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Background: Falls amongst the elderly represent a global public health challenge because of their potential to cause illness, death, and reduce the autonomy of this group. They also impact the emotional, family, social and economic well-being of those involved. Various strategies to prevent falls have been reported in the literature, focusing mainly on addressing individual risk factors, and on the continuous assessment of the risk of falls in older people. Objective: This study evaluated user satisfaction and acceptability of a comprehensive model, implemented in the community, to prevent falls amongst independent older adults aged 65 years and above. It sought to capture both the perceptions of the individuals who received the intervention and of the interventionists who implemented it. The study protocol was registered at ClinicalTrials.gov in November 2020 (ID: NCT04313062). Design: Qualitative, exploratory study using a case study design. The evaluation of the intervention followed the recommendations proposed by the Medical Research Council for complex interventions. Methods and participants: In the period between April 2021 to April 2022, 11 semi-structured interviews were conducted with independent older adults between 65 and 80 years of age who participated in the implementation of the comprehensive model in Santiago, Chile. Data were also collected with eight interventionists through: three semi-structured interviews at the beginning of the intervention; and two focus groups with seven interventionists at the end of the implementation of the model. The team members undertook a content analysis of the data collected. Results: Three themes emerged to account for the satisfaction and acceptability of the intervention with the model on the part of the participants and interventionists: (1) Previous experience of older persons and interventionists; (2) The older person-interventionist encounter and its context; and (3) Identification of facilitators, strengths and challenges for the implementation of the model. The results show a positive assessment of the model, highlighting the value of the social contact derived from the intervention by both participants and interventionists. Although the model involved an individual intervention, the participants' accounts indicate that it reached out to others, including family members and other elderly acquaintances. Moreover, the interventionists helped identify challenges in implementation and made recommendations to strengthen the model. Conclusion: The evaluation of satisfaction and feasibility of implementing the model showed positive results that will nurture the next phase of development of this model, which involves scaling up the intervention.

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O objetivo da pesquisa foi apresentar uma revisão narrativa de literatura sobre as principais dificuldades enfrentadas por cirurgiões-dentistas no atendimento domiciliar na Estratégia Saúde da Família (ESF). Realizou-se um levantamento bibliográfico com base nos bancos de dados eletrônicos (Google Acadêmico, SCIELO, BVS), com captação de documentos do Ministério da Saúde e artigos de língua inglesa e portuguesa, nos anos de 2000 a 2021. Elegeu-se 21 artigos que apresentaram o objeto de estudo com visão crítica. Foi realizada pesquisa e descrição sobre a Estratégia Saúde da Família, sobre o atendimento domiciliar e também sobre os profissionais de saúde bucal que participam do atendimento domiciliar na Estratégia Saúde da Família. O atendimento domiciliar é usado pela equipe da Estratégia Saúde da Família com foco nos usuários que não se deslocam até a Unidade Básica de Saúde (UBS) por motivos físicos, mentais e/ou sociais. Após o acréscimo da Equipe de Saúde Bucal (ESB) na Estratégia Saúde da Família, os mesmos também passaram a realizar atendimentos domiciliares. Os principais afazeres realizados pela equipe em domicílio são com foco na promoção, prevenção e tratamento. Contudo os cirurgiões-dentistas enfrentam dificuldades que atrapalham os atendimentos domiciliares, podendo-se citar: vias urbanas precária; violência; tráfico de drogas; falta de transporte; demanda de equipamentos e instrumentai; biossegurança e ergonomia que são difíceis alcançar em domicílio.

The objective of the research was to present a narrative review of the literature on the main difficulties faced by dentists in home care in the Family Health Strategy (ESF). A bibliographical survey was carried out based on electronic databases (Google Academic, SCIELO, BVS), with collection of documents from the Ministry of Health and articles in English and Portuguese, in the years 2000 to 2021. 21 articles were chosen that presented the object of study with a critical view. A research and description was carried out on the Family Health Strategy (ESF). Home care is usedby the Family Health Strategy team, focusing on users who do not go to the Basic Health Unit (UBS) for physical, mental and/or social reasons. After the addition of the Oral Health Team (ESB) to the ESF, They also began to provide home care. The main tasks performed by the theam at home are focused on promotion, prevention and treatment. However, dentists face difficulties that hinder home care, such as: prearious urban roads; violence; drug trafficking; lack of trasportation; demand for equipment and instruments; biosafety and ergonomics that are difficult to achieve at home.

