“Preventing the Pain” When Working with Family and Sexual Violence in Primary Care

Primary care professionals (PCPs) are increasingly being expected to identify and respond to family and sexual violence as the chronic nature and severity of the long-term health impacts are increasingly recognized. This discussion paper reports the authors’ expert opinion from their experiences running international workshops to prevent trauma among those who work and research sexual violence. It describes the burnout and secondary traumatic stress literature which provides the evidence supporting their work. Implications for practicing basic training in response to trauma and ongoing education are a key area for responding to family violence and preventing professional stress. A professional culture that supports and values caring well for those who have experienced family violence as well as “caring for the carer” is needed. Working in teams and having more support systems in place are likely to protect PCPs from secondary traumatic stress and burnout. Undergraduate and postgraduate training of PCPs to develop trauma knowledge and the skills to ask about and respond to family violence safely are essential. In addition, the healthcare system, workplace, and the individual practitioner support structures need to be in place to enable PCPs to provide safe and effective long-term care and access to other appropriate services for those who have experienced family violence.

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Mind the gap: is the Canadian long-term care workforce ready for a palliative care mandate?

Ageing and Society ◽

10.1017/s0144686x18001629 ◽

2019 ◽

Vol 40 (6) ◽

pp. 1223-1243 ◽

Cited By ~ 2

Author(s):

Paulette V. Hunter ◽

Lynn McCleary ◽

Noori Akhtar-Danesh ◽

Donna Goodridge ◽

Thomas Hadjistavropoulos ◽

...

Keyword(s):

Job Satisfaction ◽

Palliative Care ◽

Traumatic Stress ◽

Secondary Traumatic Stress ◽

Self Efficacy ◽

Long Term Care ◽

Professional Staff ◽

Emotional Wellbeing ◽

Term Care

AbstractThe average expected lifespan in Canadian long-term care (LTC) homes is now less than two years post-admission, making LTC a palliative care setting. As little is known about the readiness of LTC staff in Canada to embrace a palliative care mandate, the main objective of this study was to assess qualities relevant to palliative care, including personal emotional wellbeing, palliative care self-efficacy and person-centred practices (e.g. knowing the person, comfort care). A convenience sample of 228 professional and non-professional staff (e.g. nurses and nursing assistants) across four Canadian LTC homes participated in a survey. Burnout, secondary traumatic stress and poor job satisfaction were well below accepted thresholds, e.g. burnout: mean = 20.49 (standard deviation (SD) = 5.39) for professionals; mean = 22.09 (SD = 4.98) for non-professionals; cut score = 42. Furthermore, only 0–1 per cent of each group showed a score above cut-off for any of these variables. Reported self-efficacy was moderate, e.g. efficacy in delivery: mean = 18.63 (SD = 6.29) for professionals; mean = 15.33 (SD = 7.52) for non-professionals; maximum = 32. The same was true of self-reported person-centred care, e.g. knowing the person; mean = 22.05 (SD = 6.55) for professionals; mean = 22.91 (SD = 6.16) for non-professionals; maximum = 35. t-Tests showed that non-professional staff reported relatively higher levels of burnout, while professional staff reported greater job satisfaction and self-efficacy (p < 0.05). There was no difference in secondary traumatic stress or person-centred care (p > 0.05). Overall, these results suggest that the emotional wellbeing of the Canadian LTC workforce is unlikely to impede effective palliative care. However, palliative care self-efficacy and person-centred care can be further cultivated in this context.

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Title I: Modernizing Definitions and Programs Under the Administration on Aging

Innovation in Aging ◽

10.1093/geroni/igaa057.2518 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 714-715

Author(s):

Marie Gualtieri

Keyword(s):

Title I ◽

Adult Population ◽

Term Care ◽

Older Americans ◽

Aging Society ◽

Program Adaptation ◽

Older Americans Act ◽

The Individual ◽

Older Adult Population

Abstract The recent reauthorization of the Older Americans Act adds language and definitions to current issues facing the aging population. Specifically, Title I includes definitions related to program adaptation and coordination, workforce and long-term care issues, nutrition and social isolation, as well as family caregivers. Different from the last authorization, these definitions span beyond the individual experience to include other entities impacted by an aging society, such as the workforce and families. Overall, the Title I reauthorization seeks to modernize policy to reflect the current influx of the older adult population and its consequences.

