Home Care Services and the Rural Elderly.

ERIC Educational Resources Information Center

Hayslip, Bert, Jr.; And Others

1980-01-01

Independent studies examined a needs v an agency perspective on home health care service needs within a rural county. Interviews with 299 elderly, aged 60-93, revealed there were substantial needs for home health care services and the desire for services varied with residence within the county. (Author)

29 CFR 552.6 - Companionship services for the aged or infirm.

Code of Federal Regulations, 2010 CFR

2010-07-01

... services shall mean those services which provide fellowship, care, and protection for a person who, because of advanced age or physical or mental infirmity, cannot care for his or her own needs. Such services may include household work related to the care of the aged or infirm person such as meal preparation...

Health care of youth aging out of foster care.

PubMed

2012-12-01

Youth transitioning out of foster care face significant medical and mental health care needs. Unfortunately, these youth rarely receive the services they need because of lack of health insurance. Through many policies and programs, the federal government has taken steps to support older youth in foster care and those aging out. The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Pub L No. 110-354) requires states to work with youth to develop a transition plan that addresses issues such as health insurance. In addition, beginning in 2014, the Patient Protection and Affordable Care Act of 2010 (Pub L No. 111-148) makes youth aging out of foster care eligible for Medicaid coverage until age 26 years, regardless of income. Pediatricians can support youth aging out of foster care by working collaboratively with the child welfare agency in their state to ensure that the ongoing health needs of transitioning youth are met.

Care services ecosystem for ambient assisted living

NASA Astrophysics Data System (ADS)

Camarinha-Matos, Luis M.; Rosas, Joao; Ines Oliveira, Ana; Ferrada, Filipa

2015-08-01

Effective provision of care and assistance services in ambient assisted living requires the involvement and collaboration of multiple stakeholders. To support such collaboration, the development of an ecosystem of products and services for active ageing plays an important role. This article introduces a conceptual architecture that supports such care ecosystem. In order to facilitate understanding and better interrelate concepts, a 3-layered model is adopted: Infrastructure layer, Care and assistance services layer and Ambient Assisted Living ecosystem layer. A holistic perspective of ambient assisted living, namely considering four important life settings is adopted: (1) independent living; (2) health and care in life; (3) occupation in life and (4) recreation in life. The proposed architecture is designed in the context of a national Portuguese project and in accordance with the findings of a large European road mapping initiative on ICT and ageing.

THE LINK NURSE ROLE IN END OF LIFE CARE IN AGED CARE.

PubMed

Rosenberg, John

2016-08-01

The care of older people at the end of life is a key element of primary and community care. The Decision Assist -- Palliative Care Linkages project aimed to improve end of life care given to older Australians through establishing linkages between aged care and specialist palliative care services.

Creating Better School-Age Care Jobs: Model Work Standards.

ERIC Educational Resources Information Center

Haack, Peggy

Built on the premise that good school-age care jobs are the cornerstone of high-quality services for school-age youth and their families, this guide presents model work standards for school-age care providers. The guide begins with a description of the strengths and challenges of the school-age care profession. The model work standards are…

Health and aged care enabled by information technology.

PubMed

Soar, Jeffrey; Seo, Youngjoon

2007-10-01

One of the challenges facing health and welfare policymakers as well as researchers in most developed countries is the increasing demand for aging services and aged care. Low birth rates and rapid increases in the percentages of elderly people make aging and aged care one of the top-priority issues among the national agenda of many countries. The responses of governments have included initiatives to extend productive working lives and promote self-funded retirement; to promote healthy, active aging; and to encourage more care to be delivered in home and community settings. Technology will be a major enabler of these strategies. People requiring health services are increasingly being offered more care in their own homes and community settings as an alternative to hospital admission and to delay or avoid moving into institutional care. Research is providing intelligent technology to enable care in the home as well as to monitor safety, security, and quality. Innovation will provide greater independence and better access to care in their own homes for the elderly, sufferers of chronic illness, and persons with disability and reduce the incidence of hospital admissions and the length of stay when admissions do occur. Technologies will support families and professional caregivers and are expected to reduce costs. This paper reports on developments in technology to support care for the aged in home and community settings.

A comparison of the home-care and healthcare service use and costs of older Australians randomised to receive a restorative or a conventional home-care service.

PubMed

Lewin, Gill; Allan, Janine; Patterson, Candice; Knuiman, Matthew; Boldy, Duncan; Hendrie, Delia

2014-05-01

Restorative home-care services, or re-ablement home-care services as they are now known in the UK, aim to assist older individuals who are experiencing difficulties in everyday living to optimise their functioning and reduce their need for ongoing home care. Until recently, the effectiveness of restorative home-care services had only been investigated in terms of singular outcomes such as length of home-care episode, admission to hospital and quality of life. This paper reports on a more complex and perhaps more significant measure--the use and cost of the home-care and healthcare services received over the 2-year period following service commencement. Seven hundred and fifty older individuals referred for government-funded home care were randomly assigned to a restorative or standard service between June 2005 and August 2007. Health and aged care service data were sourced and linked via the Western Australian Data Linkage System. Restorative clients used fewer home-care hours (mean [SD], 117.3 [129.4] vs. 191.2 [230.4]), had lower total home-care costs (AU$5570 vs. AU$8541) and were less likely to be approved for a higher level of aged care (N [%], 171 [55.2] vs. 249 [63.0]) during follow-up. They were also less likely to have presented at an emergency department (OR = 0.69, 95% CI = 0.50-0.94) or have had an unplanned hospital admission [OR (95% CI), 0.69 (0.50-0.95)]. Additionally, the aggregated health and home-care costs of the restorative clients were lower by a factor of 0.83 (95% CI 0.72-0.96) over the 2-year follow-up (AU$19,090 vs. AU$23,428). These results indicate that at a time when Australia is facing the challenges of population ageing and an expected increase in demand for health and aged care services, the provision of a restorative service when an older person is referred for home care is potentially a more cost-effective option than providing conventional home care. © 2014 The Authors. Health and Social Care in the Community published by John

Health and human services in an age of maturity.

PubMed

Aldridge, M G

1986-12-01

Catholic health care organizations are experiencing a tension between evangelical mission and expanding competition in medical markets. For the voluntary, not-for-profit health and human services system to survive and grow, hospital communities must find new revenue sources that do not create dependence on state and federal monies. The United States entered the Age of Maturity in 1985 as the "baby boomers" born between 1945 and 1957 became 40 years old, requiring health care providers to begin to plan for their care in old age. This large aging population, combined with a longer life span for Americans, will put increased burdens on health care organizations, particularly for chronic care, up to the year 2020 or beyond. Changes in family structure and social networks will be necessary as more people care for older relatives. The ratio of nonworkers to workers will increase, further burdening national and state tax bases, Social Security, and other worker-contributor programs. Investment banks are one option to finance the older population's increased needs for health and human services. Investment banks are funded by donations from the private sector (local and national businesses), the public sector (state, national, and local agencies), and new for-profit ventures for older persons. The contributions themselves remain in a central fund, with only the interest generated being used to fund local organizations committed to financial self-sufficiency and to helping the elderly. Older persons will carry increased economic and political clout in the Age of Maturity and will constitute a large percentage of hospitals' business. Therefore hospitals will have to develop a strong market position among the elderly. They must consider integrating a new service mix of both health and human services. Candidates for new hospital services for the elderly include housing programs, long-term care and continuum of care programs, employment programs, retirement planning, estate

Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff.

PubMed

Villarosa, Amy R; Clark, Sally; Villarosa, Ariana C; Patterson Norrie, Tiffany; Macdonald, Susan; Anlezark, Jennifer; Srinivas, Ravi; George, Ajesh

2018-04-23

This study aimed to look at the practices and perspectives of residential aged care facility (RACF) care staff regarding the provision of oral health care in RACFs. Emphasis has been placed on the provision of adequate oral health care in RACFs through the Better Oral Health in Residential Aged Care programme. Endorsed by the Australian government, this programme provided oral health education and training for aged care staff. However, recent evidence suggests that nearly five years after the implementation of this programme, the provision of oral care in RACFs in NSW remains inadequate. This project utilised an exploratory qualitative design which involved a focus group with 12 RACF care staff. Participants were asked to discuss the current oral health practices in their facility, and their perceived barriers to providing oral health care. The key findings demonstrated current oral health practices and challenges among care staff. Most care staff had received oral health training and demonstrated positive attitudes towards providing dental care. However, some participants identified that ongoing and regular training was necessary to inform practice and raise awareness among residents. Organisational constraints and access to dental services also limited provision of dental care while a lack of standardised guidelines created confusion in defining their role as oral healthcare providers in the RACF. This study highlighted the need for research and strategies that focus on capacity building care staff in oral health care and improving access of aged care residents to dental services. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Age Cohort and Health Service Utilization Among Gay Men.

PubMed

Green, Daniel C; Goldbach, Jeremy T; Raymond, Henry F

2018-05-01

Gay men report unique health disparities and service utilization trends compared to their heterosexual peers including a lack of health-care participation which may lead to chronic health conditions. Limited research has been conducted analyzing group differences among gay men such as the influence of one's age cohort on disparities. The aim of this study was to examine the association age cohort has on health service utilization among gay men. A sample of 383 self-identified gay men was collected by the San Francisco Department of Public Health. Older men were less likely to have visited a medical provider in the past 12 months compared to middle-aged men (OR = 0.10; 95% CI [2.47, 39.8]) and younger men (OR = 0.35; 95% CI [1.28, 10.42]). However, older men were more likely to have a usual source of medical care compared to younger men (OR = 4.0; 95% CI [.05, .84]). Age cohort differences in health-care service utilization appear to exist among gay men. This study highlights additional areas for exploration including the impact HIV and socioeconomic status have on health-seeking behavior and health service utilization.

Co-operative working in aged care: The Cooperative for Healthy Ageing Research and Teaching Project.

PubMed

Jamieson, Maggie; Grealish, Laurie

2016-09-01

The objective of this study was to describe the partnership mechanisms that supported teaching and research in aged care, in one of the 16 funded projects under the auspices of the Teaching and Research in Aged Care Service project. Located in ACT and southern NSW, the Co-operative for Healthy Ageing Research and Teaching (CHART) was comprised of eleven partners from the residential care sector, higher education, and hospital and non-government sectors. A descriptive study of the project engagement and partnership processes and outcomes using documentation review and stakeholder interviews. The overarching goal of the CHART project was to facilitate the development of aged care service models that combine teaching, learning and research. This study describes (i) the processes and investment required to enable care providers to partner in teaching and research activities; and (ii) the structure and practices required to build workforce capacity and create career pathways in the sector. Maintaining consistency of engagement and collaboration required significant, and often invisible, investment in partnership arrangements. Overall, the partnerships were often person, rather than organisation, dependent. New student placements were introduced, but support for continued nursing placements remained variable. Local practice innovation was advanced when partnership investment was aligned at strategic and operational levels. Continuous, and often invisible, investment in maintaining operational partnerships is critical to sustained change. Partnering in a private aged care service environment to achieve sector-wide changes was challenging, but the investment can result in innovation and service improvement. © 2016 AJA Inc.

Population aging and its impacts: strategies of the health-care system in Taipei.

PubMed

Lin, Ming-Hsien; Chou, Ming-Yueh; Liang, Chih-Kuang; Peng, Li-Ning; Chen, Liang-Kung

2010-11-01

Taiwan is one of the fastest aging countries in the world. As such, the government has developed various strategies to promote an age-friendly health-care system. Health services are supported by National Health Insurance (NHI), which insures over 97% of citizens and over 99% of health-care institutes. The current health-care system has difficulties in caring for older patients with multiple comorbidities, complex care needs, functional impairments, and post-acute care needs. Taipei, an international metropolis with a well-preserved tradition of filial piety in Chinese societies, has developed various strategies to overcome the aforementioned barriers to an age-friendly health-care system. These include an emphasis on general medical care and a holistic approach in all specialties, development of a geriatrics specialty training program, development of post-acute services, and strengthening of linkages between health and social care services. Despite achievements thus far, challenges still include creating a more extensive integration between medical specialties, promotion of an interdisciplinary care model across specialties and health-care settings, and integration of health and social care services. The experiences of Taipei in developing an age-friendly health-care service system may be a culturally appropriate model for other Chinese and Asian communities. Copyright © 2010 Elsevier B.V. All rights reserved.

What keeps you strong? A systematic review identifying how primary health-care and aged-care services can support the well-being of older Indigenous peoples.

PubMed

Davy, Carol; Kite, Elaine; Aitken, Graham; Dodd, Garth; Rigney, Janice; Hayes, Jenny; Van Emden, Jan

2016-06-01

The objective of this systematic review was to identify primary health-care or aged-care strategies that have or could support the well-being of older Indigenous peoples. A search was undertaken of primary databases including Medical Literature Analysis and Retrieval System Online and Cumulative Index to Nursing and Allied Health Literature. Papers which reported on the perspectives of older Indigenous peoples, community members and provider participants were included. Findings were pooled using a meta-aggregative approach. Three high-level synthesised findings - maintaining Indigenous identity, promoting independence and delivering culturally safe care - were believed to be important for supporting the well-being of older Indigenous peoples. As physical independence often diminishes with age, having the support of culturally safe primary health-care and aged-care services that understand the importance of maintaining an Indigenous identity and promoting independence will be crucial for the well-being of older Indigenous peoples. © 2016 AJA Inc.

Assessing the market for long-term care services.

PubMed

Rice, J A; Taylor, S

1984-02-01

Traditionally, long-term care services have been used by a diverse marketplace. The chronically ill, developmentally disabled, mentally ill and aging population has looked to long-term care support services as a means of physical and emotional support. Much of the time these services were housed together for the sake of efficiency. The enormous burden these services are creating on the economy, and the growing aging population, have forced the recognition that long-term care service delivery systems must change. Alternate programming for long-term care services that reach out into the community and into individual homes is becoming an attractive approach to meeting the growing demands of the marketplace. Home health, specialized housing and creative funding mechanisms such as HMOs, are examples of initiatives undertaken by healthcare organizations that view diversification as a vehicle for survival. Market research techniques that have been used in other industries are being adapted to the healthcare industry to ensure the proper mix of services that are demanded by older, more knowledgeable consumers. The programs of the future will be market driven, with the ability of the individual to pay for such services playing a significant role. The healthcare provider of today is in a position to serve the community in new ways. By becoming an integral link in the long-term care system and by developing new programs, the organization can serve as a catalyst for change. It is up to the governing bodies and managers of these facilities to become visionaries and to accept responsibility for assessing the market for long-term care services and to guide their organization into the future.

[Informal care for dementia according to type of service].

PubMed

Brettschneider, C; Hajek, A; Stein, J; Luck, T; Mamone, S; Wiese, B; Mösch, E; Weeg, D; Fuchs, A; Pentzek, M; Werle, J; Weyerer, S; Mallon, T; van den Bussche, H; Heser, K; Wagner, M; Scherer, M; Maier, W; Riedel-Heller, S G; König, H-H

2018-05-01

Dementia is a major challenge for society and its impact will grow in the future. Informal care is an essential part of dementia care. Previous studies considered informal care as a whole and not by its components. We aimed to assess the degree of association between specific informal care services and dementia. This analysis is based on data from the seventh wave of the AgeCoDe/AgeQualiDe study. Dementia was diagnosed based on the DSM-IV criteria. Severity of dementia was assessed and categorized by means of the Clinical Dementia Rating and eight individual informal care services were considered. Logistic regression models were used to assess associations. Of the 864 participants 18% suffered from dementia (very mild: 4%; mild: 6%; moderate: 5%; severe: 3%). All informal care services were significantly associated with dementia, with an emphasis on "supervision", "regulation of financial matters" and "assistance in the intake of medication". Considering different degrees of dementia severity, similar results arose from the analyses. All three aforementioned services showed a pronounced association with all degrees of dementia severity, except for supervision and very mild dementia. The provision of all types of informal care services is associated with dementia. The association is pronounced for services that can be more easily integrated into the daily routines of the informal caregiver. Policy makers who plan to integrate informal care into the general care arrangements for dementia should consider this.

Nurses' Needs for Care Robots in Integrated Nursing Care Services.

PubMed

Lee, Jai-Yon; Song, Young Ae; Jung, Ji Young; Kim, Hyun Jeong; Kim, Bo Ram; Do, Hyun-Kyung; Lim, Jae-Young

2018-05-13

To determine the need for care robots among nurses and to suggest how robotic care should be prioritized in an integrated nursing care services. Korea is expected to be a super-aged society by 2030. To solve care issues with elderly inpatient caused by informal caregivers, the government introduced 'integrated nursing care services'; these are comprehensive care systems staffed by professionally trained nurses. To assist them, a care robot development project has been launched. The study applied a cross-sectional survey. In 2016, we conducted a multi-center survey involving 302 registered nurses in five hospitals including three tertiary and two secondary hospitals in Korea. The questionnaire consisted of general characteristics of nurses and their views on and extents of agreement about issues associated with robotic care. Trial center nurses and those with ≥10 years of experience reported positively on the prospects for robotic care. The top three desired primary roles for care robots were 'measuring/monitoring', 'mobility/activity' and 'safety care'. 'Reduction in workload', especially in terms of 'other nursing services' which were categorized as non-value-added nursing activities, was the most valued feature. The nurses approved of the aid by care robots but were concerned about device malfunction and interruption of rapport with patients. Care robots are expected to be effective in integrated nursing care services, particularly in 'measuring/monitoring'. Such robots should decrease nurses' workload and minimize non-value-added nursing activities efficiently. No matter how excellent care robots are, they must co-operate with and be controlled by nurses. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Comparison of patients’ age receiving therapeutic services in a cleft care team in Isfahan

PubMed Central

Soheilipour, Saeed; Soheilipour, Fatemeh; Derakhshandeh, Fatemeh; Hashemi, Hedieh; Memarzadeh, Mehrdad; Salehiniya, Hamid; Soheilipour, Fahimeh

2016-01-01

Background: Due to numerous difficulties in patients suffering from varieties of cleft lip and palate, their therapeutic management involves interdisciplinary teamwork. This study was conducted to compare the age of commencing treatments such as speech therapy, secondary palate and alveolar bone grafting and orthodontics between those who sought treatment early and late. Materials and Methods: In this retrospective study, 260 files of patients with cleft lip and palate based on their age at the time of admission to a cleft care team were divided into two groups: The early admission and late admission. Both groups compared based on four variables including the mean age of beginning speech therapy, palatal secondary surgery, alveolar bone grafting, and receiving orthodontics using t-test. Results: Based on the results, among 134 patients admitted for speech therapy, the mean age of initiating speech therapy in early clients was 3.3 years, and in the late ones was 9 years. Among 47 patients with secondary surgery, the mean age in early clients was 3.88 years, and in the late clients was 15.7 years. Among 17 patients with alveolar bone grafting, the mean age in the first group was 9 years, and in the other was 16.69 years. Among 24 patients receiving orthodontic services, the mean age in early clients was 7.66 years, and in the second group was 17.05 years. Conclusion: There was a significant difference between the age of performing secondary surgery and alveolar bone grafting and the age of beginning speech therapy and receiving orthodontic services in early references and late references to the team. PMID:27274350

Relationship between home care service use and changes in the care needs level of Japanese elderly.

PubMed

Kato, Gohei; Tamiya, Nanako; Kashiwagi, Masayo; Sato, Mikiya; Takahashi, Hideto

2009-12-21

With the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels. The participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician. In the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based services significantly related to

Differences by age groups in health care spending.

PubMed

Fisher, C R

1980-01-01

This paper presents differences by age in health care spending by type of expenditure and by source of funds through 1978. Use of health care services generally increases with age. The average health bill reached $2,026 for the aged in 1978, $764 for the intermediate age group, and $286 for the young. Biological, demographic, and policy factors determine each age group's share of health spending. Public funds financed over three-fifths of the health expenses of the aged, with Medicare and Medicaid together accounting for 58 percent. Most of the health expenses of the young age groups were paid by private sources.

The 2030 Problem: Caring for Aging Baby Boomers

PubMed Central

Knickman, James R; Snell, Emily K

2002-01-01

Objective To assess the coming challenges of caring for large numbers of frail elderly as the Baby Boom generation ages. Study Setting A review of economic and demographic data as well as simulations of projected socioeconomic and demographic patterns in the year 2030 form the basis of a review of the challenges related to caring for seniors that need to be faced by society. Study Design A series of analyses are used to consider the challenges related to caring for elders in the year 2030: (1) measures of macroeconomic burden are developed and analyzed, (2) the literatures on trends in disability, payment approaches for long-term care, healthy aging, and cultural views of aging are analyzed and synthesized, and(3)simulations of future income and assets patterns of the Baby Boom generation are developed. Principal Findings The economic burden of aging in 2030 should be no greater than the economic burden associated with raising large numbers of baby boom children in the 1960s. The real challenges of caring for the elderly in 2030 will involve: (1) making sure society develops payment and insurance systems for long-term care that work better than existing ones, (2) taking advantage of advances in medicine and behavioral health to keep the elderly as healthy and active as possible, (3) changing the way society organizes community services so that care is more accessible, and (4) altering the cultural view of aging to make sure all ages are integrated into the fabric of community life. Conclusions To meet the long-term care needs of Baby Boomers, social and public policy changes must begin soon. Meeting the financial and social service burdens of growing numbers of elders will not be a daunting task if necessary changes are made now rather than when Baby Boomers actually need long-term care. PMID:12236388

Computer modeling with randomized-controlled trial data informs the development of person-centered aged care homes.

PubMed

Chenoweth, Lynn; Vickland, Victor; Stein-Parbury, Jane; Jeon, Yun-Hee; Kenny, Patricia; Brodaty, Henry

2015-10-01

To answer questions on the essential components (services, operations and resources) of a person-centered aged care home (iHome) using computer simulation. iHome was developed with AnyLogic software using extant study data obtained from 60 Australian aged care homes, 900+ clients and 700+ aged care staff. Bayesian analysis of simulated trial data will determine the influence of different iHome characteristics on care service quality and client outcomes. Interim results: A person-centered aged care home (socio-cultural context) and care/lifestyle services (interactional environment) can produce positive outcomes for aged care clients (subjective experiences) in the simulated environment. Further testing will define essential characteristics of a person-centered care home.

Information management for aged care provision in Australia: development of an aged care minimum dataset and strategies to improve quality and continuity of care.

PubMed

Davis, Jenny; Morgans, Amee; Burgess, Stephen

2016-04-01

Efficient information systems support the provision of multi-disciplinary aged care and a variety of organisational purposes, including quality, funding, communication and continuity of care. Agreed minimum data sets enable accurate communication across multiple care settings. However, in aged care multiple and poorly integrated data collection frameworks are commonly used for client assessment, government reporting and funding purposes. To determine key information needs in aged care settings to improve information quality, information transfer, safety, quality and continuity of care to meet the complex needs of aged care clients. Modified Delphi methods involving five stages were employed by one aged care provider in Victoria, Australia, to establish stakeholder consensus for a derived minimum data set and address barriers to data quality. Eleven different aged care programs were identified; with five related data dictionaries, three minimum data sets, five program standards or quality frameworks. The remaining data collection frameworks related to diseases classification, funding, service activity reporting, and statistical standards and classifications. A total of 170 different data items collected across seven internal information systems were consolidated to a derived set of 60 core data items and aligned with nationally consistent data collection frameworks. Barriers to data quality related to inconsistencies in data items, staff knowledge, workflow, system access and configuration. The development an internal aged care minimum data set highlighted the critical role of primary data quality in the upstream and downstream use of client information; and presents a platform to build national consistency across the sector.

Accessing timely rehabilitation services for a global aging society? Exploring the realities within Canada's universal health care system.

PubMed

Landry, Michel D; Raman, Sudha; Al-Hamdan, Elham

2010-07-01

The proportion of older persons is increasing in developed and developing countries: this aging trend can be viewed as a two-edged sword. On the one hand, it represents remarkable successes regarding advances in health care; and on the other hand, it represents a considerable challenge for health systems to meet growing demand. A growing disequilibrium between supply and demand may be particularly challenging within publicly funding health systems that 'guarantee' services to eligible populations. Rehabilitation, including physical therapy, is a service that if provided in a timely manner, can maximize function and mobility for older persons, which may in turn optimize efficiency and effectiveness of overall health care systems. However, physical therapy services are not considered an insured service under the legislative framework of the Canadian health system, and as such, a complex public/private mix of funding and delivery has emerged. In this article, we explore the consequences of a public/private mix of physical therapy on timely access to services, and use the World Health Organization (WHO) health system performance framework to assess the extent to which the emerging system influences the goal of aggregated and equitable health. Overall, we argue that a shift to a public/private mix may not have positive influences at the population level, and that innovative approaches to deliver services would be desirable to strengthening rather than weaken the publicly funded system. We signal that strategies aimed at scaling up rehabilitation interventions are required in order to improve health outcomes in an evolving global aging society.

Population ageing and dental care.

PubMed

Harford, Jane

2009-04-01

Population ageing is a fact in both developed and developing countries. The concern about population ageing largely arises from the combination of a greater number of older people requiring greater amounts of healthcare services and pensions, and relatively fewer people working to pay for them. Oral health and dental care are important aspects of health and health care. Lower rates of edentulism and an ageing population mean that older people will feature more prominently in dental services. Traditionally, economic studies of ageing have focused on the fiscal implications of ageing, projecting the increased burden on health and welfare services that accompanies ageing. It assumed that ageing is the major driver of recent changes and those past trends will simply be amplified by faster population ageing in the future. Less work has been done to understand other past drivers of increased healthcare spending and their implications for the future. The conclusion of these reports is usually that population ageing is unaffordable with current policy settings. They have proposed policies to deal with population ageing which focused on increasing workforce participation and worker productivity to increase the tax base and reducing entitlements. However, the affordability question is as much political as a numerical. There are no clearly articulated criteria for affordability and little opportunity for public discourse about what citizens are willing to pay in taxes to support an ageing population. While the reports do not necessarily reflect public opinion, they will certainly shape it. Predicting the future for oral health is more fraught than for general health, as oral health is in the midst of an epidemiological transition from high rates of edentulism and tooth loss to low rates. Changes in the pattern of dental expenditure in the past do not mirror the experience of rapid increases in per capita expenditure on older age groups as regards general health. Dentistry

Health service utilisation amongst urban Aboriginal and Torres Strait Islander children aged younger than 5 years registered with a primary health-care service in South-East Queensland.

PubMed

Hall, Kerry K; Chang, Anne B; Anderson, Jennie; Arnold, Daniel; Otim, Michael; O'Grady, Kerry-Ann F

2018-06-01

The majority of Australia's Aboriginal and/or Torres Strait Islander children live in urban areas; however, little is known about their health service use. We aimed to describe health service utilisation amongst a cohort of urban Aboriginal and/or Torres Strait Islander children aged <5 years. We analysed health service utilisation data collected in an ongoing prospective cohort study of children aged <5 years registered with an Aboriginal-owned and operated primary health-care service. Enrolled children were followed monthly for 12 months, with data on health service utilisation collected at baseline and at each monthly follow-up. Health service utilisation rates, overall and by service provider and reason for presentation, were calculated and reported as incidence rates per 100 child-months with the corresponding 95% confidence intervals (CIs). Between February 2013 and November 2015, 180 children were enrolled, and 1541 child-months of observation were available for analysis. The overall incidence of health service utilisation was 52.5 per 100 child-months (95% CI 48.7-56.5); 81% of encounters were with general practitioners. Presentation rates were the highest for acute respiratory illnesses (30.7/100 child-months, 95% CI 27.8-33.9). In this community, acute respiratory illnesses are predominant causes of health service utilisation in young children. The health-care utilisation profile of these children presents important opportunities for health promotion and intervention. © 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Health Care Services

Science.gov Websites

State Employees Health Care Services DHSS State of Alaska Home Divisions and Agencies Alaska Pioneer Homes Behavioral Health Office of Children's Services Office of the Commissioner Office of Substance Misuse and Addiction Prevention Finance & Management Services Health Care Services Juvenile Justice

Coming of age: health-care challenges of an ageing population in Israel.

PubMed

Dwolatzky, Tzvi; Brodsky, Jenny; Azaiza, Faisal; Clarfield, A Mark; Jacobs, Jeremy M; Litwin, Howard

2017-06-24

Although Israel is still young in years, with relatively high birth rates and older people (individuals aged 65 years or older) constituting only about 11% of its population, the absolute number of older people is growing rapidly. Life expectancy is high, and increasing numbers of people are living to advanced old age (older than 85 years). A wide spectrum of geriatric care is provided within a universal system providing health services to all citizens. Community and institutional care is available, and many innovative programmes are being developed. The unique demographic characteristics of the ageing society in Israel reflect cultural and multiethnic diversity, in addition to a high rate of immigration of older people. To meet the growing challenges, address disparities, and search for innovation will require planning and development of adequate services at the highest level. Copyright © 2017 Elsevier Ltd. All rights reserved.

Income-Related Inequalities in Access to Dental Care Services in Japan.

PubMed

Nishide, Akemi; Fujita, Misuzu; Sato, Yasunori; Nagashima, Kengo; Takahashi, Sho; Hata, Akira

2017-05-12

Background : This study aimed to evaluate whether income-related inequalities in access to dental care services exist in Japan. Methods : The subjects included beneficiaries of the National Health Insurance (NHI) in Chiba City, Japan, who had been enrolled from 1 April 2014 to 31 March 2015. The presence or absence of dental visits and number of days spent on dental care services during the year were calculated using insurance claims submitted. Equivalent household income was calculated using individual income data from 1 January to 31 December 2013, declared for taxation. Results : Of the 216,211 enrolled subjects, 50.3% had dental care during the year. Among those with dental visits, the average number of days (standard deviation) spent on dental care services per year was 7.7 (7.1). Low income was associated with a decreased rate of dental care utilization regardless of age and sex. However, there was a significant inverse linear association between the number of days spent on dental care services and income levels for both sexes. Conclusions : There were income-related inequalities in access to dental care services, regardless of the age group or sex, within the Japanese universal health insurance system.

Emerging ICT implementation issues in aged care.

PubMed

Kapadia, Vasvi; Ariani, Arni; Li, Junhua; Ray, Pradeep K

2015-11-01

Demand for aged care services continues to soar as a result of an aging population. This increasing demand requires more residential aged care facilities and healthcare workforce. One recommended solution is to keep older people in their homes longer and support their independent life through the use of information and communication technologies (ICT). However, the aged care sector is still in the early stages of adopting ICT. The aim of this study was to identify the key issues that affect the adoption of ICT in the aged care sector. A systematic literature review was undertaken and involved four steps. The first two steps aimed to identify and select relevant articles. Data was then extracted from the selected articles and identified issues were analyzed and grouped into three major categories. ICT adoption issues were categorized into different perspectives, representing older people, health professionals and management. Our findings showed that all three groups were mostly concerned with issues around behavior, cost and lack of technical skills. Findings reported in this study will help decision makers at aged care settings to systematically understand issues related to ICT adoption and thus proactively introduce interventions to improve use of ICT in this sector. On the basis of our findings, we suggest future research focus on the examination of aged care workflow and assessment of return on ICT investment. Copyright © 2015. Published by Elsevier Ireland Ltd.

Health care prioritization in ageing societies: influence of age, education, health literacy and culture.

PubMed

Mak, Benise; Woo, Jean; Bowling, Ann; Wong, Florens; Chau, Pui Hing

2011-05-01

To examine how Chinese people in Hong Kong view health care prioritization and to compare the findings with those from a United Kingdom survey. A cross-sectional opinion survey was conducted in Hong Kong and 1512 participants were interviewed. Data show that the highest rankings were accorded to "treatment for children" and "high technology services." Services for the elderly, whether in the community or in hospitals, and including end-of-life care, were ranked among the lowest. This view was also shared by healthcare professionals. Compared with the UK findings, there are stark contrasts in the low ranking of end-of-life care and the high ranking of high technology services among the HK population. It is evident that most people would give priority to the young over the old in distributing a given amount of healthcare services. To meet the needs of ageing societies and to meet the needs of all users equitably, health care policy needs to acknowledge constraints and the needs for prioritization. Both the public and professionals should engage with policy makers in formulating a policy based on cost benefit considerations as well as overall societal view of prioritization that is not based on age alone. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

The delivery of clinical preventive services: acute care intervention.

PubMed

Hahn, D L

1999-10-01

. Evidence-based clinical preventive services are underutilized. We explored the major factors associated with delivery of these services in a large physician-owned community-based group practice that provided care for both fee-for-service (FFS) and health maintenance organization (HMO) patient populations. We performed a cross-sectional audit of the computerized billing data of all adult outpatients seen at least once by any primary care provider in 1995 (N = 75,621). Delivery of preventive services was stratified by age, sex, visit frequency, insurance status (FFS or HMO), and visit type (acute care only or scheduled preventive visit). Insurance status and visit type were the strongest predictors of clinical preventive service delivery. Patients with FFS coverage received 6% to 13% (absolute difference) fewer of these services than HMO patients. Acute-care-only patients received 9% to 45% fewer services than patients who scheduled preventive visits. The combination of these factors was associated with profound differences. Having insurance to pay for preventive services is an important factor in the delivery of such care. Encouraging all patients to schedule preventive visits has been suggested as a strategy for increasing delivery, but that is not practical in this setting. Assessing the need for preventive services and offering them during acute care visits has equal potential for increasing delivery.

Quality failures in residential aged care in Australia: The relationship between structural factors and regulation imposed sanctions.

PubMed

Baldwin, Richard; Chenoweth, Lynnette; Dela Rama, Marie; Liu, Zhixin

2015-12-01

To examine the relationship between structural factors and the imposition of sanctions on residential aged care services across Australia for regulatory compliance failure. Poisson Regression analysis was used to examine the association between the number of sanctions imposed and the structural characteristics of residential aged care services in Australia. Residential aged care services that have a greater likelihood of having government sanctions imposed on them are operated by for-profit providers and located in remote locations and in Victoria, Queensland, South Australia, Northern Territory and the Australian Capital Territory. The findings confirm the international literature on the relationship between residential aged care service location, ownership type and the likelihood of sanctions. In the light of the predicted expansion of residential aged care services, policy makers should give consideration to structural elements most likely to be associated with a failure to meet and maintain service standards. © 2014 ACOTA.

42 CFR 405.440 - Emergency and urgent care services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Emergency and urgent care services. 405.440 Section 405.440 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED Private Contracts § 405.440...

Primary care clinician expectations regarding aging.

PubMed

Davis, Melinda M; Bond, Lynne A; Howard, Alan; Sarkisian, Catherine A

2011-12-01

Expectations regarding aging (ERA) in community-dwelling older adults are associated with personal health behaviors and health resource usage. Clinicians' age expectations likely influence patients' expectations and care delivery patterns; yet, limited research has explored clinicians' age expectations. The Expectations Regarding Aging Survey (ERA-12) was used to assess (a) age expectations in a sample of primary care clinicians practicing in the United States and (b) clinician characteristics associated with ERA-12 scores.  This study was a cross-sectional survey of primary care clinicians affiliated with 5 practice-based research networks, October 2008 to June 2009. A total of 374 of the 1,510 distributed surveys were returned (24.8% response rate); 357 analyzed. Mean respondent age was 48.6 years (SD = 11.6; range 23-87 years); 88.0% physicians, 96.0% family medicine, 94.9% White, and 61.9% male. Female clinicians reported higher ERA-12 scores; clinicians' age expectations decreased with greater years in practice. Among the clinicians, higher ERA-12 scores were associated with higher clinician ratings of the importance of and personal skill in administering preventive counseling and the importance of delivering preventive services. Agreement with individual ERA-12 items varied widely. Unrealistically high or low ERA could negatively influence the quality of care provided to patients and patients' own age expectations. Research should examine the etiology of clinicians' age expectations and their association with older adult diagnoses and treatment. Medical education must incorporate strategies to promote clinician attitudes that facilitate successful patient aging.

Leadership and the psychosocial work environment in old age care.

PubMed

Lundgren, Dan; Ernsth-Bravell, Marie; Kåreholt, Ingemar

2016-03-01

To study leadership factors and their associations with psychosocial work environmental among nursing assistants who are engaged in old age care and to analyse (i) differences in the assessment of leadership factors and the assessment of psychosocial work environmental in nursing homes and home help services and (ii) the association between the psychosocial work environment and factors that are related to leadership in nursing homes and home help services. Leadership factors are an important element of the psychosocial work environment in old age care. The physical distance between leaders and nursing assistants is larger in home help services than in nursing homes. Therefore, it is important to study leadership separately in nursing homes and home help services. Assessments from 844 nursing assistants in nursing homes and 288 in home help services (45 nursing homes and 21 home help service units) were analysed. The data were analysed using linear regression. Age, gender, number of staff at the unit, number of years at the current working unit and educational level were controlled in Model 1. Summarised indexes that were based on all independent variables except the main independent variable were additionally controlled in Model 2. Psychosocial work environment was related to leadership factors, but stronger associations occurred more frequently in nursing homes than in home help services. Empowering leadership, support from superiors, the primacy of human resources and control over decisions were associated with higher assessments on all the variables that were related to the psychosocial work environment in both the nursing homes and home help services. Organisational differences in conducting leadership in old age care must be considered. Some leadership characteristics are better prerequisites for creating and maintaining a positive psychosocial work environment for nursing assistants in nursing homes and home help services. Due to the differences in

[Multidimensional assessment of public health care services for adolescents in Chile].

