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1.
Prof Case Manag ; 29(4): 137-138, 2024.
Article in English | MEDLINE | ID: mdl-38780459

ABSTRACT

The Centers for Medicare & Medicaid Services' (CMS) Acute Hospital Care at Home (AHCAH) waiver, which launched in November 2020, has prompted hundreds of hospitals across the country to initiate programs that allow certain patients to complete their acute care stays in the familiar comfort of their homes. But this waiver is about to expire in December 2024. It is a success; but can we continue it?


Subject(s)
Centers for Medicare and Medicaid Services, U.S. , United States , Humans , Female , Male , Home Care Services/standards , Home Care Services/organization & administration , Home Care Services/trends , Aged , Middle Aged , Aged, 80 and over , Adult
2.
BMC Geriatr ; 24(1): 389, 2024 May 01.
Article in English | MEDLINE | ID: mdl-38693502

ABSTRACT

BACKGROUND: To evaluate the effectiveness of delivering feedback reports to increase completion of LST notes among VA Home Based Primary Care (HBPC) teams. The Life Sustaining Treatment Decisions Initiative (LSTDI) was implemented throughout the Veterans Health Administration (VHA) in the United States in 2017 to ensure that seriously ill Veterans have care goals and LST decisions elicited and documented. METHODS: We distributed monthly feedback reports summarizing LST template completion rates to 13 HBPC intervention sites between October 2018 and February 2020 as the sole implementation strategy. We used principal component analyses to match intervention to 26 comparison sites and used interrupted time series/segmented regression analyses to evaluate the differences in LST template completion rates between intervention and comparison sites. Data were extracted from national databases for VA HBPC in addition to interviews and surveys in a mixed methods process evaluation. RESULTS: LST template completion rose from 6.3 to 41.9% across both intervention and comparison HBPC teams between March 1, 2018, and February 26, 2020. There were no statistically significant differences for intervention sites that received feedback reports. CONCLUSIONS: Feedback reports did not increase documentation of LST preferences for Veterans at intervention compared with comparison sites. Observed increases in completion rates across intervention and comparison sites can likely be attributed to implementation strategies used nationally as part of the national roll-out of the LSTDI. Our results suggest that feedback reports alone were not an effective implementation strategy to augment national implementation strategies in HBPC teams.


Subject(s)
Home Care Services , Primary Health Care , United States Department of Veterans Affairs , Veterans , Humans , Primary Health Care/methods , Primary Health Care/standards , United States , Veterans/psychology , Home Care Services/standards , Male , Female , Aged , Feedback , Documentation/methods , Documentation/standards , Patient Preference
3.
BMC Palliat Care ; 23(1): 115, 2024 May 02.
Article in English | MEDLINE | ID: mdl-38698397

ABSTRACT

BACKGROUND: Motor Neurone Disease (MND) leads to muscle weakening, affecting movement, speech, and breathing. Home mechanical ventilation, particularly non-invasive ventilation (NIV), is used to alleviate symptoms and support breathing in people living with MND. While home mechanical ventilation can alleviate symptoms and improve survival, it does not slow the progression of MND. This study addresses gaps in understanding end-of-life decision-making in those dependent on home mechanical ventilation, considering the perspectives of patients, family members, and bereaved families. METHODS: A UK-wide qualitative study using flexible interviews to explore the experiences of people living with MND (n = 16), their family members (n = 10), and bereaved family members (n = 36) about the use of home mechanical ventilation at the end of life. RESULTS: Some participants expressed a reluctance to discuss end-of-life decisions, often framed as a desire to "live for the day" due to the considerable uncertainty faced by those with MND. Participants who avoided end-of-life discussions often engaged in 'selective decision-making' related to personal planning, involving practical and emotional preparations. Many faced challenges in hypothesising about future decisions given the unpredictability of the disease, opting to make 'timely decisions' as and when needed. For those who became dependent on ventilation and did not want to discuss end of life, decisions were often 'defaulted' to others, especially once capacity was lost. 'Proactive decisions', including advance care planning and withdrawal of treatment, were found to empower some patients, providing a sense of control over the timing of their death. A significant proportion lacked a clear understanding of the dying process and available options. CONCLUSIONS: The study highlights the complexity and evolution of decision-making, often influenced by the dynamic and uncertain nature of MND. The study emphasises the need for a nuanced understanding of decision-making in the context of MND.


