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Khatri R, Endalamaw A, Erku D, Wolka E, Nigatu F, Zewdie A, Assefa Y. Continuity and care coordination of primary health care: a scoping review. BMC Health Serv Res 2023; 23:750. [PMID: 37443006 DOI: 10.1186/s12913-023-09718-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Healthcare coordination and continuity of care conceptualize all care providers and organizations involved in health care to ensure the right care at the right time. However, systematic evidence synthesis is lacking in the care coordination of health services. This scoping review synthesizes evidence on different levels of care coordination of primary health care (PHC) and primary care. METHODS We conducted a scoping review of published evidence on healthcare coordination. PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science and Google Scholar were searched until 30 November 2022 for studies that describe care coordination/continuity of care in PHC and primary care. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to select studies. We analysed data using a thematic analysis approach and explained themes adopting a multilevel (individual, organizational, and system) analytical framework. RESULTS A total of 56 studies were included in the review. Most studies were from upper-middle-income or high-income countries, primarily focusing on continuity/care coordination in primary care. Ten themes were identified in care coordination in PHC/primary care. Four themes under care coordination at the individual level were the continuity of services, linkage at different stages of health conditions (from health promotion to rehabilitation), health care from a life-course (conception to elderly), and care coordination of health services at places (family to hospitals). Five themes under organizational level care coordination included interprofessional, multidisciplinary services, community collaboration, integrated care, and information in care coordination. Finally, a theme under system-level care coordination was related to service management involving multisectoral coordination within and beyond health systems. CONCLUSIONS Continuity and coordination of care involve healthcare provisions from family to health facility throughout the life-course to provide a range of services. Several issues could influence multilevel care coordination, including at the individual (services or users), organizational (providers), and system (departments and sectors) levels. Health systems should focus on care coordination, ensuring types of care per the healthcare needs at different stages of health conditions by a multidisciplinary team. Coordinating multiple technical and supporting stakeholders and sectors within and beyond health sector is also vital for the continuity of care especially in resource-limited health systems and settings.
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Affiliation(s)
- Resham Khatri
- School of Public Health, the University of Queensland, Brisbane, Australia.
- Health Social Science and Development Research Institute, Kathmandu, Nepal.
| | - Aklilu Endalamaw
- School of Public Health, the University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Mount Gravatt, Australia
- Menzies Health Institute Queensland, Griffith University, Mount Gravatt, Australia
| | - Eskinder Wolka
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Australia
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Patients' Experience of Communication During Their Course of Treatment in an Oncology Outpatient Clinic: Qualitative Study. Cancer Nurs 2020; 45:E187-E196. [PMID: 33038098 DOI: 10.1097/ncc.0000000000000891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Communication between patients and healthcare professionals becomes increasingly important as patients with cancer are primarily treated in outpatient settings, where the time to communicate is brief. There is a need to understand patients' experiences of communication to ensure person-centered communication during treatment. OBJECTIVE The aim of this study was to explore how patients experience communication with healthcare professionals during their course of treatment in an oncology outpatient clinic to elucidate how their needs for support are met. METHODS Data were generated through semistructured qualitative interviews in patients with cancer who received treatment in an oncology outpatient clinic (n = 18). Interpretive description methodology and symbolic interactionism inspired the analytical approach. RESULTS Three overarching communication categories were generated, namely, verbal practices, relational practices, and nonverbal practices, which reflect distinct characteristics and the quality of the communication. Communication was characterized as being informative, cheerful, and routinized, which the patients found supportive and, contrarily, superficial, task focused, lacking continuity in care, and missing existential dimensions. CONCLUSION The communication practice in the oncology outpatient clinic especially supported patients in managing their treatment and side effects. However, psychological, social, and existential concerns were rarely addressed, requiring the patient to self-manage these issues in everyday life while living with cancer. IMPLICATIONS FOR PRACTICE Patients are socialized by verbal and nonverbal communication practices in the outpatient clinic, which influences their expectations of what to talk about during their treatment. Methods are needed to support person-centered communication in outpatient settings, so patient care needs are met more broadly.