PubMed

Williams, Catalina de T; Poblete, Fernando A; Baldrich, Francisca A

2012-09-01

Adolescents are an especially vulnerable age group in terms of behavioral issues and require skilled teams in health centers. To assess the quality of health services provided to teenage users in Primary Health Care. A study of multiple cases was carried out in two family health centers in Puente Alto, Chile. Health services delivered to adolescents were evaluated from the provider's perspective, through qualitative design of focus groups and interviews to the care teams at each centre. For technical quality, comparing electronic records of two tracer conditions (prenatal care and depression) with technical standards established by Delphi methodology and from teenage users perspective, through a survey of service satisfaction. In both centers, providers perceived a lack of training in adolescent care, a deficient preventive approach and a limited access to care. The technical evaluation showed an inappropriate recording of both tracer conditions. The instrument used to assess user satisfaction survey was reliable and showed that the best perceived issue was medical care and treatment, and the least perceived, was the access to the services. Professionals working in these health care facilities, feel unprepared to provide comprehensive approach to adolescents. The surveyed teenagers complained of limited access to care. Therefore this age group continues to be as a non-priority group for health care.

Evaluation of health care services provided for older adults in primary health care centers and its internal environment. A step towards age-friendly health centers.

PubMed

Alhamdan, Adel A; Alshammari, Sulaiman A; Al-Amoud, Maysoon M; Hameed, Tariq A; Al-Muammar, May N; Bindawas, Saad M; Al-Orf, Saada M; Mohamed, Ashry G; Al-Ghamdi, Essam A; Calder, Philip C

2015-09-01

To evaluate the health care services provided for older adults by primary health care centers (PHCCs) in Riyadh, Kingdom of Saudi Arabia (KSA), and the ease of use of these centers by older adults. Between October 2013 and January 2014, we conducted a descriptive cross-sectional study of 15 randomly selected PHCCs in Riyadh City, KSA. The evaluation focused on basic indicators of clinical services offered and factors indicative of the ease of use of the centers by older adults. Evaluations were based upon the age-friendly PHCCs toolkit of the World Health Organization. Coverage of basic health assessments (such as blood pressure, diabetes, and blood cholesterol) was generally good. However, fewer than half of the PHCCs offered annual comprehensive screening for the common age-related conditions. There was no screening for cancer. Counseling on improving lifestyle was provided by most centers. However, there was no standard protocol for counseling. Coverage of common vaccinations was poor. The layout of most PHCCs and their signage were good, except for lack of Braille signage. There may be issues of access of older adults to PHCCs through lack of public transport, limited parking opportunities, the presence of steps, ramps, and internal stairs, and the lack of handrails. Clinical services and the internal environment of PHCCs can be improved. The data will be useful for health-policy makers to improve PHCCs to be more age-friendly.

Early onset ageing and service preparation in people with intellectual disabilities: institutional managers' perspective.

PubMed

Lin, Jin-Ding; Wu, Chia-Ling; Lin, Pei-Ying; Lin, Lan-Ping; Chu, Cordia M

2011-01-01

Although longevity among older adults with intellectual disabilities is increasing, there is limited information on their premature aging related health characteristics and how it may change with increasing age. The present paper provides information of the institutional manager's perception on early onset aging and service preparation for this population. We used purposive sampling to recruit 54 institutional managers who care for people with intellectual disabilities in Taiwan. The present study employed a cross-sectional design using a self-administrative structured questionnaire that was completed by the respondents in November 2009. The results showed that more than 90% of the respondents agreed with earlier onset aging characteristics of people with ID. However, nearly all of the respondents expressed that the government policies were inadequate and the institution is not capable of caring for aging people with ID, and more than half of them did not satisfy to their provisional care for this group of people. With regard to the service priority of government aging policy for people with ID, the respondent expressed that medical care, financial support, daily living care were the main areas in the future policy development for them. The factors of institutional type, expressed adequacy of government's service, respondent's job position, age, and working years in disability service were variables that can significantly predict the positive perceptions toward future governmental aging services for people with ID (adjusted R(2) = 0.563). We suggest that the future study strategy should underpin the aging characteristics of people with intellectual disabilities and its differences with general population to provide the useful information for the institutional caregivers. Copyright © 2010 Elsevier Ltd. All rights reserved.

[Introduction of long-term care insurance: changes in service usage].

PubMed

Matsuda, Tomoyuki; Tamiya, Nanako; Kashiwagi, Masayo; Moriyama, Yoko

2013-09-01

With the aging of the population, Japan's long-term care system has shifted from a welfare-placement system to a social-insurance system, which is a precedent of policies for the elderly. We examined how individuals who used care services before the implementation of long-term care insurance (LTCI) (previous service users) currently use the LTCI services, with a focus on the processes of service use. Panel data were obtained from the Nihon University Japanese Longitudinal Study of Aging database. These data were collected by interviews conducted before (November 1999 and March 2000) and after (November 2001 and December 2001) the establishment of LTCI. Among the 3992 individuals who participated in these interviews, 416 of the previous service users, aged ≥65 years, were sampled. The outcome measures were the processes of using LTCI services (application for LTCI, certification of long-term care need, and contract with LTCI service providers). Logistic regression analysis was performed to identify individual factors associated with the process of application for LTCI. There were 133 LTCI users among the 416 previous service users (32.0%). Of the service processes used, 45.5% of previous service users were applicants, 85.7% of the applicants were certified individuals, and 88.7% of those certified used services with service contracts. The application process was significantly easier for individuals with disease (odds ratio[OR], 8.34 : 95% confidence interval [CI], 1.86-37.46), those dependent for their instrumental activities of daily living (IADL) (OR, 11.21 : 95% CI, 5.22-24.07), those with an equivalent income of <1.25 million yen (OR, 2.72 : 95% CI, 1.30-5.69), and those who had used respite care (OR, 3.29 : 95% CI, 1.16-9.35) previously. In contrast, the application process was significantly difficult for community rehabilitation users (OR, 0.38 : 95% CI, 0.17-0.82). Only half of the previous service users were applicants, and they had severe diseases or were

Effectiveness of a video-based aging services technology education program for health care professionals.

PubMed

Weakley, Alyssa; Tam, Joyce W; Van Son, Catherine; Schmitter-Edgecombe, Maureen

2017-01-19

Health care professionals (HCPs) are a critical source of recommendations for older adults. Aging services technologies (ASTs), which include devices to support the health-care needs of older adults, are underutilized despite evidence for improving functional outcomes and safety and reducing caregiver burden and health costs. This study evaluated a video-based educational program aimed at improving HCP awareness of ASTs. Sixty-five HCPs viewed AST videos related to medication management, daily living, and memory. Following the program, participants' objective and perceived AST knowledge improved, as did self-efficacy and anticipated AST engagement. About 95% of participants stated they were more likely to recommend ASTs postprogram. Participants benefitted equally regardless of years of experience or previous AST familiarity. Furthermore, change in self-efficacy and perceived knowledge were significant predictors of engagement change. Overall, the educational program was effective in improving HCPs' awareness of ASTs and appeared to benefit all participants regardless of experience and prior knowledge.

76 FR 67567 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-01

... Extended Care Services Coinsurance Amounts for CY 2012; Part A Premiums for CY 2012 for the Uninsured Aged... Program; Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for CY... announces the inpatient hospital deductible and the hospital and extended care services coinsurance amounts...

Primary Care Clinician Expectations Regarding Aging

PubMed Central

Davis, Melinda M.; Bond, Lynne A.; Howard, Alan; Sarkisian, Catherine A.

2011-01-01

Purpose: Expectations regarding aging (ERA) in community-dwelling older adults are associated with personal health behaviors and health resource usage. Clinicians’ age expectations likely influence patients’ expectations and care delivery patterns; yet, limited research has explored clinicians’ age expectations. The Expectations Regarding Aging Survey (ERA-12) was used to assess (a) age expectations in a sample of primary care clinicians practicing in the United States and (b) clinician characteristics associated with ERA-12 scores. Design and Methods: This study was a cross-sectional survey of primary care clinicians affiliated with 5 practice-based research networks, October 2008 to June 2009. A total of 374 of the 1,510 distributed surveys were returned (24.8% response rate); 357 analyzed. Mean respondent age was 48.6 years (SD = 11.6; range 23–87 years); 88.0% physicians, 96.0% family medicine, 94.9% White, and 61.9% male. Results: Female clinicians reported higher ERA-12 scores; clinicians’ age expectations decreased with greater years in practice. Among the clinicians, higher ERA-12 scores were associated with higher clinician ratings of the importance of and personal skill in administering preventive counseling and the importance of delivering preventive services. Agreement with individual ERA-12 items varied widely. Implications: Unrealistically high or low ERA could negatively influence the quality of care provided to patients and patients’ own age expectations. Research should examine the etiology of clinicians’ age expectations and their association with older adult diagnoses and treatment. Medical education must incorporate strategies to promote clinician attitudes that facilitate successful patient aging. PMID:21430129

Determinants of Utilization of Antenatal Care Services in Rural Lucknow, India

PubMed Central

Roy, Manas P.; Mohan, Uday; Singh, Shivendra K.; Singh, Vijay K.; Srivastava, Anand K.

2013-01-01

Background: Antenatal care services are the first steps towards ensuring the health of mothers and the newborn. This is the key component for achieving Millennium Development Goals by 2015. But India's performance continues to be poor in providing antenatal care services to its huge population, particularly in the rural areas. Objective: To assess the determinants of utilization of antenatal services by rural beneficiaries in Lucknow, a district of north India. Materials and Methods: The study, cross-sectional in design, was conducted from August 2009 to July 2010. Multistage random sampling was used for selecting villages. A total of 352 recently delivered women were selected following systematic random sampling. Logistic regression was used to find out the determinants of three antenatal care services. Results: Overall, 85.5% of the beneficiaries surveyed were found to receive at least three antenatal care services from any health facility. Community health centre was the most common source for such care. Significant difference was found between beneficiaries who took three antenatal care visits and who did not in terms of age, socio economic status, and timing of registration. On multiple regression, only age (OR = 2.107, 95% CI = 1.132 – 3.923) and timing of registration (OR = 2.817, 95% CI = 1.487 – 5.338) were found to be the predictors for three antenatal care visits. Conclusion: Intervention should be focused on young and late registered women for ensuring sufficient care during pregnancy. PMID:24479045

The Effect of Free Adult Preventive Care Services on Subsequent Utilization of Inpatient Services in Taiwan.

PubMed

Tian, Wei-Hua

2016-07-01

The objective of this article is to investigate the relationship between the utilization of free adult preventive care services and subsequent utilization of inpatient services among elderly people under the National Health Insurance program in Taiwan. The study used secondary data from the 2005 Taiwan National Health Interview Survey and claim data from the 2006 Taiwan National Health Insurance Research Database for the elderly aged 65 or over. A bivariate probit model was used to avoid the possible endogeneity in individuals' utilization of free adult preventive care and inpatient services. This study finds that, when individuals had utilized the preventive care services in 2005, the probability that they utilized inpatient services in 2006 was significantly reduced by 13.89%. The findings of this study may provide a good reference for policy makers to guide the efficient allocation of medical resources through the continuous promotion of free adult preventive care services under the National Health Insurance program. © Australian Council for Educational Research 2016.

Burden reduction of caregivers for users of care services provided by the public long-term care insurance system in Japan.

PubMed

Umegaki, Hiroyuki; Yanagawa, Madoka; Nonogaki, Zen; Nakashima, Hirotaka; Kuzuya, Masafumi; Endo, Hidetoshi

2014-01-01

We surveyed the care burden of family caregivers, their satisfaction with the services, and whether their care burden was reduced by the introduction of the LTCI care services. We randomly enrolled 3000 of 43,250 residents of Nagoya City aged 65 and over who had been certified as requiring long-term care and who used at least one type of service provided by the public LTCI; 1835 (61.2%) subjects returned the survey. A total of 1015 subjects for whom complete sets of data were available were employed for statistical analysis. Analysis of variance for the continuous variables and χ(2) analysis for that categorical variance were performed. Multiple logistic analysis was performed with the factors with p values of <0.2 in the χ(2) analysis of burden reduction. A total of 68.8% of the caregivers indicated that the care burden was reduced by the introduction of the LTCI care services, and 86.8% of the caregivers were satisfied with the LTCI care services. A lower age of caregivers, a more advanced need classification level, and more satisfaction with the services were independently associated with a reduction of the care burden. In Japanese LTCI, the overall satisfaction of the caregivers appears to be relatively high and is associated with the reduction of the care burden. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The emotional climate of care-giving in home-care services.

PubMed

Olsson, E; Ingvad, B

2001-11-01

The emotional aspects of the care-giving relationship in home-care services are studied, starting from the home-care recipients' and the home-care workers' perception of the emotional climate. Their experiences of the care-giving relationship and the influence from different aspects of the care-giving situation and social processes in the work organisation are explored. Two hundred and twenty-two recipients and their home-care workers in three typical Swedish municipalities were studied. The emotional climate is described with the help of a scale of 85 adjectives. Results show that home-care workers are more likely to experience the climate with a higher degree of emotionality. There is symmetry between the parties in the perception of a negative climate. However, if one party perceives the climate as close the other party is more likely to perceive it as rational or instrumental. The organisational processes, especially the group climate of the work team, principally influence the home-care recipients' perceptions. The workers' perceptions are principally influenced by age and gender of the recipients and the workers' own age. The emotional climate is constructed in a process between the parties, depending on their responses to each other. Tendencies to perceive a specific climate are strengthened or weakened by context variables and this in turn changes the care-giving interaction.

Nurse practitioners in aged care: documentary analysis of successful project proposals.

PubMed

Clark, Shannon J; Parker, Rhian M; Davey, Rachel

2014-11-01

Meeting the primary health care needs of an aging population is an increasing challenge for many Western nations. In Australia, the federal government introduced a program to develop, test, and evaluate nurse practitioner models in aged care settings. In this article, we present a documentary analysis of 32 project proposals awarded funding under the Nurse Practitioner-Aged Care Models of Practice Program. Successfully funded models were diverse and were operated by a range of organizations across Australia. We identified three key priorities as underlying the proposed models: "The right care," "in the right place," and "at the right time." In this article, we explore how these priorities were presented by different applicants in different ways. Through the presentation of their models, the program's applicants identified and proposed to address current gaps in health services. Applicants contrasted their proposed models with available services to create persuasive and competitive applications for funding. © The Author(s) 2014.

Implementation of Age-Specific Services for Transition-Age Youths in California.

PubMed

Ojeda, Victoria D; Hiller, Sarah P; Hurst, Samantha; Jones, Nev; McMenamin, Sara; Burgdorf, James; Gilmer, Todd P

2016-09-01

This study examined the implementation of age-specific services for transition-age youths in California under the Mental Health Services Act (MHSA). This study employed a sequential, exploratory mixed-methods design. Qualitative interviews with 39 mental health service area administrators in California were analyzed to develop an understanding of how the MHSA has facilitated the development of youth-specific programs or services. A quantitative survey of 180 youth-focused programs was also used to describe the range of services that were implemented, the use of evidence-based and promising practices, and the role of youths in the design, planning, delivery, and evaluation of services. Administrators described the MHSA as providing a programmatic focus and financial support for youth-specific services, outlining a stakeholder process to create buy-in and develop a vision for services, and emphasizing the role of youths in service delivery and planning. Youth-specific programs implemented a diverse array of services, including general medical care; employment and education support; housing placement and support; and family, mentoring, and social support. Programs described implementing evidence-based and promising practices and involving youths in service planning, implementation, or quality improvement activities. The MHSA has had a substantial impact on the landscape of youth-specific services in California by expanding both the number of programs and the diversity in types of services and by promoting the engagement of youths in the planning and delivery of services. Additional efforts are necessary to determine the extent to which youth-specific services yield greater improvements in youths' outcomes compared with services designed for adults.

Service quality in health care.

PubMed

Kenagy, J W; Berwick, D M; Shore, M F

1999-02-17

Although US health care is described as "the world's largest service industry," the quality of service--that is, the characteristics that shape the experience of care beyond technical competence--is rarely discussed in the medical literature. This article illustrates service quality principles by analyzing a routine encounter in health care from a service quality point of view. This illustration and a review of related literature from both inside and outside health care has led to the following 2 premises: First, if high-quality service had a greater presence in our practices and institutions, it would improve clinical outcomes and patient and physician satisfaction while reducing cost, and it would create competitive advantage for those who are expert in its application. Second, many other industries in the service sector have taken service quality to a high level, their techniques are readily transferable to health care, and physicians caring for patients can learn from them.

Home Care Services

MedlinePlus

Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help with ...

Supporting aging in place & assisted living through home care.

PubMed

Gorshe, N

2000-06-01

This article defines assisted living, discusses the pros and cons of limited regulation, scope of service, Aging-in-Place partnerships, and how home care agencies can work with assisted-living facilities to provide care. It also examines a study on assisted living in six states that is funded by the Robert Wood Johnson Foundation.

Foster care re-entry: Exploring the role of foster care characteristics, in-home child welfare services and cross-sector services.

PubMed

Lee, Sangmoo; Jonson-Reid, Melissa; Drake, Brett

2012-09-01

This study seeks to advance our understanding of how modifiable and non-modifiable factors may impact the likelihood of re-entry into foster care. Children who entered foster care for the first time following at least one report of maltreatment and were then reunified were followed from exit to re-entry, age 18 or the end of the study period using longitudinal administrative data. Risk of re-entry was explored according to a range of modifiable and non-modifiable case and service characteristics. Children removed from homes with parents who had multiple risk factors (e.g., no high school diploma, mental health diagnosis, criminal record, or teen parents) or were receiving AFDC prior to entry were more likely to re-enter. The receipt of in-home child welfare services during or after foster care was associated with reduced risk of re-entry. Having the longest placement with a relative was associated with decreased risk of re-entry. In conclusion, both modifiable and non-modifiable factors are associated with re-entry into foster care. Among modifiable factors, services appear to have a particularly strong relationship to re-entry. Our data also suggest that in-home child welfare services provided during and after foster care may be associated with improved long-term permanency after return home. Given the continued import of caregiver risk factors even among reunified families, services provided to support reunification should include attention to caregiver needs outside parenting.

Avoiding institutional outcomes for older adults living with disability: the use of community-based aged care supports.

PubMed

Ellison, Caroline; White, Amy; Chapman, Libby

2011-09-01

Most people with a disability want to remain living in their own home as they age. Without additional support, people with a disability may not be able to avoid moving into residential aged care, attending day programs, or becoming isolated from participation in the wider community. This study examined whether participants perceived access to community-based aged care supports assisted with avoiding receiving more institutional models of service as they age. Qualitative research processes were used to explore the perceptions of 60 individuals with a disability aged 50 years and over, in relation to ageing and the value of community-based aged care. Findings indicated that participants receiving community-based aged care supports reported benefits including opportunities to develop relationships, maintain daily living skills and participate in community activities. Due to a lack of confidence in the availability of access to mainstream community-based aged care services, many participants felt vulnerable or unsure about their future and ability to remain living in their own home. Several participants commented that this meant that an undesired early relocation into residential aged care or congregate disability services appeared inevitable.

Transforming Data into Practical Information: Using Consumer Input to Improve Home-Care Services

ERIC Educational Resources Information Center

Applebaum, Robert; Kunkel, Suzanne; Wilson, Ken

2007-01-01

Purpose: As funds have increased for the provision of in-home care, so too have concerns about the quality of services. In response, care management agencies and home-care providers have developed an array of monitoring activities designed to ensure the quality of services. In this article, we show how an area agency on aging both collected and…

Depression and Its Correlates Among Older Adults Accessing Aging Services

PubMed Central

Richardson, Thomas M.; Friedman, Bruce; Podgorski, Carol; Knox, Kerry; Fisher, Susan; He, Hua; Conwell, Yeates

2011-01-01

Objectives To define the prevalence and correlates of depression among older adults receiving assessments by nonmedical community-based care managers at the point of entry to care and thus prior to provision of aging services. Our long-term goal is to inform development of collaborative care models for late life depression that incorporate Aging Services Providers. Methods Aging Services Provider Network (ASPN) clients receiving in-home assessments were administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition module for affective disorders and measures of depression symptom severity, alcohol use, physical health, functional status, social support, stressful life events, and religiosity. Engagement in mental healthcare was documented. Results Subjects (N = 378) were primarily white (84%) and women (69%) with household incomes under $1,750/month (62%). Half lived alone (48%). Their mean age was 77 years. Thirty-one percent had clinically significant depressive symptoms and 27% met criteria for a current major depressive episode, of which 61% were being treated with medication and 25% by a mental health provider. Nearly half (47%) had experienced one or more episodes of major depression during their lives. Disability, number of medical conditions, number and severity of recent stressful life events, low social support, and low religiosity were independently associated with current major depression. Conclusion Depressive illness was common among this sample of ASPN clients. Because ASPN care managers have expertise in managing many of the problems correlated with depression, they may play a significant role in identifying, preventing, and collaborating in the treatment of depressive illnesses among community-dwelling older adults. PMID:22434017

Service quality perceptions in primary health care centres in Greece

PubMed Central

Papanikolaou, Vicky; Zygiaris, Sotiris

2012-01-01

Abstract Context  The paper refers to the increased competition between health care providers and the need for patient‐centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. Objective  To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. Strategy  SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. Results  The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients’ perceptions rather than expectations. Discussion and conclusions  This paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations–perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. PMID:22296402

Service quality perceptions in primary health care centres in Greece.

PubMed

Papanikolaou, Vicky; Zygiaris, Sotiris

2014-04-01

The paper refers to the increased competition between health care providers and the need for patient-centred services in Greece. Using service quality methodology, this paper investigates service quality perceptions of patients in Greek public primary health centres. To test the internal consistency and applicability of SERVQUAL in primary health care centres in Greece. SERVQUAL was used to examine whether patients have different expectations from health care providers and whether different groups of patients may consider some dimensions of care more important than others. The analysis showed that there were gaps in all dimensions measured by SERVQUAL. The largest gap was detected in empathy. Further analysis showed that there were also differences depending on gender, age and education levels. A separate analysis of expectations and perceptions revealed that this gap was because of differences in patients' perceptions rather than expectations. THIS paper raises a number of issues that concern the applicability of SERVQUAL in health care services and could enhance current discussions about SERVQUAL improvement. Quality of health care needs to be redefined by encompassing multiple dimensions. Beyond a simple expectations-perceptions gap, people may hold different understandings of health care that, in turn, influence their perception of the quality of services. © 2012 John Wiley & Sons Ltd.

Putting the 'care' back into aged care.

PubMed

Beadnell, Cathy

2006-04-01

Aged care is well and truly back on the political agenda in Australia. While the mainstream media has recently exposed a number of horrific cases of alleged abuse in aged care facilities it has done little to highlight the failings of social policy over time or to foster debate on how to improve the care of older Australians. What are the barriers to providing safe and quality aged care to a growing number of our citizens and how do we overcome them? If you relied on the recent media coverage for your impression of aged care you could be forgiven for thinking it is all bad news. But there are facilities providing high quality care and stories of nurses working wonders in the face of adversity. Cathy Beadnell considers some of the broader cultural and workforce issues in aged care.

Perceptions of the care received from Australian palliative care services: A caregiver perspective.

PubMed

Pidgeon, Tanya M; Johnson, Claire E; Lester, Leanne; Currow, David; Yates, Patsy; Allingham, Samuel F; Bird, Sonia; Eagar, Kathy

2018-04-01

ABSTRACTBackground:Caregiver satisfaction and experience surveys help health professionals to understand, measure, and improve the quality of care provided for patients and their families. Our aim was to explore caregiver perceptions of the care received from Australian specialist palliative care services. Caregivers of patients receiving palliative care in services registered with Australia's Palliative Care Outcomes Collaboration were invited to participate in a caregiver survey. The survey included the FAMCARE-2 and four items from the Ongoing Needs Identification: Caregiver Profile questionnaire. Surveys were completed by 1,592 caregivers from 49 services. Most respondents reported high satisfaction and positive experiences. Caregivers receiving care from community-based palliative care teams were less satisfied with the management of physical symptoms and comfort (odds ratio [OR] = 0.29; 95% confidence interval [CI95%] = 0.14, 0.59), with patient psychological care (OR = 0.56; CI95% = 0.32, 0.98), and with family support (OR = 0.52; CI95% = 0.35, 0.77) than caregivers of patients in an inpatient setting. If aged over 60 years, caregivers were less likely to have their information needs met regarding available support services (OR = 0.98; CI95% = 0.97, 0.98) and carer payments (OR = 0.99; CI95% = 0.98, 1.00). Also, caregivers were less likely to receive adequate information about carer payments if located in an outer regional area (OR = 0.41; CI95% = 0.25, 0.64). With practical training, caregivers receiving care from community services reported inadequate information provision to support them in caring for patients (OR = 0.60; CI95% = 0.45, 0.81). While our study identified caregivers as having positive and satisfactory experiences across all domains of care, there is room for improvement in the delivery of palliative care across symptom management, as well as patient and caregiver support, especially in community settings. Caregiver surveys can facilitate the

Children With Special Health Care Needs: Child Health and Functioning Outcomes and Health Care Service Use.

PubMed

Caicedo, Carmen

This study describes health, functioning, and health care service use by medically complex technology-dependent children according to condition severity (moderately disabled, severely disabled, and vegetative state). Data were collected monthly for 5 months using the Pediatric Quality of Life Generic Core Module 4.0 Parent-Proxy Report. Health care service use measured the number of routine and acute care office visits (including primary and specialty physicians), emergency department visits, hospitalizations, nursing health care services, special therapies, medications, medical technology devices (MTDs), and assistive devices. Child physical health was different across the condition severity groups. The average age of the children was 10.1 years (SD, 6.2); the average number of medications used was 5.5 (SD, 3.7); the average number of MTDs used was 4.2 (SD, 2.9); and the average number of assistive devices used was 4.3 (SD, 2.7). Severely disabled and vegetative children were similar in age (older) and had a similar number of medications, MTDs, and assistive devices (greater) than moderately disabled children. The advanced practice nurse care coordinator role is necessary for the health and functioning of medically complex, technology-dependent children. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Perspectives on mealtime management in residential aged care: insights from a cross-disciplinary investigation.

PubMed

Bennett, Michelle K; Ward, Elizabeth; Scarinci, Nerina; Waite, Monique

2014-01-01

Meeting the medical, nutritional, and psychosocial mealtime needs of aged care residents requires a holistic, multidisciplinary approach. To date the perspectives of this multidisciplinary team have not been adequately explored. The aim of this study was to explore the perspectives of a range of service providers involved in mealtime management in residential aged care. In-depth semistructured interviews were conducted with 61 participants from five service disciplines. Four themes emerged: ( 1 ) mealtimes are highly valued; ( 2 ) service providers face common barriers to mealtime management; ( 3 ) communication among service providers is challenging; and ( 4 ) education in mealtime management is limited. Data indicated service providers acknowledge the importance of mealtimes but recognize numerous shortfalls in current care. The need for interdisciplinary training and increased communication and collaboration among providers was emphasized, including the need for clarification of provider roles. Limited consideration of mealtimes in policy and funding documents was identified as a primary barrier in further prioritizing mealtime management and advancing mealtime care.

Beyond 'doing': Supporting clinical leadership and nursing practice in aged care through innovative models of care.

PubMed

Venturato, Lorraine; Drew, Liz

2010-06-01

Contemporary health care environments are increasingly challenged by issues associated with the recruitment and retention of qualified nursing staff. This challenge is particularly felt by residential aged care providers, with registered nurse (RN) numbers already limited and resident acuity rapidly rising. As a result, aged care service providers are increasingly exploring creative and alternative models of care. This article details exploratory research into a pre-existing, alternative model of care in a medium sized, regional residential aged care facility. Research findings suggest that the model of care is complex and multi-faceted and is an example of an integrated model of care. As a result of the implementation of this model of care a number of shifts have occurred in the practice experiences and clinical culture within this facility. Results suggest that the main benefits of this model are: (1) increased opportunities for RNs to engage in clinical leadership and proactive care management; (2) improved management and communication in relation to work processes and practices; and (3) enhanced recruitment and retention of both RNs and care workers.

Reasons for attending dental-care services in Ouagadougou, Burkina Faso.

PubMed Central

Varenne, Benoît; Msellati, Philippe; Zoungrana, Célestin; Fournet, Florence; Salem, Gérard

2005-01-01

OBJECTIVE: To determine why patients attend dental-care facilities in Ouagadougou, Burkina Faso and to improve understanding of the capacity of oral health-care services in urban west Africa. METHODS: We studied a randomly selected sample of patients attending 15 dental-care facilities in Ouagadougou over a 1-year period in 2004. Data were collected using a simple daily record form. FINDINGS: From a total of 44,975 patients, the final sample was established at 14,591 patients, of whom 55.4% were new patients and 44.6% were "booking patients". Most patients seeking care (71.9%) were aged 15-44 years. Nongovernmental not-for-profit dental services were used by 41.5% of all patients, 36% attended private dental-care services, and 22.5% of patients visited public services. The most common complaint causing the patient to seek dental-care services was caries with pulpal involvement (52.4%), and 60% of all complaints were associated with pain. The patients' dental-care requirements were found to differ significantly according to sex, health insurance coverage and occupation. CONCLUSION: Urban district health authorities should ensure provision of primary health-care services, at the patients' first point of contact, which are directed towards the relief of pain. In addition to the strengthening of outreach emergency care, health centres should also contribute to the implementation of community-based programmes for the prevention of oral disease and the promotion of oral health. Exchange of experiences from alternative oral health-care systems relevant to developing countries is urgently needed for tackling the growing burden of oral disease. PMID:16211155

Socio-economic and Demographic Determinants of Antenatal Care Services Utilization in Central Nepal.

PubMed

Pandey, Srijana; Karki, Supendra

2014-01-01

The importance of maternal health services in lessening maternal mortality and morbidity as well as neonatal deaths has received substantial recognition in the past decade. The lack of antenatal care has been identified as a risk factor for maternal mortality and other adverse pregnancy outcomes. The purpose of this study was to determine the factors affecting attendance of antenatal care services in Nepal. This is a cross-sectional descriptive study carried out in Central Nepal. Using semi-structured questionnaire, interviews were conducted with married women aged between 15-49 years, who had delivered their babies within one year. Systematic random sampling method was used to select the sample. Results were obtained by frequency distribution and cross-tabulation of the variables. More than half of the women were not aware of the consequences of lack of antenatal care. Age, education, income, type of family were strongly associated with the attendance at antenatal care service. In Nepal and in other developing countries, maternal mortality and morbidity continue to pose challenges to the health care delivery system. Variety of factors including socio-demographic, socio-economic, cultural and service availability as well as accessibility influences the use of maternal health services.

Determinants of psychology service utilization in a palliative care outpatient population.

PubMed

Azuero, Casey; Allen, Rebecca Sue; Kvale, Elizabeth; Azuero, Andres; Parmelee, Patricia

2014-06-01

Research has demonstrated that treating cancer patients' psychological and physical health leads to improved overall health. This may be especially true for palliative care patients facing serious illness. This study examines the proportion and determinants of psychology service utilization in an outpatient palliative care population. Data from an existing clinical database in an outpatient palliative clinic utilizing a collaborative care model to deliver psychology services were explored. This study was framed by Andersen's Behavioral Model of Health Service Use, which incorporates three main components: predisposing, enabling, and need factors to model health service utilization. The sample (N = 149) was majority middle aged, female, and White with a primary diagnosis of cancer. Cross-tabulations were conducted to determine how many patients who met screening criteria for depression or anxiety sought psychology services. Logistic regression analyses were conducted to assess for predisposing, enabling, and need factor determinants of psychology service utilization. Among patients who met criteria for moderate depression or anxiety, 50% did not access readily available psychology services. Enabling factors were the strongest determinant of psychology utilization. Factors associated with need for psychology services (i.e., emotional distress and psychological symptom burden) did not reach significance in determining psychology service use. This study extends current knowledge about psychology utilization to palliative care outpatients receiving care within a collaborative care model. Directions for future research include further investigation of care models that optimize enabling strategies to enhance access to these services, and examination of patient-reported barriers to receiving this care. Copyright © 2013 John Wiley & Sons, Ltd.

Expert perspectives on Western European prison health services: do ageing prisoners receive equivalent care?

PubMed

Bretschneider, Wiebke; Elger, Bernice Simone

2014-09-01

Health care in prison and particularly the health care of older prisoners are increasingly important topics due to the growth of the ageing prisoner population. The aim of this paper is to gain insight into the approaches used in the provision of equivalent health care to ageing prisoners and to confront the intuitive definition of equivalent care and the practical and ethical challenges that have been experienced by individuals working in this field. Forty interviews took place with experts working in the prison setting from three Western European countries to discover their views on prison health care. Experts indicated that the provision of equivalent care in prison is difficult mostly due to four factors: variability of care in different prisons, gatekeeper systems, lack of personnel, and delays in providing access. This lack of equivalence can be fixed by allocating adequate budgets and developing standards for health care in prison.

Access to care for autism-related services.

PubMed

Thomas, Kathleen C; Ellis, Alan R; McLaurin, Carolyn; Daniels, Julie; Morrissey, Joseph P

2007-11-01

This paper identifies family characteristics associated with use of autism-related services. A telephone or in-person survey was completed during 2003-2005 by 383 North Carolina families with a child 11 years old or younger with ASD. Access to care is limited for racial and ethnic minority families, with low parental education, living in nonmetropolitan areas, and not following a major treatment approach. Service use is more likely when parents have higher stress. Families use a broad array of services; the mix varies with child ASD diagnosis and age group. Disparities in service use associated with race, residence and education point to the need to develop policy, practice and family-level interventions that can address barriers to services for children with ASD.

Service quality in health care setting.

PubMed

Rashid, Wan Edura Wan; Jusoff, Hj Kamaruzaman

2009-01-01

This paper attempts to explore the concept of service quality in a health care setting. This paper probes the definition of service quality from technical and functional aspects for a better understanding on how consumers evaluate the quality of health care. It adopts the conceptual model of service quality frequently used by the most researchers in the health care sector. The paper also discusses several service quality dimensions and service quality problems in order to provide a more holistic conception of hospital service quality. The paper finds that service quality in health care is very complex as compared to other services because this sector highly involves risk. The paper adds a new perspective towards understanding how the concept of service quality is adopted in a health care setting.

Continuing in Foster Care Beyond Age 18: How Courts Can Help. Issue Brief 116

ERIC Educational Resources Information Center

Peters, Clark; Bell, Katie S. Claussen; Zinn, Andrew; Goerge, Robert M.; Courtney, Mark E.

2008-01-01

Research has found that foster youth who remain in care beyond age 18 are more likely to participate in services and tend to have better outcomes than those who do not. However, not all youth eligible to remain in care beyond age 18 do so. This study examines Illinois, one of the few states that extends care up to age 21, to identify the major…

Provision of Palliative Care Services by Family Physicians Is Common.

PubMed

Ankuda, Claire K; Jetty, Anuradha; Bazemore, Andrew; Petterson, Stephen

2017-01-01

Provision of palliative care services by primary care physicians is increasingly important with an aging population, but it is unknown whether US primary care physicians see themselves as palliative practitioners. This study used cross-sectional analysis of data from the 2013 American Board of Family Medicine Maintenance of Certification Demographic Survey. Of 10,894 family physicians, 33.1% (n = 3609) report providing palliative care. Those providing palliative care are significantly more likely to provide non-clinic-based services such as care in nursing homes, home visits, and hospice. Controlling for other characteristics, physicians reporting palliative care provision are significantly ( P < .05) more likely to be older, white, male, rural, and practicing in a patient-centered medical home. One third of family physicians recertifying in 2013 reported providing palliative care, with physician and practice characteristics driving reporting palliative care provision. © Copyright 2017 by the American Board of Family Medicine.

The Flexible Care Service: a third-sector service for older people with mental health needs.

