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2.
Recenti Prog Med ; 113(11): 669-673, 2022 11.
Article in Italian | MEDLINE | ID: covidwho-2098921

ABSTRACT

INTRODUCTION: Reliable venous access is essential in providing effective care for many patients. Various vascular access devices (VAD) are available, and are placed by a specialized team using ultrasound guidance in a dedicated room of the hospital; however, during the pandemic covid-19 many not autonomous or bedridden patients were unable to reach the hospital for VAD insertion, because the unavailability of ambulance for the transport. For this reason the specialized team organized a modality for positioning the VAD at bedside at home. METHODS: In 2012 a VAD-team was established by the health authority in the oncology-hematology Department at the hospital of Piacenza. This team was dedicated in positioning ultrasound-guided vascular access. During the covid-19 pandemic the VAD-team modified its organization to reach patients at home to position VAD, initially for oncologic people unable to go to the hospital; this procedure was subsequently extended to other bedridden patients with non-oncologic disease. The positioning of the VAD was performed under ultrasound guidance, according to the same modalities used in hospital. The primary endpoin was the suitability of the VAD to allow the planned treatment. The secondary endpoint was complications of the use of VADs. RESULTS: Between March 2020 to December 2020 and January 2021 to December 2021, VAD were positioned in 118 and 134 patients respectively. The VAD utilized were midlines for each patient. The mean age of the patients was 88 years, the majority were female (>60%). The majority of the patients had neurodegenerative disease (>60%) or advanced cancers (>25%). The VAD allowed the planned treatment in 94% of the patients. The complications were infrequent: VAD dislocation (<1%), thrombosis (<2%). No infection was registered. DISCUSSION AND CONCLUSION: During covid-19 pandemic, the VAD-team demonstrated the feasibility of VADs home positioning, for patients that need to be transported by ambulance to the hospital for a venous catheter insertion. This procedure allows saving of economic and human resources both for patients and caregivers, in addiction can leave the ambulance free for other use. Due to this study, this procedure has become routine practice in our health district for patients bedridden or not autonomous.


Subject(s)
COVID-19 , Home Care Services , Neurodegenerative Diseases , Thrombosis , Humans , Female , Male , Aged, 80 and over , Pandemics
4.
Int J Environ Res Public Health ; 19(20)2022 Oct 14.
Article in English | MEDLINE | ID: covidwho-2071456

ABSTRACT

With the COVID-19 pandemic, the importance of home health care to manage and monitor one's health status in a home environment became more crucial than ever. This change raised the need for smart home health care services (SHHSs) and their extension to everyday life. However, the factors influencing the acceptance behavior of SHHSs have been inadequately investigated and failed to address why users have the intention to use and adopt the services. This study aimed to analyze the influential factors and measure the behavioral acceptance of SHHSs in South Korea. This study adopted the integrated model of the unified theory of acceptance and use of technology (UTAUT) and task-technology fit (TTF) to understand the behavioral acceptance of SHHSs from users' perceptions and task-technology fit. Multiple-item scales were established based on validated previous measurement scales and adjusted in accordance with SHHS context. Data from 487 valid samples were analyzed statistically, applying partial least square structural equation modeling. The results indicated that the integrated acceptance model explained 55.2% of the variance in behavioral intention, 44.9% of adoption, and 62.5% of the continuous intention to use SHHSs, supporting 11 of the 13 proposed hypotheses. Behavioral intention was positively influenced by users' perceptions on performance expectancy, effort expectancy, social influence, and functional conditions. Task-technology fit significantly influenced performance expectancy and behavioral intention, validating the linkage between the two models. Meanwhile, task characteristics were insignificant to determine task-technology fit, which might stem from complex home health care needs due to the COVID-19 pandemic, but were not sufficiently resolved by current service technologies. The findings implied that the acceptance of SHHSs needs to be evaluated according to both the user perceptions of technologies and the matching fit of task and technology. Theoretically, this study supports the applicability of the integrated model of UTAUT and TTF to the domain of SHHS, and newly proposed the measurement items of TTF reflecting the domain specificity of SHHS, providing empirical evidence during the pandemic era in South Korea. Practically, the results could suggest to the planners and strategists of home health care services how to promote SHHS in one's health management.


