Physicians Care Team – “Scientists Are Getting Closer to a Blood Test for Alzheimer’s”

Source    : Time News
By           : Alexandra Sifferlin
Category : Physicians Group Care Team, Physicians Care Team

Scientists Are Getting Closer to a Blood Test for Alzheimer’s

The new prediction method had 87% accuracy in a recent study – A team of scientists have identified 10 proteins in the blood that can predict the onset of Alzheimer’s disease. The study, which was published in the journal Alzheimer’s & Dementia, looked at more than 1,000 people and is considered a significant step toward the development of a blood test for Alzheimer’s. The trouble with the disease is that developing drug treatments is difficult since they are often given in clinical trials when the disease has already progressed too far. The hope is that identifying the disease earlier could pave the way for drugs to halt its progression.

In the study, researchers examined blood samples from 1,148 people. There were 476 with Alzheimer’s, 220 with ‘Mild Cognitive Impairment’ (MCI) and 452 elderly control subjects who did not have dementia. All the blood samples were tested for 26 proteins that were previously linked to Alzheimer’s, and some the participants also had an MRI scan on their brain. First, the researchers found that 16 of the 26 proteins were strongly linked to brain shrinkage that happens with Alzheimer’s and MCI. In a second round of testing, researchers looked at which of the 16 could predict if MCI became Alzheimer’s. It was then that they found the combination of 10 proteins that were able to predict which people with MCI would eventually get Alzheimer’s within a year. The prediction method had 87% accuracy.

“Memory problems are very common, but the challenge is identifying who is likely to develop dementia,” slead study author Dr. Abdul Hye from the Institute of Psychiatry at King’s College London said in a statement. “There are thousands of proteins in the blood, and this study is the culmination of many years’ work identifying which ones are clinically relevant. We now have a set of 10 proteins that can predict whether someone with early symptoms of memory loss, or mild cognitive impairment, will develop Alzheimer’s disease within a year, with a high level of accuracy.” Detecting the disease early-on could be a major breakthrough for clinical trials and would be less expensive than current methods that use brain imaging or cerebrospinal spinal fluid to identify the disease.

SOURCE : time.com/2963692/alzheimers-disease-blood-test/

Physicians Care Team – “Sleep Loss Could Damage Your Brain”

Source    : Guardian LV
By            : Dan Reyes
Category  : Physicians Group Care Team, Physicians Care Team

Sleep Loss Could Damage Your Brain

If your work schedule or lifestyle keeps you from getting enough sleep on a regular basis, you might want to read the recent sleep study report from the University of Pennsylvania School of Medicine – if you have the brain cells to read it, that is. The study came to conclusion that regular sleep deprivation can damage your brain, permanently. According doctor Sigrid Veasey who, along with colleagues from Peking University conducted the study, said that in general it was assumed that the brain fully recovered after bouts of short- or long-term sleep loss. But there were some studies that suggested that people didn’t always fully recover even after a few days of full sleep.

So, Veasey’s team wanted to figure out if sleep loss injures neurons, exactly which neurons it injures and if the brain could repaired itself with extra sleep. To begin to answer those questions, they put groups of mice on different sleep schedules, which mimicked the average work schedules of shift workers. Some mice had normal rest, another group had little sleep for a short period of time and the final group were deprived of sleep for an extended amount of time. What they found was that, in response to short amounts of time without sleep, the brain of the mice produced a certain protein which protected the neurons in the locus coeruleus (LC) – the part of the brain responsible for alertness. But over a long periods of time without sleep, the brain stopped producing the protein and the neurons in LC began to die. They determined that the mice lost up to 25 percent of the neurons in the LC.

According to Dr. Veasey, this is the first study to show that sleep loss can lead to permanent brain damage in mice. At this point, there are several questions that Dr. Veasey says his team plans to do more research on. First, the team will look at the brains of shift workers, post-mortem, to see if the results that they saw in mice are the same in humans. They also need to determine what counts as short-term or long-term sleep loss in humans, as well as the amount of neuron loss. Dr. Veasey said that the amount of loss could very quite a bit between individuals when you take into consideration things like age, weight, sedentary lifestyle, diet, and overall health. They will also be doing more tests with the protein that protected the cells during short-term sleep loss. If it turns out the the protein can help with long-term sleep deprivation, Dr. Veasey that this could be the first step in developing a treatment for people like shift workers, who regularly forego sleep. Dr. Veasey said that up until this point, no one believed that damage could be done to the brain just from lack of sleep. But that the findings of his study support a growing body of research which deals with how important it is to get regular amounts of rest.

