Community Care System Research Articles

Activities of a Pharmacist in Community Medicine in Nagasaki, Japan

With the increasing separation of dispensing and prescribing, Japanese pharmacists have changed over the past 50 years. Changes affecting pharmacists include the bashing of the separation of dispensing and prescribing, the formulation of the "Vision for Patient-centered Pharmacies" and the implementation of the Action Plan to realize this vision, and the amendment of the "Pharmaceuticals and Medical Devices Act." By 2025, when many baby boomers will be 75 years of age and older, the construction of the "Integrated Community Care System" is being promoted in various regions, and pharmacists are expected to be involved in community healthcare as members of community support networks based on multidisciplinary cooperation. In Nagasaki City, Japan, a regional medical cooperation system centered on the "Nagasaki Home Doctor Net" has been established, and a multidisciplinary network supports the region. In 2007, volunteers, mainly pharmacy managers, established the "Nagasaki Pharmaceutical Care Net (P-net)" to provide home medical care. To date, these volunteers have been involved in community healthcare while continuing their studies through the group. At the symposium, I introduced my active involvement in community healthcare as a pharmacist and as a member of P-net. I hope this symposium will help pharmacists' involvement and collaboration in community healthcare.

Patterns of care contacts in the final year of life among opioid overdose fatalities in southern Sweden: a latent class analysis

BackgroundUnderstanding the heterogeneity of opioid overdose fatalities is critical to developing effective preventive interventions. This study examines patterns of care contacts among people who subsequently died from opioid overdose. The aim was to identify distinct groups of deceased individuals, based on their contacts with different care agencies in their last year of life.MethodsA retrospective registry study was conducted in Skåne, Southern Sweden. All recorded opioid overdose fatalities during the study period were included, n = 191. Latent class analysis was used to identify patterns of care contacts in the last year of life.ResultsThree distinct classes were identified: “Few care contacts,” with limited interaction with any services; “Social service contacts,” comprising individuals who predominantly had contacts with the social services and, to a lesser extent, with prison and probation services; and “Numerous care contacts,” with extensive contacts with both healthcare and social services. The “few care contacts” class comprises about half of the population. This is an important finding, since this group has not been clearly visible in previous research. The analysis indicates significant gaps in service provision, particularly regarding substance use treatment and mental health support.ConclusionsUsing a person-centred approach, this article offers a novel way of analysing care contacts among people who subsequently died from opioid overdose. The identification of distinct groups, particularly a large group of people with minimal contact with the community care system, highlights the need for more targeted outreach and support work. Developing targeted interventions in emergency and inpatient care settings may provide an opportunity to reach the group with few care contacts.

Strengthening the role of primary care for the success of the community care system

Background: Globally, population aging is a widespread phenomenon. However, Korea is experiencing this demographic shift at the fastest rate globally. As the number of older adults increases, the local primary healthcare system has become increasingly important in supporting them to maintain their lives within the community.Current Concepts: The integrated medical support project is systematic and comprehensive, focusing on services provided by primary care providers. The project requires a tailored implementation plan specific to the community for long-term operations. Therefore, providers need to explore roles and collaborative measures to establish a sustainable system of primary care-centered supportive care for elderly patients.Discussion and Conclusion: Local governments must identify patients, establish a cooperative system, manage and entrust patient information and communications technology (ICT), educate ICT users, and secure a budget to integrate and provide medical care in the community effectively. The local medical association should establish and operate a medical and healthcare support center, coordinate a consultative body between medical institutions, and implement a 24-hour patient response system. The proposed medical and healthcare support center will facilitate cooperation and comprehensive evaluation during home visits by primary care doctors. This center can also connect patients needing care by collaborating with local care-related organizations. In addition to providing home-visit services, primary care institutions must establish a system for conducting comprehensive patient evaluations with medical care support teams. Additionally, the recommendation is to incorporate elements beyond home-visit treatment fees to facilitate the systematic and intensive management of patients.

Expanding the roles of malaria post workers in Thailand: A qualitative study of stakeholder perspectives.

