Cancer care has evolved rapidly, increasing the demand on healthcare resources. While many non-oral cancer treatments are administered in the hospital, not all necessitate complex medical care. ...Treatments that can be administered subcutaneously, intramuscularly, or as short intravenous infusions with a low risk of extravasation can be safely administered in the community.
Since 2017, the National University Cancer Institute, Singapore (NCIS) has operated a program called NCIS on-the-go (NOTG) comprising a network of community cancer treatment clinics located within 20 km of the hospital. NOTG provides 17 low-risk treatments and nursing services run by oncology-trained nurses without on-site physicians. Patients who receive their first dose of cancer treatment uneventfully in the cancer centre can opt-in to receive subsequent doses at any NOTG clinic.
Treatment at NOTG has become more mainstream over the years, with its workload increasing by over sevenfold since 2017, and is now responsible for ∼10% of the total main cancer centre workload. The program is sustainable and financially viable to operate. A survey of 155 patients revealed a 96.8% user satisfaction rate, with the majority reporting tangible savings in travelling time, waiting time, and travelling costs. The diversion of low-risk treatments to NOTG has indirectly increased capacity and reduced waiting times at the main cancer centre for patients requiring complex cancer treatments, resulting in a win–win situation.
NOTG represents an innovative model of care to deliver low-risk cancer treatments safely in the community and can be easily replicated in other countries.
•Some low-risk cancer treatments can be safely administered in the community rather than in the hospital.•We describe a novel model of cancer treatment delivery in the community that is easy to implement and financially viable.•This program involves a network of community cancer treatment clinics that have been running successfully since 2017.•This program now services 10% of the total treatment workload of the institute’s cancer centre.•A survey of 155 program users reported a 96.8% user satisfaction rate, with tangible cost and time savings.
The Emergency Medicine Researchers of Niagara (EMRoN) program is an evolving research incubator with the Niagara Regional Campus (NRC) of McMaster University’s Michael G DeGroote School of Medicine ...and Niagara Health (NH) that is becoming a productive research organization aligned with the strategic priorities of its partner organizations (NRC and NH). EMRoN is committed to advancing local community health care standards and sharing best practices with provincial and national peers. In its first two years of operation EMRoN has achieved success in new structures, processes and outcomes that position it well to be a fulsome research organization for years to come.
Schizophrenia is a disabling, chronic psychiatric disorder that poses numerous challenges in its management and consequences. It extols a significant cost to the patient in terms of personal ...suffering, on the caregiver as a result of the shift of burden of care from hospital to families, and on society at large in terms of significant direct and indirect costs that include frequent hospitalizations and the need for long-term psychosocial and economic support, as well as life-time lost productivity.
‘Burden of care’ is a complex construct that challenges simple definition, and is frequently criticized for being broad and generally negative. Frequently, burden of care is more defined by its impacts and consequences on caregivers. In addition to the emotional, psychological, physical and economic impact, the concept of ‘burden of care’ involves subtle but distressing notions such as shame, embarrassment, feelings of guilt and self-blame.
The early conceptualization of ‘burden of care’ into two distinct components (objective and subjective) has guided research efforts until the present time. Objective burden of care is meant to indicate its effects on the household such as taking care of daily tasks, whereas subjective burden indicates the extent to which the caregivers perceive the burden of care. Research contributions in later years (1980s to the present) have added more depth to understanding of the construct of burden of care by exploring important determinants and factors that likely contribute or mediate the caregiver’s perception of burden of care. Several studies examined the role of gender, and reported that relatives of male patients with schizophrenia frequently experience more social dysfunction and disabilities than those of female patients. Similarly, a number of other studies documented the contribution of ethnicity and cultural issues to subjective burden of care. Although there is no complete agreement on whether a specific cluster of psychotic symptoms has the most impact on a caregiver’s burden of care, there is agreement that the severity of symptoms increases it.