Subject(s)
COVID-19 , Home Care Services , Humans , COVID-19/epidemiology , Pandemics , Republic of Korea , Technology
5.
BMJ Open ; 12(10): e062927, 2022 10 11.
Article in English | MEDLINE | ID: covidwho-2064160

ABSTRACT

INTRODUCTION: Demographic change in Germany is accompanied by a birth rate deficit and increasing life expectancy. One effect of the ageing population is an increase in people needing care, most of whom want to grow old in their homes and to be cared for there. At the same time, informal caregivers are a core resource in the German care system, but due to social changes, this resource is not endless. Processes of social change in German society will cause further erosion in the potential number of informal local caregivers. Therefore, it will be increasingly important to provide conditions so that individuals at a distance who support people needing care are actually able to do so. Distance caregiving is a broad field, posing questions of intergenerational and intragenerational solidarity and the balance between work, family and caring responsibilities. Systematic research is required into opportunities and limitations, including innovative technology, in the whole field of care arrangements over a distance. The demands of the different actors in the distance caregiving arrangement are not yet known and are the subject of our study. METHODS AND ANALYSIS: This study will develop a model for distance caregiving. A qualitative multimethod research design (non-interventional study) will be adopted. The study will take place between September 2021 and August 2024. Participants will be selected by a purposeful sampling process. Phenomenological analysis will guide our data analysis. Data collected in this study will allow for triangulation, thereby increasing the trustworthiness of findings. ETHICS AND DISSEMINATION: Ethical approval for this study has been granted by the ethics committee of the Faculty of Medicine of the Charité, Universitätsmedizin Berlin (ID: EA1/371/21). Dissemination of the results will take place among the scientific community. Results will also be disseminated among the public and actors involved in healthcare and nursing care.


Subject(s)
Home Care Services , Caregivers , Germany , Humans , Life Expectancy , Qualitative Research
7.
PLoS One ; 17(9): e0274269, 2022.
Article in English | MEDLINE | ID: covidwho-2029785

ABSTRACT

INTRODUCTION: Accelerating rates of dementia worldwide coupled with older adults living longer in the community calls for greater focus on quality home care support services. Few frameworks for quality dementia home care exist though prior findings have found elements considered to be important for "good" home care for people living with dementia. This study aimed to identify core components of a quality home care experience for people with dementia and their caregivers. METHODS: As part of a larger research study, in-depth interviews were conducted with persons living with dementia and caregivers (n = 25) to explore hospital-to-home care transitions. The design used for this study was a qualitative description. We used deductive-inductive thematic analysis, which was informed by previous work in this area. Open codes were mapped to pre-determined themes, and for codes not accommodated by an a piori framework, new themes were developed. FINDINGS: Our findings resulted in 4 overarching themes. Two themes were identified deductively (Availability and Acceptability of Home Care Services) and two inductively (Adaptability and Affordability of Home Care Services). Findings highlight the roles of family-care provider partnerships and responsive support in receiving quality home care, and the cost associated with unmet needs. INTERPRETATION: With an aging population, an increase in home care client acuity, and post-COVID-19 concerns over long-term care, more attention is needed to improve the quality of home care. The demand for these services will continue to increase particularly for those living with dementia and their families. The findings of availability, acceptability, adaptability, and affordability as core to quality care can help lay the groundwork for a home care framework for persons living with dementia and their caregivers. Future research could benefit from comparative analyses to evaluate the applicability of the findings to non-dementia home care service users and caregivers.


