Essential Elements of Home-based Palliative Care Model: A Rapid Review.

The need for palliative care is increasing due to the rising burden of non-communicable diseases and some communicable diseases. Chronic illnesses demand patient-centred care that focuses on the patient's individual healthcare needs. Palliative care improves the patients' and caregivers' quality of life by providing pain and symptom relief through a holistic approach after the disease is diagnosed. Though there are various models followed in different countries, home-based palliative care is preferred by patients who wish to stay close to their loved ones at their end of life. For providing home-based care, there are certainly important elements that have to be taken care of before planning the implementation because every country has its own healthcare needs, system, and context. India is a developing country where isolated Palliative Care is practiced, hence the situation demands the need of addressing the essential elements that can be included in the protocol of home-based palliative care to enhance the quality of care. Therefore, this study aims to identify a few elements needed to provide home-based palliative care in the Indian context. A rapid review was conducted where seven studies were included that mentioned the elements of home-based palliative care. The electronic databases searched were MedLine, PubMed, and Cochrane databases of systematic reviews. The review was carried out over a period of 8 weeks in June and July 2022. Seven common essential themes were identified; (i) inter-sectoral and inter-professional cooperation, (ii) trust and safety, (iii) holistic management, (iv) non-academic palliative care, (v) spiritual care, (vi) support to caregivers, and (vii) funding and financial support. Our review of effective palliative care models explicates the essential elements for quality home-based care for patients with a terminal illness. The application of the elements must be relevant to the local context due to the huge diversity of the country.

Progressive disability in elderly population among tribals of Telangana: a cross sectional study.

BACKGROUND: The tribal population of Telangana, India, lives in remote and difficult conditions. This study was carried out to find out estimate, the prevalence and progression of disability in elderly population among tribals of Khammam District, Telangana state, India. METHODS: A population based cross sectional survey was conducted in villages of Tribal Sub Plan area. Elderly people who are 60 years or older were chosen with a two stage sampling procedure: (1) probability proportion to size was used to select clusters and (2) in each selected cluster households were selected by systematic random sampling. The participants were interviewed with the 36 item Telugu version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire. Socio- demographic information, behavioral measurements, health and social benefit indicators were also assessed. Descriptive analytical methods were used for prevalence estimation and logistic regression was used to examine the associations of progressive age over disability among elderly. RESULTS: A total of 506 elderly people from 1349 households in 20 villages across 31mandals of Khammam were interviewed. Majority of elderly population among tribals were illiterate (men 88.94%; women 99.33%), used tobacco (men 81.25%; women 57.72%), consumed alcohol (men 80.77%; women 47.32%) and were hypertensive (men 53.85%; women 63.42%). The prevalence of disability was higher in women. Maximum disability in the interviewed elderly population was seen in domains of performing house hold activities, and mobility. In comparison with men, women expressed more disability for majority of domains. As age progressed, the disability for self-care domain increased to a maximum of 2.6 times in men and 6.6 times in women and for mobility domain increased to a maximum of 9.7 times in men and 7.2 times in women. CONCLUSIONS: Although present disability modifying mobility Assistive Devices (AD) can help elderly in overcoming disability, these are primarily designed for built environments. As the needs, cultural sensitivities, and living environment of elderly population in tribals are unique, newer innovative assistive devices should be designed and developed.

Study of morbidity profile of a rural population in Tamil Nadu.

OBJECTIVE: To identify the reported morbidity profile of people according to age, gender and organ system affected using International Classification of Diseases (ICD) coding, in a demographically defined area in Tamil Nadu in order to identify their health care needs and to plan appropriate interventions strategies. MATERIALS AND METHODS: This is a-cross sectional study using a convenience sample of 12308 persons sceened from the 41 panchayat units of the Kattankulathur block, comprising 90 villages with a population of about 2,00,890, over a period of one year. Diagnosis made were coded using ICD 10 version and data collected was analysed by appropriate statistical methods to explain the distribution of morbidity profile among the study population. RESULT: Out of total, 38.1% screened were males and 61.9% were females. Underfives were 5.3%, school going children 43.3%, adults 39.2% and elderly 12.3%. Majority had illness affecting respiratory system (20%), 'symptoms and signs' (19%), musculo-skeletal system (16.1%) and digestive system(11.9%). 'Symptoms and signs' classification, is a group of conditions which is of nonspecific diseases, signs, symptoms, abnormal findings and complaints, apart from the system specific conditions diagnosed properly and not elsewhere classified, More males were affeced with respiratory, digestive and illnesses with 'symptoms and signs' while more women were affected with musculo-skeletal problems. Only 9.7 % of patients reported with non-communicable diseases. Among them, 55 % women and 42.3 % men had osteoarthritis and 15.7 % women and 21.3 % men had cataract. About 15.8 % women and 18.1 % men had hypertension and other heart diseases while 9.7 % women and 8.4 % men had diabetes and 10.0 % men and 3.9 % women had chronic respiratory diseases. CONCLUSION: School going children and adults have higher levels of morbidity when compared to elderly and under five children. More females reported with illness but morbidity was found to be higher among males. The burden of illness increased with age. Acute ailments were responsible for high morbidity among children, while chronic ailments caused high morbidity among the elderly.

Assessment of prescribing practices among urban and rural general practitioners in Tamil Nadu.

BACKGROUND: Studying drug use pattern among medical practitioners is of vital importance in the present scenario where irrational drug use and development of drug resistance is becoming rampant. OBJECTIVE: To assess, the pattern of prescribing practices among the general practitioners in a defined rural and urban area of Tamil Nadu. MATERIALS AND METHODS: A community based descriptive study was conducted to collect 600 prescriptions from the catchment areas of rural and urban health training centers of a medical college using prescribing indicators as per the WHO "How to investigate drug use in health facilities" tool. RESULTS: This prescription study revealed that multivitamins (19.5%), antibiotics (19.3%), drugs for gastro-intestinal tract (GIT) (18%), analgesic non-steroidal anti-inflammatory drugs/ (NSAID's) (15.1%), and antihistaminic (12.5%) were prescribed frequently. Among the antibiotics, amoxicillin (49.2%) was the most commonly prescribed followed by gentamicin (31.7%). Percentage of prescriptions with an antibiotic was 55% and nearly 62% of the practitioners prescribed drugs by their generic names. As a practice of poly-pharmacy, it was observed that the average number of drugs prescribed in urban and rural area was nearly 5 and 4, respectively. Nearly 80% of the urban and rural practitioners were prescribing at least one injection. Study of the quality of prescriptions revealed that there was poor legibility, high usage of abbreviations, inadequate details of the drugs, and absence of signature by practitioners in the prescriptions. CONCLUSION: This study clearly highlights the practice of poly-pharmacy, low usage of generic drugs, injudicious usage of antibiotics and injections and low usage of drugs prescribed from essential drugs list.