RESUMEN
PURPOSE: This study examined commonalities and differences in the experiences and challenges of White, Black, and Hispanic informal caregivers in New York, NY. DESIGN AND METHODS: A randomly selected representative cross-section of 2,241 households was contacted through telephone interviews. Complete data were available for 380 eligible participants, who were classified as White (n = 164), Black (n = 129) and Hispanic (n = 87). Descriptive, bivariate, and multivariate analyses were conducted to examine differences in caregiving intensity, reported difficulty with providing care, and having unmet needs with care provision. RESULTS: Over 70% of caregivers had no help from formal caregivers, even though over 80% had been providing care for at least 1 year, and 40% had been providing this care for 20 or more hr per week. Compared with White caregivers, Black caregivers were more likely to provide higher intensity care, to report having unmet needs with care provision, and to experience increased religiosity since becoming caregivers, but were less likely to report difficulty with providing care. Hispanic caregivers were more likely than White caregivers to have help from formal caregivers and to experience increased religiosity since becoming caregivers. IMPLICATIONS: Although many similarities exist in the experiences and challenges of informal caregivers, gaining insight from different populations of family caregivers would help program planners, policy makers, and formal caregivers to develop and implement culturally sensitive programs and policies that are supportive of the needs of these caregivers in their ever-expanding roles. Future efforts also should focus on exploring the potentially significant role that community resources, in particular, religious institutions, could play in providing outreach and support to racial/ethnic minority caregivers.
Asunto(s)
Negro o Afroamericano/estadística & datos numéricos , Cuidadores/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud , Hispánicos o Latinos/estadística & datos numéricos , Atención Domiciliaria de Salud , Población Blanca/estadística & datos numéricos , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Ciudad de Nueva YorkRESUMEN
OBJECTIVE: To determine the frequency of possible medication errors in a population of older home healthcare patients according to expert panel objective criteria. DESIGN: A cross-sectional survey. SETTING: Two of the largest urban home healthcare agencies in the United States. PARTICIPANTS: Home healthcare patients age 65 and older admitted to selected offices of these agencies between October 1996 and September 1998. MEASUREMENTS: We used two sets of consensus-based expert panel criteria to define possible medication errors. The Home Health Criteria identify patients with patterns of medication use and signs and symptoms that indicate sufficient likelihood of a medication-related problem to warrant reevaluating the patient. The Beers criteria identify medications that experts have deemed generally inappropriate for older patients. RESULTS: The 6,718 study subjects took a median of five drugs; 19% were taking nine or more medications. A possible medication error was identified for 19% of patients according to Home Health Criteria, 17% according to the Beers criteria, and 30% according to either. Possible errors increased linearly with number of medications taken. When patients taking one to three medications were compared with those taking nine or more drugs, the percentages with possible errors were, respectively, 10% and 32% for the Home Health Criteria, 8% and 32% for the Beers criteria, and 16% and 50% for both. CONCLUSION: Nearly one-third of the home healthcare patients surveyed had evidence of a potential medication problem or were taking a drug considered inappropriate for older people. More-effective methods are needed to improve medication use in this vulnerable population.
Asunto(s)
Servicios de Atención de Salud a Domicilio/normas , Errores de Medicación/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios Transversales , Quimioterapia Combinada , Femenino , Adhesión a Directriz/estadística & datos numéricos , Adhesión a Directriz/tendencias , Investigación sobre Servicios de Salud , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/tendencias , Humanos , Modelos Lineales , Modelos Logísticos , Los Angeles , Masculino , Errores de Medicación/prevención & control , Errores de Medicación/tendencias , Ciudad de Nueva York , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Gestión de Riesgos , Gestión de la Calidad Total , Procedimientos Innecesarios/estadística & datos numéricos , Procedimientos Innecesarios/tendenciasRESUMEN
This policy brief reports the results of a study that examined how policy makers acquire information about long-term care (LTC) and why research findings in the field often don't filter through to them. It describes the "brokers" that provide LTC research information to policy makers and outlines what can be done to make certain such information reaches policy makers and is suited to their needs. It concludes by recommending that more effort be put into disseminating LTC research information, both to communicate more effectively within the resource constraints that currently exist and to encourage increased investment in research brokering activities for the future.
