WEST AFRICAN COLLEGE OF PHYSICIANS (FACULTY OF FAMILY MEDICINE) HOME HEALTH CARE 2015 JOINT UPDATE...
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Transcript of WEST AFRICAN COLLEGE OF PHYSICIANS (FACULTY OF FAMILY MEDICINE) HOME HEALTH CARE 2015 JOINT UPDATE...
WEST AFRICAN COLLEGE OF PHYSICIANS
(FACULTY OF FAMILY MEDICINE)
HOME HEALTH CARE2015 JOINT UPDATE COURSE/TOT
DR UDO E ATKINSON NATIONAL HOSPITAL ABUJA
OBJECTIVES
By the end of this session, participants will do the following:
Overview of Home Health Care Home Health Care Nigeria experience Explain Home Health Care Benefits of Home Health Care Describe Home Health Care services List the members of Home Health Care Team Describe the skills necessary for Home Health Care Describe the resources necessary for Home Health Care
Pretest 1: Multiple choice (one
best answer)Home health care is within the purview of
a) Facility care
b) Primary care
c) Family care
d) Patient centred care
e) Preventive care
Pretest 2: Multiple choice (one best answer)
The following is a setting for Home Health Care
a) Nursing home
b) Prison
c) Home for the Handicapped
d) Home setting for the purpose of promoting, maintaining or restoring health
e) Home for the internally displaced persons
Pretest 3: Multiple choice (one best answer)
Which of the following group of people do not need Home Health Care?
a) Mothers and newborns, home from the hospital after 24 hours
b) Patients of all ages who return home after surgery
c) Patients who have simple treatment requiring medication monitoring
d) Haemophiliacs
e) Patients with chronic Kidney disease
Pretest 4: Multiple choice (one best answer)
Home Health Care services include the following except
a) Pain management
b) Prescription management
c) Skilled nursing
d) Medication reminders
e) Medication teaching
Pretest 5: Multiple choice (one best answer)
Longitudinal care is not
a) Coordinated care
b) Ongoing monitoring
c) Comprehensive care
d) Preventive care
e) Episodic care
HOME HEALTH CARE: OVERVIEW
As life expectancy increases with aging population in our society and
people become incapacitated through ill-health or injuries, home health
care will become necessary in our healthcare
And with the serious challenges facing the public health care system at
every level in this country, and the need for reduced hospital stays for
people of any age who are disabled, chronically or terminally ill, recovery
from surgery or injury, home health care will be very complementary.
Informally, caregivers at home are generally family members or friends;
formally, home health care consists of a professional health care team
working towards a common goal
HOME HEALTH CARE IN NIGERIA
MeCure home healthcare Medication set up
Medicine administration
Wound care
Insulin injection
Intensive care ambulance
Florence Nightingale Care Agency (FNCA) Home based health care
Home health check-up
Professional personal care
Supreme homecare services Ltd Live-In-home care services for
activities of daily living
Day homecare-daily visit basis
Specialty care-diabetes care, BP
checks, wound care, indwelling
catheter care
Care of chronically or terminally care
Post delivery care for mother and baby at home
Physiotherapy
PRIMARY CARE
“Primary care is that care provided by physicians specifically trained for
and skilled in comprehensive first contact and continuing care for
persons with any undiagnosed sign, symptom, or health concern (the
"undifferentiated" patient) not limited by problem origin (biological,
behavioral, or social), organ system, or diagnosis”.
“Primary care includes health promotion, disease prevention, health
maintenance, counseling, patient education, diagnosis and treatment of
acute and chronic illnesses in a variety of health care settings (e.g., office,
inpatient, critical care, long-term care, home care, day care, etc.)”.
PRIMARY CARE (cont’d)
Depending on the health conditions and practice settings, and through
coordination of care, patient may be referred for secondary or tertiary care
within the health system
Family Physicians with wide breadth of knowledge in many areas of
medicine are key care givers; others include Paediatricians, General
Internists, Registered Nurses and Pharmacists etc.,
However, these other care givers, do not provide these services within the
context of comprehensive, first contact and continuing care
"Primary care" does not fully describe the activities of family physicians nor
the practice of family medicine.
