scholarly journals The topicality of regulatory of general practitioners-family doctors activity regarding of palliative care patients the quality of life the determination and assessment

2021 ◽  
Vol 10 (4) ◽  
pp. 107-111
Author(s):  
O.P. Bratsyun ◽  
O.G. Shekera ◽  
L.F. Matyukha ◽  
A.V. Tsarenko
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Palliative Care ◽  
Primary Health Care ◽  
Medical Care ◽  
Ministry Of Health ◽  
Primary Health ◽  
Eortc Qlq C30 ◽  
Eortc Qlq

Background. Access to palliative care and symptom relief for patients with incurable and serious illnesses remains a pressing issue for the health systems of many countries around the world. It is estimated that more than 40 million patients with serious illnesses and life-threatening and limiting conditions require palliative care (PC) each year. Most of the patients requiring PC are at home, so PC that can alleviate most of the suffering of the patient and his family is provided by general practitioners. Settling the regulatory framework is an important factor in providing quality palliative care. The purpose of the study: to propose amendments to the regulatory documents governing the provision of palliative care to determine and assess the quality of life of patients. Materials and methods. Scientific literature, WHO documents, EORTC QLQ-C30 questionnaire and patient survey results (n = 219). We used the method of system analysis, synthesis, sociological and medical-statistical. Results. We analyzed literature sources regarding a patient-family-centered approach in the health care system. We studied the WHO recommendations for determining the quality of life (QOL) of patients. We identified a gap in the current documents regulating the provision of PC in assessing the QOL of patients. As a result of involving patients (n = 219) in self-assessment of the QOL using the EORTC QLQ-C30 questionnaire and further ensuring the subjective needs of patients, an improvement in their QOL was established. It was proposed to amend the orders of the Ministry of Health of Ukraine, regulating the provision of primary medical care and PС, in order to achieve the main goal of this type of medical care - to ensure the maximum achievable QOL. Conclusions. 1. It has been shown that the regulatory framework for the provision of PС regulates the provision of the most attainable QOL of the patient as the main goal of this type of medical care. However, the use of funds for determining the level of QOL and its components by doctors when providing PС on an outpatient basis, including at home, is not not regulated by law. 2. It has been proven that the use of the EORTC QLQ-C30 questionnaire to determine the QOL of patients receiving PС allows assessing their general and psycho-emotional state, as well as the level of the patient's functioning from his subjective point of view. This ensures the patient's partnership in a multidisciplinary team, his responsibility and participation in the treatment. At the same time, the key need of the patient to be involved in decision-making on diagnostics and the choice of treatment methods in accordance with personal beliefs and expectations is satisfied. 3. It is necessary to amend the order of the Ministry of Health of Ukraine dated 04.06.2020 No. 1308 "On improving the organization of the provision of palliative care in Ukraine" on the procedure for providing PC and the order of the Ministry of Health of Ukraine dated 03.19.2018 No. 504 "On approval of the Procedure for the provision of primary health care" according to the list medical services for the provision of primary health care in terms of using questionnaires to determine QOL and achieve the main goals of PC.

scholarly journals Effects of clown activities on patients eligible for palliative care in primary health care

2021 ◽  
Vol 74 (5) ◽  
Author(s):  
Fernando Ribeiro dos Santos ◽  
Sandra Pinto ◽  
Juliana Dias Reis Pessalacia ◽  
Bruna Moretti Luchesi ◽  
Lucimeire Aparecida da Silva ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Health Care ◽  
Palliative Care ◽  
Primary Health Care ◽  
Post Intervention ◽  
Primary Health ◽  
Home Based ◽  
Quasi Experimental

