Advanced Care Planning for Persons With Dementia in Primary Care: Attitudes and Barriers Among Health-Care Professionals

2018 ◽  
Vol 34 (4) ◽  
pp. 248-254 ◽  
Author(s):  
Linda Lee ◽  
Loretta M. Hillier ◽  
Jason Locklin ◽  
Jennifer Lee ◽  
Karen Slonim
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Family Practice ◽  
Health Care Professionals ◽  
Comfort Level ◽  
Care Planning ◽  
Memory Clinic ◽  
Point Scale ◽  
Collaborative Memory ◽  
Regular Family

Background: Advance care planning (ACP) provides clarity on goals and preferences for future health-care decisions, the timeliness of which is critical for persons with dementia. Aim: This study assessed Primary Care Collaborative Memory Clinic (PCCMC) health-care practitioners’ desire for more education on ACP, capacity for and attitudes toward ACP, and current ACP practices in their regular family practice and in their PCCMC. Methods: Primary Care Collaborative Memory Clinic health-care professionals completed a questionnaire in which they rated their interest in learning various ACP-related topics (5-point scale: not at all to very much so), attitudes toward ACP, and the importance of and perceived degree of responsibility for ACP (5-point scale: not at all to extremely). Respondents estimated ACP completion in regular family practice and PCCMC. Results: Two hundred and sixty one surveys were completed. Mean knowledge ratings were moderate (M = 3.0) and mean ratings of interest in ACP topics were all high (median ≥ 4). Despite the perception that ACP is very important (M = 4.9) and the responsibility of PCCMCs (M = 3.7), the majority of respondents estimated that 40% or fewer patients have had ACP. Ratings of willingness to conduct ACP (M = 3.7) and comfort level (M = 3.4) were moderate but significantly exceeded ratings of ability (M = 2.9), comfort (M = 3.5), and confidence (M = 2.8). Conclusion: There was a striking disconnect between perceptions of the importance of completing ACP for persons with dementia and actual ACP completion rates. Primary Care Collaborative Memory Clinics may be in an ideal position to support ACP discussions; however, there is a need to improve health-care professionals’ knowledge and attitudes toward ACP.

Flawed communications: Health professionals’ experience of collaboration in the care of frail elderly patients

2017 ◽  
Vol 46 (7) ◽  
pp. 680-689 ◽  
Author(s):  
Anders Hansson ◽  
Ann Svensson ◽  
Britt Hedman Ahlström ◽  
Lena G. Larsson ◽  
Berit Forsman ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Elderly Patients ◽  
Frail Elderly ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Health Care Systems ◽  
Care Physician ◽  
Care Planning ◽  
Care Nurse

Aims: Frail elderly patients who have multiple illnesses do not fare well in modern health care systems, mainly due to a lack of care planning and flawed communication between health professionals in different care organisations. This is especially noticeable when patients are discharged from hospital. The aim of this study was to explore health care professionals’ experience of obstacles and opportunities for collaboration. Methods: Health professionals were invited to participate in three focus groups, each consisting of a hospital physician, a primary care physician, a hospital nurse, a primary care nurse, a municipal home care nurse or an assistant officer, a physical or occupational therapist and a patient or a family member representative. These individual people were then asked to discuss the obstacles and opportunities for communication between themselves and with the patients and their relatives when presented with the case report of a fictitious patient. Content analysis was used to identify categories. Results: Several obstacles were identified for effective communication and care planning: insufficient communication with patients and relatives; delayed collaboration between care-givers; the lack of an adequate responsible person for care planning; and resources not being distributed according to the actual needs of patients. The absence of an overarching responsibility for the patient, beyond organisational borders, was a recurring theme. These obstacles could also be seen as opportunities. Conclusions: Obstacles for collaboration were found on three levels: societal, organisational and individual. As health care professionals are well aware of the problems and also see solutions, management for health care should support employees’ own initiatives for changes that are of benefit in the care of frail elderly patients with multiple illnesses.

