Meg Hegarty

Integration, Coordination and Multidisciplinary Care: What can These Approaches Offer to Australian Primary Health Care?

Australias population is ageing and the consequential burden of chronic disease increasingly challenges the health system. This has raised interest in, and awareness of, approaches built on multidisciplinary teams and integrated and coordinated care in managing the complex care needs of patient groups such as the chronically ill or frail aged. A systematic investigation of the literature relating to these approaches provided the opportunity to explore the meaning of these terms and their potential application and relevance to the Australian primary health care setting. Five systematic reviews of a sentinel condition and an exemplar approach to coordinated and multidisciplinary care were completed. Common learnings from the individual reviews were identified. The literature suggests that approaches encouraging a coordinated and multidisciplinary plan of care for individual patients and/or particular populations may improve a variety of outcomes. There are many methodological considerations in conducting reviews of complex interventions and in assessing their applicability to the Australian health system.

Communication and decision making for patients with end stage diseases in an acute care setting

Abstract Twenty retrospective patient case studies were collated in an acute care teaching hospital using a case note audit and in addition interviews were undertaken with 40 nursing staff following the deaths of these patients in order to: analyse the end of life care received; identify any deficits in care provision and to enable the nursing division to target any inadequacies in care found. Findings indicated that communication between medical and nursing staff and between nursing staff, patients and family around end of life issues continue to be poor and that discussions regarding NFR decisions occurred too close to death, creating unnecessary stress for both patients and families. Recommendations regarding palliative approaches in the acute care setting are detailed.

Former palliative caregivers who identify that additional spiritual support would have been helpful in a population survey

Background: Palliative care encompasses physical, psychosocial and spiritual care for patients and caregivers. No population data are available on bereaved people who subsequently report that additional spiritual support would have been helpful. Methods: In a population survey, a respondent-defined question was asked regarding ‘additional spiritual support’ that would have been helpful if someone ‘close to them had died’ an expected death in the previous five years. Data (socio-demographic [respondent]); clinical [deceased]) directly standardized to the whole population were analysed. Results: There were 14,902 participants in this study (71.6% participation rate), of whom 31% (4665) experienced such a death and 1084 (23.2%) provided active hands-on (day-to-day or intermittent) care. Fifty-one of the 1084 (4.7%) active caregivers identified that additional spiritual support would have been helpful. The predictors in a regression analysis were: other domains where additional support would have been helpful (OR 1.69; 95% CI 1.46–1.94; p < 0.001); and being female (OR 3.23; 95% CI 1.23 to 8.33; p = 0.017). ‘Additional spiritual support being helpful’ was strongly associated with higher rates where additional support in other domains would also have been helpful in: all bereaved people (2.7 vs 0.6; p < 0.0001); and in active caregivers (3.7 vs 0.8; p < 0.0001). Conclusion: People who identify that additional spiritual support would have been helpful have specific demographic characteristics. There is also a strong association with the likelihood of identifying that a number of other additional supports would have been helpful. Clinically, the need for additional spiritual support should open a conversation about other areas where the need for further support may be identified.

Refractory suffering: The impact of team dynamics on the interdisciplinary palliative care team

OBJECTIVE This qualitative study aimed to describe the skill sets that experienced palliative care clinicians possess when managing refractory suffering. METHOD Thirteen tape recorded semi-structured interviews and four online questionnaires were completed by participants with at least two years clinical palliative care experience. The research team undertook cross sectional thematic analysis of the transcribed interviews. RESULTS In the face of refractory suffering, team cohesion was identified as a key requirement to support the interdisciplinary team. However, team cohesion was found to be undermined by philosophical differences between team members, a paradigm shift concerning cure versus care and individual opinions regarding the chosen approach and levels of respect between the individual disciplines involved in the care of a person with a life limiting illness. SIGNIFICANCE OF RESULTS The findings of this study highlight the precarious nature of the interdisciplinary team when significant challenges are faced. As a result of witnessing refractory suffering the division and fracturing of teams can easily occur; often team members are completely unaware of its cause. The findings of this study contribute to the limited literature on the nature of refractory suffering from the perspective of the interdisciplinary team.

National consultation informing development of guidelines for a palliative approach for aged care in the community setting

This study aimed to obtain perspectives from key stakeholders to inform the development of Australian national guidelines for a palliative approach to aged care in the community setting.

Palliative care for people with dementia: Aged care staff perspectives

and NPS-activity coupling patterns (2) high post-consultation satisfaction, providing support for the service, and (3) problematic implementation of the strategies at follow-up calls. Factors such as caregiver readiness, home situations, perceived NPS severity, and the dynamic nature and complexity of NPS-activity patterns, influenced the implementation. Conclusions: The clinic directly addresses the needs of dementia caregivers in terms of managing NPS behaviors and maximizing activity level of people with dementia at home. The results further our understanding of NPS, as to how they are related to activity patterns of people with dementia, and what strategies work and how. The information is useful for clinicians and caregivers to implement effective NPS management strategies.

Asia Pacific Palliative Care Development Through Education

an odds ratio of 5.2 following pramipexole therapy in patients with a Hoehn and Yahr stage less than three. Methylphenidate also is being increasingly used for decreasing PD-related fatigue. It mediates its effects through its blocking effect on norepinephrine transporters in the corpus striatum. It also acts on the prefrontal cortex. Inaddition,methylphenidateblockspresynaptic dopamine transporters, which further abrogates PD-related fatigue. The usual effective dose is a treatment regimen including 10 mg administered three times a day. Modafinil is also emerging as an agent with significant efficacy in mitigating PD-associated fatigue. A significant improvement in scores on the Epworth Sleepiness Scale is seen following modafinil therapy. This has been confirmed by Tyne et al. in a recent study in which patients were administered a maximum dosage of 400 mg daily, which was increased over the duration of a month. Part of the fatigue in patients with PD can be attributed to dopamine deficiency. As a result, levodopa administration does improve fatigue in PD patients to some extent by virtue of its direct dopaminergic effects. Thus far, the above treatment options have shown considerable promise. There is a need to increase awareness about these treatment options among physicians treating patients with PD-associated fatigue.