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OBJECTIVE: To establish prevalence and associations of provision of nursing home visits (NHV) and home visits (HV) by early-career specialist GPs. Of particular interest were associations of rurality with performing NHVs and HVs. METHODS: A cross-sectional study. DESIGN: A questionnaire-based study. SETTING: Australian general practice. PARTICIPANTS: Early-career specialist GPs, practising in Australia, who attained Fellowship between January 2016 and July 2018, inclusive, having completed GP training in NSW, the ACT, Eastern Victoria or Tasmania. MAIN OUTCOME MEASURES: Current provision of NHV and HV. RESULTS: NHV were provided by 34% of participants (59% in rural areas) and HV by 41% of participants (60% in rural areas). Remote, rural or regional practice location, as compared to major-city practice, was strongly associated with performing NHV as an early-career specialist GP; multivariable OR 5.87 (95% CI: 2.73, 12.6), p < 0.001, and with the provision of HV; multivariable OR 3.64 (95% CI: 1.63, 8.11), p = 0.002. Rurality of GP training (prior to attaining Fellowship) was significantly univariably associated with providing NHV and with providing HV as an early-career specialist GP. On multivariable analyses, these were no longer statistically significant. CONCLUSION: Early-career specialist GPs located in regional/remote areas are more likely than their urban colleagues to provide NHV and HV.

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Background: It has been shown that surgical residents who took few or no in-house calls during medical school felt less prepared for the residency. In this study, our objective was to assess the impact of in-house calls carried out by medical students on their perceptions of medical training, including the influence on specialty choice. Methods: The students were asked to complete an anonymized questionnaire at the first and last day of their general surgery clerkship. Students were asked regarding importance for medical training and education, preparation for the internship, learning opportunities, skills acquisition; negative effects, including fatigue, negative effect over medical training, personal life, and physical and mental health derangements; and the student's perception of the residents' in-house calls and parameters affecting specialty selection: difficulty of the residency, prestige, and future career opportunities. Results: A total of 42 medical students responded to 84 questionnaires. There was a significant difference in the importance of calls among male students before the beginning of the clerkships compared with the end of the clerkship (4.53 versus 4.21, P = .034). At the end of general surgery clerkship, students indicated that the calls less impaired studying during the clerkship (2.5 versus 2.21, P < .05) compared with the beginning of the clerkship. Female students ranked the calls as less demanding at the end of the clerkship (2.53 versus 2.12, P < .05). The impact of the residency difficulty on the selection of their future specialty was rated higher by the students at the end of the clerkship compared with their expectations at the beginning (3.13 versus 2.85, P = .033). Conclusions: In conclusion, our study demonstrates that in-house calls performed by medical students during their general surgery clerkships have a significant influence on their perceptions of medical training and choice of specialty. The study also highlights the importance of gender differences in the students' perception of the importance and impact of calls on their well-being.

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BACKGROUND: High-need, high-cost Medicare patients can have difficulties accessing office-based primary care. Home-based primary care (HBPC) can reduce access barriers and allow a clinician to obtain valuable information not obtained during office visit, possibly leading to reductions in hospital use. OBJECTIVE: To determine whether HBPC for high-need, high-cost patients reduces hospitalizations and Medicare inpatient expenditures. DESIGN: We conducted a matched retrospective cohort study using a difference-in-differences analysis to examine patients 2 years before and 2 years after their first home visit (HBPC group). PARTICIPANTS: The study included high-need, high-cost fee-for-service Medicare patients without prior HBPC use, of which 55,303 were new HBPC recipients and 156,142 were matched comparison patients. INTERVENTION: Receipt of at least two HBPC visits and, within 6 months of the index HBPC visit, a majority of a patient's primary care visits in the home. MAIN MEASURES: Total and potentially avoidable hospitalizations and Medicare inpatient expenditures. KEY RESULTS: HBPC reduced total hospitalization rates, but the marginal effects were not statistically significant: a reduction of 11 total hospitalizations per 1000 patients in the first year (- 0.6%, p = 0.19) and 14 in the second year (- 0.7%, p = 0.16). However, HBPC reduced potentially avoidable hospitalization rates in the second year. The estimated marginal effect was a reduction of 6 potentially avoidable hospitalizations per 1000 patients in the first year (- 1.6%, p = 0.16) and 11 in the second (- 3.1%, p = 0.01). The estimated effect of HBPC was a small decrease in inpatient expenditures of $24 per patient per month (- 1.1%, p = 0.10) in the first year and $0 (0.0%, p = 0.99) in the second. CONCLUSIONS: After high-need, high-cost patients started receiving HBPC, they did not experience fewer total hospitalizations or lower inpatient spending but may have had lower rates of potentially avoidable hospitalizations after 2 years.

