scholarly journals Informal and formal care infrastructure and perceived need for caregiver training for frail US veterans referred to home and community-based services

2010 ◽  
Vol 6 (1) ◽  
pp. 57-66 ◽  
Author(s):  
Courtney Harold Van Houtven ◽  
Eugene Z. Oddone ◽  
Morris Weinberger
Keyword(s):  
Primary Care ◽  
Informal Care ◽  
Medical Center ◽  
Caregiver Training ◽  
Community Based ◽  
Home Health Services ◽  
Home Based ◽  
Chi Squared ◽  
Us Veterans ◽  
Community Based Services

Objectives: To describe the informal care network of US veterans referred to home and community-based services (Homemaker Home Health services, H/HHA, or Home-Based Primary Care, HBPC) at the Durham Veterans Affairs Medical Center (VAMC), including: quantity and types of tasks provided and desired content for caregiver training programs. Methods: All primary care patients referred to H/HHA or HBPC during the preceding 3 months were sent questionnaires in May 2007. Additionally, caregivers were sent questionnaires if a patient gave permission. Descriptive statistics and chi-squared tests were performed. Results: On average, patients received 5.6 hours of VA care and 47 hours of informal care per week. 26% of patients (38% of patients with caregiver proxy respondents) and 59% of caregivers indicated the caregiver would be interested in participating in a training program by phone or on-site. Significant barriers to participation existed. The most common barriers were: transportation; no time due to caregiving or work demands; caregiver’s own health limitations; and no need. Conclusions: Caregiver training needs to be tailored to overcome barriers to participate. Overcoming these barriers may be possible through in-home phone or internet training outside traditional business hours, and by tailoring training to accommodate limiting health problems among caregivers.

scholarly journals EFFECTIVENESS OF HOME- AND COMMUNITY-BASED SERVICES IN DECREASING HEALTH CARE EXPENDITURE IN TAIWAN

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S159-S159
Author(s):  
Ya-Mei Chen ◽  
Hsiao-Wei Yu ◽  
Ying-Chieh Wang
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Long Term Care ◽  
Community Based ◽  
Term Care ◽  
Care Recipients ◽  
Home Based ◽  
Number Of Visits ◽  
Community Based Services

Abstract Ideally, continuum of care involves wide-ranging health and long-term care (LTC) services. Taiwan’s National Health Insurance scheme and 10-Year Long-term Care Plan attempts to provide universal and fundamental services of continuum care. However, the accessibility of these services for care recipients remains unclear. This study aims to examine the effectiveness of continuum care in decreasing the healthcare expenditure of LTC recipients using home- and community-based services (HCBS). Data collated from the 2010–2013 Long-Term Care Service Management System (N = 77,251) were subjected to latent class analysis to identify subgroups of recipients using HCBS. Subsequently, the 1-year primary care expenditure after receiving HCBS was compared through generalized linear modeling. Three discrete HCBS subgroups were found: home-based personal care (HP), home-based health care (HH), and community-based care (CC). No difference in the number of visits to doctors and the average primary care expenses was observed between the HP and HH subgroups. However, considering physical and psychosocial confounders, care recipients in the CC subgroup recorded a higher number of visits to doctors (β = 3.05, SD = 0.25, p < 0.05) and lower primary care expenditure (β = -98.15, SD = 43.17, p = 0.02) than the other two subgroups. These findings suggest that LTC recipients in Taiwan may obtain better continuum care only for CC service recipients. Additionally, community-based LTC services may lower the cost of health expenditure after 1 year.

scholarly journals Utilization of a Cardiometabolic Health Nurse – a Novel Strategy to Manage Comorbid Physical and Mental Illness

2014 ◽  
Vol 4 (1) ◽  
pp. 22-28 ◽  
Author(s):  
Brenda Happell ◽  
Robert Stanton ◽  
David Scott
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Physical Health ◽  
Allied Health ◽  
Cardiometabolic Health ◽  
Community Based ◽  
Mental Health Consumers ◽  
Health Nurse ◽  
Health Consumers ◽  
Community Based Services

