Home Care Practice Research Articles

Nurse-Led Medication Management for Older People in Home Care: A Systematic Review of Evolving Nurse Responsibilities in Technology-assisted Care

Technology-assisted care is transforming the home care landscape for older people requiring medication management. With evolving roles and responsibilities, nurse-led interventions are shaping the future of nursing practice in home care. This review aimed to identify and describe nurse-led roles in medication management in home care for older people within the context of technology-assisted care. A systematic review employing an integrative approach was conducted on the PubMed (covering MEDLINE), Scopus, CINAHL, ProQuest, and Embase, targeting studies published in English over the past decade, from 2014 to 2024. The initial database search identified 1629 studies, which were subsequently narrowed down to 20 studies selected for data analysis and narrative research synthesis. The review findings were classified into 3 categories: “fundamental principles,” “nurses and their role identities,” and “enhanced care quality and medication safety.” Given the effectiveness of nurses as leaders in technology-assisted home care for enhancing medication management safety, it is essential to implement policies that support and improve their involvement in multidisciplinary healthcare teams. Additionally, continuous education and training focused on technology-assisted care competencies are necessary to ensure nurses are well-prepared to enhance patient safety in home care.

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

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

The Impact of Physical Environment on Residents’ Well-Being and Staff Care Practice in Dementia Care Homes in Canada and the Netherlands

This qualitative study examines how the physical environment affects residents’ well-being and staff’s practice in dementia care homes. Staff members in four care homes participated in focus groups in Canada and the Netherlands. Thematic analysis generated five themes: (i) promoting autonomy and social engagement, (ii) creating a home-like atmosphere, (iii) managing sensory stimulation, (iv) fostering a sense of connectedness, and (v) facilitating a stress-free work environment The study highlights the physical environment’s profound impact on residents’ well-being and staff care practice.

Organisational conditions for safety management practice in homecare and nursing homes, pre-pandemic and in pandemic

The outbreak of COVID-19 pandemic was a major challenge for health care and eldercare service all over the world, regarding prevention of spread of contagion to both the elderly and care workers. This study used a mix method design, aiming to identify important conditions for Occupational Health and Safety Management (OHSM) in practice in home care and nursing homes, in general and regarding the prevention of spread of contagion. The result show how conditions for OHSM differed according to eldercare setting and had stronger importance in homecare, both pre-pandemic and in pandemic. Routines and standardized procedures of OHSM was introduced and improved during the pandemic. The routines and standardized procedures had importance for OHSM and COVID-specific OHSM, especially in homecare (r2: 0,86) but also in nursing homes (r2: 0,39). Team communication of risks, work adjustments and equality climate were also of importance. The OHSM work in homecare was understood as Rooms for re-constructing standardized guidelines to un-standardized settings. The practice of safety work was formed by room for elders’ independent decisions of forming their homes and by room for groupthink shaped by employees’ earlier knowledge experiences and norms. Supportive conditions with equal climate, explicable routines, visual instructions and reflections of OHSM have stronger importance where work environments are unstandardized and work and organizational conditions underdeveloped (i.e. homecare). To better bridge the gap between work as imagine and done in unstandardized contexts, conditions in general and specifically the opportunities to reflect and adapt routines together need to be improved.

The methodological challenges faced when conducting hydration research in UK care homes.

The evidence base for hydration practice in care homes is underdeveloped. High-quality research is therefore needed to determine what practices support older people with dementia in drinking sufficient fluid. However, methodological developments are needed to be able to do this. To highlight the methodological issues researchers encountered during a feasibility cluster, randomised controlled trial of ThinkDrink, a hydration care guide for people with dementia living in UK care homes. This is a challenging area because of the complexity of recruitment, participation and data collection in care homes. Researchers must pay extra attention to rigour and quality in the design of their studies. There may be multiple challenges, so various strategies may be required. It is important that researchers continue to reflect on rigorous approaches to develop evidence in a crucial area of care, despite these challenges. Researchers working in complex environments face a variety of challenges to complete methodologically rigorous research. It is important for researchers to be critical of research processes and data, to mitigate and overcome these challenges.