Subject(s)
COVID-19 , Home Care Services , Aged , Caregivers , Humans , Qualitative Research , Quality of Health Care
9.
Int J Environ Res Public Health ; 19(18)2022 Sep 06.
Article in English | MEDLINE | ID: covidwho-2010069

ABSTRACT

Background: Care to Move (CTM) provides a series of consistent 'movement prompts' to embed into existing movements of daily living. We explored the feasibility of incorporating CTM approaches in home care settings. Methods: Feasibility study of the CTM approach in older adults receiving home care. Recruitment, retention and attrition (three time points), adherence, costs to deliver and data loss analyzed and differentiated pre and post the COVID-19 pandemic. Secondary outcomes, including functional status, physical activity, balance confidence, quality of life, cost to implement CTM. Results: Fifty-five home care clients (69.6% of eligible sample) participated. Twenty were unable to start due to COVID-19 disruptions and health issues, leaving 35 clients recruited, mostly women (85.7%), mean age 82.8 years. COVID-19 disruption impacted on the study, there was 60% retention to T2 assessments (8-weeks) and 13 of 35 (37.1%) completed T3 assessments (6-months). There were improvements with small to medium effect sizes in quality of life, physical function, balance confidence and self-efficacy. Managers were supportive of the roll-out of CTM. The implementation cost was estimated at EUR 280 per carer and annual running costs at EUR 75 per carer. Conclusion: Embedding CTM within home support services is acceptable and feasible. Data gathered can power a definitive trial.


Subject(s)
COVID-19 , Home Care Services , Aged , Aged, 80 and over , COVID-19/epidemiology , Delivery of Health Care , Feasibility Studies , Female , Functional Status , Humans , Male , Pandemics , Quality of Life
10.
JAMA Netw Open ; 5(8): e2229067, 2022 08 01.
Article in English | MEDLINE | ID: covidwho-2007076

ABSTRACT

Importance: Home hospital care is the substitutive provision of home-based acute care services usually associated with a traditional inpatient hospital. Many home hospital models require a physician to see patients at home daily, which may hinder scalability. Whether remote physician visits can safely substitute for most in-home visits is unknown. Objective: To compare remote and in-home physician care. Design, Setting, and Participants: This randomized clinical trial assessed 172 adult patients at an academic medical center and community hospital who required hospital-level care for select acute conditions, including infection, heart failure, chronic obstructive pulmonary disease, and asthma, between August 3, 2019, and March 26, 2020; follow-up ended April 26, 2020. Interventions: All patients received acute care at home, including in-home nurse or paramedic visits, intravenous medications, remote monitoring, and point-of-care testing. Patients were randomized to receive physician care remotely (initial in-home visit followed by daily video visit facilitated by the home hospital nurse) vs in-home care (daily in-home physician visit). In the remote care group, the physician could choose to see the patient at home beyond the first visit if it was felt to be medically necessary. Main Outcomes and Measures: The primary outcome was the number of adverse events, compared using multivariable Poisson regression at a noninferiority threshold of 10 events per 100 patients. Adverse events included a fall, pressure injury, and delirium. Secondary outcomes included the Picker Patient Experience Questionnaire 15 score (scale of 0-15, with 0 indicating worst patient experience and 15 indicating best patient experience) and 30-day readmission rates. Results: A total of 172 patients (84 receiving remote care and 88 receiving in-home physician care [control group]) were randomized; enrollment was terminated early because of COVID-19. The mean (SD) age was 69.3 (18.0) years, 97 patients (56.4%) were female, 77 (45.0%) were White, and 42 (24.4%) lived alone. Mean adjusted adverse event count was 6.8 per 100 patients for remote care patients vs 3.9 per 100 patients for control patients, for a difference of 2.8 (95% CI, -3.3 to 8.9), supporting noninferiority. For remote care vs control patients, the mean adjusted Picker Patient Experience Questionnaire 15 score difference was -0.22 (95% CI, -1.00 to 0.56), supporting noninferiority. The mean adjusted 30-day readmission absolute rate difference was 2.28% (95% CI, -3.23% to 7.79%), which was inconclusive. Of patients in the remote group, 16 (19.0%) required in-home visits beyond the first visit. Conclusions and Relevance: In this study, remote physician visits were noninferior to in-home physician visits during home hospital care for adverse events and patient experience, although in-home physician care was necessary to support many patients receiving remote care. Our findings may allow for a more efficient, scalable home hospital approach but require further research. Trial Registration: ClinicalTrials.gov Identifier: NCT04080570.