PubMed

Ryder, Elaine

2015-01-01

Demographic patterns indicate that by 2030, one in five people in England will be over 65. Together with the fact that as people age they are more likely to suffer from comorbidities, it is of paramount importance that local services are designed to meet the needs of individual older people. The Flexible Care Service is a resource for older people with mental health problems. Through the use of client case studies, the Department of Health's 'six Cs' (care, compassion, competence, communication, courage and commitment) are used as a framework to demonstrate how a third-sector service such as Flexible Care can offer a person-centred approach in order to meet the diverse needs of individual clients. The framework is also used to demonstrate the high level of skills needed by flexible carers in order to provide this support.

Physical activity levels of older adults receiving a home care service.

PubMed

Burton, Elissa; Lewin, Gill; Boldy, Duncan

2013-04-01

The 3 study objectives were to compare the activity levels of older people who had received a restorative home care service with those of people who had received "usual" home care, explore the predictors of physical activity in these 2 groups, and determine whether either group met the minimum recommended activity levels for their age group. A questionnaire was posted to 1,490 clients who had been referred for a home care service between 2006 and 2009. Older people who had received a restorative care service were more active than those who had received usual care (p = .049), but service group did not predict activity levels when other variables were adjusted for in a multiple regression. Younger individuals who were in better physical condition, with good mobility and no diagnosis of depression, were more likely to be active. Investigation of alternatives to the current exercise component of the restorative program is needed.

Interest-Based Curriculum for House Care Services: House Cares.

ERIC Educational Resources Information Center

Natchitoches Parish School Board, LA.

The 11-unit curriculum guide for house care services, a Federally sponsored project, is designed to help students identify interests and develop skills associated with house care services. Two introductory units deal with the world of work and the total area of house care services. The following unit topics are: sanitation and safety; equipment;…

Which need characteristics influence healthcare service utilization in home care arrangements in Germany?

PubMed

Dorin, Lena; Turner, Suzi C; Beckmann, Lea; große Schlarmann, Jörg; Faatz, Andreas; Metzing, Sabine; Büscher, Andreas

2014-05-22

We see a growing number of older adults receiving long-term care in industrialized countries. The Healthcare Utilization Model by Andersen suggests that individual need characteristics influence utilization. The purpose of this study is to analyze correlations between need characteristics and service utilization in home care arrangements. 1,152 respondents answered the questionnaire regarding their integration of services in their current and future care arrangements. Care recipients with high long-term care needs answered the questionnaire on their own, the family caregiver assisted the care recipient in answering the questions, or the family caregiver responded to the questionnaire on behalf of the care recipient. They were asked to rank specific needs according to their situation. We used descriptive statistics and regression analysis. Respondents are widely informed about services. Nursing services and counseling are the most used services. Short-term care and guidance and training have a high potential for future use. Day care, self-help groups, and mobile services were the most frequently rejected services in our survey. Women use more services than men and with rising age utilization increases. Long waiting times and bad health of the primary caregiver increases the chance of integrating services into the home care arrangements. The primary family caregiver has a high impact on service utilization. This indicates that the whole family should be approached when offering services. Professionals should react upon the specific needs of care dependents and their families.

Which need characteristics influence healthcare service utilization in home care arrangements in Germany?

PubMed Central

2014-01-01

Background We see a growing number of older adults receiving long-term care in industrialized countries. The Healthcare Utilization Model by Andersen suggests that individual need characteristics influence utilization. The purpose of this study is to analyze correlations between need characteristics and service utilization in home care arrangements. Methods 1,152 respondents answered the questionnaire regarding their integration of services in their current and future care arrangements. Care recipients with high long-term care needs answered the questionnaire on their own, the family caregiver assisted the care recipient in answering the questions, or the family caregiver responded to the questionnaire on behalf of the care recipient. They were asked to rank specific needs according to their situation. We used descriptive statistics and regression analysis. Results Respondents are widely informed about services. Nursing services and counseling are the most used services. Short-term care and guidance and training have a high potential for future use. Day care, self-help groups, and mobile services were the most frequently rejected services in our survey. Women use more services than men and with rising age utilization increases. Long waiting times and bad health of the primary caregiver increases the chance of integrating services into the home care arrangements. Conclusion The primary family caregiver has a high impact on service utilization. This indicates that the whole family should be approached when offering services. Professionals should react upon the specific needs of care dependents and their families. PMID:24884598

Psychosocial changes following transition to an aged care home: qualitative findings from Iran.

PubMed

Zamanzadeh, Vahid; Rahmani, Azad; Pakpour, Vahid; Chenoweth, Lynnette Lorraine; Mohammadi, Eesa

2017-06-01

The study explored the psychosocial effects of transitioning from home to an aged care home for older Iranian people. Moving from one's own home to a communal aged care home is challenging for older people and may give rise to numerous psychosocial responses. The extent and intensity of such changes have rarely been explored in Middle Eastern countries. Data were collected through purposive sampling by in-depth semi-structured interviews with 20 participants (17 people living in aged care homes and three formal caregivers). All the interviews were recorded and typed, and conventional qualitative content analysis was used, eliciting common themes. There were four common themes: communication isolation, resource change, monotone institutional life and negative emotional response. Participants lost their previous support systems when transitioning to an aged care home and were not able to establish new ones. Routine care was provided by formal caregivers with little attention to individual needs, and minimal support was given to help maintain the older person's independence. These losses gave rise to negative emotions in some of the participants, depending on their previous lifestyle and accommodation arrangements. The extent and intensity of psychosocial changes occurring in most of the participants following their transition to an aged care home indicates the need for a review of Iranian aged care services. To assist older Iranian people adapt more readily when making the transition to aged care home and to meet their unique psychosocial needs, a family-centred approach to service delivery is recommended. © 2016 John Wiley & Sons Ltd.

Aging in Australia: country of birth and language preferences of residents in aged care facilities.

PubMed

Petrov, Ljubica; Joyce, Catherine; Gucciardo-Masci, Tonina

2017-09-05

Objective There is a need to better understand the use of aged care services by people from culturally and linguistically diverse backgrounds. The aim of the present study was to describe the prevalence of people living in residential aged care facilities (RACFs) who were born in non-English-speaking countries and/or have a preferred language other than English and to describe service utilisation rates. Methods The present study consisted of a secondary analysis of data from the Australian Institute of Health and Welfare National Aged Care Data Clearinghouse. Data were analysed by country of birth, preferred language, state or territory and Aged Care Planning Regions within Victoria. Results Nationally, over 30000 (18.3%) RACF residents were born in a non-English-speaking country. In Victoria, almost one in four RACF residents (23.9%) was born in a non-English-speaking country, and approximately one in eight (13.1%) has a preferred language other than English. Most Victorian RACFs (72.4%) have at least one resident with a preferred language other than English. Approximately one in four residents (26.1%) with a preferred language other than English are the sole speaker of the language in their facility. Conclusion All RACFs need to effectively address the needs and preferences of their residents, including those who were born in a non-English-speaking country or prefer to speak a language other than English. What is known about the topic? The number of older people from a non-English-speaking background continues to increase, but little is known about the prevalence of this cohort living in RACFs and how aged care providers are responding to their needs and preferences. What does this paper add? The present study provides detailed, service- and policy-relevant information, demonstrating a substantial degree of diversity among people living in RACFs, with wide distribution across facilities and regions. The findings confirm the need for a systematic, sector

Aged care nurses' job control influence satisfaction and mental health.

PubMed

Elliott, Kate-Ellen J; Rodwell, John; Martin, Angela J

2017-10-01

Relationships exist between aged care nurses' perceptions of psychosocial work characteristics, job satisfaction and mental health, suggesting these characteristics may be important for the management of aged care services. An expanded demand-control-support model that included justice perceptions was examined to determine its impact on multiple types of psychological and organisational well-being outcomes (i.e. job satisfaction, psychological distress and depression). Data were collected from a sample of 173 aged care nurses using a self-report survey and analysed using hierarchical multiple regression. A significant proportion (27-28%) of the variance in aged care nurses' satisfaction, depression and psychological distress was explained by the psychosocial factors included in the model. Job control had the most consistent impact with direct effects on job satisfaction, psychological distress and depression. Informational justice was associated with both psychological distress and depression. Targeting job control may provide the biggest response for nurse managers in aged care, as it is likely to influence nurses' job satisfaction, psychological distress and depression. Facility managers should implement organisational policies and procedures that promote higher levels of control over how nurses perform their work in order to improve nurse well-being in aged care settings. © 2017 John Wiley & Sons Ltd.

Interest in Long-Term Care among Health Services Administration Students

ERIC Educational Resources Information Center

Temple, April; Thompson, Jon M.

2011-01-01

The aging of the population has created increased opportunities for health administrators in long-term care. This study consisted of a cross-sectional survey of 68 undergraduate health services administration students to explore factors related to interest in a career in long-term care administration. One third expressed interest working in the…

Age and closeness of death as determinants of health and social care utilization: a case-control study.

PubMed

Forma, Leena; Rissanen, Pekka; Aaltonen, Mari; Raitanen, Jani; Jylhä, Marja

2009-06-01

We used case-control design to compare utilization of health and social services between older decedents and survivors, and to identify the respective impact of age and closeness of death on the utilization of services. Data were derived from multiple national registers. The sample consisted of 56,001 persons, who died during years 1998-2000 at the age of > or = 70, and their pairs matched on age, gender and municipality of residence, who were alive at least 2 years after their counterpart's death. Data include use of hospitals, long-term care and home care. Decedents' utilization within 2 years before death and survivors' utilization in the same period of time was assessed in three age groups (70-79, 80-89 and > or = 90 years) and by gender. Decedents used hospital and long-term care more than their surviving counterparts, but the time patterns were different. In hospital care the differences between decedents and survivors rose in the last months of the study period, whereas in long-term care there were clear differences during the whole 2-year period. The differences were smaller in the oldest age group than in younger age groups. Closeness of death is an important predictor of health and social service use in old age, but its influence varies between age groups. Not only the changing age structure, but also the higher average age at death affects the future need for services.

Access to special care dentistry, part 7. Special care dentistry services: seamless care for people in their middle years--part 1.

PubMed

Lewis, D; Fiske, J; Dougall, A

2008-09-27

Children and older people have been relatively well served by specialist dental care. Despite increasing disability amongst people in their middle years, there have been no or few dedicated dental teams with responsibility for provision of their oral care. This article explores the ethos and practicality of seamless care across the age groups and the primary/secondary care interface, with a focus on embedding oral health into general healthcare plans through the multidisciplinary team approach. The article explores four conditions--rheumatoid arthritis, Huntingdon's disease, multiple sclerosis and diabetes. It considers the features of each condition and how they can impact on both oral health and the delivery of dental services. It also considers the elements of care that contribute to a holistic and seamless approach to oral care services.

Age-Related Variation in Health Service Use and Associated Expenditures among Children with Autism

ERIC Educational Resources Information Center

Cidav, Zuleyha; Lawer, Lindsay; Marcus, Steven C.; Mandell, David S.

2013-01-01

This study examined differences by age in service use and associated expenditures during 2005 for Medicaid-enrolled children with autism spectrum disorders. Aging was associated with significantly higher use and costs for restrictive, institution-based care and lower use and costs for community-based therapeutic services. Total expenditures…

Preventive care and recall intervals. Targeting of services in child dental care in Norway.

PubMed

Wang, N J; Aspelund, G Ø

2010-03-01

Skewed caries distribution has made interesting the use of a high risk strategy in child dental services. The purpose of this study was to describe the preventive dental care given and the recall intervals used for children and adolescents in a low caries risk population, and to study how the time spent for preventive care and the length of intervals were associated with characteristics of the children and factors related to care delivery. Time spent for and type of preventive care, recall intervals, oral health and health behaviour of children and adolescents three to 18 years of age (n = 576) and the preventive services delivered were registered at routine dental examinations in the public dental services. The time used for preventive dental care was on average 22% of the total time used in a course of treatment (7.3 of 33.4 minutes). Less than 15% of the variation in time spent for prevention was explained by oral health, oral health behaviours and other characteristics of the children and the service delivery. The mean (SD) recall intervals were 15.4 (4.6) months and 55% of the children were given intervals equal to or longer than 18 months. Approximately 30% of the variation in the length of the recall intervals was explained by characteristics of the child and the service delivery. The time used for preventive dental care of children in a low risk population was standardized, while the recall intervals to a certain extent were individualized according to dental health and dental health behaviour.

Characteristics of care management agencies affect expenditure on home help and day care services: A population-based cross-sectional study in Japan.

PubMed

Feng, Mei; Igarashi, Ayumi; Noguchi-Watanabe, Maiko; Yoshie, Satoru; Iijima, Katsuya; Yamamoto-Mitani, Noriko

2017-11-01

The financial interests of care management agencies can affect how care managers assist clients' use of long-term care insurance services. The present study examined the relationship between clients' service expenditures, and whether the home help and day care service agencies belonged to the same organization as the care management agency. Population-based data were obtained from a suburban municipality in Japan. We investigated 4331 persons with care needs certificates (levels 1-5), including those using home help (n = 1780) or day care (n = 2141) services. Data on the service expenditures, and clients' and agencies' characteristics were analyzed using multiple linear regression analyses controlling for potential confounders. Home help service users spent an average of US$558.1 ± 590.1 for home help service, and day care service users spent US$665.0 ± 415.9 for day care service. Living alone, living in a condominium/apartment, higher care needs, more severe cognitive impairment and lower use of other services were associated with higher home help service expenditure. Day care service expenditure increased with older age, female sex, higher care needs, more severe cognitive impairment and higher physical function. Clients whose service agencies and care management agencies belonged to the same organization had higher expenditures, even after adjusting for confounders (home help: β = 0.126, P = 0.007; day care: β = 0.085, P = 0.002, respectively). Financial interests of care management agencies might significantly influence clients' service expenditure. We should develop an effective system to minimize this influence. Geriatr Gerontol Int 2017; 17: 2224-2231. © 2017 Japan Geriatrics Society.

Long-term care-service use and increases in care-need level among home-based elderly people in a Japanese urban area.

PubMed

Koike, Soichi; Furui, Yuji

2013-04-01

The objective of this study was to examine the effects of home-based long-term care insurance services on an increase in care need levels and discuss its policy implications. We analyzed care need certification and long-term care service use data for 3006 non-institutionalized elderly persons in a Tokyo ward effective as of October 2009 and 2010. Individual care need assessment intervals and their corresponding changes in care need level were calculated from data at two data acquisition points of care need assessment. Those who had been certified but did not use any long-term care insurance service were defined as the control group. The Cox proportionate hazard model was used to determine whether the use of a long-term care insurance service is associated with increased care need level. After adjusting for sex, age, and care need level, the hazard ratio for the probability of increased care need level among service users was calculated as 0.75 (95% confidence interval, 0.64-0.88; p < 0.001). Home-based long-term care service use may prevent an increase in care need level. Administrative data on care need certification and services use could be an effective tool for evaluating the long-term care insurance system. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Improving health care delivery to aging adults with disabilities: social work with dual eligibles in a climate of health care reform.

PubMed

Bachman, Sara S; Gonyea, Judith G

2012-01-01

Adults aging with disabilities comprise a diverse group. In this article, we identify the prevalence and characteristics of this target population, focusing on adults who are dually eligible for Medicare and Medicaid. We articulate challenges in the delivery of health, social, and support services to adults aging with disabilities, particularly how existing health care policy and financing contributes to fragmentation of care. Finally, we identify opportunities for social workers to advocate for and promote system improvements in the delivery of care for aging adults with disabilities in the current climate of health care reform.

Trial Implementation of a Telerehabilitation Exercise System in Residential Aged Care.

PubMed

Hutchinson, Marie; Wendt, Neil; Smith, Stuart Trevor

2018-01-01

The 2011 Productivity Commission report, Caring for Older Australians, observed that as the number of older Australians rises and the demand for aged care services increases, there will be a commensurate increase in demand for a well-trained aged care workforce. One of the significant issues impacting upon the ability of the aged services sector to respond to a growing number of older adults is to attract and retain sufficient numbers of staff. A number of factors are acknowledged to contribute to a failure of the aged care sector to attract and retain workers including: poor sector reputation, poor working conditions, including high client-staff ratios, a lack of career paths and professional development opportunities and low rates of remuneration. Poor perceptions about working in the aged care sector (e.g. that aged care nursing is less glamorous than nursing in the acute care sector) appear to develop early, with many nursing students indicating that they do not view aged care as an attractive career choice. Undergraduate nursing students have often found clinical placements in aged care unsatisfactory and unsettling, dissuading them from considering aged care as an employment option on graduation. In the following we describe one way we have attempted to address this issue by training undergraduate health sciences students (occupational therapy, nursing) to deliver a physical activity program to residents of an aged care facility using a novel telerehabilitation technology that enables remote prescription and monitoring of exercise programs. The main purpose of this quality assurance trial was to explore the feasibility and safety of supervised use of a novel telerehabilitation exercise system with older adults living in residential aged care. Four residents were recruited into the study and all displayed limitations in mobility, balance, strength and endurance. None had any had previous experience with computer games or interactive technologies. Resident

Age-related variation in primary care-type presentations to emergency departments.

PubMed

Freed, Gary; Gafforini, Sarah; Carson, Norman

2015-08-01

A significant amount of attention has been paid to the increase in emergency department (ED) presentations in Australia. Questions have arisen regarding whether all of those presenting to the ED are actually in need of true emergency services. Under-standing the characteristics of those patients who may be cared for in non-emergency settings is important for future health system strategies. The aim of this study was to identify age-related variation in primary care type emergency department (ED) presentations over time. A secondary analysis of data from the Victorian emergency minimum dataset (VEMD) between 2002-13 was conducted. The main outcomes were patterns of primary care type ED presentations for different ages groups over time, age-specific patterns of specific primary care type exclusion criteria and primary care type ED presentations by residents from aged care facilities. The proportion of triage category 4 or 5 ED presentations that met the criteria for a primary care type visit was greatest in the 0-4-year age group and tended to decrease as the age of the patient increased. Triage category 4 or 5 presentation by ambulance was uncommon in the younger age groups, surpassed 10% in the 50-54-year age group, and was >70% for those aged >90 years. The greater proportion of residential aged care facility patients who arrived by ambulance resulted in a much smaller proportion of primary care type visits. There are marked differences by age in the proportion of triage category 4 or 5 ED presentations that met the criteria for primary care type visits. These results indicate it was primarily younger patients who presented to the ED with non-urgent conditions. Most might be able to safely receive care in a primary care setting.

Intergenerational Service Learning: To Promote Active Aging, and Occupational Therapy Gerontology Practice

ERIC Educational Resources Information Center

Horowitz, Beverly P.; Wong, Stephanie Dapice; Dechello, Karen

2010-01-01

Americans are living longer, and the meaning of age has changed, particularly for Boomers and seniors. These demographic changes have economic and social ramifications with implications for health care, including rehabilitation services, and health science education. Service learning is an experiential learning pedagogy that integrates traditional…

In-reach nursing services improve older patient outcomes and access to emergency care.

PubMed

Street, Maryann; Considine, Julie; Livingston, Patricia; Ottmann, Goetz; Kent, Bridie

2015-06-01

To identify the impact of in-reach services providing specialist nursing care on outcomes for older people presenting to the emergency department from residential aged care. Retrospective cohort study compared clinical outcomes of 2278 presentations from 2009 with 2051 presentations from 2011 before and after the implementation of in-reach services. Median emergency department length of stay decreased by 24 minutes (7.0 vs 6.6 hours, P < 0.001) and admission rates decreased by 23% (68 vs 45%, P < 0.001). The proportion of people with repeat emergency department visits within six months decreased by 12% (27 vs 15%). The proportion of admitted patients who were discharged with an end of life palliative care plan increased by 13% (8 vs 21%, P = 0.007). There was a significant reduction in the median length of stay, fewer hospital admissions and fewer repeat visits for people from residential aged care following implementation of in-reach services. © 2014 ACOTA.

Dental Care Presents The Highest Level Of Financial Barriers, Compared To Other Types Of Health Care Services.

PubMed

Vujicic, Marko; Buchmueller, Thomas; Klein, Rachel

2016-12-01

The Affordable Care Act is improving access to and the affordability of a wide range of health care services. While dental care for children is part of the law's essential health benefits and state Medicaid programs must cover it, coverage of dental care for adults is not guaranteed. As a result, even with the recent health insurance expansion, many Americans face financial barriers to receiving dental care that lead to unmet oral health needs. Using data from the 2014 National Health Interview Survey, we analyzed financial barriers to a wide range of health care services. We found that irrespective of age, income level, and type of insurance, more people reported financial barriers to receiving dental care, compared to any other type of health care. We discuss policy options to address financial barriers to dental care, particularly for adults. Project HOPE—The People-to-People Health Foundation, Inc.

Receipt of Selected Preventive Health Services for Women and Men of Reproductive Age - United States, 2011-2013.

PubMed

Pazol, Karen; Robbins, Cheryl L; Black, Lindsey I; Ahrens, Katherine A; Daniels, Kimberly; Chandra, Anjani; Vahratian, Anjel; Gavin, Lorrie E

2017-10-27

Receipt of key preventive health services among women and men of reproductive age (i.e., 15-44 years) can help them achieve their desired number and spacing of healthy children and improve their overall health. The 2014 publication Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs (QFP) establishes standards for providing a core set of preventive services to promote these goals. These services include contraceptive care for persons seeking to prevent or delay pregnancy, pregnancy testing and counseling, basic infertility services for those seeking to achieve pregnancy, sexually transmitted disease (STD) services, and other preconception care and related preventive health services. QFP describes how to provide these services and recommends using family planning and other primary care visits to screen for and offer the full range of these services. This report presents baseline estimates of the use of these preventive services before the publication of QFP that can be used to monitor progress toward improving the quality of preventive care received by women and men of reproductive age. 2011-2013. Three surveillance systems were used to document receipt of preventive health services among women and men of reproductive age as recommended in QFP. The National Survey of Family Growth (NSFG) collects data on factors that influence reproductive health in the United States since 1973, with a focus on fertility, sexual activity, contraceptive use, reproductive health care, family formation, child care, and related topics. NSFG uses a stratified, multistage probability sample to produce nationally representative estimates for the U.S. household population of women and men aged 15-44 years. This report uses data from the 2011-2013 NSFG. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system designed to monitor selected maternal behaviors and experiences

Horizontal inequity in public health care service utilization for non-communicable diseases in urban Vietnam

PubMed Central

Kien, Vu Duy; Van Minh, Hoang; Giang, Kim Bao; Weinehall, Lars; Ng, Nawi

2014-01-01

Background A health system that provides equitable health care is a principal goal in many countries. Measuring horizontal inequity (HI) in health care utilization is important to develop appropriate and equitable public policies, especially policies related to non-communicable diseases (NCDs). Design A cross-sectional survey of 1,211 randomly selected households in slum and non-slum areas was carried out in four urban districts of Hanoi city in 2013. This study utilized data from 3,736 individuals aged 15 years and older. Respondents were asked about health care use during the previous 12 months; information included sex, age, and self-reported NCDs. We assessed the extent of inequity in utilization of public health care services. Concentration indexes for health care utilization and health care needs were constructed via probit regression of individual utilization of public health care services, controlling for age, sex, and NCDs. In addition, concentration indexes were decomposed to identify factors contributing to inequalities in health care utilization. Results The proportion of healthcare utilization in the slum and non-slum areas was 21.4 and 26.9%, respectively. HI in health care utilization in favor of the rich was observed in the slum areas, whereas horizontal equity was achieved among the non-slum areas. In the slum areas, we identified some key factors that affect the utilization of public health care services. Conclusion Our results suggest that to achieve horizontal equity in utilization of public health care services, policy should target preventive interventions for NCDs, focusing more on the poor in slum areas. PMID:25095780

Using assistive technology services at differing levels of care: healthy older couples' perceptions.

PubMed

Harrefors, Christina; Axelsson, Karin; Sävenstedt, Stefan

2010-07-01

The aim of the study was to describe healthy older couples' perceptions of using assistive technology services when needing assistance with care. The use of information technology-based assistive technology services in elder care has increased as a result of an increase of care performed in private homes. The use of assistive technology services in care of older people at home has been evaluated as something positive by patients, relatives and nursing staff, while as resistance to their increased use has also been noted. Twelve healthy couples, aged over 70 years, from northern Sweden were interviewed in 2005 about their perceptions of using assistive technology services in the case of being in need of assistance with personal care. Open, individual semi-structured interviews supported by written vignettes describing three levels of caring needs were used and the data analysed with content analysis. The findings were interpreted as one main theme with three categories: Asset or threat depends on caring needs and abilities. Three categories were identified within the theme: Assistive technology services provide an opportunity; The consequences of using assistive technology services are hard to anticipate; and Fear of assistive technology services when completely dependent on care. Trust and security in the care of older people who are severely ill, dependent on care and living at home should be a hallmark in using assistive technology services. Human presence is an important dimension and must be considered when developing concepts for use of assistive technology services.

Trends in Aging-Related Services During Nephrectomy: Implications for Surgery in an Aging Population.

PubMed

Tan, Hung-Jui; Litwin, Mark S; Chamie, Karim; Saliba, Debra; Hu, Jim C

2017-10-01

To characterize the extent to which geriatric and related healthcare services are provided to older adults undergoing surgery for kidney cancer, a potential growth area in geriatrics and oncology. Population-based observational study. Surveillance, Epidemiology, and End Results cancer data linked with Medicare claims. Adults aged 65 and older with kidney cancer treated surgically from 2000 to 2009 (N = 19,129). Receipt of geriatric consultation, medical comanagement during the surgical hospitalization, inpatient physical or occupational therapy (PT/OT), and postacute PT/OT during the surgical care episode. Multivariable, mixed-effects models were used to identify associated participant and hospital characteristics, examine trends over time, and characterize hospital-level variation. Geriatric consultation occurred rarely in the perioperative period (2.6%). Medical comanagement (15.8%), inpatient PT/OT (34.2%), and postacute PT/OT (15.6%) occurred more frequently. In our mixed-effects models, participant age and comorbidity burden appeared to be consistent determinants of use of services, although hospital-level variation was also noted (P < .001). Use of geriatric consultation increased modestly in the latter years of the study period (P < .05). In contrast, medical comanagement (183%), inpatient PT/OT (73%), and postacute PT/OT (71%) increased substantially over the study period (P < .001). Although geriatric consultation remained sparse, use of medical comanagement and rehabilitation services has grown considerably for older adults undergoing surgery for kidney cancer. Efforts to reorganize cancer and surgery care should explore reasons for variation and the potential for these service elements to meet the health needs of an aging population. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

A Home-Based Palliative Care Consult Service for Veterans.

PubMed

Golden, Adam G; Antoni, Charles; Gammonley, Denise

2016-11-01

We describe the development and implementation of a home-based palliative care consult service for Veterans with advanced illness. A retrospective chart review was performed on 73 Veterans who received a home-based palliative care consult. Nearly one-third were 80 years of age or older, and nearly one-third had a palliative diagnosis of cancer. The most common interventions of the consult team included discussion of advance directives, completion of a "do not resuscitate" form, reduction/stoppage of at least 1 medication, explanation of diagnosis, referral to home-based primary care program, referral to hospice, and assessment/support for caregiver stress. The home-based consult service was therefore able to address clinical and psychosocial issues that can demonstrate a direct benefit to Veterans, families, and referring clinicians. © The Author(s) 2015.

Home care clients in the last year of life: is material deprivation associated with service characteristics?

PubMed

Goodridge, Donna; Buckley, Alan; Marko, Josh; Steeves, Megan; Turner, Hollie; Whitehead, Steve

2011-09-01

To compare demographic, social, medical, and health care characteristics of home care clients in the last year of life by quintile of deprivation and examine associations between material deprivation and service characteristics. This retrospective study used administrative data for 700 clients who died while receiving home care services. Outcome measures were the receipt of supportive or palliative home care. Associations were assessed using multiple logistic regression. Material deprivation was not associated with either the hours of home care received or the receipt of supportive home care services. Clients with dementia or stroke, those were older than 80 years and those who were single were less likely to receive palliative care services than other groups. Inequalities in allocation of home care services based on age, diagnosis, and marital status, but not material deprivation, suggest the need to carefully match service with need at the end of life.

THE UTILIZATION OF EYE CARE SERVICES BY PERSONS WITH GLAUCOMA IN RURAL SOUTH INDIA

PubMed Central

Robin, Alan L; Nirmalan, Praveen K; Krishnadas, Ramasamy; Ramakrishnan, Rengappa; Katz, Joanne; Tielsch, James; Thulasiraj, Ravilla D; Friedman, David S

2004-01-01

ABSTRACT Purpose To determine utilization of eye care services, in particular those relating to glaucoma, in a rural population of southern India aged 40 years or older. Methods A total of 5,150 subjects aged 40 years or older selected through a random cluster sampling technique from three districts in southern India underwent detailed ocular examinations for vision impairment, blindness, and ocular morbidity. Information regarding previous use of eye care services was collected from this population through a questionnaire administered by trained social workers prior to ocular examinations. Results One thousand eight hundred and twenty-seven persons (35.5%) gave a history of prior eye examinations, primarily from a general hospital (n = 1,073, 58.7%). Increasing age and education were associated with increased utilization of eye care services. Among the 3,323 persons who had never sought eye care, 912 (27.4%) had felt the need to have an eye examination but did not do so. Only one third of persons with vision impairment, cataracts, refractive errors, and glaucoma had previously utilized services. Of the 64 subjects diagnosed as having primary open-angle glaucoma, 32 (50%) had previously seen an ophthalmologist, but none had had an eye examination within 1 year before the study. Only six (19%) of the 32 had been diagnosed as having glaucoma (9% of all subjects found to have glaucoma in the survey). Thirteen (20.3%) of the 64 subjects were blind in either eye due to glaucoma, including one person who was bilaterally blind. Conclusions A large proportion of persons in a rural population of southern India who require eye care are currently not utilizing existing eye care services. Strategies to improve the uptake of services are required to reduce the burden of blindness due to glaucoma in southern India. PMID:15747744

Consider long-term care as service alternative.

PubMed

Loria, L S

1987-04-01

The increasing demand for elderly care services, pressures on inpatient average length of stay and payment levels, and potential financial rewards from providing additional services, makes long-term care look attractive to hospitals. Long-term care, however, is not for every hospital. Before deciding to establish long-term care services, management should examine how the service fits within the hospital's strategic plan. The action plan below provides guidance in evaluating a decision to use hospital facilities for long-term care. Examine how long-term care services fit within the hospital's strategic plan. Study area demographics and competitors to assess the need and supply of long-term care services. Survey the medical staff, consumers and payers to determine attitudes, perceptions and interests regarding long-term care services. Develop a facility plan that identifies areas of excess capacity that can be most easily converted into long-term care with minimal effects on hospital operations. Prepare a financial feasibility analysis of the contribution margin and return on investment attributable to long-term care services. Include an impact analysis on hospital operations. Establish a management task force to develop a detailed implementation plan including assigned individual responsibilities and related timetable. Develop an effective marketing plan designed to generate increased patient market share.

The Association between Freedom of Choice and Effectiveness of Home Care Services.

PubMed

Steffansson, Marina; Pulliainen, Marjo; Kettunen, Aija; Linnosmaa, Ismo; Halonen, Miikka

2016-03-31

The aim of this paper is to study home care clients' freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. A structured postal survey was conducted among regular home care clients (n = 2096) aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients' subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations. As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services. Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients' opinions and to thereby improve the effectiveness of home care services.

The Association between Freedom of Choice and Effectiveness of Home Care Services

PubMed Central

Pulliainen, Marjo; Kettunen, Aija; Linnosmaa, Ismo; Halonen, Miikka

2016-01-01

Objectives: The aim of this paper is to study home care clients’ freedom to choose their services, as well the association between the effectiveness of home care services and freedom of choice, among other factors. Methods: A structured postal survey was conducted among regular home care clients (n = 2096) aged 65 or older in three towns in Finland. Freedom of choice was studied based on clients’ subjective experiences. The effectiveness of the services was evaluated by means of changes in the social-care-related quality of life. Regression analyses were used to test associations. Results: As much as 62% of home care recipients reported having some choice regarding their services. Choosing meals and visiting times for the care worker were associated with better effectiveness. The basic model, which included needs and other factors expected to have an impact on quality of life, explained 15.4% of the changes in quality of life, while the extended model, which included the freedom-of-choice variables, explained 17.4%. The inclusion of freedom-of-choice variables increased the adjusted coefficient of determination by 2%. There was a significant positive association between freedom of choice and the effectiveness of public home care services. Conclusion: Freedom of choice does not exist for all clients of home care who desire it. By changing social welfare activities and structures, it is possible to show respect for clients’ opinions and to thereby improve the effectiveness of home care services. PMID:27616949

For the betterment of the family care for the aged with dementia.

PubMed

Matsuda, N

2001-06-01

To investigate the feeling of burden and needs in care, a questionnaire was made which consists of "feeling of burden in care" (family Maslash Burnout Inventory for care or M.B.I. in short) and "family needs" (own making). It was mailed to ninety-nine caregiver of the family with the aged with dementia who cared them at home utilizing day-care service at a special nursing home for the aged, and attended family class once a month. 67 valid answers were obtained. The average age of caregiver was 57.0 years; seventy-six percent of them were female. Their difficulties were own health condition and lack of a cooperator for care. The main component analysis of family M.B.I. for care showed that fatigue was the main factor, indicating that it is very important to provide the families with mental support. Many caregivers thought that their care were useful and worthy; however score of "emotional exhaustion" were higher and score of "self attainment" were lower.

Valuable human capital: the aging health care worker.

PubMed

Collins, Sandra K; Collins, Kevin S

2006-01-01

With the workforce growing older and the supply of younger workers diminishing, it is critical for health care managers to understand the factors necessary to capitalize on their vintage employees. Retaining this segment of the workforce has a multitude of benefits including the preservation of valuable intellectual capital, which is necessary to ensure that health care organizations maintain their competitive advantage in the consumer-driven market. Retaining the aging employee is possible if health care managers learn the motivators and training differences associated with this category of the workforce. These employees should be considered a valuable resource of human capital because without their extensive expertise, intense loyalty and work ethic, and superior customer service skills, health care organizations could suffer severe economic repercussions in the near future.

Care provision expectations of remote adult children of ageing parents.

PubMed

Veil, Klaus D; Soar, Jeffrey; Su, Ying

2013-01-01

The expectations of adult children about their elderly parents regarding their care provision was surveyed. We found that the needs and expectations regarding their elderly parents included better information on entitlements of their parents, how to access relevant aged care services, the challenges of remotely dealing with dementia and depression of their parents, accessing medical and non-medical services and access to respite care. The aim was to identify needs that ICTs could potential to assist with. While the majority of respondents (67.2%) stated that they were satisfied or very satisfied with the frequency of contact with their elderly parent(s), they also cited logistical/transport difficulties, lack of time and stress as potential barriers in being in regular contact with their parents. The responses also indicated a high level of interest in a service that could act as a case manager to assist the adult child in discharging their responsibilities, manage access to services and to monitor the well-being of the parent. There is a need for further research to explore how this might be accomplished, whether such a service was viable and what funding models could be applied.

Contracting for intensive care services.

PubMed

Dorman, S

1996-01-01

Purchasers will increasingly expect clinical services in the NHS internal market to provide objective measures of their benefits and cost effectiveness in order to maintain or develop current funding levels. There is limited scientific evidence to demonstrate the clinical effectiveness of intensive care services in terms of mortality/morbidity. Intensive care is a high-cost service and studies of cost-effectiveness need to take account of case-mix variations, differences in admission and discharge policies, and other differences between units. Decisions over development or rationalisation of intensive care services should be based on proper outcome studies of well defined patient groups. The purchasing function itself requires development in order to support effective contracting.

[Association between preventive care provided in public dental services and caries prevalence].

PubMed

Celeste, Roger Keller; Nadanovsky, Paulo; De Leon, Antonio Ponce

2007-10-01

To assess the association between preventive care provided in public dental services and young people's oral health. Oral health data on 4,033 young people aged 15 to 19 years living in 85 municipalities of the state of Rio Grande do Sul, Southern Brazil, were obtained from the national oral health survey "Saúde Bucal Brasil 2003" for the period 2002-2003. The following variables were studied: age, gender, income, education, time elapsed since last dental visit, reason for dental visit, and water fluoridation. Data on dental care services were obtained from the national database of public health services. Statistical analysis was performed using multilevel logistic regression. Youngsters from the 21 municipalities with the lowest preventive care (scaling + fluoride + sealants) rates per 100 inhabitants were 2.27 (95% CI: 1.45;3.56) more likely to have non-filled dental cavities than those from the 21 municipalities with the highest care rates. After adjustment for a number of individual and contextual factors this likelihood decreased to 1.76 (95% CI: 1.13;2.72). The variance attributable to variables at municipal level was 14.1% for the empty model and decreased to 10.5% for the fully adjusted model. Rio Grande do Sul public dental services may have contributed for the reduction in the number of non-filled cavities in young people. However, it was not possible to detect the impact of this service on total dental caries experience.