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Objetivo: compreender a percepção e implementação da visita domiciliar na Primeira Semana Saúde Integral, segundo enfermeiros da Atenção Primária. Método: estudo qualitativo, realizado por entrevistas com cinco enfermeiras em Unidades de Saúde da Família no curimataú paraibano, entre agosto e dezembro de 2019. Os dados foram interpretados pela Análise de Conteúdo. Resultados: percebeu-se a partir de duas categorias que, os enfermeiros reconhecem a Primeira Semana Saúde Integral como estratégia de integralidade na saúde ao binômio, utilizando unicamente a visita domiciliar como ação; distinguem os elementos necessários para a implementação desta conforme as diretrizes nacionais, todavia identificaram desafios, bem como estratégias para dirimi-los. Considerações finais: reforça-se a ideia da educação permanente para qualificação dos profissionais na Atenção Primária, bem como a inserção de um instrumento para a realização das visitas domiciliares, potencializando assim as ações de cuidado

Objective: to understand the perception and implementation of home visits in the First Integral Health Week, according to Primary Care nurses. Method: qualitative study, carried out with five nurses in Family Health Units in curimataú, Paraíba, between August and December 2019. Data were interpreted by Content Analysis. Results: it was noticed from two categories that the nurses recognize the First Integral Health Week as a strategy of integrality in health to the binomial, using only the home visit as an action; distinguish the elements necessary for the implementation of this according to the national guidelines, however they identified challenges, as well as strategies to solve them. Final considerations: the idea of continuing education for the qualification of professionals in Primary Care is reinforced, as well as the insertion of an instrument for carrying out home visits, thus enhancing care actions

Objetivos: comprender la percepción e implementación de la visita domiciliaria en la Primera Semana de Salud Integral, según los enfermeros de Atención Primaria. Método: estudio cualitativo, realizado con cinco enfermeros en Unidades de Salud de la Familia en Curimataú, Paraíba, entre agosto y diciembre de 2019. Los datos fueron interpretados por Análisis de Contenido. Resultados: se percibió a partir de dos categorías que los enfermeros reconocen la Primera Semana de Salud Integral como una estrategia de integralidad en salud al binomio, utilizando únicamente la visita domiciliaria como acción; distinguen los elementos necesarios para la implementación de este de acuerdo a los lineamientos nacionales, sin embargo identificaron desafíos, así como estrategias para solucionarlos. Consideraciones finales: se refuerza la idea de educación continua para la calificación de profesionales en la Atención Básica, así como la inserción de un instrumento para la realización de visitas domiciliarias, potenciando así las acciones de cuidado

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ABSTRACT Objective: To analyze characteristics of the home visit (HV) in Brazil, 2012 and 2017. Methods: Ecological study, with panel data whose units of analysis were the Primary Health Care teams in Brazil, participants of the 1st and 3rd cycles of the Program to Improve Access and Quality of Primary Care of the Unified Health System. Descriptive, inferential and spatial analyzes (alpha=5%) were performed. Results: There was an increase in the proportion of teams that carried out home visits at a frequency defined based on risk and vulnerability analysis and actively searched for people with respiratory symptoms and women with delayed and altered cytopathological examination. In the heat maps, the Northeast, Southeast and South regions had a higher concentration of teams that carried out the HV and carried out an active search. Conclusion: The maintenance and qualification of HVs must be a priority in Brazil, since there are few countries in the world with such capillarity of health services, reaching the homes of millions of people.

RESUMO Objetivo: Analisar características da visita domiciliar (VD) no Brasil em 2012 e 2017. Métodos: Estudo ecológico com dados em painel cujas unidades de análise foram as equipes de saúde da Atenção Primária à Saúde no Brasil, participantes do 1º e 3º ciclos do Programa de Melhoria do Acesso e Qualidade da Atenção Básica do Sistema Único de Saúde. Foram realizadas análises descritivas, inferenciais e espaciais (alpha=5%). Resultados: Houve aumento na proporção de equipes que realizavam visita domiciliar com periodicidade definida a partir da análise de risco e vulnerabilidade e na de busca ativa de pessoas com sintomáticos respiratórios e de mulheres com exame citopatológico atrasado e alterado. Nordeste, Sudeste e Sul foram as regiões com maior concentração de equipes que realizavam a VD e faziam busca ativa. Conclusão: A manutenção e qualificação das VD deve ser uma prioridade no Brasil, uma vez que poucos são os países no mundo com tamanha capilaridade dos serviços de saúde, alcançando os domicílios de milhões de pessoas.

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INTRODUCTION: Early discharge holds several advantages and seems safe after planned cesarean section among low-risk women. However, breastfeeding rates are lower after cesarean section. Thus, concern has been raised that early discharge among these women may affect breastfeeding even further. Therefore, we aimed to assess the effect of early discharge the day after planned cesarean section on breastfeeding, among parous women when a home-visit by a midwife was provided the day after discharge. METHODS: We conducted a secondary analysis of a randomized trial. Parous women (n=143) planned for cesarean section were allocated to either discharge within 28 hours after planned cesarean section followed by a home visit the day after (early discharge) or discharge at least 48 hours after planned cesarean section (standard care). The participants filled in questionnaires approximately 2 weeks before delivery and 1 week, 4 weeks, and 6 months postpartum. RESULTS: The proportions of women initiating breastfeeding were 84% versus 87% (early discharge vs standard care). After 6 months, 23% versus 21% were exclusively breastfeeding, while 29% versus 42% were partially breastfeeding. The mean duration of exclusive breastfeeding was 3.4 months (SD=2.3) in both groups. None of these differences was statistically significant. In both groups, the women's breastfeeding self-efficacy score before cesarean section correlated with the duration of breastfeeding. After 4 weeks, low-score rates were 28% versus 30%. CONCLUSIONS: Early discharge with follow-up home visits by a midwife after planned cesarean section in parous women is feasible without compromising breastfeeding.