Home care practice behavior and its influencing factors of primary care providers: a multicenter cross-sectional study in Sichuan Province, China

BackgroundPrimary care providers play an important role in home health care, and their practice behavior is significant for care quality and patient outcomes. This study aimed to assess the home care practice behavior of Chinese primary care providers and to explore the factors associated with the practice behavior.MethodsA multicenter cross-sectional design with a convenience sample was used to survey 863 registered primary care providers from 62 primary health care settings in Sichuan Province, China. Descriptive statistics, t-test or ANOVA for one-way analysis, and Pearson’s correlation analyses were used to compare the differences and examine the relationships between participants’ demographics and experience of home care services and practice behavior. Multiple linear regression models were performed to identify salient variables associated with the practice behavior from among demographic and home care experience.ResultsThe score of home care practice behavior questionnaire was 97.25 ± 21.05. The average scores for the dimensions of home visit preparation, assessment, medical care behavior and safety practice were 3.70 ± 0.95, 3.76 ± 1.02, 3.66 ± 1.03, and 3.20 ± 0.46, respectively. Home care practice behavior was associated with working years, working experience in general hospitals, work area, home care experience such as client types of home care, service frequency and willingness, explaining 21.5% of the total variance.ConclusionChinese primary care providers had a medium to high level of home care practice behavior but poor implementation of safety practice. The results may provide clues to increased focus and implementation of safety practice, as well as providing targeted measures based on influencing factors.

End-of-life care at home: Dignity of family caregivers.

Healthcare services are increasingly being shifted to home settings for patients nearing end-of-life. Consequently, the burden on family caregivers is significant. Their vulnerable situation remains poorly understood and there is little information available regarding their experiences of dignity. This study seeks to understand the experiences of family caregivers related to dignity and loss of dignity, aiming to provide a deeper insight into their situation when caring for a home-dwelling family member nearing end-of-life. This exploratory study consists of a second analysis combining data from two primary studies, including 24 family caregivers of a family member nearing end-of-life, and is founded upon Gadamer's philosophical hermeneutics. Approval was obtained from the Norwegian Agency for Shared Services in Education and Research and was based on voluntary participation, informed consent, and confidentiality. The following three main themes were identified: Having a meaningful existence within the living environment, being seen and valued as a family caregiver in relation with others and suffering in a space of loneliness. These contextual, relational, and existential perspectives were found to be closely interrelated. The dignity of family caregivers was closely tied to being seen as unique individuals, not merely caregivers, thereby requiring healthcare professionals (HCPs) to understand their personal needs. This study highlights the emotional distress and loneliness family caregivers feel in their dual role within the healthcare system, thereby calling for HCPs to adopt an attitude of gentleness and recognition to impart dignity-preserving care in homecare practices.

Collaborative medication reviews in community pharmacies-Drug-related problems and the process of communicating them with physicians: A retrospective validation study.

Cooperation between practicing community pharmacists (PPs) and primary care physicians has traditionally been limited, with scarce communication on therapeutic issues. The aim of this study was to assess how PPs communicate in writing with physicians regarding (1) the clinically relevant problems they have identified in patients' medications and (2) recommendations to solve the problems to identify development needs in the communication process. This retrospective validation study assessed medication reviews conducted by PPs in collaboration with home care nurses, practice nurses, and physicians for 46 older (≥65 years) home care clients in the Municipality of Lohja, Finland. The therapeutic and communicative appropriateness of clinically relevant drug-related problems (DRPs) identified by PPs and reported in writing to physicians was blindly evaluated by (1) an accredited pharmacist (AP) and (2) two physicians specialized in geriatric pharmacotherapy. Descriptive statistical analysis was conducted to compare the assessments. The PPs (n = 13) identified 189 DRPs and made 4.1 recommendations per patient in 46 written reports to physicians. Of the PPs' written recommendations for medication changes, 46% (155/334) were the same as those by the AP. The two specialized physicians evaluated 69% and 67% of PPs' recommendations to be clinically relevant. The way the DRPs and recommendations to solve them were communicated was evaluated as appropriate in 38% and 38%, respectively, of the case reports written by the PPs. The PPs were able identify DRPs quite well, particularly inappropriate medication use, according to current care guidelines and formularies. It was found that improvement was needed in the communication of DRPs in written reports with physicians. Interprofessional learning by working in care teams would be suitable for strengthening patient care-oriented competencies.

