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Vo MTH, Nakamura K, Seino K, Moncatar TJRT, Han TDT, Siongco KLL, Tashiro Y, Van Vo T. Can collaboration among health and social care workers play a role in addressing geriatric care challenges? A qualitative case study in Central Vietnam. Int Health 2024; 16:387-398. [PMID: 37757862 PMCID: PMC11218886 DOI: 10.1093/inthealth/ihad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/19/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Vietnam's healthcare system offers limited services and facilities for older adults. This study explored the perceptions of health and social care workers regarding geriatric care issues, their impact on older adults and the potential of collaboration for enhancing older adults' health and well-being. METHODS This qualitative case study employed 27 focus group discussions and two in-depth interviews with 174 participants in Thua Thien Hue Province, Vietnam. An inductive thematic analysis was conducted. RESULTS According to the participants, the major challenges that hindered geriatric care consisted of caregiver and care recipient issues, which were identified to constrain care accessibility, resulting in decreased physical, mental and social health. Across different settings and professions, collaboration was considered a routine and natural aspect of daily work. It was perceived that establishing and strengthening collaboration could facilitate improvement in health and social welfare services through the prioritization of needs and enhancement of caregiver skills and training. CONCLUSIONS Collaboration was viewed as ad hoc but indispensable for addressing the identified geriatric care issues that could improve the general health and well-being of older adults. The findings indicate a need for better collaboration in Vietnam, achieved through defined guidelines, training and improved interprofessional education and practice.
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Affiliation(s)
- Man Thi Hue Vo
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
- College of Public Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
- World Health Organization Collaborating Centre for Healthy Cities and Urban Policy Research, Tokyo, Japan
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
- World Health Organization Collaborating Centre for Healthy Cities and Urban Policy Research, Tokyo, Japan
| | - T J Robinson T Moncatar
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila 1000, Philippines
| | - Tran Dai Tri Han
- Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue 530000, Vietnam
| | - Kathryn Lizbeth L Siongco
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
- College of Nursing, University of the Philippines Manila, Manila, Philippines
| | - Yuri Tashiro
- Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Thang Van Vo
- Faculty of Public Health, Hue University of Medicine and Pharmacy, Hue University, Hue 530000, Vietnam
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
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Işik AK, Özturan İU, Pekdemir M, Doğan NÖ, Yaka E, Yilmaz S. Adherence to Clinical Practice Guidelines for Non-ST Elevation Acute Coronary Syndrome in the Emergency Department: Exploring the Role of Social, Healthcare-system, and Clinical Determinants. Crit Pathw Cardiol 2023; 22:128-134. [PMID: 37815841 DOI: 10.1097/hpc.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
OBJECTIVES The aim of this study was to assess adherence to the European Society of Cardiology 2020 non-ST elevation acute coronary syndrome (NST-ACS) guidelines, identify factors affecting this compliance, and explore the link between adherence and adverse cardiac outcomes. METHODS This prospective cohort study was conducted in a tertiary-level academic hospital between January 2022 and January 2023. Patients diagnosed with NST-ACS in the emergency department (ED) were included. The primary outcome measured was the rate of adherence to the guidelines, and secondary outcomes were factors affecting this adherence in the ED and its association with 28-day adverse cardiac outcomes. RESULTS Of the 298 patients included, guideline adherence was achieved in 32.2% in the ED. The highest compliance was observed in performing a 12-lead electrocardiogram (ECG) within 10 minutes (99.7%), while the lowest was found for obtaining additional right and posterior ECG leads when ongoing ischemia was suspected (42.3%). Factors associated with better adherence included the experience level of the treating physician, the presence of cardiac-quality chest pain, initial ischemic ECG findings, higher initial troponin levels, and advanced history, electrocardiogram, age, risk factors, and troponin score and Charlson comorbidity index. Complete guideline adherence over 28 days was achieved in 19.1% of patients and was found to be significantly associated with lower rates of adverse cardiac outcomes. CONCLUSIONS Adherence to NST-ACS guidelines was generally low but was associated with improved patient outcomes. This study highlighted the importance of various factors associated with guideline adherence. Future research should explore further barriers to guideline adherence and develop targeted interventions.
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Affiliation(s)
- Abdullah Kürşat Işik
- From the Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Hempel S, Ganz D, Saluja S, Bolshakova M, Kim T, Turvey C, Cordasco K, Basu A, Page T, Mahmood R, Motala A, Barnard J, Wong M, Fu N, Miake-Lye IM. Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel. BMJ Open 2023; 13:e060232. [PMID: 37197809 DOI: 10.1136/bmjopen-2021-060232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE For large, integrated healthcare delivery systems, coordinating patient care across delivery systems with providers external to the system presents challenges. We explored the domains and requirements for care coordination by professionals across healthcare systems and developed an agenda for research, practice and policy. DESIGN The modified Delphi approach convened a 2-day stakeholder panel with moderated virtual discussions, preceded and followed by online surveys. SETTING The work addresses care coordination across healthcare systems. We introduced common care scenarios and differentiated recommendations for a large (main) healthcare organisation and external healthcare professionals that contribute additional care. PARTICIPANTS The panel composition included health service providers, decision makers, patients and care community, and researchers. Discussions were informed by a rapid review of tested approaches to fostering collaboration, facilitating care coordination and improving communication across healthcare systems. OUTCOME MEASURES The study planned to formulate a research agenda, implications for practice and recommendations for policy. RESULTS For research recommendations, we found consensus for developing measures of shared care, exploring healthcare professionals' needs in different care scenarios and evaluating patient experiences. Agreed practice recommendations included educating external professionals about issues specific to the patients in the main healthcare system, educating professionals within the main healthcare system about the roles and responsibilities of all involved parties, and helping patients better understand the pros and cons of within-system and out-of-system care. Policy recommendations included supporting time for professionals with high overlap in patients to engage regularly and sustaining support for care coordination for high-need patients. CONCLUSIONS Recommendations from the stakeholder panel created an agenda to foster further research, practice and policy innovations in cross-system care coordination.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - David Ganz
- Geriatrics Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sonali Saluja
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Timothy Kim
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolyn Turvey
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA
- Rural Health Resource Center, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
| | - Kristina Cordasco
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aashna Basu
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Care in the Community Service, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Tonya Page
- Office of Community, Clinical Integration & Field Support, Veteran Affairs Central Office, Kentucky City, Kentucky, USA
| | - Reshma Mahmood
- Santa Maria and San Luis Obispo Community Outpatient Clinics, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Jenny Barnard
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle Wong
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ning Fu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, Guangdong, China
| | - Isomi M Miake-Lye
- VA West Los Angeles Evidence-based Synthesis Program, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Alpay L, Koster Y, Dallinga J, Siemonsma P, Verhoef J, Kassens E, Flaton P, Baars K, van Kessel F. Technology-based interprofessional collaboration in primary care for home rehabilitation of the older adults: A dutch exploratory study. Health Informatics J 2023; 29:14604582231169299. [PMID: 37083311 DOI: 10.1177/14604582231169299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Primary healthcare professionals face an increasing number of geriatrics patients, and patient care often involves different disciplines. eHealth offers opportunities to support interprofessional collaboration (IPC). This exploratory study aimed to gain insight in 1) IPC in community-based rehabilitation, 2) facilitators and barriers for technology-based IPC and 3) technological IPC solutions envisioned by the primary healthcare professionals An focus group with six primary healthcare professionals and a design thinking session with four participants were conducted. Data analysis was based upon an IPC model. Results indicate that facilitators and barriers for IPC can be clustered in three categories: human, organization and technology, and provide some requirements to develop suitable IPC technological solutions Primary healthcare professionals recognise the urgency of working collaboratively. Current barriers are understanding each other's professional vocabulary, engaging the older adults, and using technology within the patient's environment. Further research is needed to integrate IPC components in a technological solution.
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Affiliation(s)
- Laurence Alpay
- Medical Technology Research Group, Inholland University of Applied Sciences, Haarlem, Netherlands
| | - Ybranda Koster
- Medical Technology Research Group, Inholland University of Applied Sciences, Haarlem, Netherlands
| | - Joan Dallinga
- Medical Technology Research Group, Inholland University of Applied Sciences, Haarlem, Netherlands
| | - Petra Siemonsma
- Physical Therapy Research Group, Leiden University of Applied Sciences, Leiden, Netherlands
| | - John Verhoef
- Physical Therapy Research Group, Leiden University of Applied Sciences, Leiden, Netherlands
| | - Erzy Kassens
- Arembergelaan Fysiotherapie, Voorburg, Netherlands
| | | | - Koen Baars
- Sport Sciences Research Group, Inholland University of Applied Sciences, Haarlem, Netherlands
| | - Floor van Kessel
- Sport Sciences Educational Program, Inholland University of Applied Sciences, Haarlem, Netherlands
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Burns D, Goodlad C, Hamblin K, Zimpel‐Leal K. Innovation in UK independent homecare services: A thematic narrative review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3447-e3458. [PMID: 35924757 PMCID: PMC10087811 DOI: 10.1111/hsc.13954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/30/2022] [Accepted: 07/08/2022] [Indexed: 06/17/2023]
Abstract
This paper reports the findings of a thematic narrative review of peer-reviewed articles exploring innovation in UK independent homecare services published between January 2009-August 2021. Our analysis of 15 papers reveals four broad innovation types: personalised funding, operational models, workforce development and assistive technology. We conclude that research focused on innovation in independent homecare offers important insights into the positive and negative outcomes of different types of innovation for providers, care workers and people receiving care. There are, however, also areas which are neglected and need further elaboration, including more robust evidence of outcomes and clearer articulation of innovation processes.
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Development and Validation of an Interprofessional Collaboration Scale for Home Health Care for the Frail Elderly. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:106-113. [DOI: 10.1016/j.anr.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/04/2022] [Accepted: 03/27/2022] [Indexed: 11/22/2022] Open
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van Bijsterveld SC, Barten JA, Molenaar EALM, Bleijenberg N, de Wit NJ, Veenhof C. Psychometric evaluation of the Decision Support Tool for Functional Independence in community-dwelling older people. JOURNAL OF POPULATION AGEING 2022; 16:1-23. [PMID: 35368880 PMCID: PMC8960690 DOI: 10.1007/s12062-022-09361-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/11/2022] [Indexed: 11/06/2022]
Abstract
Background The aging population is increasingly faced with daily life limitations, threatening their Functional Independence (FI). These limitations extend different life domains and require a broad range of community-care professionals to be addressed. The Decision Support Tool for Functional Independence (DST-FI) facilitates community-care professionals in providing uncontradictory recommendations regarding the maintenance of FI in community-dwelling older people. The current study aims to determine the validity and reliability of the DST-FI. Methods Sixty community-care professionals completed a twofold assessment. To assess construct validity, participants were asked to assign predefined recommendations to fifty cases of older people to maintain their level of FI. Hypotheses were tested regarding the expected recommendations per case. Content validity was assessed by questions on relevance, comprehensiveness, and comprehensibility of the current set of recommendations. Twelve participants repeated the assessment after two weeks to enable both within- and between rater reliability properties, expressed by an Intraclass Correlation Coefficient. Results Seven out of eight predefined hypotheses confirmed expectations, indicating high construct validity. As the recommendations were indicated 'relevant' and 'complete', content validity was high as well. Agreement between raters was poor to moderate while agreement within raters was moderate to excellent, resulting in moderate overall reliability. CONCLUSION The DST-FI suggests high validity and moderate reliability properties when used in a population of community-dwelling older people. The tool could facilitate community-care professionals in their task to preserve FI in older people. Future research should focus on psychometric properties like feasibility, acceptability, and developing and piloting strategies for implementation in community-care.
