Sun Winnie, Doran Diane M, Wodchis Walter P, Peter Elizabeth
Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe St N, Oshawa, ON, L1H 7K4, Canada.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada.
BMC Health Serv Res. 2017 Mar 14;17(1):206. doi: 10.1186/s12913-017-2103-9.
In an era of a rapidly aging population who requires home care services, clients must possess or develop therapeutic self-care ability in order to manage their health conditions safely in their homes. Therapeutic self-care is the ability to take medications as prescribed and to recognize and manage symptoms that may be experienced, such as pain. The purpose of this research study was to investigate whether therapeutic self-care ability explained variation in the frequency and types of adverse events experienced by home care clients.
A retrospective cohort design was used, utilizing secondary databases available for Ontario home care clients from the years 2010 to 2012. The data were derived from (1) Health Outcomes for Better Information and Care; (2) Resident Assessment Instrument-Home Care; (3) National Ambulatory Care Reporting System; and (4) Discharge Abstract Database. Descriptive analysis was used to identify the types and prevalence of adverse events experienced by home care clients. Logistic regression analysis was used to examine the association between therapeutic self-care ability and the occurrence of adverse events in home care.
The results indicated that low therapeutic self-care ability was associated with an increase in adverse events. In particular, logistic regression results indicated that low therapeutic self-care ability was associated with an increase in clients experiencing: (1) unplanned hospital visits; (2) a decline in activities of daily living; (3) falls; (4) unintended weight loss, and (5) non-compliance with medication.
This study advances the understanding about the role of therapeutic self-care ability in supporting the safety of home care clients. High levels of therapeutic self-care ability can be a protective factor against the occurrence of adverse events among home care clients. A clear understanding of the nature of the relationship between therapeutic self-care ability and adverse events helps to pinpoint the areas of home care service delivery required to improve clients' health and functioning. Such knowledge is vital for informing health care leaders about effective strategies that promote therapeutic self-care, as well as providing evidence for policy formulation in relation to risk mitigation in home care.
在人口迅速老龄化且需要居家护理服务的时代，客户必须具备或培养治疗性自我护理能力，以便在家中安全地管理自身健康状况。治疗性自我护理是指按处方服药以及识别和处理可能出现的症状（如疼痛）的能力。本研究的目的是调查治疗性自我护理能力是否能解释居家护理客户经历的不良事件的频率和类型的差异。
采用回顾性队列设计，利用2010年至2012年安大略省居家护理客户可用的二级数据库。数据来源于：（1）更好信息与护理的健康结果；（2）居家护理居民评估工具；（3）国家门诊护理报告系统；以及（4）出院摘要数据库。描述性分析用于确定居家护理客户经历的不良事件的类型和患病率。逻辑回归分析用于检验治疗性自我护理能力与居家护理中不良事件发生之间的关联。
结果表明，治疗性自我护理能力低与不良事件增加有关。具体而言，逻辑回归结果表明，治疗性自我护理能力低与以下情况的客户增加有关：（1）非计划的医院就诊；（2）日常生活活动能力下降；（3）跌倒；（4）意外体重减轻；以及（5）不遵医嘱服药。
本研究推进了对治疗性自我护理能力在支持居家护理客户安全方面作用的理解。高水平的治疗性自我护理能力可以成为居家护理客户预防不良事件发生的保护因素。清楚了解治疗性自我护理能力与不良事件之间关系的性质有助于确定改善客户健康和功能所需的居家护理服务提供领域。这些知识对于告知医疗保健领导者促进治疗性自我护理的有效策略至关重要，同时也为制定居家护理风险缓解政策提供证据。
