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Comparing the experiences of rural and urban family caregivers of the terminally ill.

https://arctichealth.org/en/permalink/ahliterature117484
Source
Rural Remote Health. 2013 Jan-Mar;13(1):2250
Publication Type
Article
Author
Kevin Brazil
Sharon Kaasalainen
Allison Williams
Christine Rodriguez
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. brazilk@mcmaster.ca
Source
Rural Remote Health. 2013 Jan-Mar;13(1):2250
Language
English
Publication Type
Article
Keywords
Adult
Aged
Caregivers - psychology - statistics & numerical data
Cost of Illness
Cross-Sectional Studies
Family Health - statistics & numerical data
Family Relations
Female
Health Services Accessibility - statistics & numerical data
Health status
Humans
Male
Middle Aged
Neoplasms - epidemiology
Ontario
Rural Health Services - utilization
Social Class
Social Support
Terminally ill
Urban Health Services - utilization
Abstract
There are many challenges in delivering rural health services; this is particularly true for the delivery of palliative care. Previous work has identified consistent themes around end-of-life care, including caregiver burden in providing care, the importance of informal care networks and barriers imposed by geography. Despite these well-known barriers, few studies have explored the experience of palliative care in rural settings. The purpose of the present study was to compare the experiences of rural family caregivers actively providing end-of-life care to the experiences of their urban counterparts.
Caregivers' perceived health status, the experience of burden in caregiving, assessment of social supports and the pattern of formal care used by the terminally ill were explored using a consistent and standardized measurement approach. A cross-sectional survey study was conducted with 100 informal caregivers (44 rural, 56 urban) actively providing care to a terminally ill patient recruited from a publicly funded community agency located in northeastern Ontario, Canada. The telephone-based survey included questions assessing: (i) caregiver perceived burden (14-item instrument based on the Caregiver's Burden Scale in End-of-Life Care [CBS-EOLC]); (ii) perceived social support (modified version of the Multidimensional Scale of Perceived Social Support [MSPSS] consisting of 12 items); and (iii) functional status of the care recipient (assessed using the Eastern Collaborative Oncology Group performance scale).
Rural and urban caregivers were providing care to recipients with similar functional status; the majority of care recipients were either capable of all self-care or experiencing some limitation in self-care. No group differences were observed for caregiver perceived burden: both rural and urban caregivers reported low levels of burden (CBS-EOLC score of 26.5 [SD=8.1] and 25.0 [SD=9.2], respectively; p=0.41). Urban and rural caregivers also reported similarly high levels of social support (mean MSPSS total score of 4.3 [SD=0.7] and 4.1 [SD=0.8], respectively; p=0.40). Although caregivers across both settings reported using a comparable number of services (rural 4.8 [SD=1.9] vs urban 4.5 [SD=1.8]; p=0.39), the types of services used differed. Rural caregivers reported greater use of family physicians (65.1% vs 40.7%; p=0.02), emergency room visits (31.8% vs 13.0%; p=0.02) and pharmacy services (95.3% vs 70.4%; p=0.002), while urban caregivers reported greater use of caregiver respite services (29.6% vs 11.6%; p=0.03).
Through the use of standardized tools, this study explored the experiences of rural informal family caregivers providing palliative care in contrast to the experiences of their urban counterparts. The results of the present study suggest that while there are commonalities to the caregiving experience regardless of setting, key differences also exist. Thus, location is a factor to be considered when implementing palliative care programs and services.
PubMed ID
23294373 View in PubMed
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Patient-specific academic detailing for smoking cessation: feasibility study.

https://arctichealth.org/en/permalink/ahliterature256860
Source
Can Fam Physician. 2014 Jan;60(1):e16-23
Publication Type
Article
Date
Jan-2014
Author
Margaret Jin
Antony Gagnon
Mitchell Levine
Lehana Thabane
Christine Rodriguez
Lisa Dolovich
Author Affiliation
Hamilton Family Health Team, Pharmacy, 10 George St, 3rd Floor, Hamilton, ON L8P 1C8. margaret.jin@hamiltonfht.ca.
Source
Can Fam Physician. 2014 Jan;60(1):e16-23
Date
Jan-2014
Language
English
Publication Type
Article
Keywords
Cohort Studies
Education, Medical, Continuing - methods
Feasibility Studies
Female
Humans
Male
Models, Educational
Nurse Practitioners - education
Ontario
Pharmacists
Physicians, Primary Care - education
Primary Health Care - methods
Smoking Cessation
Tobacco Use Cessation Products
Abstract
To describe and to determine the feasibility of a patient-specific academic detailing (PAD) smoking cessation (SC) program in a primary care setting.
Descriptive cohort feasibility study.
Hamilton, Ont.
Pharmacists, physicians, nurse practitioners, and their patients.
Integrated pharmacists received basic academic detailing training and education on SC and then delivered PAD to prescribers using structured verbal education and written materials. Data were collected using structured forms.
Five main feasibility criteria were generated based on Canadian academic detailing programs: PAD coordinator time to train pharmacists less than 40 hours; median time of SC education per pharmacist less than 20 hours; median time per PAD session less than 60 minutes for initial visit; percentage of prescribers receiving PAD within 3 months greater than 50%; and number of new SC referrals to pharmacists at 6 months more than 10 patients per 1.0 full-time equivalent (FTE) pharmacist (total of approximately 30 patients).
Eight pharmacists (5.8 FTE) received basic academic detailing training and education on SC PAD. Forty-eight physicians and 9 nurse practitioners consented to participate in the study. The mean PAD coordinator training time was 29.1 hours. The median time for SC education was 3.1 hours. The median times for PAD sessions were 15 and 25 minutes for an initial visit and follow-up visit, respectively. The numbers of prescribers who had received PAD at 3 and 6 months were 50 of 64 (78.1%) and 57 of 64 (89.1%), respectively. The numbers of new SC referrals at 3 and 6 months were 11 patients per FTE pharmacist (total of 66 patients) and 34 patients per FTE pharmacist (total of 200 patients), respectively.
This study met the predetermined feasibility criteria with respect to the management, resources, process, and scientific components. Further study is warranted to determine whether PAD is more effective than conventional academic detailing.
Notes
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PubMed ID
24452574 View in PubMed
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