A novel nurse-coordinated home care model for palliative care in advanced cancer: A pilot interventional study from suburban Mumbai

IF 0.9 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH PROGRESS IN PALLIATIVE CARE Pub Date : 2022-06-19 DOI:10.1080/09699260.2022.2081440

A. Ghoshal, A. Damani, J. Deodhar, L. Quadros, K. Ganpathy, M. Muckaden

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Abstract

Background: Demand for home-based health care services has increased considerably in India. Traditionally, home-based care services are physician-led which puts pressure on the understaffed healthcare sector. This study aims to pilot a new model, the Nurse coordinated Home Care (NCHC) service in suburban Mumbai (India). Methods: In this pilot interventional study, 101 patients with advanced cancer along with their caregivers were enrolled over 16 months. The nurse coordinator (NC) administered study questionnaires every month. Follow-up visits were based on case severity. Local general practitioners (LGPs) were identified and involved in patient care. Results: Severe Edmonton Symptom Assessment System (ESAS) symptoms were reduced by >2 points in 4 out of 7 instances (57.1%). The number of physician visits was lesser than NC visits (162 vs 341), home deaths were more than hospital deaths (57 vs 14), study retention rate was 99%, 87.5% LGPs participated, 98% of questionnaires were returned. Satisfaction on FAMCARE-2 showed a maximum score of ‘Satisfied’, caregiver burden in ZBI was little/no for 95%, mean scores for ESAS pain was 2, PPSv2 score was 70%−100% for the majority, mean scores on EORTC QLQ-C15-PAL were 77 - Functional scales, 21.5 - Symptom scales, and 64.3 - Global health status/quality of life. NCHC median intervention costs per patient were less than usual care (₹2049.50 vs ₹11490.09). Conclusion: A home care service model that includes nurse coordination and case management streamlines access to healthcare services and resources while reducing the cost of care along with reduced caregiver burden, with increased levels of satisfaction.

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一种新的护理协调家庭护理模式，用于晚期癌症的姑息治疗：孟买郊区的一项试点干预研究

背景：印度对家庭医疗服务的需求大幅增加。传统上，家庭护理服务是由医生主导的，这给人手不足的医疗保健部门带来了压力。这项研究旨在在孟买（印度）郊区试行一种新的模式，即护士协调家庭护理（NCHC）服务。方法：在这项先导性介入研究中，101名晚期癌症患者及其护理人员在16个月内入选。护士协调员（NC）每月进行研究问卷调查。根据病例的严重程度进行随访。当地全科医生（LGP）被确定并参与患者护理。结果：严重埃德蒙顿症状评估系统（ESAS）症状在7例病例中有4例（57.1%）降低了2分以上。医生就诊次数少于NC就诊次数（162次vs 341次），家庭死亡人数多于医院死亡人数（57次vs 14次），研究保留率为99%，87.5%的LGP参与，98%的问卷被退回。FAMCARE-2的满意度最高得分为“满意”，ZBI的护理人员负担很小/没有（95%），ESAS疼痛的平均得分为2，PPSv2得分为70%-100%（大多数），EORTC QLQ-C15-PAL的平均得分分别为77-功能量表、21.5-症状量表和64.3-全球健康状况/生活质量。NCHC每位患者的干预费用中位数低于常规护理(₹2049.50 vs₹11490.09）。结论：包括护士协调和病例管理在内的家庭护理服务模式简化了获得医疗服务和资源的途径，同时降低了护理成本，减轻了护理人员的负担，提高了满意度。

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来源期刊

PROGRESS IN PALLIATIVE CARE PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

2.60

自引率

11.80%

发文量

期刊介绍： Progress in Palliative Care is a peer reviewed, multidisciplinary journal with an international perspective. It provides a central point of reference for all members of the palliative care community: medical consultants, nurses, hospital support teams, home care teams, hospice directors and administrators, pain centre staff, social workers, chaplains, counsellors, information staff, paramedical staff and self-help groups. The emphasis of the journal is on the rapid exchange of information amongst those working in palliative care. Progress in Palliative Care embraces all aspects of the management of the problems of end-stage disease.