Статті в журналах: "Home care package services"

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Brotherhood, Kelly, Barbara Hanratty, Gemma Spiers, Camila Caiado, and Julia Newton. "PATTERNS OF SOCIAL CARE USE WITHIN THE OLDER POPULATION: WHAT CAN WE LEARN FROM ROUTINELY COLLECTED DATA?" Innovation in Aging 7, Supplement_1 (December 1, 2023): 707. http://dx.doi.org/10.1093/geroni/igad104.2294.

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Abstract Research with routinely collected social care data has untapped potential to inform new care delivery approaches and techniques. To identify opportunities for service improvement and enhance our understanding of care pathways experienced by the older population, we collaborated with a local authority in the North East of England. We set out to characterise the use of social care services and associated outcomes within the local older population (aged 65+). 171,386 records were extracted from the local authority’s social care case management system, relating to 38,191 unique individuals across the last 40 years. We identified the care packages provided to the local population, including care provided in care homes (with and without nursing), private households and assisted living facilities. The study population varied in terms of the number of care packages provided to each individual (median 7 packages, IQR 4-11) and the average duration of individual care packages (median 41 days, IQR 14 - 274 days). The care pathways that are most common amongst the older population will be described, including sequencing and outcomes, and grouped by the reason for providing care (e.g., respite, long-term care) and the reason why each care package ended (e.g., death, returning home). The wide range of care pathways experienced demonstrate the heterogeneity in needs and preferences within the older population. This dataset and analyses are an invaluable way of identifying areas of potential unmet need and evaluating the effectiveness of short-term care services.

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Missell, Rachel, Sarah Szanton, Thomas Caprio, Kobi Nathan, and Adam Simning. "CAPABLE Transitions: A Home Health Agency-Based Intervention to Optimize the SNF-to-Home Transition." Innovation in Aging 4, Supplement_1 (December 1, 2020): 872–73. http://dx.doi.org/10.1093/geroni/igaa057.3226.

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Abstract Community Aging in Place-Advancing Better Living for Elders (CAPABLE) consists of an interprofessional team of a registered nurse (RN), occupational therapist (OT), and handyworker that delivers an in-home client-specific package of interventions to optimize function. CAPABLE aims to reduce functional impairment, home hazards, and acute medical services use and is being widely disseminated. To expand CAPABLE to older adults transitioning from the skilled nursing facility (SNF) to home, we developed CAPABLE Transitions, which makes several important modifications to CAPABLE. First, CAPABLE Transitions will be implemented within a Medicare-certified home health agency (CHHA) and delivered to CHHA clients. Second, it will be delivered to CHHA clients with and without dementia. Adding urgency to CAPABLE Transitions’ development, including persons with dementia has the potential to decrease high utilization of services and meet care transition needs. Third, it includes an initial RN care transition visit. Fourth, its services are more intensely delivered at the beginning of the intervention, shortly after SNF discharge. Beginning in the fall of 2020, CAPABLE Transitions will be tested in a feasibility study of 60 older adults discharged from post-acute SNF care to CHHA services in Rochester, NY. We have designed this 3-year feasibility study to consist of yearly recruitment waves that will enable us to iteratively assess and refine the intervention. Following this study, we hope to test CAPABLE Transitions’ effect on improving home time, quality of life, and the use of acute medical services in order to assist older adults in aging in place.

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Tangcharoensathien, Viroj, Saranya Sachdev, Shaheda Viriyathorn, Kriddhiya Sriprasert, Lalitaya Kongkam, Kanchana Srichomphu, and Walaiporn Patcharanarumol. "Universal access to comprehensive COVID-19 services for everyone in Thailand." BMJ Global Health 7, no. 6 (June 2022): e009281. http://dx.doi.org/10.1136/bmjgh-2022-009281.

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Despite Thailand having had universal health coverage (UHC) with comprehensive benefit packages since 2002, services are neither listed nor budget earmarked for COVID-19 responses. Policy decisions were made immediately after the first outbreak in 2020 to fully fund a comprehensive benefit package for COVID-19. The Cabinet approved significant additional budget to respond to the unfolding pandemic. The comprehensive benefit package includes laboratory tests, contact tracing, active case findings, 14-day quarantine measures (including tests, food and lodging), field hospitals, ambulance services for referral, clinical services both at hospitals and in home and community isolation, vaccines and vaccination cost, all without copayment by users. No-fault compensation for adverse events or deaths following vaccination is also provided. Services were purchased from qualified public and private providers using the same rate, terms and conditions. The benefit package applies to everyone living in Thailand including Thai citizens and migrant workers. A standardised and comprehensive COVID-19 benefit package for Thai and non-Thai population without copayment facilitates universal and equitable access to care irrespective of capacity to pay and social status and nationality, all while aiming to supporting pandemic containment. Making essential services available, notably laboratory tests, through the engagement of qualified both public and private sectors boost supply side capacity. These policies and implementations in this paper are useful lessons for other low-income and middle-income countries on how UHC reinforces pandemic containment.

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Keogh, Fiona, Tom Pierse, and Eamon O'Shea. "96 Service Priorities for People with Dementia in Ireland: A Mixed Methods Study of Health Care Professionals." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.57.

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Abstract Background Public services for people with dementia living in the community face significant resource constraints. The aims of this study are to identify an optimum mix of services for six dementia case types and to gain a greater understanding of the resource allocation decision making process. Methods Irish datasets were used to identify dementia cases types representing 46% of cases in the datasets. Vignettes were prepared for six case types ranging from low to high dependency and needs. Carers, people with dementia and health and social care professionals (HSCPs) took part in mixed methods workshops. Initial findings for the HSCPs are reported here (N=23). HSCP participants firstly quantitatively identified an optimum care package for a set of six vignettes, then qualitatively discussed the needs and individual case factors that were driving service recommendations. The quantitative exercise was repeated with a budget constraint. The sessions finished with a discussion on service and case prioritisation. Results When no budget constraint is imposed, participants recommended the use of a wide range of services. Home help, in-home respite and day care services comprised 62% of spending in this scenario. When a budget constraint was imposed, participants focused on essential care and reduced services aimed at prevention, quality of life and carer support. Resources were not redistributed between cases (e.g. from low need to higher need cases) as a similar proportion of the budget was allocated to each of the cases in both scenarios. Conclusion People with dementia living in the community and their families have a wide range of health and social care needs. Optimum dementia care packages included a wide range of services to meet these needs. However, a budget constraint resulted in a much narrower range of services with consequent implications in terms of unmet need and a reactive rather than preventive approach to care.

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Doyle, Caroline, Marie King, Shane Kirwan, Bernie Jennings, Aoife Farrington, Brian Keogh, and Gráinne Donohue. "Evaluation of the home care service: a remote inpatient service for people requiring mental health care." British Journal of Mental Health Nursing 12, no. 3 (August 2, 2023): 1–10. http://dx.doi.org/10.12968/bjmh.2022.0023.

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Background/Aims In response to the COVID-19 pandemic, St Patrick's Mental Health Services introduced a home care package, offering all the elements of the inpatient programmes, but provided to the service user remotely in their own home. A survey was used to evaluate service user experiences of receiving remote inpatient mental health treatment via the home care service. Methods All participants who had a virtual admission were invited to complete a quantitative survey online. Data were inputted into the Statistical Package for Social Sciences software and a descriptive analysis was completed. Results A total of 88 participants completed the online survey, the majority of whom were women (62.5%) and between the ages of 61 and 70 years (28.4%). Diagnosis was most often depression (60.2%) or anxiety (29.4%) and almost 66% of participants had previous inpatient experience. Staff rated most highly by participants were the consultant psychiatrist (96.7%), ward-based nursing staff (95.2%) and their psychologist (92.3%). The highest rating statements, which participants rated as part of a questionnaire, were around technology options (87.1%), one-to-one work with a clinician (81.3%) and arranging collection of medicine (81%). Conclusions Preliminary scores on this survey demonstrate that remote care is an effective way to improve access, enhance quality and provide efficient care. Further research should consider clinical outcomes with this model compared to standard care.

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Stocker, Rachel, Siân Russell, Jennifer Liddle, Robert O. Barker, Adam Remmer, Joanne Gray, Barbara Hanratty, and Joy Adamson. "Experiences of a National Early Warning Score (NEWS) intervention in care homes during the COVID-19 pandemic: a qualitative interview study." BMJ Open 11, no. 7 (July 2021): e045469. http://dx.doi.org/10.1136/bmjopen-2020-045469.

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BackgroundThe COVID-19 pandemic has taken a heavy toll on the care home sector, with residents accounting for up to half of all deaths in Europe. The response to acute illness in care homes plays a particularly important role in the care of residents during a pandemic. Digital recording of a National Early Warning Score (NEWS), which involves the measurement of physical observations, started in care homes in one area of England in 2016. Implementation of a NEWS intervention (including equipment, training and support) was accelerated early in the pandemic, despite limited evidence for its use in the care home setting.ObjectivesTo understand how a NEWS intervention has been used in care homes in one area of North-East England during the COVID-19 pandemic, and how it has influenced resident care, from the perspective of stakeholders involved in care delivery and commissioning.MethodsA qualitative interview study with care home (n=10) and National Health Service (n=7) staff. Data were analysed using thematic analysis.ResultsUse of the NEWS intervention in care homes in this area accelerated during the COVID-19 pandemic. Stakeholders felt that NEWS, and its associated education and support package, improved the response of care homes and healthcare professionals to deterioration in residents’ health during the pandemic. Healthcare professionals valued the ability to remotely monitor resident observations, which facilitated triage and treatment decisions. Care home staff felt empowered by NEWS, providing a common clinical language to communicate concerns with external services, acting as an adjunct to staff intuition of resident deterioration.ConclusionsThe NEWS intervention formed an important part of the care home response to COVID-19 in the study area. Positive staff perceptions now need to be supplemented with data on the impact on resident health and well-being, workload, and service utilisation, during the pandemic and beyond.

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Ingram, Jennifer, Peter S. Blair, Jane E. Powell, Sarah Manns, Heather Burden, David Pontin, Margaret Redshaw, et al. "Preparing for Home: a before-and-after study to investigate the effects of a neonatal discharge package aimed at increasing parental knowledge, understanding and confidence in caring for their preterm infant before and after discharge from hospital." Health Services and Delivery Research 4, no. 10 (March 2016): 1–114. http://dx.doi.org/10.3310/hsdr04100.

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BackgroundImproved survival and shorter length of stay (LOS) for preterm infants, together with poorly organised discharge planning in some neonatal units, leaves many parents ill prepared to take their babies home, with increased use of out-of-hours services. Despite the importance accorded to family-orientated neonatal care by the Department of Health and the National Institute for Health and Care Excellence, few neonatal units offer structured, family-orientated discharge planning.ObjectivesTo implement a parent-orientated discharge planning approach (Train-to-Home package) for preterm infants and investigate the effects on parental self-efficacy scores, infants’ LOS and change in costs associated with use of health-care resources in the 8 weeks after discharge, before and after implementation.DesignA before-and-after study, investigating the effects of Train-to-Home package during two 11-month periods, immediately before and after its implementation.SettingFour local neonatal units in South West England.ParticipantsInfants without major anomalies, born at 27–33 weeks’ gestation, admitted to the participating units, and their parents.Train-to-Home interventionA parent-orientated package that incorporated approaches to improving parents’ involvement in, and understanding of, their baby’s needs. It comprised a train graphic and supporting care pathways to facilitate parents’ understanding of their baby’s progress through the neonatal unit, combined with improved estimation, soon after hospital admission, of the baby’s likely discharge date.Main outcome measuresPrimary – Perceived Maternal Parenting Self-Efficacy (PMPS-E) scores before and after implementing the Train-to-Home package; secondary – infant LOS and health-care utilisation after discharge.ResultsWe recruited 128 and 117 infants, respectively, in phase 1 (before implementation) and phase 2 (after implementation). In phase 2, parents reported improved understanding of babies’ progress, and preparedness for discharge, although PMPS-E scores did not change. The number of visits to emergency departments (EDs) fell from 31 in phase 1 to 20 in phase 2 (p < 0.05), with a significant reduction in associated health-care costs (from £3400 to £2200;p < 0.05) after hospital discharge. LOS did not change, but in both phases of the study > 50% of infants went home at > 3 weeks before their estimated date of delivery. Many nurses felt that the estimated discharge dates were over-optimistic, despite being based upon recent local data, and accurately predicting discharge dates for almost 75% of babies in the study.HarmsNo adverse consequences were identified.ConclusionsThe very early discharge of most babies made further shortening of LOS very difficult to achieve. Despite the lack of change of the parental self-efficacy scores, parents reported that their understanding and confidence in caring for their infants were improved by the Train-to-Home package, and the reduction in ED attendance and associated costs supports this assessment. The present study was limited by the tight time constraints for implementation, limited cascading of staff training and lack of staff confidence in the estimated dates of discharge.Future workProvision of the Train-to-Home package as a web-based system, allowing individual neonatal units and parents to access and use the materials, may allow more effective implementation in the future.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Stewart, Jill, Rachel Crockett, Jim Gritton, Brendon Stubbs, and Ann Pascoe. "Ageing at home? Meeting housing, health and social needs." Journal of Integrated Care 22, no. 5/6 (December 15, 2014): 242–52. http://dx.doi.org/10.1108/jica-04-2014-0010.

