Reduction in Symptoms for Homebound Patients Receiving Home-Based Primary and Palliative Care

Abstract

Background: Increasing numbers of patients are living with multiple, chronic medical conditions and functional impairments that leave them homebound. Home-based primary and palliative care (HBPC) programs provide access to health care services for this vulnerable population. Homebound patients have high symptom burden upon program enrollment. Yet little is known as to how individual symptoms are managed at home, especially over longer time periods. Objectives: The purpose of this study was to determine whether high symptom burden decreases following HBPC enrollment. Methods: All patients newly enrolled in an HBPC program who reported at least one symptom on the Edmonton Symptom Assessment Scale (ESAS) were eligible for telephone ESAS follow-up. Patients received a comprehensive initial home visit and assessment by a physician with subsequent follow-up care, interdisciplinary care management including social work, and urgent in-home care as necessary. Multivariate linear mixed models with repeated measures were used to assess the impact of HBPC on pain, depression, anxiety, tiredness, and loss of appetite among patients with moderate to severe symptom levels at baseline. Results: One hundred forty patients were followed. Patient pain, anxiety, depression, and tiredness significantly decreased following intervention with symptom reductions seen at 3 weeks and maintained at 12 weeks. ( p < 0.01) Loss of appetite trended toward an overall significant decrease and showed significant reductions at 12 week follow-up. Conclusion: In a chronically ill population of urban homebound, patient symptoms can be successfully managed in the home. Future work should continue to explore symptom assessment and management over time for the chronically ill homebound.

Association Between Hospice Use and Depressive Symptoms in Surviving Spouses

“…42 Although use of such services among patients who did not use hospice would have biased our effect size to the null, research should examine the impact of the receipt of palliative care services other than hospice on caregiver depression. We only studied surviving spouses able to independently complete the CES-D survey; hospice may have different effects on depressive symptoms in spouses with poorer health.…”

Tempo gasto por equipe multiprofissional em assistência domiciliar: subsídio para dimensionar pessoal

“…Removal of sutures 5 Oximetry measurement 5 Measurement / assessment and recording of vital signs 5 Registration and approval of the caregiver in the home visit form 6 Professional …”

“…(1) Thus, home care prevails as an alternative to hospitalization by the innovation potential of the current techno-care model, consolidating the comprehensiveness and continuity of care and enabling the following: quality and humanization of care; teamwork focused on the expanded clinic; development of bonds and effective participation of caregivers and families in the production of unique therapeutic projects; reduction of hospital admissions and re-admissions, with release of hospital beds and consequent lower costs of care. (2)(3)(4)(5) Aiming to regulate this care modality already validated in other countries, but still not consolidated in the public service of Brazil, the Ministry of Health launched the Programa Melhor em Casa ('Better at Home Program') -Domiciliary Care in 2011, under the Brazilian Unified Health System. The recently published Ordinance number 963/2013 reaffirms home care as a technological incorporation of substitute or complementary character to hospital intervention for low and medium complexity, initiated in the Emergency Department and complementary to Primary Care.…”

Constipation in palliative care : Prevalence, definitions, symptom distress and risk-factors

“…Therefore, palliative care should be based on patients' needs instead of diagnoses (Moens, Higginson et al 2014). Furthermore, palliative care has been shown to be an effective approach to reduce symptoms (Gomes 2014, Ornstein, Wajnberg et al 2013 and improve quality of life, regardless of how it is organised (Aoun, O'Connor et al 2012).…”

“…Proper symptom assessment is vital in symptom management and can avoid unnecessary suffering and improve patients' quality of life (Krumm, Larkin et al 2014, Ornstein, Wajnberg et al 2013. Although symptom relief is one of the most frequent interventions, in palliative care (Van Mechelen, Aertgeerts et al 2013) and one of the corner-stones of palliative care, symptoms are not always adequately treated (Laugsand, Jakobsen et al 2011).…”