Genetic Competencies Essential for Health Care Professionals in Primary Care

2005 ◽  
Vol 50 (3) ◽  
pp. 177-183 ◽  
Author(s):  
Janet L. Engstrom ◽  
Marlene G. S. Sefton ◽  
Jolie Kim Matheson ◽  
Kristine M. Healy
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Professionals

scholarly journals Advance care planning in Norwegian nursing homes – limited awareness of the residents’ preferences and values? A qualitative study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lisbeth Thoresen ◽  
Reidar Pedersen ◽  
Lillian Lillemoen ◽  
Elisabeth Gjerberg ◽  
Reidun Førde
Keyword(s):  
Health Care ◽  
Nursing Homes ◽  
Advance Care Planning ◽  
Health Care Professionals ◽  
Qualitative Content Analysis ◽  
Care Planning ◽  
Next Of Kin ◽  
Medical Issues ◽  
Interdisciplinary Approaches ◽  
Advance Care

Abstract Background 52% of all deaths in Norway occur in nursing homes. Still advance care planning (ACP) is scarce and heterogeneous. To improve the implementation and practice of ACP in nursing homes, knowledge about health care professionals’ views on ACP is vital. The objective of this study is to explore nurses and physicians’ aims and experiences with carrying out ACP in nursing homes. Methods Semi-structured group interviews were conducted with 20 health care professionals, recruited from nursing homes where ACP was performed regularly. Qualitative content analysis was used to analyse the data. Results The primary aim of the nursing home professionals when doing ACP in nursing homes were to build alliances with next of kin to avoid misunderstandings and future conflicts. Two main experiences with ACP were described: i) due to the sensitivity of ACP issues, it was important to balance directness with being sensitive, and ii) when the physicians raised questions concerning future medical treatment, the answers from residents as well as next of kin were often hesitant and unclear. Conclusion Our study add insights into how ACP is practiced in nursing homes and the professionals’ agenda. A focus on medical issues and achieving consensus with next of kin may result in lack of involvement of the residents and limited awareness of the residents’ needs. Interdisciplinary approaches, ACP-training and tailored guidelines may improve the implementation and practice of ACP.

scholarly journals Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals (Preprint)

2020 ◽  
Author(s):  
Inga Hunter ◽  
Phoebe Elers ◽  
Caroline Lockhart ◽  
Hans Guesgen ◽  
Amardeep Singh ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Information Needs ◽  
Sensor Data ◽  
Care Providers ◽  
Community Based ◽  
Age In Place

BACKGROUND Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. OBJECTIVE The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being. METHODS Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. RESULTS The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns. CONCLUSIONS The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

scholarly journals Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals

10.2196/24157 ◽  
2020 ◽  
Vol 8 (12) ◽  
pp. e24157
Author(s):  
Inga Hunter ◽  
Phoebe Elers ◽  
Caroline Lockhart ◽  
Hans Guesgen ◽  
Amardeep Singh ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Older People ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Information Needs ◽  
Sensor Data ◽  
Care Providers ◽  
Community Based ◽  
Age In Place

Background Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. Objective The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being. Methods Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. Results The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns. Conclusions The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

Across the spectrum: Strategies to improve recognition and treatment of mental disorders in primary care

2017 ◽  
Author(s):  
Victoria J. Palmer ◽  
Rob Whitley
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Social Workers ◽  
Health Care Professionals ◽  
Occupational Therapists ◽  
Whole Person ◽  
Seeking Help

There is an abundance of published literature documenting the important role of primary care in the recognition, treatment and management of mental disorders. Despite this, general practitioners, nurses, social workers, occupational therapists, physiotherapists, and other primary health care professionals remain under acknowledged, and the multidisciplinary team arrangements needed for effective management elusive. Individual and community stigma attached to seeking help has not been removed. This chapter provides an overview of these existing barriers and outlines strategies for implementation to improve recognition and treatment of mental disorders across the spectrum in primary care. These strategies are focused on the delivery of whole person, resulting in integrated and person-centred care.