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Purpose – The purpose of this paper is to consolidate the range of issues relevant to owner occupiers who age in place and to offer an initial overview of how effective partnerships can respond to and meet the changing needs of housing, health and social care of our ageing population. Design/methodology/approach – Issues affecting older people's changing needs are considered holistically and considered in terms of how partnerships can be enhanced to develop improved services in the future. Findings – Most owners wish to stay in their own homes for as long as possible and it can be cost-effective to do so; however, we need to look at new and innovative ways of developing and providing front-line services to enhance health and safety in the home, but also quality of life and wellbeing such as combating loneliness and isolation. However, although there are examples of evidence-based good practice, service provision is variable and there is a risk that many older home owners may miss out on services for which they may are eligible. With this in mind, it may be helpful to develop a new framework where one key practitioner holds responsibility to consolidate and coordinate the range of local services available as a package that offers a range of housing, health and social care services. Originality/value – There are currently many policy and practice gaps in older owner occupier's housing conditions and suitability to meet their changing needs. This paper has a particular starting point in housing, and how other personal or technological services can help support independence for as long as possible and adapt to the owner-occupier's changing health and social care needs as they age in place. The authors emphasise the importance of sharing evidence-based good practice partnerships.

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Pearson (Eastern Kuku‐Yalanji and Torres Strait Islander), Odette, Tracy Air, Greer Humphrey, Clare Bradley, Noeleen Tunny, Alex Brown (Yuin Nation), Steven L. Wesselingh, Maria C. Inacio, and Gillian E. Caughey. "Aged care service use by Aboriginal and Torres Strait Islander people after aged care eligibility assessments, 2017–2019: a population‐based retrospective cohort study." Medical Journal of Australia 221, no. 1 (July 2024): 31–38. http://dx.doi.org/10.5694/mja2.52353.

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AbstractObjectiveTo characterise the socio‐demographic characteristics, aged and health care needs, and aged care services used by older Aboriginal and Torres Strait Islander people assessed for aged care service eligibility.Study designPopulation‐based retrospective cohort study; analysis of Registry of Senior Australians (ROSA) National Historical Cohort data.Setting, participantsAboriginal and Torres Strait Islander people aged 50 years or older who were first assessed for aged care service eligibility (permanent residential aged care, home care package, respite care, or transition care) during 1 January 2017 – 31 December 2019.Major outcome measuresSocio‐demographic and aged care assessment characteristics; health conditions and functional limitations recorded at the time of the assessment; subsequent aged care service use.ResultsThe median age of the 6209 people assessed for aged care service eligibility was 67 years (interquartile range [IQR], 60–75 years), 3626 were women (58.4%), and 4043 lived in regional to very remote areas of Australia (65.1%). Aboriginal health workers were involved in 655 eligibility assessments (10.5%). The median number of health conditions was six (IQR, 4–8); 6013 (96.9%) had two or more health conditions, and 2592 (41.8%) had seven or more. Comorbidity was most frequent among people with mental health conditions: 597 of 1136 people with anxiety (52.5%) and 1170 of 2416 people with depression (48.5%) had seven or more other medical conditions. Geriatric syndromes were recorded for 2265 people (36.5%); assistance with at least one functional activity was required by 6190 people (99.7%). A total of 6114 people (98.5%) were approved for at least one aged care service, 3218 of whom (52.6%) subsequently used these services; the first services used were most frequently home care packages (1660 people, 51.6%).ConclusionDespite the high care needs of older Aboriginal and Torres Strait Islander people, only 52% used aged care services for which they were eligible. It is likely that the health and aged care needs of older Aboriginal and Torres Strait Islander people are not being adequately met.

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Diema Konlan, Kennedy, Nathaniel Kossi Vivor, Isaac Gegefe, Imoro A. Abdul-Rasheed, Bertha Esinam Kornyo, and Isaac Peter Kwao. "The Practice of Home Visiting by Community Health Nurses as a Primary Healthcare Intervention in a Low-Income Rural Setting: A Descriptive Cross-Sectional Study in the Adaklu District of the Volta Region, Ghana." Scientific World Journal 2021 (March 24, 2021): 1–11. http://dx.doi.org/10.1155/2021/8888845.

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Background. Home visit is an integral component of Ghana’s PHC delivery system. It is preventive and promotes health practice where health professionals render care to clients in their own environment and provide appropriate healthcare needs and social support services. This study describes the home visit practices in a rural district in the Volta Region of Ghana. Methodology. This descriptive cross-sectional study used 375 households and 11 community health nurses in the Adaklu district. Multistage sampling techniques were used to select 10 communities and study respondents using probability sampling methods. A pretested self-designed questionnaire and an interview guide for household members and community health nurses, respectively, were used for data collection. Quantitative data collected were coded, cleaned, and analysed using Statistical Package for Social Sciences into descriptive statistics, while qualitative data were analysed using the NVivo software. Thematic analysis was engaged that embraces three interrelated stages, namely, data reduction, data display, and data conclusion. Results. Home visit is a routine responsibility of all CHNs. The factors that influence home visiting were community members’ education and attitude, supervision challenges, lack of incentives and lack of basic logistics, uncooperative attitude, community inaccessibility, financial constraint, and limited number of staff. Household members (62.3%) indicated that health workers did not adequately attend to minor ailments as 78% benefited from the service and wished more activities could be added to the home visiting package (24.5%). Conclusion. There should be tailored training of CHNs on home visits skills so that they could expand the scope of services that can be provided. Also, community-based health workers such as community health volunteers, traditional birth attendants, and community clinic attendants can also be trained to identify and address health problems in the homes.

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Taylor, Donald H., Marion Danis, S. Yousuf Zafar, Lynn J. Howie, Gregory P. Samsa, Steven P. Wolf, and Amy P. Abernethy. "There Is a Mismatch Between the Medicare Benefit Package and the Preferences of Patients With Cancer and Their Caregivers." Journal of Clinical Oncology 32, no. 28 (October 1, 2014): 3163–68. http://dx.doi.org/10.1200/jco.2013.54.2605.

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Purpose To identify insured services that are most important to Medicare beneficiaries with cancer and their family caregivers when coverage is limited. Methods A total of 440 participants (patients, n = 246; caregivers, n = 194) were enrolled onto the CHAT (Choosing Health Plans All Together) study from August 2010 to March 2013. The exercise elicited preferences about what benefits Medicare should cover for patients with cancer in their last 6 months of life. Facilitated sessions lasted 2.5 hours, included 8 to 10 participants, and focused on choices about Medicare health benefits within the context of a resource-constrained environment. Results Six of 15 benefit categories were selected by > 80% of participants: cancer care, prescription drugs, primary care, home care, palliative care, and nursing home coverage. Only 12% of participants chose the maximum level of cancer benefits, a level of care commonly financed in the Medicare program. Between 40% and 50% of participants chose benefits not currently covered by Medicare: unrestricted cash, concurrent palliative care, and home-based long-term care. Nearly one in five participants picked some level of each of these three benefit categories and allocated on average 30% of their resources toward them. Conclusion The mismatch between covered benefits and participant preferences shows that addressing quality of life and the financial burden of care is a priority for a substantial subset of patients with cancer in the Medicare program. Patient and caregiver preferences can be elicited, and the choices they express could suggest potential for Medicare benefit package reform and flexibility.

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Bose, Mampi. "Determinants of Choice of Care Providers During Childbirth in Rural West Bengal, India." Indian Journal of Human Development 13, no. 1 (March 6, 2019): 47–70. http://dx.doi.org/10.1177/0973703018822555.

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The article analyses determinants of choice of care providers during childbirth. Public health facilities provide care for free to all women during childbirth in West Bengal. In addition, a cash incentive is also attached with the service package for poor women who give birth at public health facilities. However, a section of women still prefer to give birth at home and some avail services from private facilities. The article attempts to explore the reasons underlying such difference. This analysis is based on primary data collected from four villages of Jalpaiguri district following multistage sampling method. It involved a survey of 251 households having at least one child below 2 years. Multinomial logistic regression model was used to analyse the data. The results suggest that quality of public health services, rural infrastructure, utilization of antenatal care and conditional cash transfers influenced the choice of care providers. Women who were eligible for and were aware of Janani Suraksha Yojana were less likely to go to private health facilities for childbirth. However, the programme did not seem to be effective in terms of reducing delivery at home.

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Raeisi, Alireza, Jafar Sadegh Tabrizi, Ardeshir Khosravi, Amin Ataey, Masoumeh Ebrahimi Tavani, Hossein Gholami, Amir Masoud Azad, Elaheh Koosha, Seyed Hossein Wassegh, and Salar Mohammaddokht. "General Vaccination and Active Prevention of COVID-19 Epidemic at the Primary Health Care Level: The Fifth Step of the National Mobilization Program against COVID-19." Depiction of Health 13, Suppl 1 (April 9, 2022): 101–16. http://dx.doi.org/10.34172/doh.2022.20.

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Background. One of the most effective ways to prevent coronavirus disease 2019 (COVID-19) is to perform general vaccination and actively prevent the outbreak at the primary health care level. The present study aimed to review the measures against COVID-19 in Iran from April to September 2021. Methods. A cross-sectional and descriptive study was conducted at the national level from April to September 2021. Data related to COVID-19 vaccination, prevention, care, and outpatient services was collected from databases, including first level electronic health record systems, the portal of Network Management Center, the portal of Infectious Diseases Management Center, and the portal of Health Observatory. The target population of the study included medical universities and schools in Iran. Using a census sampling method, all 63 medical universities and schools in the country were included in the study. The Statistical Package for the Social Sciences (SPSS) version 16 was utilized to analyze the collected data. Results. In the fifth step of the national mobilization program against COVID-19 epidemic, a total of 1,228 vaccination centers with 6,490 stations were established across the country from April to September 2021. In these centers, more than 47 million doses of the COVID-19 vaccines were injected. At this step, over 15 million people exposed to close contact with infected people were intercepted. A home care team was deployed at each selected health center for COVID-19, providing 532,551 home care services. At the fifth step, the monitoring teams issued 1,015,831 warnings to trading, industrial, or administrative units, which led to the sealing of 73,443 units. Also, more than six million rapid tests were performed in homes and health units. During the same period, 30,843 vulnerable households received support packages. Conclusion. The national mobilization program to combat COVID-19 in Iran focused on the community and primary health care system. The program was successful in strengthening the health system to expand vaccination and actively prevent COVID-19 epidemic.

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Clarkson, Paul, David Challis, Jane Hughes, Brenda Roe, Linda Davies, Ian Russell, Martin Orrell, et al. "Components, impacts and costs of dementia home support: a research programme including the DESCANT RCT." Programme Grants for Applied Research 9, no. 6 (June 2021): 1–132. http://dx.doi.org/10.3310/pgfar09060.

