Receiving Home Care Services Research Articles

Home care pharmacy: extending clinical pharmacy services beyond infusion therapy.

A clinical pharmacy program was developed at an established home health care (HHC) agency to demonstrate the need for clinical pharmacy services in the HHC population and to explore opportunities for providing pharmaceutical care beyond infusion-related therapies. Initial experiences of this pilot project are described. Patients were found to be primarily elderly (mean age, 70 years) and to use a substantial number of medications. While only 11% of patients referred to the agency required infusion therapy, multiple opportunities for pharmacist involvement in patient care were identified and a variety of projects were undertaken. A drug information service was developed, a retrospective evaluation of patients with congestive heart failure led to an interventional study, a cisapride intervention was implemented, home vancomycin monitoring was assessed, pharmaceutical care services were provided to patients enrolled in a long-term home care program, a pain management initiative was begun, adverse drug reactions were identified and reported, and pharmacists participated in agency policy development. Preliminary data suggest that pharmacist involvement positively affected patient care. Drug information was provided on 232 occasions. Cisapride was discontinued in five patients with contraindications to the agent. Comprehensive pharmacotherapy assessments were performed on 29 long-term-care patients, generating 129 therapy recommendations of which 33% were accepted. Pharmacists working with a home care agency identified numerous opportunities for improving patient care. Many of the patients receiving home care services were elderly, took a substantial number of medications, and were at risk for drug-related problems and suboptimal therapy.

The clinical and cost-effectiveness of treating recurrent preterm labor with subcutaneous terbutaline

Objective: To compare clinical and cost-effectiveness of continuous subcutaneous terbutaline (SQT) versus oral tocolytic agents (PO) for tocolytic maintenance after recurrent preterm labor (RPTL) in singleton gestations.Methods: A retrospective, matched cohort design was used to identify patients from a perinatal database of women who received home care services from April 1995 to December 1998. Inclusions: singleton gestation, received PO after initial preterm labor at more than 20 weeks, were hospitalized with RPTL at less than 35 weeks, available outcome data. Exclusions: indicated deliveries related to hypertension, diabetes, or fetal conditions. Data were divided by treatment after RPTL (SQT or continued PO). Patients were matched for gestational age (GA) at RPTL. A standardized cost model was applied to compare total antepartum hospital (HSP), nursery, and outpatient charges.Results: There were 279 women per group. Gestational age at RPTL was 31.6 ± 2.2 weeks. Of SQT patients, 70.6% reached at least 36 weeks versus 56.6% of PO patients (P <0.001). Per patient charges were less in the SQT group for HSP (3,986 ± 6,895 versus 5,495 ± 7,131, P = 0.009) and nursery (7,143 ± 20,048 versus 15,050 ± 32,648, P <0.001). Outpatient charges were less for the PO group (1,390 ± 1,152 versus 5,520 ± 3,292, P <0.001). Wilcoxon, paired t, and McNemar’s test statistics were used for comparisons.Conclusion: Fewer HSP and nursery days, as well as less utilization of the neonatal intensive care unit, suggest cost-effectiveness of SQT for the treatment of RPTL in singleton gestations. legendlegendPO (n = 279)SQT (n = 279)P valueGestational age at delivery, weeks35.7 ± 2.836.5 ± 2.1<0.001BW <2,500 g38.0%20.8%<0.001NICU admission26.2%18.6%0.003Nursery days8.7 ± 16.04.9 ± 9.8<0.001Total charges, $21,935 ± 33,10716,649 ± 21,7010.017legendAll data are the means ± SD, or percentage, as indicated. BW indicates birth weight; NICU, neonatal intensive care unit.

Le rapport entre l'adéquation des services de maintien à domicile et la trajectoire de travail des personnes soignantes

AbstractThis article examines to what extent the presence or absence, adequacy or inadequacy of formal services impacts on the work trajectory of caregivers to elderly relatives. The article is based on a qualitative study with 20 employed caregivers' whose elderly relatives received homecare services from one of two Montreal CLSCs: Results reveal the key role played by formal services in caregivers' attempts to juggle caregiving demands with those of their employment. They illustrate how the presence or the insufficiency of these services, their adequacy or inadequacy, combined with the other accommodations which caregivers put into place, can be determinants in caregivers' decisions to continue working and in their capacity to function well in the work place.