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Hoffstädt H, Stouthard J, Meijers MC, Westendorp J, Henselmans I, Spreeuwenberg P, de Jong P, van Dulmen S, van Vliet LM. Patients' and Clinicians' Perceptions of Clinician-Expressed Empathy in Advanced Cancer Consultations and Associations with Patient Outcomes. Palliat Med Rep 2020; 1:76-83. [PMID: 34223461 PMCID: PMC8241346 DOI: 10.1089/pmr.2020.0052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Empathy is a cornerstone of effective communication. However, clinicians' and patients' perceptions of clinician-expressed empathy might differ. The independent perceptions of patients and clinicians on clinician-expressed empathy in advanced cancer consultations and the associations of these perceptions with patient outcomes are unknown. Objective: We assessed (1) patients' and clinicians' independent perceptions of clinician-(self-)expressed empathy in advanced cancer consultations and (2) the associations between these perceptions and affective patient outcomes. Methods: This observational study included data from 41 consultations in the advanced breast cancer setting. Postconsultation, patients' and clinicians' perceptions of clinician-expressed empathy were assessed, as well as patients' (1) pre-post anxiety, (2) post-anxiety, (3) emotional well-being, and (4) satisfaction. Multilevel regression analyses were run to draw conclusions. Results: Patients perceived higher levels of empathy than clinicians, without a significant relationship between the two (mean [M] = 85.47, standard deviation [SD] = 14.00 vs. M = 61.88, SD = 15.30, 0-100 scale; β = 0.14, p < 0.138, 95% confidence interval [CI] = -0.04 to 0.32). Higher patient-perceived empathy was associated with decreased anxiety [(1) β = -0.67, p = 0.039, 95% CI = -1.30 to -0.03; (2) β = -0.15, p = 0.042, 95% CI = -0.30 to -0.01], higher satisfaction (β = 0.05, p < 0.001, 95% CI = 0.03 to 0.08), and lower emotional distress (β = -0.32, p < 0.001, 95% CI = -0.48 to -0.16). There were no associations with clinicians' perceptions [(1) β = -0.34, p = 0.307, 95% CI = -1.00 to 0.31; (2) β = -0.02, p = 0.824, 95% CI = -0.17 to 0.14; (3) β < 0.01, p = 0.918, 95% CI = -0.03 to 0.02; (4) β = 0.08, p = 0.335, 95% CI = -0.08 to 0.25]. Conclusions: Patients' and clinicians' empathy perceptions differed. In improving patient outcomes, the focus should be on patients' perceptions of clinician-expressed empathy. Future research could focus on ways to elicit patients' perceptions of empathy with the higher aim of improving patient outcomes.
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Affiliation(s)
- Hinke Hoffstädt
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Communication, Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Jacqueline Stouthard
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maartje C Meijers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Janine Westendorp
- Department of Communication, Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Peter Spreeuwenberg
- Department of Communication, Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Paul de Jong
- Department of Medical Oncology, St Antonius Hospital, Utrecht, The Netherlands
| | - Sandra van Dulmen
- Department of Communication, Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Communication, Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands
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4
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Chen YY, Hsieh CI, Chung KP. Continuity of Care, Follow-Up Care, and Outcomes among Breast Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3050. [PMID: 31443512 PMCID: PMC6747467 DOI: 10.3390/ijerph16173050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 12/17/2022]
Abstract
This retrospective cohort study examined the effects of care continuity on the utilization of follow-up services and outcome of breast cancer patients (stages I-III) in the post-treatment phase of care. Propensity score matching and generalized estimation equations were used in the analysis of data obtained from national longitudinal databases. The continuity of care index (COCI) was calculated separately for primary care physicians (PCP) and oncologists. Our results revealed that breast cancer survivors with a higher oncology COCI were more likely than those with a lower oncology COCI to use mammography or breast ultrasound during the follow-up period (OR = 1.26, 95% CI: 1.19-1.32; OR = 1.12, 95% CI: 1.06-1.18; respectively). In terms of health outcomes, a higher oncology COCI was associated with a lower likelihood of hospitalization (OR = 0.78, 95% CI: 0.71-0.85) and emergency department use (OR = 0.88, 95% CI: 0.82-0.95). A higher PCP COCI was also associated with a lower likelihood of hospitalization (OR = 0.77, 95% CI: 0.70-0.85) and emergency department use (OR = 0.75, 95% CI: 0.68-0.82). Overall, this study determined that ambulatory care continuity is positively associated with the likelihood of using recommended follow-up care services and negatively associated with adverse health events among breast cancer survivors.
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Affiliation(s)
- Yun-Yi Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei 10055, Taiwan
| | - Cheng-I Hsieh
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei 10055, Taiwan.