An integrative review of home care recommendations for women after caesarean section.

To describe home-based care and practices recommended for mothers after caesarean section (CS), existing in the literature. Systematic review. This integrative literature review was conducted by using Google Scholar, PubMed and Hinari databases from its inception to June 2021. The search included research articles, protocols and guidelines that describe home care practice after CS and assessed for their quality. Synthesis of recommendations from the included literature was classified based on the type of study design, and the review was guided by methodology registered in Prospero (ID CRD42021276905). A total of 681 literatures were found, and 12 met the criteria. Recommended home care components were divided into four major categories; wound care practice (wound cleaning, drying and bandage change); nutrition (high-protein diet, vitamin C, fibre and balanced diet); exercise (pelvic floor muscle, walking and breathing exercise) and hygiene (bathing and wearing clean clothes). There was limited literature addressing the components of perineal care and home environment. Varying recommendations were found regarding wound cleaning and dressing in the studies done in low- and high-income countries.

The effects of occupational and mental stress among home care rehabilitation professionals working during the COVID-19 pandemic: An exploratory qualitative study.

Home care rehabilitation professionals (hcRPs) provide health services for clients with a broad range of medical conditions. During the COVID-19 pandemic, home care rehabilitation professionals experienced exacerbations of pre-existing work-related stressors, increased risk of transmission of the COVID-19 virus, reduced resource availability, greater workloads, and staffing shortages. The primary aim of this study was to examine the experience and impact of occupational and mental stress on hcRPs working during the COVID-19 pandemic. Semi-structured interviews were conducted with 24 hcRPs working in Ontario, Canada during the COVID-19 pandemic. Inductive thematic analysis was used to interpret and organize the data into conceptualized themes. Interview data was organized into three themes: (a) unique challenges of a home care rehabilitation professional, (b) COVID-19 exacerbations of home care occupational and mental stress, and (c) personal and workplace coping strategies. Many participants reported reducing their hours or taking on adjunctive roles in different clinical settings outside of home care due to work-related stress exacerbated by the COVID-19 pandemic. With a focus on the effects of COVID-19 on the practice of home care, this study provides a unique perspective on the challenges experienced by hcRPs during an emergent and evolving global public health concern. The exploratory nature of this research works towards providing a framework of factors to be addressed when creating sustainable healthcare interventions, as well as recommendations to support hcRPs to benefit both the community and health-care providers.

Communication support in care homes for older adults: Views and reported practices of speech and language therapists and care home activities staff in the UK.

Speech and language therapists (SLTs) and care home activities staff play key roles in managing and supporting the communication needs of older residents in care homes. However, the current practice and perspectives of these two professions in the United Kingdom has not been examined. To investigate the practice patterns and views of SLTs and activities staff working in UK care homes for older adults in relation to residents' communication needs. Two online surveys, with 63 questions (SLT survey) and 46 questions (activities staff survey) in total, were created using the online platform Qualtrics. Participants were asked to consider their routine practice before COVID-19. Results were analysed using descriptive statistics and qualitative content analysis. A total of 116 valid responses were received from SLTs and 29 valid responses from activities staff. A high level of communication needs in care homes was reported by both participant groups, as was insufficient time and resources and lack of managerial encouragement in this area. SLTs reported that the majority of referrals to their service from care homes was for swallowing needs (70%). Cognitive communication difficulty was the most commonly reported communication need by SLTs (65%). Most SLTs (73%-87%) provided some level of communication intervention and considered management of residents' communication needs to be both part of the SLT role and a good investment of their time. Lack of confidence setting goals and providing direct intervention for communication needs was reported, with 25% feeling stressed at the thought of this. The main themes from free text responses about SLT service improvement were increased staff training, funding (of resources and specialist posts) and changes to service provision (referral criteria and accessibility/awareness of SLT service). Hearing impairment was the communication need most commonly reported by activities staff (43%). Participants demonstrated relatively high awareness of communication difficulty in residents and reported high levels of knowledge and confidence identifying and supporting residents' communication. Most (79%-89%) considered identifying and supporting the communication needs of residents to be part of their role and expressed interest in receiving further training in communication support. The reported activities staff data set may be positively biased. SLTs and activities staff were highly motivated to support the communication needs of care home residents. Increased training, time and resources dedicated to managing the communication needs of residents emerged as opportunities for service improvement across both data sets. What is already known on the subject There is a high level of communication need amongst older care home residents. Social interaction and relationships are important factors contributing to quality of life in this population and rely on successful communication. Speech and language therapists (SLTs) and activities staff play key roles in managing and supporting the communication needs of this client group, but the current practice and perspectives of these professions in the United Kingdom has not been examined. What this study adds A high level of communication need in care home residents was identified by both SLT and activities staff and both participant groups were motivated to address, identify and manage this need. However, insufficient time and resources, as well as a perceived lack of encouragement from managers to provide communication support/intervention, were reported by both groups. SLT practice was constrained by referral criteria and care pathways, which differed between services. Suggestions for SLT service improvement are reported. Clinical implications of this study Targeted, ongoing staff training is required in care homes to improve the communication environment and develop care home staff capacity to support residents' communication needs. There is also a call for service level improvements to increase the range of SLT practice in care homes, including a greater focus on communication needs and more specialist (e.g., dementia) SLT roles.

