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With increasing survival rates of children born extremely preterm (EPT), before gestational week 28, the post-discharge life of these families has gained significant research interest. Quantitative studies of parental experiences post-discharge have previously reported elevated levels depressive symptoms, posttraumatic stress-disorder and anxiety among the parents. The current investigation aims to qualitatively explore the situation for parents of children born EPT in Sweden during the first year at home. Semi-structured interviews were performed with 17 parents of 14 children born EPT; eight parents were from an early intervention group and nine parents from a group that received treatment as usual, with extended follow-up procedures. Three main themes were identified using a thematic analytic approach: child-related concerns, the inner state of the parent, and changed family dynamics. Parents in the intervention group also expressed themes related to the intervention, as a sense of security and knowledgeable interventionists. The results are discussed in relation to different concepts of health, parent–child interaction and attachment, and models of the recovery processes. In conclusion, parents describe the first year at home as a time of prolonged parental worries for the child as well as concerns regarding the parent’s own emotional state.

Background Japan is promoting physician‐led home visits. Among patients receiving home care, activities of daily living (ADLs) affect both caregiver burden and patients' quality of life. This study aimed to determine the incidence of ADL improvement in physician‐led home care and to identify associated factors. Methods This retrospective cohort study included patients aged 65 years or older with a Barthel Index (BI) score of 90 or less who began receiving physician‐led home visits between February 1, 2013, and January 31, 2016. The primary outcome was defined as a ≥ 10‐point improvement in the BI score from baseline. Changes in BI following the initiation of home visits were analyzed using the cumulative incidence function, with death treated as a competing risk. Cause‐specific Cox regression was conducted to identify factors associated with BI improvement. Results A total of 660 patients were analyzed, with a median follow‐up of 308 days. The one‐year cumulative incidence of ADL improvement, accounting for competing risks, was 27.1%. Cause‐specific Cox regression showed that patients with MMSE‐J scores < 14 were less likely to improve ADLs, whereas those transitioning from hospital to home care had a higher likelihood of improvement. Conclusion Following the initiation of physician‐led home visits, approximately one‐quarter of patients experienced improvement in ADLs. Transition of care from hospital to home was associated with better ADL outcomes, while improvement was less likely among those with severe cognitive impairment. These findings may help estimate ADL changes at the start of home care. A quarter of patients initiating physician‐led home visits showed improvement in activities of daily living (ADLs). Hospitalization before home visits care was associated with better ADLs, while improvement was less likely among those with severe cognitive impairment. These findings may help estimate ADLs changes at the start of home care.

Background Early postpartum facility discharge negatively impacts mothers’ proper and effective use postnatal care. Cognizant of these facts, home-based postnatal care practices have been promoted to complement facility-based care to reduce neonatal mortality. This systematic review evaluated the effectiveness and cost-effectiveness of home-based postnatal care on exclusive breastfeeding practice and neonatal mortality in low-and-middle-income countries. Methods Randomized trials and quasi-experimental studies were searched from electronic databases including PubMed, Popline, Cochrane Central Register of Controlled Trials and National Health Service Economic Evaluation databases. Random-effects meta-analysis model was used to pool the estimates of the outcomes accounting for the variability among studies. Results We identified 14 trials implementing intervention packages that included preventive and promotive newborn care services, home-based treatment for sick neonates, and community mobilization activities. The pooled analysis indicates that home-based postpartum care reduced neonatal mortally by 24% (risk ratio 0.76; 95% confidence interval 0.62–0.92; 9 trials; n  = 93,083; heterogeneity p  < .01) with no evidence of publication bias (Egger’s test: Coef. = − 1.263; p  = .130). The subgroup analysis suggested that frequent home visits, home visits by community health workers, and community mobilization efforts with home visits, to had better neonatal survival. Likewise, the odds of mothers who exclusively breastfed from the home visit group were about three times higher than the mothers who were in the routine care group (odds ratio: 2.88; 95% confidence interval: 1.57–5.29; 6 trials; n  = 20,624 mothers; heterogeneity p  < .01), with low possibility of publication bias (Coef. = − 7.870; p  = .164). According to the World Health Organization’s Choosing Interventions that are Cost-Effective project recommendations, home-based neonatal care strategy was found to be cost-effective. Conclusions Home visits and community mobilization activities to promote neonatal care practices by community health workers is associated with reduced neonatal mortality, increased practice of exclusive breastfeeding, and cost-effective in improving newborn health outcomes for low-and-middle-income countries. However, a well-designed evaluation study is required to formulate the optimal package and optimal timing of home visits to standardize home-based postnatal interventions.

Despite the 2012 fee revision raising fees for home-visit nursing services to increase their supply in Japan, 300 to 500 home-visit nursing agencies (VNA) are still being closed annually. This study aims to identify the regional and organizational characteristics of the VNAs that closed after the 2012 fee revision. A longitudinal observational study was conducted using nationwide panel data of VNAs from 2014 to 2017 (N = 6496). Multiple logistic regression models stratified by years of operation were used for the analysis. We identified 821 closed agencies (12.6%). In this study, many important factors related to VNA closures were found. In the less than three years group, there were regional factors (lower aging rate and larger number of clinics) and an organizational factor (higher proportion of users under 40 years of age). In the 3–14 years group, there was a regional factor (larger number of clinics) and organizational factors (smaller number of FTE nurses, smaller number of users per FTE nurse, and smaller number of medical care types that can be provided). In the over 15 years group, there was an organizational factor (smaller number of FTE nurses). The findings provide valuable insights for policymakers in avoiding VNA closures.

Background Ultrasound hip screening is crucial for the early detection of developmental dysplasia (DDH), but little is known about standardized training approaches for nurses. This study aimed to evaluate an educational program combining web-based learning and objective structured clinical examination (OSCE) training to improve nurses’ knowledge and skills in ultrasound hip screening and DDH prevention during universal neonatal and infant home visits. Methods The program targeted two objectives: (1) to enable nurses to understand the Graf method and acquire standard plane ultrasound images, and (2) to equip them to provide preventive health education on DDH. The intervention included five web-based modules and a two-day OSCE-based hands-on program, supervised by orthopedic pediatric surgeons. Outcomes included (1) knowledge test scores obtained from the web-based modules (range: 0–50 points), (2) OSCE scores (36 items, range: 0–360; global rating ≧3 on a 1–6), including delivery of preventive health education, (3) ability to capture a standard plane image using a phantom within three minutes, and (4) ability to capture a standard plane image with infant volunteers, assessed by medical supervisors. Results Nineteen participants (18 public health nurses and one midwife) from three municipalities completed the program. The mean knowledge test score was 47.2 (SD: 2.2), and the mean OSCE score was 329.3 (SD: 21.7), with a global rating of 4.4 (SD: 0.7). All participants conducted the preventive health education component. Eighteen participants (right hip) and 17 (left hip) successfully captured standard plane images using a phantom within three minutes. In scans of 39 infant volunteers, 34 scans (87.2%) successfully captured the standard plane; participants self-reported 31 as successful, though two were objectively classified as failures. Conclusions The educational program improved nurses’ ultrasound hip-screening skills and their capacity to deliver preventive health education during universal home visits. These findings support the potential feasibility of expanding nurse-led ultrasound screening and DDH prevention efforts in community settings. Trial registration This study was registered with the University Hospital Medical Information Network Clinical Trial Registry before starting the study (No. UMIN000051929, August 16, 2023).