An extensive literature concerning family interventions in schizophrenia has demonstrated the positive impact of various family interventions in improving family environment, reducing relapse and easing the burden of care. Although the evidence of such positive impact of family interventions in schizophrenia is well documented, such interventions are neither widely used nor appropriately integrated in care plans, and are frequently underfunded.
Although the cost of caregiving is considered to be significant, there are no reliable estimates of the costs associated with such care. The majority of available literature categorized the cost of burden of care among the indirect costs of schizophrenia in general. In recent years, attempts to compare the costs of caregiving in several countries have been reported in the evolving literature on this topic. ‘Burden of care’ as a complex construct certainly requires the development of appropriate methodology for its costing.
In achieving a balance between the patients’ and caregivers’ perspectives, caregivers have to be included in the care plan and adequate information and support extended to the family and caregivers. Access to better treatment for patients, including medications, psychosocial interventions and rehabilitation services, are important basic elements in easing the burden on caregivers. Other measures such as availability of crisis management, provision of legally mandated community treatment to avert hospitalization, and well informed and balanced advocacy are also important.
Although research efforts have been expanded in the last 3 decades, an urgent need exists for enhancing such efforts, particularly in the development and evaluation of effective family interventions strategies. There is also a need for continued improvement in the delivery of psychiatric services to the severely psychiatrically ill and their families. As there is a lack of reliable cost information about the family burden of care specific to schizophrenia, there is an urgent need to develop reliable approaches that can generate data that can inform in policy making and organization of services.
To develop a reflection method for community nurses and certified nursing assistants to support the implementation of the Dutch Informal Care guideline in daily care.
Design-based research.
A design ...group and four test groups of community nurses and nursing assistants were formed to develop a reflection method that aligns with the needs and preferences of its end-users. The design and test group meetings were video recorded. The video data were iteratively discussed and analysed thematically to adapt and refine the method and to identify its key features.
A final reflection method was developed. Five main themes were identified from the analysis: the group, reflective triggers, knowledge about the guidelines, the coach and preconditions. The themes are linked to nine key features representing the building blocks of the reflection method. The key features are group size, participants with different (educational) backgrounds, pairs of participants, expressing thoughts, video feedback, reflection game, making the connection with the guideline, coaching as a process facilitator and meeting organizational and contextual conditions for implementation.
An evidence- and practice-based reflection method for community nurses and certified nursing assistants is developed to support the implementation. By involving community nurses and certified nursing assistants, the method closely matches their needs and preferences. Critical elements of the reflection method are a game element, video feedback and working in pairs in a group of participants from different (educational) backgrounds. Guidance is needed to make the transfer from theory to practice.
A reflection method for community nurses and certified nursing assistants was developed to enhance care work according to guideline recommendations, aiming to improve the care provided by informal caregivers.
The COREQ guideline was used.
This reflection method was developed in close collaboration with all stakeholders during the entire study.
Objective:
Personal Health Budget has been provided to consumers with severe mental illness within a policy shift toward a person-tailored mental healthcare treatment based on individual unmet needs. ...Evidence of beneficial effects of Personal Health Budget is still scarce. The aim of this study was to provide preliminary data on clinical and social benefits of adding Personal Health Budget to a standard pharmacotherapy in patients with severe mental illness across a 24-month follow-up period.
Methods:
Participants (n = 137) were individuals with severe mental illness, aged 18–50 years, recruited in one of the adult mental health services of the Parma Department of Mental Health. They completed the Global Assessment of Functioning scale, the Health of the Nation Outcome Scale and the Brief Psychiatric Rating Scale. This age range was chosen to limit Personal Health Budget interventions to adults with a non-prolonged illness duration. Friedman’s test for repeated measure was used to assess the longitudinal stability of functioning and clinical parameters. A linear regression analysis was also performed.
Results:
A significant decrease in all Global Assessment of Functioning scale, Health of the Nation Outcome Scale and Brief Psychiatric Rating Scale scores along the 24 months of follow-up was observed. Regression analysis results specifically showed a relevant association between a Personal Health Budget multiaxial intervention and the longitudinal reduction in Brief Psychiatric Rating Scale ‘Negative Symptoms’ and Health of the Nation Outcome Scale ‘Social Problems’ subscores.