Subject(s)
Decision Making , Family , Motor Neuron Disease , Qualitative Research , Respiration, Artificial , Terminal Care , Humans , Motor Neuron Disease/psychology , Motor Neuron Disease/therapy , Motor Neuron Disease/complications , Male , Female , Middle Aged , Respiration, Artificial/methods , Respiration, Artificial/psychology , Aged , Terminal Care/methods , Terminal Care/psychology , Family/psychology , United Kingdom , Adult , Aged, 80 and over , Home Care Services/standards
4.
BMC Palliat Care ; 23(1): 137, 2024 May 29.
Article in English | MEDLINE | ID: mdl-38811957

ABSTRACT

BACKGROUND: In the context of pediatric palliative care, where the quality of life of children with life-limiting or life-threatening conditions is of utmost importance, the integration of health technology must support the provision of care. Research has highlighted the role of healthcare personnel when utilizing health technology in home-based pediatric palliative care, but specific knowledge of healthcare personnel's views on the technological relevance remains limited. Therefore, our study has explored potentials and limitations of health technology in home-based pediatric palliative care from the perspectives of healthcare personnel. METHODS: Our study utilized a qualitative, descriptive, and exploratory design, including five focus groups with a total of 22 healthcare personnel. The participants were selected from various health regions in Norway and were experienced in providing home-based pediatric palliative care. Using reflexive thematic analysis, we interpreted data obtained from focus groups, identified patterns, and developed themes. RESULTS: The analysis resulted in the development of three intersecting themes: balancing in-person interaction and time in home-based pediatric palliative care; exchange of information can improve timely and appropriate care; and the power of visual documentation in pediatric palliative care. The healthcare personnel acknowledged difficulties in fully replacing in-person interaction with health technology. However, they also emphasized potentials of health technology to facilitate information sharing and the ability to access a child's health record within interdisciplinary teams. CONCLUSION: The results underscored that technology can support pediatric palliative care but must be thoughtfully integrated to ensure an individualized patient-centered approach. To maximize the benefits of health technology in enhancing home-based pediatric palliative care, future research should address the limitations of current health technology and consider the opinions for information sharing between relevant healthcare team members, the child, and their family.


Subject(s)
Focus Groups , Health Personnel , Home Care Services , Palliative Care , Qualitative Research , Humans , Palliative Care/methods , Palliative Care/standards , Norway , Focus Groups/methods , Home Care Services/trends , Home Care Services/standards , Health Personnel/psychology , Female , Male , Pediatrics/methods , Pediatrics/standards , Adult , Biomedical Technology/methods , Biomedical Technology/trends , Attitude of Health Personnel , Middle Aged
5.
BMC Palliat Care ; 23(1): 129, 2024 May 22.
Article in English | MEDLINE | ID: mdl-38778303

ABSTRACT

OBJECTIVES: To better understand the type of care offered to Italian patients with advanced breast cancer at the End-of-Life (EoL), we conducted a retrospective observational study. EoL was defined as the period of six months before death. METHODS: One hundred and twenty-one patients with advanced breast cancer (ABC) treated at IRCCS San Martino Policlinic Hospital who died between 2017 and 2021 were included. Data about patient, disease, and treatment characteristics from breast cancer diagnosis to death, along with information about comorbidities, medications, imaging, specialist evaluations, hospitalization, palliative care and home care, hospice admissions, and site of death were collected. RESULTS: 98.3% of the patients received at least one line of active treatment at EoL; 52.8% were hospitalized during the selected period. Palliative (13.9%), psychological (7.4%), and nutritional evaluations (8.2%) were underutilized. Palliative home care was provided to 52% of the patients. Most of the patients died at home (66.1%) and fewer than one out of five (18.2%) died at the hospital. Among the patients who died at home, 27.3% had no palliative support. CONCLUSIONS: Our findings indicate that palliative care in EoL breast cancer patients is still inadequate. Only a minority of patients had psychological and nutritional support While low nutritional support may be explained by the fact that typical symptoms of ABC do not involve the gastrointestinal tract, the lack of psychological support suggests that significant barriers still exist. Data on the site of death are encouraging, indicating that EoL management is increasingly home centered in Italy.


Subject(s)
Breast Neoplasms , Palliative Care , Terminal Care , Humans , Retrospective Studies , Female , Italy , Breast Neoplasms/therapy , Breast Neoplasms/psychology , Breast Neoplasms/mortality , Middle Aged , Aged , Terminal Care/methods , Terminal Care/statistics & numerical data , Terminal Care/standards , Aged, 80 and over , Palliative Care/methods , Palliative Care/statistics & numerical data , Adult , Home Care Services/statistics & numerical data , Home Care Services/standards
6.
BMC Health Serv Res ; 24(1): 657, 2024 May 22.
Article in English | MEDLINE | ID: mdl-38778319

