Provision Of Community-based Care Research Articles

The Elderly's Demand for Community-Based Care Services and Its Determinants: A Comparison of the Elderly in the Affordable Housing Community and Commercial Housing Community of China.

With the rapid aging of the world population, great pressure has been placed on the provision of community-based care in China. This paper aimed to compare the demand and its determinants for various community-based care services among the elderly in the affordable housing community (AHC) and commercial housing community (CHC) of China. Two community-based surveys were conducted separately in the AHC and CHC of Nanjing City, China. In total, 408 valid questionnaires were returned from the Daishan AHC while 8422 valid questionnaires were received from the CHCs. The chi square test indicated that the respondents in the AHC had significantly higher demands for five types of services (the meal-aid service, the cleaning-aid service, the bath-aid service, the rehabilitation therapy service, and the first-aid service) than those in the CHCs of Nanjing. Further, the Cochran–Mantel–Haenszel test showed that factors influencing the elderly's demands for these services varied across communities. Several policy implications could be obtained to improve the efficiency of community-based care provision.

Patient-level outcomes and virologic suppression rates in HIV-infected patients receiving antiretroviral therapy in Rwanda.

The Rwanda national HIV program has been successful at scaling up antiretroviral therapy (ART) to achieve universal access. The AIDSRelief Model of Care focuses on four key principles: (1) earlier initiation of ART; (2) use of durable, highly-potent, and sequence-friendly first-line ART regimens; (3) early detection of treatment failure; and (4) provision of community-based care and support to ensure optimal adherence and follow up/engagement in care. We conducted a retrospective cohort study of randomly-selected HIV-infected patients at AIDSRelief-supported sites using a stratified, random sample of 583 adults (>15 years) who initiated ART from 30 June 2008 to 1 February 2010. At ART initiation, the median patient age was 38 years, and 67% were female. The baseline median CD4+ cell count was 309 cells/mm3. Overall virologic suppression was 91%. Married/ever married status (adjusted prevalence odds ratio [aPOR] 3.75, 95% confidence interval [CI] 1.30-10.78) and self-reported adherence ≥95% in the past month (aPOR 2.76, 95% CI 1.00-7.62) were significantly associated with viral suppression in the multivariable model. Excellent virologic outcomes were achieved in Rwandan AIDSRelief sites utilizing the AIDSRelief Model of Care during the scale-up of ART in the country.

Perspectives of policy-makers and stakeholders about health care waste management in community-based care in South Africa: a qualitative study

BackgroundIn South Africa, a new primary health care (PHC) re-engineering initiative aims to scale up the provision of community-based care (CBC). A central element in this initiative is the use of outreach teams comprising nurses and community health workers to provide care to the largely poor and marginalised communities across the country. The provision of care will inevitably lead to an increase in the amount of health care waste (HCW) generated in homes and suggests the need to pay more attention to the HCW that emanates from homes where there is care of a patient. CBC in South Africa is guided by the home-based care policy. However, this policy does not deal with issues about how HCW should be managed in CBC. This study sought to explore health care waste management (HCWM) in CBC in South Africa from the policy-makers’ and stakeholders’ perspective.MethodsSemi-structured interviews were conducted with 9 policy-makers and 21 stakeholders working in 29 communities in Durban, South Africa. Interviews were conducted in English; were guided by an interview guide with open-ended questions. Data was analysed thematically.ResultsThe Durban Solid waste (DSW) unit of the eThekwini municipality is responsible for overseeing all waste management programmes in communities. Lack of segregation of waste and illegal dumping of waste were the main barriers to proper management practices of HCW at household level while at the municipal level, corrupt tender processes and inadequate funding for waste management programmes were identified as the main barriers. In order to address these issues, all the policy-makers and stakeholders have taken steps to collaborate and develop education awareness programmes. They also liaise with various government offices to provide resources aimed at waste management programmes.ConclusionsHCW is generated in CBC and it is poorly managed and treated as domestic waste. With the rollout of the new primary health care model, there is a greater need to consider HCWM in CBC. There is need for the Department of Health to work together with the municipality to ensure that they devise measures that will help to deal with improper HCWM in the communities.