Background Comorbid chronic illnesses, such as cardiovascular disease, respiratory conditions, and type 2 diabetes are common among people with serious mental illness. Management of comorbid illness in the mental health setting is sometimes ad hoc and poorly delivered. Use of a cardiometabolic health nurse (CHN) is proposed as one strategy to improve the delivery of physical health care to this vulnerable population. Objective To report the CHN's utilization of primary care and allied health referrals from a trial carried out in a regional community mental health service. Design Feasibility study. Mental health consumers were referred by their case manager or mental health nurse to the CHN. The CHN coordinated the physical health care of community-based mental health consumers by identifying the need for, and providing referrals to, additional services, including primary care, allied health, and community-based services. Results Sixty-two percent of participants referred to the CHN received referrals for primary care, allied health, and community-based services. Almost all referrals received follow-up by the CHN. Referrals were most commonly directed to a general practitioner and for nurse-delivered services. Conclusion The CHN role shows promise in coordinating the physical health of community-based mental health consumers. More studies on role integration and development of specific outcome measurement tools are needed.

scholarly journals Revisiting the four core functions (4Cs) of primary care: operational definitions and complexities

2021 ◽  
Vol 22 ◽  
Author(s):  
Geronimo Jimenez ◽  
David Matchar ◽  
Gerald Choon Huat Koh ◽  
Shilpa Tyagi ◽  
Rianne M. J. J. van der Kleij ◽  
...  
Keyword(s):  
Primary Care ◽  
Digital Health ◽  
Descriptive Analysis ◽  
Community Based ◽  
Social Community ◽  
Health Technologies ◽  
Levels Of Care ◽  
Electronic Search ◽  
First Contact ◽  
Community Based Services

Abstract Background: The four primary care (PC) core functions (the ‘4Cs’, ie, first contact, comprehensiveness, coordination and continuity) are essential for good quality primary healthcare and their achievement leads to lower costs, less inequality and better population health. However, their broad definitions have led to variations in their assessment, in the innovations implemented to improve these functions and ultimately in their performance. Objectives: To update and operationalise the 4Cs’ definitions by using a literature review and analysis of enhancement strategies, and to identify innovations that may lead to their enhancement. Methods: Narrative, descriptive analysis of the 4Cs definitions, coming from PC international reports and organisations, to identify measurable features for each of these functions. Additionally, we performed an electronic search and analysis of enhancement strategies to improve these four Cs, to explore how the 4Cs inter-relate. Results: Specific operational elements for first contact include modality of contact, and conditions for which PC should be approached; for comprehensiveness, scope of services and spectrum of population needs; for coordination, links between PC and higher levels of care and social/community-based services, and workforce managing transitions and for continuity, type, level and context of continuity. Several innovations like enrolment, digital health technologies and new or enhanced PC provider’s roles, simultaneously influenced two or more of the 4Cs. Conclusion: Providing clear, well-defined operational elements for these 4Cs to measure their achievement and improve the way they function, and identifying the complex network of interactions among them, should contribute to the field in a way that supports efforts at practice innovation to optimise the processes and outcomes in PC.

Impact of informal care levels on discontinuation of living at home in community-dwelling dependent elderly using various community-based services

2011 ◽  
Vol 52 (2) ◽  
pp. 127-132 ◽  
Author(s):  
Masafumi Kuzuya ◽  
Jun Hasegawa ◽  
Yoshihisa Hirakawa ◽  
Hiromi Enoki ◽  
Sachiko Izawa ◽  
...  
Keyword(s):  
Informal Care ◽  
Community Dwelling ◽  
Community Based ◽  
Dependent Elderly ◽  
Community Based Services ◽  
At Home

Implementation of Telehealth Services at the VA during COVID-19 (Preprint)

2021 ◽  
Author(s):  
Claudia Der-Martirosian ◽  
Tamar Wyte-Lake ◽  
Michelle Balut ◽  
Karen Chu ◽  
Leonie Heyworth ◽  
...  
Keyword(s):  
Primary Care ◽  
Los Angeles ◽  
Medical Center ◽  
Low Cost ◽  
Patient Choice ◽  
Department Of Veterans Affairs ◽  
Telephone Interviews ◽  
Qualitative Approaches ◽  
Home Based ◽  
State And Local