ABSTRACT

BACKGROUND: Infection prevention and control (IPC) research has long neglected the home healthcare sector with its unique challenges. This study aimed to gain an understanding of the barriers to the implementation of infection prevention practices relevant to this setting, the related attitudes, perceived relevance and priorities from the home healthcare worker perspective in Switzerland. METHODS: The mixed-method study involved semi-structured interviews (n = 18) and an anonymous web-based survey (n = 144) among nursing assistants and nurses from two home healthcare organizations in northwest Switzerland. Questions in both sub-studies focused on perceived challenges to infection prevention practices, perceived relevance, and related attitudes and mitigation strategies. Using an exploratory-sequential design, survey questions were designed to quantify and complement the findings from the interview study. RESULTS: Healthcare workers in these two organisations felt adequately protected, trained and supported by their organisations regarding IPC (survey agreement rates > 90%). General challenges to IPC in the home environment most agreed on were lack of cleanliness, lack of space, and the priorities of the patient to be respected (survey agreement rates 85.4%, 77.1%, and 70.8%, respectively). Practices and perceived challenges in the case of colonisation with multi-drug resistant organisms (MDRO) and potentially infectious diarrheal or respiratory illnesses varied highly regarding information transfer, use of protective equipment, and use and disinfection practices of multi-use equipment. Challenges to hand hygiene, sharps safety, waste management and decontamination of equipment did not feature as a prominent concern. CONCLUSIONS: This study is the first to characterise the implementation of infection prevention practices and the related challenges in home healthcare in Switzerland. Home healthcare workers describe various challenges related to infection prevention practices as largely manageable in their work routine, and generally show satisfaction with the support provided by their organisations regarding IPC precautions. Key findings regarding challenges amenable to interventions include uncertainty and inconsistency regarding the management of MDRO colonisation and acute illnesses, and gaps in information transfer. Those challenges may benefit from both organisational interventions and further research into the level of precautions that are appropriate to the home healthcare setting.


Subject(s)
Home Care Services , Infection Control , Humans , Switzerland , Infection Control/methods , Infection Control/standards , Home Care Services/standards , Home Care Services/organization & administration , Female , Male , Attitude of Health Personnel , Interviews as Topic , Adult , Middle Aged , Surveys and Questionnaires , Qualitative Research
7.
BMJ Open Qual ; 13(2)2024 May 27.
Article in English | MEDLINE | ID: mdl-38802269

ABSTRACT

BACKGROUND: The diffusion of innovation in healthcare is sluggish. Evidence-based care models and interventions take years to reach patients. We believe the healthcare community could deliver innovation to the bedside faster if it followed other sectors by employing an organisational framework for efficiently accomplishing work. Home hospital is an example of sluggish diffusion. This model provides hospital-level care in a patient's home instead of in a traditional hospital with equal or better outcomes. Home hospital uptake has steadily grown during the COVID-19 pandemic, yet barriers to launch remain for healthcare organisations, including access to expertise and implementation tools. The Home Hospital Early Adopters Accelerator was created to bring together a network of healthcare organisations to develop tools necessary for programme implementation. METHODS: The accelerator used the Agile framework known as Scrum to rapidly coordinate work across many different specialised skill sets and blend individuals who had no experience with one another into efficient teams. Its goal was to take 40 weeks to develop 20 'knowledge products',or tools critical to the development of a home hospital programme such as workflows, inclusion criteria and protocols. We conducted a mixed-methods evaluation of the accelerator's implementation, measuring teams' productivity and experience. RESULTS: 18 healthcare organisations participated in the accelerator to produce the expected 20 knowledge products in only 32 working weeks, a 20% reduction in time. Nearly all (97.4%) participants agreed or strongly agreed the Scrum teams worked well together, and 96.8% felt the teams produced a high-quality product. Participants consistently remarked that the Scrum team developed products much faster than their respective organisational teams. The accelerator was not a panacea: it was challenging for some participants to become familiar with the Scrum framework and some participants struggled with balancing participation in the Accelerator with their job duties. CONCLUSIONS: Implementation of an Agile-based accelerator that joined disparate healthcare organisations into teams equipped to create knowledge products for home hospitals proved both efficient and effective. We demonstrate that implementing an organisational framework to accomplish work is a valuable approach that may be transformative for the sector.


Subject(s)
COVID-19 , Humans , SARS-CoV-2 , Diffusion of Innovation , Pandemics , Home Care Services/standards , Home Care Services, Hospital-Based/organization & administration
8.
BMJ Open Qual ; 13(2)2024 May 30.
Article in English | MEDLINE | ID: mdl-38816007

