Use Of Home Visits Research Articles

Examining the Association Between DCT Solutions Use and Participant Diversity in Clinical Trials.

Whereas anecdotal reports suggest that the use of decentralized clinical trial (DCT) solutions can improve participant diversity in clinical trials there is no quantitative evidence to support such reports. Tufts CSDD conducted this initial study based on data collected from prior research and publicly available data drawn from Clinicaltrials.gov to compare and contrast participant diversity in trials which included various DCT solutions - virtual visits or televisits, home visits, devices or wearables, and the use of local labs. The results of this analysis indicate that the use of local labs is associated with a lower percentage of white participants; the use of virtual visits or televisits is associated with a lower percentage of Black participants; and the use of devices or wearables was not associated with any significant change in participant demographics. The use of home visits could not be tested for significant differences.

Implementation of Home Infusions in a Multinational Preclinical Alzheimer’s Disease Study

AbstractBackgroundThe A4 Study is a Phase 3 clinical trial investigating solanezumab in preclinical Alzheimer’s disease. The COVID‐19 pandemic impacted the delivery of elective health services worldwide and social distancing restrictions created challenges for clinical trial participants to continue monthly infusions. In an effort to retain A4 participants, decentralized clinical trial methods were implemented, including deployment of mobile research nurses to conduct home visits.MethodThe A4 Study is a 4.5 year double‐blind trial, followed by an optional 4 year open‐label treatment period. The study launched in 2014 and 1163 males and females between the ages of 65 and 85 years old have been dosed. Home visits were not originally included in the study protocol, but were implemented in 2020 to mitigate the COVID‐19 pandemic impact on study conduct. PCM Trials offered home visits as an option to allow participants to continue to receive investigational product. Mobile research nurses traveled to participant homes and administered the 30‐ to 60‐minute intravenous infusions every 4 weeks.ResultTo date, more than 1,400 home infusions visits have been conducted in the A4 Study. 124 participants were enrolled in home infusions (99 in the United States; 1 in Canada and 24 in Australia) from 18 sites.ConclusionImplementation of home visits led to several positive outcomes, including reduced participant burden (particularly for participants living in rural/remote locations), study continuity and maintenance of treatment regimen, and retention of participants. Considering the length of the study, the infusion frequency, and the age of the participants, home visits have been a valuable option to help study completion and compliance. Data integrity and participant safety were ensured and maintained with the use of home visits in the A4 study.

Broadening Heart Failure Care Beyond Cardiology: Challenges and Successes Within the Landscape of Multidisciplinary Heart Failure Care.

Heart failure (HF) is a growing public health concern that impairs the quality of life and is associated with significant mortality. As the prevalence of heart failure increases, multidisciplinary care is essential to provide comprehensive care to individuals. The challenges of implementing an effective multidisciplinary care team can be daunting. Effective multidisciplinary care begins at the initial diagnosis of heart failure. The transition of care from the inpatient to the outpatient setting is critically important. The use of home visits, case management, and multidisciplinary clinics has been shown to decrease mortality and heart failure hospitalizations, and major society guidelines endorse multidisciplinary care for heart failure patients. Expanding heart failure care beyond cardiology entails incorporating primary care, advanced practice providers, and other disciplines. Patient education and self-management are fundamental to multidisciplinary care, as is a holistic approach to effectively address comorbid conditions. Ongoing challenges include navigating social disparities within heart failure care and limiting the economic burden of the disease.

Community Engagement: Lessons Learned From the AAASPS and SDBA.

Community engagement is a means to help overcome challenges to the delivery of health care and preventative services. On the occasion of the 2021 International Stroke Conference Edgar J. Kenton III Lecture, I review community engagement strategies utilized in the AAASPS trial (African-American Antiplatelet Stroke Prevention Study) and SDBA (Studies of Dementia in the Black Aged) observational studies that I directed. The main community engagement strategies included use of home visits (bringing the study to the community), engagement of churches, community advisors, community physicians, other healthcare providers, major Black community organizations, and utilization of diversity training. Community engagement strategies were a major component of AAASPS and SDBA that helped to ensure successful recruitment and retention of an underrepresented community in clinical trial and observational studies. Lessons learned from these studies largely carried out in the 1980s and 1990s helped to dispel myths that Blacks could not be recruited into large-scale clinical trials, emphasized the importance of studying underrepresented groups with adequate statistical power to test primary study hypotheses, and provided foundational recruitment and retention methods for future consideration.

