Geographic Concentration Of Home-Based Medical Care Providers

Abstract Home-based medical care (HBMC) is emerging in China, but research understanding the efficiency and effectiveness of this new care model is rare. In this study, researchers interviewed 17 Chinese homebound adults aged 45 and older (53% females, mean age=76) who have received HBMC, and collected detailed information regarding their experiences and attitudes toward HBMC. Participants were recruited from healthcare institutions in Shanghai, Jinan, and Zhangqiu of China. The evaluation of patients’ experiences with HBMC yielded both positive and negative aspects. Positive experiences included 1) the delivery method was convenient for homebound patients; 2) health problems could be detected timely because doctors visited patients regularly; 3) home care providers had better bedside manners and professional skills than hospital-based providers; 4) the medical insurance covered the cost of home care services. Negative experiences related to the supply and quality of care, including 1) the scope of current HBMC services was too limited to meet the needs of homebound patients; 2) the visit time was too short; 3) healthcare providers’ professional skills varied greatly. Findings from this study suggest that the HBMC model benefited Chinese older adults, primarily homebound adults, in terms of convenience and affordability. There are opportunities to expand the scope of home care services and improve the quality of care. Policymakers may consider providing more resources and incentives to enhance HBMC in China. Educational programs may be created to train more HBMC providers and improve their professional skills.

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The Special Perils of Being Old and Sick in Prison

Federal Sentencing Reporter ◽

10.1525/fsr.2020.32.5.276 ◽

2020 ◽

Vol 32 (5) ◽

pp. 276-284

Author(s):

William J. Jefferson

Keyword(s):

United States ◽

Health Care ◽

Medical Care ◽

Health Care Providers ◽

The United States ◽

United States Constitution ◽

Care Providers ◽

Medical Practitioners ◽

Medical Needs ◽

Access To Medical Care

The United States Supreme Court declared in 1976 that deliberate indifference to the serious medical needs of prisoners constitutes the unnecessary and wanton infliction of pain…proscribed by the Eighth Amendment. It matters not whether the indifference is manifested by prison doctors in their response to the prisoner’s needs or by prison guards intentionally denying or delaying access to medical care or intentionally interfering with treatment once prescribed—adequate prisoner medical care is required by the United States Constitution. My incarceration for four years at the Oakdale Satellite Prison Camp, a chronic health care level camp, gives me the perspective to challenge the generally promoted claim of the Bureau of Federal Prisons that it provides decent medical care by competent and caring medical practitioners to chronically unhealthy elderly prisoners. The same observation, to a slightly lesser extent, could be made with respect to deficiencies in the delivery of health care to prisoners of all ages, as it is all significantly deficient in access, competencies, courtesies and treatments extended by prison health care providers at every level of care, without regard to age. However, the frailer the prisoner, the more dangerous these health care deficiencies are to his health and, therefore, I believe, warrant separate attention. This paper uses first-hand experiences of elderly prisoners to dismantle the tale that prisoner healthcare meets constitutional standards.

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Cardiac rehabilitation via telerehabilitation in COVID-19 pandemic situation

The Egyptian Heart Journal ◽

10.1186/s43044-021-00156-7 ◽

2021 ◽

Vol 73 (1) ◽

Author(s):

Dian M. Sari ◽

Laurentia C. G. Wijaya

Keyword(s):

Cardiac Rehabilitation ◽

Health Care Providers ◽

Rehabilitation Program ◽

Lifestyle Changes ◽

Second Phase ◽

Main Body ◽

Cardiac Rehabilitation Program ◽

Care Providers ◽

Adherence To Medication ◽

Home Based

Abstract Background Adherence to medication and lifestyle changes are very important in the secondary prevention of cardiovascular disease. One of the ways is by doing a cardiac rehabilitation program. Main body of the abstract Cardiac rehabilitation program is divided into three phases. The cardiac rehabilitation program’s implementation, especially the second phase, center-based cardiac rehabilitation (CBCR), has many barriers not to participate optimally. Therefore, the third phase, known as home-based cardiac rehabilitation (HBCR), can become a substitute or addition to CBCR. On the other hand, this phase is also an essential part of the patients’ functional capacity. During the coronavirus disease-2019 pandemic, HBCR has become the leading solution in the cardiac rehabilitation program’s sustainability. Innovation is needed in its implementation, such as telerehabilitation. So, the cardiac rehabilitation program can be implemented by patients and monitored by health care providers continuously. Short conclusion Physicians play an essential role in motivating patients and encouraging their family members to commit to a sustainable CR program with telerehabilitation to facilitate its implementation.

