scholarly journals Abordagem do Delirium na Comunidade

2021 ◽  
Author(s):  
Catarina Rebelo ◽  
Hugo Oliveira ◽  
Maria do Céu Rocha
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
General Practitioners ◽  
Domiciliary Care ◽  
General Physicians

INTRODUÇÃO: O delirium é uma das complicações neuropsiquiátricas mais frequentes em Cuidados Paliativos. Constitui uma disfunção neurológica grave, não existindo diretrizes bem estabelecidas para a sua gestão na comunidade. O objetivo deste trabalho consiste na revisão da evidência existente sobre a abordagem do delirium na comunidade, em particular em Portugal.MÉTODOS: Revisão da literatura utilizando os termos MeSH delirium, palliative care, domiciliary care, general practitioners, general physicians, primary care, Portugal e end of life.RESULTADOS E CONCLUSÃO: O delirium é, habitualmente, multifatorial, tendo um impacto importante nos serviços de saúde, profissionais, cuidadores e, sobretudo, nos doentes. A evidência científica para o seu tratamento é escassa e aplica-se, sobretudo, aos cuidados hospitalares. A estruturação de cuidados de qualidade no âmbito da prevenção, identificação atempada e gestão precoce do delirium, no contexto dos Cuidados Paliativos na comunidade, deve incluir o doente, a sua família e o ambiente onde se insere.

Palliative care consultations in primary care: a cross-sectional survey among Dutch general practitioners

2016 ◽  
pp. bmjspcare-2015-000967 ◽  
Author(s):  
Patrick D Hoek ◽  
Henk J Schers ◽  
Jan C M Hendriks ◽  
Kris C P Vissers ◽  
Jeroen G J Hasselaar
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
General Practitioners ◽  
Cross Sectional Survey ◽  
Cross Sectional

scholarly journals How can primary care enhance end-of-life care for liver disease? Qualitative study of general practitioners’ perceptions and experiences

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017106 ◽  
Author(s):  
Holly Standing ◽  
Helen Jarvis ◽  
James Orr ◽  
Catherine Exley ◽  
Mark Hudson ◽  
...  
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Liver Disease ◽  
End Of Life ◽  
General Practitioners ◽  
End Of Life Care ◽  
Symptom Relief ◽  
Social Consequences ◽  
Life Care ◽  
Qualitative Interview Study

BackgroundLiver disease is the third most common cause of premature death in the UK. The symptoms of terminal liver disease are often difficult to treat, but very few patients see a palliative care specialist and a high proportion die in hospital. Primary care has been identified as a setting where knowledge and awareness of liver disease is poor. Little is known about general practitioners’ (GPs) perceptions of their role in managing end-stage liver disease.ObjectiveTo explore GPs’ experiences and perceptions of how primary care can enhance end-of-life care for patients with liver disease.DesignQualitative interview study, thematic analysis.ParticipantsPurposive sample of 25 GPs from five regions of England.ResultsGPs expressed a desire to be more closely involved in end-of-life care for patients with liver disease but identified a number of factors that constrained their ability to contribute. These fell into three main areas; those relating directly to the condition, (symptom management and the need to combine a palliative care approach with ongoing medical interventions); issues arising from patients’ social circumstances (stigma, social isolation and the social consequences of liver disease) and deficiencies in the organisation and delivery of services. Collaborative working with support from specialist hospital clinicians was regarded as essential, with GPs acknowledging their lack of experience and expertise in this area.ConclusionsEnd-of-life care for patients with liver disease merits attention from both primary and secondary care services. Development of care pathways and equitable access to symptom relief should be a priority.

scholarly journals Collaborative Networks in Primary and Specialized Palliative Care in Switzerland - Perspectives of Doctors and Nurses

