Effect of postnatal home visits on maternal/infant outcomes in Syria: a randomized controlled trial

OBJECTIVE: Early postpartum home visiting is universal in many Western countries. Studies from developing countries on the effects of home visits are rare. In Syria, where the postpartum period is rather ignored, this study aimed to assess whether a community-based intervention of postnatal home visits has an effect on maternal postpartum morbidities; infant morbidity; uptake of postpartum care; use of contraceptive methods; and on selected neonatal health practices. DESIGN: A randomized controlled trial was carried out in Damascus. Three groups of new mothers were randomly allocated to receive either 4 postnatal home visits (A), one visit (B), or no visit (C). SAMPLE: A total of 876 women were allocated and followed up. INTERVENTION: Registered midwives with special training made a one or a series of home visits providing information, educating, and supporting women. RESULTS: A significantly higher proportion of mothers in Groups A and B reported exclusively breastfeeding their infants (28.5% and 30%, respectively) as compared with Group C (20%), who received no visits. There were no reported differences between groups in other outcomes. CONCLUSIONS: While postpartum home visits significantly increased exclusive breastfeeding, other outcomes did not change. Further studies framed in a nonbiomedical context are needed. Other innovative approaches to improve postnatal care in Syria are needed.     

Impact of pharmacist-conducted home visits on the outcomes of lipid-lowering drug therapy

OBJECTIVE: To evaluate a pharmacist-conducted educational and monitoring programme, designed to promote dietary and lifestyle modification and compliance with lipid-lowering drug therapy, for patients with dyslipidaemia. METHODS: This was a prospective, randomized, controlled study. The participants were 94 adults, with 81 completing the study (intervention group: 39; control group: 42), with a cardiovascular-related diagnosis and discharged from hospital, between April and October 2001, on lipid-lowering drug therapy. Patients in the intervention group were visited at home monthly by a pharmacist, who educated the patients on the goals of lipid-lowering treatment and the importance of lifestyle issues in dyslipidaemia and compliance with therapy, assessed patients for drug-related problems, and measured total blood cholesterol levels using point-of-care testing. Patients in the control group received standard medical care. The main outcome measure was total blood cholesterol levels after 6 months, and an evaluation of patient and general practitioner satisfaction with the programme. RESULTS: There was no significant difference in baseline total blood cholesterol levels between the two groups. The reduction over the course of the study in cholesterol levels within the intervention group was statistically significant (4.9 +/- 0.7 to 4.4 +/- 0.6, P<0.005), whereas there was no change within the control group (P=0.26). At follow-up, 44% of the intervention group patients and 24% of the control group patients had cholesterol levels below 4.0 mmol/L (P=0.06). The reduction in total cholesterol in the intervention group should translate to an expected 21% reduction in cardiovascular mortality risk and a 16% reduction in total mortality risk--more than twice the risk reduction achieved in the control group. In addition, the programme was very well received by the patients and their general practitioners, by satisfaction questionnaire. CONCLUSION: A pharmacist-conducted educational and monitoring intervention improved the outcomes of lipid-lowering drug therapy.     

The outcomes of nurse practitioner (NP)-Provided home visits: A systematic review

BackgroundWith the shortage of primary care providers to provide home-based care to the growing number of homebound older adults in the U.S. Nurse Practitioners (NPs) are increasingly utilized to meet the growing demand for home-based care and are now the largest type of primary care providers delivering home-visits.PurposeThe purpose of this study was to systematically examine the current state of the evidence on health and healthcare utilization outcomes associated with NP-home visits.MethodFive Databases (PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library) were systematically searched to identify studies examining NP-home visits. The search focused on English language studies that were published before April 2019 and sought to describe the outcomes associated with NP-home visits. We included experimental and observational studies.  Quality appraisal was performed with the Kmet, Lee & Cook tool, and results summarized qualitatively. The impact of NP-home visits on clinical (functional status, quality of life [QOL]), and healthcare utilization (hospitalization, Emergency department(ED) visits) outcomes was evaluated.Results/DiscussionA total of 566 citations were identified; 7 met eligibility criteria and were included in the review. The most commonly reported outcomes were emergency department (ED) visits and readmissions. Given the limited number of articles generated by our search and wide variation in intervention and outcomes measures. NP-home visits were associated with reductions in ED visits in 2 out of 3 studies and with reduction in readmissions in 2 out of 4 studies.ConclusionPublished studies evaluating the outcomes associated with NP-home visits are limited and of mixed quality. Limitations include small sample size, and variation in duration and frequency of NP-home visits. Future studies should investigate the independent effect of NP-home visits on the health outcomes of older adults using large and nationally representative data with more rigorous study design.     

