Enhanced access to professional advice represents a potentially effective method of increasing carers' confidence in their ability to undertake practical aspects of home-based care. Evidence suggests that nurses and other health providers may better assist home-based carers by providing the information and skills-training necessary to facilitate this. This may necessitate the involvement of carers in the design and testing of new educational interventions.
The administration of medication is an important therapeutic intervention. However, concerns have been raised about the management of this procedure in the acute area. Therefore, a survey was conducted with registered nurses (n = 24) and patients (n = 57) from three acute admission wards in an inner city hospital in the north west of England. Semistructured interviews were conducted immediately following medication administration and then analyzed using thematic analysis. Nurses' views were categorized into three themes: ward environment, communication, and sharing of information. Nurses reported that policies and procedures provided clear guidance, but that the task remained stressful and the role of other professionals affected the integrity of the procedure. Patients' views were categorized into four themes: effects and side-effects of medication, the process of administration, therapeutic relationships, and the sharing of information. Most patients were accepting of the administration of their medication, but called for improvements in information sharing and side-effect management. Information sharing is pivotal in establishing therapeutic relationships, but the time of administration might not be the most appropriate occasion for this.
Effective psychological and pharmacological treatments are available, but for depressed older adults with long-term physical conditions, the outcome of routine care is generally poor. This paper introduces the chronic care model, a systemic approach to quality improvement and service redesign, which was developed by Ed Wagner and colleagues. The model highlights six key areas that need to be addressed, if depression is to be tackled more effectively in this neglected patient group: delivery system design, patient-provider relationships, decision support, clinical information systems, community resources and healthcare organization. Three influential programmes, the Improving Mood Promoting Access to Collaborative Treatment programme, the Prevention of Suicide in Primary Care Elderly Collaborative Trial, and the Program to Encourage Active, and Rewarding Lives for Seniors, have shown that when the model is adopted, significant improvements in outcomes can be achieved. The paper concludes with a case study, which illustrates the difference that adopting the chronic care model can make. Radical changes in working practices may be required, to implement the model in practice. However, Greg Simon, a leading researcher in the field of depression care, has suggested that there is already sufficient evidence to justify a shift in emphasis from research towards dissemination and implementation.
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