Main Care Providers Research Articles

Roles and Responsibilities of Family Home Caregivers for Elderly People in Qatar: Experiences and Challenges

The family, as a social institution in Qatar, is the main care provider for its older adult members. In this paper we examine what caregivers do – their work practices – and the different roles and responsibilities that home caregivers perform when providing care for elderly persons in Qatar. The findings of this study were based from a larger study using qualitative descriptive design. This article demonstrates the work practices and main challenges that caregivers face while taking care of their elderly. We argue that a main source of stress for caregivers is the lack of formal services and supports geared towards individuals caring for their ageing loved ones; addressing this service gap would alleviate some of the demands associated with caregiving. The paper will present exemplars of caregivers taking care of their elderly relative. These exemplars are used to support the analysis which is clustered around identified related themes. The main findings regarding the challenges that caregivers face include: feelings of responsibility; dependency on caregiver; emotional care; social planning; problem solving; and environmental quality. All of the themes impacted the health of the caregivers and led to stress and burden on the life of the caregiver.

Outcomes in Older Adults with Multimorbidity Associated with Predominant Provider of Care Specialty.

To determine whether receiving the predominance of ambulatory visits from a primary care provider compared to a specialty provider is associated with better outcomes in older adults with multi morbidity. Observational study using propensity score matching. Medicare fee-for-service, 2011-12. Beneficiaries aged 65 and older with multimorbidity. The independent variable was an indicator for having a specialty (versus primary care) as the predominant provider of care (PPC). Main outcomes were 1-year mortality, hospitalization, standardized expenditures, and ambulatory visit patterns. Two-thirds of 3,934,942 beneficiaries with multimorbidity had a primary care provider as their PPC. Individuals with a specialty PPC had more hospitalizations (40.3 more per 1,000) and higher spending ($1,781 more per beneficiary) than those with a primary care PPC, but there was little difference in mortality (0.2% higher) or preventable hospitalizations. Spending differences were largest for professional fees ($769 higher per beneficiary), inpatient stays ($572 higher per beneficiary), and outpatient facilities ($510 higher per beneficiary) (all P<.001). In addition, people with a specialist PPC had lower continuity of care and saw more providers. Older adults with multimorbidity with a specialist as their main ambulatory care provider had higher spending and lower continuity of care than those whose PPC was in primary care but similar clinical outcomes.

43 Serial transient elastography readings indicate progression of untreated fibrosis among patients attending opioid substitution treatment clinic in south county dublin

Background Injecting drug use (IDU) is a major driver of the hepatitis c virus (HCV) epidemic. Opioid substitution treatment clinics (OST) are the main provider of care for these individuals. Aim To assess the prevalence of significant liver disease and progression in patients attending an OST clinic and evaluate the effectiveness of opportunistic Transient Elastography (TE) service in this setting. Method Unselected serial TE readings were carried out on patients in the OST clinic in 2008 and 2016. Mortality in the 2008 group was related to TE readings and progression of TE readings from 2008 to 2016 was recorded. Results In 2008, 84 patients were scanned. Of these 77% were HCV Ab positive and 58% of this group were HCV viraemic. By 2016, all of the 2008 patients with TE scores>13 Kilopascal (Kpa) had died (a total of 13 patients) and 11 of these patients died as a result of liver failure associated with hepatitis c viraemia and alcohol. In 2016 105 scans were carried out on surviving patients from 2008 who still attended the clinic and on new patients attending the clinic. 16 patients (15%) of the 2016 population had TE scores>13 Kpa, the previous threshold for death at eight years. Conclusions This longitudinal data demonstrates universal mortality at 8 years among OST patients with a TE reading of 13 Kpa or greater. Among surviving patients it demonstrated widespread progression of TE readings to levels indicating a requirement for early DAA treatment, and to levels previously associated with high mortality.

