Implementation Of Care Plans Research Articles

Cancer survivorship and long-term outcomes: navigating the challenges beyond treatment

The increasing number of cancer survivors due to advancements in early detection and treatment has shifted the focus of oncology to the long-term health and well-being of these individuals. Cancer survivorship encompasses a wide range of challenges that extend beyond the completion of treatment, including physical, psychological, social, and economic issues. This review explores the long-term physical health consequences of cancer treatment, such as neuropathy, cardiotoxicity, and chronic conditions, and highlights the psychological burdens, including anxiety, depression, and cognitive impairment, commonly faced by survivors. The article also addresses the social and economic impacts, such as difficulties in returning to work and financial toxicity, which further complicate the survivorship experience. Additionally, the review emphasizes the importance of assessing and improving the quality of life (QoL) for survivors through personalized interventions and the implementation of survivorship care plans (SCPs). Emerging research on biomarkers, telemedicine, and policy advocacy is discussed as critical components for advancing survivorship care. The review concludes that a comprehensive approach, including ongoing research, personalized care, and supportive policies, is essential to meet the diverse needs of cancer survivors and improve their long-term outcomes and QoL.

Implementation of an electronic nursing care plan in a training and research hospital: qualitative examination of nurses' experiences and opinions

Implementation of an electronic nursing care plan in a training and research hospital: qualitative examination of nurses' experiences and opinions

The development and implementation of a specialised care plan for late preterm and small for gestational age neonates admitted in maternity settings

IntroductionWhile there is recognition that Late preterm (LP) and small for gestational age (SGA) neonates have complex needs, reports on pragmatic approaches to optimise the care of these infants in practice are limited. AimTo implement and evaluate a specialised care plan to support the provision of optimal care to LP and SGA neonates admitted on maternity wards. MethodsA specialised care plan was implemented in a pre-post interventional study. Data were collected on neonates’ characteristics, hypoglycaemic incidents, and hypoglycaemia that led to a Neonatal Intensive Care admission. ResultsApproximately 10% of neonates born in the pre and post intervention periods were LP or SGA. Neonatal hypoglycaemic events reduced from six pre-intervention to three events post-intervention. Instances of neonatal hypoglycaemia that led to Neonatal Intensive Care admission reduced from three pre-intervention to one post-intervention. ConclusionThe specialised care plan was effective in optimising care for LP and SGA neonates.

Multidisciplinary approach to advance care planning and directives in patients with end-stage renal disease: a point of view on patient-centered decision-making.

Implementing Advance Care Planning (ACP) for patients with End-Stage Kidney Disease (ESKD), particularly in the context of hemodialysis, presents significant challenges. Despite existing legal frameworks, disparities in advance care planning practices are evident across Europe. The present perspective introduces a multidisciplinary model, initiated in 2019. This model incorporates a specialized team comprising a nephrologist, a psychologist, a palliative care specialist, and an anesthesiologist/intensivist. Through this collaborative approach, we aimed to comprehensively address the intricate medical, emotional, and psychological dimensions in advance care planning. In this point of view, we discuss the strengths of our model, its potential for European Nephrology, and advocate for guidelines to enhance advance care planning implementation within the nephrology community.

The implementation of person-centred plans in the community-care sector: a qualitative study of organizations in Ontario, Canada

