Patient satisfaction in Home care services through e-Palliative Care -An experience of tertiary cancer centre from Kerala

Objectives: e-palliative care (PC) is an evolving concept wherein technological interface is used to deliver PC to the patients with advanced cancer at their doorstep. This study aims to find out the level of satisfaction of patients receiving e-palliative homecare (e-PHC) service from a tertiary Cancer Center using the validated e-Palliative Patient Satisfaction Questionnaire –Malayalam (PSQM). Materials and Methods: In this prospective study, patients/caregivers on home care were given the e - Palliative PSQM by the homecare nurse after the patient had consulted the doctor through e-PHC service. The questionnaire had 15 statements with response graded using Likert scale. Descriptive analysis was performed to compute the distribution of observed responses to obtain the level of satisfaction among patients or caregivers receiving e-PHC service. Results: This study was done among 120 homecare patients whose median age was 69 (62-79) with almost equal prevalence of both genders. Stage 4 malignancy was seen in 107 (89.2%) patients with the commonest being gastrointestinal malignancy (N=34, 28.3%) The mean score of response for General satisfaction, Technical quality, Communication, Financial aspect, Time spent with doctor and Accessibility and convenience were observed as 4.52, 3.92, 4.48, 4.55, 4.52 and 4.49 respectively. The overall satisfaction was found to be 4.39. Conclusion: The overall satisfaction of patients receiving e-PHC service from our Institution is seen to be high. e- palliative care is a feasible option for providing excellent PC in developing countries with limited resources and financial constraints.

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P035: Improving emergency department outcomes for Alberta seniors

CJEM ◽

10.1017/cem.2020.242 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S77-S77

Author(s):

G. Sandhar ◽

M. Kruhlak ◽

L. Krebs ◽

L. Gaudet ◽

S. Couperthwaite ◽

...

Keyword(s):

Home Care ◽

Descriptive Analysis ◽

Patient Characteristics ◽

Home Care Services ◽

Community Services ◽

Care Services ◽

Lengths Of Stay ◽

General Weakness ◽

Transition Coordinators ◽

Referral Form

Introduction: In 2010, Alberta Health Services (AHS) introduced Transition Coordinators (TC), a unique nursing role focused on assessment of elderly patients to support safe discharge home. The objective of this study is to describe patient characteristics to predict safe discharge for seniors (≥65 years of age) and identify barriers that can be used to improve ED outcomes for these patients. Methods: Two trained research assistants conducted a chart review of the TC referral form and the ED Information System (EDIS) for patients seen by TCs between April and June 2017. Information on patient characteristics, existing home care and community services, the index ED visit and subsequent revisits were extracted. Data were entered into a purpose-built database in REDCap. A descriptive analysis was conducted; results are reported as mean ± standard deviation (SD), median (interquartile range [IQR]), or proportions, as appropriate. Results: A total of 1411 patients with TC referral forms were included (779 [55%] female). The majority of these patients were ≥65 (1350 [96%]) with a mean age of 82 ± 9.6. The majority of patients were triaged as a CTAS of 3 (835 [59%]) with the most common reasons for presentation including: shortness of breath (128 [9%]), abdominal pain (94 [6.7%]), and general weakness (81 [5.7%]). Nearly one third of patients (391 [30%]) were already receiving home care services; (96 [7%]) received a new home care referral as a result of their ED visit. Of all the patients, 1111 (79%) had comorbidities (median: 3 [IQR: 1 to 5]). Overall, 38% (n = 536) patients had visited the ED in the 12 months prior to the index with a median of 2 [IQR: 1 to 4) visits. On average, patient's length of stay for their index visits was 12 ± 0.35 hours. Admissions occurred for 599 [42%] patients with delays being common; the mean time between the decision to admit and the patient leaving the ED was 6 hrs ± 0.23. Conclusion: Seniors in the ED are complex patients who experience long lengths of stay and frequent delays in decision-making. Upon discharge, few patients receive referrals to community supports, potentially increasing the likelihood of revisits and readmissions. Future studies should assess whether the presence of TCs is associated with better outcomes in the community.

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Simultaneous Care clinic (SCC): A three-year monoinstituional experience.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.169 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 169-169

Author(s):

Silvia Stragliotto ◽

Antonella Brunello ◽

Sara Galuppo ◽

Sabina Murgioni ◽

Vincenzo Dadduzio ◽

...

