How to Help Depressed Older People Living in Residential Care: A Multifaceted Shared-Care Intervention for Late-Life Depression

Objective: To describe a population-based, multifaceted shared-care intervention for late-life depression in residential care as a new model of geriatric practice, to outline its development and implementation, and to describe the lessons learned during the implementation process. Setting: A large continuing-care retirement community in Sydney, Australia, providing three levels of care (independent living units, assisted-living complexes, and nursing homes). Participants:) The intervention was implemented for the entire non-nursing home population (residents in independent and assisted living: N = 1,466) of the facility and their health care providers. Of the 1,036 residents who were eligible and agreed to be interviewed, 281 (27.1%) were classified as depressed according to the Geriatric Depression Scale. Intervention Description: The intervention included: (a) multidisciplinary collaboration between primary care physicians, facility health care providers, and the local psychogeriatric service; (b) trainning for primary care physicians and other facility health care providers about detecting and managing depression; and (c) depression-related health education/promotion programs for residents. Conclusions: The intervention was widely accepted by residents and their health care providers, and was sustained and enhanced by the facility after the completion of the study. It is possible to implement and sustain a multifaceted shared-care intervention for late-life depression in a residential care facility where local psychogeriatric services are scarce, staff-to-resident ratios are low, and the needs of depressed to residents are substantial.

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Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial Commentary: Beyond the boundary for a randomised controlled trial?

BMJ ◽

10.1136/bmj.319.7211.676 ◽

1999 ◽

Vol 319 (7211) ◽

pp. 676-682 ◽

Cited By ~ 79

Author(s):

R. H Llewellyn-Jones ◽

K. A Baikie ◽

H. Smithers ◽

J. Cohen ◽

J. Snowdon ◽

...

Keyword(s):

Randomised Controlled Trial ◽

Residential Care ◽

Controlled Trial ◽

Late Life ◽

Shared Care ◽

Late Life Depression ◽

Care Intervention ◽

Randomised Controlled

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Programs for adult survivors of childhood cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.8.2864 ◽

1998 ◽

Vol 16 (8) ◽

pp. 2864-2867 ◽

Cited By ~ 101

Author(s):

K C Oeffinger ◽

D A Eshelman ◽

G E Tomlinson ◽

G R Buchanan

Keyword(s):

Health Care ◽

Childhood Cancer ◽

Health Care Providers ◽

Primary Care Physicians ◽

Adult Survivors ◽

Care Providers ◽

Care Needs ◽

Survivors Of Childhood Cancer

PURPOSE The potential for late effects of treatment necessitates long-term monitoring of adult survivors of childhood cancer. The purpose of this study was to determine how institutions follow up young adult survivors of pediatric malignancy. Specifically, we were interested in the types of health care providers who follow up these patients, how the follow-up is administered, and what barriers to follow-up have been encountered. METHODS A 16-item questionnaire was mailed to the 219 members of the Children's Cancer Group (CCG) and the Pediatric Oncology Group (POG). The survey consisted of four categories of questions that asked for information regarding the existence of a program to follow up young adults, the setting of the program, routine activities of the program, and commonly encountered barriers to care. RESULTS One hundred eighty-two members returned the survey (83% response rate). Fifty-three percent of the respondents have a long-term follow-up clinic at their institution. Whereas 44% have a mechanism for following up adult survivors, only 15% of the programs have established a formal database for adults. Nearly all the programs (93%) use a pediatric oncologist. Although an adult oncologist assists in 13% of the programs, primary care physicians are uncommonly (8%) involved. CONCLUSION Few programs focus on the long-term health care needs of adult survivors of childhood cancer. The majority of existing programs are in pediatric institutions, without significant input from adult-oriented, generalist health care providers.

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Heart failure management insights from primary care physicians and allied health care providers in Southwestern Ontario

BMC Family Practice ◽

10.1186/s12875-020-1080-y ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Narlon C. Boa Sorte Silva ◽

Roseanne W. Pulford ◽

Douglas S. Lee ◽

Robert J. Petrella

Keyword(s):

Heart Failure ◽

Primary Care ◽

Health Care ◽

Health Care Providers ◽

Primary Care Physicians ◽

Allied Health ◽

Care Providers ◽

Heart Failure Management ◽

Allied Health Care

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Mandibular Brown Tumor of Secondary Hyperparathyroidism Requiring Extensive Resection: A Forgotten Entity in the Developed World?