SOURCE : guardianlv.com/2014/03/sleep-loss-could-damage-your-brain/

Physicians Group Care Team – “Concerns About Cancer Centers Under Health Law”

Source    : Siouxcity Journal
By           : RICARDO ALONSO-ZALDIVAR Associated Press
Category : Physicians Group Care Team, Physicians Care Team

Physicians Group Care Team

Some of America’s best cancer hospitals are off-limits to many of the people now signing up for coverage under the nation’s new health care program. Doctors and administrators say they’re concerned. So are some state insurance regulators. An Associated Press survey found examples coast to coast. Seattle Cancer Care Alliance is excluded by five out of eight insurers in Washington’s insurance exchange. MD Anderson Cancer Center says it’s in less than half of the plans in the Houston area. Memorial Sloan-Kettering is included by two of nine insurers in New York City and has out-of-network agreements with two more. In all, only four of 19 nationally recognized comprehensive cancer centers that responded to AP’s survey said patients have access through all the insurance companies in their states’ exchanges.

Not too long ago insurance companies would have been vying to offer access to renowned cancer centers, said Dan Mendelson, CEO of the market research firm Avalere Health. Now the focus is on costs. “This is a marked deterioration of access to the premier cancer centers for people who are signing up for these plans,” Mendelson said. Those patients may not be able get the most advanced treatment, including clinical trials of new medications. And there’s another problem: it’s not easy for consumers shopping online in the new insurance markets to tell if top-level institutions are included in a plan. That takes additional digging by the people applying.
“The challenges of this are going to become evident … as cancer cases start to arrive,” said Norman Hubbard, executive vice president of Seattle Cancer Care Alliance. Before President Barack Obama’s health care law, a cancer diagnosis could make you uninsurable. Now, insurers can’t turn away people with health problems or charge them more. Lifetime dollar limits on policies, once a financial trap-door for cancer patients, are also banned.

The new obstacles are more subtle. To keep premiums low, insurers have designed narrow networks of hospitals and doctors. The government-subsidized private plans on the exchanges typically offer less choice than Medicare or employer plans. By not including a top cancer center an insurer can cut costs. It may also shield itself from risk, delivering an implicit message to cancer survivors or people with a strong family history of the disease that they should look elsewhere. For now, the issue seems to be limited to the new insurance exchanges. But it could become a concern for Americans with job-based coverage, too, if employers turn to narrow networks.
The AP surveyed 23 institutions around the country that are part of the National Comprehensive Cancer Network. Two additional institutions that joined this week were not included in the survey. Cancer network members are leading hospitals that combine the latest clinical research and knowledge with a multidisciplinary approach to patient care. They say that patients in their care have better-than-average survival rates. The unique role of cancer centers is recognized under Medicare. Several are exempt from its hospital payment system, instituted to control costs.

SOURCE : siouxcityjournal.com/ap/washington/concerns-about-cancer-centers-under-health-law/article_49addd70-9625-584a-a281-c48a31299388.html

Physicians Care Team|”Diabetes Teams With NPs PAs Mostly Successful”

Source                  :        medpagetoday.com
Category            :        Physicians Group
By                         :         David Pittman
Posted By         :       Health Care Facilities Casselberry, 

Physicians Care Team

A study comparing care teams with physician assistants (PAs) and nurse practitioners (NPs) with those of just physicians found outcomes were generally the same in 13 of 20 measures for diabetic patients without highly complex conditions. However, patients with care supplemented by PAs and NPs with highly complex conditions experienced worse outcomes in several areas compared with patients receiving physician-only care, Christine Everett, PhD, PA-C, MPH, professor in the physician assistant program at Duke University School of Medicine in Durham, N.C., and colleagues found. For example, NPs and PAs who didn’t treat highly complex patients and didn’t deliver chronic care experienced a 30% lower rate of emergency department visits compared with physician-only teams (odds ratio [OR] for emergency visits 0.70, 95% CI 0.56-0.93), the authors wrote in the November issue of Health Affairs. However, those NP/PA care teams that did treat highly complex patients experienced a 50% higher rate of ED visits (OR 1.5, 95% CI 1.06-2.03).

