International Posters 921 – 925
921 Investigating the views and experiences of health workers from Bwindi Community Hospital, Uganda, with regards to tobacco use
Aims/Objectives To explore the views and experiences health workers of Bwindi Community Hospital (BCH) have on tobacco use so as to suggest recommendations for improving their tobacco use services.
Content of Presentation A qualitative research design consisting of semi structured interviews with 11 health workers from Bwindi Community Hospital in Uganda.
Relevance/Impact Tobacco use is one of the world’s greatest threats to public health, the challenge of which has been taken up by Primary Care. Globalisation, economic growth and weak tobacco regulations have put Uganda at risk of a tobacco epidemic. Similar to other low-income countries, when met with an under-resourced primary care system providing education and support, it is important to ensure an efficient system. An insight into health workers’ understanding of tobacco use and the support for tobacco users they can deliver could be used to identify and address issues in the services they provide.
Outcomes The participants did not use tobacco themselves and were all aware of the harmful effects. Health workers did not ask patients about tobacco use unless they presented with associated symptoms or conditions, implying inadequate detection of users. Participants believed tobacco use to be a public health threat and were enthusiastic in supporting patients. A connection between alcohol and tobacco intake was identified.
Discussion From our qualitative work, we recommend:Screening for tobacco use on admission; Providing a workshop on tobacco cessation counselling for staff; Integrating tobacco cessation into the BCH alcoholics anonymous programme.
922 Maori health (hauora) insights – from a year working in a GP health centre in New Zealand
Aims/Objectives To demostrate and share learning from working in a Maori community as a GP in New Zealand 2015-2016To use the rich Maori language as subsection headingsBe present to discuss the learning themes raised from the poster presentation.
Content Based on experience of patient consultations, discussions within the health centre team, local education events and personal reading of history of Maori Health. The work is all my own and I have sought and received full written consent from the practice manager to present and publish this work. The subsections for the poster would be words from the Maori Language (Te Reo Maori); this would be done with the greatest and humble respect to the language itselfAs a border to the poster I would wish to use kowhaiwhia – a visual artwork design which has a story and a meaning- see file below for example.
Relevance/Impact on UK General Practice Examples of some of the subsection heading Maori words: Hauora (Health) – holistic practice Manaaketanga (care/hospitality/generosity) – preventing GP burnout Mana* (respect/prestige) – health promotion/behavioural change Korero (Speaking) – communication skills.
Outcomes Champion the current holistic care the RCGP aims forChange the way healthcare teams work, to better support each other and prevent GP burnoutImprove health outcomes by promoting behavioural change in patients through better understanding of Mana*Improve communication and consultation skills.
Discussion Improved knowledge of Maori health and culture. Apply to one’s own practice and what changes would/could you make? Consolidate and support good practice.
923 Going back to the future: targeted holistic care in general practice for managing the Japanese frail elderly
The Japanese healthcare system is facing mounting challenges as a result of its rapidly increasing elderly population. Over investigation and prolonged hospitalisation are common, with figures demonstrating that 46% of inpatients are over 65 years, a third of whom have been hospitalised for over a year. In order to rise to the challenge of providing cost effective community based healthcare, general practice was introduced.As an emerging specialty general practice must compete in a climate where patients have open access to hospital specialists and investigations.
During my exchange visit to Tokyo, I found clinics operating with the resources of superpractices, offering blood tests within an hour, administration of intravenous medications and same day CT scanning. Unexpectedly I noted a de-medicalised, holistic approach to the elderly patients. Core values such as continuity of care were upheld with doctors routinely visiting their own housebound patients every two weeks. Doctors complemented their therapies by encouraging hobbies, prescribing haiku writing (a form of Japanese poetry) and calligraphy.
Simple but effective education posters addressing common geriatric complaints were distributed in clinic and long term care facilities focused on preserving a feeling of “usefulness” by encouraging patients to be involved in the cooking and serving of food.
The Japanese family medicine doctors are breaking new ground by going back to traditional management principles, prioritising continuity of care and a feeling of worth to society above over investigation. As more services move out of hospital and the UK progresses to a model of healthcare federations and superpractices with increased access to tests, we could learn from their efforts; going ‘back to the future’ in furthering holistic care for our elderly population.
924 Critical care for advanced cancer patients: observations from a tertiary cancer centre in India
Aims This study aims to quantify the proportion of palliative care patients receiving care in ITU in a tertiary cancer centre in India. It aims to establish the outcomes of these admissions and determine the need for a change in hospital policy regarding critical care in advanced cancer patients.
Content Using hospital records, all the palliative care patients treated in ITU over a period of one year (2015) were identified. Demographic details, diagnosis and staging, length of admission in ITU, place and date of death were recorded.
Relevance The establishment of palliative care as a medical specialty is relatively new in India and very few physicians have received any formal training in the palliative model of care. End of life care is often managed poorly. One of the major issues is the frequent admission of dying patients to intensive care where they receive many futile invasive interventions.
Outcomes In 2015 an estimated 20% of palliative care inpatients, all with advanced or metastatic malignancies, received care in ITU. Of these, 73% died in ITU after an average admission length of four days. 15% were discharged from ITU ‘against medical advice’.
Discussion This study provides confirmation of the high numbers of patients with advanced cancer being admitted to intensive care at end of life in this centre. Of those who did not die in ITU, the next most frequent outcome was ‘discharge on risk bond’ (DORB – meaning against medical advice). This puts responsibility, legally, on the family’s shoulders and appears to be a defensive practice on the part of the doctors, despite potentially leaving patients and family feeling guilty or unsupported.
925 Introducing the FM360 exchange programme
Aims Introduce the Family Medicine 360 exchange programme. Outline benefits of becoming a host or exchange participant. Signpost eligible GPs and potential hosts towards participation and processes involved.
Content Since 2013, Family Medicine 360 is a worldwide observational exchange open to all trainees (AiT) and GPs within five years of qualification (First5), building upon the success of European Hippokrates exchanges. These self funded exchanges are 2-4 weeks, and are formally overseen by national and regional exchange coordinators within the WONCA network. Participants reflect upon the two contrasting general practice systems using a structured and standardised approach. We will highlight past participants’ reflections and learning, illustrating the wide variety of experiences available and personal and professional benefits.
Relevance The Department of Health and Modernising Medical Careers have been encouraging learning by undertaking international work. Exchanges provide an opportunity to learn from each other, enriched by different cultural and socio-economic contexts, enhancing professional and personal development. Exposure to different primary care systems stimulates new ideas amongst hosts and exchangees which may trigger change, improve practice and provide personal inspiration and perspective. The FM360 exchange programme offers AiT and First5 GPs the opportunity for global learning, however participation and awareness are low in the UK.
Outcomes:We hope to raise awareness of the FM 360 programme to encourage hosts and potential exchangees’ involvement.
DiscussionThe international FM-360 exchange scheme offers a unique opportunity to experience general practice, introducing new ways of thinking. We will describe how and why GPs can get involved.