Subject(s)
COVID-19 , Home Care Services , Physicians , Adult , Aged , COVID-19/epidemiology , Female , Hospitals, Community , Humans , Male , Patient Readmission
11.
Adv Skin Wound Care ; 35(9): 499-508, 2022 Sep 01.
Article in English | MEDLINE | ID: covidwho-2001448

ABSTRACT

OBJECTIVE: To create a blended format model to navigate interprofessional team assessments of patients with complex wounds during COVID-19 as a quality improvement process. METHODS: During clinical assessments, patients were interviewed in their homes with representation from their circle of care and primary nurse on site linked to a live virtual interprofessional blended remote team model (wound care nurse specialist, advanced wound care doctor). Eligible patients had completed a wound care clinical pathway without wound closure. Palliative patients with complex wounds and patients without precise/accurate diagnoses were also included. This process addressed the components of Wound Bed Preparation 2021: manage the cause, address patient-centered concerns, determine the ability to heal, optimize local wound care, and evaluate outcomes on an ongoing basis. RESULTS: Since April 2020, 48 patients were referred to the Home and Community Care Support Services patient navigation interprofessional team. Patients' home-care services were initiated between 2012 and 2021. The team provided closure in 29% of patients and the wound surface area reduced in 66%. Pain was reduced in 73% of patients and appropriate infection management was implemented in 79%. In addition, nursing visits were reduced by 73% and there was a 77% decrease in supply usage. CONCLUSIONS: This project validated the Wound Bed Preparation Paradigm 2021 as a process for assessing patients with complex wounds using a blended virtual and home-based assessment. Patient navigation with this blended model benefited patients and improved healthcare system utilization with projected cost savings.


Subject(s)
COVID-19 , Home Care Services , Patient Navigation , Delivery of Health Care , Humans , Wound Healing
12.
Int J Environ Res Public Health ; 19(15)2022 07 30.
Article in English | MEDLINE | ID: covidwho-1994054

ABSTRACT

Population aging has increased the demand for elderly care worldwide. The home-based elderly care system plays an important role in meeting this demand in developing countries. The quality of home-based elderly care is associated with the job satisfaction of caregivers in home-based elderly care programs, which has rarely been studied. This paper explores the factors that affect the job satisfaction of these elderly caregivers, including personal characteristics, working conditions, employment status, training, caregiver-client relationships, welfare, work experience, and burnout. It utilizes data from the Shanghai Domestic-work Professionalization Survey (SDPS), which was conducted among four types of in-home caregivers (n = 1000) in Shanghai over the period from May to September 2021. This paper selected a sample of elderly caregivers (n = 285) to examine their job satisfaction. The results show that gender, age, marital status, how they earned the job, relation with clients, social insurance, and work experience are significantly associated with the job satisfaction of in-home elderly caregivers, and their job satisfaction is negatively associated with their burnout levels. However, training and working conditions have no significant effect on the job satisfaction of in-home elderly caregivers, which is different from previous studies on formal care workers, such as nurses, in the institutional care system.


Subject(s)
Burnout, Professional , Home Care Services , Aged , Caregivers , China , Humans , Job Satisfaction , Surveys and Questionnaires
13.
J Gen Intern Med ; 37(9): 2302-2305, 2022 07.
Article in English | MEDLINE | ID: covidwho-1971801
14.
Health Expect ; 25(4): 1508-1516, 2022 08.
Article in English | MEDLINE | ID: covidwho-1961575

ABSTRACT

BACKGROUND: Patients are increasingly expected to take an active role in their own care. Participation in nursing documentation can support patients to take this active role since it provides opportunities to express care needs and preferences. Yet, patient participation in electronic nursing documentation is not self-evident. OBJECTIVE: To explore how home-care patients perceive their participation in electronic nursing documentation. METHODS: Semi-structured interviews were conducted with 21 home-care patients. Interview transcripts were analysed in an iterative process based on the principles of reflexive inductive thematic analysis. RESULTS: We identified a typology with four patient types: 'high need, high ability', 'high need, low ability', 'low need, high ability' and 'low need, low ability'. Several patients felt a need for participation because of their personal interest in health information. Others did not feel such a need since they trusted nurses to document the information that is important. Patients' ability to participate increased when they could read the documentation and when nurses helped them by talking about the documentation. Barriers to patients' ability to participate were having no electronic devices or lacking digital skills, a lack of support from nurses and the poor usability of electronic patient portals. CONCLUSION: Patient participation in electronic nursing documentation varies between patients since home-care patients differ in their need and ability to participate. Nurses should tailor their encouragement of patient participation to individual patients' needs and abilities. Furthermore, they should be aware of their own role and help patients to participate in the documentation. PATIENT OR PUBLIC CONTRIBUTION: Home-care patients were involved in the interviews.


