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Park H, Yoon J. Willingness to pay for chronic disease management services provided by primary care nurses. HUMAN RESOURCES FOR HEALTH 2024; 22:49. [PMID: 38978050 PMCID: PMC11229183 DOI: 10.1186/s12960-024-00935-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 06/25/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Due to the rapid increase in chronic diseases in South Korea, the Korean government has expanded chronic disease management to primary care. Thus, the role of primary care nurses is critical. However, the fee for chronic disease management services provided by primary care nurses has not been set, and few studies have evaluated the value of nursing services. This study aimed to estimate the willingness to pay (WTP) for chronic disease management services provided by primary care nurses and to identify the factors that affect WTP. METHODS This study adopted a descriptive research design and conducted a cross-sectional online survey from January 16 to 18, 2023. The inclusion criteria were community residents aged ≥ 20 years living in South Korea and capable of participating in online surveys. A total of 520 people participated in this study. A contingent valuation method (CVM) was used with double-bound dichotomous choice questions along with open-ended questions. The mean WTP was calculated using a Tobit model. RESULTS The mean WTP of the 520 study participants for one chronic disease management service provided by primary care nurses was 15,390.71 Korean won ($11.90). Factors affecting WTP were having a chronic disease, recognition of primary care nurses, and the first-bid price. Community residents with fewer chronic diseases, high awareness of primary care nurses, and a higher first-bid price showed higher WTP for chronic disease management services provided by primary care nurses. CONCLUSIONS Primary care is important worldwide due to the increasing number of chronic diseases, and Korea is no exception. However, payment for services by primary care nurses is undervalued compared to their critical role and skills. This has led to problems such as a primary care nurse shortage and burnout. This study estimated individuals' WTP for chronic disease management services provided by primary care nurses. The results can be used as a basic resource for setting the fee for services provided by primary care nurses. It is also a good starting point to understand the benefits of primary care nurse services.
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Affiliation(s)
- HanNah Park
- College of Nursing, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - JuYoung Yoon
- College of Nursing, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
- Research Institute of Nursing Science, Seoul National University, Seoul, 03080, Republic of Korea.
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Harrop DL, Bryce V, Kitchener T, Grugan S, Renouf S, Mitchell S, Hasking G, Pauza D, Richards G, Ng ACT, Wang WYS. Effects of a culturally informed model of care for Aboriginal and Torres Strait Islander patients with acute coronary syndrome in a tertiary hospital in Australia: a pre-post, quasi-experimental, interventional study. Lancet Glob Health 2024; 12:e623-e630. [PMID: 38485429 DOI: 10.1016/s2214-109x(23)00601-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 03/19/2024]
Abstract
BACKGROUND Aboriginal and Torres Strait Islander (Indigenous) peoples with cardiac disease in Australia have worse outcomes than non-Indigenous people with cardiac disease. We hypothesised that the implementation of a culturally informed model of care for Indigenous patients hospitalised with acute coronary syndrome (ACS) would improve their clinical outcomes. METHODS For this pre-post, quasi-experimental, interventional study, cohorts of Indigenous patients before and after the implementation of a model of care were compared. The novel, culturally informed, multidisciplinary-team model of care was a local programme of care developed to reduce morbidity and mortality from cardiac conditions among Indigenous Australians. All index admissions in the 24-month pre-implementation period (Jan 1 2013, to Dec 31, 2014) were analysed, as were all index admissions in the 12-month post-implementation period (Oct 1, 2015, to Sept 30, 2016). Comparisons were also made with non-Indigenous cohorts in the same timeframes. Admissions were excluded if the patient did not survive to hospital discharge. The study was conducted at Princess Alexandra Hospital, a tertiary hospital in metropolitan Brisbane (QLD, Australia). Data on presentation, comorbidities, investigations, treatment, and for outcomes were manually collected from a consolidated clinical information application. Mortality data were obtained from the Queensland Registry of Births, Deaths, and Marriages. The primary outcome was a composite of death, acute myocardial infarction, unplanned revascularisation, and cardiac readmission at 90 days after index admission, assessed in all patients. FINDINGS The Indigenous cohorts included 199 patients admitted with ACS before the model of care was implemented (85 [43%] were female and 114 [57%] were male) and 119 admitted post-implementation (62 [52%] were female and 57 [48%] were male). The non-Indigenous cohorts included 440 patients with ACS before the model of care was implemented (140 [32%] were female and 300 [68%] were male) and 467 admitted post-implementation (143 [31%] were female and 324 [69%] were male). Compared with the pre-implementation group, Indigenous patients admitted post-implementation had a significant reduction in the primary outcome (67 [34%] of 199 vs 24 [20%] of 119; hazard ratio 0·60, 95% CI 0·40-0·90; p=0·012), which was driven by a reduction in unplanned cardiac readmissions (64 [32%] of 199 vs 21 [18%] of 119; 0·55, 0·35-0·85; p=0·0060). There was no significant change in non-Indigenous patients between the pre-implementation and post-implementation timeframes in the composite endpoint at 90 days (81 [18%] of 440 vs 93 [20%] of 467; 1·08, 0·83-1·41; p=0·54). Pre-implementation, there was significantly more incidence of the primary outcome in Indigenous patients than non-Indigenous patients (p<0·0001), with no significant difference in the post-implementation period (p=0·92). INTERPRETATION Clinical outcomes for Indigenous patients admitted to a tertiary hospital in Australia improved after implementation of a culturally informed model of care, with a reduction in the disparity in incidence of primary endpoints that existed between Indigenous and non-Indigenous patients before implementation. FUNDING Queensland Department of Health Aboriginal and Torres Strait Islander Health Division (now First Nations Health Office).
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Affiliation(s)
- Danielle L Harrop
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Vivian Bryce
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Tanya Kitchener
- Aboriginal and Torres Strait Islander Liaison Service, Mater Hospital, Brisbane, QLD, Australia
| | - Sean Grugan
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Sonia Renouf
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Scott Mitchell
- Department of Pharmacy, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | - Debra Pauza
- First Nations Health Office, Queensland Health, Brisbane, QLD, Australia
| | - Gregory Richards
- Queensland Aboriginal and Islander Health Council, Brisbane, QLD, Australia
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - William Y S Wang
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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Calvert ML, Korgaonkar S, Ramachandran S, Sarver DE. Follow-Up Care After Maltreatment: Sociodemographic Associations With Timeliness in a Southern State. CHILD MALTREATMENT 2023; 28:634-647. [PMID: 36281769 DOI: 10.1177/10775595221134155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Children who experience maltreatment are at elevated risk of developing mental health difficulties. Even so, they often do not receive timely, evidenced-based mental health treatment, which may exacerbate the risk of poor outcomes. This study aims to describe the receipt of timely follow-up care after maltreatment in a southern state with known treatment shortages and aims to identify factors associated with timely follow-up care. We utilized a retrospective cohort design using 2014 Mississippi Medicaid administrative claims data for youth 0-18 years. Prevalence estimates and associations with definite and probable maltreatment (based on recorded age/injury combinations) during inpatient and outpatient healthcare encounters were evaluated. Rates of 30-day maltreatment follow-up with any medical or behavioral health provider were also assessed. Prevalence estimates of definite and probable maltreatment in the eligible study population (N = 324,752) were 0.53% and 3.8%, respectively. Only one-third of identified children received 30-day follow-up. Black and older children as well as children diagnosed with anxiety or depression were more likely to receive 30-day follow-up than younger children, white children, and children without anxiety or depression. Low rates of timely follow-up indicate the need for intentional workflow practices to increase the likelihood of follow-up.
