Patients Receiving Home Health Care Research Articles

Status of Telenursing and Future Use Intentions in Home Health Care in the Post-COVID-19 Era

This study aimed to investigate the current status and workload of telenursing by home healthcare nurses in the post-COVID-19 era, where telenursing has become indispensable, and identify factors that influence the intention to use telenursing. This study employed a cross-sectional descriptive approach based on an online survey. A total of 137 active home care nurses were surveyed for over 6 weeks starting in December 2022. Among the participants, 33.8% (N = 44) responded that they were currently using telenursing services. Most telenursing was conducted for consultation and education, using various technologies. The intention to use telenursing was significantly higher among individuals with higher educational levels and telenursing experience. The greater the social influence, which indicates the extent to which people around them believe that telenursing should be used, and more positive the attitudes toward telenursing, the higher the intention to use it. A clear definition of telenursing is required to improve people’s understanding of telenursing before its official implementation in Korea. Telenursing may be used to provide health care education and consultation while maintaining the continuity of care not only for patients receiving home health care but also for community-dwelling patients. To recognize and evaluate current telenursing practices, telenursing content should be recorded accurately. Finally, attitudes toward telenursing and social influence must be considered when developing strategies to improve nurses’ intentions to use and activate telenursing in the near future.

Managing Home Health-Care Services With Dynamic Arrivals During a Public Health Emergency

We consider a public health emergency, during which a high number of patients and their varying health conditions necessitate prioritizing patients receiving home health care. Moreover, the dynamic emergence of patients needing urgent care during the day should be handled by rescheduling these patients. In this article, we present a reoptimization framework for this dynamic problem to periodically determine which patients will be visited in which order on each day to maximize the total priority of visited patients and to minimize the overtime for the health-care provider. This optimization framework also aims to minimize total routing time. A mixed-integer programming (MIP) model is formulated and solved at predetermined reoptimization times, to assure that urgent patients are visited within the current day, while visits of others may be postponed, if overtime is not desired or limited. The effectiveness of a schedule is evaluated with respect to several performance metrics, such as the number of patients whose visits are postponed to the next day, waiting time of urgent patients, and required overtime. The MIP-based approach is compared to two practical heuristics that achieve satisfactory performance under a nervous service system by excelling in different criteria. The MIP-based reoptimization approach is demonstrated for a case during the COVID-19 pandemic. We contribute to the home health-care literature by managing dynamic/urgent patient arrivals under a multiperiod setting with prioritized patients, where we optimize different rescheduling objectives via three alternative reoptimization approaches.

Co-creating a novel practice model for connecting oral health- and home health care services – The importance of the users’ experiences

Introduction and aim: Our society is faced with an increased number of elderly patients living at home with poor oral health status. Internationally and in Norway, the home health care service (HHCS) and the dental health care service (DHCS) are disbanding, resulting in a lack of adequate and coordinated oral health services. In the development of the intervention “Connecting ORAL health- and home health care service for patients receiving home health care” (CORAL), we recognised that user involvement was essential in the design of a coherent practice model. However, it has been debated whether users are listened to or whether they act as tokens when participating in development of interventions. The aim was therefore to investigate how different users expressed their perspectives in the co-creation process of the CORAL intervention.
 Methods: Three different user groups from which five patient representatives, three HHCS and five DHCS participated in two workshops. The workshops were based on innovation theories and led by researchers. To promote a creative and feasible dialogue among the users, a case was used as a boundary object in the discussions. All the user groups were encouraged to contribute with their knowledge and experiences in conversations about what they considered important in the development of a context-specific intervention to connect HHCS and DHCS. All conversations at the workshops were audio recorded and analysed using a thematic analysis approach.
 Results: The analysis of the development process showed that the different user groups’ perspectives varied. HHCS and DHCS were more active and had a stronger “voice” during the workshops than patient representatives. We did not find any distinct disagreement at the workshops. However, the various user groups had slightly different perspectives on what was highlighted as important in the development of a context-specific intervention. There are common elements among the users; for example, they all emphasised oral health knowledge as important. Patient representatives expressed that they need knowledge about oral health rights, HHCS expressed that they needed knowledge about oral health care and DHCS expressed that they could teach the requested knowledge to the other two groups. Furthermore, the users highlighted the current service organisation and contact between the services as challenging. The patient representatives expressed a need to ensure the continuity of care as they were the ones who provided contact between the services. HHCS and DHCS expressed that they needed patient information from each other, and both service representatives gave examples of how challenging it was to collaborate with each other.
 Conclusion: Overall, the results showed that the three user groups have different perspectives, which highlight the importance of including all end users in the development process of an intervention. However, we acknowledge that the patient representatives’ “voice” was somewhat unclear due to their relatively inactive participation in the conversations.
 Implications: Designing an intervention together with the end users may lead to successful uptake among the user groups. However, inequality in user participation, may lead to diminished adaptation of the intervention to the user group whose opinions are least expressed.

