Quality problems of community home care service in Beijing: a qualitative observatory study / 中华全科医师杂志

Objective:To investigate the quality issues of community home care service in Beijing.Methods:A study on quality of community home care service was conducted from March to May in 2021 in six urban districts of Beijing, and 10 community health service centers were selected as study sites by purpose sampling method. The quality issues of home care service were studied by observing the process of 17 home care services, interviewing medical staff and reviewing relevant medical documents.Results:The study extracted 3 structural quality problems and 6 process quality problems of home care service. The structural quality problems included unclear service scheduling and insufficient qualification of the personnel; lacking special transportations; and lacking home health service standards in some centers. The process quality problems included incomplete material preparation, wearing jewelry during medical procedures, no physical check-up before procedures, not strictly following the aseptic principle in the operation, not properly disposing medical wastes, wrong or missing filling of medical documents.Conclusions:There are some problems in the implementation of community home care service in Beijing, such as insufficient medical personnel and material resources, unclear service scheduling, lack of unified medical service standards, and insufficient quality management. Therefore, these problems should corrected to ensure the quality of community home care services in Beijing.

Inquérito Brasileiro Sobre Terapia de Nutrição Domiciliar: panorama atual / Brazilian Survey on Home Nutrition Therapy: current overview / Encuesta brasileña sobre terapia nutricional domiciliaria: panorama actual

Objetivo: descrever como a terapêutica nutricional domiciliar é realizada no Programa Melhor em casa do Ministério da Saúde e na Saúde suplementar. Método: Estudo transversal, com dados secundários, onde foram selecionados os perfis de profissionais atuantes em atenção domiciliaria no Brasil. A coleta de dados ocorreu de março a junho de 2018, depois de submetido e aprovado pelo Comitê de Ética e Pesquisa. Resultados: Dos 289 brasileiros, 74% eram profissionais atuantes na Assistência domiciliaria. O tipo de Terapia Nutricional realizada foi 67% enteral exclusiva seguida de 33% terapia mista. A prescrição realizada de dieta exclusiva artesanal foi de 9% e de dieta enteral mista 55%. A maioria recebe dieta por gravidade intermitente, seguida de administração em "bolus", gravitacional contínua e controle do gotejamento através da bomba de infusão. Conclusão: Os achados nos dão uma visão panorâmica da terapia nutricional enteral domiciliar no Brasil. A aumento da terapia nutricional domiciliaria se faz necessária especialmente pelo aumento da população idosa e consequentemente de maior presença das doenças crônicas que podem levar a incapacidade, dependência, maior tempo de hospitalização e custos para o sistema de saúde. É fundamental a presença da equipe interdisciplinar, de boas práticas e do acompanhamento das famílias nos domicílios.

Objective: To learn how home nutritional therapy is carried out in the Ministry of Health's Better Home Program and in Supplementary Health. Method: Cross-sectional study, with secondary data, in which the profiles of professionals working in home care in Brazil were selected. Data collection took place from March to June 2018, after being submitted and approved by the Ethics and Research Committee. Results: Of the 289 Brazilians, 74% were professionals working in home care. The type of nutritional therapy performed was 67% exclusive enteral followed by 33% mixed therapy. The prescription of an exclusive handmade diet was 9% and a mixed enteral diet 55%. Most receive intermittent gravity diet, followed by bolus administration, continuous gravitational and drip control through the infusion pump. Conclusion: The findings give us a panoramic view of home enteral nutritional therapy in Brazil. The increase in home nutritional therapy is necessary especially because of the increase in the elderly population and, consequently, the greater presence of chronic diseases that can lead to disability, dependence, longer hospitalization and costs for the health system. The presence of an interdisciplinary team, good practices and monitoring of families at home is essential.