ABSTRACT

Previous work found referrals for end-of-life care are made late in the dying process and assessment processes for care funding, through continuing healthcare fast-track funding often inhibit people being able to die at home. The average time to discharge was 6.3 days and 29% died in hospital, as median survival was only 15 days.We aimed to support discharge to home within 1 day by December 2023 for patients, wishing to die at home, referred to the end-of-life discharge team in a medium-sized district general hospital in Southwest England.In phase 1, we identified 13 people on a patient-by-patient basis, learning from obstacles. Barriers identified included sourcing of equipment, communication between teams and clunky paperwork. Median time to discharge was 2 days (range within 24 hours to 8 days) with 2/13 (15.4%) dying prior to discharge. In phase 2, we extended the pilot, and 104 patients were identified; 94 people were discharged to home, with a median of wait of 1 day (range 0-7) to discharge, and 10 (9.6%) died prior to discharge (median 1 day; range 0-4). Median survival from discharge for the 94 who achieved their wishes to go home to die was 9 days (range 1-205 days). Only 26/94 (27.7%) people survived more than 30 days.Rapid decision-making and structures to support home-based end-of-life care can support more people to die in their preferred place of care, by using a community-based rapid response team instead of, or in parallel with continuing healthcare fast-track funding referral applications. Current pathways and funding models are not fit for purpose in an urgent care scenario when we have only one chance to get it right.


Subject(s)
Home Care Services , Quality Improvement , Terminal Care , Humans , Terminal Care/methods , Terminal Care/statistics & numerical data , Terminal Care/standards , Home Care Services/statistics & numerical data , Home Care Services/standards , Female , England , Male , Aged , Aged, 80 and over , Middle Aged , Patient Discharge/statistics & numerical data , Patient Discharge/standards
9.
Health Qual Life Outcomes ; 22(1): 40, 2024 May 30.
Article in English | MEDLINE | ID: mdl-38816717

ABSTRACT

PURPOSE: The Quality of Life-Aged Care Consumers (QOL-ACC), a valid preference-based instrument, has been rolled out in Australia as part of the National Quality Indicator (QI) program since April 2023 to monitor and benchmark the quality of life of aged care recipients. As the QOL-ACC is being used to collect quality of life data longitudinally as one of the key aged care QI indicators, it is imperative to establish the reliability of the QOL-ACC in aged care settings. Therefore, we aimed to assess the reliability of the QOL-ACC and compare its performance with the EQ-5D-5L. METHODS: Home care recipients completed a survey including the QOL-ACC, EQ-5D-5L and two global items for health and quality of life at baseline (T1) and 2 weeks later (T2). Using T1 and T2 data, the Gwet's AC2 and intra-class correlation coefficient (ICC) were estimated for the dimension levels and overall scores agreements respectively. The standard error of measurement (SEM) and the smallest detectable change (SDC) were also calculated. Sensitivity analyses were conducted for respondents who did not change their response to global item of quality of life and health between T1 and T2. RESULTS: Of the 83 respondents who completed T1 and T2 surveys, 78 respondents (mean ± SD age, 73.6 ± 5.3 years; 56.4% females) reported either no or one level change in their health and/or quality of life between T1 and T2. Gwet's AC2 ranged from 0.46 to 0.63 for the QOL-ACC dimensions which were comparable to the EQ-5D-5L dimensions (Gwet's AC2 ranged from 0.52 to 0.77). The ICC for the QOL-ACC (0.85; 95% CI, 0.77-0.90) was comparable to the EQ-5D-5L (0.83; 95% CI, 0.74-0.88). The SEM for the QOL-ACC (0.08) was slightly smaller than for the EQ-5D-5L (0.11). The SDC for the QOL-ACC and the EQ-5D-5L for individual subjects were 0.22 and 0.30 respectively. Sensitivity analyses stratified by quality of life and health status confirmed the base case results. CONCLUSIONS: The QOL-ACC demonstrated a good test-retest reliability similar to the EQ-5D-5L, supporting its repeated use in aged care settings. Further studies will provide evidence of responsiveness of the QOL-ACC to aged care-specific interventions in aged care settings.


Subject(s)
Home Care Services , Quality of Life , Humans , Quality of Life/psychology , Female , Male , Aged , Reproducibility of Results , Australia , Surveys and Questionnaires , Aged, 80 and over , Home Care Services/standards , Psychometrics/instrumentation
10.
Afr J Prim Health Care Fam Med ; 16(1): e1-e9, 2024 May 06.
Article in English | MEDLINE | ID: mdl-38708728

