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Expectations and user experience of a multimodal medicine management system for older users
- Authors:
- HARJUMAA Marja, et al
- Journal article citation:
- Journal of Assistive Technologies, 8(2), 2014, pp.51-63.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to analyse the adoption of a multimodal medication management system (MMS) targeted on older people and home care professionals. The paper aims to describe the expectations of the system and the user experience findings from an empirical qualitative field trial. The field trial results are used to discuss how MMSs should be designed in order to improve adherence to medications. Design/methodology/approach: The paper suggests that building a multimodal medicine management system targeted on both older users and home care professionals brings many benefits over electronic medicine dispenser systems or general reminder systems. The research process uses an iterative prototyping approach including phases of requirements analysis and concept design, prototype building and evaluation in a field trial. Findings: The study demonstrates how a system that merely satisfied users during the prototype building phase does not necessarily succeed as well as expected in the field trials. It would be important to consider reasons for medication non-adherence and non-technology factors influencing willingness to adopt new assistive devices in order to promote diffusion of new MMSs at home. The paper also discusses how the different persuasive functionalities of the system addressed patient-centred factors influencing non-adherence and how they could be addressed. Research limitations/implications: This study has some limitations. The actual adherence to medications was not measured. However, in the future, it will be important to study how the MMSs influence medication adherence. Also, the user experiences of the home care professionals were not studied in the field trials. Home care professionals who were involved in the user studies and trials merely estimated the value for their patients and not for themselves. Originality/value: This paper analyses design issues relevant when designing systems to help older people manage their medications. (Publisher abstract)
Implementation of home hospitalization and early discharge as an integrated care service: a ten years pragmatic assessment
- Authors:
- HERNANDEZ Carme, et al
- Journal article citation:
- International Journal of Integrated Care, 18(2), 2018, p.12. Online only
- Publisher:
- International Foundation for Integrated Care
Home Hospitalization has proven efficacy, but its effectiveness and potential as an Integrated Care Service in a real world setting deserves to be explored. Objective: To evaluate implementation and 10 years follow-up of Home Hospitalization and Early Discharge as an Integrated Care Service in an urban healthcare district in Barcelona. Methods: Prospective study with pragmatic assessment. Patients: Surgical and medical acute and exacerbated chronic patients requiring admission into a highly specialized hospital, from 2006 to 2015. Intervention: Home-based individualized care plan, administered as a hospital-based outreach service, aiming at substituting hospitalization and implementing a transitional care strategy for optimal discharge. Main measurements: Emergency Department, readmissions and mortality. Patients’ and professionals’ perspectives, technologies and costs were evaluated. Results: 4,165 admissions (71 ± 15 yrs; Charlson Index 4 ± 3). In-hospital stay was 1 (0–3) days and the length of home-based stay was 6 (5–7) days. The 30-day readmission rate was 11% and mortality was 2%. Patients, careers and health professionals expressed high levels of satisfaction (98%). At the start, the service was reimbursed at a flat rate of 918€ per patient discharged, significantly lower than conventional hospitalization (2,879€) but still allowing the hospital to keep a balanced budget. At present, there is no difference in the payment schemes for both types of services. Conclusions: The service freed an average of 6 in-hospital days per patient. The program showed health value generation, as well as potential for synergies with community-based Integrated Care Services. (Edited publisher abstract)
Hospital-at-home Integrated Care Programme for the management of disabling health crises in older patients: comparison with bed-based Intermediate Care
- Authors:
- MAS Miquel A., et al
- Journal article citation:
- Age and Ageing, 46(6), 2017, pp.925-931.