Recognition and treatment of life-threatening events in the community setting-part 1: the journey.

Community-based care provision and the associated workload for health professionals working in the community are on the increase. In recent years, in particular, there has been a greater requirement for the acute aspect of care. It is of the utmost importance that patient deterioration is recognised, and that staff can escalate care in an appropriate and timely way. Of the 576 potentially avoidable deaths reported to the National Patient Safety Agency in 2005, 64 were related to patient deterioration not being recognised or acted upon. The community-specific 'Acute Life-threatening Events Recognition and Treatment' (CSA) course enables practitioners (both registered and non-registered) to identify deteriorating patients and to take appropriate action to ensure that safe, quality care is maintained through early recognition and improved clinical decision-making. North Somerset Community Partnership is the first community area in the UK to facilitate the CSA course. This article is the first of a two-part series on the course. It details the journey from the start, identifying the challenges that were overcome and the success that has followed.

Putting Two and Two Together? Early Childhood Education, Mothers’ Employment and Care Service Expansion in Chile and Mexico

In recent years, several middle-income countries, including Chile, Mexico and Uruguay, have increased the availability of early childhood education and care (ECEC) services. These developments have received little scholarly attention so far, resulting in the (surely unintended) impression that Latin American social policy is tied to a familialist track, when in reality national and regional trends are more varied and complex. This article looks at recent efforts to expand ECEC services in Chile and Mexico. In spite of similar concerns over low female labour force participation and child welfare, the approaches of the two countries to service expansion have differed significantly. While the Mexican programme aims to kick-start and subsidize home- and community-based care provision, with a training component for childminders, the Chilean programme emphasizes the expansion of professional ECEC services provided in public institutions. By comparing the two programmes, this article shows that differences in policy design have important implications in terms of the opportunities the programmes are able to create for women and children from low-income families, and in terms of the programmes’ impacts on gender and class inequalities. It also ventures some hypotheses about why the two countries may have chosen such different routes.

Changing Patterns of Care Coordination Within Old-Age Services in England

There has been a focus internationally in recent years on policies and strategies to divert the long-term care of frail older people away from residential and nursing home care and enhance provision of community-based care by improving care coordination through increased differentiation within care management arrangements and service integration between health and social care. The aim of this article is to explore variations over time in care coordination arrangements within old-age services using data from national postal surveys of English local authorities. Indicators of differentiation and integration developed from earlier research were used to compare changes over time. There appeared to be some evidence of change relating to integration at both organizational and practice levels, but little change was detected in respect of differentiation within care management arrangements. The impact of the findings in the context of four enduring themes related to international case/care management literature--eligibility, integrated health and social care, shared information, and targeting--are discussed and the relevance of these in relation to possible future trends is explored.

The quality and adequacy of care received at home in the last 3 months of life by people who died following a stroke: a retrospective survey of surviving family and friends using the Views of Informal Carers Evaluation of Services questionnaire

Stroke is the third leading cause of death in the UK. Despite this, little is known about the care needs of people who die from or following a stroke. In early 2003, a total of 183 questionnaires were returned from a survey of 493 people who had registered a stroke-related death in four Primary Care Trusts, giving a response rate of 37%. This paper reports on 53 deceased from the survey who had lived at home during their last 3 months and who had been ill for more than 1 month. The data were analysed to explore the role of informal carers and the provision of community-based care in the last 3 months of life. Family and friends helped 82% of deceased with household tasks, 68% with personal care, 66% with taking medication and 54% with night-time care. By contrast, health and social services helped 30% with household tasks, 54% with personal care, 20% with taking medication and 6% with night-time care. Two-fifths (43%) of informants had to give up work or make major life changes to care for the deceased, and 26% of informants found looking after them 'rewarding'. Half (51%) reported that help and support from health services were excellent or good compared to 38% for social services. Results from the Regional Study of Care for the Dying indicated that people who died from a stroke in 1990 and their informal carers would have benefited from increased levels of community-based care and enhanced communication with care professionals. Our data suggest that informal carers continue to provide the majority of care for those who die from stroke, despite government initiatives to improve care for stroke patients and frail elderly people. Further research is required to explore best practice and service provision in caring for this group.