Social inclusion, care and belonging of children with spina bifida: perspectives from Uganda

This study presents a situation analysis on daily functioning, caregiving, and inclusion of children with spina bifida in Uganda. 139 children with spina bifida and their families from 4 regions in Uganda participated in this study. Findings show how a complex play of cultural values, globalization and access to biomedical care determines knowledge, and negative attitudes about, and perception of children with spina bifida. Families and private non for profit organisations are the main providers of care of the children. Children with spina bifida had a more negative perception of themselves, were Jess likely to be in school, and had lower cognitive outcome compared to their siblings. Daily functioning and social inclusion were affected by motor function, incontinence, lack of support for caregivers, low household income, limited resources and knowledge of inclusive teaching, bullying, and inaccessibility of public transport, roads, and buildings. Positive experiences of belonging were found at family and household level and were closely related to the ‘ubuntu’ concept. When a child belongs, the child has a chance to live, to participate, to become, to be included. To facilitate inclusion, families need to be supported, and negative attitudes and behaviour of community members, teachers, and health workers need to be addressed.

Social inclusion, care and belonging of children with spina bifida: perspectives from Uganda

This study presents a situation analysis on daily functioning, caregiving, and inclusion of children with spina bifida in Uganda. 139 children with spina bifida and their families from 4 regions in Uganda participated in this study. Findings show how a complex play of cultural values, globalization and access to biomedical care determines knowledge, and negative attitudes about, and perception of children with spina bifida. Families and private non for profit organisations are the main providers of care of the children. Children with spina bfida had a more negative perception of themselves, were less likely to be in school, and had lower cognitive outcome compared to their siblings. Daily functioning and social inclusion were affected by motor function, incontinence, lack of support for caregivers, low household income, limited resources and knowledge of inclusive teaching, bullying, and inaccessibility of public transport, roads, and buildings. Positive experiences of belonging were found at family and household level and were closely related to the ‘ubuntu’ concept. When a child belongs, the child has a chance to live, to participate, to become, to be included. To facilitate inclusion, families need to be supported, and negative attitudes and behaviour of community members, teachers, and health workers need to be addressed. Key words: disability, inclusion, spina bifida, Uganda, Africa

Effect of Attachment Styles to Parents on Sexual Dysfunction Domains of Married Women.

IntroductionAccording to Bowbly attachment theory, attachment of a baby and its main care provider, influences on social growth and the baby’s feelings throughout its life. The present study was performed aim to determine the effect of attachment style to parents on domains of sexual dysfunction in married women.MethodsThis cross-sectional study was carried out on two hundred married women who were fertile, and referred private and governmental gynecology clinics in Mashhad, Iran, in 2014. Data collection tools were three questionnaires; Demographic and marital questionnaire, Female sexual function index questionnaire, and Adult attachment style questionnaire. Data were analyzed by SPSS version 20 (IBM© SPSS© Statistics version 20 using independent-samples t-test and logistic regression. The statistical tests were performed at the 95% confidence interval.ResultMean of safe attachment style to parents in all aspect of sexual dysfunction was significantly lower (p≤0.01), however, mean of distant attachment style to parents in all aspects of sexual dysfunction was significantly higher (p≤0.05).ConclusionSecure and distance attachment style to the mother showed maximum power of prediction for sexual dysfunction, which indicates the importance of attachment to parents and its impact on adult relationships.

Hospital Contracting Reforms: The Lebanese Ministry of Public Health Experience

—Since 2009, the Ministry of Public Health (MoPH) in Lebanon has been going through a major reform initiative to improve its contracting system with private and public hospitals. The private sector is the main provider of hospital care in the country and the main contractor to the MoPH for the provision of curative care. As an “insurer of last resort,” the MoPH plays an important role in providing hospital coverage to 53% of the population who lack coverage by private or public insurance schemes, through contractual arrangements with the private sector. Historically, the MoPH used hospital accreditation as the basis for contracting and for determining the reimbursement rate. However, recent studies by the MoPH showed that reimbursing hospitals solely on accreditation results was not appropriate and led to an unfair and inefficient reimbursement system. The reform program included the development of several components, in particular, an automated billing system, a utilization review function, standardized admission criteria, and a hospital case mix index that accounts for case complexity. In 2014, the MoPH started implementing a new mixed-model contracting system with private and public hospitals. Preliminary evaluation of the new model suggests that the system incentivized hospitals to admit fewer inappropriate cases and more cases that are more complex/serious. This article shares one experience of how to introduce a merit-based system to face the common practice of political clientelism and confessional/religious-based favoritism in Lebanon. It highlights the importance of stakeholder engagement in a framework of networking and participatory governance that proved to be a key element behind the resilience of a diversified health system.