Subject(s)
Home Care Services , Patient Participation , Documentation , Humans , Qualitative Research
15.
BMJ Open ; 12(5): e059577, 2022 05 19.
Article in English | MEDLINE | ID: covidwho-1950177

ABSTRACT

OBJECTIVES: To investigate the experiential impact of the COVID-19 pandemic on patients with non-COVID, life-threatening disease and their family carers. DESIGN: An interpretative qualitative design informed by phenomenological hermeneutics and based on data from in-depth interviews, performed between June and September 2020. SETTING: Patients receiving specialised palliative home care and their family carers living in Sweden. PARTICIPANTS: 22 patients (male/female 11/11) and 17 carers (male/female 5/12) aged 50 years and older. All the patients received specialised palliative home care and most were diagnosed with cancer. INCLUSION CRITERIA: aged 18 years or older, diagnosed with an incurable life-threatening, non-COVID disease, sufficient strength to participate and capacity to provide informed consent. Participants were selected through a combination of convenient and consecutive sampling. RESULTS: The significance of the pandemic for both patients and carers showed a continuum from being minimally affected in comparison to the severe underlying disease to living in isolation with constant fear of becoming infected and falling ill with COVID-19, which some likened to torture.The imposed restrictions on social contact due to the pandemic were particularly palpable for this group of people with a non-COVID-19, life-limiting condition, as it was said to steal valuable moments of time that had already been measured.Most patients and carers found access to specialised palliative home care was maintained despite the pandemic. This care was of paramount importance for their sense of security and was often their sole visiting social contact. CONCLUSIONS: In the pandemic situation, highly accessible support from healthcare and social care at home is particularly important to create security for both patients and carers. Thus, to provide appropriate support, it is important for healthcare and social care personnel to be aware of the great diversity of reactions patients in palliative care and their carers may have to a pandemic threat.


Subject(s)
COVID-19 , Home Care Services , Aged , COVID-19/epidemiology , Caregivers , Female , Humans , Male , Middle Aged , Palliative Care , Pandemics , Qualitative Research , SARS-CoV-2
16.
PLoS One ; 17(5): e0268517, 2022.
Article in English | MEDLINE | ID: covidwho-1933274

ABSTRACT

This article proposes a novel dynamic objective function in a multi-period home health care (HHC) problem, known as the nurse-patient relationship (NPR). The nurse-patient relationship score indicating the trust a patient has for his or her care worker increases when the same people meet regularly and decreases when they are apart. Managing human resources in HHC is a combination of routing and scheduling problems. Due to computational complexity of the HHC problem, a 28-day home health care problem is decomposed into daily subproblems, and solved sequentially with the tabu search. The solutions are then combined to give a solution to the original problem. For problems with less complex constraints, the NPR model can also be solved using exact methods such as CPLEX. For larger scale instances, however, the numerical results show that the NPR model can only be solved in reasonable times using our proposed tabu search approach. The solutions obtained from the NPR models are compared against those from existing models in the literature such as preference and continuity of care. Essentially, the analysis revealed that the proposed NPR models encouraged the search algorithm to assign the same care worker to visit the same patient. In addition, it had a tendency to assign a care worker on consecutive days to each patient, which is one of the key factors in promoting trust between patients and care workers. This leads to the efficacy of monitoring patient's disease progression and treatment.