PRIMARY MEDICAL CARE
Primary Medical Care
Comprises comprehensive care, patient-centred care,
coordinated care, accessible service and quality and
safety in the comfort of the patient’s home
These are the Core functions of primary health
care
Delivered through Primary Care
DEFINITIONHome health care is a
formal, regulated program of care, providing a range of skilled medical and therapeutic services to individuals and familieswomen and men regardless of age or disease
infants, children and adolescents regardless of disease in the comfort of
their homes by a variety of licensed health care professionals and
caregiversCan vary from being temporary to long term depending on the need of
patientRedefining of patient care from hospital or facility to home
DEFINITION cont’d
In-Home non-medical care (Home Care)
Informal non-medical care provided mostly by family members,
friends and other people who are not licensed medical personnel
(such as doctors, nurses) or licensed caregivers
Supportive personal care, medication reminders, companionship,
meal preparation, laundry, housekeeping, etc.,
The family is the most important care provider for the patient
What are the GOALS of HOME HEALTH CARE
Improve the health and quality of life of the patient and family through comprehensive primary medical care and nursing and rehabilitative services
Reduce the need for hospitalization and nursing home and other institutional placement
Provide support for the informal caregiver Reduce emergency unit visits Reduce hospital length of stay and the risk of hospital re-admission Allow terminal patients to die at home in comfort if that is their
wish Enhance optimal growth and development of infants and children To maximize the level of patient’s independence
CHARACTERISTICS OF CURRENT HEALTHCARE SYSTEMS
Poor funding Inadequately equipped Expensive Unhealthy rivalry among healthcare workers Incessant strikes in the health sector Activity based rather than performance Ineffective Inefficient Difficult to access and to use
BENEFITS of Home Health Care
Offers uninterrupted services to patient and the family
More convenient
Encourages continuity of care
Enhances quality of life
Promotes independence despite the limitations of their medical conditions
Maintaining individualism
Home is always associated with comfort, security and positive feeling
Home care keeps families together while providing support.
Home care can often be customized and personalized to patient needs
Helps patient become self sufficient as possible
Less expensive
As effective as care the patients get in a hospital
Who is a FAMILY PHYSICIAN? “A FAMILY PHYSICIAN is one who takes professional responsibility
for the comprehensive care of unselected patients with undifferentiated
problems and who is committed to the person regardless of age, gender,
illness or organ systems affected in the context of the family”
A FAMILY PHYSICIAN does not treat diseases but takes care of the
whole person in a HOLISTIC manner using the BIOPSYCHOSOCIAL
approach
The scope of FAMILY PRACTICE is determined by HUMAN NEEDS
and not by diagnoses or procedures
What are the Human Resources for Home Health Care team
FAMILY PHYSICIANS
General Internist
Paediatricians
Obstetricians/ Gynaecologists
Nurses
Mental health nurses
Pharmacists
Medical Social workers
Speech therapists
Occupational therapists
Physiotherapists
Dieticians
Patient and family members
Dentists
What are the Resources for Home Health Care team? Cont’d
Non-Human resources
Medical Equipment-BP Monitor, Glucometer, ECG machine, USS, and other diagnostics that can be done at home, etc.
Non-Medical equipment-bed, wheelchairs and other assistive devices used in the home
Sources of Health Care financing-Out of pocket, donations etc.
What Skills does a FAMILY PHYSICIAN need to achieve set goals in Home Health Care
Skills from the breadth and depth of
knowledge acquired during the residency
training programmes
Skills acquired through life-long learning
activities
What Skills does a FAMILY PHYSICIAN need to achieve set goals in Home Health care
Cognitive experience
Practical knowledge
Psychomotor skills
Attitudinal Orientation
Good communication and interpersonal skills
Meticulous attention to details
Medical information management
Skills in the use of family medicine tools
Ability to integrate current evidence-
based content into every patient’s home
Advocacy
A team leader
Skills in generating and using data to
drive change
Ability to develop long term healing
relationships with patients
All these makes you a resource to a
defined population
What are the responsibilities of the FAMILY PHYSICIAN in Home Health Care?
