Spending one's last days and dying at home is a common wish of people with a life-limiting illness. Home-based palliative care is essentially organised at the primary level to meet the needs of ...palliative patients and their carers. The aim of this study was to identify the characteristics of home-based palliative care, focusing on those who identify palliative patients, what their needs are and how this affects their length of life and site of death.
This retrospective cohort study analysed routinely collected notes of patients enrolled in home-based palliative care between 2015 and 2021. Palliative care was provided by a primary health care team in a predominantly rural area.
This study included 107 palliative patients, aged 71±11.4 years, 94% of whom had cancer. They were enrolled in palliative care by their primary care team or by hospital staff. The enrolment by hospital staff (3%) resulted in significantly shorter survival (p=0.008). Patients lived an average of 66 days, and 65% of patients died at home. Home-based palliative care was found to respond to both basic and complex palliative medical needs, but was weaker in addressing socio-economic, psychological or spiritual issues.
This exemplary primary-level palliative team provided home-based palliative care that has improved over the years in terms of all the observed quality indicators: early enrolment, the proportion of patients dying at home and the ability to address needs. Specialised mobile palliative teams, hospitals and other palliative care settings complement home-based palliative care.
Teoretična izhodišča. Socialna oskrba na domu je pomembna storitev za starejše z zdravstvenimi težavami, prebivajoče v domačem okolju. Ob zagotavljanju boljše kakovosti življenja ta storitev pomembno ...razbremenjuje institucionalne storitve zdravstvenega in socialnovarstvenega sistema.
Ugotovitve različnih avtorjev kažejo, da imajo starejši ljudje po večini negativen odnos do oskrbe na domu na daljavo. Da bi spoznali stališča starejših do te storitve v Sloveniji, smo izvedli ...raziskavo, katere rezultati so obravnavani v tem članku. Izkazalo se je, da imajo starejši ljudje do oskrbe na domu na daljavo pozitiven odnos, kar smo pripisali učinkovitemu informiranju. Ozaveščanje potencialnih uporabnikov je zato ključnega pomena pri njenem sprejetju v družbi, vendar se je treba pri uvajanju te storitve različno odzivati na potrebe starejših v mestnem in podeželskem okolju.
Theory. Social homecare is important for older people, as it enables them to remain in their own homes during worsening health, thus relieving the burden on institutional facilities such as homes for ...the elderly or nursing homes and hospitals.
Method. A representative survey of social homecare users was employed to assess determinants of the scope of social homecare in Slovenia. Multiple regression analysis was used to evaluate determinants defined by Andersen’s behavioral model that affect the scope of social homecare.
Results. As expected, need (Functional impairment B = .378, P = 0.000) was the most important explanatory component, followed by availability of informal care network (Lives alone B = -.136, P = 0.000; Has children B = - .142; P = 0.000) and other contextual factors such as total costs of the services (B = -.075; P = 0.003) and temporal availability of services (B=-.075, P=0.012). The model explained 18% of variability in the scope of social homecare.
Conclusion. This study showed that data on the individual level, as opposed to data on an aggregated level, show different determinants of social homecare utilization. Moreover, the results showed that social homecare is especially important in two circumstances: when older people have a high level of need and when they do not have access to informal care networks. Contextual factors had a moderate effect on the scope of social homecare, which shows universal access to the latter at the individual level.
Teoretična izhodišča. Socialna oskrba na domu je pomembna storitev za starejše z zdravstvenimi težavami, prebivajoče v domačem okolju. Ob zagotavljanju boljše kakovosti življenja ta storitev pomembno razbremenjuje institucionalne storitve zdravstvenega in socialnovarstvenega sistema.
Metoda. Na podatkih reprezentativne raziskave uporabnikov socialne oskrbe na domu smo raziskali vpliv teh dejavnikov na obseg socialne oskrbe na domu. Z multiplo regresijsko analizo smo ugotovili vpliv dispozicijskih in kontekstualnih dejavnikov ter potreb na število aktivnosti, pri katerih uporabnikom pomagajo socialne oskrbovalke.
Rezultati. Kot predpostavlja teoretski model, potrebe (B = ,378, P = 0,000) pojasnijo največji del variabilnosti obsega socialne oskrbe na domu. Po pojasnjevalni moči sledijo razpoložljivost neformalnih oskrbovalcev(živi sam B = -0,136, P = 0,000; ima otroke B = -0,142; P = 0,000) ter drugi kontekstualni dejavniki, kot so skupni stroški ure oskrbe(B = -0,075; P = 0,003) in časovna razpoložljivost socialne oskrbe na domu(B= -0,075, P=0,012). Končni model pojasni 18% obsega socialne oskrbe na domu.
Razprava. Dokazali smo, da na individualni ravni na uporabo socialne oskrbe na domu vplivajo drugi dejavniki kot na agregirani ravni. Socialna oskrba na domu je najpomembnejša ob veliki potrebi po oskrbi in odsotnosti neformalnih oskrbovalcev. Zmeren vpliv kontekstualnih dejavnikov nakazuje sorazmerno enakomeren dostop do socialne oskrbe na domu.
Contextual factors of home care utilization in Slovenia Background: Andersen's behavioural model for predicting the use of health care services has already been used to explain the utilization of ...home care services or other community type services. The model includes predisposing and enabling factors and illness level. We will use the enabling factors to explain variability in the utilization of home care services across Slovenian municipalities. Methods: Multiple classification analysis is performed on municipalities as units of analysis. The dependent variable is the number of users of home care among 1000 residents of the municipality (both 65+). Several enabling factors are included in the model, which measure the characteristics of municipalities and their residents. Results: Enabling factors explain 13% of the variability in the number of home care users. Significantly more users are found in municipalities that are more urban, have a lower number of residents per km2, have a higher proportion of students and percentage of active population. Organizational factors (the price of services and the provision of services during afternoons, weekends and holidays)are not related to the number of users, and nor is the number of residents receiving financial social assistance. Conclusions: The study revealed important determinants of the utilization of home care services in Slovenian municipalities. The lack of a significant relationship between the number of users and organizational factors can be attributed to the novelty of this program in Slovenia. We stress the need to conduct more research in this field, especially the collection of data on the individual level of users. PUBLICATION ABSTRACT
PDF
