scholarly journals Can Home‐Based Primary Care Drive Integration of Medical and Social Care for Complex Older Adults?

2019 ◽  
Vol 67 (7) ◽  
pp. 1333-1335 ◽  
Author(s):  
Bruce Leff ◽  
Andrew Lasher ◽  
Christine S. Ritchie
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Social Care ◽  
Home Based Primary Care ◽  
Home Based

Addressing COVID-19 Worry and Social Isolation in Home-Based Primary Care

2020 ◽  
Author(s):  
Rachel Elizabeth Weiskittle ◽  
Michelle Mlinac ◽  
LICSW Nicole Downing
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Social Workers ◽  
Social Isolation ◽  
Mental Health Providers ◽  
Health Providers ◽  
Home Based Primary Care ◽  
Home Based ◽  
Socially Isolated

Social distancing measures following the outbreak of COVID-19 have led to a rapid shift to virtual and telephone care. Social workers and mental health providers in VA home-based primary care (HBPC) teams face challenges providing psychosocial support to their homebound, medically complex, socially isolated patient population who are high risk for poor health outcomes related to COVID-19. We developed and disseminated an 8-week telephone or virtual group intervention for front-line HBPC social workers and mental health providers to use with socially isolated, medically complex older adults. The intervention draws on skills from evidence-based psychotherapies for older adults including Acceptance and Commitment Therapy, Cognitive-Behavioral Therapy, and Problem-Solving Therapy. The manual was disseminated to VA HBPC clinicians and geriatrics providers across the United States in March 2020 for expeditious implementation. Eighteen HBPC teams and three VA Primary Care teams reported immediate delivery of a local virtual or telephone group using the manual. In this paper we describe the manual’s development and clinical recommendations for its application across geriatric care settings. Future evaluation will identify ways to meet longer-term social isolation and evolving mental health needs for this patient population as the pandemic continues.

scholarly journals Evaluation of an initiative to improve advance care planning for a home-based primary care service

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michelle B. Cox ◽  
Margaret J. McGregor ◽  
Madison Huggins ◽  
Paige Moorhouse ◽  
Laurie Mallery ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Decision Maker ◽  
Care Service ◽  
Do Not Resuscitate ◽  
Substitute Decision Maker ◽  
Home Based Primary Care ◽  
Home Based ◽  
Before And After ◽  
Advance Care

Abstract Background Advance care planning (ACP) is a process that enables individuals to describe, in advance, the kind of health care they would want in the future. There is evidence that ACP reduces hospital-based interventions, especially at the end of life. ACP for frail older adults is especially important as this population is more likely to use hospital services but less likely to benefit from resource intensive care. Our study goal was to evaluate whether an approach to ACP developed for frail older adults, known as the Palliative and Therapeutic Harmonization or PATH, demonstrated an improvement in ACP. Methods The PATH approach was adapted to a primary care service for homebound older adults in Vancouver, Canada. This retrospective chart review collected surrogate measures related to ACP from 200 randomly selected patients enrolled in the service at baseline (prior to June 22, 2017), and 114 consecutive patients admitted to the program after implementation of the PATH ACP initiative (October 1, 2017 to May 1, 2018). We compared the following surrogate markers of ACP before and after implementation of the PATH model, chart documentation of: frailty stage, substitute decision-maker, resuscitation decision, and hospitalization decision. A composite ACP documentation score that ascribed one point for each of the above four measures (range 0 to 4) was also compared. For those with documented resuscitation and hospitalization decisions, the study examined patient/ substitute decision-maker expressed preferences for do-not-resuscitate and do-not-hospitalize, before and after implementation. Results We found the following changes in ACP-related documentation before and after implementation: frailty stage (27.0% versus 74.6%, p < .0001); substitute decision-maker (63.5% versus 71.9%, p = 0.128); resuscitation decision documented (79.5% versus 67.5%, p = 0.018); and hospitalization decision documented (61.5% versus 100.0%, p < .0001); mean (standard deviation) composite ACP documentation score (2.32 (1.16) versus 3.14 (1.11), p < .0001). The adjusted odds ratios (95% confidence intervals) for an expressed preference of do-not-resuscitate and do-not-hospitalize after implementation were 0.87 (0.35, 2.15) and 3.14 (1.78, 5.55), respectively. Conclusions Results suggest partial success in implementing the PATH approach to ACP in home-based primary care. Key contextual enablers and barriers are important considerations for successful implementation.

scholarly journals HOSPITALIZATION AND PLACE-OF-DEATH AMONG HOMEBOUND OLDER ADULTS IN A HOME-BASED PRIMARY CARE PROGRAM

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 1347-1347
Author(s):  
N. Stall ◽  
K. Salvi ◽  
A.P. Costa ◽  
M. Nowaczynski ◽  
S. Sinha
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Care Program ◽  
Place Of Death ◽  
Home Based Primary Care ◽  
Home Based ◽  
Primary Care Program ◽  
Homebound Older Adults

scholarly journals Rationale and design of a randomized controlled trial of home-based primary care versus usual care for high-risk homebound older adults

2018 ◽  
Vol 68 ◽  
pp. 90-94 ◽  
Author(s):  
Jennifer M. Reckrey ◽  
Abraham A. Brody ◽  
Elizabeth T. McCormick ◽  
Linda V. DeCherrie ◽  
Carolyn W. Zhu ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Randomized Controlled Trial ◽  
High Risk ◽  
Usual Care ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Home Based Primary Care ◽  
Home Based ◽  
Homebound Older Adults

Developing a model of home-based primary care in South Korea: A 1.5-year case study

2020 ◽  
Vol 40 (6) ◽  
pp. 1403-1428
Author(s):  
Chang-O Kim ◽  
Jongwon Hong ◽  
Mihee Cho ◽  
Eunhee Choi ◽  
Soong-nang Jang
Keyword(s):  
Primary Care ◽  
South Korea ◽  
Home Based Primary Care ◽  
Home Based
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