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Evaluating the integration of palliative care in national health systems: an indicator rating process with EAPC task force members to measure advanced palliative care development

BMC Palliative Care ◽

10.1186/s12904-021-00728-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Natalia Arias-Casais ◽

Eduardo Garralda ◽

Miguel Antonio Sánchez-Cárdenas ◽

John Y. Rhee ◽

Carlos Centeno

Keyword(s):

Primary Care ◽

Palliative Care ◽

Long Term Care ◽

Task Force ◽

National Level ◽

Structured Interviews ◽

Term Care ◽

Care Facilities ◽

Rating Process

Abstract Background Palliative care (PC) development cannot only be assessed from a specialized provision perspective. Recently, PC integration into other health systems has been identified as a component of specialized development. Yet, there is a lack of indicators to assess PC integration for pediatrics, long-term care facilities, primary care, volunteering and cardiology. Aim To identify and design indicators capable of exploring national-level integration of PC into the areas mentioned above. Methods A process composed of a desk literature review, consultation and semi-structured interviews with EAPC task force members and a rating process was performed to create a list of indicators for the assessment of PC integration into pediatrics, long-term care facilities, primary care, cardiology, and volunteering. The new indicators were mapped onto the four domains of the WHO Public Health Strategy. Results The literature review identified experts with whom 11 semi-structured interviews were conducted. A total of 34 new indicators were identified for national-level monitoring of palliative care integration. Ten were for pediatrics, five for primary care, six for long-term care facilities, seven for volunteering, and six for cardiology. All indicators mapped onto the WHO domains of policy and education while only pediatrics had an indicator that mapped onto the domain of services. No indicators mapped onto the domain of use of medicines. Conclusion Meaningful contributions are being made in Europe towards the integration of PC into the explored fields. These efforts should be assessed in future regional mapping studies using indicators to deliver a more complete picture of PC development.

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Practices and perspectives of primary care physicians in Japan and the United States about diagnosing dementia: a qualitative study

BMC Geriatrics ◽

10.1186/s12877-021-02457-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

M. Abe ◽

S. Tsunawaki ◽

M. Dejonckheere ◽

C. T. Cigolle ◽

K. Phillips ◽

...

Keyword(s):

Primary Care ◽

Early Intervention ◽

Advance Directives ◽

Primary Care Physicians ◽

Long Term Care ◽

Term Care ◽

Care Services ◽

The Us ◽

Diagnosis Of Dementia

Abstract Background While dementia is a common problem in Japan and the US, primary care physicians' practices and perspectives about diagnosing dementia in these different healthcare systems are unknown. Methods Qualitative research was conducted in an ethnographic tradition using semi-structured interviews and thematic analysis in primary care settings across Japan and in the Midwest State of Michigan, US. Participants were a total of 48 primary care physicians, 24 each from Japan and the US participated. Both groups contained a mixture of geographic areas (rural/urban), gender, age, and years of experience as primary care physicians. Results Participants in Japan and the US voiced similar practices for making the diagnosis of dementia and held similar views about the desired benefits of diagnosing dementia. Differences were found in attitudes about the appropriate timing of formally diagnosing dementia. Japanese physicians tended to make a formal diagnosis when problems that would benefit from long-term care services emerged for family members. US physicians were more proactive in diagnosing dementia in the early stages by screening for dementia in health check-ups and promoting advance directives when the patients were still capable of decision-making. Views about appropriate timing of diagnostic testing for dementia in the two systems reflect what medical or nursing care services physicians can use to support dementia patients and caregivers. Conclusions Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US. Testing to establish an early diagnosis of dementia by primary care physicians only partly relates to testing and treatment options available. Benefits of making the diagnosis included the need to activate the long-term care services in Japan and for early intervention and authoring advance directives in the US.

