Home Care Providers Research Articles

Countering social exclusion through inclusive homecare provision: Utilising a participatory life-course approach to influence policy

Homecare models can be effective mechanisms in securing wellbeing and ageing-in-place goals prevalent in health policy agendas. However, the relevance and utility of these models for those living in socially and environmentally insecure conditions has rarely been considered. This is marked by an assumption of in-situ care delivery in private dwellings, and the absence of such groups from homecare development processes. This study aims to harnesses the experiences and preferences of older people in homelessness (OH), older Irish Travellers (OT), and professional stakeholders in an evidence-based co-production of policy recommendations for inclusive homecare provision. The study employed a participatory approach involving the integration of lived experience evidence in a multistakeholder co-production process. Methods comprised: five separate focus groups with OH, OT and service providers (n = 30); two consultative forums involving focus group participants together; and 49 life-course interviews with OH (n = 27) and OT (n = 22) and adults. Findings demonstrate that sizeable gaps in care remain for these groups, and that resource constraints and legislative restrictions prevail for professional stakeholders. Co-produced policy recommendations for inclusive homecare provision based on these experiences and group preferences are presented and discussed.

Workforce thresholds and the non-linear association between registered nurse staffing and care quality in long-term residential care: A retrospective longitudinal study of English care homes with nursing

BackgroundCare needs amongst 425,000 dependent older residents in English care homes are becoming more complex. The quality of care in these homes is influenced by staffing levels, especially the presence of registered nurses (RNs). Existing research on this topic, often US-focused and relying on linear assumptions, has limitations. This study aims to investigate the non-linear relationship between RN staffing and care quality in English care homes using machine learning and administrative data from two major care home providers. MethodsA retrospective observational study was conducted using data from two English care home providers. Each was analysed separately due to variations in data reporting and care processes. Various care quality indicators and staffing metrics were collected for a 3.5-year period. Regression analysis and machine learning (random forest) were employed to identify non-linear relationships. Ethical approval was obtained for the study. ResultsUsing linear methods, higher skill mix – more care provided by RNs – was associated with lower incidence of adverse outcomes, such as urinary tract infections and hospitalisations. However, non-linear skill mix–outcome relationship modelling revealed both low and high skill mix levels were linked to higher risks. The effects of agency RN usage varied between providers, increasing risks in one but not the other. DiscussionThe study highlights the cost implications of increasing RN staffing establishments to improve care quality, suggesting a non-linear relationship and an optimal staffing threshold of around one-quarter of care provided by nurses. Alternative roles, such as care practitioners, merit exploration for meeting care demands whilst maintaining quality. This research underscores the need for a workforce plan for social care in England. It advocates for the incorporation of machine learning models alongside traditional regression-based methods. Our results may have limited generalisability to smaller providers and experimental research to redesign care processes effectively may be needed. ConclusionRNs are crucial for quality in care homes. Contrary to the assumption that higher nurse staffing necessarily leads to better care quality, this study reveals a nuanced, non-linear relationship between RN staffing and care quality in English care homes. It suggests that identifying an optimal staffing threshold, beyond which increasing nursing inputs may not significantly enhance care quality may necessitate reconsidering care system design and (human) resource allocation. Further experimental research is required to elucidate resource-specific thresholds and further strengthen evidence for care home staffing. Tweetable abstractHow much nursing care is needed to assure quality in care homes? Evidence from 2 English care home providers shows that nurse sensitive outcomes (an indicator of quality) are better when ~25 % of care is provided by nurses. Nurse shortages increase risks for residents.

A qualitative exploration of challenges recruiting older adults for Being Your Best, a co-designed holistic intervention to manage and reduce frailty: lessons learnt amidst the COVID-19 pandemic in Melbourne, Australia

ObjectivesResearchers face numerous challenges when recruiting participants for health and social care research. This study reports on the challenges faced recruiting older adults for Being Your Best, a co-designed holistic...

