Medication management has a key role in the daily tasks of home care professionals delivered to older clients in home care. The aim of this study was to examine the effect of using a robot for ...medication management on home care professionals´ use of working time.
A pragmatic non-randomized controlled clinical trial was conducted. The participants were home care professionals who carried out home care clients' medication management. Home care clients were allocated into intervention groups (IG) and control groups (CG) (n = 64 and 46, respectively) based on whether or not they received the robot. Data were collected using the Working Time Tracking Form prior to and 1 and 2 months after introducing the intervention. The t-test was used to compare the groups at each three timepoints. Analysis of Covariance was used to examine the groups' differences for the total time for medications as the number of visits per day as the covariate.
With robot use, the total amount of home visits decreased by 89.4% and 92.4% after 1 and 2 months of intervention use, respectively, compared to pre-intervention (p < 0.001). The total working time used for medication management considering the number of visits per day decreased from 54.2 min (95% CI 37.4-44.3) to 34.9 min (31.4-38.3), i.e., by slightly over 19 min (p < 0.001) in the IG group. During the follow-up, the total working time used for medication management considering the number of visits per day remained the same in the CG group.
Using a robot for medication management had a notable effect on decreasing the use of working time of home care professionals. For health services, decreased use of working time for medication management means that the time saved can be assigned to services that cannot be replaced otherwise. More digital solutions should be developed based on home care clients' and professionals' needs to meet the challenge of the growing number of older people in need of home care and ensure their safety.
ClinicalTrials.gov Identifier: NCT05908604 retrospectively registered (18/06/2023).
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CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
There has been a limited understanding of the longitudinal trajectory and determinants of socio-emotional outcomes among children in out-of-home care (OOHC).
This study aimed to examine child ...socio-demographics, pre-care maltreatment, placement, and caregiver factors associated with trajectories of socio-emotional difficulties of children in OOHC.
The study sample (n = 345) included data from the Pathways of Care Longitudinal Study (POCLS), a prospective longitudinal cohort of children aged 3–17 years who entered the OOHC system in New South Wales (NSW) Australia, between 2010 and 2011.
Group-based trajectory models were used to identify distinct socio-emotional trajectory groups based on the Child Behaviour Check List (CBCL) Total Problem T-scores completed at all four Waves 1–4. Modified Poisson regression analysis was conducted to assess the association (risk ratios) of socio-emotional trajectory group membership with pre-care maltreatment, placement, and caregiver-related factors.
Three trajectories of socio-emotional development were identified: ‘persistently low difficulties’ (average CBCL T-score changed from 40 to 38 over time), normal (average CBCL T-score changed from 52 to 55 over time), and clinical (average CBCL T-score remained at 68 over time) trajectories. Each trajectory presented a stable trend over time. Relative/kinship care, as compared with foster care, was associated with the “persistently low” socio-emotional trajectory. Being male, exposure to ≥8 pre-care substantiated risk of significant harm (ROSH) reports, placement changes, and caregiver's psychological distress (more than two-fold increased risk) were associated with the clinical socio-emotional trajectory.
Early intervention to ensure children have a nurturing care environment and psychological support to caregivers are vital for positive socio-emotional development over time among children in long-term OOHC.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
33.
Admission avoidance hospital at home Shepperd, Sasha; Doll, Helen; Angus, Robert M ...
Cochrane database of systematic reviews,
01/2008
4
Journal Article
Peer reviewed
Open access
Admission avoidance hospital at home is a service that provides active treatment by health care professionals in the patient's home for a condition that otherwise would require acute hospital ...in-patient care, and always for a limited time period. In particular, hospital at home has to offer a specific service to patients in their home requiring health care professionals to take an active part in the patients' care. If hospital at home were not available then the patient would be admitted to an acute hospital ward. Many countries are adopting this type of care in an attempt to reduce the demand for acute hospital admission.
To determine, in the context of a systematic review and meta analysis, the effectiveness and cost of managing patients with admission avoidance hospital at home compared with in-patient hospital care.
The following databases were searched through to January 2008: MEDLINE, EMBASE, CINAHL, EconLit and the Cochrane Effective Practice and Organisation of Care Group (EPOC) register. We checked the reference lists of articles identified electronically for evaluations of hospital at home and obtained potentially relevant articles. Unpublished studies were sought by contacting providers and researchers who were known to be involved in this field.
Randomised controlled trials recruiting patients aged 18 years and over. Studies comparing admission avoidance hospital at home with acute hospital in-patient care. The admission avoidance hospital at home interventions may admit patients directly from the community thereby avoiding physical contact with the hospital, or may admit from the emergency room.
Two authors independently extracted data and assessed study quality. Our statistical analyses sought to include all randomised patients and were done on an intention to treat basis. We requested individual patient data (IPD) from trialists, and relied on published data when we did not receive trial data sets or the IPD did not include the relevant outcomes. When combining outcome data was not possible because of differences in the reporting of outcomes we have presented the data in narrative summary tables.For the IPD meta-analysis, where at least one event was reported in both study groups in a trial, Cox regression models were used to calculate the log hazard ratio and its standard error for mortality and readmission separately for each data set (where both outcomes were available). We included randomisation group (admission avoidance hospital at home versus control), age (above or below the median), and gender in the models. The calculated log hazard ratios were combined using fixed effects inverse variance meta analysis. If there were no events in one group we used the Peto odds ratio method to calculate a log odds ratio from the sum of the log-rank test 'O-E' statistics from a Kaplan Meier survival analysis. Statistical significance throughout was taken at the two-sided 5% level (p<0.05) and data are presented as the estimated effect with 95% confidence intervals. For each comparison using published data for dichotomous outcomes we calculated risk ratios using a fixed effects model to combine data.
