Understanding complex care for older adults within Canadian home care: a systematic literature review

In the context of an aging population, both the need for home care services and its complexity of care have increased in many high-income countries. Yet, the definition of what constitutes complex care is largely elusive. This systematic review examined the conceptual definition of complex care within the home care environment using several social and health science databases for research published from 2000 to 2017. Of the 25 articles and reports identified, only 16 addressed complex care specifically and included older adults, aging, and/or home care. The results showed that complex care for older adults is primarily defined from a biomedical approach focusing on chronic disease and management and less commonly from the perspective of the social determinants of health. Future studies should consider the importance of the continuum of care needs from both the biomedical and the social determinants to adequately plan and provide care for older adults.     

Hospital care at home: an evaluation of a scheme for orthopaedic patients

We report on an evaluation of the practicality and acceptability of the 'Going Home Service', an early discharge intensive patient support scheme for orthopaedic patients in their own homes. Patient outcomes were assessed in terms of health and functional status and the impact on patient's carers was assessed. Eight-seven patients who were successfully discharged from the service were compared with 17 patients readmitted to hospital prior to their discharge from the service, 44 patients suitable for the service who did not take it up and 15 patients discharged from hospital traditionally immediately prior to the service becoming operational. Data were collected via face to face semistructured interviews and note searching. Twenty-six of the patients' informal carers were also interviewed. The majority of patients in all four groups were elderly women, readmitted patients being significantly older than those successfully discharged. The readmitted patients were also more likely to have been admitted originally for traumatic surgery and less likely to have been independently mobile prior to the initial admission. Hospital length of stay was shorter amongst Going Home Service patients than those cared for traditionally, but the total episode of care was greater. Patients and carers were well satisfied with the service. Although there was no evidence that quality of life or functionality were affected by their early discharge, at three months post operation, there was some evidence that Going Home Service patients were experiencing less pain than those discharged traditionally. This early discharge service provided a good quality of health and social care for the majority of patients. However, it did not suit all patients and a minority were re-admitted. The findings reported here add to those obtained in other settings and highlight new aspects for consideration in the planning and delivery of high quality hospital at home schemes.     

Families' experiences of caring at home for a technology-dependent child: a review of the literature

Recent medical advances have led to the emergence of a group of chronically ill children who are dependent upon technology for their survival. Many of these children are cared for at home by their parents. This paper presents an overview of the literature that has examined the experiences of families caring for a technology-dependent child at home. The social, emotional and financial impact on families and their perspectives on the services supporting them at home is described. The paper concludes by identifying areas where further research is needed.     

国内外全科医生工作满意度研究综述

全科医生作为基层医疗卫生服务的主要提供者,其服务质量和水平的提升对增进居民健康具有重要意义,而工作满意度直接影响了其医疗过程,进而影响到整个基本医疗卫生服务的供给效率和质量。因此,笔者从全科医生工作满意度这一视角入手,通过文献梳理,比较分析国内外全科医生工作满意度的测量工具、满意度水平和影响因素,从而对全科医生工作满意度的研究现状进行综述。研究发现国内全科医生工作满意度研究方法单一、内容趋于一致。在影响因素的研究中需进一步考虑加入工作自主性、工作多样性、客观工作环境等工作特征相关因素。在研究设计时考虑论证强度更高的纵向研究或队列研究。将研究结果与政策制定相结合,通过研究促进全科医生制度的完善。     

Shared care: a review of the literature

This review examines broad issues of concern regarding the primary/secondarycare interface. The main purpose was to identify areas of goodpractice which could be adapted for more general use. One ofthe most fundamental aspects identified was communication, whichis discussed in some detail. Also covered are shared prescribingand disease management. The data suggest that the most effectivesystem(s) of shared care has yet to be established. Furtherqualitative and economic evaluations are required, taking intoaccount patient preferences. Although the literature does describecertain practice exemplars, it is clear that inter- and intra-professionalcommunication continues to be a problem. Whilst informationtechnology may provide some of the solutions, it is concludedthat a culture change, which compels health professionals tomake sharing of patient information a much higher priority,is reauired. Keywords. Shared care, seamless care, hospital, general practice, family practice.     

