West Health Institute, 10350 North Torrey Pines Road, La Jolla, CA, 92037, USA.
BMC Geriatr. 2018 Oct 11;18(1):241. doi: 10.1186/s12877-018-0931-z.
Medically complex vulnerable older adults often face social challenges that affect compliance with their medical care plans, and thus require home and community-based services (HCBS). This study describes how non-medical social needs of homebound older adults are assessed and addressed within home-based primary care (HBPC) practices, and to identify barriers to coordinating HCBS for patients.
An online survey of members of the American Academy of Home Care Medicine (AAHCM) was conducted between March through November 2016 in the United States. A 56-item survey was developed to assess HBPC practice characteristics and how practices identify social needs and coordinate and evaluate HCBS. Data from 101 of the 150 surveys received were included in the analyses. Forty-four percent of respondents were physicians, 24% were nurse practitioners, and 32% were administrators or other HBPC team members.
Nearly all practices (98%) assessed patient social needs, with 78% conducting an assessment during the intake visit, and 88% providing ongoing periodic assessments. Seventy-four percent indicated 'most' or 'all' of their patients needed HCBS in the past 12 months. The most common needs were personal care (84%) and medication adherence (40%), and caregiver support (38%). Of the 86% of practices reporting they coordinate HCBS, 91% followed-up with patients, 84% assisted with applications, and 83% made service referrals. Fifty-seven percent reported that coordination was 'difficult.' The most common barriers to coordinating HCBS included cost to patient (65%), and eligibility requirements (63%). Four of the five most frequently reported barriers were associated with practices reporting it was 'difficult' or 'very difficult' to coordinate HCBS (OR from 2.49 to 3.94, p-values < .05).
Despite the barriers to addressing non-medical social needs, most HBPC practices provided some level of coordination of HCBS for their high-need, high-cost homebound patients. More efforts are needed to implement and scale care model partnerships between medical and non-medical service providers within HBPC practices.
患有多种复杂疾病的脆弱老年人往往面临着影响其医疗护理计划依从性的社会挑战，因此需要家庭和社区为基础的服务（HCBS）。本研究描述了家庭为基础的初级保健（HBPC）实践中如何评估和解决居家老年人的非医疗社会需求，并确定协调患者 HCBS 服务的障碍。
2016 年 3 月至 11 月期间，在美国对美国家庭医疗学会（AAHCM）的成员进行了一项在线调查。制定了一份 56 项的调查，以评估 HBPC 实践的特点以及实践如何识别社会需求以及协调和评估 HCBS。在收到的 150 份调查中，有 101 份数据被纳入分析。44%的受访者是医生，24%是执业护士，32%是管理员或其他 HBPC 团队成员。
几乎所有的实践（98%）都评估了患者的社会需求，其中 78%在就诊时进行评估，88%提供定期的评估。74%的人表示在过去 12 个月中，他们的大多数或所有患者都需要 HCBS。最常见的需求是个人护理（84%）和药物依从性（40%），以及照顾者支持（38%）。在报告协调 HCBS 的 86%的实践中，91%对患者进行了随访，84%协助申请，83%进行了服务转介。57%的人报告说协调工作“困难”。协调 HCBS 的最常见障碍包括对患者的费用（65%）和资格要求（63%）。在五个最常报告的障碍中，有四个与报告协调 HCBS“困难”或“非常困难”的实践有关（OR 从 2.49 到 3.94，p 值<0.05）。
尽管存在解决非医疗社会需求的障碍，但大多数 HBPC 实践为其高需求、高费用的居家患者提供了一定程度的 HCBS 协调。需要进一步努力，在 HBPC 实践中实施和扩大医疗和非医疗服务提供者之间的护理模式伙伴关系。
