Scheduled Home Visits Research Articles

Early childhood home visiting programme: factors contributing to success

This paper reports a study of the factors that public health nurses, home visitors and parents consider important for the success of an early childhood home visiting programme. The primary aim of early child home visiting programmes is to promote healthy and safe growth and development of infants and children in at-risk families. Few studies have focused on actual programme components which foster this outcome. The research was a descriptive, qualitative evaluation. Success of the programme was defined as positive changes in families which were seen as directly related to participation. The 58 participants were 24 public health nurses, 14 home visitors and 20 parents. One in-depth semistructured audio-taped interview was conducted with each participant between October 2003 and February 2004. All interviews were transcribed and analysed using open coding; themes and categories were developed and reviewed for congruence of coding. Participants discussed several factors that they considered important for the success of the programme: its particular characteristics, the programme activities and the healthcare providers. Components contributing to the success of early childhood home visiting programmes include a strength-based philosophy, voluntary enrollment of parents, regularly scheduled home visits, a curriculum to structure the home visitor's interventions, and careful attention to the selection, training, and supervision of home visitors.

CHF death/readmission rate decreased by 48% in a prospective study of a nurse managed home-based congestive heart failure disease management program in a small community hospital

Background: To determine if benefits of a nurse run home-based congestive heart failure program, previously associated with tertiary care hospitals, can be obtained in a small community hospital setting. Description: This prospective study followed consecutive patients admitted to Holland Community Hospital with a primary diagnosis of CHF for a period of one year. Entry requirements included a primary congestive heart failure diagnosis confirmed by chest x-ray, diminished left ventricular function (EF≤50%) measured by echocardiography, and residence within 25 miles of the hospital. Exclusions included diagnosis of myocardial infarction and residence in nursing homes or assisted living facilities. This study population was compared to an identical patient group hospitalized the previous year. The primary endpoint was reducing hospital readmissions and out of hospital mortality. Secondary goals included improving disease knowledge, compliance with dietary and medication regimes, and quality of life. Clinical Intervention: Upon hospital discharge, patients were assigned to a registered nurse community case manager dedicated to the program. The patient received a combination of regularly scheduled home visits and telephone calls. Patient contacts included assessments of heart failure and dietary knowledge, medication compliance, disease management education and appropriate referrals to social service, dietary, and cardiac rehabilitation. Prospectively defined tools were used to assess heart failure and dietary knowledge, medication compliance, and quality of life. These patients were provided education and follow-up for a period of one-year. In addition to the formalized education, a monthly support group was also offered to these patients. This meeting was structured to provide education as well as an opportunity for sharing their experience and mutual support. Results: Death and readmission rates were decreased in the study patients by 48%. Based on hospital days, a cost savings of $1,024 per enrollee was obtained. In addition, enrollees achieved significant improvemnt in medication and dietary compliance, as well as heart failure knowledge. Patients also perceived an overall increase in their quality of life. Conclusion: Nurse managed home-based congestive heart failure programs can be successfully implemented in the community hospital setting. Such interventions are a cost-effective method to decrease congestive heart failure hospitalizations and death, enhance quality of life, and improve medical compliance. Background: To determine if benefits of a nurse run home-based congestive heart failure program, previously associated with tertiary care hospitals, can be obtained in a small community hospital setting. Description: This prospective study followed consecutive patients admitted to Holland Community Hospital with a primary diagnosis of CHF for a period of one year. Entry requirements included a primary congestive heart failure diagnosis confirmed by chest x-ray, diminished left ventricular function (EF≤50%) measured by echocardiography, and residence within 25 miles of the hospital. Exclusions included diagnosis of myocardial infarction and residence in nursing homes or assisted living facilities. This study population was compared to an identical patient group hospitalized the previous year. The primary endpoint was reducing hospital readmissions and out of hospital mortality. Secondary goals included improving disease knowledge, compliance with dietary and medication regimes, and quality of life. Clinical Intervention: Upon hospital discharge, patients were assigned to a registered nurse community case manager dedicated to the program. The patient received a combination of regularly scheduled home visits and telephone calls. Patient contacts included assessments of heart failure and dietary knowledge, medication compliance, disease management education and appropriate referrals to social service, dietary, and cardiac rehabilitation. Prospectively defined tools were used to assess heart failure and dietary knowledge, medication compliance, and quality of life. These patients were provided education and follow-up for a period of one-year. In addition to the formalized education, a monthly support group was also offered to these patients. This meeting was structured to provide education as well as an opportunity for sharing their experience and mutual support. Results: Death and readmission rates were decreased in the study patients by 48%. Based on hospital days, a cost savings of $1,024 per enrollee was obtained. In addition, enrollees achieved significant improvemnt in medication and dietary compliance, as well as heart failure knowledge. Patients also perceived an overall increase in their quality of life. Conclusion: Nurse managed home-based congestive heart failure programs can be successfully implemented in the community hospital setting. Such interventions are a cost-effective method to decrease congestive heart failure hospitalizations and death, enhance quality of life, and improve medical compliance.

The Client Adherence Profiling-Intervention Tailoring (CAP-IT) intervention for enhancing adherence to HIV/AIDS medications: a pilot study.

This article describes the Client Adherence Profiling-Intervention Tailoring (CAP-IT) intervention designed to enhance adherence to HIV/AIDS medications and reports the results of a pilot study aimed at assessing the feasibility of CAP-IT. Initially, CAP-IT was designed to be implemented by nurse case managers during regularly scheduled home visits; it is currently under revision for use in an outpatient, ambulatory care setting. CAP-IT is an innovative, structured nursing assessment and care-planning activity that allows a standardized assessment of client needs and tailored highly active antiretroviral therapy adherence intervention strategies. CAP-IT is significantly different from the current standard nursing case management practice. Pilot study results in a sample of 10 home care patients suggests that clients have knowledge and skill deficits related to adherence and in the management of the side effects of medications. In addition, the pilot study supported the acceptability of the protocol to clients and the feasibility of integrating CAP-IT into nurse case manager practice. The pilot study results also provided evidence for the efficacy of CAP-IT. The next steps include testing CAP-IT in a randomized clinical trial to determine its effectiveness.

Bicycle helmet promotion among low income preschool children

Objective—To evaluate the effectiveness of a multifaceted bicycle helmet promotion program for low income children attending preschool enrichment programs throughout Washington State. Study sample—Preschool Head Start programs that conducted routine...

Utilization of hospice/home care in pediatric oncology A national survey

The prevalence, utilization, and efficacy of home care services for children dying from cancer was examined. Information was obtained from a survey completed by 85 institutions in 47 states, 76% of the sample solicited. Home care services were offered by 85.9% of institutions; 43.8% of these administered their own programs and 56.2% relied upon community-based services. Institutions which provided their own services offered home care to a greater proportion of eligible patients, had a larger proportion of families accept this option, and had a smaller proportion of children return to the hospital to die than institutions which used community agencies. The most frequent problems with community agencies included inexperience with pediatric issues and procedures, inadequate pain management, and reluctance of families to work with unfamiliar staff. Institutionally administered programs were more likely to provide regularly scheduled home visits, care by pediatric oncology nurses, and bereavement follow-up. The most important factors inhibiting institutions from developing their own home care programs were anticipated problems with pain and other symptom management, uncertainty as to family competency to provide care, and concern regarding the effects of home care on patients and their families. Potential problems in providing home care services for children should be balanced against the expected benefits to the patient and family.