Reintegration of Women Post Obstetric Fistula Repair: Experience of Family Caregivers

In northern Ghana, families traditionally function as the main provider of care. The role of family, however, is becoming increasingly challenged with the social shifts in Ghanaian culture moving from extended kinship to nuclear households. This has implications for the care of women post obstetric fistula (OF) repair and their family members who assist them to integrate back into their lives prior to developing the condition. This research is part of a larger critical ethnographic study which explores a culture of reintegration. For this article, we draw attention to the findings related to the experience of family caregivers who care for women post OF repair in northern Ghana. It is suggested that although family caregivers are pleased to have their family member return home, there are many unanticipated physical, emotional, and economic challenges. Findings lead to recommendations for enhancing the reintegration process and the need for adequate caregiving support.

The Profile of Saudi Nursing Workforce: A Cross-Sectional Study.

Introduction The Royal Monarchy in Saudi Arabia decreed that all sectors of the workforce would be subject to a policy of “Saudisation” to reduce the reliance on the expatriate workforce and to reduce the unemployment rate of Saudi nationals (Al-Mahmoud et al., 2012). Methodology A cross-sectional design was chosen to investigate the research questions. The population of this study comprised Saudi Registered Nurses working in MOH hospitals in Riyadh which is the main health care provider in Saudi Arabia (Aboul-Enein, 2002; MOH, 2009). Results and Findings A total number of 1,198 questionnaires were distributed and 61.2% (n = 741) were returned. The findings of the study showed that the questionnaires were collected from an equal portion of the study locale and that a sample of 741 is enough to create a strong conclusion and answer the problem set in this study and all the questions in the study have been provided with answers with enough data and literatures to supports its findings. Conclusion and Recommendations The results indicate that an increase in the recruitment of Saudi males may simply reflect cultural issues such as gender specific facilities and the Saudisation program's nondiscriminatory approach to employment of both genders into nursing.

Long-term care in Spain: Difficulties in professionalizing services

ABSTRACTThe aim of this article is to analyze the difficulties in professionalizing the long-term care system in Spain. Since 2006, the new Spanish law has recognized care as a subjective right, and regulations are being designed to create a framework for its professionalization. Nowadays, family remains the most important group of providers who care for their elders, and women remain the main informal caregivers. Why do families resist using public long-term care services and professional carers included in the new law? The hypothesis highlights sociocultural factors as an obstacle to professionalization of long-term care services in addition to political and economic factors. The results show qualitative data about expectations, preferences, and discourses that women caregivers have in relation to their responsibility. The empirical material includes 25 interviews with different profiles of caregivers and six focus groups with family caregivers. The article suggests that the Spanish ideal of care is a problem for the professionalization of services because the family remains as the main provider of care—without specific skills, knowledge, and abilities.

A criança com doença falciforme e a família: revisão integrativa

Aim: To identify scientific evidence about families of children with sickle cell disease. Method: An integrative review of the search used the following descriptors: anemia sickle cell; hemoglobin SC disease; hemoglobin sickle; family; family relations; and, child. The search was carried out for literature in Portuguese, English, and Spanish. The search used databases such as MEDLINE, LILACS, CINAHL, and PubMed, and looked for articles published between January 2005 and January 2015. Results: There were 16 articles selected that originated the following thematic categories: the impact of sickle cell disease on the family, psychosocial effects on family dynamics, child's quality of life, and family and social support/support networks. Discussion: The studies report that the family remains the main provider of care for children with sickle cell disease, and that families faces challenges in achieving comprehensive care and fighting for their children’s quality of life. C onclusion: This evidence will provide support for multi-professional teams in the construction of continuous care for the families of children who are sickle cell patients.