Unraveling medication errors in enteral tube administration: A cross-sectional study in geriatric patients receiving home health care

BackgroundMedication administration through enteral feeding tubes requires careful consideration, as several medications are unsuitable for such administration due to interactions with feeding formulas or adverse effects when crushed. These errors can lead to feeding tube obstruction, reduced drug efficacy, or drug toxicity. ObjectiveThis study aimed to assess medication errors in geriatric patients using enteral feeding tubes who were enrolled in a home health care program. MethodThis was a cross-sectional observational study conducted at the Ministry of Health Government Hospital in Makkah City, Saudi Arabia. Medication errors related to chronic oral drugs in geriatric patients using enteral feeding tubes were evaluated, including inappropriate medications for enteral tube administration, inappropriate preparation, drug-nutrient interaction, and availability of liquid formulation, following established guidelines. ResultsOf the total 233 medications prescribed to 46 patients receiving enteral tube feeding at home, 49.3% exhibited at least one form of medication error, totaling 135 errors. Medication errors were highly prevalent among the patients (93.4%), with the leading cause being the administration of medications unsuitable for enteral feeding tubes (33.3%), predominantly due to the use of controlled release or enteric-coated formulations. ConclusionThis study underscores the high prevalence of medication errors in older patients receiving enteral feeding at home. To ensure patient safety and optimal outcomes, healthcare professionals should utilize available resources and seek expert advice when selecting medications and dosage forms for tube-fed patients. Pharmacists play a critical role in promoting safe drug use and can greatly contribute by educating patient caregivers on proper medication preparation and administration techniques, thus preventing harm to patients.

Investigetion of Pressure Sores Frequency and Risk Factors of Patients Registered to Home Health Unit

Aim: The study was to investigate the frequency of pressure sores, the risk factors causing their formation, and their relationship with nutrition in patients receiving home health services. Materials and Methods: After scanning all 4098 patients registered with the Home Health Unit of an Education and Research Hospital in İzmir, Turkey, it was discovered that 186 of them had pressure sores. The study concluded with 151 patients as 35 patients passed away during the data collection process. The questionnaire employed in the study comprised two parts: The first part examined patients' sociodemographic and clinical characteristics, while the second part utilized the Pressure Ulcer Scale for Healing, Braden Pressure Ulcer Risk Assessment Scale, and Malnutrition Universal Screening Tool. Results: Pressure sores were found in 3.69% of the 4098 patients. The mean age of the patients was 78.29 (78.28±14.51), and 103 (68.2%) were female patients. Upon analyzing patients based on the presence of chronic diseases, it was noted that the risk of pressure sore development was notably higher in the high and very high-risk groups, particularly among those with neurological diseases. Approximately 44.4% of the patients utilized nutritional products. A statistically significant correlation was observed between the use of high-protein dietary products and the Braden scale score.. Conclusion: This study shows that the patients receiving Home Health Care Services are in the risky group in terms of pressure sores and malnutrition, but the incidence decreases with good care and caregiver education. The most important factors that increased the risk of pressure sore formation and the severity of pressure sores were neurological disease, nutritional status, and urinary and fecal incontinence.