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Affiliation(s)
- Maegan L Calvert
- Department of Psychiatry, Brain Imaging Research Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Siddhi Korgaonkar
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, Oxford, MS, USA
| | - Sujith Ramachandran
- Department of Pharmacy Administration, University of Mississippi School of Pharmacy, Oxford, MS, USA
| | - Dustin E Sarver
- Department of Pediatrics, Center for Advancement of Youth, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
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Möckli N, Simon M, Denhaerynck K, Martins T, Meyer-Massetti C, Fischer R, Zúñiga F. Care coordination in homecare and its relationship with quality of care: A national multicenter cross-sectional study. Int J Nurs Stud 2023; 145:104544. [PMID: 37354791 DOI: 10.1016/j.ijnurstu.2023.104544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION As health care complexity increases, skilled care coordination is becoming increasingly necessary. This is especially true in homecare settings, where services tend to be highly interprofessional. Poor coordination can result in services being provided twice, at the wrong time, unnecessarily or not at all. In addition to risking harm to the client, such confusion leads to unnecessary costs. From the patient's perspective, then, professional coordination should help both to remove barriers limiting quality of care and to minimize costs. To date, though, studies examining the relationship between care coordination and care quality have faced multiple challenges, leading to mixed results. And in homecare contexts, where the clients are highly vulnerable and diverse care interfaces make coordination especially challenging, such studies are rare. OBJECTIVES Therefore, the aim of this study was to explore the relationship, from the perspectives of clients and of homecare professionals, between coordination and quality of care. For both groups, we hypothesized that better coordination would correlate with higher ratings of quality of care. For the clients, we predicted that higher coordination ratings would lead to lower incidence of unplanned health care use, i.e., emergency department (ED) visits, unscheduled urgent medical visits and hospitalizations. DESIGN AND METHODS This study is part of a national multi-center cross-sectional study in the Swiss homecare setting. We recruited 88 homecare agencies and collected data between January and September 2021 through written questionnaires for agencies' managers, employees (n = 3223) and clients (n = 1509). To test our hypotheses, we conducted multilevel analyses. RESULTS Employee-perceived care coordination ratings correlated positively with employee-rated quality of care (OR = 2.78, p < .001); client-perceived care coordination problems correlated inversely with client-reported quality of care (β = -0.55, p < .001). Client-perceived coordination problems also correlated positively with hospitalizations (IRR = 1.20, p < .05) and unscheduled urgent medical visits (IRR = 1.18, p < .05), but not significantly with ED visits. No associations were discernible between employee-perceived coordination quality and either health care service use or client quality-of-care ratings. DISCUSSION While results indicate relationships between coordination and diverse aspects of care quality, various coordination gaps (e.g., poor information flow) also became apparent. The measurement of both care coordination and quality of care remains a challenge. Further research should focus on developing and validating a coordination questionnaire that measures care coordination.
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Affiliation(s)
- Nathalie Möckli
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Michael Simon
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Kris Denhaerynck
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland; Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Tania Martins
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Carla Meyer-Massetti
- Clinical Pharmacology & Toxicology, Department of General Internal Medicine, Inselspital - University Hospital of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, CH-3012 Bern, Switzerland
| | - Roland Fischer
- Centre for Primary Health Care, University of Basel, Rheinstrasse 26, CH-4410 Liestal, Switzerland
| | - Franziska Zúñiga
- Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, CH-4056 Basel, Switzerland.
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Cao W, Li L, Mathur P, Thompson J, Milks MW. A mobile health application for patients eligible for statin therapy: app development and qualitative feedback on design and usability. BMC Med Inform Decis Mak 2023; 23:128. [PMID: 37468892 PMCID: PMC10357764 DOI: 10.1186/s12911-023-02221-4] [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: 10/18/2022] [Accepted: 06/28/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death in the United States (US). Despite the well-recognized efficacy of statins, statin discontinuation rates remain high. Statin intolerance is a major cause of statin discontinuation. To accurately diagnose statin intolerance, healthcare professionals must distinguish between statin-associated and non-statin-associated muscle symptoms, because many muscle symptoms can be unrelated to statin therapy. Patients' feedback on muscle-related symptoms would help providers make decisions about statin treatment. Given the potential benefits and feasibility of existing apps for cardiovascular disease (CVD) management and the unmet need for an app specifically addressing statin intolerance management, the objectives of the study were 1) to describe the developmental process of a novel app designed for patients who are eligible for statin therapy to lower the risk of CVD; 2) to explore healthcare providers' feedback of the app; and 3) to explore patients' app usage experience. METHODS The app was developed by an interdisciplinary team. Healthcare provider participants and patient participants were recruited in the study. Providers were interviewed to provide their feedback about the app based on screenshots of the app. Patients were interviewed after a 30 days of app usage. RESULTS The basic features of the app included symptom logging, vitals tracking, patient education, and push notifications. Overall, both parties provided positive feedback about the app. Areas to be improved mentioned by both parties included: the pain question asked in symptom tracking and the patient education section. Both parties agreed that it was essential to add the trend report of the logged symptoms. CONCLUSIONS The results indicated that providers were willing to use patient-reported data for disease management and perceived that the app had the potential to facilitate doctor-patient communication. Results also indicated that user engagement is the key to the success of app efficacy. To promote app engagement, app features should be tailored to individual patient's needs and goals. In the future, after it is upgraded, we plan to test the app usability and feasibility among a more diverse sample.
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Affiliation(s)
- Weidan Cao
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA.
| | - Lang Li
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, 43210, USA
| | - Puneet Mathur
- Department of Research Information Technology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - John Thompson
- Department of Research Information Technology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - M Wesley Milks
- Division of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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Greene MZ, Gillespie KH. Factors Related to Burnout Among Perinatal Home Visiting Nurses. J Perinat Neonatal Nurs 2023; 37:187-195. [PMID: 37494686 PMCID: PMC10372681 DOI: 10.1097/jpn.0000000000000748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
PURPOSE Risks for burnout among nurses have been understudied in public and community health settings. This qualitative descriptive study aimed to describe the experiences of nurses working in a perinatal community health program for high-risk families with a focus on challenges and risks for burnout. METHODS We conducted field observation and semistructured individual interviews in 2019 with nurses at 2 sites implementing Prenatal Care Coordination (PNCC), a Medicaid benefit for high-risk pregnant people and infants in Wisconsin. A larger parent study assessed the implementation of PNCC overall through a thematic analysis process. Initial deductive coding was guided by the Consolidated Framework for Implementation Research. FINDINGS Emergent themes demonstrated that PNCC nurses face several significant barriers and known risks for burnout, including role strain related to scope of practice and training, discordant racial and socioeconomic identities leading to role conflict, and low control combined with high psychological demand. CONCLUSIONS Given that the COVID-19 pandemic has exacerbated burnout risk among nurses in hospital settings, and that nurses addressing social determinants of health may be at increased risk for burnout, these findings represent a critical perspective on the experiences and needs of perinatal nurses in public and community health settings.
