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Downing NJ, Skaczkowski G, Hughes-Barton D, Stone H, Robinson L, Gunn KM. A qualitative exploration of the role of a palliative care pharmacist providing home-based care in the rural setting, from the perspective of health care professionals. Aust J Rural Health 2024; 32:510-520. [PMID: 38544325 DOI: 10.1111/ajr.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 06/11/2024] Open
Abstract
INTRODUCTION Pharmacists are often not recognised as a core part of palliative care teams, despite their ideal placement to assist with the burden of medication management. OBJECTIVE This study explored the role of pharmacists working in the rural palliative care team, in the home-based setting. DESIGN Health care professionals working with palliative care patients in rural South Australia participated in semi-structured interviews. Data were analysed using thematic analysis. FINDINGS Data from 20 participants identified 10 themes. Theme 1: This model of care gives patients a choice. Theme 2: The pharmacist is a trusted source of support and information. Theme 3: Patient, carer and family distress is reduced. Theme 4: Enables patients to stay at home by improving medication knowledge and decreasing burden; 4.1-Patient, carer and family's understanding about medication management is improved, 4.2-Patient, carer and family travel is decreased, 4.3-Burden associated with getting to the doctor is decreased. Theme 5: Communication between all parties is enhanced; 5.1-Enhanced communication between the patient and health care team, 5.2-Enhanced communication within the health care team. Theme 6: Patient, carer and family burden of coordinating prescriptions and medications is reduced. Theme 7: Benefits health care professionals by improving medication knowledge, reducing workload and stress; 7.1-Understanding about medications and their management is improved, 7.2-Workload is reduced, 7.3-Work-related stress is reduced. Theme 8: The disparity of care between rural and urban patients is reduced. Theme 9: Helps to address rural workforce shortages. Theme 10: Challenges of this model of care; 10.1-A need for greater pharmacist capacity to meet demand, 10.2-A need for increased and sustained funding for the pharmacist role, 10.3-Large amount of travel to get to patients. CONCLUSION Rural health care professionals are supportive of pharmacists working as part of the palliative care team in home-based settings and identified many benefits of this model of care.
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Affiliation(s)
- Natasha J Downing
- IIMPACT in Health, Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Gemma Skaczkowski
- IIMPACT in Health, Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Donna Hughes-Barton
- IIMPACT in Health, Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Helen Stone
- Pharmaceutical Society of Australia, Adelaide, South Australia, Australia
| | - Leah Robinson
- Pharmaceutical Society of Australia, Sydney, New South Wales, Australia
| | - Kate M Gunn
- IIMPACT in Health, Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Tamai R, Dawit L, Lee P, Simmons OL, Ding L, Yuan L. The Association of Metabolic Risk Factors with Advanced Adenomas in Hispanic Patients. Dig Dis Sci 2024; 69:1403-1410. [PMID: 38363522 PMCID: PMC11026227 DOI: 10.1007/s10620-024-08323-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Obesity and metabolic syndrome (MetS) have been implicated as rising risk factors for the development of colorectal cancers. A rapid increase in the prevalence of obesity and severe obesity among Hispanic patients in the United States may present substantially increased risk for advanced colorectal neoplasia in this population. Currently, there is very little research in this area. AIMS We sought to identify metabolic risk factors for advanced adenomas (AA) in Hispanic Americans. METHODS We retrospectively reviewed data from the Los Angeles General (LAG) Medical Center of asymptomatic Hispanic patients above 45 years of age who underwent their first colonoscopies following a positive screening FBT. Patient demographics, metabolic characteristics, as well as colon polyp size and histology were recorded. Polyps were classified as adenomas or AA (including both high-risk adenomas and high-risk serrated polyps). Relative risk for AA was assessed by multivariate logistical regression analyses. RESULTS Of the 672 patients in our study, 41.4% were male, 67% had adenomas, and 16% had AA. The mean BMI was 31.2 kg/m2. The mean HDL-C was 49.5 mg/dL (1.28 mmol/L) and the mean triglyceride level was 151 mg/dL. 44.6% had diabetes and 64.1% had hypertension. When comparing patients with AA to patients with no adenoma, male sex, BMI > 34.9 kg/m2, and elevated fasting triglyceride levels were associated with an increased risk of AA. FIB-4 ≥1.45 was also associated with an increased risk of AA in males. There was no significant difference in the risk of AA with diabetes, hypertension, FIB-4 score, LDL-C level, and HDL-C level. CONCLUSIONS Hispanic patients with a positive FBT were observed to have a high incidence of AA. Class II obesity (BMI ≥ 35 kg/m2), elevated triglyceride levels were identified as risk factors among males in our study. Early interventions to address these modifiable risk factors in at-risk populations, such as multi-disciplinary weight management programs for the treatment of obesity and related co-morbidities, could potentially lead to risk reduction and CRC prevention.
