The qualitative descriptive approach results in a summary in everyday, factual language that facilitates understanding of a selected phenomenon across disciplines of health science researchers.
ObjectivesTo determine whether a home-based care coordination program focused on medication self-management would affect the cost of care to the Medicare program and whether the addition of technology, a medication-dispensing machine, would further reduce cost.DesignRandomized, controlled, three-arm longitudinal study.SettingParticipant homes in a large Midwestern urban area.ParticipantsOlder adults identified as having difficulty managing their medications at discharge from Medicare Home Health Care (N = 414).InterventionA team consisting of advanced practice nurses (APNs) and registered nurses (RNs) coordinated care for two groups: home-based nurse care coordination (NCC) plus a pill organizer group and NCC plus a medication-dispensing machine group.MeasurementsTo measure cost, participant claims data from 2005 to 2011 were retrieved from Medicare Part A and B Standard Analytical Files.ResultsOrdinary least squares regression with covariate adjustment was used to estimate monthly dollar savings. Total Medicare costs were $447 per month lower in the NCC plus pill organizer group (P = .11) than in a control group that received usual care. For participants in the study at least 3 months, total Medicare costs were $491 lower per month in the NCC plus pill organizer group (P = .06) than in the control group. The cost of the NCC plus pill organizer intervention was $151 per month, yielding a net savings of $296 per month or $3,552 per year. The cost of the NCC plus medication-dispensing machine intervention was $251 per month, and total Medicare costs were $409 higher per month than in the NCC plus pill organizer group.ConclusionNurse care coordination plus a pill organizer is a cost-effective intervention for frail elderly Medicare beneficiaries. The addition of the medication machine did not enhance the cost effectiveness of the intervention.
The Praxis Theory of Suffering enables nurses to recognize and respond according to the behaviors of suffering, and to endure with healthy, adaptive, and normalizing behaviors that enable preserving self.
In 1998, a brave cardiologist named Dean Ornish published a book called Love and Survival with a straightforward hypothesis and went on to defend, with scientific evidence, the notion that "love and intimacy are among the most powerful factors in health and illness" (1). He boldly declared, "I am not aware of any other factor in medicine-not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgerythat has a greater impact on our quality of life, incidence of illness, and premature death from all causes." In the nearly two decades since his seminal work was made available for the general public, patients and researchers alike have focused on the knowledge that the people we surround ourselves with, providing support and being supported, matters deeply to our health and well-being. This field of inquiry has firmly established the criticality of social relationships for sustaining and improving health (2) and associated the lack of social integration with specific conditions such as cardiovascular disease, depression, cancer, infection, and mortality (3). Newer analytical techniques such as social network analysis are helping a fresh generation of researchers explore patterns of social connectedness through innovative procedures and algorithms that further expand our understanding.For the purpose of this review, social support is defined as researchers to achieve connection, and to assess the state of the science in this area. We hypothesized that being connected to someone who cares is good for your health. We believe this holds true even when connection is accomplished with mobile technologies. Thirty five studies were included in this review, 21utilized technology to enhance patient-provider connection. The articles included in this review were from a total of more than nine countries and took place in hospital, physician office, and community settings.They represented people from childhood through to old age. Technologies evaluated include: telephone interventions, email, text messaging, interactive voice response (IVR), video blogs, apps, websites, and social media. There were multiple operational definitions of social support and self-management used as variables within the studies. Findings from this review suggest that being connected does matter to patients with diabetes, and being connected to family matters the most, even though the associations are complex and not always predictable. Furthermore, patients with diabetes will utilize a variety of technologies to connect with healthcare providers, team members, and even other people with the same disease. The use of technology with diabetes patients positively impacts a variety of health outcomes, such as HbA1c, weight, physical activity, healthy eating, cholesterol and frequency of glycemic monitoring.
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