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Tong J, Meehan R, Iannicello D, Li R, Joy T, Spaic T, Tung TH, Clemens KK. Improving the efficiency of virtual insulin teaching for patients admitted to hospital through the COVID-19 pandemic: a quality improvement initiative. BMJ Open Qual 2023; 12:e002305. [PMID: 37328282 PMCID: PMC10277138 DOI: 10.1136/bmjoq-2023-002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/25/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Throughout the COVID-19 pandemic, many areas of medicine transitioned to virtual care. For patients with diabetes admitted to hospital, this included diabetes education and insulin teaching. Shifting to a virtual model of insulin teaching created new challenges for inpatient certified diabetes educators (CDE). OBJECTIVE We advanced a quality improvement project to improve the efficiency of safe and effective virtual insulin teaching throughout the COVID-19 pandemic. Our primary aim was to reduce the mean time between CDE referral to successful inpatient insulin teach by 0.5 days. DESIGN, SETTING, PARTICIPANTS We conducted this initiative at two large academic hospitals between April 2020 and September 2021. We included all admitted patients with diabetes who were referred to our CDE for inpatient insulin teaching and education. INTERVENTION Alongside a multidisciplinary team of project stakeholders, we created and studied a CDE-led, virtual (video conference or telephone) insulin teaching programme. As tests of change, we added a streamlined method to deliver insulin pens to the ward for patient teaching, created a new electronic order set and included patient-care facilitators in the scheduling process. MAIN OUTCOME AND MEASURES Our main outcome measure was the mean time between CDE referral and successful insulin teach-back. Our process measure was the percentage of successful insulin pen deliveries to the ward for teaching. As balance measures, we captured the percentage of patients with a successful insulin teach, the time between insulin teach and hospital discharge, and readmissions to hospital for diabetes-related complications. RESULTS Our tests of change improved the efficiency of safe and effective virtual insulin teaching by 0.27 days. The virtual model appeared less efficient than usual in-person care. CONCLUSIONS In our centre, virtual insulin teaching supported patients admitted to hospital through the pandemic. Improving the administrative efficiency of virtual models and leveraging key stakeholders remain important for long-term sustainability.
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Affiliation(s)
- Jeffery Tong
- Medicine, Western University, London, Ontario, Canada
| | - Rebecca Meehan
- Centre for Diabetes, Endocrinology and Metabolism, St.Joseph's Health Care London, London, Ontario, Canada
| | - Dane Iannicello
- Centre for Diabetes, Endocrinology and Metabolism, St.Joseph's Health Care London, London, Ontario, Canada
| | - Raymond Li
- Medicine, Western University, London, Ontario, Canada
| | - Tisha Joy
- Medicine, Western University, London, Ontario, Canada
- Centre for Diabetes, Endocrinology and Metabolism, St.Joseph's Health Care London, London, Ontario, Canada
| | - Tamara Spaic
- Medicine, Western University, London, Ontario, Canada
- Centre for Diabetes, Endocrinology and Metabolism, St.Joseph's Health Care London, London, Ontario, Canada
| | - Tsan-Hua Tung
- Centre for Quality, Innovation and Patient Safety, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Kristin K Clemens
- Medicine, Western University, London, Ontario, Canada
- Centre for Diabetes, Endocrinology and Metabolism, St.Joseph's Health Care London, London, Ontario, Canada
- Centre for Quality, Innovation and Patient Safety, Schulich School of Medicine and Dentistry, London, Ontario, Canada
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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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Bennink C, de Mul M, van der Klift M, Broijl A, Tick L, de Jongh E, Garvelink M, Lobbezoo D, Sonneveld P, Hazelzet J. Improving Outcome-Driven Care in Multiple Myeloma Using Patient-Reported Outcomes: A Qualitative Evaluation Study. THE PATIENT 2023; 16:255-264. [PMID: 36790557 PMCID: PMC9930010 DOI: 10.1007/s40271-023-00616-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Multiple myeloma is an incurable disease with a considerable illness and treatment burden, which negatively impacts patients' quality of life. This study aimed to evaluate the implementation of multiple myeloma care in five Dutch hospitals, related to the three objectives of outcome-driven care, which are defined as (1) providing information for shared decision making in individual patient care, (2) supporting the learning capacity of healthcare professionals and healthcare institutions through benchmarking and (3) developing outcome-driven and patient-centred contracting by health insurers. METHODS In this qualitative study, semi-structured interviews about experiences with patient-reported outcomes were conducted with patients, healthcare professionals and other stakeholders 2 years after implementation. Data were thematically analysed, and emerging topics were clustered around the three objectives of outcome-driven care. RESULTS A total of 46 interviews were held (15 with patients, 16 with professionals and 15 with other stakeholders) that showed patients with multiple myeloma were willing to complete patient-reported outcomes, although integration of patient-reported outcomes in shared decision making fell short in clinical practice. Aggregated patient-reported outcomes were considered important for improving quality of care; however, data collection and data exchange are hindered by privacy legislation, limitations of IT systems and a lack of data standards. Patient-reported outcomes were expected to contribute to cost-effective multiple myeloma treatment, yet outcome-driven reimbursement is still lacking. CONCLUSIONS Outcome-driven multiple myeloma care using patient-reported outcomes is feasible, provided that (1) patient-reported outcomes and shared decision making are integrated into clinical practice, (2) legal and technical obstacles hindering data collection are removed and (3) health insurers adjust their reimbursement plans to facilitate outcome-driven care.
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Affiliation(s)
- Christine Bennink
- Department of Haematology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- Department of Haematology, Amphia, Breda, The Netherlands.
| | - Marleen de Mul
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | | | - Annemiek Broijl
- Department of Haematology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Lidwine Tick
- Department of Haematology, Maxima Medical Center, Veldhoven, Eindhoven, The Netherlands
| | - Eva de Jongh
- Department of Haematology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Mirjam Garvelink
- Department of Haematology, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Dorien Lobbezoo
- Department of Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pieter Sonneveld
- Department of Haematology, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jan Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Acero MX, Minvielle E, Waelli M. Are Nurse Coordinators Really Performing Coordination Pathway Activities? A Comparative Analysis of Case Studies in Oncology. Healthcare (Basel) 2023; 11:healthcare11081090. [PMID: 37107925 PMCID: PMC10137695 DOI: 10.3390/healthcare11081090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Patient Pathway Coordination (PPC) improves patient care quality and safety, particularly in oncology. PPC roles, such as nurse coordinators (NCs), have positively impacted the quality of patient care and reduced financial costs. However, NCs and their real activities in Health Care Organizations (HCOs) are unclear. Our aim was to identify, quantify, and compare all activities performed by NCs in oncology care settings from an organizational approach. Methods: We used qualitative and quantitative approaches based on case study principles. We accumulated 325 observation hours by shadowing and timing the activities of 14 NCs in four French HCO in oncology. Data analysis was conducted using an analytical framework to investigate the Activity of PAtient PAthway Nurse Coordinators in Oncology (APANCO). Results: Our research generated important findings: (1) NC roles and job titles are not standardized. (2) Non-coordination related activities are important in NC work content. Non-coordination times were consistent with distribution times between ward NCs and NCs in centralized structures. Ward NCs had higher non-coordination activities when compared with NCs in centralized structures. (3) PPC times varied for both ward NCs and NCs in centralized structures. Ward NCs performed less design coordination when compared with NCs in centralized structures, and this latter group also performed more external coordination than ward NCs. Conclusions: NCs do not just perform PPC activities. Their position in HCO structures, wards, or centralized structures, influence their work content. Centralized structures allow NCs to focus on their PPC roles. We also highlight different dimensions of NC work and training requirements. Our study could help managers and decision-makers develop PPC roles in oncology.