Home care service providers in Brussels: time adjustments during COVID-19 and the consequences for frontline home care workers

Home care service providers have been considerably affected by the COVID-19 crisis. Since the beginning of the pandemic, their internal organisation has undergone important changes, including in terms of time schedules, to adapt to the needs of the older population and those of workers. In most cases, they had to reduce the provision of services, either because care workers – the majority of whom are women – were no longer available to cover the shifts, or because families had cancelled the services. In other cases, they had to meet increased demand. The most dramatic consequences were borne by female care workers, who had to combine working time adjustments with family obligations. Drawing from the material collected before and after the impact of the pandemic in Belgium, which includes interviews with public and private home care providers, this article explores the consequences that time adjustments had on frontline care workers and on the organisations themselves.

Factors Associated With Change in S3-NIV Score Over Time in People With Chronic Respiratory Failure Treated With Long-Term Home Noninvasive Ventilation

IntroductionMonitoring changes in symptoms over time during long-term nocturnal home non-invasive ventilation (NIV) using patient-reported outcome measures is crucial. This study aimed to identify factors associated with changes in the S3-NIV total score, its two domains (“respiratory symptoms” and “sleep and NIV-related side effects”) and individual item responses. MethodsWe conducted a retrospective, longitudinal data analysis of a cohort of adults with chronic respiratory failure treated with NIV. Data were obtained from a French homecare provider. Multivariate linear and multinomial ordinal mixed effect models were used to identify factors associated with changes in S3-NIV scores over time. ResultsMedian follow-up was 2 years for 2135 participants. Each participant completed a median of five S3-NIV questionnaires; totaling 11,359 analyzed questionnaires. Type of respiratory condition, sex, age and time since NIV initiation were associated with change in S3-NIV score over time. NIV adherence was not associated with total S3-NIV score but high adherence was associated with more severe respiratory symptoms and an improvement in sleep and NIV-related side effects during the follow-up. Intensity of pressure support was associated with a lower total S3-NIV score and more side effects. Face masks and supplemental oxygen were associated with a lower S3-NIV total score. ConclusionChanges in S3-NIV scores over time are associated with the individual's characteristics and NIV settings. Analysis of the two domains and individual items of the S3-NIV could increase understanding of the difficulties experienced by people on NIV.

Pain Management on Elderly People: Caregivers Readiness on Managing Pain at Home

<p><strong>Background</strong>: The diseases that appear in the elderly tend to create excessive and chronic pain with the prevalence of pain occurs in people over 65 years of age. Families as caregivers have to pay more attention to the condition of the elderly so that they need readiness and skills on managing pain at home. Caring on the elderly was very complex and requires patience, including in pain treatment. This study was to overview the family readiness on managing pain for the elderly people.</p><p><strong>Methods</strong>: This study used an analytic descriptive design with a sample of 98 caregivers who cared for the elderly with pain at home. The research instrument used the <em>Nursing Outcomes Classification</em> on a 5-likert scale which asked about family readiness in caring for the family. Data analyzed by using descriptive frequency analysis.</p><p><strong>Results</strong>: A total of 53 people (54.1%) caregivers stated that they were not prepared to care for elderly people with pain at home. It was explained that caregivers mostly stated that they did not know about the disease process of elderly pain and the recommended treatment procedures on managing the pain (each mean of 1.923 and 2.000). Meanwhile, caregivers generally accepted the condition as taking on the role of home care (mean: 3.317).</p><p><strong>Conclusion: </strong>It was concluded that caregivers tended to not have the readiness in taking care of elderly pain at home. It is expected that caregivers can increase knowledge about pain management and be ready to provide home care to the elderly.</p><p><strong>Keywords</strong>: Pain management, caregivers, readiness, elderly, home</p>

P067 Support Programme for Patients Receiving Imraldi or Benepali Therapy for Immune-Mediated Inflammatory Disorders: 12-Month Persistence