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What does effective end-of-life care at home for children look like? A qualitative interview study exploring the perspectives of bereaved parents

Palliative Medicine ◽

10.1177/02692163211023300 ◽

2021 ◽

pp. 026921632110233

Author(s):

Cari Malcolm ◽

Katherine Knighting

Keyword(s):

End Of Life ◽

End Of Life Care ◽

Care Service ◽

Life Care ◽

Care Providers ◽

Specialist Care ◽

Bereaved Parents ◽

Home Based ◽

Qualitative Interview Study ◽

At Home

Background: End-of-life care for children with life-shortening conditions is provided in a range of settings including hospital, hospice and home. What home-based, end-of-life care should entail or what best practice might look like is not widely reported, particularly from the perspective of parents who experienced the death of a child at home. Aim: To explore the value and assess the effectiveness of an innovative model of care providing home-based, end-of-life care as perceived by families who accessed the service. Design: A qualitative descriptive study design was employed with in-depth semi-structured interviews conducted with bereaved parents. Setting/participants: Thirteen bereaved parents of 10 children supported by the home-based end-of-life care service. Results: Parents reported effective aspects of end-of-life care provided at home to include: (1) ability to facilitate changes in preferred place of death; (2) trusted relationships with care providers who really know the child and family; (3) provision of child and family-centred care; (4) specialist care and support provided by the service as and when needed; and (5) quality and compassionate death and bereavement care. Parents proposed recommendations for future home-based end-of-life care including shared learning, improving access to home-based care for other families and dispelling hospice myths. Conclusion: Parents with experience of caring for a dying child at home offer valuable input to future the policy and practice surrounding effective home-based, end-of-life care for children. New models of care or service developments should consider the key components and attributes for effective home-based end-of-life identified by bereaved parents in this study.

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Sex Differences in the Medical Utilization for Ischemic Heart Disease Among Newly Diagnosed Hypertensive Korean Patients (P04-170-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.p04-170-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Jiae Shin ◽

Dongwoo Ham ◽

Seoeun Ahn ◽

Hee-Young Paik ◽

Hyojee Joung

Keyword(s):

Medical Care ◽

Medical Cost ◽

Medical Utilization ◽

Care Utilization ◽

Newly Diagnosed ◽

Care Providers ◽

Men And Women ◽

Hypertensive Patients ◽

Medical Care Utilization ◽

The Mean

Abstract Objectives This study aimed to investigate sex differences in the medical utilization for ischemic heart disease (IHD) among newly diagnosed hypertensive patients using a cohort data of South Korea. Methods We analyzed the National Sample Cohort version 2.0 of the National Health Insurance Service. Newly diagnosed hypertensive patients aged 40–84 were extracted from the baseline population, who received health examinations during 2003–2006 without pre-existing type 2 diabetes or circulatory diseases. Propensity score was applied to match men to women with the same ratio of body mass index (BMI) and fasting blood glucose (FBG) among the patients. Men and women (each 10, 110) were selected for analyses and followed until the end of 2015. Person-year was defined as the period from the diagnosis of hypertension to the incidence of IHD. Associations between IHD and the medical care utilization such as the mean of medical care visit, the mean medical cost, and the type and the location of medical care providers were investigated using Cox proportional hazard model. Hazard ratios (HR) of IHD according to medical care utilization were adjusted for age, income, BMI, FBG, smoking, and alcohol consumption. Results Incidence rates (per 1000 person-years) of IHD were 43.1 in men and 43.0 in women. The mean follow-up period was 5.2 person-years. The HRs of IHD were significantly higher in the subjects with a high mean medical cost (T3) (men, HR = 1.39, 95% CI 1.25–1.54; women, HR = 1.33, 95% CI 1.20–1.48) than in those with a low mean medical cost (T1). However, the subjects visiting medical care providers more (T3) had lower HRs than those visiting less (T1) (men, HR = 0.80, 95% CI 0.72–0.89; women, HR = 0.79, 95% CI 0.71–0.88). Conclusions Hypertensive patients in Korea showed an increased risk of IHD when they paid medical cost more and visited medical care less per person-year in both men and women. Funding Sources This research was supported by Support Program for Women in Science, Engineering and Technology through the National Research Foundation of Korea funded by the Korea government (MSIT). (No.2016H1C3A1903202). Supporting Tables, Images and/or Graphs