The impact of Covid-19 pandemic on community-oriented mental health services: The experience of Friuli Venezia Giulia region, Italy

Objectivesto assess the changes in prevalence, incidence and hospitalisation rates during the first four months of 2020, compared to the same period of 2019, in Friuli Venezia Giulia Mental Health Departments (MHDs); to analyse the features of MHDs patients tested for Sars-Cov-2, and to monitor whether MHDs applied and adhered to regional recommendations. MethodsObservational study using MHDs’ administrative data and individual data on suspected and positive cases of Sars-Cov-2. Adherence to recommentations was assessed using 21 indicators. Changes in rates were calculated by Poisson regression analysis, while the Fisher exact test was used for assessing differences between suspected and positive cases. ResultsThe decrease in voluntary admission rates on 100,000 inhabitants in hospital services was significantly larger from January to April 2020, compared to the same period of 2019 (P<0.001), while no other data showed a significant decrease. Among the 82 cases tested for Sars-Cov-2, five were positive, and they significantly differ from suspected cases only in that they were at home or in supported housing facilities prior to the test. The MHDs mostly complied with the indicators in the month after the publication of recommendations. ConclusionsOutpatient services continued to work normally during the emergency, while hospital services decreased their activities. A low number of positive cases was found among MHDs’ users, which might be linked to a rapid reconversion of services, with an extensive use of home visits and telepsychiatry. These preliminary data should be interpreted with caution, due to the small size and the limited period of observation.

Client attrition in the Nurse-Family Partnership® : Revisiting metrics of impact in a home visitation program in the United States.

The Nurse-Family Partnership® (NFP) is an evidence-based home-visiting program for low-income, first-time mothers. NFP® has demonstrated benefits for reducing child maltreatment and improving parenting, child development and families' economic self-sufficiency. It is now implemented widely in the US where, despite the use of home visits, which generally reduce barriers to program participation, only 35% of clients nationwide complete the 2.5-year program. This concurrent mixed-methods study was conducted in 2013 in an urban northeastern US NFP site and included administrative program data, surveys (n=56), in-depth interviews (n=14) with nurse home visitors, and focus groups with nurse supervisors (n=13). We explored associations between nurses' attrition rates and their perspectives on client attrition and retention strategies. Wefurtherconducted an inductive thematic analysis of the qualitative data. Findings indicate that nurses' attrition rates were not significantly associated with their views and strategies to retain clients. Nurses and supervisors noted that clients' competing priorities and 'chaotic lives' primarily explained attrition. They thought that clients often left the program upon receiving enough information and skills or achieving key milestones, which may reflect reaching a saturation point, albeit prior to the full completion of the program. We offer recommendations to assess performance based on client accomplishments rather than whether they participated until the prescribed endpoint.

Socioeconomic determinants of access to health services among older adults: a systematic review.

ABSTRACTOBJECTIVE The objective of this study was to analyze the association between the socioeconomic characteristics and the access to or use of health services among older adults.METHODS This is a systematic review of the literature. The search has been carried out in the databases PubMed, LILACS and Web of Science, without restriction of dates and languages; however we have included only articles published in Portuguese, English, and Spanish. The inclusion criteria were: observational design, socioeconomic factors as variables of interest in the analysis of the access to or use of health services among older adults, representative sample of the target population, adjustment for confounding factors, and no selection bias.RESULTS We have found 5,096 articles after deleting duplicates and 36 of them have been selected for review after the process of reading and evaluating the inclusion criteria. Higher income and education have been associated with the use and access to medical appointments in developing countries and some developed countries. The same association has been observed in dental appointments in all countries. Most studies have shown no association between socioeconomic characteristics and the use of inpatient and emergency services. We have identified greater use of home visits in lower-income individuals, with the exception of the United States.CONCLUSIONS We have observed an unequal access to or use of health services in most countries, varying according to the type of service used. The expansion of the health care coverage is necessary to reduce this unequal access generated by social inequities.

