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 research study presented in this article (based on my PhD dissertation), aimed to explore the shifting meaning of “asylum” for people with severe mental illness (SMI), who are residents of ...community care units (CCUs), by comparing and contrasting participants’ experiences of CCUs with their previous lives in institutions. Currently, there is a gap in the Greek context in the field of qualitative studies exploring the issues of deinstitutionalisation and community care based on residents’ and staff members’ experiences. Semi-structured interviews were conducted with residents (N=35) and staff members (N=20) of four CCUs run by Klimaka (a non-governmental organisation) in Attica, the legal advisor of Klimaka, two mental health officers, a psychologist and a psychiatrist from Dromokaition Mental Health Hospital. Data were analysed thematically. Most residents felt that institutions provided a “temporary asylum” based on: 1) financial security; 2) stress-free daily routine; 3) segregation from the pressures of the outside world; 4) good or neutral relationships with staff; and 5) trust in their treatment. But most felt that the hospital had never become their actual home. All residents felt that CCUs offered them a temporary or permanent asylum, based on: 1) financial security; 2) enriched daily routine; 3) wider social networks; 4) an increased degree of freedom; 5) good relationships with staff; 6) trust in treatment, with increased awareness; and 7) absence of abuse. Twelve residents felt that the CCU was their permanent residence, while for seven of them it was a temporary one, before moving to more autonomous living conditions. The study concludes that “Asylum” does not represent a physical entity, but a set of interrelated criteria which, if met by services, can be achieved for people with SMI anywhere.
The research study presented in this article (based on my PhD dissertation), aimed to explore the shifting meaning of “asylum”, for people with severe mental illness (SMI), who are residents of ...community care units (CCUs), by comparing and contrasting participants’ experiences of CCUs with their previous lives in institutions. Semi-structured interviews were conducted with residents (N=35) and staff members (N=20) of four CCUs run by Klimaka (a non-governmental organisation) in Attica, the legal advisor of Klimaka, two mental health officers, a psychologist and a psychiatrist from Dromokaition Mental Health Hospital. Data were analysed thematically. Most residents felt that institutions provided a “temporary asylum” based on: 1) financial security; 2) stress-free daily routine; 3) segregation from the pressures of the outside world; 4) good or neutral relationships with staff; and 5) trust in their treatment. But most felt that the hospital had never become their actual home. All residents felt that CCUs offered them a temporary or permanent asylum, based on: 1) financial security; 2) enriched daily routine; 3) wider social networks; 4) an increased degree of freedom; 5) good relationships with staff; 6) trust in treatment, with increased awareness; and 7) absence of abuse. Twelve residents felt that the CCU was their permanent residence, while for seven of them it was a temporary one, before moving to more autonomous living conditions. The study concludes that “Asylum” as a place offering safety and security, does not represent a physical entity, but a set of interrelated criteria which, if met by services, can be achieved for people with SMI anywhere. In relation to treatment, residents’ experiences revealed increased awareness of the pharmaceutical treatment, increased monitoring by staff members and increased participation in psychotherapy, while in CCUs.
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.
PDF