- Publisher:
- Oxford University Press
Objective: To analyse the clinical impact of a home-based Intermediate Care model in the Catalan health system, comparing it with usual bed-based care. Design: Quasi-experimental longitudinal study. Setting: Hospital Municipal de Badalona and El Carme Intermediate Care Hospital, Badalona, Catalonia, Spain. Participants: Older patients with medical and orthopaedic disabling health crises in need of Comprehensive Geriatric Assessment (CGA) and rehabilitation. Methods: A CGA-based hospital-at-home Integrated Care Programme (acute care and rehabilitation) was compared with a propensity score matched cohort of contemporary patients attended by usual inpatient hospital care (acute care plus intermediate care hospitalisation), for the management of medical and orthopaedics processes. Main outcomes measures were: (a) Health crisis resolution (referral to primary care at the end of the intervention); (b) functional resolution: relative functional gain and (c) favourable crisis resolution (health + functional) = a + b. The article compared between-groups outcomes using uni/multivariable logistic regression models. Results: Clinical characteristics were similar between home-based and bed-based groups. Acute stay was shorter in home group: 6.1 (5.3–6.9) versus 11.2 (10.5–11.9) days, P < 0.001. The home-based scheme showed better results on functional resolution and on favourable crisis resolution, with shorter length of intervention, with a reduction of −5.72 (−9.75 and −1.69) days. Conclusions: In the study, the extended CGA-based hospital-at-home programme was associated with shorter stay and favourable clinical outcomes. Future studies might test this intervention to the whole Catalan integrated care system. (Edited publisher abstract)
Analysing equity in the use of long-term care in Europe
- Authors:
- RODRIGUES Ricardo, ILINCA Stefania, SCHMIDT Andrea
- Publisher:
- European Commission
- Publication year:
- 2014
- Pagination:
- 39
- Place of publication:
- Brussels
There are significant differences across social protection systems in Europe in the scope, breadth and depth of coverage of the risk to need long-term care in old-age. Together with other factors, such as education, household structure or societal values regarding care for frail older people, these differences can have a significant impact on the use of long-term care. Using SHARE data, this Research Note compares differences between European countries in the use of long-term care across income groups, for older people living at home. It analyses not only inequalities in the use of long-term care, but also differences in use that persist after differences in need have been taken into consideration, i.e. horizontal inequity. For this purpose, concentration indices, concentration curves and horizontal inequity indices are estimated for home care services and informal care. The countries analysed here are Austria, Germany, Sweden, the Netherlands, Spain, Italy, France, Denmark, Greece, Belgium and Czech Republic. The findings suggest that differences in use of home care services across income groups mostly reflect differences in need between those same groups. For informal care, the differences in use persist even after accounting for needs, and less affluent individuals are much more likely to use informal care. Some possible causes for these differences and policy implications are considered.
Towards a model of externalisation and denationalisation of care? The role of female migrant care workers for dependent older people in Spain
- Author:
- ROMERO Belén Agrela
- Journal article citation:
- European Journal of Social Work, 15(1), 2012, pp.45-61.
- Publisher:
- Taylor and Francis
The aim of this article is to analyse the role of migrant care workers in relation to older dependent people in Spain. This new model of care has come about due to: the rapid ageing of the population of Spain; the lack of formal care services; and the increasing presence of women in the labour market resulting in a shortage of informal care. These factors have led to a situation in which ‘importing’ female immigrants has become something of an ‘informal solution’ among both policy-makers and people who require their services. This article analyses how this point has been reaching, drawing primarily upon the connection established between the welfare state, the feminisation of migrations, and global care chains. It describes the limitations of the public system of protection of elders, as well as those of formal care services, making eldercare reliant upon family involvement. Since the high cost of private companies’ services cannot be met by all family budgets, resorting to migrant carers emerges as a solution to the problem. Finally, the article argues that the current conditions favour the production of social inequalities related to gender, class and nationality, and considers the implications for social work practice.
Struggles for recognition and redistribution: family carers and domestic workers in Spanish eldercare
- Author:
- PETERSON Elin
- Journal article citation:
- International Journal of Care and Caring, 2(4), 2018, pp.459-476.
- Publisher:
- Policy Press
Theories of social justice have identified the revaluation of caregiving work as a global challenge. Still, struggles for recognition are shaped by the specific cultural and institutional contexts in which they emerge. This article explores struggles for the recognition of caregiving work in Spanish eldercare, focusing on advocacy for family carers and for domestic workers. Drawing on interviews, findings reveal that domestic workers' needs are politicised to a greater extent than family carers' needs; empowerment and claims for workers' rights contrast with notions of self-care and mutual support. While the struggles are differentiated, the undervaluation of eldercare is a common theme. (Publisher abstract)
Can smart homes extend people with Alzheimer's disease stay at home?
