Physicians Care Team

Source :   trinidadexpress.com
Category :     Physicians Care Team
By :   Anna Ramdass
Posted By       :   Health Care Facilities Casselberry

Physicians Care Team

The National Oncology Centre (NOC) is almost a decade overdue and yesterday Health Minister Dr Fuad Khan renewed a promise that cancer care is coming and it will be delivered in 18 months at a cost of $443 million. On Saturday Prime Minister Kamla Persad-Bissessar and Acting President Timothy Hamel-Smith attended a charity concert hosted by the Trinidad and Tobago Cancer Society (TTCS) featuring British band Blake at the National Academy for the Performing Arts (NAPA), Port of Spain. Funds from the concert will be used to purchase a digital mammography machine at cost of some $2 million. TTCS head Dr Jacqueline Sabga as well as former chairman Dr George Laquis both spoke of the high cost of cancer care in this country. Laquis lamented the absence of the NOC, as he stressed its need and for Government to take the lead role in cancer care and treatment saying that private sector cannot do it alone. The NOC was the brainchild of the previous People’s National Movement administration who promised to have it operational by 2004. The Persad-Bissessar-led People’s Partnership Government promised to deliver the NOC to the people. Khan, speaking to the Express yesterday, explained that time was spent—buying the design plans for the NOC from Farrow Partnership which was completed about 18 months ago at a cost of $900,000.

Khan said the Urban Development Corporation of Trinidad and Tobago (UDeCOTT) put out tenders for the project. “It took a while because I made some changes in the plan,” said Khan. He said the initial plans were not adequate as there were four bunkers and linear accelerators but there was no advanced equipment. Khan said he asked that a cyber knife—a special radiotherapy unit with capability of “burning tumours” be added. He said he also asked that a special PET CT scan machine —a cyclotrone unit and other lab equipment be included. UDeCOTT, he said, finalised the tender process and a contractor was selected. He said the note for the budget for the project will today go before the Finance and General Purposes Committee which he expects will go through with ease as everything was “above board” and then the Cabinet will pass its approval later this week. “The foundation (of the NOC) is there already and we should start to build on it within the month,” said Khan. Asked for the projected completion date, Khan said, “I asked them to do it in 18 months or less if they can working night and day.” He further disclosed that Phoenix Park Gas Processors Limited has donated $60 million towards the NOC which will be used to buy one of the required advanced machines. Khan said he hopes that corporate entities in this country also lend a helping hand. According to the website of the designers of the NOC—Farrow Partnership—the NOC is a three-storey structure with four radiation treatment bunkers linked to the existing Eric Williams Hospital via walkways and landscaping. Gentle sloping lines and sprawling ‘therapy gardens’ create a ‘village gathering place’ for cancer patients and their families.

The website stated that “one of the challenges on this project was planning to consider future flexibility of the facility and its related impacts on the host hospital. Working closely with the user groups in Trinidad, Farrow Partnership brought the firm’s experience in designing internationally recognized cancer centres to the project,”. Last year April Khan told the Parliament that the NOC would provide radiation therapist services using linear accelerator technology, chemotherapy, CT simulation, treatment planning and high dose radiation (HDR) brachytherapy. He said further that when the NOC is established, it would become the one-stop shop for cancer care using a multi-disciplinary team approach, from diagnosis to treatment to cure, under the central control of a specialist care team of oncologists, specialist physicians, specialist surgeons, interventional radiologists, histopathologists, haematologists, palliative care and pain management specialists, oncology pharmacists, oncology nurses, medical physicists, radiation therapists, dosimetrists and counsellors/social workers.

Source : trinidadexpress.com/news/CANCER-PROMISE-220137811.html

Source :   http://www.hawaiireporter.com/
Category :   Certified Family Physicians
By : Guest Contributor
Posted By       :   Health Care Facilities Casselberry

Physicians Care Team

The complexity and incidence of chronic conditions afflicting the elderly has far outstripped the capacity of physicians to tackle them alone. A national shortage of geriatricians has the country turning to professionals trained in other disciplines — pharmacists, nurses, nurse practitioners, and physician assistants — to address the healthcare needs of an aging U.S. population.It’s not the case that delegating care from physicians to other professionals results in second-rate treatment. In the case of nurse practitioners (NPs), it’s exactly the opposite. A recent study led by Dr. David Reuben, director of geriatrics at UCLA, and published in the Journal of American Geriatrics Society shows that patients co-managed by a nurse practioner and a primary care physician together were more likely to receive the recommended care than those seen by a doctor working independently.

The study followed the referral and treatment of 485 patients over age 75 deemed to have more than one of four conditions: urinary incontinence, risk for falls, depression, and dementia. The patients were seen in two primary care practices and randomly assigned to see a doctor only, or a NP-doctor team. Patients who managed jointly by an NP and doctor were significantly more likely to receive recommended care, as outlined by evidence-based practice recommendations titled Assessing Care of the Vulnerable Elders, or ALCOVE-2 for short.

Patients screening positive for dementia received 59 percent of the recommended care NP-doctor teams, compared to 38 percent from physicians alone. Similarly, patients treated for falls received 80 percent of the recommended care from NP-physician teams, compared to only 34 percent from physicians alone. When treating patients with incontinence, co-managing with nurse practitioners led to 66 percent of recommendations followed, compared to only 19 percent when treated by physicians alone. For depression, patients received equal care between the, doctors and doctor-NP teams, all receiving 60-63 percent of the recommended care.

The ALCOVE-2 recommendations, along with prevailing medical wisdom, suggest that treatment extend beyond prescribing a pill, but incorporate education about behavioral changes. Demands on physicians’ time lead them to resort to quick fixes, while nursing education emphasizes sitting down and teaching the patient about lifestyle changes. The results illustrate the difference: 95 percent of patients with incontinence who saw the NP-doctor teams were given instruction on non-drug approaches, such as Kegel exercises, which strengthen the pelvic floor muscles and lessen urinary incontinence. Meanwhile, patients with incontinence who saw physicians only received little to no instruction. “Its been shown over and over that [non-drug approaches are] at least as effective and without the side effects,” Reuben told The New York Times. According to Reuben, the nurses’ advantage in addressing problems is inherent; It’s their job to address these common complications of aging, and nurses generally have more time to sit with patients.

About 61 percent of the original 1,084 patients screened had a condition requiring attention, yet a third of these never received the proper referral. Physicians participating in the study hesitated to refer patients to nurse practitioners, and nurse practitioners often saw patients without a referral. This study is not the first to highlight the challenges of adopting a team approach to care. Similarly, Reuben’s study is not the first to highlight the benefits of the team approach. Other research shows that nurse practitioner-doctor partnerships provided better support for patients with congestive heart failure and type 2 diabetes. Despite the evidence, resistance to expanding the role of nurses remains, leaving some proponents of team approaches wondering when, or if, change will occur.