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OBJECTIVE: Despite close to all-embracing access to child healthcare, health divides exist among children in Sweden. Home visits to families with new-born babies are a cost-effective way to identify and strengthen vulnerable families. An extended postnatal home visiting programme has been implemented in a disadvantaged suburb in Stockholm with positive results. DESIGN: Longitudinal, prospective study and register study from medical records. SETTING: A vulnerable rural area in Sweden. INTERVENTION: A parent advisor from the social services and a midwife performed an extended home visiting programme during the end of pregnancy to mothers of children born between 1 May 2018 and 31 May 2019. During these children's first 15 months, three additional home visits were made by a parent advisor and a child healthcare nurse. The aim of the study is to evaluate the effect of the intervention on the health of the children and the mothers. SUBJECTS: All firstborn children at the study site (N = 30 study, N = 55 control group). MAIN OUTCOME MEASURES: The proportion participating in visits to the child and maternal healthcare services, children being breastfed and receiving childhood vaccinations. RESULTS: There were fewer absentees in the study group during routine check-up visits (93 vs. 84%). More mothers in the study group attended the check-up with the midwives (90 vs. 80%). More children in the study group were breastfed (90 vs. 67%) and received all vaccinations (100 vs. 96%). CONCLUSION: Supplementing the extended home visiting programme with a visit at the end of pregnancy seems to contribute to fewer absentees at routine visits for both mothers and children; furthermore, more children were breastfed and vaccinated compared with the control group.

Evaluation of four additional home visits to all firstborn children by parent advisors and healthcare professionals during the end-of-pregnancy period and early childhood in a vulnerable area showed the following benefits:More children in the study were breastfed and received all vaccinations compared with the control group.There were fewer absentees at the routine check-up visits to the child healthcare centre in the study compared with the control group.More mothers in the study group attended the check-up visits to the midwife 2 months after delivery compared with the controls.

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In recent years, Japan has promoted home visits to support older adults, with caregivers playing an important role. However, caregivers generally experience a high frequency of anxiety and depression, and the factors associated with these conditions among home visit caregivers remain unknown. To identify the associated factors, we conducted a questionnaire-based cross-sectional study of home visit caregivers in Tokushima Prefecture, Japan. The survey included caregivers' Hospital Anxiety and Depression Scale;sociodemographic items of patients and caregivers;and caregivers' perceptions of the home care environment, patients, and themselves. The questionnaires were sent to 379 caregivers;203 responded (53.6% response rate), of which 173 were valid (85.2% valid response rate). The prevalence of anxiety and depression was 43.9% and 69.4%, respectively. Multiple logistic regression analysis of factors associated with anxiety and depression showed that stable family finances (OR:0.69, 95% CI:0.48-1.00, p=0.049) and stable caregiver health (OR:0.45, 95% CI:0.30-0.68, p<0.001) were associated with anxiety. Further, stable family finances (OR:0.60, 95% CI:0.38-0.93, p=0.022), stable caregiver health (OR:0.49, 95% CI:0.30-0.81, p=0.005), and stable patient condition (OR:0.51, 95% CI:0.29-0.92, p=0.025) were associated with depression. These findings demonstrate that caregiver wellbeing is essential in home care settings. J. Med. Invest. 70 : 443-449, August, 2023.

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É comum o armazenamento de medicamentos pelas famílias brasileiras, seja por uso contínuo, por sobras de um tratamento, pelo abandono ou para a automedicação. Dessa maneira o presente estudo objetiva analisar o estoque domiciliar de medicamentos da população adstrita na Estratégia Saúde da Família (ESF) de Rondonópolis-MT de fevereiro a junho de 2022, visando analisar as condições de armazenamento, realizar o levantamento de todos os fármacos dos domicílios em suas diferentes formas farmacêuticas e identificar o perfil de uso dos medicamentos conforme suas indicações terapêuticas. Trata-se de um estudo transversal, de caráter exploratório, e de base descritiva. Foi aplicado um questionário por domicílio durante visita domiciliar. Sobre a amostra estudada, 83,9% (n=281) dos entrevistados era do sexo feminino, faixa etária com predomínio de pessoas acima de 40 anos, com um nível de escolaridade baixo e renda familiar mais baixa. Dos participantes da pesquisa, 97,6% possuíam farmácia caseira. Esses medicamentos eram armazenados principalmente na cozinha, no quarto e na sala. As classes terapêuticas mais numerosas foram: analgésicos (14,2%), AINEs (8,9%) e anti-hipertensivos (7,7%). A quantidade de medicamentos armazenados foi significativamente maior entre praticantes de automedicação e participantes sem conhecimento adequado sobre o uso dos medicamentos, revelando a necessidade do farmacêutico como promotor de ações de educação em saúde sobre uso racional de medicamentos.