Objetivo: Conocer cómo se lleva a cabo la terapia nutricional domiciliaria en el Programa Mejor Hogar del Ministerio de Salud y en Salud Complementaria. Método: Estudio transversal, con datos secundarios, en el que se seleccionaron los perfiles de los profesionales que trabajan en la atención domiciliaria en Brasil. La recolección de datos tuvo lugar de marzo a junio de 2018, luego de ser presentados y aprobados por el Comité de Ética e Investigación. Resultados: De los 289 brasileños, el 74% eran profesionales que trabajaban en la atención domiciliaria. El tipo de terapia nutricional realizada fue 67% enteral exclusiva seguida de 33% terapia mixta. La prescripción de una dieta exclusiva artesanal fue del 9% y una dieta enteral mixta del 55%. La mayoría recibe una dieta de gravedad intermitente, seguida de administración de bolo, control gravitacional continuo y de goteo a través de la bomba de infusión. Conclusión: Los hallazgos nos brindan una visión panorámica de la terapia nutricional enteral domiciliaria en Brasil. El aumento de la terapia nutricional domiciliaria es necesario sobre todo por el aumento de la población anciana y, en consecuencia, la mayor presencia de enfermedades crónicas que pueden derivar en discapacidad, dependencia, mayor internación y costos para el sistema de salud. La presencia de un equipo interdisciplinario, buenas prácticas y seguimiento de las familias en el hogar es fundamental.

Research progress of comprehensive assessment tools in home care service / 中华全科医师杂志

A comprehensive assessment tool for home care can help to determine the service needs.This article summarizes some of the advanced assessment scales that have been internationally applied for the home health care and to discuss the direction for development of the assessment tools in China.

Development of the outcome evaluation index system for home care service of disabled elderly under the long-term care insurance in Guangzhou / 中国实用护理杂志

Objective@#To develop the outcome evaluation index system for home care service of disabled elderly based on the long-term care insurance in Guangzhou.@*Methods@#Delphi method was used to develop the outcome evaluation index system for home care service of disabled elderly under the long-term care insurance in Guangzhou. The Analytic Hierarchy Process was used to determine the weights of all indexes.@*Results@#After two rounds of expert consultation, questionnaire response rates were 86.67%, 100%; expert authority coefficients were 0.843, 0.858; coefficients of variation ranged from 0.07 to 0.23 and 0.00 to 0.14; coordination coefficients ranged from 0.221 to 0.355 and 0.379 to 0.433 (P<0.01). The final index system consisted of 5 first-level indicators, 17 second-level indicators, and 59 third-level indicators. The analytic hierarchy process was used to determine the weights of all indexes, and the consistency test (CR<0.1) was performed.@*Conclusions@#The outcome evaluation index system for home care service of disabled elderly under the long-term care insurance in Guangzhou was scientific and reliable, the weights of all indexes were reasonable, which could provide reference for the designated service institution on evaluation and improvement of the effect of home care service of long-term care insurance for disabled elderly.

Profile of patients attended by the speech therapists of the home care service / Perfil dos usuários atendidos pela fonoaudiologia do serviço de atenção domiciliar

ABSTRACT Objective: to ascertain the profile of home care service (HCS) users with speech and language complaints in João Pessoa, Paraíba (PB). Methods: a descriptive and quantitative study using an indirect documentation technique based on an analysis of primary source documents, characterized as a documentary study, conducted at a HCS, in João Pessoa, PB, that stores user information in the form of medical records. All patient records included by the HCS from June 2012 to June 2016 were analyzed. After the eligibility criteria were applied, the sample consisted of 114 medical records. The collected data were entered into a Microsoft Excel spreadsheet to generate descriptive statistics using IBM SPSS (version 21.0). Results: most patients were males (59.6%), elderly (62.3%), had been diagnosed with a stroke (57.9%),had histories of dysphagia (76.3%), speech problems (58.8%), swallowing disorders (80.7%), and abnormal chewing (77.2%). Dysphagia is often associated with stroke, predominantly among males and the elderly. Conclusion difficulty in swallowing, or dysphagia, is often associated with stroke, predominantly in the presence of the sociodemographic and clinical variables associated with men and the elderly.

RESUMO Objetivo: verificar o perfil dos usuários com queixas fonoaudiológicas do serviço de atenção domiciliar do município de João Pessoa, Paraíba. Métodos: trata-se de um estudo transversal, descritivo, natureza quantitativa, mediante técnica de documentação indireta a partir da análise de documentos de fontes primárias, sendo caracterizado, portanto, como estudo documental. A pesquisa foi realizada junto ao serviço de atenção domiciliar (SAD) do município de João Pessoa/PB, que dispõe de informações dos usuários armazenadas em forma de prontuários. Todos os prontuários dos pacientes atendidos pelo SAD no período de junho de 2012 a junho de 2016 foram analisados, e após os critérios de elegibilidade, amostra ficou constituída por 114 prontuários. Os dados coletados foram inseridos em uma planilha do Microsoft Excel para realização de estatística descritiva no Software IBM SPSS (versão 21.0). Resultados: verificou-se que a maioria dos pacientes atendidos foi do sexo masculino (59,6%), idosos (62,3%) e diagnosticados com acidente vascular encefálico (57,9%). Além disso, apresentaram histórico de disfagia (76,3%), problemas de fala (58,8%), deglutição alterada (80,7%) e mastigação alterada (77,2%). A disfagia está frequentemente associada aos AVE's apresentando predomínio de indivíduos do sexo masculino e idosos. Conclusão: concluiu-se que a alteração de dificuldade de deglutição, ou seja, a disfagia está frequentemente associada aos AVE's apresentando o predomínio das variáveis sociodemográficas e clínicas de homens e idosos.