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Affiliation(s)
- S. C. van Bijsterveld
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J. A. Barten
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, The Netherlands
| | - E. A. L. M. Molenaar
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, The Netherlands
| | - N. Bleijenberg
- Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
- Research Group Proactive Care in Older People, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, The Netherlands
| | - N. J. de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - C. Veenhof
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, The Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
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Bonavia T, Julián M. Effective Behaviors in Work Teams: Spanish Adaptation of the Individual Behavior Analysis Scale. Front Psychol 2022; 13:809731. [PMID: 35356347 PMCID: PMC8959135 DOI: 10.3389/fpsyg.2022.809731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
There are hardly any instruments to measure teamwork behaviors from an individual approach. This applies both in interprofessional teams or not, and in teams involved in health, social care, and other areas. The Individual Behavior Analysis (IBA) scale measures efficacious behavior in work teams. It is one of the few instruments proposed in the literature to measure personal skills necessary for teamwork. Only a previous exploratory analysis of the scale was informed in another study. This article analyzes its internal structure using different confirmatory factor analyses and its internal consistency, with a sample of 815 employees working for Spanish social organizations in the geriatric field, both private and public. The results of the definitive version adapted to Spanish, referred to as Individual Behavior Analysis -25, indicate a good fit of the model to the data and good reliability. Factor analysis confirmed the existence of two factors: Communication skills and Acceptance, with good internal consistency coefficients. This scale is a useful instrument for assessing, based on the reviewed literature, two of the most important individual skills an efficacious team should have.
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Affiliation(s)
- Tomas Bonavia
- Department of Social Psychology, Universitat de València, Valencia, Spain
| | - Martín Julián
- Department of Psychology, Faculty of Health Sciences, Universidad Europea de Valencia, Valencia, Spain
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Wei H, Horns P, Sears SF, Huang K, Smith CM, Wei TL. A systematic meta-review of systematic reviews about interprofessional collaboration: facilitators, barriers, and outcomes. J Interprof Care 2022; 36:735-749. [DOI: 10.1080/13561820.2021.1973975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Holly Wei
- PhD Program, School of Nursing, University of Louisville, Louisville, KY, USA
| | - Phyllis Horns
- College of Nursing, East Carolina University, Greenville, NC, USA
| | - Samuel F. Sears
- Department of Psychology, East Carolina University, Greenville, NC, USA
| | - Kun Huang
- College of Nursing, East Carolina University, Greenville, NC, USA
| | | | - Trent L. Wei
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Poškutė V, Kazlauskaitė R, Matonytė I. Stakeholder collaboration in long-term care of older people in Lithuania. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:193-202. [PMID: 33852735 DOI: 10.1111/hsc.13389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/08/2021] [Accepted: 03/03/2021] [Indexed: 06/12/2023]
Abstract
Demographic situation, changes in the role of women in society and growing demand for long-term care (LTC) of older people have challenged the ability to meet the growing LTC needs in most developed countries. In countries where responsibility for LTC is still largely laid on families, it is, however, even more critical and calls for improvements in formal LTC systems. More intensive stakeholder collaboration in LTC policy development, organising and delivery are of primary importance in improving LTC systems. Such collaboration, however, is not always successful; thus, it is critical to understand what makes it effective and efficient. In this paper, we specifically look into multistakeholder collaboration in LTC in Lithuania, one of the fastest ageing countries in the EU, with the demand for LTC services growing fast and exceeding the supply despite rising business and NGO engagement. To determine facilitators of such collaboration, we build on the data obtained through eight focus group discussions with all key stakeholder representatives (LTC policymakers, organisers and service providers [public, private and NGOs], 54 participants in total). Our findings indicate that in addition to national and organisational level facilitators studied in prior research, there are important individual level factors, such as meaningfulness at work, concern and care for others, possibility for personal growth and development, satisfaction with supervision, a sense of belonging and role clarity. On the other hand, our results show that collaboration is constrained by a shortage of human resources, increased workload caused by growing LTC demand, bureaucratic requirements, legal restrictions, lack of awareness of LTC service availability among elder persons, and prevailing social norms and attitudes to institutionalised care. Interestingly, a lack of financial resources is not perceived as a major constraint.
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Affiliation(s)
| | | | - Irmina Matonytė
- ISM University of Management and Economics, Vilnius, Lithuania
- General Jonas Žemaitis Military Academy of Lithuania, Vilnius, Lithuania
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Avinash B, Shivamallu A, Ashwini TS, Sowmya HK, Ali I, Kudagi V. Interprofessional management of orofacial pain: Wearing many hats! JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:S65-S67. [PMID: 36110700 PMCID: PMC9469429 DOI: 10.4103/jpbs.jpbs_556_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/11/2021] [Indexed: 11/07/2022] Open
Abstract
Orofacial pain is one the commonest chronic oral health disorder. Yet, its complete management is still a researchable matter as it is a disorder which is caused due to various factors. It is very rare is find a single etiology leading to orofacial pain. It often encompasses multiple etiological factors. Hence it is important to understand that not one but multiple healthcare professionals are needed for its successful outcome and thus forming an interprofessional management team becomes important.
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Haruta J, Goto R, Ozone S, Maeno T. What role conceptions do multi-healthcare professionals have of physicians and what role expectation do they have of physicians in a community? BMC FAMILY PRACTICE 2021; 22:217. [PMID: 34727872 PMCID: PMC8565048 DOI: 10.1186/s12875-021-01568-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022]
Abstract
Background To create an effective community-based integrated care system, interprofessional collaboration based on healthcare professionals’ mutual understanding of their respective roles must be promoted. This study aimed to identify the role conception and role expectation that other healthcare professionals have towards physicians in the context of a community-based integrated care system. Methods We organized focus groups and adopted ‘Role Theory’ as a theoretical framework. We collected data from healthcare professionals attending a conference on community-based integrated care systems in Japan. Fifty-four non-physician healthcare professionals consented to participate in 7 focus groups. Theme analysis based on the verbatim recorded transcripts was conducted in accordance with the framework of “Role Theory”. Results The role conception of physicians is as a figure of intellectual authority positioned at the top of a traditional hierarchy, with a personal character of criticism/autonomy/closedness, not accommodative of interference from others, and upholding the Biomedical Model as an absolute standard. In response to this, the role expectation of physicians in the community is that they undertake actions that only physicians can undertake to ensure that a flat organization functions properly in providing medical explanations during patient transitions, and to offer healthcare support for patients who are difficult to access. This role expectation also includes the perception of patients as human beings, with physicians adapting to the Bio-Psycho-Social Model, explaining to patients about their disease as an authoritative voice based on an understanding of psychosocial circumstances, and sharing the prognosis of disease or disability. The expected personal character is a person with an open mind who allows others to seek advice, as well as a sense of approachableness which facilitates such seeking of advice. Conclusion In the context of a community-based integrated care system, physicians should consider the understanding of their role conception and role expectation that other professionals have of them, and endeavor to create an open relationship with all healthcare professionals while giving careful consideration to their own role.
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Affiliation(s)
- Junji Haruta
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan. .,Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
| | - Ryohei Goto
- Department of General Medicine and Primary Care, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Sachiko Ozone
- Department of General Medicine and Primary Care, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Montano AR, Cornell PY, Gravenstein S. Barriers and facilitators to interprofessional collaborative practice for community-dwelling older adults: An integrative review. J Clin Nurs 2021; 32:1534-1548. [PMID: 34405476 DOI: 10.1111/jocn.15991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/28/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aim of this integrative review was to synthesise empirical reports of interprofessional collaborative practice (IPCP) for community-dwelling older adults and uncover barriers and facilitators related to its success as a model of care for this population. BACKGROUND IPCP is a model of care that has demonstrated positive outcomes for community-dwelling older adults. However, a summary of barriers and facilitators to IPCP models has not been presented. METHODS An integrative review using the method posited by Whittemore and Knafl was completed to identify barriers and facilitators to IPCP for community-dwelling older adults. The literature search was reported following PRISMA guidelines. RESULTS Four themes emerged as barriers to IPCP: (1) A (Potential) Logistical Nightmare, (2) All About the Money, (3) If We Can't Test It, Can We Recommend It? and (4) Challenging for the Team, Challenging for the Client. Three themes emerged as facilitators to IPCP: (1) Reducing Resource Waste, (2) The "C" in IPCP and (3) What Matters Most. CONCLUSIONS IPCP models for community-dwelling older adults must adapt to the setting of care and client needs. Interprofessional education opportunities for team members facilitate effective IPCP. Healthcare policies and funding structures need to address IPCP for community-dwelling older adults for this model to be successful and sustainable. RELEVANCE TO CLINICAL PRACTICE Nurses participate on and lead IPCP teams caring for community-dwelling older adults and, therefore, need to be aware of barriers and facilitators to this model of care.
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Affiliation(s)
- Anna-Rae Montano
- Brown University School of Public Health, Providence, RI, USA.,Providence VA Medical Center, Providence, RI, USA
| | - Portia Y Cornell
- Brown University School of Public Health, Providence, RI, USA.,Providence VA Medical Center, Providence, RI, USA
| | - Stefan Gravenstein
- Brown University School of Public Health, Providence, RI, USA.,Providence VA Medical Center, Providence, RI, USA.,Brown University Warren Alpert Medical School, Providence, RI, USA
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Abstract
Introduction: Interprofessional collaboration (IPC) is increasingly used but diversely implemented in primary care. We aimed to assess the effectiveness of IPC in primary care settings. Methods: An overview (review of systematic reviews) was carried out. We searched nine databases and employed a double selection and data extraction method. Patient-related outcomes were categorized, and results coded as improvement (+), worsening (–), mixed results (?) or no change (0). Results: 34 reviews were included. Six types of IPC were identified: IPC in primary care (large scope) (n = 8), physician-nurse in primary care (n = 1), primary care physician (PCP)-specialty care provider (n = 5), PCP-pharmacist (n = 3), PCP-mental healthcare provider (n = 15), and intersectoral collaboration (n = 2). In general, IPC in primary care was beneficial for patients with variation between types of IPC. Whereas reviews about IPC in primary care (large scope) showed better processes of care and higher patient satisfaction, other types of IPC reported mixed results for clinical outcomes, healthcare use and patient-reported outcomes. Also, reviews focusing on interventions based on pre-existing and well-defined models, such as collaborative care, overall reported more benefits. However, heterogeneity between the included primary studies hindered comparison and often led to the report of mixed results. Finally, professional- and organizational-related outcomes were under-reported, and cost-related outcomes showed some promising results for IPC based on pre-existing models; results were lacking for other types. Conclusions: This overview suggests that interprofessional collaboration can be effective in primary care. Better understanding of the characteristics of IPC processes, their implementation, and the identification of effective elements, merits further attention.
