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Home care medicine

Thomas R Freeman, Leslie Boisvert, Eric Wong, Stephen Wetmore, Heather Maddocks
OBJECTIVE: To determine the range of services and procedures offered by family physicians who define themselves as comprehensive practitioners and compare responses across 3 generations of alumni of a single family practice program. DESIGN: Cross-sectional survey. SETTING: Western University in London, Ont. PARTICIPANTS: All graduates of the family medicine program between 1985 and 2012. MAIN OUTCOME MEASURES: Self-reported provision of the following types of care: in-office care, in-hospital care, intrapartum obstetrics, housecalls, palliative care, after-hours care, nursing home care, minor surgery, emergency department care, sport medicine, and walk-in care...
October 2018: Canadian Family Physician Médecin de Famille Canadien
Peter Damiano, Julie Reynolds, Jill Boylston Herndon, Susan McKernan, Raymond Kuthy
OBJECTIVE: To develop the first standardized definition of the patient-centered dental home (PCDH). DATA SOURCES/STUDY SETTING: Primary data from a 55-member national expert panel and public comments. STUDY DESIGN: We used a modified Delphi process with three rounds of surveys to collect panelists' ratings of PCDH characteristics and open-ended comments. The process was supplemented with a 1-month public comment period. DATA COLLECTION/EXTRACTION METHODS: We calculated median ratings, analyzed consensus using the interpercentile range adjusted for symmetry, and qualitatively evaluated comments...
October 10, 2018: Health Services Research
Vicki Hunt, Dave Anderson, Richard Lowrie, Colette Montgomery Sardar, Susan Ballantyne, Graeme Bryson, John Kyle, Peter Hanlon
UK, home-based patients with COPD receive specialist care from respiratory physicians, nurses, and general practitioners (GPs), but increasing complexity of therapeutic options and a GP/Nurse workforce crisis suggests merit in testing the role of home visits by a clinical pharmacist. We conducted a non-randomised intervention study with a contemporaneous comparator group, in Glasgow (Scotland). A clinical pharmacist (working closely with a consultant respiratory physician) visited patients with COPD living at home, assessing respiratory and other co-morbid conditions, and medicines then, with patient approval, agreed treatment modifications with a consultant physician...
October 10, 2018: NPJ Primary Care Respiratory Medicine
Edwige Apetoh, Marina Tilly, Carine Baxerres, Jean-Yves Le Hesran
BACKGROUND: Malaria is the main cause of hospital admissions in Benin and a leading cause of death in childhood. Beside consultations, various studies have underlined the management of the disease through home treatment. The medicines used can be purchased in informal market of pharmaceutical drugs (IMPD) without prescription or any involvement of healthcare professional. Pharmaceutical drugs are sold by informal private vendors, who operate at any time in the immediate environment of the patients...
October 10, 2018: Malaria Journal
Gregory J Norman, Amy J Wade, Andrea M Morris, Jill C Slaboda
BACKGROUND: Medically complex vulnerable older adults often face social challenges that affect compliance with their medical care plans, and thus require home and community-based services (HCBS). This study describes how non-medical social needs of homebound older adults are assessed and addressed within home-based primary care (HBPC) practices, and to identify barriers to coordinating HCBS for patients. METHODS: An online survey of members of the American Academy of Home Care Medicine (AAHCM) was conducted between March through November 2016 in the United States...
October 11, 2018: BMC Geriatrics
Ryuichi Ohta, Yoshinori Ryu, Takuji Katsube
Among medical professionals, the role of home care workers is crucial in the care of patients in their homes. In Japan, however, research on the difficulties home care workers face while working in rural zones is limited. Using thematic analysis, a qualitative study was conducted with 57 home care workers in a rural area of Japan. Findings revealed the difficulties they experienced regarding the medical problems of their patients and in their relationships with other professionals. The old customs of rural medicine and the system of long-term care insurance strongly influence relationships among multiprofessionals, leading to conflict and hierarchy...
October 9, 2018: Home Health Care Services Quarterly
Laura Maria Francisca Kuijpers, Charlotte Gryseels, Sambunny Uk, Panha Chung, Sotharith Bory, Bun Sreng, Amy Parry, Jan Jacobs, Koen Peeters Grietens
Enteric fever is a systemic bacterial infection in humans that is endemic in Cambodia and for which antibiotic resistance is increasingly reported. To guide public health programs, this qualitative study sought to explore community perceptions on transmission and treatment. Participant observation was carried out in hospital settings, pharmacies, and at a community level in Phnom Penh. In-depth interviews 39 and one focus group discussion were carried out with blood culture-confirmed enteric fever patients and purposively selected key informants...
