Social science & medicine
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Social science & medicine · Mar 1996
ReviewThe development of Ontario's Home Care Program: a critical geographical analysis.
In order to gain a greater breadth of understanding medical geographical issues, such as medically underserviced regions, medical geographers are paying more attention to health policy. Using existing evaluations, an historical analysis of home care programs in Canada's largest and most populous province informs how developments in long-term health care policy have contributed to the geographical inequalities that exist in home care services throughout the province. ⋯ In many western countries, home health care has moved from being a complementary or alternative form of long-term care, to the favored form of long-term care. The most recent long-term care policy reform in Ontario points to the decentralization of long-term care, a strategy that has already been in affect in some western countries.
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Social science & medicine · Mar 1996
Determinants of informal caregivers' satisfaction with services for dying cancer patients.
The association between bereaved informal caregivers' satisfaction with services delivered by district nurses, general practitioners and hospital doctors, and various service and non-service variables was examined to assess whether satisfaction is a reflection of service characteristics, non-service related factors, or attributable to both. Secondary analysis was undertaken on a sub-sample from the "Regional Study of Care for the Dying" (RSCD) in which bereaved relatives or friends of a random sample of deaths in 1990 in 20 health districts across England were interviewed some ten months after the death. 1858 relatives or close friends/neighbours of people who died from cancer were included in this analysis. Using multiple logistic regression, larger odds ratio were found in association with service than non-service variables. ⋯ For instance, having no bereavement-related psychological problems was positively associated with high satisfaction with district nurses (OR = 2.3, 95% CI = 1.6 - 3.4) and GPs (OR = 2.0, 95% CI = 1.4 - 2.8), while the informal caregiver perceiving caring as rewarding as opposed to a burden was positively associated with high satisfaction with district nurses (OR = 3.7, 95% CI = 1.8 - 7.5) and negatively associated with high satisfaction with hospital doctors (OR = 0.46, 95% CI = 0.24 - 0.86). The findings indicate that, in post-bereavement surveys evaluating services delivered to dying cancer patients, informal caregivers' satisfaction is mainly determined by service characteristics. However, attributes of both patients and informal caregivers also play an important role.