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Dawson MLW, Neal A, West K. Go Team Go! Interprofessional Practice for Pediatric Feeding in the Schools. Lang Speech Hear Serv Sch 2024; 55:394-408. [PMID: 38227486 DOI: 10.1044/2023_lshss-23-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
PURPOSE The purpose of this clinical focus article is to discuss processes and procedures for building school-based programs to address the feeding and swallowing needs of students in the public-school setting. Interprofessional practice (IPP) team member roles and responsibilities, screening, eligibility, considerations for developing Individualized Education Programs that address the needs of students with pediatric feeding disorder (PFD) and dysphagia, as well as billing documentation requirements, are discussed. Additionally, coordination across the continuum of service delivery for students with PFD and dysphagia is investigated. Guidance on documentation, processes, and procedures that comply with the Individuals with Disabilities Education Act mandates will be provided. CONCLUSIONS This clinical focus article will demonstrate that students with PFD and dysphagia continue to present to public schools and require skilled services and supports in order to meet their individualized needs. School-based speech-language pathologists have a legal requirement to provide these supports when deemed educationally relevant. Schools must employ processes and procedures that result in the timely and effective evaluation and identification of students with PFD and dysphagia. An IPP approach to the management of PFD and dysphagia is critical to ensure optimal outcomes for students found eligible for services.
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Affiliation(s)
- Michelle L W Dawson
- Department of Communication Sciences and Disorders, James Madison University, Harrisonburg, VA
| | - Angie Neal
- South Carolina State Department of Education, Office of Special Education Services, Columbia
| | - Kristen West
- Department of Communication Sciences and Disorders, Pennsylvania Western University, Clarion
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井 淼, 王 悦, 景 晓, 毛 新. [Screening for Duchenne muscular dystrophy in newborns in the Ningxia region]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:258-261. [PMID: 38557377 PMCID: PMC10986384 DOI: 10.7499/j.issn.1008-8830.2309151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To evaluate the incidence rate of Duchenne muscular dystrophy (DMD) in the male newborns in the Ningxia region and establish a critical threshold for screening DMD in newborns to distinguish between the normal population and affected individuals. METHODS A total of 10 000 male newborns were screened using immunofluorescence analysis of creatine kinase isoenzyme concentrations in heel spot dried blood specimens. Newborns with the concentrations higher than the critical threshold were recalled for serum creatine kinase measurements. Genetic testing was performed to confirm diagnosis in cases showing abnormalities. RESULTS Among the screened 10 000 male newborns, two were confirmed to have DMD through genetic testing, resulting in a preliminary estimated incidence rate of 1/5 000 for male newborns in the Ningxia region. The critical threshold for creatine kinase isoenzyme concentration in newborns in this region was determined to be 468.57 ng/mL. CONCLUSIONS Screening for DMD in newborns is feasible in the Ningxia region. Early screening, diagnosis, and treatment of DMD can improve the quality of life for affected individuals and help families make informed decisions regarding further pregnancies.
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Krieg KD, Nooraie RY, Favella M, Iadarola S, Kuo DZ, O'Connor TG, Petrenko CLM, Bayer ND. Coping Factors for Caregivers of Children With Medical Complexity During Hospitalization. Hosp Pediatr 2023; 13:e371-e376. [PMID: 37969006 DOI: 10.1542/hpeds.2023-007207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
OBJECTIVES This study aimed to identify coping factors for caregivers of children with medical complexity (CMC) to manage the stressors and experience associated with their child's hospitalization. METHODS We conducted semistructured interviews with CMC caregivers over a video-conferencing platform to examine factors that they perceive impact their coping while their children are hospitalized. Interviews were audio-recorded, transcribed, and imported into a qualitative coding software (MAXQDA). Using a modified grounded theory approach, we assigned process and in vivo codes to the transcripts and conducted interpretive analysis to identify themes. Once we reached thematic saturation, we finalized themes by discussing them to achieve group consensus and processed themes through triangulation with our institution's pediatric family advisory council. RESULTS We interviewed 14 caregivers (11 mothers and 3 fathers) and identified 3 major themes. The factors that contributed to CMC caregiver coping with their child's hospitalizations included caregivers: feeling that they are prioritizing their child's needs over their own, feeling trust in their child's interdisciplinary healthcare team, and feeling their self-care practices are well adjusted to the hospital setting. CONCLUSIONS Our study found 3 coping factors for caregivers of CMC during their child's hospitalization. Development and testing of interventions that enhance these coping practices may better support CMC caregivers during their child's hospitalizations. Potential interventions could include developing structured processes to establish caregiver involvement in their child's hospital care and helping caregivers modify their existing coping mechanisms to the hospital setting.
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Affiliation(s)
- Kathleen D Krieg
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | | | | | | | - Thomas G O'Connor
- Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Christie L M Petrenko
- Pediatrics
- Mt. Hope Family Center, Department of Psychology, University of Rochester, Rochester, New York
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Dionne É, Haggerty J, Scott CM, Doucet S, Stewart T, Quesnel-Vallée A, Montelpare W, Urquhart R, Sutherland JM, Couturier Y. Toward Comprehensive Care Integration in Canada: Delphi Process Findings from Researchers, Clinicians, Patients and Decision Makers. Healthc Policy 2023; 19:24-38. [PMID: 37850703 PMCID: PMC10594939 DOI: 10.12927/hcpol.2023.27181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Introduction From a larger study examining policy and program information on how Canadian provinces integrate care services, this study aimed to create "priority lists" of 10-15 services that are "absolutely needed" for care integration. Methodology A diverse group of over 50 Canadian stakeholders participated in virtual consensus-building using the nominal group technique and a modified e-Delphi method to identify services that focused on two different groups: children and youth with high functional health needs and older adults in functional decline. Results Three lists - containing services, processes and infrastructure elements - emerged: one per tracer condition group and a consolidated list. The latter identified the following five services as top priority for primary care integration: mental health and addictions services; home care; transition between urgent-emergency-acute care; medication reconciliation in community pharmacies; and respite care. No single social service was a clear priority, but those that mitigate material deprivation emerged within the top 10. Discussion This humble pan-Canadian study shows that priority services in health and social services are neither well integrated nor connected to primary care. It also suggests that effective policy strategizing for primary care integration for those with complex care needs may require thinking beyond the logic of services - given their siloed organization.
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Affiliation(s)
- Émilie Dionne
- Researcher and Adjunct Professor, VITAM - Centre de recherche en santé durable, Department of Sociology, Faculty of Social Sciences, Laval University, Quebec City, QC
| | - Jeannie Haggerty
- McGill Research Chair in Family and Community Medicine, McGill University and St. Mary's Hospital Research Centre, Montréal, QC
| | - Catherine M Scott
- Adjunct Professor, University of Calgary and University of British Columbia-Okanagan, Executive Coach and Knowledge Mobilisation Consultant, K2A Consulting, Calgary, AB
| | - Shelley Doucet
- Jarislowsky Chair in Interprofessional Patient-Centred Care, Associate Professor, Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB
| | - Tara Stewart
- Assistant Professor, Department of Community Health Sciences, University of Manitoba, Researcher/Evaluator, George & Fay Yee Centre for Healthcare Innovation, Manitoba SPOR SUPPORT Unit, Winnipeg, MB
| | - Amélie Quesnel-Vallée
- Canada Research Chair in Policies and Health Inequalities, Professor, Department of Epidemiology, Biostatistics and Occupational Health, Department of Sociology, McGill University, Montréal, QC
| | - William Montelpare
- Margaret and Wallace McCain Chair in Human Development and Health, Professor, Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PEI
| | - Robin Urquhart
- Endowed Chair in Population Cancer Research, Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS
| | - Jason M Sutherland
- Professor, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC
| | - Yves Couturier
- Scientific Director and Réseau-1 Quebec Professor, École de travail social, Faculté des lettres et des sciences humaines, Université de Sherbrooke, Sherbrooke, QC
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5
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Haggerty J, Scott CM, Couturier Y, Quesnel-Vallée A, Dionne ÉM, Stewart T, Urquhart R, Montelpare W, Doucet S, Oelke ND. Connecting Health and Social Services for Patients with Complex Care Needs: A Pan-Canadian Comparative Policy Research Program. Healthc Policy 2023; 19:10-23. [PMID: 37850702 PMCID: PMC10594949 DOI: 10.12927/hcpol.2023.27182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Comprehensive primary healthcare for patients with complex care needs requires connections to other health services, social services and community supports. This descriptive comparative policy research program used publicly available documents and informant interviews to examine progress toward integrated comprehensive care through the lens of services needed by children and youth (0-25 years) and community-dwelling older adults (≥ 65 years) with high functional health needs. This article describes five projects. The following three findings emerged across all the projects: Canada indeed has multiple health systems; numerous integrated service delivery solutions are being trialled and most focus on medical services; and it is an ongoing challenge for ministries of health to engage physicians and physician associations in integration.
