Factors influencing the outcome of community care in a quick response trial in St. John's, Newfoundland

Barrowman, Gwynedd (1998) Factors influencing the outcome of community care in a quick response trial in St. John's, Newfoundland. Masters thesis, Memorial University of Newfoundland.

[English] PDF - Accepted Version Available under License - The author retains copyright ownership and moral rights in this thesis. Neither the thesis nor substantial extracts from it may be printed or otherwise reproduced without the author's permission. Download (7MB)

Abstract

Quick Response (QR) Programs have been implemented in many places to assist patients and their families when through ill-health they are suddenly unable to manage at home. The aim is to tide them over a short-term crisis by providing speedy practical support in the home, to avoid unnecessary hospitalization, and where appropriate to provide information to assist families in making decisions for the future. -- This work summarizes the achievements of a number of QR programs in Canada, and outlines the methods and results of the QR project carried out in St. John's, Newfoundland in 1995. This was a clinical trial in which appropriate patients who came to the Emergency Room (ER) were randomized to receive either QR in their homes, or standard care, in hospital or at home, as ordered by the physician. Health status and function in daily living were measured using three well-validated questionnaires: the modified Barthel, the Short Form-36 and the Sickness Impact Profile. Care provided over three months, and the associated costs, were documented. Caregiver stress was measured using the Relatives' Stress Scale and the General Health Questionnaire-30. Enrolment in the study was poor: possible explanations are presented. -- Care in the community will play an increasingly important role as the population of Canada ages. The objectives of a community health agency are not the same as those of an acute care system; in the context of community care for people referred from the ER, some definitions of success are proposed. Based on data from the QR project, increasing age and the presence of one or more adverse diagnoses such as congestive heart failure, chronic obstructive lung disease and dementia were identified as predictors of an unsuccessful intervention by Community Health, whereas a supportive network of family and friends increased the likelihood of success. Finally, some suggestions for future research and development in community health care are presented.

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