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15
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Nishiguchi S, Sugaya N, Saigusa Y, Inamori M. Effect of interprofessional collaboration among nursing home professionals on end-of-life care in nursing homes. Drug Discov Ther 2021; 15:93-100. [PMID: 33952776 DOI: 10.5582/ddt.2021.01030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As end-of-life (EOL) care in nursing homes is gradually increasing, interprofessional collaboration in EOL care in nursing homes is becoming important. However, a method for measuring interprofessional collaboration has not been established. Therefore, this study aimed to clarify the effect of interprofessional collaboration on EOL care in nursing homes. Questionnaires were mailed to the facility directors of 378 nursing homes in Kanagawa Prefecture, Japan, and distributed to nurses, care managers, and professional caregivers. Three professionals from each nursing home completed the same questionnaire, which included 9 items on EOL care: shared facility policy, residents' wishes, each professional's roles, person in charge of the facility, residents' conditions, mental status of residents' families, emergency codes, residents' key people, and sufficient discussion among professionals. Based on the professionals' responses, interprofessional collaboration was assessed. We used multivariable analysis, with interprofessional collaboration as an independent factor. The outcome was the amount of EOL care in the nursing home. A total of 180 (47.6%) nursing homes participated. Multivariable analysis showed that interprofessional collaboration (beta [β] coefficient 2.5, 95% confidence interval [CI] 0.45-4.48; p = 0.017), availability of EOL care bonuses (β coefficient 4.4, 95% CI 1.41-7.38; p = 0.004), physician support for emergency care during off time (β coefficient 5.4, 95% CI 1.86-8.94; p = 0.003), and EOL care conferences (β coefficient 4.1, 95% CI 1.19-6.99; p = 0.006) were significant factors associated with the amount of EOL care in the nursing homes. We found evidence in the adjusted model that interprofessional collaboration among facility professionals is effective for EOL care in nursing homes.
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Affiliation(s)
- Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan.,Unit of Public Health and Preventive Medicine, Yokohama City University, Yokohama, Japan.,Department of Internal Medicine, Hayama Heart Center, Miura, Japan
| | - Nagisa Sugaya
- Unit of Public Health and Preventive Medicine, Yokohama City University, Yokohama, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Masahiko Inamori
- Department of Medical Education, Yokohama City University, Yokohama, Japan
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16
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Ahmed A, van den Muijsenbergh METC, Mewes JC, Wodchis WP, Vrijhoef HJM. Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review. BMJ Open 2021; 11:e043280. [PMID: 33895713 PMCID: PMC8074568 DOI: 10.1136/bmjopen-2020-043280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify the relationships between the context in which integrated care programmes (ICPs) for community-dwelling frail older people are applied, the mechanisms by which the programmes do (not) work and the outcomes resulting from this interaction by establishing a programme theory. DESIGN Rapid realist review. INCLUSION CRITERIA Reviews and meta-analyses (January 2013-January 2019) and non-peer-reviewed literature (January 2013-December 2019) reporting on integrated care for community-dwelling frail older people (≥60 years). ANALYSIS Selection and appraisal of documents was based on relevance and rigour according to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards criteria. Data on context, mechanisms, programme activities and outcomes were extracted. Factors were categorised into the five strategies of the WHO framework of integrated people-centred health services (IPCHS). RESULTS 27 papers were included. The following programme theory was developed: it is essential to establish multidisciplinary teams of competent healthcare providers (HCPs) providing person-centred care, closely working together and communicating effectively with other stakeholders. Older people and informal caregivers should be involved in the care process. Financial support, efficient use of information technology and organisational alignment are also essential. ICPs demonstrate positive effects on the functionality of older people, satisfaction of older people, informal caregivers and HCPs, and a delayed placement in a nursing home. Heterogeneous effects were found for hospital-related outcomes, quality of life, healthcare costs and use of healthcare services. The two most prevalent WHO-IPCHS strategies as part of ICPs are 'creating an enabling environment', followed by 'strengthening governance and accountability'. CONCLUSION Currently, most ICPs do not address all WHO-IPCHS strategies. In order to optimise ICPs for frail older people the interaction between context items, mechanisms, programme activities and the outcomes should be taken into account from different perspectives (system, organisation, service delivery, HCP and patient).
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Affiliation(s)
- Anam Ahmed
- Panaxea, Amsterdam, Netherlands
- Primary and Community Care, Radboudumc, Nijmegen, Gelderland, Netherlands
| | | | | | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Hubertus J M Vrijhoef
- Panaxea, Amsterdam, Netherlands
- Department of Patient and Care, Maastricht University Medical Centre+, Maastricht, Netherlands
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17
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Moncatar TJRT, Nakamura K, Siongco KLL, Seino K, Carlson R, Canila CC, Javier RS, Lorenzo FME. Interprofessional collaboration and barriers among health and social workers caring for older adults: a Philippine case study. HUMAN RESOURCES FOR HEALTH 2021; 19:52. [PMID: 33874959 PMCID: PMC8056548 DOI: 10.1186/s12960-021-00568-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/18/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND There is limited information on how the barriers to interprofessional collaboration (IPC) across various professionals, organizations, and care facilities influence the health and welfare of older adults. This study aimed to describe the status of IPC practices among health and social workers providing care for older adults in the Philippines; investigate the perceived barriers to its implementation and perceived effects on geriatric care; and identify possible solutions to address the barriers limiting collaborative practice. METHODS A case study approach was utilized employing 12 semi-structured in-depth interviews and 29 focus group discussions with care workers from selected primary health care units, public and private hospitals, and nursing homes that are directly involved in geriatric care delivery in two cities in the Philippines. Overall, 174 health and social workers consented to participate in this study. All interviews were audio-recorded and transcribed verbatim. An inductive thematic analysis using NVivo 12® was used to identify and categorize relevant thematic codes. RESULTS Interprofessional geriatric care provided by health and social workers was observed to be currently limited to ad hoc communications typically addressing only administrative concerns. This limitation is imposed by a confluence of barriers such as personal values and beliefs, organizational resource constraints, and a silo system care culture which practitioners say negatively influences care delivery. This in turn results in inability of care providers to access adequate care information, as well as delays and renders inaccessible available care provided to vulnerable older adults. Uncoordinated care of older adults also led to reported inefficient duplication and overlap of interventions. CONCLUSION Geriatric care workers fear such barriers may aggravate the increasing unmet needs of older adults. In order to address these potential negative outcomes, establishing a clear and committed system of governance that includes IPC is perceived as necessary to install a cohesive service delivery mechanism and provide holistic care for older adults. Future studies are needed to measure the effects of identified barriers on the potential of IPC to facilitate an integrated health and social service delivery system for the improvement of quality of life of older adults in the Philippines.
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Affiliation(s)
- TJ Robinson T. Moncatar
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8519 Japan
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, 1000 Metro Manila, Philippines
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8519 Japan
- World Health Organization Collaborating Centre for Healthy Cities and Urban Policy Research, Tokyo, 113-8519 Japan
| | - Kathryn Lizbeth L. Siongco
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8519 Japan
- College of Nursing, University of the Philippines Manila, 1000 Metro Manila, Philippines
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8519 Japan
- World Health Organization Collaborating Centre for Healthy Cities and Urban Policy Research, Tokyo, 113-8519 Japan
| | - Rebecca Carlson
- Institute of Global Affairs, Tokyo Medical and Dental University, Tokyo, 113-8519 Japan
| | - Carmelita C. Canila
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, 1000 Metro Manila, Philippines
| | - Richard S. Javier
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, 1000 Metro Manila, Philippines
| | - Fely Marilyn E. Lorenzo
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, 1000 Metro Manila, Philippines
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18
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Montano AR. A concept analysis of interprofessional collaborative practice for community-dwelling older adults. Nurs Forum 2021; 56:413-420. [PMID: 33533058 DOI: 10.1111/nuf.12553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Abstract
Models of interprofessional collaborative practice have demonstrated improved outcomes for community-dwelling older adults. However, the concept of interprofessional collaborative practice for community-dwelling older adults needs clarification and a clear definition. A concept analysis based on the method posited by Walker and Avant was conducted to formulate an operational definition of this concept. Defining attributes, antecedents, consequences and empirical referents were identified from a review of the literature. A model case and contrary case were selected to further clarify the concept of interprofessional collaborative practice for community-dwelling older adults. Nurses are ideal leaders of interprofessional teams caring for older adults and can utilize this concept in practice, education and research.
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Affiliation(s)
- Anna-Rae Montano
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island, USA
- The Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
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19
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Ruud I, Stålesen JH, Sandnes A, Ellingsen KE, Espegren OR. Kan en ny organisering av fastlegetjenesten bidra til å redusere pasientsikkerhetsrisiko i helsetjenesten til personer med utviklingshemming? TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2020-02-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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20
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Chau JPC, Lo SHS, Lee VWY, Yiu WM, Chiang HCY, Thompson DR, Lau AYL. Fostering gerontology students' competence in Interprofessional collaborative practice. BMC MEDICAL EDUCATION 2020; 20:388. [PMID: 33109173 PMCID: PMC7592570 DOI: 10.1186/s12909-020-02273-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Interprofessional collaborative practice (IPCP) is increasingly recognised as being crucial for the provision of holistic care and optimising health outcomes among older adults, many with multiple complex health problems. However, little is known about the challenges of facilitating this in practice. Therefore, this study explores these issues from the perspective of different healthcare professionals and how this might inform interprofessional education curricula. METHODS Sixteen different healthcare professionals working in a variety of aged care (acute, rehabilitative and community) settings were invited to participate in individual semi-structured in-depth interviews designed to: (i) explore the meaning of IPCP; (ii) explore the facilitators of and barriers to IPCP; and (iii) examine the opportunities and challenges in interprofessional gerontological education. All interviews were tape-recorded and transcribed verbatim with thematic analysis conducted by two independent researchers. RESULTS Three major themes emerged from the interviews: the need for IPCP; role preparedness, scope and liability; and strategies for interprofessional education. Respondents shared a common belief that IPCP improves the quality of life of older adults in both hospital and community settings by improving person-centred coordinated care and decision making in care planning. However, respondents perceived major barriers to IPCP to be lack of knowledge about healthcare professionals' scope of practice, lack of training in interprofessional collaboration, professional culture and stereotypes, and liability issues. Suggested approaches to overcome these barriers included innovative teaching and learning approaches, engaging students early on in the curriculum of health professional degree programmes, and enhancing collaborative effective communication in health and social care settings. CONCLUSIONS It is anticipated that these findings will be used to inform the development of a new interprofessional gerontological education curriculum that aims to enhance students' competence in IPCP.