In Thailand, since the 2000s, malaria post (MP) workers have been tasked with promptly detecting and treating all malaria cases to prevent onward transmission in the communities. Expanding their roles to provide health services beyond malaria has been proposed as a strategy to sustain their activities until elimination is reached. This article examines the perspectives of stakeholders on community-based malaria care to assess prospects for expanding the role of MPs. The study incorporated in-depth interviews (IDIs) and focus group discussions (FGDs). In forested communities and local health facilities in northeast Thailand bordering Lao PDR and Cambodia, where malaria transmission is low, IDIs were conducted with 13 MPs and 23 community members. An additional 14 policymakers and implementers across the health sector in Thailand were interviewed. The respondents highlighted how in these border areas population groups most at risk of malaria, namely forest goers and migrants, are reluctant to visit public health facilities. In these areas, MP workers are well integrated in their communities and remain relevant although the communities no longer see malaria as spriority. Common conditions such as dengue, diabetes, insect bites, diarrhea, mental illness and substance abuse, were identified as local health concerns needing potential add-on services from MP workers. Although challenges in terms of training, supervision, and financing were raised, opportunities included additional funds from local administrative offices to maintain and integrate malaria activities with other health programmes. Changes to the roles of MPs should be adapted to changing local needs, some of which were identified in this study, should avoid duplication and potential tensions with other local health programmes, and need to build on the capacity of the community and primary care system. These enabling factors are worthy of consideration by any malaria programmes looking into maintaining their village malaria workers in the Greater Mekong Subregion.

Adverse Childhood Experiences and Chronic Low Back Pain in Adulthood: The Role of Emotion Regulation

Chronic low back pain (cLBP) is characterized by biopsychosocial determinants that collectively result in a substantial burden at the individual, community, and health care system levels. A growing body of literature suggests that childhood adversity is longitudinally associated with the development and maintenance of various chronic pain conditions in adulthood. Little research has investigated the psychological processes that might underlie the association between adverse childhood experiences (ACEs) and cLBP. Emotion regulation comprises a substantive part of the subjective experience of pain and may be a potential mechanism through which ACEs contribute to cLBP etiology and maintenance. Thus, the current study examined the extent to which emotion dysregulation mediated the relationship between ACEs and pain severity (pain at rest and movement-evoked pain) in adults with cLBP. Participants included 183 adults (53.0% female, 62.5% non-Hispanic Black) between the ages of 18 and 85 with cLBP. Participants self-reported on ACEs, pain, difficulties in emotion regulation (DER), depression, and completed brief physical function tasks. In data analytic models, sociodemographic variables were included as covariates. Analyses revealed that emotion regulation mediated the relationship between ACEs and cLBP severity at rest (indirect effect = .15 [95% CI {.06–.25}]) and with movement (indirect effect = 1.50 [95% CI {.69–2.57}]). Findings suggest ACEs are linked to cLBP severity in adulthood through DER. This aligns with research demonstrating that childhood maltreatment can lead to DER, which perpetuate over the lifespan to impact adult health outcomes. PerspectiveThis study presents emotion dysregulation as a psychological pathway through which childhood adversity may contribute to cLBP in adulthood. This work may bolster our understanding of social experiences as risk factors for chronic pain, while identifying targets for clinical intervention. Trial RegistrationThis study utilized baseline data collected as part of a parent trial titled “Examining Racial and SocioEconomic Disparities in Chronic Low Back Pain” (ClinicalTrials.gov ID: NCT03338192).

향후 건강 상태에 따른 노인의 현 주택 계속 거주 의사에 미치는 요인 건강 상태와 주택환경 중심으로

This study aims to explore the association between the current health status and housing environment and the decision to age in place (AIP), taking into account the future health status of older Korean adults. The study utilized data from the 2020 National Survey of Older Koreans, with a total sample size of 9,920 participants who conducted a self-report. The results showed that, when maintaining the current health status, the decision of AIP had a statistically significant difference with factors such as education level, having a partner, living situation, residential area, and annual household income. However, when considering a weaker health status, the decision of AIP showed a statistically significant difference with sex, educational level, having a partner, and living situation. The results of the logistic regression analyses revealed that when maintaining the current health status, participants with better subjective health conditions and higher depressive scores were more likely to move to a better housing environment. Also, participants who have lived in a single house, townhouse, and multiplex unit, who are not homeowners, have lower satisfaction with their current house, and have higher needs for services for living in their current house were likely to move to a better housing environment. When having a weaker health status, participants who have lower cognitive status, live in a townhouse and multiplex unit, are not homeowners, have lower satisfaction with their current house, and have higher needs for services for living in their current house were less likely to decide on AIP. The study provided evidence for building a community care system by exploring the association of factors related to the decision of AIP with health status.

