scholarly journals Individually Tailored Palliative Care in a Rural Region: A Representative Chart Survey and Physicians’ Experiences with Integrated Care

2016 ◽  
Vol 2016 ◽  
pp. 1-8
Author(s):  
André Terhorst ◽  
Helena Albrecht ◽  
Birgitta Weltermann
Keyword(s):  
Palliative Care ◽  
Rural Areas ◽  
Mortality Data ◽  
Cross Sectional ◽  
Representative Study ◽  
Public Data ◽  
Hospital Patients ◽  
German Region ◽  
Dying At Home ◽  
At Home

Background. Dying at home represents a special challenge in rural areas. This representative study describes the palliative care for patients in a rural German region. Methods. In a cross-sectional, representative study all physicians of a large rural area were surveyed in terms of their palliative care for a biennial period. In prestructured interviews and chart reviews physicians, practices, and palliative care patients’ characteristics were obtained. The data were matched with regional mortality data. Results. According to public data 463 inhabitants died during the biennial period: 248 patients (53.6%) died outside the region’s borders including all in-hospital patients, while 215 died within this territory (46.4%). Of the latter, a total of 91 patients (42.3%) received care by the 14 physicians surveyed (on average: 6.6 patients per physician). 89% of families were actively involved in care, especially in multigenerational family scenarios. If family members were not involved, nursing services were active instead. Significant predictors for dying at home were the wish to die at home, a cancer diagnosis, and having family support. Conclusions. This study shows a physician-based, individually tailored, rural palliative care approach which allowed the majority of patients to die at home. Families were documented as an important social resource.

scholarly journals Experiences of relatives with outpatient palliative care: a cross-sectional study

2020 ◽  
Vol 26 (5) ◽  
pp. 230-237
Author(s):  
André Fringer ◽  
Sabrina Stängle ◽  
Iren Bischofberger ◽  
Daniel Büche ◽  
Renate Praxmarer ◽  
...  
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Response Rate ◽  
Cross Sectional Study ◽  
Descriptive Statistics ◽  
Sectional Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Dying At Home ◽  
At Home

Aim: The authors aimed to evaluate the experiences of the relatives of dying people, both in regard to benefits and special needs, when supported by a mobile palliative care bridging service (MPCBS), which exists to enable dying people to stay at home and to support patients' relatives. Design: A cross-sectional survey. Methods: A standardised survey was performed, asking 106 relatives of dying people about their experiences with the MPCBS (response rate=47.3%). Descriptive statistics were analysed using SPSS 23. Findings: Many relatives (62.5%) reported that their dying relations when discharged from a facility to stay at home were not symptom-free. The MPCBS helped relatives maintain home care, and this was reported to be helpful. Support provided by the MPCBS made it easier for 77.6% of relatives to adjust care as soon as situations changed, and helped ensure that symptoms could be better controlled, at least for 68.2% of relatives. Younger relatives felt more encouraged by the MPCBS to care for their relatives dying at home.

scholarly journals There's no Place like Home: Oklahoman's Preferences for Site of Death

2008 ◽  
Vol 1 ◽  
pp. PCRT.S1058 ◽  
Author(s):  
Marianne Matzo ◽  
Kamal Hijjazi
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
Income Level ◽  
Stated Preferences ◽  
Care Needs ◽  
Attitudes And Behaviors ◽  
Dying At Home ◽  
Palliative Care Needs ◽  
Insight Into ◽  
At Home

Objective This study sought to document Oklahomans knowledge, attitudes, and behaviors regarding palliative care; this paper focuses on subjects stated preferences for where they would choose to die. Design Quantitative study used a random state-wide telephone sample of Oklahoma residents. Subjects Data from 804 residents in the State of Oklahoma between November and December (2005). Results An overwhelming majority of the respondents (80%) reported preference to die at home in the event that they suffer a terminal illness. The proportion of respondents under the age of 65 who preferred to die at home (80.9%) was slightly higher than those aged 65 and over (74.8%). Also, while 81.4% of the female respondents reported preference for dying at home, 75.8% of the male respondents shared such preference (P < 0.05). More married respondents (82.7%) than non-married respondents (74.7%) reported preference for dying at home (P < 0.01). A significant association (P < 0.05) between income level and preference for dying at home was noted. While 84.3% of those with income level at $21,000 or more reported reference for dying at home, 76.4% of those with income below $21,000 reported the same preference. Conclusions This paper offers insight into factors that influence Oklahoman's stated preferences for site of death that can assist the statewide agenda in the planning and provision of palliative care. This information can be adapted in other states or countries to determine palliative care needs.