Promoting seniors' health--confronting the issue of incontinence.

Incontinence is a demoralizing and costly problem that severely affects the quality of seniors' lives. With the aging Canadian population expected to double within the next 15 years, the elderly are at the highest risk of developing incontinence. It is now recognised that incontinence can be successfully managed, and in many cases, resolved. A survey was conducted with seniors experiencing problems with incontinence who were receiving home care services. Results showed that incontinence has a significant impact on their lives. Seniors tend to mistakenly see the problem as an inevitable factor in the aging process; consequently many hesitate to seek information. In addition, they face barriers to receiving incontinence care that includes knowledge and access to services and resources. Nurses have the potential to take a leading role in reducing the problem of incontinence and in reducing the impact on the lives of seniors. In order to realize this potential, nurses need to be more aware of their attitudes towards incontinence and more informed about conservative treatment options. Some thought needs to be given to the role of the general nurse, and the role of a specialized nurse such as the nurse continence advisor.

Understanding Sleep Disturbance: Pragmatics for Home Health Care Providers

Sleep is not only an integral part of everyone's life, but provides an incredibly accurate mirror on the quality of life. Disturbed sleep equates with disturbed daytime functioning. Such a correlation makes great sense, particularly with the realization that sleep and wake cycles are based in the same biological rhythms. While everyone has a few nights of suboptimal sleep from time to time, some people live their lives sleeping poorly, experiencing daytime sleepiness, and functioning marginally. The causes of these patterns of poor sleep are many, and this paper will focus on how to focus a lens on clinical assessment of sleep to make sense out of sleep-related complaints and related behaviors in persons receiving home care services.

An In-Home Medication Inventory Among Elderly Receiving Home Care Services

An In-Home Medication Inventory Among Elderly Receiving Home Care Services

A Study on Fatigue of Caregivers of the Frail Elderly Living at Home, Using Cumulative Fatigue Symptoms Index(CFSI).

This study aimed to assess the degree of mental and physical fatigue and the related factors in 70 caregivers of the frail elderly who received home care services in Shizuoka City, Japan, using a Cumulative Fatigue Symptoms Index (CFSI) and compared them with age-adjusted con trol group of 126 women living with healthy elderly relatives aged 65 and older. The subjects were subdivided into two groups (less than 60 years of age, and older). The following results were obtained: 1) The CFSIs for chronic tiredness, general fatigue, physical disorders, anxiety, depressive feeling, irritability, and decreased vitality were higher in the caregivers than in the control subjects of both age groups. 2) Fatigue of the caregivers, particularly those aged 60 or over, was chiefly due to chronic tiredness and mental fatigue. 3) According to multiple regression analysis, factors related to the CFSIs of the caregivers were closely associated with inadequate sleep duration and poor health. It has been suggested that use of visiting nurse service and home-help service for 24 hours are necessary to relieve the caregivers from fatigue and to enable them to take enough sleep, and that day services are effective to guarantee caregivers' personal health and well-being.

Older persons' preferences for site of treatment in acute illness.

