scholarly journals Home Care Pharmacy Practice in Canada: A Cross-Sectional Survey of Services Provided, Remuneration, Barriers, and Facilitators

2017 ◽  
Vol 70 (4) ◽  
Author(s):  
Sherilyn Houle ◽  
Linda MacKeigan
Keyword(s):  
Home Care ◽  
Patient Care ◽  
Pharmacy Practice ◽  
Barriers And Facilitators ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Medication Therapy ◽  
Soins À Domicile ◽  
Home Based ◽  
Home Based Care

<p><strong>ABSTRACT</strong></p><p><strong>Background:</strong> As the population ages, and individuals desire to remain in their homes as long as possible, the need for in-home care is expected to increase. However, pharmacists have rarely been included in studies of in-home care, and little is known about the prevalence or effectiveness of pharmacists’ home-based services in Canada.</p><p><strong>Objective:</strong> To identify pharmacy practices in Canada that regularly provide in-home patient care and to identify specific services provided, remuneration obtained, and barriers and facilitators influencing the provision of home-based care.</p><p><strong>Methods:</strong> A link to a web-based survey was posted in e-newsletters of provincial, territorial, and national pharmacy associations in Canada. In addition, pharmacists known to the researchers as providing in-home clinical services were contacted directly. The survey was open from October to December 2015. Practices or organizations that performed at least one home visit per week for clinical purposes, with documentation of the services provided, were eligible to participate. One response per practice or organization was allowed.</p><p><strong>Results:</strong> Seventeen practices meeting the inclusion criteria were identified, representing community, hospital, and clinic settings. Home visits were most commonly performed for individuals with complex medication regimens or nonadherence to medication therapy. The most common services were conducting medication reconciliation and reviews and counselling patients about medication adherence. No practices or organizations billed patients for these services, yet lack of remuneration was an important barrier identified by many respondents. Although 12 (71%) of the respondents collected data for evaluative purposes, collection of clinical or health system outcome data was rare.</p><p><strong>Conclusions:</strong> Few Canadian pharmacy practices that provide in-home patient care at least once a week could be identified. Data collection suitable to establish an evidence base for this service was infrequently performed by practices and organizations providing home-based care. Such evidence is needed to justify the expansion of this service nationally, including consistent and adequate remuneration from governments or other payers.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte :</strong> Au fur et à mesure que la population vieillit et que les gens désirent rester le plus longtemps possible à leur domicile, on s’attend à une croissance des besoins de soins à domicile. Or, les pharmaciens ont rarement été inclus dans les études de soins à domicile et l’on connaît peu de choses sur la prévalence et l’efficacité des services de soins à domiciles prodigués par des pharmaciens au Canada.</p><p><strong>Objectifs :</strong> Recenser les pharmacies au Canada qui prodiguent régulièrement des soins à domicile et déterminer précisément quels sont les services fournis, la rémunération obtenue et les éléments qui font obstacle ou facilitent la prestation de soins à domicile.</p><p><strong>Méthodes :</strong> Un lien menant à un sondage en ligne a été inclus dans les infolettres d’associations provinciales, territoriales et nationales de pharmacie au Canada. De plus, les chercheurs ont communiqué directement avec les pharmaciens dont ils savaient qu’ils offraient des services cliniques à domicile. Le sondage était accessible d’octobre à décembre 2015. Les pharmacies ou les organismes qui faisaient au moins une visite à domicile par semaine à des fins cliniques et qui consignaient les services fournis étaient admissibles à l’étude. Une réponse par pharmacie ou par organisme était permise.</p><p><strong>Résultats :</strong> Dix-sept pharmacies répondant aux critères d’inclusion ont été recensées. Elles provenaient de milieux communautaire, hospitalier et clinique. Les visites à domicile étaient le plus souvent faites auprès de personnes ayant une pharmacothérapie complexe ou n’observant pas le traitement médicamenteux. Les services les plus fréquents étaient : établir des bilans comparatifs des médicaments, procéder à des évaluations de la pharmacothérapie et offrir de l’information aux patients sur l’observance pharmacothérapeutique. Aucune pharmacie ou aucun organisme n’a facturé ces services aux patients; or, l’absence de rémunération représentait un des principaux obstacles selon bon nombre de répondants. Bien que 12 (71 %) des répondants aient recueilli des données à des fins d’évaluation, on effectuait rarement la cueillette de données sur les résultats cliniques ou du système de santé.</p><p><strong>Conclusions :</strong> On a pu recenser que peu de pharmacies canadiennes qui offrent des soins à domicile aux patients au moins une fois par semaine. On a noté qu’on réalisait trop peu fréquemment la collecte de données permettant de fournir un fondement à ce service. De telles données probantes sont nécessaires pour justifier le fait d’étendre ce service à l’ensemble du pays et de dégager une rémunération uniforme et adéquate provenant des gouvernements ou d’autres payeurs.</p>

scholarly journals Assessment of Utilization of HBCP Services for Children Diagnosed with Chronic and Terminal Illnesses Aged between 1-14 Years in Meru County, Kenya