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Affiliation(s)
- Robert Tamai
- Division of Gastroenterology and Hepatology, Department of Medicine, Keck School of Medicine of USC, HCC 261 1510 San Pablo Street, Health Sciences Campus, Los Angeles, CA, 90089, USA
| | - Lillian Dawit
- Division of Gastroenterology and Hepatology, Department of Medicine, Keck School of Medicine of USC, HCC 261 1510 San Pablo Street, Health Sciences Campus, Los Angeles, CA, 90089, USA
| | - Patrick Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Keck School of Medicine of USC, HCC 261 1510 San Pablo Street, Health Sciences Campus, Los Angeles, CA, 90089, USA
| | - Okeefe L Simmons
- Division of Gastroenterology and Hepatology, Department of Medicine, Keck School of Medicine of USC, HCC 261 1510 San Pablo Street, Health Sciences Campus, Los Angeles, CA, 90089, USA
| | - Li Ding
- Department of Preventative Medicine, University of Southern California, Los Angeles, CA, USA
| | - Liyun Yuan
- Division of Gastroenterology and Hepatology, Department of Medicine, Keck School of Medicine of USC, HCC 261 1510 San Pablo Street, Health Sciences Campus, Los Angeles, CA, 90089, USA.
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Low C, Namasivayam P, Barnett T. Co-designing Community Out-of-hours Palliative Care Services: A systematic literature search and review. Palliat Med 2023; 37:40-60. [PMID: 36349547 PMCID: PMC9843546 DOI: 10.1177/02692163221132089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In order to provide responsive, individualised and personalised care, there is now greater engagement with patients, families and carers in designing health services. Out-of-hours care is an essential component of community palliative care. However, little is known about how patients, families and carers have been involved in the planning and design of these services. AIM To systematically search and review the research literature that reports on how out-of-hours palliative care services are provided in the community and to identify the extent to which the principles of co-design have been used to inform the planning and design of these services. DESIGN Systematic literature search and review. DATA SOURCES A systematic search for published research papers from seven databases was conducted in MEDLINE, PsycINFO, Embase, Emcare, PubMed, CINAHL and Web of Science, from January 2010 and December 2021. Reference list searches of included papers were undertaken to source additional relevant literature. A manifest content analysis was used to analyse the data. RESULTS A total of 77 papers were included. The majority of out-of-hours services in the community were provided by primary care services. The review found little evidence that patients, families or carers were involved in the planning or development of out-of-hours services. CONCLUSION Incorporating patients, families and carers priorities and preferences in the planning and designing of out-of-hours palliative care service is needed for service providers to deliver care that is more patient-centred. Adopting the principles of co-design may improve how out-of-hours care scan be delivered.