Impact of the COVID-19 Pandemic on Latino Families With Alzheimer Disease and Related Dementias: Qualitative Interviews With Family Caregivers and Primary Care Providers.

Latino individuals experience disparities in the care of Alzheimer disease and related dementias (ADRD) and have disproportionately high COVID-19 infection and death outcomes. We aimed to gain an in-depth understanding of the impact of the COVID-19 pandemic among Latino families with ADRD in the United States. This was a qualitative study of 21 informal caregivers of Latino individuals with ADRD and 23 primary care providers who serve Latino patients. We recruited participants nationwide using convenience and snowball sampling methods and conducted remote interviews in English and Spanish. We organized the transcripts for qualitative review to identify codes and themes, using a pragmatic approach, a qualitative description methodology, and thematic analysis methods. Qualitative analysis of transcripts revealed eight themes, including (1) the pandemic influenced mental and emotional health; (2) the pandemic impacted physical domains of health; (3) caregivers and care recipients lost access to engaging activities during the confinement; (4) the pandemic impacted Latino caregivers' working situation; (5) the pandemic impacted health care and community care systems; (6) health care and community care systems took measures to reduce the impact of the pandemic; (7) Latino families experienced barriers to remote communication during the pandemic; and (8) caregiver social support was critical for reducing social isolation and its sequalae. Latino families with ADRD experienced similar but also unique impacts compared to those reported in the general population. Unique impacts may result from Latino individuals' underserved status in the United States, commonly held cultural values, and their intersectionality with ADRD-related disability. Family caregiver social support was crucial during this time of adversity. These findings suggest the need for more equitable access, culturally appropriate and trustworthy content and delivery of health care and community services, as well as stronger financial and social supports for family caregivers.

Addressing Perinatal Substance Use: A Triad Approach Led by the Colorado Perinatal Care Quality Collaborative.

Unintentional overdose is a leading driver of maternal death in Colorado. The high volume of maternal deaths from preventable causes lends questions to failures in our clinical and community-based care for pregnant and postpartum people. The Colorado Maternal Mortality Review Committee identified 3 main contributors including stigma in the community and health care system, fragmentation of the health care system, and the need for more clinician training. The Colorado Perinatal Care Quality Collaborative led a 3-pronged intervention to address these challenges and improve perinatal care. The first intervention, the Colorado Alliance for Innovation on Maternal Health Substance Use Disorder quality improvement initiative, partnered with birthing hospitals statewide to institute universal screening and timely referral for individuals at risk of substance use disorder (SUD) and perinatal mood and anxiety disorders. The second intervention, the Improve Perinatal Access, Coordination, and Treatment for Behavioral Health initiative, established a perinatal support network within communities. This program assists individuals with SUD, perinatal mood and anxiety disorders, or social needs to navigate the perinatal period. The third intervention, the Colorado Maternal Overdose Matters Plus program, has enhanced in-hospital access to pharmacotherapy for pregnant and postpartum individuals with SUD through training and technical support. These collaborative initiatives aim to minimize barriers to care by integrating inpatient screening, treatment referrals, pharmacotherapy access, and community care support to mitigate maternal mortality in Colorado.

Family Reflections on a Lifecourse Journey after Neonatal Intensive Care: Neurodiversity, Enablement and Hope.