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Affiliation(s)
- Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR.
| | - Vivian Wing Yan Lee
- Centre for Learning Enhancement And Research, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Wai Ming Yiu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - Helen Chung Yan Chiang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Alexander Yuk Lun Lau
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
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21
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Håkonsen SJ, Pedersen PU, Bygholm A, Thisted CN, Bjerrum M. Lack of focus on nutrition and documentation in nursing homes, home care- and home nursing: the self-perceived views of the primary care workforce. BMC Health Serv Res 2019; 19:642. [PMID: 31492130 PMCID: PMC6729022 DOI: 10.1186/s12913-019-4450-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 08/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Malnutrition is a comprehensive challenge for the nursing home, home care- and home nursing sector. Nutritional care and the subsequent documentation are a common and multifaceted healthcare practice that requires that the healthcare professionals possess complex combinations of competencies in order to deliver high-quality care and treatment. The purpose of this study was to investigate how a varied group of healthcare professionals’ perceive their own competencies within nutrition and documentation and how organizational structures influence their daily work and the quality of care provided. Methods Two focus groups consisting of 14 healthcare professionals were conducted. The transcribed focus group interviews was analyzed using the qualitative content analysis approach. Results Six categories were identified: 1) Lack of uniform and systematic communication affect nutritional care practices 2) Experience-based knowledge among the primary workforce influences daily clinical decisions, 3) Different attitudes towards nutritional care lead to differences in the quality of care 4) Differences in organizational culture affect quality of care, 5) Lack of clear nutritional care responsibilities affect how daily care is performed and 6) Lack of clinical leadership and priorities makes nutritional care invisible. Conclusions The six categories revealed two explanatory themes: 1) Absent inter- and intra-professional collaboration and communication obstructs optimal clinical decision-making and 2) quality deterioration due to poorly-established nutritional care structure. Overall, the two themes explain that from the healthcare professionals’ point of view, a visible organization that allocates resources as well as prioritizing and articulating the need for daily nutritional care and documentation is a prerequisite for high-quality care and treatment. Furthermore, optimal clinical decision making among the healthcare professionals are compromised by imprecise and unclear language and terminology in the patients’ healthcare records and also a lack of clinical guidelines and standards for collaboration between different healthcare professionals working in nursing homes, home care or home nursing. The findings of this study are beneficial to support organizations within these settings with strategies focusing on increasing nutritional care and documentation competencies among the healthcare professionals. Furthermore, the results advocate for the daily involvement and support of leaders and managers in articulating and structuring the importance of nutritional care and treatment and the subsequent documentation. Electronic supplementary material The online version of this article (10.1186/s12913-019-4450-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S J Håkonsen
- Centre of Clinical Guidelines - Danish National Clearing house, Department of Health Science and Technology, University of Aalborg, Aalborg, Denmark. .,Danish Centre of Systematic Reviews: A Joanna Briggs Institute Centre of Excellence, Aalborg, Denmark.
| | - P U Pedersen
- Centre of Clinical Guidelines - Danish National Clearing house, Department of Health Science and Technology, University of Aalborg, Aalborg, Denmark.,Danish Centre of Systematic Reviews: A Joanna Briggs Institute Centre of Excellence, Aalborg, Denmark
| | - A Bygholm
- Department of Communication and Psychology, University of Aalborg, Aalborg, Denmark
| | - C N Thisted
- Department of Public Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark
| | - M Bjerrum
- Centre of Clinical Guidelines - Danish National Clearing house, Department of Health Science and Technology, University of Aalborg, Aalborg, Denmark.,Danish Centre of Systematic Reviews: A Joanna Briggs Institute Centre of Excellence, Aalborg, Denmark.,Department of Public Health, Section of Nursing Science, Aarhus University, Aarhus, Denmark
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22
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Kemper‐Koebrugge W, Adriaansen M, Laurant M, Wensing M. Actions to influence the care network of home-dwelling elderly people: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:973-981. [PMID: 30637827 PMCID: PMC6850451 DOI: 10.1111/hsc.12714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 12/04/2018] [Accepted: 12/20/2018] [Indexed: 06/09/2023]
Abstract
Positive impact of care networks of home-dwelling elderly people may be based on several network mechanisms: navigation to resources, negotiation between participants and contagion of behaviours. Little is known about actions of participants-elderly people, informal caregivers or formal care providers-to activate such mechanisms and generate support. Aim of this study was to identify actions in relation to these network mechanisms. A cross-sectional qualitative study of 48 interviews with home-dwelling elderly people, informal caregivers and formal care providers in the eastern parts of the Netherlands was conducted between March and September 2016. A framework analysis on network mechanisms categorised actions. Actions were reviewed by network party and compared between networks to explore relations between actions and networks. Results showed that participants navigated through existing relations to seek support. Actions on negotiation were aimed at ameliorating existing relations. Few examples and no actions on contagion of behaviours were found. Actions seemed driven by incidents and existing relations. Elderly people rarely initiated actions, informal caregivers felt hampered by their position in the network. Consistent patterns of relations between actions and network characteristics did not emerge. We concluded that the full potential of network-based support of elderly people is probably underused. Particularly promising seem: navigating the neighbourhood for new informal care, using opposite opinions as a catalyst for change and bringing quality of life and dilemma's into dialogue in the network.
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Affiliation(s)
- Wendy Kemper‐Koebrugge
- Faculty of Health and Social StudiesHAN University of Applied SciencesNijmegenThe Netherlands
| | - Marian Adriaansen
- Faculty of Health and Social StudiesHAN University of Applied SciencesNijmegenThe Netherlands
| | - Miranda Laurant
- Faculty of Health and Social StudiesHAN University of Applied SciencesNijmegenThe Netherlands
- IQ Healthcare, Radboud University Nijmegen Medical Centre, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Michel Wensing
- IQ Healthcare, Radboud University Nijmegen Medical Centre, Radboud Institute for Health SciencesNijmegenThe Netherlands
- Department of General Practice and Health Services ResearchUniversity Hospital Heidelberg, Marsilius ArkadenHeidelbergGermany
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23
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Harnett PJ, Kennelly S, Williams P. A 10 Step Framework to Implement Integrated Care for Older Persons. AGEING INTERNATIONAL 2019. [DOI: 10.1007/s12126-019-09349-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Duarte-Climents G, Sánchez-Gómez MB, Rodríguez-Gómez JÁ, Rodríguez-Álvarez C, Sierra-López A, Aguirre-Jaime A, Gómez-Salgado J. Impact of the Case Management Model through Community Liaison Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111894. [PMID: 31146341 PMCID: PMC6603531 DOI: 10.3390/ijerph16111894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 11/16/2022]
Abstract
The objective of the present study is to assess the model’s impact on patients and their families in terms of outcomes and the efficiency results for the health system in Tenerife, Canary Islands, selecting a period of eight years from the time interval 2002–2018. The employed indicators were collected on a monthly basis. They referred to home care and its impact on clinical outcomes and on the use of resources. The comparison between the indicators’ tendencies with and without the liaison nurse model was done with the F-test by Snedecor. All these tests are bilateral, with a level of significance of p < 0.05. In those areas with community liaison nurse (CLN), improvements have been found in indicators that describe: (1) the management of the clinical status of patients, (2) the efficiency of the use of resources, and (3) the quality and compliance with the process that also includes home visits and social risk detection and management. It can be said that in the basic areas of primary health care where the work of the CLN develops there are improvements in the management of the patients’ clinical condition as well as in the quality and efficiency of care.
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Affiliation(s)
- Gonzalo Duarte-Climents
- University School of Nursing, Candelaria NS University Hospital, University of La Laguna, Canary Islands Health Service, 38010 Santa Cruz de Tenerife, Spain.
| | - María Begoña Sánchez-Gómez
- University School of Nursing, Candelaria NS University Hospital, University of La Laguna, Canary Islands Health Service, 38010 Santa Cruz de Tenerife, Spain.
| | - José Ángel Rodríguez-Gómez
- University School of Nursing and Physiotherapy, Health Sciences School, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain.
| | | | - Antonio Sierra-López
- Department of Preventive Medicine and Public Health, University of La Laguna, 38200 Santa Cruz de Tenerife, Spain.
| | - Armando Aguirre-Jaime
- Research Support Unit for Primary Care Management and Candelaria NS University Hospital, 38010 Santa Cruz de Tenerife, Spain.
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain.
- Safety and Health Posgrade Program, Universidad Espíritu Santo, Guayaquil 091650, Ecuador.
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25
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Chadborn NH, Goodman C, Zubair M, Sousa L, Gladman JRF, Dening T, Gordon AL. Role of comprehensive geriatric assessment in healthcare of older people in UK care homes: realist review. BMJ Open 2019; 9:e026921. [PMID: 30962238 PMCID: PMC6500328 DOI: 10.1136/bmjopen-2018-026921] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Comprehensive geriatric assessment (CGA) may be a way to deliver optimal care for care home residents. We used realist review to develop a theory-driven account of how CGA works in care homes. DESIGN Realist review. SETTING Care homes. METHODS The review had three stages: first, interviews with expert stakeholders and scoping of the literature to develop programme theories for CGA; second, iterative searches with structured retrieval and extraction of the literature; third, synthesis to refine the programme theory of how CGA works in care homes.We used the following databases: Medline, CINAHL, Scopus, PsychInfo, PubMed, Google Scholar, Greylit, Cochrane Library and Joanna Briggs Institute. RESULTS 130 articles informed a programme theory which suggested CGA had three main components: structured comprehensive assessment, developing a care plan and working towards patient-centred goals. Each of these required engagement of a multidisciplinary team (MDT). Most evidence was available around assessment, with tension between structured assessment led by a single professional and less structured assessment involving multiple members of an MDT. Care planning needed to accommodate visiting clinicians and there was evidence that a core MDT often used care planning as a mechanism to seek external specialist support. Goal-setting processes were not always sufficiently patient-centred and did not always accommodate the views of care home staff. Studies reported improved outcomes from CGA affecting resident satisfaction, prescribing, healthcare resource use and objective measures of quality of care. CONCLUSION The programme theory described here provides a framework for understanding how CGA could be effective in care homes. It will be of use to teams developing, implementing or auditing CGA in care homes. All three components are required to make CGA work-this may explain why attempts to implement CGA by interventions focused solely on assessment or care planning have failed in some long-term care settings. TRIAL REGISTRATION NUMBER CRD42017062601.
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Affiliation(s)
- Neil H Chadborn
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care East Midlands, Nottingham, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care East of England, Cambridge, UK
| | - Maria Zubair
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Lídia Sousa
- Santa Maria University Hospital, Lisbon, Portugal
| | - John R F Gladman
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care East Midlands, Nottingham, UK
- Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Tom Dening
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Adam L Gordon
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care East Midlands, Nottingham, UK
- Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
- School of Health Sciences, City, University of London, London, UK
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26
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Abstract
Purpose
The purpose of this paper is to report on the findings of the first stage of a project seeking to evaluate and overcome inter-professional barriers between health and social care staff within a single, co-located, integrated community team. The project seeks to answer the following questions: first, Do inter-professional barriers to integrated working exist between health and social care staff at the interface of care delivery? Second, If inter-professional barriers exist, can joint health and social care assessments help to overcome them? The paper develops the current evidence base through findings from a staff questionnaire and the initial findings of a pilot study of joint health and social care assessments aimed at overcoming inter-professional barriers to integration.
Design/methodology/approach
The first stage of the project involved running an anonymous, online questionnaire with health and social care staff within a single, co-located community adult health and social care team. The questionnaire aimed to explore staffs’ perceptions of inter-professional collaboration when assessing the health and care needs of service users with a high degree of complexity of need. The second element of the study presents the initial findings of a small pilot of joint health and social care assessments. A second staff survey was used in order to provide a “before and after” comparative analysis and to demonstrate the effect of joint assessments on staffs’ perceptions of inter-professional collaboration at the interface of care delivery.
Findings
Health and social care staff value joint working as a means of improving quality of care. However, they also felt that inter-professional collaboration did not occur routinely due to organisational limitations. Staff members who participated in the pilot of joint assessments believed that this collaborative approach improved their understanding of other professional roles, was an effective means of enabling others to understand their own roles and helped to better identify the health and care needs of the most complex service users on their caseloads. Initial findings suggest that joint assessments may be a practical means of overcoming inter-professional barriers related to a lack of communication and lack of understanding of job roles.
Practical implications
The questionnaires highlighted the need for integration strategies that are aimed at facilitating collaborative working between staff of different professions, in order to achieve the aims of integration, such as a reduction in duplication of work and hand-offs between services.
Originality/value
To date, few studies have explored either staff perceptions of collaborative working or the effectiveness of joint assessments as a means of overcoming inter-professional barriers. This paper adds new data to an important area of integration that legislators and researchers increasingly agree requires more focus. Although the findings are limited due to the small scale of the initial pilot, they provide interesting and original data that will provide insight into future workforce integration strategies.
