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Assessing the Delivery of Coordinated Care to Patients with Advanced Chronic Kidney Disease in Ontario, Canada: A Survey of Patients and Healthcare Professionals. Int J Integr Care 2021; 21:30. [PMID: 34220394 PMCID: PMC8231462 DOI: 10.5334/ijic.5587] [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] [Indexed: 12/04/2022] Open
Abstract
Introduction: Patients with advanced Chronic Kidney Disease (CKD) have complex health needs, and thus require care that is coordinated across professionals and organizations. This study aimed to describe the extent of coordinated care delivery for patients with advanced CKD from the perspectives of both patients and healthcare professionals. Methods: The Coordination Scale of the Patient Assessment of Chronic Illness Care (PACIC-26) survey was administered to a random sample of 14,257 patients on maintenance dialysis or receiving care in end-stage kidney disease preparation clinics in Ontario, Canada. A five-item survey was administered to 596 multidisciplinary nephrology professionals. Results: Among the 1,925 patient respondents, 67% reported they had been referred to an allied health professional; 19% had been encouraged to attend programs in the community; and 34% had been told how their visits with other types of doctors helped their treatment (% reporting “always” or “most of the time”). Patient responses were significantly different by treatment modality/setting, but not by gender or geographic location of treatment facility. Among the 276 professional respondents, 37% reported their patients’ care was well-coordinated across settings; 56% reported participating in interdisciplinary care planning discussions; and 53% reported they are aware of appropriate home and community services to support their patients (% reporting “always” or “most of the time”). Conclusion: The results suggest that care for patients with advanced CKD in Ontario is not consistently coordinated. Healthcare professionals may enhance patient perceptions of coordinated care through explicit communication with patients about how the professionals they see and treatments or services they receive influence their overall health and well-being. At a systems level, there is a need to improve professional awareness of and linkages to home- and community-based services.
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Jarjou'i A, Mendlovic J, Dadon Z, Sneineh MA, Tabi M, Kalak G, Jarallah YR, Yinnon AM, Munter G. Availability, timeliness, documentation and quality of consultations among hospital departments: a prospective, comparative study. Isr J Health Policy Res 2021; 10:19. [PMID: 33866967 PMCID: PMC8053423 DOI: 10.1186/s13584-021-00446-0] [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: 10/14/2020] [Accepted: 02/10/2021] [Indexed: 01/03/2023] Open
Abstract
Background Many in-patients require care from practitioners in various disciplines. Consultations most probably have significant implications for hospitalization outcomes. Purpose To determine key aspects of consultations provided by various departments to formulate an optimal policy. Methods This study comprised two methods: first, a questionnaire was completed in 2019 by 127 physicians interns, residents and senior doctors) from the medical and surgical departments (64 from the surgical wards, 43 from the medical wards and 22 from the emergency room and General ICU) regarding the availability, timeliness and documentation rate of the consultations they received from different disciplines. The investigators rounded through the various departments that were included in the study and they accosted a sample of interns, residents and attending physicians, who were then asked to fill the questionnaire. Overall compliance of filling the questionnaire was 95%. Residents accounted for 72% of the filled questionnaires, seniors and interns accounted for 15 and 13% respectively. Second, a convenience sample of 300 electronic records of hospitalized patients (135 from the surgical wards, 129 from the Medical wards and 36 from the emergency room and General ICU) of actually carried out consultations was reviewed for validated indicators of quality for both the consultation request and response. We used a 5-point Likert scale, ranging from poor (1) to superb (5), to grade the measured parameters. Results The availability, timeliness and documentation rate for medical consultations were 4 ± 0.9, 4.1 ± 0.9 and 4.3 ± 0.9 respectively, as compared with surgical consultations 3.2 ± 1.1, 3.4 ± 1.2 and 3.6 ± 1.2 respectively (P < 0.001). The mean time (in hours) from the consultation request till documentation (of the requested consultation) by consultants in the medical and surgical departments was 3.9 ± 5.9 and 10.0 ± 15.6, respectively (P < 0.001). The quality of requests of consultations from the medical and surgical departments was 3.4 ± 1.1 and 2.8 ± 1.2, respectively (P < 0.001). Two different models of consultations are employed: while each medical department adopts several departments for medical consultations, each day’s on-call surgeon provides all the hospital’s surgical consultations. Conclusion We detected significant differences in key aspects of consultations provided by the departments. The medical model of consultations, in which each medical department adopts several other wards to which it provides consulting services upon request, should probably be adopted as a major policy decision by hospitals directors to enhance inter-departmental consultations. Supplementary Information The online version contains supplementary material available at 10.1186/s13584-021-00446-0.
