Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2017

Open Access 01-12-2017 | Research article

Examining the relationship between therapeutic self-care and adverse events for home care clients in Ontario, Canada: a retrospective cohort study

Authors: Winnie Sun, Diane M. Doran, Walter P. Wodchis, Elizabeth Peter

Published in: BMC Health Services Research | Issue 1/2017

Login to get access

Abstract

Background

In an era of a rapidly aging population who requires home care services, clients must possess or develop therapeutic self-care ability in order to manage their health conditions safely in their homes. Therapeutic self-care is the ability to take medications as prescribed and to recognize and manage symptoms that may be experienced, such as pain. The purpose of this research study was to investigate whether therapeutic self-care ability explained variation in the frequency and types of adverse events experienced by home care clients.

Methods

A retrospective cohort design was used, utilizing secondary databases available for Ontario home care clients from the years 2010 to 2012. The data were derived from (1) Health Outcomes for Better Information and Care; (2) Resident Assessment Instrument-Home Care; (3) National Ambulatory Care Reporting System; and (4) Discharge Abstract Database. Descriptive analysis was used to identify the types and prevalence of adverse events experienced by home care clients. Logistic regression analysis was used to examine the association between therapeutic self-care ability and the occurrence of adverse events in home care.

Results

The results indicated that low therapeutic self-care ability was associated with an increase in adverse events. In particular, logistic regression results indicated that low therapeutic self-care ability was associated with an increase in clients experiencing: (1) unplanned hospital visits; (2) a decline in activities of daily living; (3) falls; (4) unintended weight loss, and (5) non-compliance with medication.