Subject(s)
Home Care Services , Algorithms , Humans , Nurse-Patient Relations
17.
Transplant Proc ; 54(5): 1324-1328, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1931143

ABSTRACT

BACKGROUND: The aim of this study was to identify home care management strategies for patients undergoing liver transplant, through teleconsultation, during the COVID-19 pandemic for maintenance and improvements in treatment adherence. METHODS: This was a qualitative, exploratory, and descriptive research study. Participants included patients who underwent liver transplant between 2020 and 2021. Through a semistructured script, data were analyzed according to the recommendations of content analysis and then simple statistics were applied. RESULTS: Twenty-two people participated in the study. Two analysis categories were developed, which resulted in 7 strategies and 22 care actions. The care strategy with the highest adherence involved actions related to the prevention of COVID-19. CONCLUSIONS: Teleconsultation is an excellent tool to manage and supervise post-liver transplant care of patients. Considering that teleconsultation has presented strategies and care actions, which were developed by the patients, the patients have a direct effect on treatment adherence despite pandemic impositions.


Subject(s)
COVID-19 , Home Care Services , Liver Transplantation , Remote Consultation , Humans , Pandemics/prevention & control , Remote Consultation/methods
18.
Int J Risk Saf Med ; 33(3): 249-259, 2022.
Article in English | MEDLINE | ID: covidwho-1924016

ABSTRACT

BACKGROUND: The pandemic that began around February 2020, caused by the viral pathogen SARS-CoV-2 (COVID-19), has still not completed its course at present in June 2022. OBJECTIVE: The open research to date highlights just how varied and complex the outcome of the contagion can be. METHOD: The clinical pictures observed following the contagion present variabilities that cannot be explained completely by the patient's age (which, with the new variants, is rapidly changing, increasingly affecting younger patients) nor by symptoms and concomitant pathologies (which are no longer proving to be decisive in recent cases) in relation to medium-to-long term sequelae. In particular, the functions of the vascular endothelium and vascular lesions at the pre-capillary level represent the source of tissue hypoxia and other damage, resulting in the clinical evolution of COVID-19. RESULTS: Keeping the patient at home with targeted therapeutic support, aimed at not worsening vascular endothelium damage with early and appropriate stimulation of endothelial cells, ameliorates the glycocalyx function and improves the prognosis and, in some circumstances, could be the best practice suitable for certain patients. CONCLUSION: Clinical information thus far collected may be of immense value in developing a better understanding of the present pandemic and future occurrences regarding patient safety, pharmaceutical care and therapy liability.


Subject(s)
COVID-19 , Home Care Services , Endothelial Cells , Humans , Pandemics , SARS-CoV-2
20.
J Paediatr Child Health ; 58(6): 969-977, 2022 06.
Article in English | MEDLINE | ID: covidwho-1916209

ABSTRACT

AIM: Procedures normally performed in the hospital setting are increasingly delivered as part of hospital at home (HAH) programmes. The aim of this study is to describe the procedures and diseases treated during the first 2 years of a new paediatric HAH programme. METHODS: This is a retrospective, observational study conducted in the HAH programme of Niño Jesús Children's Hospital (Spain). We included demographic data, diagnosis and procedures delivered to patients admitted to the HAH programme from November 2018 to November 2020. RESULTS: There were 935 admissions of 833 patients. The median age was 5 years (interquartile range 2.3-9.5). Seventy-five percent of patients were previously healthy. The most frequent illnesses were acute infections (37%) (e.g. complicated appendicitis and ENT, genitourinary, skin and soft tissue infections) and acute respiratory diseases (17.3%) (e.g. asthma, bronchiolitis and pneumonia). Thirty-six percent of admissions underwent nocturnal polysomnography. The median length of stay was 4 days (SD 4.9 days). Eight percent of the episodes studied required care in the emergency department due to condition worsening (55.3%) and problems with devices (36.1%). Hospital readmission was required in 5.6% of cases, 42.4% of which later resumed care in the HAH. The estimated daily cost of HAH is 330.65 euros, while the hospital per-day costs of polysomnography, asthma and endovenous therapy are 1899.24, 1402.5, and 976.26 euros. Ninety percent of families reported a high level of satisfaction. CONCLUSIONS: Paediatric HAH programmes are a feasible, cost-effective alternative to hospital care. Further studies should compare the evolution of patients treated in the traditional hospital setting and those in HAH.


Subject(s)
Asthma , Home Care Services , Acute Disease , Child , Child, Preschool , Follow-Up Studies , Hospitals , Humans
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