Homecare user needs from the perspective of the patient and carers: a review

There is a global shift towards a blending of care delivery within formal and informal environments in direct response to economic and demographic pressures. Homecare is at the hub of this activity, enabling people to age in place and keeping families intact. However, our understanding of patient and carer needs is fragmented; understandably so, given the complexity of these needs. This descriptive review offers a content analysis of papers focused on patients' and carers' needs and homecare published between January 2010 and October 2013. It is evident that homecare is an intensely researched area, yet it is disjointed. Emerging research emphasizes the need to take a holistic approach. Firstly, incorporating emotional psychosocial and cultural elements will help to draw together our current understanding within a more cohesive framework. Secondly, tensions that hinder communication and collaboration between stakeholders must be resolved. Thirdly, information and communications technology is rapidly becoming synonymous with homecare, and offers solutions for facilitating care delivery, collaboration, and training of future professionals. The rate of international activity promises much for future research collaborations to compare, contrast, and identify best practices for the future of homecare as we endeavor to meet the ever-increasing pressures on health and social care systems

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Telemedicine

Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios

Perception And Utilization Of Telehealth Services Among Home Health Care Agencies: A National Survey

Eun hae Kim Despite the widely known effectiveness of telehealth services in screening and treating both chronic disease and depression in older adults, their adoption among home health care agencies has been slow. Furthermore, there is a lack of empirical research on telehealth use, barriers, and facilitators of adoption in the home health sector. For these reasons, this study examined home health care staff perceptions and use of telehealth for chronic disease and depression care among older patients. Five hundred and sixteen staff from member home health care agencies of the National Association for Homecare and Hospice (NAHC) completed an online survey. The national survey comprised of 33 questions and was informed by the Unified Theory of Acceptance and Use of Technology Model (Venkatesh et al., 2003) and Bobni’ Innovation Culture paradigm. Twenty staff also participated in a 45-minute qualitative telephone interview. The qualitative interview questions focused on telehealth experience and perceived barriers and facilitators to telehealth adoption. Among HHC agencies that reported using telehealth, telephone (63%) and remote-monitoring devices (56%) were the most utilized telehealth technology. Telehealth services included monitoring of health services (64%), chronic disease management (58%), and patient health education (43%). Telehealth was the least used for depression counseling (15%). Overall, there was a positive perception towards telehealth for patient care. However, telehealth was perceived more positively for chronic disease management (90.7%) than for depression care (53%). A majority (74%) perceived themselves as having the knowledge necessary to use telehealth for chronically ill patients while only 32% did for depressed patients. Results suggest that although there is a positive perception towards telehealth for patient care, there are other factors (e.g., lack of resources and reimbursement, training and buy-in from staff or patients) that affect HHC agencies’ adoption and use of telehealth. Therefore, further education is needed to support telehealth use for depression care. Additionally, there needs to be a reimbursement for telehealth visits by HHC agencies, as well as policies and regulations that ensure the quality of care provided by telehealth services. Future studies may consider comparing existing telehealth programs and identifying policies and regulations that are supportive of such programs

Using Telehealth to Support Informal Caregivers of Elders with Urinary Incontinence: A Pilot/Feasibility Study

Urinary Incontinence (UI) is a prevalent and burdensome condition affecting care-dependent, community-dwelling elders (CRs) and their informal caregivers (CGs). Although treatable, UI remains inadequately managed resulting in negative medical, physical, psychosocial and economic impacts. A quasi-experimental, pre-posttest design was used to explore the feasibility and acceptability of a technology-facilitated behavioral intervention designed to enhance the home environment of CRs with UI and strengthen informal CG self-efficacy. CGs received a 6-week evidence-based, prompted voiding and educational program delivered via tablet-personal computer. CGs also received a supportive component in the form of weekly telephone calls from a UI nurse expert. Care-recipient (% change in wetness) and CG outcomes (technology usage, perceived ease of use, UI knowledge, self-efficacy, burden) were measured at 3-weeks and 6-weeks and analyzed descriptively. Qualitative feedback regarding CG satisfaction and perceptions of the intervention were obtained at the conclusion of the study. The development and implementation of the intervention were feasible. The major challenge to feasibility was the recruitment of eligible participants. CGs were adherent to technology usage, however adherence to prompted voiding was inconsistent. CGs demonstrated slight increases in UI-related self-efficacy, UI knowledge, and decreases in UI-related bother. CRs demonstrated a mean 62.53% reduction in wet checks. CGs consistently rated the intervention extremely high and found access to a UI expert beneficial. These preliminary findings suggest that the use of telehealth systems to deliver an evidence-based, UI intervention may be a feasible and acceptable way to improve CG confidence and knowledge in UI management and reduce CR wetness

Untangling the complexity of connected health evaluations

Societal changes are forcing us to reconsider how healthcare is delivered and ICT can support this reimagining of healthcare delivery. One of the emerging trends in this area is Connected Health. However, the evaluation of Connected Health technologies is crucial to assess whether their implementation has had a positive impact on healthcare delivery. To support this assessment process, we developed, an exploratory framework for the evaluation of Connected Health technologies in healthcare settings. This framework was developed after having critically appraised the existing findings of health information system evaluation studies. It also builds on previous models of Information Systems evaluation, in particular, the Information Systems Success Model. Our framework incorporates the concept of assessment from multiple perspectives. Furthermore, the framework identifies the primary stakeholders and extends the assessment based on their concerns. Finally, we elaborate on the framework, detailing its application to a Connected Health solution for primary care based dementia patients in Ireland