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Farrell B, Thompson W, Black CD, Archibald D, Raman-Wilms L, Grassau P, Patel T, Weaver L, Eid K, Winslade N. Health care providers' roles and responsibilities in management of polypharmacy: Results of a modified Delphi. Can Pharm J (Ott) 2018; 151:395-407. [PMID: 30559915 PMCID: PMC6293398 DOI: 10.1177/1715163518804276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little is known about the roles that allow interprofessional teams to effectively manage older patients experiencing polypharmacy. OBJECTIVES To identify and examine the consensus on salient interprofessional roles, responsibilities and competencies required in managing polypharmacy. METHODS Four focus groups with 35 team members practising in geriatrics were generated to inform survey development. The sessions generated 63 competencies, roles or responsibilities, which were categorized into 4 domains defined by the Canadian Interprofessional Health Collaborative. The resulting survey was administered nationally to geriatric health care professionals who were asked to rate the importance of each item in managing polypharmacy; we sought agreement within and across professions using a confirmatory 2-round Delphi method. RESULTS Round 1 was completed by 98 survey respondents and round 2 by 72. There was high intra-professional and interprofessional consensus regarding the importance of competencies among physicians, nurses and pharmacists; though pharmacists rated fewer competencies as important. Less consensus was observed among other health care professionals or they indicated the nonimportance of competencies despite focus group discussion to the contrary. DISCUSSION Although there is a strong consensus of polypharmacy management competencies across team members who have been more traditionally involved in medication management, there continue to be health care providers with differing understandings of competencies that may contribute to reduced reliance on medication. Lower importance ratings suggest pharmacists may not acknowledge or recognize their own potential roles in interprofessional polypharmacy management. CONCLUSION Further exploration to understand the underutilization of professional expertise in managing polypharmacy will contribute to refining role clarity and translating competencies in practical settings, as well as guiding educators regarding curricular content.
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Affiliation(s)
| | - Wade Thompson
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Cody D. Black
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Douglas Archibald
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Lalitha Raman-Wilms
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Pamela Grassau
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Tejal Patel
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Lynda Weaver
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Khaled Eid
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
| | - Nancy Winslade
- Department of Family Medicine (Farrell, Archibald),
University of Ottawa, Ottawa
- School of Epidemiology, Public Health and Preventive
Medicine (Thompson), University of Ottawa, Ottawa
- School of Pharmacy (Farrell, Patel), University of
Waterloo, Waterloo
- Bruyère Research Institute (Farrell, Thompson,
Black, Archibald, Eid, Grassau), Ottawa
- Leslie Dan Faculty of Pharmacy (Raman-Wilms),
University of Toronto
- Bruyère Continuing Care (Weaver), Ottawa
- Department of Medicine (Winslade), McGill
University, Montreal, Quebec
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Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. Understanding new models of integrated care in developed countries: a systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06290] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BackgroundThe NHS has been challenged to adopt new integrated models of service delivery that are tailored to local populations. Evidence from the international literature is needed to support the development and implementation of these new models of care.ObjectivesThe study aimed to carry out a systematic review of international evidence to enhance understanding of the mechanisms whereby new models of service delivery have an impact on health-care outcomes.DesignThe study combined rigorous and systematic methods for identification of literature, together with innovative methods for synthesis and presentation of findings.SettingAny setting.ParticipantsPatients receiving a health-care service and/or staff delivering services.InterventionsChanges to service delivery that increase integration and co-ordination of health and health-related services.Main outcome measuresOutcomes related to the delivery of services, including the views and perceptions of patients/service users and staff.Study designEmpirical work of a quantitative or qualitative design.Data sourcesWe searched electronic databases (between October 2016 and March 2017) for research published from 2006 onwards in databases including MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index, Social Science Citation Index and The Cochrane Library. We also searched relevant websites, screened reference lists and citation searched on a previous review.Review methodsThe identified evidence was synthesised in three ways. First, data from included studies were used to develop an evidence-based logic model, and a narrative summary reports the elements of the pathway. Second, we examined the strength of evidence underpinning reported outcomes and impacts using a comparative four-item rating system. Third, we developed an applicability framework to further scrutinise and characterise the evidence.ResultsWe included 267 studies in the review. The findings detail the complex pathway from new models to impacts, with evidence regarding elements of new models of integrated care, targets for change, process change, influencing factors, service-level outcomes and system-wide impacts. A number of positive outcomes were reported in the literature, with stronger evidence of perceived increased patient satisfaction and improved quality of care and access to care. There was stronger UK-only evidence of reduced outpatient appointments and waiting times. Evidence was inconsistent regarding other outcomes and system-wide impacts such as levels of activity and costs. There was an indication that new models have particular potential with patients who have complex needs.LimitationsDefining new models of integrated care is challenging, and there is the potential that our study excluded potentially relevant literature. The review was extensive, with diverse study populations and interventions that precluded the statistical summary of effectiveness.ConclusionsThere is stronger evidence that new models of integrated care may enhance patient satisfaction and perceived quality and increase access; however, the evidence regarding other outcomes is unclear. The study recommends factors to be considered during the implementation of new models.Future workLinks between elements of new models and outcomes require further study, together with research in a wider variety of populations.Study registrationThis study is registered as PROSPERO CRD37725.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maxine Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Bunn F, Goodman C, Russell B, Wilson P, Manthorpe J, Rait G, Hodkinson I, Durand MA. Supporting shared decision-making for older people with multiple health and social care needs: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BackgroundHealth-care systems are increasingly moving towards more integrated approaches. Shared decision-making (SDM) is central to these models but may be complicated by the need to negotiate and communicate decisions between multiple providers, as well as patients and their family carers; this is particularly the case for older people with complex needs.ObjectivesTo provide a context-relevant understanding of how models to facilitate SDM might work for older people with multiple health and care needs and how they might be applied to integrated care models.DesignRealist synthesis following Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) publication standards.ParticipantsTwenty-four stakeholders took part in interviews.Data sourcesElectronic databases including MEDLINE (via PubMed), The Cochrane Library, Scopus, Google and Google Scholar (Google Inc., Mountain View, CA, USA). Lateral searches were also carried out. All types of evidence were included.Review methodsIterative stakeholder-driven, three-stage approach, involving (1) scoping of the literature and stakeholder interviews (n = 13) to develop initial programme theory/ies, (2) systematic searches for evidence to test and develop the theories and (3) validation of programme theory/ies with stakeholders (n = 11).ResultsWe included 88 papers, of which 29 focused on older people or people with complex needs. We identified four theories (context–mechanism–outcome configurations) that together provide an account of what needs to be in place for SDM to work for older people with complex needs: understanding and assessing patient and carer values and capacity to access and use care; organising systems to support and prioritise SDM; supporting and preparing patients and family carers to engage in SDM; and a person-centred culture of which SDM is a part. Programmes likely to be successful in promoting SDM are those that create trust between those involved, allow service users to feel that they are respected and understood, and engender confidence to engage in SDM.LimitationsThere is a lack of evidence on interventions to promote SDM in older people with complex needs or on interprofessional approaches to SDM.ConclusionsModels of SDM for older people with complex health and care needs should be conceptualised as a series of conversations that patients, and their family carers, may have with a variety of different health and care professionals. To embed SDM in practice requires a shift from a biomedical focus to a more person-centred ethos. Service providers are likely to need support, both in terms of the way services are organised and delivered and in terms of their own continuing professional development. Older people with complex needs may need support to engage in SDM. How this support is best provided needs further exploration, although face-to-face interactions and ongoing patient–professional relationships are key.Future workThere is a need for further work to establish how organisational structures can be better aligned to meet the requirements of older people with complex needs. This includes a need to define and evaluate the contribution that different members of health and care teams can make to SDM for older people with complex health and care needs.Study registrationThis study is registered as PROSPERO CRD42016039013.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Patricia Wilson
- Centre for Health Service Studies, University of Kent, Canterbury, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King’s College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London Medical School (Royal Free Campus), London, UK
| | - Isabel Hodkinson
- Tower Hamlets Clinical Commissioning Group, The Tredegar Practice, London, UK
| | - Marie-Anne Durand
- The Preference Laboratory, The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
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Goodman C, Norton C, Buswell M, Russell B, Harari D, Harwood R, Roe B, Rycroft-Malone J, Drennan VM, Fader M, Maden M, Cummings K, Bunn F. Managing Faecal INcontinence in people with advanced dementia resident in Care Homes (FINCH) study: a realist synthesis of the evidence. Health Technol Assess 2018; 21:1-220. [PMID: 28805188 DOI: 10.3310/hta21420] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Eighty per cent of care home residents in the UK are living with dementia. The prevalence of faecal incontinence (FI) in care homes is estimated to range from 30% to 50%. There is limited evidence of what is effective in the reduction and management of FI in care homes. OBJECTIVE To provide a theory-driven explanation of the effectiveness of programmes that aim to improve FI in people with advanced dementia in care homes. DESIGN A realist synthesis. This was an iterative approach that involved scoping of the literature and consultation with five stakeholder groups, a systematic search and analysis of published and unpublished evidence, and a validation of programme theories with relevant stakeholders. DATA SOURCES The databases searched included PubMed, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Scopus, SocAbs, Applied Social Sciences Index and Abstracts, BiblioMap, Sirius, OpenGrey, Social Care Online and the National Research Register. RESULTS The scoping identified six programme theories with related context-mechanism-outcome configurations for testing. These addressed (1) clinician-led support, assessment and review, (2) the contribution of teaching and support for care home staff on how to reduce and manage FI, (3) the causes and prevention of constipation, (4) how the cognitive and physical capacity of the resident affect outcomes, (5) how the potential for recovery, reduction and management of FI is understood by those involved and (6) how the care of people living with dementia and FI is integral to the work patterns of the care home and its staff. Data extraction was completed on 62 core papers with iterative searches of linked literature. Dementia was a known risk factor for FI, but its affect on the uptake of different interventions and the dementia-specific continence and toileting skills staff required was not addressed. Most care home residents with FI will be doubly incontinent and, therefore, there is limited value in focusing solely on FI or on single causes of FI such as constipation. Clinical assessment, knowledge of the causes of FI and strategies that recognise the individuals' preferences are necessary contextual factors. Valuing the intimate and personal care work that care home staff provide to people living with dementia and addressing the dementia-related challenges when providing continence care within the daily work routines are key to helping to reduce and manage FI in this population. LIMITATIONS The synthesis was constrained by limited evidence specific to FI and people with dementia in care homes and by the lack of dementia-specific evidence on continence aids. CONCLUSIONS This realist synthesis provides a theory-driven understanding of the conditions under which improvement in care for care home residents living with dementia and FI is likely to be successful. FUTURE WORK Future multicomponent interventions need to take account of how the presence of dementia affects the behaviours and choices of those delivering and receiving continence care within a care home environment. STUDY REGISTRATION This study is registered as PROSPERO CRD42014009902. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Marina Buswell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Danielle Harari
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Division of Health and Social Care, King's College London, London, UK
| | - Rowan Harwood
- Health Care of Older People, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Brenda Roe
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
| | | | - Vari M Drennan
- Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston and St George's, London, UK
| | - Mandy Fader
- Health Sciences, University of Southampton, Southampton, UK
| | - Michelle Maden
- School of Health Sciences, University of Liverpool, Liverpool, UK
| | | | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
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Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res 2018; 18:350. [PMID: 29747651 PMCID: PMC5946491 DOI: 10.1186/s12913-018-3161-3] [Citation(s) in RCA: 301] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/29/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION Prospero registration number: 42016037725 .