October 8, 2018: American Journal of Tropical Medicine and Hygiene
Jörg-Christian Renz, Matthias Meinck
OBJECTIVE: Preventive home visits (PHV) are a measure for promoting the health of elderly people. A study of these measures used over the past 40 years in many countries across the globe revealed a very diverse picture regarding targeted groups, applied structures and intervention contents. So far, there has been no clear evidence of their effectiveness on outcomes such as mortality, need for care, hospital or nursing home admissions. However, a steady increase in PHV programmes in Germany warrants an examination of the current national practice...
October 1, 2018: Das Gesundheitswesen
Sue Jordan, Timothy Banner, Marie Gabe-Walters, Jane M Mikhail, Jeff Round, Sherrill Snelgrove, Mel Storey, Douglas Wilson, David Hughes
INTRODUCTION: Improved medicines' management could lead to real and sustainable improvements to the care of older adults. The overuse of mental health medicines has featured in many reports, and insufficient patient monitoring has been identified as an important cause of medicine-related harms. Nurse-led monitoring using the structured adverse drug reaction (ADRe) profile identifies and addresses the adverse effects of mental health medicines. Our study investigates clinical impact and what is needed to sustain utilisation in routine practice in care homes...
September 28, 2018: BMJ Open
Adejumoke I Ayede, Amir Kirolos, Kayode R Fowobaje, Linda J Williams, Ayobami A Bakare, Oladapo B Oyewole, Oluwaseun B Olorunfemi, Oluwaseun Kuna, Nkechi T Iwuala, Abolanle Oguntoye, Simeon O Kusoro, Mofeyisade E Okunlola, Shamim A Qazi, Harish Nair, Adegoke G Falade, Harry Campbell
Background: Childhood pneumonia is the single largest infectious cause of death in children under five worldwide. Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) provide health information on care sought for sick children in resource poor settings. Despite not being primarily designed to identify childhood pneumonia, there are concerns that reported episodes of "symptoms of acute respiratory infection" in DHS and MICS are often interpreted by other groups as a "proxy" for childhood pneumonia...
December 2018: Journal of Global Health
Andrea Williams, Amber Cadick
As the population ages, more Americans are moving into nursing homes/long-term care facilities. Per Accreditation Council for Graduate Medical Education 2017 guidelines, family medicine residents are required to gain experience and competence working in long-term care facilities; however, this unique environment poses several challenges for residents to hear the wishes of their patients over the demands of the patient's medical care team and family members. Also, many patients in long-term care facilities have sensory impairments (e...
November 2018: International Journal of Psychiatry in Medicine
Thierry Vial, Anne Marie Patat, David Boels, Delphine Castellan, Antoine Villa, Hélène Theophile, Romain Torrents, Behrouz Kassai
OBJECTIVE: The objectives of this study are to carefully describe the context of methotrexate medication errors, to details medical consequences and management approaches, and to determine the rate of fatal outcome. METHODS: Data on methotrexate medication errors were obtained from the French network of poison control and pharmacovigilance centres, which collected and documented reported drug-induced adverse effects. Cases were included if the intake was more than 2-fold the intended weekly dose or a weekly cumulative dose ≥ 30 mg and a follow-up of at least 4 days after the last dose...
September 19, 2018: Joint, Bone, Spine: Revue du Rhumatisme
Kathryn King-Shier, Hude Quan, Charles Mather, Elaine Chong, Pamela LeBlanc, Nadia Khan
Background: There are ethno-cultural differences in cardiac patients' adherence to medications. It is unclear why this occurs. We thus aimed to generate an in-depth understanding about the decision-making process and potential ethno-cultural differences, of white, Chinese, and south Asian cardiac patients when making the decision to adhere to a medication regimen. Methods: A hierarchical descriptive decision-model was generated based on previous qualitative work, pilot tested, and revised to be more parsimonious...
