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BMC Health Services Research Jun 2020Being homeless entails higher mortality, morbidity, and prevalence of psychiatric diseases. This leads to more frequent and expensive use of health care services.... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Being homeless entails higher mortality, morbidity, and prevalence of psychiatric diseases. This leads to more frequent and expensive use of health care services. Medical respite care enables an opportunity to recuperate after a hospitalization and has shown a positive effect on readmissions, but little is known about the cost-effectiveness of medical respite care for homeless people discharged from acute hospitalization. Therefore, the aim of the present study was to investigate the cost-effectiveness of a 2-week stay in post-hospital medical respite care.
METHODS
A randomized controlled trial and cost-utility analysis, from a societal perspective, was conducted between April 2014 and March 2016. Homeless people aged > 18 years with an acute admission were included from 10 different hospitals in the Capital Region of Denmark. The intervention group (n = 53) was offered a 2-week medical respite care stay at a Red Cross facility and the control group (n = 43) was discharged without any extra help (usual care), but with the opportunity to seek help in shelters and from street nurses and doctors in the municipalities. The primary outcome was the difference in health care costs 3 months following inclusion in the study. Secondary outcomes were change in health-related quality of life and health care costs 6 months following inclusion in the study. Data were collected through Danish registries, financial management systems in the municipalities and at the Red Cross, and by using the EQ-5D questionnaire.
RESULTS
After 3 and 6 months, the intervention group had €4761 (p = 0.10) and €8515 (p = 0.04) lower costs than the control group, respectively. Crude costs at 3 months were €8448 and €13,553 for the intervention and control group respectively. The higher costs in the control group were mainly related to acute admissions. Both groups had minor quality-adjusted life year gains.
CONCLUSIONS
This is the first randomized controlled trial to investigate the cost-effectiveness of a 2-week medical respite care stay for homeless people after hospitalization. The study showed that the intervention is cost-effective. Furthermore, this study illustrates that it is possible to perform research with satisfying follow-up with a target group that is hard to reach.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT02649595.
Topics: Adult; Aftercare; Cost-Benefit Analysis; Denmark; Ill-Housed Persons; Humans; Middle Aged; Patient Discharge; Respite Care
PubMed: 32503545
DOI: 10.1186/s12913-020-05358-4 -
Health Expectations : An International... Sep 2023Caring for children and youth with special health care needs (CYSHCN) is a significant undertaking for families. While respite care is intended to address this burden,...
INTRODUCTION
Caring for children and youth with special health care needs (CYSHCN) is a significant undertaking for families. While respite care is intended to address this burden, demand continues to exceed supply. Exploring the perspectives of respite service providers (SPs) and stakeholders (SKs) provides unique insight into families' needs and respite care systems.
METHODS
We conducted semistructured interviews with 41 respite care SPs and SKs across four Canadian provinces to ascertain perspectives on current and ideal respite care for families of CYSHCN. The analysis included delineating units of meaning from the data, clustering units of meaning to form thematic statements and extracting themes. The second-level analysis involved applying themes and subthemes to cross-functional process maps.
FINDINGS
Participants noted the critical, but sometimes absent role of Community Service Workers, who have the ability to support families accessing and navigating respite care systems. SPs and SKs identified current respite systems as operating in crisis mode. New findings suggest an ideal respite care system would incorporate advocacy for families, empower families and value CYSHCN, their families and respite workers.
CONCLUSION
The evidence of unmet respite care needs of families of CYSHCN across Canada has long been available. Our findings identifying respite system challenges and solutions can be used by funders and policymakers for planning and enhancing resources, and by healthcare professionals, respite care providers and SKs to understand barriers and take action to improve respite outcomes to meet the respite needs of all families and CYSHCN.
PATIENT OR PUBLIC CONTRIBUTION
The research team is composed of patients, researchers, clinicians and decision-makers along with our Family Advisory Committee (FAC) composed of members of families of CYSHNC. The FAC was formed and met regularly with research team members, knowledge users and collaborators throughout the study to provide input on design, review themes and ensure findings are translated and disseminated in a meaningful way.