Policies, Practices, and Environmental Characteristics Among Family Child Care Homes in South Carolina.

Background: Child care program requirements have adopted nutrition and physical activity standards to address childhood obesity, but few studies have examined the effects of these standards in family child care homes (FCCHs). Methods: In a cross-sectional study (2017-2019), the Childcare Home Eating and Exercise study examined self-reported provider characteristics and observed policies and practices related to physical activity and nutrition in FCCHs in South Carolina. Two-sample t-tests were used to compare observed nutrition and physical activity policy, practice, and environment scores in child care homes that participated in versus did not participate in the state's ABC Quality program, which is designed to improve child care and includes policies and practices intended to increase physical activity levels and improve diet quality. Results: Environment and Policy Assessment and Observation results for nutrition and physical activity were 7.5 out of 21 and 11.8 out of 30, respectively, indicating much room for improvement in nutrition and physical activity policies, practices, and environment in South Carolina FCCHs. The study found one difference between FCCHs that did and did not participate in the ABC Quality program; non-ABC homes provided more time for physical activity. Conclusions: Future research should develop ways to strengthen the guidelines and improve the implementation of obesity prevention standards in FCCHs.

Home Care Practices that Improve Performance of Activities of Daily Living of Patients Post-stroke:A Systematic Review.

Evidence is inconsistent on the effectiveness of home rehabilitation for patients post-stroke. This review aims to explore home care practices that improve the performance of activities of daily living of patients post-stroke. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), clinical trials and mixed-methods studies published from 2012 to 2022 were gathered from PubMed, ScienceDirect, EBSCO, and ProQuest in December 2022. The Mixed Method Appraisal Tool (MMAT) was used for quality appraisal. Narrative synthesis approach was utilized to present the findings. A total of 758 articles were screened, and 10 were included in the final analysis. Five out of ten programs were found superior compared with usual care. Factors that influence the effectiveness of the programs include the age of the participants, severity of disabilities, family participation, and presence of a multidisciplinary team. A multidisciplinary healthcare team approach toward the enhancement of knowledge, skills, and behaviors of patients and their families is common in effective home care. The role of nurses is emphasized not only as providers of direct patient care but also as coordinators of the healthcare team and patients and their families. This study provides insights for policymakers in developing healthcare system for post-stroke care. J. Med. Invest. 71 : 197-204, August, 2024.

A novel application of a self-report comprehensive assessment: Where do telephone assessments fit in home care practice?