Characteristics of Nurses' Activities in Support of Elderly People who Spent Their End-of-life Period in the Community Using a Small-sized Multifunctional in Home Care / 日本プライマリ・ケア連合学会誌

Introduction: We aimed to clarify the characteristics of the activities of nurses who provide end-of-life care to users of small-sized multifunctional in-home care services (SMICS) and consider effective end-of-life care for elderly persons who use SMICS.Methods: Semi-structured interviews were conducted with 16 nurses who belonged to SMICSs, and the results were analyzed qualitatively and inductively.Results: The nurses provided four core categories of support: "support so that the elderly person and their family can spend a better end-of-life period together while maintaining their everyday lifestyle," "support so that the family and care staff can deal with the elderly person's dying process," "support so that the elderly person or their family can clarify where and how they want to spend their end-of-life and fulfillment of their wishes," and "provision of medical care suitable for the wishes of the elderly person or their family and disease conditions." Conclusion: The results indicated that nurses supported the elderly and their families by clarifying the care they desire and to support the elderly person, their family, and those who assist them in daily living. In addition, nurses should help not only toward maintenance of daily living but also adapt the medical system so that the elderly person can spend their end-of-life period in a familiar place.

Demand and willing to pay for oral hygiene service in long-term care insurance of elderly / 대한구강보건학회지

OBJECTIVES: This study was conducted to identify the demand and willingness to pay for oral hygiene services among elderly people with long-term care insurance. METHODS: Our study was a cross-sectional analysis. Subjects comprised 126 elderly individuals from long-term home-care centers. A total of 28 centers were selected through convenience sampling from among 78 centers in ○○. For analysis, semi-structured questionnaires that required about 20–30 minutes to complete were used. Analysis was performed using SPSS 23.0 software. RESULTS: The overall demand for oral hygiene services was 44.4%, and willingness to pay was 31.0%. Thirty-three people (58.9%) of elderly those who have demand for an oral hygiene service were willing to pay for the service, and 64 people (91.4%) who did not have a demand were not willing to pay for it. Among those with partial dependence on brushing, 65.6% had demand for oral hygiene services and 50.0% were willing to pay costs. Among basic livelihood beneficiaries, 69.6% were willing to pay for oral hygiene services; general subjects and relievers were less willing to pay. CONCLUSIONS: The overall demand for oral hygiene services among elderly people was 44.4%, and the willingness to pay was as low as 31.0%.

Vivências de graduandos e fisioterapeutas no contexto domiciliário à pessoa idosa fragilizada / Experiences of undergraduates students of physical therapy in the residence of frail elderly patient

Este estudo é oriundo de investigação qualitativa, assentado em multitécnica e se propõe a conhecer as vivências de graduandos e profissionais fisioterapeutas no cuidado domiciliário à pessoa fragilizada e sua família. Foi realizado em quarto instituições de ensino superior do estado da Bahia, com 43 participantes, sendo 28 graduandos e 15 fisioterapeutas. Os dados foram triangulados e compreendidos à luz da análise de conteúdo. Os resultados evidenciaram que o ambiente domiciliar é, por vezes, um espaço desconhecido da vivência acadêmica dos graduandos e profissionais fisioterapeutas, pois expressam sentimentos de insegurança e medo para atuarem nesse contexto por carência na formação acadêmica. Destacam a necessidade de reformulação dos componentes curriculares à inserção do processo formador ao contexto comunitário-domiciliar mais proximal, cujos saberes os potencializam de referências teórico-práticos sobre família, envelhecimento e comunidade. (AU)