PubMed: 37705308
DOI: 10.1111/hex.13831 -
BMC Health Services Research Jul 2021Family caregivers assume substantial caregiving responsibilities for persons with chronic conditions, such as individuals with spinal cord injury, which leads to...
BACKGROUND
Family caregivers assume substantial caregiving responsibilities for persons with chronic conditions, such as individuals with spinal cord injury, which leads to negative impacts on their lives. Respite care and other services are provided as a temporary relief and support for them. Design of appropriate respite care programs depends on identification of beneficiary subgroups for the different types of service. This study aimed to quantify the uptake of different respite and support services for family caregivers, the reasons for non-use, and to explore the respective predictors.
METHODS
A cross-sectional survey of family caregivers of persons with spinal cord injury was conducted nationwide in Switzerland. The use of 11 different respite and support services during the previous 12 months was investigated, along with caregivers' reasons for not using any respite. Classification trees were used to characterize the beneficiaries and reasons for not using respite.
RESULTS
About a third of family caregivers used at least one type of respite or support service during the previous 12 months. Utilization of respite care was greater among those who employed professional home care (57% vs 24% of those without professional home care). Marked cantonal differences were also observed in utilization of respite care. The primary reason for not using respite services was "no demand" (80% of non-users of respite services), mainly among caregivers who were less emotionally affected by their caregiving tasks.
CONCLUSIONS
Utilization of respite and support services depends more on place of residence and use of home care services than on functional status of the care recipient. Accordingly, programs should be tailored to the cultural context of their potential users. This is best achieved through coordination with local health care professionals who can identify needs, provide information, initiate referrals, and integrate the care into a larger support plan.
Topics: Caregivers; Cross-Sectional Studies; Home Care Services; Humans; Respite Care; Switzerland
PubMed: 34215229
DOI: 10.1186/s12913-021-06651-6 -
International Journal of Geriatric... Aug 2022Restricted knowledge exists with regard to the association between grandchild care and loneliness among older Europeans. Hence, our goal was to investigate the...
OBJECTIVES
Restricted knowledge exists with regard to the association between grandchild care and loneliness among older Europeans. Hence, our goal was to investigate the association between the onset of grandchild care and loneliness in different European regions and stratified by sex longitudinally.
METHODS/DESIGN
Longitudinal data were taken from waves 5 to 6 of the 'Survey of Health Ageing, and Retirement in Europe' (SHARE) (n = 83,416 observations). Loneliness was assessed using the established three-item version of the Revised UCLA Loneliness scale. Transitions into grandchild care (= onset of grandchild care) served as key independent variable. It was adjusted for several covariates in regression analysis. Linear FE regressions with cluster-robust standard errors were used to mitigate the challenge of unobserved heterogeneity.
RESULTS
Linear FE regressions showed that the onset of grandchild care was significantly associated with an increase in loneliness levels among women (but not men) in Southern Europe (β = 0.28, p = 0.01), whereas the onset of grandchild care was not significantly associated with changes in loneliness levels in both sexes in Western Europe, Eastern Europe, Northern Europe and Israel.
CONCLUSIONS
Our study emphasized the association between the onset of grandchild care and increases in loneliness among women in Southern Europe. Efforts (e.g., respite services) are required to support this group to avoid loneliness.
Topics: Aging; Europe; Family; Female; Humans; Loneliness; Longitudinal Studies; Male; Retirement
PubMed: 35861228
DOI: 10.1002/gps.5785 -
Public Health Nursing (Boston, Mass.) Jan 2021A program evaluation to demonstrate the feasibility of a recuperative care pilot project to address the needs of unhoused individuals.
OBJECTIVE
A program evaluation to demonstrate the feasibility of a recuperative care pilot project to address the needs of unhoused individuals.
DESIGN
The study is a descriptive postprogram evaluation.
SAMPLE
A total of 73 referrals were made to the project with 23 admissions.
MEASURE
Data regarding number and type of referrals for admission, cost of respite care per guest and per day, hospital costs avoided, referrals to community services, and discharge destination were collected.
INTERVENTION
A case management care model was used. The project staff included a public health nurse and an outreach worker.
