scholarly journals Profiles of Frailty among Older People Users of a Home-Based Primary Care Service in an Urban Area of Barcelona (Spain): An Observational Study and Cluster Analysis

2021 ◽  
Vol 10 (10) ◽  
pp. 2106
Author(s):  
Juan-José Zamora-Sánchez ◽  
Edurne Zabaleta-del-Olmo ◽  
Sergio Fernández-Bertolín ◽  
Vicente Gea-Caballero ◽  
Iván Julián-Rochina ◽  
...  
Keyword(s):  
Primary Care ◽  
Cluster Analysis ◽  
Observational Study ◽  
Older People ◽  
Care Service ◽  
Primary Care Service ◽  
Moderate Degree ◽  
Care Needs ◽  
Home Based Primary Care ◽  
Home Based

Background: The multidimensional assessment of frailty allows stratifying it into degrees; however, there is still heterogeneity in the characteristics of people in each stratum. The aim of this study was to identify frailty profiles of older people users of a home-based primary care service. Methods: We carried out an observational study from January 2018 to January 2021. Participants were all people cared for a home-based primary care service. We performed a cluster analysis by applying a k-means clustering technique. Cluster labeling was determined with the 22 variables of the Frail-VIG index, age, and sex. We computed multiple indexes to assess the optimal number of clusters, and this was selected based on a clinical assessment of the best options. Results: Four hundred and twelve participants were clustered into six profiles. Three of these profiles corresponded to a moderate frailty degree, two to a severe frailty degree and one to a mild frailty degree. In addition, almost 75% of the participants were clustered into three profiles which corresponded to mild and moderate degree of frailty. Conclusions: Different profiles were found within the same degree of frailty. Knowledge of these profiles can be useful in developing strategies tailored to these differentiated care needs.

Oral health status and needs of homebound elderly in an urban home-based primary care service

2012 ◽  
Vol 33 (5) ◽  
pp. 218-226 ◽  
Author(s):  
R. Gluzman ◽  
H. Meeker ◽  
P. Agarwal ◽  
S. Patel ◽  
G. Gluck ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Oral Health ◽  
Care Service ◽  
Oral Health Status ◽  
Primary Care Service ◽  
Home Based Primary Care ◽  
Home Based

scholarly journals Evaluation of an initiative to improve advance care planning for a home-based primary care service

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michelle B. Cox ◽  
Margaret J. McGregor ◽  
Madison Huggins ◽  
Paige Moorhouse ◽  
Laurie Mallery ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Decision Maker ◽  
Care Service ◽  
Do Not Resuscitate ◽  
Substitute Decision Maker ◽  
Home Based Primary Care ◽  
Home Based ◽  
Before And After ◽  
Advance Care

Abstract Background Advance care planning (ACP) is a process that enables individuals to describe, in advance, the kind of health care they would want in the future. There is evidence that ACP reduces hospital-based interventions, especially at the end of life. ACP for frail older adults is especially important as this population is more likely to use hospital services but less likely to benefit from resource intensive care. Our study goal was to evaluate whether an approach to ACP developed for frail older adults, known as the Palliative and Therapeutic Harmonization or PATH, demonstrated an improvement in ACP. Methods The PATH approach was adapted to a primary care service for homebound older adults in Vancouver, Canada. This retrospective chart review collected surrogate measures related to ACP from 200 randomly selected patients enrolled in the service at baseline (prior to June 22, 2017), and 114 consecutive patients admitted to the program after implementation of the PATH ACP initiative (October 1, 2017 to May 1, 2018). We compared the following surrogate markers of ACP before and after implementation of the PATH model, chart documentation of: frailty stage, substitute decision-maker, resuscitation decision, and hospitalization decision. A composite ACP documentation score that ascribed one point for each of the above four measures (range 0 to 4) was also compared. For those with documented resuscitation and hospitalization decisions, the study examined patient/ substitute decision-maker expressed preferences for do-not-resuscitate and do-not-hospitalize, before and after implementation. Results We found the following changes in ACP-related documentation before and after implementation: frailty stage (27.0% versus 74.6%, p < .0001); substitute decision-maker (63.5% versus 71.9%, p = 0.128); resuscitation decision documented (79.5% versus 67.5%, p = 0.018); and hospitalization decision documented (61.5% versus 100.0%, p < .0001); mean (standard deviation) composite ACP documentation score (2.32 (1.16) versus 3.14 (1.11), p < .0001). The adjusted odds ratios (95% confidence intervals) for an expressed preference of do-not-resuscitate and do-not-hospitalize after implementation were 0.87 (0.35, 2.15) and 3.14 (1.78, 5.55), respectively. Conclusions Results suggest partial success in implementing the PATH approach to ACP in home-based primary care. Key contextual enablers and barriers are important considerations for successful implementation.