BackgroundPerson-centred planning refers to a model of care in which programs and services are developed in collaboration with persons receiving care (i.e., persons-supported) and tailored to their unique needs and goals. In recent decades, governments around the world have enacted policies requiring community-care agencies to adopt an individualized or person-centred approach to service delivery. Although regional mandates provide a framework for directing care, it is unclear how this guidance is implemented in practice given the diversity and range of organizations within the sector. This study aims to address a gap in the literature by describing how person-centred care plans are implemented in community-care organizations.MethodsWe conducted semi-structured interviews with administrators from community-care organizations in Ontario, Canada. We asked participants about their organization’s approach to developing and updating person-centred care plans, including relevant supports and barriers. We analyzed the data thematically using a pragmatic, qualitative, descriptive approach.ResultsWe interviewed administrators from 12 community-care organizations. We identified three overarching categories or processes related to organizational characteristics and person-centred planning: (1) organizational context, (2) organizational culture, and (3) the design and delivery of person-centred care plans. The context of care and the types of services offered by the organization were directly informed by the needs and characteristics of the population served. The culture of the organization (e.g., their values, attitudes and beliefs surrounding persons-supported) was a key influence in the development and implementation of person-centred care plans. Participants described the person-centred planning process as being iterative and collaborative, involving initial and continued consultations with persons-supported and their close family and friends, while also citing implementation challenges in cases where persons had difficulty communicating, and in cases where they preferred not to have a formal plan in place.ConclusionsThe person-centred planning process is largely informed by organizational context and culture. There are ongoing challenges in the implementation of person-centred care plans, highlighting a gap between policy and practice and suggesting a need for comprehensive guidance and enhanced adaptability in current regulations. Policymakers, administrators, and service providers can leverage these insights to refine policies, advocating for inclusive, flexible approaches that better align with diverse community needs.

Identifying Conditions for Successful Advance Care Planning Implementation in Primary Care: Coincidence Analysis (RP108)

Identifying Conditions for Successful Advance Care Planning Implementation in Primary Care: Coincidence Analysis (RP108)

The role of nursing care during post-burn mood disorders: A narrative review

Burn injury patients often experience a range of psychological challenges, such as pain, anxiety, and depression. In this context, nurses have a crucial responsibility in caring for clients with mood disorders. In the current study, the authors aim to provide a comprehensive perspective on nursing role during post-burn mood disorders among burn patients by reviewing previous evidence literature. A comprehensive literature search was conducted on PubMed and Scopus databases using the following key terms "burns", "severe burns", "mood disorders", and "nursing". The search desire focused on papers related to burns, mood disorders, and nursing. 20 studies were selected for this review. Nurses play a crucial role in managing post-burn psychological conditions like depression, post-traumatic stress disorder (PTSD), and anxiety. Their responsibilities include early detection, holistic assessment, and intervention in addressing patients' emotional well-being. Educating patients and families, providing emotional support, and creating a therapeutic environment are critical aspects of nursing care. Nurses work to demystify psychological conditions, encourage mental health engagement, and implement personalized care plans. By reducing stress, promoting emotional well-being, and facilitating access to mental health services, nurses contribute significantly to burn survivors' recovery and quality of life. Nursing’s integral role in managing post-burn psychological conditions like depression, PTSD, and anxiety is crucial. Nurses provide compassionate, holistic care that meets the diverse needs of burn survivors, guiding them toward recovery.

Nursing care in a patient with hysterectomy for cervical cancer

Introduction: Cervical cancer continues to be the leading cause of death worldwide for many women, this type of cancer does not start suddenly, but has a previous evolution from precursor or precancerous lesions, the diagnosis is made in advanced stages of the disease, decreasing or canceling the chances of curative treatment. It is expected that by the year 2032 there will be 21.4 million new patients dealing with this disease in the world. Objective: To develop specialized and individualized comprehensive nursing care in patients with cervical cancer, based on scientific evidence recommendations and interventions. We present the assessment of a post-operative hysterectomy patient for cervical cancer where the nursing care process is applied. Methodology: A clinical case study, a 44-year-old patient was selected for convenience, applying the methodology of the nursing care process, the assessment was made through the 11 functional patterns of Marjory Gordon, the data were obtained from the clinical history, interview and physical examination of the patient. The main human responses are identified to analyze objective and subjective data, clinical judgments are made to implement care plans under the NANDA, NOC, NIC taxonomy. Results: 7 altered patterns were identified; considering as main diagnosis: acute pain and risk of complication; hemorrhage. Nursing care plans were implemented according to the Area model. A change score of +1 and +2 was obtained, which subsequently improved with nursing care. Conclusions: after the surgical procedure; According to the altered patterns, the nursing care process was carried out, observing improvement in the altered patterns, however, the patient remained hospitalized to continue with the specialized therapeutic plans, this implies that the gynecological-obstetric service must have professionals in nursing specialized in this area.