In 1969, my sister Christianne was born late preterm with a genetic disorder and given a very pessimistic prognosis. I will describe, from a family perspective, some lifecourse lessons about neurodiversity using the World Health Organization International Classification Model of Functioning (WHO-ICF). This model emphasizes that, in communicating about the complexity of outcomes of disability, attention must be paid to facilitators and barriers for optimizing health, functioning in daily life, and participation in the community. I will describe several developmental lifecourse lessons learned in negotiating fragmented systems of health, education, and community care. I will suggest ways to improve physician-parent communication, focusing on enablement to decrease a family's sense of isolation and despair. I have benefitted from my parents' archives, discussions with all my seven sisters (including Christianne), and discussions with my brother and sister-in law. They all have provided invaluable feedback from a family perspective during Christianne's lived lifecourse journey with neurodiversity.

노인복지관 이용 노인들의 돌봄 욕구 분석

This study used integrated research methods to explore the role of senior welfare centers in implementing the care recognized in the senior welfare field as a service. Because it is not easy to determine what level and scope of care should be provided as a service at senior welfare centers, the role and identity of senior welfare centers need to be redefined in the community care system. Based on this reality, this study was conducted through a mixture of qualitative and quantitative research to examine what care is perceived by those using Senior Welfare Center B and the content of actual care that meets the needs of the elderly. The qualitative study was conducted through FGI and categorized and analyzed using the grounded theory method, and the quantitative study was conducted through statistical analysis after surveying 300 users of B Senior Welfare Center. As a result of the FGI analysis, the active life and health care of the elderly, the active life of the elderly and B elderly welfare center, the active life and social participation of the elderly, the active life and lifelong education of the elderly, and the conclusion of the active life of the elderly were presented as major issues. In the quantitative analysis, the priorities of care services and specific contents of care to be considered were derived. Based on the results of quantitative and qualitative research, the paradigm of care required by the elderly party was examined, and the role of elderly welfare center for the elderly to practice social and cultural care was suggested.

GERO-EDUCATION IN JAPAN: COMMUNITY RE-DESIGNING TO ACHIEVE HEALTHY AGING AND WELL-BEING

Abstract Japan has achieved the world’s highest level of life expectancy and is currently experiencing a super-aging society. Because of this, we have to take steps towards achieving a healthy aging society with evidence-based policies and longevity with happiness (well-being). In addition, it is necessary to integrate digitalization with information and communications technology through more than just the conventional healthcare measures such as going into the local community to increase opportunities for people from all generations to connect and interact. We also have to realize a true “population approach” with the aim of building a community where residents can easily engage in community-based activities centered on self-help and mutual aid. It is an urgent task to create a place for activities such as lifelong education and multi-generational exchanges as well as to build a comprehensively integrated community care system that allows people to live with peace of mind when they need long-term care. Thinking about planning the 100-year life, the super-aging society has had consequences for the healthcare and social care of older people in Japan, leading to societal innovations that promote health in older people. To extend the healthy life expectancy and achieve a bottom-up sense of community resilience and activity, an interdisciplinary gerontological collaboration with multi-stakeholders is indispensable, with collaborators such as municipal governments, industries, professional staffs, academic researchers (including universities, young career researchers, and students), and citizens. This session will introduce our efforts to promote gerontology education through redesigning the community with comprehensive knowledge.

Centering family voice during a public health crisis: Challenge and opportunity for health collaborations and community systems of care.

Evidence is lacking about how to integrate family and community voice into systems of care. This is particularly relevant in public health crises when reducing barriers to health care and resources is critical for everyone, but especially community members who typically experience more barriers to care. Addressing this gap, this study investigated the voice strategies used by systems of care to respond to the COVID-19 pandemic. We conducted semi-structured interviews in three U.S. counties with agency leaders representing healthcare, public health, and early childhood partners in local systems of care (n = 15) and resource navigators who worked with families (n = 4). We found that systems of care were better able to identify and respond to family priorities when they used diverse voice strategies, implemented among multiple agencies involved and at multiple time points. Family and community voice helped uncover blind spots in the crisis response, facilitating reaching more individuals in need. Flexibility in safety net service policies and protocols was critical to each organization in the system of care. Systems of care that develop a multi-dimensional approach to voice strategies that can be readily mobilized in a public health crisis will be more apt to meet emerging needs. Questions remain about whether power sharing that occurred in the context of crisis translates into reform that builds out from family priorities. Common issues to meeting family needs that could be addressed prior to a crisis included outdated resource lists, confusing application processes, poorly translated materials, and insufficient broadband access. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Transforming Care for Older Adults Living with Complex Health Conditions in Ontario Post-Covid: Conference Proceedings and Recommendations.