Demographic, Clinical, and Biomedical Profile of Diabetic Patients Receiving Home Healthcare in Saudi Arabia

Demographic, Clinical, and Biomedical Profile of Diabetic Patients Receiving Home Healthcare in Saudi Arabia

A Novel Home-Based Medication Management Program and Its Influence on Hospitalization Rates among Home Health Care Recipients

Patients do not take their medicine as prescribed 50% of the time, and of medication-related hospital admissions in the United States, 33% to 69% are due to poor medication adherence, at a cost of approximately $100 billion a year. Continue CareRx (CCRx) is a novel home-based medication management program that includes adherence packaging alongside medication reconciliation, review, and education by clinicians. We hypothesized that home health patients receiving the CCRx service may have a lower hospitalization rate than control home health patients. Between May 1, 2021, and March 31, 2023, 113 home health patients whose insurance covered the program were enrolled in CCRx. Home health patients not eligible for the program due to a noncovered pharmacy insurance benefit made up the control group (n = 21,304), which was matched with the CCRx group on age range (45-99 years old) and gender (67% women). Hospitalization rate was calculated in both groups and compared using generalized estimating equations analysis. The control group had a total of 7015 hospitalizations during the study period during 2,128,738 total managed days, whereas the CCRx group had 21 hospitalizations during 23,622 total managed days. These translated into rates of 1203 hospitalizations per 1000 per year for the control group, and 324 hospitalizations per 1000 per year for the CCRx group. The results showed that there was a significant main effect of group in predicting individual annual hospitalization rate (Wald χ2 = 56.415, P < .01). Specifically, being in the control group was associated with a 43.42-fold increase in the likelihood of a higher hospitalization rate (95% Wald CI for odds ratios: 7.24-230.44). Home health recipients enrolled in CCRx experienced a 73.1% lower hospitalization rate than controls. Making the program more widely available to patients receiving home health care may present a significant opportunity to reduce hospitalizations in this group.

The effects of music therapy on enhancing the overall health of elderly patients receiving home health care: A controlled study

Music therapy can be defined as the application of sound and music to integrate cognitive, affective, and motor aspects, fostering awareness and enhancing creative processes. Scientific literature lacks studies that standardize music therapy procedures and assessments for elderly patients receiving home health care. This study aimed to systematically analyze the effects of music therapy on the overall health of elderly patients receiving home health care. Twenty elderly individuals were divided into control and intervention groups, and two blinded examiners used the Individualized Music Therapy Assessment Profile (IMTAP) and system of music therapy evaluation for people with Alzheimer&amp;rsquo;s and other dementias scales to evaluate them before and after 12 weeks of treatment. Only members of the intervention group received weekly individual music therapy sessions. Statistical analysis included inter-rater correlation, comparison between independent samples (group pairings), and comparison between related samples (differences between initial and final evaluations within groups) with a significance threshold of P &amp;le; 0.05. In the initial condition, the two groups exhibited dissimilarity only in the IMTAP scale&amp;rsquo;s Musicality and Fine Motricity domains domain among the 15 evaluated domains. Comparing the initial and final conditions within each group, the intervention group demonstrated significance in 11 subscales, whereas the control group showed significance in only two subscales. These results highlight more significant improvements in the intervention group, extending across all dimensions of life. The findings from this study suggest that music therapy may offer benefits to elderly patients receiving home health care, contributing to their overall health.

Anemia Frequency in Geriatric Patients Receiving Home Health Care: A Retrospective Study