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Stegmann ME, Homburg TM, Meijer JM, Nuver J, Havenga K, Hiltermann TJN, Maduro JH, Schuling J, Brandenbarg D, Berendsen AJ. Correspondence between primary and secondary care about patients with cancer: a Delphi consensus study. Support Care Cancer 2019; 27:4199-4205. [PMID: 30825025 PMCID: PMC6803614 DOI: 10.1007/s00520-019-04712-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/22/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To provide optimal care for patients with cancer, timely and efficient communication between healthcare providers is essential. In this study, we aimed to achieve consensus regarding the desired content of communication between general practitioners (GPs) and oncology specialists before and during the initial treatment of cancer. METHODS In a two-round Delphi procedure, three expert panels reviewed items recommended for inclusion on referral and specialist letters. RESULTS The three panels comprised 39 GPs (42%), 42 oncology specialists (41%) (i.e. oncologists, radiotherapists, urologists and surgeons) and 18 patients or patient representatives (69%). Final agreement was by consensus, with 12 and 35 items included in the GP referral and the specialist letters, respectively. The key requirements of GP referral letters were that they should be limited to medical facts, a short summary of symptoms and abnormal findings, and the reason for referral. There was a similar requirement for letters from specialists to include these same medical facts, but detailed information was also required about the diagnosis, treatment options and chosen treatment. After two rounds, the overall content validity index (CVI) for both letters was 71%, indicating that a third round was not necessary. DISCUSSION This is the first study to differentiate between essential and redundant information in GP referral and specialist letters, and the findings could be used to improve communication between primary and secondary care.
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Affiliation(s)
- M E Stegmann
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands.
| | - T M Homburg
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
| | - J M Meijer
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
| | - J Nuver
- University Medical Center Groningen, Department of Medical Oncology, University of Groningen, Groningen, The Netherlands
| | - K Havenga
- University Medical Center Groningen, Department of Surgery, University of Groningen, Groningen, The Netherlands
| | - T J N Hiltermann
- University Medical Center Groningen, Department of Pulmonary Diseases, University of Groningen, Groningen, The Netherlands
| | - J H Maduro
- University Medical Center Groningen, Department of Radiation Oncology, University of Groningen, Groningen, The Netherlands
| | - J Schuling
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
| | - D Brandenbarg
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
| | - A J Berendsen
- University Medical Center Groningen, Department of General Practice and Elderly Care Medicine, University of Groningen, HPC FA 21, Postbus 30.001, 9700, RB, Groningen, The Netherlands
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Charalambous A, Wells M, Campbell P, Torrens C, Östlund U, Oldenmenger W, Patiraki E, Sharp L, Nohavova I, Domenech-Climent N, Eicher M, Farrell C, Larsson M, Olsson C, Simpson M, Wiseman T, Kelly D. A scoping review of trials of interventions led or delivered by cancer nurses. Int J Nurs Stud 2018; 86:36-43. [DOI: 10.1016/j.ijnurstu.2018.05.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 05/18/2018] [Accepted: 05/22/2018] [Indexed: 11/27/2022]
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Plate S, Emilsson L, Söderberg M, Brandberg Y, Wärnberg F. High experienced continuity in breast cancer care is associated with high health related quality of life. BMC Health Serv Res 2018; 18:127. [PMID: 29458376 PMCID: PMC5819266 DOI: 10.1186/s12913-018-2925-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 02/09/2018] [Indexed: 01/30/2023] Open
Abstract
Background High experienced continuity is known to be associated with lower needs for supportive care and most likely higher quality of life. On this background, the aim of this study was to investigate if patient-experienced continuity of care was associated with health-related quality of life (HRQoL) in breast cancer patients treated at two different-sized breast cancer units. Methods In 2016, two questionnaires, “Statements on experienced continuity of care” and “The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30)”, were sent out to patients diagnosed between 2011 and 2014 at two different-sized breast cancer units in Sweden. Lead times and other data reflecting medical quality were collected from the patients’ medical records and from the National Swedish Breast Cancer Quality Register. Results Of 356 eligible patients, 231 (65%) answered the questionnaires, of whom 218 patients were included in the analyses. A statistically significant association was found between high experienced continuity and high global HRQoL (p = 0.03). Continuity was higher at the smaller unit, while no major differences between the units were found regarding medical quality or lead times. Conclusion The study found that high experienced continuity and HRQoL was strongly associated. A statistically significant higher continuity of care was found at the smaller unit, in line with what was expected. The absence of clinically relevant differences in lead times and medical quality may indicate that continuity could be achieved without loss of quality.