Child Health Care Services in Austria.

PubMed

Kerbl, Reinhold; Ziniel, Georg; Winkler, Petra; Habl, Claudia; Püspök, Rudolf; Waldhauser, Franz

2016-10-01

We describe child health care in Austria, a small country in Central Europe with a population of about 9 million inhabitants of whom approximately 1.7 million are children and adolescents under the age of 20 years. For children and adolescents, few health care indicators are available. Pediatric and adolescent health provision, such as overall health provision, follows a complex system with responsibilities shared by the Ministry of Health, 19 social insurance funds, provinces, and other key players. Several institutions are affiliated with or cooperate with the Ministry of Health to assure quality control. The Austrian public health care system is financed through a combination of income-based social insurance payments and taxes. Pediatric primary health care in Austria involves the services of general pediatricians and general practitioners. Secondary care is mostly provided by the 43 children's hospitals; tertiary care is (particularly) provided in 4 state university hospitals and 1 private university hospital. The training program of residents takes 6 years and is completed by a final examination. Every year, this training program is completed by about 60 residents. Copyright © 2016 Elsevier Inc. All rights reserved.

Cost-Effectiveness of Orthogeriatric and Fracture Liaison Service Models of Care for Hip Fracture Patients: A Population-Based Study.

PubMed

Leal, Jose; Gray, Alastair M; Hawley, Samuel; Prieto-Alhambra, Daniel; Delmestri, Antonella; Arden, Nigel K; Cooper, Cyrus; Javaid, M Kassim; Judge, Andrew

2017-02-01

Fracture liaison services are recommended as a model of best practice for organizing patient care and secondary fracture prevention for hip fracture patients, although variation exists in how such services are structured. There is considerable uncertainty as to which model is most cost-effective and should therefore be mandated. This study evaluated the cost- effectiveness of orthogeriatric (OG)- and nurse-led fracture liaison service (FLS) models of post-hip fracture care compared with usual care. Analyses were conducted from a health care and personal social services payer perspective, using a Markov model to estimate the lifetime impact of the models of care. The base-case population consisted of men and women aged 83 years with a hip fracture. The risk and costs of hip and non-hip fractures were derived from large primary and hospital care data sets in the UK. Utilities were informed by a meta-regression of 32 studies. In the base-case analysis, the orthogeriatric-led service was the most effective and cost-effective model of care at a threshold of £30,000 per quality-adjusted life years gained (QALY). For women aged 83 years, the OG-led service was the most cost-effective at £22,709/QALY. If only health care costs are considered, OG-led service was cost-effective at £12,860/QALY and £14,525/QALY for women and men aged 83 years, respectively. Irrespective of how patients were stratified in terms of their age, sex, and Charlson comorbidity score at index hip fracture, our results suggest that introducing an orthogeriatrician-led or a nurse-led FLS is cost-effective when compared with usual care. Although considerable uncertainty remains concerning which of the models of care should be preferred, introducing an orthogeriatrician-led service seems to be the most cost-effective service to pursue. © 2016 American Society for Bone and Mineral Research. © 2016 American Society for Bone and Mineral Research.

Future trends in health and health care: implications for social work practice in an aging society.

PubMed

Spitzer, William J; Davidson, Kay W

2013-01-01

Major economic, political, demographic, social, and operational system factors are prompting evolutionary changes in health care delivery. Of particular significance, the "graying of America" promises new challenges and opportunities for health care social work. At the same time, the Patient Protection and Affordable Care Act of 2010, evolution of Accountable Care Organizations, and an emphasis on integrated, transdisciplinary, person-centered care represent fundamental shifts in service delivery with implications for social work practice and education. This article identifies the aging shift in American demography, its impact on health policy legislation, factors influencing fundamentally new service delivery paradigms, and opportunities of the profession to address the health disparities and care needs of an aging population. It underscores the importance of social work inclusion in integrated health care delivery and offers recommendations for practice education.

Confidentiality Concerns and Sexual and Reproductive Health Care Among Adolescents and Young Adults Aged 15-25.

PubMed

Copen, Casey E; Dittus, Patricia J; Leichliter, Jami S

2016-12-01

Data from the National Survey of Family Growth •About 7% of persons aged 15-25 would not seek sexual or reproductive health care because of concerns that their parents might find out about it. •For females aged 15-17 and 18-25, those who had confidentiality concerns were less likely to receive sexual and reproductive health services in the past year compared with those without these concerns. •Less than one-half of teenagers aged 15-17 (38.1%) spent some time alone in the past year during a visit with a doctor or other health care provider without a parent, relative, or guardian in the room. •Teenagers aged 15-17 who spent some time alone during a visit with a health care provider were more likely to have received sexual or reproductive health services in the past year compared with those who had not. Confidentiality concerns can impact adolescent and young adults' access to sexual and reproductive health services (1-4). Young people who are covered by their parents' private health insurance may be deterred from obtaining these services due to concerns that their parents might find out about it (2). Similarly, confidentiality concerns may arise because youth seeking such services may not have time alone during a visit with a health care provider (4). This report describes two measures related to confidentiality concerns and sexual and reproductive health care. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Factors promoting resident deaths at aged care facilities in Japan: a review.

PubMed

Sugimoto, Kentaro; Ogata, Yasuko; Kashiwagi, Masayo

2018-03-01

Due to an increasingly ageing population, the Japanese government has promoted elderly deaths in aged care facilities. However, existing facilities were not designed to provide resident end-of-life care and the proportion of aged care facility deaths is currently less than 10%. Consequently, the present review evaluated the factors that promote aged care facility resident deaths in Japan from individual- and facility-level perspectives to exploring factors associated with increased resident deaths. To achieve this, MEDLINE, CINAHL, Web of Science and Ichushi databases were searched on 23 January 2016. Influential factors were reviewed for two healthcare services (insourcing and outsourcing facilities) as well as external healthcare agencies operating outside facilities. Of the original 2324 studies retrieved, 42 were included in analysis. Of these studies, five focused on insourcing, two on outsourcing, seven on external agencies and observed facility/agency-level factors. The other 28 studies identified individual-level factors related to death in aged care facilities. The present review found that at both facility and individual levels, in-facility resident deaths were associated with healthcare service provision, confirmation of resident/family end-of-life care preference and staff education. Additionally, while outsourcing facilities did not require employment of physicians/nursing staff to accommodate resident death, these facilities required visits by physicians and nursing staff from external healthcare agencies as well as residents' healthcare input. This review also found few studies examining outsourcing facilities. The number of healthcare outsourcing facilities is rapidly increasing as a result of the Japanese government's new tax incentives. Consequently, there may be an increase in elderly deaths in outsourcing healthcare facilities. Accordingly, it is necessary to identify the factors associated with residents' deaths at outsourcing facilities. �

45 CFR 98.50 - Child care services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Child care services. 98.50 Section 98.50 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.50 Child care services. (a) Of the funds remaining after...

45 CFR 98.50 - Child care services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Child care services. 98.50 Section 98.50 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.50 Child care services. (a) Of the funds remaining after...

45 CFR 98.50 - Child care services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Child care services. 98.50 Section 98.50 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.50 Child care services. (a) Of the funds remaining after...

45 CFR 98.50 - Child care services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Child care services. 98.50 Section 98.50 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.50 Child care services. (a) Of the funds remaining after...

45 CFR 98.50 - Child care services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Child care services. 98.50 Section 98.50 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Use of Child Care and Development Funds § 98.50 Child care services. (a) Of the funds remaining after...

Financing Respite Care Services: An Initial Exploration.

ERIC Educational Resources Information Center

Ross, E. Clarke

1980-01-01

The report discusses financing respite care (short term care of the handicapped to provide family relief) services for the developmentally disabled (DD). Respite care is examined as a component of a comprehensive service delivery system for the DD, and the scope of respite care services as conceptualized by its advocates is reviewed. Nationally…

Nursing staff work patterns in a residential aged care home: a time-motion study.

PubMed

Qian, Siyu; Yu, Ping; Hailey, David

2016-11-01

Objective Residential aged care services are challenged by an increasing number of residents and a shortage of nursing staff. Developing strategies to overcome this challenge requires an understanding of nursing staff work patterns. The aim of the present study was to investigate the work processes followed by nursing staff and how nursing time is allocated in a residential aged care home. Methods An observational time-motion study was conducted at two aged care units for 12 morning shifts. Seven nurses were observed, one per shift. Results In all, there were 91h of observation. The results showed that there was a common work process followed by all nurse participants. Medication administration, documentation and verbal communication were the most time-consuming activities and were conducted most frequently. No significant difference between the two units was found in any category of activities. The average duration of most activities was less than 1min. There was no difference in time utilisation between the endorsed enrolled nurses and the personal carers in providing nursing care. Conclusion Medication administration, documentation and verbal communication were the major tasks in morning shifts in a residential aged care home. Future research can investigate how verbal communication supports nursing care. What is known about the topic? The aging population will substantially increase the demand for residential aged care services. There is a lack of research on nurses' work patterns in residential aged care homes. What does this paper add? The present study provides a comprehensive understanding of nurses' work patterns in a residential aged care home. There is a common work process followed by nurses in providing nursing care. Medication administration, verbal communication and documentation are the most time-consuming activities and they are frequently conducted in the same period of time. Wound care, physical review and documentation on desktop computers are

A 10-Year Cross-Sectional Analysis of Air Force Flight and Operational Medicine Clinic Health Care Services.

PubMed

Tvaryanas, Anthony P; Maupin, Genny M; Fouts, Brittany L

2016-05-01

This study described the patient population and the health care services delivered in the Air Force Flight and Operational Medicine Clinics (FOMCs) over the past 10 years. A cross-sectional analysis was performed on the retrospective cohort of patients who received care at a FOMC from 2003 to 2012. A total of 714,157 individuals, generating 4,829,626 encounters, were included in the cohort. They were predominately male service members under the age of 41. One-fifth of individuals were retirees and family members, with one-third being in the pediatric age range. The cohort accessed health care services for three primary reasons: health examinations (28%), occupational dispositions (18%), and primary care (54%). When primary care was sought, the predominate health conditions were upper respiratory infections, back problems, and nontraumatic joint disorders. When services and procedures were a component of the care, they were predominately associated with health examinations involving ophthalmologic, auditory, and cardiac screening tests. Individuals accessing the FOMCs had relatively low need for access to health care services, requiring a median of two annual encounters. This study provided insight into the health care delivered in FOMCs and establishes a foundation for future planning and management of FOMC health care delivery. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Service Users' Involvement and Engagement in Interprofessional Care.

PubMed

Kaini, B K

2016-01-01

Interprofessional care is joint working between health care professionals by pooling their skills, knowledge and expertise, to make joint decisions and learn from each other for the benefits of service users and healthcare professionals. Service users involvement is considered as one of the important aspects of planning, management and decision making process in the delivery of health care to service users. Service users' involvement is not the same as public involvement and partnership arrangements in health care. The active involvement and engagement of service users in health care positively contributes to improve quality of care, to promote better health and to shape the future of health services. Service users are always at the centre of health care professionals' values, work ethics and roles. Moreover, service users centred interprofessional team collaboration is very important to deliver effective health services.

Determinants of Utilization of Eye Care Services in a Rural Adult Population of a Developing Country

PubMed Central

Olusanya, Bolutife A.; Ashaye, Adeyinka O.; Owoaje, Eme T.; Baiyeroju, Aderonke M.; Ajayi, Benedictus G.

2016-01-01

Purpose: To describe the factors that determine the utilization of eye care services in a rural community in South-Western Nigeria. Methods: A descriptive cross-sectional survey using a multistage sampling technique was conducted. The main outcome measure was self-reported previous consultation of an orthodox medical facility for eye care. Results: The study sample included 643 participants. Only 122 (19%) respondents had previously visited orthodox facilities in search of eye care and 24% of those with presenting visual acuity <6/18 had sought eye care. Characteristics associated with previous utilization of eye care services were age of =70 years (odds ratio [OR] ≥ 1.7, P = 0.02); male gender (OR = 1.5, P = 0.04); literacy (OR = 1.7, P = 0.007); and residing close to an eye care facility (OR = 2.8, P < 0.001). Blind respondents were three times more likely to seek eye care (P < 0.001). Regression analysis revealed that factors associated with increased likelihood of utilization of eye care services included age ≥70 years; literacy; residence close to an eye facility; being diabetic or hypertensive; history of ocular symptoms, and blindness. Conclusions: These findings suggest that a significant proportion (75%) of adults in the study area are not utilizing eye care services and that blindness is an important determinant of utilization of eye care services. Health education and awareness campaigns about the importance and benefits of seeking eye care early, and the provision of community-based eye care programs are essential to boost the uptake of eye care services in this community as well as other rural areas of West Africa. PMID:26957847

Quantitative comparisons of urgent care service providers.

PubMed

Qin, Hong; Prybutok, Gayle L; Prybutok, Victor R; Wang, Bin

2015-01-01

The purpose of this paper is to develop, validate, and use a survey instrument to measure and compare the perceived quality of three types of US urgent care (UC) service providers: hospital emergency rooms, urgent care centres (UCC), and primary care physician offices. This study develops, validates, and uses a survey instrument to measure/compare differences in perceived service quality among three types of UC service providers. Six dimensions measured the components of service quality: tangibles, professionalism, interaction, accessibility, efficiency, and technical quality. Primary care physicians' offices scored higher for service quality and perceived value, followed by UCC. Hospital emergency rooms scored lower in both quality and perceived value. No significant difference was identified between UCC and primary care physicians across all the perspectives, except for interactions. The homogenous nature of the sample population (college students), and the fact that the respondents were recruited from a single university limits the generalizability of the findings. The patient's choice of a health care provider influences not only the continuity of the care that he or she receives, but compliance with a medical regime, and the evolution of the health care landscape. This work contributes to the understanding of how to provide cost effective and efficient UC services. This study developed and validated a survey instrument to measure/compare six dimensions of service quality for three types of UC service providers. The authors provide valuable data for UC service providers seeking to improve patient perceptions of service quality.

What has influenced patient health-care expenditures in Japan?: variables of age, death, length of stay, and medical care.

PubMed

Sato, Emi; Fushimi, Kiyohide

2009-07-01

This study considers variables related to health-care expenditures associated with aging and long-term hospitalization in Japan. We focused on daily per capita inpatient health-care expenditures, and examined the impact of inpatient characteristics such as sex, age, survived or deceased, length of stay, adult disease, and type of medical care received during the duration of each stay. We analyzed data from the Survey of Medical-Care Activities in Public Health Insurance by multinomial logistic regression analyses. Age of patient had little impact on per capita inpatient health-care expenditures per day. As regards length of stay, inpatient stays of 8-14 days had a little impact on health-care expenditures. This study suggested that these results might be due to the kind of medical care received. More research is needed to determine the appropriate medical services to reduce long-term hospitalization. In the last month of care for patients who died, medical examinations had a great influence on health-care expenditures. This study showed that increasing medical examinations in the end-of-life care needs further investigation.

Resource utilization and cost analyses of home-based palliative care service provision: the Niagara West End-of-Life Shared-Care Project.

PubMed

Klinger, Christopher A; Howell, Doris; Marshall, Denise; Zakus, David; Brazil, Kevin; Deber, Raisa B

2013-02-01

Increasing emphasis is being placed on the economics of health care service delivery - including home-based palliative care. This paper analyzes resource utilization and costs of a shared-care demonstration project in rural Ontario (Canada) from the public health care system's perspective. To provide enhanced end-of-life care, the shared-care approach ensured exchange of expertise and knowledge and coordination of services in line with the understood goals of care. Resource utilization and costs were tracked over the 15 month study period from January 2005 to March 2006. Of the 95 study participants (average age 71 years), 83 had a cancer diagnosis (87%); the non-cancer diagnoses (12 patients, 13%) included mainly advanced heart diseases and COPD. Community Care Access Centre and Enhanced Palliative Care Team-based homemaking and specialized nursing services were the most frequented offerings, followed by equipment/transportation services and palliative care consults for pain and symptom management. Total costs for all patient-related services (in 2007 $CAN) were $1,625,658.07 - or $17,112.19 per patient/$117.95 per patient day. While higher than expenditures previously reported for a cancer-only population in an urban Ontario setting, the costs were still within the parameters of the US Medicare Hospice Benefits, on a par with the per diem funding assigned for long-term care homes and lower than both average alternate level of care and hospital costs within the Province of Ontario. The study results may assist service planners in the appropriate allocation of resources and service packaging to meet the complex needs of palliative care populations.

Postnatal care utilization and associated factors among women of reproductive age Group in Halaba Kulito Town, Southern Ethiopia.

PubMed

Abuka Abebo, Teshome; Jember Tesfaye, Dawit

2018-01-01

Despite postnatal care services significant role in improving maternal and new-born health, services are underutilized in most developing countries including Ethiopia. Hence, it is important to identify factors that facilitate or impede postnatal care services utilization. The aim of this study was to assess postnatal care services utilization and associated factors among reproductive age women who gave live birth in 2015 at Halaba kulito town, Southern Ethiopia. A community-based cross-sectional study was conducted on 401 reproductive age women who gave live birth a year prior to the survey. Data were collected by using structured questionnaire. Bivariate and multivariable logistic regression analysis were carried out to identify factors associated with postnatal care services utilization. A significant association was declared when p -value is less than 0.05. The strength of association was determined by calculating odds ratio at 95% confidence interval. In this study, postnatal care services utilization by reproductive age women was 47.9%. Multivariable analysis revealed that government employed (AOR = 3.01, 95%CI = 1.36, 6.67), have three ANC visits (AOR = 4.29, 95% CI = 1.59, 11.55), have four ANC visits (AOR = 9.55, 95% CI = (3.46, 26.39), gave last birth at Health Centre (AOR = 10.76, 95% CI = 3.26, 35.57), gave last birth at Hospital (AOR = 13.15, 95% CI = (3.64, 47.50), didn't aware of at least one postpartum danger signs (AOR = 0.06, 95% CI = (0.01, 0.37), didn't know child care and had three ANC visits (AOR =0 .14, 95% CI (0.02, 0.8), and didn't know child care and had four or more ANC visits (AOR =0 .13, 95% CI (0.02, 0.79) were significantly associated with postnatal care services utilization. This study assessed PNC services utilization and associated factors among reproductive age women. The study results provided a basic understanding of factors that associated with PNC services utilization by

[Reembursing health-care service provider networks].

PubMed

Binder, A; Braun, G E

2015-03-01

Health-care service provider networks are regarded as an important instrument to overcome the widely criticised fragmentation and sectoral partition of the German health-care system. The first part of this paper incorporates health-care service provider networks in the field of health-care research. The system theoretical model and basic functions of health-care research are used for this purpose. Furthermore already established areas of health-care research with strong relations to health-care service provider networks are listed. The second part of this paper introduces some innovative options for reimbursing health-care service provider networks which can be regarded as some results of network-oriented health-care research. The origins are virtual budgets currently used in part to reimburse integrated care according to §§ 140a ff. SGB V. Describing and evaluating this model leads to real budgets (capitation) - a reimbursement scheme repeatedly demanded by SVR-Gesundheit (German governmental health-care advisory board), for example, however barely implemented. As a final step a direct reimbursement of networks by the German sickness fund is discussed. Advantages and challenges are shown. The development of the different reimbursement schemes is partially based on models from the USA. © Georg Thieme Verlag KG Stuttgart · New York.

Utilization of Routine Primary Care Services Among Dancers.

PubMed

Alimena, Stephanie; Air, Mary E; Gribbin, Caitlin; Manejias, Elizabeth

2016-01-01

This study examines the current utilization of primary and preventive health care services among dancers in order to assess their self-reported primary care needs. Participants were 37 dancers from a variety of dance backgrounds who presented for a free dancer health screening in a large US metropolitan area (30 females, 7 males; mean age: 27.5 ± 7.4 years; age range: 19 to 49 years; mean years of professional dancing: 6.4 ± 5.4 years). Dancers were screened for use of primary care, mental health, and women's health resources using the Health Screen for Professional Dancers developed by the Task Force on Dancer Health. Most dancers had health insurance (62.2%), but within the last 2 years, only approximately half of them (54.1%) reported having a physical examination by a physician. Within the last year, 54.1% of dancers had had a dental check-up, and 56.7% of female dancers received gynecologic care. Thirty percent of female participants indicated irregular menstrual cycles, 16.7% had never been to a gynecologist, and 16.7% were taking birth control. Utilization of calcium and vitamin D supplementation was 27.0% and 29.7%, respectively, and 73.0% were interested in nutritional counseling. A high rate of psychological fatigue and sleep deprivation was found (35.1%), along with a concomitant high rate of self-reported need for mental health counseling (29.7%). Cigarette and recreational drug use was low (5.4% and 5.4%); however, 32.4% engaged in binge drinking within the last year (based on the CDC definition). These findings indicate that dancers infrequently access primary care services, despite high self-reported need for nutritional, mental, and menstrual health counseling and treatment. More studies are warranted to understand dancers' primary health care seeking behavior.

Preferences for home- and community-based long-term care services in Germany: a discrete choice experiment.

PubMed

Lehnert, T; Günther, O H; Hajek, A; Riedel-Heller, S G; König, H H

2018-04-06

Most people prefer to "age in place" and to remain in their homes for as long as possible even in case they require long-term care. While informal care is projected to decrease in Germany, the use of home- and community-based services (HCBS) can be expected to increase in the future. Preference-based data on aspects of HCBS is needed to optimize person-centered care. To investigate preferences for home- and community-based long-term care services packages. Discrete choice experiment conducted in mailed survey. Randomly selected sample of the general population aged 45-64 years in Germany (n = 1.209). Preferences and marginal willingness to pay (WTP) for HCBS were assessed with respect to five HCBS attributes (with 2-4 levels): care time per day, service level of the HCBS provider, quality of care, number of different caregivers per month, co-payment. Quality of care was the most important attribute to respondents and small teams of regular caregivers (1-2) were preferred over larger teams. Yet, an extended range of services of the HCBS provider was not preferred over a more narrow range. WTP per hour of HCBS was €8.98. Our findings on preferences for HCBS in the general population in Germany add to the growing international evidence of preferences for LTC. In light of the great importance of high care quality to respondents, reimbursement for services by HCBS providers could be more strongly linked to the quality of services.

Market variations in intensity of Medicare service use and beneficiary experiences with care.

PubMed

Mittler, Jessica N; Landon, Bruce E; Fisher, Elliot S; Cleary, Paul D; Zaslavsky, Alan M

2010-06-01

Examine associations between patient experiences with care and service use across markets. Medicare fee-for-service (FFS) and managed care (Medicare Advantage [MA]) beneficiaries in 306 markets from the 2003 Consumer Assessments of Healthcare Providers and Systems (CAHPS) surveys. Resource use intensity is measured by the 2003 end-of-life expenditure index. We estimated correlations and linear regressions of eight measures of case-mix-adjusted beneficiary experiences with intensity of service use across markets. We merged CAHPS data with service use data, excluding beneficiaries under 65 years of age or receiving Medicaid. Overall, higher intensity use was associated (p<.05) with worse (seven measures) or no better care experiences (two measures). In higher-intensity markets, Medicare FFS and MA beneficiaries reported more problems getting care quickly and less helpful office staff. However, Medicare FFS beneficiaries in higher-intensity markets reported higher overall ratings of their personal physician and main specialist. Medicare MA beneficiaries in higher-intensity markets also reported worse quality of communication with physicians, ability to get needed care, and overall ratings of care. Medicare beneficiaries in markets characterized by high service use did not report better experiences with care. This trend was strongest for those in managed care.

A blueprint for community benefit. A CHA-AAHA (Catholic Health Association-American Association of Homes for the Aging) document helps long-term care providers plan for and implement needed services.

PubMed

Forschner, B; Trocchio, J

1993-05-01

A collaborative effort of the Catholic Health Association (CHA) and the American Association of Homes for the Aging, The Social Accountability Program: Continuing the Community Benefit Tradition of Not-for-Profit Homes and Services for the Aging helps long-term care organizations plan and report community benefit activities. The program takes long-term care providers through five sequential tasks: reaffirming commitment to the elderly and others in the community; developing a community service plan; developing and providing community services; reporting community services; and evaluating the community service role. To help organizations reaffirm commitment, the Social Accountability Program presents a process facilities can use to review their historical roots and purposes and evaluate whether current policies and procedures are consistent with the organizational philosophy. Once this step is completed, providers can develop a community service plan by identifying target populations and the services they need. For facilities developing and implementing such services, the program suggests ways of measuring and monitoring them for budgetary purposes. Once they have implemented services, not-for-profit healthcare organizations must account for their impact on the community. The Social Accountability Program lists elements to be included in community service reports. It also provides guidelines for evaluating these services' effectiveness and the organization's overall community benefit role.

Preferences for long-term care services: willingness to pay estimates derived from a discrete choice experiment.

PubMed

Nieboer, Anna P; Koolman, Xander; Stolk, Elly A

2010-05-01

Ageing populations increase pressure on long-term care. Optimal resource allocation requires an optimal mix of care services based on costs and benefits. Contrary to costs, benefits remain largely unknown. This study elicits preferences in the general elderly population for long-term care services for varying types of patients. A discrete choice experiment was conducted in a general population subsample aged 50-65 years (N = 1082) drawn from the Dutch Survey Sampling International panel. To ascertain relative preferences for long-term care and willingness to pay for these, participants were asked to choose the best of two care scenarios for four groups of hypothetical patients: frail and demented elderly, with and without partner. The scenarios described long-term care using ten attributes based on Social Production Function theory: hours of care, organized social activities, transportation, living situation, same person delivering care, room for individual preferences, coordination of services, punctuality, time on waiting list, and co-payments. We found the greatest value was attached to same person delivering care and transportation services. Low value was attached to punctuality and room for individual preferences. Nursing homes were generally considered to be detrimental for well-being except for dementia patients without a partner. Overall, long-term care services were thought to produce greatest well-being for the patients 'without a partner' and those 'with dementia'. Individuals combining these two risk factors would benefit the most from all services except transportation which was considered more important for the frail elderly. The results support the notion that long-term care services represent different value for different types of patients and that the value of a service depends upon the social context. Examination of patient profiles confirmed the notion that physical, mental and social vulnerability affect valuation of the services. Policy

What patients think about choice in healthcare? A study on primary care services in Finland.

PubMed

Aalto, Anna-Mari; Elovainio, Marko; Tynkkynen, Liina-Kaisa; Reissell, Eeva; Vehko, Tuulikki; Chydenius, Miisa; Sinervo, Timo

2018-06-01

The ongoing Finnish health and social service reform will expand choice by opening the market for competition between public and private service providers. This study examined the attitudes of primary care patients towards choice and which patient-related factors are associated with these attitudes. A sample of attenders during one week in health centres of 12 big cities and municipal consortiums (including seven outsourced local units) and in primary care units of one private company providing outsourced services for municipalities (aged 18-95, n=8128) was used. The questionnaire included questions on choice-related attitudes, sociodemographic factors, health status, use of health services and patient satisfaction. Of the responders, 77% regarded choice to be important, 49% perceived genuine opportunities to make choices and 35% were satisfied with the choice-relevant information. Higher age, low education, having a chronic illness, frequent use of services, having a personal physician and being satisfied with the physician and with waiting times were related to assigning more importance on choice. Younger patients, those with higher education as well as those with chronic illness regarded their opportunities of choosing the service provider and availability of choice-relevant information poorer. The Finnish primary care patients value choice, but they are critical of the availability of choice-relevant information. Choices of patients with complex health care needs should be supported by developing integrated care alternatives and by increasing the availability of information on existing care alternatives to meet their needs.

Receipt of Selected Preventive Health Services for Women and Men of Reproductive Age — United States, 2011–2013

PubMed Central

Robbins, Cheryl L.; Black, Lindsey I.; Ahrens, Katherine A.; Daniels, Kimberly; Chandra, Anjani; Vahratian, Anjel; Gavin, Lorrie E.

2017-01-01

Problem/Condition Receipt of key preventive health services among women and men of reproductive age (i.e., 15–44 years) can help them achieve their desired number and spacing of healthy children and improve their overall health. The 2014 publication Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs (QFP) establishes standards for providing a core set of preventive services to promote these goals. These services include contraceptive care for persons seeking to prevent or delay pregnancy, pregnancy testing and counseling, basic infertility services for those seeking to achieve pregnancy, sexually transmitted disease (STD) services, and other preconception care and related preventive health services. QFP describes how to provide these services and recommends using family planning and other primary care visits to screen for and offer the full range of these services. This report presents baseline estimates of the use of these preventive services before the publication of QFP that can be used to monitor progress toward improving the quality of preventive care received by women and men of reproductive age. Period Covered 2011–2013. Description of the System Three surveillance systems were used to document receipt of preventive health services among women and men of reproductive age as recommended in QFP. The National Survey of Family Growth (NSFG) collects data on factors that influence reproductive health in the United States since 1973, with a focus on fertility, sexual activity, contraceptive use, reproductive health care, family formation, child care, and related topics. NSFG uses a stratified, multistage probability sample to produce nationally representative estimates for the U.S. household population of women and men aged 15–44 years. This report uses data from the 2011–2013 NSFG. The Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing, state- and population-based surveillance system

Personal Care Services Utilization by Individuals with Developmental Disabilities

ERIC Educational Resources Information Center

Harrington, Charlene; Kang, Taewoon

2010-01-01

This study examined factors associated with the use of personal care services (PCS) and the amount of authorized hours in California in 2004-2005. Of those Medicaid-eligible individuals with developmental disabilities living at home, 31% received PCS. When we controlled for client need, gender, and age, individuals who were Asian/Pacific…

Use of hospital-based health care services among children aged 1 through 9 years who were born very preterm - a population-based study.

PubMed

Klitkou, Søren T; Iversen, Tor; Stensvold, Hans J; Rønnestad, Arild

2017-08-17

Very preterm (VPT) children, with a birth weight below 1500 g or delivered before 32 weeks of gestational age, are at increased risk of poorer long-term health outcomes and higher rates of hospitalization in childhood. However, considerable variation exists in the need for in-hospital care within this population. We assessed the utilization and distribution of hospital-based care from ages 1 through 9 years for a nationwide population. This was a population-based cohort of VPT children born in the period 2001-2009. We evaluated their utilization of hospital care in 2008-2010, when aged 1-9 years old. Outcomes were the incidence of hospital admissions and outpatient visits. We used Poisson regression models with multiple imputation of missing data. Children born VPT had more hospital admissions compared with the general population of children aged 1-9 years. The rates of hospital admissions and outpatient visits were strongly related to clinical characteristics of the child at birth and age at admission/outpatient visit but to only a variable and minor degree to characteristics pertaining to maternal health, the sociodemographic factors, and geographical proximity to hospital services. Prior to this study, hospital utilization during the period 5-9 years old has been poorly documented. We found that excess utilization of hospital resources on average declines with increasing age. We also noted substantial differences in the use of hospital care across age groups and clinical factors for VPT children. The added information from the health status of mothers, social background, and geographic measures of access was limited.

Health-enabling technologies for pervasive health care: on services and ICT architecture paradigms.

PubMed

Haux, Reinhold; Howe, Jurgen; Marschollek, Michael; Plischke, Maik; Wolf, Klaus-Hendrik

2008-06-01

Progress in information and communication technologies (ICT) is providing new opportunities for pervasive health care services in aging societies. To identify starting points of health-enabling technologies for pervasive health care. To describe typical services of and contemporary ICT architecture paradigms for pervasive health care. Summarizing outcomes of literature analyses and results from own research projects in this field. Basic functions for pervasive health care with respect to home care comprise emergency detection and alarm, disease management, as well as health status feedback and advice. These functions are complemented by optional (non-health care) functions. Four major paradigms for contemporary ICT architectures are person-centered ICT architectures, home-centered ICT architectures, telehealth service-centered ICT architectures and health care institution-centered ICT architectures. Health-enabling technologies may lead to both new ways of living and new ways of health care. Both ways are interwoven. This has to be considered for appropriate ICT architectures of sensor-enhanced health information systems. IMIA, the International Medical Informatics Association, may be an appropriate forum for interdisciplinary research exchange on health-enabling technologies for pervasive health care.

A health economic model for the development and evaluation of innovations in aged care: an application to consumer-directed care-study protocol.

PubMed

Ratcliffe, Julie; Lancsar, Emily; Luszcz, Mary; Crotty, Maria; Gray, Len; Paterson, Jan; Cameron, Ian D

2014-06-25

Consumer-directed care is currently being embraced within Australia and internationally as a means of promoting autonomy and choice in the delivery of health and aged care services. Despite its wide proliferation little research has been conducted to date to assess the views and preferences of older people for consumer-directed care or to assess the costs and benefits of such an approach relative to existing models of service delivery. A comprehensive health economic model will be developed and applied to the evolution, implementation and evaluation of consumer-directed care in an Australian community aged care setting. A mixed methods approach comprising qualitative interviews and a discrete choice experiment will determine the attitudes and preferences of older people and their informal carers for consumer-directed care. The results of the qualitative interviews and the discrete choice experiment will inform the introduction of a new consumer-directed care innovation in service delivery. The cost-effectiveness of consumer-directed care will be evaluated by comparing incremental changes in resource use, costs and health and quality of life outcomes relative to traditional services. The discrete choice experiment will be repeated at the end of the implementation period to determine the extent to which attitudes and preferences change as a consequence of experience of consumer-directed care. The proposed framework will have wide applicability in the future development and economic evaluation of new innovations across the health and aged care sectors. The study is approved by Flinders University Social and Behavioural Research Ethics Committee (Project No. 6114/SBREC). Findings from the qualitative interviews, discrete choice experiments and the economic evaluation will be reported at a workshop of stakeholders to be held in 2015 and will be documented in reports and in peer reviewed journal articles. Published by the BMJ Publishing Group Limited. For permission to

Home Health Care: Services and Cost

ERIC Educational Resources Information Center

Widmer, Geraldine; And Others

1978-01-01

Findings from a study of home care services in one New York district document the value and relatively modest costs of home health care for the chronically ill and dependent elderly. Professional nurses coordinated the care, but most of the direct services were provided by home health aides and housekeepers. (MF)

Sharing is caring: The potential of the sharing economy to support aging in place.

PubMed

Miller, Julie; Ward, Carley; Lee, Chaiwoo; D'Ambrosio, Lisa; Coughlin, Joseph

2018-01-24

This article explores innovative applications of sharing economy services that have the potential to support a population aging in place, especially the "oldest old," aged 85 and older, and their caregivers. A mixed-methods study conducted by the MIT AgeLab examined perceptions of and experiences with sharing economy services, ultimately finding opportunities and barriers to use. Thus, although sharing economy services have potential to support aging in place, to do so successfully will require reconstructing how older adults, family caregivers, aging service professionals, gerontology educators, and gerontology students conceptualize and deliver care to an aging population. We suggest examples for gerontology educators to integrate into their classrooms to further cultivate an appreciation among students of multiple approaches to intervention, including those that leverage sharing economy and technology-enabled platforms to support older adults and their caregivers.

Family functioning, health and social support assessed by aged home care clients and their family members.

PubMed

Hautsalo, Katja; Rantanen, Anja; Astedt-Kurki, Päivi

2013-10-01

The aim of this study was to describe aged home care clients' and their family members' experiences of their family functioning, family health and social support received. An additional purpose was to determine which factors are connected with social support. Increasing life expectancy and ageing of the population require consideration of the adequacy of home care services and the role of family members as care providers. The older population is a very heterogeneous group because of their variable needs and several disabilities. To ensure the quality of home care, experimental information is needed from clients and their family members. A survey design with convenience sampling. The home care client and a family member of his/her answered a questionnaire together, including background questions, the Family Functioning, Health and Social Support instrument and an open question about support received from home care. Statistical methods were used to describe quantitative data, and content analysis was used in analysing the replies to the open question. Family health was noted as good, and family functioning and overall social support fairly good. An older person's higher basic education, higher age of the family member, better family health and male gender were connected with better social support received. The relationship of the older person and the family member as well as the duration of home care service use had an effect on social support received. The content analysis raised expectations related to time, planning of service, organisational factors and caring practise. Home care clients' and families' needs for support vary, and therefore, the assessment of needs, care planning and updating are important. The variable support needs of older people and their family members require flexible and adaptable home services. Cooperation between all participants involved in care would promote the well-being of the older person and the entire family. © 2012 Blackwell

Empowering aged care nurses to deliver person-centred care: Enabling nurses to shine.

