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"Eyes in the Home": Addressing Social Complexity in Veterans Affairs Home-Based Primary Care.

作者信息

Hulen Elizabeth, Laliberte Avery, Ono Sarah, Saha Somnath, Edwards Samuel T

机构信息

Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.

Department of Sociology, Portland State University, Portland, OR, USA.

出版信息

J Gen Intern Med. 2021 Apr;36(4):894-900. doi: 10.1007/s11606-020-06356-2. Epub 2021 Jan 11.


DOI:10.1007/s11606-020-06356-2
PMID:33432431
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8042101/
Abstract

BACKGROUND: Home-Based Primary Care (HBPC) has demonstrated success in decreasing risk of hospitalization and improving patient satisfaction through patient targeting and integrating long-term services and supports. Less is known about how HBPC teams approach social factors. OBJECTIVE: Describe HBPC providers' knowledge of social complexity among HBPC patients and how this knowledge impacts care delivery. DESIGN, SETTING, AND PARTICIPANTS: Between 2018 and 2019, we conducted in-person semi-structured interviews with 14 HBPC providers representing nursing, medicine, physical therapy, pharmacy, and psychology, at an urban Veterans Affairs (VA) medical center. We also conducted field observations of 6 HBPC team meetings and 2 home visits. APPROACH: We employed an exploratory, content-driven approach to qualitative data analysis. RESULTS: Four thematic categories were identified: (1) HBPC patients are socially isolated and have multiple layers of medical and social complexity that compromise their ability to use clinic-based care; (2) providers having "eyes in the home" yields essential information not accessible in outpatient clinics; (3) HBPC fills gaps in instrumental support, many of which are not medical; and (4) addressing social complexity requires a flexible care design that HBPC provides. CONCLUSION AND RELEVANCE: HBPC providers emphasized the importance of having "eyes in the home" to observe and address the care needs of homebound Veterans who are older, socially isolated, and have functional limitations. Patient selection criteria and discharge recommendations for a resource-intensive program like VA HBPC should include considerations for the compounding effects of medical and social complexity. Additionally, staffing that provides resources for these effects should be integrated into HBPC programming.

摘要

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本文引用的文献

[1]
"It's Like Riding Out the Chaos": Caring for Socially Complex Patients in an Ambulatory Intensive Care Unit (A-ICU).

Ann Fam Med. 2019-11

[2]
Dedicated to the Mission: Strategies US Department of Veterans Affairs Home-Based Primary Care Teams Apply to Keep Veterans at Home.

J Am Geriatr Soc. 2019-10-8

[3]
Long-Term Care Admissions Following Hospitalization: The Role of Social Vulnerability.

Healthcare (Basel). 2019-7-15

[4]
The Resurgence of Home-Based Primary Care Models in the United States.

Geriatrics (Basel). 2018-7-16

[5]
Loneliness in Primary Care Patients: A Prevalence Study.

Ann Fam Med. 2019-3

[6]
Perceived Effectiveness of Home-Based Primary Care Teams in Veterans Health Administration.

Gerontologist. 2020-4-2

[7]
Interdisciplinary Team Perspectives on Mental Health Care in VA Home-Based Primary Care: A Qualitative Study.

Am J Geriatr Psychiatry. 2018-11-2

[8]
Barriers and facilitators to implementation of VA home-based primary care on American Indian reservations: a qualitative multi-case study.

Implement Sci. 2017-9-2

[9]
Preventing Hospitalization with Veterans Affairs Home-Based Primary Care: Which Individuals Benefit Most?

J Am Geriatr Soc. 2017-8

[10]
Addressing Social Determinants of Health and Health Inequalities.

JAMA. 2016-10-25

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