Browsing by Subject "Home health care"

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    Family caregiving, home medical devices, and the sociotechnical system: Bringing the biomedical sciences into the bioethics discourse
    (2013-08) Rosenstein, Benjamin E.
    Informal caregiving by family members has been a substantial, cost-effective resource for the medical system. More recently, complex devices have made it possible to sustain patient's lives at home in more acute situations for longer periods of time. The arguments supporting the use of home care devices have been predicated on improving patients' quality of life since patients want to live out their life in their home. Ethically, this has been advocated as a means by which medicine can support patient-autonomy. This assumes the patient had a choice in using these devices and, more broadly, that the family caregiver had any choice. Autonomy fails to distinguish that a patient's autonomous choice is based on the expectation of use and that family will provide care. I will argue that neither the care recipient nor caregiver has autonomy and that the relationship they share is far more important. This usual deference to patient-autonomy overlooks the caregiver, the true user, on whom the patient and the system is reliant. Pushing this cultural objective of sustaining autonomy are the home care technologies themselves through the force of the technological imperative. While we often conceive of technologies as neutral objects, I argue they are cultural artifacts reflecting social values and practices. These values are imbued in these technologies' development and design by biomedical scientists and engineers who create them. These same people, though, are separated from the values and needs of family caregivers, challenging the goals of home care. I will argue they should not be separated since they are not neutral but rather moral actors within the larger context of the medical sociotechnical system.
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    High risk medication regimens and medication related predictors of hospital readmission in elderly home care patients.
    (2010-10) Dierich, Mary Therese Jancaric
    Adverse drug events are a primary cause of hospitalization in the elderly. Nearly 70% of the $177.4 billion dollars spent on drug related morbidity and mortality in the U.S. is due to hospitalizations. Polypharmacy, inappropriate medications or medication regimen complexity have all been implicated as precursors to adverse drug events and as indicators of high risk medication regimens. Understanding the relationship between medication regimens and readmission is important when evaluating potential errors in administration, risk-benefit ratios, and readmission risk. However, due to definitional and measurement issues, the high risk medication regimen remains an elusive concept. This study characterizes medication regimens, defines high risk medication regimens, and determines if high risk medication regimens predict re-hospitalization in home healthcare clients over age 65. An exploratory, secondary analysis of OASIS data and medication records from 15 home care agencies was used to characterize medication use in 911 older adults discharged from the hospital to their first episode of home care in 2004. Conceptual and operational definitions of polypharmacy, potentially inappropriate medications, medication regimen complexity, and high risk medication regimens were developed. Logistic regression and structural equation modeling were used to examine the relationship between comorbidity, a variety of risk factors supported by the literature, high risk medication regimens (defined by polypharmacy, potentially inappropriate medication regimens, and medication regimen complexity) and re-hospitalization to determine if high risk medication regimens predicted rehospitalization in these subjects. Factor analysis revealed that high risk medication regimens are composed of polypharmacy, potentially inappropriate medication regimens, and medication regimen complexity, and that a model using this concept rather than individual medication variables proved to be the most predictive and parsimonious model. The model accounted for 10% of variance in re-hospitalization in this sample. Additionally, high risk medication regimens appear to have as much influence as comorbidity on hospital readmission. Future research should include high risk medication regimens as a predictor of readmission and previously completed studies may need to be re-evaluated in light of these findings. Both the findings and the methodology will be useful in examining predictive potential of high risk medications regimens in other settings.