ABSTRACT

BACKGROUND:  Stroke patients who are discharged from hospital because of limited access to rehabilitation facilities are cared for by lay caregivers who at times have limited knowledge of infection prevention and control (IPC). User-friendly educational interventions can help bridge this knowledge gap and enhance safe care of these persons. AIM:  To describe the development and validation of educational interventions for home-based stroke patients. The validation process enhanced the reliability and validity of the job aid resulting in standardised quality patient care of stroke patients. SETTING:  Mutasa district, Manicaland province, Zimbabwe. METHODS:  The systematic six steps in quality intervention development guided the development of the job aid. Graphic designers assisted with development of diagrams and annotations. A purposively selected eight-member panel of IPC expert reviewers was invited to validate the job aid using a standardised validation tool. RESULTS:  The panel agreed that the job aid's title, target group and media of instruction were adequately explained, and the background could be easily understood during practice. The content was approved with some modifications on the description of instructions to caregivers. Seven reviewers agreed that the materials used ensured understandability, acceptability, practicability and usability of the educational interventions by caregivers, and one reviewer was neutral in commenting effectiveness of the job aid. CONCLUSION:  The developed job aid addressed knowledge barriers in IPC for caregivers, and the reviewers confirmed that the developed job aid was adequate for effective use by lay home-based caregivers.Contribution: Utilisation of this intervention standardises patient care practices.


Subject(s)
Caregivers , Home Care Services , Stroke , Humans , Zimbabwe , Home Care Services/standards , Reproducibility of Results , Infection Control/methods , Health Knowledge, Attitudes, Practice , Female , Male
11.
BMC Med Res Methodol ; 24(1): 98, 2024 Apr 27.
Article in English | MEDLINE | ID: mdl-38678174

ABSTRACT

BACKGROUND: Language barriers can impact health care and outcomes. Valid and reliable language data is central to studying health inequalities in linguistic minorities. In Canada, language variables are available in administrative health databases; however, the validity of these variables has not been studied. This study assessed concordance between language variables from administrative health databases and language variables from the Canadian Community Health Survey (CCHS) to identify Francophones in Ontario. METHODS: An Ontario combined sample of CCHS cycles from 2000 to 2012 (from participants who consented to link their data) was individually linked to three administrative databases (home care, long-term care [LTC], and mental health admissions). In total, 27,111 respondents had at least one encounter in one of the three databases. Language spoken at home (LOSH) and first official language spoken (FOLS) from CCHS were used as reference standards to assess their concordance with the language variables in administrative health databases, using the Cohen kappa, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV). RESULTS: Language variables from home care and LTC databases had the highest agreement with LOSH (kappa = 0.76 [95%CI, 0.735-0.793] and 0.75 [95%CI, 0.70-0.80], respectively) and FOLS (kappa = 0.66 for both). Sensitivity was higher with LOSH as the reference standard (75.5% [95%CI, 71.6-79.0] and 74.2% [95%CI, 67.3-80.1] for home care and LTC, respectively). With FOLS as the reference standard, the language variables in both data sources had modest sensitivity (53.1% [95%CI, 49.8-56.4] and 54.1% [95%CI, 48.3-59.7] in home care and LTC, respectively) but very high specificity (99.8% [95%CI, 99.7-99.9] and 99.6% [95%CI, 99.4-99.8]) and predictive values. The language variable from mental health admissions had poor agreement with all language variables in the CCHS. CONCLUSIONS: Language variables in home care and LTC health databases were most consistent with the language often spoken at home. Studies using language variables from administrative data can use the sensitivity and specificity reported from this study to gauge the level of mis-ascertainment error and the resulting bias.


Subject(s)
Language , Humans , Ontario , Female , Male , Middle Aged , Databases, Factual/statistics & numerical data , Adult , Aged , Communication Barriers , Health Surveys/statistics & numerical data , Health Surveys/methods , Long-Term Care/statistics & numerical data , Long-Term Care/standards , Long-Term Care/methods , Home Care Services/statistics & numerical data , Home Care Services/standards , Reproducibility of Results
12.
J Nurs Adm ; 54(5): 278-285, 2024 May 01.
Article in English | MEDLINE | ID: mdl-38648361

ABSTRACT

BACKGROUND: The relationship between the practice environment, empowerment, and outcomes such as quality of care, job satisfaction, and intent to stay has been extensively studied in healthcare settings, including hospitals and long-term care facilities. Research consistently demonstrates that a positive practice environment, characterized by supportive leadership, adequate resources, and opportunities for professional growth, are associated with better quality of care, increased job satisfaction, and higher intent to stay among healthcare professionals. Limited knowledge exists regarding the specific relationship between the practice environment, empowerment, and these outcomes within home care organizations. OBJECTIVE: This study assesses the impact of strategies on nurse practice environment, social capital, decision latitude, workload, care quality, job satisfaction, and retention in a Belgian home healthcare organization. METHODS: A longitudinal survey was conducted in a home healthcare organization, with data collected at 3 time points: baseline (T1) (2015), T2 (2018), and T3 (2021). RESULTS: In T3, respondents reported significantly higher scores for departmental and general management compared with T1. The interventions led to significant improvements in social capital and decision latitude. Self-reported quality of care at the department level showed a significant increase, whereas no significant change was observed for quality of care during the last round. CONCLUSION: The implementation of strategies and interventions as part of a broader healthcare transformation process had a positive impact. Improvements were observed in nurse-reported quality of care, job satisfaction, and intent to stay in nursing. These findings emphasize the effectiveness of the implemented measures in enhancing nursing practice and creating a positive work environment. Continuous efforts to implement and evaluate such strategies are essential for enhancing the satisfaction and retention of nursing teams within healthcare organizations.