“This raises the question of whether a team approach that divides primary care delivery between clinicians would work for all patient populations, particularly the most clinically complex patients,” they wrote. “Such patients may be best served through a continuous relationship with a single primary care clinician.” The authors used data from Medicare patients with diabetes treated at a single multi-speciality physician group in 2008 to examine the quality of diabetes care. They identified more than 2,500 patients from ages 23 to 102 and examined 20 areas of quality. Of the 261 primary care panels studied, 55% had team care with PAs and NPs to some degree. Another 39% had only a physician, while 5% consisted solely of a PA or NP. Results showed differences between outcomes for highly complex patients if they were treated by teams with NPs and PAs compared with physicians alone. For example, teams that included NPs and PAs and that didn’t treat highly complex patients were 54% less likely to have poor versus good glycemic control (OR 0.46, 95% CI 0.22-0.97). However, teams with NPs and PAs that treated complex patients showed a 1.8 times greater odds of having poor versus good glycemic control (95% CI: 1.21-2.67).

Highly complex patients were defined according to the Johns Hopkins Ambulatory Care Group System Predictive Model, which produces a patient risk score predicting the future use of healthcare resources. “Our findings suggest that policies related to system redesign and to workforce development and deployment should preserve the capacity for flexibility in team implementation and role definition,” the authors wrote. At least three previous studies have shown that care teams with PAs and NPs can control diabetes just as well as those treated by physicians alone, Everett and colleagues said. But an understanding of how to use those providers is not established. They said a key takeaway from their study was that determining the proper role for primary care teams “will require an even more nuanced approach than that taken in the current analysis.” “Our findings failed to identify an optimal role for PAs and NPs in the team-based care of diabetes patients,” the authors wrote. “However, the results tend to confirm that there are a variety of potentially effective roles.” They said practices should account for factors such as patient characteristics when determining how to place PAs and NPs in care teams.

Source:medpagetoday.com/PublicHealthPolicy/WorkForce/42711

Physicians Care Team|”Team Care Doesn’t Reduce Physician Burnout”

Source                 :       familypracticenews.com
Category            :       Physicians Care Team
By                       :        M. ALEXANDER OTTO
Posted By         :       Health Care Facilities Casselberry

Physicians Care Team

Team-based care – a cornerstone of redesigning clinics into patient-centered medical homes – won’t necessarily decrease physician burnout, according to researchers from Allina Health, a large Midwestern integrated health system based in Minneapolis. Among other benefits, team-based care is supposed to decrease the workload on physicians – a major driver of doctor burnout – by adding a few extra hands to help with paperwork, phone calls, and other tasks. It didn’t seem to do that, though, in the study. Investigators administered the Maslach Burnout Inventory to doctors, mid-level providers, clinical assistants, and other staff at four community primary care clinics as they switched to a team-care approach, with three clinical assistants for every two doctors, and at 3, 6, and 12 months thereafter. The findings were compared with results from Maslach surveys administered at the same time intervals to physicians and others at four community primary care clinics that stuck to the traditional one physician/one clinical assistant staffing model. Both rural and suburban clinics run by Allina Health participated in the study.

“Much to our chagrin, we found no significant impact of team care on burnout prevalence and severity” at any of the survey points. “There was a slight trend early [for doctors] that degraded over time, and there was a slight [favorable] trend among clinical assistants … but nothing statistically significant,” said lead investigator Dr. William Spinelli, a family practitioner in Hastings, Minn. Response rates varied at each time interval, with 60-96 providers – physicians, physician assistants, and nurse practitioners – filling out the Maslach at each survey point, split roughly equally among team care and control clinics. At baseline, about 35% (17) of providers at team-care clinics hit the Maslach mark for burnout as did about 40% (19) of providers at control-group clinics. That rose to about 50% (30) in both settings at 3 months, and stayed at about 50% (17) in the control clinics but dropped back to about 35% (12) in the team-care clinics at month 6. At 1 year, burnout among team-care providers remained at about 35% (11), but had fallen to 30% (10) among control-clinic providers. The differences were not statistically significant.

