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Article

Paul Clarkson, Rebecca Hays, Sue Tucker, Katie Paddock and David Challis

A growing ageing population with complex healthcare needs is a challenge to the organisation of healthcare support for older people residing in care homes. The lack of…

Abstract

Purpose

A growing ageing population with complex healthcare needs is a challenge to the organisation of healthcare support for older people residing in care homes. The lack of specialised healthcare support for care home residents has resulted in poorer outcomes, compared with community-dwelling older people. However, little is known about the forms, staff mix, organisation and delivery of such services for residents’ physical healthcare needs. The paper aims to discuss these issues.

Design/methodology/approach

This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to provide an overview of the range of healthcare services delivered to care homes and to identify core features of variation in their organisation, activities and responsibilities. The eligibility criteria for studies were services designed to address the physical healthcare needs of older people, permanently residing in care homes, with or without nursing. To search the literature, terms relating to care homes, healthcare and older people, across ten electronic databases were used. The quality of service descriptions was appraised using a rating tool designed for the study. The evidence was synthesised, by means of a narrative summary, according to key areas of variation, into models of healthcare support with examples of their relative effectiveness.

Findings

In total, 84 studies, covering 74 interventions, identified a diverse range of specialist healthcare support services, suggesting a wide variety of ways of delivering healthcare support to care homes. These fell within five models: assessment – no consultant; assessment with consultant; assessment/management – no consultant; assessment/management with consultant; and training and support. The predominant model offered a combination of assessment and management. Overall, there was a lack of detail in the data, making judgements of relative effectiveness difficult. Recommendations for future research include the need for clearer descriptions of interventions and particularly of data on resident-level costs and effectiveness, as well as better explanations of how services are implemented (review registration: PROSPERO CRD42017081161).

Originality/value

There is considerable debate about the best means of providing healthcare to older people in care homes. A number of specialist initiatives have developed and this review seeks to bring these together in a comparative approach deriving models of care of value to policy makers and commissioners.

Details

Quality in Ageing and Older Adults, vol. 19 no. 1
Type: Research Article
ISSN: 1471-7794

Keywords

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Article

Mette Kollerup, Tine Curtis and Birgitte Schantz Laursen

Employing a participatory approach, the purpose of this paper is to identify possible areas for improvement in visiting nurses’ post-hospital medication management and to…

Abstract

Purpose

Employing a participatory approach, the purpose of this paper is to identify possible areas for improvement in visiting nurses’ post-hospital medication management and to facilitate suggestions for changes in future practices.

Design/methodology/approach

Based on a previous study on visiting nurses’ post-hospital medication management, two workshops were conducted in a visiting nurse department in a Danish municipality.

Findings

The visiting nurses emphasised knowledge of patients’ basic needs and prioritised their performance of context-specific nursing assessments, with a preventive focus as a prerequisite for improved patient safety in post-hospital medication management.

Research limitations/implications

The participatory approach can increase the acceptability and feasibility of changes regarding future practices and thereby reduce the gap between official documents and daily practice. Although the local development of suggestions for changes in practices does not provide general knowledge, a subsequent detailed description of the changes in practices can promote transferability to other healthcare settings after local adjustments are made.

Practical implications

Flexible home healthcare, with stable relationships enabling the continuous assessment of the patient’s needs and symptoms, along with subsequent adjustments being made in care and medical treatment, might enhance patient safety in post-hospital medication management.

Originality/value

This paper adds to the knowledge of the need for integrated care in medication management in patients’ homes. It argues for primary healthcare professionals as “experts in complexity” and suggests a reconsideration of the purchaser-provider division of care to patients with unstable health conditions and complex care needs during the first days following hospital discharge.

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Abstract

Purpose

This paper aims to explore the match between needs and services related to participation for frail older adults receiving home care.

Design/methodology/approach

A qualitative multiple case study was conducted with 11 triads each involving an elder, a caregiver and a healthcare provider working in a Health and Social Services Centers (HSSCs).