PubMed

Marriott-Statham, Kelly; Mackay, Maria; Brennan, Ngaire; Mackay, Jacinta

2018-05-23

In this paper, the authors will describe the journey of registered nurses across a series of workshops as part of a research project that was undertaken in a regional aged care service in New South Wales, Australia. The aim of the project was to empower the participant registered nurses to positively influence the health care workplace culture within the residential care home by raising consciousness about their own practice. Registered nurses were actively involved in this reconnaissance phase of a participatory action research project through practice development principles and methods. Registered nurses determined the content and the outcomes of the overall program. The researchers evaluated the impact of a series of workshops, designed to develop skills and knowledge using nominal group technique. Results revealed registered nurses perceived they were empowered to flourish, and developed an understanding of the uniqueness of their role. A shared understanding of the role of the registered nurse in the aged care setting was fundamental in enabling them to feel empowered to lead their team and contribute positively to the workplace culture. Overall, the outcomes of this project have positively impacted workplace culture. Copyright © 2018. Published by Elsevier Ltd.

Age inclusive services or separate old age and working age services? A historical analysis from the formative years of old age psychiatry c.1940-1989.

PubMed

Hilton, Claire

2015-04-01

The Equality Act 2010 made it unlawful to discriminate in the provision of services on the grounds of age. This legislation is open to interpretation, but it is affecting the way older people's services are defined and provided. Historical evidence indicates that, since the 1940s, apart from psychiatrists working in dedicated old age services, most were unenthusiastic about working with mentally unwell older people and unsupportive of those who chose to do so. A historical analysis might shed light on current dilemmas about 'all age' or 'old age' services and inform decision-making on future mental health services.

Integrating nutrition services into primary care

PubMed Central

Crustolo, Anne Marie; Kates, Nick; Ackerman, Sari; Schamehorn, Sherri

2005-01-01

PROBLEM BEING ADDRESSED Nutrition services can have an important role in prevention and management of many conditions seen by family physicians, but access to these services in primary care is limited. OBJECTIVE OF PROGRAM To integrate specialized nutrition services into the offices of family physicians in Hamilton, Ont, in order to improve patient access to those services, to expand the range of problems seen in primary care, and to increase collaboration between family physicians and registered dietitians. PROGRAM DESCRIPTION Registered dietitians were integrated into the offices of 80 family physicians. In collaboration with physicians, they assessed, treated, and consulted on a variety of nutrition-related problems. A central management team coordinated the dietitians’ activities. CONCLUSION Registered dietitians can augment and complement family physicians’ activities in preventing, assessing, and treating nutrition-related problems. This model of shared care can be applied to integrating other specialized services into primary care practices. PMID:16805083

Utilization of hospital services for cancer care in Mexico.

PubMed

Hernández-Ávila, Juan Eugenio; Palacio-Mejía, Lina Sofía; González-González, Leonel; Morales-Carmona, Evangelina; Espín-Arellano, Lucino Iván; Fernández-Niño, Julián Alfredo; Mohar-Betancourt, Alejandro; Hernández-Ávila, Mauricio

2016-04-01

To analyze the utilization of hospital services for cancer care by location, sex, age group and care institution in Mexico from 2004-2013. Time series study from 2004-2013, based on administrative records of hospital discharges for cancer in the health sector, including the private sector. The utilization rate increased significantly from 290 to 360 per 100 000 inhabitants. A total of 62% of hospital discharges related to malignant tumors were concentrated in eight types of cancer. Leukemia, breast and colorectal cancers almost doubled in the period. While lung cancer showed a decline among men, it increased among women. A total of 63.1% of cancer patients were women, and 81% of cases occurred in the public sector. From 2011, the Ministry of Health was the main provider of hospital services for cancer care. Increases in utilization were mainly found in the Ministry of Health, quite possibly as a result of the implementation of universal insurance.

WORKING MOTHERS AND THE NEED FOR CHILD CARE SERVICES.

ERIC Educational Resources Information Center

Women's Bureau (DOL), Washington, DC.

DATA AND CHARTS DOCUMENT THE RISING NUMBER OF WORKING MOTHERS IN THE UNITED STATES TODAY AND THE INCREASING NEED FOR CHILD CARE SERVICES. DATA WERE OBTAINED FROM U.S. DEPARTMENTS OF LABOR, COMMERCE, AND HEALTH, EDUCATION, AND WELFARE. NEARLY 10 MILLION MOTHERS WITH CHILDREN UNDER 18 YEARS OF AGE WERE WORKERS IN MARCH 1966. MORE THAN ONE OF THREE…

42 CFR 440.167 - Personal care services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Personal care services. 440.167 Section 440.167 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.167 Personal care services. Unless defined differently by a State...

42 CFR 440.167 - Personal care services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Personal care services. 440.167 Section 440.167 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.167 Personal care services. Unless defined differently by a State...

42 CFR 440.167 - Personal care services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 4 2012-10-01 2012-10-01 false Personal care services. 440.167 Section 440.167 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.167 Personal care services. Unless defined differently by a State...

42 CFR 440.167 - Personal care services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Personal care services. 440.167 Section 440.167 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.167 Personal care services. Unless defined differently by a State...

42 CFR 440.167 - Personal care services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Personal care services. 440.167 Section 440.167 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: GENERAL PROVISIONS Definitions § 440.167 Personal care services. Unless defined differently by a State...

Satisfaction with general practitioner treatment of depression among residents of aged care facilities.

PubMed

Mellor, David; Davison, Tanya; McCabe, Marita; Kuruvilla, George; Moore, Kathleen; Ski, Chantal

2006-06-01

This article investigates consumer perspectives on the treatment for depression among older people in residential facilities. Aged care residents who were aware of being treated for depression in the past 6 months (24 women and 7 men, mean age = 83 years) participated in an interview that assessed their perspective on treatments. Although more than half of the participants in the sample reported overall satisfaction with the medical treatments received for depression, qualitative data provided indications of unsatisfactory service delivery, including perceptions of low treatment efficacy, short consultation times, the failure to assess affective symptomatology, and negative responses to residents' disclosure of symptoms. The findings are discussed in relation to previous research on consumer satisfaction with health services and issues that may be pertinent to the elderly depressed. Training for general practitioners providing treatment in aged care is indicated.

Experiencing health care service quality: through patients' eyes.

PubMed

Schembri, Sharon

2015-02-01

The primary aim of the present study was to consider health care service quality from the patients' perspective, specifically through the patient's eyes. A narrative analysis was performed on 300 patient stories. This rigorous analysis of patient stories is designed to identify and describe health care service quality through patients' eyes in an authentic and accurate, experiential manner. The findings show that there are variant and complex ways that patients experience health care service quality. Patient stories offer an authentic view of the complex ways that patients experience health care service quality. Narrative analysis is a useful tool to identify and describe how patients experience health care service quality. Patients experience health care service quality in complex and varying ways.

General practice and residential aged care: A qualitative study of barriers to access to care and the role of remuneration.

PubMed

Burgess, Stephen; Davis, Jenny; Morgans, Amee

2015-01-01

More than 169,000 people live in residential aged care facilities (RACFs). As people age they use health services, particularly general practitioner (GP) services, more frequently but many GPs do not attend patients in RACFs. To examine GPs' perceptions of barriers to providing care to patients in RACFs. This study was conducted in June 2014 in the Bayside Medicare Local (BML) region in Victoria, Australia; all participants were drawn from this region. Two focus groups (FGs) were conducted. One was for GPs (n=5) that have a specific interest in practicing in RACFs, the other with RACF staff (n=8) representing public, private, and not-for-profit aged care providers. Results were presented to the Royal Australian College of General Practitioners (RACGP) National Standing Committee for General Practice Advocacy and Support for feedback and validation of the findings against national perspectives of the effect of remuneration on the provision of GP services in RACFs. Remuneration problems are a barrier to the provision of GP services to patients in RACFs. These problems can be grouped into: direct remuneration, opportunity cost, additional administrative burden, and unremunerated work. GPs' perceptions of the effects of these problems on willingness to practice in RACFs are described. Innovative models of remuneration for GPs attending RACFs are needed to ameliorate the problems identified. Such models need to capture and pay for activities that are time consuming but often unremunerated.

Preventive dental health care experiences of preschool-age children with special health care needs.

PubMed

Huebner, Colleen E; Chi, Donald L; Masterson, Erin; Milgrom, Peter

2015-01-01

This study examined the preventive dental health care experiences of young children with special needs and determined the feasibility of conducting clinical dental examinations at a community-based early intervention services center. Study methods included 90 parent interviews and dental examinations of their preschool-age children. Thirteen percent of the children received optimal preventive care, defined as twice daily tooth brushing with fluoridated toothpaste and two preventive dental visits in the prior 12 months; 37% experienced care that fell short in both areas. Optimal care was more common among children of parents who reported tooth brushing was not a struggle and those with a personal dentist. Parents' opinion of the study experience was generally positive. Few children with special needs receive effective preventive care early, when primary prevention could be achieved. Barriers to optimal care could be readily addressed by the dental community in coordination with early intervention providers. © 2014 Special Care Dentistry Association and Wiley Periodicals, Inc.

42 CFR 440.168 - Primary care case management services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Primary care case management services. 440.168... care case management services. (a) Primary care case management services means case management related services that— (1) Include location, coordination, and monitoring of primary health care services; and (2...

42 CFR 440.168 - Primary care case management services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... care case management services. (a) Primary care case management services means case management related services that— (1) Include location, coordination, and monitoring of primary health care services; and (2... 42 Public Health 4 2014-10-01 2014-10-01 false Primary care case management services. 440.168...

42 CFR 440.168 - Primary care case management services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... care case management services. (a) Primary care case management services means case management related services that— (1) Include location, coordination, and monitoring of primary health care services; and (2... 42 Public Health 4 2011-10-01 2011-10-01 false Primary care case management services. 440.168...

42 CFR 440.168 - Primary care case management services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... care case management services. (a) Primary care case management services means case management related services that— (1) Include location, coordination, and monitoring of primary health care services; and (2... 42 Public Health 4 2012-10-01 2012-10-01 false Primary care case management services. 440.168...

42 CFR 440.168 - Primary care case management services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... care case management services. (a) Primary care case management services means case management related services that— (1) Include location, coordination, and monitoring of primary health care services; and (2... 42 Public Health 4 2013-10-01 2013-10-01 false Primary care case management services. 440.168...

Improving care planning and coordination for service users with medical co-morbidity transitioning between tertiary medical and primary care services.

PubMed

Cranwell, K; Polacsek, M; McCann, T V

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: Mental health service users with medical co-morbidity frequently experience difficulties accessing and receiving appropriate treatment in emergency departments. Service users frequently experience fragmented care planning and coordinating between tertiary medical and primary care services. Little is known about mental health nurses' perspectives about how to address these problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Emergency department clinicians' poor communication and negative attitudes have adverse effects on service users and the quality of care they receive. The findings contribute to the international evidence about mental health nurses' perspectives of service users feeling confused and frustrated in this situation, and improving coordination and continuity of care, facilitating transitions and increasing family and caregiver participation. Intervention studies are needed to evaluate if adoption of these measures leads to sustainable improvements in care planning and coordination, and how service users with medical co-morbidity are treated in emergency departments in particular. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Effective planning and coordination of care are essential to enable smooth transitions between tertiary medical (emergency departments in particular) and primary care services for service users with medical co-morbidity. Ongoing professional development education and support is needed for emergency department clinicians. There is also a need to develop an organized and systemic approach to improving service users' experience in emergency departments. Introduction Mental health service users with medical co-morbidity frequently experience difficulties accessing appropriate treatment in medical hospitals, and often there is poor collaboration within and between services. Little is known about mental health nurses' perspectives on how to address these problems. Aim To explore mental health nurses

Implementation of a Preventive Services Bundle in Academic Pediatric Primary Care Centers.

PubMed

Samaan, Zeina Marcho; Brown, Courtney M; Morehous, John; Perkins, Alison A; Kahn, Robert S; Mansour, Mona E

2016-03-01

Previous studies have documented poor rates of delivery of preventive services, 1 of the core services provided in the primary care medical home setting. We aimed to increase the reliability of delivering a bundle of preventive services to patients 0 to 14 months of age from 58% of patient visits to 95% of visits. The bundle includes administration of routine vaccinations, offering influenza vaccination, completed lead screening, completed developmental screening tool, screening for maternal depression and food insecurity, and documentation of gestational age. The setting was 3 academic pediatric primary care clinics that serve 31,000 patients (>90% Medicaid). Quality improvement methodology was used and key driver diagram was determined. Patient "Ideal Visit Flow" and the Responsible, Accountable, Support, Consulted, and Informed Matrix were developed to drive accountability for components of the ideal flow. Plan, Do, Study, Act cycles were used to develop successful interventions. The percent of patients seen who received all bundle elements for which they were eligible was plotted weekly on a run chart, and statistical process control methods were used to determine a significant change in performance. The preintervention percentage of patient visits ages 0 to 14 months receiving all preventive service bundle elements was 58%. The postintervention percentage is 92%. Innovative redesign led to improvement in percentage of patients age 0 to 14 months who received the entire preventive services bundle. Key elements for success were multidisciplinary site-specific teams, redesigned visit flow, effective communication, and resources for data and project management. Copyright © 2016 by the American Academy of Pediatrics.

[Care pathway of children managed by the Bouches-du-Rhone Child Welfare Services].

PubMed

Martin, Anaïs; Jego-Sablier, Maeva; Prudhomme, Johanne; Champsaur, Laurence

2017-12-05

To describe the care pathway of children managed by the Bouches-du-Rhône Child Welfare Services and to propose ways to improve this care pathway. ESSPER-ASE 13 survey is a descriptive and cross-sectional survey carried out between April 2013 and April 2014, which included 1,092 children under the age of 18 years placed in a Bouches-du-Rhône Child Welfare Services children's home or foster care. This survey studied the physical and mental health and the medical follow-up characteristics of these children. This article focuses on care pathway data. 82% of children were followed by general practitioners, while 15% of children, essentially children under the age of 6 years in child care, were followed by Maternal and Infant Protection (Protection Maternelle et Infantile). The care pathway of these children involved multiple actors and was dominated by psychological follow-up. On average, the children were followed by 2 professionals (specialist or paramedical professional) in addition to the medical examiner. In terms of prevention, children's immunization coverage rates were better than national rates. Coordination of the numerous actors is essential, including the creation of a referring physician.

Service learning at dementia care programs: an orientation and training program.

PubMed

Lambert-Shute, Jennifer J; Jarrott, Shannon E; Fruhauf, Christine A

2004-01-01

The present paper describes a project that addresses the unique challenge service-learners face at dementia care programs. The project was conducted in conjunction with two courses on aging that offer students a service-learning (S-L) option at a university adult day service (ADS) program that accepts service-learners from these courses. The intervention consisted of two elements: (a) an orientation and follow- up sessions in which students learned about the causes of dementia, the behavioral characteristics exhibited by persons with dementia, and the best methods of interacting effectively with cognitively impaired persons; and (b) a structured scrapbook project for service-learners to exercise their new knowledge and skills. The authors designed the project to increase students' comfort in the dementia care setting and to facilitate students' knowledge of the elderly. The following sections describe the project and its procedures, benefits, and challenges. Recommendations for continuing the project and for adapting the project to other dementia sites are provided.

Integrated approach to oral health in aged care facilities using oral health practitioners and teledentistry in rural Queensland.

PubMed

Tynan, Anna; Deeth, Lisa; McKenzie, Debra; Bourke, Carolyn; Stenhouse, Shayne; Pitt, Jacinta; Linneman, Helen

2018-04-16

Residents of residential aged care facilities are at very high risk of developing complex oral diseases and dental problems. Key barriers exist in delivering oral health services to residential aged care facilities, particularly in regional and rural areas. A quality improvement study incorporating pre- and post chart audits and pre- and post consultation with key stakeholders, including staff and residents, expert opinion on cost estimates and field notes were used. One regional and three rural residential aged care facilities situated in a non-metropolitan hospital and health service in Queensland. Number of appointments avoided at an oral health facility Feedback on program experience by staff and residents Compliance with oral health care plan implementation Observations of costs involved to deliver new service. The model developed incorporated a visit by an oral health therapist for screening, education, simple intervention and referral for a teledentistry session if required. Results showed an improvement in implementation of oral health care plans and a minimisation of need for residents to attend an oral health care facility. Potential financial and social cost savings for residents and the facilities were also noted. Screening via the oral health therapist and teledentistry appointment minimises the need for a visit to an oral health facility and subsequent disruption to residents in residential aged care facilities. © 2018 National Rural Health Alliance Ltd.

Care pathways as boundary objects between primary and secondary care: Experiences from Norwegian home care services.

PubMed

Håland, Erna; Røsstad, Tove; Osmundsen, Tonje C

2015-11-01

The need for integration of healthcare services and collaboration across organisational boundaries is highlighted as a major challenge within healthcare in many countries. Care pathways are often presented as a solution to this challenge. In this article, we study a project of developing, introducing and using a care pathway across healthcare levels focusing on older home-dwelling patients in need of home care services after hospital discharge. In so doing, we use the concept of boundary object, as described by Star and Griesemer, to explore how care pathways can act as tools for translation between specialist healthcare services and home care services. Based on interviews with participants in the project, we find that response to existing needs, local tailoring, involvement and commitment are all crucial for the care pathway to function as a boundary object in this setting. Furthermore, the care pathway, as we argue, can be used to push boundaries just as much as it can be used as a tool for bridging across them, thus potentially contributing to a more equal relationship between specialist healthcare services and home care services. © The Author(s) 2015.

Child Care Data and Services.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Finance.

A publication releasing the most important current statistics, reports, statutory language, and regulations on child care is presented. Data are presented under the following general topics: (1) Child Care Services and Working Mothers, (2) Child Care Arrangements of Working Mothers Today, (3) Federal Assistance for Child Care, (4) How Much Does…

Factors associated with linkage to HIV care and TB treatment at community-based HIV testing services in Cape Town, South Africa.

PubMed

Meehan, Sue-Ann; Sloot, Rosa; Draper, Heather R; Naidoo, Pren; Burger, Ronelle; Beyers, Nulda

2018-01-01

Diagnosing HIV and/or TB is not sufficient; linkage to care and treatment is conditional to reduce the burden of disease. This study aimed to determine factors associated with linkage to HIV care and TB treatment at community-based services in Cape Town, South Africa. This retrospective cohort study utilized routinely collected data from clients who utilized stand-alone (fixed site not attached to a health facility) and mobile HIV testing services in eight communities in the City of Cape Town Metropolitan district, between January 2008 and June 2012. Clients were included in the analysis if they were ≥12 years and had a known HIV status. Generalized estimating equations (GEE) logistic regression models were used to assess the association between determinants (sex, age, HIV testing service and co-infection status) and self-reported linkage to HIV care and/or TB treatment. Linkage to HIV care was 3 738/5 929 (63.1%). Linkage to HIV care was associated with the type of HIV testing service. Clients diagnosed with HIV at mobile services had a significantly reduced odds of linking to HIV care (aOR 0.7 (CI 95%: 0.6-0.8), p<0.001. Linkage to TB treatment was 210/275 (76.4%). Linkage to TB treatment was not associated with sex and service type, but was associated with age. Clients in older age groups were less likely to link to TB treatment compared to clients in the age group 12-24 years (all, p-value<0.05). A large proportion of clients diagnosed with HIV at mobile services did not link to care. Almost a quarter of clients diagnosed with TB did not link to treatment. Integrated community-based HIV and TB testing services are efficient in diagnosing HIV and TB, but strategies to improve linkage to care are required to control these epidemics.

Racial/Ethnic Differences in Use of Health Care Services for Diabetes Management.

PubMed

Chandler, Raeven Faye; Monnat, Shannon M

2015-12-01

Research demonstrates consistent racial/ethnic disparities in access to and use of health care services for a variety of chronic conditions. Yet we know little about whether these disparities exist for use of health care services for diabetes management. Racial/ethnic minorities disproportionately suffer from diabetes, complications from diabetes, and diabetes-related mortality. Proper diabetes management can reduce the risk of complications and premature mortality. Using a large national data set (N = 37,705) of White, Black, Hispanic, Asian, and Native American U.S. adults aged 65 years and older who have been diagnosed with diabetes, we examine three specific types of health care provider (HCP) use for diabetes management: number of times seen by a health care professional for diabetes, number of times feet have been checked by a health care professional, and number of visits for a glycosylated hemoglobin check. We found that net of controls for a variety of demographic and socioeconomic characteristics, Blacks and Hispanics had significantly more visits to a HCP for their diabetes and significantly more glycosylated hemoglobin checks than Whites, and Blacks and Native Americans had significantly more HCP feet checks than Whites. Our results suggest that the reduced access to health care services traditionally found among racial/ethnic minorities does not hold for access to health care services for diabetes management, where racial/ethnic minority diabetics are actually more likely to use care than are White diabetics. Future research should examine whether higher use of health care services for diabetes among racial/ethnic minorities is due to greater disease severity among racial/ethnic minorities than among non-Hispanic Whites. © 2015 Society for Public Health Education.

Main characteristics of patients of primary health care services in Brazil

PubMed Central

Guibu, Ione Aquemi; de Moraes, José Cássio; Guerra, Augusto Afonso; Costa, Ediná Alves; Acurcio, Francisco de Assis; Costa, Karen Sarmento; Karnikowski, Margô Gomes de Oliveira; Soeiro, Orlando Mario; Leite, Silvana Nair; Álvares, Juliana

2017-01-01

ABSTRACT OBJECTIVE To characterize patients of primary health care services according to demographic and socioeconomic aspects, habits and lifestyle, health condition, and demand for health services and medicines. METHODS This study is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services), a cross-sectional study carried out between 2014 and 2015. Interviews were conducted with patients over the age of 17 years, with a standardized questionnaire, in primary health care services of a representative sample of cities, stratified by regions of Brazil. The analysis was performed for complex samples and weighted according to the population size of each region. RESULTS A total of 8,676 patients were interviewed, being 75.8% women, most of them aged from 18 to 39 years; 24.2% men, most of them aged from 40 to 59 years; 53.7% with elementary school; 50.5% reported to be of mixed race ethnicity, 39.7%, white, and 7.8%, black. Half of patients were classified as class C and 24.8% received the Bolsa Familia benefit. Only 9.8% had health insurance, with higher proportion in the South and lower in the North and Midwest. The proportion of men who consumed alcohol was higher than among women, as well as smokers. The self-assessment of health showed that 57% believed it to be very good or good, with lower proportion in the Northeast. The prevalence of chronic diseases/conditions, such as hypertension (38.6%), dyslipidemia (22.7%), arthritis/rheumatism (19.4%), depression (18.5%), diabetes (13.6%), and others are higher in these patients them among the general population. Medicines were predominantly sought in the health care service or in pharmacies of the Brazilian Unified Health System. CONCLUSIONS It was possible to characterize the profile of patients of Primary Health Care, but the originality of the research and its

Preventive dental health care experiences of preschool-age children with special health care needs

PubMed Central

Huebner, Colleen E.; Chi, Donald L.; Masterson, Erin; Milgrom, Peter

2014-01-01

Purpose This study examined the preventive dental health care experiences of young children with special needs and determined the feasibility of conducting clinical dental examinations at a community-based early intervention services center. Methods Study methods included 90 parent interviews and dental examinations of their preschool-age children. Results Thirteen percent of the children received optimal preventive care, defined as twice daily tooth brushing with fluoridated toothpaste and two preventive dental visits in the prior 12 months; 37 percent experienced care that fell short in both areas. Optimal care was more common among children of parents who reported tooth brushing was not a struggle and those with a personal dentist. Parents' opinion of the study experience was generally positive. Conclusions Few children with special needs receive effective preventive care early, when primary prevention could be achieved. Barriers to optimal care could be readily addressed by the dental community in coordination with early intervention providers. PMID:25082666

Designing Fit for Purpose Health and Social Services for Ageing Populations.

PubMed

Woo, Jean

2017-04-25

Population ageing is occurring in all countries, regardless of the level of economic development. While the rising burden of chronic diseases and disabilities as a consequence of this demographic transition is well recognized, the increasing prevalence of geriatric syndromes as a public health issue is not as well recognized. Recently the World Health Organization's World Health and Ageing Report emphasized functional ability as an important outcome for aging populations, highlighting the concept of raising intrinsic capacity throughout the life course. The complementary perspective is the prevention of frailty, which has physical, cognitive, social and psychological dimensions. Therefore, services for older people should encompass medical as well as social components. The need and evolution for a transition in health and social services in Hong Kong, a special administrative region of China which has a population with the world's highest life expectancy, is presented as an example of how one developed economy attempts to meet the challenges of population ageing. There is a need to shift to integrated care in the community instead of specialty dominated hospital care, and to establish regular activities in the community to adopt and maintain a lifestyle that reduces frailty and disability (or promotes intrinsic capacity). A top down approach with financial incentives, together with public education to help drive policy changes, are key drivers of change. It is expected that there will be much heterogeneity between different countries in terms of barriers and facilitators, such that each country needs to document their needs and design appropriate services.

Designing Fit for Purpose Health and Social Services for Ageing Populations

PubMed Central

Woo, Jean

2017-01-01

Population ageing is occurring in all countries, regardless of the level of economic development. While the rising burden of chronic diseases and disabilities as a consequence of this demographic transition is well recognized, the increasing prevalence of geriatric syndromes as a public health issue is not as well recognized. Recently the World Health Organization’s World Health and Ageing Report emphasized functional ability as an important outcome for aging populations, highlighting the concept of raising intrinsic capacity throughout the life course. The complementary perspective is the prevention of frailty, which has physical, cognitive, social and psychological dimensions. Therefore, services for older people should encompass medical as well as social components. The need and evolution for a transition in health and social services in Hong Kong, a special administrative region of China which has a population with the world’s highest life expectancy, is presented as an example of how one developed economy attempts to meet the challenges of population ageing. There is a need to shift to integrated care in the community instead of specialty dominated hospital care, and to establish regular activities in the community to adopt and maintain a lifestyle that reduces frailty and disability (or promotes intrinsic capacity). A top down approach with financial incentives, together with public education to help drive policy changes, are key drivers of change. It is expected that there will be much heterogeneity between different countries in terms of barriers and facilitators, such that each country needs to document their needs and design appropriate services. PMID:28441324

The paradox of the Aged Care Act 1997: the marginalisation of nursing discourse.

PubMed

Angus, Jocelyn; Nay, Rhonda

2003-06-01

This paper examines the marginalisation of nursing discourse, which followed the enactment of the Aged Care Act 1997. This neo-reform period in aged care, dominated by theories of economic rationalism, enshrined legislation based upon market principles and by implication, the provision of care at the cheapest possible price. This paper exposes some of the gaps in the neo-reform period and challenges the assertion that the amalgamation of nursing homes and hostels in such an environment can provide better quality of care and life for residents. It argues that this amalgamation entails a transformation towards a social model of care and fails to address the professional healthcare needs of the acutely sick and complex extreme old person and makes evident new gaps in the provision of aged care services. The paper proceeds to present strategies where the future for nursing practice in aged care necessarily involves a judicious balancing of individual cases alongside economic prescriptions of care and ever-changing public policy initiatives. It concludes that this can be achieved through a more interactive public, professional and advocacy discourse. The methodology involves extensive analysis of public documents including media, academic journals, government reports and interviews with recognised leaders in the field of aged care. The study utilises a critical interpretative framework consistent with the logic of Michel Foucault.

The aging population: imperative to uncouple sex and gender to establish "gender equal" health care.

PubMed

Bachmann, Gloria A; Mussman, Brianna

2015-04-01

The transgender community has long been marginalized in society. As the world's population ages, gender-unbiased health services for this growing population, with age-related chronic illnesses, will be essential. To optimally eliminate hurdles that trans individuals often confront when requesting services, it appears judicious to eliminate the strict and antiquated definition of what constitutes "normal" female and "normal" male. A review of literature on transgender medicine on PubMed over the last five years was conducted. Existing statistics indicate that unacceptable bias and discrimination are occurring, making trans patients less likely to seek care. There are emerging initiatives that address the transgender and gender non-conforming population. Ongoing needs include defining what constitutes "gender equal," understanding the continuum of gender identity, and establishing and implementing guidelines for gender equal counseling and care. With the routine practice of defining sex at birth and equating sex with gender in the health care setting, the transgender patient encounters multiple barriers to accessing and acquiring health care services. These strict gender labels appear to preclude the institution of gender equal care. Care templates on gender equal patient encounters should be implemented to better address transgender health needs in a non-biased manner. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The Use of Data Analytics to Build an Australian Context-Sensitive Health Informatics Framework for Consumer-Directed Community Aged Care.

PubMed

Georgiou, Andrew; Jorgensen, Mikaela; Siette, Joyce; Westbrook, Johanna I

2017-01-01

The challenge of providing services that meet the growing needs of an ageing population is one confronted by communities across Australia and internationally. The aim of this study was to: a) undertake semi-structured interviews and focus groups across a sample of service and technical staff to identify the interconnection between communication, information, work practices and performance; and b) carry out a comprehensive review of existing data sources to identify the data linkages required to identify and monitor performance across different dimensions of the quality of aged care spectrum. The results from this study provided empirical evidence of the interconnection between communication, information, work practices and performance; and highlighted numerous potential data linkages which can be used to monitor performance across different dimensions of aged care. These included: the uptake and utilisation of community care services, community aged care client interactions and transitions (with hospitals and other health care providers), and quality of life measures (e.g., health and safety status, symptoms of depression and anxiety, social integration and mortality rates).

Projected Use of Long-Term-Care Services by Enrolled Veterans

ERIC Educational Resources Information Center

Kinosian, Bruce; Stallard, Eric; Wieland, Darryl

2007-01-01

Purpose: The purpose of this article is to describe the projected use for long-term-care services through 2012. Design and Methods: We constructed a static-component projection model using age, function, and other covariates. We obtained enrollee projections from the Veterans Health Administration (VHA) and combined these with nursing home and…

Personal care workers in Australian aged care: retention and turnover intentions.

PubMed

Radford, Katrina; Shacklock, Kate; Bradley, Graham

2015-07-01

This study examined factors influencing personal care workers' intentions to stay or leave Australian aged care employment - especially for older workers. Retention of personal care workers is particularly important in aged care as they provide the majority of the direct care via community aged care or long-term aged care environments. However, there is limited research on what drives their turnover and retention. A survey was conducted during 2012 collecting 206 responses from workers within community and long-term aged care in four organisations in Australia. Perceived supervisor support, on-the-job embeddedness and area of employment were identified as predictors of both intention to stay and to leave, although the relationship strength differed. Community care workers were more likely to stay and reported more supervisor support than long-term care workers. Unexpectedly, age and health status were not predictors of staying or leaving. While there are similarities between retention and turnover motivators, there are also differences. Within a global context of health worker shortages, such new knowledge is keenly sought to enhance organisational effectiveness and sustain the provision of quality aged care. Retention strategies for older workers should involve increasing supervisor support, and seeking to embed workers more fully within their organisation. © 2013 John Wiley & Sons Ltd.

Disparities in Insurance Coverage, Health Services Use, and Access Following Implementation of the Affordable Care Act: A Comparison of Disabled and Nondisabled Working-Age Adults

PubMed Central

Kennedy, Jae; Wood, Elizabeth Geneva; Frieden, Lex

2017-01-01

The objective of this study was to assess trends in health insurance coverage, health service utilization, and health care access among working-age adults with and without disabilities before and after full implementation of the Affordable Care Act (ACA), and to identify current disability-based disparities following full implementation of the ACA. The ACA was expected to have a disproportionate impact on working-age adults with disabilities, because of their high health care usage as well as their previously limited insurance options. However, most published research on this population does not systematically look at effects before and after full implementation of the ACA. As the US Congress considers new health policy reforms, current and accurate data on this vulnerable population are essential. Weighted estimates, trend analyses and analytic models were conducted using the 1998-2016 National Health Interview Surveys (NHIS) and the 2014 Medical Expenditure Panel Survey. Compared with working-age adults without disabilities, those with disabilities are less likely to work, more likely to earn below the federal poverty level, and more likely to use public insurance. Average health costs for this population are 3 to 7 times higher, and access problems are far more common. Repeal of key features of the ACA, like Medicaid expansion and marketplace subsidies, would likely diminish health care access for working-age adults with disabilities. PMID:29166812

Disparities in Insurance Coverage, Health Services Use, and Access Following Implementation of the Affordable Care Act: A Comparison of Disabled and Nondisabled Working-Age Adults.

PubMed

Kennedy, Jae; Wood, Elizabeth Geneva; Frieden, Lex

2017-01-01

The objective of this study was to assess trends in health insurance coverage, health service utilization, and health care access among working-age adults with and without disabilities before and after full implementation of the Affordable Care Act (ACA), and to identify current disability-based disparities following full implementation of the ACA. The ACA was expected to have a disproportionate impact on working-age adults with disabilities, because of their high health care usage as well as their previously limited insurance options. However, most published research on this population does not systematically look at effects before and after full implementation of the ACA. As the US Congress considers new health policy reforms, current and accurate data on this vulnerable population are essential. Weighted estimates, trend analyses and analytic models were conducted using the 1998-2016 National Health Interview Surveys (NHIS) and the 2014 Medical Expenditure Panel Survey. Compared with working-age adults without disabilities, those with disabilities are less likely to work, more likely to earn below the federal poverty level, and more likely to use public insurance. Average health costs for this population are 3 to 7 times higher, and access problems are far more common. Repeal of key features of the ACA, like Medicaid expansion and marketplace subsidies, would likely diminish health care access for working-age adults with disabilities.

Medicare's bundling pilot: including post-acute care services.

PubMed

Dummit, Laura A

2011-03-28

Fee-for-service Medicare, in which a separate payment is made for each service, rewards health care providers for delivering more services, but not necessarily coordinating those services over time or across settings. To help address these concerns, the Patient Protection and Affordable Care Act of 2010 requires Medicare to experiment with making a bundled payment for a hospitalization plus post-acute care, that is, the recuperative or rehabilitative care following a hospital discharge. This bundled payment approach is intended to promote more efficient care across the acute/post-acute episode because the entity that receives the payment has financial incentives to keep episode costs below the payment. Although the entity is expected to control costs through improved care coordination and efficiency, it could stint on care or avoid expensive patients instead. This issue brief focuses on the unique challenges posed by the inclusion of post-acute care services in a payment bundle and special considerations in implementing and evaluating the episode payment approach.

Commissioning of specialist palliative care services in England.

PubMed

Lancaster, Harriet; Finlay, Ilora; Downman, Maxwell; Dumas, James

2018-03-01

Some failures in end-of-life care have been attributed to inconsistent provision of palliative care across England. We aimed to explore the variation in commissioning of services by Clinical Commissioning Groups (CCGs) using a data collection exercise. We sent a Freedom of Information request in the form of an open questionnaire to all 209 CCGs in England to assess their commissioning of palliative and end-of-life care services, mainly focused on the provision of specialist palliative care services. 29 CCGs provided information about the number of patients with some form of palliative care needs in their population. For specialist palliative care services, CCGs allocated budgets ranging from £51.83 to £2329.19 per patient per annum. 163 CCGs (77.90%) currently commission 7-day admission to their specialist palliative care beds. 82.84% of CCGs commission 7-day specialist palliative care services in patients' own homes and out-of-hours services rely heavily on hospice provision. 64 CCGs (31.37%) commission pain control teams, the majority of whom only operate in regular working hours. 68.14% of CCGs reported commissioning palliative care education of any sort for healthcare professionals and 44.85% of CCGs had no plans to update or review their palliative care services. The most important finding from this exercise is that the information CCGs hold about their population and services is not standardised. However, information based on data that are more objective, for example, population and total budget for palliative care, demonstrate wide variations in commissioning. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Primary health-care costs associated with special health care needs up to age 7 years: Australian population-based study.

PubMed

Quach, Jon; Oberklaid, Frank; Gold, Lisa; Lucas, Nina; Mensah, Fiona K; Wake, Melissa

2014-10-01

We studied infants and children with and without special health care needs (SHCN) during the first 8 years of life to compare the (i) types and costs to the government's Medicare system of non-hospital health-care services and prescription medication in each year and (ii) cumulative costs according to persistence of SHCN. Data from the first two biennial waves of the nationally representative Longitudinal Study of Australian Children, comprising two independent cohorts recruited in 2004, at ages 0-1 (n = 5107) and 4-5 (n = 4983) years. Exposure condition: parent-reported Children with Special Health Care Needs Screener at both waves, spanning ages 0-7 years. Federal Government Medicare expenditure, via data linkage to the Medicare database, on non-hospital health-care attendances and prescriptions from birth to 8 years. At both waves and in both cohorts, >92% of children had complete SHCN and Medicare data. The proportion of children with SHCN increased from 6.1% at age 0-1 years to 15.0% at age 6-7 years. Their additional Medicare costs ranged from $491 per child at 6-7 years to $1202 at 0-1 year. This equates to an additional $161.8 million annual cost or 0.8% of federal funding for non-hospital-based health care. In both cohorts, costs were highest for children with persistent SHCNs. SHCNs incur substantial non-hospital costs to Medicare, and no doubt other sources of care, from early childhood. This suggests that economic evaluations of early prevention and intervention services for SHCNs should consider impacts on not only the child and family but also the health-care system. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

SOCIO-ECONOMIC INEQUALITIES IN THE USE OF DENTAL CARE SERVICES IN EUROPE: WHAT IS THE ROLE OF PUBLIC COVERAGE?