Abstract Background/Aims Low persistence to long-term therapy for chronic disease is a recognised problem. Evidence suggests that increasing patients’ ability to manage their own health condition may positively impact adherence and persistence, leading to improved clinical outcomes. In 2019, Biogen initiated a patient support programme (PSP), in addition to the pre-existing medication home delivery (‘homecare’) service, to improve the knowledge, skills and confidence of patients self-administering Imraldi (adalimumab ADL) and Benepali (etanercept ETN). Methods This real-world, retrospective, database study includes patients enrolled into the PSP within 12 months of ADL/ETN initiation. At first ADL/ETN administration all patients receive a face-to-face nurse training visit, followed by a second nurse training visit or follow-up call to coincide with the second injection. Following this, patients consenting to enrol in the PSP receive nurse coaching calls at Weeks 3, 10, 22 and 34, whilst non-PSP patients self-manage thereafter. The analysis presented here excludes patients who were enrolled into the PSP more than 12 months after ADL/ETN initiation. Data including demographics and type/duration of ADL/ETN therapy was captured by the homecare provider for the PSP cohort from November 2019 to February 2022, and for the non-PSP cohort between February 2016 (ETN) or November 2018 (ADL) and February 2022. Persistence at 12 months post-initiation was estimated using Kaplan-Meier (KM) techniques, overall and by subgroup including indication (rheumatology, dermatology, gastroenterology) and whether biologic naïve or switched from another biologic. Results Persistence at 12 months for patients enrolled in the PSP was 77.5% and in the non-PSP cohort was 73.6%. Lowest persistence by prior biologic exposure was 70.9% in the non-PSP biologic naïve cohort. By therapeutic area, the greatest differential between PSP vs non-PSP group (75.7% vs 67.6%) was in the gastroenterology cohort, which also had the lowest non-PSP persistence of any subgroup. (Table) Conclusion Compared to the non-PSP cohort, patients enrolled in the PSP had higher persistence at 12 months after initiation, across all indications and regardless of prior biologic exposure. This real-world evidence indicates the benefits of a PSP to patients with chronic diseases, and that particular attention should be paid to biologic-naïve patients. Disclosure A. Clark: Corporate appointments; AC is an employee of Biogen Idec Ltd. T. Shering: Corporate appointments; TS is an employee of Biogen Idec Ltd. J. Addison: Corporate appointments; JA is an employee of Biogen Idec Ltd.

What do private providers of home care want? An analytical framework

ABSTRACT Private for-profit home care providers are key participants in European long-term care regimes. Yet, their policy preferences toward market making and market development remain under-researched. We present an analytical framework that identifies and explains those preferences. It outlines three key types of policies that shape home care markets: regulatory, financial and labour policies. We illustrate private providers’ views on those policies by reference to Ireland’s home care regime. Irish home care is a compelling case for this study. A major package of regulatory reforms is currently being introduced and private providers have outlined clear preferences about it. Our paper is based on interviews with 14 leading individuals involved in the home care sector. We find and explain how private providers wish to increase regulation over their activities; to split purchaser and provider roles; to reduce private forms of financing; and to expand the pool of labour available to them. We discuss how those preferences shed light on the political economic power dynamics that shape the Irish care regime. Our analytical framework may be applicable to other welfare markets at different stages of development and in other institutional contexts.

Children's and parents' experiences of home care provided by hospital staff: A scoping review.