Are specialist-provided end-of-life scenarios key to initiation of advance care planning in primary care? A mixed-methods study.

Specialist-provided end-of-life scenarios (SP-EOLS) may improve advance care planning (ACP) implementation in primary care by helping overcome barriers such as uncertain prognosis and poor interprofessional collaboration. We aimed to explore the current use and potential impact of SP-EOLS on ACP in Dutch primary care. We performed a mixed-methods study. From patients discussed in a hospital-based academic palliative care multidisciplinary team meeting between 2016 and 2019 and died, we collected primary care electronic medical records data on SP-EOLS, actual EOLS, and ACP initiation and applied descriptive and comparative analyses. Subsequently, we interviewed general practitioners (GPs) and thematically analyzed the transcripts. In 69.7% of 66 reviewed patient files, SP-EOLS were found. In patients whose GP had received SP-EOLS, ACP conversations were more often reported (92.0 vs. 61.0%, p = 0.006). From 11 GP interviews, we identified 4 themes: (1) SP-EOLS guide GPs, patients, and relatives when dealing with an uncertain future perspective; (2) SP-EOLS provide continuity of care between primary and secondary/tertiary care; (3) SP-EOLS should be tailored to the individual patient; and (4) SP-EOLS need to be personalized and uniformly transferred to GPs. SP-EOLS may facilitate ACP conversations by GPs. They have the potential to help overcome existing barriers to ACP implementation by providing guidance and supporting interprofessional collaboration. Future research should focus on improving SP-EOLS and tailor them to the needs of all end users, focusing on improving their effect on ACP conversations.

Attitude of the health team to the infant home care plan during the COVID-19 pandemic: A cross-sectional study.

Maintaining and improving infant health and continuing care at home are very important for the health system. According to the coronavirus disease 2019 (COVID-19) pandemic and its effects on the health system capacity and medical staff's physical-mental health, this study investigated the health staff's attitude on the implementation of an infant home care plan. This descriptive-analytical cross-sectional study was conducted on 130 nurses, midwives, and doctors working in the newborn care department in Isfahan health-therapeutic centers, with at least 6 months of work experience. The samples were selected by random multistage method and completed the researcher-made 5-point Likert questionnaire with 25 items and two areas of education support and security safety. The total score of this questionnaire varied from 25 to 125, and obtaining a score equal to or greater than 91 meant that people had a favorable opinion about home care for babies. The reliability of the questionnaire was reported by Cronbach's α of 0.79, and content validity ratio (CVR) and content validity index (CVI) scores of 0.88-0.99 and 0.79-0.1, respectively. Data analysis was performed using the Statistical Package for the Social Sciences version 18.0 (SPSS) (Chicago, USA) and analysis of descriptive statistics, Chi-square, and Pearson correlation tests at a 0.05 significance level. The mean score of medical staff's attitude was obtained at 77.59 ± 11.71 and the security-safety and education-support domains scores were 41.3 ± 6.34 and 36.29 ± 6.11, respectively. In addition, a significant inverted relationship was observed between the mean score of medical staffs"attitude with age and the number of shifts. According to the results, the medical staff's attitude about the infant home care program is neutral, and designing a professional educational period, considering economic preparations and responsibility assurance is essential for creating confidence and acceptance of the infant home care program by the medical staff.

Changes in care managers' positive attitudes toward dying patients compared to that of nurses by one-day online advance care planning communication training.