It is common for Brazilian families to store medications, whether for continuous use, leftover from treatment, due to abandonment, or for self-medication. Thus, this study aimed to analyze the home drug storage of the population attached to the Family Health Strategy (FHS) in Rondonópolis-MT from February to June 2022, to assess storage conditions, conduct a survey of all pharmaceuticals in the households in their different pharmaceutical forms, and identify the medication use profile according to their therapeutic indications. This was a cross-sectional, exploratory, descriptive-based study. A questionnaire was administered to each household during home visits. Regarding the study sample, 83.9% (n=281) of the respondents were female, predominantly over 40 years old, with a low level of education and lower family income. Of the participants, 97.6% had home pharmacies. These medications were primarily stored in kitchens, bedrooms, and living rooms. The most numerous therapeutic classes were analgesics (14.2%), NSAIDs (8.9%), and antihypertensive drugs (7.7%). The quantity of stored medications was significantly higher among those practicing self-medication and participants with inadequate knowledge about medication use, revealing the need for pharmacists as promoters of health education actions on rational drug use.

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BACKGROUND: Home visits have often been performed for diabetes management, but with the increased use of the internet and smartphones, people are opting for telenursing as the main method for monitoring and controlling diabetes. OBJECTIVE: This study compares the effects of home visits and telenursing on diabetes management. METHODS: Four electronic databases (MEDLINE, Embase, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature) were used as data sources. Glycated hemoglobin (HbA1c), fasting blood sugar, and two-hour post-prandial glucose levels were used as outcome measures. A subgroup analysis was performed based on the type of diabetes and follow-up. RESULTS: Of 1890 studies, 24 (2801 participants) were selected and meta-analyzed. The nursing interventions provided during nursing visits or telenursing mainly included education on diabetes and blood sugar control. It was seen that HbA1c decreased with a weighted mean difference of -0.66 (95 % confidence interval -0.82 to -0.51, p < .001) % in home visits and -0.56 (95 % confidence interval -0.81 to -0.31, p < .001) % in telenursing. The fasting blood sugar reported only in telenursing was reduced by a weighted mean difference of -14.23 (95 % confidence interval 27.59 to -0.88, p = .04) mg/dL and two-hour post-prandial glucose was reduced with a mean difference of -15.84 (95 % confidence interval -24.45 to -7.24, p = .003) mg/dL. Furthermore, low heterogeneity was found among the studies. In a subgroup analysis of diabetes type, HbA1c in home visits was reduced by -0.86 % in type 1 diabetes and -0.62 % in type 2 diabetes, while in telenursing, the reductions were -0.65 % and -0.53 %, respectively. Fasting blood glucose was reduced by -6.08 mg/dL and -18.50 mg/dL, respectively, whereas two-hour postprandial blood sugar was reduced by -14.49 mg/dL and -30.30 mg/dL, respectively, in telenursing. In the subgroup analysis of the follow-up period, HbA1c during home visits decreased by -0.63 % at 10 to 16 weeks, -0.73 % at 24 to 36 weeks, and -0.64 % at 52 weeks or more, while in telenursing, the reductions were -0.80 %, -0.44 %, and -0.07 %, respectively. Home visits were not statistically significant between 10 and 16 weeks, whereas telenursing was not significant at 52 weeks or more. CONCLUSIONS: Despite telenursing reducing HbA1c slightly less than home visits, evidence from this systematic review suggests that telenursing is a similarly effective approach for controlling blood glucose levels in patients with diabetes. Telenursing is a nursing intervention that can be used as an alternative to home visits for patients requiring diabetes management.

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A comunidade quilombola de Sacopã, cuja existência remonta a mais de 100 anos, está localizada na zona sul do Rio de Janeiro, na Lagoa Rodrigo de Freitas, e continua preservando cultura, ancestralidade e tradições do povo negro até os dias atuais. Neste estudo, tem-se como objetivo relatar a experiência das consultas do enfermeiro da Estratégia Saúde da Família (ESF) realizadas na comunidade quilombola Sacopã. Trata-se de um estudo do tipo relato de experiência, com abordagem qualitativa. As visitas domiciliares ocorreram nos dias 29 de setembro de 2021, no turno da tarde, e 6 de outubro de 2021, nos turnos da manhã e da tarde. O processo de enfermagem foi aplicado, incluindo triagem com aferição da pressão arterial e medição da glicemia capilar, renovação das prescrições de medicamentos, teste de sensibilidade plantar, agendamento de exames de colpocitologia e mamografias, avaliação dos registros de vacinação infantil, aconselhamento e educação em saúde. Essas ações visam atender às demandas da população quilombola e reparar os atrasos nas visitas domiciliares causados pela pandemia de covid-19. Vale ressaltar que realizar consultas de enfermagem no formato de atendimento domiciliar proporciona conforto, fortalece o vínculo entre a unidade de saúde e a comunidade, possibilita uma imersão na realidade local, aproxima os profissionais das famílias e reduz os custos de deslocamento, garantindo assim um cuidado holístico e abrangente aos usuários.