To describe what is known from existing scientific literature on children's and parents' experiences of hospital-based home care and to identify future research areas. The scoping review design used adheres to the methodological framework of Arksey and O'Malley, and to the PRISMA-ScR checklist. A systematic search was conducted, and peer-reviewed scientific papers were screened through the application of Rayyan software. Data were extracted and presented in table and synthesised thematically as narrative text. Searches were carried out November 2021 and updated November 2022 in the CINAHL, MEDLINE, Embase, Cochrane, Scopus, Web of Science, Academic Search Elite, and Amed databases and Google Scholar. A total of 1950 studies were screened and assessed for eligibility. Eight studies met the inclusion criteria by reporting on parents' experiences, whereas five out of these eight studies also reported on the experiences of children. Parents of children with cancer and preterm children reported feeling more in control, being empowered, and being more connected to their children's care team when their children were receiving hospital-based home care. The family's own resources were activated, and they felt more involved in their children's care compared to being in an inpatient setting. Children with cancer, acute infection, chronic disease, and/or a syndrome reported feeling safer and more comfortable in their home environment and experienced better interaction with their care providers. Some aspects of the children's health-related quality of life (HRQOL) were improved. The identified studies indicate that hospital-based home care is a valued alternative to traditional inpatient care by both parents and children. The mode of care has no crucial negative effects. Future studies should encompass the experiences of children with different diagnoses and syndromes and compare patients treated in a traditional hospital setting with those in a hospital-based home-care programme. Children's and parents' experiences of HBHC indicate that it offers a good solution if parents are well prepared and feel in control. In addition, certain structural conditions must be in place before this type of care can be established: there must be a certain number of patients and the hospital must not be too far away. In the field of neonatal home care, professionals should be more responsive to fathers' needs and tailor support by focusing on their individual experiences and needs. Our findings may guide and inform best practice for present and future providers of HBHC. Hospital-based home care can offer families a greater degree of autonomy, more flexible care options, improved family functioning, improved communication with care providers, and more control over the child's care. When certain structural conditions are met, such as a certain number of patients, the hospital not being too far away, and parents being well prepared and feeling in control, then hospital-based home care is valued as an alternative to traditional inpatient care. Specific aspects of children's HRQOL may improve, and the psychosocial burden on the family does not increase. HBHC provides a valued alternative to traditional inpatient care and allows families to receive care in the comfort of their own home. Our findings may guide and inform best practice for present and future providers of hospital-based home care. In this scoping review, we have adhered to the Preferred Reporting Items for Systematic reviews and Meta Analyses Extension for Scoping Reviews checklist. There has been no direct patient or public contribution to the review. Not required.

Sociological determinants of adherence to continuous positive airway pressure in the management of sleep apnoea syndrome: protocol for a transdisciplinary, prospective observational study

IntroductionObstructive sleep apnoea syndrome (OSAS) is a chronic multiorgan pathology that has a negative impact on quality of life. Continuous positive airway pressure (CPAP) is the first-line treatment for OSAS....

Monitoring of physiologic features and treatment aspects of children on home invasive mechanical ventilation.

Pediatric home invasive mechanical ventilation patients are a small but resource-intensive cohort, requiring close monitoring and multidisciplinary care. Patients are often dependent on their ventilator for life support, with any significant complications such as equipment failure, tracheostomy blockage, or accidental decannulation becoming potentially life-threatening if not identified quickly. This review discusses the indications and variations in practice worldwide, in terms of models of care, including home care provision, choice of equipment, and monitoring. With advances in technology, optimal monitoring strategies for home, continue to be debated: In-built ventilator alarms are often inadequately sensitive for pediatric patients, necessitating additional external monitoring devices to minimize risk. Pulse oximetry has been the preferred monitoring modality at home, though in some special circumstances such as congenital central hypoventilation syndrome, home carbon dioxide monitoring may be important to consider. Children should be under regular follow-up at specialist respiratory centers where clinical evaluation, nocturnal oximetry, and capnography monitoring and/or poly(somno)graphy and analysis of ventilator download data can be performed regularly to monitor progress. Recent exciting advances in technology, particularly in telemonitoring, which have potential to hugely benefit this complex group of patients are also discussed.

Pilot Study to Determine the Effectiveness of a Home Health Nursing Simulation.

Demand for home care has increased due to the expansion of preventive care, people living longer with chronic conditions, and the need for healthcare services as the baby boom population ages. Nurses must be prepared to meet the needs of patients and families in the home setting. Home care nursing simulations have been utilized as a teaching-learning strategy in baccalaureate nursing education, yet less is known about their use with practicing home care nurses and associate degree nursing students. The purpose of this pilot study using simulation was to prepare practicing nurses and student nurses to respond using nursing skills and clinical judgment. The convenience sample consisted of associate degree nursing students (n = 9), practicing home healthcare nurses (n = 8), and nursing faculty (n = 2). The Simulation Effectiveness Tool - Modified (SET-M) Survey (Leighton et al., 2015) was utilized for data collection. Participants perceived the home healthcare simulation to be an effective practice experience with high overall agreement for Pre-briefing, Scenario-Confidence, Scenario-Learning, and Debriefing. The findings of this study provide data to support partnerships to provide home care simulation experiences for associate degree nursing students and practicing home care nurses.