Subject(s)
Job Satisfaction , Quality of Health Care , Humans , Longitudinal Studies , Belgium , Female , Male , Home Care Services/standards , Adult , Middle Aged , Surveys and Questionnaires , Leadership
14.
Rev Bras Enferm ; 77(1): e20230080, 2024.
Article in English, Portuguese | MEDLINE | ID: mdl-38655978

ABSTRACT

OBJECTIVES: to identify mothers' perceptions about caring for newborns in the home environment, from the perspective of complexity thinking. METHODS: qualitative, exploratory and descriptive research, carried out between November/2022 and February/2023. Data were collected through individual interviews with 21 mothers from southern Brazil who cared for newborns at home and analyzed using the thematic analysis technique. RESULTS: the four thematic axes resulting from the data analysis: Living amidst order and disorder; embracing singularities; dealing with the certain and the uncertain; support network in the (re)organizing process demonstrate that the mother caring for a newborn in their home environment experiences a distinct and plural adaptive process, which must be welcomed and understood by health professionals who work within the family environment. FINAL CONSIDERATIONS: the care of newborns in a home environment, in the perception of mothers, requires differentiated attention and a formal or informal support network that considers the unique specificities of each woman/mother in the personal, family and social spheres. Therefore, in addition to the social support network, it is important to rethink home intervention approaches.


Subject(s)
Mothers , Perception , Qualitative Research , Humans , Mothers/psychology , Female , Brazil , Infant, Newborn , Adult , Social Support , Infant Care/methods , Infant Care/psychology , Infant Care/standards , Home Care Services/standards , Home Care Services/trends
15.
Rev Med Interne ; 45(4): 226-238, 2024 Apr.
Article in French | MEDLINE | ID: mdl-38632029

ABSTRACT

Patients hospitalised with acute venous thromboembolism (VTE), and notably patients with pulmonary embolism, often remain in hospital for extended periods due to the perceived risk of complications. However, several studies have shown that home treatment of selected patients is feasible and safe, with a low incidence of adverse events. This may offer clear benefits for patients' quality of life, hospital planning and cost to the health service. Nonetheless, there is a need for a VTE risk-stratification tool specifically addressing prognosis in patients with cancer. This may aid in the selection of low-risk patients with cancer and VTE who are suitable for outpatient treatment. Although several prognostic scores have been proposed, we suggest using a pragmatic clinical decision-making tool such as the Hestia criteria for selecting patients for home care in everyday clinical practice. Once patients have been discharged, it is mandatory to monitor patients regularly (we suggest after 3 days, 10 days, 1 month and 3 months, or more frequently if needed) with the involvement of a multidisciplinary team, so that appropriate and timely remedial action can be taken in case of warning signs of complications. If patients are selected carefully and monitored effectively, many patients who experience acute VTE can be cared for safely at home.


Subject(s)
Home Care Services , Neoplasms , Venous Thromboembolism , Humans , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology , Venous Thromboembolism/therapy , Venous Thromboembolism/diagnosis , Neoplasms/complications , Neoplasms/therapy , Neoplasms/epidemiology , Home Care Services/standards , Home Care Services/organization & administration , France/epidemiology , Quality of Life , Prognosis
16.
Asian Pac J Cancer Prev ; 25(4): 1189-1193, 2024 Apr 01.
Article in English | MEDLINE | ID: mdl-38679977

ABSTRACT

OBJECTIVE: This study aimed to identify nursing outcomes and quality indicators for older adults with end-stage cancer receiving home health care. METHODS: Nineteen experts and professional caregivers, including palliative doctors, nursing faculty, advanced practice nurses, and registered nurses, participated in the Delphi technique. Final medians and interquartile ranges were calculated. RESULT: Seven components with 43 nursing outcomes and quality indicators for older adults with end-stage cancer were developed, encompassing physical pain relief, symptom management, physical well-being, complication prevention, psychosocial support, caregiver and family roles in end-of-life care, and advance care planning. CONCLUSION: The caregiver and family's role in end-of-life care had the most indicators, reflecting the significance of family involvement in Thailand's cultural context. Consistent implementation of these indicators is crucial, and correlational analysis of indicator scores can enhance their validity.