scholarly journals Workshop: Health workforce meets HSR: Tackling regional inequalities in health service provision

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Services ◽  
Health Workforce ◽  
Health Care Professionals ◽  
Rural Areas ◽  
Hospital Care ◽  
Health Service Provision ◽  
Care Practices ◽  
Do So

Abstract Background Many countries across Europe are facing considerable challenges in providing accessible and high quality care regardless of where people live. A major element is the difficulty that countries face to attract and retain health care professionals to work in remote and rural areas. This applies to primary care services as well as to hospital care, and to the care provided by physicians and other health professionals, including nurses. A widely shared question is therefore how to safeguard access to health care in rural areas and to solve recruitment and retention problems in such regions, both of medical and nursing staff. The workshop will build on last year’s joint workshop of the Sections on HSR and HWR that ended with questions related to how to organize accessible and equitable health services including the workforces required to do so. Objectives This workshop will provide a snapshot of studies from across the European region, with a particular focus on differences between rural and urban health care practices and the types of solutions being used to reduce regional disparities in provision of care. This often refers to retention and recruitment strategies, but the session will also address other types of solutions in the organization of care that can help ensure accessible care, including in vulnerable regions and settings. Tackling this challenge will therefore require a joint approach, tapping into experience from health workforce research as well as wider health services research, bringing together research into the organization and management of healthcare and into the health human resources providing this care, operated from different angles and being informed by different research traditions and data sources. Based on statements, we will discuss the topic of how to organize accessible and equitable health services including the workforces required to do so after the presentations. Key messages Workforce policies should focus on retaining primary care workforce in rural areas and integrated policies should attract new primary care practices. Both in primary care and hospital care new solutions are being sought which should help resolve regional differences in access to care and attractiveness for the health workforce.

Regional shortages in a small country: how to provide the right care in the right place?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Hansen ◽  
R Batenburg ◽  
E Vis ◽  
L Van der Velden
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Professionals ◽  
Hospital Care ◽  
Ageing Population ◽  
Regional Collaboration ◽  
Care Workers ◽  
Vested Interests ◽  
More Care ◽  
The Right

Abstract Background The Netherlands, though being a relatively small and densely populated country, is faced with a similar challenge as other countries in terms of regional differences in access to care and attractiveness for care workers to build their careers. Both in primary care and hospital care new solutions are being sought which should help resolve these growing difficulties. Methods We conducted a literature review, survey and registry analysis, and held interviews with key stakeholders. Results Substantial differences exist between regions in the supply of both primary care and hospital care doctors. Particular and less populated regions appear to be hit in multiple ways, both with an extra ageing population requiring more care as well as by limited attractiveness for both primary care and hospital care workers. Solutions being used so far are mostly initiated by individual health care settings, such as strategic personnel management, redistribution of tasks and campaigns to increase the inflow of staff. Increasingly, solutions are also being explored at regional level, including a growing emphasis on regional collaboration, both in providing the right care in the right place as well as in terms of joint recruitment strategies. Still, such approaches only have a limited effect as a result of which new approaches are needed. Conclusions Strategies to improve the attractiveness of particular regions are now often fragmented, both between types of professions and sectors and different regions. In addition, innovative and new solutions appear to be hampered by vested interests of stakeholders. If new solutions are to be developed it is key that stakeholders are willing to compromise, be it when it comes to the autonomy of health care professionals and their associations and to the financial commitments required from government and insurer side.

scholarly journals Infection control strategy and primary care assistance in Campania region during the national lockdown due to COVID-19 outbreak: the experience of two tertiary emergency centers

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Angela Mauro ◽  
Nicola Improda ◽  
Letizia Zenzeri ◽  
Francesco Valitutti ◽  
Erica Vecchione ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Infection Control ◽  
Control Strategy ◽  
Health Care Professionals ◽  
Close Contact ◽  
Time Lapse ◽  
High Rate ◽  
Self Medication ◽  
Campania Region

