Implementation and Evaluation of a Depression Care Model for Homebound Elderly

Madden-Baer, Rose; McConnell, Eleanor; Rosati, Robert J.; Rosenfeld, Peri; Edison, Ilaina

doi:10.1097/ncq.0b013e318265702a

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…Each model can influence service delivery and care outcomes. Key elements to consider include collaboration between providers, physician remuneration practices, level of care integration and decision‐making autonomy (Blom et al., ; Frank & Wilson, ; Hurlock‐Chorostecki & Acorn, ; Madden‐Baer, McConnell, Rosati, Rosenfeld, & Edison, ). Dahrouge, Hogg, Lemelin, Liddy, and Legault () distinguished between consultative and shared care models.…”

Section: Introductionmentioning

confidence: 99%

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Implementing primary healthcare nurse practitioners in long‐term care teams: A qualitative descriptive study

Kilpatrick

Jabbour

Tchouaket

et al. 2019

Journal of Advanced Nursing

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Aim To identify the conditions needed to implement nurse practitioners (NP) in long‐term care (LTC) in Québec, Canada. Design A qualitative descriptive study was undertaken. Methods Semi‐structured interviews (N = 91) and socio‐demographic questionnaires were completed with providers and managers from May 2016–March 2017. Nurse practitioner activity logs were compiled at three sites. Content analysis was used. Results All sites initially implemented a shared care model but not all sites successfully implemented a consultative model. The progression was influenced by physicians’ level of comfort in moving towards a consultative model. Weekly meetings with physicians and nurse managers and an office for NPs located near healthcare teams facilitated communication and improved implementation. Half‐time NP positions facilitated recruitment. Improvements were noted in timely care for residents, family involvement and quality of documentation of the healthcare team. Regulatory restrictions on prescribing medications used frequently in LTC and daily physician presence at some sites limited implementation. Conclusion The project fostered an understanding of the conditions needed to successfully implement NPs in LTC. An examination of the perspective of residents and families is needed.

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Section: Introductionmentioning

confidence: 99%

“…They provide nursing personnel with support to develop their knowledge and skills (Sangster-Gormley et al, 2013). NPs improve patient and family satisfaction and increase use of advanced directives and quality of care in LTC (Acorn, 2015;Lin, Hsiao, Glen, Pai, & Zeng, 2014;Morilla-Herrera et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

Implementing primary healthcare nurse practitioners in long‐term care teams: A qualitative descriptive study

Kilpatrick

Jabbour

Tchouaket

et al. 2019

Journal of Advanced Nursing

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“…Findings suggest that depression continues to be under-detected inmedicallyill,homeboundelderlypatients. (Madden-Baer et al, 2013). If such needs beyondmedicalcarecanbeaddressed,this mayreducedepressiononsetandstopapossiblecycleofhospitalreadmissions.…”

Section: Recommendations For Future Researchmentioning

confidence: 99%

Who's next? Referral prioritisation criteria for home care occupational therapy

Raymond

Feldman

Prudhomme

et al. 2013

International Journal of Therapy and Rehabilitation

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Who'snext?Referral prioritisationcriteriaforhome careoccupationaltherapy Background/aims: Prioritising referrals on waiting lists is common practice in rehabilitation. However, little is known about the exact criteria that are used in home-based occupational therapy to determine the level of urgency. This study aimed to identify prioritisation criteria in home-based occupational therapy services in Quebec, Canada and to describe how they are used in practice. Methods: A mail and telephone survey of 55 home care programmes across Quebec was conducted. Participants provided information about occupational therapy wait times and referral prioritisation tools and practices. A detailed quantitative content analysis compared the content of all referral prioritisation tools. Results: This study identified 48 main categories of referral prioritisation criteria, but only nine of them were present in the majority of tools. Wait times vary greatly between priority levels, with a median of 2 days for urgent referrals and 20 months for low priority referrals. In general, problems related to safety and remaining at home are considered more urgent than problems related to independence, quality of life, and activities outside the home. Conclusions: These findings highlight the need for more consistent and evidence-based prioritisation criteria for occupational therapy in home care in order to facilitate equitable access to these services.