Aim: This study aims to investigate the frequency and causes of anemia in geriatric patients registered in the Home Health Services Unit of our hospital and to apply appropriate treatment regimens according to the etiology. Methods: This descriptive study was conducted between 15.03.2022 and 15.03.2023. The files of 282 patients who received service from the Home Health Services Unit between August 1, 2020 and November 30, 2021 were reviewed retrospectively. Geriatric patients who had laboratory tests requested in the last 6 months were included. Socio-demographic data of the patients, chronic diseases, and the number of chronic diseases were recorded. The World Health Organization criteria were considered for the diagnosis of anemia. The causes are grouped as anemia due to iron deficiency, chronic renal failure, vitamin B12 deficiency, folic acid deficiency, and other anemias. Results: A total of 282 individuals, 198 (70.2%) women, were included in the study. The mean age of the participants is 79.2±11.06 years, 218 (77.3%) of them live in rural areas. 33.7% of the patients have 3 chronic diseases. Anemia was detected in 176 (62.4%) patients. 44.9% of the participants had anemia due to chronic renal failure, 28.4% had anemia due to iron deficiency, 13.1% had anemia due to vitamin B12 deficiency, 13.1% had anemia due to folate deficiency, and 26.1% had unclassified anemia. The presence of anemia was significantly higher in patients with a diagnosis of malignancy and in participants with 4 or more chronic diseases. Conclusion: This study shows that anemia is a common health problem in geriatric patients receiving home health care. In this population, effective management of the process by detecting anemia in individuals screened with regular visits as a result of continuous care in home health care, conducting research on the etiology, and controlling comorbidities may be important steps to improve the patient's quality of life. We recommend that physicians dealing with geriatric patients keep in mind the importance of detecting and managing anemia in their patients and organize their routine examinations in this perspective. Keywords: home health care, geriatrics, patients, anemia

Examining the role of race and quality of home health agencies in delayed initiation of home health services for individuals with Alzheimer's disease and related dementias (ADRD).

We examined differences in the timeliness of the initiation of home health care by race and the quality of home health agencies (HHA) among patients with Alzheimer's disease and related dementias (ADRD). Medicare claims and home health assessment data were used for the study cohort: individuals aged ≥65 years with ADRD, and discharged from the hospital. Home healthlatency was defined as patients receiving home health care after 2 days following hospital discharge. Of 251,887 patients with ADRD, 57% received home health within 2 days following hospital discharge. Black patients were significantly more likely to experience home health latency (odds ratio [OR]=1.15, 95% confidence interval [CI]=1.11-1.19) compared to White patients. Home health latency was significantly higher for Black patients in low-rating HHA (OR=1.29, 95% CI=1.22-1.37) compared to White patients in high-rating HHA. Black patients are more likely to experience a delay in home health care initiation than White patients.

Care Burden and Influencing Factors of Elderly Patients Receiving Home Health Care: Perspectives of Patients and Caregivers

Care Burden and Influencing Factors of Elderly Patients Receiving Home Health Care: Perspectives of Patients and Caregivers

Exploring nursing-sensitive events in home healthcare: A national multicenter cohort study using a trigger tool

BackgroundThe provision of home healthcare is increasing in response to the growing aging population with the need for chronic disease management in their homes. Safety work differs from hospital care. The incidence of adverse events in home healthcare is sparsely studied but is estimated to occur in-one third of patients, and most are deemed preventable. Although nursing care is crucial for risk assessment and preventive work in the home environment, the role of registered nurses in the prevention of no-harm incidents and adverse events has not received sufficient scientific attention. ObjectivesTo explore nursing-sensitive events in patients receiving home healthcare. Design, setting and participantsA Swedish national multicenter study based on a structured record review of 600 randomly chosen healthcare records from 10 organizations in different regions of the country. MethodsTen trained teams, each including physician(s) and registered nurses, undertook a review based on the Global Trigger Tool method. The review covered a maximum of 90 days from admission to home healthcare. First, each record was screened for the presence of 38 predefined triggers. In the second step, every potential event was assessed according to preventability, types of events, severity, time of occurrence, consequences of the event, and potential contributing causes. ResultsIn total, 699 events were identified in the study. Of these, 495 (74.0%) were classified as nursing-sensitive (227 no-harm incidents and 268 adverse events) and affected 267 (44.5%) patients, with a mean of 1.9 events per patient. The majority (n = 367, 73.1%) were considered preventable. The most prominent types of nursing-sensitive event were falls (n = 138, 27.9%), pressure ulcers (n = 62, 12.5%), healthcare-associated infections (n = 58, 11.7%) and medication management (n = 50, 10.1%). Concerning severity, 45.9% were classified as no-harm incidents and another 36.6% resulted in temporary harm that required extra healthcare resources: 226 hospital days, 66 physician visits in outpatient care, and 99 in home healthcare. All severity types occurred from day 1, except death, which included only one patient. The most frequent contributing factors were deficiencies in nursing care, treatment & diagnosis, with the subgroups nursing care, observation, treatment & follow-up, followed by deficiencies in the organization. ConclusionsNursing-sensitive events in home healthcare are common, often preventable, and occur from the start of the care period. This study contributes to increased knowledge of patient safety shortcomings and points to the important role that registered nurses play in patient safety work.