To explore how older persons form preferences for site of medical care by examining their perceptions of home care and hospital care. Qualitative analysis of in-depth interviews using the constant comparative method. Respondents' homes. Twenty-nine persons age 65 to 89 years who had been hospitalized with congestive heart failure, chronic obstructive pulmonary disease, or pneumonia and were receiving home care services. Respondents, who thought of home care only as a means to provide low-intensity and low-frequency services, were initially skeptical about expanded home care services to treat acute illness. Regardless of their opinions about home and hospital, all respondents preferred the site associated with the greatest chance of survival. If the sites offered equal survival, 52% of the respondents preferred treatment at home because of freedom from the constraints of the hospital and the comfort of familiar surroundings. For respondents who preferred the hospital, the home represented a frightening and lonely place to be sick. Respondents' views of the home and hospital were shaped by their social supports, self-reliance, religious beliefs, and past illness experiences. Because survival appears to be the most important determinant of preference, home treatment of acute illness is a viable alternative only if it provides outcomes equivalent to those of hospitalization. Strongly held perceptions that home care can only be a low-intensity service may limit preferences for home treatment. When expected outcomes at the two sites are similar, the challenge to the health care system will be incorporating patient preference about the process of care into decisions about the appropriate site of care.

The impact of the nursecontinence advisor on continence care

Objective: To evaluate the impact of the nurse continence advisor (NCA) on reducingincontinence of patients receiving home care services. Design: A prospective 6-month pilot study of NCA service provided to incontinent patients was conducted. Setting: The study sample was drawn from three contiguous regional governmentfunded Home Care Programs (HCP) in southern Ontario Participants: Incontinent patients admitted to Home Care from June to December 1996 were assessed by four NCAs from participating visiting nursing agencies. Main outcome measures: A modified version of the Wyman Incontinence Impact Questionnaire (Wyman 1987) was completed by patients on admission and discharge. Descriptive data about patients was collected using an incontinence assessment form. Findings: One hundred and seventy-four patients (54 men and 120 women) were seen by the four NCAs over a period of 6 months. Twenty-nine percent of the patients completed the Impact Questionnaire. The greatest change noted was in patients' knowledge about and ability to control and cope with their incontinence. Forty-two percent of the patients were moderately improved or continent. There was a positive correlation between the number of NCA visits and a better overall outcome (p Conclusions: The findings of this pilot study suggest that the role of the NCA has the potential to contribute significantly to the resolution of incontinence and decreasing the cost of incontinence care in home care programs.

Errors in prescribing HIV-1 protease inhibitors

The purpose of this study was to describe and quantify errors in dosage frequency associated with written medical orders, compared to manufacturer's recommendations and current therapeutic recommendations for protease inhibitors, for persons living with HIV disease/AIDS who were receiving home care services. A convenience sample was used for a univariate descriptive study to collect information from client records on the dosing intervals prescribed for three protease inhibitors: indinavir, ritonavir, and saquinavir. The study took place between December 1, 1996, and January 15, 1997, at a certified home health agency (CHHA) in New York City. The final sample accrued consisted of 202 adults who were receiving home care. The mean age of the sample was 42 years (SD = 9.43), ranging from 24 to 69 years. The majority were people of color, and Medicaid was the principle payor source for all health care needs. The main outcome measure was the number of errors in dosage frequency documented in written medical orders for protease inhibitors Protease inhibitors were ordered for 91 (45.1%) of the sample. Of the total number of medical orders for protease inhibitors, according to manufacturer's recommendations and current therapeutic recommendations, incorrect dosing schedules were noted in 36 (39.6%) of the records. Additional findings included errors in the dosages of drug prescribed and orders for protease inhibitors as monotherapy. Errors identified with ordering protease inhibitors included the incorrect frequency, the incorrect dose, and the ordering of protease inhibitor as a monotherapeutic agent instead of in combination with other recommended antiretroviral agents. Making clinicians aware of these problems may assist in reducing the incidence of these errors.

Family Caregiver's Satisfaction with Home Care in the Taipei Metropolitan Area

This research was designed to evaluate the quality of home care by examining family caregiver's satisfaction with home care services received. The sample for this study were 110 families using home care from the Taipei Metropolitan Area. Data were collected from interviews of the family members. The degree of satisfaction with each attribute of services was measured using a Likert scale with 5 responses. The degree of general satisfaction with home care was averaged across 19 attributes. More than 91.0% of the family caregivers believed that the respect, consideration, concern for questions, and acceptance for suggestions from home care workers did not need any improvement. In contrast, at least two-thirds of the family caregivers felt the speedy provision of services in an emergency and the degree of ease of contacting home care workers by telephone needed improvement. The number of desired attributes that were received was a significant determinant of general satisfaction with home care services received. Family caregivers who received at least 14 attributes tended to be more satisfied with home care services than the respondents who received fewer than 14 attributes of home care services. Overall, subjects receiving home care services were satisfied. The more desired attributes of home care received, the higher the satisfaction with home care.