This study is based on qualitative research based on multi technics and aims to know the experiences of undergraduate and professional physiotherapists in the home care of the frail person and his/her family. It was held in four institutions of higher education in the State of Bahia with 43 participants, of which 28 were undergraduates and 15 physiotherapists. The data were triangulated and understood in light of the content analysis. The results showed that the home environment is sometimes an unknown area of the academic experience of undergraduates and physiotherapists who express feelings of insecurity and fear to act in this context due to lack of academic training. They emphasize the need to reformulate the curricular components to the insertion of the formation process into the more proximal community-domicile context, whose knowledges empower them with theoretical-practical references on family, aging and community. (AU)

Effectiveness of home service in rehabilitation of post-stroke patients on recovering period / 中华全科医师杂志

One hundred and fifty eight post-stroke patients in the recovering period were divided into intervention group (78 cases) and control group (80 cases).Patients in intervention group received home rehabilitation service provided by general practitioners (GP) for 6 months,while patients in control group received routine rehabilitation.After 6-months,the scores of self-rated health measurement scale (SRHMS) in intervention group were significantly higher than those of control group (P ＜0.01);the visiting time and frequency,medical costs and time of caregiving were decreased (P ＜ 0.01);and the satisfaction score of the patients in intervention group was 97％.The results show that home rehabilitation service can improve effectiveness of rehabilitation for post-stroke patient in recovering period.

Comparison of Walking, Muscle Strength, Balance, and Fear of Falling Between Repeated Fall Group, One-time Fall Group, and Nonfall Group of the Elderly Receiving Home Care Service

PURPOSE: The purpose of this study was to provide information to develop a program to prevent repeated falls by analyzing the difference in gait, muscle strength, balance, and fear of falling according to their fall experience. METHODS: The study subjects were 110 elderly individuals aged over 60 years who agreed to their participation in this research. The study participants were categorized into a repeated fall group (n = 40), a one-time fall group (n = 15), and a nonfall group (n = 46) of the elderly. Measurements of gait, muscle strength, balance, and fear of falling were taken in each group. RESULTS: With regard to gait, there were significant differences among three groups in gait cycle (F = 3.50, p = .034), speed (F = 13.06, p < .001), and cadence (F = 5.59, p = .005). Regarding muscle strength in the upper and lower limbs, statistically significant differences were shown among three groups in muscle strength of upper (F = 16.98, p < .001) and lower (F = 10.55, p < .001) limbs. With regard to balance, the nonfall group had significantly greater results than the one-time fall group and repeated fall group in dynamic balance (F = 10.80, p < .001) and static balance (F = 8.20, p = .001). In the case of the fear of falling, the repeated fall group had significantly higher score than other two groups (F = 20.62, p < .001). CONCLUSION: This study suggests that intervention program should be tailored to fall risk factors to enhance gait and balance and lower body muscle strength and reduce the fear of falling to prevent repeated incidences of falls in this population.

Home-Based Hospice Care Provided by a Free-Standing Hospice Center: Patients' Characteristics and Service Conditions / 한국호스피스완화의료학회지

PURPOSE: This study was conducted to investigate patients' characteristics and actual conditions of home-based services offered by a free-standing hospice center. METHODS: A retrospective review was performed with the medical records of 75 patients who received home-based hospice care from a free-standing hospice center from January 2014 through December 2014. RESULTS: Most patients (54.7%) were enrolled via self-directed referral. The reason for the service termination was death at home 25.3%, admission to a hospice ward 50.7%, hospitalization 22.6% and patients' refusal 2.7%. Seventy three patients had cancer, and two patients had ALS. Among all, 58.7% were in a dying phase, and 34.7% were almost completely bedfast at the time of their enrollment in this study. When they enrolled, the patients' physical symptoms were characterized as pain (89.4%), sleep disturbance (71.2%), urinary difficulties (35.8%) and defecation difficulties (47.8%). Among all, 77.4% terminated the home visit service within one month. The mean frequency of the home visits was 3.25 (±3.98), and less than five in 82.7% of patients. The mean frequency of the phone service was 3.40 (±3.12). The frequency of doctor's home visits was 1.21±0.79 on average, and the figure increased when patients' conditions turned unstable. CONCLUSION: It is necessary to develop a home-based hospice care model with consideration of patients' characteristics and the actual service conditions delivered by free-standing hospice facilities.

