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The 2-year costs and effects of a public health nursing case management intervention on mood-disordered single parents on social assistance.

https://arctichealth.org/en/permalink/ahliterature191135
Source
J Eval Clin Pract. 2002 Feb;8(1):45-59
Publication Type
Article
Date
Feb-2002
Author
Maureen Markle-Reid
Gina Browne
Jacqueline Roberts
Amiram Gafni
Carolyn Byrne
Author Affiliation
System-Linked Research Unit on Health and Social Service Utilization, School of Nursing, McMaster University, Room 3N46, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. mreid@mcmaster.ca
Source
J Eval Clin Pract. 2002 Feb;8(1):45-59
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Case Management - economics
Child
Cost-Benefit Analysis
Depressive Disorder - economics - nursing - rehabilitation
Employment
Female
Health Care Costs
Health Services - utilization
Health Services Accessibility
Humans
Male
Ontario
Public Assistance
Public Health Nursing - economics
Single Parent - psychology
Social Adjustment
Abstract
This randomized controlled trial was designed to evaluate the 2-year costs and effects of a proactive, public health nursing case management approach compared with a self-directed approach for 129 single parents (98% were mothers) on social assistance in a Canadian setting. A total of 43% of these parents had a major depressive disorder and 38% had two or three other health conditions at baseline.
Study participants were recruited over a 12 month period and randomized into two groups: one receiving proactive public health nursing and one which did not.
At 2 years, 69 single parents with 123 children receiving proactive public health nursing (compared with 60 parents with 91 children who did not receive public health nursing services) showed a slightly greater reduction in dysthymia and slightly higher social adjustment. There was no difference between the public health and control groups in total per parent annual cost of health and support services. However, costs were averted due to a 12% difference in non-use of social assistance in the previous 12 months for parents in the public health nursing group. This translates into an annual cost saving of 240,000 dollars (Canadian) of costs averted within 1 year for every 100 parents.
In the context of a system of national health and social insurance, this study supports the fact that it is no more costly to proactively service this population of parents on social assistance.
PubMed ID
11882101 View in PubMed
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Age and mental health predict early device-specific quality of life in patients receiving prophylactic implantable defibrillators.

https://arctichealth.org/en/permalink/ahliterature126084
Source
Can J Cardiol. 2012 Jul-Aug;28(4):502-7
Publication Type
Article
Author
Sandra L Carroll
Maureen Markle-Reid
Donna Ciliska
Stuart J Connolly
Heather M Arthur
Author Affiliation
School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. carroll@mcmaster.ca
Source
Can J Cardiol. 2012 Jul-Aug;28(4):502-7
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Character
Cohort Studies
Defibrillators, Implantable - psychology
Depressive Disorder - psychology
Female
Heart Failure - complications - psychology
Humans
Male
Middle Aged
Multivariate Analysis
Myocardial Ischemia - complications - psychology
Ontario
Patient Acceptance of Health Care - psychology
Prospective Studies
Quality of Life - psychology
Socioeconomic Factors
Treatment Outcome
Ventricular Fibrillation - prevention & control - psychology
Abstract
Ventricular arrhythmia is a significant cause of sudden death. Implantable cardioverter-defibrillators (ICDs) offer at-risk patients a prophylactic treatment option. This prophylaxis is largely responsible for growth in utilization of ICDs. Identification of factors that may impact device-specific quality of life (QOL) is warranted. The influence of preimplant patient variables on postimplant device-specific QOL is unknown. The study aimed to determine whether preimplant psychosocial, generic health-related quality of life (HRQOL), personality disposition, or demographic factors predicted early postimplant device-specific QOL.
A prospective cohort study design was employed in 70 adults receiving an ICD for primary prevention. Preimplant, we measured generic HRQOL, personality disposition, depressive symptoms, age, and sex. The primary outcome was 3-month ICD device-specific QOL as measured by the Florida Patient Acceptance Scale (FPAS). We applied hierarchical multivariate regression analysis.
Mean age was 64.8 ± 9.4 years; 12.9% were women. Most had ischemic heart disease (77%) and a heart failure history (54.3%). Preimplant prevalence of elevated depressive symptoms was 30%. Three months post implant, the mean adjusted FPAS score was 76.8 ± 12.98. Of the variance in FPAS scores, 37% was explained by the independent variables. Younger age and poor preimplant mental HRQOL contributed most to lower FPAS scores.
Patient support and psychosocial interventions should target younger ICD candidates and those reporting poor preimplant mental HRQOL; these patients may be at risk for poor postimplant device-specific QOL.
PubMed ID
22425267 View in PubMed
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Availability and acceptability of Canadian home and community-based services: perspectives of family caregivers of persons with dementia.