Conducting a literature review on the effectiveness of health care interventions

The dramatic increase in the volume of research based information means that effective policy makers must be able to conduct and interpret literature reviews. This article sets out the steps that should be followed in doing so. They are: explicitly defining the question; locating relevant literature; assessing the quality of studies and deciding whether they should be included; synthesizing and re-analyzing the results; and presenting them in a clear and concise manner. The article identifies the leading sources of information, including electronic databases and useful Internet addresses and describes briefly how each stage should be conducted, highlighting the strengths and weaknesses of different approaches and the ways in which bias may be introduced.     

The effects of complications and comorbidities on the quality of preventive diabetes care: a literature review

Although concurrent conditions such as complications and comorbidities are common in people with diabetes, both are often omitted from studies of the quality of diabetes preventive care. This systematic review of the literature on the quality of diabetes preventive care assesses not only trends in the reporting of and adjusting for complications and comorbidities, but also the limitations of current measures of complications and comorbidities. This review identified 34 studies in which the quality of diabetes preventive care was assessed with process measures and complications or comorbidities were reported. More often than not, the studies identified the presence of certain complications or comorbidities, counted complications or comorbidities, or used comorbidity indices to measure morbidity. While earlier studies reported the prevalence of complications or comorbidities, more recent studies use complications or comorbidities as covariates in regression models. Despite this progress, the effects of complications and comorbidities on care processes are unclear because of cross-study variation among measures of complications and comorbidities and because very few studies address the independent effects of complications and comorbidities. Effective measures of complications and comorbidity are necessary to evaluate the quality of diabetes preventive care, particularly for patients with concurrent conditions. Current reported measures of complications and comorbidities may not address constructs related to quality, underscoring the need for a methodology that is better than the approaches now documented in the literature.     

The use of data for process and quality improvement in long term care and home care: a systematic review of the literature

BackgroundStandardized resident or client assessments, including the Resident Assessment Instrument (RAI), have been available in long term care and home care settings (continuing care sector) in many jurisdictions for a number of years. Although using these data can make quality improvement activities more efficient and less costly, there has not been a review of the literature reporting quality improvement interventions using standardized data.ObjectivesTo address 2 questions: (1) How have RAI and other standardized data been used in process or quality improvement activities in the continuing care sector? and (2) Has the use of RAI and similar data resulted in improvements to resident or other outcomes?Data SourcesSearches using a combination of keyword and controlled vocabulary term searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Cochrane Library, and PsychINFO.Eligibility Criteria, Participants, and InterventionsEnglish language publications from database inception to October 2008 were included. Eligibility criteria included the following: (1) set in continuing care (long-term care facility or home care), (2) involved some form of intervention designed to improve quality or process of care, and (3) used standardized data in the quality or process improvement intervention.Study Appraisal and Synthesis MethodsAfter reviewing the articles, we grouped the studies according to the type of intervention used to initiate process improvement. Four different intervention types were identified. We organized the results and discussion by these 4 intervention types.ResultsKey word searches identified 713 articles, of which we excluded 639 on abstract review because they did not meet inclusion criteria. A further 50 articles were excluded on full-text review, leaving a total of 24 articles. Of the 24 studies, 10 used a defined process improvement model, 8 used a combination of interventions (multimodal), 5 implemented new guidelines or protocols, and 1 used an education intervention.Conclusions/ImplicationsThe most frequently cited issues contributing to unsuccessful quality improvement interventions were lack of staff, high staff turnover, and limited time available to train staff in ways that would improve client care. Innovative strategies and supporting research are required to determine how to intervene successfully to improve quality in these settings characterized by low staffing levels and predominantly nonprofessional staff. Research on how to effectively enable practitioners to use data to improve quality of care, and ultimately quality of life, needs to be a priority.     

Smoking in the nursing home: a case report and literature review

We report a case of second- and third-degree burns in an elderly nursing home resident with dementia who was smoking in her room. This case highlights the risks of smoking by residents in long-term care settings. It also raises awareness to the issues involving smoking cessation and restriction of smoking privileges in the long-term care setting.     

The effects of woman abuse on health care utilization and health status: a literature review.