Provision of impactful Home Health Care through the knowledge of the
patient’s family and its dynamics
Scope of the Home Health Care will be determined by the patient and
family needs and not by diagnoses or procedures
Provision of integrated and accessible healthcare services through
sustained partnership with patients in the context of the family
Provision of comprehensive, continuous and coordinated care for the
patient and the family at any given stage of their life cycles
Provides promotive, preventive, curative and rehabilitative services
MEDICAL ETHICS IN HOME HEALTH CARE
Provide competent medical services with compassion
and show respect for the dignity and privacy of the
patient and patient’s home
FP must not go beyond the physical and emotional
boundaries of the doctor-patient relationship
Be honest and forthright with patients, families and
other professional home health care team members
MEDICAL ETHICS IN HOME HEALTH CARE
Respect the rights of the patients, families, colleagues
and other healing professionals and also safeguard
patients and families confidentiality
Respect the professional integrity and needs of non-physicians
and interact in appropriate manner commensurate with that
professional respect
MEDICAL ETHICS IN HOME HEALTH CARE
You may refuse to provide treatment to a patient, if in your
opinion the patient cannot be adequately evaluated in the
home setting
Decline home visit if the specific home or neighborhood is
unsafe and communicate same with the patient and
family/caregiver and arrange for an alternative approach to
care for the patient
Request payment only for services rendered
Never accept compensation in exchange for your signature
What are the roles of the Family Physician?
Identify patient/family for home healthcare
Assess the scope of the Health needs of the patient/family using the biopsychosocial approach
Risk stratification
Health risk management plan
Define the standard of care and cost of care for patient and family
Define patient and family roles as team members
Ensure patients understand their roles and responsibilities in their care plan
Management of patient care
Coordination of care and advocacy
Health promotion and wellness needs
Open and keep clinical records, visit notes and every daytime summaries of each encounter with patient and family
Who should be considered for Home Health Care
Patients who are:Recovering from illness, injury or surgery Undergoing treatment-complex treatmentDisabledChronically illTerminally illElderly adults, 65 years and over with
functional impairment
HOME HEALTHCARE SERVICES
Medical care Nursing care Physical, occupational, and/or
speech therapy Medical social services Care from home health aides Homemaker or attendant care Companionship Medication reminders
Volunteer care Nutritional support Medical equipment and supplies Laboratory and X-ray imaging
and other diagnostics that can be done at home
Pharmaceutical services Transportation Home-delivered meals
HOME HEALTHCARE SERVICES(SKILLED HOME HEALTH SERVICES cont’d)
Diabetic care Rehabilitative Therapeutic Geriatric care Cardiac care Continence management Medication Teaching Injections Consultations
Wound care for pressure sores or a surgical wound
Patient and caregiver education
Intravenous or nutrition therapy
Monitoring serious illness
and unstable health status
Post-delivery mother and
child care
Functions of Primary Health Care delivered by Primary Care through Home Health Care
COMPREHENSIVE CAREBiopsychosocial needsHealth promotionDisease preventionWellnessAcute careChronic care
Functions of Primary Health Care delivered by Primary Care through Home Health Care cont’d
PATIENT-CENTRED CARERelationship basedPatient and families are the core of the care team
Whole person care respecting their peculiar needs,
cultures, values and preferences
Functions of Primary Health Care delivered by Primary Care through Home HealthCare cont’d
COORDINATED CARE
Coordinates care across all spectrum of the
broader health care system
Establishing clear and open communications
among patients, families and other members of
the broader care team
Functions of Primary Health Care delivered by Primary Care through Home HealthCare cont’d
ACCESSIBLE SERVICES
Delivers accessible services with shorter waiting
time for urgent needEnhances in-person hours
Patients preferences regarding access are
respected
Functions of Primary Health Care delivered by Primary Care through Home HealthCare cont’d
QUALITY AND SAFETYApplication of evidence-based best practices
Use of appropriate Family Medicine tools to guide
shared decision making with patients and families
Responding to patients’ experiences and patient
satisfaction
TYPES HOME HEALTH CARE SERVICES
Home Health CareHome Respite careAdult Residential DaycareNursing CarePalliative CareHospice Care
HOME HEALTH CARE SERVICES
Home Health Care
Provision of comprehensive care, patient-centred care,
coordinated care, accessible service and quality and safety
in the comfort of patient’s home
Skilled services include wound care, IV therapy, diabetic
care, catheter care, cardiac and respiratory assessment
and care, medication management and pain management
HOME HEALTH CARE SERVICES
Home Respite Care
These care services offer families the opportunity to
take a break from their caregiving responsibilities,
leaving their family member or loved one in the
hands of a respite giver
HOME HEALTH CARE SERVICES
Adult Residential DayCare
Daytime adult medical care services providing
professional and compassionate care to your family
member/patient to enable him or her live as
independently as possible in his or her own home.