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“I felt useless”: a qualitative examination of COVID-19’s impact on home-based primary care providers in New York

Home Health Care Services Quarterly ◽

10.1080/01621424.2021.1935383 ◽

2021 ◽

pp. 1-15

Author(s):

Ksenia Gorbenko ◽

Emily Franzosa ◽

Sybil Masse ◽

Abraham A Brody ◽

Orla Sheehan ◽

...

Keyword(s):

Primary Care ◽

New York ◽

Primary Care Providers ◽

Care Providers ◽

Home Based Primary Care ◽

Home Based

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M-health for maternal health- bridging the gaps!!

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175822 ◽

2017 ◽

Vol 7 (1) ◽

pp. 1

Author(s):

Sheeba Marwah ◽

Pratima Mittal

Keyword(s):

Health Care ◽

Cost Effectiveness ◽

Maternal Health ◽

Medical Care ◽

Health Care Providers ◽

Mobile Technology ◽

Clinical Applications ◽

Obstetrics And Gynecology ◽

Care Providers ◽

Effectiveness Data

This article reviews significance, potential and principles to consider when setting up a telemedicine (TM) program to provide care to women in the field of obstetrics and gynecology, essentially deploying mobile technology. There are various benefits of such TM clinical applications. The consensus among patients and health care providers is that this technology is convenient to provide needed subspecialty medical care, even when it is not available locally. Such innovations are clinically successful, but economic and cost-effectiveness data are lacking.

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“You get three different hats on and try to figure it out:” home based care provision during a disaster

BMC Nursing ◽

10.1186/s12912-021-00676-2 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Sue Anne Bell ◽

Sarah Dickey ◽

Marie-Anne Rosemberg

Keyword(s):

Older Adults ◽

Health Care ◽

Focus Groups ◽

Home Health ◽

Care Provision ◽

Care Providers ◽

Home Based ◽

Health Agencies ◽

Home Health Agencies ◽

Home Based Care

Abstract Background Home based care is a vital, and growing, part of the health care system that allows individuals to remain in their homes while still receiving health care. During a disaster, when normal health care systems are disrupted, home based care remains a vital source of support for older adults. The purpose of this paper is to qualitatively understand the barriers and facilitators of both patients and providers that influence the provision of home based care activities in two hurricane affected communities. Methods Using qualitative inquiry informed by the social ecological model, five focus groups were conducted with home based care providers (n = 25) in two settings affected by Hurricane Irma and Hurricane Harvey. An open-source database of home health agencies participating in Centers for Medicare and Medicaid Services programs was used to identify participants. Data were manually coded and larger themes were generated from recurring ideas and concepts using an abductive analysis approach. Results Twenty five participants were included in one of five focus groups. Of the 22 who responded to the demographic survey, 65 % were registered nurses, 20 % were Licensed Vocational Nurses (LVN), and 15 % were other types of health care providers. 12 % of the sample was male and 88 % was female. Five themes were identified in the analysis: barriers to implementing preparedness plans, adaptability of home based care providers, disasters exacerbate inequalities, perceived unreliability of government and corporations, and the balance between caring for self and family and caring for patients. Conclusions This study provides qualitative evidence on the factors that influence home based care provision in disaster-affected communities, including the barriers and facilitators faced by both patients and providers in preparing for, responding to and recovering from a disaster. While home based care providers faced multiple challenges to providing care during and after a disaster, the importance of community supports and holistic models of care in the immediate period after the disaster were emphasized. We recommend greater inclusion of home health agencies in the community planning process. This study informs the growing body of evidence on the value of home based care in promoting safety and well-being for older adults during a disaster.