Conclusions

This study advances the understanding about the role of therapeutic self-care ability in supporting the safety of home care clients. High levels of therapeutic self-care ability can be a protective factor against the occurrence of adverse events among home care clients. A clear understanding of the nature of the relationship between therapeutic self-care ability and adverse events helps to pinpoint the areas of home care service delivery required to improve clients’ health and functioning. Such knowledge is vital for informing health care leaders about effective strategies that promote therapeutic self-care, as well as providing evidence for policy formulation in relation to risk mitigation in home care.
Appendix
Available only for authorised users
Literature
1.
2.
3.
4.
Madigan E. Tullai-McGuinness: an examination of the most frequent adverse events in home care agencies. Home Healthc Nurse. 2004;22(4):256–62.CrossRefPubMed
5.
Coleman E, Mahoney E, Parry C. Assessing the quality of preparation for post hospital care from the patient’s perspective: the care transitions measure. Med Care. 2005;43:246–55.CrossRefPubMed
6.
Benbassat J, Taragin M. Hospital readmissions as a measure of quality of health care. Arch Intern Med. 2000;160:1074–81.CrossRefPubMed
7.
Parry C, Mahoney E, Chalmers SA, Coleman EA. Assessing the quality of transitional care further applications of the care transitions measure. Med Care. 2008;46(3):317–22.CrossRefPubMed
8.
Pryor J. Coaching patients to self-care: a primary responsibility of nursing. J Compilation. 2009;4:79–88.
9.
Williams P, Lum J, Deber R, Montgomery R, Kuluski K, Peckham A, et al. Aging at home: integrating community-based care for older persons. Heatlhc Papers. 2010;10(1):10–23.
10.
11.
Massotti P, McColl MA, Green M. Adverse events experienced by homecare patients: a scoping review of the literature. Int J Qual Health Care. 2010;22(2):115–25.CrossRef
12.
Doran MD, Hirdes JP, Blais R, Baker GR, Poss JW, Li X, Hill D, Gruneir A, Heckman G, Lacroix H, Mitchell L, O’Beirne M, White N, Droppo L, Foebel AD, Qian G, Nahm SM, Yim O, McIsaac C, Jantzi M. Adverse events among Ontario home care clients associated with emergency room visit or hospitalization: a retrospective cohort study. BMC Health Serv Res. 2013;13:227.CrossRefPubMedPubMedCentral
13.
Blais R, Sears N, Doran D, Baker R, Macdonald M, Mitchell L, Thales S. Assessing adverse events among home care clients in three Canadian provinces using chart review. BMJ Qual Safety Online First. 2013;0:1–9.
14.
Sidani S. In: Doran DM, editor. Nursing outcomes: the state of the science. 2nd ed. Sudbury: Jones & Barlett Learning; 2011.
15.
Sidaini S. Therapeutic self-care tool guidelines for use. Toronto: University of Toronto; 2001.
16.
Kumar C. Application of Orem’s self-care deficit theory and standardized nursing languages in a case study of a woman with diabetes. Int J Nurs Terminol Classif. 2007;18:103–10.CrossRefPubMed
17.
Sidani S. Self-care. In: Doran DM, editor. Nursing-sensitive outcomes: state of the science. Sudbury: Jones & Barlett Learning; 2003.
18.
19.
Doran D, Hirdes J, Blais R, Baker R, Pickard J, Jantzi M. The nature of safety problems among Canadian home care clients: evidence from the RAI-HC reporting system. J Nurs Manag. 2009;17:165–74.CrossRefPubMed
20.
Lang A, MacDonald M, Storch J, Elliot K, Stevenson L, Lacroix H, et al. Home care safety perspectives from clients, family members, caregivers and paid providers. Healthc Q. 2009;12(Special issue):97–101.CrossRefPubMed
21.
Doran D, Hirdes J, Poss J, Jantzi M, Regis Blais G, Baker R, Pickard J. Identification of safety outcomes for Canadian home care clients: evidence from the resident assessment instrument: home care reporting system concerning emergency room visits. Healthc Q. 2009;12:40–8.CrossRefPubMed
22.
Sears NA, Baker GR, Barnsley J, Short S. The incidence of adverse events among home care patients. Int J Qual Health Care. 2013;1:1–13.
23.
Nagle L, White P, Pringle D. Collecting outcomes in spite of our systems. Can J Nurs Inform. 2007;2(3):4–8.
24.
Chaboyer W, Ringdal M, Aitken L, Kendale E. Self-care after traumatic injury and the use of therapeutic self-care scale in trauma populations. J Adv Nurs. 2013;69(2):286–94.
25.
Sidani S. Effects of patient centered care on patient outcomes: an evaluation. Res Theory Nurs Pract. 2008;22(1):24–37.CrossRefPubMed
26.
Doran D, Harrison M, Laschinger H, Hirdes J, Rukholm E, Sidani S, McGillis L, Tourangeau A. Nursing-sensitive outcomes data collection in acute care and long-term care settings. Nurs Res. 2006;55(2):S75–81.CrossRefPubMed
27.
Doran M, O’Brien-Pallas L, Sidani S, McGillis-Hall L, Petryshen P, Hawkins J, et al. An evaluation of nursing sensitive outcomes for quality care. J Int Nurs Perspect. 2003;3(3):109–25.
28.
Landis F, Tua E, Onder G, Carrara B, Sgadari A, Rinaldi C, et al. Minimum data set for home care: a valid instrument to assess frail older people living in the community. Med Care. 2003;12:1184–90.
29.
Morris JN, Fries BE, Steel K, Ikegami N, Bernabei R, Carpenter GI, Gilgen R, Hirdes JP, Topinkova E. Comprehensive clinical assessment in community setting: applicability of the MDS-HC. J Am Geriatr Soc. 1997;45:1017–24.CrossRefPubMed
30.
31.
32.
Dalby D, Hirdes J, Fries B. Risk adjustment methods for home care quality indicators (HCQIs) based on the minimum data set for home care. BMC Health Serv Res. 2005;5(7):1–12.
33.
Xu Y, Kubilius A. Developing risk adjustment techniques using the SAS system for assessing health care quality in the IMSystem, Joint Commission on Accreditation of Healthcare. 2010. p. 1–5.
34.
Hirdes J, Fries B, Morris J, Ikegami N, Zimmerman D, Dalby D, et al. Home care quality indicators (HCQIs) based on the MDS-HC. The Gerontologist. 2005;44(5):665–79.CrossRef
35.
Jones R, Hirdes J, Poss J, Kelly M, Berg K, Fries B, et al. Adjustment of nursing home quality indicators. BMC Health Serv Res. 2010;10(96):1–8.
36.
Hirdes J, Frijters D, Teare G. The MDS-CHESS scale: a new measure to predict mortality in the institutionalized elderly. J Am Geriatr Soc. 2003;51:96–100.CrossRefPubMed
37.
Hibbard J, Mahoney E, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Serv Res. 2005;40(6):1918–30.CrossRefPubMedPubMedCentral
38.
Hibbard J, Stockard J, Mahoney E, Tusler M. Development of the patient activation measure (PAM): conceptualizing and measuring activation in patients and consumers. Health Serv Res. 2005;39(4):1005–26.
39.
Hibbard J, Tusler M. Assessing activation stage and employing a “next steps” approach to supporting patient self-management. J Ambul Care Manage. 2007;30(1):2–8.CrossRefPubMed
40.
Sun W, Doran D, Wodchis W, Peter E. Examining the relationship between therapeutic self-care and adverse events for home care clients. University of Toronto, Canada: ProQuest Dissertation Publishing; 2014.
41.
Maher R, Hanlon J, Hajjar E. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):1–11.CrossRef
42.
Kahn J, Angus D. Going home on the right medications: prescription errors and transitions of care. JAMA. 2011;306(8):878–9.CrossRefPubMed
43.
Delafuente JC. Understanding and preventing drug interactions in elderly patients. Crit Rev Oncol Hematol. 2003;48:133–43.CrossRefPubMed
44.
Hanlon JT, Schmader KE, Koronkowski MJ, Weinberger M, Landsman PB, Samsa GP, et al. Adverse drug events in high risk older outpatients. J Am Geriatr Soc. 1997;45:945–8.CrossRefPubMed
45.
Canadian Institute for Health Information. Seniors and the health care system. What is the impact of multiple chronic conditions? Toronto: Author; 2011.
46.
Mery G, Wodchis W, Bierman A, Laberge M. Caring for people with multiple chronic conditions: a necessary intervention in Ontario. Working Paper Series. 2013;2:1–57.
47.
Registered Nurses’Association of Ontario (RNAO). Prevention of falls and fall injuries in the older adult. Toronto: Author; 2011.
Metadata
Title
Examining the relationship between therapeutic self-care and adverse events for home care clients in Ontario, Canada: a retrospective cohort study
Authors
Winnie Sun
Diane M. Doran
Walter P. Wodchis
Elizabeth Peter
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2017
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-017-2103-9

Other articles of this Issue 1/2017

BMC Health Services Research 1/2017 Go to the issue

Research article

Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals

Research article

Enablers and barriers to evidence based planning in the district health system in Uganda; perceptions of district health managers

Research article

Evaluating the sub-national fidelity of national Initiatives in decentralized health systems: Integrated Primary Health Care Governance in Nigeria

Research article

A longitudinal study looking at and beyond care recipient health as a predictor of long term care home admission

Research article

Do elections matter for private-sector healthcare management in Brazil? An analysis of municipal health policy

Research article

Developing a measure of mental health service satisfaction for use in low income countries: a mixed methods study