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Affiliation(s)
- Susann Plate
- Department of Surgery, Arvika Hospital, kirurgiska kliniken, Arvika sjukhus, S-670 80, Arvika, Sweden.
| | - Louise Emilsson
- Primary care research unit, Landstinget Värmland, Sweden.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | - Yvonne Brandberg
- Department of Oncology, Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Wärnberg
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Kim JH, Park EC, Kim TH, Lee Y. Hospital Charges and Continuity of Care for Outpatients with Hypertension in South Korea: A Nationwide Population-Based Cohort Study from 2002 to 2013. Korean J Fam Med 2017; 38:242-248. [PMID: 29026483 PMCID: PMC5637214 DOI: 10.4082/kjfm.2017.38.5.242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/19/2016] [Accepted: 08/02/2016] [Indexed: 11/18/2022] Open
Abstract
Background Continuity of care (COC) has received attention over the past decade. COC has also become increasingly important for hospital managers and policy makers because of competitive health care market conditions. The purpose of this study was to assess the association between hospital charges and patients' continuity of care-assessed by three indices of continuity of care—among outpatients with hypertension in South Korea. Methods This study used the National Health Insurance Service–Cohort Sample Database from 2002 to 2013. A total of 247,125 participants were analyzed at baseline (2002); continuity of care was defined using the continuity of care index, the Herfindahl–Hirschman index (a new continuity of care index), and the “most frequent provider continuity” index. Primary analyses were based on the generalized estimating equation regression model, which accounts for correlation among individuals within each hospital. Results After adjustment for age, sex, residential region, patient clinical complexity level, diagnosed code, hospital type, organization type, number of beds, number of doctors, and year, there was a negative correlation between hospital charges and continuity of care index (β=−0.163, P<0.0001), the Herfindahl–Hirschman index (β=−0.105, P<0.0001), and the “most frequent provider continuity” index (β=−0.131, P<0.0001). Subgroup analyses based on hospital type produced similar trends. Conclusion For all indices studied, hospital charges declined gradually with increasing continuity of care. Our study suggests that long-term, trusting partnerships between patients and physicians reduce hospital costs.
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Affiliation(s)
- Jae-Hyun Kim
- Department of Health Administration, Dankook University College of Health Science, Cheonan, Korea.,Institute of Health Promotion and Policy, Dankook University, Cheonan, Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hyun Kim
- Institute of Health Services Research, Yonsei University, Seoul, Korea.,Deprtment of Hospital Management, Yonsei University Graduate School of Public Health, Seoul, Korea
| | - Yunhwan Lee
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea.,Institute on Aging, Ajou University Medical Center, Suwon, Korea
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Gillespie H, Kelly M, Duggan S, Dornan T. How do patients experience caring? Scoping review. PATIENT EDUCATION AND COUNSELING 2017; 100:1622-1633. [PMID: 28392179 DOI: 10.1016/j.pec.2017.03.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Summarise empirical research into patients' experiences of caring in order to promote this as a core condition for the work of health professionals. METHODS A review team: carried out a scoping review with a phenomenological orientation that did not privilege any profession or context of care; comprehensively searched six databases from inception to the present, including all English language articles that report patients' lived experiences of caring; and identified and contrasted uncaring experiences. RESULTS 43 articles straddled nursing, medicine, and physiotherapy, and a wide range of care settings. Patients experienced caring when competent professionals displayed positive attitudes, communicated effectively, formed relationships, helped them navigate clinical services, and engaged emotionally. CONCLUSION This research provides a rich description of caring, which was derived from patients', rather than professionals', experiences. PRACTICE IMPLICATIONS Whilst publications and basic professional curricula are dominated by the perspectives of single professions, this research describes patients' experiences that can prepare all health professionals to be caring in collaborative, interprofessional practice.
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Affiliation(s)
- Hannah Gillespie
- Centre for Medical Education, Faculty of Medicine, Health, Life Sciences, Queen's University Belfast, Belfast, UK
| | - Martina Kelly
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Sarah Duggan
- Centre for Medical Education, Faculty of Medicine, Health, Life Sciences, Queen's University Belfast, Belfast, UK
| | - Tim Dornan
- Centre for Medical Education, Faculty of Medicine, Health, Life Sciences, Queen's University Belfast, Belfast, UK.