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Affiliation(s)
- Jeannie Haggerty
- McGill Research Chair in Family and Community Medicine, McGill University and St. Mary's Hospital Research Centre, Montréal, QC
| | - Catherine M Scott
- Adjunct Professor, University of Calgary and University of British Columbia-Okanagan, Executive Coach and Knowledge Mobilisation Consultant, K2A Consulting, Calgary, AB
| | - Yves Couturier
- Scientific Director and Réseau-1 Quebec Professor École de travail social, Faculté des lettres et des sciences humaines, Université de Sherbrooke, Sherbrooke, QC
| | - AméLie Quesnel-Vallée
- Canada Research Chair in Policies and Health Inequalities, Professor, Department of Epidemiology, Biostatistics and Occupational Health, Department of Sociology, McGill University, Montréal, Qc
| | - ÉMilie Dionne
- Researcher and Adjunct Professor, VITAM - Centre de recherche en santé durable, Department of Sociology, Faculty of Social Sciences, Laval University, Québec, QC
| | - Tara Stewart
- Assistant Professor, Department of Community Health Sciences, University of Manitoba, Researcher/Evaluator, George & Fay Yee Centre for Healthcare Innovation, Manitoba SPOR SUPPORT Unit, Winnipeg, MB
| | - Robin Urquhart
- Endowed Chair in Population Cancer Research, Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS
| | - William Montelpare
- Margaret and Wallace McCain Chair in Human Development and Health, Professor, Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, Pei
| | - Shelley Doucet
- Jarislowsky Chair in Interprofessional Patient-Centred Care, Associate Professor, Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB
| | - Nelly D Oelke
- Associate Professor, School of Nursing, Faculty of Health and Social Development, University of British Columbia, Okanagan, BC
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Platt JM, Nettel-Aguirre A, Bjornson CL, Mitchell I, Davis K, Bailey JM. Multidisciplinary coordination of care for children with esophageal atresia and tracheoesophageal fistula. J Child Health Care 2023:13674935231174503. [PMID: 37224564 DOI: 10.1177/13674935231174503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Esophageal Atresia/Tracheoesophageal Atresia (EA/TEF) is a multisystem congenital anomaly. Historically, children with EA/TEF lack coordinated care. A multidisciplinary clinic was established in 2005 to provide coordinated care and improve access to outpatient care. This single-center retrospective cohort study was conducted to describe our cohort of patients with EA/TEF born between March 2005 and March 2011, assess coordination of care, and to compare outcomes of children in the multidisciplinary clinic to the previous cohort without a multi-disciplinary clinic. A chart review identified demographics, hospitalizations, emergency visits, clinic visits, and coordination of outpatient care. Twenty-seven patients were included; 75.9% had a C-type EA/TEF. Clinics provided multidisciplinary care and compliance with the visit schedule was high with a median of 100% (IQR 50). Compared to the earlier cohort, the new cohort (N = 27) had fewer hospital admissions and LOS was reduced significantly in the first 2 years of life. Multidisciplinary care clinics for medically complex children can improve coordination of visits with multiple health care providers and may contribute to reduced use of acute care services.
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Affiliation(s)
- Jody M Platt
- Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alberto Nettel-Aguirre
- Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Candice L Bjornson
- Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Kathryn Davis
- Alberta Children's Hospital, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Ja Michelle Bailey
- Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
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Cohen E, Quartarone S, Orkin J, Moretti ME, Emdin A, Guttmann A, Willan AR, Major N, Lim A, Diaz S, Osqui L, Soscia J, Fu L, Gandhi S, Heath A, Fayed N. Effectiveness of Structured Care Coordination for Children With Medical Complexity: The Complex Care for Kids Ontario (CCKO) Randomized Clinical Trial. JAMA Pediatr 2023; 177:461-471. [PMID: 36939728 PMCID: PMC10028546 DOI: 10.1001/jamapediatrics.2023.0115] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Importance Children with medical complexity (CMC) have chronic conditions and high health needs and may experience fragmented care. Objective To compare the effectiveness of a structured complex care program, Complex Care for Kids Ontario (CCKO), with usual care. Design, Setting, and Participants This randomized clinical trial used a waitlist variation for randomizing patients from 12 complex care clinics in Ontario, Canada, over 2 years. The study was conducted from December 2016 to June 2021. Participants were identified based on complex care clinic referral and randomly allocated into an intervention group, seen at the next available clinic appointment, or a control group that was placed on a waitlist to receive the intervention after 12 months. Intervention Assignment of a nurse practitioner-pediatrician dyad partnering with families in a structured complex care clinic to provide intensive care coordination and comprehensive plans of care. Main Outcomes and Measures Co-primary outcomes, assessed at baseline and at 6, 12, and 24 months postrandomization, were service delivery indicators from the Family Experiences With Coordination of Care that scored (1) coordination of care among health care professionals, (2) coordination of care between health care professionals and families, and (3) utility of care planning tools. Secondary outcomes included child and parent health outcomes and child health care system utilization and cost. Results Of 144 participants randomized, 141 had complete health administrative data, and 139 had complete baseline surveys. The median (IQR) age of the participants was 29 months (9-102); 83 (60%) were male. At 12 months, scores for utility of care planning tools improved in the intervention group compared with the waitlist group (adjusted odds ratio, 9.3; 95% CI, 3.9-21.9; P < .001), with no difference between groups for the other 2 co-primary outcomes. There were no group differences for secondary outcomes of child outcomes, parent outcomes, and health care system utilization and cost. At 24 months, when both groups were receiving the intervention, no primary outcome differences were observed. Total health care costs in the second year were lower for the intervention group (median, CAD$17 891; IQR, 6098-61 346; vs CAD$37 524; IQR, 9338-119 547 [US $13 415; IQR, 4572-45 998; vs US $28 136; IQR, 7002-89 637]; P = .01). Conclusions and Relevance The CCKO program improved the perceived utility of care planning tools but not other outcomes at 1 year. Extended evaluation periods may be helpful in assessing pediatric complex care interventions. Trial Registration ClinicalTrials.gov Identifier: NCT02928757.
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Affiliation(s)
- Eyal Cohen
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Quartarone
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julia Orkin
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Myla E Moretti
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Abby Emdin
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Hospital, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrew R Willan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nathalie Major
- Department of Paediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Audrey Lim
- Department of Pediatrics, Hamilton Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada
| | - Sanober Diaz
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Lisa Osqui
- Provincial Council for Maternal and Child Health, Toronto, Ontario, Canada
| | - Joanna Soscia
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence M. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Anna Heath
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Statistical Science, University College London, London, United Kingdom
| | - Nora Fayed
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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Hall N, Rousseau N, Hamilton DW, Simpson AJ, Powell S, Brodlie M, Powell J. Providing care for children with tracheostomies: a qualitative interview study with parents and health professionals. BMJ Open 2023; 13:e065698. [PMID: 36720577 PMCID: PMC9890767 DOI: 10.1136/bmjopen-2022-065698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To explore the experience of caring for children with tracheostomies from the perspectives of parents and health professional caregivers. DESIGN Qualitative semistructured interview study. SETTING One region in England covered by a tertiary care centre that includes urban and remote rural areas and has a high level of deprivation. PARTICIPANTS A purposive sample of health professionals and parents who care for children who have, or have had, tracheostomies and who received care at the tertiary care centre. INTERVENTION Interviews undertaken by telephone or video link. PRIMARY AND SECONDARY OUTCOME MEASURES Qualitative reflexive thematic analysis with QSR Nvivo 12. RESULTS This paper outlines key determinants and mediators of the experiences of caregiving and the impact on psychological and physical health and quality of life of parents and their families, confidence of healthcare providers and perceived quality of care. For parents, access to care packages and respite care at home as well as communication and relationships with healthcare providers are key mediators of their experience of caregiving, whereas for health professionals, an essential influence is multidisciplinary team working and support. We also highlight a range of challenges focused on the shared care space, including: a lack of standardisation in access to different support teams, care packages and respite care, irregular training and updates, and differences in health provider expertise and experiences across departments and shift patterns, exacerbated in some settings by limited contact with children with tracheostomies. CONCLUSIONS Understanding the experiences of caregiving can help inform measures to support caregivers and improve quality standards. Our findings suggest there is a need to facilitate further standardisation of care and support available for parent caregivers and that this may be transferable to other regions. Potential solutions to be explored could include the development of a paediatric tracheostomy service specification, increasing use of paediatric tracheostomy specialist nurse roles, and addressing the emotional and psychological support needs of caregivers.