Conclusion:
Our findings support the useful implementation of a Health of the Nation Outcome Scale approach for severe mental illness patients within the Italian mental health service network.
Resumen: La crisis de nuestra atención primaria de salud se manifiesta en las encuestas de satisfacción de los usuarios y en el desánimo de los profesionales. Gobierno, sociedades científicas y ...sindicatos han elaborado numerosos documentos con propuestas para salir de la crisis, pero muy pocas han acabado aplicándose o han producido un cambio significativo. La crisis es inherente al ámbito de atención primaria, dado que la atención centrada en la persona y la intervención sobre los condicionantes de salud de la población no están alineadas con la medicalización creciente de un sistema sanitario orientado a la atención de problemas. Las propuestas van en la línea de: la integración de servicios para hacer frente al creciente aumento de las enfermedades crónicas y la comorbilidad; el paso de un liderazgo de control y mando a un liderazgo compartido; las innovaciones encaminadas a paliar la escasez de médicos de familia, incluyendo el aumento de las competencias de los otros miembros del equipo y la incorporación de nuevas profesiones; las innovaciones organizativas que mejoren la accesibilidad, pero aumentado al mismo tiempo la continuidad; el uso racional de la telemedicina; la modificación del currículum de grado para finalmente introducir la disciplina de la Medicina de Familia; y la generalización de los proyectos locales exitosos de atención comunitaria. La futura crisis económica, la escasez de profesionales y el progresivo envejecimiento de la población podrían propiciar que finalmente se apliquen paulatinamente algunas de estas propuestas ya que no es esperable que se produzca una reforma radical. Abstract: Primary health care crisis is shown in user satisfaction surveys and in the discouragement of professionals. Government, scientific societies, and unions have drawn up numerous documents with proposals to get out of the crisis, but very few have been applied or ended up with a significant change. The crisis is inherent to the primary care discipline because person centered care and population health condition interventions are not aligned with the growing medicalization of a health system focused on health problems care. The proposals are along the following lines: the integration of services in order to deal with the growing increase in chronic pathologies and comorbidity; the transition from control and command leadership to shared leadership; innovations aimed at easing the shortage of family doctors, including increasing other team members and the incorporation of new professions; organizational innovations aimed to improve accessibility, but at the same time increase continuity; the rational use of telemedicine; the modification of the undergraduate curriculum to finally include the discipline of family medicine; and the generalization of successful local community care projects. The future economic crisis, the shortage of professionals and the growing population aging could lead to the gradual application of some of these proposals, since it is not expected that a radical reform will take place.
Thailand is experiencing demographic changes owing to an increase in its older population. In this study we focus on the northeastern part of Thailand, where community ties are strong, to elucidate ...the relationship between caregivers and care recipients in the provision and reception of effective support. The aim of this study is to clarify the sharing of care among relatives and communities, and to describe their burden focusing on both negative and positive aspects, through semi-structured interviews in order to establish an innovative and cultural approach to alleviating the burden.Qualitative interviews were conducted with 16 primary caregivers in October 2018. The Grounded Theory Approach (GTA) was employed to stratify their narrative related to caregiving. The family caregiver burden consists of four parts: psychological burden, physical burden, time constraint, and economic burden. The process of determining the caregiving burden takes into account not only the nature of the long-term care provided, but also the three mediator factors of sense of mission as a family, the benefit of providing care, and the Buddhist faith. In addition, the moderator factor of sharing care among family members and relatives alleviates the caregiver burden.Based on the study results, it was concluded that positive feelings toward care provision lead to motivation to continue quality care. Therefore, in long-term care support policy, it is necessary not only to reduce the burden of long-term care but also to take into consideration Thai culture and Buddhist beliefs, and to find support that makes nursing care worthwhile and meaningful.
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