Suchergebnisse

Objectives: Current barriers to implementing Advanced Care Planning (ACP) will be examined as applied to the healthcare system. Methods: A literature review was performed looking at the current practices of ACP (e.g. filling out advanced directives (AD), Medical Orders for Life Sustaining Treatment (MOLST)/ Physician Orders for Life Sustaining Treatment (POLST), etc.), physician comfort level with having end-of-life discussion (EOL), successful/unsuccessful interventions to increase ACP/EOL discussions among health care providers (HCP), and the current political environment with respect to physicians' ability to implement ACP/EOL discussions. Cochrane, Pubmed, and Google Scholar were searched for papers written in English after 2000 in the United States In order to be eligible, the studies were required to discuss educational interventions, patient/physician barriers, and/or political barriers surround ACP/EOL discussions. Results: Seventeen articles were identified to meet the inclusion criteria and are included in this review. Barriers identified by both the physician and the patient were: lack of time, lack of awareness, lack of comfort, and lack of a systematic approach. Educational interventions for health care providers somewhat improved comfort levels. The introduction of the Medicare Reimbursement had a substantial impact on increasing the amount of ACP/EOL conversations reported. Conclusions: Although there is some evidence that educational interventions aimed at health care providers improves the providers' knowledge, self-efficacy, and communication with regards to ACP, health-system and political barriers remain to impact ACP implementation. Medicare reimbursement not only allows physicians to be paid for their time facilitating these discussion, but legitimizes its need. It is recommended that a systematic approach to ACP, throughout the course of the patient's life, will improve implementation rates and physician/patient comfort levels with ACP/EOL discussions.

Purpose The life expectancy in the United States is longer than ever before. However, as the Baby Boom generation ages and people die increasingly slow deaths from chronic conditions, there will be a growing need for partnerships and programs to ensure end of life patients get the care they need in the setting that they want. One partnership in particular that has a growing following is that between hospice agencies and the Emergency Medical Services. This paper will examine potential policies at the Federal, State, and systemic levels that hinder or prevent EMS agencies from participating in hospice services. Methods A review of literature was conducted. Academic literature from after 1974 – the date of the first American hospice agency – and grey literature from after 2007 were considered. SCOPUS, CINAHL, and the Himmelfarb Library database were queried with various combinations of MeSH terms. Those results were then screened by date and content for relevance. A variety of government agencies and relevant NGOs were also searched for applicable content. Results Significant barriers to EMS involvement in hospice services exist at the Federal and State levels. At the Federal level, there is a major problem with reimbursement for both EMS and Hospice services with regards to this type of care. The Drug Enforcement Administration also has policy barriers written into the Controlled Substances Act, but there is legislation waiting for the President's signature that may reverse these barriers. Additional barriers exist on a state by state basis, but these were more difficult to determine, and searching for each independently proved challenging. Conclusion Significant barriers to EMS involvement in Hospice care exist at Federal and State levels. Because some states allow for EMS agencies to provide home health services without transport, and because the major barriers to the federal controlled substance issue is expected to resolve soon, there is an opportunity for further research into EMS / hospice collaboration ...