Integrating mental health care services in primary health care clinics: a survey of primary health care nurses’ knowledge, attitudes and beliefs

Background: Nurses are the main providers of care at primary health care (PHC) clinics; the high incidence of mental health problems at these clinics means that PHC nurses are important providers of mental health care. The PHC nurses’ knowledge regarding provision and identification of mental health problems has been shown to be poor.Aim: The study aimed to investigate the knowledge, attitudes and beliefs concerning the care of psychiatric patients at PHC level amongst nurses.Setting: The study was conducted in uThungulu Health District in the Northern Area of KwaZulu-Natal Province. Six clinics were purposively selected based on their geographical location.Methods: The study used a quantitative survey using a structured questionnaire. Simple descriptive analysis and one-way ANOVA were used to analyse the data.Results: The study revealed that 39% of the nurses were between the ages of 41 and 50 years and 92% were females. The association between past experience in working with psychiatric patients and pos...

Integrating mental health care services in primary health care clinics: a survey of primary health care nurses’ knowledge, attitudes and beliefs

Background: Nurses are the main providers of care at primary health care (PHC) clinics; the high incidence of mental health problems at these clinics means that PHC nurses are important providers of mental health care. The PHC nurses’ knowledge regarding provision and identification of mental health problems has been shown to be poor. Aim: The study aimed to investigate the knowledge, attitudes and beliefs concerning the care of psychiatric patients at PHC level amongst nurses.Setting: The study was conducted in uThungulu Health District in the Northern Area of KwaZulu-Natal Province. Six clinics were purposively selected based on their geographical location.Methods: The study used a quantitative survey using a structured questionnaire. Simple descriptive analysis and one-way ANOVA were used to analyse the data.Results: The study revealed that 39% of the nurses were between the ages of 41 and 50 years and 92% were females. The association between past experience in working with psychiatric patients and positive attitude of nurses was found to be significant.Conclusion: This study found that PHC nurses’ attitudes and beliefs towards people with mental illness were positive. PHC nurses were found to have inadequate knowledge to manage psychiatric patients.

The impact of allogeneic-hematopoietic stem cell transplantation on patients' and close relatives' quality of life and relationships

PurposeAlthough evidence suggests considerable disruption to families, the impact of allo-Hematopoietic Stem Cell Transplantation (HSCT) on patients' partners and close relatives has not been sufficiently explored. The present mixed-methods study aimed to enlighten allo-HSCT effects on patients' and close relatives' quality of life (QOL) and their relationships. MethodsPatients who received allo-HSCT between 2007 and 2010 (N = 58) and their close relatives (parents, partners and/or adult children) were asked to respond to an anonymous questionnaire including socio-demographic data, Likert-scale of the impact of HSCT on sexual, couple, family, professional and social life, as well as on perceived support. QOL of patients and close relatives was evaluated (by the FACT-BMT and by WHO-QOL-bref) as were the adjustments of the couples (patients/partners by the DAS). In-depth interviews were performed with patients and partners who consented to this proposition. ResultsPatients (N = 28) and close relatives (N = 48) reported fatigue, sleep and sexual problems, emotional distress and relationship difficulties. Patients were mainly concerned with « being a burden » to their close relatives. Close relatives' main concerns were changes in marital and family dynamics, disruptions in daily routine tasks and the responsibility for being the main provider of physical and emotional care. These difficulties increased after HSCT – notably when patients have to face the long-term consequences of the procedure. ConclusionHSCT has a negative impact on patients' partners and other close relatives' QOL. Data on this topic is still scarce and this study might pave the way for future research in this field and notably guide psychosocial interventions.

Role of district and community nurses in bereavement care: a qualitative study.