A Scoping Review of Older LGBTI People's Experiences of Homecare

Amidst the global growth of the ageing demographic in the world, an inclusive assessment of the care needs of the older lesbian, gay, bisexual, transgender, and intersex (LGBTI) population is receiving increasing attention, especially in view of reported health inequalities for these minority groups and the position of their sexual orientations and gender identities within a predominantly heteronormative health and social system. This literature review aims to identify and analyse previous research on older LGBTI people’s views, experiences, and perceptions of homecare provision. We searched the CINAHL, Medline, and PsychINFO databases and found a total of 337 records. After an eligibility assessment, 12 studies were selected, comprising 11 qualitative studies, and one mixed methods study. Under an overarching theme of fears of discrimination and of receiving suboptimal care, we further categorised our findings in the following three interlinked subthemes: (a) disclosure of gender identity and sexual orientation; (b) emerging meanings of LGBTI‐competent care; and (c) recommendations for improved quality of LGBTI‐friendly services. The overall surfacing outcome of our analysis of the participants’ experiences described in the studies examined is an aspiration for homecare services ensuring quality of holistic, person‐centred care that recognises this population’s distinct set of requirements, including knowledge and consideration of their histories of inequalities and oppression. Wider awareness about the need to re‐imagine more inclusive care for the LGBTI community has the potential to improve services and practices, reduce access barriers, and prevent inequalities.

What are the home care needs of Chinese healthcare workers: a latent class analysis.

The aging population has led to a surge in demand for home care, which has developed rapidly in China in recent years. However, there has been less empirical research into the needs of healthcare workers about providing home care. The purpose of this study was to explore the latent classes of healthcare workers' needs in primary health care institutions and to identify associated factors. From August 2021 to June 2022, a convenience sampling method was adopted to conduct a questionnaire survey on the workers of 62 primary healthcare institutions in Sichuan Province. Latent class analysis was used to categorize home care needs by Mplus 8.3. Multinomial logistic regression analysis was adopted to explore the influencing factors using SPSS 25.0. A total of 1,152 healthcare workers were included in the study. Their needs for home care were classified into four latent classes: overall high need group (18.0%); overall low need group (34.8%); high training and low support need group (29.9%), and the high security and low training need group (17.3%). The factors influencing the different need categories included working area, professional title, role of medical workers, had participated in training about home care, and feelings about home care, with Class 1 as the reference group. Our findings indicate that primary healthcare workers have multifaceted needs for providing home care. Paying attention to their diverse needs can help optimize home care and enhance service capacity. Exploring the factors affecting needs can provide targeted support to healthcare workers to ensure the quality and continuity of home care services.

Home Care Services: Experience of Shkoder's Nurses During COVID-19.

Nursing home care refers to the provision of long-term care services to individuals who are unable to live independently and require assistance with activities of daily living such as bathing, dressing, eating, and medication management. To explore the experience of nursing home care in Shkoder during COVID - 19 and to explore the key challenges and concerns associated with nursing home care during the quarantine period. A qualitative phenomenal approach study was conducted. Data were collected through one in one semi-constructed interviews. In this study were included 30 nurses who offered their service at home of patients during pandemic. Only the nurses who have a bachelor's degree in nursing and have at least 1 year of experience in providing home care were included in the interview. Those who refused and people who did not offer this service at home were excluded. Out of 37 nurses, 30 agreed to be part of this study. All these people have been invited for an interview via WhatsApp. Then we went to their place of work where the interviews were conducted in a separate room at their place of work. All audio recorded interviews were transcribed into type written text and qualitatively analyzed using an inductive thematic analysis approach. Inductive thematic analysis is a method for identifying, analyzing and reporting patterns or themes independently from existing theoretical frameworks or categories. The period time of this study was January - February 2023. The nurses in Shkodra encountered various challenges while providing home care services during the Covid-19 pandemic. Shkodra's nurses have exemplified resilience and dedication as they navigate the complexities of providing home care services during the ongoing Covid-19 pandemic.