Keyword(s):

Palliative Care ◽

Home Care ◽

Median Time ◽

Social Issues ◽

Home Care Services ◽

Cancer Type ◽

Nutritional Evaluation ◽

Care Clinic ◽

Oncological Treatment ◽

Care Services

169 Background: Early palliative care has been shown to improve outcomes in pts with advanced cancer. In accordance with ASCO and AIOM recommendations of implementing palliative care early for pts with metastatic cancer along with active cancer treatment a SCC was set up at Istituto Oncologico Veneto (IOV) in Padova since 2014; Methods: Data of pts referred to the SCC from Mar 2014 to Nov 2016 were retrieved from a prospectively maintained database. Data collected included cancer type, status of disease, PS, ongoing oncological treatment, psychological evaluation, social evaluation, nutritional evaluation, activation of home territorial services and/or Palliative Care services, use of other health services after a first visit and place of death; Results: 533 pts were evaluated by a multidisciplinary team. Overall symptom burden was low with baseline symptom scores highest for fatigue, lack of appetite and depression. Nutritional evaluation revealed 224 pts (42%) with nutritional problems, the most frequent being weight loss (n = 121). Psychological distress was present in 185 pts (35%). Social issues were present in 26 pts (5%) and were dealt with activation of social services (n = 9) or volunteer territorial services (n = 8). Patients deemed in need of home care services after the first access to the SCC were 177 (33%) and for these a formal request for Home Care services activation was sent to the Local Health Territorial Unit. After the first visit 141 patients referred to Emergency Room for intervening problems with median time of 41 days. Globally 290 pts (54%) died with 53% of deaths occurring at home. For pts who were receiving active oncological treatment median time from first-visit in the SCC and death was 126 days. We are also evaluating a score for priority for access to SCC; Conclusions: Early integrated SC may be most effective if targeted to the specific needs of each patient population

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Active identification of patients appropriate for palliative care: Impact on use of palliative care and home care resources.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.101 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 101-101

Author(s):

Nicole Mittmann ◽

Ning Liu ◽

Marnie MacKinnon ◽

Soo Jin Seung ◽

Nicole Look Hong ◽

...

Keyword(s):

Palliative Care ◽

Home Care ◽

Service Use ◽

Intervention Group ◽

Home Care Services ◽

Control Group ◽

Palliative Approach ◽

Active Identification ◽

Care Services ◽

Primary Care Teams

101 Background: This research evaluates whether active identification of patients who may benefit from a palliative approach to care changes the use of palliative care and home care services. Methods: Between 2014 and 2017, Cancer Care Ontario implemented the INTEGRATE project at 4 cancer centres and 4 primary care teams. Physicians in participating sites were encouraged to systematically identify patients who were likely to die within 1 year and would benefit from a palliative approach to care. Patients in the INTEGRATE intervention group were 1:1 matched to non-intervention controls selected from provincial healthcare administrative data based on a publicly funded health system using the propensity score-matching. Palliative care and home care services utilization was evaluated within 1 year after the date of identification (index date), censoring on death, or March 31, 2017, the study end date. Cumulative incidence function was used to estimate the probability of having used care services, with death as a competing event. Rate of service use per 360 patient-days was calculated. Analyses were done separately for palliative care and home care. Results: Of the 1,187 patients in the INTEGRATE project, 1,185 were matched to a control. The intervention and the control groups were well-balanced on demographics, diagnosis, comorbidities, and death status. The probability of using palliative services in the intervention group was 80.3%, which was significantly higher than that in the control group (62.4%) with more palliative care visits in the intervention group [29.7 (95%CI: 29.4 to 30.1] per 360 patient-days) than in the control group [19.6 (95%CI: 19.3 to 19.9) per 360 patient-days]. The intervention group had a greater probability of receiving home care (81.4%) than the control group (55.2%) with more homecare visits per 360 patient-days [64.7 (95%CI: 64.2 to 65.3) vs. 35.3 (95%CI: 34.9 to 35.7)] The intervention group also had higher physician home visits as compared to the control group (36.5% vs. 23.7%). Conclusions: Physicians actively identifying patients that would benefit from palliative care resulted in increased use of palliative care and home care services.

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