Background There exists little research elucidating the benefits of family medicine clinics for community with ample specialist healthcare resources. Methods We conducted mixed‐methods research. Within the inaugural family medicine clinic, the following data was collected during the initial 2 months: (i) newly identified healthcare needs among scheduled outpatients; (ii) management of outpatients with complex health and social needs; and (iii) provision of home‐visit care. Newly detected health care needs were summarized qualitatively using a summative content analysis. Patients' complexity was quantitatively scored using the Japanese version of the Patient Centred Assessment Method. Results Physicians identified 156 new needs and 13 complex cases. The complexity of patients receiving home‐visit care was high. Conclusions This study demonstrates that an inaugural family medicine clinic adeptly addressed a diverse spectrum of patients' healthcare needs. This study aimed to reveal how family medicine can swiftly respond to healthcare needs by examining an inaugural family medicine clinic. These findings underscore the unique significance of family medicine clinics, particularly in areas with abundant specialist medical care resources.

Pain inhibits rehabilitation. In rehabilitation at medical institutions, the usefulness of virtual reality (VR) has been reported in many cases to alleviate pain. In recent years, the demand for home rehabilitation has increased. Unlike in medical situations, the patients targeted for in-home rehabilitation often have chronic pain due to physical and psychosocial factors, and the environment is not specialized for rehabilitation. However, VR might be effective for in-home rehabilitation settings. This study aims to evaluate the feasibility of applying VR to home-visit rehabilitation for homebound patients with chronic pain. This study will test the feasibility of VR applied to home-visit rehabilitation for patients with chronic pain. A single-arm pre-post comparison will be conducted to evaluate its feasibility. Screening will be conducted on patients who have given consent to participate in the study, and those who have pain that persists or recurs for more than 3 months and receive home-visit rehabilitation will be enrolled in the study. Baseline measurements will be conducted on study participants before the start of the VR intervention. VR-applied home-visit rehabilitation will be conducted once a week for a total of 10 VR interventions. The primary endpoint is the change in pain from the baseline to the tenth intervention. Pain is a subjective symptom of the study participants and will be subjectively assessed by the Numerical Rating Scale of 11 levels from 0 to 10. Pain as the primary endpoint will be measured at 3-time points per rehabilitation session: before, during, and after the rehabilitation so that changes between time points can be evaluated. Secondary endpoints are heart rate variability, range of motion of the area in the musculoskeletal system where the pain occurs, motivation for rehabilitation, catastrophic thoughts of pain, mood state, quality of life, and interviews. Assessments will be conducted at the baseline, first, fifth, and tenth interventions. After completing the clinical study (10 VR interventions), patients will continue their regular home-visit rehabilitation as usual. Recruitment of participants began on February 22, 2022, and data collection is ongoing as of November 2024. The research results will be published in international peer-reviewed journals and through presentations at national and international conferences. This study will contribute to the development of novel rehabilitation-based solutions for homebound patients who have had difficulty obtaining adequate relief from chronic pain. Future studies will consider conducting randomized controlled trials as clinical trials to validate the efficacy of VR during home-visit rehabilitation for patients with chronic pain. DERR1-10.2196/58734.

Background Medication mismanagement is a major cause of both hospital admission and nursing home placement of frail older adults. Medication reviews by community pharmacists aim to maximise therapeutic benefit but also minimise harm. Pharmacist-led medication reviews have been the focus of several systematic reviews, but none have focussed on the home setting. Review methods To determine the effectiveness of pharmacist home visits for individuals at risk of medication-related problems we undertook a systematic review and meta-analysis of randomised controlled trials (RCTs). Thirteen databases were searched from inception to December 2018. Forward and backward citation of included studies was also performed. Articles were screened for inclusion independently by two reviewers. Randomised controlled studies of home visits by pharmacists for individuals at risk of medication-related problems were eligible for inclusion. Data extraction and quality appraisal were performed by one reviewer and checked by a second. Random-effects meta-analyses were performed where sufficient data allowed and narrative synthesis summarised all remaining data. Results Twelve RCTs (reported in 15 articles), involving 3410 participants, were included in the review. The frequency, content and purpose of the home visit varied considerably. The data from eight trials were suitable for meta-analysis of the effects on hospital admissions and mortality, and from three trials for the effects on quality of life. Overall there was no evidence of reduction in hospital admissions (risk ratio (RR) of 1.01 (95%CI 0.86 to 1.20, I 2  = 69.0%, p  = 0.89; 8 studies, 2314 participants)), or mortality (RR of 1.01 (95%CI 0.81 to 1.26, I 2  = 0%, p  = 0.94; 8 studies, 2314 participants)). There was no consistent evidence of an effect on quality of life, medication adherence or knowledge. Conclusion A systematic review of twelve RCTs assessing the impact of pharmacist home visits for individuals at risk of medication related problems found no evidence of effect on hospital admission or mortality rates, and limited evidence of effect on quality of life. Future studies should focus on using more robust methods to assess relevant outcomes.