RESULTS
One local hospital accounted for 65% of all admissions. Admitting diagnoses were abscess/wound care (44%) followed by postsurgery recovery (17%). Housing resources (65%) was a common referral with 22% of guests discharged to stable housing. Actual length of stay exceeded the planned length by an average of 24 days. Total cost per guest per day was $157.45 which is an estimated savings to referring acute care facilities of between $18,000 and $48,000 per day.
CONCLUSIONS
The project demonstrated an ability to provide unhoused individuals a place to recuperate following hospitalization in a cost-effective manner. Challenges and recommendations of the program going forward were identified.
Topics: Aftercare; Cost-Benefit Analysis; Humans; Pilot Projects; Program Evaluation
PubMed: 33190328
DOI: 10.1111/phn.12834 -
BMJ Supportive & Palliative Care Dec 2021Hospice at Home (HAH) services aim to enable patients to be cared for and die at home, if that is their choice and achieve a 'good death'. A national survey, in 2017,...
OBJECTIVE
Hospice at Home (HAH) services aim to enable patients to be cared for and die at home, if that is their choice and achieve a 'good death'. A national survey, in 2017, aimed to describe and compare the features of HAH services and understand key enablers to service provision.
METHODS
Service managers of adult HAH services in the 'Hospice UK' and National Association for Hospice at Home directories within England were invited to participate. Information on service configuration, referral, staffing, finance, care provision and enablers to service provision were collected by telephone interview.
RESULTS
Of 128 services invited, 70 (54.7%) provided data. Great diversity was found. Most services operated in mixed urban/rural (74.3%) and mixed deprivation (77.1%) areas and provided hands-on care (97.1%), symptom assessment and management (91.4%), psychosocial support (94.3%) and respite care (74.3%). Rapid response (within 4 hours) was available in 65.7%; hands-on care 24 hours a day in 52.2%. Charity donations were the main source of funding for 71.2%. Key enablers for service provision included working with local services (eg, district nursing, general practitioner services), integrated health records, funding and anticipatory care planning. Access to timely medication and equipment was critical.
CONCLUSION
There is considerable variation in HAH services in England. Due to this variation it was not possible to categorise services into delivery types. Services work to supplement local care using a flexible approach benefitting from integration and funding. Further work defining service features related to patient and/or carer outcomes would support future service development.
Topics: Adult; Caregivers; England; Home Care Services; Hospice Care; Hospices; Humans
PubMed: 31722982
DOI: 10.1136/bmjspcare-2019-001818 -
Progress in Cardiovascular Diseases 2023The coronavirus disease 2019 (COVID-19) pandemic immediately and perhaps irrevocably impacted society at large, the provision of cardiovascular (CV) care, the function... (Review)
Review
The coronavirus disease 2019 (COVID-19) pandemic immediately and perhaps irrevocably impacted society at large, the provision of cardiovascular (CV) care, the function and staffing of hospitals, and CV clinicians. Initially many clinicians at all career stages rose to the challenges, and support and accolades were the initial societal response. Politicization of the public health response as well as widespread misinformation and disinformation all negatively impacted CV clinicians' roles as well diminished and, in some cases, eliminated their public and self-esteem. Unabated stress, disrespect, and a likely lack of emotional and physical respite may all have contributed to the Great Resignation. Insights gained from review of the COVID-19 pandemic may help inform changes to foster system resiliency and prepare for an improved response to the inevitable next stressor.
Topics: Humans; COVID-19; Pandemics; SARS-CoV-2; Public Health
PubMed: 36690286
DOI: 10.1016/j.pcad.2023.01.005 -
BMC Palliative Care Feb 2022Respite care provides caregiving support to people with amyotrophic lateral sclerosis (ALS) and their care partners by providing the care partner with temporary relief...
BACKGROUND
Respite care provides caregiving support to people with amyotrophic lateral sclerosis (ALS) and their care partners by providing the care partner with temporary relief from their caregiving duties. The aim of this study was to explore the impact of respite care through the perspectives and lived experiences of people with ALS and their care partners.
METHODS
Thirty-one dyads (62 participants) of people with ALS and their care partners were assigned to either the control group or the respite care intervention. Respite care was provided in the form of home-based services. Semi-structured interviews were conducted with participants at baseline and after a six-month period to gather perspectives on ALS caregiving, perceptions of respite care, and the respite care experience. Interviews were transcribed and subjected to thematic analysis.