RACIAL DISPARITY IN THE START OF HOME HEALTHCARE IN HIGH-RISK ADRD PATIENTS BY THE QUALITY OF HOME HEALTH

Abstract Improving the quality and timely access of home health care is a new quality measure and particularly crucial in high-risk ADRD adults following hospitalization. However, a significant portion of older patients waits longer than 2 days to receive home healthcare. In this study, we examine how the quality of home health agency and race are associated with the delay in care among ADRD patients receiving home healthcare and how this delay mitigates the risk of rehospitalization. We find that Black patients in low rated home health agencies have 28% higher odds of delay in care compared to White patients in high rated home health agencies (Odds ratio (95% CI) =1.28 (1.21 - 1.36)). Timely initiation of home health care also reduces the risk of rehospitalization in minority older adults with ADRD.

Determining the frailty status in patients who apply for home health care

Background To examine the relationship between an institutionally prepared standardized patient evaluation form and the Edmonton Frail Scale (EFS) in patients receiving home health care.&#x0D; Material and Methods Our prospective, observational study included 200 patients over the age of 18 who requested home health care, regardless of gender. The EFS and institutional data collection forms were applied consecutively on the same day to all patients included in the study. &#x0D; Results Among the 200 individuals recruited for the study, 59% were female and 41% were male; the overall average age was 80 years. According to the EFS results, 4.5% of the patients were classified as non-frail, 6% were vulnerable, and 89.5% had varying degrees of frailty (mild, moderate and severe). There was a significant positive correlation between EFS score and age (p

Detecting Language Associated With Home Healthcare Patient's Risk for Hospitalization and Emergency Department Visit.

About one in five patients receiving home healthcare (HHC) services are hospitalized or visit an emergency department (ED) during a home care episode. Early identification of at-risk patients can prevent these negative outcomes. However, risk indicators, including language in clinical notes that indicate a concern about a patient, are often hidden in narrative documentation throughout their HHC episode. The aim of the study was to develop an automated natural language processing (NLP) algorithm to identify concerning language indicative of HHC patients' risk of hospitalizations or ED visits. This study used the Omaha System-a standardized nursing terminology that describes problems/signs/symptoms that can occur in the community setting. First, five HHC experts iteratively reviewed the Omaha System and identified concerning concepts indicative of HHC patients' risk of hospitalizations or ED visits. Next, we developed and tested an NLP algorithm to identify these concerning concepts in HHC clinical notes automatically. The resulting NLP algorithm was applied on a large subset of narrative notes (2.3 million notes) documented for 66,317 unique patients ( n = 87,966 HHC episodes) admitted to one large HHC agency in the Northeast United States between 2015 and 2017. A total of 160 Omaha System signs/symptoms were identified as concerning concepts for hospitalizations or ED visits in HHC. These signs/symptoms belong to 31 of the 42 available Omaha System problems. Overall, the NLP algorithm showed good performance in identifying concerning concepts in clinical notes. More than 18% of clinical notes were detected as having at least one concerning concept, and more than 90% of HHC episodes included at least one Omaha System problem. The most frequently documented concerning concepts were pain, followed by issues related to neuromusculoskeletal function, circulation, mental health, and communicable/infectious conditions. Our findings suggest that concerning problems or symptoms that could increase the risk of hospitalization or ED visit were frequently documented in narrative clinical notes. NLP can automatically extract information from narrative clinical notes to improve our understanding of care needs in HHC. Next steps are to evaluate which concerning concepts identified in clinical notes predict hospitalization or ED visit.