- Authors:
- GONZALEZ Alberto Brunete, SELMES Micheline, SELMES Jacques
- Journal article citation:
- Journal of Enabling Technologies, 11(1), 2017, pp.6-12.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to analyse the needs of people with Alzheimer's disease and their caregivers in terms of information and communications technology (ICT) and home automation, and how to foster the use of smart devices in their homes and also, to determine whether the use of ICT can extend people with Alzheimer's disease stay at home in the first stages of the illness, while facilitating their caregivers’ tasks. Design/methodology/approach: Groups of caregivers, ICT researchers and Alzheimer's disease experts were gathered to discuss the utility of several solutions. Sessions were grouped into four topics: safety, leisure, activities of daily living and friendly atmosphere. In total, 23 ICT-based solutions to improve life at home of people with Alzheimer's disease were analysed and grouped under "no interest", "some interest" and "very interesting". Caregivers rated these solutions and suggested improvements to them. Findings: In total, 18 out of 23 proposals were considered "very interesting", meaning that caregivers considered that they could truly improve the lives of people with Alzheimer's disease. Caregivers also suggested how to progressively introduce these technical solutions into their homes. Originality/value: ICT and home automation advances could be very useful if used conveniently. Caregivers consider that smart homes can help people with Alzheimer's disease in the security, leisure and daily tasks fields, increasing the time they can live alone in their own homes. (Publisher abstract)
Diversification of old-age care services for older people: trade-offs between coverage, diversification and targeting in European countries
- Authors:
- SUNDSTRÖM Gerdt, et al
- Journal article citation:
- Journal of Care Services Management, 5(1), January 2011, pp.35-42.
- Publisher:
- Taylor and Francis
The two major public services for older people are institutional care and home care. In addition to these, a number of other low-level support services have also developed including transportation, meals-on-wheels, alarm systems, and day care. Using secondary analysis of a number of earlier surveys, this paper provides information on the way in which all of these types of support are allocated and who uses them in six different countries: Denmark, Norway, Sweden, Germany, England, Spain, and Israel. It also provides a closer scrutiny of Swedish service profiles. When all types of support are considered, service coverage in these countries is approximately 50% to 100% higher than for the two major types alone. The results suggest that countries with higher service levels target all their services more strictly by needs than countries with lower service levels. In countries with lower user rates, users may get what is available with little differentiation between their needs. The article suggests that a range of services, major and minor, may suit the varying needs of older people, and that minor services may also be used as an inexpensive substitute for full support.
A comparative case study of care systems for frail elderly people: Germany, Spain, France, Italy, United Kingdom and Sweden
- Authors:
- LE BIHAN Blanche, MARTIN Claude
- Journal article citation:
- Social Policy and Administration, 40(1), February 2006, pp.26-46.
- Publisher:
- Wiley
Comparative studies of European social policies towards frail elderly people typically focus on the systems and their implementation. The study presented in this article, conducted in 2001 in six European countries (Germany, Spain, Italy, France, the United Kingdom and Sweden) aims at comparing the rights of the individuals within the different care systems. The methodology used is a case study approach, which draws on a series of situations of dependent elderly people. The analysis focuses on the public authorities' responses – the care packages, which determine the type of care required and the financial contribution of the user – in each of the six countries, in relation to the concrete situations of frail elderly people. As local variations are important, in all the countries studied, local authorities have been chosen in each of the countries. This approach provides interesting concrete elements on the services and financial help which can be given to frail elderly people, and provides an understand of the national care systems organized in the different countries and the main difficulties encountered by public authorities in facing this problem of frail elderly people.
Caring for frail elderly people: policies in evolution
- Author:
- ORGANISATION FOR ECONOMIC CO-OPERATION AND DEVELOPMENT
- Publisher:
- Organisation for Economic Co-operation and Development
- Publication year:
- 1996
- Pagination:
- 305p.,tables,bibliogs.
- Place of publication:
- Paris
Examines evolving policies on long term care for the ageing population in the OECD area, and presents detailed information from 8 countries. Each country chapter covers: the demographic and social context; current provisions; costs and charges for services; provision of services; funding issues; and trends and future plans.