The Sacopã quilombola community, which has existed for over 100 years, is in the south of Rio de Janeiro, in Lagoa Rodrigo de Freitas, and continues to preserve culture, ancestry, and traditions of the black people to this day. This study aims to report the experience of consultations with the Family Health Strategy (FHS) nurse held in the Sacopã quilombola community. It is an experience report study with a qualitative approach. The home visits were conducted on September 29, 2021, in the afternoon shift, and on October 6, 2021, in the morning and afternoon shifts. The nursing process was applied, including screening with blood pressure and capillary blood glucose measurements, renewal of the drug prescriptions, plantar sensitivity tests, scheduling of Pap smears and mammograms, evaluation of children's vaccination records, counseling, and health education. These actions aim to meet the demands of the quilombola population and address the delays in home visits that occurred due to the COVID-19 pandemic. Note that conducting nursing consultations in a home care format provides comfort, strengthens the link between the health unit and the community, allows immersion in the local reality, brings professionals closer to families, and reduces travel costs, thus ensuring holistic and comprehensive care for users.

La comunidad quilombola de Sacopã que se remonta a más de cien años está ubicada en la zona sur de Río de Janeiro, en la Lagoa Rodrigo de Freitas, y viene preservando la cultura, ancestralidad y tradiciones del pueblo negro hasta la actualidad. Este estudio tuvo por objetivo informar la experiencia de consultas con la enfermería de la Estrategia de Salud Familiar (ESF) realizadas en la comunidad quilombola de Sacopã. Se trata de un estudio de tipo informe de experiencia, con enfoque cualitativo. Las visitas domiciliarias tuvieron lugar el 29 de septiembre de 2021, por la tarde, y el 6 de octubre de 2021, por la mañana y tarde. Se aplicó el proceso de enfermería, incluyendo el triaje con medición de la presión arterial y de la glucemia capilar, renovación de prescripciones de medicamentos, prueba de sensibilidad plantar, programación de exámenes de citología vaginal y mamografías, evaluación de los registros de vacunación infantil, asesoramiento y educación en salud. El objetivo de estas acciones fue atender las demandas de la población quilombola y compensar los retrasos en las visitas domiciliarias debido a la pandemia de la covid-19. Es importante destacar que la realización de las consultas de enfermería en atención domiciliaria proporciona comodidad, fortalece el vínculo entre la unidad de salud y la comunidad, permite una inmersión en la realidad local, acerca a los profesionales a las familias y reduce los costos de desplazamiento, garantizando así una atención holística y completa a los usuarios.

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CONTEXT: Residential facilities for dependent elderly people have difficulties ensuring medical follow-up of their residents by general practitioners. The barriers to medical visits are well-known. Seine-Saint-Denis is particularly affected by the medical demography crisis. OBJECTIVES: To describe the organization of visits by general practitioners in residential facilities for dependent elderly people in Seine-Saint-Denis. To assess the influence of the institutions' status on this organization. METHOD: Quantitative descriptive cross-sectional study of 65 facilities in Seine Saint-Denis. A questionnaire drawn from the literature on known barriers to medical visits was used. RESULTS: Fifty institutions (76.9%) contributed. Most visits (88.0%) took place in patients' rooms. When the practitioner arrived, the patient was present at the site in 80.0% of the facilities, especially when they were private and associative (p = 0.01). The doctor was accompanied by a staff member in 30.0% of the facilities, especially when they were for-profit (p = 0.02). Exchanges between general practitioners and the staff were sporadic and unorganized. All in all, the public facilities seemed to be less well-organized to receive general practitioners. DISCUSSION: Residential facilities for the elderly do not seem to have implemented specific organization for visits by general practitioners, who are not integrated in the staff. CONCLUSION: Experiments with doctors gainfully employed in institutions could be carried out, following the example of several foreign countries.

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BACKGROUND: To meet the increasing demand for home healthcare in Japan, as part of the national healthcare system, home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in 2006 and 2012 respectively. This study aimed to evaluate whether HCSCs has succeeded in providing 24-h home care services through the end of life. METHODS: A retrospective cohort study was conducted using the national database in Japan. Participants were ≥ 65 years of age, had newly started regular home visits between July 2014 and September 2015, and used general clinics, conventional HCSCs, or enhanced HCSCs. Each patient was followed up for 6 months after the first visit. The outcome measures were (i) emergency house call(s), (ii) hospitalization(s), and (iii) end-of-life care defined as in-home death. Multivariable logistic regression analyses were performed for statistical analysis. RESULTS: The analysis included 160,674 patients, including 13,477, 64,616, and 82,581 patients receiving regular home visits by general clinics, conventional HCSCs, and enhanced HCSCs respectively. Compared to general clinics, the use of conventional and enhanced HCSCs was associated with an increased likelihood of emergency house calls (adjusted odds ratio [aOR] and 95% confidence intervals [CIs] of 1.62 [1.56-1.69] and 1.86 [1.79-1.93], respectively) and a decreased likelihood of hospitalizations (aOR [95% CIs] of 0.86 [0.82-0.90] and 0.88 [0.84-0.92] respectively). Among 39,082 patients who died during the follow-up period, conventional and enhanced HCSCs had more in-home deaths (aOR [95% CIs] of 1.46 [1.33-1.59] and 1.60 [1.46-1.74], respectively) compared to general clinics. CONCLUSIONS: HCSCs (especially enhanced HCSCs) provided more emergency house calls, reduced hospitalization, and enabled expected deaths at home, suggesting that further promotion of HCSCs (especially enhanced HSCSs) would be advantageous.