2021 ◽  
pp. 29-45
Author(s):  
P. K. Kubai ◽  
A. M. Mutema ◽  
M. R. Kei
Keyword(s):  
Health Care ◽  
Care Program ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Home Based ◽  
Terminal Illnesses ◽  
Home Based Care

Introduction: Worldwide, 57 million people died in 2008 from Chronic Illnesses, an estimated 40 million were in need of HBCP services with 6.6 - 10.8 million Children and adolescents dying [1,2]. 98% of Children with Chronic and Terminal illnesses (CI/TI) are found in low and middle-income Countries. Chronic and Terminal illnesses in Children are on the rise in Sub Saharan Africa. Kenya has lagged in implementation of Home Based Care to mitigate effects of CI/TI [3]. According to WHO, 2017 and Ministry of Health-Kenya 2013, millions of Children are affected by these Illnesses such as Tuberculosis, Asthma, Congenital abnormalities, HIV/AIDS and Cancer among others [4,5]. These illnesses have made families’ to suffer emotional, psychosocial and economic hardships [6,7]. Evaluation of utilization of Home Based Care Program (EHBCP) services is significant in assessing effectiveness and quality delivery of HBCP [8,9].  Aims: To assess usage of minimum essential package required in provision of Home Based Care program services for Children aged between 1-14 years diagnosed with selected Chronic and Terminal illnesses in Meru County Kenya. Study Design:  A descriptive Cross Sectional Survey. Place and Duration of Study: Conducted in Meru County Kenya Health facilities between June 2018 and Dec 2019. Methodology: Descriptive Cross Sectional Survey of 245 Health Care Providers and Caregivers of Children diagnosed with selected by proportionate to size sampling and simple random sampling from different health facilities across Meru County was utilized. Results: Utilization, delivery of quality and effective Home Based Care program was positively associated with age, experience of Health Care Workers (HCWs) 4.8 [95% CI = 1.06 – 21.68, P = 0.041]. HCWs profession, gender and years of work were positively related to utilization and delivery of HBCP services 3.03 [95%CI = 1.64 – 5.59, P<0.001]. Conclusion: Current study concludes that utilization of Minimum HBCP essential package by participants was not effective and the quality delivery of minimum HBCP essential services was inadequate, which agrees with Sips et al., 2014 study that poor service delivery leads to inadequate utilization, it concludes that restructuring HBCP services would meet individual needs for ill Children.

scholarly journals Extent of Home Based Care Program Support to Hospital Based Care for Children with Chronic and Terminal Illness in Meru County, Kenya

2021 ◽  
pp. 14-26
Author(s):  
P. K. Kubai ◽  
M. R. Kei ◽  
A. M. Mutema
Keyword(s):  
Health Care ◽  
Hospital Care ◽  
Terminal Illness ◽  
Management Practices ◽  
Care Program ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Home Based ◽  
Terminal Illnesses ◽  
Home Based Care

