The role of general practitioners and pharmacists in information exchange with family carers

Abstract: As a trial of the provision of community–service information to family carers, general practitioners and pharmacists from the Western region of Melbourne were supplied with tear–off pads listing suburb–specific community services, and were encouraged to discuss service needs with carers of people with disabilities and distribute the lists to carers accordingly. One hundred and nine general practitioners and 58 pharmacists participated in pretrial and post–trial interviews assessing their knowledge of community services and frequency of discussion with carers. Before the trial, general practitioners had significantly higher self–rated knowledge of community services and reportedly discussed these with carers more often than did pharmacists. After the five–month trial period, pharmacists showed a significant increase in self–rated knowledge and frequency of discussion. General practitioners' knowledge and discussion showed a nonsignificant increase. After the trial, the two did not differ in knowledge of services; however, general practitioners maintained a higher reported frequency of discussion about services with carers. General practitioners and pharmacists appear to be well placed to act as a service link for family carers. However, additional high–intensity strategies are needed to assist them in this role.     

Care networks of visiting nurse agencies before the long-term care insurance act

PURPOSE: To describe how organizational background impacts on care networks of visiting nurse agencies. METHODS: A questionnaire was sent to all visiting nurse agencies (3,178) in Japan, and 1,548 responded. Questions were asked about the agency's background, management system, and cooperation with other community care agencies. FINDINGS: Seventy-nine percent of visiting nurse agencies were affiliated to medical organizations consisting of hospitals, clinics, or medical nursing facilities, The exceptions cooperated with various types of community service agencies, including home care agencies, assisted device agencies, housing improvement agencies, or volunteer services. The visiting nurse agencies had more frequent contact with housing improvement agencies when home care aid agencies were included within the same organizations. The results suggest that visiting nurse agencies can be divided into two types with reference to the long-term care insurance system. One has strong cooperative relationships with hospitals, and the other with community care agencies.     

Teledermatology in pharmacies: a pilot study

We investigated community pharmacists' management of skin conditions in order to identify a need for further educational support. Twenty community pharmacists in Queensland completed a questionnaire regarding their management of skin conditions and their opinions regarding the usefulness of a potential teledermatology service. The pharmacists' accuracy in managing skin conditions was tested by a dermatologist who reviewed the pharmacists' advice in 33 cases obtained by 14 pharmacists. Overall agreement between the pharmacists and the dermatologist was moderate, with a kappa statistic of 0.58 (P < 0.05) The uptake of a potential teledermatology service was investigated in one pharmacy over one month. Five patients were offered the teledermatology service. Of these, two patients consented and three refused. All pharmacists (n = 20) indicated a desire for further education and supported the idea of a teledermatology service.     

A survey on drug-related service by homehelper in the Japanese home care system

The purposes of this study are a) to determine whether homehelpers attend to drug-related service of elder care-recipients at home and b) to determine what cooperating human resources were utilized. A structured questionnaire survey was conducted in 1997 with 403 homehelpers who provided in home care to dependent elderly person. Of the total, 19% subjects did deal with care recipients' medication. Regarding the type of service, the highest proportion of subjects had assisted by picking up medicine from pharmacy and talking it to the care recipients' home. Results showed that physicians and home visiting nurses were the most depended upon human resources in the home health care system among health, medical and welfare facilities. Results also suggested that many homehelpers are not aware that pharmacists are readily available resources for providing home health care. Hence we conclude that the respondents tend to rely on physicians or home visiting nurses to respond to care recipients care, and pharmacists should be made aware of the necessity of providing the appropriate drug-related information to physicians or home visiting nurses.     

The reprofessionalisation of community pharmacy? An exploration of attitudes to extended roles for community pharmacists amongst pharmacists and General Practioners in the United Kingdom

In the light of recent developments within the British National Health Service some sociologists have suggested that the medical profession's status is under threat. They have specified a range of factors contributing to this state of affairs, such as the new consumerism; however, it is thought that attempts by other, related occupations at reprofessionalisation are particularly significant in this trend. It may be possible to understand recent initiatives at extending community pharmacists' role within this framework. This paper suggests that while community pharmacy is developing strategies to enhance its professional status, it is not so much an attempt at usurping general practitioners'(GPs) (primary care doctors') role as a bid for survival, especially on the part of the rank and file. However, GPs do not necessarily see the initiatives in this light. Although many GPs are accommodating some changes in community pharmacy, they also perceive some of the initiatives as a threat to their autonomy and control, this was especially evident in representative bodies such as the Local Medical Committee. Doctors' accommodating attitudes were qualified with traditional attitudes of dominance such as 'limitation' and 'exclusion'. Such attitudes could prevent community pharmacy from achieving professional status. However, there is also evidence that pharmacists themselves contribute to this situation because many of them also attribute ultimate authority to doctors. Moreover, they are held back by internal occupational divisions particularly between retail pharmacists and employee pharmacists, with the former being the most insecure.     

Clinical management. Where medicine meets management. Breath of fresh air

The government's vision for community pharmacists sets out essential, enhanced and additional or supplementary services that they could provide. Some pharmacists are already training to be supplementary prescribers and planning specialist services. Supporters of the scheme hope that funds will be made available to primary care trusts for the development of community pharmacists' role; there are currently disparities in training budgets.     