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Affiliation(s)
- Maria-Ximena Acero
- ARENES-UMR 6051, EHESP, French School of Public Health, University of Rennes, 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Etienne Minvielle
- i3-CRG Ecole Polytechnique, CNRS, Institut Polytechnique de Paris, Route de Saclay, 91120 Palaiseau, France
- Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Mathias Waelli
- ARENES-UMR 6051, EHESP, French School of Public Health, University of Rennes, 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
- Global Health Institute, University of Geneva, 24 rue du Général-Dufour, 1211 Geneva, Switzerland
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11
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Tremblay S, Lal S, Xiang L, Ferro MA, Anaby D. Organization of rehabilitation services for youth with physical disabilities and mental health problems: A scoping review. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1085827. [PMID: 36891032 PMCID: PMC9986938 DOI: 10.3389/fresc.2023.1085827] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023]
Abstract
Introduction Youth with childhood-onset physical disabilities receiving rehabilitation services often present with many complex needs. Emerging evidence confirms co-occurrence of mental health problems in this population is common, and mental health is often overlooked during rehabilitation for chronic physical conditions. For example, symptoms of depression and anxiety are frequently present in adolescents with physical disability such as spina bifida or Duchenne muscular dystrophy, and access to mental health services is often limited. Addressing mental health concerns for this age group is particularly critical as it encompasses a challenging transition to adulthood. Objectives Building upon findings from a recent scoping review on the co-occurrence of physical disabilities and mental health problems, this paper synthesizes scientific literature related to the organization and delivery of services for youth with co-occurring childhood-onset physical disabilities (e.g., cerebral palsy, spina bifida) and mental health problems (e.g., depression, anxiety). Methods A scoping review protocol stemming from Arksey & O'Malley's framework and updated guidelines from the Joanna Briggs Institute was developed. Four databases (Medline, PsycINFO, CINAHL, Embase) were searched. The search was limited to French or English peer-reviewed articles published between 2000 and 2021. Articles included were primary papers addressing: 1) youth aged 15 to 24 with a childhood-onset physical disability, 2) mental health problems, and 3) healthcare service organization or delivery. They were screened by two reviewers and discussed with a third to establish consensus on the inclusion criteria and resolve disagreements. Results Sixteen articles were retained from the 1,010 screened. Many (9/16) were from the United States. Two models were found: the Biopsychosocial, Collaborative, Agency-Based Service Integration Approach (including psychiatry in a pediatric rehabilitation hospital) and the Client Network Consultation (an interagency collaboration in mental health care for children with complex healthcare needs). Twelve key principles for service organization and delivery were identified and categorized into: collaboration and coordination, training and support, and delivery of care. Conclusion Identified principles can guide improved service delivery for this population. Highlighted research gaps include the need for developing models of collaborative healthcare delivery and subsequently evaluating their effectiveness.
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Affiliation(s)
- Stephanie Tremblay
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,PEPP Montreal and ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Shalini Lal
- PEPP Montreal and ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, QC, Canada.,School of Rehabilitation, University of Montreal, Montreal, QC, Canada.,Health Innovation and Evaluation Hub, University of Montreal Hospital Research Center, Montreal, QC, Canada
| | - Lucille Xiang
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,School of Public Health, Brown University, Providence, RI, United States
| | - Mark A Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Dana Anaby
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
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12
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Witzig Brändli V, Lange C, Kobleder A, Kohler M. Effectiveness and content components of nursing counselling interventions on self‐ and symptom management of patients in oncology rehabilitation—A systematic review. Nurs Open 2022; 10:2757-2769. [PMID: 36528868 PMCID: PMC10077385 DOI: 10.1002/nop2.1545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 10/20/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
AIM To synthesize the evidence on the effectiveness and content components of nurse-led counselling interventions on the self-and symptom management of patients in oncology rehabilitation. DESIGN A systematic review METHODS: The electronic databases MEDLINE, CINAHL, Cochrane Library and Grey Literature were searched for randomized controlled trials or quasi-experimental trials. Following data extraction, a quality assessment was performed using the Joanna Briggs Institute checklist and the Cochrane risk-of-bias tool. The findings were synthesized in narrative and tabular formats. RESULTS Seven studies were included in the analysis. Two RCTs measured a statistically significant increase in self-efficacy compared to the control group, and one quasi-experimental study showed a statistically significant increase compared to the pre-intervention period. Symptom anxiety was statistically significantly reduced in two RCTs and one quasi-experimental trial. Self-management similarities in the components of the interventions were seen as identifying patients' concerns, setting goals, developing action plans and evaluating the goals and giving patient-tailored information.
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Affiliation(s)
- Verena Witzig Brändli
- OST ‐ Eastern Switzerland University of Applied Sciences, IPW‐OST – Institute of Applied Nursing Science St. Gallen Switzerland
| | - Cordula Lange
- OST ‐ Eastern Switzerland University of Applied Sciences, IPW‐OST – Institute of Applied Nursing Science St. Gallen Switzerland
| | - Andrea Kobleder
- OST ‐ Eastern Switzerland University of Applied Sciences, IPW‐OST – Institute of Applied Nursing Science St. Gallen Switzerland
| | - Myrta Kohler
- OST ‐ Eastern Switzerland University of Applied Sciences, IPW‐OST – Institute of Applied Nursing Science St. Gallen Switzerland
- Rehabilitation Centre Valens St. Gallen Switzerland
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13
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Girgis A, Bamgboje-Ayodele A, Rincones O, Vinod SK, Avery S, Descallar J, Smith A‘B, Arnold B, Arnold A, Bray V, Durcinoska I, Rankin NM, Chang CF, Eifler B, Elliott S, Hardy C, Ivimey B, Jansens W, Kaadan N, Koh ES, Livio N, Lozenkovski S, McErlean G, Nasser E, Ryan N, Smeal T, Thomas T, Tran T, Wiltshire J, Delaney GP. Stepping into the real world: a mixed-methods evaluation of the implementation of electronic patient reported outcomes in routine lung cancer care. J Patient Rep Outcomes 2022; 6:70. [PMID: 35723827 PMCID: PMC9207870 DOI: 10.1186/s41687-022-00475-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To realize the broader benefits of electronic patient-reported outcome measures (ePROMs) in routine care, we used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to inform the translation of a clinically effective ePROM system (hereafter referred to as the PRM system) into practice. The study aimed to evaluate the processes and success of implementing the PRM system in the routine care of patients diagnosed with lung cancer.
Method
A controlled before-and-after mixed-methods study was undertaken. Data sources included a self-report questionnaire and interviews with healthcare providers, electronic health record data for PRMs patients and historical controls, and field notes. Descriptive statistics, logistic regression modelling, negative binomial models, generalized estimating equations and repeated measures ANOVA were used to analyze quantitative data. Qualitative data was thematically analyzed.
Results
A total of 48/79 eligible people diagnosed with lung cancer completed 90 assessments during the 5-month implementation period (RE-AIM reach). Every assessment breached the pre-defined threshold and care coordinators reviewed and actioned 95.6% of breaches, resulting in 146 referrals to allied health services, most frequently for social work (25.3%), dietetics (18.5%), physiotherapy (18.5%) and occupational therapy (17.1%). PRMs patients had significantly fewer visits to the cancer assessment unit for problematic symptoms (M = 0.23 vs. M = 0.43; p = 0.035), and were significantly more likely to be offered referrals (71% vs. 29%, p < 0.0001) than historical controls (RE-AIM effect). The levels of ‘organizational readiness for implementing change’ (ORIC) did not show much differences between baseline and follow-up, though this was already high at baseline; but significantly more staff reported improved confidence when asking patients to complete assessments (64.7% at baseline vs. 88.2% at follow-up, p = 0.0046), and when describing the assessment tool to patients (64.7% at baseline vs. 76.47% at follow-up, p = 0.0018) (RE-AIM adoption). A total of 78 staff received PRM system training, and 95.6% of the PRM system alerts were actioned (RE-AIM implementation); and all lung cancer care coordinators were engaged with the PRM system beyond the end of the study period (RE-AIM maintenance).