Provides support, supervision and therapies while family
members or primary caregivers work
NURSING CARE
Client assessment and health education
Wound care Glucose monitoring Injection administration Blood draws Long-term care
management Vitals monitoring
Intravenous therapy Infusion therapy Tube feeding Catheter care Post-surgical care Pain management Medication management Activities of daily living
HOME HEALTH CARE SERVICESHospice care
Physical and psychological care given to a terminally ill patients to make
the final dying period of life as pain free as possible
Prevention or relief of symptoms and support for patient and family
Hospice care is given to patients considered to be terminal or within six
months or less of death
Hospice care begins after treatment of the disease is stopped when it is
obvious that the patient will not survive the illness
Care continues into bereavement period with support provided for family
members for extended period of 13-months after death occurs
HOME HEALTH CARE SERVICES
Palliative Care
Physical and compassionate care given to patients who are
chronically or terminally ill
Care can begin at diagnosis, throughout treatment, during
follow-up and at the end of life whether it is terminal or not
Economic, emotional, social and spiritual needs
Care is given for control & relieve symptoms but does not cure
CONCLUSIONSince Family Medicine is leading the
way in making health care more patient-centered and family focused, Family Physicians should take the lead in making home health care a reality in Nigeria
Post test 1: Multi choice(One best answer)
Hospice care can be givena)At diagnosis
b)Throughout treatment
c) During follow-up
d)Patients at end of life
e) Patients considered to be within six months of death
Post test 2: Multi choice(One best answer)
Which of the following is not a type of home health care?
a)Home health care
b)Home respite care
c) Adult day care
d)Palliative care
e) Hospice care
Post test 3: Multi choice(One best answer)
Functions of Primary Health Care delivered by Primary Care through Home HealthCare include all except
a)Comprehensive care
b)Coordinated care
c) Continuing care
d)Accessible service
e) Quality and safety
Post test 4: Multi choice(One best answer)
Benefit of home health carea)Helps patient become self sufficient
b)Can be customized to patient needs
c) Promotes independence despite limitations of medical conditions
d)More effective care than facility care
e) More convenient
Post test 5: Multi choice(One best answer)
Which of the following is not skilled home health care service
a) Diabetic care
b) Rehabilitative
c) Therapeutic
d) Geriatric care
e) Tube feeding
REFERENCES
1. Primary Care. Definitions from American Academy of Family Physicians AAFP.
(Available from: http://www.aafp.org/x6988.xml). Cited 26/05/2015
2. Adrienne L, Jones BS, Harris-Kojetin L, Roberto V. Characteristics and use of Home Health Care by Men and Women Aged 65 and over. National Health Statistics Reports. 2012 Apr; 52
3. Stall N, Nowaczynski M, Sinha SK. Systematic Review of outcomes from home-based primary care programs for home bound older adults. J Am Geriatr Soc. 2014 Dec; 62(12):2243-51
4. Montauk SL. Home Health Care. American Family Physician. Available from: http://www.aafp.org/ afp/981101ap/montauk.html. Cited 20/05/2015
5. Murkofsky RL, Alston K. The past, present, and future of skilled home health agency care. Clin Geriatr Med 2009; 25:1–17.
REFERENCES (cont’d) 6. Dwyer LL, Harris-Kojetin LD, Branden L, Shimizu IM. Redesign and operation of the
National Home and Hospice Care Survey, 2007. National Center for Health Statistics. Vital Health Stat 2010; 1(53).
7. International Classification of Diseases, Clinical Modification Sixth Edition. NCHS CD ROM, October 2007 No. 1. DHHS Pub No. (PHS) 07–1260; CS110232 (10/07) T28572. Available from: http://www.cdc.gov/nchs/icd/icd9cm.htm.
8. Barr MS. The need to test the patient-centred Medical Home. JAMA 2008;359:643-50
9. Rettenhense DR, Shortell SM, Fisher ES. Primary care and accountable care- two essential elements of delivery system reform. N Engl J M. 2009 Dec 10;
361(361):2301-3
10. Roland M, Guthrie B, Thome DC. Primary Medical Care in the United Kingdom. J AM Board Fam Med. 2012 Mar-Apr; 25(1):56-11
11. Sutter WN, Sutter PM. Wanted-Measurement in Home Health needed-focus on Meditation Risk. Home Health Management Practice. 2015 May; 27(2): 91-94
12. Eti S. Palliative Care: an evolving field in Medicine. Prim Care. 2011 Jun;38(2):159-71