https://arctichealth.org/en/permalink/ahliterature154656
Source
Home Health Care Serv Q. 2008;27(2):75-99
Publication Type
Article
Date
2008
Author
Dorothy A Forbes
Maureen Markle-Reid
Pamela Hawranik
Shelley Peacock
Dawn Kingston
Debra Morgan
Sandra Henderson
Beverley Leipert
S Lynn Jansen
Author Affiliation
School of Nursing, The University of Western Ontario, London, Ontario, CA. dforbes6@uwo.ca
Source
Home Health Care Serv Q. 2008;27(2):75-99
Date
2008
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Canada
Caregivers - psychology
Consumer Satisfaction
Dementia
Family
Female
Focus Groups
Health Services Accessibility
Home Care Services - economics - statistics & numerical data
Humans
Male
Rural Population
Urban Population
Abstract
Thirty-five percent of Canadians over the age of 85 have dementia, and up to 90% of their home care is provided by family and friends. The purpose of this study was to explore the use and satisfaction with home and community-based services for persons with dementia from the perspectives of family caregivers. The study was conducted using an interpretive, descriptive, qualitative approach. Six focus groups (N = 36) and three personal interviews were conducted with rural and urban caregivers in Ontario, Manitoba, and Saskatchewan, Canada. Using Lubrosky's (1994) thematic analysis, the overarching themes identified were availability and acceptability of services. The findings suggest a need for an integrated continuing care model that includes the person living with dementia and their family caregivers as partners in care, addresses all of the determinants of health, and embraces sensitivity, diversity, flexibility, and supportive services to enhance the availability and acceptability of Canadian home and community-based services.
PubMed ID
18928206 View in PubMed
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A cross-sectional study of the prevalence, correlates, and costs of falls in older home care clients 'at risk' for falling.

https://arctichealth.org/en/permalink/ahliterature145072
Source
Can J Aging. 2010 Mar;29(1):119-37
Publication Type
Article
Date
Mar-2010
Author
Maureen Markle-Reid
Gina Browne
Amiram Gafni
Jacqueline Roberts
Robin Weir
Lehana Thabane
Melody Miles
Vida Vaitonis
Catherine Hecimovich
Pamela Baxter
Sandra Henderson
Author Affiliation
McMaster University, School of Nursing, Hamilton, Ontario. mreid@mcmaster.ca
Source
Can J Aging. 2010 Mar;29(1):119-37
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Accidental Falls - economics - statistics & numerical data
Aged
Aged, 80 and over
Canada
Cognition Disorders - epidemiology
Cross-Sectional Studies
Environment
Female
Health Services for the Aged - standards
Health status
Home Care Services - standards
Humans
Male
Parkinson disease - epidemiology
Risk factors
Vision Disorders - epidemiology
Abstract
This study examined the six-month prevalence, risk factors, and costs of falls in older people using home support services who are at risk of falling. Of the 109 participants, 70.6 per cent reported >or= one fall in the previous six months, and 27.5 per cent experienced multiple falls. Although there was no statistically significant difference in any fall-related risk factor between fallers (1+ falls) and non-fallers (0 falls), fallers had clinically important trends towards lower levels of physical, social, and psychological functioning. There was no statistically significant difference between fallers and non-fallers in the total per-person costs of use of health services in the previous six months; however, there were significant differences between groups in specific types of health services. The multivariate analysis revealed the presence of five risk factors for falls: neurological disorder (e.g., cognitive impairment, Parkinson's disease), age >or= 85 years, environmental hazards, previous slip or trip, and visual impairment.
PubMed ID
20202270 View in PubMed
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Formal care providers' perceptions of home- and community-based services: informing dementia care quality.