Out-of-hours palliative care in the UK: perspectives from general practice and specialist services

Palliative care within the community requires well coordinated multidisciplinary teamworking, involving both primary and secondary care practitioners. 'Out-of-hours' periods are a potentially problematic time for delivery of high quality care. We report on two national surveys-one of medical directors of out-of-hours general practitioner cooperatives, the other of medical directors of specialist palliative care units. The aim was to describe general practitioners' and specialists' perspectives on the availability and scope of community nursing and specialist palliative care services. The results point to wide variation in service provision within the community. The two groups differed strikingly in their perceptions, the general practitioners being much less positive than the specialists about the availability of specialist advice and admission to specialist units out of hours. Equitable out-of-hours palliative care services of high quality are unlikely to be achieved without dialogue between primary and secondary care based providers, local needs assessment and adequate resourcing.     

Community treatment orders: exploring the paradox of personalisation under compulsion

The introduction of supervised community treatment, delivered through community treatment orders (CTOs) in England and Wales, contrasts with the policy of personalisation, which aims to provide service users autonomy and choice over services. This article draws upon findings from a primarily qualitative study which included 72 semi‐structured interviews (conducted between January and December 2012) with practitioners, service users and nearest relatives situated within a particular NHS Trust. The article also refers to a follow‐on study in which 30 Approved Mental Health Practitioners were interviewed. The studies aimed to develop a better understanding of how compulsory powers are being used in the community, within a policy context that emphasises personalisation and person‐centred care in service delivery. Findings from the interview data (which were analysed thematically) suggest that service users were often inadequately informed about the CTO and their legal rights. Furthermore, they tended to be offered little, or no, opportunity to make choices and have involvement in the making of the CTO and setting of conditions. Retrospectively, however, restrictions were often felt beneficial to recovery, and service users reported greater involvement in decisions at review stage. Areas of good practice are identified through which person‐centred care can be better incorporated into the making of CTOs.     

宝安区西乡街道桃源居社区居家老人护理需求研究

目的调查分析桃源居社区居家老人对社区护理服务需求的现状,为开展居家护理服务和制定内容规划提供依据。方法编制居家老人护理需求评估表,通过专业人员对240名老年人的健康功能状况和居家护理服务需求进行入户评估。结果67.08%的居家老人有居家护理服务,年龄、文化程度、自理能力是影响老年人护理需求的影响因素。结论开展居家护理能够有效提高老年人的自我保健意识和能力,对保障老年人的健康生活具有重要意义。     

Promotion of service integration among home visiting programs and community coalitions working with low-income, pregnant, and parenting women

This study assessed service integration promoted by home visitors and community coalitions in Baltimore's Comprehensive Family Support Strategy. The study first assessed home visitors' coordination of services for their clients. Two yearly home visitors surveys (n = 32) assessed changes in their perceptions of 11 community resources' availability, service quality, and referrals made to those resources. There were statistically significant increases in the percentage of home visitors who (a) reported availability of seven resources, (b) gave high service quality ratings for six resources, and (c) referred clients to all 11 resources. The study also assessed six community coalitions' actions to promote service integration during 1 year through observation of coalition meetings. Coalitions discussing more service integration exhibited greater increases in home visitors' perceptions of high service quality and referrals. Home visiting practitioners should consider including coalitions as part of their program models in order to better link clients to appropriate community resources.     

Information issues for providers of services to people with dementia living in the community in Australia: breaking the cycle of frustration

The rising prevalence of dementia and concomitant demands upon dementia services are global issues. In Australia, dementia has attained national health priority status and governments at all levels have implemented service strategies to help manage the complex lives of people with dementia. Despite recognition that information is pivotal to effective dementia service delivery, little is known about the information needs of individual providers and the processes used to transfer information between providers. This qualitative study scoped information issues for key service providers for people with dementia living in the community in southern Tasmania, Australia, including information needs, availability, and transfer. Eleven focus groups were held with general practitioners, residential aged care facility staff, home carers, community health nurses, and aged care-assessment team members. Findings revealed that provider groups shared common, albeit unbeknown to them, information needs (e.g. diagnosis, behaviours, and services) and information concerns (e.g. untrustworthy information and poor information transfer) leading to poor service coordination. General practitioners emerged as a stand-out group with markedly fewer needs and concerns than other providers, a finding of special interest given their pivotal role in dementia diagnosis and referral. Participants were adamant in their view that electronic data bases and single points of entry to dementia services would improve service provision and should be developed. The research highlights complexities and associated frustrations of information transferability, accessibility, and trustworthiness for dementia service providers in the community. Increased understanding of providers' diverse yet interdependent roles could, we believe, play an important part in breaking the cycle of frustration experienced by all participants and thus contribute to system reform.     

