Advance care planning in the community

2018 ◽  
Author(s):  
Peter Nightingale ◽  
Scott Murray ◽  
Chris Absolon
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Educational Opportunities ◽  
Care Planning ◽  
Personalized Care ◽  
Policy Initiatives ◽  
Professional Quality ◽  
Recent Developments ◽  
Advance Care ◽  
Community Movement

Advance care planning (ACP) is becoming more widely used as part of a drive to improve personalized care planning, but there is still more work to be done. Electronic Palliative Care Co-ordination systems (EPaCCs) have proved to be very effective in some areas but there are many barriers to be overcome before they are universally available. This chapter covers recent developments leading to the wider integration of ACP into primary care. These include policy initiatives, educational opportunities, information technology (IT), professional quality control and regulation, financial and business incentives, and the Compassionate Community movement. The chapter includes an overview of issues surrounding ACP in primary care and in the community.

Lessons Learned From a Pilot Project on Telemedicine Advance Care Planning in an Urban Geriatric Primary Care Office

2021 ◽  
pp. 104990912110369
Author(s):  
Olivia M. Seecof ◽  
Molly Allanoff ◽  
John Liantonio ◽  
Susan Parks
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Medical Record ◽  
Advance Care Planning ◽  
Pilot Project ◽  
Lessons Learned ◽  
Care Planning ◽  
Geriatric Population ◽  
Advance Care ◽  
Primary Care Office

Purpose: There is a dearth of literature regarding the documentation of advance care planning (ACP) in the geriatric population, despite the controversial, yet well-studied need for ACP. The purpose of this pilot study was to provide an update to a prior study from our institution that outlined the need for increased documentation of advance care planning (ACP) in an urban geriatric population. Methods: Our study involved using telemedicine to conduct dedicated ACP visits and an electronic medical record (EMR) note-template specifically designed for these visits in an attempt to increase the amount of documented ACP in the EMR in this population. Results: The study did not yield significant results due to the inability to schedule enough patients for these dedicated visits. Discussion: While our study was ultimately unsuccessful, 3 crucial lessons were identified that will inform and fuel future interventions by the authors to further the study of documentation of ACP.

scholarly journals IMPACT OF GERIATRIC INTERPROFESSIONAL TRAINING ON ADVANCE CARE PLANNING IN GERIATRIC PRIMARY CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S151-S152
Author(s):  
Maureen E Barrientos ◽  
Anna Chodos ◽  
Alicia Neumann ◽  
Yvonne Troya ◽  
Pei Chen
Keyword(s):  
Primary Care ◽  
Social Work ◽  
Advance Care Planning ◽  
Health Resources ◽  
The United States ◽  
Care Practice ◽  
Care Planning ◽  
Office Visits ◽  
Advance Care ◽  
Telephone Calls

Abstract Currently, an important measure of Advance Care Planning (ACP), Advance Health Care Directives (AHCD) documentation rate, is at 33% for older adults in the United States. To address this disparity, geriatric faculty in an academic geriatric primary care practice aimed to train geriatrics fellows and other interprofessional (IP) learners to engage patients in ACP. As part of a Geriatric Workforce Enhancement Program funded by the Health Resources and Services Administration, geriatrics faculty and the Medical Legal Partnership for Seniors based at University of California Hastings College of Law provided ACP training to fellows and IP learners, including social work interns. In practice, the fellows and social work interns collaborated to incorporate ACP into patient visits and follow-up telephone calls. To monitor ACP progress, research staff reviewed patients’ electronic health records and performed descriptive analysis of the data. In 21 months, 4 geriatrics fellows built a panel of 59 patients who on average had 3 office visits and 7 telephone calls per person. Prior to clinic enrollment, 12 (20.3%) patients had preexisting AHCD, and 47 lacked AHCD documentation. After ACP intervention, 42 of 47 patients without AHCD documentation engaged in ACP discussion. Of those who engaged in ACP discussion, 24 completed AHCD, raising AHCD completion rate to 61%, or 36 patients in the panel of 59. ACP is a complex process that benefits from skilled communication among interprofessional providers and patients. Findings underscore the potential advantages of IP training and engaging patients in ACP discussion in an academic primary care setting.