Development of a simulation tool for measurements and analysis of simulated and real data to identify ADLs and behavioral trends through statistics techniques and ML algorithms

openCon una popolazione di anziani in crescita, il numero di soggetti a rischio di patologia è in rapido aumento. Molti gruppi di ricerca stanno studiando soluzioni pervasive per monitorare continuamente e discretamente i soggetti fragili nelle loro case, riducendo i costi sanitari e supportando la diagnosi medica. Comportamenti anomali durante l'esecuzione di attività di vita quotidiana (ADL) o variazioni sulle tendenze comportamentali sono di grande importanza.With a growing population of elderly people, the number of subjects at risk of pathology is rapidly increasing. Many research groups are studying pervasive solutions to continuously and unobtrusively monitor fragile subjects in their homes, reducing health-care costs and supporting the medical diagnosis. Anomalous behaviors while performing activities of daily living (ADLs) or variations on behavioral trends are of great importance. To measure ADLs a significant number of parameters need to be considering affecting the measurement such as sensors and environment characteristics or sensors disposition. To face the impossibility to study in the real context the best configuration of sensors able to minimize costs and maximize accuracy, simulation tools are being developed as powerful means. This thesis presents several contributions on this topic. In the following research work, a study of a measurement chain aimed to measure ADLs and represented by PIRs sensors and ML algorithm is conducted and a simulation tool in form of Web Application has been developed to generate datasets and to simulate how the measurement chain reacts varying the configuration of the sensors. Starting from eWare project results, the simulation tool has been thought to provide support for technicians, developers and installers being able to speed up analysis and monitoring times, to allow rapid identification of changes in behavioral trends, to guarantee system performance monitoring and to study the best configuration of the sensors network for a given environment. The UNIVPM Home Care Web App offers the chance to create ad hoc datasets related to ADLs and to conduct analysis thanks to statistical algorithms applied on data. To measure ADLs, machine learning algorithms have been implemented in the tool. Five different tasks have been identified. To test the validity of the developed instrument six case studies divided into two categories have been considered. To the first category belong those studies related to: 1) discover the best configuration of the sensors keeping environmental characteristics and user behavior as constants; 2) define the most performant ML algorithms. The second category aims to proof the stability of the algorithm implemented and its collapse condition by varying user habits. Noise perturbation on data has been applied to all case studies. Results show the validity of the generated datasets. By maximizing the sensors network is it possible to minimize the ML error to 0.8%. Due to cost is a key factor in this scenario, the fourth case studied considered has shown that minimizing the configuration of the sensors it is possible to reduce drastically the cost with a more than reasonable value for the ML error around 11.8%. Results in ADLs measurement can be considered more than satisfactory.INGEGNERIA INDUSTRIALEopenPirozzi, Michel

Improving Depression Care for Older Home Health Patients

Rates of depression in older home healthcare (HH) patients are highly prevalent. Although depression in this population is associated with increased rates of re-hospitalization, falls, and suicides, it is frequently under diagnosed and under treated. This Capstone Report examined this problem through three interrelated manuscripts. The first manuscript explored the problem through a review of the literature. This review determined that while there are many barriers to adequate depression care, programs that train clinicians to screen for depression and connect patients to depression care encourage adequate evaluation and treatment and can result in clinically significant changes in depression scores. This review prompted the development and implementation of a depressive disorder protocol implemented in a HH agency. The second manuscript describes the results of a process evaluation, which examined HH clinician fidelity of the protocol. Trained HH clinicians did administer the PHQ-9 according to protocol and seemed more comfortable recording higher depression scores. However, trained clinicians did not refer to a mental health nurse more frequently. Important ways in which the Doctor of Nursing Practice (DNP) prepared clinician can improve care in this area are identified. The report concludes with a policy position statement and recommendations for policy change to improve depression care for older HH patients at various stakeholder levels. Programs that integrate depression care with chronic illness management make good use of HH agency resources and can be operationally and financially feasible

Predictors of Oral Health Behaviors: Examining the Effect of Patient Perceived Humanistic Attitude in the Context of the Health Belief Model

The purpose of this study was to test the explanatory power of The Health Belief Model with the added environmental condition of perceived humanistic attitude of a dental hygienist in its ability to predict individual\u27s performance of oral disease prevention behaviors. A cross section survey of an intact group of 1,943 full time employees of Old Dominion University was conducted. The response rate was 52% (n = 1001). An exclusionary rule eliminated respondents who did not have a dental hygienist provide preventive services during dental visits. Seven hundred and fifty four were included in the study analyses. The study participants included 67% female, 69% White, 63% married with an average age of 45 (SD = 10.78). Classified employees represented 46%, faculty represented 37%, and administrative employees represented 16% of the study population. Partial support for The Health Belief Model was found in predicting oral disease prevention behaviors (brushing, flossing, performing homecare, receiving recommended dental treatment, maintaining regular dental check-up, and visiting a dental provider within a year. Further, support was found for adding perceived humanistic attitude of dental hygienists as an environmental condition for predicting oral disease prevention behaviors of the employees. Data analyses revealed that individuals who perceived that they were susceptible to oral disease were less likely to perform oral disease prevention behaviors. This finding was the opposite of what was expected based upon the precepts of The Health Belief Model. Perceived benefit was not found to be a strong predictor of performing oral disease prevention behaviors. While perceived seriousness, perceived lack of barriers, and perceived humanistic attitude of dental hygienists were found to be strong predictors of engaging in oral disease prevention behaviors