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The Impact of Nutritional Status and Body Mass Index on Rehabilitation Outcomes in Patients Receiving Home-Based Medical Care

World Nutrition Journal ◽

10.25220/wnj.v03.i2.0003 ◽

2020 ◽

Vol 3 (2) ◽

pp. 15

Author(s):

Kanako Eiwa ◽

Naomi Nakayama ◽

Yumi Takami ◽

Shuko Iwasaki ◽

Yoshinori Hino ◽

...

Keyword(s):

Body Mass Index ◽

At Risk ◽

Nutritional Status ◽

Medical Care ◽

Body Mass ◽

Functional Independence ◽

The Body ◽

Rehabilitation Outcomes ◽

Home Based ◽

The Impact

Background: Home-based medical care is expanding rapidly in Japan.Objectives: We aimed to identify the factors associated with outcomes of therapy in patients receiving home-visit rehabilitation.Methods: One hundred twenty-one patients receiving home-based rehabilitation were investigated. Nutritional status was assessed by the Mini Nutritional Assessment Short Form (MNA-SF). The Functional Independence Measure (FIM) was employed to assess the activities of daily living (ADL). The body mass index (BMI), medical history, and orthopedic disease-related pain were also recorded. The primary outcome was the improvement in FIM scores in one year.Results: A total of 19 (17%) patients were malnourished and 58 (48%) were at risk of malnutrition. Malnourished patients had a lower FIM score at initiation than those at risk of malnutrition or with normal nutritional status. Only changes in patients’ BMI and MNA-SF scores over one year were significantly associated with improved FIM scores (p = 0.0079 and p = 0.0049, respectively). No association was noted with the other factors.Conclusions: This is the first report to demonstrate that changes in MNA-SF scores and BMI are significantly associated with rehabilitation outcomes in home-based care. Nutritional management is essential along with rehabilitation to improve ADL in the long-term home care setting.

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Promises and pitfalls of integrating home-based health services into Shanghai's elder-care system

Ageing and Society ◽

10.1017/s0144686x18001095 ◽

2018 ◽

Vol 40 (3) ◽

pp. 480-500

Author(s):

Yan-Yan Chen ◽

Honglin Chen ◽

Priscilla Song

Keyword(s):

Medical Care ◽

Elder Care ◽

Municipal Government ◽

Oldest Old ◽

Medical Services ◽

Ageing In Place ◽

Pilot Programme ◽

Care Giving ◽

Home Based ◽

Care System

AbstractFaced with the dramatic pace of population ageing, the Shanghai municipal government launched a pilot programme in 2013 designed to address this and to strengthen ageing-in-place arrangements by providing basic in-home medical services for residents above the age of 80. Yet after a two-year trial run, the ‘Home-Based Medical Care Scheme for the Oldest-Old’ (HBMCSOO) policy remained significantly under-utilised despite the increasing demand for medical services. Our multi-disciplinary research team of social workers and anthropologists identified two key factors impeding the implementation of home-based medical care services: (a) the distortion of policy implementation and (b) the inadequate professionalisation of community-based elder-care workers. Based on our evaluation of the pilot programme, the Shanghai municipal government made several practical adjustments to improve the subsequent city-wide policy implemented in 2016. While these changes mostly focused on minor adjustments to improve in-home medical services for the oldest-old, they represent an encouraging first step towards our call for a holistic integrated care system whose design and delivery takes into account local political and social contexts, including existing institutional infrastructure and cultural expectations about care-giving responsibilities. The challenges of implementing Shanghai's HBMCSOO policy ultimately provide instructive lessons on best practices for integrating medical and social services in order to improve ageing-in-place measures in diverse local settings around the world.

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