Information for Doctor

Why this service is important for you to think about using.

Sadly, as most doctors know, most Bangladeshi patients with serious illnesses that are life-threatening, especially patients with advanced cancers, have high levels of symptoms, particularly pain. In an Amader Gram study of 640 patients (286 men, 354 women) with advanced cancers seen in major medical centers in Dhaka, average pain scores on a scale of 0-10, were 5 or more in two-thirds of patients.  

Experts say however, that for 85% of such people, their pain should be manageable (which means their pain scores can be 4 or less) with simple interventions.

Part of the problem for busy doctors is that you do not have “real” time (that is current) symptom type and intensity information. When patients are feeling the worst, they do not want to come to the office or clinic.

A second issue is that you do not have such current and older symptom information easily accessible-at your fingertips.

Finally, some easily accessible ideas and guidelines about interventions to treat difficult symptoms are not available when and where you need them.

This Amader Gram service addresses these problems and can help you to make your seriously ill patients feel better without a lot of hassle and time.

If you want to read a scientific publication about these data please go to Love, R.R., Ferdousy, T., Paudel, B.D., Nahar, S., Dowla, R., Adibuzzaman, M., Ahsan, G.M.T., Uddin, M., Salim, R., and Ahamed, S.I.: Symptom levels in care-seeking Bangladeshi and Nepalese adults with advanced cancer. Journal of Global Oncology July 27, 2016, doi:10.1200/JGO.2016.004119

 

Dr. Fatima Bintee Azad of the Amader Gram Breast Care Center, Khulna, reviewing doctors’ site ag-palliative care clinical practice guidelines for information to treat her patient.

 

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Palliative Care specialist Dr. Rumana Dowla(Chairperson of Bangladesh Palliative and Supportive Care Foundation) is checking patient data with her patients

“Dr Shamsun Nahar reviewing doctors’ site ag-palliative care clinical practice guidelines for information to treat her patient”
“Dr Shamsun Nahar reviewing doctors’ site ag-palliative care clinical practice guidelines for information to treat her patient”

A patient and his wife learning about the cell phone questionnaire from Dr. N. M. Nazmul Kabir Prodhan, in charge of the Palliative Care unit, Delta Hospital, Dhaka
A patient and his wife learning about the cell phone questionnaire from Dr. N. M. Nazmul Kabir Prodhan, in charge of the Palliative Care unit, Delta Hospital, Dhaka

How the service works conveniently for you and your patients.

You can recommend this service to your patients and tell them to contact the Amader Gram office to make the arrangements or you can directly contact the Amader Gram office yourself (call+88 01730013709). The Amader Gram staff will make all the arrangements and get the critical information with whomever contacts our office. Once your patient is signed up and has paid you for the service (see below), Amader Gram will train the patient and family and make sure the patient has the phone capacity and can complete and send in the questionnaire reports. Amader Gram will give you a sign in password for its website where you can access your patients’ report and the Amader Gram Palliative Care Clinical Practice Guidelines.

The usual schedule is for patients to send in daily reports. When these are received in the Amader Gram server and website, two days a week, on Mondays and Thursdays, alerts will be seen to you by text message  or e-mail telling you that your patient has sent in at least one report since the last Monday or Thursday. Additionally, such text or e-mail message alerts will be sent to you when any report has a symptom score of greater than 7 (on a 0-10 point intensity scale), or when a symptom score increases by 2 units.

When you go to the ag-palliativecare.net website, at the top of the Home Page, you will see a link for “Doctors’ site”. If you click on this link, you will need your password to then see links for three new sites: :  Doctors’ site for users’ guide to symptom report reviews; Doctors’ site for patient symptom report summaries; and Doctors’ site for Amader Gram Palliative Care Clinical Practice Guidelines. You can learn how to review the patients’ report fast and completely, then review the information from your patients’ reports, old and new, and finally use the Guidelines to consider quickly whether and what kind of interventions/treatments you want to recommend for your patients. There is a comment function you can use to write recommendations. A system for using such electronically generated recommendation is being developed. Your patients’ contact and demographic information will also be right there for you to use.

How does the payment system work for this service?

You can recommend this service to your patients and then with their telephone number, you can directly contact the Amader Gram office (call +88 01730013709). This way of starting the process assures that there is a doctor’s permission and involvement in providing the service to particular patients. The Amader Gram staff will then just briefly ask for the patient’s contact information and your contact information. That’s all.  Amader Gram staff will then make all the arrangements and get the critical information from the patient to create a demographic profile, patient picture and contact data page, which you will be able to see as the first page in the doctor’s site for patient symptom report summaries. Amader Gram will train the patient and family and make sure the patient has the phone capacity and can complete and send in the questionnaire reports. Amader Gram will give you a sign-in password for its doctors’ site on the website (see Doctors’ site at top of home or any page on website—click here), page where you can access a users’ guide to symptom report reviews, patient demographic information and symptom reports and the Amader Gram Palliative Care Clinical Practice Guidelines.

The usual schedule is for patients to send in daily reports. When these are received in the Amader Gram server and website, two days a week, on Mondays and Thursdays, alerts will be seen to you by text message,  or e-mail telling you that your patient has sent in at least one report since the last Monday or Thursday. Additionally, such text or e-mail message alerts will be sent to you when any report from your patient, has a symptom score of greater than 7 (on a 0-10 point intensity scale), or when a symptom score increases by 2 units.

How do doctors get paid for using this service and treating their patients using this system?

Amader Gram will ask patients to pay to Amader Gram directly, 300 Taka per month to use the service, which payment is for Amader Gram receiving the reports, and organizing report summaries on the website for the doctor to view. If the patient does not pay, then there will be no report summaries on the website for the doctor to see.

To pay the doctor for his/her ongoing care, and to ensure good record keeping, and proper recommendations sometimes of narcotic medicines, the patient or a family member will be required to have a  paid-for clinic visit with the doctor at least every two weeks. At this visit the doctor can review what has happened in the last two weeks (looking at the summary reports on the website), update the patient’s medical record, check by telephone call to the patient (if he/she is not the person making the visit) about how the patient is doing, and make specific recommendation(s).