PubMed Central

Palència, Laia; Espelt, Albert; Cornejo-Ovalle, Marco; Borrell, Carme

2013-01-01

Objectives The aim of this study was to analyse inequalities in the use of dental care services according to socio-economic position (SEP) in individuals aged ≥50 years in European countries in 2006, and to examine the association between the degree of public coverage of dental services and the extent of inequalities, and specifically to determine whether countries with higher public health coverage show lower inequalities. Methods We carried out a cross-sectional study of 12,364 men and 14,692 women aged ≥50 years from 11 European countries. Data were extracted from the second wave of the Survey of Health, Ageing and Retirement in Europe (SHARE 2006). The dependent variable was use of dental care services within the previous year, and the independent variables were education level as a measure of SEP, whether services were covered to some degree by the country’s public health system, and chewing ability as a marker of individuals’ need for dental services. Age-standardised prevalence of the use of dental care as a function of SEP was calculated, and age-adjusted indices of relative inequality (RII) were computed for each type of dental coverage, sex, and chewing ability. Results SEP inequalities in the use of dental care services were higher in countries where no public dental care cover was provided than in countries where there was some degree of public coverage. For example, men with chewing ability from countries with dental care coverage had a RII of 1.39 (95%CI:1.29–1.51), while those from countries without coverage had a RII of 1.96 (95%CI:1.72–2.23). Women without chewing ability from countries with dental care coverage had a RII of 2.15 (95%CI:1.82–2.52), while those from countries without coverage had a RII of 3.02 (95%CI:2.47–3.69). Conclusions Dental systems relying on public coverage seem to show lower inequalities in their use, thus confirming the potential benefits of such systems. PMID:23786417

Social Service and Aging Policies: Taiwan, Hong Kong, and the United States. Proceedings (Taipei, Taiwan, May 1986).

ERIC Educational Resources Information Center

Sheppard, Harold L., Ed.

This document contains presentations on the state of social services and care for the aging in Taiwan, Hong Kong, and the United States given at the 1986 International Conference on Social Service and Aging Policies. Included are a conference statement by T. H. Li, remarks by Shui-teh Hsu, the major of Taipei, and these presentations: (1)…

Using administrative data to track fall-related ambulatory care services in the Veterans Administration Healthcare system.

PubMed

Luther, Stephen L; French, Dustin D; Powell-Cope, Gail; Rubenstein, Laurence Z; Campbell, Robert

2005-10-01

The Veterans Administration (VA) Healthcare system, containing hospital and community-based outpatient clinics, provides the setting for the study. Summary data was obtained from the VA Ambulatory Events Database for fiscal years (FY) 1997-2001 and in-depth data for FY 2001. In FY 2001, the database included approximately 4 million unique patients with 60 million encounters. The purpose of this study was: 1) to quantify injuries and use of services associated with falls among the elderly treated in Veterans Administration (VA) ambulatory care settings using administrative data; 2) to compare fall-related services provided to elderly veterans with those provided to younger veterans. Retrospective analysis of administrative data. This study describes the trends (FY 1997-2001) and patterns of fall-related ambulatory care encounters (FY 2001) in the VA Healthcare System. An approximately four-fold increase in both encounters and patients seen was observed in FY 1997-2001, largely paralleling the growth of VA ambulatory care services. More than two-thirds of the patients treated were found to be over the age of 65. Veterans over the age of 65 were found to be more likely to receive care in the non-urgent setting and had higher numbers of co-morbid conditions than younger veterans. While nearly half of the encounters occurred in the Emergency/Urgent Care setting, fall-related injuries led to services across a wide spectrum of medical and surgical providers/departments. This study represents the first attempt to use the VA Ambulatory Events Database to study fall-related services provided to elderly veterans. In view of the aging population served by the VA and the movement to provide increased services in the outpatient setting, this database provides an important resource for researchers and administrators interested in the prevention and treatment of fall-related injuries.

42 CFR 417.531 - Hospice care services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Hospice care services. 417.531 Section 417.531... (CONTINUED) MEDICARE PROGRAM HEALTH MAINTENANCE ORGANIZATIONS, COMPETITIVE MEDICAL PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Cost Basis § 417.531 Hospice care services. (a) If a Medicare enrollee of...

Health Care Services for Children and Adolescents.

ERIC Educational Resources Information Center

Perrin, James; And Others

1992-01-01

Identifies health risks and other factors that determine the need for health care services among children and adolescents. Recommendations are made to develop reforms through a coordinated care program rather than through competing systems of services. Models for community-based health care monitoring and coordination exist in other industrialized…

Managing family centered palliative care in aged and acute settings.

PubMed

Street, Annette Fay; Love, Anthony; Blackford, Jeanine

2005-03-01

This paper reports on the management of family centered palliative care in different aged care and acute Australian inpatient settings, following the integration of palliative care with mainstream services. Eighty-eight semistructured interviews were conducted and 425 questionnaires (Palliative Care Practices Questionnaire--PCPQ) were returned, completed from 12 regional and metropolitan locations. Transcribed interviews were analyzed using QSR NVivo and mean PCPQ scores from the four settings were compared. Scores on items from the PCPQ related to family centered care confirmed the analyses. Interviews revealed that factors contributing to the level of support for families offered in the various settings included the core business of the unit; the length of stay of the patients or residents; the acuity or symptom burden; and the coordinated involvement of the multidisciplinary team. Strategies for improving supportive family care are proposed.

The relationship between older Americans act in-home services and low-care residents in nursing homes.

PubMed

Thomas, Kali S

2014-03-01

The aim of the study was to investigate the relationship between supportive services provided under Title III-B of the Older Americans Act (OAA) and the prevalence of low-care residents in nursing homes (NHs). State Program Reports (state-level expenditure and utilization data for each OAA service) and NH facility-level data were analyzed using a two-way fixed effects model. Results suggest that every additional 1% of the population age 65+ that receives personal care services is associated with a 0.8% decrease in the proportion of low-care residents in NHs. Despite efforts to rebalance long-term care, there are still many NH residents who have the functional capacity to live in a less restrictive environment. This is among the first studies to suggest that states that have invested in their in-home supportive services, particularly personal care services provided through the OAA, have proportionally fewer of these people.

Medicare annual preventive care visits: use increased among fee-for-service patients, but many do not participate.

PubMed

Chung, Sukyung; Lesser, Lenard I; Lauderdale, Diane S; Johns, Nicole E; Palaniappan, Latha P; Luft, Harold S

2015-01-01

Under the Affordable Care Act (ACA), Medicare coverage expanded in 2011 to fully cover annual preventive care visits. We assessed the impact of coverage expansion, using 2007-13 data from primary care patients of Medicare-eligible age at the Palo Alto Medical Foundation (204,388 patient-years), which serves people in four counties near San Francisco, California. We compared trends in preventive visits and recommended preventive services among Medicare fee-for-service and Medicare health maintenance organization (HMO) patients as well as non-Medicare patients ages 65-75 who were covered by private fee-for-service and private HMO plans. Among Medicare fee-for-service patients, the annual use of preventive visits rose from 1.4 percent before the implementation of the ACA to 27.5 percent afterward. This increase was significantly larger than was seen for patients in the other insurance groups. Nevertheless, rates of annual preventive care visit use among Medicare fee-for-service patients remained 10-20 percentage points lower than was the case for people with private coverage (43-44 percent) or those in a Medicare HMO (53 percent). ACA policy changes led to increased preventive service use by Medicare fee-for-service beneficiaries, which suggests that Medicare coverage expansion is an effective way to increase seniors' use of preventive services. Project HOPE—The People-to-People Health Foundation, Inc.

Unmet need for disability-related health care services and employment status among adults with disabilities in the Massachusetts Medicaid program.

PubMed

Henry, Alexis D; Long-Bellil, Linda; Zhang, Jianying; Himmelstein, Jay

2011-10-01

The employment rate among adults with disabilities is significantly lower than that among adults without disabilities. Ensuring access to rehabilitative and other health care services may help to address health-related barriers to employment for working-age people with disabilities. This study examined the relationship of unmet need for 6 disability-related health care services to current employment status among working-age adults with disabilities enrolled in the Massachusetts Medicaid (MassHealth Standard) program. Study participants included 436 MassHealth Standard members aged 19 to 64 who responded to the 2005/2006 MassHealth Employment and Disability Survey. Variables included members' demographic characteristics; Medicaid health plan and Medicare enrollment; members' self-report of potentially disabling conditions and current health status; access to health care as well as need and unmet need for 6 specific disability-related health care services (medications, mental health services, substance abuse services, medical supplies, durable medical equipment, personal assistance services); and current employment status. Fifteen percent of members reported currently working. Logistic regression analysis showed that (controlling for demographics, disability, health status, and other factors) members with greater unmet need were significantly less likely to be working (odds ratio = 0.58; 95% confidence interval = 0.33 to 0.99). Members' experience of unmet need was significantly greater for physical health services (supplies, durable medical equipment, personal assistance services) than for behavioral health services (mental health and substance abuse services) or medications. Working members generally rated services as important to work. Approximately 10% to 22% of nonworking members thought they would be able to work if needs were met. Meeting unmet needs for disability-related health care services may result in modest increases in employment among certain working-age

Socioeconomic inequalities in the use of dental care services in Europe: what is the role of public coverage?

PubMed

Palència, Laia; Espelt, Albert; Cornejo-Ovalle, Marco; Borrell, Carme

2014-04-01

The aim of this study was to analyse inequalities in the use of dental care services according to socioeconomic position (SEP) in individuals aged ≥50 years in European countries in 2006, to examine the association between the degree of public coverage of dental services and the extent of inequalities, and specifically to determine whether countries with higher public health coverage show lower inequalities. We carried out a cross-sectional study of 12 364 men and 14 692 women aged ≥50 years from 11 European countries. Data were extracted from the second wave of the Survey of Health, Ageing and Retirement in Europe (SHARE 2006). The dependent variable was use of dental care services within the previous year, and the independent variables were education level as a measure of SEP, whether services were covered to some degree by the country's public health system, and chewing ability as a marker of individuals' need for dental services. Age-standardized prevalence of the use of dental care as a function of SEP was calculated, and age-adjusted indices of relative inequality (RII) were computed for each type of dental coverage, sex and chewing ability. Socioeconomic inequalities in the use of dental care services were higher in countries where no public dental care cover was provided than in countries where there was some degree of public coverage. For example, men with chewing ability from countries with dental care coverage had a RII of 1.39 (95%CI: 1.29-1.51), while those from countries without coverage had a RII of 1.96 (95%CI: 1.72-2.23). Women without chewing ability from countries with dental care coverage had a RII of 2.15 (95%CI: 1.82-2.52), while those from countries without coverage had a RII of 3.02 (95%CI: 2.47-3.69). Dental systems relying on public coverage seem to show lower inequalities in their use, thus confirming the potential benefits of such systems. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

45 CFR 400.117 - Provision of care and services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 2 2010-10-01 2010-10-01 false Provision of care and services. 400.117 Section... Child Welfare Services § 400.117 Provision of care and services. (a) A State may provide care and... agency approved or licensed under State law. (b) If a State arranges for the care and services through a...

Factors Associated to Health Care Service Use among Latino Day Laborers

PubMed Central

Boyas, Javier Francisco; Negi, Nalini Junko; Valera, Pamela

2017-01-01

Latino day laborers (LDLs) are at elevated risks for disease and injury because of the environments in which they work. Despite this recognition, a comprehensive examination of factors related to LDLs’ health service use remains unexamined. Using the Andersen model, the current exploratory study examined predisposing (age, education level, location of educational training, legal status, and marital status), enabling (income, trust in medical personnel, whether the respondent has someone they consider their personal doctor, and whether their doctor speaks the same language, perceived barriers to care), and need (self-rated health, number of chronic conditions) variables to predict use of health services among a purposive sample of LDLs (N = 150). Cross-sectional data were collected in 2012 from 4 day laborer sites in Dallas and Arlington, Texas. Regression results suggest that the strongest predictor of health care use was trust in medical providers (β = .41). LDLs who were U.S legal residents (β = .21), reported multiple chronic conditions (β = .16), and had a doctor who spoke their language (β = .15) reported significantly higher levels of health care usage. In terms of barriers, not being able to pay for services (β = −.23), lacking health care insurance coverage (β = −.22), and being embarrassed or having a family member not approve of utilizing services (β = −.18) were significantly associated with lower health care usage among LDLs. These findings suggest that LDLs are faced with a number of predisposing, enabling, and need factors that comprise health care use. PMID:28625117

Adolescents perception of reproductive health care services in Sri Lanka

PubMed Central

Agampodi, Suneth B; Agampodi, Thilini C; UKD, Piyaseeli

2008-01-01

Background Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery. Methods This qualitative study was conducted in a semi urban setting in Sri Lanka. A convenient sample of 32 adolescents between 17–19 years of age participated in four focus group discussions. Participants were selected from four midwife areas. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. All tape-recorded data was fully transcribed and thematic analysis was done. Results Psychological distresses due to various reasons and problems regarding menstrual cycle and masturbation were reported as the commonest health problems. Knowledge on existing services was very poor and boys were totally unaware of youth health services available through the public health system. On reproductive Health Matters, girls mainly sought help from friends whereas boys did not want to discuss their problems with anyone. Lack of availability of services was pointed out as the most important barrier in reaching the adolescent needs. Lack of access to reproductive health knowledge was an important reason for poor self-confidence among adolescents to discuss these matters. Lack of confidentiality, youth friendliness and accessibility of available services were other barriers discussed. Adolescents were happy to accept available services through public clinics and other health infrastructure for their services rather than other organizations. A demand was made for separate youth friendly services through medical practitioners. Conclusions and recommendations

Adolescents perception of reproductive health care services in Sri Lanka.

PubMed

Agampodi, Suneth B; Agampodi, Thilini C; Ukd, Piyaseeli

2008-05-03

Adolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery. This qualitative study was conducted in a semi urban setting in Sri Lanka. A convenient sample of 32 adolescents between 17-19 years of age participated in four focus group discussions. Participants were selected from four midwife areas. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. All tape-recorded data was fully transcribed and thematic analysis was done. Psychological distresses due to various reasons and problems regarding menstrual cycle and masturbation were reported as the commonest health problems. Knowledge on existing services was very poor and boys were totally unaware of youth health services available through the public health system. On reproductive Health Matters, girls mainly sought help from friends whereas boys did not want to discuss their problems with anyone. Lack of availability of services was pointed out as the most important barrier in reaching the adolescent needs. Lack of access to reproductive health knowledge was an important reason for poor self-confidence among adolescents to discuss these matters. Lack of confidentiality, youth friendliness and accessibility of available services were other barriers discussed. Adolescents were happy to accept available services through public clinics and other health infrastructure for their services rather than other organizations. A demand was made for separate youth friendly services through medical practitioners. Adolescent health services are inadequate and available services

What does it cost to feed aged care residents in Australia?

PubMed

Hugo, Cherie; Isenring, Elisabeth; Sinclair, David; Agarwal, Ekta

2018-02-01

Funding cuts to the aged care industry impact catering budgets and aged care staffing levels, which may in turn affect the nutritional status of aged care residents. This paper reports average food expenditure and trends in Australian residential aged care facilities (RACFs). This is a retrospective study collecting RACFs' economic outlay data through a quarterly online survey conducted over the 2015 and 2016 financial years. Data were compiled from 817 RACFs, representing 64 256 residential beds and 23 million bed-days Australia-wide. The average total spend in Australian Dollars (AUD) on catering consumables (including cutlery/crockery, supplements, paper goods) was $8.00 per resident per day (prpd) and $6.08 prpd when looking at the raw food and ingredients budget alone. Additional data from over half the RACFs (n = 456, 56%) indicate a 5% decrease in food cost ($0.31 prpd) in the last year, particularly in fresh produce, with a simultaneous 128% ($0.50 prpd) increase in cost for supplements and food replacements. Current figures are comparatively less than aged care food budgets internationally (US, UK and Canada), less than community-dwelling older adults ($17.25 prpd) and 136% less than Australian corrective services ($8.25 prpd). The current spend on food in RACFs has decreased compared with previous years, reflecting an increasing reliance on supplements, and is significantly less than current community food spend. © 2017 The Authors. Nutrition & Dietetics published by John Wiley & Sons Australia, Ltd on behalf of Dietitians Association of Australia.

Five-year forward view: lessons from emergency care at the extremes of age.

PubMed

Minhas, J S; Minhas, D; Coats, T; Banerjee, J; Roland, D

2018-03-01

Objective The progressive rise in demand on NHS emergency care resources is partly attributable to increases in attendances of children and older people. A quality gap exists in the care provision for the old and the young. The Five Year Forward View suggested new models of care but that the "answer is not one-size-fits-all". This article discusses the urgent need for person-centred outcome measures to bridge the gap that exists between demand and provision. Design This review is based on evidence gathered from literature searching across several platforms using a variety of search terms to account for the obvious heterogeneity, drawing on key 'think-tank' evidence. Settings Qualitative and quantitative studies examining approaches to caring for individuals at the extremes of age. Participants Individuals at the extremes of age (infants and older people). Main Outcome Measures Understanding similarities and disparities in the care of individuals at the extremes of age in an emergency and non-emergency context. Results There exists several similarities and disparities in the care of individuals at the extremes of age. The increasing burden of health disease on the economy must acknowledge the challenges that exist in managing patients in emergency settings at the extremes of age and build systems to acknowledge the traits these individuals exhibit. Conclusion Commissioners of services must optimise the models of care delivery by appreciating the similarities and differences between care requirements in these two large groups seeking emergency care.

20 CFR 638.542 - Child care services.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Child care services. 638.542 Section 638.542... TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.542 Child care services. (a) Job Corps centers shall, where practicable, arrange for the provision of child care for students with...

20 CFR 638.542 - Child care services.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Child care services. 638.542 Section 638.542... TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.542 Child care services. (a) Job Corps centers shall, where practicable, arrange for the provision of child care for students with...

20 CFR 638.542 - Child care services.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 3 2012-04-01 2012-04-01 false Child care services. 638.542 Section 638.542... TITLE IV-B OF THE JOB TRAINING PARTNERSHIP ACT Center Operations § 638.542 Child care services. (a) Job Corps centers shall, where practicable, arrange for the provision of child care for students with...

Health Services Utilization in Older Adults with Dementia Receiving Care Coordination: The MIND at Home Trial.

PubMed

Amjad, Halima; Wong, Stephanie K; Roth, David L; Huang, Jin; Willink, Amber; Black, Betty S; Johnston, Deirdre; Rabins, Peter V; Gitlin, Laura N; Lyketsos, Constantine G; Samus, Quincy M

2018-02-01

To investigate effects of a novel dementia care coordination program on health services utilization. A total of 303 community-dwelling adults aged ≥70 with a cognitive disorder in Baltimore, Maryland (2008-2011). Single-blind RCT evaluating efficacy of an 18-month care coordination intervention delivered through community-based nonclinical care coordinators, supported by an interdisciplinary clinical team. Study partners reported acute care/inpatient, outpatient, and home- and community-based service utilization at baseline, 9, and 18 months. From baseline to 18 months, there were no significant group differences in acute care/inpatient or total outpatient services use, although intervention participants had significantly increased outpatient dementia/mental health visits from 9 to 18 months (p = .04) relative to controls. Home and community-based support service use significantly increased from baseline to 18 months in the intervention compared to control (p = .005). While this dementia care coordination program did not impact acute care/inpatient services utilization, it increased use of dementia-related outpatient medical care and nonmedical supportive community services, a combination that may have helped participants remain at home longer. Future care model modifications that emphasize delirium, falls prevention, and behavior management may be needed to influence inpatient service use. © Health Research and Educational Trust.

Long term care needs and personal care services under Medicaid: a survey of administrators.

PubMed

Palley, H A; Oktay, J S

1991-01-01

Home and community based care services constitute a public initiative in the development of a long term care service network. One such home based initiative is the personal care service program of Medicaid. The authors conducted a national survey of administrators of this program. They received a response from 16 administrators of such programs in 1987-1988. The responses raise significant issues regarding training, access to and equity of services, quality of services, administrative oversight and the coordination of home-based care in a network of available services. Based on administrator responses, the authors draw several conclusions.

Mental health care roles of non-medical primary health and social care services.

PubMed

Mitchell, Penny

2009-02-01

Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.

Information persistence services designed to support home care.

PubMed

Rocha, Nelson Pacheco; Queirós, Alexandra; Augusto, Filipe; Rodríguez, Yosvany Llerena; Cardoso, Carlos; Grade, José Miguel; Quintas, João

2015-03-10

Due to the challenges faced by health and social care systems, in particular those related to actual demographic trends, home care emerges as a potentially cost-effective solution to answer the needs of citizens, and to allow the reallocation of resources to alternatives to hospitalization or institutionalization. Home care services require cooperation between different actors, including health and social caregivers, care receivers, and their informal caregivers (eg, relatives or friends), across time, space, and organizational boundaries. Therefore, it is foreseeable that eHealth services can contribute to their improvement. The aim of this study is to evaluate information persistence services based on the Reference Information Model (RIM) of the Health Level Seven (HL7) version 3 to support formal caregivers, both health and social care providers, and informal caregivers in the context of home care services. A pilot study was set up involving two Portuguese institutions that provide home care services for the elderly. Defining of information requirements was performed according to a comprehensive process. This included a review of the literature, observations of work activities, interviews with caregivers, care receivers and their relatives, analysis of paper documentation related to care receivers' histories, health conditions and care plans, and brainstorming groups involving specialized professionals. Following this, information objects were implemented and validated. The methodological approach, as well as the information persistence services, proved to be robust and adequate to specify, implement, and validate different types of information objects related to home care services for the elderly. This study also reinforces the application of the RIM of the HL7 version 3 beyond the strict scope of health care, allowing the persistence of not only health care information, but also information related to social assistance activities. This study contributes to the

Information Persistence Services Designed to Support Home Care

PubMed Central

Queirós, Alexandra; Augusto, Filipe; Rodríguez, Yosvany Llerena; Cardoso, Carlos; Grade, José Miguel; Quintas, João

2015-01-01

Background Due to the challenges faced by health and social care systems, in particular those related to actual demographic trends, home care emerges as a potentially cost-effective solution to answer the needs of citizens, and to allow the reallocation of resources to alternatives to hospitalization or institutionalization. Objective Home care services require cooperation between different actors, including health and social caregivers, care receivers, and their informal caregivers (eg, relatives or friends), across time, space, and organizational boundaries. Therefore, it is foreseeable that eHealth services can contribute to their improvement. The aim of this study is to evaluate information persistence services based on the Reference Information Model (RIM) of the Health Level Seven (HL7) version 3 to support formal caregivers, both health and social care providers, and informal caregivers in the context of home care services. Methods A pilot study was set up involving two Portuguese institutions that provide home care services for the elderly. Defining of information requirements was performed according to a comprehensive process. This included a review of the literature, observations of work activities, interviews with caregivers, care receivers and their relatives, analysis of paper documentation related to care receivers’ histories, health conditions and care plans, and brainstorming groups involving specialized professionals. Following this, information objects were implemented and validated. Results The methodological approach, as well as the information persistence services, proved to be robust and adequate to specify, implement, and validate different types of information objects related to home care services for the elderly. This study also reinforces the application of the RIM of the HL7 version 3 beyond the strict scope of health care, allowing the persistence of not only health care information, but also information related to social assistance

Managed Care for Children: Effect on Access to Care and Utilization of Health Services.

ERIC Educational Resources Information Center

Szilagyi, Peter G.

1998-01-01

Reviews what is known about the effect of managed care on access to health services, as well as utilization of hospital care, emergency department visits, primary care services, and specialty pediatric services. The effect of managed care appears dependent on several factors and, thus, is likely to vary according to the population served. (SLD)

China’s Rapidly Aging Population Creates Policy Challenges In Shaping A Viable Long-Term Care System

PubMed Central

Feng, Zhanlian; Liu, Chang; Guan, Xinping; Mor, Vincent

2013-01-01

In China, formal long-term care services for the large aging population have increased to meet escalating demands as demographic shifts and socioeconomic changes have eroded traditional elder care. We analyze China’s evolving long-term care landscape and trace major government policies and private-sector initiatives shaping it. Although home and community-based services remain spotty, institutional care is booming with little regulatory oversight. Chinese policy makers face mounting challenges overseeing the rapidly growing residential care sector, given the tension arising from policy inducements to further institutional growth, a weak regulatory framework, and the lack of enforcement capacity. We recommend addressing the following pressing policy issues: building a balanced system of services and avoiding an “institutional bias” that promotes rapid growth of elder care institutions over home or community-based care; strengthening regulatory oversight and quality assurance with information systems; and prioritizing education and training initiatives to grow a professionalized long-term care workforce. PMID:23213161

A transitional care service for elderly chronic disease patients at risk of readmission.

PubMed

Brand, Caroline A; Jones, Catherine T; Lowe, Adrian J; Nielsen, David A; Roberts, Carol A; King, Bellinda L; Campbell, Donald A

2004-12-13

Multiple hospital admissions, especially those related to chronic disease, represent a particular challenge to the acute health care sector in Australia. To determine whether a nurse-led chronic disease management model of transitional care reduced readmissions to acute care. A quasi-experimental controlled trial. A large tertiary metropolitan teaching hospital. 166 general medical patients aged > or = 65 years with either a history of readmissions to acute care or multiple medical comorbidities. Implementation of a chronic disease management model of transitional care aimed at improving patient management and reducing readmissions to acute care. Readmission rates and emergency department presentation rates at 3-and 6-month follow up. Secondary outcome measures include quality of life, discharge destination, and primary health care service utilisation. There was no difference in readmission rates, emergency department presentation rates, quality of life, discharge destination or primary health care service utilisation. The difficulties inherent in evaluating this type of multifactorial intervention are discussed and consideration is given to patient factors, the difficulty of influencing readmission rates, and local system issues. The outcomes of this study reflect the tension that exists between implementing multifaceted integrated health service programs and attempting to evaluate them within complex and changing environments using robust research methodologies.

Extended Foster Care for Transition-Age Youth: An Opportunity for Pregnancy Prevention and Parenting Support.

PubMed

Putnam-Hornstein, Emily; Hammond, Ivy; Eastman, Andrea Lane; McCroskey, Jacquelyn; Webster, Daniel

2016-04-01

This analysis examined California county birth rate variations among girls in foster care. The objective was to generate data to assess potential intervention points tied to federal legislation extending foster care beyond age 18 years. Child protection records for all adolescent girls in foster care at age 17 years between 2003 and 2007 (N = 20,222) were linked to vital birth records through 2011. The cumulative percentage of girls who had given birth by age 21 years was calculated by county and race/ethnicity. One in three (35.2%) adolescent girls in foster care had given birth at least once before age 21 years. Although significant birth rate variations emerged, even at the low end of the county range, more than one in four girls had given birth by age 21 years. Child welfare systems are now charged with coordinating transitional services for foster youth beyond age 18 years. Extended foster care provides new opportunities for pregnancy prevention work and targeted parenting support. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

EFFECT OF INDIVIDUAL AND COMMUNITY FACTORS ON MATERNAL HEALTH CARE SERVICE USE IN INDIA: A MULTILEVEL APPROACH.

PubMed

Yadav, Awdhesh; Kesarwani, Ranjana

2016-01-01

This study aimed to assess empirically the influence of individual and community (neighbourhood) factors on the use of maternal health care services in India through three outcomes: utilization of full antenatal care (ANC) services, safe delivery and utilization of postnatal care services. Data were from the third round of the National Family Health Survey (2005-06). The study sample constituted ever-married women aged 15-49 from 29 Indian states. Multilevel logistic regression analysis was performed for the three outcomes of interest accounting for individual- and community-level factors associated with the use of maternal health care services. A substantial amount of variation was observed at the community level. About 45%, 51% and 62% of the total variance in the use of full ANC, safe delivery and postnatal care, respectively, could be attributed to differences across the community. There was significant variation in the use of maternal health care services at the individual level, with socioeconomic status and mother's education being the most prominent factors associated with the use of maternal health care services. At the community level, urban residence and poverty concentration were found to be significantly associated with maternal health care service use. The results suggest that an increased focus on community-level interventions could lead to an increase in the utilization of maternal health care services in India.

Developing a Business Plan for Critical Care Pharmacy Services

PubMed Central

Erstad, Brian L.; Mann, Henry J.; Weber, Robert J.

2016-01-01

Critical care medicine has grown from a small group of physicians participating in patient care rounds in surgical and medical intensive care units (ICUs) to a highly technical, interdisciplinary team. Pharmacy's growth in the area of critical care is as exponential. Today's ICU requires a comprehensive pharmaceutical service that includes both operational and clinical services to meet patient medication needs. This article provides the elements for a business plan to justify critical care pharmacy services by describing the pertinent background and benefit of ICU pharmacy services, detailing a current assessment of ICU pharmacy services, listing the essential ICU pharmacy services, describing service metrics, and delineating an appropriate timeline for implementing an ICU pharmacy service. The structure and approach of this business plan can be applied to a variety of pharmacy services. By following the format and information listed in this article, the pharmacy director can move closer to developing patient-centered pharmacy services for ICU patients. PMID:27928193

Developing a Business Plan for Critical Care Pharmacy Services.

PubMed

Erstad, Brian L; Mann, Henry J; Weber, Robert J

2016-11-01

Critical care medicine has grown from a small group of physicians participating in patient care rounds in surgical and medical intensive care units (ICUs) to a highly technical, interdisciplinary team. Pharmacy's growth in the area of critical care is as exponential. Today's ICU requires a comprehensive pharmaceutical service that includes both operational and clinical services to meet patient medication needs. This article provides the elements for a business plan to justify critical care pharmacy services by describing the pertinent background and benefit of ICU pharmacy services, detailing a current assessment of ICU pharmacy services, listing the essential ICU pharmacy services, describing service metrics, and delineating an appropriate timeline for implementing an ICU pharmacy service. The structure and approach of this business plan can be applied to a variety of pharmacy services. By following the format and information listed in this article, the pharmacy director can move closer to developing patient-centered pharmacy services for ICU patients.

Factors Influencing Utilization of Primary Health Care Services in Patients with Chronic Respiratory Diseases.

PubMed

Kurpas, D; Bujnowska-Fedak, M M; Athanasiadou, A; Mroczek, B

2015-01-01

The purpose of our study was to determine the factors affecting the level of services provided in primary health care among patients with chronic respiratory diseases. The study group consisted of 299 adults (median age: 65, min-max: 18-92 years) with mixed chronic respiratory diseases, recruited from patients of 135 general practitioners. In the analysis, in addition to the assessment of the provided medical services, the following were used: Patient Satisfaction Questionnaire, Camberwell Assessment of Needs Short Appraisal Schedule, Acceptance of Illness Scale, and WHO Quality of Life Instrument Short Form. Variables that determined the level of services were the following: age, place of residence, marital status, number of chronic diseases, and level of disease acceptance, quality of life, and health behaviors. The level of provided services correlated with variables such as gender, severity of somatic symptoms, level of satisfied needs, and satisfaction with health care. We concluded that in patients with mixed chronic respiratory diseases a higher level of health care utilization should be expected in younger patients, those living in the countryside, those having a partner, with multimorbidity, a low level of disease acceptance, those satisfied with their current quality of life, with positive mental attitudes, and maintaining health practices.

Work ability, age and intention to leave aged care work.

PubMed

Austen, Siobhan; Jefferson, Therese; Lewin, Gill; Ong, Rachel; Sharp, Rhonda

2016-03-01

To describe the work ability of mature age women workers in Australia's aged care sector, and to explore the relationship between ageing, work ability and intention to leave. Logistic regression techniques were applied to a sample of 2721 responses to a survey of mature age women workers in the aged care sector. Mature age women working in the Australian aged care sector have relatively high levels of work ability by international standards. Furthermore, their work ability remains high in their 50s and 60s, in contrast to some prevailing stereotypes. However, work ability is a key determinant of intention to leave in key occupational groups. Our findings challenge some prevailing stereotypes about the work ability of mature age workers. However, they lend support for the development of retention strategies, which incorporate programs that target low work ability. © 2015 AJA Inc.

Remote eye care screening for rural veterans with Technology-based Eye Care Services: a quality improvement project.

PubMed

Maa, April Y; Wojciechowski, Barbara; Hunt, Kelly; Dismuke, Clara; Janjua, Rabeea; Lynch, Mary G

2017-01-01

Veterans are at high risk for eye disease because of age and comorbid conditions. Access to eye care is challenging within the entire Veterans Hospital Administration's network of hospitals and clinics in the USA because it is the third busiest outpatient clinical service and growing at a rate of 9% per year. Rural and highly rural veterans face many more barriers to accessing eye care because of distance, cost to travel, and difficulty finding care in the community as many live in medically underserved areas. Also, rural veterans may be diagnosed in later stages of eye disease than their non-rural counterparts due to lack of access to specialty care. In March 2015, Technology-based Eye Care Services (TECS) was launched from the Atlanta Veterans Affairs (VA) as a quality improvement project to provide eye screening services for rural veterans. By tracking multiple measures including demographic and access to care metrics, data shows that TECS significantly improved access to care, with 33% of veterans receiving same-day access and >98% of veterans receiving an appointment within 30 days of request. TECS also provided care to a significant percentage of homeless veterans, 10.6% of the patients screened. Finally, TECS reduced healthcare costs, saving the VA up to US$148 per visit and approximately US$52 per patient in round trip travel reimbursements when compared to completing a face-to-face exam at the medical center. Overall savings to the VA system in this early phase of TECS totaled US$288,400, about US$41,200 per month. Other healthcare facilities may be able to use a similar protocol to extend care to at-risk patients.

Determinants of maternal health care services utilization in Pakistan: evidence from Pakistan demographic and health survey, 2012-13.

PubMed

Zakar, Rubeena; Zakar, Muhammad Zakria; Aqil, Nauman; Chaudhry, Ashraf; Nasrullah, Muazzam

2017-04-01

The aim of this study was to determine the association between maternal utilisation of health-care services and socio-demographic factors among reproductive-age women in Pakistan. We used the sample of ever-married reproductive-age women (n = 7446) from the Pakistan Demographic and Health Survey (PDHS), 2012-13. We measured maternal utilisation of health-care services by using three dependent variables: number of antenatal care (ANC) visits, delivery assistance by a skilled health provider, and delivery in a health-care facility. Around 36.6% of women had made four or more ANC visits, 59% had received assistance from skilled health providers during delivery, and 55.3% had given birth in a health-care facility. On multivariable logistic regression, all three variables were positively associated with education and wealth, and negatively associated with birth order and women's autonomy. Policymakers and health planners may use our findings to develop efficient strategies, particularly for uneducated women and those with poor economic status, to improve the utilisation of maternal health-care services in Pakistan.

Mortality and health services utilisation among older people with advanced cognitive impairment living in residential care homes.

PubMed

Luk, James K H; Chan, W K; Ng, W C; Chiu, Patrick K C; Ho, Celina; Chan, T C; Chan, Felix H W

2013-12-01

To study the demography, clinical characteristics, service utilisation, mortality, and predictors of mortality in older residential care home residents with advanced cognitive impairment. Cohort longitudinal study. Residential care homes for the elderly in Hong Kong West. Residents of such homes aged 65 years or more with advanced cognitive impairment. In all, 312 such residential care home residents (71 men and 241 women) were studied. Their mean age was 88 (standard deviation, 8) years and their mean Barthel Index 20 score was 1.5 (standard deviation, 2.0). In all, 164 (53%) were receiving enteral feeding. Nearly all of them had urinary and bowel incontinence. Apart from Community Geriatric Assessment Team clinics, 119 (38%) of the residents attended other clinics outside their residential care homes. In all, 107 (34%) died within 1 year; those who died within 1 year used significantly more emergency and hospital services (P<0.001), and utilised more services from community care nurses for wound care (P=0.001), enteral feeding tube care (P=0.018), and urinary catheter care (P<0.001). Independent risk factors for 1-year mortality were active pressure sores (P=0.0037), enteral feeding (P=0.008), having a urinary catheter (P=0.0036), and suffering from chronic obstructive pulmonary disease (P=0.011). A history of pneumococcal vaccination was protective with respect to 1-year mortality (P=0.004). Residents of residential care homes for the elderly with advanced cognitive impairment were frail, exhibited multiple co-morbidities and high mortality. They were frequent users of out-patient, emergency, and in-patient services. The development of end-of-life care services in residential care homes for the elderly is an important need for this group of elderly.

