Implementation of Compassionate Communities: The Taipei Experience.

A worldwide movement to empower communities to support their members to care for each other at the end of life (EoL) has emerged since Kellehear published the Compassionate City Charter. This current report discusses the implementation experiences and preliminary outcomes of Compassionate Communities (CC) in Taipei City. Using the guidance of the Charter and international experiences, we have developed and multiplied a culturally sensitive, sustainable, and holistic CC program that composes municipal hospital, social, and other services, partnering with community leaders, non-governmental organizations, university students, and volunteers. Innovative campaigns, such as workshops, conferences, and the Life Issue Café, have been delivered to facilitate engagement, public education, and leadership with reverence to folk beliefs and the use of existing social networks. We have identified a model with strong collaborative leadership, high participation rates, and ongoing commitment. The gaps between asking/accepting and providing help were bridged when social connectedness was strengthened. We also integrated home-based medical care, home-based palliative care, and advance care planning to help the vulnerable who live alone, with poor status, or with limited resource access, and continue to support the community throughout the COVID-19 pandemic.

The Life Experiences Among Primary Family Caregivers of Home-Based Palliative Care.

BACKGROUND: An increasing number of patients with terminal illnesses prefer to die in their own homes due to aging, high medical payments, a limited number of hospitalization days, and the ability to receive care from family members. However, few studies have been conducted on the subjective perception and value of caregivers for home-based palliative care (HBPC). OBJECTIVE: To identify common themes and topics of primary family caregivers' lived experiences with HBPC when taking care of terminally ill family members. METHODS: We conducted audio-recorded transcripts of one-on-one in-depth interviews of primary family caregivers of HBPC. Through a purposive sampling method, the participants were all interviewed; these interviews were transcribed verbatim and analyzed using a grounded theory approach. RESULTS: A total of 22 primary family caregivers participated in the study. "Wholeheartedly accompanying one's family to the end of life at home" was the core category. Six main themes describing caregivers' experiences emerged from the interviews: (1) learning the basic skills of end-of-life home care, (2) arranging the sharing and rotation of care, (3) preparing for upcoming deaths and funerals, (4) negotiating the cultural and ethical issues of end-of-life home care, (5) ensuring a comfortable life with basic life support, and (6) maintaining care characterized by concern, perseverance, and patience. CONCLUSIONS: Primary family caregivers of HBPC need support and must learn home care skills by means of the holistic approach. It is crucial to establish assessment tools for caregivers' preparedness for HBPC, including biopsychosocial and cultural considerations.

Nationwide analysis of medical utilization in people with severe mental illness receiving home care case management.

AIM: This nationwide study investigated the change in medical utilization of psychiatric home care case management (CM). METHODS: This nationwide study enrolled patients receiving CM (N = 10,274) from January 1, 1999 to December 31, 2010, from Taiwan's National Health Insurance Research Database. Through a 2-year mirror-image comparison weighted by the contributed person-time for each subject, we evaluated changes in medical utilization. Furthermore, a case-crossover analysis was used to verify the independent effect of CM in changing medical utilization by adjusting the time-variant variables between the pre-2-year (within 2 years before receiving CM) and post-2-year (within years after receiving CM) periods. The same methodology was applied for the subsequent 2-year comparison to assess the maintenance effect. RESULTS: Of the 10,274 patients receiving CM, 69.7% had schizophrenia. The results showed a chronological trend for the intervention of CM. The adjusted mirror-image analysis revealed a significant decrement of psychiatric and involuntary admissions after the intervention, and the utilization shifted toward psychiatric outpatient service. The case-crossover analysis with the adjustment of time-variant covariates confirmed the independent effect of CM on the changes of medical utilization. The comparable effect persisted after the next 2 years of intervention. However, CM showed no impact on lowering the admission rate for comorbid physical illnesses after the intervention. CONCLUSIONS: The CM model can effectively reduce psychiatric hospitalization and involuntary admission frequency but has no effect on comorbid physical illnesses. Care models aimed at ameliorating physical problems in such patients are needed.

[The Promotion of Resources Integration in Long-Term Care Service: The Experience of Taipei City Hospital].