ABSTRACT Objective: Evaluate the effects of clown activities on quality of life, depression, stress, anxiety, aid, and social support in patients eligible for palliative care (PC) attended in Primary Health Care (PHC). Method: A quasi-experimental study, with pre-intervention and post-intervention evaluation, carried out with 16 patients eligible for early PC in PHC in a Midwestern city. Patients received 24 visits with home-based clown activities. Results: The interventions evidenced improved quality of life and social support, with significant results for the Social Activities dimension (p = 0.023). Increased scores for Anxiety (p = 0.007) and Depression (p = 0.023) were also observed. Conclusion: Clown activities can bring positive results for the quality of life and social support of patients eligible for PC at home. They should be encouraged to interact with family knowledge and enhance humanized care, integral and centered on human relationships in PHC.

scholarly journals Interface between social support, quality of life and depression in users eligible for palliative care

2017 ◽  
Vol 51 (0) ◽  
Author(s):  
Cissa Azevedo ◽  
Juliana Dias Reis Pessalacia ◽  
Luciana Regina Ferreira da Mata ◽  
Elma Lourdes Campos Pavone Zoboli ◽  
Maria da Graça Pereira
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Health Care ◽  
Palliative Care ◽  
Primary Health Care ◽  
Primary Health ◽  
Global Quality ◽  
Functional Quality ◽  
Global Quality Of Life

Abstract OBJECTIVE Analyzing the relationship between social support, quality of life and depression in patients eligible for palliative care at Primary Health Care of a municipality in the interior of Minas Gerais, Brazil. METHOD A correlational cross-sectional study carried out with patients treated in six primary health care units. Data were submitted to descriptive statistical analysis, tests for differences between averages and medians, and correlation tests. The significance level was 0.05. RESULTS The sample consisted of 115 participants, and it was identified that the higher the social support, the better the global quality of life (p<0.001) and functional quality of life (p=0.035); the greater the presence of physical symptoms, the lower the level of social support (p=0.012) and the higher the level of depression (p<0.001); the higher the symptoms of depression, the worse the global quality of life (p<0.001), functional quality of life (p<0.001) and the lower the levels of social support (p<0.001). CONCLUSION Levels of quality of life, social support and depression of patients eligible for palliative care are influenced by socioeconomic factors such as marital status, gender, age, income, education and presence of a caregiver.

scholarly journals The algorithm for providing paliative care by general practitioners - family doctors

2021 ◽  
Vol 10 (3) ◽  
pp. 92-97
Author(s):  
О.P. Bratsyun
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
General Practitioners ◽  
Family Doctor ◽  
Timely Manner ◽  
Family Doctors ◽  
Primary Health ◽  
Eortc Qlq C30 ◽  
Eortc Qlq

Background. In Ukraine, as in the rest of the world, the majority of people who face life-threatening or life-limiting illnesses and who need palliative care are at home [1]. It is estimated that palliative care is needed in 40–60 % of all deaths [2]. According to the State Statistics Service of Ukraine, 616 840 persons died in 2020 [3], respectively, approximately 250 to 370 thousand patients needed palliative care in Ukraine. The management of patients throughout the progression/development of the disease and the final phase of life is assigned to the doctors who are closest to the patient – general practitioners – family doctors. The main goal of palliative care is to ensure the most attainable quality of life for patients. At the same time, the doctor must determine in a timely manner when the volume of palliative care provided exclusively from a general practitioner – family doctor is not enough and in a timely manner to involve specialized palliative care services. Purpose of the research: to develop an algorithm for the providing of palliative care by gene­ral practitioners – family doctors with the definition of patients for whom the volume of palliative care goes beyond primary health care. Materials and methods. The current legal framework governing the provision of palliative care by general practitioners – family doctors, scientific literature, questionnaires of sociological research of patients (n = 25). Methods of system analysis, synthesis, abstraction, sociological and medical-statistical methods were used. Results. The current orders of the Ministry of Health of Ukraine and sectoral standards for the provision of medical care, which are guided by general practitioners – family doctors in the provision of palliative care, were studied and the lack of consistency in the implementation of the norms determined by different standards was revealed. It was found that the use of tools to determine the level of quality of life (QOL) as the main purpose of palliative care is not proposed. The duty of the general practitioner – family doctor is the timely involvement of specialized services in the provision of palliative care. At the same time, there is no specific indicator or criterion that may indicate an insufficient provision of palliative care at the level of primary health care. Questionnaires have been proposed for determining the QOL of patients (EORTC QLQ-C30) and self-assessment of depression (PHQ-9). It has been shown that indicators of less than 50 points on the functional scales of the EORTC QLQ-C30 questionnaire and / or 10 or more points on the PHQ-9 depression scale are evidence of the need to accompany the patient by a psychologist, clergyman and social worker, that is the basis for the involvement of a multidisciplinary team of mobile palliative care. A unified algorithm of actions for the provision of palliative care by general practitioners – family doctors has been developed. Conclusions. To ensure the implementation of the rules and regulations defined for general practitioners – family doctors by various regulatory documents, instructions and sectoral standards, it is necessary to introduce an algorithm (unified scheme) of doctor's actions in the provision of palliative care. Therefore, general practitioners – family doctors need to timely apply an algorithm for identifying patients for whom the provision of palliative care provided exclusively by general practitioners – family doctors is insufficient and to establish interaction with mobile palliative services.

