Informal caregiver strain, preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: Results of a randomised controlled trial

Utens, Cecile M.A.; Schayck, Onno C. P. van; Goossens, Lucas; Mölken, M.P.H.M. (Maureen P.H.M.) Rutten-Van; Demunck, Dirk R. A. J.; Seezink, Wiel; Vliet, Monique van; Smeenk, Frank W.J.M.

doi:10.1016/j.ijnurstu.2014.01.002

Cited by 19 publications

(29 citation statements)

References 34 publications

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“…Carers of patients with COPD are at risk of various psychological health problems, such as anxiety and depression; partners of patients with COPD are typically elderly with their own health problems 18. Utens and others looked at carer strain in an RCT of ESD compared with UC, and showed no difference in the caregiver strain index between allocation groups 19. Given the higher treatment needs of patients in HAH, we anticipated that the carers of patients treated with HAH would report increased carer burden.…”

Section: Discussionmentioning

confidence: 99%

What are the positive drivers and potential barriers to implementation of hospital at home selected by low-risk DECAF score in the UK: a qualitative study embedded within a randomised controlled trial

et al. 2019

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ObjectiveHospital at home (HAH) for chronic obstructive pulmonary disease exacerbation selected by low-risk Dyspnoea, Eosinopenia, Consolidation, Acidaemia and atrial Fibrillation (DECAF) score is clinical and cost-effective; DECAF is a prognostic score indicating risk of mortality. Up to 50% of admitted patients are suitable, a much larger proportion than earlier services. Introduction of new models of care is challenging, but may be facilitated by informed engagement with stakeholders. This qualitative study sought to identify facilitators and barriers to implementation of HAH.DesignSemistructured interviews, data were analysed using thematic-construct analysis.SettingInterviews were conducted within patients’ homes and hospitals in North East England.Participants89 participants were interviewees; 44 patients, 15 carers, 15 physicians, 11 specialist nurses and 4 managers.ResultsFacilitators include the following: (1) availability of home comforts and maintaining independence (with positive influences on perceived rate of recovery, sleep quality and convenience for friends, family and carers) and (2) confidence in the continuity of HAH care. Barriers include the following: (1) fear of being alone at home; (2) privacy issues and not wanting visitors and (3) resistance to change. Clinician concerns occasionally delayed return home, principally during the early phase of the trial. Nurses cited higher workload and greater responsibility, but with additional resource and training; overall, they viewed HAH positively. Operational concerns included keeping medical records in a patient’s home and inability to capture activity within current payment systems.ConclusionHAH selected by DECAF was preferred to inpatient care by most patients and their families. Implementation in other hospitals will require education, training and service planning, tailored to overcome the identified barriers.Trial registration numberISRCTN29082260.

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Section: Discussionmentioning

confidence: 99%

What are the positive drivers and potential barriers to implementation of hospital at home selected by low-risk DECAF score in the UK: a qualitative study embedded within a randomised controlled trial

et al. 2019

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“…(29) Esto es consistente, con estudios en los que los cuidadores de pacientes con exacerbación aguda de EPOC experimentan mayor sobrecarga en programas domiciliarios en los que tienen que asumir un incremento de actividades en relación con la hospitalización convencional podría aliviar a los cuidadores de algunos de las tareas. (8) Aunque las políticas de salud apelan a la colaboración entre cuidadores formales e informales, los servicios se centran principalmente en el paciente. En consecuencia, los profesionales tienen el riesgo de excluir a los cuidadores familiares.…”

Section: Discussionunclassified

“…(8) Sobre la presencia de síntomas depresivos en los cuidadores se ha observado que están presentes durante la hospitalización, pero tras el alta hospitalaria del paciente, el nivel de dependencia del paciente será determinante para la presencia de síntomas depresivos. (9) Por otra parte, la ansiedad del cuidador es un problema común durante la hospitalización (10) pero su evolución puede ser diferente después en el domicilio del paciente cuando el cuidador se enfrenta a situaciones muy estresantes como la disnea.…”

Section: Introductionunclassified

Ansiedad entre cuidadores de pacientes con Enfermedad Pulmonar Obstructiva Crónica tras el alta hospitalaria