BACKGROUND At the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting non-urgent in-person appointments. Even though, the VA was an early adopter of telehealth in the late 1990’s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020. OBJECTIVE We compare telehealth services use at one VA Medical Center, Greater Los Angeles across three clinics, primary care (PC), cardiology, and home-based primary care (HBPC), 12-months before and 12-months after onset of COVID-19 (March 2020). METHODS We used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of the percentage of monthly telehealth visits, as well as telephone vs. VA Video Connect (VVC) visits were examined for each clinic. Semi-structured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC, during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes. RESULTS Prior to COVID-19, telehealth use varied (7%-27%), but at the onset of COVID-19, telehealth use increased substantially and reached its peak: 80% PC (April 2020), 70% cardiology, 79% HBPC (both in May 2020). Telephone was the main modality of patient choice. Several important barriers and facilitators were noted: multiple steps to use video, flexibility in using different video-capable platforms, provision of free/low-cost infrastructure (devices, internet access), scheduling and staffing considerations, technical support for patients, identifying staff telehealth champions, and developing workflows to help incorporate telehealth into treatment plans. CONCLUSIONS Technological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions that improve access to care beyond the pandemic.

Towards a comprehensive telecardiology monitoring centre for community-based services

1997 ◽  
Vol 3 (1_suppl) ◽  
pp. 60-62 ◽  
Author(s):  
D Shanit ◽  
R A Greenbaum
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Primary Care ◽  
General Practitioner ◽  
Pilot Study ◽  
Community Based ◽  
Monitoring Centre ◽  
Accident And Emergency ◽  
Community Based Services

In a pilot study of primary-care telecardiology, 2563 consultations were carried out over 18 months. Following teleconsultation, 2076 patients (81%) were found to be suitable for management entirely by the general practitioner, without the need for referral to hospital. The system identified 487 patients (19%) with cardiac problems who required either admission to hospital or outpatient assessment. There was a resultant saving of referrals to hospital accident and emergency departments. Extension of the telecardiology service to include tele-echocardiography may result in faster access to diagnosis and better management of patients in heart failure, improving patients’ quality of life and reducing hospitalization.

Use of Home- and Community-Based Services in Taiwan’s National 10-Year Long-Term Care Plan

2018 ◽  
Vol 39 (7) ◽  
pp. 722-730 ◽  
Author(s):  
Hsiao-Wei Yu ◽  
Yu-Kang Tu ◽  
Po-Hsiu Kuo ◽  
Ya-Mei Chen
Keyword(s):  
Daily Living ◽  
Long Term Care ◽  
Care Group ◽  
Community Based ◽  
Term Care ◽  
Use Patterns ◽  
Care Recipients ◽  
Home Based ◽  
Community Based Services

We aimed to understand the relationships between care recipients’ profiles and home- and community-based services (HCBS use patterns. Data were from the 2010 to 2013 Long-Term Care Service Management System in Taiwan ( N = 78,205). We used latent class analysis and multinomial logistic regression analyses. Three HCBS use patterns were found. Care recipients who lived alone, lived in less urbanized areas, and had instrumental activities of daily living disabilities were more likely to be in the home-based personal care group. Those in the home-based personal and medical care group were more likely than others to have a primary caregiver. Care recipients who had poorer abilities at basic activities of daily living and cognitive function, better household income, and lived in a more urbanized area were more likely to be in the non-personal care multiple services group. The findings suggest that policymakers alleviate barriers to accessing various patterns of HCBS should be encouraged.

scholarly journals FAMILY CAREGIVER SCREENING IN PRIMARY CARE: CLINICIAN AND CAREGIVER PERSPECTIVES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S207-S207
Author(s):  
Catherine Riffin
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Qualitative Content Analysis ◽  
Care Plan ◽  
Care Practice ◽  
Community Based ◽  
Multidisciplinary Practice ◽  
Depth Interviews ◽  
Community Based Services

Abstract Despite broad appreciation of family caregivers’ relevance to older adults’ health care, few primary care-based interventions have incorporated mechanisms to facilitate systematic caregiver identification, screening, and support. Actionable knowledge regarding how such interventions may be incorporated into clinical practice is remarkably limited. This study used in-depth interviews to elucidate clinicians’ (N=25) and caregivers’ (N=20) perspectives on and suggestions for integrating caregiver screening into primary care practice. Transcripts were analyzed using qualitative content analysis. Participants emphasized the importance of tailoring the caregiver screening intervention to local circumstances and to patient and caregiver preferences. They advocated for an action-oriented approach that would link identified risks with a concrete plan for follow-up (e.g., referral to training) and outcomes relevant to the patient’s care plan. Overall, participants advised that integrating the intervention into practice would require the support of multidisciplinary practice staff, stronger connections between medical and community-based services, and appropriate reimbursement for clinicians.

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