Research on demand for elderly home care service and its influential factors in Tianjin district / 中国实用护理杂志

Objective To analyze the demand for home care service and its influential factors among elderly in Tianjin city.Methods A total of 254 residents aged 60 and above from Tianjin city were investigated with a self-designed questionnaireDemand for Home Care Service,Katz index of independence in Activities of Daily Living(ADL) and Lawton Instrumental Activities of Daily Living (IADL) scale.Results The mean score for home care service has been revealed (2.40±0.67),as the ranking demonstrated:public welfare (3.61±1.04),social participation (2.69±1.32),medical service (2.56±0.90),rights safeguard by law (2.37±1.54),mental need (2.26±0.99),and need for daily life care (1.73±0.69).Multiple linear regression analysis showed that income,education level,activity of daily living and the convenience degree of seeking treatment were major factors affecting demand for home care service among elderly,which explained 16.3％ of the variance.Conclusions Oriented by demand,further progress shall be achieved multidimensionally,under which circumstances,individualized service ought to be de-livered.Simultaneously,the vulnerable elderly groups require more attention.

Benefícios da atenção domiciliar ao idoso portador de dano crônico: revisão sistemática da literatura / Benefits of home care to the elderly with chronic diseases: systematic literature review / Beneficios de la atención domiciliaria a los ancianos con daño crónico: revisión sistemática de literatura

O estudo objetivou descrever os benefícios da atenção domiciliar ao idoso portador de dano crônico, por meio de revisão sistemática da literatura, realizada na base de dados MEDLINE do PubMed. Nove artigos compuseram a amostra, abrangendo um total de 1825 idosos, com seguimento de 3 meses a 10 anos e todos compararam a atenção domiciliar com outro tipo de atendimento. Houve prevalência do sexo masculino nas amostras estudadas e da insuficiência cardíaca como doença de base. Pacientes que receberam atenção domiciliar tiveram menor mortalidade. Quanto a hospitalizações, médiade dias de internação hospitalar, capacidade funcional e qualidade de vida, a atenção domiciliar apresentou resultados semelhantes aos de outro tipo de atendimento. A atenção domiciliar revelou-se de menor custo. Os resultados encontrados não são unânimes, sendo necessários mais estudos para a eficácia dessas intervenções.

The study aimed to describe the benefits of home care in elderly with chronic diseases through systematic review of the literature in the MEDLINE database from PubMed. Nine articles were included in the sample, covering a totalof 1825 elderly, with a follow up period of 3 months to 10 years. All studies compared home care with other attention. There were more male in the studies samples and Heart Failure as basis disease. Mortality was lower in patients receiving home care, meanwhile for hospitalizations, mean day of hospitalization, functional capacity and quality of were also similar among those receiving home care to those who received other care. Regarding costs, the home care was less expensive. The results are not unanimous, further studies are necessary to the effectiveness of these interventions.

El objetivo fue describir los beneficios de la atención domiciliaria a los ancianos con daño crónico a través derevisiones sistemáticas de la literatura en la base de datos MEDLINE en PubMed. Nueve artículos compusieron la muestra, abarcando de 1825 ancianos, con un seguimiento de 3 meses a 10 años y todos compararon los cuidados en el hogar con otros tipos de atención. Hubo un predominio de varones en las muestras estudiadas y de la insuficiencia cardíaca como la enfermedad de base. Los pacientes que recibieron cuidados en el hogar tuvieron una menor mortalidad. En cuanto a losingresos, el promedio de días de hospitalización, la capacidad funcional y la calidad de vida, la atención domiciliaria presentó resultados similares a los de otro tipo de atención. La atención en el hogar fue de menor costeo. Los resultados no son unánimes, siendo necesarios más estudios sobre la eficacia de esas intervenciones.

A case of lung cancer who received intrathecal catheter implantation to relieve intractable cancer pain and opioid-induced delirium

<b>Introduction</b>: We described a patient with lung cancer who suffered from severe pain due to pelvic bone metastasis and opioid-induced delirium. Induction of subarachnoid analgesia using implanted intrathecal catheter almost abolished his pain and enable home palliative care. <b>Case description</b>: Seventy-year old man was admitted for intractable leg and hip pain due to pelvic bone metastasis and delirium induced by opioid. Although he was initially administered continuous subcutaneous morphine injection for opioid titration, delirium was deteriorated. Opioid rotation to oxycodone and increase in antipsychotic drugs could not improve his delirium. Epidural analgesia with local anesthetic and small dose of morphine improve his delirium with adequate analgesic effect. Finally, he was received intrathecal catheter implantation and discharged to home palliative care. <b>Conclusion</b>: Neuraxial analgesia may provide not only sufficient analgesia but also lower risk of delirium in patient who was administered high dose of opioids because of intractable cancer pain.