Conclusion
This study demonstrates the potential of the PRM system in enhancing the routine care of lung cancer patients, through leveraging the capabilities of automated web-based care options.
Plain English summary
Research has shown the clear benefits of using electronically collected patient-reported outcome measures (ePROMs) for cancer patients and health services. However, we need to better understand how to implement ePROMs as part of routine care. This study evaluated the processes and outcomes of implementing an ePROMs system in the routine care of patients diagnosed with lung cancer. Key findings included: (a) a majority of eligible patients completed the scheduled assessments; (b) patient concerns were identified in every assessment, and care coordinators reviewed and actioned almost all of these, including making significantly more referrals to allied health services; (c) patients completing assessments regularly were less likely to present to the cancer assessment unit with problematic symptoms, suggesting that ePROMs identified patient concerns early and this led to a timely response to concerns; (d) staff training and engagement was high, and staff reporting increased confidence when asking patients to complete assessments and when describing the assessment tool to patients at the end of the implementation period. This study shows that implementing ePROMs in routine care is feasible and can lead to improvements in patient care.
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14
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Bamgboje-Ayodele A, Avery S, Pearson J, Mak M, Smith K, Rincones O, Vinod S, Bray V, Ducinoska I, McCarthy K, Williamson K, Delaney GP, Girgis A. Adapting an integrated care pathway for implementing electronic patient reported outcomes assessment in routine oncology care: Lessons learned from a case study. J Eval Clin Pract 2022; 28:1072-1083. [PMID: 35470525 DOI: 10.1111/jep.13688] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/16/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVE Details of the development and implementation of integrated care pathways (ICPs) in the context of electronic collection of patient reported outcomes (ePROs) for cancer patients are largely lacking in the literature. This study describes what, why and how decisions were made to adapt and implement an ePROs ICP for patients with lung cancer. METHODS A consensus process was utilized, with the implementation advisory group including multidisciplinary representation from three participating hospitals, to identify local champions and adapt and incorporate the ePRO ICP into the local contexts. Engagement meetings were documented via meeting transcripts, and detailed notes from October 2019 to November 2020 were content-analysed to identify decision-making themes based on the Consolidated Framework for Implementation Research; workflows and process maps were reviewed and modified to integrate ePROs. RESULTS In total, 55 engagement activities were held (24 meetings, 20 workshops 11 educational sessions), with n = 96 staff from multiple disciplines participating in the ePROs implementation through advisory meetings, process mapping, change management and staff education. Decisions were made regarding eligible patient cohorts to include, the process for onboarding patients onto the ePRO system, and follow-up and referral pathways. Rationales for decisions included alignment with existing workflows, utilizing available staff, minimizing staff and patient burden and maximizing patient engagement. CONCLUSION Existing resources, staff input and technical and logistical reasons often guided the ICP decisions, highlighting the need for in-depth engagement across all stakeholders for optimal implementation of ePRO ICPs. The ePRO implementation required substantial dialogue and systematic resolution to reach agreement on the final processes. Adapting the local ICP through rigorous engagement facilitated the successful implementation of ePROs as business-as-usual at all three cancer centres. Involving all relevant stakeholders is critical to the successful adaptation of ICPs before their introduction into routine care.
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Affiliation(s)
- Adeola Bamgboje-Ayodele
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Sandra Avery
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Macarthur Cancer Therapy Centre, South Western Sydney Local Health District, Campbelltown, New South Wales, Australia.,Bankstown Cancer Therapy Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia
| | - Joanne Pearson
- Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Macarthur Cancer Therapy Centre, South Western Sydney Local Health District, Campbelltown, New South Wales, Australia.,Bankstown Cancer Therapy Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia
| | - May Mak
- Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Kylie Smith
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Macarthur Cancer Therapy Centre, South Western Sydney Local Health District, Campbelltown, New South Wales, Australia.,Bankstown Cancer Therapy Centre, South Western Sydney Local Health District, Bankstown, New South Wales, Australia
| | - Orlando Rincones
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Shalini Vinod
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Victoria Bray
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Ivana Ducinoska
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Karina McCarthy
- Cancer Institute New South Wales (CINSW), St Leonards, New South Wales, Australia
| | - Kimberley Williamson
- Cancer Institute New South Wales (CINSW), St Leonards, New South Wales, Australia
| | - Geoff P Delaney
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | | | - Afaf Girgis
- UNSW Medicine & Health, University of New South Wales (UNSW Sydney), Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
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15
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Mc Namara KP, Rosenbaum S, Rocks T, Manias E, Freeman CR, Shee AW, Schlicht KG, Calder RV, Moloney J, Morgan M. Workforce development for better management of physical comorbidities among people with serious mental illness. Med J Aust 2022; 217 Suppl 7:S39-S42. [PMID: 36183315 PMCID: PMC9828575 DOI: 10.5694/mja2.51705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/09/2022] [Accepted: 06/29/2022] [Indexed: 01/11/2023]
Affiliation(s)
| | | | - Tetyana Rocks
- Institute for Mental and Physical Health and Clinical Translation (IMPACT)Deakin UniversityMelbourneVIC
| | - Elizabeth Manias
- Centre for Quality and Patient Safety Research, Institute for Health TransformationDeakin UniversityMelbourneVIC
| | | | - Anna Wong Shee
- Deakin UniversityWarrnamboolVIC,Grampians HealthBallaratVIC
| | - Katherine G Schlicht
- Centre for Quality and Patient Safety Research, Institute for Health TransformationDeakin UniversityMelbourneVIC
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16
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Gonçalves I, Mendes DA, Caldeira S, Jesus E, Nunes E. Nurse‐led care management models for patients with multimorbidity in hospital settings: a scoping review. J Nurs Manag 2022; 30:1960-1973. [DOI: 10.1111/jonm.13621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/13/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Isabel Gonçalves
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
| | | | - Sílvia Caldeira
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
| | - Elvio Jesus
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
| | - Elisabete Nunes
- Universidade Católica Portuguesa Institute of Health Sciences, Centre for Interdisciplinary Research in Health Portugal
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17
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Khodayarimotlagh Z, Ahmadi F, Sadooghiasl A, Vaismoradi M. Professional protection as the strategy of nurse managers to deal with nursing negligence. Int Nurs Rev 2022; 69:442-449. [DOI: 10.1111/inr.12744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Fazlollah Ahmadi
- Nursing Department, Faculty of Medical Sciences Tarbiat Modares University Tehran Iran
| | - Afsaneh Sadooghiasl
- Nursing Department, Faculty of Medical Sciences Tarbiat Modares University Tehran Iran
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18
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Integrating network theory into the study of integrated healthcare. Soc Sci Med 2021; 296:114664. [PMID: 35121369 DOI: 10.1016/j.socscimed.2021.114664] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 12/13/2022]
Abstract
Healthcare policy in the United States (U.S.) has focused on promoting integrated healthcare to combat fragmentation (e.g., 1993 Health Security Act, 2010 Affordable Care Act). Researchers have responded by studying coordination and developing typologies of integration. Yet, after three decades, research evidence for the benefits of coordination and integration are lacking. We argue that research efforts need to refocus in three ways: (1) use social networks to study relational coordination and integrated healthcare, (2) analyze integrated healthcare at three levels of analysis (micro, meso, macro), and (3) focus on clinical integration as the most proximate impact on patient outcomes. We use examples to illustrate the utility of such refocusing and present avenues for future research.