Case Reports in Medicine ◽

10.1155/2015/567543 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 10

Author(s):

Mohammed Qaisi ◽

Matthew Loeb ◽

Lindsay Montague ◽

Ron Caloss

Keyword(s):

United States ◽

Health Care ◽

Health Care Providers ◽

Primary Care Physicians ◽

Disease Process ◽

The United States ◽

Brown Tumor ◽

Care Providers ◽

Extensive Resection ◽

Underdeveloped Countries

Brown tumor of hyperparathyroidism (BTHPT) is rare in the United States and not frequently seen in clinical practice. This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT. Conversely, BTHPT is more common in underdeveloped countries where fewer patients have access to health care and hyperparathyroidism (HPT) goes untreated. It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT. We present a case report of a patient in the United States with a large mandibular BTHPT requiring an extensive resection in the setting of secondary HPT. Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early.

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MULTIDISCIPLINARY APPRAOACH OF HEALTH CARE PROFESSIONALS IN PROVIDING PREEMINENT TREATMENT TO PATIENTS

Pakistan Journal of Rehabilitation ◽

10.36283/pjr.zu.3.2/002 ◽

2014 ◽

Vol 3 (2) ◽

pp. 2

Author(s):

Shamma Tabassum

Keyword(s):

Health Care ◽

Health Care Providers ◽

Care Coordination ◽

Health Care Professionals ◽

Primary Care Physicians ◽

Health Care Services ◽

Service Providers ◽

Health Care Service ◽

Care Providers ◽

Care Services

A strong communication and efficient coordination is required among various health care service providers, working together to provide appropriate delivery of health care services. In case, various stake holders in the network of health care providers fail to exercise such competent organization and management, patients will have to bear undesirable consequences1. This situation can lead to amplified costs and decreased quality of health care services. Studies have shown that the communication gaps between health care providers escort towards the reduction of care coordination and readmissions2. It has been originated that both hospitals and primary care physicians experiences parallel challenges like lack of time and difficulty in reaching other practitioners resulting in scant information evaluation, medication list inconsistencies and a lack of certainty with respect to liabilities for impending tests and home health2.The communication between patients and relevant medical staff is also very crucial, particularly at the time of admission and discharge. This emphasizes that there are numerous challenges in care coordination, information dealing, follow-up care and treatment management.

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Concierge Medicine: Should Financial Considerations Prevail Over Ethical And Moral Concerns?

Journal of Business & Economics Research (JBER) ◽

10.19030/jber.v7i2.2257 ◽

2011 ◽

Vol 7 (2) ◽

Author(s):

Fred Lauer ◽

Benjamin A. Neil

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Providers ◽

Primary Care Physicians ◽

Good Health ◽

Ethical Question ◽

Care Providers ◽

Financial Status ◽

Existing Problems ◽

Care Health

Many primary care physicians are now considering changing their practices to the new concierge medical practice. Also known as boutique medicine, retainer or "highly attentive" medicine. This new style practice offers access to a physician who has now limited the size of his practice in exchange for an annual fee.  These practices are nearly all primary care, and usually vary in size from 600 patients to 300 or less and carry a typical fee of $1,500.00 a year. Although a recent phenomenon, boutique medicine remains a small niche. But the number of practices continues to grow. Particularly on the East and West coasts where there are more wealthier people, who expect more from their health care providers.  Benefits of this new practice include same-day or next-day appointments not under time constraints, house calls, 24 hour a day access by cell phone, annual wellness evaluations and highly appointed offices.  One of the major criticisms of concierge medicine involves those who do not participate in such a program. The practices also displace patients to other medical providers. And as such, create problems of excessive demand on the existing physicians who do not participate.  Generally speaking, the patients who elect to participate in concierge practices are healthier and require less intensive care than those cared for in other settings. All this without consideration of the approximately 45 million Americans who live without health care insurance, which only serves to compound the existing problems.  There "VIP" medical services with their superior amenities and convenience can be purchased by those with sufficient wealth. However, the question should not turn on the quality of health care which depends on the amount of money an individual can spend on it. Many would regard good health as a right rather than a privilege.  The final ethical question is to consider the thought that an individual might experience more or less morbidity or mortality based on how much money they could devote to medical care. Health care should not be discretionary, as everyone should be entitled to the quality without regard to financial status.

