Optimal Care For People Research Articles

The Multidisciplinary Team in the Treatment of Patients With Epilepsy

Optimal care for people with epilepsy (PwE) requires a multidisciplinary patient-oriented team, a concept that emerged from oncology. This article reviews the role of advanced practice providers, dieticians, psychologists, pharmacists, psychiatrists, and social workers in working alongside neurologists in caring for PwE. The article examines training and licensure requirements, clinical needs, and scope of practice for these disciplines. The review concludes by providing recommendations and a framework for multidisciplinary care for PwE.

Invisible bleeds: Lived experiences and barriers to care for men with hemophilia

IntroductionGuidelines of the World Federation of Hemophilia support the provision of equitable, optimal care for people with hemophilia (PWH). However, limited research exists examining the lived experiences of PWH or the barriers to care they may encounter. The primary objective of this exploratory study was to describe the experiences of men with hemophilia in Canada. MethodsWe conducted a qualitative descriptive study using a semistructured interview guide and analyzed transcribed interviews using inductive thematic content analysis. Inclusion criteria were: age ≥18 years, English‐speaking, and confirmed diagnosis of inherited hemophilia A or B. ResultsA total of 11 participants were interviewed. Median age was 39 years old (29–73 years old), and diagnoses included severe hemophilia A (n = 5), mild hemophilia A (n = 2), and severe hemophilia B (n = 4). Three primary themes arose: (1) impact on identity and daily life; (2) dynamic changes in treatment; and (3) barriers to care and identified needs. Major subthemes included chronic pain and activity limitation, psychosocial burden, and symptom normalization. Multidisciplinary care, coordinated surgical care, improved emergency care, and clear care plans were identified as ongoing needs. DiscussionMen with hemophilia described significant symptom burden and areas of ongoing need. Collaborative efforts between hematologists, emergency room physicians, and surgeons to establish hospital‐specific testing, treatment and referral guidelines, and regular hemophilia treatment center audits may help address these care gaps, providing more person‐centered, equitable care. Future work is required to implement these strategies and monitor their effects.

Psychosocial Interventions for People With Dementia and Their Caregivers in Primary Care

Psychosocial interventions, such as occupational and behavioral therapy are effective opportunities to support people with dementia and their caregivers in adapting to the cognitive and behavioral changes and the resulting challenges in everyday life they are facing. However, psychosocial interventions do not seem to have found their way into routine care yet. We wanted to get an insight into the knowledge and attitudes general practitioners have about occupational and behavioral therapy. In an online survey we asked medical students about the relevance of dementia, occupational therapy, and behavioral therapy during their studies. In another online survey we asked practitioners what they had learned about these topics and to what extent they are making use of psychosocial interventions. Then semi-structured interviews were carried out with general practitioners all over Germany, exploring their experiences with dementia and psychosocial interventions in primary care as well as their expectations regarding interdisciplinary cooperation. It became obvious that psychosocial interventions are not conveyed sufficiently within medical school. A lack of occupational therapy prescriptions for people with dementia seemed to result from uncertainties regarding the content of the approach and the budgeting of the prescriptions. Barriers for prescriptions of behavioral treatment were a lack of therapy places and the perceived inadequacy of the approach for this target group. General retentions to invest in people with dementia were expressed. These obstacles need to be overcome in order to provide optimal care for people with dementia and their family caregivers.

Psychosocial Interventions for People With Dementia and Their Caregivers in Primary Care

Psychosocial interventions, such as occupational and behavioral therapy are effective opportunities to support people with dementia and their caregivers in adapting to the cognitive and behavioral changes and the resulting challenges in everyday life they are facing. However, psychosocial interventions do not seem to have found their way into routine care yet. We wanted to get an insight into the knowledge and attitudes general practitioners have about occupational and behavioral therapy. In an online survey we asked medical students about the relevance of dementia, occupational therapy, and behavioral therapy during their studies. In another online survey we asked practitioners what they had learned about these topics and to what extent they are making use of psychosocial interventions. Then semi-structured interviews were carried out with general practitioners all over Germany, exploring their experiences with dementia and psychosocial interventions in primary care as well as their expectations regarding interdisciplinary cooperation. It became obvious that psychosocial interventions are not conveyed sufficiently within medical school. A lack of occupational therapy prescriptions for people with dementia seemed to result from uncertainties regarding the content of the approach and the budgeting of the prescriptions. Barriers for prescriptions of behavioral treatment were a lack of therapy places and the perceived inadequacy of the approach for this target group. General retentions to invest in people with dementia were expressed. These obstacles need to be overcome in order to provide optimal care for people with dementia and their family caregivers.