An exploratory study of how occupational therapists develop therapeutic relationships with family caregivers.

Family members, who provide 70% to 80% of all long-term care, have often been perceived by occupational therapists as a barrier to, rather than a partner in, effective care for elderly persons. This perception suggests that in order to build effective partnerships to manage complex issues, occupational therapists working with elderly persons must develop effective strategies for involving family members in the therapeutic process. This article describes a pilot study that examined how occupational therapists engage family caregivers of elderly persons receiving home care services. A qualitative descriptive approach was used to explore the behaviors demonstrated by two occupational therapists when working with family caregivers. The findings point to four primary types of occupational therapist-caregiver interaction, categorized as: caring, partnering, informing, and directing. These interaction styles were compared with current literature describing state-of-the-art occupational therapy practices with older adults and family caregivers. An emphasis was placed on examining how therapeutic interactions can evoke different caregiver responses and influence the development and maintenance of collaborative therapeutic relationships. The results of this pilot study can serve as a framework for further exploration of interactive strategies that promote caregiver empowerment and ultimately influence the ability of families to assume responsibility for the long-term care required by many chronically disabled older adults.

Evaluation of the dietary intake of homebound elderly and the feasibility of dietary supplementation.

The dietary intake of elderly subjects receiving home care services (n = 145) was studied to assess the adequacy of their intake, and their ability to maintain normal body weight. In a second part of the study, the feasibility of providing nutrient supplements to underweight subjects or those with important recent weight loss was evaluated. For the survey, three 24-hour recalls, height, weight and lifestyle habits were evaluated in a home interview and two follow-up telephone contacts. The effects of dietary supplementation of 14 subjects at risk of malnutrition (underweight or with substantial weight loss) over 12 weeks were evaluated. Mean energy intake for the entire group was low (males 1546 kcal; females 1152 kcal) and on average barely covered estimated resting energy expenditure. Recent weight loss was negatively correlated with energy intake among underweight subjects (R = -0.64; p < 0.001). Dietary supplementation resulted in an average increase in daily intake of 390 kcal with an average weight gain of 1.27 kg over the 12-week period. Weight change was directly associated with measures of functional status; hand-grip strength (r = 0.75; p = 0.002) and general well-being score (r = 0.46; p = 0.095). Homebound elderly were at high risk of inadequate protein and energy intake. Dietary supplementation in high risk individuals was well tolerated and led to modest weight gain and improvements in general well-being.

Emergency department-based home care

To assess the feasibility of coordinating home care services from an inner-city emergency department. In a preintervention survey, the home care needs of 650 consecutive patients being discharged from the ED were evaluated. A nurse-coordinator who arranged and managed rapidly deployed home care services then was assigned to the ED for eight months. Patients were referred, and home care services were provided regardless of insurance status. Teaching hospital serving a large indigent population. Adult patients about to be discharged home from the ED. Forty-five of 650 (7%) surveyed patients were not receiving home care services for which they were eligible. In the subsequent eight-month period, 670 patients were referred for home care on discharge from the ED (2% of all discharges). Seventy-six percent of these patients were women, and the average age was 73.5 years. Four hundred fifty patients (67%) received visits from home care providers managed by the ED coordinator. For 99 of these patients (22%), the availability of rapidly deployed home care services obviated the need for emergency admission to the hospital. Net billings to third-party payers exceeded the costs of the program. A significant proportion of elderly patients being discharged from the ED need home health services. Access to rapidly deployed home care services can obviate the need for hospital admission for a select group of debilitated patients. The provision of home care services from the ED is economically feasible.