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Pu C, Chou YJ. The impact of continuity of care on emergency room use in a health care system without referral management: an instrumental variable approach. Ann Epidemiol 2016; 26:183-8. [PMID: 26851825 DOI: 10.1016/j.annepidem.2015.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 12/14/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of the study was to determine whether continuity of care (COC) is beneficial in national health care systems without referral management by controlling for endogeneity of COC. METHODS We used National Health Insurance (Taiwan) claims data from 2008, encompassing approximately 23 million people, to determine whether COC is associated with reduced emergency room (ER) use by hypertension and diabetic patients in 2009. We used an instrumental variable approach to account for endogeneity associated with patients' COC levels. RESULTS After controlling for endogeneity, the marginal effect of COC on ER use probability when the COC score increased from 0 to 1 was 7.6% (P < .001) and 14.8% (P < .001) for hypertension and diabetic patients, respectively. CONCLUSIONS We determined that COC is more effective for reducing ER use than are models that assume that COC is exogenous. It has been argued that in many countries, health care systems without referral management encourage physician shopping and hinder physician-patient communication. However, there are benefits to disease-specific COC. Because current estimations have failed to take endogeneity biases into account, COC is more effective than is currently assumed.
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Affiliation(s)
- Christy Pu
- Department of Public Health, National Yang-Ming University, Taipei, Taiwan ROC.
| | - Yiing-Jenq Chou
- Department of Public Health, National Yang-Ming University, Taipei, Taiwan ROC
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Tsai HY, Chou YJ, Pu C. Continuity of care trajectories and emergency room use among patients with diabetes. Int J Public Health 2015; 60:505-13. [PMID: 25779687 DOI: 10.1007/s00038-015-0671-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To analyze the pattern of continuity of care (COC) using trajectory analysis for a group of patients newly diagnosed with diabetes, and determine whether various trajectories lead to distinct patient outcomes. METHODS We used the Taiwan National Health Insurance claims database. Newly diagnosed patients with diabetes in 2005 totaling 4367 were included in this study. All patients were followed up to 2011. We identified groups of COC trajectories using trajectory analysis. We subsequently determined whether various COC trajectories were associated with the frequency of total and diabetes-related emergency room (ER) use using negative binomial models. RESULTS We discovered five distinct COC trajectories for our newly diagnosed diabetes sample based on trajectory analysis. The early-seeker group had the lowest IRR for total ER visits (IRR = 0.56, P < 0.001), followed by the high-maintainer group (IRR = 0.67, P < 0.001). Similar results were obtained for diabetes-specific ER use. CONCLUSIONS We identified various COC trajectories for diabetes patients. Chronic disease patients may seek a suitable physician by compromising care continuity at the onset of disease progression and exhibit favorable outcome.
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Affiliation(s)
- Hui-Ying Tsai
- Institute of Hospital and Healthcare Administration, National Yang-Ming University, Taipei, Taiwan
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12
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Al-Azri M, Al-Awisi H, Al-Rasbi S, El-Shafie K, Al-Hinai M, Al-Habsi H, Al-Moundhri M. Psychosocial impact of breast cancer diagnosis among omani women. Oman Med J 2015; 29:437-44. [PMID: 25584162 DOI: 10.5001/omj.2014.115] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 11/22/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore different psychosocial impacts on Omani women diagnosed with breast cancer. METHODS Semi-structured individual interviews were conducted with 19 Omani women diagnosed with breast cancer to describe the impact of the disease on their personal and social life. Women were recruited from wards and out-patient clinics at the Sultan Qaboos University Hospital, Muscat. RESULTS Four main themes emerged. These were: a) factors related to psychological distress of the disease and uncertainty (worry of death, interference with work and family responsibilities, searching for hope/cure, travelling overseas); b) reactions of family members (shocked, saddened, unity, pressure to seek traditional treatments); c) views of society (sympathy, isolation, reluctant to disclose information); and d) worries and threats about the future (side effects of chemotherapy, spread of the disease, effect on offspring). CONCLUSION Breast cancer diagnosis has several devastating psychosocial impacts on women in Oman. Healthcare professionals working with women with breast cancer should be aware of the different psychosocial impacts of the disease on women's lives. Appropriate measures must be taken by the decision makers whenever needed, including enforcing positive views and support of Oman's society towards women with breast cancer.