Introduction: In Canada, long-stay home care patients are a prevalent group of frail older adults living in the community. Home care patients have a high emergency department visit rate compared to those living independently without formal home care services. In March 2020, concerted efforts were put into place to reduce COVID-19 transmission and spread in health sectors, including older adult home care populations.
 Description: The interRAI home care (HC) assessment is the practice standard for face-to-face comprehensive assessments in home care. The interRAI Check Up is a comprehensive self-report assessment that can be completed in-person, by video call or telephone. Check Up assessment items are consistent with the content items of interRAI HC. During pandemic mandated restrictions, care coordinators used the Check Up to assess new and existing patients over the phone or by video call to ensure continuity of care. Feasibility and utility of the Check Up was evaluated through a staff survey and focus groups in two distinct regions of Ontario.
 Discussion: A total of 48 care coordinators completed the survey, of which 7 consented to provide feedback in the focus groups. Care coordinators found the Check Up easy to pivot to during the pandemic, citing familiarity with questions and risk algorithms. The Check Up results were helpful in gaining an understanding of the patient’s medical issues, functional status, mood, and informal supports, while telephone and video assessments saved travel time. According to the care coordinators, patients and informal care givers were comfortable answering the questions over the phone and appreciative of interaction with a health professional. Although care coordinators were accustomed to telephone check ins, language barriers, hearing impairment, and inability to see the home environment were limitations. Care coordinators found telephone assessments, using the Check Up, most beneficial in the absence of cognitive impairment and with patients previously known and assessed by the care coordinator. 
 Conclusion: The interRAI Check Up was an efficient method of completing a comprehensive assessment over the phone. Care coordinators found the Check Up to be best suited for reassessments and as a new assessment with stable, cognitively intact patients. Our findings support use of the interRAI Check Up as a promising and feasible addition to the suite of tools for home care coordination.

Transforming Home Community Nursing Practice Through Nurse Empowerment: H.O.P.E. Approach to Care

Ageing at home is the expressed wish of the fastest growing older adult population. Life care, not just medical/health care, can holistically address care needs of this population. Receiving care at home provides the best opportunity for care providers to address a person’s care needs within their natural environment- the place they call home. With heightened concerns of COVID-19 transmission, older audits are hesitant to have multiple care providers in the home and staff are overwhelmed with work as several team members are off due to personal and/or medical reasons. Coupled with the current state of the Canadian homecare practice setting at the system level, a change is needed. The pandemic became the catalyst to transform/evolve the way SE Health provides care for the betterment of our clients, staff and organization- thus spearheading the H.O.P.E.- Home, Opportunity, People, Empowerment model of care. This leading organizational model of care provides nurses with optimal autonomy and flexibility to deliver best life, home and community care. Empowerment provides nurses with optimal autonomy and flexibility to deliver excellent life care with clients and their circle of care members. Caseload management and self-directed scheduling are unique home and community care competencies that are fostered and supported by optimization of operational processes. Therefore, operationalization of nursing practice in this model requires both optimization of Service Coordination function and digital enablement. One digital innovation, MySE Life App was created to address this need. The MySE Life App is a bespoke digital application designed by nurses, for nurses that provides access to key information to support holistic care delivery in a single application. The tool empowers informed decision making around planning, coordination, and delivering exceptional quality care by giving nurses access to client information on demand. The components of H.O.P.E. Model of Care brings homecare back to basics and care back to the future. To bring this ambition to life, we employed implementation science to bring rigor to the implementation approach and support the change management of over 8,000 leaders across the organization nationally. As Primary Nursing is the core of this organizational model, first year of implementation has focused on optimizing scope of nursing practice and continuity of care. H.O.P.E. nursing competency development through a Novice to Expert journey was also undertaken. Three key success insights will be shared with real life implementation scenarios: 1) empowering the nurse and the client, 2) implementation science informed execution, and 3) operationalizing nurse practice with enabling technology and redesigned structures, processes, and leadership. Learning insights can inform healthcare organizations in how creating a nurse empowered practice culture impacts client safety, quality care and sustainable business outcomes. As the implementation moves towards sustainability in nursing, the learnings will also be applied to accelerate the implementation across other health care disciplines such as personal support workers and allied health disciplines in the organization. The implementation of H.O.P.E. Model of Care illustrates how home and community care can work better for people and the broader system in a resource constrained environment.