The Effects of a Mobile Computerized System for Individual Tailored Home Care Services in a City

PURPOSE: The aim of this study was to evaluate the process and outcome of a mobile computerized system for individual home visiting healthcare. METHODS: A nonequivalent control group non-synchronized design was employed for this study. The newly constructed system was administered to 80 healthcare providers in the experimental group for 8 weeks. Data were analyzed using descriptive analysis, t-test, and ANCOVA with the SPSS 18.0 program. RESULTS: In the process stage, the difference in the frequency of computerized information usage between the experimental and control groups was significant as 8.88+/-3.20 and 7.08+/-2.92, respectively (t=3.90, p<.001). In the outcome evaluation stage, all kinds of healthy lifestyle such as alcohol use, nutrition, weight management and mental health were not improved. CONCLUSION: The findings of this study showed that the revised mobile computerized system was an effective device for individual visiting healthcare providers. Further advanced strategies for using this system should be developed and applied in a broad range of community healthcare.

Needs Assessment for the Beneficiaries of Home-Based Cancer Patients Management Project / 農村醫學 地域保健

OBJECTIVES: This study was performed to investigate the service needs of the beneficiaries who had enrolled in home-based management programs for cancer patients. METHODS: From March to May 2009, 676 cancer patients who were registered in home-based cancer patient management programs were selected as subjects for this study. The data were collected using a questionnaire along with a face-to-face interview performed by officers in charge of the home-based care programs of 47 regional health centers. Fifteen patients were excluded due to incomplete data, leaving 661 subjects who were ultimately enrolled in the study. RESULTS: The mean age of subjects was 64.0 +/- 12.5 years, and males comprised 45.1% (298/661) of the sample. The results of factor analysis for service needs showed that there were five main categories and Cronbach's alpha ranged from 0.593 to 0.890 for each factor. The service needs categories in order of importance were social support, information and education, psychological problems, physical symptoms and household chores. The service needs scores were significantly different when subjects were stratified by age, habitation, religion and disease classification. When we divided the subjects into complete remission, under treatment and terminally ill groups, the needs scores of the terminally ill patient group were significantly higher than those of the other groups (p<0.001). CONCLUSIONS: Service provision based on patient and beneficiary needs could be an effective intervention to reduce the economic burden of cancer management and to improve the quality of life of cancer patients receiving home-based care. Therefore, it is recommended that individual cancer patient care programs be developed and administered according to patient age, habitation and disease severity.

Cost-benefit Analysis of Home Visiting Care for Vulnerable Populations with Hypertension

PURPOSE: This study was to investigate the effect of home visiting care service and to evaluate the effect from the cost-benefit perspective. METHODS: Target participants were enrolled in 2007~2008 for home visiting care and provided with a home visiting nursing service for more than 18 months in J Ward of S City. Of 391 participants, 244 who satisfied the inclusion criteria were used in the final analysis. Cost-benefit analysis was done using the net benefit and benefit/cost ratio. RESULTS: After providing the home care nursing service, the blood pressure control rate increased from 50.8% to 75.4%. Of the subjects, 39.8% maintained their blood pressure level within the target range. As a whole, the net benefit of home visiting care per person ranged from 434,964.86 to 447,112.43 won and the benefit/cost ratio ranged from 2.82 to 2.84. CONCLUSION: Home visiting care for vulnerable populations with hypertension was effective in both maintaining blood pressure and reducing blood pressure to the target range. Therefore these results are especially useful for establishing the value of home visiting services for policy makers as well as for prioritizing vulnerable populations.