Overall, women providers were slightly less burned out than men, but gender offered no protective effect on further analysis (for example, odds ratio at the 12-month survey point 1.12; 95% confidence interval 0.56-2.42; P = 0.75). There did, however, seem to be a protective effect for “decreasing from full-time [36 hours of direct outpatient contact per week, for instance] to part-time work, which is interesting because there are data in the literature suggesting there is no difference,” Dr. Spinelli said. Overall, 630 providers, clinical assistants, and other staff members, a category that included, for example, licensed practical nurses and x-ray technicians, participated in the study; they completed 1,405 electronic surveys. Across the three job categories in both settings, most of the study participants were white, female, and 31-60 years old. Full-time status at each of the study points ranged from 37.8% to 50.8%, and most participants had been on the job for more than 4 years.

Burnout prevalence was higher among doctors than among clinical assistants and other staffers. Clinical assistant burnout prevalence hovered at about 25% in both settings throughout the study, and at about 30% for other workers. Burnout was less common, but not significantly less, in both job categories in team-care clinics. “When you begin to look at design initiatives focused on the providers, we also have to ask if those initiatives are going to benefit other workers. We have another study” in process “that suggests there is a differential set of contributing factors for burnout; for providers, it’s definitely workload, for [others] it turns out that workload is far less of an issue than [are] things such as fairness and rewards. There’s not going to be a one size fits all solution” for burnout in the clinic, Dr. Spinelli said. National data suggests burnout approaches 46% for all U.S. physicians, and about 50% for family physicians. The Maslach Burnout Inventory is a 22-question measure of emotional exhaustion, cynicism, depersonalization, and other issues. Burnout is defined as meeting certain cut-points on such problems. Dr. Spinelli has no disclosures.

Source:familypracticenews.com/news/practice-trends/single-article/team-care-doesnt-reduce-physician-burnout/428bba2a0f708dc0a455c1116ec17e15.html?tx_ttnews%5BsViewPointer%5D=1

Physicians Care Team|”ACP Paper Outlines Fresh Thinking For Team Based Care”

Source                 :      modernhealthcare.com
Category            :      Physicians Care Team
By                       :      Andis Robeznieks 
Posted By         :     Health Care Facilities Casselberry

Physicians Care Team

Declaring that the “move toward team-based care requires fresh thinking,” the American College of Physicians released a new policy paper that outlines professionalism, licensure, reimbursement and research principles for such teams to follow. The document appears unlikely to settle deep divisions between physicians and their team members on those matters. Teams of physicians, nurses, physician assistants, clinical pharmacists, social workers and other health professionals require “a new way of thinking about clinical responsibilities and leadership, one that recognizes that different clinicians will assume principal responsibility for specific elements of a patient’s care as the patient’s needs dictate,” according to the authors, Robert Doherty, ACP senior vice president for government and public policy, and Ryan Crowley, ACP senior health policy analyst. The paper, “Principles Supporting Dynamic Clinical Care Teams,” was published Monday in the Annals of Internal Medicine. Doherty and Crowley acknowledge that there are barriers to achieving the vision of physician-led teams, not the least of which is a shortage of internal medicine physicians in some communities. In these circumstances, the ACP encourages a cooperative approach among available healthcare professionals as well as the use of telehealth technology.

Still, they reaffirm the importance of each patient having “an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care” and a personal physician who “leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients”—a component of theJoint Principles of the Patient-Centered Medical Home, which were adopted in 2007 by the ACP, American Academy of Family Physicians, American Osteopathic Association and the American Academy of Pediatrics. The American Medical Association (PDF) and the AAFP each issued similar policy statements in 2012 contending that teams should be physician-led. Both were met with a backlash from nurse practitioners and physician assistants. In an accompanying editorial to the new ACP paper, Dr. Anna Reisman, with the Yale School of Medicine, New Haven, Conn., predicted that “some of the content in the ACP position paper will not inspire high-fives from our (nurse practitioner) colleagues,” but credited the ACP for moving the issue forward.

“Although solving the scope-of-practice controversy may be beyond the reach of the College’s position paper—or of this editorial—failure to resolve this issue hinders the development of dynamic clinical care teams, particularly in states where NPs can practice autonomously,” Reisman wrote. “It is heartening, then, to find the College rising above the familiar negative rhetoric by acknowledging the effectiveness of NPs in some settings, such as nurse-managed health centers in underserved areas.” Nevertheless, Angela Golden and Kenneth Miller, co-presidents of the American Association of Nurse Practitioners, begin an additional accompanying editorial by blasting the notion that physician leadership needs to be a requirement of collaborative care teams. “The AANP believes that team-based care is best thought of as a multidisciplinary, nonhierarchical collaborative centered on a patient’s needs,” the AANP leaders wrote. “These needs and the patient’s preferences should determine which provider leads a healthcare team. Team leadership should not be defined by a particular professional nor by a regulatory or licensing body.” The ACP, however, calls for licensing bodies to value the additional training physicians undergo.