The virtual conference 'Transforming Care: Supporting Older Adults Post-COVID in Ontario' was held in October 2021. It was organized by Specialized Geriatric Services (SGS) East and held over three half-days. The guiding themes included: The Need, The Innovation, and The Transformation. Over 500 participants heard from ~50 clinicians, researchers, administrators, older adults, care partners, and community partners. The pandemic uncovered and exacerbated existing issues and pushed us to explore new ways to support older adults living with complex health conditions. The following key priorities were identified: older adults and their care partners call for personalized care experiences, and a lifespan approach to care delivery; aging in the community remains the most common preference; an integrated community care system that supports aging at-home should be prioritized; care delivery by SGS interprofessional teams and specialists is paramount to providing comprehensive care; building health human resource capacity should be a system priority; and promising innovations should be scaled and spread. Evidence shows that we cannot return to status-quo; post-pandemic planning of both who we serve and how we serve needs to be anchored in system renewal, not just recovery. Renewal means integrating lessons learned during the pandemic into the redesign of our systems of care. Investments in innovative, upstream strategies that support home and community-based care, and target health promotion and prevention are necessary. The provincial and regional infrastructure of SGS has the expertise and capacity to assist Ontario Health Teams in responding to the evolving health and social needs of this population.

Patient, family, community, and health care system predictors of continuous glucose monitor use.

Patient, family, community, and health care system predictors of continuous glucose monitor use.

Training items for trainee residents in community medicine in rural areas

ObjectiveTo examine the significant events experienced by initial trainees during community medicine training, evaluate their impact on community medicine practice, and support improvements in rural community medicine training.ResultsThree faculty teachers independently evaluated the reports of 25 residents who had completed a four-week community medicine training in a rural area to analyze major events. The reports were analyzed using topics from the Model Core Curriculum for Medical Education that relate to rural medicine. The most frequently reported items were identified as follows: Primary care: 9 (36.0%); integrated community care systems: 8 (32.0%); medical care in the local community: 7 (28.0%); home health care and systems, patient-physician relationship, and end-of-life medical treatment and care: 6 each (24.0%). Reports from residents describing events related to home health care and systems and end-of-life medical treatment and care were related to more than one item.

Development and evaluation of a nursing care profile for the promotion of preventive care measures in post-disaster evacuation areas

Japan is the first country to adopt a return policy after the all-village evacuation due to the Fukushima disaster and reporting on whatâ–™s happening in such areas is important. This is the premise of the work of Naomi Ito, a Public Health Nurse with a Masters of Public Health (MPH) degree and a research assistant in the Department of Radiation Health Management at Fukushima Medical University, Japan. Her research focuses on health issues, including both the direct impacts and secondary health effects in communities where people are encouraged to return following an evacuation order. Important issues are nursing care for the elderly and the concept of â–˜ageing in placeâ–™. In her current study, Ito is investigating a number of cases of Fukushima nuclear accident evacuees following the 2011 nuclear accident in Fukushima and how ageing in place was impacted by relocation, including the cases of three individuals evacuated from Katsurao village who did not return to their original homes following evacuation orders. By looking at their respective health conditions, Ito gained insight into the current situation and key challenges. This research is highlighting issues associated with the provision of medical and welfare services in areas affected by the nuclear accident, with hospitals closed and the evacuation of younger people changing the social structure and impacting the future of this community. The researchers believe that a comprehensive community care system is crucial and that it is important to consider the health challenges facing evacuated residents and a required improvement to medical, welfare and transportation systems.