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Background Over half of people with dementia live at home. We know little about what home support could be clinically effective or cost-effective in enabling them to live well. Objectives We aimed to (1) review evidence for components of home support, identify their presence in the literature and in services in England, and develop an appropriate economic model; (2) develop and test a practical memory support package in early-stage dementia, test the clinical effectiveness and cost-effectiveness of routine home support in later-stage dementia and design a toolkit based on this evidence; and (3) elicit the preferences of staff, carers and people with dementia for home support inputs and packages, and evaluate the cost-effectiveness of these approaches in early- and later-stage dementia. Design We undertook (1) an evidence synthesis, national surveys on the NHS and social care and an economic review; (2) a multicentre pragmatic randomised trial [Dementia Early Stage Cognitive Aids New Trial (DESCANT)] to estimate the clinical effectiveness and cost-effectiveness of providing memory aids and guidance to people with early-stage dementia (the DESCANT intervention), alongside process evaluation and qualitative analysis, an observational study of existing care packages in later-stage dementia along with qualitative analysis, and toolkit development to summarise this evidence; and (3) consultation with experts, staff and carers to explore the balance between informal and paid home support using case vignettes, discrete choice experiments to explore the preferences of people with dementia and carers between home support packages in early- and later-stage dementia, and cost–utility analysis building on trial and observational study. Setting The national surveys described Community Mental Health Teams, memory clinics and social care services across England. Recruitment to the trial was through memory services in nine NHS trusts in England and one health board in Wales. Recruitment to the observational study was through social services in 17 local authorities in England. Recruitment for the vignette and preference studies was through memory services, community centres and carers’ organisations. Participants People aged > 50 years with dementia within 1 year of first attendance at a memory clinic were eligible for the trial. People aged > 60 years with later-stage dementia within 3 months of a review of care needs were eligible for the observational study. We recruited staff, carers and people with dementia for the vignette and preference studies. All participants had to give written informed consent. Main outcome measures The trial and observational study used the Bristol Activities of Daily Living Scale as the primary outcome and also measured quality of life, capability, cognition, general psychological health and carers’ sense of competence. Methods Owing to the heterogeneity of interventions, methods and outcome measures, our evidence and economic reviews both used narrative synthesis. The main source of economic studies was the NHS Economic Evaluation Database. We analysed the trial and observational study by linear mixed models. We analysed the trial by ‘treatment allocated’ and used propensity scores to minimise confounding in the observational study. Results Our reviews and surveys identified several home support approaches of potential benefit. In early-stage dementia, the DESCANT trial had 468 randomised participants (234 intervention participants and 234 control participants), with 347 participants analysed. We found no significant effect at the primary end point of 6 months of the DESCANT intervention on any of several participant outcome measures. The primary outcome was the Bristol Activities of Daily Living Scale, for which scores range from 0 to 60, with higher scores showing greater dependence. After adjustment for differences at baseline, the mean difference was 0.38, slightly but not significantly favouring the comparator group receiving treatment as usual. The 95% confidence interval ran from –0.89 to 1.65 (p = 0.56). There was no evidence that more intensive care packages in later-stage dementia were more effective than basic care. However, formal home care appeared to help keep people at home. Staff recommended informal care that cost 88% of formal care, but for informal carers this ratio was only 62%. People with dementia preferred social and recreational activities, and carers preferred respite care and regular home care. The DESCANT intervention is probably not cost-effective in early-stage dementia, and intensive care packages are probably not cost-effective in later-stage dementia. From the perspective of the third sector, intermediate intensity packages were cheaper but less effective. Certain elements may be driving these results, notably reduced use of carers’ groups. Limitations Our chosen outcome measures may not reflect subtle outcomes valued by people with dementia. Conclusions Several approaches preferred by people with dementia and their carers have potential. However, memory aids aiming to affect daily living activities in early-stage dementia or intensive packages compared with basic care in later-stage dementia were not clinically effective or cost-effective. Future work Further work needs to identify what people with dementia and their carers prefer and develop more sensitive outcome measures. Study registration Current Controlled Trials ISRCTN12591717. The evidence synthesis is registered as PROSPERO CRD42014008890. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information.

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Lolich, Luciana, and Virpi Timonen. "Fortunate and fearful: emotions evoked by home-care policies for older people in Ireland." Emotions and Society 2, no. 1 (May 1, 2020): 61–78. http://dx.doi.org/10.1332/263169020x15843025702815.

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This article examines the emotions of fear and feeling fortunate experienced by key actors in home-care services in Ireland. We take a relational approach to emotions; that is to say, an understanding that emotions are produced in social interactions and play an essential part in how people engage with, and respond to, long-term care policies. The study involved focus groups and in-depth interviews with 104 participants. Our findings show that the most vulnerable participants – service users and care workers on precarious contracts – feel fortunate or fearful about outcomes that had, or would have, a direct impact on them: respectively, having a good carer and obtaining job satisfaction, or losing a home-care package and not having enough work. Professionals were more likely to speak about luck and fear, not in relation to what could happen to them directly but in relation to the fate of service users and care workers. The unregulated home-care services in Ireland have influenced actors to construe their own and others’ participation in the system as increasingly individualised, where desired outcomes depend on one’s good luck or strong personal relationships. For the system to work properly trust needs to be present not only at the micro level of individual relationships but also at a system level. This could lead to a decline in emotions that centre on feeling fortunate and fearful, and an increase in expressions of trust and a sense of control by both care providers and care recipients.

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Lewis, Richard. "Assessing Damages for the Costs of Care." Medical Law International 3, no. 2-3 (March 1998): 159–68. http://dx.doi.org/10.1177/096853329800300304.

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This article examines the compensating benefits which may be taken into account to reduce the amount which a plaintiff may claim for the costs of care in English law. The concern is not with payments of money to the plaintiff, but with savings resulting either from the plaintiff receiving care free of charge, or from paying for a comprehensive care package which saves on the living expenses which the plaintiff would otherwise have had to meet. These compensating benefits therefore include the gratuitous care and nursing provided by family and friends at home; and the care provided in a hospital, nursing home or other institution, when board and lodging is then also supplied. Similar policy issues arise no matter whether the plaintiff is provided with money to purchase care (eg an attendance allowance) or is provided with that care directly and free of charge. There is no necessary distinction between, on the one hand, the provision of free medical and hospital treatment and, on the other, the reimbursement of medical expenses through the mechanism of insurance.1 Although in its present review of damages the Law Commission treat gratuitous nursing services as distinct from “collateral benefits,” it accepts that if the plaintiff is seen as incurring a need for services and this constitutes an initial pecuniary loss, the question of whether to deduct the value of the services as a collateral benefit does then arise.2 This article examines the basic rules relevant to such deduction, but it begins by considering the effect upon damages of the existence of free health care under the NHS.

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Nesterenko, V. G. "Calculation of the need for resources of the health care system to provide palliative care to the population of Ukraine in 2018–2020." Experimental and Clinical Medicine 91, no. 2 (June 30, 2022): 65–73. http://dx.doi.org/10.35339/ekm.2022.91.2.nes.

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Financing of the needs of the health care system of Ukraine at the current stage takes place in the form of payment for packages of contracted services by the National Health Service of Ukraine. One of these packages is palliative and hospice care (PHC). In the professional environment, there is a debate about the composition of this package and the amount of funding. The right to PHC is one of the important components of the general right of Ukrainians to health care, and it must be ensured both from the point of view of medical ethics and to fulfill Ukraine's international obligations. The calculation of the amount of PHC financing is carried out in accordance with the data of demographic statistics (in particular, the number of available adult population and children aged 0–14), the calculated number of patients who need PHC, the availability of hospices, palliative departments and beds, as well as the possibility of their creation/deployment, presence of field (mobile) PHC teams, which should provide approximately 60% of such assistance. The study calculated the need for the Ukrainian PHC system in personnel and material resources: the number of palliative departments and beds, mobile teams, doctors and nurses, for the period 2018–2020. It was established that the minimum and optimal number of required palliative departments during this period ranged from 83 to 257 for adults and 19 to 66 for children, the number of required beds was (1,136–1,434) and (576–629), outpatient (mobile) services – (259–517) and (59–396), inpatient doctors – (215–285) and (118–52), inpatient nurses – (568–1,720) and (104–944), doctors of mobile teams – (518–2,066) and (118–1,582), nurses of mobile teams – (518–6,197) and (118–4,746), respectively. Factors that can cause calculation errors (specificity of treatment and prevention facilities in the regions, the presence of palliative patients in a small number who should be provided with help at home), other limitations of the study are established. Keywords: hospices, mobile palliative care services, human resources, contracted medical services.

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Gavarskhar, Fatemeh, Farid Gharibi, and Elham Dadgar. "Care services for older persons: A scoping review." Malaysian Family Physician 17, no. 2 (May 15, 2022): 22–37. http://dx.doi.org/10.51866/rv1221.

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Introduction: With an increasing life expectancy and proportion of older adults, the number of people in need of care services is also increasing. This study aimed to determine and describe various available care services for older persons reported in literature. Methods: English-language articles published between the years of 1990 and 2018 in Scopus, ProQuest, PubMed, and Google Scholar databases or search engines were reviewed. The search resulted in 46,927 articles. All selected studies were systematically evaluated and screened based on title, abstract, and full text related to the study’s objective. Finally, 246 articles were included in the study. The care services in older persons care systems were identified from the selected articles and were presented in extraction tables. Final conclusions were made based on the types of services provided and their frequency of citation. Results: The research results showed that numerous systems exist to provide care services for older adults, including long-term care services, home care services, housing for the aged, day care centres, senior centres, nursing homes, and hospice care services. Regarding older adults’ care needs and the objectives and missions of each care system, different care services, such as personal care, social support services, medical care services, and nutrition services, have been identified in the service packages. Conclusion: This study describes the diverse care services available for older persons that have been reported in the literature. Further research in different healthcare systems is required regarding what is most essential and lacking in each setting.

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Giosa, Justine L., Margaret Saari, Paul Holyoke, John P. Hirdes, and George A. Heckman. "Developing an evidence-informed model of long-term life care at home for older adults with medical, functional and/or social care needs in Ontario, Canada: a mixed methods study protocol." BMJ Open 12, no. 8 (August 2022): e060339. http://dx.doi.org/10.1136/bmjopen-2021-060339.

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IntroductionThe COVID-19 pandemic exacerbated existing challenges within the Canadian healthcare system and reinforced the need for long-term care (LTC) reform to prioritise building an integrated continuum of services to meet the needs of older adults. Almost all Canadians want to live, age and receive care at home, yet funding for home and community-based care and support services is limited and integration with primary care and specialised geriatric services is sparse. Optimisation of existing home and community care services would equip the healthcare system to proactively meet the needs of older Canadians and enhance capacity within the hospital and residential care sectors to facilitate access and reduce wait times for those whose needs are best served in these settings. The aim of this study is to design a model of long-term ‘life care’ at home (LTlifeC model) to sustainably meet the needs of a greater number of community-dwelling older adults.Methods and analysisAn explanatory sequential mixed methods design will be applied across three phases. In the quantitative phase, secondary data analysis will be applied to historical Ontario Home Care data to develop unique groupings of patient needs according to known predictors of residential LTC home admission, and to define unique patient vignettes using dominant care needs. In the qualitative phase, a modified eDelphi process and focus groups will engage community-based clinicians, older adults and family caregivers in the development of needs-based home care packages. The third phase involves triangulation to determine initial model feasibility.Ethics and disseminationThis study has received ethics clearance from the University of Waterloo Research Ethics Board (ORE #42182). Results of this study will be disseminated through peer-reviewed publications and local, national and international conferences. Other forms of knowledge mobilisation will include webinars, policy briefs and lay summaries to elicit support for implementation and pilot testing phases.

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Maximova, Margarita N., and Dina D. Mutigullina. "Satisfaction of Senior Citizens with Services in the Framework of Social Long-Term Care Packages." Social’naya politika i sociologiya 20, no. 4 (141) (December 29, 2021): 110–17. http://dx.doi.org/10.17922/2071-3665-2021-20-4-110-117.

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The purpose of the article is to assess the satisfaction of elderly citizens and people with disabilities in need of care with the services included in the social packages of long-term care. A questionnaire survey was carried out for elderly citizens and disabled people who receive services in outof-home social service departments of integrated social service centers for the population of five districts of the Republic of Tatarstan. The results showed that care services play a key role in social services for these categories of citizens, and should be provided free of charge. The directions for improving the provision of services included in the social packages of long-term care are formulated.

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Olivier, Cyril, Corinne Collingnon, Emmanuelle Fouteau, Gregory Emery, and Jacques Belghiti. "OP132 How A Shared Management Of Home Infusion Can Control Expenditure." International Journal of Technology Assessment in Health Care 33, S1 (2017): 61–62. http://dx.doi.org/10.1017/s026646231700191x.