Culturally appropriate communication training programs for a wide range of professions that can be used during infection epidemics are crucial for advance care planning implementation. Starting in 2018, the Japanese Ministry of Health, Labour and Welfare made a major policy change, and doctors, nurses, and social workers, and care managers were identified in the guidelines as the professions that promote advance care planning. Motivated by the lack of online programs for Japanese care managers, we proposed a new one-day program. This study aimed to determine the changes in the positive attitude of care managers toward dying patients compared to that of nurses, which has been used in past literature as an outcome of advance care planning educational interventions, after administering the program in Japan. Before-after comparison study. Care managers were recruited through our website, ACP-Piece, http://plaza.umin.ac.jp/~acp-piece/piece.html. A questionnaire survey concerning positive attitudes toward dying patients was administered before and after the program on 28 August 2021. Sixty-six subjects participated in the training and 60 participants, including 14 care managers, consented to the study and completed the questionnaire surveys before and after the program. The Frommelt attitude toward care of the dying scores for care managers increased after the program (p-values, confidence intervals, and effect sizes: p < 0.001, -11.90 to -4.388, -1.252). After training, care managers had a significantly higher maximum score occurrence than nurses. Older care managers with advance care planning experience may have had a higher maximum score occurrence compared to younger, inexperienced participants. To our knowledge, this is the first to demonstrate the increased positive attitude scores toward dying patients after online communication training for Japanese care managers. The limitations of this study include the lack of evidence regarding reasons for score changes, long-term score changes, and effectiveness for patients and their families.

Coping Mechanisms Among Patients with Terminal Illnesses

Patients with terminal illnesses face multifaceted challenges that affect their emotional, physical, and social well-being. Understanding how these patients cope with the complexities of their condition is crucial for improving healthcare support and interventions. This study aims to explore the various coping mechanisms employed by terminally ill patients and to identify the main themes of these strategies. A qualitative research design was utilized for this study, focusing on semi-structured interviews with 24 terminally ill patients. Interviews were conducted until theoretical saturation was achieved, ensuring comprehensive coverage of the experiences discussed by participants. Data analysis was performed using NVivo software to facilitate the thematic analysis and to identify recurrent patterns in the coping strategies described. Four main themes were identified in the study: Emotional Coping, Physical Coping, Social Support, and Practical Management. Emotional Coping included categories such as Acceptance, Denial, Expression, Spiritual Coping, and Distraction. Physical Coping was characterized by Pain Management and Routine Maintenance. Social Support emerged strongly with subthemes like Family Involvement, Peer Support, and Professional Help. Practical Management involved Information Seeking, Healthcare Navigation, Resource Utilization, Legacy Activities, and Future Planning. Each category was supported by specific concepts illustrating the patients’ coping strategies. The study revealed a broad spectrum of coping mechanisms that are critical for managing the challenges posed by terminal illnesses. These mechanisms span emotional, physical, social, and practical domains, highlighting the need for a holistic approach in the care and support of terminally ill patients. Healthcare providers should consider these diverse coping strategies when designing and implementing care plans to enhance patient well-being and quality of life.

How can we develop a well-supported policy plan? Towards a cocreative development of a new informal care policy plan in Flanders: process and research results.

In Belgium, there is a growing awareness about the importance of informal carers to cover persons' care and support needs. In the last decades several efforts were made in order to support informal carers, reduce levels of burden and enhance quality of life. In 2016, Flanders launched the Flemish informal care policy plan 2016-2020, which was created to valorise and support informal carers in the Dutch speaking part of Belgium and in Brussels. This policy plan came to an end and an evaluation of its implementation was necessary to outline future policy priorities and actions.&#x0D; The evaluation methodology used insights from the analytic hierarchy process and was characterised by a participatory approach. Stakeholders from different stakeholder groups (i.e., informal carers, informal care organisations, organisations for persons with care and support needs and their relatives, professional care organisations, policy makers and researchers) were involved in all steps of the research process. In collaboration with the researchers, stakeholders generated knowledge, which formed the basis for the next steps of the research process. Focus groups were held with each stakeholder group, which aimed to explore the goals of a successful Flemish informal care policy. Six goals were identified by the participants, each containing around eight preconditions to achieve the identified goal. The generated input was used in an online questionnaire to evaluate the Flemish informal care policy plan 2016-2020 and define priorities for a new informal care policy plan. &#x0D; The online questionnaire gathered data of 1,045 respondents from different stakeholder groups. Although the results show that the identified needs and priorities in the Flemish informal care policy plan 2016-2020 are still prominent, there is a discrepancy between the perspective of informal carers and the perspective of health and social care professionals. Most informal carers indicate that the various priorities of a successful informal care policy were not present in the implementation of the Flemish informal care plan 2016-2020, which was not the case for health and social care professionals. Regarding the new Flemish informal care policy plan, two objectives were prioritised by most participants in the different participant profiles: ‘recognising and acknowledging informal carers’ and 'supporting informal carers'. The selected goals for a new informal care policy plan as well as the selected preconditions within these goals show that the provision of care and support should be perceived as a process rather than a product. Furthermore, informal care should be approached as a matter that goes beyond care and wellbeing.&#x0D; Following the evaluation study, a participatory trajectory was initiated to outline future policy priorities and actions for a new informal care policy plan. Therefore, interviews with experts and policymakers were conducted, cocreation workshops with informal care organisations were held and a validation session with broader stakeholders was conducted.&#x0D; The evaluation study and participatory trajectory offered interesting insights for the creation of a sense of ownership in policy making and facilitated content development and implementation of a new informal care policy plan, taking various stakeholder perspectives into account.

