Home-Based Primary Care for Homebound Older Adults: Literature Review

Kim, Chang-O

doi:10.4235/agmr.2018.22.2.62

Cited by 20 publications

(15 citation statements)

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“…5,24 To be called home-based primary care, one of the alternatives to primary care in several countries, a physician should provide comprehensive and continuous healthcare services through interdisciplinary teams at a patient's home. 15,24,25 Third, community-based social services may contribute to expanding a new healthcare market for physician home visits. Interestingly, in this study, using healthcare services from a social welfare center or Gyeong-ro-dang was analyzed as the most significant factor that increased both the need and WTP for physician home visits.…”

Section: Discussionmentioning

confidence: 99%

“…Over the last 30 years, Aging in Place has been emphasized due to population In recent years, there has been an opinion that Korea needs to establish an alternative medical model based on the community, including a primary geriatric physician system and homebased primary care for homebound older adults with increasing concerns about frailty. [13][14][15][16] The Korean government recently announced the Community Care Policy in 2018, which includes: 1) strengthening community-based health care services, 2) ensuring health rights for vulnerable groups, 3) setting up a discharge pathway from hospital to returning home, and 4) building a community-based public-private partnership system. The role of primary care physicians in community care is to organize and coordinate various outpatient and home care services.…”

Section: Introductionmentioning

confidence: 99%

“…In the present study, we developed a theoretical model of the WTP for physician home visits based on a literature review of medical sociology and service marketing. 15,[18][19][20] According to Fig. 1, the process is comprised of four stages: illness experience, help seeking, service utilization, and post-use behavior.…”

Section: Introductionmentioning

confidence: 99%

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Who Are the People Willing to Pay for Physician Home Visits?

Kim

Jang

2020

J Korean Med Sci

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Background: Since the recently announced Community Care Policy, there has been an opinion that Korea needs to establish an alternative medical model such as physician home visits. This study aimed to assess the need and willingness to pay (WTP) for physician home visits among the community-dwelling Korean older population and to determine the most important factors that influence older adults to decide to use a physician home visit service. Methods: A total of 797 people aged 60 years or older who were randomly selected from a nationwide dataset using a multi-stage stratified sampling method answered a questionnaire on the need and WTP for physician home visits. Results: A total of 39.3% of participants reported that they would like a physician home visit when they need help. Among older adults who needed physician home visits (n = 313), the WTP amount for physician home visits was 21,982 ± 17,546 KRW. Logit and Tobit regression analyses showed that the higher valuated need and WTP for physician home visits was associated with a lower level of physical/psychosocial functioning measured by EuroQol-five dimensions score (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.27; P = 0.035) and a higher level of satisfaction when using community-based services such as public health centers (OR, 1.32; 95% CI, 1.02-1.72; P = 0.034), social welfare centers and Gyeong-ro-dang (OR, 1.61; 95% CI, 1.04-2.50; P = 0.033; β = 8.39; standard error, 3.63; P = 0.021). Conclusion: This study provides evidence that the decision to pay for a physician home visit service is based upon the complex interactions among an individual's physical and psychosocial functioning, personal experiences of service utilization, and demographic factors. The value for physician home visits should be qualified based on the empirical data of WTP, which comes from a consumer-centered perspective.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Who Are the People Willing to Pay for Physician Home Visits?

Kim

Jang

2020

J Korean Med Sci

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“…5 Home-based primary care services are promoted among the older population to improve their access to health care and their ability to remain safely in their own homes without being institutionalized. 6 Home-based primary care is a multidisciplinary support model involving services ranging from assistance with basic daily living to tertiary-level health care for those who have difficulty accessing office-based primary care. 7 A systematic review has demonstrated that this model could improve quality of life (QOL) and satisfaction levels and reduce depression levels and disability among older adults who are homebound.…”

Section: Introductionmentioning

confidence: 99%

Effect of a Telecare Case Management Program for Older Adults Who Are Homebound During the COVID-19 Pandemic

Wong

Chow

et al. 2021

JAMA Netw Open

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IMPORTANCE Older adults who are homebound can be difficult to reach owing to their functional limitations and social distancing during the COVID-19 pandemic, leaving their health needs unrecognized at an earlier stage.OBJECTIVE To determine the effectiveness of a telecare case management program for older adults who are homebound during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial was conducted among 68 older adults in Hong Kong from May 21 to July 20, 2020, with a last follow-up date of October 20, 2020. Inclusion criteria were being 60 years or older, owning a smartphone, and going outside less than once a week in the previous 6 months. INTERVENTIONS Participants in the telecare group received weekly case management from a nurse supported by a social service team via telephone call and weekly video messages covering self-care topics delivered via smartphone for 3 months. Participants in the control group received monthly social telephone calls. MAIN OUTCOMES AND MEASURESThe primary outcome was the change in general self-efficacy from before the intervention to after the intervention at 3 months. Self-efficacy was measured by the Chinese version of the 10-item, 4-point General Self-efficacy Scale, with higher scores representing higher self-efficacy levels. Analysis was performed on an intention-to-treat basis. RESULTS A total of 68 participants who fulfilled the criteria were enrolled (34 in the control group and 34 in the intervention group; 56 [82.4%] were women; and mean [SD] age, 71.8 [6.1] years). At 3 months, there was no statistical difference in self-efficacy between the telecare group and the control group. Scores for self-efficacy improved in both groups (β = 1.68; 95% CI, −0.68 to 4.03; P = .16). No significant differences were found in basic and instrumental activities of daily living, depression, and use of health care services. However, the telecare group showed statistically significant interactions of group and time effects on medication adherence (β = −8.30; 95% CI, −13.14 to −3.47; P = .001) and quality of life (physical component score: β = 4.99; 95% CI, 0.29-9.69; P = .04). CONCLUSIONS AND RELEVANCEIn this randomized clinical trial, participants who received the telecare program were statistically no different from the control group with respect to changes in self-efficacy, although scores in both groups improved. After the intervention, the telecare group had better medication adherence and quality of life than the control group, although the small sample size may limit generalizability. A large-scale study is needed to confirm these results. (continued) Key Points Question Can a telecare case management program delivered by a nurse case manager supported by a health-social team improve self-efficacy, health-related measures, and health care service utilization outcomes among older adults who are homebound? Findings In this randomized clinical trial with 68 participants, there was no statistical difference in self-efficacy between the telecare group...

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“…3) For example, in the United States, various models of community-based long-term care, such as the Program of All-inclusive Care for the Elderly, Home Based Primary Care, Adult Day Health Care, and social health maintenance organization, have been investigated and virtually operated. 4,5) These models have something in common. That is, they follow the AIP philosophy.…”

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confidence: 99%