The home-based medical care integrated plan under Taiwan National Health Insurance has changed from paying for home-based medical care, home-based nursing, home-based respiratory treatment, and palliative care to paying for a single, continuous home-based care service package. Formerly, physician-visit regulations limited home visits for home-based nursing to providing medical related assessments only. This limitation not only did not provide practical assistance to the public but also caused additional problems for those with mobility problems or who faced difficulties in making visits hospital. This 2016 change in regulations opens the door for doctors to step out their 'ivory tower', while offering the public more options to seek medical assistance in the hope that patients may change their health-seeking behavior. The home-based concept that underlies the medical service system is rooted deeply in the community in order to set up a sound, integrated model of community medical care. It is a critical issue to proceed with timely job handover confirmation with the connecting team and to provide patients with continuous-care services prior to discharge through the discharge-planning service and the connection with the connecting team. This is currently believed to be the only continuous home-based medical care integrated service model in the world. This model not only connects services such as health literacy, rehabilitation, home-based medical care, home-based nursing, community palliative care, and death but also integrates community resources, builds community resources networks, and provides high quality community care services.

Acupuncture assisted local anesthesia for penile surgeries.

Although the mechanism of acupuncture for analgesia is not fully elucidated, a combination of acupuncture and several methods of topical blocks for local anesthesia has been effective to patients with indications for penile surgeries on ambulatory basis. We sought to review this unique clinical application since 1998. To summarize practice-based medical literature contingent this unique application and, in contrast, the commonly agreed either general or spinal anesthesia concerning those surgeries on this most sensitive organ-the delicate penis. From July 1998 to July 2013, total of 1,481 males underwent penile surgeries with specific topical nerve blockage in addition to acupuncture in which the acupoints of Hegu (LI4), Shou San Li (LI10), Quchi (LI11), and either Waiguan (TE5) or Neiguan (PC6) were routinely used. Careful anesthetic block of the paired dorsal nerve in the penile hilum associated with a peripenile infiltration was categorized to method I which is sufficient to anesthetize the penile structures for varied penile surgeries including 993 men of penile venous stripping surgeries, 336 cases of penile corporoplasty, 8 males of urethroplasty, 7 patients of vaso-vasostomy, 6 men of penile arterial reconstruction and 3 surgeries of penectomy. Whereas the bilateral cavernous nerve block and crural blockage were indispensably added up for anesthetizing the sinusoids of the corpora cavernosa (CC) for penile implant of varied model. It was allocated to method II and had been applied in 125 males. A further topical injection of the medial low abdominal region made it possible for implanting a three-piece model in three males. Thus recent discoveries and better understanding of the penile anatomy had been meaningful in the development and improvement of specific nerve blockade techniques for penile surgeries in particularly adding up with acupuncture techniques, while minimizing anesthetic adverse effects and resulting in a rapid return to daily activity with minimal complications.

The use of complementary and alternative medicine for patients with traumatic brain injury in Taiwan.

BACKGROUND: The use of complementary and alternative medicine (CAM) continues to increase in Taiwan. This study examined the use of CAM and beliefs about CAM as expressed by patients with traumatic brain injury (TBI) in Taiwan. METHODS: TBI patients and their accompanying relatives were interviewed by using a structured questionnaire at an outpatient clinic in a medical center in northern Taiwan. RESULTS: A total of 101 patients with TBI participated in the study. Sixty-four (63%) patients had used at least one form of CAM after sustaining TBI. CAM users had used an average of 2.72 forms of CAM after sustaining TBI. The most frequently used CAM category was traditional Chinese medicine (37; 57.8%), followed by folk and religious therapies (30; 46.9%), and dietary supplements (30; 46.9%). The majority of the patients (45; 70.3%) did not report CAM use because they felt it was unnecessary to do so. Patients who used CAM had a significantly stronger positive belief in CAM than those who did not (t = -2.72; P = .008). After using CAM, most of the patients (54; 85%) perceived moderate satisfaction (2.89 ± 0.44), according to a 4-point Likert scale. CONCLUSION: Although the use of CAM is common for TBI patients receiving conventional medical health care in Taiwan, most patients did not inform health care personnel about their CAM use. TBI patients perceive combined use of CAM and conventional medicine as beneficial for their overall health.