2020 ◽  
Vol 13 (1) ◽  
pp. 36-43
Author(s):  
R. Schweighoffer ◽  
E. Reeves ◽  
B. Liebig
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
General Practitioners ◽  
Service Providers ◽  
Healthcare Providers ◽  
Collaborative Networks ◽  
Interaction Patterns ◽  
Specialized Care ◽  
Specialized Palliative Care ◽  
Doctors And Nurses

Purpose: To date, information about collaborative networks of doctors and nurses in palliative care is still scarce, yet of great importance in revealing gaps in collaboration. This paper investigates the collaboration frequencies of medical doctors and nurses within, and across, different settings of palliative care. Methods: The study was based on a Swiss national survey on “Collaboration and cooperation in Palliative Care”. The subjects surveyed included service providers in the primary and specialized palliative care sectors, as well as support services (N=1111). Information about ties between providers was gathered by asking professionals to estimate the frequency of interaction with other professionals within the last year, on a daily, weekly, monthly and yearly basis. Social network analysis was used to assess the interaction patterns of nurses and doctors (N= 728) in primary and specialized care settings. Results: Visual representations indicated that, contrary to primary care settings, healthcare providers in specialized care settings reported of numerous interactions with other professions. In primary care, general practitioners reported the least frequent interactions with other professions. Of all providers investigated, specialized doctors in hospitals and hospices reported the densest collaborative networks. Implication: Gaps regarding collaboration in Swiss palliative care provision were revealed. Based on the results of the study, recommendations on how to improve service quality by strengthening the interaction patterns of general practitioners, as well as community-based palliative care, are provided.

scholarly journals Service change and innovation in community end-of-life care during the COVID-19 pandemic: Qualitative analysis of a nationwide primary care survey

2021 ◽  
pp. 026921632110493
Author(s):  
Sarah Mitchell ◽  
Madeleine Harrison ◽  
Phillip Oliver ◽  
Clare Gardiner ◽  
Helen Chapman ◽  
...  
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
United Kingdom ◽  
End Of Life ◽  
General Practitioners ◽  
End Of Life Care ◽  
Life Care ◽  
Specialist Palliative Care ◽  
Care Services ◽  
Palliative Care Services

Background: Primary healthcare teams (general practice and community nursing services) within the United Kingdom provided the majority of community end-of-life care during COVID-19, alongside specialist palliative care services. As international healthcare systems move to a period of restoration following the first phases of the pandemic, the impact of rapidly-implemented service changes and innovations across primary and specialist palliative care services must be understood. Aim: To provide detailed insights and understanding into service changes and innovation that occurred in UK primary care to deliver end-of-life care during the first phase of the COVID-19 pandemic. Design: Cross-sectional online survey. Responses were analysed using descriptive statistics and thematic analysis. Setting/participants: United Kingdom survey of general practitioners and community nurses, circulated via regional and national professional networks. Results: A total of 559 valid responses were received from 387 community nurses, 156 general practitioners and 16 ‘other’. Over a third of respondents ( n = 224; 40.8%) experienced changes in the organisation of their team in order to provide end-of-life care in response to the COVID-19 pandemic. Three qualitative themes were identified: COVID-19 as a catalyst for change in primary palliative care; new opportunities for more responsive and technological ways of working; and pandemic factors that improved and strengthened interprofessional collaboration. Conclusion: Opportunity has arisen to incorporate cross-boundary service changes and innovations, implemented rapidly at the time of crisis, into future service delivery. Future research should focus on which service changes and innovations provide the most benefits, who for and how, within the context of increased patient need and complexity.

scholarly journals Community end-of-life care during the COVID-19 pandemic: Initial findings of a UK primary care survey

2021 ◽  
Author(s):  
Sarah Mitchell ◽  
Phillip Oliver ◽  
Clare Gardiner ◽  
Helen Chapman ◽  
Dena Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
General Practice ◽  
End Of Life ◽  
General Practitioners ◽  
End Of Life Care ◽  
Life Care ◽  
Face To Face ◽  
The Uk ◽  
Remote Consultations