Care Recipient Factors That Predict Caregiver Burden in Older Adult Dyads

As individuals age, changes in their health status and functional level may begin to require caregiving from family caregivers. The role of caregiver can be taxing, a well-established phenomenon known as caregiver burden. While many studies have examined the factors within the caregiver that can be predictive of caregiver burden (or burnout), relatively few have examined the factors of the care recipient that predict caregiver burden. Using a sample of individuals enrolled in the Department of Veteran’s Affairs Home Based Primary Care program, we collected data on demographic, psychological (i.e. mood and cognitive) and nursing (e.g. ADL/IADL, fall risk, etc.) factors. Using stepwise regression modeling, we discovered that only care recipient’s age, IADL impairment, and gender predicted caregiver burden. We discuss possible causes of the relationships and implications for nursing and homecare practice.

SUCCESSFUL METHODS FOR ELICITING VIEWS OF DIRECT CARE WORKERS REGARDING NEEDS AND PREFERENCES OF HOME CARE CLIENTS

Abstract Over the past decades, as the recruitment and retention of Direct Care Workers (DCWs) has become a critical issue, numerous studies have sought to elicit workers’ views, particularly on job satisfaction, stressors, and intent to stay. This project, which includes a review of those studies, uncovered a wide variety of methods and approaches, which we are evaluating for use in future studies that would capture direct care worker’s insights regarding the needs and preferences of the people for whom they provide support. In particular, this project, in conjunction with a larger one designed to assess dually-eligible care recipients’ experiences with formal home care, explores methodologies best suited to capturing the congruence of DCWs’ views with those of recipients’ needs and preferences. It would test the hypothesis that DCWs’ assessments may supplement recipients’ insights, and may strengthen advocacy to improve home care access, policies and practices. The presentation will offer a systematic review of methods and instruments, including use of validated tools and those with face validity that addresses culturally relevant factors, as well as the use of focused and hypothesis-generating open-ended interviews that are sensitive to the power relationships and voices of those participants in the endeavor. The presenters will offer potentially innovative practices, such as observation, documentation analysis, and the use of Delphi techniques which draw on the knowledge and expertise of DCWs. The presentation will also draw on studies that utilized technology and social media to reach and engage this study population.

Neonatal Home-Care Practices of Mothers in Ihiala Local Government Area of Anambra State

This study investigated neonatal home-care practices of mothers in Ihiala Local Government Area of Anambra State. 398 nursing mothers participated in a longitudinal survey to evaluate the newborn home-care behaviors of mothers in Ihiala, Anambra State. For the study, newly delivered moms who gave their informed consent were progressively selected from communities in each town in Ihiala, L.G.A., Anambra State. Data was gathered from the women in their homes using a questionnaire that the researchers had devised, tested, and validated. Data collected were loaded into SPSS version 23. Data were analyzed and summarized in tables of frequencies and percentages. The study's findings demonstrated that, despite being below the specified level of 75% and above, the majority of moms received adequate cord and thermoregulatory care, with mean scores of 65.48 and 73.6%. There was still evidence of subpar neonatal care practices in the area, including the use of tooth paste (12.9%), shea butter (27.9%), and herbs (27.4%) on the cord, as well as the non-practice of exclusive breastfeeding (72.6%) and skin-to-skin care (75.6%). Neonatal practices are influenced by age, parity, education, occupation, and delivery location. Despite their high level of awareness, it was found that the mothers did not perform proper neonatal home care. To enhance neonatal care practices and empower moms to make educated decisions about their own and their child's health, it is advised that maternal education and women's empowerment be promoted.

Knowledge about Acute Respiratory Infection and Home Care Practice among Mothers of Under Five Years Children in Hima Rural Municipality, Jumla, Nepal

