Reducing inequalities in care for patients with non-malignant diseases: Insights from a realist evaluation of an integrated palliative care pathway.

BACKGROUND: The need for palliative care is growing internationally with an increasing prevalence of non-malignant diseases. The integrated care pathway was implemented in primary care by multidisciplinary teams from 2009 in a locality in the North East of England. Fourteen general practitioner practices provided data for the study. AIM: To find whether, how, and under what circumstances palliative care registrations are made for patients with non-malignant diseases in primary care. DESIGN: General practitioner practice data were analysed statistically and qualitative data were collected from health care professionals and members of relevant organisations. FINDINGS: A mixed-effects logistic model indicated a significant difference beyond the 0.1% level (p < 0.001) in registrations between the malignant and non-malignant groups in 2011, with an odds ratio of 0.09 (=exp(-2.4266)), indicating that patients in the non-malignant group are around 11 times (1/0.09) less likely to be registered than patients in the malignant group. However, patients with non-malignant diseases were significantly more likely to be registered in 2012 than in 2011 with an odds ratio of 1.46, significant beyond the 1% level. Qualitative analyses indicate that health care professionals find registering patients with non-malignant diseases stressful, yet feel that their confidence in treating this population is increasing. CONCLUSION: The integrated care pathway began to enable the reduction in inequalities in care by identifying, registering and managing an increasing number of palliative patients with non-malignant diseases. Consensual and inclusive definitions of palliative care were developed in order to legitimise the registration of such patients.

Survey of speech and language therapy provision for people with Parkinson's disease in the United Kingdom: patients' and carers' perspectives.

BACKGROUND: Communication and swallowing changes are prominent in Parkinson's disease, but there remains a lack of information regarding the experiences and expectations of people with Parkinson's disease in respect of speech-language therapy (SLT) services. AIMS: To conduct a survey of people with Parkinson's disease and their carers in the United Kingdom to elicit their views concerning communication and swallowing changes in Parkinson's disease and the support they envisage in helping with these changes. METHODS & PROCEDURES: A national survey utilizing a questionnaire developed for the project, accessible by people with Parkinson's disease in web-based, e-mail or paper forms. OUTCOMES & RESULTS: A total of 168 people with Parkinson's disease (median = 7 years since diagnosis, range = 0.5-30) and 47 carers who provided their impression of the experience of the PwPD responded. Of these 215, 92 (43%) had no contact with SLT services. In general those who had seen an SLT found it a positive experience. Pointers for improvement centred around timing, intensity, duration and access to SLT as well as issues around transfer and maintenance of gains outside of clinic and (lack of) attention to psychosocial dimensions. Availability of ongoing support as the situation evolved and access to SLT when it was needed were two prominent features desired of a responsive service. CONCLUSIONS & IMPLICATIONS: Responses suggest that when SLT is available it offers positive support, but respondents felt (re)access when and where SLT is needed could improve, as well as what aspects of swallowing and communication were addressed in assessment and therapy. We reflect on possible recommendations to address the challenges for SLT services in considering organization and content of provision.

Preparing African American nurses for graduate school: practical tips.

Returning to school for an advanced degree in nursing is a major lifetime decision and a new phase in life, whether you set an academic, career or professional goal. As in any new experience some degree of anxiety is to be expected and could result in frustration and uncertainty. For some African American students navigating the application process can be a challenging experience. However by following a few practical tips and using a variety of resources, your experience can be an exhilarating and a successful accomplishment. The primary aim of this article is to delineate strategies for academic success with a focus on African American students who are considering graduate education in nursing. This article offers practical help on how to get started in selecting a graduate nursing program, details on navigating the application process, and suggested approaches for surviving in graduate school.