Asunto(s)
Comunicación , Cuidados a Largo Plazo , Formulación de Políticas , Investigadores , Política de Salud , Investigación sobre Servicios de Salud , Humanos , Gestión de la Información , Relaciones Interprofesionales , Estados UnidosRESUMEN
SETTING: Six New York State Department of Health tuberculosis (TB) directly observed therapy (DOT) programs in public, private and community facilities in New York City. OBJECTIVE: A key feature of the TB DOT program was provision of incentives to motivate patients and increase adherence to therapy. The study hypothesis was that adherence will improve as the value of incentives increases and bonuses are added in a schedule of increasing rewards. DESIGN: The study population consisted of 365 patients in six inner city TB DOT programs. Interviews, clinical data and attendance records for 3+ years were analyzed. RESULTS: Patients who adhered (attending 80% of prescribed DOT visits each month of treatment) and those who did not were similar on seven demographic factors (e.g., age and sex), but were significantly different on clinical and social variables. Previous TB, resistance to rifampin, human immunodeficiency virus infection, psychiatric illness, homelessness, smoking and drug use were related to non-adherence. High adherence was significantly associated with fewer months in treatment (P < 0.016). Logistic regression showed that the odds that a patient would adhere to therapy were greater with increased incentives. Odds of adherence were significantly lower with rifampin resistance and psychiatric illness. CONCLUSION: Increasing incentives is associated with improved adherence to therapy in inner city TB populations.
Asunto(s)
Antituberculosos/uso terapéutico , Motivación , Cooperación del Paciente/psicología , Cooperación del Paciente/estadística & datos numéricos , Régimen de Recompensa , Tuberculosis/tratamiento farmacológico , Tuberculosis/psicología , Adulto , Resistencia a Medicamentos , Femenino , Humanos , Modelos Logísticos , Masculino , Trastornos Mentales/complicaciones , Persona de Mediana Edad , Análisis Multivariante , Ciudad de Nueva York , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Factores de Tiempo , Tuberculosis/complicaciones , Salud UrbanaAsunto(s)
Servicios de Salud Comunitaria/economía , Accesibilidad a los Servicios de Salud/economía , Cuidados a Largo Plazo/economía , Programas Controlados de Atención en Salud/economía , Capitación , Financiación Gubernamental , Humanos , Formulación de Políticas , Gobierno Estatal , Estados UnidosAsunto(s)
Financiación Gubernamental , Anciano Frágil , Viviendas para Ancianos/economía , Anciano , Personas con Discapacidad , Financiación Gubernamental/tendencias , Viviendas para Ancianos/estadística & datos numéricos , Humanos , Cuidados a Largo Plazo/economía , Cuidados a Largo Plazo/tendencias , Formulación de Políticas , Privacidad , Garantía de la Calidad de Atención de Salud , Gobierno Estatal , Estados UnidosAsunto(s)
Servicios de Salud Comunitaria/economía , Anciano Frágil , Gastos en Salud/estadística & datos numéricos , Servicios de Salud para Ancianos/economía , Medicaid/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Servicios de Salud Comunitaria/estadística & datos numéricos , Servicios de Salud Comunitaria/tendencias , Personas con Discapacidad , Predicción , Gastos en Salud/tendencias , Servicios de Salud para Ancianos/estadística & datos numéricos , Servicios de Salud para Ancianos/tendencias , Humanos , Cuidados a Largo Plazo/economía , Cuidados a Largo Plazo/tendencias , Medicaid/tendencias , Gobierno Estatal , Estados UnidosRESUMEN
Extensive research was conducted to develop the proposed Prospective Payment System (PPS) and to ensure that it will adequately cover the costs of care for Medicare beneficiaries receiving the home health benefit. However, there is tremendous variation among the patients served by agencies, meaning that the system will impact each agency somewhat differently. Using the methods outlined in this article, agencies can determine potential problem areas under PPS, enabling them to develop and implement solutions before October 1, 2000.
Asunto(s)
Episodio de Atención , Servicios de Atención de Salud a Domicilio/economía , Medicare/economía , Sistema de Pago Prospectivo/organización & administración , Anciano , Femenino , Humanos , Masculino , Estados UnidosRESUMEN
OBJECTIVE: To determine whether daily videotelephone or regular telephone reminders would increase the proportion of prescribed cardiac medications taken in a sample of elderly individuals who have congestive heart failure (CHF). METHODS: The authors recruited community-dwelling individuals age 65 and older who had the primary or secondary diagnosis of CHF into a randomized controlled trial of reminder calls designed to enhance medication compliance. There were three arms: a control group that received usual care; a group that received regular daily telephone call reminders; and a group that received daily videotelephone call reminders. Compliance was defined as the percent of therapeutic coverage as recorded by Medication Event Monitoring System (MEMS) caps. Subjects were recruited from 2 sources: a large urban home health care agency and a large urban ambulatory clinic of a major teaching hospital. Baseline and post-intervention MOS 36-Item Short-Form Health Survey (SF-36) scores and Minnesota Living with Heart Failure (MLHF) scores were obtained. RESULTS: There was a significant time effect during the course of the study from baseline to post-intervention (F[2,34] = 4.08, p < .05). Over time the elderly individuals who were called, either by telephone or videotelephone, showed enhanced medication compliance relative to the control group. There was a trend, but no significant difference between the two intervention groups. Both SF-36 and MLHF scores improved from baseline to post-intervention for all groups. There was no significant change in the SF-36 scores for the sample, but there was a significant change for the MLHF scores (p < .001). The control group had a significant fall off in the medication compliance rate during the course of the study, dropping from 81% to 57%. CONCLUSIONS: Telephone interventions are effective in enhancing medication compliance and may prove more cost effective than clinic visits or preparation of pre-poured pill boxes in the home. Technologic advances which enable clinicians to monitor and enhance patient medication compliance may reduce costly and distressing hospitalization for elderly individuals with CHF.