The district nurse is one of the main providers of palliative care, which includes bereavement care. However, previous evidence shows a lack of education and training, as well as time management, as important factors in the delivery of bereavement care. This qualitative study aimed to explore the provision of bereavement care from a district nurse's perspective. Data were collected from five participants using semi-structured interviews, and thematically analysed to produce the findings. The interviews were conducted within the author's and participants' working environments to maintain a professional stance between both parties. The results suggest an awareness of bereavement care, but a lack of training and education into the theoretical aspects of the care. Knowing the types and stages of bereavement would be beneficial, both in the delivery and the identification of the most effective time to refer on. Bereavement care was understood to be part of the district nurse role, but the findings suggest that some nurses get too involved and no end date could be standardised, as each case is dependent on need. More experience of bereavement care and exposure increased awareness to its importance and improved confidence toward its delivery.

“Padecendo no paraíso”: as dificuldades encontradas pelas mães no cuidado à criança com sofrimento mental

Objetivou-se resgatar histórias de mães que têm filhos com sofrimento mental, identificando quais são as dificuldades vivenciadas por elas, bem como as relações experimentadas no cuidado para com o filho. Trata-se de uma pesquisa exploratória, descritiva e qualitativa, realizada no CAPSi no município de Campina Grande/PB/Brasil, com cinco mães de crianças com sofrimento mental. A produção do material ocorreu por meio de entrevista semiestruturada e da História Oral Temática. Os resultados foram expressos em quatro eixos temáticos: 1) As limitações e o isolamento da criança; 2) A anulação do “ser” mulher, para a permanência do “ser” mãe; 3) “Uma luta solitária”: a mulher como principal provedora de cuidados aos filhos; 4) Das dificuldades de aceitação na família ao preconceito da sociedade. Identificaram-se dificuldades de natureza fisiológica e outras de cunho social. Faz-se necessária a construção de redes sociais de apoio, maior acolhimento e amparo pela comunidade à essas mães.

Statin Selection in Qatar Based on Multi-indication Pharmacotherapeutic Multi-criteria Scoring Model, and Clinician Preference

PurposeStatin selection for the largest hospital formulary in Qatar is not systematic, not comparative, and does not consider the multi-indication nature of statins. There are no reports in the literature of multi-indication−based comparative scoring models of statins or of statin selection criteria weights that are based primarily on local clinicians’ preferences and experiences. This study sought to comparatively evaluate statins for first-line therapy in Qatar, and to quantify the economic impact of this. MethodsAn evidence-based, multi-indication, multi-criteria pharmacotherapeutic model was developed for the scoring of statins from the perspective of the main health care provider in Qatar. The literature and an expert panel informed the selection criteria of statins. Relative weighting of selection criteria was based on the input of the relevant local clinician population. Statins were comparatively scored based on literature evidence, with those exceeding a defined scoring threshold being recommended for use. FindingsWith 95% CI and 5% margin of error, the scoring model was successfully developed. Selection criteria comprised 28 subcriteria under the following main criteria: clinical efficacy, best publish evidence and experience, adverse effects, drug interaction, dosing time, and fixed dose combination availability. Outcome measures for multiple indications were related to effects on LDL cholesterol, HDL cholesterol, triglyceride, total cholesterol, and C-reactive protein. Atorvastatin, pravastatin, and rosuvastatin exceeded defined pharmacotherapeutic thresholds. Atorvastatin and pravastatin were recommended as first-line use and rosuvastatin as a nonformulary alternative. It was estimated that this would produce a 17.6% cost savings in statins expenditure. Sensitivity analyses confirmed the robustness of the evaluation’s outcomes against input uncertainties. ImplicationsIncorporating a comparative evaluation of statins in Qatari practices based on a locally developed, transparent, multi-indication, multi-criteria scoring model has the potential to considerably reduce expenditures on statins. Atorvastatin and pravastatin should be the first-line statin therapies in the main Qatari health care provider, with rosuvastatin as an alternative.

Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses' hand washing.

