General practice palliative care: Patient and carer expectations, advance care plans and place of death-a systematic review

Background: With an increasing ageing population in most countries, the role of general practitioners (GPs) and general practice nurses (GPNs) in providing optimal end of life (EoL) care is increasingly important. Objective: To explore: (1) patient and carer expectations of the role of GPs and GPNs at EoL; (2) GPs’ and GPNs’ contribution to advance care planning (ACP) and (3) if primary care involvement allows people to die in the place of preference. Method: Systematic literature review. Data sources: Papers from 2000 to 2017 were sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. Results: From 6209 journal articles, 51 papers were relevant. Patients and carers expect their GPs to be competent in all aspects of palliative care. They valued easy access to their GP, a multidisciplinary approach to care and well-coordinated and informed care. They also wanted their care team to communicate openly, honestly and empathically, particularly as the patient deteriorated. ACP and the involvement of GPs were important factors which contributed to patients being cared for and dying in their preferred place. There was no reference to GPNs in any paper identified. Conclusions: Patients and carers prefer a holistic approach to care. This review shows that GPs have an important role in ACP and that their involvement facilitates dying in the place of preference. Proactive identification of people approaching EoL is likely to improve all aspects of care, including planning and communicating about EoL. More work outlining the role of GPNs in end of life care is required

Concepts, reflections and applications of social equity: approaches to accessibility to primary goods and services in the region of Flanders, Belgium

Mobility presents a variety of opportunities as it allows users to access locations and services, and to meet people beyond their immediate surroundings. While the concept of mobility primarily focuses on the ease of moving, accessibility delineates the actual potential to participate in out-of-home activities. As a result, accessibility is a complex concept with a multitude of foci. This complexity is presented in the first section, which explains the general concept of accessibility, how it is defined and how it is related to the notion of transport-related exclusion. This section also gives an overview of the body of literature on the measures to determine area-based as well as personal accessibility levels and points out the important contrast between the simple, easy-to-interpret methods, adopted by policy makers and the complex methods preferred by experts. The second section clarifies how the dichotomous relationship between the urban and rural environment is reflected in transport policy that emphasizes on (especially car-based) mobility rather than on accessibility. Furthermore, the environmental and economic points of view are highlighted and the common policy strategies focused on sustainability are illustrated. Subsequently, the shortcomings in the way in which the contemporary debates concerning mobility, sustainability and the social implications of transport planning are conducted, are criticized. Finally, the last part of this section is dedicated to an extensive discussion on the ability of transport policies to, on the one hand, generate spatially as well as temporally uneven accessibility effects that give preference to certain population groups above others, and on the other hand, their ability to strive for a more equitable distribution of transport services amongst the population. The third section proposes two methodologies for measuring transport-related social exclusion implemented in a literature-based case study in Flanders. These studies comprise the following topics: measuring transport gaps by relating the social to the transport disadvantage and measuring modal disparities by comparing accessibility by private and public transport. The former investigates in which areas the provision of the public transport system is not tailored to specific public transport needs. The latter examines the disparity in access by private and public transport in order to highlight the car dependency. Both case studies incorporate the temporal variability in provision through the private and public transport network, as the time-of-day strongly influences accessibility levels

Exemption policies and community preferences for tropical endemic diseases in the Bamako initiative programme in Nigeria.

We determined the actual written policies/guidelines and practices of fee exemptions aimed at the primary health-care level for tropical diseases treatment within the Bamako initiative system and the community's and decision makers' preferences for exemption in Nigeria. Health policy documents from the federal and state ministries of health were reviewed to determine the guidelines for exemptions, services, goods and category of people to receive exemptions. The records of the local government areas, health centres and community health committees were also reviewed to check who had received exemptions and modalities for doing so. In addition, household surveys using questionnaires was conducted. There is no clear-cut national policy regarding exemption. In areas where exemption exists, these are largely unofficial, as no official documents exist to support exemption. A total of 1594 individuals were surveyed. Community members prefer pregnant women, children and patients with TB, malaria, onchocerciasis and leprosy to be exempted from payment of fees: decision makers prefer the poor, children and patients with malaria, TB and leprosy to be exempted from payment for drugs, registration, consultation and preventive services such as immunization and antenatal services. One area of divergence between the preferences of the community and decision makers is the issue of exempting people with malaria and HIV/AIDS

SPATIAL ACCESSIBILITY OF HEALTH CARE IN INDIANA

Healthy populations and access to health care services are significant factors influencing economic development and prosperity. Since geographic access is an essential feature of an overall health system, it is important for health service researchers to develop accurate measures of physical access to health. In this paper we develop a series of gravity-based health care accessibility measures for all the counties in Indiana. The measures go beyond local availability of health care services within a county and account for travel impedance via distance-discounted health care services accessible throughout the state. When applied to Indiana counties, the results show sharp disparities in health care accessibility with extensive pockets of poor accessibility in rural and peripheral areas. The research concludes with a demonstration of how spatial accessibility measures can be beneficially used to evaluate of policies indicative of changes in the provision of health services.spatial accessibility, health care, geographic information systems (GIS),