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The Recognition and Treatment of Late-Life Depression: A View from Primary Care

The International Journal of Psychiatry in Medicine ◽

10.2190/q5yb-j2uw-ldak-g1fx ◽

1996 ◽

Vol 26 (2) ◽

pp. 155-171 ◽

Cited By ~ 31

Author(s):

Christopher M. Callahan ◽

Hugh C. Hendrie ◽

William M. Tierney

Keyword(s):

Older Adults ◽

Primary Care ◽

Depressive Symptoms ◽

Primary Care Physicians ◽

Late Life ◽

Primary Care Providers ◽

Future Research ◽

Care Providers ◽

Late Life Depression ◽

Primary Care Patients

Objective: Efforts to improve the recognition and treatment of late-life depression in primary care are often based on the assumption that primary care physicians underutilize currently available and effective treatments. This article reviews the validity of this assumption and offers recommendations for future research. Methods: Clinical trials designed to improve the recognition and treatment of late-life depression in primary care are reviewed. Because studies limited to older adults are rare, we also include studies enrolling younger patients. These data are reviewed in the context of recent reviews on the prevalence of depression in primary care settings and the effectiveness of available treatments. Results: Although depressive symptoms are common among older adults, there is insufficient literature documenting the proportion of these patients who respond to currently available treatments. Patients with uncomplicated major depressive disorder constitute the minority of primary care patients with depressive symptoms. Nearly all available studies of treatment effectiveness of pharmacotherapy or psychotherapy focus on older adults with uncomplicated major depression. Currently available treatment options may apply to less than 15 percent of depressed primary care patients. Conclusions: More research is needed to help primary care providers manage their depressed patients with comorbid medical conditions, functional disability, or minor or chronic depressions. In addition, more research is needed to identify those patients who would benefit from specialized or interdisciplinary care.

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Assessing Older Adults’ Perceptions of Sensor Data and Designing Visual Displays for Ambient Environments

Methods of Information in Medicine ◽

10.3414/me13-02-0009 ◽

2014 ◽

Vol 53 (03) ◽

pp. 152-159 ◽

Cited By ~ 16

Author(s):

J. Chung ◽

T. Le ◽

H. Thompson ◽

G. Demiris ◽

B. Reeder

Keyword(s):

Health Care ◽

Health Care Providers ◽

Assisted Living ◽

Family Members ◽

Ambient Assisted Living ◽

Perceived Usefulness ◽

Sensor Data ◽

Care Providers ◽

Visual Displays ◽

Adult Participants

SummaryIntroduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Using Data from Ambient Assisted Living and Smart Homes in Electronic Health Records“.Objectives: Our objectives were to: 1) characterize older adult participants’ perceived usefulness of in-home sensor data and 2) develop novel visual displays for sensor data from Ambient Assisted Living environments that can become part of electronic health records.Methods: Semi-structured interviews were conducted with community-dwelling older adult participants during three and six-month visits. We engaged participants in two design iterations by soliciting feedback about display types and visual displays of simulated data related to a fall scenario. Interview transcripts were analyzed to identify themes related to perceived usefulness of sensor data.Results: Thematic analysis identified three themes: perceived usefulness of sensor data for managing health; factors that affect perceived usefulness of sensor data and; perceived usefulness of visual displays. Visual displays were cited as potentially useful for family members and health care providers. Three novel visual displays were created based on interview results, design guidelines derived from prior AAL research, and principles of graphic design theory.Conclusions: Participants identified potential uses of personal activity data for monitoring health status and capturing early signs of illness. One area for future research is to determine how visual displays of AAL data might be utilized to connect family members and health care providers through shared understanding of activity levels versus a more simplified view of self-management. Connecting informal and formal caregiving networks may facilitate better communication between older adults, family members and health care providers for shared decision-making.

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Monitoring the Physical Health of Cancer Survivors: A Survivorship-Focused Medical History

Journal of Clinical Oncology ◽

10.1200/jco.2006.06.0541 ◽

2006 ◽

Vol 24 (32) ◽

pp. 5105-5111 ◽

Cited By ~ 83

Author(s):

Patricia A. Ganz

Keyword(s):

Primary Care ◽

Health Care ◽

Cancer Survivors ◽

Medical History ◽

Health Care Providers ◽

Primary Care Physicians ◽

Care Providers ◽

Follow Up Care ◽

Physical Effects

Cancer survivors frequently visit their primary-care physicians, as well as oncology specialists, for follow-up care. There is a need to monitor these survivors for the late physical effects of cancer, yet few health care providers have received training in how to do this. This article provides guidance on how to take a cancer survivor-directed medical history to facilitate the elicitation of relevant exposures, family history, and symptoms that may be related to the late effects of cancer therapy.

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