UK homecare providers' views about, and experiences of, digitalisation: A national survey.

Using digital systems to support the management and delivery of social care is a priority for UK governments. This study explored progress towards, and experiences of, digitalisation in the homecare sector and providers' views on contributing client data to a national policy/research dataset. Over 150 UK homecare providers completed an on-line survey (October-December 2022). The survey was hosted on Qualtrics and comprised fixed- and free-text response questions. The recruited sample aligned with the profile of UK homecare providers in terms of use of digital systems, organisation type and size. Almost all respondents (95.5%) were using digital systems, in part or exclusively, to support care delivery. However, many (42.7%) reported a desire to further digitalise or a dissatisfaction with existing systems. Findings highlight the time and work involved in choosing a a software system, with the decision regarded as relatively high risk. Over 50 different software systems were being used across the sample. Most respondents (72.5%) supported the creation of a national dataset on homecare users. However, support and recompense are likely to needed to secure buy-in from what is a predominantly private sector context. Findings suggest a complex and changing situation, with numerous different digital systems being used and the sector at different stages of digitalisation. The high-pressure, low margin context of UK homecare appeared to be exerting an influence on progress towards digitalisation. Evaluations of government strategies to stimulate and support digitalisation in this diverse and predominantly private sector context will be valuable.

Developing the Patient Falls Risk Report: A mixed-methods study on sharing falls-related clinical information from home care with primary care providers

Background: Only 24% of Canadian primary care providers communicate with home care providers about the needs and services of patients. This service gap puts vulnerable people at risk of adverse events. One tool that may enhance communication between home care and primary care is the interRAI home care (interRAI-HC), a mandated comprehensive geriatric assessment in home care. The focus of this study was on development of a one-page document for sharing falls-related clinical information from the interRAI-HC with primary care providers (i.e., the Patient Falls Risk Report).
 Target audience: Primary care providers who feel siloed from the rest of the health care system.
 About the intervention: The Patient Falls Risk Report is a structured, one-page, faxable form that contains falls-related patient information derived from interRAI-HC assessments. The report is evidence-based and includes personalized information on future falls risk, balance, cognition, pain, foot problems, medications, and physical activity levels, as well as recommendations for falls prevention in older persons.
 Stakeholder engagement and other research methods: This mixed-methods intervention development study began with one-on-one stakeholder engagement via semi-structured interviews with primary care providers. We first explored their views on falls-related information sharing. Then, we tested a prototype of the Patient Falls Risk Report for usability and utility, thematically analyzing the findings to iteratively to develop the tool. The report was then evaluated again with voluntary self-report surveys based on the System Usability Scale.
 Results: A sample of 9 interview participants co-developed the Patient Falls Risk Report to improve its clarity and level of detail. All participants stated that they would use the report in their practices and most believed that it could support care provision due to its inclusion of relevant, actionable information. In the end, a survey sample of 27 participants determined that the report was highly usable, with an overall usability score of 83.4 (95% CI = 78.7, 88.2). However, the need for improved shared care planning and community responsibility was also emphasized.
 
 Impact: This study demonstrates that information collected from existing clinical assessments can be shared with primary care providers in a useful manner. It also highlights criteria to inform the design of future information-sharing interventions, especially those harnessing interRAI assessments.
 Key Learning: Primary care providers need tailored and consistent streams of communication with other health care providers so that collaboration and integration can become a reality. 
 Next Steps: We are at a turning point in health care, where the functionality of health information systems is improving, and fax is becoming increasingly obsolete. Based on the recently published results of this study [1], we are currently collaborating with government and eHealth organizations on an implementation plan for interRAI information sharing with patients and caregivers in Ontario, Canada. 
 1. Nova AA, Heckman G, Giangregorio LM, Alarakhia M. Developing the Patient Falls Risk Report: A Mixed-Methods Study on Sharing Falls-Related Clinical Information from Home Care with Primary Care Providers. Canadian Journal on Aging / La Revue canadienne du vieillissement. 2022;1–14.
 