Long Term Implications of Home Healthcare Management on Mortality in Older Adults with Functional Difficulties in the Saudi Community.

Background: This study aims to investigate whether certain demographic factors of patients receiving home healthcare (HHC) interventions have any positive impact on mortality. Methods: the study included all patients who were enrolled in the HHC program in a referred medical complex, Jeddah, Saudi Arabia between the years 2017 and 2020 (593 patients). Results: A total of 6548 HHC visits were received during the study period. From the total number of visits, 3592 (54.9%) HHC visits were scheduled in the year 2020 compared to 157 (2.4%) scheduled HHC visits in 2017 (p < 0.001). The most successful HHC visits were provided in 2020 compared with the year 2017 (2193 vs. 132; p < 0.001). The cancelled HHC visits were observed to be the lowest (194) in 2019. Three explanatory variables of mortality [age, having a major diagnosis (diabetes mellitus, cerebrovascular diseases, and bedridden), and having more cancelled visits] made a statistically significant contribution to the logistic regression model after controlling for other variables. Suffering from cerebrovascular diseases and/or bedridden were the strongest predictor of death in patients receiving HHC. Conclusions: During the 2020 pandemic, there was a sharp increase in HHC compared to previous years. Three significant explanatory variables of mortality [age, having a major diagnosis (diabetes mellitus, cerebrovascular diseases, and bedridden), and having more cancelled visits] were reported.

Home Health Care Nursing Impacts on Emergency Department Utilization.

With health care costs continuing to rise, much attention has been focused on appropriate emergency department (ED) utilization, and nationwide interventions have been developed to support reduction in health care costs and ED use including primary care, community, and home health models. The following is a review of the current state of the evidence regarding patients receiving home health care nursing (HHN) services and impacts on ED utilization. There are significant gaps in the literature regarding the transition from home to ED in patients receiving HHN services; what tools are utilized by home health nurses for triage of patients at home in order to recommend transfer to the ED or other care sources; and what measures are in place for HHN patients regarding variables that are considered to have a higher impact on ED utilization. There is a substantial lack of evidence about whether the effects of HHN services have any relation to, in particular decreasing, ED utilization. There is increasing evidence of the impacts of nurse practitioner care within the community.

Impacts of the Home Health Value‐Based Purchasing (HHVBP) Model After the First Payment Adjustment Year

Research ObjectiveThe Home Health Value‐Based Purchasing (HHVBP) Model provides financial incentives for quality improvement to home health agencies in nine states with the goal of improving quality and efficiency of care for Medicare beneficiaries. The maximum Medicare payment adjustment increases during each of the five years of the model, ranging from ±3% in 2018 to ±8% in 2022. Our goal is to understand the early impact of the HHVBP Model on quality, utilization, and Medicare spending during its first three years (2016–2018), which includes the first year in which payment adjustments to agencies took effect.Study DesignCMS randomly selected nine states to participate in the HHVBP Model starting January 2016, with mandatory participation from all agencies. Agencies in these states received performance scores for 20 measures of quality of care used to determine their payment adjustment relative to other agencies within their state. To evaluate the effects of HHVBP, we used a difference‐in‐differences design and multivariate linear regression to compare differences in the changes in outcomes of the nine HHVBP states with those in the 41 comparison states for three years pre‐intervention (2013–2015) through the first three years of the model (2016–2018). We evaluated agency performance using Outcome and Assessment Information Set (OASIS)‐based quality measures and measures of claims‐based Medicare fee‐for‐service (FFS) health care utilization and spending.Population StudiedMedicare and Medicaid patients receiving home health care in the nine HHVBP states and forty‐one comparison states.Principal FindingsWe found evidence of slightly greater improvements in most measures of improved functional status used to determine payment adjustments in HHVBP states relative to non‐HHVBP states. Compared to non‐HHVBP states, Medicare FFS beneficiaries who received home health care in the nine HHVBP states had a relative decrease in unplanned hospitalization rate (−1.8%) and in skilled nursing facility (SNF) stays (−4.9%) from pre‐HHVBP implementation average levels. Conversely, we observed a 2.4% increase in emergency department (ED) visits relative to the average pre‐implementation rates for HHVBP states. Overall, we found evidence of a 1.2% reduction in Medicare spending due to HHVBP, corresponding to an average $141 million reduction in annual Medicare spending in HHVBP states over the first three years of the model. The reduction in spending among home health Medicare FFS patients was driven primarily by reductions in inpatient hospital spending (−2%) and SNF spending (−4%). We did not find an appreciable difference in savings between the third year—in which payment adjustments were applied—and the first two years of the model prior to HHVBP agencies receiving payment adjustments.ConclusionsThrough the HHVBP Model's first three years—which includes the first year of payment adjustments to agencies—we found modest impacts of HHVBP: lower growth in Medicare spending, declines in unplanned hospitalizations and use of SNFs, somewhat greater increases in ED use, and somewhat greater improvements in many OASIS‐based quality measures among home health patients in the HHVBP states.Implications for Policy or PracticeThe findings from current and subsequent research will inform policymakers, home health care patients, and other stakeholders about potential benefits of expanding the model to include agencies in other states.Primary Funding SourceCenters for Medicare and Medicaid Services.