Background There is consensus that medical schools have a duty to educate students about social determinants of health (SDOH) and equip them with skills required to ameliorate health disparities. Although the National Academy of Medicine (NAM) urged the development of experiential long term programs, teaching is usually conducted in the pre-clinical years or as voluntary courses. ETGAR a required health disparities course, based on the social ecological model, was initiated to answer the NAM call. This study aimed to ascertain the course impact on students learning of SDOH and health disparities. Methods Students during their first clinical year cared for four patients in their transition from hospital back home, one patient in each internal medicine, surgery, pediatrics and obstetrics/gynecology rotation. The students home-visited their patients after meeting them in hospital and preparing a plain language discharge letter. Training session prior to the course, a tutorial in each rotation, and structured feedback gave the educational envelope. Mixed methodology was employed to evaluate the course impact. Quantitative data collected by students during the home-visit: patients’ characteristics and quality and safety of the transition back home using the Medication Discrepancy Tool and Care Transition Measure questionnaire. Stakeholders’ views were collected via interviews and focus groups with students representing all affiliated hospitals, and interviews with heads of departments most involved in the course. Results Three hundred six students in three academic years, between October 2016–July 2019, completed home visits for 485 disadvantaged patients with improvement in patients’ knowledge of their treatment (3.2 (0.96) vs 3.8 (0.57), Z = -7.12, p  < .0001) and identification of medication discrepancies in 42% of visits. Four themes emerged from the qualitative analysis: contribution to learning, experience-based learning, professional identity formation, and course implementation. Conclusions ETGAR was perceived to complement hospital-based learning, making students witness the interaction between patients’ circumstances and health and exposing them to four patients’ environment levels. It provided a didactic framework for promoting awareness to SDOH and tools and behaviors required to ameliorate their impact on health and health disparities. The course combined communication and community learning into traditionally bio-medical clinical years and serves as a model for how social-ecology approaches can be integrated into the curriculum.

Background Physician-led home visit care with medical teams (Zaitaku care) has been developed on a national scale to support those who wish to stay at home at the end of life, and promote a system of community-based integrated care in Japan. Medical care at the end of life can be expensive, and is an urgent socioeconomic issue for aging societies. However medical costs of physician-led home visits care have not been well studied. We compared the medical costs of Zaitaku care and hospital care at the end of life in a rapidly aging community in a rural area in Japan. Methods A cross-sectional study was performed to compare the total medical costs during patients’ final days of life (30 days or less) between Zaitaku care and hospital care from September 2012 to August 2013 in Fukuoka Prefecture, Japan. Results Thirty four patients died at home under Zaitaku care, and 72 patients died in the hospital during this period. The average daily cost of care during the last 30 days did not differ significantly between the two groups. Although Zaitaku care costs were higher than hospital care costs in the short-term (≦10 days, Zaitaku care $371.2 vs. Hospital care $202.0, p  = 0.492), medical costs for Zaitaku care in the long-term care (≧30 days) were less than that of hospital care ($155.8 vs. $187.4, p  = 0.055). Conclusions Medical costs of Zaitaku care were less compared with hospital care if incorporated early for long term care, but it was high if incorporated late for short term care. For long term care, medical costs for Zaitaku care was 16.7% less than for hospitalization at the end of life. This physician-led home visit care model should be an available option for patients who wish to die at home, and may be beneficial financially over time.