https://arctichealth.org/en/permalink/ahliterature152215
Source
Home Health Care Serv Q. 2009;28(1):1-23
Publication Type
Article
Date
2009
Author
Lynn Jansen
Dorothy A Forbes
Maureen Markle-Reid
Pamela Hawranik
Dawn Kingston
Shellie Peacock
Sandra Henderson
Beverly Leipert
Author Affiliation
School of Nursing, University of Western Ontario, London, Ontario, Canada. sjansen3@uwo.ca
Source
Home Health Care Serv Q. 2009;28(1):1-23
Date
2009
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Community Health Services - organization & administration
Dementia - psychology - therapy
Female
Focus Groups
Health Services Accessibility - organization & administration
Home Care Services - organization & administration
Humans
Male
Manitoba
Middle Aged
Needs Assessment - organization & administration
Nursing Methodology Research
Ontario
Patient Acceptance of Health Care
Qualitative Research
Quality of Health Care - organization & administration
Questionnaires
Saskatchewan
Social Support
Time Factors
Abstract
Little attention has been given to the perceptions of formal care providers on the nature and quality of home- and community-based dementia care. The purpose of this descriptive interpretive research was to explore formal care providers' perceptions of their experiences with Canadian home- and community-based dementia care. Participants within three personal interviews and six focus groups (n = 41) included nurses, social workers, therapists, home care aides, and Alzheimer Society personnel (front line/management) in rural and urban areas of Saskatchewan (n = 16), Manitoba (n = 20), and Ontario (n = 8). Two overarching thematic categories, Service Availability and Service Acceptability, emerged from the data analysis. Subthemes of availability were identified as: (a) challenges of service availability, including service wait lists, lack of home care provider training, lack of community-based dementia care infrastructure, and sociocultural and geographic barriers to accessing dementia services; and (b) essential facilitators of availability, including service infrastructure, service bridging, and agency partnerships to form coordinated care systems. Subthemes of acceptability were revealed as: (a) essential components of dementia care, including provision of comprehensive personal care and the use of dementia care professional practice knowledge within a home care setting; and (b) service challenges, including inadequate service time for the physical care and socioemotional support of the client and family caregiver, caregiver and formal provider difficulty with navigation of a fragmented care system, lack of system coordination, and financial costs of services. Essential, integrated dementia care could be established by listening to the "voices of formal care providers," thereby decreasing dementia care costs and increasing the quality of life for those with dementia, and their family caregivers.
PubMed ID
19266368 View in PubMed
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Gender differences in use and availability of home and community-based services for people with dementia.

https://arctichealth.org/en/permalink/ahliterature157345
Source
Can J Nurs Res. 2008 Mar;40(1):39-59
Publication Type
Article
Date
Mar-2008
Author
Dorothy A Forbes
S Lynn Jansen
Maureen Markle-Reid
Pamela Hawranik
Debra Morgan
Sandra Henderson
Beverly Leipert
Shelley Peacock
Dawn Kingston
Author Affiliation
School of Nursing, University of Western Ontario, London, Canada. dforbes6@uwo.ca
Source
Can J Nurs Res. 2008 Mar;40(1):39-59
Date
Mar-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada - epidemiology
Community Health Services - utilization
Cross-Sectional Studies
Dementia - epidemiology - psychology
Female
Health Care Surveys
Health Services Accessibility - organization & administration
Health Services for the Aged - utilization
Home Care Services - utilization
Humans
Male
Men - psychology
Needs Assessment
Nursing Methodology Research
Outcome Assessment (Health Care)
Patient Acceptance of Health Care - psychology - statistics & numerical data
Questionnaires
Sex Factors
Women - psychology
Abstract
The purpose was to examine the use and availability of home and community-based services by men and women with dementia using data from the 2003 Canadian Community Health Survey. Variables of interest were based on the Andersen and Newman model and included predisposing, enabling, need, and use of health service variables, perceived unmet health and home care needs, and availability of home and community-based health services. Women reported better health and received more supportive care yet had more unmet home care needs than men.Thus, the caregivers of men with dementia (often their wives) were particularly vulnerable to negative outcomes, as their care recipients had poorer health yet received fewer services. These gender differences should be considered when policies and programs are developed, the needs of care recipients and caregivers are assessed, and services are provided.
PubMed ID
18459271 View in PubMed
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Knowledge exchange throughout the dementia care journey by Canadian rural community-based health care practitioners, persons with dementia, and their care partners: an interpretive descriptive study.