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Evaluating the implementation of a primary care intervention to reduce prescriptions of benzodiazepines (BENZORED IV)

10.21203/rs.3.rs-281452/v1 ◽

2021 ◽

Author(s):

Isabel Socias ◽

Alfonso Leiva ◽

Haizea Pombo-Ramos ◽

Ferran Bejarano ◽

Ermengol Sempere-Verdú ◽

...

Keyword(s):

Primary Care ◽

Traffic Accidents ◽

Implementation Strategies ◽

Developed Countries ◽

Successful Implementation ◽

Implementation Climate ◽

Primary Care Settings ◽

The Individual

Abstract Background: General practitioners (GPs) in developed countries widely prescribe benzodiazepines (BZDs) for their anxiolytic, hypnotic, and muscle-relaxant effects. Treatment duration, however, is rarely limited and this results in a significant number of chronic users. Long-term BZD use is associated with cognitive impairment, falls with hip fractures, traffic accidents, and increased mortality. The BENZORED IV trial was a hybrid type 1 trial conducted to evaluate the effectiveness and implementation of an intervention to reduce BZD prescription in primary care. The purpose of this qualitative study was to analyze facilitator and barriers to implement the intervention to primary care settings.Methods: Focus group meetings with GPs from the intervention arm of the BENZORED IV trial were held at primary healthcare centers in the three districts. For sampling purposes, the GPs were classified as high or low implementers according to the success of the intervention measured at 12 months. The Consolidated Framework for Implementation Research (CFIR) was used to conduct the meetings and to code, rate and analyze the dataResults: Three of the 41 CFIR constructs strongly distinguished between high and low implementers: The complexity in the intervention, the individual Stage of Change and the key stakeholder’s engagement. Seven constructs weakly discriminated between the two groups: the adaptability in the intervention, the external policy and incentives, the implementation climate, the relative priority, the self-efficacy and formally appointed implementation leader engaging. Fourteen constructs did not discriminate between the two groups, six had insufficient data for evaluation, and eleven had no data for evaluation.Conclusion: We identified constructs that could explain the variation in the implementation of the intervention, this information is relevant to design successful implementation strategies to implement the intervention.

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Optimizing childhood oncology care transition from pediatric to adult settings: A survey of primary care physicians’ and residents’ perspectives

Clinical & Investigative Medicine ◽

10.25011/cim.v43i2.33566 ◽

2020 ◽

Vol 43 (2) ◽

pp. E14-23

Author(s):

Sophie Marcoux, MD, PhD Marcoux ◽

Caroline Laverdière

Keyword(s):

Primary Care ◽

Cancer Survivors ◽

Childhood Cancer ◽

Primary Care Physicians ◽

Adult Survivors ◽

Likert Scale ◽

Care Transition ◽

Term Care

Purpose: The majority of childhood cancer survivors suffer from late adverse effects after the completion of treatment. The prospect of most survivors reaching middle-age is a relatively new phenomenon, and the ways by which current and future primary care physicians (PCPs) will address this novel public health challenge are uncertain. Methods: A survey assessing knowledge level and information delivery preferences regarding long-term follow-up guidelines for adult patients having survived a childhood cancer was distributed by e-mail through the Quebec (Canada) national associations of PCPs and residents (n=238). Results: Participants reported an estimated average of 2.9 ± 1.9 cancer survivors in their yearly caseload, and only 35.3% recalled having provided services to at least one survivor in the last year. Most participants indicated ignoring validated follow-up guidelines for these patients (average score 1.66 on a Likert scale from “1—totally disagreeing” to “5—totally agreeing”). Scarce access to personalized follow-up guidelines and lack of clinical exposure to cancer survivors were identified as main obstacles in providing optimal care to these patients (respective averages of 1.66 and 1.84 on a Likert scale from “1— is a major obstacle” to “5—is not an obstacle at all”). Conclusion: The PCPs and residents rarely provide care for childhood cancer adult survivors. On an individual basis, there is a clear need for increased awareness, education and collaboration regarding long-term care of childhood cancer adult survivors during medical training. On a more global basis, structural, organizational and cultural changes are also needed to ensure adequate care transition.