Foreword

For over 30 years, people with disabilities have called for the elimination of barriers to their full participation in society. 1 Many barriers affect the likelihood that persons with disabilities will lead healthy lives. The idea that persons with disabilities are capable of living healthy lives has not been obvious in most health science literature; the subject is focused on and written by persons with disabilities and is also present to some extent in the social science literature. Instead, the emphasis of health science literature has been on disability as a medical pathology with an emphasis on cure and/or rehabilitation. The purpose of this issue is to encourage discourse on barriers within the health care arena to inspire new approaches to the study of such barriers and the elimination of them. Family and community health professionals should remain aware that health is an achievable state for many persons with disabilities. Evidence suggests that persons with disabilities may view health as a process of self-actualization, role achievement, and/or environmental adaptation. 2 In one study, 2 73% of the 135 persons with disabilities in independent living centers ranked their health as excellent. Multiple barriers have been described within the literature that may be classified as attitudinal and/or environmental. Attitudinal barriers are preconceived perceptions that create stereotypes and negative emotional responses to persons with disabilities, and these responses may affect family relations, work opportunities, and educational attainment. 3 Attitudinal barriers can limit the person's ability to lead a fulfilling life—to achieve the full range of possibilities that life has to offer. These attitudes also influence what services will be provided through legislation and economic programs. 4 Environmental barriers for people with disabilities are physical obstacles to goods, services, and activities that are otherwise accessible to those without disabilities. Environmental barriers prevent access to public and private buildings and prevent people with physical impairments from riding public transit or operating motorized vehicles. 3 Varying degrees of legislation have been implemented in many countries to eliminate environmental barriers; however, many barriers may exist in trying to obtain effective health care in the home and community instead of institutionalized health care. In our issue, Nosek and colleagues' exploration of women with disabilities adds support to the position that health is a multidimensional state, which may be achieved if analyzed from the perspective of the woman with the disability. Jones and Bell provide evidence of the negative health consequences of barriers to health for women with disabilities. Both articles demonstrate how gender and disability interact to create attitudinal and environmental barriers for women. Three of our articles focus on environmental barriers that may be eliminated through changes in attitudinal barriers. Fox and Kim's description of Kansas' experience with the Medicare waiver program provides an analysis of how the provision of community-based care is affected by public policy. Mulvihill and colleagues description of the best practices for out-of-school care helps to define ways communities can better provide the services needed by children with disabilities. Nyamathi and colleagues analysis of how mental health is influenced by veteran status is evidence for how health care access can influence perceived health outcomes. Becker and Stuifbergen's work assess both environmental and attitudinal barriers to health promotion. Interestingly, they describe barriers to health promotion across three different groups, which demonstrate the commonalities in experiences for persons with different medical diagnosis. Harrison and Kahn offer a possibility for understanding how barriers may be created within a culture. This model is from a cultural perspective that no longer relies on medical diagnosis for the designation of disability. This builds upon prior work on disability as a rite of passage, and it could inspire new studies of disability within various cultures. As stated earlier, our goal is to encourage discourse on barriers to health for persons with disabilities in order to inspire new approaches to the study of these barriers and, thus, to their elimination. One topic that remains unexplored in this issue relates to how age interacts with barriers in persons with various disabilities. Intervention studies aimed at the elimination of attitudinal and environmental barriers are also needed. The success of this issue will be seen in the discourse it produces on the topic and to the extent that such discourse eventually leads to social change.

Mobile telecare--a mobile support system to aid the provision of community-based care.

Mobile telecare--a mobile support system to aid the provision of community-based care.