Introduction: Chronic and Terminal illnesses continue to increase and aggravate the burden of disease and the diminish space in our hospitals and communities, Worldwide, 57 million persons died in 2008, an estimated 40 million were in need of HBCP, 6.6 - 10.8 million Children died, 98% Chronic and Terminal illnesses (CI/TI) are found in low and middle-income Countries. Chronic and Terminal illnesses in Children are on the rise in Sub Saharan Africa. Kenya lags in implementation of Home Based Care to mitigate effects of CI/TI. WHO, 2017 and Ministry of Health-Kenya 2013 shows that Children are affected by these Illnesses. These illnesses have made families’ to suffer psychosocial and economic hardships. Evaluation of determinants of Home Based Care Program (EHBCP) services by assessing if effective and quality delivery of HBCP Supports Hospital Based Care is key. Aims: To determine the extent to which Home Based Care Program services Support to Hospital Based Care for Children aged 1-14 years diagnosed with selected Chronic and Terminal illnesses in Meru County Kenya. Study Design: A descriptive Cross Sectional Survey. Place and Duration of Study: Meru County, Kenya between June 2018 and Dec 2019. Methodology: Methodology: Descriptive Cross Sectional Survey of 245 Caregivers of Children diagnosed with Chronic and Terminal illness were selected by proportionate to size sampling and simple random sampling from Meru County Health Facilities. Results: Delivery of quality and effective Home Based Care Program was positively associated with age, return rate of over 100% was achieved with about 245 respondents being interviewed (132%),experience of Health Care Workers (HCWs) 4.8 [95% CI = 1.06 – 21.68, P = 0.041]. HCWs profession, gender and years of work were positively related to Hospital Based Care services 3.03 [95%CI = 1.64 – 5.59, P<0.001]. Use of minimum HBCP package was found to be useful in support of hospital care, as 50.4% reported that its support was of a good or great extent. The trend was observed in all aspects of the minimum HBCP package studied, with 52.4%, 54.4% and 46.4% having the opinion that use of the package by caregivers, in management and mitigation of complications supported hospital care by a good or great extent respectively. Conclusion: Need for an urgent adoption of holistic approach on health care system strengthening by putting up a well-integrated Home Based Care Program with quality Minimum HBCP essential package to support the mainstream health care system. In addition adopt better management practices, planning strategies, resource allocation and monitoring for effective HBCP programmes as per the current guidelines to bridge the gaps identified in planning, management practices to fill the disjointed policy implementation and resource inadequacies in implementation of HBCP services to support Hospital Based care for ultimate delivery of quality care among the Chronically and Terminally ill Children.

scholarly journals Knowledge and preparedness for home-based, family-centered management of COVID-19 patients and dead bodies among residents in a COVID-19 high-risk setting

2021 ◽  
Author(s):  
Blaise Kiyimba ◽  
Teddy Onyait ◽  
Livingstone Kamoga ◽  
Arnold Atuhaire ◽  
Patrick Ssekatono ◽  
...  
Keyword(s):  
Patient Care ◽  
Knowledge Score ◽  
Cross Sectional Study ◽  
Multivariable Logistic Regression Analysis ◽  
Dead Body ◽  
Cross Sectional ◽  
Home Based ◽  
Significant Difference ◽  
Household Heads ◽  
Home Based Care

Abstract Background The overwhelming coronavirus disease- 2019 (COVID-19) cases have called for inevitable home-based care for some cases and direct involvement in COVID-19 dead body burials by many families worldwide. However, data on the knowledge and readiness by families for these practices is still scarce, hence this study among residents of Wakiso district, Uganda. Methods We conducted a cross-sectional study between 6th March and 4th April 2021. Household heads aged 15years and above in 5 sub counties of Wakiso district were interviewed using a pre-tested questionnaire. Multivariable logistic regression analysis was used to assess the association between COVID-19 related knowledge on home-based care and burials with demographics characteristics. Results We enrolled 205 participants, with a median age of 28 (range: 25–35) years. Majority (n = 157, 76.6%) were female and had achieved at least secondary level of education (n = 117, 57.1%). The mean knowledge score on home-based care for COVID-19 patient was 49.5 %, while that on COVID-19 dead body management was 36.5%. Seven (3.4%) respondents were ready to undertake home-based care and dead body management. For the remainder 198 (96.6%) unready respondents reported inadequate knowledge (n = 166, 84%) and lack of personal protective equipment (PPE) (n = 17, 8.6%) as major barriers for their readiness. There was no statistically significant difference in both the knowledge on home-based COVID-19 patient care and dead body management stratified by demographics characteristics. Conclusion The knowledge and preparedness for home-based Covid-19 patient care and dead body management are suboptimal among Wakiso district residents. More public education programmes and PPE provision are recommended.

scholarly journals Impacts of the COVID-19 Pandemic on Home Health and Home Care Agency Managers, Clients, and Aides: A Cross-Sectional Survey, March to June, 2020

2020 ◽  
pp. 108482232098041
Author(s):  
Susan R. Sama ◽  
Margaret M. Quinn ◽  
Catherine J. Galligan ◽  
Nicole D. Karlsson ◽  
Rebecca J. Gore ◽  
...  
Keyword(s):  
Home Care ◽  
Infection Prevention ◽  
Complete Information ◽  
Home Health ◽  
Workforce Training ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Home Based ◽  
Pandemic Planning ◽  
The Impact