Estimates of the physical abuse of women by husbands or boyfriends in the United States range from 85 per 1000 couples to 113 per 1000 couples per year. Victims of abuse are much more likely than nonvictims to have poor health, chronic pain problems, depression, suicide attempts, addictions, and problem pregnancies. Abused women use a disproportionate amount of health care services, including emergency room visits, primary care, and community mental health center visits. Despite its high prevalence and the disproportionate use of health care services it causes, woman abuse is rarely recognized by health care providers. Even when the abuse is recognized, health care professionals often provide inappropriate or even harmful treatment. Because many abused women pass through the health care system, it is important that providers learn how to identify those who are abused, treat all the effects of the abuse, and make appropriate referrals.     

Hospital or home care for the severely disabled: a cost comparison.

A case study of severely disabled patients needing regular mechanical help with breathing following poliomyelitis was set up in 1970 to establish what medical, technical, and social support would be required for home rather than hospital care. In this paper these two care alternatives are considered from an economic point of view and a detailed cost comparison is made between entirely hospital based care and predominantly home care.     

Hospital or home care for the severely disabled: a cost comparison.

A case study of severely disabled patients needing regular mechanical help with breathing following poliomyelitis was set up in 1970 to establish what medical, technical, and social support would be required for home rather than hospital care. In this paper these two care alternatives are considered from an economic point of view and a detailed cost comparison is made between entirely hospital based care and predominantly home care.     

Suit says working at home is a form of job accommodation

The Equal Employment Opportunity Commission (EEOC) in San Francisco filed a reasonable accommodation complaint on behalf of Andrea Lee against Lockheed Martin Corp. Lee developed complications of diabetes and asked to work at home two days per week to maintain her doctor's recommended eating and exercise schedules. Lockheed refused. EEOC claims the company permitted a similarly situated male employee to work at home on a regular basis and alleged that the company's action was sex discrimination as well as discrimination on the basis of disability. The agency seeks a permanent injunction to bar Lockheed from denying such reasonable accommodations, as well as compensatory and punitive damages. The case tests the court's receptiveness to working at home as a form of accommodation. EEOC recognizes that some jobs require the worker's presence at the job site and that some workers need supervision, but holds there are situations where working at home is appropriate. Enforcement guidance issued by the EEOC in March on working at home is provided.     

Housing and dementia care - a scoping review of the literature

This paper reports the findings of a scoping study designed to describe the evidence base with regard to housing provision for elderly people with dementia with the aim of identifying gaps in existing knowledge. This report from the scoping study findings covers studies of housing and accommodation in relation to dementia that have been published in the UK since the early 1980s, although we draw on limited aspects of overseas research to illuminate issues missing from the UK research agenda. The results reveal a significant number of research gaps in the UK context, most notably in relation to end-of-life care for people with dementia and the effectiveness of integrated and segregated facilities. UK policy regarding the development of extra-care housing also neglects the long-term future of people with dementia. A more robust evidence base will be required, combining a variety of methodological approaches, if UK dementia research is to contribute to future housing policy developments.     

End-of-life care volunteers: a systematic review of the literature.

This report presents a review of 1988 and onwards research and other literature on end-of-life (EOL) care volunteers. Only 18 research or case studies articles were identified for an integrative review through a search of nine library databases. A review of this literature revealed three themes: (1) the roles of EOL volunteers, (2) volunteer training and other organizational needs or requirements, and (3) outcomes, particularly the impact of volunteering on volunteers and the impact of volunteers on EOL care. Despite limited statistical evidence, the available literature on EOL care volunteers clearly indicates that considerable potential benefit can be derived from EOL care volunteers' contributions, with their efforts benefiting dying persons, their families, paid EOL staff, and the volunteers themselves. More specifically, willing volunteers, particularly those with diverse skills and abilities, have the potential to significantly and positively impact EOL care in that they can perform many necessary and extra functions of value. Volunteers often augment and enhance the range of EOL care services provided to terminally ill individuals and their families. Volunteers should also be recognized as increasing the accessibility of EOL care. The role of the volunteer is not without challenge, however, both for the individuals who volunteer and the organizations that must orient them and provide a meaningful role for them.