AbstractBackgroundThousands of people in the UK have required end-of-life care in the community during the COVID-19 pandemic. Primary healthcare teams (general practice and community nursing services) have provided the majority of this care, alongside specialist colleagues. There is a need to learn from this experience in order to inform future service delivery and planning.AimTo understand the views of general practitioners and community nurses providing end-of-life care during the first wave of the COVID-19 pandemic.Design and SettingA web-based, UK-wide questionnaire survey circulated via professional general practice and community nursing networks during September and October 2020.MethodResponses were analysed using descriptive statistics and an inductive thematic analysis.ResultsValid responses were received from 559 individuals (387 community nurses, 156 General Practitioners (GPs) and 16 unspecified role), from all regions of the UK. The majority reported increased involvement in providing community end-of-life care. Contrasting and potentially conflicting roles emerged between GPs and community nurses. There was increased use of remote consultations, particularly by GPs. Community nurses took greater responsibility in most aspects of end-of-life care practice, particularly face-to-face care, but reported feeling isolated. For some GPs and community nurses, there has been considerable emotional distress.ConclusionPrimary healthcare services are playing a critical role in meeting increased need for end-of-life care in the community during the COVID-19 pandemic. They have adapted rapidly, but the significant emotional impact, especially for community nurses, needs addressing alongside rebuilding trusting and supportive team dynamics.How this fits in (4 sentences)This study provides insights into experiences of delivering end-of-life care in the community during the first wave of the COVID-19 pandemic from the perspectives of UK general practitioners (GPs) and community nurses.Services have changed and adapted rapidly to meet increased need in terms of both volume and complexity, with community nurses taking greater responsibility for most areas of palliative care clinical practice, and GPs undertaking more care planning conversations.While GPs and specialist palliative care services conducted more remote consultations, community nurses carried out face-to-face end-of-life care and reported a feeling of isolation.As the pandemic progresses, and the increased need for end-of-life care in the community persists, more effective service models and multi-disciplinary teamwork in primary care are urgently needed.

scholarly journals Palliative care and complex chronic conditions since the perspective of healthcare professionals

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Doñate-Martínez ◽  
L Llop ◽  
J Garcés
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Early Identification ◽  
Chronic Conditions ◽  
Healthcare Professionals ◽  
Care Pathway ◽  
Holistic View ◽  
Complex Chronic Conditions ◽  
Symptom Intensity

Abstract Background According to the WHO, palliative care (PC) is applicable early in the course of illness together with other curative therapies. Early PC has demonstrated beneficial effects on quality of life and symptom intensity among cancer patients. However, PC is not as early integrated on the care pathway of complex chronic conditions (CCC). This abstract presents barriers and needs identified to effectively implement early PC on CCC performed under the EU-funded InAdvance project (ref.: 825750). Methods Semi-structured interviews were performed with 16 healthcare professionals (HPs) from primary care and hospital settings working with older patients with CCC in Valencia (Spain). Results Interviews reported that main needs identified to provide early PC are: (a) coordinated strategies between multi-setting HPs to an early identification of CCC patients in need of PC; (b) adequate resources to attend patients' PC needs from a holistic view, i.e. psychosocial and spiritual needs; and (c) early integration of basic PC at primary care teams. The main barriers identified were: (a) stereotypes associated to the traditional PC approach; (b) poor knowledge from HPs of the PC holistic approach; and (c) lack of specific protocols or pathways for CCC in need of PC. Conclusions Specific skills and resources are the most relevant needs to effectively provide early PC among patients with CCC. First, it is urgent to demystify the negative culture-related vision of PC that is commonly associated to sedation and last days of a person's life. Also, multidisciplinary HPs require specific training to identify and provide early PC tailored to CCC. And, it is required a strategic and multi-setting organizational approach with fluent information flow and coordinated roles. Key messages Healthcare expenditure would be considerably reduced, especially at hospital and emergency units, with an early identification of patients with CCC in need of PC. Empowering primary HPs in PC would improve the quality of care of patients with CCC.

