Impact of interprofessional collaborative practice in palliative care on outcomes for advanced cancer inpatients in a resource-limited setting.

BACKGROUND: Palliative care for patients with advanced cancer improves suffering symptoms, and quality of life (QoL). However, routine implementation of palliative care by specialty palliative care consultation is still an unmet need among in-patients with advanced cancer. Our study aim is to evaluate the effectiveness of a team-based approach on QoLs and readmission rate when compared to routine practice by among medical oncologists. METHODS: This study was a prospective, Quasi-Experimental design. In-patients with advanced cancer were non-randomly assigned to receive palliative care service by team-based approach or medical oncologists only. The primary endpoint was QoL. The secondary endpoint was the readmission rate at 7 and 30 days of hospital discharge. RESULTS: One hundred twenty-two in-patients were enrolled. In-patients who were assessed by a team-based approach had significantly improved change scores of subjective well-being (SWB) when compared to another group (∆ SWB: -1 [-19 - 11] vs 0 [-9 - 15], p-value = 0.043). Furthermore, patients who were assessed under a team-based approach had significantly decreased in terms of readmission rate at 7 days of hospital discharge (4.92% in the team-based approach group vs. 19.67% in the medical oncologist group, p-value = 0.013). CONCLUSIONS: Interdisciplinary collaboration is the key to success in establishing goals of care, which are supporting the best possible QoL and relieving suffering symptoms for those in-patients with advanced cancer. Furthermore, the readmission rate at 7 days of hospital discharge was significantly reduced by a team-based approach. Therefore, comprehensive palliative care assessment by interprofessional collaborative practice is required. TRIAL REGISTRATION: Thai Clinical Trials Registry (TCTR): number 20200312001. Date of first registration on 09/03/2020.

Associated factors of blood pressure control and complications of hypertension in hypertensive rural Thai populations of Baan Nayao, Chachoengsao Province.

OBJECTIVE: To assess associated factors of uncontrolled blood pressure and complications of hypertension in hypertensive rural Thai populations. MATERIAL AND METHOD: A cross-sectional study was conducted in hypertensive rural Thai people aged > or =35 years-old in Baan Nayao, Chachoengsao Province, Thailand. Blood pressure (BP) was measured and questionnaires were answered. After 12-hr fasting, blood samples were taken for determining plasma glucose, lipid profiles and serum creatinine. Morning urine samples were collected for microalbuminuria testing and electrocardiography (ECG) was performed to detect left ventricular hypertrophy (LVH). RESULTS: Of the 289 participants (97 males and 192 females) mean duration of hypertension was 4.29 +/- 4.95 years and 61.5% did not achieve target BP control. Among participants who had ECG performed and urine sample investigation, 15.7% demonstrated LVH and 25.3% had microalbuminuria. In uncontrolled BP participants, 20% had LVH and 24.8% had microalbuminuria whereas in controlled BP participants, 7.8% had LVH and 26.1% had microalbuminuria. Uncontrolled BP was associated with males, dyslipidemia, diabetes, abdominal obesity, metabolic syndrome, always having salty food and salts added for seasoning. The independent risks of uncontrolled BP were hypertensive male (OR = 2.48, 95% CI = 1.07-5.76) and metabolic syndrome (OR = 2.59, 95% CI = 1.24-5.40). Males were also at risk for LVH (OR = 2.86, 95% CI = 1.31-6.23) and history of lipid disorders was a risk of microalbuminuria (OR = 3.13, 95% CI = 1.47-6.67). CONCLUSION: Males and metabolic syndrome were independently associated with uncontrolled BP in hypertensive participants. Males had more risk than females to develop LVH and having history of lipid disorders lead to microalbuminuria occurrence. Thus, life style modification may prove beneficial to these rural hypertensive participants.