Evde Bakım Hastalarında Görülen Yeni Ürolojik Problemler: Çıkmayan Sondalar

Objective: The aim of this study was to evaluate urological problems and solutions in patients receiving home health care. Material and Method: The study included 99 patients were with chronic urethral catheter use among 1950 patients who received home health care between January 2017 and February 2019. The problems faced by patients and health personnel, ways to deal with problems and the reasons for applying to urology specialist were recorded. Results: The mean age of the patients included in the study was 77.3 (48-96) years. Fifty-five patients (55.5%) were male. Among the primary diseases of home care patients, 58 (58.5%) were the most common neurological problems. The urological problems were urinary infection in 18.1%, inability to remove the catheter in 18.1%, urethral erosion due to chronic irritation in 15.1% and hematuria in 8%. Antibiotherapy was applied to patients with urinary infection. Hematuria was treated in situ by irrigation and interruption if anticoagulant use was discontinued. In patients with urethromeatal erosion, a condom catheter was passed or a clean intermittent catheterization was performed and treated using local ointment. The patients who could not be probed were brought to the hospital for consultation with the urologist and the catheter was removed by interventional procedures (urethral or suprapubic). Conclusion: Urological problems are seen in 60% of the problems faced by home care patients, and a low percentage of these problems require urologist support.

Medical care needs for patients receiving home healthcare in Taiwan: Do gender and income matter?

Studies about medical care needs for home healthcare (HHC) previously focused on disease patterns but not gender and income differences. We used the Taiwan National Health Research Insurance Database from 1997 to 2013 to examine trends in medical care needs for patients who received HHC, and the gender and income gaps in medical care needs, which were represented by resource utilization groups (RUG). We aimed to clarify three questions: 1. Are women at a higher level of medical care needs for HHC than men, 2. Does income relate to medical care needs? 3. Is the interaction term (gender and income) related to the likelihood of medical care needs? Results showed that the highest level of medical care need in HHC was reducing whereas the basic levels of medical care need for HHC are climbing over time in Taiwan during 1998 and 2013. The percentages of women with income-dependent status in RUG1 to RUG4 are 26.43%, 26.24%, 30.68%, and 32.07%, respectively. Women were more likely to have higher medical care needs than men (RUG 3: odds ratio, OR = 1.17, 95% confidence interval, CI = 1.10-1.25; RUG4: OR = 1.13, 95% CI = 1.06-1.22) in multivariates regression test. Compared to the patients with the high-income status, patients with the income-dependent status were more likely to receive RUG3 (OR = 2.34, 95% CI = 1.77-3.09) and RUG4 (OR = 1.98, 95% CI = 1.44-2.71). The results are consistent with the perspectives of fundamental causes of disease and feminization of poverty theory, implying gender and income inequalities in medical care needs. Policymakers should increase public spending for delivering home-based integrated care resources, especially for women with lower income, to reduce the double burden of female poverty at the higher levels of medical care needs for HHC.