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Whitehead L, Palamara P, Allen J, Boak J, Quinn R, George C. Nurses' perceptions and beliefs related to the care of adults living with multimorbidity: A systematic qualitative review. J Clin Nurs 2021; 31:2716-2736. [PMID: 34873763 DOI: 10.1111/jocn.16146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To identify and synthesise the available qualitative evidence on nurses' perceptions and beliefs related to the care of adults living with multimorbidity. BACKGROUND The rising prevalence of adults living with multimorbidity has increased demand for health care and challenges nursing care. No review has been conducted to date of the studies of nurses' perceptions and beliefs related to the provision of care to guide policy makers, practitioners and further research to identify and deliver quality care for persons living with multimorbidity. DESIGN Systematic review of qualitative studies conducted in line with the PRISMA checklist. METHODOLOGY Eight electronic publication databases and sources of grey literature were searched to identify original qualitative studies of the experience of nurses caring for adults with multiple chronic conditions with no restrictions on the date of publication or study context. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data were extracted using the Joanna Briggs Institute standardised data extraction tool for qualitative research. Data synthesis was undertaken through meta-aggregation. RESULTS Eleven qualitative studies were included in the review. All studies met eight or more of the 10 assessment criteria of the JBI Critical Appraisal Checklist for Qualitative Research. Four synthesised findings were generated from the aggregated findings: (i) the challenge of providing nursing care; (ii) the need to deliver holistic and person-centred nursing care; (iii) the importance of developing a therapeutic nurse-patient relationship, and (iv) delivering nursing care as part of an interprofessional care team. CONCLUSIONS The complexity of multimorbidity and the predominant single-disease model of chronic care present challenges for the delivery of nursing care to adults living with multimorbidity. RELEVANCE TO CLINICAL PRACTICE The nursing care of persons with multimorbidity needs to incorporate holistic assessment and person-centred care principles as part of a collaborative and interprofessional team approach. PROSPERO REGISTRATION CRD42020186773.
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Affiliation(s)
- Lisa Whitehead
- Centre for Nursing, Midwifery and Health Services Research, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Peter Palamara
- Centre for Nursing, Midwifery and Health Services Research, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Jacqueline Allen
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Jennifer Boak
- Bendigo Health, 100 Barnard Street, Bendigo, Victoria, Australia
| | - Robyn Quinn
- Australian College of Nursing, Parramatta, VIC
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20
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Dalhammar K, Malmström M, Sandberg M, Falkenback D, Kristensson J. Health care utilization among patients with oesophageal and gastric cancer: the impact of initial treatment strategy and assignment of a contact nurse. BMC Health Serv Res 2021; 21:1019. [PMID: 34579714 PMCID: PMC8477461 DOI: 10.1186/s12913-021-07042-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 09/14/2021] [Indexed: 12/26/2022] Open
Abstract
Background Patients diagnosed with oesophageal and gastric cancer face a poor prognosis and numerous challenges of symptom management, lifestyle adjustments and complex treatment regimens. The multifaceted care needs and rapid disease progression reinforce the need for proactive and coherent health care. According to the national cancer strategy, providing coherent health care and palliative support is an area of priority. More knowledge is needed about health care utilization and the characteristics of the health care service in order to understand the readiness, accessibility and quality of current health care. The aim of this study was to describe individuals’ health care use from the time of treatment decision until death, and investigate the impact of the initial treatment strategy and assignment of a contact nurse (CN) on health care use among patients with oesophageal and gastric cancer. Methods This population-based cohort study included patients who died from oesophageal and gastric cancer in Sweden during 2014–2016. Through linking data from the National Register for Oesophageal and Gastric Cancer, the National Cause of Death Register, and the National Patient Register, 2614 individuals were identified. Associations between the initial treatment strategy and CN assignment, and health care use were investigated. Adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated using Poisson regression. Results Patients receiving palliative treatment and those receiving no tumour-directed treatment had a higher IRR for unplanned hospital stays and unplanned outpatient care visits compared with patients who received curative treatment. Patients receiving no tumour-directed treatment also had a lower IRR for planned hospital stays and planned outpatient care visits compared with patients given curative treatment. Compared with this latter group, patients with palliative treatment had a higher IRR for planned outpatient care visits. Patients assigned a CN had a higher IRR for unplanned hospital stays, unplanned outpatient care visits and planned outpatient care visits, compared with patients not assigned a CN. Conclusions A palliative treatment strategy and no tumour-directed treatment were associated with higher rates of unplanned health care compared with a curative treatment strategy, suggesting that a proactive approach is imperative to ensure quality palliative care.
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Affiliation(s)
- Karin Dalhammar
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden. .,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden.
| | - Marlene Malmström
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Sandberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Dan Falkenback
- Department of Surgery, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jimmie Kristensson
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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21
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Weaver R, O'Connor M, Ngune I, Smith RC, Phillips J, Halkett G. Perspectives of the sarcoma clinical nurse consultant role: A qualitative study. Collegian 2021. [DOI: 10.1016/j.colegn.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Gonçalves I, Mendes DA, Caldeira S, Nunes EMGT. Nurse-led care management models for patients with multimorbidity in hospital settings: a scoping review protocol. JBI Evid Synth 2021; 19:1934-1940. [PMID: 34400595 DOI: 10.11124/jbies-20-00222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this scoping review is to map the nurse-led care management models for patients with multimorbidity in hospital settings. INTRODUCTION The increase of chronic diseases and the associated multimorbidity create challenges for health care resources and services. Considering their role and skill set, nurses are in a position to lead the transformation of health care for patients with chronic illness. Several nurse-led care management models in the community have been identified in the literature, but little is known about these models in hospital settings. It is necessary to map the existing nurse-led care management models and describe their characteristics, differences, and similarities, and the implications for patients with multimorbidity in a hospital environment. INCLUSION CRITERIA This scoping review will consider studies focusing on nurse-led care management models for adult patients with multimorbidity in hospital settings, including readmissions, discharges, and visits to emergency services. METHODS The search will include Web of Science, CINAHL, MEDLINE, Nursing and Allied Health Collection, and gray literature through OpenGrey. This review will be restricted to studies published in English. A three-step search strategy will be used, and the articles identified in the databases will be organized and the duplicates removed. The titles and abstracts will be analyzed by two independent reviewers. Full texts will be imported into a bibliographic reference management system. The findings will be presented in tables and descriptive summary.