https://arctichealth.org/en/permalink/ahliterature118715
Source
Rural Remote Health. 2012 Oct;12(4):2201
Publication Type
Article
Date
Oct-2012
Author
Dorothy A Forbes
Sara Finkelstein
Catherine M Blake
Maggie Gibson
Debra G Morgan
Maureen Markle-Reid
Ivan Culum
Emily Thiessen
Author Affiliation
Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada. dorothy.forbes@ualberta.ca
Source
Rural Remote Health. 2012 Oct;12(4):2201
Date
Oct-2012
Language
English
Publication Type
Article
Keywords
Canada
Caregivers
Community Health Services - manpower
Community-Based Participatory Research
Dementia - psychology - therapy
Female
Humans
Information Dissemination
Male
Qualitative Research
Abstract
Accessing, assessing, exchanging, and applying dementia care information can be challenging in rural communities for healthcare practitioners (HCPs), persons with dementia (PWD), and their care partners. The overall purpose of this research was to enable HCPs, care partners, and PWD to use dementia care information more effectively by examining their information needs, how these change over time, and how they access, assess, and apply the knowledge.
A qualitative interpretive descriptive approach was used. A convenience sample was initially recruited through study collaborators in Southwestern Ontario, followed by purposive sampling. Nine rural dementia care networks consisting of PWD (n = 5), care partners (n = 14), and HCPs (n = 14) were recruited and 80 interviews were conducted at three time points. Transcripts were coded using Lubrosky's thematic analysis.
Six stages of the dementia care journey were identified: (1) recognizing the symptoms; (2) receiving a diagnosis; (3) loss of independence; (4) initiating and using home care and respite services; (5) long-term care (LTC) placement; and (6) decisions related to end-of-life care. Rural care partners identified the need for different types of knowledge during each of these critical decision points of the dementia care journey. They accessed information from family members, friends, local organizations, and dementia internet sites. Persons with dementia tended not to identify the need for dementia care information. The HCPs accessed dementia care information from their own organization, other organizations, and internet sites. Care partners and HCPs assessed the trustworthiness of the information based on whether the source was a well-known agency or their own organization. Barriers to knowledge exchange included: lack of rural community-based services for dementia care; care partners reluctant to seek help and had limited energy; and lack of integration of dementia-related services and supports. Facilitators of knowledge exchange included: rural care partners with healthcare experience who were actively seeking information; development of trusting relationships between HCPs, care partners, and PWD; and formal mechanisms for exchanging information within and across rural community-based organizations.
This research illustrates the stages of the dementia care journey, and the types of information typically needed, accessed, assessed, and applied at each stage. Healthcare practitioners can use these findings to support rural care partners in navigating their dementia care journey. Support is needed as care partners often do not have the time, energy, skills, or knowledge to seek out dementia care information independently. In addition, PWD typically do not recognize the need for this knowledge, leaving care partners potentially isolated in this journey. Developing formal linkages within and across rural organizations will facilitate knowledge exchange and the delivery of cost-effective, quality dementia care. However, additional rural community-based resources are urgently needed to implement these recommendations. This may require a redistribution of resources from acute care to rural community care.
PubMed ID
23176308 View in PubMed
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Nurse-led health promotion interventions improve quality of life in frail older home care clients: lessons learned from three randomized trials in Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature130162
Source
J Eval Clin Pract. 2013 Feb;19(1):118-31
Publication Type
Article
Date
Feb-2013
Author
Maureen Markle-Reid
Gina Browne
Amiram Gafni
Author Affiliation
School of Nursing and Associate Member, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. mreid@mcmaster.ca
Source
J Eval Clin Pract. 2013 Feb;19(1):118-31
Date
Feb-2013
Language
English
Publication Type
Article
Keywords
Accidental Falls - statistics & numerical data
Activities of Daily Living
Aged
Aged, 80 and over
Costs and Cost Analysis
Geriatric Assessment
Health Promotion - economics - organization & administration
Health status
Home Care Services - economics - organization & administration
Humans
Mental health
Nurses
Nutritional Status
Ontario
Quality of Life
Randomized Controlled Trials as Topic
Social Support
Abstract
This paper explores the lessons learned from a series of three randomized controlled trials that included 498 community-living frail older adults (=65 years) using home care services in Southern Ontario, Canada. Each study was designed to evaluate the effectiveness of different multi-component nurse-led health promotion and disease prevention (HPDP) interventions.
The nurse-led HPDP interventions were 6- or 12-month multi-component and evidence-based strategies targeting known risk factors for functional decline and frailty. Across the three studies, a common approach was used to measure the change in health-related quality of life (HRQOL) (SF-36) and the costs of use of health services (Health and Social Services Utilization Inventory) from baseline to the end of the intervention.
The main lesson learned from the three studies is that nurse-led HPDP interventions for frail older home care clients provide greater improvements in HRQOL compared with usual home care. Such approaches are highly acceptable to this population and can be implemented using existing home care resources. Nurse-led HPDP interventions should include multiple home visits, multidimensional screening and assessment, multi-component evidence-based HPDP strategies, intensive case management, inter-professional collaboration, providers with geriatric training and experience, referral to and coordination of community services, and theory use.
The results of the three trials underscore the need to reinvest in nurse-led HPDP interventions in home care to optimize HRQOL and promote ageing in place in the target population of frail older adults. More studies are needed to evaluate the effectiveness of additional nurse-led HPDP interventions in other contexts and settings.
PubMed ID
22029487 View in PubMed
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8 records – page 1 of 1.