Health Care Management in ALS Patients

Abstract

An optimized management of amyotrophic lateral sclerosis (ALS) is an added value of a follow-up by an interdisciplinary team. The aim of this study was to identify which professionals are involved in care of ALS patients at Portugal and their impact on quality of life (QoL). We divided the sample in Group 1 (G1; Southern) and Group 2 (G2; Northern) and used a semi-structured questionnaire, functional status scale (Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised [ALSFRS-R]), and QoL evaluation to perform the study. There were observed differences at admission in ALSFRS-R, higher in G1, presence of specialized professionals higher in G2; non-invasive ventilation equipment had higher use and compliance in G1. Multiple regression analysis shows gender, education level, and technical aids as predictors of QoL. The study showed that, despite regional differences, there were external factors common to both groups that influenced QoL.

Cost-effectiveness of home care services versus hospital care for pediatric patients worldwide: A protocol for systematic review and meta-analysis

“…The demand for HCS appears, therefore, as another challenge for health systems, contributing to change the focus of care and the environment in which care is provided. [2,3] In addition, continued care in the home environment is accompanied by other equally relevant health needs, such as the aging population, as well as the care provided to premature babies, to children with special needs and chronic diseases, to adults with multiple chronic-degenerative diseases, to individuals in palliative care, life support and rehabilitation.…”

“…Thus, the relevance of the need to implement HCS stands out in the current and future health agenda of all health systems, aiming to contribute to the configuration of substitutive health networks and the transformation of health practice. [2][3][4] Researchers already question the real need for hospitalization for certain health problems, considering some reasons for hospitalization as dispensable or unnecessarily prolonged, and that they can be replaced or complemented by an HCS. [2][3][4][5] In addition to cost reduction, the HCS has been representing in the world scenario the connotation of offering quality care, providing welfare and comfort by allowing the patient to stay in their home environment, integrated into their life context.…”

“…[2][3][4] Researchers already question the real need for hospitalization for certain health problems, considering some reasons for hospitalization as dispensable or unnecessarily prolonged, and that they can be replaced or complemented by an HCS. [2][3][4][5] In addition to cost reduction, the HCS has been representing in the world scenario the connotation of offering quality care, providing welfare and comfort by allowing the patient to stay in their home environment, integrated into their life context. [5] It is important to emphasize that health financing is a topic that always raises debates in order to better define the use and allocation of resources for society as a whole.…”

“…[6][7][8] It is known that several countries are in the process of adapting to this new demand for care, due especially to issues of economic viability. [2,3] This adaptation has strengthened the emergence of new strategies and mechanisms for health care, such as HCS, which combines technological and scientific resources present in the hospital with the family environment. [9] The home has emerged, added to its humanizing characteristic and the demographic and epidemiological profile of the population, as a place with potential to expand and qualify the care processes.…”

“…[9] The home has emerged, added to its humanizing characteristic and the demographic and epidemiological profile of the population, as a place with potential to expand and qualify the care processes. [10] Moreover, the development of HCS on the world scene has been following demographic and epidemiological changes [11] and is related to reducing the risk of infections [12] the humanization of care and quality of life, greater involvement of family members with the patient's illness, closer relationship between the health team, patient and family, [13] cost reduction, increased hospital bed turnover with bed management, de-hospitalization [14] lower rates of clinical worsening and acute complications, less demand for urgency and emergency services, and lower readmission rates, [15] implementation of palliative care [3] and effective actions for prevention, promotion and recovery of health. [4] A systematic review and meta-analysis aimed at evaluating the effect of "hospital at home" services in adults >16 years that significantly replace inpatient time on health outcomes, showed that hospital at home is associated with reductions in mortality, re-admission rates and costs, and increases in patients and caregiver satisfaction, but no change in caregiver burden.…”