Quality of life and adherence to mediterranean diet among type 2 diabetes mellitus patients of a primary health care clinic in Hebron city, Palestine

2021 ◽  
pp. 1-10
Author(s):  
Manal Badrasawi ◽  
May Hamdan ◽  
Mohammad Al Tamimi
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Health Care ◽  
Primary Health Care ◽  
Mediterranean Diet ◽  
Well Being ◽  
Care Clinic ◽  
Primary Health Care Clinic ◽  
Primary Health

BACKGROUND: Diabetes mellitus (DM) is a lifelong metabolic disease with a high rate of mortality and morbidity. Uncontrolled and untreated diabetes results in serious complications that subsequently cause patients’ quality of life (QoL) to deteriorate. Adherence to Mediterranean diet (MD) may relieve the complications of diabetes, thereby improving the quality of life for these patients. OBJECTIVE: The aim of this study was to assess the QoL of DM patients who adhered to MD. METHODS: In this cross-sectional study, we examined the QoL and MD data of 106 DM II patients being treated at a primary health care clinic in Hebron. We used the SF-36 questionnaire to measure the patients’ QoL and the MEDAS tool to assess their MD adherence. We also recorded their anthropometric measurements, abdominal obesity, lifestyle habits and blood biochemical results. RESULTS: The sample comprised male and female DM II patients between the ages of 35 and 72, with their mean age being 55.8±10.24. Patients’ QoL scores showed a significant relationship with three BMI categories, i.e., total QoL score, physical function, and pain domains (p <  0.05). In terms of diet, high adherence to MD had a positive impact on all domains and on patients’ total QoL with significant differences in physical functioning, emotional well-being, social functioning and pain domains. CONCLUSION: Patients’ QoL domains were relatively low and highly affected by DM II. Patients with greater MD adherence reported higher scores in all QoL domains. Significantly higher scores were noted for the physical, social and pain domains. Hence, MD is a recommended dietary pattern for DM II patients to achieve a better QoL.

scholarly journals Comorbid mental disorders and quality of life of people with epilepsy attending primary health care clinics in rural Ethiopia

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0238137
Author(s):  
Ruth Tsigebrhan ◽  
Abebaw Fekadu ◽  
Girmay Medhin ◽  
Charles R. Newton ◽  
Martin J. Prince ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Seizure Frequency ◽  
Functional Disability ◽  
Social Outcomes ◽  
Primary Health ◽  
Comorbid Mental Disorders