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Maxine Johnson
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Duncan Chambers
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Anthea Sutton
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Elizabeth Goyder
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
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Grol SM, Molleman GRM, Kuijpers A, van der Sande R, Fransen GAJ, Assendelft WJJ, Schers HJ. The role of the general practitioner in multidisciplinary teams: a qualitative study in elderly care. BMC FAMILY PRACTICE 2018; 19:40. [PMID: 29523092 PMCID: PMC5845178 DOI: 10.1186/s12875-018-0726-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 03/01/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the western world, a growing number of the older people live at home. In the Netherlands, GPs are expected to play a pivotal role in the organization of integrated care for this patient group. However, little is known about how GPs can play this role best. Our aim for this study was to unravel how GPs can play a successful role in elderly care, in particular in multidisciplinary teams, and to define key concepts for success. METHODS A mixed qualitative research model in four multidisciplinary teams for elderly care in the Netherlands was used. With these four teams, consisting of 46 health care and social service professionals, we carried out two rounds of focus-group interviews. Moreover, we performed semi-structured interviews with four GPs. We analysed data using a hybrid inductive/deductive thematic analysis. RESULTS According to the health care and social service professionals in our study, the role of GPs in multidisciplinary teams for elderly care was characterized by the ability to 'see the bigger picture'. We identified five key activities that constitute a successful GP role: networking, facilitating, team building, integrating care elements, and showing leadership. Practice setting and phase of multidisciplinary team development influenced the way in which GPs fulfilled their roles. According to team members, GPs were the central professionals in care services for older people. The opinions of GPs about their own roles were diverse. CONCLUSIONS GPs took an important role in successful care settings for older people. Five key concepts seemed to be important for best practices in care for frail older people: networking (community), facilitating (organization), team building (professional), integrating care elements (patient), and leadership (personal). Team members from primary care and social services indicated that GPs had an indispensable role in such teams. It would be advantageous for GPs to be aware of this attributed role. Attention to leadership competencies and to the diversity of roles in multidisciplinary teams in GP training programmes seems useful. The challenge is to convince GPs to take a lead, also when they are not inclined to take this role in organizing multidisciplinary teams for older people.
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Affiliation(s)
- Sietske M. Grol
- Department of Primary and Community Care, Radboud University Medical Center, route 119, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Gerard R. M. Molleman
- Department of Primary and Community Care, Radboud University Medical Center, route 119, PO Box 9101, 6500 HB Nijmegen, the Netherlands
- Department of Healthy Living, Community Health Service Gelderland-Zuid, POB 1120, 6501 BC Nijmegen, the Netherlands
| | - Anne Kuijpers
- Department of Primary and Community Care, Radboud University Medical Center, route 119, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Rob van der Sande
- Lectureship of primary and community care, Han University of Applied Sciences, POB 6960, 6503 GL Nijmegen, the Netherlands
| | - Gerdine A. J. Fransen
- Department of Primary and Community Care, Radboud University Medical Center, route 119, PO Box 9101, 6500 HB Nijmegen, the Netherlands
- Department of Healthy Living, Community Health Service Gelderland-Zuid, POB 1120, 6501 BC Nijmegen, the Netherlands
| | - Willem J. J. Assendelft
- Department of Primary and Community Care, Radboud University Medical Center, route 119, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Henk J. Schers
- Department of Primary and Community Care, Radboud University Medical Center, route 119, PO Box 9101, 6500 HB Nijmegen, the Netherlands
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Who is on the primary care team? Professionals' perceptions of the conceptualization of teams and the underlying factors: a mixed-methods study. BMC FAMILY PRACTICE 2017; 18:111. [PMID: 29281980 PMCID: PMC5745958 DOI: 10.1186/s12875-017-0685-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 12/08/2017] [Indexed: 01/28/2023]
Abstract
Background Due to the growing prevalence of elderly patients with multi-morbidity living at home, there is an increasing need for primary care professionals from different disciplinary backgrounds to collaborate as primary care teams. However, it is unclear how primary care professionals conceptualize teams and what underlying factors influence their perception of being part of a team. Our research question is: What are primary care professionals’ perceptions of teams and team membership among primary care disciplines and what factors influence their perceptions? Methods We conducted a mixed-methods study in the Dutch primary care setting. First, a survey study of 152 professionals representing 12 primary care disciplines was conducted, focusing on their perceptions of which disciplines are part of the team and the degree of relational coordination between professionals from different disciplinary backgrounds. Subsequently, we conducted semi-structured interviews with 32 professionals representing 5 primary care disciplines to gain a deeper understanding of the underlying factors influencing their perceptions and the (mis)alignment between these perceptions. Results Misalignments were found between perceptions regarding which disciplines are members of the team and the relational coordination between disciplines. For example, general practitioners were viewed as part of the team by helping assistants, (district) nurses, occupational therapists and geriatric specialized practice nurses, whereas the general practitioners themselves only considered geriatric specialized practice nurses to be part of their team. Professionals perceive multidisciplinary primary care teams as having multiple inner and outer layers. Three factors influence their perception of being part of a team and acting accordingly: a) knowing the people you work with, b) the necessity for knowledge exchange and c) sharing a holistic view of caregiving. Conclusion Research and practice should take into account the misalignment between primary care professionals’ perceptions of primary care teams, as our study notes variations in the conceptualization of primary care teams. To enhance teamwork between professionals from different disciplinary backgrounds, professionals acknowledge the importance of three underlying conditions: team familiarity, regular and structured knowledge exchange between all professionals involved in the care process and realizing and believing in the added value for patients of working as a team. Electronic supplementary material The online version of this article (10.1186/s12875-017-0685-2) contains supplementary material, which is available to authorized users.
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Leach MJ, Wiese M, Thakkar M, Agnew T. Integrative health care - Toward a common understanding: A mixed method study. Complement Ther Clin Pract 2017; 30:50-57. [PMID: 29389479 DOI: 10.1016/j.ctcp.2017.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/22/2017] [Accepted: 12/05/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To generate a multidisciplinary stakeholder-informed definition of integrative health care (IHC). METHODS A mixed-method study design was used, employing the use of focus groups/semi-structured interviews (phase-1) and document analysis (phases 2 and 3). Phase-1 recruited a purposive sample of Australian health consumers/health providers. Phase-2 interrogated websites of international IHC organisations for definitions of IHC. Phase-3 systematically searched bibliographic databases for articles defining IHC. Data were analysed using thematic analysis. RESULTS Data were drawn from 54 health consumers/providers (phase-1), 23 IHC organisation webpages (phase-2) and 23 eligible articles (phase-3). Seven themes emerged from the data. Consensus was reached on a single, 65-word definition of IHC. CONCLUSION An unambiguous definition of IHC is critical to establishing a clearer identity for IHC, as well as providing greater clarity for consumers, health providers and policy makers. In recognising the need for a clearer description, we propose a scientifically-grounded, multi-disciplinary stakeholder-informed definition of IHC.
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Affiliation(s)
- Matthew J Leach
- Department of Rural Health, University of South Australia, Adelaide, South Australia, Australia.
| | - Marlene Wiese
- Southgate Institute for Health, Society & Equity, Flinders University of SA, Bedford Park, South Australia, Australia.
| | - Manisha Thakkar
- Department of Bioscience, Endeavour College of Natural Health, Adelaide, South Australia, Australia.
| | - Tamara Agnew
- Health Economics & Social Policy Group, University of South Australia, Adelaide, South Australia, Australia.
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Jones J, Haverhals LM, Manheim CE, Levy C. Fostering Excellence: An Examination of High-Enrollment VHA Medical Foster Home Programs. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2017; 30. [PMID: 31660039 DOI: 10.1177/1084822317736795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This qualitative study aimed to assist the US Veterans Health Administration (VHA) to efficiently target recruitment into VHA Medical Foster Homes (MFHs) by understanding how high-enrollment MFH (HE-MFH) program attributes optimized MFH enrollment. We used an emergent exploratory design to study 3 HE-MFH programs across the United States. Data were collected from August 2013 through June 2014 through individual in-person and phone interviews and in-person focus group discussions with 39 MFH care providers. Three main themes emerged as essential for optimizing HE-MFH program enrollment: (1) alignment of right caregiver, right home, and right Veteran; (2) care practices that support caregiver, Veteran, and home-based primary care (HBPC); and (3) workplace practices and processes that demonstrate support of the MFH coordinator role by facility leadership and the HBPC team.
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Affiliation(s)
| | | | | | - Cari Levy
- University of Colorado, Aurora, USA.,Seattle-Denver Center of Innovation, CO, USA
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Gougeon L, Johnson J, Morse H. Interprofessional collaboration in health care teams for the maintenance of community-dwelling seniors' health and well-being in Canada: A systematic review of trials. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.xjep.2017.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Murphy F, Hugman L, Bowen J, Parsell F, Gabe-Walters M, Newson L, Jordan S. Health benefits for health and social care clients attending an Integrated Health and Social Care day unit (IHSCDU): a before-and-after pilot study with a comparator group. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:492-504. [PMID: 26918781 DOI: 10.1111/hsc.12329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2016] [Indexed: 06/05/2023]
Abstract
It is thought that integrating health and social care provision can improve services, yet few evaluations of integrated health and social care initiatives have focused on changes in clinical outcomes and used comparator groups. The aim of this pilot study was to identify whether attendance at an integrated health and social care day unit (IHSCDU) affected selected outcomes of functional mobility, number of prescribed medications, and physical and psychological well-being. A secondary aim was to examine the utility of the tools to measure these outcomes in this context; the feasibility of the recruitment and retention strategy and the utility of the comparator group. A before-and-after comparison design was used with non-randomised intervention and comparator arms. The intervention arm comprised 30 service users attending the IHSCDU and the comparator arm comprised 33 service users on a community nursing caseload. Measures of functional mobility (Barthel's Index) and physical and psychological well-being (SF-12® ) were taken from all participants in both arms at three data collection points: baseline, 4 and 9 months later, between November 2010 and September 2012. Participants and outcomes were identified prospectively and in both arms, the individual was the unit of assignment. No significant changes were noted in functional mobility and psychological well-being and the number of medications prescribed increased in both arms. There was a trend towards a significant difference between study arms in the change in the SF-12® physical health outcome measure and this outcome measure could be usefully explored in future studies. The recruitment and retention strategy was feasible although our comparator group had some limitations in not being closely matched in terms of age, functional mobility and mental well-being.
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Affiliation(s)
- Fiona Murphy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Laura Hugman
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Judith Bowen
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Fran Parsell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Marie Gabe-Walters
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Louise Newson
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Sue Jordan
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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van Dongen JJJ, van Bokhoven MA, Daniëls R, Lenzen SA, van der Weijden T, Beurskens A. Interprofessional primary care team meetings: a qualitative approach comparing observations with personal opinions. Fam Pract 2017; 34:98-106. [PMID: 28122925 PMCID: PMC5266085 DOI: 10.1093/fampra/cmw106] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The number of people with multiple chronic conditions requiring primary care services increases. Professionals from different disciplines collaborate and coordinate care to deal with the complex health care needs. There is lack of information on current practices regarding interprofessional team (IPT) meetings. OBJECTIVES This study aimed to improve our understanding of the process of interprofessional collaboration in primary care team meetings in the Netherlands by observing the current practice and exploring personal opinions. METHODS Qualitative study involving observations of team meetings and interviews with participants. Eight different IPT meetings (n = 8) in different primary care practices were observed by means of video recordings. Experiences were explored by conducting individual semi-structured interviews (n = 60) with participants (i.e. health care professionals from different disciplines) of the observed team meetings. The data were analysed by means of content analysis. RESULTS Most participants expressed favourable opinions about their team meetings. However, observations showed that team meetings were more or less hectic, and lacked a clear structure and team coordinator or leader. There appears to be a discrepancy between findings from observations and interviews. From the interviews, four main themes were extracted: (1) Team structure and composition, (2) Patient-centredness, (3) Interaction and (4) Attitude and motivation. CONCLUSION IPT meetings could benefit from improvements in structure, patient-centredness and leadership by the chairpersons. Given the discrepancy between observations and interviews, it would appear useful to improve team members' awareness of aspects that could be improved before training them in dealing with specific challenges.