scholarly journals The Need for Palliative Care in Primary Health Care

2018 ◽  
Vol 1 (3) ◽  
pp. 103
Author(s):  
Nita Arisanti ◽  
Dany Hilmanto ◽  
Elsa Pudji Setiawati ◽  
Veranita Pandia
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
Primary Health Care ◽  
Service Providers ◽  
Primary Health ◽  
Stage Disease ◽  
Family Perceptions ◽  
Dying At Home ◽  
End Stage ◽  
At Home

.................... The access to palliative care in ends of life is one of the patients’ rights. Therefore it should be delivered into every level of health care for patients and family members. In some countries, palliative care is more frequent delivered in hospitals compare to primary health care, even though primary health care has a significant role in providing palliative care. Most families prefer to care for patients at home rather than in the hospital................................... The implementation of palliative care in Indonesia is still very limited to certain hospitals, even though doctors in primary care have great potential to offer such care to people in the community. Some of the factors contributing to the implementation are cultural and socioeconomic factors, patient and family perceptions, attitudes of service providers, lack of trained personnel, distribution of palliative care units, lack of consolidation and limited funds. As a result, patients with end-stage disease die in hospitals without receiving palliative care or dying at home with inadequate support................

scholarly journals Availability of home palliative care services and dying at home in conditions needing palliative care: A population-based death certificate study

2020 ◽  
Vol 34 (4) ◽  
pp. 504-512 ◽  
Author(s):  
Miharu Nakanishi ◽  
Asao Ogawa ◽  
Atsushi Nishida
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Primary Care Physicians ◽  
Death Certificate ◽  
Care Services ◽  
Primary Care Services ◽  
Hospital Beds ◽  
Palliative Care Services ◽  
Dying At Home ◽  
At Home

Background: Avoiding inappropriate care transition and enabling people with chronic diseases to die at home have become important health policy issues. Availability of palliative home care services may be related to dying at home. Aim: After controlling for the presence of hospital beds and primary care physicians, we examined the association between availability of home palliative care services and dying at home in conditions requiring such services. Design: Death certificate data in Japan in 2016 were linked with regional healthcare statistics. Setting/participants: All adults (18 years or older) who died from conditions needing palliative care in 2016 in Japan were included. Results: There were 922,756 persons included for analysis. Malignant neoplasm (37.4%) accounted for most decedents, followed by heart disease including cerebrovascular disease (31.4%), respiratory disease (14.7%) and dementia/Alzheimer’s disease/senility (11.5%). Of decedents, 20.8% died at home or in a nursing home and 79.2% died outside home (hospital/geriatric intermediate care facility). Death at home was more likely in health regions with fewer hospital beds and more primary care physicians, in total and per condition needing palliative care. Number of home palliative care services was negatively associated with death at home. The adjustment for home palliative care services disappeared in heart disease including cerebrovascular disease and reversed in respiratory disease. Conclusion: Specialised home palliative care services may be suboptimal, and primary care services may serve as a key access point in providing baseline palliative care to people with conditions needing palliative care. Therefore, primary care services should aim to enhance their palliative care workforce.

Palliative Care Consultation Affects How and Where Heart Failure Patients Die

2020 ◽  
pp. 104990912096356
Author(s):  
Richard Pham ◽  
Casey McQuade ◽  
Alex Somerfeld ◽  
Sandra Blakowski ◽  
Gavin W. Hickey
Keyword(s):  
Heart Failure ◽  
Palliative Care ◽  
Chi Square ◽  
Code Status ◽  
Heart Failure Patients ◽  
Palliative Care Consultation ◽  
Care Consultation ◽  
Dying At Home ◽  
The Impact ◽  
At Home

Objective: Determine the role of palliative care on terminal code status and setting of death for those with heart failure. Background: Although palliative care consultation (PCC) has increased for many conditions, PCC has not increased in those with cardiovascular disease. While it has been shown that the majority of those with heart failure die in medical facilities, the impact of PCC on terminal code status and setting of death requires further analysis. Methods: Patients admitted with heart failure between 2014-2015 at an academic VA Healthcare System were reviewed. Primary outcome was terminal code status. Secondary outcomes included setting of death, hospice utilization, and mortality scores. Student t-testing and Chi-square testing were performed where appropriate. Results: 334 patients were admitted with heart failure and had a median follow up time of 4.3 years. 196 patients died, with 122 (62%) receiving PCC and 74 (38%) without PCC. Patients were more likely to have terminal code statuses of comfort measures with PCC (OR = 4.6, p = 0.002), and less likely to be full code (OR = 0.09, p < 0.001). 146 patients had documented settings of death and were more likely to receive hospice services with PCC (OR 6.76, p < 0.001). A patient’s chance of dying at home was not increased with PCC (OR 0.49, p = 0.07), but they were more likely to die with inpatient hospice (OR = 17.03; p < 0.001). Conclusion: Heart failure patients who received PCC are more likely to die with more defined care preferences and with hospice services. This does not translate to dying at home.