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Affiliation(s)
- Isabel Gonçalves
- Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Lisbon, Portugal.,Hospital da Luz, Lisbon, Portugal
| | | | - Sílvia Caldeira
- Universidade Católica Portuguesa, Institute of Health Sciences, Center for Interdisciplinary Research in Health, Lisbon, Portugal.,Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Coimbra, Portugal
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Xu D(R, Dev R, Shrestha A, Zhang L, Shrestha A, Shakya P, Hughes JP, Shakya PR, Li J, Liao J, Karmacharya BM. NUrse-led COntinuum of care for people with Diabetes and prediabetes (NUCOD) in Nepal: study protocol for a cluster randomized controlled trial. Trials 2020; 21:442. [PMID: 32471476 PMCID: PMC7257188 DOI: 10.1186/s13063-020-04372-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study will be to improve diabetes prevention, access to care and advocacy through a novel cost-effective nurse-led continuum of care approach that incorporates diabetes prevention, awareness, screening and management for low-income settings, and furthermore utilizes the endeavor to advocate for establishing a standard diabetes program in Nepal. Methods We will conduct a two-arm, parallel group, stratified cluster randomized controlled trial of the NUrse-led COntinuum of care for people with Diabetes (N1 = 200) and prediabetes (N2 = 1036) (NUCOD) program, with primary care centers (9 outreach centers and 17 government health posts) as a unit of randomization. The NUCOD program will be delivered through the trained diabetes nurses in the community to the intervention group and the outcomes will be compared with the usual treatment group at 6 and 12 months of the intervention. The primary outcome will be the change in glycated hemoglobin (HbA1c) level among diabetes individuals and progression to type 2 diabetes among prediabetes individuals, and implementation outcomes measured using the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework. Outcomes will be analyzed on an intention-to-treat basis. Discussion The results of this trial will provide information about the effectiveness of the NUCOD program in improving clinical outcomes for diabetes and prediabetes individuals, and implementation outcomes for the organization. The continuum of care model can be used for the prevention and management of diabetes and other noncommunicable diseases within and beyond Nepal with similar context. Trial registration ClinicalTrials.gov, NCT04131257. Registered on 18 October 2019.
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24
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Reid AE, Doucet S, Luke A. Exploring the role of lay and professional patient navigators in Canada. J Health Serv Res Policy 2020; 25:229-237. [PMID: 32188293 DOI: 10.1177/1355819620911679] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To explore the roles of patient navigators in different settings and situations for various patient populations and to understand the rationale for implementing lay and professional models of patient navigation in a Canadian context. METHODS A qualitative descriptive design was applied, using interviews with 10 patient navigators from eight Canadian provinces, and Braun and Clarke's six phases of thematic analysis to guide the analysis of interview transcripts. RESULTS Findings indicate that a patient navigator's personality and experience (personal and work-related) may be more important than their specific designation (i.e. lay or professional). CONCLUSIONS Lay and professional navigators in Canada appear to be well suited to provide navigational services across populations. This study has the potential to inform future research, policy, and the delivery of navigation programmes in Canada.
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Affiliation(s)
- Amy E Reid
- Research Coordinator, Department of Nursing and Health Sciences, Centre for Research in Integrated Care, University of New Brunswick Saint John, Canada
| | - Shelley Doucet
- Jarislowsky Chair in Interprofessional Patient-Centred Care, University of New Brunswick Saint John, Canada.,Director, Centre for Research in Integrated Care, University of New Brunswick Saint John, Canada.,Associate Professor, Department of Nursing and Health Sciences, University of New Brunswick Saint John, Canada.,Co-Director, NaviCare/SoinsNavi, University of New Brunswick Saint John, Canada
| | - Alison Luke
- Research Associate, Department of Nursing and Health Sciences, Centre for Research in Integrated Care, University of New Brunswick Saint John, Canada
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Nembhard IM, Buta E, Lee YSH, Anderson D, Zlateva I, Cleary PD. A quasi-experiment assessing the six-months effects of a nurse care coordination program on patient care experiences and clinician teamwork in community health centers. BMC Health Serv Res 2020; 20:137. [PMID: 32093664 PMCID: PMC7038598 DOI: 10.1186/s12913-020-4986-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Recognition that coordination among healthcare providers is associated with better quality of care and lower costs has increased interest in interventions designed to improve care coordination. One intervention is to add care coordination to nurses’ role in a formal way. Little is known about effects of this approach, which tends to be pursued by small organizations and those in lower-resource settings. We assessed effects of this approach on care experiences of high-risk patients (those most in need of care coordination) and clinician teamwork during the first 6 months of use. Methods We conducted a quasi-experimental study using a clustered, controlled pre-post design. Changes in staff and patient experiences at six community health center practice locations that introduced the added-role approach for high-risk patients were compared to changes in six locations without the program in the same health system. In the pre-period (6 months before intervention training) and post-period (about 6 months after intervention launch, following 3 months of training), we surveyed clinical staff (N = 171) and program-qualifying patients (3007 pre-period; 2101 post-period, including 113 who were enrolled during the program’s first 6 months). Difference-in-differences models examined study outcomes: patient reports about care experiences and clinician-reported teamwork. We assessed frequency of patient office visits to validate access and implementation, and contextual factors (training, resources, and compatibility with other work) that might explain results. Results Patient care experiences across all high-risk patients did not improve significantly (p > 0.05). They improved somewhat for program enrollees, 5% above baseline reports (p = 0.07). Staff-perceived teamwork did not change significantly (p = 0.12). Office visits increased significantly for enrolled patients (p < 0.001), affirming program implementation (greater accessing of care). Contextual factors were not reported as problematic, except that 41% of nurses reported incompatibility between care coordination and other job demands. Over 75% of nurses reported adequate training and resources. Conclusions There were some positive effects of adding care coordination to nurses’ role within 6 months of implementation, suggesting value in this improvement strategy. Addressing compatibility between coordination and other job demands is important when implementing this approach to coordination.
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Affiliation(s)
- Ingrid M Nembhard
- The Wharton School, University of Pennsylvania, Health Care Management Department, 3641 Locust Walk, 207 Colonial Penn Center, Philadelphia, PA, 19104, USA.
| | - Eugenia Buta
- Yale Center for Analytical Sciences (YCAS), 300 George Street, Suite 555, New Haven, CT, 06519, USA
| | - Yuna S H Lee
- Columbia University Mailman School of Public Health, Department of Health Policy & Management, 722 West 168th Street, R476, New York, NY, 10032, USA
| | - Daren Anderson
- Weitzman Institute, Community Health Center, Inc., 631 Main St., Middletown, CT, 06457, USA
| | - Ianita Zlateva
- Weitzman Institute, Community Health Center, Inc., 631 Main St., Middletown, CT, 06457, USA
| | - Paul D Cleary
- Yale School of Public Health, 60 College St., P.O. Box 208034, New Haven, CT, 06520-8034, USA
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van Dongen SI, de Nooijer K, Cramm JM, Francke AL, Oldenmenger WH, Korfage IJ, Witkamp FE, Stoevelaar R, van der Heide A, Rietjens JA. Self-management of patients with advanced cancer: A systematic review of experiences and attitudes. Palliat Med 2020; 34:160-178. [PMID: 32009565 PMCID: PMC7433395 DOI: 10.1177/0269216319883976] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with advanced cancer are increasingly expected to self-manage. Thus far, this topic has received little systematic attention. AIM To summarise studies describing self-management strategies of patients with advanced cancer and associated experiences and personal characteristics. Also, to summarise attitudes of relatives and healthcare professionals towards patient self-management. DESIGN A systematic review including non-experimental quantitative and qualitative studies. Data were analysed using critical interpretive synthesis. Included studies were appraised on methodological quality and quality of reporting. DATA SOURCES MEDLINE, Embase, Cochrane Central, PsycINFO, CINAHL, Web of Science and Google Scholar (until 11 June 2019). RESULTS Of 1742 identified articles, 31 moderate-quality articles describing 8 quantitative and 23 qualitative studies were included. Patients with advanced cancer used self-management strategies in seven domains: medicine and pharmacology, lifestyle, mental health, social support, knowledge and information, navigation and coordination and medical decision-making (29 articles). Strategies were highly individual, sometimes ambivalent and dependent on social interactions. Older patients and patients with more depressive symptoms and lower levels of physical functioning, education and self-efficacy might have more difficulties with certain self-management strategies (six articles). Healthcare professionals perceived self-management as desirable and achievable if based on sufficient skills and knowledge and solid patient-professional partnerships (three articles). CONCLUSION Self-management of patients with advanced cancer is highly personal and multifaceted. Strategies may be substitutional, additional or even conflicting compared to care provided by healthcare professionals. Self-management support can benefit from an individualised approach embedded in solid partnerships with relatives and healthcare professionals.
