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Paediatric home care in Tower Hamlets: a working partnership with parents
M A Tatman1, C Woodroffe, P J Kelly
1Wolfson Child Health Monitoring Unit, Institute of Child Health, London.
Insights
This study describes a paediatric home care service, finding it useful for families, especially disadvantaged ones, and reducing hospital stays. Clear agreement on clinical responsibility between parents and professionals is recommended.
Area of Science:
- Pediatric Healthcare
- Home Care Services
- Nursing
Background:
- Paediatric home care services offer an alternative to hospitalisation.
- Evaluating the initial years of such a service is crucial for understanding its impact and utility.
Purpose of the Study:
- To describe the operational aspects and outcomes of a paediatric home care service during its first two years.
- To assess the views of parents and general practitioners on the service's effectiveness and identify areas for improvement.
Main Methods:
- An observational, cross-sectional study was conducted over two years (1989-91) in an inner London health district.
- Data were collected from 611 referred children, with in-depth interviews of parents and questionnaires for general practitioners from a selected sample.
- Service descriptions, costs, and user feedback were the primary measures.
Main Results:
- The service saw increasing referrals and visits, serving disadvantaged and ethnic minority families.
- Parents found the service useful, particularly for guidance and support, with 53% reporting reduced hospitalisation.
- While generally positive, disagreements on clinical responsibility and communication issues with general practitioners were noted.
Conclusions:
- The paediatric home care service successfully provided advanced nursing care in the home setting.
- Establishing clear agreements on clinical responsibility between parents and healthcare professionals at the point of referral is essential for optimal service delivery.
Objectives:
To describe the first two years of a paediatric home care service.
Design:
Observational cross sectional study, 1989-91.
Setting:
One inner London health district.
Patients:
611 children referred to the service; 50 children selected from those referred during the first year, whose parents were interviewed and whose general practitioners were invited to complete a questionnaire.
Main Measures:
Description and costs of service; views of parents and general practitioners of selected sample of children.
Results:
In its second year the team received 303 referrals and made 4004 visits at a salary cost of 98000 pounds, an average of 323 pounds/referral and 24 pounds/visit. This represented a referral rate of 3.2% (258/7939) of inpatient episodes from the main referring hospital between 1 December 1989 and 30 November 1990. Of all referrals to the service, 343(56%) came from hospital inpatient wards. The service was used by disadvantaged and ethnic minority families. The children's parents (in 28(61%) families) and the home care team did a wide range of nursing tasks in the home. Parents of 47(94%) children sampled agreed to be interviewed, and those of 43(91%) found the service useful; guidance and support were most commonly appreciated (33, 70%). Parents of 25(53%) children said that hospital stay or attendance had been reduced or avoided. Parents and general practitioners disagreed on clinical responsibility in 10 children, and communication was a problem for some general practitioners.
Conclusions:
The service enabled children to receive advanced nursing care at home. Clinical responsibility should be agreed between parents and professionals at referral.
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