scholarly journals A qualitative study of home care client and caregiver experiences with a complex cardio-respiratory management model

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Connie Schumacher ◽  
Darly Dash ◽  
Fabrice Mowbray ◽  
Lindsay Klea ◽  
Andrew Costa
Keyword(s):  
Health Service ◽  
Qualitative Study ◽  
Home Care ◽  
Therapeutic Relationship ◽  
Service Use ◽  
Management Model ◽  
Health Service Use ◽  
Self Management ◽  
Home Based ◽  
Respiratory Management

Abstract Background Home care clients are typically older and have some degree of medical, physical, cognitive or social conditions that require formal or informal support to promote healthy aging in the community. Home care clients contribute a significant proportion of health service use, including emergency department visits. The DIVERT-CARE trial introduced a cardio-respiratory management model to improve client motivation, symptoms and rates of unwarranted health service use. Our objective was to explore the perceptions and experiences of individuals who participated in the DIVERT-CARE self-management support and education intervention. Methods A qualitative study was nested within a pragmatic randomized control trial and conducted following a 15-week multi-component cardio-respiratory intervention. A phenomenological descriptive design was employed using thematic analysis. Post-intervention, clients and their caregivers were invited to participate in a semi-structured telephone interview. Interview questions were designed to elicit the experience with the intervention components. Results A total of 29 interviews were completed from June 2018 to March 2020 from participants in Ontario, Newfoundland, and British Columbia. Three themes were identified; self-care trajectory and burden of responsibility, learning and behaviour change, and feeling connected pre-emptively to care providers, the information and medical advice, and connection through the therapeutic relationship. Conclusions Home care clients experience unique challenges in managing cardio-respiratory related chronic disease. Home-based interventions fostered a therapeutic relationship of connectedness while equipping clients with necessary knowledge and skills. These results inform recommendations for community nursing, and home-based self-management supports for older community-residing individuals.

scholarly journals A Qualitative Study of Home Care Client and Caregiver Experiences With a Complex Cardio-respiratory Management Model

2021 ◽  
Author(s):  
Connie Schumacher ◽  
Darly Dash ◽  
Fabrice Mowbray ◽  
Lindsay Klea ◽  
Andrew Costa
Keyword(s):  
Health Service ◽  
Qualitative Study ◽  
Home Care ◽  
Service Use ◽  
Emergency Department Visits ◽  
Management Model ◽  
Health Service Use ◽  
Self Management ◽  
Home Based ◽  
Respiratory Management

Abstract BackgroundHome care clients are typically older and have some degree of medical, physical, cognitive or social conditions that require formal or informal support to promote healthy aging in the community. Home care clients contribute a significant proportion of health service use, including emergency department visits. The DIVERT-CARE trial introduced a cardio-respiratory management model to improve patient motivation, symptoms and rates of unwarranted health service use. Our objective was to explore the perceptions and experiences of individuals who participated in the DIVERT-CARE self-management support and education intervention.MethodsA qualitative study was nested within a pragmatic randomized control trial and conducted following a 15-week multicomponent cardio-respiratory intervention. A phenomenological descriptive design was employed using thematic analysis. Post-intervention, clients and their caregivers were invited to participate in a semi-structured telephone interview. Interview questions were designed to elicit the experience with the intervention components.ResultsA total of 29 interviews were completed from June 2018 to March 2020 from participants in Ontario, Newfoundland, and British Columbia. Five themes were identified; self-care trajectory and responsibility, learning and behaviour change, pre-emptive connection to care providers, connection to information and the health system, and connection through therapeutic relationships.ConclusionsHome care clients experience unique challenges in managing chronic disease. Home-based interventions fostered a therapeutic relationship of connectedness while equipping clients with necessary knowledge and skills. These results inform recommendations for community nursing, and home-based self-management supports for older community-residing individuals.

scholarly journals Mediation Role of Health Service Use and Depression on Multimorbidity and Self-rated Health in Home-based Long-term Care Residents: a Cross-sectional Study

2021 ◽  
Author(s):  
Huosheng Yan ◽  
Wenjia Peng ◽  
Mengying Li ◽  
Xinghui Li ◽  
Tingting Yang ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Health Service ◽  
Service Use ◽  
Long Term Care ◽  
Health Service Use ◽  
Term Care ◽  
Self Rated Health ◽  
Home Based

Abstract Background: Multimorbidity is common among older people and a major cause of reduced quality of life. The study aim was to investigate the relationship between multimorbidity and self-rated health and its mediators in home-based long-term care residents.Methods: Participants were 1067 home-based long-term care residents covered by long-term care insurance in Shanghai. Stratified sampling was used to select participants from six Shanghai districts. Data were collected using face-to-face interviews. Multimorbidity was defined as co-occurrence of ≥2 chronic diseases in the same person. The 30-item Geriatric Depression Scale was used to assess depressive symptoms. Structural equation modeling was used for data analysis.Results: The findings showed that 59.4% of participants had multimorbidity and 67.7% reported depressive symptoms. The mean self-rated health score was 1.97 (standard deviation [SD] = 0.861) and mean health service use frequency was 1.61 (SD = 3.406) per month. Compared with participants with no multimorbidity, those with multimorbidity were more likely to report low self-rated health (β = −0.141, p<0.001), more severe depressive symptoms (β = 0.100, p<0.001), and more health service use (β = 0.121, p<0.001). Low self-rated health may be caused by depression and health service use (β = −0.280, p<0.001). The effect of multimorbidity on self-rated health was significantly mediated by depression (β = −0.024, p<0.001) and health service use (β = −0.034, p<0.001).Conclusion: Multimorbidity is associated with self-rated health, and depression and health service use mediate this association. Prevention and proper management of multimorbidity and depression in long-term care residents may help to maintain and improve quality of life.