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Affiliation(s)
- Sophie I van Dongen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kim de Nooijer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jane M Cramm
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anneke L Francke
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.,Amsterdam Public Health (APH) Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Wendy H Oldenmenger
- Faculty of Nursing and Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frederika E Witkamp
- Faculty of Nursing and Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Rik Stoevelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Judith Ac Rietjens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Guzek M, Szafraniec-Buryło S, Wyrębiak A, Kowalczyk D, Bukato G, Prusaczyk A, Żuk P, Czech M, Kurpas D. The role of primary care physicians and nurses in convincing patients to participate in a colorectal cancer screening program in a Polish coordinated care organization: a questionnaire-based study. MEDICAL SCIENCE PULSE 2019. [DOI: 10.5604/01.3001.0013.2986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Medical assistants/care coordinators play a crucial role in the coordinated care system. The tasks of nurses and some qualified supporting staff have been extended to include this role along with the implementation of the pilot program POZ Plus in Polish primary healthcare. A personalized approach to the patient is especially important during the implementation of large-scale prevention programs. Aim of the study: To assess who has the greatest influence on the patient’s decision to undergo screening colonoscopy and outline the current and potential roles of nurses in this process. Material and methods: This questionnaire-based study was conducted at the coordinated care facility Medical and Diagnostic Center (CMD) in Siedlce, Poland between March 1st and June 15th, 2017. Results: 138 patients participated in the study. The majority (75; 54.4%) reported they were directly convinced to undergo colonoscopy by a primary care physician. 18 (13.0%) were convinced by a nurse, and 22 (15.9%) by another specialist. The remaining (23; 16.7%) patients indicated other factors. The majority of patients (74; 53.6%) responded saying that all necessary information about the entire test course was provided by the nurse, while 35 (25.4%) shared that this information had come from the primary care physician, 8 (5.80%) from the specialist doctor, 3 (2.17%) from the receptionist and 18 (13.0%) from other sources of information, such as the Internet, leaflets and notice boards. Conclusions: We found that primary care physicians at this institution have an important role in convincing patients to undergo preventive colonoscopy, while nurses provide key information to patients on the preparation and the course of this procedure. Although the current model seems to be effective in a coordinated care setting, there may be still a place for nurse care coordinators to take on some tasks previously performed by doctors.
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Affiliation(s)
| | | | | | | | - Grzegorz Bukato
- Department of Psychiatry, Physiotherapy Division, Medical University of Warsaw, Poland
| | | | - Paweł Żuk
- Medical and Diagnostic Centre, Siedlce, Poland
| | - Marcin Czech
- Department of Pharmacoeconomics, Institute of Mother and Child, Warsaw, Poland
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Perpetua EM, Clarke SE, Guibone KA, Keegan PA, Speight MK. Surveying the Landscape of Structural Heart Disease Coordination: An Exploratory Study of the Coordinator Role. STRUCTURAL HEART 2019. [DOI: 10.1080/24748706.2019.1581962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Reorienting ourselves to the reality of hospitalization. Geriatr Nurs 2019; 40:105-106. [DOI: 10.1016/j.gerinurse.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Panozzo S, Collins A, McLachlan SA, Lau R, Le B, Duffy M, Philip JA. Scope of Practice, Role Legitimacy, and Role Potential for Cancer Care Coordinators. Asia Pac J Oncol Nurs 2019; 6:356-362. [PMID: 31572755 PMCID: PMC6696811 DOI: 10.4103/apjon.apjon_29_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: The cancer care coordinator (CCC) role has become a priority in providing coordinated, patient-centered, supported care for patients, and their families experiencing cancer. The CCC role exists with heterogeneity across tumor streams, clinical disciplines, and institutions. This study explored CCCs perceptions and experiences of their role, scope of practice, and potential for future role development. Methods: This research used a mixed methods design. Focus groups and individual interviews were conducted with a purposive sample of 16 CCCs from two tertiary public teaching hospitals in Melbourne, Australia. A thematic analysis approach was used. A quantitative record of relative time spent on tasks was also collected. Results: Three major themes were identified: (1) Perceptions of role legitimacy, (2) Structure and funding of the role determines scope of practice, and (3) Reflections on the potential for the role. Variability was evident in predominant tasks undertaken, integration into the unit, level of patient contact, and regard from other professional colleagues. Variability appears to relate to employment time assigned to the role, and history and structure of the role. Conclusions: The findings underline the need when establishing and reviewing CCC roles for explicit attention to be given to the reporting, integration, structural, and collegiate support for the role as this will profoundly influence its success.
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Affiliation(s)
- Stacey Panozzo
- Department of Medicine, University of Melbourne, Australia.,Palliative Medicine Research Group, St. Vincent's Hospital Melbourne, Australia.,Peter MacCallum Cancer Centre, Australia
| | - Anna Collins
- Department of Medicine, University of Melbourne, Australia.,Palliative Medicine Research Group, St. Vincent's Hospital Melbourne, Australia
| | | | - Rosalind Lau
- Centre for Palliative Care, St. Vincent's Hospital Melbourne, Australia
| | - Brian Le
- Peter MacCallum Cancer Centre, Australia.,Palliative and Supportive Care Unit, Royal Melbourne Hospital, Australia
| | - Mary Duffy
- Peter MacCallum Cancer Centre, Australia
| | - Jennifer A Philip
- Department of Medicine, University of Melbourne, Australia.,Palliative Medicine Research Group, St. Vincent's Hospital Melbourne, Australia
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Saucier A, Biron A. Développement d’un consensus professionnel face aux interventions de l’infirmière pivot en oncologie en vue de soutenir la planification des effectifs au Québec. Can Oncol Nurs J 2018; 28:301-307. [PMID: 31148842 PMCID: PMC6516936 DOI: 10.5737/23688076284301307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Au Québec, près de 250 infirmières pivot en oncologie (IPO) sont déployées au Québec pour soutenir les personnes atteintes d’un cancer. Il devient toutefois de plus en plus évident que ce nombre est insuffisant. Une étude a été menée afin d’estimer les besoins en IPO pour la province. L’établissement d’un consensus professionnel par la technique du groupe nominal et la méthode Delphi ont été utilisés pour atteindre cet objectif. Les données obtenues permettent de baser les décisions de planification des effectifs sur des évidences mesurées dans la réalité du travail actuel des IPO. Ainsi, il est espéré que celles-ci contribueront à une meilleure planification des effectifs pour répondre aux besoins de personnes atteintes de cancer et leurs proches.
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Affiliation(s)
| | - Alain Biron
- Volet pratique professionnelle, Professeur adjoint, Ingram School of Nursing-McGill University
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