Background Evidence from high-income countries demonstrates that co-morbid mental disorders in people with epilepsy adversely affect clinical and social outcomes. However, evidence from low-income countries is lacking. The objective of this study was to measure the association between co-morbid mental disorders and quality of life and functioning in people with epilepsy. Methods A facility-based, community ascertained cross-sectional survey was carried out in selected districts of the Gurage Zone, Southern Ethiopia. Participants were identified in the community and referred to primary health care (PHC) clinics. Those diagnosed by PHC workers were recruited. Co-morbid mental disorders were measured using a standardised, semi-structured clinical interview administered by mental health professionals. The main outcome, quality of life, was measured using the Quality of Life in Epilepsy questionnaire (QOLIE-10p). The secondary outcome, functional disability, was assessed using the 12-item World Health Organization Disability Assessment Schedule (WHODAS-2). Results The prevalence of comorbid mental disorders was 13.9%. Comorbid mental disorders were associated with poorer quality of life (Adjusted (Adj.) β -13.27; 95% CI -23.28 to-3.26) and greater disability (multiplier of WHODAS-2 score 1.62; 95% CI 1.05, 2.50) after adjusting for hypothesised confounding factors. Low or very low relative wealth (Adj. β = -12.57, 95% CI -19.94 to-5.20), higher seizure frequency (Adj.β coef. = -1.92, 95% CI -2.83 to -1.02), and poor to intermediate social support (Adj. β coef. = -9.66, 95% CI -16.51 to -2.81) were associated independently with decreased quality of life. Higher seizure frequency (multiplier of WHODAS-2 score 1.11; 95% CI 1.04, 1.19) was associated independently with functional disability. Conclusion Co-morbid mental disorders were associated with poorer quality of life and impairment, independent of level of seizure control. Integrated and comprehensive psychosocial care is required for better health and social outcomes of people with epilepsy.

scholarly journals VES-13 and WHOQOL-bref cutoff points to detect quality of life in older adults in primary health care

2019 ◽  
Vol 53 ◽  
pp. 26 ◽  
Author(s):  
Samira Monteiro Silva ◽  
Alfredo Nicodemos Cruz Santana ◽  
Nayhane Nayara Barbosa da Silva ◽  
Maria Rita Carvalho Garbi Novaes
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Primary Health Care ◽  
Negative Predictive Value ◽  
Roc Curve ◽  
Predictive Value ◽  
Older Individuals ◽  
Primary Health ◽  
Cutoff Points

OBJECTIVE: To determine Vulnerable Elders Survey (VES-13) and WHOQOL-bref cutoff points to detect poor quality of life (QoL) in older individuals. METHODS: This is a cross-sectional study, performed in all primary health care units in Samambaia, DF, Brazil. The data were collected from August 2016 to May 2017. The sample size of 466 older individuals treated in primary health care was obtained considering a 5% margin of error, 95% confidence level, 50% prevalence, and 20% possible losses, in a population of 13,259 older individuals. The subjects answered the VES-13 and WHOQOL-bref questionnaires. They were divided into 3 subgroups: poorQoL (older individuals with self-reported very poor or poor QoL AND very dissatisfied or dissatisfied with their health), goodQoL (very good or good QoL AND very satisfied or satisfied with Health) and indeterminateQoL (NOT belonging to poorQoL or goodQoL subgroups). A receiver-operating characteristic (ROC) curve was performed with poorQoL (case) versus goodQoL (control) to determine the cutoff score in VES-13 and WHOQOLbref. A diagnostic test using these cutoffs was carried out in all older individuals (n = 466). RESULTS: The VES-13 and WHOQOL-bref cutoff points to detect poorQoL were ≥ 2 and < 60, respectively. The area under ROC curve of VES-13 and WHOQOL-bref was 0.741 (CI95% 0.659- 0.823; p < 0.001) and 0.934 (CI95% 0.881-0.987; p < 0.001), respectively. In diagnostic tests, VES-13 showed 84% sensitivity and 98.2% negative predictive value, and WHOQOL-bref, 88% sensitivity and 99% negative predictive value. CONCLUSIONS: VES-13 score ≥ 2 and WHOQOL-bref score < 60 adequately detected poorQoL in patients treated in primary health care. Our data suggest that older individuals with these scores require special treatment such as geriatrics collaborative care to improve this scenario, considering QoL impact on mortality.

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