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Affiliation(s)
- Nicola Hall
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Surgical, Diagnostic and Devices Division, University of Leeds, Leeds, UK
| | - David W Hamilton
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - A John Simpson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Powell
- Department of Paediatric Otolaryngology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Malcolm Brodlie
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Respiratory Medicine, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Jason Powell
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Paediatric Otolaryngology, Great North Children's Hospital, Newcastle upon Tyne, UK
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Pollock MD, Ming D, Chung RJ, Maslow G. Parent-to-parent peer support for children and youth with special health care needs: Preliminary evaluation of a family partner program in a healthcare system. J Pediatr Nurs 2022; 66:6-14. [PMID: 35597132 DOI: 10.1016/j.pedn.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/16/2022] [Accepted: 05/06/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE Children and youth with special health care needs (CYSHCN) have complex care and coordination needs that are often managed by parents or primary caregivers. This study describes a parent-to-parent peer support pilot program for parents of CYSHCN implemented in both outpatient and inpatient settings across a large health system. DESIGN & METHODS Retrospective data from the Family Partner Program documentation in patient health records are described. Descriptions about the encounters and types of support provided are also reviewed using qualitative descriptive analysis. RESULTS Three Family Partners conducted 203 encounters with parents of 90 CYSHCN over six months. Family Partners provided both emotional and tangible support. Primary themes discussed included the persistent care, coordination and management needs related to parenting a child with complex care needs, the subsequent worry and stress about their child and family, and the need for stress management and self-care. CONCLUSION This study provides early evidence that implementation of a parent-to-parent peer support program for parents of CYSHCN in a large, academic medical center is feasible. Family Partners enhanced their healthcare team's ability to provide patient- and family-centered support for pediatric patients and their families through the provision of emotional and tangible support. PRACTICE IMPLICATIONS Family Partners, who are trained in effective use of the shared experience, the health coach model, and healthcare systems, and who are supported by a strong supervisory team, are ideally suited to support families and patients as they address their concerns and unmet needs and navigate complex health circumstances.
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Affiliation(s)
- McLean D Pollock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America.
| | - David Ming
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States of America
| | - Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States of America
| | - Gary Maslow
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America; Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States of America
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Peters VJT, Bok LA, de Beer L, van Rooij JJM, Meijboom BR, Bunt JEH. Destination unknown: Parents and healthcare professionals' perspectives on transition from paediatric to adult care in Down syndrome. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1208-1216. [PMID: 35665576 PMCID: PMC9546452 DOI: 10.1111/jar.13015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 05/10/2022] [Accepted: 05/20/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Transitioning from paediatric medical care to adult care is a challenging process for children, parents and healthcare professionals. The aim of this study was to explore the experiences, concerns and needs of parents of children with Down syndrome and of professionals regarding this transition. METHOD A qualitative study was performed using semi-structured interviews with 20 parents of children with Down syndrome and six healthcare professionals. RESULTS We showed that parents and professionals have concerns during each of the three distinct phases of transition (preparation, transfer and integration). Data disclose specific concerns regarding communication, continuity of care and rebuilding trust. We propose a framework for the transition to adult care. CONCLUSIONS The transition in medical care for children with Down syndrome should be flexible, patient-centred and coordinated together with patients and parents. Only in ensuring continuity of care will individuals with Down syndrome not get lost in transition.
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Affiliation(s)
- Vincent J T Peters
- Department of Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, The Netherlands.,Department of Internal Medicine, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Levinus A Bok
- Department of Paediatrics, Máxima Medisch Centrum, Veldhoven, The Netherlands
| | - Lieke de Beer
- Department of Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, The Netherlands
| | - Joyce J M van Rooij
- Department of Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, The Netherlands
| | - Bert R Meijboom
- Department of Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, The Netherlands.,Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Noord-Brabant, The Netherlands.,Department of Marketing, Innovation and Organization, Ghent University, Ghent, Belgium
| | - Jan Erik H Bunt
- Department of Paediatrics, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
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11
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Thevathasan N, Luck KE, Luke A, Doucet S. Perceptions and experiences of care providers as clients of NaviCare/SoinsNavi: a patient navigation centre for children and youth with complex care needs. INTEGRATED HEALTHCARE JOURNAL 2022. [DOI: 10.1136/ihj-2020-000072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
ObjectiveNaviCare/SoinsNavi is a bilingual patient navigation centre for children and youth 25 years of age or younger with complex care needs in New Brunswick. This research-based centre employs two bilingual patient navigators, one a registered nurse and the other a lay navigator, who assist children/youth, family members and the care team by facilitating more convenient and integrated care using a personalised family-centred approach. The purpose of this study was to explore the perceptions and experiences of care providers who use NaviCare/SoinsNavi. This study builds on ongoing research exploring the experiences of children/youth and their families who are clients of NaviCare/SoinsNavi.MethodsInterviews were conducted with 10 care providers (n=10) from various sectors including social support services (n=6), primary care (n=2), mental health services (n=1) and acute care (n=1).ResultsQualitative interviews were conducted and five themes related to the participants’ perceptions and experiences with NaviCare/SoinsNavi emerged, including : (1) trusted source, (2) connector, (3) capacity builder, (4) partner and (5) time saver. The overall impression of NaviCare/SoinsNavi was positive in the service’s ability to help support care providers and streamline the care they provide to their clients.ConclusionsIt is within every healthcare provider’s scope of practice to provide navigational support to essential programmes and services; however, due to limitations in time, resources and capacity, services such as NaviCare/SoinsNavi can be used to help close gaps in care that exists for children/youth with complex care needs and their families.
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Implementing a Care Coordination Strategy for Children with Medical Complexity in Ontario, Canada: A Process Evaluation. Int J Integr Care 2022; 22:9. [PMID: 35582499 PMCID: PMC9053529 DOI: 10.5334/ijic.6073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 04/11/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: A provincial strategy to expand care coordination and integration of care for children with medical complexity (CMC) was launched in Ontario, Canada in 2015. A process evaluation of the roll-out examined the processes, mechanisms of impact, and contextual factors affecting the implementation of the Complex Care for Kids Ontario (CCKO) intervention strategy. Methods: This process evaluation was conducted and analyzed according to the United Kingdom Medical Research Council (UK-MRC) process evaluation framework. To evaluate the implementation of the CCKO intervention, a multi-method study design was used, including semi-structured interviews with 38 key informants and 10 families of CMC involved in CCKO. To further understand implementation details across regional sites, provincial-level implementation plans, and process documents were reviewed. Discussion: Strengths of CCKO included novel collaborations and partnerships between complex care teams, community partners and regional sites. Issues relating to communication and coordination across care sectors created challenges to holistic care coordination objectives. Provincial system fragmentation limited the ability of CCKO to provide seamless care coordination due to the multiple care sectors involved. Conclusion: This study adds to the understanding of the processes involved in a population-level care coordination intervention for CMC. Lessons learned through CCKO can help facilitate reproducibility and necessary adjustments of the intervention in different settings.