Asunto(s)
Cuidados Posteriores/métodos , Enfermería en Salud Comunitaria/métodos , Insuficiencia Cardíaca/tratamiento farmacológico , Cooperación del Paciente/psicología , Teléfono , Anciano , Anciano de 80 o más Años , Insuficiencia Cardíaca/enfermería , Insuficiencia Cardíaca/psicología , Humanos , Investigación en Evaluación de EnfermeríaAsunto(s)
Medicare/economía , Anciano , Humanos , Medicare/estadística & datos numéricos , Estados UnidosRESUMEN
OBJECTIVES: In response to rising demand and increased costs for home care services for frail elderly and disabled Medicaid clients, New York City implemented cluster care, a shared-aide model of home care. Our objective: to evaluate the effects of cluster care on home care hours and costs, client functioning, depressive symptoms, and satisfaction. DATA SOURCES: Client interviews, conducted prior to implementation and again 16 months later; Medicaid claims records; home attendant payroll files; and vendor agency records. STUDY DESIGN: The study employed a pretest/posttest design, comparing 229 clients at the first seven demonstration sites to 175 clients at four comparison sites before and after cluster care implementation. Regression methods were used to analyze pre and post-intervention data. PRINCIPAL FINDINGS: Cluster care reduced costs by about 10 percent. Most savings occurred among the more vulnerable clients (those with five or more ADL/IADL limitations). Clients at cluster care sites who started out with fewer than five limitations appeared to decline somewhat more slowly than similarly impaired clients at comparison sites, while those with more than five ADL/IADLs tended to decline more rapidly. This difference was small-less than one limitation per year. Cluster care is associated with a significant decline in satisfaction but appears unrelated to depressive symptoms. CONCLUSIONS: Cluster care appears benign for home care clients with fewer limitations. For the more vulnerable, we recommend experimentation with low-cost interventions that might augment service and improve outcomes without reverting to traditional one-on-one care.
Asunto(s)
Personas con Discapacidad , Anciano Frágil , Servicios de Atención de Salud a Domicilio/economía , Medicaid/organización & administración , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Análisis por Conglomerados , Ahorro de Costo/economía , Ahorro de Costo/estadística & datos numéricos , Personas con Discapacidad/estadística & datos numéricos , Femenino , Anciano Frágil/estadística & datos numéricos , Reforma de la Atención de Salud , Investigación sobre Servicios de Salud/métodos , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Humanos , Modelos Lineales , Masculino , Medicaid/estadística & datos numéricos , Ciudad de Nueva York , Evaluación de Resultado en la Atención de Salud/economía , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Satisfacción del Paciente/economía , Satisfacción del Paciente/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/métodos , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Estados UnidosRESUMEN
To determine the usefulness of the Center for Epidemiological Studies Depression Scale (CES-D) as a measure of depressive symptoms among frail and disabled elderly, we conducted a first- and second-order confirmatory factor analysis testing the four-factor structure of the CES-D and the existence of a single underlying second-order factor. We also examined the relative contribution of the somatic factor of the total symptom score, and relationships of age, race, functional status, and health with the four factors. We found that the factor structure is replicated when used with frail elderly, and scores are not distorted by the disproportionate influence of somatic items. Age and health do not affect the somatic subscale more than the other three subscales. Functional limitations are associated with higher somatic scores. We conclude that the CES-D is an appropriate tool to measure depressive symptoms in frail elderly.
Asunto(s)
Depresión/diagnóstico , Personas con Discapacidad/psicología , Anciano Frágil/psicología , Actividades Cotidianas , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedad , Análisis Factorial , Familia , Femenino , Salud , Estado de Salud , Humanos , Estilo de Vida , Masculino , Estado Civil , Grupos Raciales , Reproducibilidad de los Resultados , Factores SexualesRESUMEN
Four work life demonstration projects designed to upgrade home aide employment, reduce turnover, and increase continuity of care were evaluated using randomly selected experimental and control groups at each of 11 agencies. The projects reduced worker turnover in the experimental groups from 10 to 44 percentage points. Where it was measured, continuity of care also significantly improved. Local political, economic, and competitive conditions affected the viability of the projects, which added from $.09 to $1.43 to the aides' hourly wage.