Reduction in Symptoms for Homebound Patients Receiving Home-Based Primary and Palliative Care

To cite this article:
Katherine Ornstein, Ania Wajnberg, Halley Kaye-Kauderer, Gary Winkel, Linda DeCherrie, Meng Zhang, and Theresa Soriano. Journal of Palliative Medicine. September 2013, 16(9): 1048-1054. doi:10.1089/jpm.2012.0546.

Published in Volume: 16 Issue 9: September 16, 2013
Online Ahead of Print: June 8, 2013

• Journal of Palliative Medicine

Author information

Katherine Ornstein, PhD, MPH,¹ Ania Wajnberg, MD,² Halley Kaye-Kauderer,³ Gary Winkel, PhD,⁴ Linda DeCherrie, MD,¹ Meng Zhang, MD,² and Theresa Soriano, MD, MPH²

¹Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.

²The Samuel Bronfman Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.

³Yale University, New Haven, Connecticut.

⁴Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York.

Address correspondence to:

Katherine Ornstein, PhD, MPH

Department of Geriatrics and Palliative Medicine

Icahn School of Medicine at Mount Sinai

Box 1070

One Gustave L. Levy Place

New York, NY 10029

E-mail: Katherine.ornstein@mssm.edu

Accepted April 11, 2013

ABSTRACT

Background: Increasing numbers of patients are living with multiple, chronic medical conditions and functional impairments that leave them homebound. Home-based primary and palliative care (HBPC) programs provide access to health care services for this vulnerable population. Homebound patients have high symptom burden upon program enrollment. Yet little is known as to how individual symptoms are managed at home, especially over longer time periods.

Objectives: The purpose of this study was to determine whether high symptom burden decreases following HBPC enrollment.

Methods: All patients newly enrolled in an HBPC program who reported at least one symptom on the Edmonton Symptom Assessment Scale (ESAS) were eligible for telephone ESAS follow-up. Patients received a comprehensive initial home visit and assessment by a physician with subsequent follow-up care, interdisciplinary care management including social work, and urgent in-home care as necessary. Multivariate linear mixed models with repeated measures were used to assess the impact of HBPC on pain, depression, anxiety, tiredness, and loss of appetite among patients with moderate to severe symptom levels at baseline.

Results: One hundred forty patients were followed. Patient pain, anxiety, depression, and tiredness significantly decreased following intervention with symptom reductions seen at 3 weeks and maintained at 12 weeks. (p<0.01) Loss of appetite trended toward an overall significant decrease and showed significant reductions at 12 week follow-up.

Conclusion: In a chronically ill population of urban homebound, patient symptoms can be successfully managed in the home. 

 Future work should continue to explore symptom assessment and management over time for the chronically ill homebound.