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INTRODUCTION:In France, medical devices (MDs) for home-based infusion used to be covered by the health insurance system if included on the list of products and services qualifying for reimbursement under a generic description corresponding to a class of products with the same indications. This coverage modality offered no resistance to unnecessary or wasteful spending. Besides, between 2010 and 2015 the expenditure related to these MDs have increased from EUR192million to EUR289million (+50 percent).METHODS:The French National Authority for Health (HAS) has assessed the actual benefit of these MDs which have the same indications as the drugs infused at home. This work led to standardize the infusion types (gravity, elastomeric pump or active system requiring an energy source) and the quantities of MDs needed to carry out the different cares (installation, connection, withdrawal) according to the infusion route. At this step, considering that the priority was to redefine the MDs required at home for each care type, no economical assessment had been conducted.RESULTS:Based on this medical assessment, the Ministry of Health has distinguished three types of infusion and three types of services (home installation, monitoring and consumables) since 2016. In total, twenty-four packages have been set up for reimbursement with non-cumulative rules. Doctors are in charge to prescribe the appropriate packages; providers and nurses determine together the optimal devices needed for each patient according to his environment.CONCLUSIONS:These HAS recommendations on practice standardization have been the keystone for cost negotiations. The new coverage modalities aim to motivate liberal nurses to choose the best fitted products and providers to deliver the right quantities to patients. The expected benefits are an adjusted evaluation of the necessary equipment and a control of health expenditure due to the fixed costs of each infusion package.

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Macgregor, Aisha, Alasdair Rutherford, Brendan McCormack, Jo Hockley, Margaret Ogden, Irene Soulsby, Maisie McKenzie, Karen Spilsbury, Barbara Hanratty, and Liz Forbat. "Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK." BMJ Open 11, no. 2 (February 2021): e049486. http://dx.doi.org/10.1136/bmjopen-2021-049486.

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IntroductionPalliative and end-of-life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths and avoidable hospitalisations. Care home staff can feel unsupported to look after residents at the end of life. Approaches for improving end-of-life care are often education-focused, do not triage residents and rarely integrate clinical care. This study will adapt an evidence-based approach from Australia for the UK context called ‘Palliative Care Needs Rounds’ (Needs Rounds). Needs Rounds combine triaging, anticipatory person-centred planning, case-based education and case-conferencing; the Australian studies found that Needs Rounds reduce length of stay in hospital, and improve dying in preferred place of care, and symptoms at the end of life.Methods and analysisThis implementation science study will codesign and implement a scalable UK model of Needs Rounds. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to identify contextual barriers and use facilitation to enable successful implementation. Six palliative care teams, working with 4–6 care homes each, will engage in two phases. In phase 1 (February 2021), stakeholder interviews (n=40) will be used to develop a programme theory to meet the primary outcome of identifying what works, for whom in what circumstances for UK Needs Rounds. Subsequently a workshop to codesign UK Needs Rounds will be run. Phase 2 (July 2021) will implement the UK model for a year. Prospective data collection will focus on secondary outcomes regarding hospitalisations, residents’ quality of death and care home staff capability of adopting a palliative approach.Ethics and disseminationFrenchay Research Ethics Committee (287447) approved the study. Findings will be disseminated to policy-makers, care home/palliative care practitioners, residents/relatives and academic audiences. An implementation package will be developed for practitioners to provide the tools and resources required to adopt UK Needs Rounds.Registration detailsRegistration details: ISRCTN15863801.

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Jessop, Dorothy Jones, and Ruth E. K. Stein. "Providing Comprehensive Health Care to Children With Chronic Illness." Pediatrics 93, no. 4 (April 1, 1994): 602–7. http://dx.doi.org/10.1542/peds.93.4.602.

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Objectives. To test whether a program of outreach and comprehensive health care for children with chronic disorders provides more complete care and reduces unmet health needs compared with traditional care. Design. A pretest-posttest randomized control trial. Setting. An inner-city municipal teaching hospital. Sample. Two hundred nineteen systematically enrolled mothers of children with diverse chronic physical health conditions. Interventions. A comprehensive outreach program, Pediatric Home Care (PHC), contrasted with Standard Care. Measurements and Results. Nine elements of comprehensive care established in the literature as components of a basic package of care for those with chronic conditions. The PHC intervention addressed gaps in services and improved both the acquisition and maintenance of elements of comprehensive care. Conclusions. These data suggest mechanisms through which comprehensive care programs may contribute to the improvement in psychological and social outcomes previously reported for those in the PHC intervention.

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Tzavaras, A., M. Botsivaly, K. Koutsourakis, and B. Spyropoulos. "Ensuring the Continuity of Care of Cardiorespiratory Diseases at Home." Methods of Information in Medicine 49, no. 02 (2010): 156–60. http://dx.doi.org/10.3414/me9305.

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Summary Objectives: A significant portion of care related to cardiorespiratory diseases is provided at home, usually but not exclusively, after the discharge of a patient from hospital. It is the purpose of the present study to present the technical means which we have developed, in order to support the adaptation of the continuity of care of cardiorespiratory diseases at home. Methods: We have developed an integrated system that includes: first, a prototype laptop-based portable monitoring system that comprises low-cost commercially available components, which enable the periodical or continuous monitoring of vital signs at home; second, software supporting medical decision-making related to tachycardia and ventricular fibrillation, as well as fuzzy-rules-based software supporting home-ventilation optimization; third, a typical continuity of care record (CCR) adapted to support also the creation of a homecare plan; and finally, a prototype ontology, based upon the HL7 clinical document architecture (CDA), serving as basis for the development of semantically annotated web services that allow for the exchange and retrieval of homecare information. Results: The flexible design and the adaptable data-exchange mechanism of the developed system result in a useful and standard-compliant tool, for cardiorespiratory disease-related homecare. Conclusions: The ongoing laboratory testing of the system shows that it is able to contribute to an effective and low-cost package solution, supporting patient supervision and treatment. Furthermore, semantic web technologies prove to be the perfect solution for both the conceptualization of a continuity of care data exchange procedure and for the integration of the structured medical data.

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Sharma, Aarti, Vipin Raj, Nitin Tiwari, Devendra Kumar, Manish Kumar Goel, and Damodar Bachani. "Assessment of Barriers and Facilitators to InstitutionalDelivery in an Urban Area of Delhi: A CommunityBased Cross-Sectional Study." Journal of Maternal and Child Health 8, no. 4 (2023): 382–89. http://dx.doi.org/10.26911/thejmch.2023.08.04.01.

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Background:Since motherhood is one of the most important rolesin the life of any women and needs utmost priority in dealing with the delivery time, so the study was conducted with the aim to explore data related to antenatal check-ups and associated barriers for notavailing the services and the reasons for the health facility preferred (Govt. or Private). for which a semi structured, pretested interview schedule was administered to all the study subjects for obtaining the relevant details. Subjects and Method:The community based cross sectional study was carried out in Palam area of west Delhi from January to December 2016 with a sample size was of 250 and analysis was done using Statistical Package for Social Sciences (SPSS version 20). The independent variables under study were social demographic characteristics, while dependent variables were the different reasons cited for preferring home delivery by the study subjects. Results:Among the women interviewed, 60.8% women preferred a Govt. health care facility for antenatal services, 14.4% visited only private health care facility for complete antenatal services whereas 22.4% were those who availed antenatal service from both Government as well as Private health care. Nearly two-third (65.2%) of the deliveries took place in Government facility, whereas around 25% preferred private facility for the delivery and remaining 10% were home deliveries. Conclusion:The reasons need to be explored by systematic continuous monitoring and supervision of services including periodic beneficiaries view point on services being provided, re-orientation of service providers and counselling of pregnant women in order to achieve hundred percent institutional deliveries or by skilled birth attendant. Keywords:barriers, facilitators, institutional delivery

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O’Lawrence, Henry, and Rohan Chowlkar. "Cost effectiveness in palliative care setting." International Journal of Organization Theory & Behavior 21, no. 2 (June 11, 2018): 62–71. http://dx.doi.org/10.1108/ijotb-02-2018-0017.

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Purpose The purpose of this paper is to determine the cost effectiveness of palliative care on patients in a home health and hospice setting. Secondary data set was utilized to test the hypotheses of this study. Home health care and hospice care services have the potential to avert hospital admissions in patients requiring palliative care, which significantly affects medicare spending. With the aging population, it has become evident that demand of palliative care will increase four-fold. It was determined that current spending on end-of-life care is radically emptying medicare funds and fiscally weakening numerous families who have patients under palliative care during life-threatening illnesses. The study found that a majority of people registering for palliative and hospice care settings are above the age group of 55 years old. Design/methodology/approach Different variables like length of stay, mode of payment and disease diagnosis were used to filter the available data set. Secondary data were utilized to test the hypothesis of this study. There are very few studies on hospice and palliative care services and no study focuses on the cost associated with this care. Since a very large number of the USA, population is turning 65 and over, it is very important to analyze the cost of care for palliative and hospice care. For the purpose of this analysis, data were utilized from the National Home and Hospice Care Survey (NHHCS), which has been conducted periodically by the Centers for Disease Control and Prevention’s National Center for Health Statistics. Descriptive statistics, χ2 tests and t-tests were used to test for statistical significance at the p<0.05 level. Findings The Statistical Package for Social Sciences (SPSS) was utilized for this result. H1 predicted that patients in the age group of 65 years and up have the highest utilization of home and hospice care. This study examined various demographic variables in hospice and home health care which may help to evaluate the cost of care and the modes of payments. This section of the result presents the descriptive analysis of dependent, independent and covariate variables that provide the overall national estimates on differences in use of home and hospice care in various age groups and sex. Research limitations/implications The data set used was from the 2007 NHHCS survey, no data have been collected thereafter, and therefore, gap in data analysis may give inaccurate findings. To compensate for this gap in the data set, recent studies were reviewed which analyzed cost in palliative care in the USA. There has been a lack of evidence to prove the cost savings and improved quality of life in palliative/hospice care. There is a need for new research on the various cost factors affecting palliative care services as well as considering the quality of life. Although, it is evident that palliative care treatment is less expensive as compared to the regular care, since it eliminates the direct hospitalization cost, but there is inadequate research to prove that it improves the quality of life. A detailed research is required considering the additional cost incurred in palliative/hospice care services and a cost-benefit analysis of the same. Practical implications While various studies reporting information applicable to the expenses and effect of family caregiving toward the end-of-life were distinguished, none of the previous research discussed this issue as their central focus. Most studies addressed more extensive financial effect of palliative and end-of-life care, including expenses borne by the patients themselves, the medicinal services framework and safety net providers or beneficent/willful suppliers. This shows a significant hole in the current writing. Social implications With the aging population, it has become evident that demand of palliative/hospice care will increase four-fold. The NHHCS have stopped keeping track of the palliative care requirements after 2007, which has a negative impact on the growing needs. Cost analysis can only be performed by analyzing existing data. This review has recognized a huge niche in the evidence base with respect to the cost cares of giving care and supporting a relative inside a palliative/hospice care setting. Originality/value The study exhibited that cost diminishments in aggressive medications can take care of the expenses of palliative/hospice care services. The issue of evaluating result in such a physically measurable way is complicated by the impalpable nature of large portions of the individual components of outcome. Although physical and mental well-being can be evaluated to a certain degree, it is significantly more difficult to gauge in a quantifiable way, the social and profound measurements of care that help fundamentally to general quality of care.

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Quadir, Aurangzaib, Abdul Ghafoor, Syed Karam Shah, Shahid H. Khokhar, Hussain Hadi, Ghulam Nabi Kazi, Kinz ul Eman, Sher Afghan Raisani, and Zaeem ul Haq. "Optimizing outcomes for drug resistant tuberculosis patients through provision of a comprehensive care package." Pakistan Journal of Public Health 12, no. 1 (June 28, 2022): 12–16. http://dx.doi.org/10.32413/pjph.v12i1.958.