2018: Patient Preference and Adherence
Sıdıka Kaya, Gulay Sain Guven, Seda Aydan, Onur Toka
OBJECTIVE: This study aimed to identify predictors of internal medicine patients' readmission to hospital, using Andersen's behavioral model. METHODS: This prospective cohort study included 2622 patients aged ≥18 years, who were admitted to internal medicine wards at a university hospital between 1 February 2015 and 31 January 2016. Independent variables were divided into four groups (predisposing, enabling, need, and utilization), based on Andersen's model, and included in stepwise logistic regression analysis...
September 17, 2018: International Journal of Health Planning and Management
F Murden, D Bailey, F Mackenzie, R S Oeppen, P A Brennan
Medicine and surgery can be demanding professions with high levels of burnout, but few healthcare professionals are given training or education in the management of stress, and the ability of individuals to cope with work and other pressures is often taken for granted. Emotional resilience - the ability to recover from a stressful event, whether at work or at home - is influenced by factors that are both within and outside our control. In this review, we provide an overview of emotional resilience for surgeons and other healthcare professionals, and focus on the factors that can be modulated to help us cope with difficult or complex situations...
September 13, 2018: British Journal of Oral & Maxillofacial Surgery
Eleanor Wilson, Glenys Caswell, Nicola Turner, Kristian Pollock
CONTEXT: Increased life expectancy, technical advances in treatment and symptom control, and the extension of palliative care in community settings not only lengthen life, but make it possible for many patients to be cared for, and to die, at home. Moreover, death increasingly occurs in late old age and after a prolonged period of co-morbidity and/or frailty. This has far reaching consequences for the way that professional services are resourced and organised, and for the informal carers who are often responsible for providing the greater part of patient care, including management of complex medication regimes...
September 11, 2018: Journal of Pain and Symptom Management
Gregory Castelli, Jennifer L Bacci, Sarah Krahe Dombrowski, Maria Osborne, Aaron Difilippo, Patricia M Klatt, Melissa Somma McGivney
BACKGROUND AND OBJECTIVES: Pharmacist inclusion in patient-centered medical home (PCMH) teams has been shown to benefit both patients and practices. However, pharmacists' inclusion on these teams is not widespread, partly because the work they do is not well known. The Successful Collaborative Relationships to Improve PatienT care (SCRIPT) project was started in August 2009 to understand the clinical and economic impact of pharmacists providing direct patient care. The objective of this study was to describe the work of pharmacists practicing as integrated members of the patient care team within PCMHs through retrospective analysis of their patient care documentation over a 4-year time frame...
September 2018: Family Medicine
Christina Y Chen, James M Naessens, Paul Y Takahashi, Rozalina G McCoy, Bijan J Borah, Lynn S Borkenhagen, Ashley K Kimeu, Ricardo L Rojas, Matt G Johnson, Sue L Visscher, Stephen S Cha, Bjorg Thorsteinsdottir, Gregory J Hanson
CONTEXT: Identifying high-value health care delivery for patients with clinically complex and high-cost conditions is important for future reimbursement models. OBJECTIVES: The objective of this study was to assess the Medicare reimbursement savings of an established palliative care homebound program. METHODS: This is a retrospective cohort study involving 50 participants enrolled in a palliative care homebound program and 95 propensity-matched control patients at Mayo Clinic in Rochester, Minnesota, between September 1, 2012, and March 31, 2013...
August 28, 2018: Journal of Pain and Symptom Management
Rachel Joseph, Samantha Fernandes, Sarah Derstine, Micaela McSpadden
Over 3 million India-born immigrants live in the United States, yet their health-seeking behaviors are little understood. Information on health and access to care was collected from 20 adult Indian immigrants living in the United States. Participants preferred complementary and alternative medicine home remedies to address their health needs, although they accessed health services more quickly for their children. They also reported barriers in using insurance and accessing healthcare.
August 29, 2018: Journal of Christian Nursing: a Quarterly Publication of Nurses Christian Fellowship
Mick P Kelly, Tyler E Calkins, Chris Culvern, Monica Kogan, Craig J Della Valle
BACKGROUND: More surgeons are offering patients the option of having adult reconstructive procedures performed as an outpatient at an ambulatory surgery center. However, it is unknown if these patients have higher or lower satisfaction with their care than patients having a traditional inpatient stay. The purpose of this study is to compare satisfaction between inpatients and outpatients undergoing hip or knee arthroplasty. METHODS: Portions of the Health Consumer Assessment of Healthcare Providers and Systems survey, the Friends and Family Test, and 8 additional questions were administered to 174 consecutive patients...
November 2018: Journal of Arthroplasty
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