Background and Objectives: Acute Respiratory Infection (ARI) is defined as acute infective inflammatory changes in any part of respiratory tract, from the nasal mucosa to the alveoli, with an alteration in the respiratory physiology. ARI is a leading causes of mortality and morbidity in under-five children worldwide. This study aimed to assess knowledge about acute respiratory infection and home care practice among mothers of under-five year’s children and to determine the factors associated with it among mothers of under five children in Hima Rural Municipality, Jumla. Materials and Methods: The community based cross sectional study was conducted. Data was collected using systematic random sampling technique method and face to face interview was conducted using pretested semi-structured questionnaire. Data entry was used Epi-data 4.6 version and analyzed by using SPSS 20.0 version. Results: About 94.9% of the participant’s mother had heard about the ARI and 24.9% participant’s mother had high level of knowledge about ARI. 70.8% participants keep the child in a room with window and door close the room warm. As prevention and control highest percentage of the participants mothers 61.1% preferred to give Tito leaf tea. 59.1% mother were breast feeding than frequently to their ARI babies. Conclusion: The most of the women had knowledge about ARI. More than half of mothers preferred health facility for neighbor child as a choice of treatment. Most of the mothers kept their child in a room with window and door closed to keep the room warm. More than half reduce fever by cold sponge and wrap the child with tight and thick when child had ARI. Most of the ARI cases were treated at home and cured. Among total participants less than half followed health post after not cured at home.

The Care Home Independent Pharmacist Prescriber Study (CHIPPS): development and implementation of an RCT to estimate safety, effectiveness and cost-effectiveness

Background Medicine prescribing, monitoring and administration in care homes can be significantly enhanced. Effective interventions to improve pharmaceutical care and resident outcomes are required. The enablement of pharmacists to prescribe provides an opportunity for pharmacist independent prescribers to assume responsibility for improving pharmaceutical care, medication-related outcomes and resident safety whilst reducing general practitioner workload. Objective(s) To determine the effectiveness and cost-effectiveness of pharmacist independent prescribing in care homes. Design Development work was undertaken through five work packages before the delivery of the definitive trial. Triads of pharmacist independent prescribers, care home and general practice with responsibility over 20 care home residents were recruited and cluster randomised to intervention or usual care for 6 months. Researchers were blinded at recruitment stage only. Recruitment of 880 residents was required to provide 80% statistical power, to show a 21% reduction in falls over 6 months, assuming 20% attrition. Randomisation was undertaken electronically at triad level, stratified by geographical area. Intention-to-treat analysis undertaken using a negative binomial model. Parameters were estimated using a generalised estimating equation approach. Costs were captured from an NHS perspective. Quality of life (EuroQol; five domain; five level) was collected by proxy to enable cost/quality-adjusted life-year estimation. A concurrent process evaluation was performed. Safety was monitored through a review of pharmacist independent prescriber activities, independent concerns reporting and review of adverse events. Participants Forty-nine triads of general practitioners, pharmacist independent prescribers and care homes were recruited with 454 residents allocated to the intervention arm and 428 to the control arm. Intervention Medication review and care planning, medication reconciliation, staff training, support with care home medication-related procedures, deprescribing and authorisation of monthly prescriptions. Main outcome measure Fall rate per person over 6 months. Results Data for 449 intervention and 427 control residents available for final analysis. The 6-month fall rate ratio in favour of intervention was 0.91 (95% confidence interval 0.66 to 1.26; p=0.58). No significant difference in secondary outcomes was identified except Drug Burden Index (rate ratio 0.83, 95% confidence interval 0.75 to 0.92; p<0.001). No harms were identified. One quarter of medication-related interventions were associated with a reduced risk of falls. The intervention was positively received. Limitations Participant self-selection bias may have affected the generalisability of findings. Open-label cluster randomised controlled trial limited by 6-month follow-up. Potential ceiling effect due to concurrent pharmacist-led interventions. Falls potentially insufficiently proximal to the intervention. Conclusions To enhance effectiveness and acceptance of the proposed model, effective integration into care home and general practitioner teams was identified as a central requirement. A core outcome set and a training package were developed. The final model of care, whilst being safe and well received and resulting in a reduction in drug burden, demonstrated no improvement in the primary outcome of falls. With no improvement in quality-adjusted life-years identified, the pharmacist independent prescriber intervention was not estimated to be cost-effective. Future work To develop and evaluate better models of care for enhancing medication outcomes and safety in care homes or re-test with a longer intervention and follow-up period and a stronger primary outcome. Trial registration This trial is registered as ISRCTN10663852, definitive trial: ISRCTN17847169. Study registration This study is registered as PROSPERO CRD20150907. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: RP-PG-0613-20007) and is published in full in Programme Grants for Applied Research; Vol. 11, No. 10. See the NIHR Funding and Awards website for further award information.