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Background: The paper presents the salient features of a comprehensive treatment package for drug resistant tuberculosis (DR-TB), its adaptation and implementation in two indoor care hospital settings in Pakistan, and lessons learned from this implementation. Methods: A pilot study was undertaken on a group of 100 patients at two Programmatic Management of Drug-Resistant TB (PMDT) sites. Fifty patients each were selected from the Samli Sanatorium Murree and the Lady Reading Hospital, Peshawar by the National Tuberculosis Control authorities, and delivered a comprehensive package of services, including psychosocial and food support. Data were collected using standard TB tools and surveillance indicators. The results were compared between intervention and a historical cohort of DR-TB patients. Results: Among the total 100 patients, the treatment success rate was 88%, the failure rate was 4%, while there were 7% deaths. A patient was transferred out while none were lost to follow-up, indicating much improvement over the historical cohort. Patients ranked the economic support, free medicines and nutritional support as most helpful, while majority of providers found the intervention sustainable. Conclusion: A comprehensive package including the psychosocial support can be crucial in enhancing DR-TB outcomes. Regular interaction with patients and improved nutrition leads to improved treatment adherence, while capacity building of psychologists and home visits can further benefit the DR-TB patients leading to their cure.

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Guisado-Fernandez, Estefania, Brian Caulfield, Paula Alexandra Silva, Laura Mackey, David Singleton, Daniel Leahy, Sébastien Dossot, Dermot Power, Diarmuid O'Shea, and Catherine Blake. "Development of a Caregivers’ Support Platform (Connected Health Sustaining Home Stay in Dementia): Protocol for a Longitudinal Observational Mixed Methods Study." JMIR Research Protocols 8, no. 8 (August 28, 2019): 13280. http://dx.doi.org/10.2196/13280.

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Background Dementia disease is a chronic condition that leads a person with dementia (PwD) into a state of progressive deterioration and a greater dependence in performing their activities of daily living (ADL). It is believed nowadays that PwDs and their informal caregivers can have a better life when provided with the appropriate services and support. Connected Health (CH) is a new technology-enabled model of chronic care delivery where the stakeholders are connected through a health portal, ensuring continuity and efficient flow of information. CH has demonstrated promising results regarding supporting informal home care and Aging in Place, and it has been increasingly considered by researchers and health care providers as a method for dementia home care management. Objective This study aims to describe the development and implementation protocol of a CH platform system to support informal caregivers of PwDs at home. Methods This is a longitudinal observational mixed methods study where quantitative and qualitative data will be combined for determining the utility of the CH platform for dementia home care. Dyads, consisting of a PwD and their informal caregiver living in the community, will be divided into 2 groups: the intervention group, which will receive the CH technology package at home, and the usual care group, which will not have any CH technology at all. Dyads will be followed up for 12 months during which they will continue with their traditional care plan, but in addition, the intervention group will receive the CH package for their use at home during 6 months (months 3 to 9 of the yearly follow-up). Further comprehensive assessments related to the caregiver’s and PwD’s emotional and physical well-being will be performed at the initial assessment and at 3, 6, 9, and 12 months using international and standardized validated questionnaires and semistructured individual interviews. Results This 3-year funded study (2016-2019) is currently in its implementation phase and is expected to finish by December 2019. We believe that CH can potentially change the PwD current care model, facilitating a proactive and preventive model, utilizing self-management–based strategies, and enhancing caregivers’ involvement in the management of health care at home for PwDs. Conclusions We foresee that our CH platform will provide knowledge and promote autonomy for the caregivers, which may empower them into greater control of the care for PwDs, and with it, improve the quality of life and well-being for the person they are caring for and for themselves through a physical and cognitive decline predictive model. We also believe that facilitating information sharing between all the PwDs’ care stakeholders may enable a stronger relationship between them, facilitate a more coordinated care plan, and increase the feelings of empowerment in the informal caregivers. International Registered Report Identifier (IRRID) DERR1-10.2196/13280

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Rasaily, Reeta, NC Saxena, Sushma Pandey, Bishan S. Garg, Saraswati Swain, Sharad D. Iyengar, Vinita Das, et al. "Effect of home-based newborn care on neonatal and infant mortality: a cluster randomised trial in India." BMJ Global Health 5, no. 9 (September 2020): e000680. http://dx.doi.org/10.1136/bmjgh-2017-000680.

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BackgroundHome-based newborn care has been found to reduce neonatal mortality in rural areas. Study evaluated effectiveness of home-based care delivered by specially recruited newborn care workers- Shishu Rakshak (SR) and existing workers- anganwadi workers (AWW) in reducing neonatal and infant mortality rates.MethodsThis three-arm, community-based, cluster randomised trial was conducted in five districts in India. Intervention package consisted of pregnancy surveillance, health education, care at birth, care of normal/low birthweight neonates, identification and treatment of sick neonates and young infants using oral and injectable antibiotics and community mobilisation. The package was similar in both intervention arms—SR and AWW; difference being healthcare provider. The control arm received routine health services from the existing health system. Primary outcomes were neonatal and young infant mortality rates at ‘endline’ period (2008–2009) assessed by an independent team from January to April 2010 in the study clusters.FindingsA total of 6623, 6852 and 5898 births occurred in the SR, AWW and control arms, respectively, during the endline period; the proportion of facility births were 69.0%, 64.4% and 70.6% in the three arms. Baseline mortality rates were comparable in three arms. During the endline period, the risk of neonatal mortality was 25% lower in the SR arm (adjusted OR 0.75, 95% CI 0.57 to 0.99); the risks of early neonatal mortality, young infant mortality and infant mortality were also lower by 32%, 27%, and 33%, respectively. The risks of neonatal, early neonatal, young infant, infant mortality in the AWW arm were not different from that of the control arm.InterpretationHome-based care is effective in reducing neonatal and infant mortality rates, when delivered by a dedicated worker, even in settings with high rates of facility births.Trial registration numberThe study was registered with Clinical Trial Registry of India (CTRI/2011/12/002181).

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Saari, Margaret, Justine Giosa, Paul Holyoke, John Hirdes, George Heckman, and Valentina Cardozo. "Integrating health and social care in the community to support a new model of Long-term Life Care at home." International Journal of Integrated Care 23, S1 (December 28, 2023): 487. http://dx.doi.org/10.5334/ijic.icic23181.

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Background: Long-term care (LTC) reform was an international priority well before the COVID-19 pandemic. While strategies to promote de-institutionalization, rehabilitation, caregiver support and enhanced home and community care have varied by country in terms of implementation and success, the pandemic universally reinforced existing system-specific barriers and weaknesses. In Canada, heightened access issues and silo-ed delivery of community-based medical, functional and social care and support services contributed to increased caregiver burnout and growing residential care waitlists. Aims: This study aimed to develop an alternative model to residential LTC that would enable older adults to live, age and receive care at home long-term. The specific objectives were to: 1) describe variation in medical, functional and psychosocial ‘life care’ needs of community-dwelling older adults; 2) develop a model of needs-based care with packages to support variation in needs; and 3) to assess preliminary feasibility of the model using the Ontario, Canada (population 15 million) health care market. Approach: An exploratory, sequential, mixed methods design was applied (5). Phase 1 involved historical analysis of 2017-18 Ontario interRAI home care assessments (n=283,601) and 2018-19 Ontario service utilization data (n=115,000) to develop unique patient vignettes. Phase 2 was a 6-week modified eDelphi process with interdisciplinary home care clinicians (n=42) to develop care packages for the model, including types and dose of care and services. Six focus groups (n=67) were then conducted with older adults, caregivers and health and social care providers across Ontario to validate and refine the model. Phase 3 explored feasibility of the emerging model through comparison of the home care patient vignettes with the needs of the residential LTC population using 2017-18 Ontario interRAI data (n=115,000). Preliminary costing of the model was based on existing system per diems and direct care costs in comparable transitional care models. Results: A model of ‘Long-term Life Care’ at home (LTLifeC model) includes care packages to meet the dominant life care needs of 6 unique patient groups representing known predictors of LTC home admission: social frailty, caregiver distress, chronic disease, cognition/ behaviours, medical complexity, and geriatric syndromes. Overlap in care needs of home care and LTC populations confirms potential to shift care to the community; yet current home care clients receive six times less daily care hours on average, compared to residential LTC standards. New LTLifeC packages of home-based interdisciplinary care ranged from 3.1-8.9 hours daily, including comprehensive assessment, integrated care planning, direct care provision and community referral(s). Initial cost comparisons suggest plausible short and long-term system benefits of model adoption. Learnings: Evidence-informed decision making for sustainable home and community care as part of an integrated system of LTC requires attention to both routinely collected health information, or ‘big data’, and expertise by lived-experience. Adoption of the LTLifeC model will require decision-making to prioritize societal values for living and aging at home and in community. Next Steps: An evaluation framework will be developed to guide pilot implementation and testing of the LTLifeC model through the lens of the quadruple aim.

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Uffendell, Chloe, and John Stevens. "Early intervention in psychosis team (EIT): pathways to care." BJPsych Open 7, S1 (June 2021): S109. http://dx.doi.org/10.1192/bjo.2021.322.

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AimsThe main aim of this study was to investigate whether the EIT access and waiting time standard (>60% of people experiencing first episode psychosis (FEP) are treated with a NICE-approved care package within two weeks of referral) was being met within Liverpool EIT.We also wanted to understand the pathway to treatment within EIT services, identify delays in the process of triage/assessment/MDT/medical review and implement changes to reduce delays.MethodThis study was a retrospective cross-sectional audit of all patients accepted on to the FEP pathway following MDT discussion in the Liverpool EIT Teams across May and June 2020.Case notes were analysed for delays in referral, engagement with assessment and care-coordinators, as well as prescriber review offering medication. The data were collated and analysed before implementing changes.Result40 patients presented as FEP in May and June 2020, 6 were excluded due to an extended inpatient stay.Within the remaining patient cohort (n = 34), 64.7% of patients were engaged with a care package within 14 days. Only 14.7% of patients received an offer of medication within 14 days, the mean time to be offered medication was 39 days.26% of patients first contact within MerseyCare Trust was with EIT, 74% presented elsewhere. 24% instead presented to liaison psychiatry from A&E departments, 18% to the single point of access team, 9% to criminal justice liaison team (CJLT) and 9% to North West Ambulance Service triage car.29% of referrals came from the community (GP and counselling services), 15% from CRHT (crisis resolution and home treatment team), 14% from CJLT, 12% from urgent care team, 9% from liaison psychiatry.ConclusionThe Access and Waiting time standard was met. However, this study showed that patients were not being referred to EIT at first point of contact. This study shows 26% of service users first presented to liaison psychiatry, yet only 1/3 of those were immediately referred to EIT, the remainder being later referred by other services e.g. CRHT.In addition to referral delays, lack of medical practitioner availability caused significant delays in arranging medical reviews, delaying patients access to medication.The changes implemented to address these issues included educating MerseyCare services in the early recognition of psychosis to increase early referral. Non-medical prescribers’ roles were developed to perform initial medical reviews in addition to doctors, allowing patients earlier medication access. This allowed ‘urgent slots’ to be developed, time set aside for emergencies enabling prompt review of urgent cases.

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Reed, Elizabeth, Jane Berg, and Lesley Spencer. "36 Together to care." BMJ Supportive & Palliative Care 7, no. 3 (September 2017): A361.1—A361. http://dx.doi.org/10.1136/bmjspcare-2017-001407.36.

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IntroductionAlthough many care homes are committed to providing good quality end of life care, in reality a significant number of Nursing Home (NH) residents die in hospital after emergency admission hours or days before their death.To provide more coordinated services for dying people and their families, the hospice in partnership with a NH developed a six month project with the NH providing 2 palliative care beds and in return for a comprehensive training package in end of life care.Research aimAssess the impact of the educational intervention on NH staff and therefore their confidence and competence in caring for residents at the end of life.MethodsA longitudinal mixed method approach using 3 methods at baseline, 3 and 6 months:1. A survey to all NH staff incorporating a self-efficacy palliative care scale (SEPC) to rate confidence on a 10 point Likert scale (Mason and Ellershaw, 2004).2. Pre and post intervention semi-structured interviews with the staff participating in the T2C educational intervention.3. Focus group of hospice staff 6 months post T2C educational intervention.ResultsAt 6 months confidence increased and was sustained in all aspects of end of life care but most markedly in communication and symptom control. Confidence decreased in NH staff not undertaking the education intervention indicating work to do in peer learning.ConclusionA palliative care educational intervention can increase confidence and competence in NH staff to care for residents in a NH so reduce risk of unplanned hospital admission.Reference. Mason, S. Ellershaw, J. Assessing undergraduate palliative care education: validity and reliability of two scales examining perceived efficacy and outcome expectancies in palliative care. Medical Education2004;38:1103–1110

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Jeon, Yun-Hee, Judith Fethney, Judy M. Simpson, Richard Norman, Luisa Krein, Mirim Shin, Lee-Fay Low, et al. "FC18: Can rehabilitation improve functional independence of older people with dementia? A pragmatic randomized controlled trial (RCT) of the Interdisciplinary Home-bAsed Reablement Program (I-HARP)." International Psychogeriatrics 35, S1 (December 2023): 80–81. http://dx.doi.org/10.1017/s1041610223001163.

