Bits & bytesin palliatieve zorg?
Health valley
13 maart 2014
Jeroen Hasselaar
Universitair Docent
Radboudumc
cover van 'Care at a distance', Amsterdam University Press
2.
Waar staan we?
•Waar is onze patient?
• Waar heeft die patient behoefte
aan?
• Waar ligt een kansrijke inzet van
telezorg?
• Wat is de link met health valley?
Het klinisch team
3.
Palliatieve zorg (WHO2002)
Vereist een benadering die de kwaliteit van het leven verbetert van patienten en hun naasten die te
maken hebben met een levensbedreigende aandoening, door het voorkomen en verlichten van lijden,
door middel van vroegtijdige signaleringen zorgvuldige beoordeling en behandeling van pijn en andere
problemen van lichamelijke, psychosociale en spirituele aard.
Er gaat veelgoed maar:
cover van 'Care at a distance', Amsterdam University Press
*Te weinig anticiperend handelen
*Veel reguliere zorgverleners
hebben onvoldoende kennis van
en ervaring met palliatieve zorg
*Te weinig samenwerking,
informatie-uitwisseling tussen
betrokken zorgverleners
Teleconsultatie in palliatievezorg; research that fits
Interviewen:
-Ervaringen van gebruikers
-Praktische normativiteit
Observeren:
-Teleconsultatie & context
-Teleconsultatie in het
ziekenhuis/teleconsultatie thuis
Empirische oz & ethiek:
-De waarde en aanvaardbaarheid van
teleconsultatie in de praktijk van de
palliatieve zorg
+
Europees ‘best practice’project
• Bevat resultaten taxonomie en benchmark
(InSup-C)
• Bevat informatie over optimaliseren van lokale
palliatieve zorg
• Ter ondersteuning van lokale organisatie die
meer kennis op wil doen over optimaliseren
zorgverlening.
16.
Self-checklist
• Bevat benchmarkmet ‘best practices’
geïntegreerde palliatieve zorg
• Lokale organisatie zet praktijk af tegen checklist
• Aanknopingspunten voor verbetering
#12 Ouderen – values of life – conceptualisering van decision tree(s) - feedback
#13 Fitting research to innovative practices (zie ook Pols)
Media ethnography:
descriptive: “the processes that shape and shift the goals and outcomes of innovative practices”
Practical knowledge (experiences of users) & practical normatity of users > without obscuring the situated and contestable nature of this knowledge
Observations without disrupting the innovative work (hoewel je regelmatig dreigt een onderdeel te worden van de interventie).
#14 Basically 3 players are involved in palliative team care for AYA-patients
Caregivers within the hospital
GPs or caregivers within the community
The patients and their informal caregivers.(home)
Ussually communication is between 2 of the 3 players at a moment (verschillende pijltjes)
By introducing teleconsultations by means of Facetalk opportunity to
Introduce community caregivers to the multidisciplinary hospital team of caregivers.
Introduce the patient to participate in multidisciplinary teammeeting and/or team care. the patient becomes a partner
But what will be the consequences of doing so?
#15 To find out about dynamics in team care and what will happen when we introduce the patient to the multidisciplinary team, we will make recordings (audio and visual) of Multidisciplinary teleconsultations by using FaceTalk.
#19 Legend
Step 1
a. The NP initiates digital bedside consultations with the patient on a regular basis (starting with 1 teleconsultation a week)
b. Duration: approximately 30 minutes
c. Standardized inventory of patient's symptoms and other multidimensional problems
d. The NP provides practical advice on caring and nursing; abstains from direct medical treatment advices and decisions
Step 2 (not the focus of this particular study)
a. The NP discusses her findings with palliative care specialist and reports to the primary care physician
b. Involved health care professionals compose and/or discuss the treatment plan
c. As long as the patient resides at home, the primary care physician is responsible for discussing the treatment plan with the patient and together they decide about further treatment and care.
Important notes
a. A patient cannot directly contact the SPCT via the teleconsultation route as to secure the primary care physician's central position and to prevent an overload of the care system.
b. In case the primary care physician participated 'real time' by visiting the patient at home during teleconsultations, the teleconsultation with a patient/consultation with a primary care physician/feedback to the patient was compressed into a single interaction.
