[An approach to home care. How does the Catalonian public health system handle home care?]

Abstract

Objective: To describe the organizational model, resources and implementation of the home care program run by the Catalonian public health service, and to note difficulties reported by primary care professionals.

Design: Cross-sectional, descriptive study.Setting. Autonomous Community of Catalonia.

Participants: 214 primary care centers (PCCs) operating under reformed administrative procedures were surveyed, and responses were obtained from 112 (52.3%).

Main measures: Semistructured, self-administered questionnaire sent by mail, with variables that identified the center, resources, organization and use of protocols for home care. Questionnaires were collected during July to November, 2000.

Results: Home care programs were being used at 90.2% (95% CI, 84.7%-95.7%) of the centers, and had been in effect for a mean of 5.6 years. Nursing services predominated in 64% of the case, with nurses spending a mean of 5.09 h/week on the program, twice as much time as physicians and social workers. The mean rate of computerization of the data was 31.3%, and was highest (P<.05) in Gerona (51%) and in PCCs run privately (70%). Of all participating PCCs, 70% had social workers on the staff, 13% had a home care nurse and 50% operated in coordination with social services. Of all PCCs, 79.5% (95% CI, 72.1%-86.9%) used specific protocols for pressure sores (69.1%), terminal illnesses (43.6%), bedridden patients (41.8%) and pain management (40.9%). Evaluations were done with the Barthel scale (73.2%), the Mini-Mental State Examination (73.2%) and the Norton scale (53.6%). Continuing education (66%) and activities for care providers (>75%) were frequent in home care programs. The main difficulties identified were the burden of care (65.2%), time constraints (51.8%), inadequate social support (43.8%) and lack of coordination with other levels of care (33%).

Conclusions: Noteworthy findings were the dedication of nursing staff to the home care programs, the low level of computerization of the data, the limitations in social service resources, the uniformity of assessment protocols and scales, and the agreement regarding current difficulties.