title: Reduction in symptoms for homebound patients receiving home-based primary and palliative care.
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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.
authors.forename: Katherine
authors.initials: K
authors.lastname: Ornstein
authors.forename: Ania
authors.initials: A
authors.lastname: Wajnberg
authors.forename: Halley
authors.initials: H
authors.lastname: Kaye-Kauderer
authors.forename: Gary
authors.initials: G
authors.lastname: Winkel
authors.forename: Linda
authors.initials: L
authors.lastname: DeCherrie
authors.forename: Meng
authors.initials: M
authors.lastname: Zhang
authors.forename: Theresa
authors.initials: T
authors.lastname: Soriano
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006297:Health Services Accessibility; D006699:Home Care Services; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011320:Primary Health Care; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D063189:Symptom Assessment; D016896:Treatment Outcome