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Recommended Common Data Elements for International Research in Long-Term Care Homes: Exploring the Workforce and Staffing Concepts of Staff Retention and Turnover

Gerontology and Geriatric Medicine ◽

10.1177/2333721419844344 ◽

2019 ◽

Vol 5 ◽

pp. 233372141984434 ◽

Cited By ~ 2

Author(s):

Franziska Zúñiga ◽

Charlene H. Chu ◽

Veronique Boscart ◽

Anette Fagertun ◽

Montserrat Gea-Sánchez ◽

...

Keyword(s):

Long Term Care ◽

Intention To Leave ◽

Rapid Review ◽

Staff Retention ◽

Common Data Element ◽

Term Care ◽

Common Data Elements ◽

The Individual ◽

Staff Level

The aim of this review is to develop a common data element for the concept of staff retention and turnover within the domain of workforce and staffing. This domain is one of four core domains identified by the WE-THRIVE ( Worldwide Elements to Harmonize Research in Long-Term Care Li ving Environments) group in an effort to establish an international, person-centered long-term care research infrastructure. A rapid review identified different measurement methods to assess either turnover or retention at facility level or intention to leave or stay at the individual staff level. The selection of a recommended measurement was guided by the WE-THRIVE group’s focus on capacity rather than deficits, the expected availability of internationally comparable data, and the goal to provide a short, ecologically viable measurement. We therefore recommend to measure staff’s intention to stay with a single item, at the individual staff level. This element, we argue, is an indicator of staff stability, which is important for reduced organizational cost and improved productivity, positive work environment, and better resident–staff relationships and quality of care.

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An Estimation of the Individual Illiquidity Risk for the Elderly Spanish Population with Long-Term Care Needs

Lecture Notes in Business Information Processing - Modeling and Simulation in Engineering, Economics and Management ◽

10.1007/978-3-319-40506-3_8 ◽

2016 ◽

pp. 71-81 ◽

Cited By ~ 1

Author(s):

Estefania Alaminos ◽

Mercedes Ayuso ◽

Montserrat Guillen

Keyword(s):

Long Term Care ◽

The Elderly ◽

Spanish Population ◽

Care Needs ◽

Term Care ◽

The Individual

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Does characterising patterns of multimorbidity in stroke matter for developing collaborative care approaches in primary care?

Primary Health Care Research & Development ◽

10.1017/s1463423619000240 ◽

2019 ◽

Vol 20 ◽

Author(s):

Maria Raisa Jessica (Ryc) V Aquino ◽

Grace M Turner ◽

Jonathan Mant

Keyword(s):

Primary Care ◽

Model Of Care ◽

Care Needs ◽

Term Care ◽

Future Directions ◽

Mortality And Morbidity ◽

Causes Of Mortality ◽

Ischaemic Attack ◽

Care Practices

Abstract Stroke and transient ischaemic attack (TIA) remain leading causes of mortality and morbidity globally. Although mortality rates have been in decline, the number of people affected by stroke has risen. These patients have a range of long-term needs and often present to primary care. Furthermore, many of these patients have multimorbidities which increase the complexity of their healthcare. Long-term impacts from stroke/TIA along with care needs for other morbidities can be challenging to address because care can involve different healthcare professionals, both specialist and generalist. In the ideal model of care, such professionals would work collaboratively to provide care. Despite the commonality of multimorbidity in stroke/TIA, gaps in the literature remain, particularly limited knowledge of pairings or clusters of comorbid conditions and the extent to which these are interrelated. Moreover, integrated care practices are less well understood and remain variable in practice. This article argues that it is important to understand (through research) patterns of multimorbidity, including number, common clusters and types of comorbidities, and current interprofessional practice to inform future directions to improve long-term care.

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