Why and how Flanders wants to roll out goal-oriented, integrated care based on life goals.&amp;nbsp; A reflection between policymakers and policy organizations.

Flanders believes that integrated care can only be achieved by linking medical care, with welfare and social care, creating local government participation and including the voice of the patient and his or her caregiver in local and central policy processes. &#x0D; In order to evolve from fragmented primary care to integrated care, a participatory procedure was mapped out in Flanders: since 2020 existing structures were changed and several tools have been developed to transform the way of care into goal oriented care. &#x0D; The Flemish meso level was thoroughly rearranged: during the covid years population-based approach was rolled out by local care councils. The care council aims to install integrated, goal-oriented care within the local network of medical care providers, social and welfare providers and local authorities, in cooperation with the patient and his or her caregiver. Together with all these partners, the care council takes care of a population of at least 75,000 people.Finally primary care, and by extension the entire care scene, will evolve towards better goal-oriented, integrated care. This evolution is supported by the implementation of the digital care and support plan which is flanked by a the reform traject of palliative care in Flanders,&#x0D; The main goal of in Flanders care organization is putting the patient in the driving seat of the care-process which will be based on life goals&#x0D; For policymakers and organizations, this presentation aims to look back at the complex change process, outline future challenges and share lessons learned.&#x0D; We show how strategically chosen change management creates connection between welfare, social and medical care. How, the interaction between patient and caregivers and local authorities try to achieve integrated care in the local communities&#x0D; We show our complex challenge of introducing quality thinking and building organizational resilience for future crises within the young care council.&#x0D; We discuss the complexity of linking local priorities with global policy objectives and vice versa.

Factors Affecting the Implementation of Nursing Care Plans in Patient Care

Abstract: Background: Nursing Care Plan (NCP) is used in practice as a systematic and scientific problem-solving method to determining the care needs of individuals. There is lack of research on factors affecting regarding utilization of nursing care plan in patient care. Objective: The objective of this study were to evaluate the implementation of the nursing process and to determine the factors that may influence the implementation of the nursing process. Materials and Methods: A cross-sectional survey was conducted at a private hospital during February to June, 2023. The study protocol was reviewed and approved. Permission from institutional heads was sought. Informed consent was obtained before data collection. Simple random sampling method was employed. The data were collected with structured questionnaires whose responses were rated on Likert scale. Data were coded and analyzed using SPSS v25.0. Result: A total 108 nurses participated in the study. Study findings revealed 89% of the nurses were female nurses and 82% possessed diploma in nursing. The knowledge 50.5%, confidence 50.9% and willingness 54.2%, were at borderline good level. Whereas, assessment and diagnosis, planning, implementation, evaluation, and nurses’ views about nursing care planning implementation were at &lt; 50% as poor. There was a moderate positive correlation between knowledge and implementation R-Value 0.312 and confidence and evaluation R-Value 0.246. Barrier to implement nursing process included uncooperative patients, lack of awareness about nursing process, lack of preparedness, low satisfaction level, lack of in-service training, lack of time, and high patient flow. Conclusion: Study’s findings revealed knowledge, confidence and willingness of the nurses determine the use of nursing process in their nursing practice.

