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3 results

  • ‘It’s not just the word care, it’s the meaning of the word…(they) actually care': caregivers’ perceptions of home-based primary care in Toronto, Ontario

  • TRACY SMITH-CARRIER, THUY-NGA PHAM, SABRINA AKHTAR, GAYLE SEDDON, MARK NOWACZYNSKI, SAMIR K. SINHA
  • Journal:
    Ageing & Society / Volume 38 / Issue 10 / October 2018
    Published online by Cambridge University Press:
    17 May 2017, pp. 2019-2040
    Print publication:
    October 2018

  • The frail and homebound older adult populations currently experience difficulties accessing primary care in the medical office. Given this fundamental access to care problem, and the questionable care quality that arises when navigating a labyrinthine health-care system, these populations have typically been subject to inadequate primary care. To meet their needs better, growing research stresses the importance of providing comprehensive home-based primary care (HBPC), delivered by an inter-professional team of health-care providers. Family care-givers typically provide the majority of care within the home, yet their perceptions of HBPC remain under-researched. The purpose of this study was to explore unpaid care-givers' perceptions of and experiences with HBPC programmes in Toronto, Canada. We conducted qualitative inductive content analysis, using analytic procedures informed by grounded theory, to discover a number of themes regarding unpaid care-givers' understandings of HBPC. Findings suggest that, compared to the standard office-based care model, HBPC may better support unpaid care-givers, providing them assistance with system navigation and offering them the peace of mind that they are not alone, but have someone to call should the need arise. The implications of this research suggest that HBPC could be a model to help mitigate the discontinuities in care that patients with comorbid chronic conditions and their attendant unpaid care-givers experience when accessing fragmented health, home and social care systems.

  • Disaster Preparedness in Home-based Primary Care: Policy and Training

  • Maria L. Claver, Tamar Wyte-Lake, Aram Dobalian
  • Journal:
    Prehospital and Disaster Medicine / Volume 30 / Issue 4 / August 2015
    Published online by Cambridge University Press:
    19 June 2015, pp. 337-343
    Print publication:
    August 2015
  • Introduction

    Veterans served by Veterans Health Administration (VHA) home-based primary care (HBPC) are an especially vulnerable population due to high rates of physical, functional, and psychological limitations. Home-bound patients tend to be an older population dealing with normal changes that accompany old age, but may not adequately be prepared for the increased risk that often occurs during disasters. Home health programs are in an advantageous position to address patient preparedness as they may be one of the few outside resources that reach community-dwelling adults.

    Problem

    This study further explores issues previously identified from an exploratory study of a single VHA HBPC program regarding disaster preparedness for HBPC patients, including ways in which policy and procedures support the routine assessment of disaster preparedness for patients, including patient education activities.

    Methods

    This project involved semi-structured interviews with 31 practitioners and leadership at five VHA HBPC programs; three urban and two rural. Transcripts of the interviews were analyzed using content analysis techniques.

    Results

    Practitioners reported a need for further training regarding how to assess properly patient disaster preparedness and patient willingness to prepare. Four themes emerged, validating themes identified in a prior exploratory project and identifying additional issues regarding patient disaster preparedness: (1) individual HBPC programs generally are tasked with developing their disaster preparedness policies; (2) practitioners receive limited training about HBPC program preparedness; (3) practitioners receive limited training about how to prepare their patients for a disaster; and (4) the role of HBPC programs is focused on fostering patient self-sufficiency rather than presenting practitioners as first responders. There was significant variability across the five sites in terms of which staff have responsibility for preparedness policies and training.

    Conclusion

    Variability across and within sites regarding how patient needs are addressed by preparedness policies, and in terms of preparedness training for HBPC providers, could place patients at heightened risk of morbidity or mortality following a disaster. Despite the diversity and uniqueness of HBPC programs and the communities they serve, there are basic aspects of preparedness that should be addressed by these programs. The incorporation of resources in assessment and preparedness activities, accompanied by increased communication among directors of HBPC programs across the country, may improve HBPC programs’ abilities to assist their patients and their caregivers in preparing for a disaster.

    ClaverML, Wyte-LakeT, DobalianA. Disaster Preparedness in Home-based Primary Care: Policy and Training. Prehosp Disaster Med. 2015;30(4):17.

  • Analyzing the Interprofessional Working of a Home-Based Primary Care Team*

  • Tracy Smith-Carrier, Sheila Neysmith
  • Journal:
    Canadian Journal on Aging / La Revue canadienne du vieillissement / Volume 33 / Issue 3 / September 2014
    Published online by Cambridge University Press:
    07 August 2014, pp. 271-284

  • Increasingly, interprofessional teams are responsible for providing integrated health care services. Effective teams, however, are not the result of chance but require careful planning and ongoing attention to team processes. Based on a case study involving interviews, participant observation, and a survey, we identified key attributes for effective interprofessional working (IPW) within a home-based primary care (HBPC) setting. Recognizing the importance of a theoretical model that reflects the multidimensional nature of team effectiveness research, we employed the integrated team effectiveness model to analyze our findings. The results indicated that a shared vision, common goals, respect, and trust among team members – as well as processes for ongoing communication, effective leadership, and mechanisms for conflict resolution – are vital in the development of a high-functioning IPW team. The ambiguity and uncertainty surrounding the context of service provision (clients’ homes), as well the negotiation of external relationships in the HBPC field, require further investigation.