Evaluation of an Organisational Intervention to Promote Integrated Working between Health Services and Care Homes in the Delivery of End-of-Life Care for People with Dementia: Understanding the Change Process Using a Social Identity Approach

In the United Kingdom, approximately a third of people with dementia live in long-term care facilities for adults, the majority of whom are in the last years of life. Working arrangements between health services and care homes in England are largely ad hoc and often inequitable, yet quality end-of-life care for people with dementia in these settings requires a partnership approach to care that builds on existing practice.This paper reports on the qualitative component of a mixed method study aimed at evaluating an organisational intervention shaped by Appreciative Inquiry to promote integrated working between visiting health care practitioners (i.e. General Practitioners and District Nurses) and care home staff. The evaluation uses a social identity approach to elucidate the mechanisms of action that underlie the intervention, and understand how organisational change can be achieved.We uncovered evidence of both (i) identity mobilisation and (ii) context change, defined in theory as mechanisms to overcome divisions in healthcare. Specifically, the intervention supported integrated working across health and social care settings by (i) the development of a common group identity built on shared views and goals, but also recognition of knowledge and expertise specific to each service group which served common goals in the delivery of end-of-life care, and (ii) development of context specific practice innovations and the introduction of existing end-of-life care tools and frameworks, which could consequently be implemented as part of a meaningful bottom-up rather than top-down process.Interventions structured around a Social Identity Approach can be used to gauge the congruence of values and goals between service groups without which efforts to achieve greater integration between different health services may prove ineffectual. The strength of the approach is its ability to accommodate the diversity of service groups involved in a given area of care, by valuing their respective contributions and building on existing ways of working within which practice changes can be meaningfully integrated.     

Effect of the remuneration system on the general practitioner''s choice between surgery consultations and home visits.

OBJECTIVE--To assess the influence of the remuneration system, municipality, doctor, and patient characteristics on general practitioners' choices between surgery and home visits. DESIGN--Prospective registration of patient contacts during one week for 116 general practitioners (GPs). SETTING--General practice in rural areas of northern Norway. MAIN OUTCOME MEASURE--Type of GP visit (surgery v home visit). RESULTS--The estimated home visit rate was 0.14 per person per year. About 7% (range 0-39%) of consultations were home visits. Using multilevel analysis it was found that doctors paid on a "fee for service" basis tended to choose home visits more often than salaried doctors (adjusted odds ratio 1.90, 99% confidence interval 0.98, 3.69), but this was statistically significant for "scheduled" visits only (adjusted OR 4.50, 99% CI 1.67, 12.08). Patients who were older, male, and who were living in areas well served by doctors were more likely to receive home visits. CONCLUSION--In the choice between home visits and surgery consultations, doctors seem to be influenced by the nature of the remuneration when the patient's problem is not acute. Although home visiting is a function of tradition, culture, and organisational characteristics, the study indicates that financial incentives may be used to change behaviour and encourage home visiting.     

The scope of naturopathic medicine in Canada: an emerging profession

In Canada, naturopathic medicine is an emerging profession that is gaining formal recognition, including provincial/territorial regulation. While naturopathic medicine has undergone significant growth and legitimization, it still faces substantial challenges to acceptance as a full-fledged health care profession within the Canadian health care system. For example, professionalization theories indicate the importance of clear professional boundaries as well as the need for 'new' groups to find a place in the system of professions. This has been problematic for naturopathic practitioners who continue to practice within a broad scope of practice that encompasses many different therapeutic modalities. Development of statutory regulation also requires delineation of a specific, well-defined scope of practice. The purpose of this study was to describe naturopathic practitioners' perception of their training and their current scope of practice. Two thirds (n = 315) of all licensed Canadian naturopathic practitioners responded to the survey. The results showed that naturopathic practitioners are trained in, and practice, a wide range of therapeutic modalities and diagnostic procedures. Practitioners disagreed about their scope of practice, as 57% thought it was too restrictive, 31% felt it was about right and 13% thought it was too broad. A large majority felt there was some or a great deal of overlap with other practitioners' scope of practice. We conclude that multiple challenges are facing naturopathic medicine, including scope of practice, overlap with other professions, social closure, scarcity of vacancies and lack of cohesion. The future of naturopathic medicine will depend on how effectively the profession will use available strategies to overcome barriers to statutory self-regulation.     

上海市基层社区家庭病床上门服务项目调查与分析

目的了解上海市基层社区家庭病床上门服务项目提供现状,为完善管理提供依据。方法根据上海市家庭病床数据汇总表,统计2017年上海市基层社区开展上门服务项目情况。结果上海市中心城区和郊区可开展上门服务项目数均值分别为27.61±7.44、21.37±10.40,已开展上门服务项目均值分别为21.23±8.12、17.57±10.93,比较差异P值均<0.01。全市有超过82.92%的基层社区可开展6项家庭病床上门服务检查项目,超过80%的基层社区可开展换药、护理指导、导尿、康复指导、预约出诊、肌肉注射等家庭病床上门服务治疗项目。结论上海市中心城区与郊区可开展和已开展家庭病床上门服务项目数存在较大差异,可提供家庭病床服务项目与患者需求之间也存在较大差距。可借鉴国外经验,从政府、机构、患者三方入手,多方发力,共同促进家庭病床工作持续开展。