Community care

‘Community care’ has no hard and fast definition. However, what it means in practical terms is the decentralisation of care, taking it away from acute care settings such as hospitals, and bringing it closer to primary care. Patients are therefore treated in settings such as the local GP surgery or at home, by encouraging out-patient ambulatory care and using facilities like day-care units or local clinics. For the elderly and disabled, such local care is much more acceptable than travelling and experiencing in-patient care. Europe’s ageing population means that there will be increasing numbers of care-dependent older people who will be in need of community care.

This shift towards community care has a number of advantages; it better addresses the needs of patients, but at the same time offers considerable savings to healthcare systems. Indeed, studies have shown that between 20 - 30% of patients over the age of 75 who enter a hospital for acute care are admitted inappropriately. Furthermore, once admitted, they remain in the hospital for far longer than necessary, occupying much-needed and expensive hospital beds – institutional care can be around 10 times more expensive than home care.

Investment in community care offers clear benefits. Innovative medical technology already supports patients in a variety of areas, including helping them to live with and manage their incontinence, and using telemedicine to improve cardiac care. In the case of incontinence, the pursuit of ever better solutions is enabling patients to self-manage their condition with minimum recourse to hospital care. For patients with an Implantable Cardioverter Defibrillator (ICD), the industry’s investment in remote monitoring technology is helping to deliver better, more comprehensive and more cost-effective care.

Although the definition may differ from country to country, community care will become an increasing part of healthcare budgets. Used appropriately, it will deliver better care more effectively to a growing segment of the population. The medical technology industry is continuing to innovate methods to make it possible for people to better manage their disease or health condition themselves and minimise their use of hospital care. However, for citizens to derive the full benefit of these advances, policymakers need to invest in the infrastructure that will deliver effective community care, including public awareness. This will provide a further step towards sustainable, cost-effective healthcare systems.

Incontinence care

Incontinence is a condition whereby people have difficulty in controlling their urge to urinate or defecate, and may pass water or solid waste involuntarily. It can affect both men and women, and although not a consequence of ageing, it does become more common as people get older. Figures from the World Health Organization suggest as many as 8% of the total population may suffer from urinary incontinence.

Incontinence in all its forms is associated with severe impacts on sufferers’ quality of life. They can easily be embarrassed by their condition, which can lead to social withdrawal and isolation. Worse, it can lead to sleep disturbance, relationship issues and even depression. For sufferers, dealing and managing with the problem can be the dominant factor in their day-to-day living, regardless of the severity.

Helping sufferers to manage their incontinence is a major challenge. Often - perhaps because of the fear of stigma - patients suffering from incontinence can find it difficult to discuss their condition with their physician. Instead, they may try to deal with the problem themselves, often in inappropriate ways. This also makes it extremely difficult to make a proper assessment of the true impact of the problem on patients and healthcare systems alike.

Yet, when patients do request assistance there are many treatment options available which can be tailored to individual needs. First-line therapies could be adjustments to diet, bowel or bladder training or perhaps medication. Surgery is also an option, but is generally considered after other options have been tried. For those patients where first-line therapies have not been successful, the medical technology industry produces a number of solutions to assist in dealing with incontinence.

At the simplest level, pads or pants can assist in capturing any leaks and preventing odours, giving patients the confidence to continue to live and work normally. Other devices that can be considered are external urinary sheaths to capture and divert leaks, or catheters inserted into the urethra to allow urine to flow for collection and disposal. The catheters can be either short-term, or can be left in place as long-term or ‘indwelling’ devices.

In more serious cases of faecal incontinence, some patients may need to have an Ostomy, a surgically-created opening in the body for the discharge of body wastes. Ostomies are usually put in place when more serious medical conditions such as cancer, inflammatory bowel disease or spinal injury mean that patients cannot pass waste normally. Depending on whether it is for liquid or solid waste, the ureter, or small or large bowel will protrude through the wall of the stomach; this is called the stoma. Attached to the stoma will be a container or pouch to collect the waste; this will need to be changed regularly – often several times per day.

Advances in technology have made the care and management of stoma easier for patients. In the past, patients with a stoma were often sent home without any form of collection equipment; it was up to them to improvise. They had to use metal, glass or porcelain bowls. Although glass receptacles were relatively easy to clean, the consequences if the glass broke were worrying. Furthermore, these receptacles were dirty, smelly, were easily visible under clothing and they often leaked.

It was not until the late 1950s that the first disposable ostomy bag with an adhesive ring was created; it was made from plastic, had a skin-friendly adhesive and was much easier to wear. Since then, manufacturers have developed much more patient-friendly products, which are easier to wear, hide and change. Nowadays they include technology to deal with any odours that may occur, and allow patients to undertake many of the activities that they previously enjoyed, including sports and travelling. Indeed, people become much more active once they have a stoma, as their symptoms have been relieved.

As a result of innovation in stoma and ostomy care by medical technology manufacturers, citizens can enjoy the benefits of participating fully in society- working, socialising, exercising – without the stigma they may have experienced in the past.