Provision Of Domiciliary Care Research Articles

How Aging Population Affects Health Care Expenditures in Pakistan? A Bayesian VAR Analysis

The changing population structure has raised serious concerns about future health care expenditures in Pakistan. Growing proportion of aged people could lead to a higher health care expenditure as occurrence of chronic-degenerative diseases increases and a large demand for health and social care is visualized with a subsequent effect on health expenditures. Considering the above research problem, the current study analyzed the effects of ageing population on health care expenditures in Pakistan using a time-series data from period 1995 to 2014. Bayesian VAR approach was applied to evaluate the impacts of population ageing on health care expenditures. From the results of the study it was clear that health expenditure of Pakistan showed more response towards aged population as compared to life expectancy and per capita GDP. Population aging brought about 2.6 percent increase in health care expenditures and are expected to rise to 17.2 percent in tenth year when compared to the base year. Life expectancy also brought an increase in healthcare expenditure; bringing about 3.6 percent increase in health care expenditures per capita and 14.2 percent increase in tenth year. Real GDP per capita explains 1.7 percent fluctuation in health care expenditures per capita in third year which increases to 3 percent in tenth year. A macro level dedicated health policy for elderly people could help to minimize the health care expenditures such as, training of primary care doctors in geriatrics and provision of domiciliary care. Ageing population illnesses that give hike to health care expenditure should be considered for further research to get more truthful outcomes.

S135 Long-term outcomes in patients referred to a specialised weaning centre; The impact of referral source, non-invasive ventilation and diagnosis

Introduction The expansion of specialised weaning centres serving networks of external ICUs has been recommended by the NHS commissioning board. However, data are limited for this proposed model of care. Papworth Hospital provides a multi-disciplinary weaning service in-line with these recommendations. Methods We analysed the records of patients transferred to our service for weaning from invasive ventilation (IMV) between 1992–2011 inclusive. Patients were categorised according to diagnosis (neuromuscular, COPD, post-surgical, non-COPD respiratory, chest-wall disorders and others). Results 458 patients receiving IMV (92% via tracheostomy) were transferred (mean age 61 years, 259 (57%) male, 421 (92%) from external ICUs with a median ICU stay of 33 days. On arrival, 422 (92%) were ventilator-dependent and 37 (8%) required nocturnal IMV. The median PaCO 2 was 10 kPa. Neuromuscular problems included Motor Neurone Disease (21%), Tetraplegia (12%), Muscular Dystrophies (11%), and Myotonic Dystrophy (9%). 417 (91%) patients survived to hospital discharge, with 330 (72%) weaned from IMV (median stay 24 days if decannulated, 37 days if IMV continued). Non-invasive ventilation (NIV) facilitated weaning in 79%. From the date of ICU admission, 63% of the whole cohort were alive at 1 year, 43% at 3 years, and 33% at 5 years. When adjusted for case-mix, survival was similar for external and in-house referrals. At least 343 (82%) survivors were discharged home. Further outcome data are summarised in Table 1. COPD patients had the lowest rate of death and/or failed decannulation (13%); further, long-term NIV was associated with a significant increase in survival (p = 0.01), despite normocapnia (5.9kPa) if completely weaned. 33% neuromuscular patients required long-term IMV, typically due to bulbar problems, although 65% were discharged home. Continued IMV in other groups conferred a very poor prognosis. Conclusions These data confirm high levels of survival and discharge home in patients referred to a specialised weaning service. Repatriation to the referring ICU was rarely necessary. NIV was important in the graded withdrawal of IMV and the provision of domiciliary care. In COPD, NIV use on discharge was associated with improved survival. Overall outcomes were favourable when compared to international data and are supportive of current national service plans.

Women’s experience of domiciliary postnatal care in Victoria and South Australia: a population-based survey

Despite the expansion of postnatal domiciliary services, we know little about the women receiving visits and how they regard their care. The aim of this study is to examine the provision of postnatal domiciliary care from a consumer perspective. All women who gave birth in September-October 2007 in South Australia and Victoria were mailed questionnaires 6 months after the birth. Women were asked if they had received a midwifery home visit, and to rate the care they received. More women in South Australia reported receiving a domiciliary visit than in Victoria (88.0% v. 76.0%) and they were more likely to rate their care as 'very good' (69.1% v. 63.4%). Younger women, women on a lower income, who were holding a healthcare concession card or who had not completed secondary education were less likely to receive a visit. Although the majority of women in public maternity care in Victoria and South Australia receive domiciliary care and rate it positively, there are significant state-based differences. Those more likely to benefit from domiciliary care are less likely to receive a visit. There is a need to further explore the purpose, aims and content of domiciliary care at individual and state-wide levels.

Carers of the elderly--knowledge, use of and satisfaction with day care services.

This is a descriptive study of carers of dependent elderly in inner city Dublin, outlining their awareness, use of and satisfaction with day services. A striking finding from this work, consistent with other studies, is the heavy burden of care which is shouldered by informal carers which should be acknowledged by society. The study highlights a) that levels of use of domiciliary care by carers appear to be very low, b) that there is some evidence of targeting of domiciliary services to the more dependent elderly, c) that day centres and clubs are popular and acceptable to a minority of carers, d) that many carers have no informal help, e) where informal help is available, relatives of carers play a very important role in facilitating carers to accept formal domiciliary care. Recommendations include, a) improving the level and range of provision of domiciliary care, b) alerting professionals such as general practitioners and public health nurses to their role as informant and facilitator of formal care to carers, c) formulating a plan to encourage uptake of domiciliary services by carers, d) review of care provided in day centres.

Barriers to dental care in an elderly population resident in an inner city area

A sample of 765 elderly people living in London was interviewed and examined. Barriers to dental care stemmed from: elderly people's beliefs that dentures should last a life-time and dental visits are unnecessary for edentulous persons; mobility difficulties; fear; problems with access to NHS care and with access to satisfactory care. The attitudes of general dental practitioners, community dentists and final year dental students towards elderly people were favourable. Sixty per cent of surgeries were on the ground floor, and 46 percent of premises were unsuitable for wheelchair access. Carers wanted improvement in domiciliary services. The provision of domiciliary care was significantly related to training. There was a paucity of experience in this field amongst dental students. Community dentists recognized a need for retraining before providing care for handicapped elderly people.

Medical Care Program of the Veterans Administration

HISTORICAL R.SUiM Prior to World War I, April 6, 1917 to November 11, 1918, national gratitude was expressed mainly in the form of pension payments, originally for disability incurred in service and for dependents of deceased veterans, and later, for service in itself. Additional benefits consisted of grants of public lands and the furnishing of domiciliary care for those disabled. The provision of domiciliary care was inaugurated by the Congress during February 1811 by legislation establishing the Naval Home at Philadelphia, Pennsylvania, which, however, was not occupied by disabled ex-members of the Navy and Marine Corps until 1833. Then, after the Mexican War, the Congress, in March 1851, passed an act creating military asylums for invalid soldiers. Two such institu-