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Doucet S, Luke A, Anthonisen G, Witherspoon R, MacNeill AL, MacNeill L, Kelly KJ, Fearon T. Hospital-based patient navigation programmes for patients who experience injury-related trauma and their caregivers: a scoping review protocol. BMJ Open 2022; 12:e055750. [PMID: 35459669 PMCID: PMC9036420 DOI: 10.1136/bmjopen-2021-055750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Patients who experience injury-related trauma tend to have complex care needs and often require support from many different care providers. Many patients experience gaps in care while in the hospital and during transitions in care. Providing access to integrated care can improve outcomes for these patients. Patient navigation is one approach to improving the integration of care and proactively supporting patients and their caregivers as they navigate the healthcare system. The objective of this scoping review is to map the literature on the characteristics and impact of hospital-based patient navigation programmes that support patients who experience injury-related trauma and their caregivers. METHODS AND ANALYSIS This review will be conducted in accordance with Joanna Briggs Institute methodology for scoping reviews. The review will include primary research studies, unpublished studies and evaluation reports related to patient navigation programmes for injury-related trauma in hospital settings. The databases to be searched will include CINAHL (EBSCO), EMBASE (Elsevier), ProQuest Nursing & Allied Health, PsycINFO (EBSCO) and MEDLINE (Ovid). Two independent reviewers will screen articles for relevance against the inclusion criteria. Results will be presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews (PRISMA-ScR) flow diagram and follow the PRISMA-ScR checklist. The extracted data will be presented both tabularly and narratively. ETHICS AND DISSEMINATION Ethics approval is not required, as the scoping review will synthesise information from publicly available material. To disseminate the findings of this review, the authors will submit the results for publication in a medical or health sciences journal, present at relevant conferences and use other knowledge translation strategies to reach diverse stakeholders (eg, host webinars, share infographics).
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Affiliation(s)
- Shelley Doucet
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, New Brunswick, Canada
| | - Alison Luke
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, New Brunswick, Canada
| | - Grailing Anthonisen
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Richelle Witherspoon
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, New Brunswick, Canada
- University of New Brunswick Libraries, University of New Brunswick Fredericton, Fredericton, New Brunswick, Canada
| | - A Luke MacNeill
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Lillian MacNeill
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Katherine J Kelly
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Taylor Fearon
- Centre for Research in Integrated Care, University of New Brunswick, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
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Daae E, Feragen KB, Sitek JC, von der Lippe C. It's more than just lubrication of the skin: parents' experiences of caring for a child with ichthyosis. Health Psychol Behav Med 2022; 10:335-356. [PMID: 35402085 PMCID: PMC8986293 DOI: 10.1080/21642850.2022.2053685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The ichthyoses are a group of genetic skin disorders, characterized by excessive amounts of dry, thickened skin, which may be fragile, inelastic and prone to fissures and infection. Skin care is time consuming and demanding, and, usually performed by the parents. Methods: We aimed to explore parental experience of caring for a child with ichthyosis, and collected data using semistructured interview, and thematic analysis. Results: Our analysis revealed four main themes: Parents' and others' reactions to the child's difference, Experiences with healthcare services, It's all skin care, and Impact on relationships. Conclusion: After birth of a child with severe ichthyosis, the parents experienced emotional distress and stigmatization due to the different appearance of the skin and healthcare professionals' lack of knowledge. Skin care caused pain in the child, was time consuming, and caused financial burdens. This study can guide healthcare professionals on where to focus future efforts in meeting the clinical and psychological needs of parents caring for a child with ichthyosis.
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Affiliation(s)
- Elisabeth Daae
- Center for Rare Disorders, Oslo University Hospital HF, Oslo, Norway
| | | | - Jan C Sitek
- Department of Dermatology, Oslo University Hospital HF, Oslo, Norway
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A pilot study of disease related education and psychotherapeutic support for unresolved grief in parents of children with CF. Sci Rep 2022; 12:5746. [PMID: 35388038 PMCID: PMC8987037 DOI: 10.1038/s41598-022-09463-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 03/14/2022] [Indexed: 12/21/2022] Open
Abstract
Diagnosis of chronic disease in a child can result in unresolved grief (UG) in parents. This study aimed to evaluate the efficacy of psychological insight-oriented therapy (IOT) as a treatment for UG compared to disease related education in parents of children with cystic fibrosis (CF). Sequence of delivery, first IOT then disease related education (or vice versa) was also examined, to let all participants experience both interventions. Parents were screened for UG. Parents with UG were randomised to either five 1-h sessions of IOT or five 1-h sessions of education. Measures were assessed pre-intervention, after the first intervention period (primary efficacy assessment), and after the second intervention period (swapping intervention). Forty-seven parents were screened of which 46.8% (22/47) had UG. Median duration of UG was 5 years (range: 6 months–14 years). Anxiety (50% vs. 20%, p = 0.03) and stress (59% vs. 28%, p = 0.03) were significantly more prevalent in parents with UG. There was no difference between arms in the odds of UG resolving either following the first intervention period (OR 0.88; 95% CI 0.5, 1.5) or the second intervention period (OR 0.91; 95% CI 0.5, 1.6). While not statistically significant, adjusted mean values for seven of the eight mental health measures were lower in the IOT (first) arm compared to the ED (first) arm, following the first intervention period. UG is a significant burden for families affected by CF. Provision of disease related education and psychological support, regardless of sequence, can result in resolution of grief. Trial registration number: ACTRN12621000796886, date of registration 24/06/2021, retrospectively registered.
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Chow AJ, Iverson R, Lamoureux M, Tingley K, Jordan I, Pallone N, Smith M, Al-Baldawi Z, Chakraborty P, Brehaut J, Chan A, Cohen E, Dyack S, Gillis LJ, Goobie S, Graham ID, Greenberg CR, Grimshaw JM, Hayeems RZ, Jain-Ghai S, Jolly A, Khangura S, MacKenzie JJ, Major N, Mitchell JJ, Nicholls SG, Pender A, Potter M, Prasad C, Prosser LA, Schulze A, Siriwardena K, Sparkes R, Speechley K, Stockler S, Taljaard M, Teitelbaum M, Trakadis Y, van Karnebeek C, Walia JS, Wilson BJ, Wilson K, Potter BK. Families' healthcare experiences for children with inherited metabolic diseases: protocol for a mixed methods cohort study. BMJ Open 2022; 12:e055664. [PMID: 35193919 PMCID: PMC8867352 DOI: 10.1136/bmjopen-2021-055664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Children with inherited metabolic diseases (IMDs) often have complex and intensive healthcare needs and their families face challenges in receiving high-quality, family centred health services. Improvement in care requires complex interventions involving multiple components and stakeholders, customised to specific care contexts. This study aims to comprehensively understand the healthcare experiences of children with IMDs and their families across Canada. METHODS AND ANALYSIS A two-stage explanatory sequential mixed methods design will be used. Stage 1: quantitative data on healthcare networks and encounter experiences will be collected from 100 parent/guardians through a care map, 2 baseline questionnaires and 17 weekly diaries over 5-7 months. Care networks will be analysed using social network analysis. Relationships between demographic or clinical variables and ratings of healthcare experiences across a range of family centred care dimensions will be analysed using generalised linear regression. Other quantitative data related to family experiences and healthcare experiences will be summarised descriptively. Ongoing analysis of quantitative data and purposive, maximum variation sampling will inform sample selection for stage 2: a subset of stage 1 participants will participate in one-on-one videoconference interviews to elaborate on the quantitative data regarding care networks and healthcare experiences. Interview data will be analysed thematically. Qualitative and quantitative data will be merged during analysis to arrive at an enhanced understanding of care experiences. Quantitative and qualitative data will be combined and presented narratively using a weaving approach (jointly on a theme-by-theme basis) and visually in a side-by-side joint display. ETHICS AND DISSEMINATION The study protocol and procedures were approved by the Children's Hospital of Eastern Ontario's Research Ethics Board, the University of Ottawa Research Ethics Board and the research ethics boards of each participating study centre. Findings will be published in peer-reviewed journals and presented at scientific conferences.