García-Guillamón

Bernabeu-Mora

Montilla-Herrador

et al. 2017

eglobal

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Objetivo: Identificar los factores que influyen en cambios en la ansiedad de los cuidadores tres meses después del alta hospitalaria por exacerbación aguda de la Enfermedad Pulmonar Obstructiva Crónica (EPOC). Metodología: Estudio longitudinal. Participaron 87 cuidadores de pacientes hospitalizados por exacerbación aguda de EPOC. Se midió la ansiedad en el momento de la hospitalización y tres meses después del alta. Además, se midieron potenciales factores asociados a su cambio en cuatro dominios: Contexto del cuidado, demandas del cuidado, recursos y características del paciente. Utilizamos regresiones logísticas múltiples univariadas y multivariadas para determinar los cambios en la ansiedad tres meses después. Resultados: Presentaron ansiedad en el momento de la hospitalización el 57,5% de los cuidadores. De ellos, el 44% había remitido su ansiedad tres meses después del alta hospitalaria. Sin embargo, el 22% de los cuidadores quienes no habían presentado ansiedad en el momento de la hospitalización se mostraron ansiosos a los 3 meses. La gravedad de la EPOC y no recibir apoyo de otro cuidador disminuyó las probabilidades de remisión de la ansiedad. La sobrecarga moderadamente alta incrementa las probabilidades de presentar nuevos síntomas de ansiedad. Conclusiones: La percepción de los síntomas de la ansiedad es dinámica. Los cuidadores pueden recuperarse si reciben ayuda de otro cuidador o si el paciente al que cuidan no está en un estado severo de EPOC.

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“…Yorgunluk, hastaların %43-58'inin yaşadığı bir semptomdur. Hastalar dispne, uykusuzluk ve oksijen saturasyonun düşük olması nedeniyle yorgunluk hissedebilmektedirler (Utens, van Schayck, Goossens, Rutten-van Mölken, DeMunck, seezink & et al, 2014;Şahin, Aytekin & Tuğ 2014;Antoniu & Ungureanu, 2015). Yorgunluk, hastaların yaşam kalitesini ve günlük yaşam aktivitelerini olumsuz olarak etkilemekte (Eclerblad, Tödt, Jakobsson, Unosson, Skargren, Kentsson &Theander, 2014;Park & Larson, 2015) ve fiziksel aktivite ve mental durumun bozulmasına neden olmaktadır (Stridsman, Skär, Hedman, Rönmark & Lindberg, 2014).…”

Section: Kronik Obstrüktif Akciğer Hastalığı Ve Semptomlarıunclassified

An effıcıent approach to care cost effectıveness ın patıents dıagnosed wıth stable COPD: Patıent coachıng<p> Stabil KOAH tanılı hastalarda bakım maliyet etkinliği üzerine etkili bir yaklaşım: Hasta koçluğu

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2016

HumanSciences

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Chronic Obstructive Pulmonary Disease is a disease characterized by chronic asthma, bronchitis, and interstitial pulmonary diseases. The most frequent and ever-exacerbating symptoms of the disease involve dyspnea, cough, sputum, loss of appetite, fatigue, anxiety, and depression. As the incidence, severity and distress of symptoms accelarate; treatment and care needs of patients also increase. Increasing treatment and care needs in the process of disease and adherence to treatment have a negative effect on the care cost. Patient coaching is an approach that will make an important contribution to the increase of adherence to treatment and disease and the decrease of care cost by developing the symptom management and self-care skills of patients. ÖzetKronik obstrüktif akciğer hastalığı (KOAH); kronik astım, bronşit ve interstisyel akciğer hastalıkları ile karakterize bir hastalıktır. Hastalıkta en sık karşılaşılan ve şiddeti giderek artan semptomlar, dispne, öksürük, balgam, iştahsızlık, yorgunluk, anksiyete ve depresyondur. Semptomların görülme oranı, şiddeti ve bireyde yarattığı stres düzeyi arttıkça hastaların tedavi ve bakım gereksinimlerinde de artış görülmektedir. Hastalık ve tedaviye uyum sürecinde artan tedavi ve bakım gereksinimleri bakım maliyetini olumsuz yönde etkilemektedir. Hasta koçluğu, hastaların semptom yönetimi ve öz bakım becerilerini geliştirerek hastalığa ve tedaviye uyumunun artmasında ve bakım maliyetinin düşmesinde önemli katkı sağlayacak olan bir yaklaşımdır.

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Informal caregiver strain, preference and satisfaction in hospital-at-home and usual hospital care for COPD exacerbations: Results of a randomised controlled trial

Cited by 19 publications

References 34 publications

What are the positive drivers and potential barriers to implementation of hospital at home selected by low-risk DECAF score in the UK: a qualitative study embedded within a randomised controlled trial

What are the positive drivers and potential barriers to implementation of hospital at home selected by low-risk DECAF score in the UK: a qualitative study embedded within a randomised controlled trial

Ansiedad entre cuidadores de pacientes con Enfermedad Pulmonar Obstructiva Crónica tras el alta hospitalaria

An effıcıent approach to care cost effectıveness ın patıents dıagnosed wıth stable COPD: Patıent coachıng<p> Stabil KOAH tanılı hastalarda bakım maliyet etkinliği üzerine etkili bir yaklaşım: Hasta koçluğu

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