We included 10 RCTs (n=1333), 7 of which were eligible for the IPD. Five out of these seven trials contributed to the IPD meta-analysis (n=850/975; 87%). There was a non significant reduction in mortality at three months for the admission avoidance hospital at home group (adjusted HR 0.77, 95% CI 0.54 to 1.09; p=0.15), which reached significance at six months follow-up (adjusted HR 0.62, 95% CI 0.45 to 0.87; p=0.005). A non significant increase in admissions was observed for patients allocated to hospital at home (adjusted HR 1.49, 95% CI 0.96 to 2.33; p=0.08). Few differences were reported for functional ability, quality of life or cognitive ability. Patients reported increased satisfaction with admission avoidance hospital at home. Two trials conducted a full economic analysis, when the costs of informal care were excluded admission avoidance hospital at home was less expensive than admission to an acute hospital ward.
We performed meta-analyses where there was sufficient similarity among the trials and where common outcomes had been measured. There is no evidence from the analysis to suggest that admission avoidance hospital at home leads to outcomes that differ from inpatient hospital care.
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NUK, OILJ, UL, UM, UPUK, VSZLJ
Children with disability are over-represented in out-of-home care (OOHC) in Australia and internationally. Yet we know little about their circumstances, placement types, support needs, and the ...outcomes of their trajectories and wellbeing through care.
We examine the wellbeing and outcomes of children with and without disabilities in OOHC.
We use panel data from waves 1–4 of the Pathways of Care Longitudinal Study (POCLS) collected between June 2011 and November 2018 by the New South Wales (NSW) Department of Communities and Justice (DCJ), Australia. The POCLS sampling framework covers all children aged 0–17 years who entered OOHC in NSW for the first time between May 2010 and October 2011 (n = 4126). A subset of these children (n = 2828) had final Children's Court orders by 30 April 2013. Among these, caregivers of 1789 children agreed to participate in the interview component of the POCLS.
We employ a random effects estimator to analyse the panel data. This is standard practice to exploit a panel database when some of the key explanatory variables are time invariant.
Children with disability have poorer wellbeing than children without disability across the three domains of physical health, socio-emotional wellbeing, and cognitive ability. However, children with disability have fewer difficulties at school and better school bonding. The type of placements – namely relative/kinship care, restoration/adoption/guardianship, foster care and residential care – have little or limited association with wellbeing of children with disability.
Children with disability tend to have lower levels of wellbeing in OOHC than children without disability, and this is driven mainly by their disability status rather than care factors.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background:
Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients ...with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion.
Aim:
To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care.
Design:
A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients’ responses to the EQ-5D quality of life instrument.
Setting/participants:
Patients with chronic and severe heart failure were randomly assigned to an intervention (n = 36) or control (n = 36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6 months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital.
Results:
EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs.
Conclusion:
The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Globally, Indigenous children have historical and contemporary connections with government child protection services that have caused significant harm to their long-term health and wellbeing. ...Innovative, culturally secure and recovery focussed service provision is required. This paper describes a research protocol that has been designed by Indigenous researchers led by Indigenous Elders, to explore culturally secure care planning and service delivery in out-of-home care agencies in Australia. Using participatory action research methods, we will collect data using a variety of forums, including focus groups and semi-structured interviews. These data will explore the challenges for out-of-home care agencies in providing culturally secure care-planning, cultural activity and resources, and explore solutions to address factors that influence health and can assist to redress social inequities for Indigenous children. We aim to recruit approximately 100 participants for the qualitative study and 40 participants for the quantitative survey. Study participants will initially be recruited using purposive sampling, and as the study progresses will be recruited using a mixture of purposive and convenience sampling techniques. The rich data that this study is expected to yield, will inform ways to collect cultural information about Indigenous children and ways to provide cultural connections and activities that will have benefit to Indigenous children and families, and a broad range of social services.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The increasing risk of disasters worldwide poses challenges both to health care infrastructures and to home care providers, who must maintain decentralised services for those in need of long-term ...care for as long as possible, even under adverse circumstances. However, both the kind of organisational precautions that home care providers consider in preparation for disasters and the available evidence on the effectiveness of these precautions remain largely unclear. An integrative literature review was thus performed via a systematic search of several international databases in order to identify original research on organisational disaster planning by home care providers and to determine the evidence base of this research. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Of the 286 results, 12 articles met the inclusion criteria and presented results from nine studies on disaster planning. Three overarching types of activities carried out by home care providers were identified inductively. The overall scientific quality of the studies was moderate, and none investigated the effectiveness of disaster planning by home care providers. Despite the variety of possible activities that home care providers already consider, evidence on how to make organisational disaster planning effective and sustainable remains lacking.
Mixing personal history, interviewee voices, and academic theory from the fields of care work, the sociology of work, medical sociology, and nursing, Taking Care of Our Own introduces us to the ...hidden world of family caregivers. Using a multidimensional approach, Sherry N. Mong seeks to understand and analyze the types of skilled work that family caregivers do, the processes through which they learn and negotiate new skills, and the meanings that both caregivers and nurses attach to their care work. Taking Care of Our Own is based on sixty-two in-depth interviews with family caregivers, home and community health care nurses, and other expert observers to provide a lens through which in-home care processes are analyzed, while also exploring how caregivers learn necessary procedures. Further, Mong examines the emotional labor of caregiving, as well as the identities of caregivers and nurses who are key players in the labor process, and gives attention to the ways in which the labor is transferred from medical professionals to family caregivers.
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