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Affiliation(s)
- Jerôme Jean Jacques van Dongen
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands and .,Department of Family Medicine, School for Public and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Marloes Amantia van Bokhoven
- Department of Family Medicine, School for Public and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Ramon Daniëls
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands and
| | - Stephanie Anna Lenzen
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands and.,Department of Family Medicine, School for Public and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, School for Public and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Anna Beurskens
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, Faculty of Health, Zuyd University of Applied Sciences, Heerlen, The Netherlands and.,Department of Family Medicine, School for Public and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands
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An Ecological Approach to Reducing Potentially Inappropriate Medication Use: Canadian Deprescribing Network. Can J Aging 2017; 36:97-107. [PMID: 28091333 DOI: 10.1017/s0714980816000702] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Polypharmacy is growing in Canada, along with adverse drug events and drug-related costs. Part of the solution may be deprescribing, the planned and supervised process of dose reduction or stopping of medications that may be causing harm or are no longer providing benefit. Deprescribing can be a complex process, involving the intersection of patients, health care providers, and organizational and policy factors serving as enablers or barriers. This article describes the justification, theoretical foundation, and process for developing a Canadian Deprescribing Network (CaDeN), a network of individuals, organizations, and decision-makers committed to promoting the appropriate use of medications and non-pharmacological approaches to care, especially among older people in Canada. CaDeN will deploy multiple levels of action across multiple stakeholder groups simultaneously in an ecological approach to health system change. CaDeN proposes a unique model that might be applied both in national settings and for different transformational challenges in health care.
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Coll-Planas L, Del Valle Gómez G, Bonilla P, Masat T, Puig T, Monteserin R. Promoting social capital to alleviate loneliness and improve health among older people in Spain. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:145-157. [PMID: 26427604 DOI: 10.1111/hsc.12284] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 06/05/2023]
Abstract
Loneliness is especially frequent among older people in Southern Europe. Furthermore, promoting social capital to tackle loneliness and its health effects is an understudied intervention strategy. Therefore, a complex intervention was piloted in Spain in a pre-post study with a 2-year follow-up. Its aims were to explore the feasibility of the intervention and its short- and long-term effects. It was conducted in one mixed rural-urban and two urban areas of diverse socioeconomic levels from 2011 to 2012. The intervention framework was based on social capital theory applying a behaviour change model and care co-ordination. The intervention comprised: (i) a co-ordinated action aimed at building a network between primary healthcare centres and community assets in the neighbourhood and (ii) a group-based programme, which promoted social capital among lonely older people, especially social support and participation. Older people active in senior centres volunteered as gatekeepers. The main outcome domain was loneliness. Secondary outcome domains were participation, social support, self-perceived health, quality of life, depressive symptoms and use of health resources. Pre-post changes were assessed with t-test, Wilcoxon signed-rank test and McNemar's test. Differences between the three time points were assessed with a one-way ANOVA with repeated measures. Social workers and nurses were successfully involved as group leaders, 10 volunteers took part and 38 participants were included. After the intervention, loneliness decreased while social participation and support significantly increased. Furthermore, the number of visits to nurses increased. Exactly 65.8% of the participants built social contacts within the group and 47.4% became engaged in new activities. Two years later, social effects were maintained and depressive symptoms had decreased. Exactly 44.7% of the participants continued to be in contact with at least one person from the group and 39.5% continued participating. The intervention contributes a novel and feasible social capital-based approach for alleviating loneliness among older adults while prompting meaningful changes in their lives.
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Affiliation(s)
- Laura Coll-Planas
- Fundació Salut i Envelliment (Foundation on Health and Ageing), Universitat Autònoma de Barcelona, Barcelona, Spain
- IIB Sant Pau, Barcelona, Spain
| | - Gabriela Del Valle Gómez
- Fundació Salut i Envelliment (Foundation on Health and Ageing), Universitat Autònoma de Barcelona, Barcelona, Spain
- IIB Sant Pau, Barcelona, Spain
| | - Petra Bonilla
- Equip d'Atenció Primària Sant Martí de Provençals, Institut Català de la Salut, Barcelona, Spain
| | - Teresa Masat
- Equip d'Atenció Primària Cardedeu, Institut Català de la Salut, Barcelona, Spain
| | - Teresa Puig
- IIB Sant Pau, Barcelona, Spain
- Servicio de Epidemiología Clínica y Salud Pública, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosa Monteserin
- Fundació Salut i Envelliment (Foundation on Health and Ageing), Universitat Autònoma de Barcelona, Barcelona, Spain
- IIB Sant Pau, Barcelona, Spain
- Equip d'Atenció Primària Sardenya, EAP Sardenya, Barcelona, Spain
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Bookey-Bassett S, Markle-Reid M, Mckey CA, Akhtar-Danesh N. Understanding interprofessional collaboration in the context of chronic disease management for older adults living in communities: a concept analysis. J Adv Nurs 2016; 73:71-84. [PMID: 27681818 DOI: 10.1111/jan.13162] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2016] [Indexed: 11/30/2022]
Abstract
AIM To report a concept analysis of interprofessional collaboration in the context of chronic disease management, for older adults living in communities. BACKGROUND Increasing prevalence of chronic disease among older adults is creating significant burden for patients, families and healthcare systems. Managing chronic disease for older adults living in the community requires interprofessional collaboration across different health and other care providers, organizations and sectors. However, there is a lack of consensus about the definition and use of interprofessional collaboration for community-based chronic disease management. DESIGN Concept analysis. DATA SOURCES Electronic databases CINAHL, Medline, HealthStar, EMBASE, PsychINFO, Ageline and Cochrane Database were searched from 2000 - 2013. METHODS Rodgers' evolutionary method for concept analysis. RESULTS The most common surrogate term was interdisciplinary collaboration. Related terms were interprofessional team, multidisciplinary team and teamwork. Attributes included: an evolving interpersonal process; shared goals, decision-making and care planning; interdependence; effective and frequent communication; evaluation of team processes; involving older adults and family members in the team; and diverse and flexible team membership. Antecedents comprised: role awareness; interprofessional education; trust between team members; belief that interprofessional collaboration improves care; and organizational support. Consequences included impacts on team composition and function, care planning processes and providers' knowledge, confidence and job satisfaction. CONCLUSION Interprofessional collaboration is a complex evolving concept. Key components of interprofessional collaboration in chronic disease management for community-living older adults are identified. Implications for nursing practice, education and research are proposed.
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Affiliation(s)
| | | | - Colleen A Mckey
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
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Grimshaw P, McGowan L, McNichol E. Building a system-wide approach to community relationships with the findings of a scoping review in health and social care. J Health Organ Manag 2016; 30:1047-1062. [PMID: 27700476 DOI: 10.1108/jhom-01-2016-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose For leadership and management of Western health systems, good quality relationships are a fundamental cornerstone of organising health and social care (H&SC) delivery, delivering benefits across organisations and communities. The purpose of this paper is to explore the extant management, H&SC literature, grounded in older people care, reveal behaviours, processes and practices that if readily identified across a context will support healthy relationships across the "whole system" of stakeholders. Design/methodology/approach An academic/practitioner group designed and guided a scoping literature review of the H&SC and broader management literature to identify and extract important behaviours, processes and practices underlying the support of high-quality relationships. A search strategy was agreed and key health and management databases were interrogated and 51 papers selected for inclusion. Working with the practitioners, the selected papers were coded and then organised into emergent themes. Findings The paper outlines the relational behaviours, processes and practice elements that should be present within an older peoples care community, to support a healthy relational environment. These elements are presented under the five emergent literature themes of integrity, compassion, respect, fairness and trust. These five topics are examined in detail. A way forward for building statements using the review material, that may be applied to reveal relational patterns within older people care, is also explored and outlined. Research limitations/implications All literature reviews are subject to practical decisions around time, budget, scope and depth restraints. Therefore potentially relevant papers may have been missed in the review process. The scoping review process adapted here does not seek to make any major considerations with regards to the weighting of evidence behind the primary research. Originality/value This paper contributes to a growing need for designers of health systems to more fully understand, measure and draw on the value of relationships to help bridge the gap between diminishing resources and the expanding demand on H&SC services.
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Affiliation(s)
- Paul Grimshaw
- School of Healthcare, University of Leeds , Leeds, UK
| | - Linda McGowan
- School of Healthcare, University of Leeds , Leeds, UK
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Primary Health Care Providers' Perspectives: Facilitating Older Patients' Access to Community Support Services. Can J Aging 2016; 35:499-512. [PMID: 27666084 DOI: 10.1017/s0714980816000568] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The purpose of the study examined in this article was to understand how non-physician health care professionals working in Canadian primary health care settings facilitate older persons' access to community support services (CSSs). The use of CSSs has positive impacts for clients, yet they are underused from lack of awareness. Using a qualitative description approach, we interviewed 20 health care professionals from various disciplines and primary health care models about the processes they use to link older patients to CSSs. Participants collaborated extensively with interprofessional colleagues within and outside their organizations to find relevant CSSs. They actively engaged patients and families in making these linkages and ensured follow-up. It was troubling to find that they relied on out-of-date resources and inefficient search strategies to find CSSs. Our findings can be used to develop resources and approaches to better support primary health care providers in linking older adults to relevant CSSs.
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van Dongen JJJ, van Bokhoven MA, Daniëls R, van der Weijden T, Emonts WWGP, Beurskens A. Developing interprofessional care plans in chronic care: a scoping review. BMC FAMILY PRACTICE 2016; 17:137. [PMID: 27655185 PMCID: PMC5031251 DOI: 10.1186/s12875-016-0535-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/15/2016] [Indexed: 11/29/2022]
Abstract
Background The number of people suffering from one or more chronic conditions is rising, resulting in an increase in patients with complex health care demands. Interprofessional collaboration and the use of shared care plans support the management of complex health care demands of patients with chronic illnesses. This study aims to get an overview of the scientific literature on developing interprofessional shared care plans. Methods We conducted a scoping review of the scientific literature regarding the development of interprofessional shared care plans. A systematic database search resulted in 45 articles being included, 5 of which were empirical studies concentrating purely on the care plan. Findings were synthesised using directed content analysis. Results This review revealed three themes. The first theme was the format of the shared care plan, with the following elements: patient’s current state; goals and concerns; actions and interventions; and evaluation. The second theme concerned the development of shared care plans, and can be categorised as interpersonal, organisational and patient-related factors. The third theme covered tools, whose main function is to support professionals in sharing patient information without personal contact. Such tools relate to documentation of and communication about patient information. Conclusion Care plan development is not a free-standing concept, but should be seen as the result of an underlying process of interprofessional collaboration between team members, including the patient. To integrate the patients’ perspectives into the care plans, their needs and values need careful consideration. This review indicates a need for new empirical studies examining the development and use of shared care plans and evaluating their effects. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0535-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jerôme Jean Jacques van Dongen
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, Zuyd University of Applied Sciences, Nieuw Eyckholt 300, 6419 DJ, Heerlen, The Netherlands. .,Department of Family Medicine, Maastricht University, CAPHRI School for Public health and Primary Care, Maastricht, The Netherlands.