scholarly journals What is the present role for general practitioners in dementia care? Experiences of general practitioners, patients and family carers in Portugal

Dementia ◽  
2020 ◽  
pp. 147130122097771
Author(s):  
Conceição Balsinha ◽  
Steve Iliffe ◽  
Sónia Dias ◽  
Alexandre Freitas ◽  
Joana Grave ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Social Contexts ◽  
Dementia Care ◽  
Family Carers ◽  
Primary Care Teams ◽  
Qualitative Interview Study ◽  
Framework Approach ◽  
Advanced Stages ◽  
Patient Relationships

Background Governments are being challenged to integrate at least part of dementia care into primary care. However, little is known about the current role of general practitioners (GPs) regarding dementia care, especially in countries that do not have dementia strategies in place. The aim of this study was to explore the experiences of GPs, persons with dementia and their family carers in Portuguese primary care settings, to better understand GPs’ contribution to dementia care. Methods A qualitative interview study of participants recruited from six practices in different social contexts within the Lisbon metropolitan area was carried out. Purposive sampling was used to recruit GPs, persons with dementia and carers. Interviews with GPs explored dementia care comprehensiveness, including satisfactory and challenging aspects. Interviews with patients and carers explored the experience of talking to GPs about cognitive impairments and related difficulties and the type of help received. Thematic analysis of interview transcripts was carried out using the framework approach. Results Five major themes were identified: GPs have a limited contribution to dementia care, the case of advanced dementia, doctor–patient relationships, doctor–carer relationships and management of chronic conditions other than dementia. Conclusion General practitioners seemed to contribute little to dementia care overall, particularly regarding symptom management. The exception was patients with advanced stages of dementia, given that specialists no longer followed them up. Remarkably, GPs seemed to be alone within primary care teams in providing dementia care. These findings strongly suggest that Portuguese primary care is not yet prepared to comply with policy expectations regarding the management of dementia.

scholarly journals 5 Primary care delivers palliative care during COVID-19: a national UK survey of GP’s and community nurses

2021 ◽  
Author(s):  
Catriona R Mayland ◽  
Sarah Mitchell ◽  
Phillip Oliver ◽  
Clare Gardiner ◽  
Helen Chapman ◽  
...  
Keyword(s):  
Primary Care ◽  
Palliative Care

Challenging care work: General practitioners’ perspectives on caring for young adults with complex psychosocial problems

2019 ◽  
pp. 136345931987410
Author(s):  
Julie Høgsgaard Andersen ◽  
Tine Tjørnhøj-Thomsen ◽  
Susanne Reventlow ◽  
Annette Sofie Davidsen
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Young Adults ◽  
General Practitioners ◽  
Mental Health Problems ◽  
Psychosocial Problems ◽  
Health Problems ◽  
Care Work ◽  
Psychiatric Nurses ◽  
Provision Of Care

The international literature shows that primary care is well placed to address mental health problems in young people, but that primary care professionals experience a range of challenges in this regard. In Denmark, young adults who have complex psychosocial problems, and who are not in education or work, cause political and academic concern. They are also in regular contact with their general practitioners, the Danish municipalities and psychiatric services. However, little is known about general practitioners’ perspectives on caring for this vulnerable group of patients. In this article, we investigate how general practitioners’ care work is shaped by the bureaucratic management of care in a complex infrastructure network comprising the general practitioners, psychiatry, the municipalities and the young adults. The analysis is based on interviews and focus groups with general practitioners, psychiatric nurses and social workers. We employ Tronto’s concept of care and the concept of boundary work as a theoretical framework. We argue that general practitioners strive to provide care, but they are challenged by the following: contested diagnostic interpretations and the bureaucratic significance of diagnoses for the provision of care from psychiatry and the municipalities, systemic issues with handling intertwined social and mental health problems, and the young adults’ difficulties with accessing and receiving available care.

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