Excerpt from the 2023 American Association for the Study of Liver Diseases practice guideline: prevention, diagnosis, and treatment of hepatocellular carcinoma

The 2023 American Association for the Study of Liver Diseases practice guidelines (hereinafter referred to as the Guidelines) provide the latest approach for the prevention, diagnosis, and treatment of hepatocellular carcinoma. The prior American Association for the study of Liver Diseases (AASLD) HCC guidelines have been updated to reflect the clinically significant advances in multiple fields of HCC. Notable examples of these updates include recommendations for the use of ultrasound and alpha-fetoprotein for HCC monitoring, the expansion of surgical treatment indications, the addition of immunosuppressive therapy as first-line systemic therapy, and the implementation of clear multidisciplinary care and proactive care planning.

Implementing integrated care guidelines in asthma and COPD: It ain't easy!

ObjectiveTo evaluate the implementation of a guideline-based, integrated, standardised, personal approach in patients with Chronic Obstructive Pulmonary Disease (COPD) or Asthma in a real-life situation. MethodsPatients at the outpatient clinic of the department of pulmonary disease were included in a controlled cohort study, comparing the use of diagnostic items and ‘Personalised care plans' (PCPs) in patients with obstructive lung disease before (2013) and after (2015) implementation of a personalised diagnostic pathway. Results were compared with reference data (2016) from two control hospitals that used the same guidelines but did not implement this pathway. Results100 patients were selected for all three cohorts. After implementing the diagnostic pathway in 2015, 35 % of patients visited attended all pre-planned appointments, whereas 65 % of patients did not: they were diagnosed using usual care. Factors contributing to patients not attending the diagnostic care pathway were: the logistical complexity and intensity of the 2-day pathway, patients willingness to participate in a personalised pathway, and low social economic status or low literacy. After the implementation of the pathway, a significant improvement was seen in the number of PCPs (P < 0.001) and the number of diagnostic items registered recorded in the patients' electronic medical records (P < 0.001). ConclusionImplementing a standardised diagnostic pathway in a real-life population significantly improved the number of personalised care plans, demonstrating that the implementation of holistic care planning is feasible in this population. Nevertheless, the pathway needs further improvements to maximize the number of patients benefitting from it, including logistical streamlining, removing unnecessary diagnostic tools, and increasing the focus on low literacy. Additionally, we found that implementing existing guidelines in a real life context is complex. Therefore, it is required to prioritize the translation of current guidelines into every-day practice, before expanding existing guidelines and protocols.

Documentation of cognitive impairment screening amongst older hospitalised Australians: a prospective clinical record audit

BackgroundFailure to detect cognitive impairment (CI) in hospitalised older inpatients has serious medical and legal implications, including for the implementation of care planning. This mixed methods study aimed to determine amongst hospital in-patients aged ≥ 65 years: (1) Rates of documentation of screening for CI, including the factors associated with completion of screening; (2) Rates of undocumented CI amongst patients who had not received screening during their admission; (3) Healthcare provider practices and barriers related to CI screening.MethodsA mixed methods study incorporating a clinical audit and interviews with healthcare providers was conducted at one Australian public hospital. Patients were eligible for inclusion if they were aged 65 years and older and were admitted to a participating ward for a minimum of 48 h. Patient characteristics, whether CI screening had been documented, were extracted using a template. Patients who had not been screened for CI completed the Montreal Cognitive Assessment (MoCA) to determine cognitive status. Interviews were conducted with healthcare providers to understand practices and barriers to screening for CI.ResultsOf the 165 patients included, 34.5% (n = 57) had screening for CI documented for their current admission. Patients aged > 85 years and those with two or more admissions had greater odds of having CI screening documented. Among patients without CI screening documented, 72% (n = 78) were identified as cognitively impaired. While healthcare providers agreed CI screening was beneficial, they identified lack of time and poor knowledge as barriers to undertaking screening.ConclusionsCI is frequently unrecognised in the hospital setting which is a missed opportunity for the provision of appropriate care. Future research should identify feasible and effective strategies to increase implementation of CI screening in hospitals.

