What is known
What is new
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Families’ socioeconomic characteristics and caregivers’ experience of acute homecare is essential to gain a better understanding of an acute homecare program.
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The assessment of families’ expectations and actual experiences can facilitate the recruitment of new patients.
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Evaluation of the caregiver’s and child’s experiences can help the medical staff improve healthcare.
Introduction
Methods
“SJD a Casa” program
Participants
Ethical considerations
Experimental design
Statistical analysis
Results
Mean;sd or n;% | |
---|---|
Parent 1 age (n = 209) | 38.7;6.2 |
Parent 2 age (n = 196) | 38.7;6.11 |
Parent 1 origin (n = 217) | |
Africa | 4;1.84% |
America | 36;16.59% |
Asia | 6;2.76% |
Europe | 11;5.07% |
Spain | 160;73.73% |
Parent 2 origin (n = 203) | |
Africa | 4;1.97% |
America | 30;14.78% |
Asia | 5;2.46% |
Europe | 15;7.39% |
Spain | 149;73.40% |
Parents’ highest education (n = 214) | |
Elementary school | 8;3.74% |
High school | 54;25.23% |
College education | 152;71.03% |
Familial economic characteristics | |
Receiving economic support (n = 218) | 74;33.94% |
Someone in family is unemployed (n = 214) | 51;23.83% |
Friends and family support if needed (n = 217) | 153;70.51% |
Home characteristics | |
Patient has his/her own room (n = 215) | 134;62.33% |
Shared house with other families (n = 215) | 3;1.40% |
House well-equipped to accommodate hospitalization (n = 217) | 213;98.16% |
Patients’ characteristics | |
Chronic condition (n = 215) | 25;11.63% |
Disability degree (n = 218) | 10;4.59% |
Level of dependence (n = 214) | 11;5.14% |
Work reduction (n = 213) | 22;10.33% |
n;% | |
---|---|
Reasons for choosing acute home-hospitalization (n = 372) | |
Child and family comfort | 249;66.94% |
Balancing work and family life | 93;25% |
Child’s health | 75;20.16% |
Economic burden caused by hospitalization | 6;1.61% |
Othersa | 18;4.84% |
Factors influencing the choice of acute homecare | |
Being admitted in a hospital previously (n = 217) | 119;54.84% |
Patient’s anxiety during examination in a hospital (n = 351) | 131;37.32% |
Increased economic burden during conventional hospitalization (n = 354) | 243;68.64% |
Previous traumatic event in a hospitalb (n = 217) | 37;17.05% |
Expected experience (n = 372) n;% | Actual experience (n = 218) n;% | Fisher’s exact test (p value) | |
---|---|---|---|
HOMECARE: CAREGIVER’S WELL-BEING | |||
Difficulties in contacting the healthcare team | |||
Yes | 12;3.26% | 2;0.92% | 0.094 |
No | 356;96.74% | 216;99.08% | |
Difficulties in administering medicationsa | |||
Yes | 2;0.55 | 14;6.45% | < 0.001 |
No | 363;99.45% | 203;93;55% | |
Workload | |||
Moreb | 57;16.19% | 18;8.8% | 0.091 |
Usual | 236;67.05% | 147;68.06% | |
Less | 59;16.76% | 50; 23.15% | |
Feelings at home | |||
Better | 314;88.95% | 171;79,17% | 0.004 |
Equal | 36;10.2% | 40;18.52% | |
Worse | 3;0.85% | 5;2.31% | |
HOMECARE: CHILD’S WELL-BEING | |||
Sleeping | |||
Better | 262;67.24% | 169;77.52% | 0.449 |
Equal | 88;24.79% | 48;22.02% | |
Worse | 5;1.41% | 1;0.46% | |
Eating | |||
Better | 236;67.24% | 163;75.02% | 0.091 |
Equal | 109;31.05% | 53;24.42% | |
Worse | 6;1.71% | 1;0.46% | |
Playing | |||
Better | 298;86.88% | 197;91.63% | 0.105 |
Equal | 41;11.95% | 18;8.37% | |
Worse | 4;1.17% | 0;0% | |
Hygiene | |||
Better | 213;60.34% | 160;73.73% | 0.001 |
Equal | 134;37.96% | 57;26.27% | |
Worse | 6;1.7% | 0;0% |
Expressing fear/restlessness: | |
“I was afraid my boy could get worse, and I didn’t know what to do.” | |
“I have felt a bit restless and nervous because of lack of confidence, as I knew I didn’t have a nurse 24 hours a day (…).” | |
Other feelings: | |
“I’ve felt happier because I’ve been accompanied by my family and the health team, which has helped professionally and humanly.” | |
“I feel tired, but happy to see my child getting better.” | |
“What really helped was not having to entertain a 1-year-old girl in a hospital bed. She seemed quieter in her own environment. The medication administration produced me some anxiety at the beginning, but having seen this in hospital, after a while everything went smoothly (...). I also was very grateful with the hospital’s training (...).” |
Homecare: Why the child felt better at home | n;% |
Because they were accompanied by their families and were in their own environment | 177;84.69% |
Because the child had improved when transferred to homecare | 16;7.66% |
Both | 8;3.83% |
Other answersa | 8;3.83% |
Homecare recovery: Speed | |
The same or faster than that in the hospital | 175;81.02% |
Slower than that in the hospital | 41;18.98% |
Excellent n;% | Very good n;% | Good n;% | Regular n;% | Bad n;% | Very bad n;% | Fisher’s exact test (p value) | |
---|---|---|---|---|---|---|---|
INFORMATION | |||||||
Home-hospitalization (n = 217) | 179;82.49% | 32;14.75% | 4;1.84% | 2;0.92% | 0;0% | 0;0% | 0.014 |
Conventional hospitalization (n = 218) | 152;69.72% | 49;22.48% | 11;5.05% | 5;2.29% | 0;0% | 1;0.46% | |
CARE | |||||||
Home-hospitalization (n = 216) | 184;85.19% | 28;12.96% | 2;0.93% | 2;0.93% | 0;0% | 0;0% | 0.004 |
Conventional hospitalization (n = 216) | 157;72.69% | 46;21.3% | 10;4.63% | 2;0.93% | 1;0.46% | 0;0% |
n;% | |
---|---|
Comparison of the economic burden in the hospital and in homecare (n = 205) | |
Higher in the hospital | 124;60.49% |
The same as that in the hospital | 74;36.1% |
Higher in homecare | 7;3.41% |
Extra expenditure because of home-hospitalization (n = 218) | |
Yes | 33;15.14% |
No | 185;84.86% |
Mean;sd or n;% | |
---|---|
Rating SJD a Casa (n = 217) | 9.47;0.822 |
Repeating homecare if needed (n = 215) | |
Yes | 211;98.14% |
No | 4;1.86% |
Related to the telemonitoring dispositive: | |
“Wireless monitoring dispositive.” | |
“Being able to have the monitoring software in my phone, rather than having a tablet.” | |
Related to the healthcare team’s organization: | |
“To better specify visiting hours and medication scheduling, which must be difficult with so many children admitted to homecare.” | |
“To include transportation to hospital when the patient needs to be checked there.” | |
“Being myself mother and primary care physician, I think primary care should be contacted before discharge in case of chronic or complex patients.” | |
“To answer the phone quickly.” | |
Related to medical devices used to administer medication: | |
“The nebulizer is too noisy.” | |
“The nebulizer is too slow.” |