for Elderly in Long-TERm care (Shelter) project and 1469 home care patients participating in the Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. Exposure to interactions between drugs and geriatric syndromes was assessed by 2015 Beers criteria. 790/4023 (19.6%) residents in the Shelter Project and 179/1469 (12.2%) home care patients in the IBenC Project presented with one or more drug interactions with geriatric syndromes. In the Shelter project, 288/373 (77.2%) residents experiencing a fall, 429/659 (65.1%) presenting with delirium and 180/2765 (6.5%) with urinary incontinence were on one or more interacting drugs. In the IBenC project, 78/172 (45.3%) participants experiencing a fall, 80/182 (44.0%) presenting with delirium and 36/504 (7.1%) with urinary incontinence were on one or more interacting drugs. Drug-geriatric syndromes interactions are common in long-term care patients. Future studies and interventions aimed at improving pharmacological prescription in the long-term care setting should assess not only drug-drug and drug-disease interactions, but also interactions involving geriatric syndromes.

Measuring consumer outcomes: Development and testing of the Australian Community Care Outcomes Measure

In the increasingly competitive environment of aged care in Australasia, how can providers and consumers be sure that the care support delivered is efficient and makes a positive difference? Monitoring outcomes has long been emphasised for ensuring quality service delivery, yet there is currently no consistently applied approach available. This paper considers the importance of measuring outcomes in community care and reports on the development and field trial of the Australian Community Care Outcomes Measure (ACCOM). The ACCOM combines data already collected by services on the capabilities and care needs of individual consumers and their demographic characteristics with a short questionnaire on quality of life based on the Adult Social Care Outcomes Toolkit (ASCOT). It is completed by consumers and staff. In the first round of a field test of the ACCOM (2016), baseline data were successfully collected for over 200 individual aged care clients, each receiving consumer-directed care (CDC) packages at home. Results show the measure to be practical and easy to use. A second round to measure change and enable the calculation of outcomes for each consumer was successfully completed 6 months later. Field testing of the ACCOM shows promising results. More extensive trials of the measure are planned across Australia.

Substantial between-country differences in organising community care for older people in Europe-a review.

The European population is aging. The main drivers of public spending on health care for people of 65 years and older are hospital admission and admission to long-term care facilities. High quality community care can be a cost-effective and quality solution to respond to the impact of ageing populations on health-care systems. It is unclear how well countries are equipped to provide affordable and quality community care. The aim of this article is to describe and compare community care delivery with care-dependent older people in Europe. This study is conducted within the European Union-financed IBenC project [Identifying best practices for care-dependent elderly byBenchmarkingCosts and outcomes of community care (FP7)] in which six European countries are involved. To compare the community care delivery with care-dependent older people in these countries, we performed a systematic comparison of macro indicators using metadata complemented with data from multinational surveys. Data on the following dimensions are described and compared: population of the country, governmental expenditures on health, sources of community health services funding, governmental vision and regulation on community care, community care organisations and care professionals, eligibility criteria for and equity in receiving care and the involvement of informal care. : Because of the variations in the European community care contexts, the growing demand for community care as a cost-effective and quality solution to the care burden of aging populations will have country-specific impacts. When learning from other countries' best practices, in addition to researchers, policy makers should take full account of local and national care contexts.