In the section on licensing principles, the ACP notes that “Licensing bodies should recognize that the skills, training, clinical experience, and demonstrated competencies of physicians, nurses, physician assistants, and other health professionals are not equal and not interchangeable,” and that “Changes in licensure laws must not harm patients by allowing health professionals to deliver services for which they are not qualified.” In addition to the licensing controversy, the paper takes on fee-for-service reimbursement. “Traditional fee-for-service payment systems may contribute to high-volume, fragmented, rushed and uncoordinated care, compared with payment models that create incentives for all members of the clinical care team to work together in a highly coordinated manner,” the authors stated. In contrast, they add that reimbursement models such as bundled payments, accountable care organizations, risk-adjusted global capitation and salaried compensation “may contribute to high-quality, cost-conscious care through clinical-care teams.”

Source : http://www.modernhealthcare.com/article/20130917/BLOG/309179995/acp-paper-outlines-fresh-thinking-for-team-based-care#

Physicians Care Team|”Halifax Health Care Team Heads To Haiti”

Source                 :      thechronicleherald.ca
Category            :      Physicians Care Team
By                       :      CLARE MELLOR STAFF REPORTER
Posted By         :     Health Care Facilities Casselberry

Physicians Care Team

Broken Earth is a medical mission that originated out of St. John’s, N.L., with a multidisciplinary medical team composed of doctors and nurses from various specialities that travel to Haiti to provide (medical) education as well as to deliver medical care to those in need. The surgeon (Andrew Furey) in Newfoundland that started this group … has been down to Haiti several times. (He) came and presented to our group in Halifax (during the spring). Their organization challenged us to put together a team here. I am one of the two orthopedic surgeons that are going, but it is a multi-faceted group, so there is a plastic surgeon, general surgeon, a number of emergency physicians, nurses from the recovery room, (nurses) from (emergency) that are going to go down the week of Nov. 16 to 23. … There will be a team of 24, comprised of about half physicians and half nurses, and we’ll be providing a variety of both emergency and surgical services there. There is a hospital (where we) will be working, alongside the local health care workers to provide care, as well as to educate some of their trainees. … Part of the team that is going down (includes) two pediatric emergency physicians and (pediatric) nurses.

There are a lot of residual injuries and deformities from injuries that were sustained in the earthquake: fractures that haven’t healed or that have healed in a crooked position, a lot of arthritis and deformity … as well as some acute injuries that will come in. They have two functioning operating rooms (at the hospital) so we will probably be doing four to five surgeries per day in those rooms, so we are hoping probably 40 to 50 procedures throughout the week. We really have no idea what to expect going down there, just about anything can come through the door at any time. We will have some lead time from the group that is going to be there the week before but a lot of this will be uncertainty. We are looking forward to it but we are also a little anxious about what we’ll find. We’re hoping that this will become a recurrent thing for us. There has been a lot of interest locally with the nurses and physicians and a lot of people are volunteering their time and resources to do this. We are hoping to make another trip in the spring and, hopefully, it will be at least twice a year that this will be able to be sustained.

At this point we are looking for support from donors. This first mission, because of the timing, we’re funding it ourselves. The doctors have all agreed to contribute funds to support themselves and we were able to access some funds … to pay for the nurses. … For this to be a sustainable thing in the future, we are certainly going to need (community) support. Unfortunately, now that the post earthquake media frenzy has settled, Haiti has fallen off a lot of people’s radar. (It) is certainly a country that is still in desperate need of medical care. They really have limited resources. Even before the earthquake, they were in quite a financial hardship and things have been that much worse since the disaster.

