Palliative care management committees: a model of collaborative governance for primary health care.

IF 1.3 Q4 RESPIRATORY SYSTEM Public Health Action Pub Date : 2023-03-21 DOI:10.5588/pha.22.0028
A Kochuvilayil, S Rajalakshmi, A Krishnan, S M Vijayanand, V R Kutty, T Iype, R P Varma
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Abstract

Setting: The community-based primary palliative care programme in Kerala, India, has received international acclaim. Programme functioning is supported through Palliative Care Management Committees (PMCs) at the local government (LG) level.

Objective: To study the functioning of the PMCs within the decentralised governance space to identify achievements, gaps and notable innovations.

Design: This qualitative study included seven key informant interviews (KIIs), 28 in-depth interviews and a review of relevant publicly available policies and documents. Major themes were recognised from the KII transcripts. Codes emerging from the document review and in-depth interview transcripts were mapped into the identified thematic areas.

Results: Successful PMCs raised resources like money, human resource, equipment, had good skilled care options for symptom relief and facilitated reduced out-of-pocket expenditure by providing home care and free medicines, and improved access to interventions that addressed the social determinants of suffering like poverty. PMCs had varying managerial and technical capacities. In some LGs, the programme was weak and mostly limited to the supply of medicines, basic aids and appliances to patients' homes.

Conclusion: Despite varied implementation patterns, PMCs in Kerala are examples of state-supported, community-owned care initiatives, that can potentially address medical and social determinants of suffering.

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姑息治疗管理委员会:初级卫生保健协作治理模式。
环境:印度喀拉拉邦以社区为基础的初级姑息治疗方案获得了国际赞誉。方案的运作是通过地方政府一级的姑息治疗管理委员会来支持的。目的:研究分散治理空间中pmc的功能,以确定成就、差距和显著创新。设计:本定性研究包括7次关键信息提供者访谈(KIIs)、28次深度访谈以及对相关公开政策和文件的回顾。主要的主题是从KII的成绩单中识别出来的。从文件审查和深入访谈笔录中产生的代码已映射到确定的专题领域。结果:成功的pmc筹集了资金、人力资源、设备等资源,提供了缓解症状的良好熟练护理选择,并通过提供家庭护理和免费药物促进了自付支出的减少,并改善了获得干预措施的机会,解决了贫困等痛苦的社会决定因素。私营企业的管理和技术能力各不相同。在一些地方政府,方案很薄弱,主要限于向病人家中提供药品、基本的辅助设备和器具。结论:尽管实施模式各不相同,但喀拉拉邦的pmc是国家支持、社区拥有的护理倡议的例子,可以潜在地解决造成痛苦的医疗和社会决定因素。
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来源期刊
Public Health Action
Public Health Action RESPIRATORY SYSTEM-
自引率
0.00%
发文量
29
期刊介绍: Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.
期刊最新文献
TB burden and diagnostic challenges at Sandaun Provincial Hospital in West Sepik Province of PNG, 2016-2021. TB-related technical enquiries received at the Research Institute of Tuberculosis, Japan, during COVID-19. Continuous quality improvement in a community-wide TB screening and prevention programme in Papua New Guinea. Effects of extrapulmonary TB on patient quality of life and recurrence. Impact of Truenat on TB diagnosis in Nigeria.
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