Dementia behaviour management programme at home: impact of a palliative care approach on care managers and professional caregivers of home care services

Background: Paramedics commonly face acute crises of patients in palliative care, but their involvement in end-of-life care is not planned systematically. Aim: To evaluate a protocol for end-of-life care at home including pre-planned integration of paramedics and end-of-life care wards. Design: Paramedic visits to patients in end-of-life care protocol were retrospectively studied. Setting/Participants: All of the patients who had registered for the protocol between 1 March 2015 and 28 February 2017 in North Karelia, Finland, were included in this study. Results: A total of 256 patients were registered for the protocol and 306 visits by paramedic were needed. A need for symptom control (38%) and transportation (29%) were the most common reasons for a visit. Paramedics visited 43% and 70% of the patients in areas with and without 24/7 palliative home care services, respectively ( p < 0.001); while 58% of all the visits were done outside of office hours. Problems were resolved at home in 31% of the visits. The patient was transferred to a pre-planned end-of-life care ward and to an emergency department in 48% and 16% of the cases, respectively. More patients died in end-of-life care wards in areas without (54%) than with (33%) 24/7 home care services ( p = 0.001). Conclusions: Integration of paramedics into end-of-life care at home is reasonable especially in rural areas without 24/7 palliative care services and outside of office hours. The majority of patients can be managed at home or with the help of an end-of-life care ward without an emergency visit.

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Evaluation of a Closed-loop Insulin Delivery System at Home With Tailored Home Care Services in Poorly Controlled DT2

Case Medical Research ◽

10.31525/ct1-nct04233229 ◽

2020 ◽

Author(s):

Keyword(s):

Home Care ◽

Delivery System ◽

Closed Loop ◽

Insulin Delivery ◽

Home Care Services ◽

Care Services ◽

Insulin Delivery System ◽

At Home

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Simultaneous Care clinic (SCC): A three-year monoinstituional experience.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.169 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 169-169

Author(s):

Silvia Stragliotto ◽

Antonella Brunello ◽

Sara Galuppo ◽

Sabina Murgioni ◽

Vincenzo Dadduzio ◽

...

Keyword(s):

Palliative Care ◽

Home Care ◽

Median Time ◽

Social Issues ◽

Home Care Services ◽

Cancer Type ◽

Nutritional Evaluation ◽

Care Clinic ◽

Oncological Treatment ◽

Care Services

169 Background: Early palliative care has been shown to improve outcomes in pts with advanced cancer. In accordance with ASCO and AIOM recommendations of implementing palliative care early for pts with metastatic cancer along with active cancer treatment a SCC was set up at Istituto Oncologico Veneto (IOV) in Padova since 2014; Methods: Data of pts referred to the SCC from Mar 2014 to Nov 2016 were retrieved from a prospectively maintained database. Data collected included cancer type, status of disease, PS, ongoing oncological treatment, psychological evaluation, social evaluation, nutritional evaluation, activation of home territorial services and/or Palliative Care services, use of other health services after a first visit and place of death; Results: 533 pts were evaluated by a multidisciplinary team. Overall symptom burden was low with baseline symptom scores highest for fatigue, lack of appetite and depression. Nutritional evaluation revealed 224 pts (42%) with nutritional problems, the most frequent being weight loss (n = 121). Psychological distress was present in 185 pts (35%). Social issues were present in 26 pts (5%) and were dealt with activation of social services (n = 9) or volunteer territorial services (n = 8). Patients deemed in need of home care services after the first access to the SCC were 177 (33%) and for these a formal request for Home Care services activation was sent to the Local Health Territorial Unit. After the first visit 141 patients referred to Emergency Room for intervening problems with median time of 41 days. Globally 290 pts (54%) died with 53% of deaths occurring at home. For pts who were receiving active oncological treatment median time from first-visit in the SCC and death was 126 days. We are also evaluating a score for priority for access to SCC; Conclusions: Early integrated SC may be most effective if targeted to the specific needs of each patient population

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Active identification of patients appropriate for palliative care: Impact on use of palliative care and home care resources.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.101 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 101-101

Author(s):

Nicole Mittmann ◽

Ning Liu ◽

Marnie MacKinnon ◽

Soo Jin Seung ◽

Nicole Look Hong ◽

...

Keyword(s):

Palliative Care ◽

Home Care ◽

Service Use ◽

Intervention Group ◽

Home Care Services ◽

Control Group ◽

Palliative Approach ◽

Active Identification ◽

Care Services ◽

Primary Care Teams

101 Background: This research evaluates whether active identification of patients who may benefit from a palliative approach to care changes the use of palliative care and home care services. Methods: Between 2014 and 2017, Cancer Care Ontario implemented the INTEGRATE project at 4 cancer centres and 4 primary care teams. Physicians in participating sites were encouraged to systematically identify patients who were likely to die within 1 year and would benefit from a palliative approach to care. Patients in the INTEGRATE intervention group were 1:1 matched to non-intervention controls selected from provincial healthcare administrative data based on a publicly funded health system using the propensity score-matching. Palliative care and home care services utilization was evaluated within 1 year after the date of identification (index date), censoring on death, or March 31, 2017, the study end date. Cumulative incidence function was used to estimate the probability of having used care services, with death as a competing event. Rate of service use per 360 patient-days was calculated. Analyses were done separately for palliative care and home care. Results: Of the 1,187 patients in the INTEGRATE project, 1,185 were matched to a control. The intervention and the control groups were well-balanced on demographics, diagnosis, comorbidities, and death status. The probability of using palliative services in the intervention group was 80.3%, which was significantly higher than that in the control group (62.4%) with more palliative care visits in the intervention group [29.7 (95%CI: 29.4 to 30.1] per 360 patient-days) than in the control group [19.6 (95%CI: 19.3 to 19.9) per 360 patient-days]. The intervention group had a greater probability of receiving home care (81.4%) than the control group (55.2%) with more homecare visits per 360 patient-days [64.7 (95%CI: 64.2 to 65.3) vs. 35.3 (95%CI: 34.9 to 35.7)] The intervention group also had higher physician home visits as compared to the control group (36.5% vs. 23.7%). Conclusions: Physicians actively identifying patients that would benefit from palliative care resulted in increased use of palliative care and home care services.