Psychosocial home visits in cancer treatment: a qualitative study on the content of home visits

As an initial part of a large randomized psychosocial intervention study on the effect of home visits to Danish patients with colorectal cancer, a qualitative interview study was performed to investigate how these home visits should be carried out. The study included 21 informants, consisting of a of patients with colorectal cancer, an of patients with breast cancer who had previously received home visits in another project, a of volunteers performing home visits, and a of researchers in the field of home visiting. The results of qualitative semistructured interviews were compared and analyzed. Common themes were identified and placed in a paradigm model. Respect for the patient as a fellow human being was a prerequisite for ensuring confidence and was chosen as the core category in the analysis. The analysis suggested that visits to patients' homes resulted in better balanced contacts than did visits at hospitals. Most patients requested personal involvement and continuity from their visitors, preferably a healthcare professional capable of providing health information and practical help. In conclusion, we expect that coping with the consequences of a diagnosis of cancer will be improved when patients are regarded as individuals rather than as objects. Home visits may facilitate this process.     

What were the outcomes of home follow-up visits after postpartum hospital discharge?

OBJECTIVES: To assess health outcomes of home follow-up visits after postpartum discharge and assess relationships between the number of home visits and selected outcomes among women who gave birth at two Queensland, Australia, regional hospitals. DESIGN: A cross sectional study. Services provided during the home visits were responsive to a woman's need rather than having a structured protocol of services. MAIN OUTCOME MEASURES: The four measured health outcomes were: 1) postpartum depression; 2) confidence to undertake maternal roles; 3) breastfeeding; and, 4) satisfaction with postpartum care. RESULTS: Of 210 women who were invited to participate in the study, 143 (68.1%) provided information. Women who received a higher number of home visits had significantly lower confidence to undertake maternal roles than those who received fewer home visits. There was a positive correlation between the number of home follow-up visits and postpartum depression among women who gave birth at one hospital (Hospital B), but not at the other (Hospital A). No relationship was found between the home postpartum visits and the other outcomes. CONCLUSION: These results could be explained in that home follow-up visits were offered to all women at Hospital A while Hospital B only provided home visits to women who had a health risk due to their social, physical and psychological characteristics. The lack of protocol home visits and the characteristics of women receiving the visits were probably the major factors which influenced these limited beneficial outcomes.     

社区产妇产后访视情况的调查分析

目的调查社区产后访视情况,并提出相应的对策。方法采用自行设计的调查问卷对86名分娩后的产妇进行调查。结果86名产妇中,57.0%产妇接受过1次产后访视,59.3%产妇接受访视时间为15～30 min;72.1%访视内容以伤口及恶露检查为主;23.3%访视人员为代乳品公司职员。影响访视质量的因素是,74.4%产妇认为访视人员专业知识缺乏,47.7%认为访视内容缺乏专业性,24.4%认为访视不及时。结论拓宽产后保健知识途径,加快产后访视人员知识更新,拓展保健知识内容,规范化管理对提高社区产妇产后访视服务质量具有积极的意义。     

Dropping out of maternal and child home visits

The purpose of this study was to examine the relationship between nurse and client characteristics and the reason for client termination from public health nursing maternal and child home visits. The results indicate that clients who dropped out of services received more contacts from the nurses, missed more appointments with the nurses, and were given advice from the nurses on more topics. They also differed from clients who continued with services until the nursing care plan goals were met in reference to marital status, mental illness, source of payment for services, and use of WIC and food stamps. Nurses whose clients were more likely to continue until goals were met were higher in conscientiousness, learned more from experience, and learned less from coworkers or learning on their own. They also worked more hours per week. These findings have implications for practice and research.