Provision of specialized palliative care in a multiprofessional network.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 144-144
Author(s):  
Jens Hermann Papke
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Outpatient Setting ◽  
Multiprofessional Team ◽  
Nursing Services ◽  
Palliative Care Teams ◽  
Specialized Palliative Care ◽  
Dying At Home ◽  
Karnofsky Index ◽  
At Home

144 Background: In Germany specialised palliative care in outpatient setting is financed by health insurances since 2007. Home Care Sachsen e.V. is a specialised palliative care provider working with two palliative care teams including qualified nurses, physicians and social workers in closely cooperation with general practitioners and nursing services. We report about the results of our work in a rural area around Dresden in Saxony, Germany. Methods: Our data were collected prospectively with PalliDoc software. Results: Between 2011 – 2013 Home Care Sachsen e.V. served for 1,572 pts (888 m, 684 f); 93% with an oncologic disease. Median age was 71 y, Karnofsky index was 40%, median caring time 27 days. In this time, 25% of our pts had one stay in hospital, 8% two and 4% three and more. 63% had no stays in hospital. At least 1,271 pts. died: 65% at home; 9% in nursing homes and hospices; 15% in palliative care units and 11% in hospital. Conclusions: Mean home death rate of oncologic pts without intervention in Germany is about 44% (Papke J, Koch R: Places of Death from Cancer in a Rural Location. Onkologie (2007) 30, 105-08). This proportion could be enhanced considerably with outpatient palliative care. Providing of specialised palliative care with a multiprofessional team is effective to increase the rate of dying at home and to fulfill one of the strongest wishes of pts in a palliative situation.

scholarly journals Caring and Conflict-Palliative Care in the Armed Forces: The Challenges for Caregivers

2021 ◽  
Vol 0 ◽  
pp. 1-14
Author(s):  
Savita Butola ◽  
Sushma Bhatnagar ◽  
Fiona Rawlinson
Keyword(s):  
Palliative Care ◽  
Rural Areas ◽  
Family Members ◽  
Community Support ◽  
Armed Forces ◽  
Structured Interviews ◽  
Transfer Policy ◽  
Remote Areas ◽  
Care At Home ◽  
At Home

Objectives: In India, Palliative care remains inaccessible, especially in remote areas. This study aimed at exploring the experience of caregivers related to arranging palliative care at home, for personnel and family members of an armed force. Materials and Methods: Qualitative study based on thematic analysis of semi-structured interviews with adult caregivers - either serving personnel or their dependent family members. Results: Lack of palliative care in rural areas makes arranging home care challenging for Indian caregivers, especially in armed forces. The families stay alone and personnel cannot be there to look after loved ones. Constraints of leave, financial and legal problems, frequent movement and social isolation disrupt care as well as family and community support systems, leading to psycho-social problems and stress for the serving personnel as well as families. Educating staff, integrating palliative care into existing medical services, coordinating with other agencies to increase awareness and provide care at home, access to opioids, timely leave, reimbursement of expenses, increased family accommodation, guidance about benefits, and considerate implementation of transfer policy can help mitigate some of their problems. Conclusion: These caregivers face physical exhaustion, psycho-social, financial, legal, and spiritual issues- some common to all rural Indians and others unique to the armed forces. Understanding their experiences will help the providers find solutions, especially in relation to the unique needs of the men in uniform.

scholarly journals Factors Affecting Home Delivery among Women Living in Remote Areas of Rural Zambia: A Cross-Sectional, Mixed-Methods Analysis

2021 ◽  
pp. 1-13
Author(s):  
Ireen Chola Mwape Musonda
Keyword(s):  
Maternal Mortality ◽  
Health Facility ◽  
Low Income ◽  
Rural Areas ◽  
Home Delivery ◽  
Childbearing Age ◽  
Long Distance ◽  
Cross Sectional ◽  
Home Deliveries ◽  
At Home

Luapula Province has the highest maternal mortality and one of the lowest facility-based births in Zambia. The distance to facilities limits facility-based births for women in rural areas. In 2013, the government incorporated maternity homes into the health system at the community level to increase facility-based births and reduce maternal mortality. Despite the policy to stopping traditional birth attendants from conducting deliveries at home and encouraging all women to give birth at the health facility under skilled care, many women still give birth at home. An exploratory cross section survey was used to gather data by conducting structured interviews with 50 women of childbearing age who had a recent or previous home delivery. The following factors were found to be associated with home deliveries in surrounding villages in kashikishi; abrupt onset/precipitate labor, long distance/transport difficulties to reach the nearest health facility, having had successful HD, poverty/low income and gender though having a small percentage. Parity in which the majority were multiparas’ women, attitude was also associated with home deliveries and other unforeseen circumstances such as a funeral and being alone at home at the onset of labour.

Sign in / Sign up

Export Citation Format

Share Document