Effects of Multidisciplinary Home Care on Quality of Life of Home-bound and Bed-bound Elderly Patients

Abstract

Objective: To study the effect of multidisciplinary home care on health problems and quality of life of home-bound and bed-bound elderly patients. Method: Study design was a quasi-experiment measuring the effects before and after the provision of multidisciplinary home care for 3 times within 6 months for18 home-bound and 9 bed-bound elderly patients. The care began with identifying patients’ health problems, basic physical and drug use problems and collaborative resolution of the problems between health team and family members. Outcomes of the study included quality of life, drug related problems (DRPs), medication adherence, clinical outcomes for hypertension, diabetes mellitus and kidney diseases, depression, movement, complications from being bed-bound and satisfaction. Data collection was done using forms for adverse drug reaction based on WHO’s criteria, scale for interviewing adherence (Brief Medication Questionnaires; BMQ), pill count, depression screening test (9Q), modified Barthel index for movement assessment, Braden's score for bed sores, quality of Life scale (EQ-5D-5L-VAS), and satisfaction questionnaire. Results: At the beginning of the study, DRPs were identified in 8 of 18 home-bound patients, while DRPs were identified in 6 of 9 bed bound patients. Interventions eliminated DRPs in all patients. Drug adherent patients increased from 6 to 17 (P<0.001) in the home-bound patients and from 4 to 9 (P=0.031) in the bed-bound patients. Intervention improved the number of patients with clinical outcomes meeting the goals from 5 to 18 (P<0.001) in the home-bound patients and from 8 to 9 (P=0.347) in the bed-bound patients. Subjects with depression decreased from 10 to 3 (P<0.001) in the home-bound patients and from 9 to 6 (P=0.091) in the bed-bound patients. Subjects with bed-bound complications (Barden's score) decreased from 9 to 4 (P=0.059) in the bed-bound patients. After interventions, quality of life among subjects improved by 0.08 (P<0.001) in the home-bound patients and 0.05 score (P<0.001) in the bed-bound patients. Satisfaction towards multidisciplinary home care increased by 0.63 (P<0.001) in the home-bound patients and 0.50 score (P<0.001) in the bed-bound patients. Bathel index increased by 3.05 (P<0.001) in the home-bound patients and 1.67 (P<0.001) in the bed-bound patients. Depression score decreased by 1.66 (P<0.001) in the home-bound patients and 3.44 (P<0.001) in the bed-bound patients. Conclusions: Multidisciplinary home care for the home-bound and bed-bound elderly patients decreases DRPs, depression, bed-bound complications in bed bound group. It also increases medication adherence, clinical outcomes within targeted goals, Bathel index score, quality of life and satisfaction towards home care by the multidisciplinary team. Therefore, such home care services should be promoted as a policy. Moreover, there is a need to expand collaborative network to local administrative organizations to improve the quality of life in other domains.