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Affiliation(s)
- Andrea J Chow
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ryan Iverson
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Nicole Pallone
- Patient Partner, Canadian PKU & Allied Disorders Inc, Toronto, Ontario, Canada
| | - Maureen Smith
- Patient Partner, Canadian Organization for Rare Disorders, Toronto, Ontario, Canada
| | - Zobaida Al-Baldawi
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Pranesh Chakraborty
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jamie Brehaut
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alicia Chan
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Eyal Cohen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Dyack
- Division of Medical Genetics, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lisa Jane Gillis
- Department of Medicine, Johns Hopkins All Children's Hospital, St Petersburg, Florida, USA
| | - Sharan Goobie
- Division of Medical Genetics, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Cheryl R Greenberg
- Rady Faculty of Health Sciences, Max Rady College of Medicine, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Robin Z Hayeems
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Shailly Jain-Ghai
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Ann Jolly
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Contagion Consulting Group, Ottawa, Ontario, Canada
| | - Sara Khangura
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer J MacKenzie
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Nathalie Major
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - John J Mitchell
- Division of Pediatric Endocrinology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amy Pender
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Murray Potter
- Hamilton Health Sciences, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Chitra Prasad
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Lisa A Prosser
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Andreas Schulze
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Department of Biochemistry, University of Toronto, Toronto, ON, Canada
- Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Komudi Siriwardena
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Rebecca Sparkes
- Departments of Medical Genetics and Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Kathy Speechley
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Sylvia Stockler
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mari Teitelbaum
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Yannis Trakadis
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Clara van Karnebeek
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Jagdeep S Walia
- Medical Genetics, Department of Pediatrics, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Brenda J Wilson
- Faculty of Medicine Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Thevathasan N, Flood KE, Luke A, Campbell SA, Doucet S, Gander S. Caregiver's Perspectives on the Healthcare Experiences of Children With Behaviour-Related Disorders. Cureus 2022; 14:e22084. [PMID: 35308696 PMCID: PMC8920816 DOI: 10.7759/cureus.22084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/07/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Social Pediatrics focuses on targeting and mitigating the effects of the social determinants of health on a child’s well-being and development. Negative health outcomes have been seen in children who have faced poverty, food insecurity, inadequate housing, and traumatic events. In particular, children who come from socioeconomically disadvantaged households are more likely to develop behavioural problems. The purpose of this study is to explore the experiences of caregivers for children with a behaviour-related disorder. This includes children affected by attention, academic, and social issues (e.g. attention-deficit hyperactivity disorder, autism spectrum disorder). This study will aim to understand the strengths, barriers, and social limitations to accessing and receiving care for children with behavioural disorders. Methods: A qualitative descriptive design was used to conduct three focus groups. Of the 64 caregivers contacted, a total of 13 participants agreed to be in the study. All focus groups were analyzed using inductive thematic analysis. Results: Preliminary findings suggest that caregivers value pediatricians who spend time, communicate, and make a human connection with their patients. Barriers included physician turnover, long wait times for referrals, and a lack of knowledge regarding services and programs available in their area. Three major themes emerged from this study including (1) timeliness to care, (2) advocacy, and (3) relationship building. Conclusion: Findings suggested that caregivers valued pediatricians who spend time to make a human connection with their patients. Barriers included physician turnover, long wait times for referrals, and a lack of knowledge of available services. Caregivers who were young mothers felt an added layer of judgement when accessing the necessary care for their children. This study is important as it contributes to our knowledge on the role Social Pediatrics can play in the care of children with behaviour-related disorders.
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Leibring I, Anderzén‐Carlsson A. Young children's experiences of support when fearful during treatment for acute lymphoblastic leukaemia-A longitudinal interview study. Nurs Open 2022; 9:527-540. [PMID: 34651461 PMCID: PMC8685861 DOI: 10.1002/nop2.1092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/31/2021] [Accepted: 09/29/2021] [Indexed: 11/11/2022] Open
Abstract
AIM AND OBJECTIVES To describe young children's experiences of valuable support in managing their fears about treatment for acute lymphoblastic leukaemia. The focus was specifically on support from parents and healthcare professionals. DESIGN The study had a qualitative descriptive longitudinal design. METHODS The study analysed 35 interviews with 13 children at three different times during their treatment period. Data were analysed using a matrix-based method. The Consolidated criteria for reporting qualitative research (COREQ) guidelines have been followed. RESULTS Parents and healthcare professionals provide important support to children undergoing treatment for acute lymphoblastic leukaemia, although their roles differ. Children valued their parents' closeness and advocacy, being able to participate in their own care, and being given pain relief during procedures known to create pain. Valued support from healthcare professionals changed over time, from providing information and showing the tools that would be used in procedures, to paying attention to the child's needs and desires. It was more important for children to be able to choose between different alternatives in medical procedures than deciding on major treatment issues.
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Affiliation(s)
- Ingela Leibring
- Institution for HealthFaculty of Health, Science and TechnologyKarlstad UniversityKarlstadSweden
| | - Agneta Anderzén‐Carlsson
- University Health Care Research CenterFaculty of Medicine and HealthÖrebro UniversityÖrebroSweden
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Thomas J, Santurri L, Borrero L, Cech D. Perceptions of the caregiver-pediatric physical therapist relationship1. J Pediatr Rehabil Med 2022; 15:507-516. [PMID: 36057801 DOI: 10.3233/prm-210081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Collaboration between physical therapists and caregivers of children who receive physical therapy is integral to providing family-centered care. Successful collaboration depends upon the therapeutic relationship built within the caregiver-therapist dyad. However, the nature of these relationships is not well understood. The purpose of this study was to explore the caregiver-pediatric physical therapist relationship from the perspectives of the caregiver and pediatric physical therapist. METHODS A qualitative multiple case study methodology was used; a caregiver and pediatric physical therapist represented a bounded case. Each caregiver and therapist engaged in separate, semi-structured, in-depth interviews. RESULTS Through within- and cross-case coding, three themes were identified: physical therapist as a guide, the caregiver-pediatric physical therapist connection, and professional qualities and performance. CONCLUSION These themes help to provide an understanding of the therapeutic relationships that can occur between caregivers and pediatric physical therapists, which can help support effective collaboration as part of providing family-centered care.
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Affiliation(s)
- Jodi Thomas
- School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
| | - Laura Santurri
- Department of Interprofessional Health & Aging Studies, University of Indianapolis, Indianapolis, IN, USA
| | - Lisa Borrero
- Department of Interprofessional Health & Aging Studies, University of Indianapolis, Indianapolis, IN, USA
| | - Donna Cech
- Department of Physical Therapy, Midwestern University, Downers Grove, IL, USA
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Ong KS, Reeder M, Alriksson-Schmidt AI, Rice S, Feldkamp ML. Parents' report on the health care management of spina bifida in early childhood. J Pediatr Rehabil Med 2022; 15:621-631. [PMID: 36530103 PMCID: PMC10964179 DOI: 10.3233/prm-220027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study aimed to describe health care use by type of health providers and care settings visited by children with spina bifida (SB) and to compare this use between children with and without a shunt. METHODS Health care use data were extracted from a larger study on the health and functioning of children with SB aged 3-6 years. The present study focused on the medical information subsection of a parent-reported survey related to SB care, general care, specialty care (e.g., neurosurgery), emergency care, and complications related to SB and shunts. RESULTS Parents of 101 children with SB participated. Most of the children were male with myelomeningocele and had a shunt. They visited a health care provider for SB care an average of 7.4 times and a specialist an average of 11.9 times in the previous 12 months. Most visited a multidisciplinary clinic for SB-related care and a private physician's office for general care. Children with a shunt had more SB-related medical visits, more visits to a specialist, and a greater number of different types of specialists than those without it. Frequency of emergency room visits did not differ between the two groups. Health providers informed parents about headaches, vomiting, and fever as signs of complications, and some parents did report shunt-related complications. CONCLUSION SB is a complex medical condition requiring that children receive medical care from various medical specialists, especially for children with a shunt. Findings on health care use suggest high levels of monitoring and care coordination that parents navigate to care for their child.