RESULTS
Caregiving challenges specific to the care partner and the patient-care partnership relationship were identified. Overall, people with ALS and care partners responded positively to in-home respite care and reported improved relationship quality, more time for the care partner to pursue personal commitments or take a break, and improved emotional well-being for both the person with ALS and the care partner. Barriers and concerns were raised surrounding privacy and staff consistency.
CONCLUSION
This study highlights respite care as a critical tool to alleviate caregiving challenges and support the needs of people with ALS and their care partners. Engagement with the ALS community and formal evaluations of respite care services should be prioritized in order to minimize barriers and best meet the needs of people with ALS and their care partners.
Topics: Amyotrophic Lateral Sclerosis; Caregivers; Emotions; Humans; Qualitative Research; Respite Care
PubMed: 35227242
DOI: 10.1186/s12904-022-00919-2 -
Health Affairs (Project Hope) Sep 2020The coronavirus disease 2019 (COVID-19) pandemic presented unprecedented challenges to the New York City Health + Hospitals system. In addition to ramping up capacity... (Review)
Review
The coronavirus disease 2019 (COVID-19) pandemic presented unprecedented challenges to the New York City Health + Hospitals system. In addition to ramping up capacity and adapting operations quickly to handle the patient surge, NYC Health + Hospitals had to find new ways to provide emotional and psychological support for patients, families, and staff. To help families keep in touch, dedicated staff members provided daily updates by telephone and used tablets for virtual visits. An expanded palliative care team held virtual consultations with families to discuss advance care planning and end-of-life decisions. Bereavement hotlines were set up for families who lost loved ones. Enhanced staff support included one-on-one and group sessions with behavioral health specialists, a behavioral health hotline, a webinar series, and respite rooms, as well as complimentary lodging and child care. NYC Health + Hospitals created new rituals to celebrate recoveries and mourn losses. As regular operations resume, NYC Health + Hospitals plans to sustain and build on emotional and psychological support initiatives developed during the surge.
Topics: Adaptation, Psychological; Burnout, Professional; COVID-19; Communicable Diseases, Emerging; Coronavirus Infections; Delivery of Health Care; Female; Health Personnel; Humans; Male; Mortality; New York City; Nurse-Patient Relations; Occupational Health; Pandemics; Physician-Patient Relations; Pneumonia, Viral
PubMed: 32673086
DOI: 10.1377/hlthaff.2020.00929 -
The American Journal of Hospice &... Jun 2021This study aimed to explore health professional, patient, family, and caregiver perceptions of palliative care, availability of palliative care services to patients...
OBJECTIVES
This study aimed to explore health professional, patient, family, and caregiver perceptions of palliative care, availability of palliative care services to patients across South Dakota, and consistency and quality of palliative care delivery.
METHODS
Six focus groups were conducted over two months. Participants included interprofessional healthcare team members, patients, family members of patients, and caregivers. Individuals with palliative care experiences or interest in palliative care were invited to participate. Recruitment strategies included emails, flyers, and direct contact by members of the Network. Snowball sampling was used to recruit participants.
RESULTS
Forty-six participants included patients, family members, caregivers and interprofessional health care team members. Most participants were Caucasian (93.3%) and female (80%). Six primary themes emerged: Need for guidance toward the development of a holistic statewide palliative care model; Poor conceptual understanding and awareness; Insufficient resources to implement complete care in all South Dakota communities; Disparities in the availability and provision of care services in rural SD communities; Need for relationship and connection with palliative care team; and Secondary effects of palliative care on patients/family/caregivers and interprofessional healthcare team members. Significance of Results: Disproportionate access is a principle problem identified for palliative care in rural South Dakota. Palliative care is poorly understood by providers and recipients of care. Service reach is also tempered by lack of resources and payer reimbursement constraints. A model for palliative care in these rural communities requires concerted attention to their unique needs and design of services suited for the rural residents.
Topics: Female; Humans; Palliative Care; Perception; Qualitative Research; Rural Health Services; Rural Population; South Dakota
PubMed: 32869662
DOI: 10.1177/1049909120953808