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Affiliation(s)
- Amir Jarjou'i
- Internal Medicine, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel. .,Division of Internal Medicine, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, P.O. Box 3235, 91031, Jerusalem, Israel.
| | - Joseph Mendlovic
- Deputy CEO, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel
| | - Ziv Dadon
- Division of Internal Medicine, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, P.O. Box 3235, 91031, Jerusalem, Israel.,Department of Cardiology, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel
| | - Marwan Abu Sneineh
- Division of Internal Medicine, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, P.O. Box 3235, 91031, Jerusalem, Israel
| | - Meir Tabi
- Division of Internal Medicine, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, P.O. Box 3235, 91031, Jerusalem, Israel.,Department of Cardiology, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel
| | - George Kalak
- Division of Internal Medicine, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, P.O. Box 3235, 91031, Jerusalem, Israel
| | - Yousef R Jarallah
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel
| | - Amos M Yinnon
- Division of Internal Medicine, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, P.O. Box 3235, 91031, Jerusalem, Israel.
| | - Gabriel Munter
- Internal Medicine, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, Jerusalem, Israel.,Division of Internal Medicine, Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, P.O. Box 3235, 91031, Jerusalem, Israel
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Chauhan BF, Jeyaraman MM, Mann AS, Lys J, Skidmore B, Sibley KM, Abou-Setta AM, Zarychanski R. Behavior change interventions and policies influencing primary healthcare professionals' practice-an overview of reviews. Implement Sci 2017; 12:3. [PMID: 28057024 PMCID: PMC5216570 DOI: 10.1186/s13012-016-0538-8] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/13/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers. METHODS Study design: overview of reviews. DATA SOURCE MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015). STUDY SELECTION two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language. DATA EXTRACTION AND SYNTHESIS two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors' conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.). RESULTS Of 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change. CONCLUSIONS Behavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.
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Affiliation(s)
- Bhupendrasinh F Chauhan
- College of Pharmacy, University of Manitoba, Winnipeg, Canada.
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
| | - Maya M Jeyaraman
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Justin Lys
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Kathryn M Sibley
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ahmed M Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ryan Zarychanski
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
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Altalib HH, Elzamzamy K, Pugh MJ, Gonzalez JB, Cheung KH, Fenton BT, Kerns RD, Brandt CA, LaFrance WC. Communicating diagnostic certainty of psychogenic nonepileptic seizures - a national study of provider documentation. Epilepsy Behav 2016; 64:4-8. [PMID: 27723497 DOI: 10.1016/j.yebeh.2016.08.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/25/2016] [Accepted: 08/31/2016] [Indexed: 11/29/2022]
Abstract
Management of psychogenic nonepileptic seizures (PNES) requires collaboration among and between health care professionals. Although criteria are established for diagnosis of PNES, miscommunication between neurologists, primary care providers, and mental health professionals may occur if the clinical impression is not clearly articulated. We extracted progress notes from the Department of Veterans Affairs (VA) electronic health record (EHR) nationally to study veterans who were evaluated for PNES. Of the 750 patients being worked up for PNES, the majority of patients did not meet criteria for PNES (64.6%). Of those who were thought to suffer from PNES, 147 (19.6%) met International League Against Epilepsy (ILAE) criteria for documented PNES, 14 (1.9%) for clinically established PNES, and 104 (13.9%) for probable or possible PNES. Neurologists tended to use ambiguous language, such as "thought to be" or "suggestive of" to describe their impressions of patients overall, even those with definitive PNES. Ambiguous language may lead to miscommunication across providers and inappropriate health care.
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Affiliation(s)
- Hamada H Altalib
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA; Yale University, Department of Neurology, USA; Yale University, Department of Psychiatry, USA.
| | - Khalid Elzamzamy
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA
| | - Mary Jo Pugh
- South Texas VA Healthcare System, USA; University of Texas Health Science Center, Department of Biostatistics and Epidemiology, USA
| | | | - Kei-Hoi Cheung
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA; Yale University, Department of Emergency Medicine, USA
| | - Brenda T Fenton
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA
| | - Robert D Kerns
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA; Yale University, Department of Neurology, USA; Yale University, Department of Psychiatry, USA
| | - Cynthia A Brandt
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, USA; Yale University, Department of Emergency Medicine, USA
| | - W Curt LaFrance
- Brown University, Departments of Psychiatry and Neurology, USA; Providence VA Medical Center, Department of Psychiatry, USA
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