Home health and home care (HH&HC) agencies provide essential medical and supportive services to elders and people with disabilities, enabling them to live at home. Home-based care is an important alternative to facility-based care, especially for infection prevention during the COVID-19 pandemic. The majority of the HH&HC workforce is comprised of aides, who also are vulnerable to COVID-19. There are limited data on the COVID-19 experience of HH&HC agencies, clients and aides. A survey of Massachusetts HH&HC agency managers was conducted June 1 to 30, 2020 to assess the impact of COVID-19 on agencies, clients, and aides early in the pandemic and to identify needs for future pandemic planning. Of the 94 agencies with completed surveys, most (59.6%) provided services to clients with COVID-19 and 3-quarters (73.7%) employed aides who tested positive for COVID-19, were symptomatic, and/or quarantined. Most agencies (98.7%) experienced a decrease in demand for home visits, reflecting clients’ concern about infection, family members assuming care duties, and/or aides being unavailable for work. Simultaneously, managers’ workloads increased to develop more extensive infection prevention policies, procedures and workforce training and sourcing scarce personal protective equipment (PPE). The COVID-19 pandemic imposed substantial new infection prevention responsibilities on HH&HC agencies, clients, and aides. Specific HH&HC needs for future pandemic planning include complete information on the infection status of clients; ready access to affordable PPE and disinfectants; and guidance, tools, and training tailored for the industry. HH&HC should be incorporated more fully into comprehensive healthcare and public health pandemic planning.

Clinical Pharmacy Practice Patterns Among North Carolina Rural Hospitals

2019 ◽  
pp. 089719001986632 ◽  
Author(s):  
Cameron Lanier ◽  
Jason Moss ◽  
Robert Tunney ◽  
Ruthanne Baird ◽  
Kim Kelly
Keyword(s):  
North Carolina ◽  
Patient Care ◽  
Clinical Pharmacy ◽  
Pharmacy Practice ◽  
Rural Hospitals ◽  
Pharmacy Services ◽  
Clinical Services ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Clinical Pharmacy Services

Introduction: Rural hospitals are isolated without adequate funding needed to provide for clinical services offered at larger health systems. The purpose of this study is to determine the clinical pharmacy services available and desired by rural hospitals in North Carolina. Methods: This prospective, cross-sectional, survey was distributed to a cohort of rural pharmacy directors and managers at rural hospitals across North Carolina. Data collected pertained to characteristics of the hospital and pharmacy, pharmacy director, clinical services, and responder impressions on their ability to maintain or enhance clinical services. Responses were summarized utilizing descriptive statistics and free-responses were coded for similar themes. Results: Seventeen respondents (32.6%) completed the survey. Clinical activities varied, as did characteristics of the hospitals and staff. Improved patient care is the primary reason why hospital pharmacies expand their clinical participation (46.7%). Pharmacy directors believed growth of clinical activities was a long-term goal while reporting regulations, staff, and finances as barriers to growth. Conclusion: Clinical pharmacy services vary in NC rural hospitals. Directors exhibit a willingness to expand clinical responsibilities. Rural hospital pharmacy directors desire pharmacists to be active clinically in patient care, but face barriers in reaching that goal.

Occupational Exposures in the Homecare Environment: Piloting an Observation Tool

2021 ◽  
pp. 108482232098691
Author(s):  
Elizabeth Bien ◽  
Kermit Davis ◽  
Susan Reutman ◽  
Gordon Gillespie
Keyword(s):  
Home Care ◽  
Patient Care ◽  
Occupational Safety ◽  
Occupational Exposures ◽  
Care Patient ◽  
Home Healthcare ◽  
Occupational Hazards ◽  
Cross Sectional ◽  
Direct Observations ◽  
Occupational Setting

The population of home healthcare workers (HHCWs) is rapidly expanding. Worker tasks and the unique home care environments place the worker at increased risks of occupational exposures, injury, and illness. Previous studies focusing on occupational exposures of HHCWs are limited to self-reports and would benefit from direct observations. The purpose of this study is to describe the occupational hazards observed in the unique work environment of home healthcare. HHCWs and home care patient participants were recruited from one home care agency in the Midwest to be observed during a routine home visit. This cross-sectional study used a trained occupational health nurse for direct observation of the occupational setting. Standardized observations and data collection were completed using the Home Healthcare Worker Observation Tool. The observer followed a registered nurse and occupational therapist into 9 patient homes observing visits ranging from 22 to 58 minutes. Hazards observed outside of and within the home include uneven pavements (n = 6, 67%), stairs without railings (n = 2, 22%), throw rugs (n = 7, 78%), unrestrained animals (n = 2, 22%), dust (n = 5, 56%), and mold (n = 2, 22%). Hand hygiene was observed prior to patient care 2 times (22%) and after patient care during 5 visits (56%). Observations have identified hazards that have the potential to impact workers’ and patients’ health. The direct observations of HHCWs provided opportunities for occupational safety professionals to understand the occupational exposures and challenges HHCWs encounter in the home care environment and begin to identify ways to mitigate occupational hazards.