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Manoeuvring challenging demands: care managers, the Free Choice System and older users of home care services with reduced decision-making capacity

International Journal of Care and Caring ◽

10.1332/239788220x15966470345919 ◽

2020 ◽

Vol 4 (4) ◽

pp. 479-495

Author(s):

Anna Dunér ◽

Gerd Gustafsson

Keyword(s):

Decision Making ◽

Home Care ◽

Free Choice ◽

Home Care Services ◽

Focus Group Interviews ◽

Care Services ◽

Care Managers ◽

Decision Making Capacity ◽

Older Users ◽

Group Interviews

The aim of this article is to describe and analyse how care managers experience and manage the Swedish Free Choice System in relation to older users of home care services with reduced decision-making capacity. The empirical data were generated by focus group interviews with care managers working in local eldercare authorities that had implemented the Free Choice System. The findings reveal that care managers used various strategies, and justifications for them, based on various coexisting logics: the market logic; the logic of public administration; and the logic of care.

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An evaluation of contracted palliative care home care services in Ontario, Canada

Evaluation and Program Planning ◽

10.1016/s0149-7189(00)00044-6 ◽

2001 ◽

Vol 24 (1) ◽

pp. 23-31 ◽

Cited By ~ 5

Author(s):

Allison M. Williams ◽

Michelle V. Caron ◽

Maria McMillan ◽

Anne Litkowich ◽

Noreen Rutter ◽

...

Keyword(s):

Palliative Care ◽

Home Care ◽

Care Home ◽

Home Care Services ◽

Care Services

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Relações de poder na atenção domiciliar: tensões e contradições entre profissionais, usuários e cuidadores

Revista de Enfermagem UFPE on line ◽

10.5205/1981-8963-v12i4a110272p897-907-2018 ◽

2018 ◽

Vol 12 (4) ◽

pp. 897 ◽

Cited By ~ 1

Author(s):

Yara Cardoso Silva ◽

Kênia Lara Silva Lara Silva ◽

Maria José Menezes Brito

Keyword(s):

Discourse Analysis ◽

Home Care ◽

Social Control ◽

Power Relations ◽

Analytical Study ◽

Home Care Services ◽

Care Services ◽

Care At Home ◽

Relations Of Power ◽

At Home

RESUMOObjetivo: analisar as relações de poder que se estabelecem nas práticas da Atenção Domiciliar. Método: estudo qualitativo, analítico, apoiado no referencial de poder foucaultiano, com dados obtidos por meio de 109 visitas às equipes de atenção domiciliar. Realizaram-se observações sobre a produção do cuidado; também, foram feitas entrevistas com cinco pacientes/cuidadores e dez profissionais. Os dados foram analisados na perspectiva da Análise de Discurso. Resultados indicam que as relações que atravessam a produção do cuidado no domicílio se caracterizam por envolvimento, empatia, vínculos e acolhimentos, mas, também, revelam a disciplinarização, o controle e a normatização que afetam o cuidado na atenção domiciliar. Conclusão: há momentos de produção e interdição do cuidado que compõem, simultaneamente, dois planos dos efeitos das relações de poder na atenção domiciliar. Descritores: Assistência Domiciliar; Serviços de Assistência Domiciliar; Poder (Psicologia).ABSTRACT Objective: to analyze the relations of power that are established in the practices of Home Care. Method: qualitative, analytical study, based on Foucauldian power referral, with data obtained through 109 visits to home care teams. Observations on the production of care were made; interviews were also conducted with Five patients / caregivers and ten professionals. The data was analyzed from the perspective of Discourse Analysis. Results indicate that the relationships that cross the production of care at home are characterized by involvement, empathy, bonds and welcoming, but also reveal the disciplinarization, control and standardization that affect care in the home. Conclusion: there are moments of production and interdiction of care that simultaneously compose two plans of the effects of power relations in home care. Descriptors: Home Care Services; Power (Psychology); Social Control; Informal. RESUMENObjetivo: analizar las relaciones de poder que se establecen en las prácticas de la Atención Domiciliaria. Método: estudio cualitativo, analítico, apoyado en el referencial de poder foucaultiano, con datos obtenidos por medio de 109 visitas a los equipos de atención domiciliaria. Realiz observaciones sobre la producción del cuidado; también, se realizaron entrevistas con cinco pacientes / cuidadores y diez profesionales. Los datos fueron analizados en la perspectiva del Análisis de Discurso. Resultados: indican que las relaciones que atraviesan la producción del cuidado en el domicilio se caracterizan por involucración, empatía, vínculos y acogidas, pero, también, revelan la disciplinarización, el control y la normatización que afectan el cuidado en la atención domiciliaria. Conclusión: hay momentos de producción e interdicción del cuidado que componen simultáneamente dos planes de los efectos de las relaciones de poder en la atención domiciliaria. Descriptores: Servicios de Atención Domiciliaria; Poder (Psicología); Controles Informales de la Sociedad.

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