Learning from Others: International Comparisons of Death and Dying

Death comes to us all, but attitudes towards death vary greatly. Take Dylan Thomas (“Do not go gentle into that good night; rage, rage at the dying of the light”) and Elisabeth Kubler-Ross (“Dying is nothing to fear. It can be the most wonderful experience of your life.”), as examples. The Commonwealth Fund's latest International Health Policy Survey (Osborn et al. 2014) also shows that how we prepare for ill health or death varies considerably around the world. In France, for instance, only 12% of seniors living outside of healthcare institutions say that they have had a discussion with family, a close friend or a health professional about the healthcare treatment they want if they become very ill and cannot make decisions for themselves. That compares with 78% in the US, 72% in Germany and 66% in Canada. Across all 11 countries included in the survey, the proportion of seniors who said that they had a written plan describing treatment that they want at the end of life was lower. It ranged from 4-5% in Norway, Sweden and France to 46–58% in Canada, the US and Germany. Interestingly, there is much less variation in the settings in which older adults die. A 2013 article (Broad et al. 2013) compiled the latest published rates of place of death for 45 populations, including data for 10 of the 11 countries included in the Commonwealth Fund survey. Among these countries, the authors found that deaths in hospital or residential aged care facilities varied from 65% in New Zealand to 80% in Australia. In both cases, as always, caution is required in interpreting international comparisons. Nevertheless, they do provide a prompt for a number of important policy conversations – comparisons being a type of mirror through which we have the potential to better understand ourselves. Authors in this issue of Healthcare Policy/Politiques de Sante use these and many other techniques to illuminate important policy, research and practice questions facing the health sector today. These range from how to capture patient perspectives on primary and community care outcomes to drivers of spending on prescription medications. Also in this issue are contributions on how best to share and apply new knowledge, including an online repository of documents addressing healthcare renewal and the research–policy divide for oral health inequality. Whatever your role in health policy, I hope that the thoughtful commentary and new research published in this issue of Healthcare Policy/Politiques de Sante offers interesting new insights and perspectives for you.

PALLIATIVE CARE BY THE COMMUNITY – MAXIMISING THE IMPACT OF VOLUNTEERS IN HOME CARE SERVICES

IntroductionThe Volunteer Management in Palliative Care (VMPC) survey (67% response rate) revealed that 32% of hospices that involve volunteers do so within their home care service. This is considerably lower...

Effectiveness of structured patient-clinician communication with a solution focused approach (DIALOG+) in community treatment of patients with psychosis – a cluster randomised controlled trial

BackgroundLarge numbers of patients with psychosis have regular meetings with key clinicians in the community. There is little evidence on how these meetings should be conducted to be therapeutically effective. DIALOG, a computer mediated procedure, was shown to improve outcomes in a European multi-centre trial. DIALOG structures the patient-clinician communication and makes it patient-centred, but does not guide clinicians as to how to respond to patients’ concerns. DIALOG has been further developed into DIALOG+, which uses advanced software and, additionally, provides a four step approach - based on a solution focused model - for addressing patients’ concerns. We designed a cluster randomised controlled trial to test the effectiveness of DIALOG+ in improving treatment outcomes of patients with psychosis in the community.Methods/designKey workers are recruited from community mental health teams in East London and randomly allocated to either the intervention or control group. Out of their case loads, we identify patients with schizophrenia (F 20–29) and a moderate or lower level of subjective quality of life (MANSA score <5), who are treated according to the allocation of their key workers. Key workers in the intervention group are trained in using DIALOG+ and use it with each patient over a six-month period. Control patients rate their satisfaction with life and treatment on a tablet to control for the effect of regular ratings and the use of modern technology. We are recruiting up to 42 key workers to reach a total sample size of 180 patients. Clinical and social outcomes including costs are assessed after 3, 6 and 12 months. Primary outcome is subjective quality-of-life at 6 months.DiscussionThe trial aims to evaluate the effectiveness of a novel intervention (DIALOG+) which uses modern technology to support routine patient-clinician meetings in community care, makes the communication patient centred and guides patients and clinicians to address concerns. DIALOG+ is a generic and widely applicable intervention. If shown as effective, it can be used to improve outcomes of community care on a large scale, ensuring that routine encounters are therapeutically effective. DIALOG+ can also be implemented across services at relatively low additional costs.Trial registrationCurrent Controlled Trials ISRCTN34757603

Integrating health and social care: implications for joint working and community care outcomes for older people

In England, the theme of promoting collaborative working between social and primary health care remains high on the policy agenda. The underlying assumption, largely untested, is that a greater degree of structural integration benefits service users. This paper reports the findings from a feasibility study comparing two models of joint working and examining the relative impact of personal characteristics, service use and co-location on the likelihood of older people remaining in the community. Baseline standardised interviews with 79 older people aged 75 + with complex needs in two social services departments were carried out following referral, covering social circumstances, physical and mental health and services received, with follow-up interviews after six months. Contacts between social workers and primary care were tracked. The findings suggest that co-location does not necessarily lead to substantially closer interprofessional working in terms of greater contact between social workers and GPs or social workers and community nurses. Factors affecting outcome were degree of cognitive impairment, intensity of home care received and whether the older person lived alone. Whatever the model of collaborative working, its effects on remaining in the community must be assessed in the wider context of the characteristics and services received by older people.

