Author :
Publisher :
ISBN 13 :
Total Pages : 113 pages
Book Rating : 4.:/5 (124 download)
Book Synopsis Exploring "What Works" in Veterans Affairs Home-Based Primary Care by :
Download or read book Exploring "What Works" in Veterans Affairs Home-Based Primary Care written by and published by . This book was released on 2021 with total page 113 pages. Available in PDF, EPUB and Kindle. Book excerpt: Home Based Primary Care (HBPC) is an interdisciplinary care model involving comprehensive primary care services for patients with chronic illness who are unable to access clinic-based care. The largest HBPC program in the United States is run by the Department of Veterans Affairs (VA) and provides team-based primary care service to Veterans with complex, chronic conditions. The VA HBPC model includes primary care visits from a physician, nurse practitioner, or physician assistant, nurse care management, service coordination by a social worker, mental health services from a social worker or psychologist, nutrition counseling from a dietician, and help with medication management. In both VA and non-VA settings, HBPC has demonstrated success in improving patient and system outcomes. It is largely unknown how and in what circumstances HBPC positively impacts patients' health outcomes but may be related to the integration of long-term services and supports, strong patient-provider relationships, and highly functioning interprofessional teams. Thus, the specific aims of this study are: 1) explore how HBPC providers understand and address concurrent medical and social needs; 2) examine the ways in which providers in the VA HBPC program understand and manage their relationships with patients with respect to patient power and decision-making; and 3) investigate HBPC team function and coordination between clinic-based primary care physicians. Findings from this study drive three main conclusions. First, having the home visit component of VA HBPC gives providers unparalleled insight into the impact that overlapping medical and social complexity has on HBPC patients. The home visit combined with the flexible nature of HBPC programming allows for providers to directly address patients' care needs. Second, HBPC providers experience relationship boundary challenges stemming from patient's social isolation and the mutual emotional attachments that form between patients and providers. However, HBPC providers have developed individual and team-based strategies to address these challenges. Third, HBPC teams are highly functioning when it comes to intra-team collaboration and care coordination, but they have substantial gaps in the coordination of patient care activities with clinic-based primary care providers and staff. This gap has caused confusion and frustration over the role of HBPC and what types of patients HBPC should serve and reveals a need for increased horizontal communication between HBPC teams and clinic-based primary care providers and staff. These findings provide evidence for the development of future studies that investigate the wider impact that these care patterns may have on patient care outcomes. Additionally, these findings provide data for health policies targeted towards patients with complex medical and social care needs.