| | - Marloes Amantia van Bokhoven
- Department of Family Medicine, Maastricht University, CAPHRI School for Public health and Primary Care, Maastricht, The Netherlands
| | - Ramon Daniëls
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, Zuyd University of Applied Sciences, Nieuw Eyckholt 300, 6419 DJ, Heerlen, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Maastricht University, CAPHRI School for Public health and Primary Care, Maastricht, The Netherlands
| | - Wencke Wilhelmina Gerarda Petronella Emonts
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, Zuyd University of Applied Sciences, Nieuw Eyckholt 300, 6419 DJ, Heerlen, The Netherlands
| | - Anna Beurskens
- Research Centre for Autonomy and Participation for People with Chronic Illnesses, Zuyd University of Applied Sciences, Nieuw Eyckholt 300, 6419 DJ, Heerlen, The Netherlands.,Department of Family Medicine, Maastricht University, CAPHRI School for Public health and Primary Care, Maastricht, The Netherlands
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Gridley K, Brooks J, Birks Y, Baxter K, Parker G. Improving care for people with dementia: development and initial feasibility study for evaluation of life story work in dementia care. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04230] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundImproving dementia care quality is an urgent priority nationally and internationally. Life story work (LSW) is an intervention that aims to improve individual outcomes and care for people with dementia and their carers. LSW gathers information and artefacts about the person, their history and interests, and produces a tangible output: the ‘life story’.ObjectiveTo establish whether or not full evaluation of LSW was feasible.DesignMixed-methods feasibility study.MethodsIn-depth interviews and focus groups explored experiences of LSW and best practice with people with dementia, family members and dementia care staff. A systematic review explored best practice and theories of change for LSW. These stages helped to identify the outcomes and resources to explore in the feasibility study. A representative sample survey of health and social care dementia care providers in England established LSW practice in different settings. A survey of a self-selected sample of family members of people with dementia explored how LSW is experienced. Two small outcome studies (stepped-wedge study in six care homes and pre-test post-test study in inpatient specialist dementia care wards) explored the feasibility of full evaluation of LSW in these settings.SettingsSurvey: generalist and specialist care homes; NHS dementia care settings; and community dementia services. Feasibility study: care homes and NHS inpatient dementia care wards.ParticipantsNHS and social care services, people with dementia, family carers, care home staff and NHS staff.InterventionsLSW.Main outcome measuresSpread of LSW and good practice, quality of life (QoL) for the person with dementia and carers, relationships between people with dementia and family carers, staff attitudes about dementia, staff burnout, resource use and costs.Review methodsNarrative review and synthesis, following Centre for Review and Dissemination guidelines.ResultsGood practice in LSW is identifiable, as are theories of change about how it might affect given outcomes. Indicators of best practice were produced. LSW is spreading but practice and use vary between care settings and are not always in line with identified good practice. Two different models of LSW are evident; these are likely to be appropriate at different stages of the dementia journey. The feasibility study showed some positive changes in staff attitudes towards dementia and, for some people with dementia, improvements in QoL. These may be attributable to LSW but these potential benefits require full evaluation. The feasibility work established the likely costs of LSW and highlighted the challenges of future evaluation in care homes and inpatient dementia care settings.LimitationsThere was insufficient evidence in the literature to allow estimation of outcome size. We did not carry out planned Markov chain modelling to inform decisions about carrying out future evaluation because of the dearth of outcome data in the literature; low levels of data return for people with dementia in the hospital settings; lack of detected effect for most people with dementia; and questions about implementation in the research settings.ConclusionsLSW is used across different health and social care settings in England, but in different ways, not all of which reflect ‘good practice’. This large, complex study identified a wide range of challenges for future research, but also the possibility that LSW may help to improve care staff attitudes towards dementia and QoL for some people with dementia.Future workFull evaluation of LSW as an intervention to improve staff attitudes and care is feasible with researchers based in or very close to care settings to ensure high-quality data collection.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Kate Gridley
- Social Policy Research Unit, University of York, York, UK
| | - Jenni Brooks
- Social Policy Research Unit, University of York, York, UK
| | - Yvonne Birks
- Social Policy Research Unit, University of York, York, UK
| | - Kate Baxter
- Social Policy Research Unit, University of York, York, UK
| | - Gillian Parker
- Social Policy Research Unit, University of York, York, UK
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Perrier L, Adhihetty C, Soobiah C. Examining semantics in interprofessional research: A bibliometric study. J Interprof Care 2016; 30:269-77. [DOI: 10.3109/13561820.2016.1142430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Telemedicine in diabetes foot care delivery: health care professionals' experience. BMC Health Serv Res 2016; 16:134. [PMID: 27091459 PMCID: PMC4836108 DOI: 10.1186/s12913-016-1377-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 04/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background Introducing new technology in health care is inevitably a challenge. More knowledge is needed to better plan future telemedicine interventions. Our aim was therefore to explore health care professionals’ experience in the initial phase of introducing telemedicine technology in caring for people with diabetic foot ulcers. Methods Our methodological strategy was Interpretive Description. Data were collected between 2014 and 2015 using focus groups (n = 10). Participants from home-based care, primary care and outpatient hospital clinics were recruited from the intervention arm of an ongoing cluster randomized controlled trial (RCT) (Clinicaltrials.gov: NCT01710774). Most were nurses (n = 29), but the sample also included one nurse assistant, podiatrists (n = 2) and physicians (n = 2). Results The participants reported experiencing meaningful changes to their practice arising from telemedicine, especially associated with increased wound assessment knowledge and skills and improved documentation quality. They also experienced more streamlined communication between primary health care and specialist health care. Despite obstacles associated with finding the documentation process time consuming, the participants’ attitudes to telemedicine were overwhelmingly positive and their general enthusiasm for the innovation was high. Conclusions Our findings indicate that using a telemedicine intervention enabled the participating health care professionals to approach their patients with diabetic foot ulcer with more knowledge, better wound assessment skills and heightened confidence. Furthermore, it streamlined the communication between health care levels and helped seeing the patients in a more holistic way.
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Bookey-Bassett S, Markle-Reid M, McKey C, Akhtar-Danesh N. A review of instruments to measure interprofessional collaboration for chronic disease management for community-living older adults. J Interprof Care 2016; 30:201-10. [DOI: 10.3109/13561820.2015.1123233] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bergmo TS, Berntsen GK, Dalbakk M, Rumpsfeld M. The effectiveness and cost effectiveness of the PAtient-Centred Team (PACT) model: study protocol of a prospective matched control before-and-after study. BMC Geriatr 2015; 15:133. [PMID: 26499256 PMCID: PMC4619094 DOI: 10.1186/s12877-015-0133-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study protocol describes the evaluation of a comprehensive integrated care model implemented at two hospital sites at the University Hospital of North Norway (UNN). The PAtient Centred Team (PACT) model includes proactive, patient-centred interdisciplinary teams that aim to improve the continuum and quality of care of frail elderly patients and reduce health care costs. The main objectives of the evaluation are to analyse the effectiveness and cost effectiveness of using patient-centred teams as part of routine service provision for this patient group. The evaluation will analyse the effect on patient health and functional status, patient experiences and hospital utilisation, and it will conduct an economic evaluation. This paper describes the PACT model and the rationale for and design of the planned effectiveness and cost-effectiveness study. METHODS/DESIGN This is a prospective, non-randomised matched control before-and-after intervention study. Patients in the intervention group will be recruited from the hospital sites that have implemented the PACT model. The controls will be recruited from two hospitals without the model. The control patients and the index patients will be matched according to sex, age and number of long-term conditions. The study aims to include 600 patients in each group, which will provide sufficient power to detect a clinical change in the primary outcome. The primary outcome is the physical dimension of the Short Form Health Survey (SF-36). Secondary outcomes are the Patient Generated Index (PGI), the Patient Activation Measure (PAM), the Patient Assessment of Chronic Illness Care (PACIC), hospitalisation and length of stay. The cost-effectiveness study takes a health provider perspective and calculates the cost per quality-adjusted life-years (QALYs) gained. The data will be collected at baseline, 6 and 12 months. The data will be analysed using techniques and models that recognise the lack of randomisation and the correlation of cost and effect data. DISCUSSION The study results will provide knowledge about whether the integrated care model implemented at UNN improves the quality of care for the frail elderly with multiple conditions. The study will establish whether the PAC. T model improves health and functional status and is cost effective compared to the usual care for this patient group. TRIAL REGISTRATION ClinicalTrials.gov: NCT02541474.
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Affiliation(s)
- Trine S Bergmo
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, 9038, Tromsø, Norway.
| | - Gro K Berntsen
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, 9038, Tromsø, Norway.
| | - Monika Dalbakk
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
| | - Markus Rumpsfeld
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
- Department of Clinical Medicine, University of Tromsø - The Arctic University of Norway, Tromsø, Norway.
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Goodman C, Rycroft Malone J, Norton C, Harari D, Harwood R, Roe B, Russell B, Fader M, Buswell M, Drennan VM, Bunn F. Reducing and managing faecal incontinence in people with advanced dementia who are resident in care homes: protocol for a realist synthesis. BMJ Open 2015; 5:e007728. [PMID: 26163032 PMCID: PMC4499729 DOI: 10.1136/bmjopen-2015-007728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Faecal incontinence (FI) is the involuntary loss of liquid or solid stool that is a social or hygienic problem. The prevalence of FI in residents of care homes is high, but it is not an inevitable consequence of old age or dementia. There is good evidence on risk factors, but few studies provide evidence about effective interventions. There is a need to understand how, why, and in what circumstances particular programmes to reduce and manage FI are effective (or not) for people with dementia. The purpose of this review is to identify which (elements of the) interventions could potentially be effective, and examine the barriers and facilitators to the acceptability, uptake and implementation of interventions designed to address FI in people with dementia who are resident in care homes. METHODS AND ANALYSIS A realist synthesis approach to review the evidence will be used which will include studies on continence, person-centred care, implementation research in care homes, workforce and research on care home culture. An iterative four-stage approach is planned. Phase 1: development of an initial programme theory or theories that will be 'tested' through a first scoping of the literature and consultation with five stakeholder groups (care home providers, user representatives, academics and practice educators, clinicians with a special interest in FI and continence specialists). Phase 2: a systematic search and analysis of published and unpublished evidence to test and develop the programme theories identified in phase 1. Phase 3: validation of programme theory/ies with a purposive sample of participants from phase 1. ETHICS AND DISSEMINATION The overall protocol does not require ethical review. The University research ethics committee will review interviews conducted as part of phase 1 and 3. The final fourth phase will synthesise and develop recommendations for practice and develop testable hypotheses for further research.
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Affiliation(s)
- Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jo Rycroft Malone
- School of Healthcare Sciences, Bangor University School of Health Care Sciences, Bangor, UK
| | - Christine Norton
- Florence Nightingale School of Nursing & Midwifery, King's College London, London, UK
| | - Danielle Harari
- Division of Health and Social Care, Department of Ageing and Health, Guys and St Thomas’, King's College London, London, UK
| | - Rowan Harwood
- Health Care of Older People Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Brenda Roe
- Faculty of Health and Social Care, Edge Hill University of Manchester, Manchester, UK
| | - Bridget Russell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Mandy Fader
- Department of Health Sciences, University of Southampton, Southampton, UK
| | - Marina Buswell
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Vari M Drennan
- Faculty of Health, Social Care and Education, St Georges University of London and Kingston University, UK
| | - Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
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