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Affiliation(s)
- Katherine S. Ong
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew Reeder
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA
| | - Ann I. Alriksson-Schmidt
- Orthopedics, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sydney Rice
- Department of Pediatrics, University of Arizona, Tucson, AZ, USA
| | - Marcia L. Feldkamp
- Department of Pediatrics, Division of Medical Genetics, University of Utah, Salt Lake City, UT, USA
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Yu J, Cook S, Imming C, Knezevich L, Ray K, Houtrow A, Rosenberg AR, Schenker Y. A Qualitative Study of Family Caregiver Perceptions of High-Quality Care at a Pediatric Complex Care Center. Acad Pediatr 2022; 22:107-115. [PMID: 34020106 PMCID: PMC9979253 DOI: 10.1016/j.acap.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Pediatric complex care centers are an increasingly common approach to address the needs of children with medical complexity (CMC). We sought to better understand CMC caregivers' perceptions of what constitutes high-quality care at a complex care center. METHODS We conducted a cross-sectional qualitative study of family caregivers of CMC receiving care at a pediatric complex care center situated within a tertiary-care children's hospital. In-depth, semistructured interviews focused on caregivers' general experiences at the clinic, positive and negative experiences related to core components of the pediatric medical home, and recommendations for improvements. We thematically analyzed transcripts through a mixed inductive and deductive approach, using constant comparative methodology, with the pediatric medical home model as an organizing framework. RESULTS We conducted interviews with 20 participants (18 [90%] biological parents; 19 [95%] female; mean age 39 years) in outpatient settings. Caregivers described 2 major themes: 1) the value of having a clinician "quarterback" who is in-charge of their child's care and caregivers' go-to for questions and concerns, and 2) wanting clinicians who are personally invested in and willing to "go above and beyond" for their child. Participants discussed how and which components of the medical home model enable CMC clinicians to meet these needs. CONCLUSIONS Family caregivers of CMC want clinicians who take responsibility for managing their child's overall care and demonstrate personal commitment to ensuring their child's well-being. Multiple aspects of the medical home framework, rather than care coordination alone, help meet caregivers' perceptions of high-quality complex care.
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Affiliation(s)
- Justin Yu
- Department of Pediatrics, Division of Pediatric Hospital Medicine; University of Pittsburgh School of Medicine, Pittsburgh, PA,Palliative Research Center (PaRC), University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Stacey Cook
- Department of General Pediatrics, Division of Complex Care, Boston Children’s Hospital, Boston MA
| | - Christina Imming
- Department of Pediatrics, Division of Pediatric Hospital Medicine; University of Pittsburgh School of Medicine, Pittsburgh, PA,Complex Care Center of UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA,Department of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Liana Knezevich
- Complex Care Center of UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Kristin Ray
- Department of Pediatrics, Division of General Academic Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Amy Houtrow
- Department of Physical Medicine and Rehabilitation, Division of Pediatric Rehabilitation Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Abby R. Rosenberg
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA,Palliative Care and Resilience Lab, Seattle Children’s Research Institute, Seattle, WA
| | - Yael Schenker
- Palliative Research Center (PaRC), University of Pittsburgh School of Medicine, Pittsburgh, PA,Division of General Internal Medicine, Section of Palliative Care and Medical Ethics; University of Pittsburgh School of Medicine, Pittsburgh, PA
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22
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Chakraborti M, Gitimoghaddam M, McKellin WH, Miller AR, Collet JP. Understanding the Implications of Peer Support for Families of Children With Neurodevelopmental and Intellectual Disabilities: A Scoping Review. Front Public Health 2021; 9:719640. [PMID: 34888278 PMCID: PMC8649771 DOI: 10.3389/fpubh.2021.719640] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Families are integrally involved in day-to-day caregiving of children with neurodevelopmental and intellectual disabilities (NDID). Given the widespread and increasing prevalence of children with NDID and the impact of family caregiving on psychological, social, and economic implications for both the child and family, understanding and supporting these families is an important public health concern. Objective: We conducted a scoping review on peer support networks to understand their implications on families. Considering increasing prevalence of NDID's, understanding the implications of existing networks is critical to improve and nurture future support networks that can complement and reduce the burden on existing formal support systems. Design: A comprehensive search of multiple databases was conducted. Articles were screened by two reviewers and any disagreements were resolved by a third reviewer. We explored existing research on parent-to-parent peer support networks, which included networks that developed informally as well as those that involved a formal facilitator for the group interpersonal processes. There were no limits on the study design, date and setting of the articles. We included all research studies in English that included an identifier for (i) "peer support networks," (ii) "children with neurodevelopmental and intellectual disabilities" and (iii) "family caregiver outcomes." Results: We identified 36 articles. Majority of the studies were conducted in North America, and were face to face networks. They included families of children with a wide range of NDIDs. Relevant information extracted from different studies highlighted peer support network characteristics and development process, needs of family caregivers attending these networks, factors affecting caregiver participation and the impact of peer support networks on family caregivers. These networks represent a way to strengthen family caregivers, developing resilience and social interactions. Family caregivers sharing similar experiences support one another and provide critical information to each other. Although results are encouraging, future studies incorporating improved study designs are needed to better evaluate the effectiveness of peer support networks. Furthermore, studies where peer support networks develop organically while the child is supported are warranted. Conclusion: Although results obtained are encouraging, our findings support the need for further research studies of peer support networks with better designs and more detailed description of the factors involved in the development.
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Affiliation(s)
- Michelle Chakraborti
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mojgan Gitimoghaddam
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - William H. McKellin
- Department of Anthropology, University of British Columbia, Vancouver, BC, Canada
| | - Anton Rodney Miller
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Paul Collet
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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23
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Van Speybroeck A, Beierwaltes P, Hopson B, McKee S, Raman L, Rao R, Sherlock R. Care coordination guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2021; 13:499-511. [PMID: 33285645 PMCID: PMC7838978 DOI: 10.3233/prm-200738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a person's care to facilitate the appropriate delivery of health care services. Organizing care involves the marshalling of personnel and other resources needed to carry out all required patient care activities. It is often managed by the exchange of information among participants responsible for different aspects of care [1]. With an estimated 85% of individuals with Spina Bifida (SB) surviving to adulthood, SB specific care coordination guidelines are warranted. Care coordination (also described as case management services) is a process that links them to services and resources in a coordinated effort to maximize their potential by providing optimal health care. However, care can be complicated due to the medical complexities of the condition and the need for multidisciplinary care, as well as economic and sociocultural barriers. It is often a shared responsibility by the multidisciplinary Spina Bifida team [2]. For this reason, the Spina Bifida Care Coordinator has the primary responsibility for overseeing the overall treatment plan for the individual with Spina Bifida[3]. Care coordination includes communication with the primary care provider in a patient's medical home. This article discusses the Spina Bifida Care Coordination Guideline from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida and explores care coordination goals for different age groups as well as further research topics in SB care coordination.
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Affiliation(s)
| | | | - Betsy Hopson
- Children’s Hospital of Alabama, Birmingham, AL, USA
| | - Suzanne McKee
- Orlando Health Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Lisa Raman
- Nursing Committee and Educational Initiatives, Worldwide Syringomyelia and Chiari Task Force, Lawrenceville, GA, USA
- Spina Bifida Association, Patient and Clinical Services, Lawrenceville, GA, USA
| | - Ravindra Rao
- Loma Linda University Medical Center, Loma Linda, CA, USA
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24
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Lin JLL, Quartarone S, Aidarus N, Chan CY, Hubbert J, Orkin J, Fayed N, Major N, Soscia J, Lim A, French SD, Moretti ME, Cohen E. Process Evaluation of a Hub-and-Spoke Model to Deliver Coordinated Care for Children with Medical Complexity across Ontario: Facilitators, Barriers and Lessons Learned. Healthc Policy 2021; 17:104-122. [PMID: 34543180 PMCID: PMC8437255 DOI: 10.12927/hcpol.2021.26574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Complex Care for Kids Ontario (CCKO) is a multi-year strategy aimed at expanding a hub-and-spoke model to deliver coordinated care for children with medical complexity (CMC) across Ontario. Objective: This paper aims to identify the facilitators, barriers and lessons learned from the implementation of the Ontario CCKO strategy. Method: Alongside an outcome evaluation of the CCKO strategy, we conducted a process evaluation to understand the implementation context, process and mechanisms. Semi-structured interviews were conducted with 38 healthcare leaders, clinicians and support staff from four regions involved in CCKO care delivery and/or governance. Results: Facilitators to CCKO implementation were sustained engagement of system-wide stakeholders, inter-organizational partnerships, knowledge sharing and family engagement. Barriers to CCKO implementation were resources and funding, fragmentation of care, aligning perspectives between providers and clinical staff recruitment and retention. Conclusion: A flexible approach is required to implement a complex, multi-centre policy strategy. Other jurisdictions considering such a model of care delivery would benefit from attention to contextual variations in implementation setting, building cross-sector engagement and buy-in, and offering continuous support for modifications to the intervention as and when required.