scholarly journals The PROMISES study: a mixed methods approach to explore the acceptability of salivary progesterone testing for preterm birth risk among pregnant women and trained frontline healthcare workers in rural India

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040268
Author(s):  
Danielle Ashworth ◽  
Pankhuri Sharma ◽  
Sergio A Silverio ◽  
Simi Khan ◽  
Nishtha Kathuria ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Barriers And Facilitators ◽  
Rural India ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Thematic Framework

IntroductionIndia has an overall neonatal mortality rate of 28/1000 live births, with higher rates in rural India. Approximately 3.5 million pregnancies in India are affected by preterm birth (PTB) annually and contribute to approximately a quarter of PTBs globally. Embedded within the PROMISES study (which aims to validate a low-cost salivary progesterone test for early detection of PTB risk), we present a mixed methods explanatory sequential feasibility substudy of the salivary progesterone test.MethodsA pretraining and post-training questionnaire to assess Accredited Social Health Activists (ASHAs) (n=201) knowledge and experience of PTB and salivary progesterone sampling was analysed using the McNemar test. Descriptive statistics for a cross-sectional survey of pregnant women (n=400) are presented in which the acceptability of this test for pregnant women is assessed. Structured interviews were undertaken with ASHAs (n=10) and pregnant women (n=9), and were analysed using thematic framework analysis to explore the barriers and facilitators influencing the use of this test in rural India.ResultsBefore training, ASHAs’ knowledge of PTB (including risk factors, causes, postnatal support and testing) was very limited. After the training programme, there was a significant improvement in the ASHAs’ knowledge of PTB. All 400 women reported the salivary test was acceptable with the majority finding it easy but not quick or better than drawing blood. For the qualitative aspects of the study, analysis of interview data with ASHAs and women, our thematic framework comprised of three main areas: implementation of intervention; networks of influence and access to healthcare. Qualitative data were stratified and presented as barriers and facilitators.ConclusionThis study suggests support for ongoing investigations validating PTB testing using salivary progesterone in rural settings.

scholarly journals Perspectives from Dentists, Dental Assistants, Students, and Patients on Dental Care Adapted to the COVID-19 Pandemic: A Cross-Sectional Survey

2021 ◽  
Vol 18 (8) ◽  
pp. 3940
Author(s):  
Maximiliane Amelie Schlenz ◽  
Alexander Schmidt ◽  
Bernd Wöstmann ◽  
Andreas May ◽  
Hans-Peter Howaldt ◽  
...  
Keyword(s):  
Patient Care ◽  
Dental Care ◽  
Health Care Professionals ◽  
Dental Treatment ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Safety Measures ◽  
Dental Clinics ◽  
Positive Perspective ◽  
Dental Assistants

Dental care has been affected by SARS-CoV-2 (COVID-19) worldwide. In contrast to other dental clinics, the Justus-Liebig-University Giessen (Germany) decided not to limit dental treatment to emergencies alone, but to continue dental care for all patients, with increased safety measures. As such, health care professionals may be exposed to additional physical and mental stress. The aim of this study was to assess the perspectives of all persons involved in dental care (dentists, dental assistants, students, and patients) regarding the aspects of safety measures, anxiety about self-infection and infecting others, and other prospects in the period March to December 2020 using a questionnaire. Data collection was performed between 14 December 2020 and 23 January 2021. A total of 35 dentists (response rate of 79.5%), 23 dental assistants (65.7%), 84 students (80%), and 51 patients (21.8%) completed the survey. The patients did not notice any changes in the care received. Dentists and dental assistants reported a higher workload due to additional safety measures. The majority of dentists, students, and patients agreed that normal patient care was maintained. One-third of dental assistants would have preferred emergency treatment alone and expressed significantly higher anxiety about COVID-19 infection than all other groups (p < 0.05). In conclusion, all groups showed a predominantly positive perspective on dental care, and anxiety about self-infection and infecting others was especially low. However, additional measures are time-consuming and compound daily patient care. This concept, based on well-established infection control, might be a viable proposal for current and future pandemics.

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