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“…This article reports the results of a cluster-based randomized effectiveness trial targeting depressive symptoms in Medicare Home Health patients. Medicare recommends depression screening and intervention for home health care patients, but interventions are needed that are clinically effective and feasible . The structure and practice of home health care pose challenges to this goal.…”

Section: Introductionmentioning

confidence: 99%

“…Medicare recommends depression screening and intervention for home health care patients, but interventions are needed that are clinically effective and feasible. [8][9][10][11][12][13] The structure and practice of home health care pose challenges to this goal. First, more than 97% of patients are referred for medical or surgical conditions and have multiple comorbidities.…”

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confidence: 99%

Clinical Effectiveness of Integrating Depression Care Management Into Medicare Home Health

et al. 2015

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IMPORTANCE Among older home health care patients, depression is highly prevalent, is often inadequately treated, and contributes to hospitalization and other poor outcomes. Feasible and effective interventions are needed to reduce this burden of depression.OBJECTIVE To determine whether, among older Medicare Home Health recipients who screen positive for depression, patients of nurses receiving randomization to an intervention have greater improvement in depressive symptoms during 1 year than patients receiving enhanced usual care. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized effectiveness trial conducted at 6 home health care agencies nationwide assigned nurse teams to an intervention (12 teams) or to enhanced usual care (9 teams). Between January 13, 2009, and December 6, 2012, Medicare Home Health patients 65 years and older who screened positive for depression on routine nursing assessments were recruited, underwent assessment, and were followed up at 3, 6, and 12 months by research staff blinded to intervention status. Patients were interviewed at home and by telephone. Of 502 eligible patients, 306 enrolled in the study. INTERVENTIONS The Depression Care for Patients at Home (Depression CAREPATH) trial requires nurses to manage depression at routine home visits by weekly symptom assessment, medication management, care coordination, education, and goal setting. Nurses' training totaled 7 hours (4 onsite and 3 via the web). Researchers telephoned intervention team supervisors every other week. MAIN OUTCOMES AND MEASURES Depression severity, assessed by the 24-item Hamilton Scale for Depression (HAM-D). RESULTSThe 306 participants were predominantly female (69.6%), were racially/ethnically diverse (18.0% black and 16.0% Hispanic), and had a mean (SD) age of 76.5 (8.0) years. In the full sample, the intervention had no effect (P = .13 for intervention × time interaction). Adjusted HAM-D scores (Depression CAREPATH vs control) did not differ at 3 months (10.5 vs 11.4, P = .26) or at 6 months (9.3 vs 10.5, P = .12) but reached significance at 12 months (8.7 vs 10.6, P = .05). In the subsample with mild depression (HAM-D score, <10), the intervention had no effect (P = .90), and HAM-D scores did not differ at any follow-up points. Among 208 participants with a HAM-D score of 10 or higher, the Depression CAREPATH demonstrated effectiveness (P = .02), with lower HAM-D scores at 3 months (14.1 vs 16.1, P = .04), at 6 months (12.0 vs 14.7, P = .02), and at 12 months (11.8 vs 15.7, P = .005). CONCLUSION AND RELEVANCEHome health care nurses can effectively integrate depression care management into routine practice. However, the clinical benefit seems to be limited to patients with moderate to severe depression. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01979302

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Implementation and Evaluation of a Depression Care Model for Homebound Elderly

Cited by 5 publications

References 17 publications

Implementing primary healthcare nurse practitioners in long‐term care teams: A qualitative descriptive study

Implementing primary healthcare nurse practitioners in long‐term care teams: A qualitative descriptive study

Who's next? Referral prioritisation criteria for home care occupational therapy

Clinical Effectiveness of Integrating Depression Care Management Into Medicare Home Health

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