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The Home Care Service (SAD) provides home palliative care to patients with advanced stage cancer and their families. Mourning is a subjective, dynamic process, experienced in a unique way by the subject who has lost something/someone important to him/her. Thus, the objective was to understand the anticipatory grief experience of family members of terminal cancer patients, accompanied by a SAD, 11 family members with a heterogeneous profile participated in the study. The method used was the Focus Group, whose content analysis indicated that anticipatory grief was processed from three categories: meeting with the severity of the disease; family and care; psychic elaboration of anticipatory grief. It can be concluded that being accompanied by the SAD proves to be a facilitating element for the elaboration of anticipatory grief and a protection factor against a complicated future grief.

El Servicio de Atención Domiciliaria (SAD) proporciona cuidados paliativos a domicilio a pacientes con cáncer en estadio avanzado y sus familias. El duelo es un proceso subjetivo, dinámico, vivido de manera única por el sujeto que ha perdido algo/alguien importante para él/ella. Así, el objetivo fue comprender la experiencia de duelo anticipatorio de familiares de pacientes oncológicos terminales, acompañados de un SAD, participaron del estudio 11 familiares con perfil heterogéneo. El método utilizado fue el Grupo Focal, cuyo análisis de contenido indicó que el duelo anticipatorio fue procesado a partir de tres categorías: encuentro con la gravedad de la enfermedad; familia y cuidados; elaboración psíquica del duelo anticipatorio. Se puede concluir que el acompañamiento del SAD resulta ser un elemento facilitador para la elaboración del duelo anticipado y un factor de protección frente a un duelo futuro complicado.

O Serviço de Atendimento Domiciliar (SAD) presta cuidados paliativos domiciliares aos pacientes com câncer em estágio avançado e à sua família, nesse contexto inexoravelmente observa-se variados processos de lutos. O luto trata-se de um processo subjetivo, dinâmico, vivido de maneira singular pelo sujeito que perdeu algo/alguém importante para si. Assim, o objetivo foi compreender a experiência de luto antecipatório de familiares de pacientes oncológicos em terminalidade, acompanhados por um SAD, participaram do estudo 11 familiares de perfil heterogêneo. O método utilizado foi o Grupo Focal, cuja análise de conteúdo indicou que o luto antecipatório se processou a partir de três categorias: encontro com a gravidade da doença; família e cuidado; elaboração psíquica do luto antecipatório. Pode-se concluir que ser acompanhado pelo SAD demonstra ser elemento facilitador para elaboração do luto antecipatório e fator de proteção de um futuro luto complicado.

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BACKGROUND: Heart failure is common and is associated with high rates of hospitalization. Home care support clinics/hospitals (HCSCs) and enhanced HCSCs were introduced in Japan in 2006 and 2012, respectively. OBJECTIVE: This study aimed to examine the effect of post-discharge care by conventional or enhanced HCSCs on readmission, compared with general clinics. DESIGN: Retrospective cohort study using the Japanese nationwide health insurance claims database. PARTICIPANTS: Participants were ≥65 years of age, admitted for heart failure and discharged between July 2014 and August 2015 and received a home visit within a month following the discharge (n=12,393). MAIN MEASURES: The exposure was the type of medical facility that provides post-discharge home healthcare: general clinics, conventional HCSCs, and enhanced HCSCs. The primary outcome was all-cause readmission for 6 months after the first visit; the incidence of emergency house calls was a secondary outcome. We used a competing risk regression using the Fine and Gray method, in which death was regarded as a competing event. KEY RESULTS: At 6 months, readmissions were lower in conventional (38%) or enhanced HCSCs (38%) than general clinics (43%). The adjusted subdistribution hazard ratio (sHR) of readmission was 0.87 (95% CI: 0.78-0.96) for conventional and 0.86 (0.78-0.96) for enhanced HCSCs. Emergency house calls increased with conventional (sHR: 1.77, 95% CI:1.57-2.00) and enhanced HCSCs (sHR: 1.93, 95% CI: 1.71-2.17). CONCLUSIONS: Older Japanese patients with heart failure receiving post-discharge home healthcare by conventional or enhanced HCSCs had lower readmission rates, possibly due to compensation with more emergency house calls. Conventional and enhanced HCSCs may be effective in reducing the risk of rehospitalization. Further studies are necessary to confirm the medical functions performed by HCSCs.

