A mixed‐methods evaluation of home‐based primary care in dementia within an integrated system

2021 ◽  
Author(s):  
Huong Q. Nguyen ◽  
Jessica D. Vallejo ◽  
Mayra Macias ◽  
Maricela Garcia Shiffman ◽  
Romina Rosen ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Integrated System ◽  
Mixed Methods Evaluation ◽  
Home Based Primary Care ◽  
Home Based

scholarly journals COVID Challenges and Adaptations Among Home-Based Medical Practices: Lessons for an Ongoing Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 536-537
Author(s):  
Orla Sheehan ◽  
Naomi Gallopyn ◽  
Shanaz Sharieff ◽  
Abraham Brody ◽  
Bruce Leff ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Online Survey ◽  
Emotional Needs ◽  
Medical Practices ◽  
Home Based Primary Care ◽  
Virtual Care ◽  
Home Based ◽  
Concurrent Use

Abstract Home-based primary care (HBPC) practices rapidly adapted to maintain care during the COVID-19 pandemic. This mixed-methods national online survey of HBPC practices probed responses to COVID-19 surges, COVID-19 testing, the use of telemedicine, practice challenges due to COVID-19, and adaptations to address these challenges. Seventy-nine practices across 29 states were included in the analyses. Eighty-five percent of practices continued to provide in-person care and nearly half cared for COVID-19 patients. Most practices also pivoted to concurrent use of video visits. The top five practice challenges were: patient familiarity with telemedicine, patient and clinician anxiety, technical difficulties reaching patients, and supply shortages. Practices also described creative strategies to physically support the needs of patients. These findings illustrate the need to balance in-person and virtual care for this population, and attend to the emotional needs of patients and staff.

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.

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

scholarly journals Preparedness and Response Activities of the VA Home-Based Primary Care Program Around the Fall 2017 Hurricane Season

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 591-591
Author(s):  
Tamar Wyte-Lake ◽  
Claudia Der-Martirosian ◽  
Aram Dobalian
Keyword(s):  
Primary Care ◽  
Large Scale ◽  
Care Program ◽  
Department Of Veterans Affairs ◽  
Home Based Primary Care ◽  
Home Based ◽  
Early Implementation ◽  
Hurricane Season ◽  
Patient Health ◽  
At Risk Populations

Abstract Individuals aged seventy-five or older, who often present with multiple comorbidities and decreased functional status, typically prefer to age in their homes. Additionally, as in-home medical equipment evolves, more medically vulnerable individuals can receive care at home. Concomitantly, large-scale natural disasters disproportionally affect both the medically complex and the older old, two patient groups responsible for most medical surge after a disaster. To understand how to ameliorate this surge, we examined the activities of the nine US Department of Veterans Affairs Home-Based Primary Care programs during the 2017 Atlantic Hurricane Season. These and similar programs under Medicare connect the homebound to the healthcare community. Study findings support early implementation of preparedness procedures and intense post-Hurricane patient tracking as a means of limiting reductions in care and preventing significant disruptions to patient health. Engaging with home-based primary care programs during disasters is central to bolstering community resilience for these at-risk populations.

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.

“I felt useless”: a qualitative examination of COVID-19’s impact on home-based primary care providers in New York

2021 ◽  
pp. 1-15
Author(s):  
Ksenia Gorbenko ◽  
Emily Franzosa ◽  
Sybil Masse ◽  
Abraham A Brody ◽  
Orla Sheehan ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Primary Care Providers ◽  
Care Providers ◽  
Home Based Primary Care ◽  
Home Based
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