 

The impact of breast surgeon information on women’s breast outcome: evidence from breast conserving therapy

Introduction: With the increase in life expectancy and the development of medical knowledge, the expectation that individuals will live a quality life till the very last days is becoming the norm. Palliative care is an approach that improves the quality of life of patients and their families facing the issues associated with life-threatening illness, through the prevention and relief of suffering by means of early identification, comprehensive assessment and a management plan that considers, physical, psychosocial and spiritual needs. Despite this wholesome definition, the majority of palliative care interventions remain localized and siloed.
 Context: In 2019, the Ministry of Health in Ontario, Canada, announced the Ontario Health Teams (OHTs) as an innovative integrated care network model to deliver integrated person-centred care to Ontarians across their life trajectory (currently there are 54 teams covering 95% of the population). These teams utilize a population health management philosophy to integrate care in a person-centered manner. Integrating palliative care across care sectors and along the trajectory of the palliative care journey is a priority to many of these teams.
 Approach: In the Spring of 2022, Burlington OHT formed a working group to co-design an integrated palliative care model. This working group included patients, caregivers, palliative care physicians and nurses, primary care physicians and nurses, home and community care providers, hospice care providers, policy makers, researchers and evaluators. A participatory experience-based co-design approach was taken to identify the gaps, determine best practices, design a new care model, create an implementation plan, implement, evaluate and improve.
 The participatory experience-based co-design approach was guided by the 11-step methodology described by O'Cathain A, et al in 2019 when co-designing complex health interventions. We added some additional steps. The modified methodology included 1) planning the co-design process, 2) involving all stakeholders (including those who will implement, deliver, use and benefit from the intervention), 3) bring together a team and establish decision-making processes, 4) needs assessment via multiple engagement tools (surveys and virtual and in-person engagement sessions), 5) review published research evidence, 6) draw on existing theories/frameworks, 7) identify relevant change ideas, 8) articulate programme theory, 9) undertake primary data collection, 10) understand the local context, 11) pay attention to future implementation of the intervention in the real world, 12) design and refine the intervention and finally 13) implement and evaluate.
 The project is in its concluding stages and the final findings including the detailed integrated palliative care model description and the implementation plan will be available for the conference in May
 Implications for applicability/transferability: Designing integrated palliative care programs is a novice area of integrated care across the world. Describing the participatory experience-based co-design approach that we followed to plan our intervention has a great potential of guiding policymakers, planners, funders and implementers on how to plan and implement such interventions by facilitating a work together-plan together approach.

"Building More Connected Primary Care: Improving Connections between Primary Care and Community Care, Specialists and Hospitals for Timely and Appropriate Care"