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Objective:The Interdisciplinary Home-bAsed Reablement Program (I-HARP) integrates evidence-based rehabilitation strategies into a dementia-specific person-centred, time-limited, home-based, interdisciplinary rehabilitation package. I-HARP was a 4-month model of care, incorporated into community aged care services and hospital-based community geriatric services. I-HARP involved: 8-10 individually tailored home visits by occupational therapist and registered nurse; 2-4 optional other allied health sessions; up to A$1,000 minor home modifications and/or assistive devices; and three individual carer support sessions. The aim of the study was to determine the effectiveness of I-HARP on the health and wellbeing of people living with dementia and their family carers.Methods:A multi-centre pragmatic parallel-arm randomised controlled trial compared I-HARP to usual care in community-dwelling people with mild to moderate dementia and family carers in Sydney, Australia (2018-22). Assessments of the client’s daily activities, mobility and health-related quality of life, caregiver burden and quality of life were conducted at baseline, 4- and 12-month follow-up. Changes from baseline were compared between groups.Results:Of 260 recruited, 232 (116 dyads of clients and their carers, 58 dyads per group) completed the trial to 4-month follow-up (89% retention). Clients were: aged 60-97 years, 63% female, 57% with mild dementia and 43% with moderate dementia. The I-HARP group had somewhat better mean results for most outcome measures than usual care at both 4 and 12 months, but the only statistically significant difference was a reduction in home environment hazards at 4 months (reduction: 2.29 on Home Safety Self-Assessment Tool, 95% CI: 0.52, 4.08; p=.01, effect size [ES] 0.53). Post-hoc sub-group analysis of 66 clients with mild dementia found significantly better functional independence in the intervention group: 11.2 on Disability Assessment for Dementia (95% CI: 3.4, 19.1; p=.005; ES 0.69) at 4 months and 13.7 (95% CI: 3.7, 23.7; p=.007; ES 0.69) at 12 months.Conclusion:The I-HARP model enhanced functional independence of people with mild dementia only but not significantly in people with moderate dementia, so did not result in better outcomes in the group overall. A different type of rehabilitation model or strategies may be required as dementia becomes more severe.

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Dimla, Bernadette, Denise Wood, and Lynne Parkinson. "A Qualitative Study on How Social Workers From Regional and Metropolitan Queensland, Australia Perceive the Impact of the National Prioritisation System on Hospital Discharge Planning: A Study Protocol." International Journal of Qualitative Methods 19 (January 1, 2020): 160940692097354. http://dx.doi.org/10.1177/1609406920973543.

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In 2012, the Australian Commonwealth Government introduced a series of reforms for the aged care sector including the implementation of the National Prioritisation System for a flexible, accessible and demand-driven approach to home care services for older people. Nevertheless, an increasing number of older people continue to wait for months to be assigned home care packages on the national prioritisation queue, a component of the National Prioritisation System. There is limited evidence on the impact of the national prioritisation queue on discharge planning practices of social workers in supporting older people returning home from hospital admission. The aim of the research described in this paper is to explore the perceptions of social workers from rural and urban health services areas on how the introduction of the national prioritisation queue has influenced discharge planning of older people who are still waiting assignment of home care packages. This study protocol establishes the need for this qualitative study and provides an overview of the theoretical framework underpinning the research; discusses and describes the methods for sampling/recruitment and data collection, the approach to be utilised for qualitative analysis and the planned dissemination strategy. Understanding how social workers respond to the perceived challenges to discharge planning posed by the national prioritisation queue and the implications arising from the research have the potential to inform the development of best practice approaches and further enhance social work response to identified issues.

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Holovanova, I. A., and A. S. Shevchenko. "Evaluation of packaged funding programs for palliative and hospice care by the National Health Service of Ukraine." Experimental and Clinical Medicine 90, no. 4 (December 31, 2021): 45–52. http://dx.doi.org/10.35339/ekm.2021.90.4.hos.

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Financing of Palliative and Hospice Care (PHC) for adults and children in Ukraine is carried out from the state budget under the Medical Guarantee Programs (MGP) by the National Health Service of Ukraine (NHSU). In the professional medical environment and in the Ukrainian society, an active discussion about the list of pathologies of adults and children that require PCD, about the availability of palliative care, the effectiveness of hospices, palliative departments, wards of specialized and multidisciplinary hospitals, mobile teams, "home hospices", the availability of effective analgesia, demand for euthanasia, Ukrainian society's readiness for it continues. An important practical issue of the PHC organization is the list of medical and related services that are needed by palliative patients and that are financed by the NHSU. Working groups of specialists invited by the NHSU for expert evaluation of the list of such services constantly make corrections to the list in accordance with the feedback that exists between the NHSU and medical institutions of Ukraine that have concluded contracts for the PHC provision. This review is devoted to the analysis of changes in the list of medical services for palliative patients in accordance with the MGP. Financing of medical services provided to Ukrainians by medical institutions under the MGP began in Ukraine in 2020, when more than 1,600 specialized medical institutions concluded contracts with the NHSU under MGP, which provided services worth more than 100 billion UAH, and 123.5 billion UAH in 2021. And in 2011–2019, only a few dozen medical institutions provided PHC in Ukraine. We concluded that the MGP and package financing of PHC by the NHSU significantly expanded the capabilities of medical institutions of Ukraine to provide such care and cover the majority of patients who need it. Medical facilities must fulfill the minimum requirements of a significant volume to obtain the right to provide palliative care for budget funds. Keywords: PHC, medical guarantee programs, NHSU, health care financing.

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Cazorla, Patricia. "A Holistic Decision-Making Process to Improve the Productivity of Public Transportation in Cuenca-Ecuador." Revista Politécnica 48, no. 2 (November 1, 2021): 33–42. http://dx.doi.org/10.33333/rp.vol48n2.03.

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National governments are responsible for guaranteeing the accessibility, affordability, availability, and social acceptability of public services. If urbanization grows in an unplanned way requires more investments to extend the current infrastructure or build new ones. Since, in general, cities in developing countries lack sufficient economic resources, it is necessary to maximize the productivity of the current infrastructure to satisfy additional demand. Boosting asset utilization, optimizing maintenance planning, and expanding demand management measures could take advantage of the wasted infrastructure. The local government of Cuenca-Ecuador aims to expand the public transport supply throughout the urban area (77.5% of spatial cover and 92% of population cover in the urban area), using the maximum network capacity. Thus, it requires a holistic and inclusive framework that guarantees the implementation of the project. Studies in urban planning have shown that the productivity of the public transportation network depends on the network and activity systems. The application of actor-network theory demonstrated that the proposed solution (a package of 22 measures related to the transit-oriented development and demand-management measures) is not only necessary but feasible. The analysis allowed identifying ten interested actors and one non-interested actor. Moreover, the method highlights the role of each actor to counteract potential opponents and meet the target by 2030.

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Diwan, S., C. Berger, and E. K. Manns. "Composition of the Home Care Service Package: Predictors of Type, Volume, and Mix of Services Provided to Poor and Frail Older People." Gerontologist 37, no. 2 (April 1, 1997): 169–81. http://dx.doi.org/10.1093/geront/37.2.169.

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Mohamed, Ibrahim Gedi, Alfred Owino Odongo, and Dominic Mogere. "Factors Influencing Choice of Place for Child Delivery among Child Bearing-Aged Women in Balambala Sub-County, Garissa County, Kenya." International Journal of TROPICAL DISEASE & Health 44, no. 20 (November 8, 2023): 40–47. http://dx.doi.org/10.9734/ijtdh/2023/v44i201488.

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Background: There has been little progress made in Sub-Saharan Africa in achieving Sustainable Development Goal of reducing maternal deaths. Maternal mortality can be reduced significantly by skilled delivery. Women in low-income countries choose home deliveries despite the risks. In Kenya, maternity services are offered free-of-charge in all public health facilities. Mothers receive non-cash incentives after delivery. Investigated independent variables were health care related factors, gynecological factors and socio-cultural factors. The dependent variable was the proportions of hospital and, home deliveries. Maternal mortality rate in Balambala was found to be 587/100,000 while the national and county averages were 223 and 530/100,000 respectively. The study investigated factors influencing choice of place of child delivery. Methods: Cross-sectional study was used and participants recruited through randomization. A sample size of 384 mothers, who had 1-year-old child, registered for ante-natal care services in latest pregnancy in Balambala were interviewed at the households. Quantitative data collected using structured questionnaires and analyzed using Statistical Package for Social Sciences version 25. P-value of .05 was set as statistical significance. Descriptive and inferential statistics were calculated, nature and magnitude of association between dependent and independent variables investigated. Results: The independent variables recorded the following; p-value of 0.042 for socio-cultural factors, p-value of 0.039 for obstetric factors and p-value of 0.035 for health care related factors. Conclusion: Proportions of home and hospital deliveries were 52% and 48% respectively. The independent variables were statistically significant, p-value<.05. The researcher recommends inclusion of literacy lessons into the present ANC profile. Husbands to accompany their pregnant wives to health facilities at least 2 of the 4 scheduled ANC visits.

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Ohba, T., A. Goto, H. Nakano, K. E. Nollet, M. Murakami, K. Yoshida, Y. Yumiya, et al. "Implementing eHealth with radiation records: a new support package for evacuees returning to areas around the Fukushima Daiichi nuclear power station." Radioprotection 55, no. 4 (October 2020): 291–95. http://dx.doi.org/10.1051/radiopro/2020083.

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Following the 2011 Fukushima Daiichi nuclear power station (FDNPS) accident, numerous initiatives emerged to address the needs of evacuees, including those eligible to return home. These came from multiple channels, timely in many cases, but in retrospect, needing better coordination. By embracing eHealth, we are attempting to coordinate efforts in Fukushima intended to link returnees with health information and care providers, not only for radiological protection in particular, but also for health promotion in general. We aim to establish a comprehensive support system for residents in municipalities around the FDNPS by developing a digital application for interactive communication regarding radiation and health promotion and to link the tool to other resources provided by local health care providers and radiation specialists. This paper explains the progress of our innovative trial to introducing eHealth in areas affected by the FDNPS accident. Based on international recommendations for developing a digital tool in response to a nuclear accident, we designed a comprehensive support package including development and implementation of the application, data management, and health counselling and ethical considerations arising from such outreach. Our trial of connecting disaster-affected citizens to health services using informatics could serve as a model eHealth program for long-term restoration after a nuclear accident.

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Omongot, Samson, Winters Muttamba, Irene Najjingo, Joseph Baruch Baluku, Sabrina Kitaka, Stavia Turyahabwe, and Bruce Kirenga. "Strategies to resolve the gap in adolescent tuberculosis care at four health facilities in Uganda: The teenager’s TB pilot project." PLOS ONE 19, no. 4 (April 11, 2024): e0286894. http://dx.doi.org/10.1371/journal.pone.0286894.