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Affiliation(s)
- Christine Low
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | | | - Tony Barnett
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
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Ogi M, Campling N, Birtwistle J, Richardson A, Bennett MI, Santer M, Latter S. Community access to palliative care medicines-patient and professional experience: systematic review and narrative synthesis. BMJ Support Palliat Care 2021:bmjspcare-2020-002761. [PMID: 33775932 DOI: 10.1136/bmjspcare-2020-002761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/11/2021] [Accepted: 02/15/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Providing palliative care patients living at home with timely access to medicines is critical to enable effective symptom management, minimise burden and reduce unplanned use of healthcare services. Little is known about how diverse community-based palliative care models influence medicine access. OBJECTIVE To produce a critical overview of research on experiences and outcomes of medicine access in community-based palliative care models of service delivery through a systematic review and narrative synthesis. METHODS MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Library databases and grey literature were systematically searched for all types of studies. Study quality was assessed using the Mixed Methods Appraisal Tool; a narrative synthesis was used to integrate and summarise findings. RESULTS 3331 articles were screened; 10 studies were included in the final sample. Studies included a focus on community pharmacy (n=4), hospice emergency medication kits (HEMKs) in the home (n=3), specialist community nurse prescribers (n=1), general practice (n=1) and one study included multiple service delivery components. Community pharmacy was characterised by access delays due to lack of availability of medicine stock and communication difficulties between the pharmacy and other healthcare professionals. HEMKs were perceived to reduce medicine access time out of hours and speed symptom control. However, the majority of studies comprised small, local samples, largely limited to self-reports of health professionals. There was a lack of data on outcomes, and no comparisons between service delivery models. CONCLUSIONS Further research is required to understand which models facilitate rapid and efficient access to medicines for community-based palliative care patients.
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Affiliation(s)
- Mizue Ogi
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Natasha Campling
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Jakki Birtwistle
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Michael I Bennett
- Leeds Institute of Health Sciences, University of Leeds, Leeds, West Yorkshire, UK
| | - Miriam Santer
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
| | - Susan Latter
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
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Johnston BM, McCauley R, McQuillan R, Rabbitte M, Honohan C, Mockler D, Thomas S, May P. Effectiveness and cost-effectiveness of out-of-hours palliative care: a systematic review. HRB Open Res 2020; 3:9. [PMID: 33585789 PMCID: PMC7845148 DOI: 10.12688/hrbopenres.13006.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Out-of-hours palliative care is a priority for patients, caregivers and policymakers. Approximately three quarters of the week occurs outside of typical working hours, and the need for support in care of serious and terminal illness during these times is commonplace. Evidence on relevant interventions is unclear. Aim: To review systematically the evidence on the effect of out-of-hours specialist or generalist palliative care for adults on patient and caregiver outcomes, and costs and cost-effectiveness. Methods: A systematic review of peer-reviewed and grey literature was conducted. We searched Embase, MEDLINE [Ovid], Cochrane Library, CINAHL, Allied and Complementary Medicine [Ovid], PsycINFO, Web of Science, Scopus, EconLit (Ovid), and grey literature published between 1 January 2000 and 12 th November 2019. Studies that comparatively evaluated the effect of out-of-hours specialist or generalist palliative care for adults on patient and caregiver outcomes, and on costs and cost-effectiveness were eligible, irrespective of design. Only English-language studies were eligible. Two reviewers independently examined the returned studies at each stage (title and abstract review, full-text review, and quality assessment). Results: We identified one eligible peer-reviewed study, judged as insufficient quality. Other sources returned no eligible material. The systematic review therefore included no studies. Conclusions: The importance of integrated, 24-hour care for people in line with a palliative care approach is not reflected in the literature, which lacks evidence on the effects of interventions provided outside typical working hours. Registration: PROSPERO CRD42018111041.