Source : thechronicleherald.ca/novascotia/1156097-qa-halifax-health-care-team-heads-to-haiti

Physicians Care Team|”PCN Celebrating Three Years”

Source                 :      dailyheraldtribune.com
Category            :      Physicians Care Team
By                       :      Elizabeth McSheffrey
Posted By         :     Health Care Facilities Casselberry

Physicians Care Team

Between wait times, phone calls, clinics and more, sorting through primary health care can be a tricky business. It’s a system the Grande Prairie Primary Care Network (PCN) has been improving for years after opening its doors in 2010. Now approaching its three-year anniversary, the organization is seeking to expand its programs and streamline patient care. “Patient care is of the utmost importance and we honestly believe that every patient deserves comprehensive primary care,” says executive director Sue Belcourt. “Our physicians felt that by working together they could improve the services and the access for patients here in Grande Prairie.” The PCN is a non-profit group funded by the provincial government to improve communication, co-ordination and quality across city practices. Its membership includes 45 doctors, 19 clinics and various professionals in nursing, nutrition, social, behavioural and exercise health. The network sees anywhere between 300 and 400 patients at a time, but serves a broader community of roughly 60,000 people. “We’re basically an extension of the physicians’ offices,” Belcourt says of her multi-disciplinary care team.

“We work together with Alberta Health Services and with community service agencies to facilitate the most appropriate primary care support for patients.” Through its various initiatives, the organization has already reduced clinic wait times and improved services by bringing the Alberta AIM (Access, Improvement, Measures) program to Grande Prairie. It has helped more than 10 physicians graduate from the efficiency-boosting program and introduced 20 new clinical assistants to local clinics. The organization recently launched a six-week exercise pilot program targeting the cardiovascular health, strength and flexibility of its patients. “We’re really excited about the work that we do,” says the director. “Our ultimate goal is that through our website, patients will be able to log in… go to their physicians’ link and book their appointments online.” The PCN plans to launch a brand new website this month that will serve as a one-stop shop for health care information in Grande Prairie.

It is also waiting on government approval to offer a chronic pain management and after-hours care clinic within the immediate community. On Sept. 26, Belcourt’s team will host a Health Trade Show to announce these initiatives to the public and discuss its newest programs and services. The annual event will also feature displays from dozens of community and non-profit groups, the majority of whom operate in the health care sector. “It’s open to the public and for physicians, clinical staff and anybody who is interested in what kind of services and supports are available to primary care patients in Grande Prairie,” says Belcourt. “We have 50 spots available and I think we’re at probably 80% registration right now, so there’s still some room.” The trade show will take place from 5 p.m. to 8 p.m. at the Paradise Inn and Conference Centre (11201-100 Ave,) and is available to the community free of charge.

Source : dailyheraldtribune.com/2013/09/23/pcn-celebrating-three-years-looks-to-expand

Physicians Care Team|”Palliative Care Pioneer”

Source                 :     thestar.com
Category            :     Physicians Care Team
By                       :      Jacques Gallant
Posted By         :     Health Care Facilities Casselberry

Physicians Care Team

When he passed away, Larry Librach fulfilled a wish that so many other terminally ill Canadians had asked of him over the past three decades: the ability to die at home. The 67-year-old physician, a pioneer in palliative care who played a significant role in changing the Canadian medical community’s approach to death, succumbed to pancreatic cancer on Thursday. His colleagues say his lasting legacy will be improved end-of-life care, not just in Toronto, but throughout the country. As co-founder of the Temmy Latner Centre for Palliative Care at Mount Sinai Hospital, Librach strived to deliver that type of care in the home, recognizing that there is no other place where the majority of dying Canadians would rather spend their final days. Community in shock after boys killed by snake: Deputy mayorCommunity in shock after boys killed by snake: Deputy mayor. When he arrived on the medical scene in the 1970s, very little attention was paid to end-of-life care compared to other specialties. After all, these patients were going to die anyway, so why bother? But Librach strongly felt that terminally ill people had the right to the same kind of quality treatment as any other patient. He emphasized the importance of good pain management of pain and symptoms, as well as advance planning so that a person’s wishes could be met right up to their demise. By the 1980s, at the height of the AIDS crisis, he was a family physician at Toronto Western Hospital and director of its Palliative Care Consult Service.