Socioeconomic Differences in and Predictors of Home-Based Palliative Care Health Service Use in Ontario, Canada

PubMed Central

Cai, Jiaoli; Guerriere, Denise N.; Zhao, Hongzhong; Coyte, Peter C.

2017-01-01

The use of health services may vary across people with different socioeconomic statuses, and may be determined by many factors. The purposes of this study were (i) to examine the socioeconomic differences in the propensity and intensity of use for three main home-based health services, that is, home-based palliative care physician visits, nurse visits and personal support worker (PSW) hours; and (ii) to explore the determinants of the use of home-based palliative care services. A prospective cohort study was employed. A total of 181 caregivers were interviewed biweekly over the course of the palliative care trajectory, yielding a total of 994 interviews. The propensity and intensity of health service use were examined using logistic regression and negative binomial regression, respectively. The results demonstrated that both the propensity and intensity of home-based nurse and PSW visits fell with socioeconomic status. The use of home-based palliative care services was not concentrated in high socioeconomic status groups. The common predictors of health service use in the three service categories were patient age, the Palliative Performance Scale (PPS) score and place of death. These findings may assist health service planners in the appropriate allocation of resources and service packages to meet the complex needs of palliative care populations. PMID:28718797

Socioeconomic Differences in and Predictors of Home-Based Palliative Care Health Service Use in Ontario, Canada.

PubMed

Cai, Jiaoli; Guerriere, Denise N; Zhao, Hongzhong; Coyte, Peter C

2017-07-18

The use of health services may vary across people with different socioeconomic statuses, and may be determined by many factors. The purposes of this study were (i) to examine the socioeconomic differences in the propensity and intensity of use for three main home-based health services, that is, home-based palliative care physician visits, nurse visits and personal support worker (PSW) hours; and (ii) to explore the determinants of the use of home-based palliative care services. A prospective cohort study was employed. A total of 181 caregivers were interviewed biweekly over the course of the palliative care trajectory, yielding a total of 994 interviews. The propensity and intensity of health service use were examined using logistic regression and negative binomial regression, respectively. The results demonstrated that both the propensity and intensity of home-based nurse and PSW visits fell with socioeconomic status. The use of home-based palliative care services was not concentrated in high socioeconomic status groups. The common predictors of health service use in the three service categories were patient age, the Palliative Performance Scale (PPS) score and place of death. These findings may assist health service planners in the appropriate allocation of resources and service packages to meet the complex needs of palliative care populations.

The Dementia Services Mini-Screen: A Simple Method to Identify Patients and Caregivers Needing Enhanced Dementia Care Services

PubMed Central

Borson, Soo; Scanlan, James M.; Sadak, Tatiana; Lessig, Mary; Vitaliano, Peter

2014-01-01

Objective The National Alzheimer’s Plan calls for targeted health system change to improve outcomes for persons with dementia and their family caregivers. We explored whether dementia-specific service needs and gaps could be predicted from simple information that can be readily acquired in routine medical care settings. Method Primary family caregivers for cognitively impaired older adults (n=215) were asked about current stress, challenging patient behaviors, and prior-year needs and gaps in 16 medical and psychosocial services. Demographic data, caregiver stress, and patient clinical features were evaluated in regression analyses to identify unique predictors of service needs and gaps. Results Caregiver stress and patient behavior problems together accounted for an average of 24% of the whole-sample variance in total needs and gaps. Across all analyses, including total, medical, and psychosocial services needs and gaps, all other variables combined (comorbid chronic disease, dementia severity, age, caregiver relationship, and residence) accounted for an accounted for a mean of 3%, with no variable yielding more than 4% in any equation. We combined stress and behavior problem indicators into a simple screen. In early/mild dementia dyads (n=111) typical in primary care settings, the screen identified gaps in total and psychosocial care in 84% and 77%, respectively, of those with high stress/high behavior problems vs. 25% and 23%, respectively, of those with low stress/low behavior problems. Medical care gaps were dramatically higher in high stress/high behavior problem dyads (66%) than all others (12%). Conclusion A simple tool (likely completed in 1–2 minutes) which combines caregiver stress and patient behavior problems, the Dementia Services Mini-Screen, could help clinicians rapidly identify high need, high gap dyads. Health care systems could use it to estimate population needs for targeted dementia services and facilitate their development. PMID:24315560

Children in family foster care have greater health risks and less involvement in Child Health Services.

PubMed

Köhler, M; Emmelin, M; Hjern, A; Rosvall, M

2015-05-01

This study investigated the impact of being in family foster care on selected health determinants and participation in Child Health Services (CHS). Two groups of 100 children, born between 1992 and 2008, were studied using data from Swedish Child Health Services for the preschool period up to the age of six. The first group had been in family foster care, and the controls, matched for age, sex and geographic location, had not. Descriptive statistics were used to describe differences in health determinants and participation in Child Health Services between the two groups. The foster care group had higher health risks, with lower rates of breastfeeding and higher levels of parental smoking. They were less likely to have received immunisations and attended key nurse or physician visits and speech and vision screening. Missing data for the phenylketonuria test were more common in children in family foster care. Children in family foster care were exposed to more health risks than the control children and had lower participation in the universal child health programme during the preschool period. These results call for secure access to high-quality preventive health care for this particularly vulnerable group of children. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Health insurance coverage and use of family planning services among current and former foster youth: implications of the health care reform law.

PubMed

Dworsky, Amy; Ahrens, Kym; Courtney, Mark

2013-04-01

This research uses data from a longitudinal study to examine how two provisions in the Patient Protection and Affordable Care Act could affect health insurance coverage among young women who have aged out of foster care. It also explores how allowing young people to remain in foster care until age twenty-one affects their health insurance coverage, use of family planning services, and information about birth control. We find that young women are more likely to have health insurance if they remain in foster care until their twenty-first birthday and that having health insurance is associated with an increase in the likelihood of receiving family planning services. Our results also suggest that many young women who would otherwise lack health insurance after aging out of foster care will be eligible for Medicaid under the health care reform law. Because having health insurance is associated with use of family planning services, this increase in Medicaid eligibility may result in fewer unintended pregnancies among this high-risk population.

[Intensive care services resources in Spain].

PubMed

Martín, M C; León, C; Cuñat, J; del Nogal, F

2013-10-01

To identify the resources related to the care of critically ill patients in Spain, which are available in the units dependent of the Services of Intensive Care Medicine (ICM) or other services/specialties, analyzing their distribution according to characteristics of the hospitals and by autonomous communities. Prospective observational study. Spanish hospitals. Heads of the Services of ICM. Number of units and beds for critically ill patients and functional dependence. The total number of registries obtained with at least one Service of ICM was 237, with a total of 100,198 hospital beds. Level iii (43.5%) and level ii (35%) hospitals predominated. A total of 73% were public hospitals and 55.3% were non-university centers. The total number of beds for adult critically ill patients, was 4,738 (10.3/100,000 inhabitants). The services of ICM registered had available 258 intensive are units (ICUs), with 3,363 beds, mainly polyvalent ICUs (81%) and 43 intermediate care units. The number of patients attended in the Services of ICM in 2008 was 174,904, with a percentage of occupation of 79.5% A total of 228 units attending critically ill patients, which are dependent of other services with 2,233 beds, 772 for pediatric patients or neonates, were registered. When these last specialized units are excluded, there was a marked predominance of postsurgical units followed by coronary and cardiac units. Seventy one per cent of beds available in the Critical Care Units in Spain are characterized by attending severe adult patients, are dependent of the services of ICM, and most of them are polyvalent. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.

On aging and aged care in Serbia.

PubMed

Sevo, G; Davidovic, M; Erceg, P; Despotovic, N; Milosevic, D P; Tasic, M

2015-06-01

Serbia is a demographically old nation, with 17.4 % of its residents being aged 65 years and older in 2011. The previous two decades of turbulent history have significantly affected the demographic picture of this country, and their ramifications remain visible in Serbia's economic, political, cultural, and health spheres. Major demographic forces behind population aging in Serbia can be attributed to lower fertility rates, migrations, and declining mortality (reflecting improvements in overall health leading to a longer life expectancy). In Serbia, low fertility and migrations appear to play major roles, although the relative contribution of recent migrations cannot be measured with accuracy. Patterns of demographic aging vary considerably across different geographic, socioeconomic, and cultural settings. The common denominator throughout present day Serbia is extensive political and economic transition. One would expect that, given sufficient time, this process will result in improved population health, and yet, at this stage outcomes of major health care reform in Serbia are somewhat perplexing. For the second consecutive year, Serbia's health care system has been ranked at the very bottom of the scale among 34 European countries. It is then no surprise that the elderly represent particularly vulnerable population segment. This paper discusses some of the issues relevant to these demographic patterns of aging and aged care in contemporary Serbia, focusing on the period after 2000.

Are primary care services a substitute or complement for specialty and inpatient services?

PubMed

Fortney, John C; Steffick, Diane E; Burgess, James F; Maciejewski, Matt L; Petersen, Laura A

2005-10-01

To determine whether strategies designed to increase members' use of primary care services result in decreases (substitution) or increases (complementation) in the use and cost of other types of health services. Encounter and cost data were extracted from the Department of Veterans Affairs (VA) administrative data sources for the period 1995-1999. This timeframe captures the VA's natural experiment of increasing geographic access to primary care by establishing new satellite primary care clinics, known as Community-Based Outpatient Clinics (CBOCs). We exploited this natural experiment to estimate the substitutability of primary care for other health services and its impact on cost. Hypotheses were tested using ordinary least squares (OLS) regression, which was potentially subject to endogeneity bias. Endogeneity bias was assessed using a Hausman test. Endogeneity bias was accounted for by using instrumental variables analysis, which capitalized on the establishment of CBOCs to provide an exogenous identifier (change in travel distance to primary care). Demographic, encounter, and cost data were collected for all veterans using VA health services who resided in the catchment areas of new CBOCs and for a matched group of veterans residing outside CBOC catchment areas. Change in distance to primary care was a significant and substantial predictor of change in primary care visits. OLS analyses indicated that an increase in primary care service use was associated with increases in the use of all specialty outpatient services and inpatient services, as well as increases in inpatient and outpatient costs. Hausman tests confirmed that OLS results for specialty mental health encounters and mental health admissions were unbiased, but that results for specialty medical encounters, physical health admissions, and outpatient costs were biased. Instrumental variables analyses indicated that an increase in primary care encounters was associated with a decrease in specialty

Quantitative comparison of measurements of urgent care service quality.

PubMed

Qin, Hong; Prybutok, Victor; Prybutok, Gayle

2016-01-01

Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.

Racial variation in wanting and obtaining mental health services among women veterans in a primary care clinic.

PubMed Central

Bosworth, H. B.; Parsey, K. S.; Butterfield, M. I.; McIntyre, L. M.; Oddone, E. Z.; Stechuchak, K. M.; Bastian, L. A.

2000-01-01

Epidemiologic studies suggest that African-American women may be less likely to obtain mental health services. Racial differences were explored in wanting and obtaining mental health services among women in an equal access primary care clinic setting after adjusting for demographics, mental disorder symptoms, and a history of sexual trauma. Participating in the study were women veterans at a primary care clinic at the Durham Veterans Affairs Medical Center. Consecutive women patients (n = 526) between the ages of 20 and 49 years were screened for a desire to obtain mental health services. Patients were given the Primary Care Evaluation of Mental Disorders questionnaire (PRIME-MD) and a sexual trauma questionnaire. Mental health service utilization was monitored for 12 months. The median age of the women was 35.8 years; 54.4% of them were African-American. African-American women expressed a greater desire for mental health services than whites, yet mental health resources at the clinic were similarly used by both racial groups. African-American women may want more mental health services; however, given an equal access system, there were no racial differences in mental health use. PMID:10881472

Can home care services achieve cost savings in long-term care for older people?

PubMed

Greene, V L; Ondrich, J; Laditka, S

1998-07-01

To determine whether efficient allocation of home care services can produce net long-term care cost savings. Hazard function analysis and nonlinear mathematical programming. Optimal allocation of home care services resulted in a 10% net reduction in overall long-term care costs for the frail older population served by the National Long-Term Care (Channeling) Demonstration, in contrast to the 12% net cost increase produced by the demonstration intervention itself. Our findings suggest that the long-sought goal of overall cost-neutrality or even cost-savings through reducing nursing home use sufficiently to more than offset home care costs is technically feasible, but requires tighter targeting of services and a more medically oriented service mix than major home care demonstrations have implemented to date.

Prevalence and Factors Associated with the Use of Eye Care Services in South Korea: Korea National Health and Nutrition Examination Survey 2010-2012.

PubMed

Park, Yong Seok; Heo, Hwan; Ye, Byeong Jin; Suh, Young-Woo; Kim, Seung-Hyun; Park, Shin Hae; Lim, Key Hwan; Lee, Sung Jin; Park, Song Hee; Baek, Seung-Hee

2017-02-01

To estimate the factors and prevalence of eye care service utilization in the South Korean population. This cross-sectional, population-based study included data from 22,550 Koreans aged ≥5 years who participated in the Korea National Health and Nutrition Examination Survey from 2010 to 2012. For people aged 5 to 11 years (young children), information was based on self-reports of contact with eye care service in the past year; for people aged ≥12 years (older population), the information was based on the self-reported lifetime contact with eye care service. Univariate and multivariate logistic regression analyses of the complex sample survey data were performed. The prevalence of eye care service use in young children during the past year was 61.1% (95% confidence interval, 58.1%-64.1%), while that in the older population during their lifetime was 73.5%. Subjects aged 7 to 11 years were more likely to have had an eye examination in the past year than subjects aged 5 to 6 years (odds ratio, 3.83; 95% confidence interval, 2.37-6.19). Multivariate logistic regression analysis indicated that higher monthly household income, being a National Health Insurance holder, and having private health insurance were related to more frequent use of eye care services in young children. For the older population and women, those living in an urban area and those with a best-corrected visual acuity less than 20 / 40 in the worse-seeing eye were more likely to have had an eye examination during their lifetime. Low education level was associated with low lifetime use of eye care services in the older population. There are sociodemographic disparities with use of eye care services in South Korea. This population-based study provides information that is useful for determining different intervention programs based on sociodemographic disparities to promote eye care service utilization in South Korea.

Improving the delivery of preventive care services.

PubMed

Hung, Dorothy Y

2007-05-01

Performance of preventive services is an important indicator of high-quality health care, but many recommended services are not regularly offered in primary care practices. Health risk assessments, counseling, and referral to community-based programs help address risk behaviors, many of which are leading causes of preventable death and disability in the United States. This study examined various influences on the delivery of preventive services designed to address smoking, excessive consumption of alcohol, unhealthy diets, and sedentary lifestyles. More than 300 health care providers in 52 practices nationwide have contributed data to this study. Staff participation in quality improvement enhanced work relationships and also diminished the effect of practice size on the performance of preventive care. The use of nurse practitioners, allied health professionals, clinician reminders, and patient registries were positively associated with care delivery.

[Investigation of cost and medical service fee for pharmaceutical management in home medical care].

PubMed

Honma, Katsuaki; Sakai, Ritsuko; Takeshima, Akiko; Shimamori, Yoshimitsu; Hayase, Yukitoshi

2004-10-01

Due to the evolvement of the aged society and the steep rise in medical costs, the environment encircling the medical care industry has been changing remarkably. For this reason, it has become both necessary and fundamental for a community pharmacist to participate in home medical care through the pharmaceutical management service. We have studied the associated costs and medical service fees for pharmaceutical management in home medical care. The costs and medical service fees were calculated based on the pharmaceutical management service data collected during the three years from November 1998 to October 2001. As a result, the medical service fees were calculated using the old system which lasted until March 2002. Calculations using this system took into account 550 points per visit, up to two visits per month. Under the new system which started in April 2002, the number of visits taken into account is four times a month, 500 points for the first visit, 300 points from the second through to the forth visit. Then, we simulated a break-even point (BEP). It is clear that it is difficult for any community pharmacy to be specialized in home medical care. In order for the pharmacist to actively participate in home medical care in the future, it is necessary to further improve the system.

Long-Term Care Services for Veterans

DTIC Science & Technology

2017-02-14

includes but is not limited to home physical , occupational, or speech therapy ; wound care; and intravenous (IV) care. A VA physician determines that a...restoring/rehabilitating the veteran’s health, such as skilled nursing care, physical therapy , occupational therapy , and IV therapy Same as HBPC... geriatric evaluation,  palliative care,  adult day health care,  homemaker/home health aide care,  respite care, Long-Term Care Services for

Clinical Preventive Services for Older Adults: The Interface Between Personal Health Care and Public Health Services

PubMed Central

Richards, Chesley L.; Shenson, Douglas

2012-01-01

Healthy aging must become a priority objective for both population and personal health services, and will require innovative prevention programming to span those systems. Uptake of essential clinical preventive services is currently suboptimal among adults, owing to a number of system- and office-based care barriers. To achieve maximum health results, prevention must be integrated across community and clinical settings. Many preventive services are portable, deliverable in either clinical or community settings. Capitalizing on that flexibility can improve uptake and health outcomes. Significant reductions in health disparities, mortality, and morbidity, along with decreases in health spending, are achievable through improved collaboration and synergy between population health and personal health systems. PMID:22390505

The influence of nursing care integration services on nurses' work satisfaction and quality of nursing care.

PubMed

Ryu, Jeong-Im; Kim, Kisook

2018-06-20

To investigate differences in work satisfaction and quality of nursing services between nurses from the nursing care integration service and general nursing units in Korea. The nursing care integration service was recently introduced in Korea to improve patient health outcomes through the provision of high quality nursing services and to relieve the caregiving burden of patients' families. In this cross-sectional study, data were collected from a convenience sample of 116 and 156 nurses working in nursing care integration service and general units, respectively. The data were analysed using descriptive statistics, t tests and one-way analysis of variance. Regarding work satisfaction, nursing care integration service nurses scored higher than general unit nurses on professional status, autonomy and task requirements, but the overall scores showed no significant differences. Scores on overall quality of nursing services, responsiveness and assurance were higher for nursing care integration service nurses than for general unit nurses. Nursing care integration service nurses scored higher than general unit nurses on some aspects of work satisfaction and quality of nursing services. Further studies with larger sample sizes will contribute to improving the quality of nursing care integration service units. These findings can help to establish strategies for the implementation and efficient operation of the nursing care integration service system, for the improvement of the quality of nursing services, and for successfully implementing and expanding nursing care integration service services in other countries. © 2018 John Wiley & Sons Ltd.

Barriers to formal emergency obstetric care services' utilization.

PubMed

Essendi, Hildah; Mills, Samuel; Fotso, Jean-Christophe

2011-06-01

Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on "public relations" could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be

Validation of a clinical leadership qualities framework for managers in aged care: a Delphi study.

PubMed

Jeon, Yun-Hee; Conway, Jane; Chenoweth, Lynn; Weise, Janelle; Thomas, Tamsin Ht; Williams, Anna

2015-04-01

To establish validity of a clinical leadership framework for aged care middle managers (The Aged care Clinical Leadership Qualities Framework). Middle managers in aged care have responsibility not only for organisational governance also and operational management but also quality service delivery. There is a need to better define clinical leadership abilities in aged care middle managers, in order to optimise their positional authority to lead others to achieve quality outcomes. A Delphi method. Sixty-nine experts in aged care were recruited, representing rural, remote and metropolitan community and residential aged care settings. Panellists were asked to rate the proposed framework in terms of the relevance and importance of each leadership quality using four-point Likert scales, and to provide comments. Three rounds of consultation were conducted. The number and corresponding percentage of the relevance and importance rating for each quality was calculated for each consultation round, as well as mean scores. Consensus was determined to be reached when a percentage score reached 70% or greater. Twenty-three panellists completed all three rounds of consultation. Following the three rounds of consultation, the acceptability and face validity of the framework was confirmed. The study confirmed the framework as useful in identifying leadership requirements for middle managers in Australian aged care settings. The framework is the first validated framework of clinical leadership attributes for middle managers in aged care and offers an initial step forward in clarifying the aged care middle manager role. The framework provides clarity in the breadth of role expectations for the middle managers and can be used to inform an aged care specific leadership program development, individuals' and organisations' performance and development processes; and policy and guidelines about the types of activities required of middle managers in aged care. © 2014 John Wiley & Sons Ltd.

Examination of the utility of the promoting action on research implementation in health services framework for implementation of evidence based practice in residential aged care settings.

PubMed

Perry, Lin; Bellchambers, Helen; Howie, Andrew; Moxey, Annette; Parkinson, Lynne; Capra, Sandra; Byles, Julie

2011-10-01

This study examined the relevance and fit of the PARiHS framework (Promoting Action on Research Implementation in Health Services) as an explanatory model for practice change in residential aged care. Translation of research knowledge into routine practice is a complex matter in health and social care environments. Examination of the environment may identify factors likely to support and hinder practice change, inform strategy development, predict and explain successful uptake of new ways of working. Frameworks to enable this have been described but none has been tested in residential aged care. This paper reports preliminary qualitative analyses from the Encouraging Best Practice in Residential Aged Care Nutrition and Hydration project conducted in New South Wales in 2007-2009. We examined congruence with the PARiHS framework of factors staff described as influential for practice change during 29 digitally recorded and transcribed staff interviews and meetings at three facilities. Unique features of the setting were flagged, with facilities simultaneously filling the roles of residents' home, staff's workplace and businesses. Participants discussed many of the same characteristics identified by the PARiHS framework, but in addition temporal dimensions of practice change were flagged. Overall factors described by staff as important for practice change in aged care settings showed good fit with those of the PARiHS framework. This framework can be recommended for use in this setting. Widespread adoption will enable cross-project and international synthesis of findings, a major step towards building a cumulative science of knowledge translation and practice change. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

[Comparison of Patients and their Care in Urban and Rural Specialised Palliative Home Care - A Single Service Analysis].

PubMed

Heckel, M; Stiel, S; Frauendorf, T; Hanke, R M; Ostgathe, C

2016-07-01

Specialised outpatient palliative care teams (in Germany called SAPV) aim to ensure best possible end-of-life care for outpatients with complex needs. Information on the influence of living areas (rural vs. urban) on patient and care related aspects is rare. This study aims to explore differences between palliative care patients in urban and rural dwellings concerning their nursing and service characteristics. A retrospective data analysis of documentary data for 502 patients supplied by SAPV team from December 2009 to June 2012 was conducted. Patients and care characteristics were investigated by frequency analysis and were compared for both groups of urban and rural dwelling patients (T test, Chi², Fisher's exact test p < 0.05). 387 complete data sets could be included. Urban (n=197) and rural (n=190) dwelling patients were almost equally sized groups. The mean age of the whole sample was 74.5 years, 55.3% were female. Most patients were diagnosed with cancer (76.8%). No significant differences in urban and rural dwelling patients concerning most demographics, care, disease and service related aspects of palliative home care could be detected. An exception is that the rate of re-admittance to hospital is higher for rural dwelling patients (Fisher's exact test p=0.022). Although predominantly presumed, the single service analysis shows - except for the re-admittance rate to hospital - no considerable differences between palliative care patients regarding their living area. Our findings indicate that patients cared for in rural and urban settings have similar needs and impose similar requirements on palliative care teams. © Georg Thieme Verlag KG Stuttgart · New York.

Qualitative focus group study investigating experiences of accessing and engaging with social care services: perspectives of carers from diverse ethnic groups caring for stroke survivors.

PubMed

Greenwood, Nan; Holley, Jess; Ellmers, Theresa; Mein, Gill; Cloud, Geoffrey

2016-01-29

Informal carers, often family members, play a vital role in supporting stroke survivors with post-stroke disability. As populations age, numbers of carers overall and those from minority ethnic groups in particular, are rising. Carers from all ethnic groups, but especially those from black and minority ethnic groups frequently fail to access support services, making understanding their experiences important. The study therefore explored the experiences of carers of stroke survivors aged 45+ years from 5 ethnic groups in accessing and receiving social care services after hospital discharge. This qualitative study used 7 recorded focus groups with informal carers of stroke survivors. Data were analysed thematically focusing on similarities and differences between ethnic groups. Carers were recruited from voluntary sector organisations supporting carers, stroke survivors and black and minority ethnic groups in the UK. 41 carers from 5 ethnic groups (Asian Indian, Asian Pakistani, black African, black Caribbean, white British) participated in the focus groups. Several interconnected themes were identified including: the service gap between hospital discharge and home; carers as the best person to care and cultural aspects of caring and using services. Many themes were common to all the included ethnic groups but some related to specific groups. Across ethnic groups there were many similarities in the experiences of people caring for stroke survivors with complex, long-term care needs. Accessing services demands effort and persistence on carers' part. If carers believe services are unsatisfactory or that they, rather than formal services, should be providing support for stroke survivors, they are unlikely to persist in their efforts. Cultural and language differences add to the challenges black and minority ethnic group carers face. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Developing and utilising a new funding model for home-care services in New Zealand.

PubMed

Parsons, Matthew; Rouse, Paul; Sajtos, Laszlo; Harrison, Julie; Parsons, John; Gestro, Lisa

2018-05-01

Worldwide increases in the numbers of older people alongside an accompanying international policy incentive to support ageing-in-place have focussed the importance of home-care services as an alternative to institutionalisation. Despite this, funding models that facilitate a responsive, flexible approach are lacking. Casemix provides one solution, but the transition from the well-established hospital system to community has been problematic. This research seeks to develop a Casemix funding solution for home-care services through meaningful client profile groups and supporting pathways. Unique assessments from 3,135 older people were collected from two health board regions in 2012. Of these, 1,009 arose from older people with non-complex needs using the interRAI-Contact Assessment (CA) and 2,126 from the interRAI-Home-Care (HC) from older people with complex needs. Home-care service hours were collected for 3 months following each assessment and the mean weekly hours were calculated. Data were analysed using a decision tree analysis, whereby mean hours of weekly home-care was the dependent variable with responses from the assessment tools, the independent variables. A total of three main groups were developed from the interRAI-CA, each one further classified into "stable" or "flexible." The classification explained 16% of formal home-care service hour variability. Analysis of the interRAI-HC generated 33 clusters, organised through eight disability "sub" groups and five "lead" groups. The groupings explained 24% of formal home-care services hour variance. Adopting a Casemix system within home-care services can facilitate a more appropriate response to the changing needs of older people. © 2017 John Wiley & Sons Ltd.

Up-to-Date on Preventive Care Services Under Affordable Care Act: A Trend Analysis From MEPS 2007-2014.

PubMed

Hong, Young-Rock; Jo, Ara; Mainous, Arch G

2017-08-01

The utilization of preventive care services has been less than optimal. As part of an effort to address this, the Affordable Care Act (ACA) mandated that private health insurance plans cover evidence-based preventive services. To evaluate whether the provisions of ACA have increased being up-to-date on recommended preventive care services among privately insured individuals aged 18-64. Multivariate linear regression models were used to examine trends in prevalence of being up-to-date on selected preventive services, diagnosis of health conditions, and health expenditures between pre-ACA (2007-2010) and post-ACA (2011-2014). Adjusted difference-in-difference analyses were used to estimate changes in those outcomes in the privately insured that differed from changes in the uninsured (control group). After the passage of ACA, up-to-date rates of routine checkup (2.7%; 95% confidence interval, 0.8%-4.7%; P=0.007) and flu vaccination (5.9%; 95% confidence interval, 4.2%-7.6%; P<0.001) increased among those with private insurance, as compared with the control group. Changes in blood pressure check, cholesterol check and cancer screening (pap smear test, mammography, and colorectal cancer screening) were not associated with the ACA. Prevalence in diagnosis of health conditions remained constant. Slower uptrends in adjusted total health care expenditures and downtrends in adjusted out-of-pocket costs were observed during the study period. The provisions of the ACA have resulted in trivial increases in being up-to-date on selected preventive care services. Additional efforts may be required to take full advantage of the elimination of cost-sharing under the ACA.

A systematic review of integrated working between care homes and health care services

PubMed Central

2011-01-01

Background In the UK there are almost three times as many beds in care homes as in National Health Service (NHS) hospitals. Care homes rely on primary health care for access to medical care and specialist services. Repeated policy documents and government reviews register concern about how health care works with independent providers, and the need to increase the equity, continuity and quality of medical care for care homes. Despite multiple initiatives, it is not known if some approaches to service delivery are more effective in promoting integrated working between the NHS and care homes. This study aims to evaluate the different integrated approaches to health care services supporting older people in care homes, and identify barriers and facilitators to integrated working. Methods A systematic review was conducted using Medline (PubMed), CINAHL, BNI, EMBASE, PsycInfo, DH Data, Kings Fund, Web of Science (WoS incl. SCI, SSCI, HCI) and the Cochrane Library incl. DARE. Studies were included if they evaluated the effectiveness of integrated working between primary health care professionals and care homes, or identified barriers and facilitators to integrated working. Studies were quality assessed; data was extracted on health, service use, cost and process related outcomes. A modified narrative synthesis approach was used to compare and contrast integration using the principles of framework analysis. Results Seventeen studies were included; 10 quantitative studies, two process evaluations, one mixed methods study and four qualitative. The majority were carried out in nursing homes. They were characterised by heterogeneity of topic, interventions, methodology and outcomes. Most quantitative studies reported limited effects of the intervention; there was insufficient information to evaluate cost. Facilitators to integrated working included care home managers' support and protected time for staff training. Studies with the potential for integrated working were longer in

Late referral to palliative care services in Korea.

PubMed

Baek, Young Ji; Shin, Dong Wook; Choi, Jin Young; Kang, Jina; Mo, Ha Na; Kim, Yang Hyeok; Kim, Sohee; Jung, Kyu Won; Joo, Jisoo; Park, Eun-Cheol

2011-04-01

Although timely referral to palliative care services can help improve quality of life by minimizing patient and family suffering during a life-threatening illness, it remains unclear whether patients in Korea who suffer from advanced cancer are referred to palliative care services in a timely manner. We aimed to investigate the timeliness of patient referral to palliative care services in Korea by examining the duration of survival after enrollment and identify the factors contributing to earlier or later referral. Patient- and episode-level data were collected from 3867 terminal cancer patients, who were registered in 34 inpatient palliative care services designated by the Ministry of Health, Welfare, and Family Affairs. Cox proportional hazard models were used to determine factors associated with the duration of survival after enrollment in palliative care services. The median duration of survival after enrollment in palliative care services was 18 days. Male sex, liver cancer diagnosis, poor performance status, being covered by National Health Insurance, and being married were significantly associated with shorter duration of survival after enrollment, whereas a prostate cancer diagnosis was associated with longer survival. Korean terminal cancer patients are referred to palliative care very late, and the timing appears to be influenced by some socioeconomic and medical factors. Interventions, such as physician education and establishing palliative care teams, are required to promote earlier referrals in Korea. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Older people and falls: health status, quality of life, lifestyle, care networks, prevention and views on service use following a recent fall.

PubMed

Roe, Brenda; Howell, Fiona; Riniotis, Konstantinos; Beech, Roger; Crome, Peter; Ong, Bie Nio

2009-08-01

This study has investigated older people's experiences of a recent fall, its impact on their health, lifestyle, quality of life, care networks, prevention and their views on service use. Falls are common in older people and prevalence increases with age. Falls prevention is a major policy and service initiative. An exploratory, qualitative design involving two time points. A convenience sample of 27 older people from two primary care trusts who had a recent fall. Taped semi structured qualitative interviews were conducted and repeated at follow up to detect change over time and repeat falls. Data were collected on their experience of falls, health, activities of living, lifestyle, quality of life, use of services, prevention of falls, informal care and social networks. Content analysis of transcribed interviews identified key themes. The majority of people fell indoors (n = 23), were repeat fallers (n = 22) with more than half alone when they fell (n = 15). For five people it was their first ever fall. Participants in primary care trust 1 had a higher mean age than those in primary care trust 2 and had more injurious falls (n = 12, mean age 87 years vs. n = 15, mean age 81 years). The majority of non-injurious falls went unreported to formal services. Falls can result in a decline in health status, ability to undertake activities of living, lifestyle and quality of life. Local informal care and support networks are as important as formal care for older people at risk of falls or who have fallen. Access to falls prevention programmes and services is limited for people living in more rural communities. Falls prevention initiatives and services should work with local communities, agencies and informal carers to ensure equitable access and provision of information, resources and care to meet the needs of older people at risk or who have fallen.

Provision of dental care in aged care facilities NSW Australia- Part 2 as perceived by the carers (care providers).

PubMed

Webb, Bettine C; Whittle, Terry; Schwarz, Eli

2015-12-01

To investigate carers' perception of the provision of dental care in aged care facilities (ACFs) New South Wales (NSW), Australia. Carers are responsible for 'hands-on, day-to-day' care of residents, including dental care, yet there were no specific figures available concerning their role in NSW ACFs. Questionnaires were mailed to 406 NSW directors of nursing (DONs) requesting completion by a carer who was proficient in English and without the influence of the DON. The 23-item questionnaire was presented in 4 sections, and the data qualitatively analysed. 211 questionnaires were completed and returned, giving a response rate of 52%. Carers were mostly female (91.9%) in the 40-50 and >50 age groups. Oral health training had been received by 66.7% of carers, and although 73.2% thought that their training was adequate, carers in general requested further training. Long waiting periods for government dental services (69.4%) and resident unable to communicate oral health problems (69.2%) were seen as the most frequent barriers to dental care. Almost all carers reported the availability of electric tooth brushes, fluoride gel, disclosing tablets/gel, interdental brushes and the use of a foam mouth prop, while few reported the use of other dental care products. As carers provided almost all of oral health care for residents, emphasis should be placed on training in geriatric dental care techniques and use of dental products. © 2013 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.

Foster care re-entry: Exploring the role of foster care characteristics, in-home child welfare services and cross-sector services☆

PubMed Central

Lee, Sangmoo; Jonson-Reid, Melissa; Drake, Brett

2013-01-01

This study seeks to advance our understanding of how modifiable and non-modifiable factors may impact the likelihood of re-entry into foster care. Children who entered foster care for the first time following at least one report of maltreatment and were then reunified were followed from exit to re-entry, age 18 or the end of the study period using longitudinal administrative data. Risk of re-entry was explored according to a range of modifiable and non-modifiable case and service characteristics. Children removed from homes with parents who had multiple risk factors (e.g., no high school diploma, mental health diagnosis, criminal record, or teen parents) or were receiving AFDC prior to entry were more likely to re-enter. The receipt of in-home child welfare services during or after foster care was associated with reduced risk of re-entry. Having the longest placement with a relative was associated with decreased risk of re-entry. In conclusion, both modifiable and non-modifiable factors are associated with re-entry into foster care. Among modifiable factors, services appear to have a particularly strong relationship to re-entry. Our data also suggest that in-home child welfare services provided during and after foster care may be associated with improved long-term permanency after return home. Given the continued import of caregiver risk factors even among reunified families, services provided to support reunification should include attention to caregiver needs outside parenting. PMID:23729947

[eLearning service for home palliative care].

PubMed

Sakuyama, Toshikazu; Komatsu, Kazuhiro; Inoue, Daisuke; Fukushima, Osamu

2008-12-01

In order to support the home palliative care learning, we made the eLearning service for home palliative care (beta version) and tried to teach the palliative care to the medical staffs in the community. The various learners (such as nurses, pharmacists and the like) accessed to the online learning and used this eLearning service. After the learners finished eLearning for home palliative care, some questionnaires were distributed to the learners and analyzed by us. The analysis of questionnaires revealed that almost all were satisfied with our eLearning services. Especially the learners were not only interested in using the skills of opioids and the management of pain control, but they had a good cognition for the usage of opioids.

Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study).

PubMed

Beckett, Kate; Earthy, Sarah; Sleney, Jude; Barnes, Jo; Kellezi, Blerina; Barker, Marcus; Clarkson, Julie; Coffey, Frank; Elder, Georgina; Kendrick, Denise

2014-07-08

To explore views of service providers caring for injured people on: the extent to which services meet patients' needs and their perspectives on factors contributing to any identified gaps in service provision. Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers' views were elicited through semistructured interviews. Data were analysed using thematic analysis. Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. 40 service providers from a range of disciplines. Service providers described two distinct models of trauma care: an 'ideal' model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a 'real' model based on the realities of National Health Service (NHS) practice. Participants' 'ideal' model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, 'real' care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients' needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Service providers envisage an 'ideal' model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between 'real' and 'ideal' care. Using service provider views to inform service design

Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study)

PubMed Central

Beckett, Kate; Earthy, Sarah; Sleney, Jude; Barnes, Jo; Kellezi, Blerina; Barker, Marcus; Clarkson, Julie; Coffey, Frank; Elder, Georgina; Kendrick, Denise

2014-01-01

Objective To explore views of service providers caring for injured people on: the extent to which services meet patients’ needs and their perspectives on factors contributing to any identified gaps in service provision. Design Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers’ views were elicited through semistructured interviews. Data were analysed using thematic analysis. Setting Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. Participants 40 service providers from a range of disciplines. Results Service providers described two distinct models of trauma care: an ‘ideal’ model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a ‘real’ model based on the realities of National Health Service (NHS) practice. Participants’ ‘ideal’ model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, ‘real’ care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients’ needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Conclusions Service providers envisage an ‘ideal’ model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap

Dementia and Out-of-Pocket Spending on Health Care Services

PubMed Central

Delavande, Adeline; Hurd, Michael D.; Martorell, Francisco; Langa, Kenneth M.

