The Family as Recipient and Provider of Home Care: A Primary Care Perspective

Advances in modern medicine, effective medication and high-technology interventions contribute to the growth of chronic comorbidities among older people, and many children with chronic diseases that reach adulthood require long-term care at home, provided by formal and informal caregivers and coordinated by primary healthcare professionals. Home caring, performed under different conditions from those of hospital care, requires the involvement of the family that is recipient and provider of home care. This chapter discusses the contribution of family caregivers to personalized home care of dependent children and elderly recipients, coordinated by primary health professionals. Children and youth with special healthcare needs and children abused and neglected require special involvement of family caregivers. The use of digital healthcare for recipients with medical complexity is a modern way to connect home care patients to specialized care, reducing the costs of the hospital care system. However, the burden in home care should be recognized by the general practitioner. Specific interventions are addressed to the unsupportive families and real hidden patients to help maintain their health and functionality. Future family doctors’ interprofessional communication skills and resourcefulness should meet the societal changes, and the burden of home care in the modern family is approached from the perspective of academic medicine

Addressing the Health Needs of an Aging America: New Opportunities for Evidence-Based Policy Solutions

This report systematically maps research findings to policy proposals intended to improve the health of the elderly. The study identified promising evidence-based policies, like those supporting prevention and care coordination, as well as areas where the research evidence is strong but policy activity is low, such as patient self-management and palliative care. Future work of the Stern Center will focus on these topics as well as long-term care financing, the health care workforce, and the role of family caregivers

Telehealth in primary health care settings within Australia and internationally

Access to appropriate health care services is often limited for people living in rural or remote areas, or for those with restricted mobility. One approach to minimising the inequality in access for those located at a distance from health care services is through telehealth service delivery. This review examined the evidence on telehealth models in Australia and elsewhere, with a specific focus on synchronous, real-time video consultations, where patients and health care providers were present simultaneously

Seeing the wood for the trees. Carer related research and knowledge: A scoping review

This NIHR-SSCR funded scoping review provides a comprehensive mapping of what is known about carers and caring, and aims to help inform policy, practice and research in relation to carers. The review was undertaken by searching 10 electronic bibliographic databases, supplemented by additional web searches to identify academic research, grey literature and wider knowledge. The analysis adopts a selective thematic approach covering: carer variables - the characteristics of different types of carer and different caring situations; types of care - the nature of needs of the cared for person and the features of the care situation; the impact of caring – resilience and coping, employment and health; and carer support and needs assessment. The final section highlights key messages identified from the review. It found that caring involves all sections and age groups of the population, with people are likely to experience one or more periods of caregiving over their lifetime. The uniqueness of each caring relationship is also highlighted. In relation to types of carers, knowledge about ‘hard to reach’ groups, such as BAME and LGBT carers, remains sparse. Older carers are also relatively invisible in policy and research terms. It found that much of the knowledge about carers identified in the review relates to their characteristics, their lived experience and the nature of their caregiving, with relatively less being known about the effectiveness of interventions to support them. The report concludes by offering suggestions for policy and practice. An appendix provides a bibliography of the 3,434 items identified in review, classified into 17 types of reference

Breaking the Barriers to Specialty Care: Practical Ideas to Improve Health Equity and Reduce Cost - Striving for Equity in Specialty Care Full Report

Tremendous health outcome inequities remain in the U.S. across race and ethnicity, gender and sexual orientation, socio-economic status, and geography—particularly for those with serious conditions such as lung or skin cancer, HIV/AIDS, or cardiovascular disease.These inequities are driven by a complex set of factors—including distance to a specialist, insurance coverage, provider bias, and a patient's housing and healthy food access. These inequities not only harm patients, resulting in avoidable illness and death, they also drive unnecessary health systems costs.This 5-part series highlights the urgent need to address these issues, providing resources such as case studies, data, and recommendations to help the health care sector make meaningful strides toward achieving equity in specialty care.Top TakeawaysThere are vast inequalities in access to and outcomes from specialty health care in the U.S. These inequalities are worst for minority patients, low-income patients, patients with limited English language proficiency, and patients in rural areas.A number of solutions have emerged to improve health outcomes for minority and medically underserved patients. These solutions fall into three main categories: increasing specialty care availability, ensuring high-quality care, and helping patients engage in care.As these inequities are also significant drivers of health costs, payers, health care provider organizations, and policy makers have a strong incentive to invest in solutions that will both improve outcomes and reduce unnecessary costs. These actors play a critical role in ensuring that equity is embedded into core care delivery at scale.

Limits of and Alternatives to Conventional Medicine in the Context of Terminal Illness (e.g., Palliative Care)

This paper aims at analysing the evolution of palliative care in the international context and their role in the path of care for the patient and the family. Method: born in 1967 by Cicely Saunder, palliative care were aimed at assisting the terminally ill, accommodating both the needs of the patient and the family. Not only to be cured or healed, but to be taken care of. The paper examines the definitions of palliative care provided by the World Helth Organization. We observe that palliative care is not only an effective and timely response to the clinical, psychological, social and spiritual needs of the sick person and their family in an advanced and terminal stage, but an integrated care to support specialist treatment in the presence of an advanced disease picture; a space for in-depth study for the sick person and the family so that the sick person can consciously and freely choose the available treatment proposals, their limits and their consequences. A treatment path in which the transparency of the proposals is a condition for building a shared consensus with the patient and adequate communication with the family. Palliative care has acquired its own identity, its own role in the path of care for the patient and the family, pursuing the proportionality of therapeutic options and the support of the patient and the family without discrimination, with equity and equality

Solid and liquid modernity: A comparison of the social geography of places to die in the UK and Australia.

Preferred place of care and death is a widely used quality measure for palliative and end of life care services. In this article we explore the use of Zygmunt Bauman's ideas on solid and liquid modernity to understand the complexity of the social geographical contexts of delivering and receiving care. Although solid ways of dying offer certainty and standardized care, more liquid ways allow for individualized care connected to family and communities. Understanding the complex tensions between solid and liquid aspects of palliative care may allow practitioners to help dying people to die in the ways and places they prefer

Use of Telemedicine Healthcare Systems in Children and Adolescents with Chronic Disease or in Transition Stages of Life: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF)

: Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens