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Referral of Patients with Nonmalignant Chronic Diseases to Specialist Palliative Care: A Study in a Teaching Hospital in Ghana.

ABSTRACT: Ghana's chronic disease burden is on the rise. An essential aspect of clinical care in chronic disease management is to improve the quality of life of both patients and their families and to help them cope with the experience of life-limiting illness. Specialist palliative care services help reach this objective, especially in the context of complex psychosocial challenges and high symptom burden. It is, therefore, necessary that as many patients as possible get access to available specialist palliative care services. This paper explores the factors influencing referral of patients with nonmalignant chronic diseases for specialist palliative care. A qualitative approach was used to explore these factors from eight (8) participants-four (4) physician specialists and four (4) next of kin of patients with advanced nonmalignant chronic illness. Individual face-to-face interviews were conducted using a semistructured interview guide. Interviews were audio-recorded and data coded, themes and subthemes were identified, and thematic analysis was done. Barriers and motivators identified were categorized as either related to physicians, institution, or family. Barriers to referral were perception of the scope of palliative care, medical paternalism, lack of an institutional referral policy, poor human resource capacity of the palliative care team, and lack of awareness about the existence of specialist palliative care service. Poor economic status of the patient and family, poor prognosis, previous interaction with the palliative care team, and an appreciation of patients' expectations of the healthcare system were identified as motivators for referral. The palliative care team must therefore increase awareness among other health professionals about their services and facilitate the development and availability of a clear policy to guide and improve referrals.

SUBMITTER: Ofosu-Poku R

PROVIDER: S-EPMC7102405 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Referral of Patients with Nonmalignant Chronic Diseases to Specialist Palliative Care: A Study in a Teaching Hospital in Ghana.

Ofosu-Poku Rasheed R Owusu-Ansah Michael M Antwi John J

International journal of chronic diseases 20200315

Ghana's chronic disease burden is on the rise. An essential aspect of clinical care in chronic disease management is to improve the quality of life of both patients and their families and to help them cope with the experience of life-limiting illness. Specialist palliative care services help reach this objective, especially in the context of complex psychosocial challenges and high symptom burden. It is, therefore, necessary that as many patients as possible get access to available specialist pa ...[more]

PMID: 32258093

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Project description:Approximately 15% of wastes generated in hospitals is hazardous. Improper handling of this waste renders the remaining fraction infectious which is perilous to the health of hospital workers, patients, visitors and even communities. Sufficient data on medical waste management practices particularly in low-income countries such as Ghana is required for effective monitoring and policy making. This study sought to assess the waste generation rates, waste management practices, frequency of sharp injuries and the knowledge of health-care workers on waste management guidelines in Ho Teaching Hospital in Ghana. Data was collected through observations and questionnaire administration from 100 health-care workers. The results revealed that the total amount of wastes generated was 1.70kg/patient/day (490.62 kg/day) comprising of 57.48%, 33.98% and 8.54% of general, infectious and hazardous wastes respectively. Further investigations showed that 52% of the health-care workers knew about the existence of a hospital waste management policy and 89% attested that they had received training on medical waste management. The existing waste management committee was however, non-functional. Waste segregation at source and the use of color-coded waste receptacles were not strictly followed. Contaminated general wastes were landfilled whiles hazardous wastes were either incinerated or buried. Only 11% of the waste handlers were always completely dressed in personal protective equipment and about 77% of the waste handlers always sustained sharp injuries. Incentivizing the waste management team to ensure strict adherence to a waste management plan would improve waste management at the hospital. Highlights • The waste generation rate at the hospital was 1.70 kg/patient/day.• Only 11% of waste handlers were always appropriately dressed in complete PPE.• In general, there was non-compliance with the stipulated guidelines on health-care waste management in the hospital.

Project description:BackgroundSpecialist palliative care teams (SPCTs) in hospitals improve quality of life and satisfaction with care for patients with advanced disease. However, referrals to SPCTs are often limited. To identify areas for improvement of SPCTs' service penetration, we explored the characteristics and level of integration of palliative care programmes and SPCTs in Dutch hospitals and we assessed the relation between these characteristics and specialist palliative care referral rates.MethodsWe performed a secondary analysis of a national cross-sectional survey conducted among hospitals in the Netherlands from March through May 2018. For this survey, a previously developed online questionnaire, containing 6 consensus-based integration indicators, was sent to palliative care programme leaders in all 78 hospitals. For referral rate we calculated the number of annual inpatient referrals to the SPCT as a percentage of the number of total annual hospital admissions. Referral rate was dichotomized into high (≥ third quartile) and low (< third quartile). Characteristics of SPCTs with high and low referral rate were compared using univariate analyses. P-values < 0.05 were considered significant.ResultsIn total, 63 hospitals (81%) participated in the survey, of which 62 had an operational SPCT. The palliative care programmes of these hospitals consisted of inpatient consultation services (94%), interdisciplinary staffing (61%), outpatient clinics (45%), dedicated acute care beds (21%) and community-based palliative care (27%). The median referral rate was 0.56% (IQR 0.23-1.0%), ranging from 0 to 3.7%. Comparing SPCTs with high referral rate (≥1%, n = 17) and low referral rate (< 1%, n = 45) showed significant differences for SPCTs' years of existence, staffing, their level of education, participation in other departments' team meetings, provision of education and conducting research. With regard to integration, significant differences were found for the presence of outpatient clinics and timing of referrals.ConclusionIn the Netherlands, palliative care programmes and specialist palliative care teams in hospitals vary in their level of integration and development, with more mature teams showing higher referral rates. Appropriate staffing, dedicated outpatient clinics, education and research appear means to improve service penetration and timing of referral for patients with advanced diseases.

Project description:IntroductionThe population of the aged is increasing globally and in Ghana. In 2020, the population aged over 60 years in Ghana was 2,051,903 and this is expected to reach 2.5 million by 2025 and 6.3 million by 2050. Despite the envisaged increase in the number and life expectancy of the older population in Ghana that will require nursing care, there is a paucity of data on nursing staff knowledge and attitudes toward elderly patients in Ghana.ObjectivesThis study, therefore, assessed factors affecting the care of elderly patients among nursing staff in a tertiary referral health facility in the Volta region of Ghana.MethodsThe study employed a descriptive cross-sectional design using quantitative data collection approaches. A total of 150 nurses were sampled with a response rate of 95%. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 23. The analysis included logistic regression to predict factors associated with nurses' knowledge and attitude in caring for elderly patients, after multicollinearity diagnosis and controlling the effect of confounding variables.ResultsMajority (83.8%) of the nurses demonstrated good knowledge of the aging process, knowledge in the care of the elderly (88.7%), and (84.5%) had a positive caring attitude towards the elderly. Professional education, professional qualification, and knowledge on aged care were significantly associated with nurses' attitude towards the elderly (p<0.001), (p<0.005), and (p<0.010), respectively. Lack of special wards/facilities emerged as the predominantly perceived barrier to caring for the elderly as per the nurses' responses.ConclusionThe majority of nurses demonstrated good knowledge and attitude in the aging process and care of the aged. Lack of special wards/facilities and lack of staff motivation were the leading perceived barriers to rendering care to the elderly. Scaling up gerontological nursing programs and establishing special aged care facilities in Ghana with appropriate policy guidelines and regulations for implementation of care will help improve nurses' knowledge and caring attitudes toward the care of elderly patients. Likewise, a national geriatric care policy would help consolidate standard geriatric care in Ghana.

Dataset Information

Referral of Patients with Nonmalignant Chronic Diseases to Specialist Palliative Care: A Study in a Teaching Hospital in Ghana.

Publications

Referral of Patients with Nonmalignant Chronic Diseases to Specialist Palliative Care: A Study in a Teaching Hospital in Ghana.

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