Although strong, well connected primary care results in better health outcomes and health equity at a lower cost, most family physicians in Ontario, Canada are not supported by teams and have variable connections to other system sectors resulting in variable access and quality of care. A continuous relationship with a family physician and primary care team facilitates access to timely care, appropriate preventive care, reduced acute care utilization and costs, reduced mortality and more satisfied patients. This was further confirmed during the COVID 19 pandemic when patients who were attached to primary care teams had superior care for both COVID and non-COVID health issues.
 Together with patients, families, family physicians and all health care sectors, we co-created and evaluated efficient models of connecting family physicians to: specialists for just in time advice, virtual and in-person consults; to interprofessional teams tailored to the needs of their practices and to navigation services tailored to primary care. These models were co-designed with family physicians and continue to evolve based on their evolving needs:
 SCOPE (Seamless Care Optimizing the Patient Experience) connects primary care providers (PCPs) in the community to real-time supports through a single point of access, Co-designed with local PCPS, SCOPE improves access to an interprofessional team who can help with urgent medical consultations, diagnostic imaging, curated home and community care, mental health, and navigation of other services available in the hospital or in the community.
 TIP (Telemedicine IMPACT PLUS) TIP (Telemedicine IMPACT Plus) provides rapid access to case consultation by a virtual team of health care professionals to enable proactive health and social care for patients living with multi-morbidity. The case conference involves the patient/caregivers, family physician and TIP RN along with the consulting team that consists of: Psychiatrist, Internist, Pharmacist, Social Worker, Home Care Coordinator, Dietitian and others as required. The purpose of this consultation is to coordinate care and derive new solutions for addressing chronic conditions. A dedicated
 TIP nurse facilitator prepares the case, facilitates the consultation with one of 12 available teams, summarizes a coordinated care plan and coordinates the patient’s circle of care.
 Building interprofessional primary care teams based on family physician patient roster needs relies on nourishing foundational relationships with local PCPs to help identify gaps in care, engaging PCPS in continuous program improvement and developing partnerships with key stakeholders: leadership from the anchor hospital and their specialist groups, home and community care and community organizations. Joint implementation is based on the value proposition that all sectors win when care is appropriately triaged and managed in the community.
 When combined, connected and integrated into primary care practices, these initiatives build the Patient Medical Home, with the PCP at the centre of care, support to more effectively co-manage patients using existing resources more efficiently mapped to patient needs. These initiatives support relationship-based navigation, the underpinning of team-based primary care essential to improving system navigation for timely access to needs-based care.
 The target audience: patients, families, interprofessional primary care providers, specialists, home care and community providers, and hospitals.
 
 
 

Co-designing action-oriented mental health conversations: the case for integration in home and community care.

Background: The COVID-19 pandemic has reinforced concerns for the mental health and wellness of older adults worldwide. Older adults experiencing poor mental health may face both mental health stigma and ageism, which act as barriers to talking about mental health and seeking needed supports, care, and treatment. In Canada and elsewhere, there is a lack of mental health parity. The healthcare system’s focus on the physical healthcare needs of older adults creates missed opportunities for intentional conversations about mental health between providers and older patients during routine interactions.
 Aims: This project responds to aging and mental health research priorities identified by aging Canadians during the pandemic through surveys (n=1,000) and workshops (n= 52 participants). Top priorities included the need for research and action supporting: 1) skill-building in non-mental health specialists; and 2) the application of user-friendly tools to identify signs of positive and poor mental health. The aim of this multi-year research study is to co-design and test an evidence-based approach to starting mental health conversations between home and community care providers, older adults and/or their family caregivers.
 Methods: This study applies a participatory mixed methods design across three phases, guided by a working group of experts-by-lived-experience (n=30). Phase 1 involved a modified ADAPTE process including online workshops (n= 57 participants) and surveys (n=~1000) of older adults, caregivers, and health/social care providers across Canada. The workshops explored the use of an evidence-based visual model, called the Mental Health Continuum, to guide mental health conversations in home and community care. Phase 2 will involve co-design workshops with community health/social care providers in six communities (n= 3 rural; n=3 urban) across three Canadian provinces. Phase 3 will involve pilot and feasibility testing of the co-designed conversations in routine care. This abstract focuses on the findings from Phase 1. 
 Results: Workshop participants agreed that a visual model depicting mental health as a complex, multi-component construct ranging in state on a spectrum, was a helpful starting point for de-stigmatizing mental health between older adults, caregivers, and health/social care providers. However, participants felt the Mental Health Continuum needed to be adapted for use in promoting conversations in the context of home and community care. Suggested adaptations include the use of generic and action-oriented language across the model, more inclusive use of colours, capturing the element of change-over-time, removing clinical jargon from category names, and revising the signs and signals to be more aging context-relevant. Public consultation survey results are expected by the date of the conference. 
 Learnings: Engaging experts-by-lived-experience in all study phases is crucial for building on existing evidence in new research through a realist lens and ensuring widespread health issues are met with context-specific and relevant solutions. Workshops reinforced research priorities identified during the pandemic and confirmed the study’s potential to address challenges with integration of health and social care for older adults through de-stigmatizing mental health conversations.
 Next steps: The adapted Mental Health Continuum model will guide the co-design and pilot-testing work in Phases 2 and 3 of the research study.