Getting airtime: Exploring how patients shape the stories they tell health practitioners.

Effective communication during health encounters is known to decrease patient complaints, increase patient adherence and optimise health outcomes. While the aim of patient-centred care is to find common ground, health practitioners tend to drive the encounter, often interrupting patients within the first minute of the clinical conversation. Optimal care for people with chronic illnesses requires individuals to interact with health practitioners regarding their health concerns, but given these constraints, we know little about how patients strategise conversations with their care providers. This understanding may further our efforts to educate health practitioners and trainees to learn and practice patient-centred care. A constructivist grounded theory approach with iterative data collection and analysis was used to explore the processes patients use to present and shape their stories for interactions with health practitioners. Twenty-one patients (n=16 female; 5 male) representing a variety of chronic illnesses participated in semi-structured interviews. Using the constant comparative method of analysis, salient themes were ascertained. Patients engage in extensive strategic preparations for productive health encounters. From the data, we identified four related elements comprising patients' process of planning, preparing, and strategising for health encounters: deciding to go, organising to get airtime, rehearsing a game plan, and anticipating external forces. By focusing on the extensive preparatory work patients engage in, our study expands the dimensions of how we understand illness-related work. Assembling personal health information, gathering disease information and achieving equanimity represent the dimensions of this 'health interaction work'. The work patients engage in for health encounters is noteworthy yet often invisible. And work that is unseen may also be undervalued. Acknowledging, illuminating and valuing patients' preparatory work for health encounters add to how we understand patient-centred care, and this offers new targets for us to effectively teach and deliver it.

Rehabilitation of Individuals with Limb Loss due to Trauma

To provide a comprehensive overview of care and rehabilitation of those with traumatic limb loss, from preoperative to lifelong care. Comprehensive care including peer support and monitoring for the development of secondary conditions which compound disability is essential after traumatic amputation. Conditions that commonly develop after traumatic limb loss include heterotopic ossification, intact limb knee osteoarthritis, low back pain, and reduction in cardiopulmonary reserve. Optimal care for people after traumatic limb loss requires a multidisciplinary team to provide perioperative and lifelong care. In addition to ensuring optimal rehabilitation based on the individual’s vocational and avocational goals, current function, concomitant injuries, and amputation level, their psychological recovery must not be overlooked. To optimize quality of life and independence, lifelong follow-up with a physiatrist is essential to care for complications and secondary conditions, as well as to promote an active lifestyle.

Balancing on the tightrope of type 2 diabetes control

Glycaemic control still proves to be an elusive goal for many with type 2 diabetes. While there has been major progress made, we remain a considerable distance from achieving optimal care for people with diabetes, writes Mark Greener

Quality Of Life in Advanced Dementia

The aging of the world population is increasing the prevalence of people suffering from some form of a progressive degenerative disease, in most cases Alzheimer’s disease. With no effective treatment that would cure or stop the progression of these diseases many people survive into an advanced stage of dementia. Optimal care for people with advanced dementia must not only include safe environment, adequate nutrition and personal hygiene, but should also promote high quality of life during the disease process. Quality of life is a subjective quality and is difficult to determine in people who cannot meaningfully communicate their feelings. However, a study investigating perceptions of quality of life among nursing home residents with different degrees of cognitive impairment, found that there were four key themes identified by the respondents: social contact, attachment, pleasurable activities, and affect [1].

A cluster randomised controlled trial of the effect of primary care mental health workers on satisfaction, mental health symptoms and use of services: background and methodology

Mental health is a core function of primary care. There is however some evidence that primary care may not always deliver optimal care for people with mental health problems. Primary care mental health workers (PCMHWs) may have an important part to play in improving the quality and access to effective mental health services. There has, as yet, been no formal evaluation of the specific role of PCMHW. This paper describes the background to the development of the role of PCMHW and the design of a cluster randomised controlled trial to evaluate their effectiveness.