Screening assessment of the elderly in rural Thailand by a mobile unit

Diabetes management in Thailand: a literature review of the burden, costs, and outcomes

Management of diabetes represents an enormous challenge for health systems at every level of development. The latter are tested for their ability to continuously deliver high quality care to patients from the day they are diagnosed throughout their life. In this study, we review the status of diabetes management in Thailand and try to identify the key challenges the country needs to address to reduce the current (and future) medical and economic burden caused by the disease.We conducted a literature review on the burden, costs, and outcomes of diabetes in Thailand. This information was complemented by personal communication with senior officials in the Thai Ministry of Health.We identified the following priorities for the future management of diabetes in Thailand. First, increasing screening of diabetes in high risk population and promoting annual screening of diabetes complications in all diabetic patients. Second, identifying and addressing factors affecting poor treatment outcomes. Third, policy should specify clear targets and provide and use a monitoring framework to track progress. Fourth, efforts are needed to further improve data availability. Up-to-date data on the medical and economic burden of diabetes representative at the national level and at least the regional level are essential to identify needs and monitor progress towards established targets. Fifth, promotion of a healthy lifestyle for prevention of diabetes through education and quality information delivered to the public.

Impact of an oncogeriatric consulting team on therapeutic decision-making

Increased life expectancy and cancer incidence imply the need to develop a specialized care policy for elderly patients with cancer. We created an oncogeriatric consulting team (OGCT) in Toulouse University Hospital to carry out comprehensive gerontological assessment at the bedside of hospitalized patients. We analyze the impact on the final cancer treatment decision of this mobile geriatric assessment. We carried out a descriptive, retrospective real-life analysis of a patient cohort over a two-year period. The OGCT assessed 124 patients, of whom the majority were women (54.8%), median age 81 years, living at home (95.2%) and with family caregivers (86.5%). Nearly all were frail (96.7% according to the classification of Balducci and colleagues) and 3.2% were vulnerable. The team's decisions were analyzed for patients who had not yet been treated (n=107). After analysis, the team's proposal was in line with the initial cancer treatment plan in 68.2% of cases (n=73). In cases where there was a disagreement, the final decision was in line with the mobile team's proposal in 17.75% of 107 patients (n=19). The decision of the team was followed more often when their assessment proposed strictly palliative treatment. The decision to give elderly patients specific cancer treatment seems in our experience rather to be a matter for the oncologists, and is not very susceptible to modification by geriatric opinion. On the other hand, the geriatrician appears to be more credible and his/her opinion more likely to be followed when the patient is considered too frail and less aggressive, or even exclusively palliative, treatment is proposed.

Tobacco and alcohol use in rural elderly Indian population

BACKGROUND

Tobacco and alcohol use are serious health problems. Studies focusing on problems associated with tobacco and alcohol use in the elderly are limited.

AIM

To find out the prevalence of tobacco and alcohol use among rural elderly population.

METHODS

This cross-sectional study was conducted in the intensive field practice area of the Comprehensive Rural Health Services Project in Ballabgarh in Faridabad, Haryana, a rural field practice area of the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi. The sample was selected using stratified random cluster sampling. The participants were >/=60 years of age at the time of interview. Data on tobacco and alcohol use pattern of 1117 elderly were collected during the interview.

RESULTS

The prevalence of smoking was 71.8% in men (n=490) and 41.4% in women (n=497). Among men smokers, 41.5% were light smokers (20 beedis/day). Among women smokers, 71.8% were light smokers, 23.8% were moderate smokers and 4.4% were heavy smokers. Regular alcohol intake was seen in 16.3% of the men compared with 0.8% of the women.

CONCLUSION

The finding of a high prevalence of smoking and alcohol consumption among men in this rural population of India is of serious concern and therefore needs remedial measures.

Developing a mobile pharmacist-conducted wellness clinic for rural Montana communities

OBJECTIVE

To describe pharmacist-conducted disease screening services in remote communities.

SETTING

Frontier, rural, and nonrural counties throughout western Montana.

PRACTICE DESCRIPTION

Using federal telehealth funds, a motor home was converted into a mobile office and equipped with a satellite transmitting/receiving dish to provide wireless Internet access. The pharmacist uses an ultrasound unit to test heel bone density, a spirometer to test lung function, and appropriate analyzers to measure A1C and serum lipid levels. Screening clinics are held in conjunction with county health departments, tribal health authorities, community pharmacies, county agricultural extension agents, and Federally Qualified Health Centers. Employee wellness clinics are also conducted. Student pharmacists assist with screenings.

PRACTICE INNOVATION

Mobile pharmacist-conducted disease screening clinics in remote communities.

MAIN OUTCOME MEASURES

Number of communities served, number of patients screened, percentage of test results out-of-range/patients referred to their primary health care providers for follow-up, number of student pharmacists participating, and total revenues generated.

RESULTS

During the first 2 years of the project, IPHARM pharmacists traveled approximately 14,000 miles, conducted 72 clinics in 17 counties and performed 5,100 screening tests for more than 3,100 people. Approximately 36% of all screening test results were outside of expected range. More than 80 student pharmacists, most of whom were on clinical rotations, participated in the clinics and 11 community pharmacists have been trained to conduct screenings. In excess of dollar 70,000 was generated by the project in operating revenue and donations. At the conclusion of IPHARM's first year of operations, the motor home was taken out of service because of the cost of gasoline, difficulties of winter travel with such a large vehicle, and the realization that virtually all host organizations were able to provide space in which the screening clinics could be conducted.

CONCLUSION

Pharmacists and student pharmacists are capable of providing disease screening services in remote frontier and rural communities. Obtaining sufficient payment for these services in rural communities to cover costs remains a challenge.