2014-01-01

Background High levels of out-of-pocket (OOP) spending for health care may lead patients to forego needed services and medications, as well as hamper their ability to pay for other essential goods. Dementia, because it leads to disability and the loss of independence may put patients and their families at risk for high OOP spending, especially for long-term care services. Methods We used data from the Aging, Demographics, and Memory Study, a nationally representative sub-sample (n=743) of the Health and Retirement Study, to determine whether individuals with dementia had higher self-reported OOP spending compared to those with cognitive impairment without dementia (CIND) and those with normal cognitive function. We also examined the relationship between dementia and utilization of dental care and prescription medications, two types of health care that are frequently paid for out-of-pocket. Multivariate and logistic regression models were used to adjust for the influence of potential confounders. Results After controlling for demographics and comorbidities, those with dementia had more than three times the yearly OOP spending compared to those with normal cognition ($8,216 for those with dementia vs. $2,570 for those with normal cognition, p<.01) Higher OOP spending for those with dementia was mainly driven by greater expenditures on nursing home care (p<.01). Dementia was not associated with the likelihood of visiting the dentist (p=0.76) or foregoing prescription medications due to cost (p=.34). Conclusions Dementia is associated with high levels of OOP spending, but not with the use of dental care or foregoing prescription medications, suggesting that excess OOP spending among those with dementia does not “crowd out” spending on these other health care services. PMID:23154049

Spatial analysis of elderly access to primary care services.

PubMed

Mobley, Lee R; Root, Elisabeth; Anselin, Luc; Lozano-Gracia, Nancy; Koschinsky, Julia

2006-05-15

Admissions for Ambulatory Care Sensitive Conditions (ACSCs) are considered preventable admissions, because they are unlikely to occur when good preventive health care is received. Thus, high rates of admissions for ACSCs among the elderly (persons aged 65 or above who qualify for Medicare health insurance) are signals of poor preventive care utilization. The relevant geographic market to use in studying these admission rates is the primary care physician market. Our conceptual model assumes that local market conditions serving as interventions along the pathways to preventive care services utilization can impact ACSC admission rates. We examine the relationships between market-level supply and demand factors on market-level rates of ACSC admissions among the elderly residing in the U.S. in the late 1990s. Using 6,475 natural markets in the mainland U.S. defined by The Health Resources and Services Administration's Primary Care Service Area Project, spatial regression is used to estimate the model, controlling for disease severity using detailed information from Medicare claims files. Our evidence suggests that elderly living in impoverished rural areas or in sprawling suburban places are about equally more likely to be admitted for ACSCs. Greater availability of physicians does not seem to matter, but greater prevalence of non-physician clinicians and international medical graduates, relative to U.S. medical graduates, does seem to reduce ACSC admissions, especially in poor rural areas. The relative importance of non-physician clinicians and international medical graduates in providing primary care to the elderly in geographic areas of greatest need can inform the ongoing debate regarding whether there is an impending shortage of physicians in the United States. These findings support other authors who claim that the existing supply of physicians is perhaps adequate, however the distribution of them across the landscape may not be optimal. The finding that elderly

Does size matter in aged care facilities? A literature review of the relationship between the number of facility beds and quality.

PubMed

Baldwin, Richard; Chenoweth, Lynnette; Dela Rama, Marie; Wang, Alex Y

Theory suggests that structural factors such as aged care facility size (bed numbers) will influence service quality. There have been no recent published studies in support of this theory, and consequently, the available literature has not been useful in assisting decision makers with investment decisions on facility size. The study aimed to address that deficit by reviewing the international literature on the relationships between the size of residential aged care facilities, measured by number of beds, and service quality. A systematic review identified 30 studies that reported a relationship between facility size and quality and provided sufficient details to enable comparison. There are three groups of studies based on measurement of quality-those measuring only resident outcomes, those measuring care and resident outcomes using composite tools, and those focused on regulatory compliance. The overall findings support the posited theory to a large extent, that size is a factor in quality and smaller facilities yield the most favorable results. Studies using multiple indicators of service quality produced more consistent results in favor of smaller facilities, as did most studies of regulatory compliance. The theory that aged care facility size (bed numbers) will influence service quality was supported by 26 of the 30 studies reviewed. The review findings indicate that aged care facility size (number of beds) may be one important factor related to service quality. Smaller facilities are more likely to result in higher quality and better outcomes for residents than larger facilities. This has implications for those who make investment decisions concerning aged care facilities. The findings also raise implications for funders and policy makers to ensure that regulations and policies do not encourage the building of facilities inconsistent with these findings.

From Child Care to Family Care: The Parent Services Handbook.

ERIC Educational Resources Information Center

San Francisco Foundation, CA.

This handbook for child care centers that are expanding their support to parents of children in their programs begins by describing the Parent Services Project (PSP). The next section explains the many services available to parents and the variety of ways these services are provided at the PSP centers. Services include fun family events; parenting…

Choosing wisely: prevalence and correlates of low-value health care services in the United States.

PubMed

Colla, Carrie H; Morden, Nancy E; Sequist, Thomas D; Schpero, William L; Rosenthal, Meredith B

2015-02-01

Specialty societies in the United States identified low-value tests and procedures that contribute to waste and poor health care quality via implementation of the American Board of Internal Medicine Foundation's Choosing Wisely initiative. To develop claims-based algorithms, to use them to estimate the prevalence of select Choosing Wisely services and to examine the demographic, health and health care system correlates of low-value care at a regional level. Using Medicare data from 2006 to 2011, we created claims-based algorithms to measure the prevalence of 11 Choosing Wisely-identified low-value services and examined geographic variation across hospital referral regions (HRRs). We created a composite low-value care score for each HRR and used linear regression to identify regional characteristics associated with more intense use of low-value services. Fee-for-service Medicare beneficiaries over age 65. Prevalence of selected Choosing Wisely low-value services. The national average annual prevalence of the selected Choosing Wisely low-value services ranged from 1.2% (upper urinary tract imaging in men with benign prostatic hyperplasia) to 46.5% (preoperative cardiac testing for low-risk, non-cardiac procedures). Prevalence across HRRs varied significantly. Regional characteristics associated with higher use of low-value services included greater overall per capita spending, a higher specialist to primary care ratio and higher proportion of minority beneficiaries. Identifying and measuring low-value health services is a prerequisite for improving quality and eliminating waste. Our findings suggest that the delivery of wasteful and potentially harmful services may be a fruitful area for further research and policy intervention for HRRs with higher per-capita spending. These findings should inform action by physicians, health systems, policymakers, payers and consumer educators to improve the value of health care by targeting services and areas with greater use of

People diagnosed with dementia in Sweden: What type of home care services and housing are they granted? A cross-sectional study.

PubMed

Odzakovic, Elzana; Hydén, Lars-Christer; Festin, Karin; Kullberg, Agneta

2018-02-01

This study aims to examine what types of home care services and housing are granted to people with a dementia diagnosis and how these types are associated with socio-demographic factors (sex, age, marital status, native or foreign born, and regional area). A cross-sectional study of all people diagnosed with dementia in three Swedish counties was conducted from the medical records in 2012. Logistic regression analysis was carried out to investigate associations between home care services and housing and socio-demographic variables. In total, 17,405 people had a dementia diagnosis, and the majority were women, aged 80+ years, and unmarried. Some 72% were living in ordinary housing and 28% lived in special housing. Of those who lived in ordinary housing, 50% did not receive any home care service. Not receiving any type of home care services was less common for older people and was also associated with being married and living in rural municipalities. The most common home care services granted were home help and personal care. Special housing was more common for older people, unmarried persons, and those living in rural municipalities. Most people with a dementia diagnosis were living in ordinary housing, and, surprisingly, half of those did not receive any type of home care service. This knowledge is essential for making the living conditions and needs of people living with dementia more visible and to provide good home care services for people with dementia and their families.

45 CFR 98.44 - Priority for child care services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Priority for child care services. 98.44 Section 98.44 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Program Operations (Child Care Services)-Lead Agency and Provider Requirements § 98.44...

45 CFR 98.44 - Priority for child care services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Priority for child care services. 98.44 Section 98.44 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Program Operations (Child Care Services)-Lead Agency and Provider Requirements § 98.44...

45 CFR 98.44 - Priority for child care services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Priority for child care services. 98.44 Section 98.44 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Program Operations (Child Care Services)-Lead Agency and Provider Requirements § 98.44...

45 CFR 98.44 - Priority for child care services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Priority for child care services. 98.44 Section 98.44 Public Welfare Department of Health and Human Services GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Program Operations (Child Care Services)-Lead Agency and Provider Requirements § 98.44...

45 CFR 98.44 - Priority for child care services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Priority for child care services. 98.44 Section 98.44 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION CHILD CARE AND DEVELOPMENT FUND Program Operations (Child Care Services)-Lead Agency and Provider Requirements § 98.44...

Satisfaction with the local service point for care: results of an evaluation study

PubMed Central

Esslinger, Adelheid Susanne; Macco, Katrin; Schmidt, Katharina

2009-01-01

Purpose The market of care increases and is characterized by complexity. Therefore, service points, such as the ‘Zentrale Anlaufstelle Pflege (ZAPf)’ in Nuremberg, are helpful for clients to get orientation. The purpose of the presentation is to show the results of an evaluation study about the clients' satisfaction with the offers of ZAPf. Study Satisfaction with service may be measured with the SERVQUAL concept introduced by Parasuraman et al. (1988). They found out five dimensions of quality (tangibles, reliability, responsiveness, assurances and empathy). We took these dimensions in our study. The study focuses on the quality of service and the benefits recognized by clients. In spring 2007, we conducted 67 interviews by phone, based on a half standardized questionnaire. Statistical analysis was conducted using SPSS. Results The clients want to get information about care in general, financial and legal aspects, alternative care arrangement (e.g. ambulant, long-term care) and typical age-related diseases. They show a high satisfaction with the service provided. Their benefits are to get information and advice, to strengthen the ability of decision taking, to cope with changing situations in life, and to develop solutions. Conclusions The results show that the quality of service is on a high level. Critical success factors are the interdisciplinary cooperation at the service point, based on a regularly and open exchange of information. Every member focuses on an optimal individual solution for the client. Local professional service points act as networkers and brokers. They serve not only for the clients' needs but also support the effective and efficient provision of optimized care.

Development and evaluation of an aged care specific Advance Care Plan.

PubMed

Silvester, William; Parslow, Ruth A; Lewis, Virginia J; Fullam, Rachael S; Sjanta, Rebekah; Jackson, Lynne; White, Vanessa; Hudson, Rosalie

2013-06-01

To report on the quality of advance care planning (ACP) documents in use in residential aged care facilities (RACF) in areas of Victoria Australia prior to a systematic intervention; to report on the development and performance of an aged care specific Advance Care Plan template used during the intervention. An audit of the quality of pre-existing documentation used to record resident treatment preferences and end-of-life wishes at participating RACFs; development and pilot of an aged care specific Advance Care Plan template; an audit of the completeness and quality of Advance Care Plans completed on the new template during a systematic ACP intervention. 19 selected RACFs (managed by 12 aged care organisations) in metropolitan and regional areas of Victoria. Documentation in use at facilities prior to the ACP intervention most commonly recorded preferences regarding hospital transfer, life prolonging treatment and personal/cultural/religious wishes. However, 7 of 12 document sets failed to adequately and clearly specify the resident's preferences as regards life prolonging medical treatment. The newly developed aged care specific Advance Care Plan template was met with approval by participating RACFs. Of 203 Advance Care Plans completed on the template throughout the project period, 49% included the appointment of a Medical Enduring Power of Attorney. Requests concerning medical treatment were specified in almost all completed documents (97%), with 73% nominating the option of refusal of life-prolonging treatment. Over 90% of plans included information concerning residents' values and beliefs, and future health situations that the resident would find to be unacceptable were specified in 78% of completed plans. Standardised procedures and documentation are needed to improve the quality of processes, documents and outcomes of ACP in the residential aged care sector.

Mental health care treatment initiation when mental health services are incorporated into primary care practice.

PubMed

Kessler, Rodger

2012-01-01

Most primary care patients with mental health issues are identified or treated in primary care rather than the specialty mental health system. Primary care physicians report that their patients do not have access to needed mental health care. When referrals are made to the specialty behavioral or mental health care system, rates of patients who initiate treatment are low. Collaborative care models, with mental health clinicians as part of the primary care medical staff, have been suggested as an alternative. The aim of this study is to examine rates of treatment startup in 2 collaborative care settings: a rural family medicine office and a suburban internal medicine office. In both practices referrals for mental health services are made within the practice. Referral data were drawn from 2 convenience samples of patients referred by primary care physicians for collaborative mental health treatment at Fletcher Allen Health Care in Vermont. The first sample consisted of 93 consecutively scheduled referrals in a family medicine office (sample A) between January 2006 and December 2007. The second sample consisted of 215 consecutive scheduled referrals at an internal medicine office (sample B) between January 2009 and December 2009. Referral data identified age, sex, and presenting mental health/medical problem. In sample A, 95.5% of those patients scheduling appointments began behavioral health treatment; in sample B this percentage was 82%. In sample B, 69% of all patients initially referred for mental health care both scheduled and initiated treatment. When referred to a mental health clinician who provides on-site access as part of a primary care mental health collaborative care model, a high percentage of patients referred scheduled care. Furthermore, of those who scheduled care, a high percentage of patients attend the scheduled appointment. Findings persist despite differences in practice type, populations, locations, and time frames of data collection. That the

Developing a culturally appropriate mental health care service for Samoa.

PubMed

Enoka, Matamua Iokapeta Sina; Tenari, Aliilelei; Sili, Tupou; Peteru, Latama; Tago, Pisaina; Blignault, Ilse

2013-06-01

Mental Health Care Services are part of the National Health Services for Samoa. Their function is to provide mental health care services to the population of Samoa, which numbers 180,000 people. However, like many other countries in the Pacific region, mental health is considered a low priority. The mental health budget allocation barely covers the operation of mental health care services. More broadly, there is a lack of political awareness about mental health care services and mental health rarely becomes an issue of deliberation in the political arena. This article outlines the recent development of mental health care services in Samoa, including the Mental Health Policy 2006 and Mental Health Act 2007. It tells the story of the successful integration of aiga (family) as an active partner in the provision of care, and the development of the Aiga model utilizing Samoan cultural values to promote culturally appropriate family-focused community mental health care for Samoa. Mental Health Care Services today encompass both clinical and family-focused community mental health care services. The work is largely nurse-led. Much has been achieved over the past 25 years. Increased recognition by government and increased resourcing are necessary to meet the future health care needs of the Samoan people. Copyright © 2012 Wiley Publishing Asia Pty Ltd.

Enhancing resilience in registered aged care nurses.

PubMed

Cameron, Fiona; Brownie, Sonya

2010-06-01

To identify the factors that impact the resilience of registered aged care nurses, that is their capacity to adapt to the physical, mental and emotional demands of working in aged care facilities. This study explored the lived experience of nine registered nurses working in residential aged care facilities on the Sunshine Coast, Queensland, who were asked to reflect on the phenomenon of resilience in the workplace. This study found that clinical expertise, a sense of purpose in a holistic care environment, a positive attitude and work-life balance are important determinants of resilience in aged care nurses. Resilience in nurses in residential aged care facilities is enhanced when they are able to maintain long-term, meaningful relationships with residents. Collegial support that provides opportunities to debrief and validate experiences as well as the use of humour to defuse stress promotes well-being and builds resilience in the workplace.

Primary Health Care and tuberculosis: services evaluation.

PubMed

Wysocki, Anneliese Domingues; Ponce, Maria Amélia Zanon; Brunello, Maria Eugênia Firmino; Beraldo, Aline Ale; Vendramini, Silvia Helena Figueiredo; Scatena, Lúcia Marina; Ruffino, Antonio; Villa, Tereza Cristina Scatena

2017-01-01

In order to control tuberculosis, the Brazilian Ministry of Health recommends the decentralization of control actions directed to the Primary Health Care, and there are few studies on the performance of the Tuberculosis Control Program in decentralized contexts. To evaluate the performance of Primary Health Care services in tuberculosis treatment. This is an evaluative study with cross-sectional approach conducted in 2011. Two hundred and thirty-nine health professionals from Primary Health Care units were interviewed using a structured instrument based on the evaluation reference of the health services quality (structure - process - results). The performance of these services was analyzed applying techniques of descriptive statistics, validation, and construction of indicators and by determining the reduced variable "Z". The indicators "participation of professionals in tuberculosis patients' care" (structure) and "reference and counterreference" (process) had the best evaluations, whereas "professional training" (structure) and "external actions for tuberculosis control" (process) had the worst results. The decentralization of tuberculosis control actions has been taking place in a vertical manner in Primary Health Care. The challenge of controlling tuberculosis involves overcoming constraints related to the engagement, training, and turnover rates among health professionals, which is a coordination between services and monitoring of control actions in Primary Health Care.

Residential aged care in Auckland, New Zealand 1988-2008: do real trends over time match predictions?

PubMed

Broad, Joanna B; Boyd, Michal; Kerse, Ngaire; Whitehead, Noeline; Chelimo, Carol; Lay-Yee, Roy; von Randow, Martin; Foster, Susan; Connolly, Martin J

2011-07-01

in Auckland, New Zealand in 1988, 7.7% of those aged over 65 years lived in licenced residential aged care. Age-specific rates approximately doubled for each 5-year age group after the age of 65 years. Even with changes in policies and market forces since 1988, population increases are forecast to drive large growth in demand. This study shows previously unrecognised 20-year trends in rates of care in a geographically defined population. four cross-sectional surveys of all facilities (rest homes and hospitals) licenced for long-term care of older people were conducted in Auckland, New Zealand in 1988, 1993, 1998 and 2008. Facility staff completed survey forms for each resident. Numbers of licenced and occupied beds and trends in age-specific and age-standardised rates in residential aged care are reported. over the 20-year period, Auckland's population aged over 65 years increased by 43% (from 91,000 to 130,000) but actual numbers in care reduced slightly. Among those aged over 65 years, the proportion living in care facilities reduced from 1 in 13 to 1 in 18. Age-standardised rates in rest-home level care reduced from 65 to 33 per thousand, and in hospital level care, from 29 to 23 per thousand. Had rates remained stable, over 13,200 people, 74% more than observed, would have been in care in 2008. growth predicted in the residential aged care sector is not yet evident. The introduction of standardised needs assessments before entry, increased availability of home-based services, and growth in retirement villages may have led to reduced utilisation.

The relationship between access to and use of dental services following expansion of a primary care service to embrace dental team training.

PubMed

Wanyonyi, K L; Radford, D R; Gallagher, J E

2013-11-01

To investigate changes in the patient population and treatment case-mix within an expanded primary care dental training facility in Southern England. Cross-sectional analysis of patient management system data. Electronic data for patients with a closed/completed treatment plan in the 12-month period prior to, and following, dental service expansion were extracted for analysis (n = 4343). Descriptive analysis involved age, sex, payment status, deprivation status and treatment activity. Logistic regression was used to model the likelihood of treatment involving laboratory constructed devices (crowns, bridges, dentures), in relation to demography and deprivation in each time period. The volume of patients using the service increased by 48.3% (1749 cf 2594). The average age increased from 31.97 (95%CI: 30.8, 32.5) to 36.4 years (95%CI: 35.6, 37.1); greatest increase was in the over 75 years age-group (96%). The patient base became less deprived: patients exempt from payment reduced from 43.2% (n = 755) to 28.6% (n = 741) (P = 0.001) and the mean population deprivation score (IMD) reduced from 24.5 (95%CI: 23.8, 25.2) to 22.3 (95%CI: 21.7, 22.8). The volume and proportion of care involving laboratory constructed devices increased from 8.3% (n = 145) to 15.8% (n = 411) whilst assessments without interventive care decreased (34.5%-26.3%). On a logistic regression, the odds of having treatment involving laboratory constructed devices, increased with increasing age in both time periods 7% (95% CI: 1.06-1.08) and 6% (95% CI: 1.05-1.07) respectively. Furthermore, the odds increased by 38% OR: 1.38 (95% CI: 1.01-1.89) in period 2, for white patients. After adjusting for these effects, the odds of having care that involved laboratory constructed devices were less in period 2 than period 1 (100% cf 43%) for those who were technically exempt from payment (OR = 2.0; 95% CI 1.34 to 2.90 cf, OR = 1.43; 95% CI 1.13-1.81). The patient population altered in relation to age and socio

Evaluation of health care services provided for older adults in primary health care centers and its internal environment

PubMed Central

Alhamdan, Adel A.; Alshammari, Sulaiman A.; Al-Amoud, Maysoon M.; Hameed, Tariq A.; Al-Muammar, May N.; Bindawas, Saad M.; Al-Orf, Saada M.; Mohamed, Ashry G.; Al-Ghamdi, Essam A.; Calder, Philip C.

2015-01-01

Objectives: To evaluate the health care services provided for older adults by primary health care centers (PHCCs) in Riyadh, Kingdom of Saudi Arabia (KSA), and the ease of use of these centers by older adults. Methods: Between October 2013 and January 2014, we conducted a descriptive cross-sectional study of 15 randomly selected PHCCs in Riyadh City, KSA. The evaluation focused on basic indicators of clinical services offered and factors indicative of the ease of use of the centers by older adults. Evaluations were based upon the age-friendly PHCCs toolkit of the World Health Organization. Results: Coverage of basic health assessments (such as blood pressure, diabetes, and blood cholesterol) was generally good. However, fewer than half of the PHCCs offered annual comprehensive screening for the common age-related conditions. There was no screening for cancer. Counseling on improving lifestyle was provided by most centers. However, there was no standard protocol for counseling. Coverage of common vaccinations was poor. The layout of most PHCCs and their signage were good, except for lack of Braille signage. There may be issues of access of older adults to PHCCs through lack of public transport, limited parking opportunities, the presence of steps, ramps, and internal stairs, and the lack of handrails. Conclusions: Clinical services and the internal environment of PHCCs can be improved. The data will be useful for health-policy makers to improve PHCCs to be more age-friendly. PMID:26318467

Substitution of Formal and Informal Home Care Service Use and Nursing Home Service Use: Health Outcomes, Decision-Making Preferences, and Implications for a Public Health Policy.

PubMed

Chen, Chia-Ching; Yamada, Tetsuji; Nakashima, Taeko; Chiu, I-Ming

2017-01-01

The purposes of this study are: (1) to empirically identify decision-making preferences of long-term health-care use, especially informal and formal home care (FHC) service use; (2) to evaluate outcomes vs. costs based on substitutability of informal and FHC service use; and (3) to investigate health outcome disparity based on substitutability. The methods of ordinary least squares, a logit model, and a bivariate probit model are used by controlling for socioeconomic, demographic, and physical/mental health factors to investigate outcomes and costs based substitutability of informal and formal health-care use. The data come from the 2013 Japanese Study of Aging and Retirement (JSTAR), which is designed by Keizai-Sangyo Kenkyu-jo, Hitotsubashi University, and the University of Tokyo. The JSTAR is a globally comparable data survey of the elderly. There exists a complement relationship between the informal home care (IHC) and community-based FHC services, and the elasticity's ranges from 0.18 to 0.22. These are reasonable results, which show that unobservable factors are positively related to IHC and community-based FHC, but negatively related to nursing home (NH) services based on our bivariate probit model. Regarding health-care outcome efficiency issue, the IHC is the best one among three types of elderly care: IHC, community-based FHC, and NH services. Health improvement/outcome of elderly with the IHC is heavier concentrated on IHC services than the elderly care services by community-based FHC and NH care services. Policy makers need to address a diversity of health outcomes and efficiency of services based on providing services to elderly through resource allocation to the different types of long-term care. A provision of partial or full compensation for elderly care at home is recommendable and a viable option to improve their quality of lives.

The exhausting dilemmas faced by home-care service providers when enhancing participation among older adults receiving home care.

PubMed

Vik, Kjersti; Eide, Arne H

2012-09-01

Older adults wish to stay at home, participate in society and manage on their own as long as possible. Many older adults will, however, eventually become dependent on care and help to maintain their daily living. Thus, to enhance activity and participation also among older adults that receive home-based services, there is a strong need for development of knowledge-based practice regarding participation. The specific aim of this study is to explore how service providers perceive that their working conditions influence on their possibilities to promote participation among older adults, and more specifically, how they perceive the influence of their working conditions. A purposeful sampling strategy was applied, and six focus groups with professionals in two municipalities were conducted. The focus groups comprised four and six participants of varying ages, length of working experience and professions. A total of 30 service providers participated. The data were analysed by a constant comparative method following the guidelines from Grounded Theory. The analysis identified the categories 'encountering needs that cannot be met', 'expectations about participation', 'organisation of services' and 'professional standards' influencing the service delivery. During this analytical process, 'being on the verge' emerged as a core category that describes the service providers' experience of a stressful workday, i.e. when they had the feeling of working against their own professional standards and being pushed to their limits. The findings indicate how the professional standards of service providers on the whole are in line with health policy for in-home services. Policy objectives are, however, not always followed owing to different constraints at the level of service delivery. Along the path from political ideals to the practical execution of services, external circumstances related to the organisation of services are perceived as crucial. © 2012 The Authors. Scandinavian

Family-centred care delivery: comparing models of primary care service delivery in Ontario.

PubMed

Mayo-Bruinsma, Liesha; Hogg, William; Taljaard, Monica; Dahrouge, Simone

2013-11-01

To determine whether models of primary care service delivery differ in their provision of family-centred care (FCC) and to identify practice characteristics associated with FCC. Cross-sectional study. Primary care practices in Ontario (ie, 35 salaried community health centres, 35 fee-for-service practices, 32 capitation-based health service organizations, and 35 blended remuneration family health networks) that belong to 4 models of primary care service delivery. A total of 137 practices, 363 providers, and 5144 patients. Measures of FCC in patient and provider surveys were based on the Primary Care Assessment Tool. Statistical analyses were conducted using linear mixed regression models and generalized estimating equations. Patient-reported FCC scores were high and did not vary significantly by primary care model. Larger panel size in a practice was associated with lower odds of patients reporting FCC. Provider-reported FCC scores were significantly higher in community health centres than in family health networks (P = .035). A larger number of nurse practitioners and clinical services on-site were both associated with higher FCC scores, while scores decreased as the number of family physicians in a practice increased and if practices were more rural. Based on provider and patient reports, primary care reform strategies that encourage larger practices and more patients per family physician might compromise the provision of FCC, while strategies that encourage multidisciplinary practices and a range of services might increase FCC.

The adequacy of antenatal care services among slum residents in Addis Ababa, Ethiopia.

PubMed

Bayou, Yibeltal T; Mashalla, Yohana S; Thupayagale-Tshweneagae, Gloria

2016-06-15

There are recent efforts made to eliminate inequalities in the utilisation of basic health care services. More emphasis is given for improvement of health in developing countries including maternal and child health. However, disparities for the fast-growing population of urban poor are masked by the urban averages. The aim of this paper is to report on the findings of antenatal care adequacy among slum residents in Addis Ababa, Ethiopia. This was a quantitative and cross-sectional community based study design which employed a stratified two-stage cluster sampling technique to determine the sample. Data was collected using structured questionnaire administered to 870 women aged 15-49 years. Weighted 'backward selection' logistic regression models were employed to identify predictors of adequacy of antenatal care. Majority of slum residents did not have adequate antenatal care services with only 50.3, 20.2 and 11.0 % of the slum resident women initiated antenatal care early, received adequate antenatal care service contents and had overall adequate antenatal care services respectively. Educational status and place of ANC visits were important determinant factors for adequacy of ANC in the study area. Women with secondary and above educational status were 2.7 times more likely to receive overall adequate care compared to those with no formal education. Similarly, clients of private healthcare facilities were 2.2 times respectively more likely to receive overall adequate antenatal care compared to those clients of public healthcare facilities. In order to improve ANC adequacy in the study area, the policy-making, planning, and implementation processes should address the poor adequacy of ANC among the disadvantaged groups in particular and the slum residents in general.

Reimbursement for school nursing health care services: position statement.

PubMed

Lowe, Janet; Cagginello, Joan; Compton, Linda

2014-09-01

Children come to school with a variety of health conditions, varying from moderate health issues to multiple, severe chronic health illnesses that have a profound and direct impact on their ability to learn. The registered professional school nurse (hereinafter referred to as school nurse) provides medically necessary services in the school setting to improve health outcomes and promote academic achievement. The nursing services provided are reimbursable services in other health care settings, such as hospitals, clinics, and home care settings. The National Association of School Nurses (NASN) believes that school nursing services that are reimbursable nursing services in other health care systems should also be reimbursable services in the school setting, while maintaining the same high quality care delivery standards. Traditionally, local and state tax revenues targeted to fund education programs have paid for school nursing health services. School nurses are in a strategic position to advocate for improving clinical processes to better fit with community health care providers and to align reimbursements with proposed changes. Restructuring reimbursement programs will enable health care funding streams to assist in paying for school nursing services delivered to students in the school setting. Developing new innovative health financing opportunities will help to increase access, improve quality, and reduce costs. The goal is to promote a comprehensive and cost-effective health care delivery model that integrates schools, families, providers, and communities.

Qualitative focus group study investigating experiences of accessing and engaging with social care services: perspectives of carers from diverse ethnic groups caring for stroke survivors

PubMed Central

Greenwood, Nan; Holley, Jess; Ellmers, Theresa; Mein, Gill; Cloud, Geoffrey

2016-01-01

Objectives Informal carers, often family members, play a vital role in supporting stroke survivors with post-stroke disability. As populations age, numbers of carers overall and those from minority ethnic groups in particular, are rising. Carers from all ethnic groups, but especially those from black and minority ethnic groups frequently fail to access support services, making understanding their experiences important. The study therefore explored the experiences of carers of stroke survivors aged 45+ years from 5 ethnic groups in accessing and receiving social care services after hospital discharge. Design This qualitative study used 7 recorded focus groups with informal carers of stroke survivors. Data were analysed thematically focusing on similarities and differences between ethnic groups. Setting Carers were recruited from voluntary sector organisations supporting carers, stroke survivors and black and minority ethnic groups in the UK. Participants 41 carers from 5 ethnic groups (Asian Indian, Asian Pakistani, black African, black Caribbean, white British) participated in the focus groups. Results Several interconnected themes were identified including: the service gap between hospital discharge and home; carers as the best person to care and cultural aspects of caring and using services. Many themes were common to all the included ethnic groups but some related to specific groups. Conclusions Across ethnic groups there were many similarities in the experiences of people caring for stroke survivors with complex, long-term care needs. Accessing services demands effort and persistence on carers’ part. If carers believe services are unsatisfactory or that they, rather than formal services, should be providing support for stroke survivors, they are unlikely to persist in their efforts. Cultural and language differences add to the challenges black and minority ethnic group carers face. PMID:26826148

Health Insurance Coverage and Use of Family Planning Services among Current and Former Foster Youth: Implications of the Health Care Reform Law

PubMed Central

Dworsky, Amy; Ahrens, Kym; Courtney, Mark

2013-01-01

This research uses data from a longitudinal study to examine how two provisions in the Patient Protection and Affordable Care Act could affect health insurance coverage among young women who have aged out of foster care. It also explores how allowing young people to remain in foster care until age twenty-one affects their health insurance coverage, use of family planning services, and information about birth control. We find that young women are more likely to have health insurance if they remain in foster care until their twenty-first birthday and that having health insurance is associated with an increase in the likelihood of receiving family planning services. Our results also suggest that many young women who would otherwise lack health insurance after aging out of foster care will be eligible for Medicaid under the health care reform law. Because having health insurance is associated with use of family planning services, this increase in Medicaid eligibility may result in fewer unintended pregnancies among this high-risk population. PMID:23262773

Creating Public Support for Child Care Services.

ERIC Educational Resources Information Center

Yeager, Kenneth E.

The 1989 defeat by voters in Fremont (California) of the nation's first measure to fund child care services at the local level provides valuable lessons for generating public support for child care services. Information was gathered from interviews with 23 city policymakers and administrators, from campaign materials, and from participant…

Proposal of a service delivery integration index of home care for older persons: application in several European cities

PubMed Central

Henrard, Jean-Claude; Ankri, Joël; Frijters, Dinnus; Carpenter, Iain; Topinkova, Eva; Garms-Homolova, Vjenka; Finne-Soveri, Harriett; Sørbye, Liv Wergeland; Jónsson, Palmi V.; Ljunggren, Gunnar; Schroll, Marianne; Wagner, Cordula; Bernabei, Roberto

2006-01-01

Abstract Purpose To propose an integration index of home care delivery to older persons, to study its validity and to apply it to home care services of European cities. Theory Home care delivery integration was based on two dimensions referring to process-centred integration and organisational structure approach. Method Items considered as part of both dimensions according to an expert consensus (face validity) were extracted from a standardised questionnaire used in “Aged in Home care” (AdHoc) study to capture basic characteristics of home care services. Their summation leads to a services' delivery integration index. This index was applied to AdHoc services. A factor analysis was computed in order to empirically test the validity of the theoretical constructs. The plot of the settings was performed. Results Application of the index ranks home care services in four groups according to their score. Factor analysis identifies a first factor which opposes working arrangement within service to organisational structure bringing together provisions for social care. A second factor corresponds to basic nursing care and therapies. Internal consistency for those three domains ranges from 0.78 to 0.93. When plotting the different settings different models of service delivery appear. Conclusion The proposed index shows that behind a total score several models of care delivery are hidden. Comparison of service delivery integration should take into account this heterogeneity. PMID:17006549

How to integrate social care services into primary health care? An experience from Iran

PubMed Central

Montazeri, Ali; Riazi-Isfahani, Sahand; Damari, Behzad

2016-01-01

Background: Social issues have prominent effects on the peoples' physical and mental health and on the health risk factors. In Iran, many organizations provide social care services to their target population. This study aimed to explore the roles and functions of Primary Health Care (PHC) system in providing social care services in Iran. Methods: This was a qualitative study, for which data were collected via three sources: A review of the literature, in-depth interviews and focus group discussions with experts and stakeholders. The main objective was to find a way to integrate social care into the Iranian PHC system. A conventional content analysis was performed to explore the data. Results: Overall, 20 experts were interviewed and the acquired data were classified into four major categories including priorities, implementation, requirements and stewardship. The main challenges were the existing controversies in the definition of social care, social service unit disintegration, multiple stewards for social care services, weaknesses of rules and regulations and low financing of the public budget. Social care services can be divided into two categories: Basic and advanced. Urban and rural health centers, as the first level of PHC, could potentially provide basic social care services for their defined population and catchment areas such as detecting social harms in high risk individuals and families and providing counseling for people in need. They can also refer the individuals to receive advanced services. Conclusion: Iran has a successful history of establishing the PHC System especially in rural areas. This network has an invaluable capacity to provide social health services. Establishing these services needs some prerequisites such as a reform PHC structure, macro support and technical intersectoral collaboration. They should also be piloted and evaluated before they could be implemented in the whole country. PMID:27683649

Developing a costing framework for palliative care services.

PubMed

Mosoiu, Daniela; Dumitrescu, Malina; Connor, Stephen R

2014-10-01

Palliative care services have been reported to be a less expensive alternative to traditional treatment; however, little is known about how to measure the cost of delivering quality palliative care. The purpose of this project was to develop a standardized method for measuring the cost of palliative care delivery that could potentially be replicated in multiple settings. The project was implemented in three stages. First, an interdisciplinary group of palliative care experts identified standards of quality palliative care delivery in the inpatient and home care services. Surveys were conducted of government agencies and palliative care providers to identify payment practices and budgets for palliative care services. In the second phase, unit costs were defined and a costing framework was designed to measure inpatient and home-based palliative care unit costs. The final phase was advocacy for inclusion of calculated costs into the national funding system. In this project, a reliable framework for determining the cost of inpatient and home-based palliative care services was developed. Inpatient palliative care cost in Romania was calculated at $96.58 per day. Home-based palliative care was calculated at $30.37 per visit, $723.60 per month, and $1367.71 per episode of care, which averaged 45 visits. A standardized methodology and framework for costing palliative care are presented. The framework allows a country or provider of care to substitute their own local costs to generate cost information relevant to the health-care system. In Romania, this allowed the palliative care provider community to advocate for a consistent payment system. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.