Come and Knock on Our Door: Offenders’ Perspectives on Home Visits Through Ecological Theory

The use of home visits has a long and storied history in the United States from different disciplines, such as nursing, prenatal mothers, young families, health promotion, and community corrections. Ecological theory explains how formal actors play a role in the promotion in the health field through home visits, but does not address community corrections home visits. Through the use of 30 semi-structured interviews, this research seeks to expand the understanding of ecological theory by capturing the perceptions of offenders sentenced to home visits conducted by a sheriff's office. The findings suggest the participants supported the home visits by formal agents and, in general, the home visits created an atmosphere of respect between the participants and sheriff's office personnel. This study creates the context for future research to understand the role of formal agents in recidivism and evaluate the efficacy of home visits by community corrections agencies.

Use of home visits increases data completion and retention in studies involving family members

Background Previous research indicates that health and well-being is adversely affected in family members of a child with a health condition but the practical aspects of recruiting, retaining and collecting data from family members are not well reported. Using data from a cross-sectional observational study, we looked at whether use of home visits had an effect on the data completion and retention of family members.

Parent Involvement in Rural Elementary Schools in New Zealand: A Survey

We surveyed rural elementary schools in New Zealand regarding their practice of parent involvement (PI). Interviews were conducted at 22 schools using a schedule which focused on eleven aspects of PI: policy formation, acting as a resource, collaborating with teachers, sharing information on children, channels of communication, liaison with school staff, parent education, parent support, encouraging parents into school, involving diverse parents, and professional development for teachers. Analysis of data from the interviews identified several common weaknesses in PI provision: a lack of written school policies on PI; the ad hoc nature of the organization of PI; minimal parent education organized by schools; minimal focus on parent support; minimal use of home visits; limited ideas to involve diverse parents; a minimal focus on involving parents of children with special needs; and, limited professional development for teachers on working with parents. Implications for improving the practice of PI in rural elementary schools are discussed.

A Special Issue: Coding for Children With Special Health Care Needs

A Special Issue: Coding for Children With Special Health Care Needs

Home Visiting for Intervention Delivery to Improve Rural Family Asthma Management

The focus of this article is on the use of home visits in an asthma self-management intervention study with rural families who have a school-aged child with asthma. The study design involved randomization of the sample by elementary schools, then baseline (pretest) and postintervention data collection.1 The purpose of this article is to describe challenges with, and pose solutions for, implementing home visits for asthma self-management in rural areas. Home visiting is a strategy for program delivery that takes advantage of the home context for tailoring services to address the family's individual needs. The advantages of intervening in the home include being able to (a) use actual home conditions for individualizing the asthma education to meet families' needs; (b) match home visitors with family in terms of ethnicity and language; (c) retain a high percentage of families over the year-long duration of the study; and (d) not add to family burden of managing asthma.

Home visits in geropsychiatry fellowship training.

The psychiatric home visit is an effective intervention for elderly patients who otherwise would not receive mental health services. Home visits also have potential to be useful for training. Here, the current practice of home visits in geropsychiatry fellowship programs is examined. The directors of 55 current geropsychiatry fellowships in the United States were sent a 13-item questionnaire regarding the use of home visits for training. Of the 51% of programs responding, 57% provide a formal home-visit experience for fellows. Respondents commented favorably regarding the educational value of home visits, but raised concerns about funding this time-intensive clinical activity. Training programs in geropsychiatry can benefit from the inclusion of home-visit programs. A description of a recently established home-visit program illustrates the feasibility of such an enterprise when developed as a collaboration between a teaching hospital and an appropriate community agency. This arrangement provides training for fellows and allows the agency to provide broad mental health services.

Socioeconomic differences in childhood consultation rates in general practice in England and Wales: prospective cohort study

Objective:To establish how consultation rates in children for episodes of illness, preventive activities, and home visits vary by social class.Design:Analysis of prospectively collected data from the fourth national survey of...