Subject(s)
Delphi Technique , Home Care Services , Neoplasms , Quality Indicators, Health Care , Humans , Neoplasms/nursing , Neoplasms/therapy , Female , Male , Home Care Services/standards , Aged , Thailand , Terminal Care/standards , Middle Aged , Caregivers/psychology , Prognosis , Palliative Care , Adult , Follow-Up Studies , Quality of Life
17.
BMC Palliat Care ; 23(1): 108, 2024 Apr 26.
Article in English | MEDLINE | ID: mdl-38671427

ABSTRACT

BACKGROUND: Medications are commonly used for symptom control in cancer patients at the end of life. This study aimed to evaluate medication utilization among home care palliative patients with cancer at the end of life and assess the appropriateness of these medications. METHOD: This retrospective observational study included adult cancer patients who received home care in 2020. Medications taken during the last month of the patient's life were reviewed and classified into three major categories: potentially avoidable, defined as medications that usually have no place at the end of life because the time to benefit is shorter than life expectancy; medications of uncertain appropriateness, defined as medications that need case-by-case evaluation because they could have a role at the end of life; and potentially appropriate, defined as medications that provide symptomatic relief. RESULTS: In our study, we enrolled 353 patients, and 2707 medications were analyzed for appropriateness. Among those, 1712 (63.2%) were classified as potentially appropriate, 755 (27.9%) as potentially avoidable, and 240 (8.9%) as medications with uncertain appropriateness. The most common potentially avoidable medications were medications for peptic ulcers and gastroesophageal reflux disease (30.5%), vitamins (14.6%), beta-blockers (9.8%), anticoagulants (7.9%), oral antidiabetics (5.4%) and insulin products (5.3%). Among the potentially appropriate medications, opioid analgesics were the most frequently utilized medications (19.5%), followed by laxatives (19%), nonopioid analgesics (14.4%), gamma-aminobutyric acid analog analgesics (7.7%) and systemic corticosteroids (6%). CONCLUSION: In home care cancer patients, approximately one-third of prescribed medications were considered potentially avoidable. Future measures to optimize medication use in this patient population are essential.


Subject(s)
Home Care Services , Neoplasms , Humans , Retrospective Studies , Male , Female , Neoplasms/drug therapy , Neoplasms/complications , Aged , Middle Aged , Home Care Services/standards , Home Care Services/statistics & numerical data , Aged, 80 and over , Terminal Care/methods , Terminal Care/standards , Terminal Care/statistics & numerical data , Adult
18.
J Tissue Viability ; 33(2): 152-159, 2024 May.
Article in English | MEDLINE | ID: mdl-38326162

ABSTRACT

BACKGROUND: Recent trends indicate a rise in the number of elderly and bedridden patients enrolled in home care programs, leading to an increased occurrence of complications such as pressure ulcers within the home health care setting. OBJECTIVE: The primary objective of this research was to ascertain the prevalence of pressure ulcers and identify the associated factors in adults who were recipients of home health care services. METHOD: This study, adopting a cross-sectional design, encompassed a sample of 566 patients who sought services from the Home Health Care Unit in a specific province in Turkey. The timeframe for data collection spanned from August to November 2022, during which two primary instruments were employed: the "Demographic Characteristics Form" and two specific scales - the "Braden Pressure Ulcer Risk Assessment Scale" and the "ITAKI Falls Risk Scale." FINDINGS: In this study, the average age of patients receiving home health care services was identified as 75.9 years, with a standard deviation of 15.1 years. Furthermore, 73.7 % of these patients were classified as being at risk for developing pressure ulcers. The study identified a direct correlation between the risk of BRADEN pressure ulcers and the escalation in scores across several parameters. These parameters included "Addiction Status," delineated as a spectrum from addicted to non-addicted, the "Number of Medical Diagnoses," quantified on a scale, the "State of Consciousness," categorized from clear to confused, and the scores derived from the "ITAKI" scale. CONCLUSION: The findings of this study highlight the significance of pressure ulcers as a critical health issue among patients receiving home care services. It underscores the necessity for home care nurses to be acutely aware of the risk factors associated with pressure ulcers among high-risk patients.


Subject(s)
Home Care Services , Pressure Ulcer , Humans , Pressure Ulcer/epidemiology , Pressure Ulcer/etiology , Home Care Services/statistics & numerical data , Home Care Services/standards , Home Care Services/trends , Male , Female , Cross-Sectional Studies , Aged , Turkey/epidemiology , Middle Aged , Aged, 80 and over , Risk Factors , Prevalence , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Adult
19.
Nutr Hosp ; 41(2): 293-314, 2024 Apr 26.
Article in Spanish | MEDLINE | ID: mdl-38258660