Book reviews

Book reviews

The longer term outcomes of community care: a 12 year follow-up of the Camberwell High Contact Survey.

There is as yet little evidence available regarding the long-term outcomes of people with severe and enduring mental illness who have been cared for primarily in the community. A 12-year follow-up was carried out of the clinical and social problems and needs for care of a group of long-term mentally ill patients (N = 81) who were heavy users of psychiatric services when originally assessed in the Camberwell High Contact Survey between 1983 and 1985. The MRC Needs for Care Assessment Schedule used in the original baseline study was repeated at follow-up. The clinical and social functioning of the group had remained relatively stable, with high levels of problems and needs at both time points and little evidence of significant improvement or deterioration. The majority had remained in contact with services. There was some increase in levels of unmet as well as met needs, and a decrease in ratings of unmeetable needs, which may have been due to changes in clinical practice. The challenge for current service providers is not only to keep clients stable, but also to help improve the clinical and social functioning of people who may no longer be the highest priority of current community mental health services. This could be approached by identifying the continuing needs of this group, and persistently delivering active treatments.

Defining the outcomes of community care: the perspectives of older people with dementia and their carers

There is growing recognition of the need for outcome measures which reflect the aims of services for people with dementia. The development and application of existing outcome measures has often marginalised people with dementia. ‘Experts’ and carers have been viewed as primary sources when identifying relevant outcomes or domains of quality of life, and proxy respondents have often been responsible for rating outcomes on the resulting measures. This paper reports a small consultation with people with dementia and their carers to identify the desired outcomes of community care. While there was considerable overlap in the outcomes identified by people with dementia and their carers, a number of limitations of relying solely on carers as proxy respondents were identified. A key outcome, which has been relatively neglected in previous work, was maximising a sense of autonomy. A range of outcomes related to the ways in which services are delivered were also identified. Future evaluative studies should encompass both quality-of-life outcomes and service-process outcomes (the impacts of the ways in which services are delivered) in addition to other outcome measures relevant to the aims and objectives of the service.

Community care and independence: self-sufficiency or empowerment?

In the UK there is currently a new focus on the basic purpose and objectives of services, not on organizational structure or the efficiency of the systems alone, but on the outcome of services for people who receive them. The Labour government has defined the promotion of independence as a priority for health and social services, but this outcome can be interpreted in a variety of ways which may not be compatible. As part of a programme of research into identifying ways of measuring the outcomes of community care, views about outcomes have been gathered from a number of stakeholders—disabled and older service users, family members and social service staff. This article outlines the views of disabled service users collected from both in-depth interviews and focus groups in a northern city. The article focuses on outcomes of services which they identified as important and considers the meaning of independence and the wider implications for clarifying objectives and defining service quality.

Book Reviews

Book reviewed in this article:Living with Dyslexia Barbara RiddickDisability Rights Handbook: A Guide to Benefits and Services for all Disabled People, Their Families, Carers and Advisers Judith PatersonEmpowerment in Everyday Life: Learning Disability Paul Ramcharan, Gwyneth Roberts, Gordon Grant and John Borland (eds)Outcomes of Community Care for Users and Carers: A Social Services Perspective A. Nocon and H. Qureshi

Andrew Nocon and Hazel Qureshi, Outcomes of Community Care for Users and Carers, Open University Press, Buckingham, 1996, vi + 176 pp., £42.50 hard, £14.99 paper.

Andrew Nocon and Hazel Qureshi, Outcomes of Community Care for Users and Carers, Open University Press, Buckingham, 1996, vi + 176 pp., £42.50 hard, £14.99 paper.

Outcomes of Community Care for Users and Carers. A Social Services.

Outcomes of Community Care for Users and Carers. A Social Services.