Management of malignant pleural effusion in Italian clinical practice: a nationwide survey

BackgroundPleural disease (PD), particularly malignant pleural effusion (MPE), is a common cause of hospital admission and its prevalence is rising worldwide. Recent advances in diagnostic and therapeutic options, such as Indwelling Pleural Catheters (IPCs), have simplified PD treatment, allowing an effective outpatients management. Therefore, dedicated pleural services can improve PD care, guaranteeing specialized management and optimizing time and cost. We aimed to provide an overview on MPE management in Italy, mainly focused on distribution and characteristics of pleural services and IPCs use.MethodsA nationwide survey, endorsed by the Italian Thoracic Society, was distributed by email to members of selected subgroups in 2021.ResultsNinety (23%) members replied, most of whom being pulmonologists (91%). MPE resulted the most common cause of pleural effusion and was managed with heterogenous approaches, including talc pleurodesis via slurry (43%), talc poudrage (31%), repeated thoracentesis (22%) and IPCs insertion (2%). The setting of IPC insertion was inpatient care in 48% of cases, with a predominance of draining frequency every other day. IPC management mainly relied on caregivers (42%). The presence of a pleural service was reported by 37% of respondents.ConclusionsThe present study provides an extensive overview of MPE management in Italy, showing a highly heterogeneous approach, a scarce prevalence of out-patient pleural services, and a still limited adoption of IPCs, mainly due to lack of dedicated community care systems. This survey emphasizes the need of promoting a higher spreading of pleural services and an innovative healthcare delivery with more favourable cost-benefit ratio.

Physical Activity Engagement: Perspectives From Adolescents With Comorbid Asthma and Overweight/Obesity and Their Caregivers.

Most adolescents do not meet physical activity (PA) guidelines, and engagement rates are even lower among adolescents with asthma and overweight/obesity (OW/OB). Understanding barriers and facilitators to PA engagement that are unique to youth with comorbid asthma and OW/OB is important for PA promotion. The current qualitative study identified caregiver- and adolescent-reported factors contributing to PA among adolescents with comorbid asthma and OW/OB across the four domains of the Pediatric Self-Management Model: individual, family, community, and health care system. Participants were 20 adolescents (Mage = 16.01; 55% male) with asthma and OW/OB and their caregiver (90% mothers). Caregivers and adolescents participated in separate semistructured interviews about influences, processes, and behaviors related to adolescent PA engagement. Interviews were analyzed using thematic analysis. Factors contributing to PA varied across four domains. The individual domain included influences (e.g., weight status, psychological and physical challenges, asthma triggers and symptoms) and behaviors (e.g., taking asthma medications, self-monitoring). At the family level, influences included support, lack of modeling, and independence; processes included prompts and praise; and behaviors included engaging in shared PA and providing resources. Community-level influences included surrounding and settings, social support, and cornonavirus disease-2019-related changes, while behaviors included engaging in PA with others and extracurricular activities. Influences, processes, and behaviors across multiple domains interact to impact adolescent PA engagement, highlighting factors that may be potential leverage points in prevention and intervention efforts to promote adolescent PA.

Service Use as a Predictor of Change in Mental Health Problems Among Children: A Prospective Cohort Study.

Psychosocial interventions for children's mental health problems typically differ in several characteristics, such as therapist training, content, motivation for treatment, and extent of comorbid conditions among patients, depending on whether the interventions take place in clinical research studies or in real-life settings. Accordingly, the effects found in research studies may not be generalizable to typical service provision. The authors sought to examine the potential associations between receiving usual care and later psychiatric symptoms, impairment, and potential improvements in social skills. Participants (N=996) drawn from the 2003-2004 birth cohorts in Trondheim, Norway, included children who received usual care and those who did not receive any services (as a control group). The children were assessed with biennial clinical interviews from ages 4 to 14 years. Random intercept, cross-lagged panel models were combined with propensity scoring to adjust for measured time-varying and all unmeasured time-invariant confounders. Usual care was not associated with alterations in social skills or impairment due to mental health problems. Similarly, usual care provided to 7- to 12-year-olds did not predict changes in the number of symptoms of psychiatric disorders. However, usual care received at ages 0-4 and 5-6 predicted a slight increase in the number of psychiatric symptoms 2 years later. No significant associations between usual care and improved outcomes were detected. These observational findings reveal the need to implement existing evidence-based approaches in usual care and to develop evidence-based approaches to the complex cases often seen in specialty and community care systems.

Actual condition and problems to be solved regarding construction of comprehensive community care system dealing with mental disorders

Actual condition and problems to be solved regarding construction of comprehensive community care system dealing with mental disorders