HOME-BASED REHABILITATION AND ITS IMPACT ON HOSPITAL UTILIZATION

There is compelling evidence for the effectiveness of home-based occupational therapy and physiotherapy rehabilitation for community dwelling elderly who may struggle with basic activities and the functions of daily living and mobility. Nonetheless, an estimated 2% of home care’s elderly clients receive these therapies. Ontario’s home care data indicates that 78% of clients that could benefit from these specific therapies are not receiving them. The study examined a subset of elderly clients receiving home care following a hospital discharge during 2009-2010. The aim of this study was to: understand the difference between those home care clients who received occupational therapy or physiotherapy and those who did not; and determine if receiving these therapies impacted the utilization of hospital emergency departments and inpatient admissions. A retrospective cohort design and multivariate and survival analysis of hospital and home care administrative data structured the study. Results suggest that home-based rehabilitation is offered to a minority of the home care population. Distinct client characteristics and process variables significantly associated with the increased likelihood of receiving home-based occupational and physical therapies included: clients who were older, females, admitted to home care from hospital inpatient units, assessed as non-acute for clinical and service needs and required more home making support and assistance with activities of daily living. Almost one quarter of the total sample returned to hospital. Visits to emergency departments accounted for the greater part of hospital utilization and primarily for sub-acute general symptoms and signs, post-procedural complications, infections or acute episodes from chronic obstructive pulmonary disease and renal failure. Slightly over half of the clients returning to hospital did not receive home-based rehabilitation. Clients who received occupational therapy returned to the hospital sooner following their home care admission whereas clients receiving physiotherapy spent the longest time before rehospitalizing. The majority of the clients receiving occupational therapy were admitted to home care having just resolved sub-acute conditions or symptoms, many of which are known to influence functional and physical decline. Moreover, analysis of process variables indicated that the wait time for a referral to occupational therapy was two times longer compared to physiotherapy. These same clients also waited, on average, over one month before an occupational therapist’s first visit. The need to discriminate who receives home-based rehabilitation is essential to understanding how specific therapies contribute to improving systems outcomes. This study is the first examination that focuses specifically on home-based occupational therapy and physiotherapy rehabilitation and the client characteristics and process variables associated with receiving/not receiving these therapies and the impact these factors have on the time-to-rehospitalization.

UTILIZATION OF GIS AND SPATIAL ANALYSIS TECHNIQUES IN ARTISANAL AND SMALL SCALE MINING TO LOCATE A CENTRALIZED PROCESSING CENTRE

One of the global phenomena with threats to environmental health and safety is artisanal mining. There are ambiguities in the manner in which an ore-processing facility operates which hinders the mining capacity of these miners in Ghana. These problems are reviewed on the basis of current socio-economic, health and safety, environmental, and use of rudimentary technologies which limits fair-trade deals to miners. This research sought to use an established data-driven, geographic information (GIS)-based system employing the spatial analysis approach for locating a centralized processing facility within the Wassa Amenfi-Prestea Mining Area (WAPMA) in the Western region of Ghana. A spatial analysis technique that utilizes ModelBuilder within the ArcGIS geoprocessing environment through suitability modeling will systematically and simultaneously analyze a geographical dataset of selected criteria. The spatial overlay analysis methodology and the multi-criteria decision analysis approach were selected to identify the most preferred locations to site a processing facility. For an optimal site selection, seven major criteria including proximity to settlements, water resources, artisanal mining sites, roads, railways, tectonic zones, and slopes were considered to establish a suitable location for a processing facility. Site characterizations and environmental considerations, incorporating identified constraints such as proximity to large scale mines, forest reserves and state lands to site an appropriate position were selected. The analysis was limited to criteria that were selected and relevant to the area under investigation. Saaty’s analytical hierarchy process was utilized to derive relative importance weights of the criteria and then a weighted linear combination technique was applied to combine the factors for determination of the degree of potential site suitability. The final map output indicates estimated potential sites identified for the establishment of a facility centre. The results obtained provide intuitive areas suitable for consideration