published_or_final_version / Social Work / Doctoral / Doctor of Philosophy

published_or_final_version / Social Work / Master / Master of Social Work

published_or_final_version / Social Work / Master / Master of Social Work

The purpose of this study was to describe family members' influence on medication adherence rates for schizophrenic clients following an educational program presented simultaneously to both client and family member. Three chronic schizophrenic clients participated in this study, two were females, and the other was male. The two family members who provided data were husbands of the two female clients. The obtained scores and responses of two questionnaires was indicative of improved medication adherence for clients and family members. The level of adherence was similarly perceived by the clients and their family members as obtained scores and responses were similar across both time periods. However, family members' attendance at the program presentation did not influence the level of reported medicated adherence behaviors of their wives as compared to the client who attended the program alone because the greatest increase in obtained scores was reported by the client who attended the program alone.

Home care of the elderly is of increasing concern not only to purchasers and providers of health care but also to the public and to those responsible for providing social care. As with any service, the aim must be to provide care that is appropriate for each individual. To achieve that, valid and reliable measures of a person's needs are required and resources are to be used as efficiently as possible. A considerable amount of work has been carried out to develop such normative-based measures for assessing the home care needs of the elderly in the form of comprehensive geriatric assessment (CGA). CGA is a commonly used technology which has been shown to be associated with improved health status and lower service use. Despite widespread use, however, the effectiveness of different CGAs has not yet been fully investigated. In the Province of Quebec, Canada, two CGAs which differ in comprehensiveness and resource requirements are being used to assess needs at entry to home care. The aim of this study is to compare the differential impact of these two CGA procedures on patient outcomes: the Systdme de mesure de l'autonomie fonctionnelle, the longer, more comprehensive and resourceintensive CGA, and the Admission au maintien d domicile which is a shorter and less resource-intensive form of CGA. In a prospective cohort study, 158 elderly patients aged 65 years or over were assessed at admission to home care using one or the other CGA and changes in health-related quality of life as well as service use were monitored and compared at the end of a 12-week follow-up. Costs related to the use of a long or a shortform CGA were also explored. These comparisons were made while controlling for patient (age, gender, living alone, quality of life at entry, depression), process (type and intensity of care received) and structural variables (budget and staff mix). Results from comparative and multivariate analyses are in favour of not rejecting the null hypothesis that both forms of CGAs are similarly associated with outcomes. Depression was the strongest predictor of changes in quality of life and high intensity of care and a low proportion of nurses on the home care teams were the strongest predictors of service use outside HC. These results lead us to discuss whether long or shortform CGAs were developed on a comparative rather than a normative definition of needs. The implications of these findings for home care policy and practice are discussed and suggestions for future research are presented.

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Population ageing has motivated policy makers around the world to focus on how best to organise health and social care services to meet an aniticipated growing demand on services. Two popular initiatives are reablement and telecare. Reablement is an approach within homecare that enables older individuals with social care needs to improve their functional performance and live independently. Telecare, on the other hand, involves use of devices to monitor individuals' health and safety, and provide response when needed. This thesis investigates the effectiveness of reablement and telecare by conducting a comprehensive review of the literature and undertaking three empirical studies. It is composed of six chapters. The first chapter presents a theoretical model that links the demand for reablement and telecare to various outcomes. The model is estimated using a strategy that controls for the effects of confounding variables and unobservable factors, and is general in the sense that it nests several other estimation strategies and study designs as special cases. The next chapter contains the literature review. Chapters 3, 4 and 5 present the three empirical studies. The first study investigates the effect of telecare on independent living at home; the second study determines the relationship between the use of telecare and admission to hospital, while the third study determines the relationship between telecare use and the length of stay in hospital. Chapter 6 concludes the thesis and provides some suggestions for further research. Unlike the results of the previous studies, the findings from this thesis suggest that the treatment effects are not homogenous across the poulation and also vary depending on the type of telecare device under consideration.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

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