Findings

Although HSSCs in Québec are supposed to promote social integration and participation of older adults, services provided to the older adults in this study focused mainly on safety and independence in personal care, dressing, mobility and nutrition, without fully meeting older adults’ needs in these areas. Discrepancies between needs and services may be attributable to the assessment not covering all the dimensions of social participation or accurately identifying older adults’ complex needs; older adults’ and their caregivers’ difficulties identifying their needs and accepting their limitations and the assistance offered; healthcare providers’ limited knowledge and time to comprehensively assess needs and provide services; guidelines restricting the types and quantity of services to be supplied; and limited knowledge of older adults, caregivers and healthcare providers about services and resources available in the community.

Originality/value

To improve and maintain older adults’ participation, a more thorough assessment of their participation, especially in social activities, is required, as is greater support for older adults and their families in using available community resources. It is also important to review the services provided by HSSCs and to optimize partnerships with community organizations.

Details

Leadership in Health Services, vol. 27 no. 3
Type: Research Article
ISSN: 1751-1879

Keywords

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Article

Leonard L. Berry

The purpose of this article is to highlight the importance of the foundational construct of “connection” in linking design and service in performing vital functions in the…

Abstract

Purpose

The purpose of this article is to highlight the importance of the foundational construct of “connection” in linking design and service in performing vital functions in the healthcare sector. “Connection” facilitates patients receiving life-saving and life-improving care at the right time, in the right place, in the right way.

Design/methodology/approach

This article discusses various design-improvement initiatives making clear that healthcare, like any labor-intensive service delivered to people, is a human endeavor whose systems and features can be materially and cleverly enhanced once their intricacies are analyzed, understood and then redesigned to move closer to excellence.

Findings

By designing connection into healthcare and thinking holistically about the needs and preferences of users (patients), the functionality and the appeal of healthcare services can be enhanced.

Originality/value

The gap between the service that healthcare aims to deliver – and what it actually delivers – is unacceptably large. This article calls for incorporating connection through design into healthcare as a way to bridge this gap.

Details

Journal of Service Management, vol. 31 no. 5
Type: Research Article
ISSN: 1757-5818

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Article

Dimitra Dritsa and Nimish Biloria

The purpose of this paper is to investigate the role of emerging technologies in the promotion of health and well-being at the urban, domestic and bodily scale, through…

Abstract

Purpose

The purpose of this paper is to investigate the role of emerging technologies in the promotion of health and well-being at the urban, domestic and bodily scale, through the systematic examination of technologies such as physical sensing systems and physiological data monitoring, that are currently explored as drivers for achieving sustainable healthcare within a multi-scalar approach.

Design/methodology/approach

A comprehensive study of the various technologies associated with smart healthcare is provided, first investigating smart cities, physical sensing systems and geospatial data as potential enablers of public health. Then the discourse shifts towards exploring Smart Home technologies for healthcare, first reviewing strategies of enhancing the home environment with multisensory components, and then discussing the emergence of physiological monitoring devices and their interconnection with the domestic and urban environment.

Findings

While the implementation of Internet of Things, physical sensing systems and geospatial analytics in extracting and analyzing the multiple information layers of the urban, the domestic and the bodily environment, has been widely explored, there is little consideration on the transition from the domestic to the urban level, and while within each of the different scales, the need for a multi-componential approach is addressed, there is minimal effort towards its materialization.

Originality/value

The major contribution of this study therefore lies in laying the ground for further research towards a multi-scalar relational approach that views smart healthcare as a trajectory, binding the bodily, to the domestic and the urban fabric.

Details

Smart and Sustainable Built Environment, vol. 7 no. 1
Type: Research Article
ISSN: 2046-6099

Keywords

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Article

Wendy Young and Peter C. Coyte

Posits that Canadian home care services compete with hospitals and other community and public health agencies for scarce financial resources but as yet regional…

Abstract

Posits that Canadian home care services compete with hospitals and other community and public health agencies for scarce financial resources but as yet regional authorities are not responsible for paying physicians. Investigates all the various facets of home care services and concludes that by using joint ventures, there may be the possibility of making informed decisions for the Canadian healthcare system.