Feasibility and Usability of a Mobile App-Based Interactive Care Plan for Migraine in a Community Neurology Practice: Development and Pilot Implementation Study.

Migraine is a common and major cause of disability, poor quality of life, and high health care use. Access to evidence-based migraine care is limited and projected to worsen. Novel mobile health app-based tools may effectively deliver migraine patient education to support self-management, facilitate remote monitoring and treatment, and improve access to care. The risk that such an intervention may increase the care team workload is a potential implementation barrier. This study aims to describe a novel electronic health record-integrated mobile app-based Migraine Interactive Care Plan (MICP) and evaluate its feasibility, usability, and impact on care teams in a community neurology practice. Consecutive enrollees between September 1, 2020, and February 16, 2022, were assessed in a single-arm observational study of usability, defined by 74.3% (127/171) completing ≥1 assigned task. Task response rates, rate and type of care team escalations, and patient-reported outcomes were summarized. Patients were prospectively recruited and randomly assigned to routine care with or without the MICP from September 1, 2020, to September 1, 2021. Feasibility was defined by equal to or fewer downstream face-to-face visits, telephone contacts, and electronic messages in the MICP cohort. The Wilcoxon rank-sum test was used to compare continuous variables, and the chi-square test was used for categorical variables for those with at least 3 months of follow-up. A total of 171 patients were enrolled, and of these, 127 (74.3%) patients completed ≥1 MICP-assigned task. Mean escalations per patient per month was 0.9 (SD 0.37; range 0-1.7). Patient-confirmed understanding of the educational materials ranged from 26.6% (45/169) to 56.2% (95/169). Initial mean headache days per week was 4.54 (SD 2.06) days and declined to 2.86 (SD 1.87) days at week 26. The percentage of patients reporting favorable satisfaction increased from a baseline of 35% (20/57) to 83% (15/18; response rate of 42/136, 30.9% to 28/68, 41%) over the first 6 months. A total of 121 patients with MICP were compared with 62 patients in the control group. No differences were observed in the rate of telephone contacts or electronic messages. Fewer face-to-face visits were observed in the MICP cohort (13/121, 10.7%) compared with controls (26/62, 42%; P<.001). We describe the successful implementation of an electronic health record-integrated mobile app-based care plan for migraine in a community neurology practice. We observed fewer downstream face-to-face visits without increasing telephone calls, medication refills, or electronic messages. Our findings suggest that the MICP has the potential to improve patient access without increasing care team workload and the need for patient input from diverse populations to improve and sustain patient engagement. Additional studies are needed to assess its impact in primary care.

Local Implementation of the Symbiotic Community Model to Achieve Aging in Place

&lt;p&gt;進入高齡社會的臺灣，偏鄉與原住民族應如何在諸多不利因素影響下，回應在地社區高齡者的生活照顧和醫養需求，成為落實在地老化高齡社會保障政策的重要一環。本文透過余尚儒以臺東都蘭診所推動的共生社區與在宅醫療模式，以及林依瑩在臺中和平區達觀部落伯拉罕長照機構的共生型照顧服務模式與地域營造方案，來檢視高齡社會下，透過在地組織連結資源、以特色服務解決高齡醫養困境的可能性；同時也檢視目前長照2.0在原鄉的執行困境及可能的解決方向。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;In response to Taiwan’s aged society, rural and indigenous communities experience various challenges and unfavorable conditions while attempting to meet the caregiving and healthcare needs of older residents. Attending to such needs has become a crucial constituent of policy implementation aimed at ensuring social security in an aged society to achieve aging in place. This study explored two models to examine the feasibility of addressing the aforesaid problem by integrating local organizational resources and providing specialized services. The first model was the symbiotic community and home-based care model promoted at the Home Clinic Dulan in Taitung. The second model was the symbiotic care service model and place-making program promoted at the Plahan Long-term Care Institution in L’olu Tribe, which is located in Heping District, Taichung. Additionally, this study delved into existing challenges concerning the local implementation of Long-Term Care Plan 2.0 in indigenous communities, proposing possible solutions to these challenges.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;