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Objetivo: Evaluar las necesidades y las demandas de servicios desalud del cuidador principal de pacientes inmovilizados en el Centrode Salud de Caranza. Metodología: Estudio descriptivo transversalsobre los cuidadores principales de pacientes inmovilizados, mediantela identificación de inmovilizados y captación de 39 cuidadoresprincipales que voluntaria y anónimamente participaron. Inclusiónde variables de calidad (≥ 2 visitas/año), clínicas (sobrecarga, apoyo,estrés, ansiedad y depresión), sociodemográficas y de satisfaccióncon el servicio. Resultados: El indicador de calidad se superó en el89,8% de inmovilizados. Entre sobrecarga y parentesco (p = 0,040),nivel de cobertura (p = 0,012) o tiempo de respuesta (p = 0,015) seobservaron diferencias estadísticamente significativas. También hubodiferencias estadísticamente significativas entre apoyo social y nivelde cobertura (p < 0,001), tiempo de respuesta (p = 0,022), sobrecarga(p = 0,003), ansiedad (p = 0,046) o depresión (p = 0,040). Por último,se apreciaron diferencias estadísticamente significativas entre nivel deestrés y género (p = 0,035). Conclusiones: El presente trabajo muestraque las necesidades y demandas de servicios de salud se deben dirigir adisminuir el elevado nivel de sobrecarga, estrés y depresión detectado.De este modo, el estudio pone en evidencia el tipo de actuacionesmultidisciplinarias que los servicios de salud deben implementar paramejorar la calidad de vida y mitigar los problemas de salud de loscuidadores principales de pacientes inmovilizados. (AU)

Objective: Assess the needs and demands for health servicesof the main caregiver of immobilized patients at the CaranzaHealth Center. Methodology: Cross-sectional descriptive studyon the main caregivers of immobilized patients, through theidentification of immobilized patients and recruitment of 39main caregivers who voluntarily and anonymously participated.Inclusion of quality variables (≥ 2 visits/year), clinical (burden,support, stress, anxiety, and depression), sociodemographic, andsatisfaction with the service. Results: The quality indicator wasexceeded in 89.8% of fixed assets. Between burden and kinship(p = 0.040), level of coverage (p = 0.012) or response time(p = 0.015), statistical differences were observed. There were alsostatistically significant differences between social support andcoverage level (p < 0.001), response time (p = 0.022), overload(p = 0.003), anxiety (p = 0.046) or depression (p = 0.040). Finally,statistically significant differences were observed between stresslevel and gender (p = 0.035). Conclusions: The present workshows that the needs and demands of health services shouldbe aimed at reducing the high level of overload, stress anddepression detected. In this way, the study highlights the type ofmultidisciplinary actions that health services must implement toimprove the quality of life and mitigate the health problems of themain caregivers of immobilized patients. (AU)

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OBJECTIVE: To describe a feasibility pilot study for older adults that addresses the digital divide, unmet health care needs, and the 4Ms of Age-Friendly Health Systems via the emergency department (ED) follow-up home visits supported by telehealth. DATA SOURCES AND STUDY SETTING: Data sources were a pre-implementation site survey and pilot phase individual-level patient data from six US Department of Veterans Affairs (VA) EDs. STUDY DESIGN: A pre-implementation survey assessed existing geriatric ED processes. In the pilot called SCOUTS (Supporting Community Outpatient, Urgent care & Telehealth Services), sites identified high-risk patients during an ED visit. After ED discharge, Intermediate Care Technicians (ICTs, former military medics), performed follow-up telephone, or home visits. During the follow-up visit, ICTs identified "what matters," performed geriatric screens aligned with Age-Friendly Health Systems, observed home safety risks, assisted with video telehealth check-ins with ED providers, and provided care coordination. SCOUTS visit data were recorded in the patient's electronic medical record using a standardized template. DATA COLLECTION/EXTRACTION METHODS: Sites were surveyed via electronic form. Administrative pilot data extracted from VA Corporate Data Warehouse, May-October 2021. PRINCIPLE FINDINGS: Site surveys showed none of the EDs had a formalized way of identifying the 4 M "what matters." During the pilot, ICT performed 56 telephone and 247 home visits. All home visits included a telehealth visit with an ED provider (n = 244) or geriatrician (n = 3). ICTs identified 44 modifiable home fall risks and 99 unmet care needs, recommended 80 pieces of medical equipment, placed 36 specialty care consults, and connected 180 patients to a Patient Aligned Care Team member for follow-up. CONCLUSIONS: A post-ED follow-up program in which former military medics perform geriatric screens and care coordination is feasible. Combining telehealth and home visits allows providers to address what matters and unmet care needs.

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