Jane Robinson

Effectiveness of home based support for older people: systematic review and meta-analysis

Abstract Objective: To evaluate the effectiveness of home visiting programmes that offer health promotion and preventive care to older people. Design: Systematic review and meta-analysis of 15 studies of home visiting. Participants: Older people living at home, including frail older people at risk of adverse outcomes. Outcome measures: Mortality, admission to hospital, admission to institutional care, functional status, health status. Results: Home visiting was associated with a significant reduction in mortality. The pooled odds ratio for eight studies that assessed mortality in members of the general elderly population was 0.76 (95% confidence interval 0.64 to 0.89). Five studies of home visiting to frail older people who were at risk of adverse outcomes also showed a significant reduction in mortality (0.72; 0.54 to 0.97). Home visiting was associated with a significant reduction in admissions to long term care in members of the general elderly population (0.65; 0.46 to 0.91). For three studies of home visiting to frail, “at risk” older people, the pooled odds ratio was 0.55 (0.35 to 0.88). Meta-analysis of six studies of home visiting to members of the general elderly population showed no significant reduction in admissions to hospital (odds ratio 0.95; 0.80 to 1.09). Three studies showed no significant effect on health (standardised effect size 0.06; −0.07 to 0.18). Four studies showed no effect on activities of daily living (0.05; −0.07 to 0.17). Conclusion: Home visits to older people can reduce mortality and admission to long term institutional care. What is already known on this topic The benefits of regular, preventive home visits to older people are the subject of controversy A recent systematic review found no clear evidence that preventive home visits were effective What this study adds This meta-analysis of 15 trials shows that home visiting can reduce mortality and admission to institutional care among older people

Does home visiting improve parenting and the quality of the home environment? A systematic review and meta analysis

AIMS To evaluate the effectiveness of home visiting programmes on parenting and quality of the home environment. DESIGN Systematic review of the literature of randomised controlled trials and quasi-experimental studies evaluating home visiting programmes involving at least one postnatal visit. SUBJECTS Thirty four studies reported relevant outcomes; 26 used participants considered to be at risk of adverse maternal or child health outcomes; two used preterm or low birth weight infants; and two used infants with failure to thrive. Only eight used participants not considered to be at risk of adverse child health outcomes. RESULTS Seventeen studies reported Home Observation for Measurement of the Environment (HOME) scores, 27 reported other measures of parenting, and 10 reported both types of outcome. Twelve studies were entered into the meta analysis. This showed a significant effect of home visiting on HOME score. Similar results were found after restricting the analyses to randomised controlled trials and to higher quality studies. Twenty one of the 27 studies reporting other measures of parenting found significant treatment effects favouring the home visited group on a range of measures. CONCLUSIONS Home visiting programmes were associated with an improvement in the quality of the home environment. Few studies used UK health visitors, so caution must be exercised in extrapolating the results to current UK health visiting practice. Further work is needed to evaluate whether UK health visitors can achieve similar results. Comparisons with similar programmes delivered by paraprofessionals or community mothers are also needed.

Combining specialist and primary health care teams for HIV positive patients: retrospective and prospective studies

Abstract Objective: To develop and evaluate a model of health care for HIV positive patients involving specialist, hospital based teams and primary health care teams. Design: One year retrospective and 2 1/2 year prospective study. Setting: Two hospitals in west London and 88 general practitioners in 72 general practices. Subjects: 209 adults with HIV infection. Intervention: General practitioners enrolled in the project were faxed structured outpatient clinic summaries. When hospital inpatients were discharged, a brief discharge summary was faxed. General practitioners had access to consultant physicians skilled in HIV medicine through a 24 hour mobile telephone service. An HIV/AIDS management and treatment guide containing relevant local information was produced. Quarterly discussion forums for general practitioners were held, and a regular newsletter was produced. Main outcome measures: Hospital attendance and general practitioner consultations; perceived benefits and problems of patients and general practitioners. Results: The average length of a hospital inpatient stay was halved for those patients who had participated in the project for two years, and the average number of visits to the outpatient clinic per month fell for patients with AIDS. There was a substantial increase in the number of visits to general practitioners by patients with AIDS and symptomatic HIV infection. Patients and general practitioners both felt that the standard of health care provided had improved. Conclusions: This model of health care efficiently and effectively utilised existing teams of hospital and primary health care professionals to provide care for HIV positive patients. Simple, prompt, and regular communication systems which provided information relevant to the needs of general practitioners were central to its success.

Nursing history and the politics of welfare

A quiet revolution has been sweeping through the writing of nursing history over the last decade, transforming it into a robust and reflective area of scholarship. Nursing History and the Politics of Welfare highlights the significant contribution that researching nursing history has to make in settling a new intellectual and political agenda for nurses. The seventeen international contributors to this book look at nursing from different perspectives, as it has developed under different regimes and ideologies and at different times, in America, Australia, Britain, Germany, India, The Phillipines and South Africa. They highlight the role of politics and gender in understanding nursing history and propose strategies for achieving greater recognition for nursing, and bringing it into line with other related health care professions.

Project 2000 and the replacement of the traditional student workforce

This paper reports on part of a 4-year study monitoring the implementation of Project 2000 in one health authority. Its focus is on the consequences for the nursing service of replacing traditional, pre-Project 2000 students with permanent staff. It is argued that the Department of Health, who have been responsible for funding the replacement programme, have underestimated the numbers of permanent staff required to replace the traditional student workforce, and that the Project 2000 replacement exercise has contributed to a deterioration in staffing levels and skill mix.