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Affiliation(s)
- Bridget M. Johnston
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Rachel McCauley
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Regina McQuillan
- Palliative Medicine, St Francis Hospice, Dublin, D05 T9K8, Ireland
- Palliative Medicine, Beaumont Hospital, Dublin, D09 V2N0, Ireland
| | - Mary Rabbitte
- All-Ireland Institute of Hospice and Palliative Medicine, Dublin, D6W, Ireland
| | - Caitriona Honohan
- The Library of Trinity College Dublin, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - David Mockler
- The Library of Trinity College Dublin, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
| | - Peter May
- Centre for Health Policy and Management, Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
- The Irish Longitudinal study on Ageing (TILDA), Trinity College Dublin, University of Dublin, Dublin, D2, Ireland
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Kuruvilla L, Weeks G, Eastman P, George J. Medication management for community palliative care patients and the role of a specialist palliative care pharmacist: A qualitative exploration of consumer and health care professional perspectives. Palliat Med 2018; 32:1369-1377. [PMID: 29793391 DOI: 10.1177/0269216318777390] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pharmacists have a key role to play in optimisation of medication regimens and promotion of medication safety. The role of specialist pharmacists as part of the multidisciplinary palliative care team, especially in the primary care setting, is not widely recognised. AIM To explore the perspectives of stakeholders about the gaps in the current model of community palliative care services in relation to medication management and to assess their opinions pertaining to the role of a specialist palliative care pharmacist in addressing some of those gaps. DESIGN Qualitative study utilising three focus groups involving 20 stakeholders. Thematic analysis was carried out using a framework approach and interpreted in the context of the Chronic Care Model for improving primary care for patients with chronic illness. SETTING/PARTICIPANTS Setting was a large regional Australian palliative care service. Participants included palliative care consumers and clinicians specifically patients, caregivers, physicians, nurses and pharmacists. RESULTS Five major themes emerged from the focus groups: access to resources, medicines and information; shared care; challenges of polypharmacy; informal caregiver needs and potential roles of a palliative care pharmacist. Gaps in access to medicines/resources, training for generalist practitioners, communication between treating teams and lack of support for patients and carers were cited as factors adversely impacting medication management in community-based palliative care. CONCLUSION While community-based palliative care is an essential aspect of meeting the health care demands of an ageing society, the current model has several gaps and limitations. An appropriately qualified and skilled pharmacist within the palliative care team may help to address some of the gaps in relation to medication access and appropriateness.
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Affiliation(s)
- Lisha Kuruvilla
- 1 Pharmacy Department, Barwon Health, Geelong, VIC, Australia.,2 Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Greg Weeks
- 1 Pharmacy Department, Barwon Health, Geelong, VIC, Australia.,2 Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Peter Eastman
- 3 Department of Palliative Care, Barwon Health, Geelong, VIC, Australia
| | - Johnson George
- 2 Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.,4 School of Public Health and Preventative Medicine, Faculty of Medcine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Edwards Z, Blenkinsopp A, Ziegler L, Bennett MI. How do patients with cancer pain view community pharmacy services? An interview study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:507-518. [PMID: 29479766 DOI: 10.1111/hsc.12549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 06/08/2023]
Abstract
Pain experienced by many patients with advanced cancer is often not well controlled and community pharmacists are potentially well placed to provide support. The study objective was to explore the views and experiences of patients with advanced cancer about community pharmacies, their services and attitudes towards having a community pharmacist pain medicines consultation. Purposive sampling of GP clinical information systems was used to recruit patients with advanced cancer, living in the community and receiving opioid analgesics in one area of England, UK between January 2015 and July 2016. Thirteen patients had a semi-structured interview which was audio-recorded and transcribed verbatim. Data were analysed deductively and inductively using Framework analysis and incorporating new themes as they emerged. The framework comprised Pain management, Experiences and expectations, Access to care and Communication. All patients reported using one regular community pharmacy citing convenience, service and staff friendliness as influential factors. The idea of a community pharmacy medicines consultation was acceptable to most patients. The idea of telephone consultations was positively received but electronic media such as Skype was not feasible or acceptable for most. Patients perceived a hierarchy of health professionals with specialist palliative care nurses at the top (due to their combined knowledge of their condition and medicines) followed by GPs then pharmacists. Patients receiving specialist palliative care described pain that was better controlled than those who were not. They thought medicines consultations with a pharmacist could be useful for patients before referral for palliative care. There is a need for pain medicines support for patients with advanced cancer, and unmet need appears greater for those not under the care of specialist services. Medicines consultations, in principle, are acceptable to patients both in person and by telephone, and the latter was perceived to be of particular benefit to patients less able to leave the house.
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Affiliation(s)
- Zoe Edwards
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Alison Blenkinsopp
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Lucy Ziegler
- Institute of Health Sciences, University of Leeds, Leeds, UK
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