Abstract Background COVID-19 pandemic has markedly affected emergency care, due to sudden limitation of health care capacity by general practitioners (GP) and urgent need for infection control strategies. We evaluated the activity of the Emergency Department (ED) during the national lockdown (March 8–April 30), as well as the outcomes of our infection control strategy. Results Despite a reduction in access by one fifth, a proportion of febrile patients comparable to 2019 was seen (829/2492, 33.3% vs 4580/13.342, 34.3%, p = 0.3). Diagnostic swab for COVID-19 was performed in 25% of patients, especially in subjects with co-morbidities or multiple access. Six infected cases were identified, all presenting with febrile disease. Only two positive patients fulfilled the criteria for diagnostic swab provided by the Italian Health Authorities, because of close contact with suspected or confirmed cases. The rate of admission for febrile or respiratory conditions was higher than the same period of 2019 (33.4% vs 25.9%, p < 0.0001). None of the 105 health-care professionals working during the study time lapse exhibited anti-SARS-CoV-2 seroconversion. Among the 589 patients with information available, 54.9% declared no medical consultation at all prior to coming to ED, while only 40 (of which 27 with fever) had been examined by their GP before coming to ED. Nevertheless, 35.6% of the cases were already taking medications. None of the 9 patients requiring intensive care reported recent pediatric consultation, despite symptoms duration up to 30 days. Conclusion Our results provide evidence that the reduced capacity of primary care facilities during the national lockdown may have caused a high rate of self-medication as well as a delayed provision of care in some patients. Identification of pediatric patients affected with SARS-CoV-2 infection remains a challenge because of the absence of reliable predictive factors. Finally, the use of specific triage centers, with dedicated pathways to diagnose SARS-CoV-2 infection, trace contacts and allow adequate care after swabs, is effective in preventing spreading of the infection.

Advance-care planning quality improvement plan: A Cancer Care Ontario toolkit to support primary care teams to implement advance care plans in practice.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 76-76
Author(s):  
Jeff Myers ◽  
Suzanne Strasberg ◽  
Kathi Carroll ◽  
Zabin Dhanji ◽  
Ingrid Harle ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Improvement ◽  
Advance Care Planning ◽  
Cancer Care ◽  
Care Planning ◽  
Advance Care ◽  
Care Practices ◽  
Primary Care Practices ◽  
Eol Care

76 Background: In Ontario, the Ministry of Health and Long Term Care’s (MOHLTC) uses Quality Improvement Plans (QIPs) to drive system improvement aimed at providing high value, high quality care for all. To support the introduction of QIPs into the primary care sector, Cancer Care Ontario has developed an Advance Care Planning (ACP) toolkit for practices that include ACP as part of their annual QIP. ACP is an ongoing and dynamic process that involves a capable individual reflecting on their current values and beliefs for their health care, communicating their personal wishes for future health care and identifying an individual who will make decisions on their behalf in the event that they are unable to provide informed consent. The process is iterative and wishes may change over time with changes in health status. Methods: The ACP QIP was developed based on the Plan, Do, Study, Act cycle of continuous quality improvement. The ACP QIP provides primary care practices with detailed instructions on how to implement, monitor and report on an ACP Quality Improvement initiative. Importantly, the ACP QIP provides guidance and practical tools for developing objectives, establishing targets, and identifying measures and baselines for performance. CCO is actively promoting the ACP QIP in an effort to encourage uptake and broad adoption across Ontario. Results: There is now evidence that with ACP there is a greater likelihood EOL wishes will be both known and followed resulting in improved EOL care. ACP is also associated with decreased distress among the family members. Conclusions: Creating an ACP QIP supports primary care’s focus on advancing quality patient care. Importantly, implementing the ACP QIP into primary care practices has the potential to improve EOL care and secondarily reduce health care costs ultimately working towards achieving the triple aim of “better care, better health, and lower costs”.

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