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Affiliation(s)
- Mohammed Al-Azri
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Huda Al-Awisi
- Nursing Directorate, Sultan Qaboos University Hospital, Oman
| | - Samira Al-Rasbi
- Nursing Directorate, Sultan Qaboos University Hospital, Oman
| | - Kawther El-Shafie
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mustafa Al-Hinai
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Hamdan Al-Habsi
- Department of Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Mansour Al-Moundhri
- Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
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Roorda C, de Bock GH, Scholing C, van der Meer K, Berger MY, de Fouw M, Berendsen AJ. Patients' preferences for post-treatment breast cancer follow-up in primary care vs. secondary care: a qualitative study. Health Expect 2014; 18:2192-201. [PMID: 24661322 DOI: 10.1111/hex.12189] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To explore patients' preferences for follow-up in primary care vs. secondary care. METHODS A cross-sectional design was employed, involving semi-structured interviews with 70 female patients with a history of early-stage breast cancer. Using descriptive content analysis, interview transcripts were analysed independently and thematically by two researchers. FINDINGS Patients expressed the strongest preference for annual visits (31/68), a schedule with a decreasing frequency over time (27/68), and follow-up > 10 years, including lifelong follow-up (20/64). The majority (56/61) preferred to receive follow-up care from the same care provider over time, for reasons related to a personal doctor-patient relationship and the physician's knowledge of the patient's history. About 75% (43/56) preferred specialist follow-up to other follow-up models. However, primary care-based follow-up would be accepted by 57% (39/68) provided that there is good communication between GPs and specialists, and sufficient knowledge among GPs about follow-up. Perceived benefits of primary care-based follow-up referred to the personal nature of the GP-patient relationship and the easy access to primary care. Perceived barriers included limited oncology knowledge and skills, time available, motivation among GPs to provide follow-up care and patients' confidence with the present specialist follow-up. CONCLUSIONS More than half of the patients were open to primary care-based follow-up. Patients' confidence with this follow-up model may increase by using survivorship care plans to facilitate communication across the primary/secondary interface and with patients. Training GPs to improve their oncology knowledge and skills might also increase patients' confidence.
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Affiliation(s)
- Carriene Roorda
- Department of General Practice, Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christian Scholing
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaas van der Meer
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marlieke de Fouw
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Annette J Berendsen
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Taylor C, Shewbridge A, Harris J, Green JS. Benefits of multidisciplinary teamwork in the management of breast cancer. BREAST CANCER-TARGETS AND THERAPY 2013; 5:79-85. [PMID: 24648761 PMCID: PMC3929250 DOI: 10.2147/bctt.s35581] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The widespread introduction of multidisciplinary team (MDT)-work for breast cancer management has in part evolved due to the increasing complexity of diagnostic and treatment decision-making. An MDT approach aims to bring together the range of specialists required to discuss and agree treatment recommendations and ongoing management for individual patients. MDTs are resource-intensive yet we lack strong (randomized controlled trial) evidence of their effectiveness. Clinical consensus is generally favorable on the benefits of effective specialist MDT-work. Many studies have shown the benefits of receiving treatment from a specialist center, and evidence continues to accrue from comparative studies of clinical benefits of an MDT approach, including improved survival. Patients’ views of the MDT model of decision-making (and in particular its impact on involvement in decisions about their care) have been under-researched. Barriers to effective teamwork and poor decision-making include excessive caseload, low attendance at meetings, lack of leadership, poor communication, role ambiguity, and failure to consider patients’ holistic needs. Breast cancer nurses have a key role in relation to assessing holistic needs, and their specialist contribution has also been associated with improved patient experience and quality of life. This paper examines the evidence for the benefits of MDT-work, in particular for breast cancer. Evidence is considered within a context of growing cancer incidence at a time of increased financial restraint, and it may now be important to reevaluate the structure and models of MDT-work to ensure that MDTs are an efficient use of resources.
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Affiliation(s)
- Cath Taylor
- Florence Nightingale School of Nursing and Midwifery, King's College London, London UK
| | - Amanda Shewbridge
- Breast Cancer Services, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jenny Harris
- Florence Nightingale School of Nursing and Midwifery, King's College London, London UK
| | - James S Green
- Department of Urology, Barts Health NHS Trust, London, UK ; Department of Health and Social Care, London South Bank University, London, UK
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Vidnes TK, Wahl AK, Andersen MH. Patient experiences following liver transplantation due to liver metastases from colorectal cancer. Eur J Oncol Nurs 2013; 17:269-74. [DOI: 10.1016/j.ejon.2012.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/30/2012] [Accepted: 07/11/2012] [Indexed: 10/28/2022]
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