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In 2021, an estimated 10.6 million people fell ill with tuberculosis (TB) globally and 11.3% were children. About 40% of children aged five to fourteen years with TB are missed annually. In Uganda, 44% of adolescents with chronic cough of more than two weeks do not seek care from health facilities. Therefore, strategies to promote health care-seeking behaviour among adolescents were urgently needed to resolve the gap. In regard to this, the research project utilized a before and after design, in which the number of adolescents (10-19years) enrolled in the project health facilities were compared before and after the intervention. The intervention package that comprised of tuberculosis awareness and screening information was developed together with adolescents, thus; a human-centred approach was used. The package consisted of TB screening cards, poster messages and a local song. The song was broadcasted in the community radios. Poster messages were deployed in the community by the village health teams (VHTS). The TB screening cards were given to TB positive and presumptive adults to screen adolescents at home. Adolescents that were found with TB symptoms were referred to the project health facilities. Socio-demographic and clinical characteristics of eligible adolescents were collected in a period of six months from Kawolo, Iganga, Gombe and Kiwoko health facilities. To determine the effectiveness of the package, before and after intervention data were equally collected. A total of 394 adolescents were enrolled, majority (76%) were school going. The intervention improved adolescent TB care seeking in the four project health facilities. The average number of adolescents screened increased from 159 to 309 (incidence rate ratio (IRR) = 1.9, P<0.001, 95% CI [1.9, 2.0]). Those presumed to have TB increased from 13 to 29(IRR = 2.2, P<0.001, 95% CI [1.9, 2.5]). The ones tested with GeneXpert increased in average from 8 to 28(IRR = 3.3, P<0.001, 95% CI [2.8, 3.8]). There was a minimal increase in the average monthly number of adolescents with a positive result of 0.8, from 1.6 to 2.4(p = 0.170) and linkage to TB care services of 1.1, from 2 to 3.1(p = 0.154). The project improved uptake of TB services among adolescents along the TB care cascade. We recommend a robust and fully powered randomized controlled trial to evaluate the effectiveness of the Package.

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Finegan, T., P. J. White, and B. Casey. "53 HEALTHCARE PROVISION FOR OLDER PEOPLE IN KILKENNY THROUGH THE IMPLEMENTATION OF THE INTEGRATED CARE PROGRAMME FOR OLDER PEOPLE." Age and Ageing 50, Supplement_3 (November 2021): ii9—ii41. http://dx.doi.org/10.1093/ageing/afab219.53.

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Abstract Background An increase in the cost of healthcare provision is directly related to an ageing demographic nationally and internationally. It is, therefore, imperative that the system of health and social care provision for the older person is reformed. The Integrated Care Programme for Older People (ICPOP) envisages moving the locus of care from the acute system to primary and community health and social care. This research looks at the implementation and benefits of ICPOP from a clinicians and third sector organisations perspective. Methods Semi-structured interviews were conducted with six clinicians within the acute and community healthcare systems and, with two representatives from older persons third sector organisations. The interviews were held online through conferencing software and recorded. They were transcribed manually to gain a greater understanding of what was said and the context. Using a grounded theory approach, quotes were extracted, clustered together into categories or themes and, through theoretical sampling and comparison an in-depth understanding was gained, and theory developed. Results An organisational culture of innovative and collaborative practice is essential to the delivery of ICPOP as it leads to the empowerment of staff to develop integrated healthcare across disciplines and services. It is vital that funding for home support packages that provide both health and social care assistance with an adequate number of carers evenly distributed nationwide be provided. In addition, the ‘Living Well at Home’ piece of ICPOP with its important local community and social connectedness emphasis, needs to be sufficiently funded. Conclusion A culture of collaborative and innovated practice of healthcare provision exists in Kilkenny. Implementation of ICPOP is commiserate with appropriate funding for, and even distribution of, home care support packages and carers, as well as support for services that combat loneliness and social isolation enabling older people to age well at home.

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Brusco, Natasha K., Nicholas F. Taylor, Ilana Hornung, Shanandoah Schaffers, Anna Smith, and Natalie A. de Morton. "Factors that predict discharge destination for patients in transitional care: a prospective observational cohort study." Australian Health Review 36, no. 4 (2012): 430. http://dx.doi.org/10.1071/ah11052.

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Objective. To investigate factors that predict discharge destination for patients making the transition from hospital to the community. Methods. Using a prospective cohort design, 696 patients from 11 Transition Care Programs were recruited. Baseline patient and program characteristics were considered for predicting discharge destination, functional status, and patient length of stay. Results. An increased physiotherapy staffing ratio in Transition Care Program was associated with an increased likelihood that a patient was discharged home, with an improved functional or mobility status, and after a shorter length of stay. The other factor that predicted discharge to home included having an Aged Care Assessment Service classification of low level care or home with a support package. An increased physiotherapy staffing level also reduced the likelihood of discharge to low level or high level care. The other factors that predicted discharge to low level care were having higher mobility status and older age; the other factor associated with increased likelihood of predicting discharge to high level care was having an Aged Care Assessment Service classification of high level care. Conclusions. Factors on admission that predicted discharge destination were program physiotherapy staffing ratios, Aged Care Assessment Service assessment, age and mobility status. What is known about the topic? In 2004/05 Australia introduced a program called the Transition Care Program (TCP), which targets older persons at the conclusion of an acute hospital episode who require more time and support in a non-acute setting to complete their restorative process and optimise their functional capacity. This program has a particular objective to prevent inappropriate admission to a residential aged care facility. To date, there are no published papers that report the factors that predict discharge destination for patients in the Transition Care Program. What does this paper add? This study provides evidence that program physiotherapy staffing ratios, Aged Care Assessment Service assessment, age and mobility status are predictive of an increased likelihood that a patient will be discharged home with an improved functional/mobility status, after a shorter length of stay. What are the implications for practitioners? Knowledge of factors that predict discharge destination may assist healthcare practitioners and health managers in managing TCP patients and planning services.

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Gathercole, Rebecca, Rosie Bradley, Emma Harper, Lucy Davies, Lynn Pank, Natalie Lam, Anna Davies, et al. "Assistive technology and telecare to maintain independent living at home for people with dementia: the ATTILA RCT." Health Technology Assessment 25, no. 19 (March 2021): 1–156. http://dx.doi.org/10.3310/hta25190.

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Background Assistive technology and telecare have been promoted to manage the risks associated with independent living for people with dementia, but there is limited evidence of their effectiveness. Objectives This trial aimed to establish whether or not assistive technology and telecare assessments and interventions extend the time that people with dementia can continue to live independently at home and whether or not they are cost-effective. Caregiver burden, the quality of life of caregivers and of people with dementia and whether or not assistive technology and telecare reduce safety risks were also investigated. Design This was a pragmatic, randomised controlled trial. Blinding was not undertaken as it was not feasible to do so. All consenting participants were included in an intention-to-treat analysis. Setting This trial was set in 12 councils in England with adult social services responsibilities. Participants Participants were people with dementia living in the community who had an identified need that might benefit from assistive technology and telecare. Interventions Participants were randomly assigned to receive either assistive technology and telecare recommended by a health or social care professional to meet their assessed needs (a full assistive technology and telecare package) or a pendant alarm, non-monitored smoke and carbon monoxide detectors and a key safe (a basic assistive technology and telecare package). Main outcome measures The primary outcomes were time to admission to care and cost-effectiveness. Secondary outcomes assessed caregivers using the 10-item Center for Epidemiological Studies Depression Scale, the State–Trait Anxiety Inventory 6-item scale and the Zarit Burden Interview. Results Of 495 participants, 248 were randomised to receive full assistive technology and telecare and 247 received the limited control. Comparing the assistive technology and telecare group with the control group, the hazard ratio for institutionalisation was 0.76 (95% confidence interval 0.58 to 1.01; p = 0.054). After adjusting for an imbalance in the baseline activities of daily living score between trial arms, the hazard ratio was 0.84 (95% confidence interval 0.63 to 1.12; p = 0.20). At 104 weeks, there were no significant differences between groups in health and social care resource use costs (intervention group – control group difference: mean –£909, 95% confidence interval –£5336 to £3345) or in societal costs (intervention group – control group difference: mean –£3545; 95% confidence interval –£13,914 to £6581). At 104 weeks, based on quality-adjusted life-years derived from the participant-rated EuroQol-5 Dimensions questionnaire, the intervention group had 0.105 (95% confidence interval –0.204 to –0.007) fewer quality-adjusted life-years than the control group. The number of quality-adjusted life-years derived from the proxy-rated EuroQol-5 Dimensions questionnaire did not differ between groups. Caregiver outcomes did not differ between groups over 24 weeks. Limitations Compliance with the assigned trial arm was variable, as was the quality of assistive technology and telecare needs assessments. Attrition from assessments led to data loss additional to that attributable to care home admission and censoring events. Conclusions A full package of assistive technology and telecare did not increase the length of time that participants with dementia remained in the community, and nor did it decrease caregiver burden, depression or anxiety, relative to a basic package of assistive technology and telecare. Use of the full assistive technology and telecare package did not increase participants’ health and social care or societal costs. Quality-adjusted life-years based on participants’ EuroQol-5 Dimensions questionnaire responses were reduced in the intervention group compared with the control group; groups did not differ in the number of quality-adjusted life-years based on the proxy-rated EuroQol-5 Dimensions questionnaire. Future work Future work could examine whether or not improved assessment that is more personalised to an individual is beneficial. Trial registration Current Controlled Trials ISRCTN86537017. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 19. See the NIHR Journals Library website for further project information.

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Lofthouse-Jones, Chloe, Phil King, Helen Pocock, Mary Ramsay, Patryk Jadzinski, Ed England, Sarah Taylor, Julian Cavalier, and Carole Fogg. "Reducing ambulance conveyance for older people with and without dementia: evidence of the role of social care from a regional, year-long service evaluation using retrospective routine data." British Paramedic Journal 6, no. 3 (December 1, 2021): 58–69. http://dx.doi.org/10.29045/14784726.2021.12.6.3.58.

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Introduction: Older people, especially those with dementia, have a high risk of deterioration following admission to hospital. More than 60% of older people attended by South Central Ambulance Service (SCAS) clinicians are conveyed to hospital, although many conveyances may not have been due to life-threatening conditions. We aimed to understand patterns of conveyance and alternative referral pathways used following ambulance attendance to an older person.Methods: Service evaluation, using routinely collected, anonymised electronic records.Participants: Electronic records of people aged ≥75 years for whom an ambulance was dispatched between April 2016 and March 2017 within the geographical boundaries of SCAS NHS Foundation Trust, who were alive on arrival of the ambulance. Conveyance rates are described according to patient and emergency-call characteristics. Logistic regression was used to produce adjusted odds ratios for conveyance. Alternative referral pathways used are described.Results: Of 110,781 patients attended, 64% were conveyed to hospital. Factors associated with reduced odds of conveyance included out-of-hours calls (adjusted odds ratio (aOR) 0.82 [0.79‐0.85]), living alone with a care package or with family plus care package (aOR 0.66 [0.62‐0.69]; aOR 0.58 [0.54‐0.62] respectively) and a record of dementia (0.91 [0.87‐0.96]). Living in a nursing home was associated with an increased risk of conveyance (aOR 1.25 [1.15‐1.36]). Patients with dementia with more income were significantly less likely to be conveyed than those with less income. Alternative referral services were used in 22% of non-conveyed patients, most commonly GP, out-of-hours and falls services.Discussion: People aged ≥75 years have high rates of conveyance, which are influenced by factors such as out-of-hours calls, dementia and receipt of social care. Low use of alternative referral services may reflect limited availability or difficulty in access. A better understanding of how these factors influence ambulance clinician decision-making is integral to improvement of outcomes for older people.

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Barchielli, Chiara, Marco Pantini, Emanuele Gasperetti, Marco Alaimo, and Paolo Zoppi. "Changing landscapes: helping caregivers, an experience from Tuscany." International Journal of Integrated Care 23, S1 (December 28, 2023): 123. http://dx.doi.org/10.5334/ijic.icic23361.