Exits From Out-of-Home Care and Continuity of Mental Health Service Use

2009 ◽  
pp. 330-350
Author(s):  
John Landsverk ◽  
Michael S. Hurlburt ◽  
Laurel Leslie ◽  
Jennifer Rolls ◽  
Jinjin Zhang
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Home Care ◽  
Service Use ◽  
Mental Health Service Use ◽  
Health Service Use ◽  
Out Of Home Care

scholarly journals A Canadian, Multicentre, Randomized Clinical Trial of Home-Based Pulmonary Rehabilitation in Copd: Rationale and Methods

2005 ◽  
Vol 12 (4) ◽  
pp. 193-198 ◽  
Author(s):  
François Maltais ◽  
Jean Bourbeau ◽  
Yves Lacasse ◽  
Stan Shapiro ◽  
Hélène Perrault ◽  
...  
Keyword(s):  
Health Service ◽  
Pulmonary Rehabilitation ◽  
Service Use ◽  
Health Service Use ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Outpatient Rehabilitation ◽  
Primary Analysis ◽  
Home Based ◽  
T Distribution

BACKGROUND: Pulmonary rehabilitation remains largely underused. Self-monitored, home-based rehabilitation is a promising approach to improving the availability of pulmonary rehabilitation.OBJECTIVE: To report the rationale and methods of a trial comparing the effectiveness of self-monitored, home-based rehabilitation with hospital-based, outpatient rehabilitation in patients with chronic obstructive pulmonary disease (COPD).STUDY DESIGN: A parallel-group, randomized, noninferiority, multicentre trial will be performed with 240 patients with moderate to severe COPD.INTERVENTION: Patients will be randomly assigned to conventional, supervised, hospital-based outpatient rehabilitation or self-monitored, home-based rehabilitation. Both interventions will include a standardized, comprehensive self-management program, in addition to the hospital-based outpatient or home-based exercise program. After the three-month intervention, patients in both groups will be encouraged to continue exercising at home. Patients will be assessed monthy with telephone interviews and in person at enrollment, three months and 12 months.OUTCOMES: The dyspnea domain of the Chronic Respiratory Questionnaire (CRQ) at 12 months is the primary outcome variable. Secondary outcome variables include total and domain-specific CRQ scores; exercise tolerance and activity of daily living; health service use over the one-year study period; and direct and indirect costs of COPD treatment.ANALYSIS: An intent-to-treat approach will be used as the primary analysis. The primary analysis will focus on the change in the CRQ dyspnea score using a two-sided t distribution based on 95% CIs. The same approach will be used for secondary continuous outcome variables.CONCLUSION: The present trial will address two unresolved issues in pulmonary rehabilitation for patients with COPD: the short-term and long-term effectiveness of home-based pulmonary rehabilitation strategies. The authors will also determine if home-based pulmonary rehabilitation can reduce health service use (eg, hospitalizations and emergency visits) and if it can be done at a lower cost than the traditional hospital-based outpatient pulmonary rehabilitation.

scholarly journals What is the timeliness and extent of health service use of Victorian (Australia) children in the year after entry to out-of-home care? Protocol for a retrospective cohort study using linked administrative data

2019 ◽  
Vol 3 (1) ◽  
pp. e000400
Author(s):  
Karen McLean ◽  
Harriet Hiscock ◽  
Dorothy Scott ◽  
Sharon Goldfeld
Keyword(s):  
Health Service ◽  
Health Services ◽  
Home Care ◽  
Child Protection ◽  
Retrospective Cohort ◽  
Service Use ◽  
Hospital Admissions ◽  
Health Service Use ◽  
Out Of Home Care ◽  
Care Protocol

IntroductionChildren entering out-of-home care have high rates of health needs across all domains of health. To identify these needs early and optimise long-term outcomes, routine health assessment on entry to care is recommended by child health experts and included in policy in many jurisdictions. If effective, this ought to lead to high rates of health service use as needs are addressed. Victoria (Australia) has no state-wide approach to deliver routine health assessments and no data to describe the timing and use of health service visits for children in out-of-home care. This retrospective cohort data linkage study aims to describe the extent and timeliness of health service use by Victorian children (aged 0–12 years) who entered out-of-home care for the first time between 1 April 2010 and 31 December 2015, in the first 12 months of care.Methods and analysisThe sample will be identified in the Victorian Child Protection database. Child and placement variables will be extracted. Linked health databases will provide additional data: six state databases that collate data about hospital admissions, emergency department presentations and attendances at dental, mental and community health services and public hospital outpatients. The federal Medicare Benefits Schedule claims dataset will provide information on visits to general practitioners, specialist physicians (including paediatricians), optometrists, audiologists and dentists. The number, type and timing of visits to different health services will be determined and benchmarked to national standards. Multivariable logistic regression will examine the effects of child and system variables on the odds of timely health visits, and proportional-hazards regression will explore the effects on time to first health visits.Ethics and disseminationEthical and data custodian approval has been obtained for this study. Dissemination will include presentation of findings to policy and service stakeholders in addition to scientific papers.

Self-Management, Health Service Use and Information Seeking for Diabetes Care among Black Caribbean Immigrants in Toronto

2014 ◽  
Vol 38 (1) ◽  
pp. 32-37 ◽  
Author(s):  
Ilene Hyman ◽  
Enza Gucciardi ◽  
Dianne Patychuk ◽  
Joanna Anneke Rummens ◽  
Yogendra Shakya ◽  
...  
Keyword(s):  
Health Service ◽  
Diabetes Care ◽  
Information Seeking ◽  
Service Use ◽  
Health Service Use ◽  
Self Management ◽  
Caribbean Immigrants ◽  
Black Caribbean ◽  
Black Caribbean Immigrants
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