Patient and family perceptions of hospice services: “I knew they weren’t like hospitals”

Bray Y, Goodyear-Smith F. Patient and family perceptions of hospice services: “I knew they weren’t like hospitals”. Journal of Primary Health Care, 2013. 5 (3):206-213.

Abstract:
INTRODUCTION:
The vision for palliative care service provision in New Zealand is for all people who are dying and their families to have timely access to culturally appropriate, quality palliative care services. An Auckland hospice’s records show that the ethnically diverse population statistics were not reflected in the referrals for hospice services. The aim of this research was to gain a patient-and-their-family perspective on the hospice, including exploration of components of service care that could be improved for various cultural groups.
METHODS:
Patients currently under the care of the hospice and family members were recruited from hospice records. Semi-structured interviews were conducted to explore the emerging issues. The study collected data from a purposive sample of 18 palliative care patients or carer family members, ranging in age from 39 to 81 years, who reflected the ethnic diversity of the population of the region. Interviewing was carried out by an experienced research assistant and continued until data saturation was reached.
FINDINGS:
Four key themes emerged—hospice personnel’s approach to patients, quality of service, cultural barriers, and strategies for future improvement. It was determined that the latter two were the most significant to address in this article.
CONCLUSION:
The study revealed the need for information-giving and education, including public profiling of the hospice to strengthen community involvement. Strategies to reduce ethnic disparities include strengthening the awareness of, and access to, services by connecting with cultural groups through churches, community and specific cultural media.

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When is acute persistent cough in school-age children and adults whooping cough?

Philipson K, Goodyear-Smith F, Grant C, Chong A, Turner N, Stewart S. British Journal of General Practice. Aug 2013, 63(613), e573-e579(7)
DOI http://dx.doi.org.ezproxy.auckland.ac.nz/10.3399/bjgp13X670705
Abstract
Background: Pertussis is a vaccine modified disease in most age groups and hence subtle in its presentation. Current diagnostic approaches require relatively invasive sampling.
Aim: To determine the incidence of B. pertussis infection among people aged 5-49 years identified in primary care with acute persistent cough using an oral fluid based diagnostic test.
Design and setting: Active surveillance of acute persistent cough of 2 weeks duration or greater was established in Auckland, New Zealand from May to October 2011. The 15 participating primary care practices provided care for a socioeconomically diverse population.
Method: Recent B. pertussis infection was determined by measurement of IgG antibodies to pertussis toxin (PT) in an oral fluid sample. An IgG antibody titre to PT of ≥70 arbitrary units defined recent infection. Participants reported symptoms at presentation and kept a cough diary.
Results: A total of 226 participants were enrolled: 70 (31%) were children (5-16 years) and 156 (69%) were adults (17-49 years). Oral fluid samples were obtained from 225 participants. Ten per cent (23/225) had recent B. pertussis infection including a larger proportion of children than adults (17% versus 7%, P = 0.003). Neither cough duration nor any individual symptom discriminated between those with and without recent B. pertussis infection.
Conclusion: Pertussis is a frequent cause of acute persistent cough presenting to primary care. Clinical differentiation of pertussis from other causes of acute persistent cough is difficult. An oral fluid based diagnostic test, which is less invasive than other diagnostic approaches, has high acceptability in primary care.
This paper has just been published in the British Journal of General Practice.

A media release ‘Pertussis vaccine needed for adults working with children, says study’, by The Press Association, 8 August, 2013 reports that the study suggests that immunisation against whooping cough should be made available for adults who work in close contact with children.