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Affiliation(s)
- Jia Lu Lilian Lin
- PhD Candidate, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Samantha Quartarone
- Clinical Research Project Coordinator, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - Nasra Aidarus
- Senior Program Manager, Provincial Council for Maternal and Child Health, Toronto, ON
| | - Carol Y Chan
- Clinical Research Project Manager, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - Jackie Hubbert
- Clinical Director, Labatt Family Heart Centre and Critical Care Services, The Hospital for Sick Children, Toronto, ON
| | - Julia Orkin
- Medical Officer, Integrated Community Partnerships and Complex Care Program, The Hospital for Sick Children; Associate Professor, Department of Paediatrics, University of Toronto, Toronto, ON
| | - Nora Fayed
- Assistant Professor, School of Rehabilitation Therapy, Queen's University, Kingston, ON
| | - Nathalie Major
- Medical Director, Champlain Complex Care Program, Children's Hospital of Eastern Ontario; Assistant Professor, Department of Paediatrics, University of Ottawa, Ottawa, ON
| | - Joanna Soscia
- Nurse Practitioner and Clinical Practice Lead, Complex Care Program, The Hospital for Sick Children, Toronto, ON
| | - Audrey Lim
- Medical Lead, Complex Care Program, McMaster Children's Hospital - Hamilton Health Sciences; Associate Professor, Department of Pediatrics, McMaster University, Hamilton, ON
| | - Simon D French
- Professor, Department of Chiropractic, Faculty of Science and Engineering, Macquarie University, Sydney, Australia
| | - Myla E Moretti
- Health Economist and Senior Research Associate, Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, ON
| | - Eyal Cohen
- Professor, Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto; Senior Scientist and Program Head, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
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25
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Penela-Sánchez D, Ricart S, Vidiella N, García-García JJ. A study of paediatric patients with complex chronic conditions admitted to a paediatric department over a 12 month period. An Pediatr (Barc) 2021; 95:233-239. [PMID: 34479836 DOI: 10.1016/j.anpede.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/09/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The number of patients with complex chronic conditions (CCC) has increased in the last 20 years or so. There is limited data as regards the prevalence of CCC in the paediatric population and its impact on hospital admissions. The main objectives of this study are to determine the proportion of CCC in the paediatric hospital population and compare them with other groups of patients admitted (acute and chronic). PATIENTS AND METHODS A descriptive, retrospective study was carried out in a tertiary maternity-paediatric hospital (from December 2016 to November 2017). All patients admitted into the Paediatric Department were recruited with a fortnightly frequency. A series of demographic, clinical, and pregnancy data were collected. In order to identify the level of complexity of the patients, the Clinical Risk Group (CRG) was used, with 3 groups being created: acute, chronic, and CCC. Statistics analysis was performed using SPSS v24. RESULTS A total of 1433 patients were included. The proportion of CCC on the Paediatric Ward was 14.4%. The CCC were older patients, mainly admitted due to decompensation or progression of their underlying disease, had a longer admission time, and required support in the Paediatric Intensive Care Unit (PICU) more often than that of the other sub-groups. Just under half (44.7%) of the CCC were carriers of a technological device. Of the total of long stays (>1 month), 71.3% had CCC. CONCLUSIONS Patients with CCC require long hospital stays, a greater need of intensive care, and use of technology. New approaches to treatment and follow-up need to be established. They should be cost-effective, and at the same time decrease the impact of the disease on the children and their family.
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Affiliation(s)
| | - Sílvia Ricart
- Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Nereida Vidiella
- Servicio de Pediatría, Hospital Verge de la Cinta, Tortosa (Tarragona), Spain
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26
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Hu J, Wang Y, Li X. Continuity of Care in Chronic Diseases: A Concept Analysis by Literature Review. J Korean Acad Nurs 2021; 50:513-522. [PMID: 32895338 DOI: 10.4040/jkan.20079] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/17/2020] [Accepted: 07/10/2020] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to utilize concept analysis to obtain a better understanding of the concept of "continuity of care" in chronic diseases. METHODS The concept of continuity of care was analyzed using the Walker and Avant method. Covering literature in English from 1930 to 2018, the data sources included CINAHL Complete, Academic Search Complete, MEDLINE, PsyARTICLES, Health Source: Nursing/Academic Edition, Google Scholar, Science Direct, and the Cochrane Library. RESULTS A comprehensive definition of concept of continuity of care was developed based on a systematic search and synthesis. The key defining attributes were identified as (a) care over time, (b) the relationship between an individual patient and a care team, (c) information transfer, (d) coordination, and (e) meeting changing needs. The antecedents of continuity of care were having a chronic disease, inexperienced with disease management, a poorly coordinated healthcare system, and medical care limitations. The consequences of continuity of care were decreasing hospital admissions, reducing costs, reducing emergency room visits, improving the quality of life, improving patient satisfaction, and delivering good healthcare. CONCLUSION The thorough concept analysis provides insight into the nature of "continuity of care" in chronic diseases and also helps ground the concept in healthcare.
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Affiliation(s)
- Jingjing Hu
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China.
| | - Yuexia Wang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Xiaoxi Li
- Department of Nursing, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
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27
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Young J, Poole U, Mohamed F, Jian S, Williamson M, Ross J, Jaye C, Radue P, Egan T. Exploring the value of social network 'care maps' in the provision of long-term conditions care. Chronic Illn 2021; 17:95-110. [PMID: 30884966 DOI: 10.1177/1742395319836463] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES There is renewed attention to the role of social networks as part of person-centred long-term conditions care. We sought to explore the benefits of 'care maps' - a patient-identified social network map of their care community - for health professionals in providing person-centred care. METHODS We piloted care maps with 39 patients with long-term conditions in three urban and one rural general practice and two hospital wards. We interviewed the health professionals (n = 39) of these patients about what value, if any, care maps added to patient care. We analysed health professional interview data using thematic analysis to identify common themes. RESULTS Health professionals all said they learned about their patients as a person-in-context. There was an increased understanding of patients' support networks, synthesising what is known and unknown. Health professionals understood patients' perceptions of health professionals and what really mattered to patients. There was discussion about the therapeutic value of care maps. The maps prompted reflection on practice. DISCUSSION Care maps facilitated a broader focus than the clinical presentation. Using care maps may enable health professionals to support self-management rather than feeling responsible for many aspects of care. Care maps had 'social function' for health professionals. They may be a valuable tool for patients and clinicians to bridge the gap between medical treatment and patients' lifeworlds.
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Affiliation(s)
- Jessica Young
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ursula Poole
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Fardowsa Mohamed
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Shona Jian
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Martyn Williamson
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jim Ross
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Chrystal Jaye
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Peter Radue
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Tony Egan
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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28
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Adams S, Beatty M, Moore C, Desai A, Bartlett L, Culbert E, Cohen E, Stinson J, Orkin J. Perspectives on team communication challenges in caring for children with medical complexity. BMC Health Serv Res 2021; 21:300. [PMID: 33794885 PMCID: PMC8015748 DOI: 10.1186/s12913-021-06304-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with medical complexity (CMC) require the expertise of many care providers spanning different disciplines, institutions, and settings of care. This leads to duplicate health records, breakdowns in communication, and limited opportunities to provide comprehensive, collaborative care. The objectives of this study were to explore communication challenges and solutions/recommendations from multiple perspectives including (i) parents, (ii) HCPs - hospital and community providers, and (iii) teachers of CMC with a goal of informing patient care. METHODS This qualitative study utilized an interpretive description methodology. In-depth semi-structured interviews were conducted with parents and care team members of CMC. The interview guides targeted questions surrounding communication, coordination, access to information and roles in the health system. Interviews were conducted until thematic saturation was reached. Interviews were audio-recorded, transcribed verbatim, and coded and analyzed using thematic analysis. RESULTS Thirty-two individual interviews were conducted involving parents (n = 16) and care team members (n = 16). Interviews revealed 2 main themes and several associated subthemes (in parentheses): (1) Communication challenges in the care of CMC (organizational policy and technology systems barriers, inadequate access to health information, and lack of partnership in care) (2) Communication solutions (shared systems that can be accessed in real-time, universal access to health information, and partnered contribution to care). CONCLUSION Parents, HCPs, and teachers face multiple barriers to communication and information accessibility in their efforts to care for CMC. Parents and care providers in this study suggested potential strategies to improve communication including facilitating communication in real-time, universal access to health information and meaningful partnerships.