“He recognized a wrong out there and tried to right it,” said Dr. Sandy Buchman, responsible for education at the Temmy Latner Centre. “He recognized the lack of care, he saw the incredible suffering of people, and always felt there was no greater reward than to help one’s fellow human being.” Buchman said Librach’s early years in palliative care saw him and his medical partner Frank Ferris, another founder of the Latner Centre, making house calls nearly every night all over the city to people who wanted this kind of care in their homes. In 1989, he became leader of a small palliative care team at Mount Sinai Hospital which would later develop into the Latner Centre, an internationally renowned institution where Librach served as director for many years. His final professional role was as director of the University of Toronto Joint Centre for Bioethics, which has as its mandate to look for ways to improve health care standards around the world. Kerry Bowman, a clinical ethicist at Mount Sinai, works with the joint centre and knew Librach since the mid-’80s. Bowman was a student social worker then, and despite Librach’s relatively novel approach to end-of-life care, Bowman said the physician always had the respect of his colleagues and superiors. Librach also treated his patients with the utmost respect, including AIDS sufferers, who had been marginalized by a society that didn’t initially understand their illness. “Larry was warm, approachable, had high energy, and was very dedicated,” said Bowman, who noted that Librach still had so much work ahead of him.

When the time came to acknowledge his own imminent death, Librach did it with a brave face. In a video posted to the website of the Canadian Partnership Against Cancer just weeks after his diagnosis, he spoke candidly about his terminal illness and the kind of care he wanted to receive. The doctor who had for so long thought about the dying was now the patient, with the same fear of death and longing for life as anyone else. “You hope you’ve left a legacy enough so that your family carry on in a way you would be proud, and that your work, you know, has been meaningful,” he said in the video. He leaves his wife Faye, two children and three grandchildren, as well as countless friends and colleagues, notably those at his beloved Temmy Latner Centre, who were among the palliative care team that looked after him in his own home right up until the end.

Source : thestar.com/news/gta/2013/08/18/larry_librach_palliative_care_pioneer_dead_at_67.html

Physicians Care Team|”Team-Based Health Care Mustn’t Be Allowed To Endanger Patients”

Source                 :     contracostatimes.com
Category            :     Physicians Care Team
By                       :    Jeffrey Klingman
Posted By         :     Health Care Facilities Casselberry

Physicians Care Team

New beginnings often bring new challenges. Such is the case with the implementation of the Affordable Care Act, the new national law that will help millions of uninsured get the health insurance they need. Here in California, this means that large numbers of underserved communities and patients will now have access to health care coverage, triggering an increased need for more doctors to serve them. Some in the state Legislature believe that this increased demand can be met by substituting doctors with allied health professionals who do not have the same level of training and education as physicians. This approach should be met with concern, as it threatens patient safety and further fragments health care delivery. Senate Bills 491 and 492 have been introduced to allow nurse practitioners and optometrists to independently diagnose and treat patients. While physicians support a multidisciplinary approach to patient care, and many already work extensively with allied health professionals, the training of those professionals is simply not extensive enough for them to work on their own. Collaboration, where the talents and expertise of each health professional are most effectively utilized, is the better solution. In essence, passage of these bills would put California patients at risk by allowing people other than trained medical physicians to independently treat them.

Nurse practitioners and optometrists would be practicing completely on their own — without any collaboration with or supervision by physicians (or anyone else, for that matter). The landmark Institute of Medicine report “To Err is Human” recognized the risks of noncollaborative care and promoted more team-based care for improved patient safety. We need more allied professionals and doctors working together in teams, not further fragmentation of care. The expressed purpose of this legislation is to increase access to care and reduce costs. Unfortunately, what sounds great in theory fails in reality. In other states where allied health professionals have enhanced practice authority, the geographic distribution of these professionals follows the same pattern as that of physicians.

Additionally, physicians who currently work closely with allied health professionals in integrated health care systems observe that those professionals order more diagnostic tests and make more referrals than physicians, increasing health care costs for patients everywhere. The bottom line is that treatment plans and medical decisions should be made in teams led by the highest qualified member of the health care team — the physician. The Affordable Care Act itself proposes solutions to the increased demand for care that are far better than these legislative proposals that would authorize independent, non-supervised practice by allied health professionals. In fact, the Affordable Care Act encourages the use of team-based care under which physician assistants, nurse practitioners, medical assistants and other professionals work together with and are led by highly trained and experienced physicians. This approach is already authorized under existing law and it brings everyone together so that the combined skills and experience of all health professionals are working together for the patient. We welcome new opportunities to integrate the skills of all health care professionals to optimize quality of care and enhance the efficiency of the health care delivery system, as envisioned by health reform. Proposed legislation promoting fragmented health care delivery, as is the case with SB491 and SB492, would not promote this result and in fact undermines the improvements in team-based care that the Affordable Care Act seeks to achieve. We hope the Legislature agrees.

Source : contracostatimes.com/endorsements/ci_23733427/promote-team-based-health-care