Details

Leadership in Health Services, vol. 10 no. 1
Type: Research Article
ISSN: 1366-0756

Keywords

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Article

James Chowhan, Margaret Denton, Catherine Brookman, Sharon Davies, Firat K. Sayin and Isik Zeytinoglu

The purpose of this paper is to examine the mediating role of stress between work intensification and musculoskeletal disorders (MSDs) focusing on personal support workers…

Abstract

Purpose

The purpose of this paper is to examine the mediating role of stress between work intensification and musculoskeletal disorders (MSDs) focusing on personal support workers (PSWs) in home and community care.

Design/methodology/approach

The analysis sample of 922 comes from the 2015 survey of PSWs employed in Ontario, Canada. The endogenous variable is self-reported MSDs, and the exogenous variable is work intensification. Stress, measured as symptoms of stress, is the mediating variable. Other factors shown in the literature as associated with stress and/or MSDs are included as control variables. Structural equation model regression analyses are presented.

Findings

The results show that stress mediates the effect of work intensification on PSW’s MSDs. Other significant factors included being injured in the past year, facing hazards at work and preferring less hours – all had positive and significant substantive effects on MSDs.

Research limitations/implications

The survey is cross-sectional and not longitudinal or experimental in design, and it focuses on a single occupation in a single sector in Ontario, Canada and, as such, this can limit the generalizability of the results to other occupations and sectors.

Practical implications

For PSW employers including their human resource managers, supervisors, schedulers and policy-makers, the study recommends reducing work intensification to lower stress levels and MSDs.

Originality/value

The findings of this study contribute to the theory and knowledge by providing evidence on how work intensification can affect workers’ health and assist decision makers in taking actions to create healthy work environments.

Details

Personnel Review, vol. 48 no. 2
Type: Research Article
ISSN: 0048-3486

Keywords

Content available
Article

Inger Kjellberg and Stefan Szücs

The purpose of this paper is to explore stakeholder views on the policy of integrated health and social care for older people with complex needs in Sweden and the issue of…

Abstract

Purpose

The purpose of this paper is to explore stakeholder views on the policy of integrated health and social care for older people with complex needs in Sweden and the issue of trust in implementing the policy.

Design/methodology/approach

The study used a qualitative interview design and interviews with nine strategically selected stakeholders. A thematic analysis focused on trust, as defined in the theory of collaborative advantage, was used.

Findings

This study of health and social care exposed a lack of trust on political, strategic and inter-professional levels. Two opposing lines of argument were identified in the interviews. One advocated a single government authority for health and social care. The other was in accordance with recently implemented national policies, which entailed more collaboration between local government authorities, obliging them to make joint local agreements. The Swedish experience is discussed in an international context, examining the need for collaboration in integrated care services for older people.

Research limitations/implications

Although the findings are important for the current adjustment in health and social care for older people, the number of interviewees are limited. Future studies will include more regions and longitudinal studies.

Originality/value

Sweden is currently undergoing an extensive adjustment in line with recent national government policy which involves more primary health care and a corresponding reduction in the number of hospital beds. The restructuring of the care system for older people with complex needs is a paradox, as it simultaneously increases the need for centralisation while also increasing coordination and collaboration on a local basis.

Details

Journal of Integrated Care, vol. 28 no. 3
Type: Research Article
ISSN: 1476-9018

Keywords

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Abstract

Details

Quality in Ageing and Older Adults, vol. 11 no. 4
Type: Research Article
ISSN: 1471-7794

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Article

Martha E. Williams and Linda C. Smith

This is the twelfth article on science, technology, and medicine (STM) databases in a continuing series of articles summarizing and commenting on new database products…

Abstract

This is the twelfth article on science, technology, and medicine (STM) databases in a continuing series of articles summarizing and commenting on new database products. Two companion articles, onecovering social sciences, humanities, news, and general (SSH) (Online & CD‐ROM Review, vol. 22, no. 5) and the other covering business and law (BSL) (Online & CD‐ROM Review, vol. 22, no. 6) will appear in the next issues of this journal. These articles are based on the newly appearing database products in the Gale Directory of Databases. The Gale Directory of Databases (GDD) was created in January 1993 by merging Computer‐Readable Databases: A Directory and Data Sourcebook (CRD) together with the Directory of Online Databases (DOD) and the Directory of Portable Databases (DPD).

Details

Online and CD-Rom Review, vol. 22 no. 4
Type: Research Article
ISSN: 1353-2642

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