Cost-benefit Analysis of Home Visiting Care for Vulnerable Populations with Hypertension

PURPOSE: This study was to investigate the effect of home visiting care service and to evaluate the effect from the cost-benefit perspective. METHODS: Target participants were enrolled in 2007~2008 for home visiting care and provided with a home visiting nursing service for more than 18 months in J Ward of S City. Of 391 participants, 244 who satisfied the inclusion criteria were used in the final analysis. Cost-benefit analysis was done using the net benefit and benefit/cost ratio. RESULTS: After providing the home care nursing service, the blood pressure control rate increased from 50.8% to 75.4%. Of the subjects, 39.8% maintained their blood pressure level within the target range. As a whole, the net benefit of home visiting care per person ranged from 434,964.86 to 447,112.43 won and the benefit/cost ratio ranged from 2.82 to 2.84. CONCLUSION: Home visiting care for vulnerable populations with hypertension was effective in both maintaining blood pressure and reducing blood pressure to the target range. Therefore these results are especially useful for establishing the value of home visiting services for policy makers as well as for prioritizing vulnerable populations.

A case in which ketamine was highly efficacious against opioid-resistant pain caused by prostate cancer bone metastasis, enabling long-term home care

<b>Objectives</b>: Herein, we report a case in which intractable pain caused by prostate cancer bone metastasis was improved by long-term administration of ketamine at home. <b>Subject</b>: A male patient in his 50s developed prostate cancer and pelvic bone metastasis. Even after receiving combined modality therapy, including administration of morphine hydrochloride through an epidural catheter at a dose of 80mg/day and radiation therapy (twice), he continued to experience pain of bone metastasis, and in particular, significant pain was caused during body motion. The pain improved considerably after the administration of ketamine, enabling his long-term home care. <b>Conclusion</b>: We consider that ketamine still plays an important role in the improvement of opioid-resistant intractable pain of bone metastasis. Since ketamine can be used continuously at home, this medicine is able to be used for more appropriate cases as one of the choices. Palliat Care Res 2010; 5(2): 317-322

Idosos com necessidades de cuidado domiciliar / Elderly people with home care needs

Estudo exploratório e descritivo quantitativo com o objetivo de identificar o perfil sociodemográfico e epidemiológico de idosos residentes na Grande Florianópolis – SC, cadastrados em uma unidade local de saúde. Participaram do estudo 50 idosos que recebem cuidados domiciliares. Os questionários foram aplicados de outubro de 2006 a julho de 2007, e analisados com o auxílio do software EpiInfo®. Resultados: 44 (88) participantes possuem vínculo com o Programa de Saúde da Família e média de 1,04 visitas domiciliares/mês. As doenças de maior prevalência são: hipertensão arterial sistêmica, doença pulmonar obstrutiva crônica e diabetes melito. Os atendimentos de maior freqüência foram: fornecimento de medicamentos, consulta médica e/ou de enfermagem e visita domiciliar. Conclui-se que o perfil sociodemográfico e epidemiológico desses idosos mostram a necessidade de sistematização da atenção à saúde em seus domicílios dos mesmos e de seus familiares.

Quantitative exploratory and descriptive study to identify the socio-demographic and epidemiologic profile of elderly people resident in Greater Florianópolis and registered with a local health unit. Fifty elderly people receiving home care participated in the study. The questionnaires were applied from October 2006 to July 2007 and analyzed with the aid of EpiInfo® software. Results: 44 (88) of participants were enrolled in the Family Health Program and home visits averaged 1.04/month. The most prevalent illnesses were: systemic arterial hypertension, chronic obstructive lung disease and diabetes mellitus. The most frequent health care services were drug dispensation, house calls by doctor or nurse, and home visits. Conclusion: the socio-demographic and epidemiologic profile of the elderly in this study show the need to systematize home health care for them and their families.

Estudio exploratorio y descriptivo cuantitativo con el objetivo de identificar el perfil sociodemográfico y epidemiológico de ancianos residentes en la Gran Florianópolis, catastrados en una unidad local de salud. Participaron del estudio 50 ancianos que reciben cuidados en el hogar. Los cuestionarios fueron aplicados entre octubre de 2006 y julio de 2007, y analizados con el auxilio del software EpiInfo®. Resultados: 44 (88) los participantes poseen vínculo con el Programa de Salud de la Familia y media de 1,04 visitas en el hogar / mes. Las enfermedades de mayor prevalencia son: hipertensión arterial sistémica, enfermedad pulmonar obstructiva crónica y diabetes melito. Los atendimentos de mayor frecuencia fueron: fornecimento de medicinas, consultas médicas y/o de enfermería y visitas en el hogar. Conclusión: El perfil sociodemográfico y epidemiológico de ancianos de este estudio muestra la necesidad de sistematización de la atención a la salud en el hogar de los mismos y de sus familiares.