USE OF PRIMARY CARE BY EARLY DISCHARGE (ED) NEWBORNS 1604

We determined the effect of an early discharge program on the pattern of primary care visits (PCV) following discharge from the hospital.Methods: 997 study infants (Early discharge (ED) 9/1/93-5/1/94) and 1171 historical controls (C) (standard discharge 9/1/92-5/1/93) formed the original cohort. Both groups consisted of healthy newborns, (85% medicaid or selfpay) delivered vaginally with no transitional problems. For this analysis only infants who chose a public clinic for F/U were included (C=730, S=670). The early discharge program was characterized by liberal use of home visits and coordination of post hospital care. PCV was defined as a visit to the specific site identified by the mother at the time of discharge from the birth hospital. Computer and manual searches were done to determine rates of FPCV and age at visit to specific clinics. Primary care sites were divided into community based clinics (CBC) and a single hospital based clinic (HBC). Maternal variables included age, race, use of prenatal care, parity and gravidity. Infant variables included birth weight and gestational age. Bivariable (T test, chi-sq) and multivariable (Logistic regression) analyses were performed. Results: 73% of patients in the C and 79% in the ED group kept their PCV at the site indicated at discharge (n.s., Chi-sq). Infants in the ED program were likely to have a PC visit (OR=1.313, CI 1.13, 1.51). Women with substandard prenatal care (OR=0.467, CI 0.36, 0.61) and HBC users (OR=.523, CI 0.45, 0.60) were less likely to have a PC visit. Mothers of younger age and nonwhite race were less likely to make PC visits.Conclusion: Infants in the ED program were more likely to return to their stated site of primary care enhancing opportunities for health care planning and communications.

A survey of predischarge occupational therapy home assessment visits for stroke patients

Home assessment visits are a part of inpatient stroke rehabilitation programmes, but surprisingly little has been written about how often they are used or what they achieve. This study describes the use of home visits in 327 patients in a study of stroke rehabilitation after discharge from hospital. Home visits were noted in 149 (50%). A median of five problems were identified, most commonly involving mobility inside the property and the height of furniture hampering transfers. A median of four solutions were recorded, most commonly the provision of aids and equipment. Representatives of the community social and nursing services were present in a minority of visits. An occupational therapist (OT) from the Social Services was present in half the home visits in addition to the hospital OT. The study concludes that several important problems are identified on home visits and that simple solutions can be found in most cases. Social and health services, in Nottingham at least, should develop more rational working practices for home visits, so that liaison between hospital and community services is improved and duplication of work is avoided.

The New Friendly Visitors:

Social workers have always advocated for outreach to clients in their environments. As early as 1893, Mary Richmond was instructing the first social workers, known then as visitors in the value of this approach. Such advice remains valuable for modern independent social workers. In this article, the aothor's use of home visits in private clinical social work practice demonstrates the relevancc of thc earliest thcories and traditions of the profession. This rediscovery celebrates one hundred years of friendly visiting.

Home Management in a Comprehensive Preschool Program for Hearing Impaired Children

A home management program is described within the framework of a comprehensive preschool program for hearing impaired children. Advantages and problems of utilizing home visits as a part of this program are discussed. The advantages are believed to far outweigh the problems encountered, and the use of home visits in a home management program for young children with language disorders is encouraged.

Use of home visits for psychiatric evaluation. Clinical and teaching aspects.

Background and Historical Perspective The accusation is often leveled at psychiatrists by other physicians that they separate themselves from the rest of their medical colleagues and avoid the role of doctor as it is played by most other medical specialists and general practitioners. One of the points often made by such critics is that psychiatrists avoid home visits to a far greater extent than do other medical specialists. Some informal discussions among members of the Psychiatric Inpatient Service at the University of California Medical Center at Los Angeles were focused on such criticisms of psychiatrists early in 1958. Although we felt that there were many realistic reasons for different approaches to the practice of medicine among the various specialties, we also discussed at length whether some of the criticisms were not justified. Particularly we wondered whether the general lack of home visiting in the training programs of various psychiatric centers