Domiciliary Care Service at a Tertiary Centre

Background: The domiciliary service comprises of medical and rehabilitation services done at the home of patients to ensure uninterrupted care upon early discharge, render support to the family members in training the caregiver and to reduce readmission by providing quality care.

Objective: To explore the facilitators and barriers of domiciliary services at Hospital Seberang Jaya (HSJ), Penang.

Methods: A total of 53 respondents (34 trained nurses, 8 sisters, 5 matrons, 4 occupational therapists and 2 physiotherapists) involved in domiciliary care from the medical, surgical, orthopedics and pediatrics wards were interviewed using a semi-structured questionnaire as homogenous focus groups or as individuals, audio recorded, transcribed and thematically analyzed.

Results: 3 domains were identified as facilitators and barriers; Health System factors, Health professional and Patient and Caregiver factors. In facilitators, health system factors (ongoing measures in domiciliary updates, having a reference file in ward, cluster hospital concept and a dedicated person in charge). Health professional factors (teamwork, synchronized explanation and pre planned discharge), patient and caregiver factors (suitable caregiver, locale convenience of health facility) and finally the proactiveness, motivating and supportive factors that encompasses all 3. The Health System barriers were (inadequacy in; man power, public information and ineffective domiciliary team). Health Professionals Barriers were (bias selection of cases and default in responsibilities). Patient and Caregiver Barriers (unsuitable caregiver, misconception on nursing role, lacking confidence to learn and financial issues). Encompassing all were lack in continual monitoring, communication and supervision.

Conclusions: For a successful domiciliary care, health system factor, health professional factors, patient and caregiver factors need to be addressed. Its Implementation will involve all stakeholders to work for a common goal for an effective delivery of domiciliary services at HSJ.