scholarly journals Investigation of the demand for a 7-day (extended access) primary care service: an observational study from pilot schemes in England

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028138
Author(s):  
William Whittaker ◽  
Laura Anselmi ◽  
Pauline Nelson ◽  
Caroline O'Donnell ◽  
Natalie Ross ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Outcome Measures ◽  
Care Service ◽  
Primary Care Service ◽  
Secondary Outcome ◽  
Family Practitioner ◽  
Spare Capacity ◽  
Patient Demographics ◽  
Extended Access

ObjectivesTo understand how the uptake of an extended primary care service in the evenings and weekend varied by day of week and over time. Secondary objectives were to understand patient demographics of users of the service and how these varied by type of appointment and to core hour users.DesignObservational study.SettingPrimary care extended access appointments data in 13 centres in Greater Manchester, England, during 2016.ParticipantsAppointments could be booked by 1 261 326 patients registered with a family practitioner in five Clinical Commissioning Group geographic areas.Main outcome measuresPrimary outcome measure was whether an appointment was used (booked and attended), secondary outcome measures included whether used appointments were prebooked or booked the same day, and delivered by a family or nurse practitioner. Additional analyses compared patient demographics with patients reporting the use of core hour primary care services.Results65.33% of 42 472 appointments were booked and attended (used). Usage of appointments was lowest on a Sunday at 46.73% (18.07 percentage points lower usage than on Mondays (95% CI −32.46 to −3.68)). Prebooked appointments were less likely to be booked among age group 0–9 and to result in patients not attending an appointment. Family practitioner appointments were increasingly less likely to be booked with age in comparison to nurse appointments. Patients attending extended access appointments tended to be younger in comparison to core hour patients.ConclusionsThere is spare capacity in the extended access service, particularly on Sundays, suggesting reconfigurations of the service may be needed to improve efficiency of delivering the service. Patient demographics suggest the service is used by a relatively younger population than core hour services. Patient demographics varied with the types of appointment provided, these findings may help healthcare providers improve usage by tailoring appointment provision to local populations.

Addressing COVID-19 Worry and Social Isolation in Home-Based Primary Care

2020 ◽  
Author(s):  
Rachel Elizabeth Weiskittle ◽  
Michelle Mlinac ◽  
LICSW Nicole Downing
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Social Workers ◽  
Social Isolation ◽  
Mental Health Providers ◽  
Health Providers ◽  
Home Based Primary Care ◽  
Home Based ◽  
Socially Isolated

Social distancing measures following the outbreak of COVID-19 have led to a rapid shift to virtual and telephone care. Social workers and mental health providers in VA home-based primary care (HBPC) teams face challenges providing psychosocial support to their homebound, medically complex, socially isolated patient population who are high risk for poor health outcomes related to COVID-19. We developed and disseminated an 8-week telephone or virtual group intervention for front-line HBPC social workers and mental health providers to use with socially isolated, medically complex older adults. The intervention draws on skills from evidence-based psychotherapies for older adults including Acceptance and Commitment Therapy, Cognitive-Behavioral Therapy, and Problem-Solving Therapy. The manual was disseminated to VA HBPC clinicians and geriatrics providers across the United States in March 2020 for expeditious implementation. Eighteen HBPC teams and three VA Primary Care teams reported immediate delivery of a local virtual or telephone group using the manual. In this paper we describe the manual’s development and clinical recommendations for its application across geriatric care settings. Future evaluation will identify ways to meet longer-term social isolation and evolving mental health needs for this patient population as the pandemic continues.

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