• Palliative care - the new essentials

      Abel, J.; Kellehear, Allan; Karapliagou, Aliki (2018)
      Background: If global palliative care is to successfully address challenges of unequal access, continuity of care, and health services reductionism, new practice models to address these issues need to be identified, debated and tested. This paper offers one such practice model based on a public health approach to palliative care that has so far shown promising evidence of effectiveness. Methods: We describe how four essential elements within a public health model can work together to address quality and continuity of care as well as addressing the numerous barriers of access. These elements are: (I) specialist, and (II) generalist palliative care services working with (III) communities and neighbourhoods, working in their turn with their (IV) key civic institutions. Results: The positive and negative impact and advantages of each of these elements is described and discussed. Conclusions: A solely clinical model of palliative care is inadequate to addressing the multiple comorbidities and access issues characteristic of modern palliative care. A public health approach based on a close partnership between clinical services and communities/civic institutions is the optimal practice model.
    • Palliative care reimagined: a needed shift

      Abel, J.; Kellehear, Allan (2016-03)
      Palliative care, since its inception over 60 years ago, has set the standard of how to care for people who are dying. Key features among these standards have been the professional development of clinical specialisms such as palliative medicine and palliative nursing; the essential addition of the multidisciplinary team to these two new specialisms that included social, spiritual and allied health workers—an outgrowth of the recognition that routine work with the dying, their carers, and the bereaved required more than solely clinical skills; and the unique partnership with communities that yielded the volunteer movement within palliative care. Professional, evidence-based symptom management and the importance of supportive care in its widest possible sense were and remain the cornerstones of the modern palliative care approach. However, the majority of people with terminal illnesses do not have access to palliative care teams, whose main focus of care remains patients with cancer. In the context outlined above this paper therefore poses two key questions: how can we provide an equitable level of care for all people irrespective of diagnosis and how can we increase the range and quality of non-medical/nursing supportive care in a context of diminishing resources? We argue that an important opportunity and solution can be found by adopting the principles of a public health approach to end-of-life care.
    • Palliative curriculum re-imagined: A critical evaluation of the UK Palliative Medicine Syllabus

      Abel, J.; Kellehear, Allan (2018-05)
      The UK Palliative Medicine Syllabus is critically evaluated to assess its relationship and relevance to contemporary palliative care policy and direction. Three criteria are employed for this review: (1) relevance to non-cancer dying, ageing, caregivers, and bereaved populations; (2) uptake and adoption of well-being models of public health alongside traditional illness and disease models of clinical understanding; and (3) uptake and integration of public health insights and methodologies for social support. We conclude that the current syllabus falls dramatically short on all 3 criteria. Suggestions are made for future consultation and revision.
    • Reducing emergency hospital admissions: A population health complex intervention of an enhanced model of primary care and compassionate communities

      Abel, J.; Kingston, H.; Scally, Andy J.; Hartnoll, J.; Hannam, G.; Thomson-Moore, A.; Kellehear, Allan (2018-11)
      Background: Reducing emergency admissions to hospital has been a cornerstone of health care policy. There is little evidence of systematic interventions which achieved this aim across a population. We report the impact on unplanned admissions to hospital through a complex intervention over a 44 month period in Frome, Somerset. Aim: A population health complex intervention of an enhanced model of primary care and compassionate communities to improve population health and reduce emergency admissions to hospital Design: A cohort retrospective study of a complex intervention on all emergency admissions in Frome compared to Somerset from April 2013 to December 2017. Setting: Frome Medical Practice, Somerset Methods: Patients were identified using broad criteria including anyone with cause for concern. Patient centred goal setting and care planning combined with a compassionate community social approach was implemented broadly across the population of Frome. Results: There was a progressive reduction, by 7.9 cases per quarter (95% CI: 2.8, 13.1; p=0.006) in unplanned hospital admissions across the whole population of Frome, over the study period from April 2014 to December 2017. At the same time, there was sharp increase in the number of admissions per quarter, within the Somerset, with an increase in the number of unplanned admissions of 236 per quarter (95% CI: 152, 320; p<0.001). Conclusion: The complex intervention in Frome was associated with highly significant reductions in unplanned admissions to hospital with reduction of healthcare costs across the whole population of Frome