ABSTRACT

Introduction: Introduction: teleconsultation is a useful healthcare tool in the multidisciplinary management of patients with indications of home enteral nutrition (HEN). The use of different teleconsultation platforms, as it happens in the Andalusian Health System (SAS), results in heterogeneous referral processes between Primary Care and hospital services in the same region. Objectives: to establish a consensus on patient profiles and the minimum data set necessary to guarantee an adequate referral to NED teleconsultation regardless of the existing platform. These agreed aspects in Andalusia can serve as a reference in other regions. Methods: three consecutive steps were followed: a) non-systematic review of the indexed literature on teleconsultation in clinical nutrition in Spain; b) survey to know the implementation and unmet needs of teleconsultation platforms in Andalusian public hospitals; and c) working meetings and consensus of 14 health professionals of Primary Care (n = 4) and endocrinology and hospital clinical nutrition (n = 10). Results: three referral forms were agreed in which three patient profiles were defined, with the corresponding minimum set of data necessary to request NED teleconsultation. The Primary Care team should provide this set of data to the clinical nutrition specialist via a teleconsultation platform, implemented in the SAS. Conclusions: three agreed forms between healthcare professionals involved in the referral process serve to standardize the request for teleconsultation of NED between healthcare teams based on patient profiles.


Introducción: Introducción: la teleconsulta es una herramienta asistencial útil en el manejo multidisciplinar de pacientes con indicación de nutrición enteral domiciliaria (NED). El empleo de diferentes herramientas de teleconsulta de NED, como ocurre en el Sistema Andaluz de Salud (SAS), conlleva heterogeneidad en los procesos de derivación entre los servicios de Atención Primaria (AP) y hospitalaria en una misma región. Objetivos: consensuar perfiles de pacientes y conjunto de datos mínimos necesarios para garantizar una derivación adecuada a la teleconsulta de NED, independientemente de la herramienta existente. Estos aspectos consensuados en Andalucía pueden servir de referencia en otras regiones. Métodos: se siguieron tres pasos consecutivos: a) revisión no sistemática de la literatura indexada sobre la teleconsulta en nutrición clínica en España; b) encuesta para conocer la implementación y las necesidades no satisfechas de las herramientas de teleconsulta en los hospitales públicos andaluces; y c) reuniones de trabajo y consenso de 14 profesionales sanitarios de AP (n = 4) y endocrinología y nutrición clínica hospitalaria (n = 10). Resultados: se consensuaron tres formularios de derivación en los que se definieron tres perfiles de pacientes, con el correspondiente conjunto mínimo de datos necesario para solicitar la teleconsulta de NED. El equipo de AP debe proporcionar este conjunto mínimo de datos al especialista en nutrición clínica a través de una herramienta de teleconsulta, implementada en el SAS. Conclusiones: tres formularios consensuados entre profesionales sanitarios involucrados en el proceso de derivación sirven para estandarizar la solicitud de teleconsulta de NED entre equipos asistenciales en función de perfiles de pacientes.


Subject(s)
Enteral Nutrition , Home Care Services , Referral and Consultation , Remote Consultation , Humans , Remote Consultation/methods , Spain , Enteral Nutrition/standards , Enteral Nutrition/methods , Home Care Services/standards , Consensus , Primary Health Care
20.
J Palliat Care ; 39(3): 194-201, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38115739

ABSTRACT

Objective: The Palliative Performance Scale (PPS) has been reported to be as accurate as Palliative Prognostic Index (PPI). PPS is a component of the simplified PPI (sPPI). It is unknown whether PPS is as accurate as sPPI. This study aimed to compare the prognostic performance of the PPS and sPPI in patients with advanced cancer in a home palliative care setting in South Korea. Methods: This was a secondary analysis of a prospective cohort study that included Korean patients with advanced cancer who received home-based palliative care. We used the medical records maintained by specialized palliative care nurses. We computed the prognostic performance of PPS and sPPI using the area under the receiver operating characteristic curve (AUROC) and calibration plots for the 3- and 6-week survival. Results: A total of 80 patients were included, with a median overall survival of 47.0 days. The AUROCs of PPS were 0.71 and 0.69 at the 3- and 6-week survival predictions, respectively. The AUROCs of sPPI were 0.87 and 0.73 at the 3- and 6-week survival predictions, respectively. The calibration plot demonstrated satisfactory agreement across all score ranges for both the PPS and sPPI. Conclusions: This study showed that the sPPI assessed by nurses was more accurate than the PPS in a home palliative care setting in predicting the 3-week survival in patients with advanced cancer. The PPS can be used for a quick assessment.


Subject(s)
Home Care Services , Neoplasms , Palliative Care , Humans , Male , Female , Neoplasms/therapy , Palliative Care/standards , Palliative Care/statistics & numerical data , Aged , Middle Aged , Prospective Studies , Home Care Services/statistics & numerical data , Home Care Services/standards , Republic of Korea , Prognosis , Aged, 80 and over , Adult , Cohort Studies
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