Critically ill patients are at marked risk of hospital-acquired infections, which increase patients' morbidity and mortality. Registered nurses are the main health care providers of physical care, including hygiene to reduce and prevent hospital-acquired infections, for hospitalized critically ill patients. To investigate a new patient hand hygiene protocol designed to reduce hospital-acquired infection rates and improve nurses' hand-washing compliance in an intensive care unit. A preexperimental study design was used to compare 12-month rates of 2 common hospital-acquired infections, central catheter-associated bloodstream infection and catheter-associated urinary tract infection, and nurses' hand-washing compliance measured before and during use of the protocol. Reductions in 12-month infection rates were reported for both types of infections, but neither reduction was statistically significant. Mean 12-month nurse hand-washing compliance also improved, but not significantly. A hand hygiene protocol for patients in the intensive care unit was associated with reductions in hospital-acquired infections and improvements in nurses' hand-washing compliance. Prevention of such infections requires continuous quality improvement efforts to monitor lasting effectiveness as well as investigation of strategies to eliminate these infections.

Primary care physicians' practice regarding diabetes mellitus diagnosis, evaluation and management in the West region of Cameroon.

BackgroundPrimary care physicians (PCPs) are the main providers of diabetes care especially in resource-limited countries which experience extreme shortage of specialists. The present study aimed to evaluate PCPs’ approach towards diabetes mellitus (DM) diagnosis, evaluation and management in Cameroon.MethodsWe carried-out a cross-sectional survey in February 2012 in the West Region of Cameroon. Using a structured pretested questionnaire, we interviewed all PCPs working in the region who were present at their working place when the investigators visited, and volunteered to be enrolled in the study.ResultsSixty-six PCPs were interviewed. Their ages ranged from 24 to 56 years (mean 38.3, standard deviation 9.2 years). The levels of knowledge of PCPs regarding DM diagnosis were: 72.7%, 37.9%, 19.7% and 32.8% respectively obtained when using fasting plasma glucose, post-prandial glycemia, random glycemia and glycated hemoglobin as diagnostic tools. Only 6 PCPs (9.9%) prescribed the correct minimal work-up to evaluate diabetes patients at diagnosis. PCPs advised lifestyle modifications in 92.4% of cases, and thirty nine (53.1%) PCP’s used to prescribe both generic and specialty oral anti-diabetic drugs in case of uncomplicated type 2 DM management. The two main classes of anti-diabetic drugs prescribed were biguanides (77.3%) and sulfonamides (60.6%). Nearly all PCPs (97%) used to give frequent follow-up appointments to their patients. Ninety eight point five percent of participants were willing to receive any further continuous training on DM management.ConclusionPCPs knowledge and practices towards diabetes mellitus diagnosis, evaluation and management were not optimal, stressing the need to improve their capacities regarding diabetes care. As such, more educational initiatives should be taken on, alongside regular upgrade and dissemination of clinical guidelines.

PERCEPTION OF OLD AGE: ITS IMPLICATIONS FOR CARE AND SUPPORT FOR THE AGED AMONG THE ESAN OF SOUTH-SOUTH NIGERIA

Nigeria’s population is ageing rapidly. The combination of increasing longevity and the accompanying change in young caregivers’ perception of old age and the aged is having negative impact on care and support for the aged. Yet, there is little or no scholarly work in Nigeria to determine how perception of old age affects elderly care and support. This paper examines how the perception of old age affects care and support for the aged among the Esan people of South-South Nigeria. The study relies on qualitative methods namely; in-depth interviews (IDIs) and Focus Group Discussions (FGDs). In all 32 IDIs and 12 FGDs were conducted on the aged and their caregivers in both urban and rural areas. The results show that the traditional care and support for the aged in the study area is diminishing due to the way the younger generation perceives old age and the aged. The change in perception of old age and the aged is linked to Western influence which is gradually eroding the traditional/cultural belief where the aged were seen in positive light. There is need for cultural re-awakening. This may be carried out within the framework of a creative multi-track social policy intervention that would enable families to continue being the main care providers of the aged.