Initiating Advance Care Planning in Primary Care: A Model for Success

2019 ◽  
Vol 22 (4) ◽  
pp. 427-431 ◽  
Author(s):  
Barbara L. Rose ◽  
Stephanie Leung ◽  
Jillian Gustin ◽  
Julie Childers
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Care Planning ◽  
Advance Care

scholarly journals Population-Based Pragmatic Trial of Advance Care Planning in Primary Care in the University of California Health System

2019 ◽  
Vol 22 (S1) ◽  
pp. S-72-S-81 ◽  
Author(s):  
Anne M. Walling ◽  
Rebecca L. Sudore ◽  
Doug Bell ◽  
Chi-Hong Tseng ◽  
Christine Ritchie ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Advance Care Planning ◽  
Pragmatic Trial ◽  
Population Based ◽  
University Of California ◽  
Care Planning ◽  
Advance Care ◽  
The University

Enabling Advance Care Planning in Dementia Care: A Primary Care Approach

2020 ◽  
pp. 082585972097393
Author(s):  
Linda Lee ◽  
Loretta M. Hillier ◽  
Stephanie K. Lu ◽  
Donna Ward
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Health Professionals ◽  
Online Survey ◽  
Ease Of Use ◽  
Depth Information ◽  
Care Planning ◽  
Care Approach ◽  
Memory Clinics ◽  
Advance Care

Background: Lack of tools to support advance care planning (ACP) has been identified as a significant barrier to implementing these discussions. Aim: We pilot tested an ACP framework tool for use with persons living with dementia (PLWD) in primary care-based memory clinics and an Adult Day Program; this study describes user and recipient experiences with this framework. Methods: We used a mixed methods approach. Health professionals completed an online survey following pilot testing and PLWD and substitute decision makers (SDM) completed survey immediately following the ACP discussion assessing their satisfaction (5-point scale) with the framework and exploring potential outcomes. Interviews with health professionals, PLWD, and SDM were conducted to gather more in-depth information on their perceptions of the ACP framework/ discussion. Results: Surveys were completed by 12 health professionals, 13 PLWD, and 16 SDM. While PLWD and SDM were satisfied with the ACP discussion (M = 4.0/5), health professionals were minimally satisfied with the ease of use of the framework (M = 2.0/5), acceptability for patients (M = 2.4/5) and feasibility in practice (M = 1.9/5). Sixteen interviews were completed with 8 health professionals, 1 PLWD, and 7 SDM. While health professionals valued ACP, lack of time and training were identified barriers to framework use. SDM felt better prepared for future decisions and PLWD were put at ease, knowing that their wishes for care were understood. Conclusion: PLWD and SDM value the opportunity for ACP, and although health professionals identified some concerns with framework administration, they acknowledge the value and importance of ACP. Continuing efforts to refine ACP processes are justified.

Prevalence of advance care planning in a resident run clinic in an underserved community.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24067-e24067
Author(s):  
Swetha Ann Alexander ◽  
Vinay Mathew Thomas ◽  
David Wu ◽  
Radhika Kulkarni ◽  
William Rabitaille
Keyword(s):  
Primary Care ◽  
African American ◽  
Advance Care Planning ◽  
Primary Care Clinic ◽  
Retrospective Chart Review ◽  
Care Planning ◽  
Care Clinic ◽  
Underserved Community ◽  
Advance Care ◽  
End Stage

e24067 Background: Advance Care Planning (ACP) ensures that patients receive care that is in line with their values and preferences. ACP is best done in the outpatient setting. Despite recognizing the importance of ACP, the rates of ACP completion continue to be low. We conducted a retrospective study to determine the rates of ACP in a resident run primary care clinic in Hartford, Connecticut, which serves the underserved community. We looked at patient characteristics to find correlation with ACP completion. We also aimed to determine the reasons which could decrease the completion of ACP. Methods: This was a retrospective chart review. Patients who met any of the inclusion criteria [i) Age>65 ii) End stage renal disease on dialysis iii) Metastatic/Recurrent cancer iv) End stage heart failure v) COPD Gold stage D] and were seen in the primary care clinic from September 1, 2019 to December 31, 2019 were selected. Their charts were reviewed to see if ACP was documented during primary care visits over the past two years. The demographics of the patients were noted. Subsequently, a survey was distributed to residents to determine the possible causes of low rates of ACP discussion. Results: The characteristics of the 373 patients included in the study are shown in Table 1. Only 14 (3.8%) of the 373 had documentation of ACP during their primary care visits. The characteristics of the 14 patients in whom ACP was done are as follows: Sex- Female 9/14 (64%); Ethnicity- Hispanic 10/14 (71%), African American 4/14 (29%); Religious Affiliation- Christian 13/14 (93%), None 1/14 (7%); Married/Partner 2/14 (14%). Patient demographics including sex (p 0.6), religious beliefs (p 0.8), and marital status (p 0.6) did not show any correlation with the likelihood of ACP completion. Of the 31 residents who answered the survey, the most commonly listed barriers to ACP completion were the following: lack of time to conduct these discussions (94%), forgetting to conduct ACP discussions (48%), and lack of training (19%). All the residents believed that ACP discussion was beneficial to patients and medical providers. Conclusions: The rates of ACP planning in our clinic are much lower than the national average. African American and Hispanics, who make up the majority of our clinic population, traditionally have had low rates of ACP completion. This is an important issue that needs to be addressed. Advance care planning training should be also be strengthened during residency. [Table: see text]

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