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Introduction: While multi-professional care interventions are guaranteed through an integrated care model, sometimes there is no possibility to support full-time assisting patients’ families in terms of allowing them the time for their life and home management activities. The role of the caregiver is essential throughout the day to address the patient’s needs: in this way, an appropriate level of well-being can be assured to who is undergoing the last stages of illness. The growing need for forms of support caregivers who assist those patients at home, generated a reflection by the family and community nurses operating in the territory of Pistoia, Tuscany. Targeted population and stakeholders: Caregivers and families that care for under 63 patients in the end-stages of disease. Timeline: The project started in 2022 and will not be interrupted. Highlights: The patient may be untreatable, but never incurable: the healthcare professionals take care of the person and until the end. This resolution gave rise to the idea of a project called "Quick Assistance”, aimed at expanding the available services at the local level. It provides a package of 20 hours of a healthcare assistant presence at home to be used by the families needing them and provided by private firms. The activation of the service is guaranteed by the professionals’ network that revolves around the patient (Family and Community Nurses, GPs), that can identify a manifest, latent or unexpressed need and provide the appropriate response. The project is supported by the Società della Salute Pistoiese, a public entity constituted by Municipalities and the Local Health Autority for the associated exercise of territorial, socio-sanitary, and social activities. Where needs arise, care must be available to the patient and to the caregivers. This is the way in which the Tuscan NHS engages with the population, that is implementing the concept of integrated care at the microlevel, with the goal of enabling the extended concept of “patient” (patients and caregivers) to be at the centre of the care coordination. In other words, the system is adapting to the real needs expressed by the population, filling “unintentional gaps” that derive from an ongoing population knowledge process: through a participatory approach, solutions are shaped. This was the case of a 63-year-old patient in the last stages of illness that couldn’t benefit from the services offered by the system being him under 65, age above which the NHS provides for a very wide range of services, designed for elderly and fragile people. Conclusions: The project aims to provide support to families in the surveillance and assistance of the patient. “Quick Assistance” strengthens the implementation of care provision at home and is effective in reducing the caregiver burden to prevent a more serious condition, as the caregiver’s burnout. The latter becomes more frequent in modern societies: that is due to changing cultural and social characteristics that have delegated the function of proximity and presence to external subjects.

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46

Barchielli, Chiara, Marco Pantini, Emanuele Gasperetti, Marco Alaimo, and Paolo Zoppi. "Changing landscapes: helping caregivers, an experience from Tuscany." International Journal of Integrated Care 23, S1 (December 28, 2023): 256. http://dx.doi.org/10.5334/ijic.icic23099.

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Introduction: While multi-professional care interventions are guaranteed through an integrated care model, sometimes there is no possibility to support full-time assisting patients’ families in terms of allowing them the time for their life and home management activities. The role of the caregiver is essential throughout the day to address the patient’s needs: in this way, an appropriate level of well-being can be assured to who is undergoing the last stages of illness. The growing need for forms of support caregivers who assist those patients at home, generated a reflection by the family and community nurses operating in the territory of Pistoia, Tuscany. Targeted population and stakeholders: Caregivers and families that care for under 63 patients in the end-stages of disease. Timeline: The project started in 2022 and will not be interrupted. Highlights: The patient may be untreatable, but never incurable: the healthcare professionals take care of the person and until the end. This resolution gave rise to the idea of a project called ""Quick Assistance”, aimed at expanding the available services at the local level. It provides a package of 20 hours of a healthcare assistant presence at home to be used by the families needing them and provided by private firms. The activation of the service is guaranteed by the professionals’ network that revolves around the patient (Family and Community Nurses, GPs), that can identify a manifest, latent or unexpressed need and provide the appropriate response. The project is supported by the Società della Salute Pistoiese, a public entity constituted by Municipalities and the Local Health Autority for the associated exercise of territorial, socio-sanitary, and social activities. Where needs arise, care must be available to the patient and to the caregivers. This is the way in which the Tuscan NHS engages with the population, that is implementing the concept of integrated care at the microlevel, with the goal of enabling the extended concept of “patient” (patients and caregivers) to be at the centre of the care coordination. In other words, the system is adapting to the real needs expressed by the population, filling “unintentional gaps” that derive from an ongoing population knowledge process: through a participatory approach, solutions are shaped. This was the case of a 63-year-old patient in the last stages of illness that couldn’t benefit from the services offered by the system being him under 65, age above which the NHS provides for a very wide range of services, designed for elderly and fragile people. Conclusions: The project aims to provide support to families in the surveillance and assistance of the patient. “Quick Assistance” strengthens the implementation of care provision at home and is effective in reducing the caregiver burden to prevent a more serious condition, as the caregiver’s burnout. The latter becomes more frequent in modern societies: that is due to changing cultural and social characteristics that have delegated the function of proximity and presence to external subjects.

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Cornes, Michelle, Robert W. Aldridge, Elizabeth Biswell, Richard Byng, Michael Clark, Graham Foster, James Fuller, et al. "Improving care transfers for homeless patients after hospital discharge: a realist evaluation." Health Services and Delivery Research 9, no. 17 (September 2021): 1–186. http://dx.doi.org/10.3310/hsdr09170.

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Background In 2013, 70% of people who were homeless on admission to hospital were discharged back to the street without having their care and support needs addressed. In response, the UK government provided funding for 52 new specialist homeless hospital discharge schemes. This study employed RAMESES II (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) guidelines between September 2015 and 2019 to undertake a realist evaluation to establish what worked, for whom, under what circumstances and why. It was hypothesised that delivering outcomes linked to consistently safe, timely care transfers for homeless patients would depend on hospital discharge schemes implementing a series of high-impact changes (resource mechanisms). These changes encompassed multidisciplinary discharge co-ordination (delivered through clinically led homeless teams) and ‘step-down’ intermediate care. These facilitated time-limited care and support and alternative pathways out of hospital for people who could not go straight home. Methods The realist hypothesis was tested empirically and refined through three work packages. Work package 1 generated seven qualitative case studies, comparing sites with different types of specialist homeless hospital discharge schemes (n = 5) and those with no specialist discharge scheme (standard care) (n = 2). Methods of data collection included interviews with 77 practitioners and stakeholders and 70 people who were homeless on admission to hospital. A ‘data linkage’ process (work package 2) and an economic evaluation (work package 3) were also undertaken. The data linkage process resulted in data being collected on > 3882 patients from 17 discharge schemes across England. The study involved people with lived experience of homelessness in all stages. Results There was strong evidence to support our realist hypothesis. Specialist homeless hospital discharge schemes employing multidisciplinary discharge co-ordination and ‘step-down’ intermediate care were more effective and cost-effective than standard care. Specialist care was shown to reduce delayed transfers of care. Accident and emergency visits were also 18% lower among homeless patients discharged at a site with a step-down service than at those without. However, there was an impact on the effectiveness of the schemes when they were underfunded or when there was a shortage of permanent supportive housing and longer-term care and support. In these contexts, it remained (tacitly) accepted practice (across both standard and specialist care sites) to discharge homeless patients to the streets, rather than delay their transfer. We found little evidence that discharge schemes fired a change in reasoning with regard to the cultural distance that positions ‘homeless patients’ as somehow less vulnerable than other groups of patients. We refined our hypothesis to reflect that high-impact changes need to be underpinned by robust adult safeguarding. Strengths and limitations To our knowledge, this is the largest study of the outcomes of homeless patients discharged from hospital in the UK. Owing to issues with the comparator group, the effectiveness analysis undertaken for the data linkage was limited to comparisons of different types of specialist discharge scheme (rather than specialist vs. standard care). Future work There is a need to consider approaches that align with those for value or alliance-based commissioning where the evaluative gaze is shifted from discrete interventions to understanding how the system is working as a whole to deliver outcomes for a defined patient population. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 17. See the NIHR Journals Library website for further project information.

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Taib, Fahisham, Hans Van Rostenberghe, and Nurul Adilah Muhammad. "Pediatric Palliative Care in Kelantan: A Community Engagement Model." Bangladesh Journal of Medical Science 15, no. 1 (April 11, 2016): 51–56. http://dx.doi.org/10.3329/bjms.v15i1.27139.

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Holistic package of palliative care service for children is not available in most places in the South East Asia. This has resulted in unwanted suffering and loss of hope in the unfortunate families. Pediatric palliative care (PPC) is a new subspecialty in Malaysia. In our region, it was started in 2012 as a Universitys community engagement project following completion of self-initiated palliative care distance learning in Australia by a pediatrician. The grant was labeled as a flagship project and secured under the Division of Community & Industry Network of USM (BJIM) to provide service in the hospital and outreach home based PPC services, which include nursing care, needs assessment and psychosocial support for the patients and caregivers. Knowledge transfer program was initiated, in collaboration with Yayasan Orang Kurang Upaya (YOKUK) or Kelantan Foundation for the Disabled, to equip the outreach team with skills dealing with children with life limiting illnesses (LLI) in Kelantan. The move has propagated regular training setup with transformational program from hospital to community settings. This setup has led to mutual cooperation across the disciplines and provided linkages for stronger networking and training either locally or internationally. Better understanding on the importance of palliative care in the community can be achieved by having active community participation and volunteerism.Bangladesh Journal of Medical Science Vol.15(1) 2016 p.51-56

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Day, Jenny, Ann Clare Thorington Taylor, Peter Summons, Pamela Van Der Riet, Sharyn Hunter, Jane Maguire, Sophie Dilworth, et al. "Home care packages: insights into the experiences of older people leading up to the introduction of consumer directed care in Australia." Australian Journal of Primary Health 23, no. 2 (2017): 162. http://dx.doi.org/10.1071/py16022.

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This paper reports phase one, conducted from March to June 2015, of a two-phase, qualitative descriptive study designed to explore the perceptions and experiences of older people before and after the introduction of consumer directed care (CDC) to home care packages (HCP) in Australia. Eligible consumers with a local HCP provider were mailed information about the study. Data collection occurred before the introduction of CDC and included face-to-face, in-depth interviews, summaries of interviews, field notes and reflective journaling. Semi-structured questions and ‘emotional touchpoints’ relating to home care were used to guide the interview conversation. Line-by-line data analysis, where significant statements were highlighted and clustered to reveal emergent themes, was used. Five older people, aged 81 to 91 years, participated in the study. The four emergent themes were: seeking quality and reciprocity in carer relationships; patchworking services; the waiting game; and technology with utility. Continuity of carers was central to the development of a trusting relationship and perceptions of care quality among older consumers. Care coordinators and workers should play a key role in ensuring older people receive timely information about CDC and their rights and responsibilities. Participants’ use of contemporary technologies suggests opportunities to improve engagement of HCP clients in CDC.

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Tesfau, Yemane Berhane, Tesfay Gebregzabher Gebrehiwot, Hagos Godefay, and Alemayehu Bayray Kahsay. "Effect of health facility linkage with community using postnatal card on postnatal home visit coverage and newborn care practices in rural Ethiopia: A controlled quasi-experimental study design." PLOS ONE 17, no. 5 (May 12, 2022): e0267686. http://dx.doi.org/10.1371/journal.pone.0267686.

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Background Postnatal home visit has the potential to improve maternal and newborn health, but it remains as a missed opportunity in many low-and middle-income countries. This study examines the effect of health extension worker administered postnatal card combined with health facility strengthening intervention on postnatal home visit coverage, newborn care practices, and knowledge of newborn danger signs in rural Ethiopia. Methods We employed quasi-experimental design using controlled before-and-after study in intervention and comparison districts of rural Tigray, northern Ethiopia. Training of health extension workers (HEWs) on postnatal home visit (PNHV), training of healthcare providers on maternal and newborn care, and capacity building of healthcare authorities on leadership, management and governance together with health system strengthening were the implemented interventions. Baseline (n = 705) and end line (n = 980) data were collected from mothers who delivered a year before the commencement of the actual data collection in the respective surveys. We used difference-in-differences (DiD) analysis to assess the effect of the intervention on PNHV coverage, essential newborn care practices and maternal knowledge of newborn danger signs. Results A total of 1685 (100%) mothers participated in this study. In all districts, more than 1/3rd of the mothers 633(37.57%) were in the age of 30–39 years. The difference-in-differences estimator showed an average of 23.5% increase in coverage of PNHVs within three days (DiD, p<0.001) and the provision of most postnatal contents significantly increased in the intervention district in the end line survey. The knowledge of at least three danger signs increased by 13.6% (p = 0.012).The DiD estimator showed an average of 27.6% increase to check the mothers for heavy bleeding (DiD, p = 0.011). This study also revealed that the checking of maternal blood pressure increased from 5.8% to 11.8% in the comparison districts and from 9.4% to 93.3% in the intervention district. The difference-in-differences estimator result showed a 9% difference in clean cord care practices among the participants (p = 0.025), 12.2% in skin to skin care (p = 0.022), and borderline significant increase in early initiation of breastfeeding (10.5%, p = 0.051). Conclusion We conclude that the intervention package was effective in improving the coverage of PNHV, increase in knowledge of newborn danger sign and essential newborn care practices. Hence, further strengthening the linkages between health facilities and community is imperative to improve the coverage of essential lifesaving maternal and newborn care services by HEWs at home.

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