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Affiliation(s)
- Sherri Adams
- Division of Pediatric Medicine, SickKids, The Hospital for Sick Children, Toronto, Canada. .,SickKids Research Institute, Toronto, Canada. .,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
| | | | - Clara Moore
- SickKids Research Institute, Toronto, Canada
| | - Arti Desai
- Department of Pediatrics, University of Washington, Seattle, USA
| | | | | | - Eyal Cohen
- Division of Pediatric Medicine, SickKids, The Hospital for Sick Children, Toronto, Canada.,SickKids Research Institute, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Jennifer Stinson
- SickKids Research Institute, Toronto, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Department of Anesthesia and Pain Medicine, Toronto, Canada
| | - Julia Orkin
- Division of Pediatric Medicine, SickKids, The Hospital for Sick Children, Toronto, Canada.,SickKids Research Institute, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
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29
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Wray J, Sugarman H, Davis L, Butler C, McIntyre D, Hewitt R. Improving community-based care for children with a rare condition: The example of long-segment congenital tracheal stenosis and perceptions of health professionals, parents and teachers. Int J Pediatr Otorhinolaryngol 2021; 143:110651. [PMID: 33662711 DOI: 10.1016/j.ijporl.2021.110651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/08/2021] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Long segment congenital tracheal stenosis (LSCTS) is a rare, complex condition which is often poorly understood by community-based health professionals (HPs). Anecdotally, such HPs often lack confidence providing care for children, resulting in children being brought to the tertiary centre more frequently than necessary. We wanted to identify the information and support needs of HPs in primary and secondary care looking after a child with LSCTS, the views of those providing education to these children, and elicit parents' perceptions about community-based services, to improve overall care for children and families. METHOD Questionnaires were sent to 175 community-based HPs and 34 teachers involved in the care of children with LSCTS. Face-to-face or telephone interviews were conducted with 12 parents of patients with LSCTS to establish their perceptions of community-based services. RESULTS Ninety (51%) completed questionnaires were returned from HPs and 18 (53%) from teachers. Responses indicated low levels of knowledge of LSCTS. Physical, practical and communication information needs were identified by all respondent groups, together with general and condition-specific concerns. Interviews with parents indicated that they thought the level of knowledge about LSCTS in the community was low, which had a negative impact on their willingness to consult local services. Better information provision for HPs, teachers and parents was identified as a means of improving outcomes. CONCLUSION Professionals caring for children with LSCTS in the community and in schools have unmet information and support needs, with consequences for children, families, HCPs in both the community and tertiary hospital, and teachers.
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Affiliation(s)
- Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street, London, WC1N 3JH, UK.
| | - Hannah Sugarman
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street, London, WC1N 3JH, UK
| | - Laura Davis
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street, London, WC1N 3JH, UK
| | - Colin Butler
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street, London, WC1N 3JH, UK
| | - Denise McIntyre
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street, London, WC1N 3JH, UK
| | - Richard Hewitt
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street, London, WC1N 3JH, UK
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30
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Bartholdson C, Sandeberg MA, Molewijk B, Pergert P. Does participation in ethics discussions have an impact on ethics decision-making? A cross-sectional study among healthcare professionals in paediatric oncology. Eur J Oncol Nurs 2021; 52:101950. [PMID: 33862416 DOI: 10.1016/j.ejon.2021.101950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 02/24/2021] [Accepted: 03/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The overall aim of this study was to describe perceptions of the decision-making process in relation to participation/non-participation in ethics discussions among healthcare professionals in paediatric oncology. METHODS Healthcare professionals, working at three paediatric units where ethics discussions where performed answered a study-specific questionnaire focusing on perceptions of involvement, influence, responsibility and understanding of ethics decision-making. Statistical analyses included descriptive statistics, non-parametric paired t-tests and correlation tests. RESULTS Participation in ethics discussions was related to perceptions of greater involvement and the possibility of influencing decisions, as well as formal/shared responsibility for the ethics decisions related to patient care. Medical doctors and registered nurses perception of involvement in decisions, possibility to influence and responsibility decreased when they were not present during the ethics discussion or when no ethics discussion was conducted at all. Healthcare professionals had a generally good understanding of the ethical issues and the ethics decisions. The whole group considered medical doctors to be the most important participants in the ethics discussions, followed by patients/family. Healthcare professionals wanted more teamwork and viewed ethics discussions as very helpful for teamwork when dealing with ethical issues in paediatric oncology. CONCLUSIONS Ethics discussions in paediatric oncology practice increases the involvement within and the understanding of the decision-making process about ethical decisions. The understanding is not always dependent on participation, indicating a great trust in team members. Based on these findings the implementation of a structure for ethics support in paediatric oncology where patients/families are integrated is recommended.
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Affiliation(s)
- Cecilia Bartholdson
- Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Paediatric Neurology and Musculokeletal Disorders and Homecare, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
| | - Margareta Af Sandeberg
- Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Stockholm, Sweden
| | - Bert Molewijk
- Dep. Ethics, Law & Humanities, Amsterdam University Medical Centers, Amsterdam, the Netherlands; Centre for Medical Ethics, University of Oslo, Norway
| | - Pernilla Pergert
- Childhood Cancer Research Unit, Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Paediatric Haematology and Oncology, Astrid Lindgren Children's Hospital, Stockholm, Sweden
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31
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Ozkaynak M, Valdez R, Hannah K, Woodhouse G, Klem P. Understanding Gaps Between Daily Living and Clinical Settings in Chronic Disease Management: Qualitative Study. J Med Internet Res 2021; 23:e17590. [PMID: 33629657 PMCID: PMC7952231 DOI: 10.2196/17590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 11/24/2020] [Accepted: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Management of chronic conditions entails numerous activities in both clinical and daily living settings. Activities across these settings interact, creating a high potential for a gap to occur if there is an inconsistency or disconnect between controlled clinical settings and complex daily living environments. OBJECTIVE The aim of this study is to characterize gaps (from the patient's perspective) between health-related activities across home-based and clinical settings using anticoagulation treatment as an example. The causes, consequences, and mitigation strategies (reported by patients) were identified to understand these gaps. We conceptualized gaps as latent phenomena (ie, a break in continuity). METHODS Patients (n=39) and providers (n=4) from the anticoagulation clinic of an urban, western mountain health care system were recruited. Data were collected through primary interviews with patients, patient journaling with tablet computers, exit interviews with patients, and provider interviews. Data were analyzed qualitatively using a theory-driven approach and framework method of analysis. RESULTS The causes of gaps included clinician recommendations not fitting into patients' daily routines, recommendations not fitting into patients' living contexts, and information not transferred across settings. The consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised adherence to the therapy plan. We identified resources and strategies used to overcome these consequences as patient-generated strategies, routines, collaborative management, social environment, and tools and technologies. CONCLUSIONS Understanding gaps, their consequences, and mitigating strategies can lead to the development of interventions that help narrow these gaps. Such interventions could take the form of collaborative health information technologies, novel patient and clinician education initiatives, and programs that strongly integrate health systems and community resources. Current technologies are insufficient to narrow the gaps between clinical and daily living settings due to the limited number and types of routines that are tracked.
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Affiliation(s)
- Mustafa Ozkaynak
- College of Nursing, University of Colorado
- Anschutz Medical Campus, Aurora, CO, United States
| | - Rupa Valdez
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Katia Hannah
- College of Nursing, University of Colorado
- Anschutz Medical Campus, Aurora, CO, United States
| | - Gina Woodhouse
- University of Colorado Hospital, Aurora, CO, United States
| | - Patrick Klem
- University of Colorado Hospital, Aurora, CO, United States
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Donovan DJ, Macciola D, Paul EA, Rama G, Krishnan U, Starc TJ, Weller RJ, Glickstein JS. Design and implementation of a patient passport in a pediatric cardiology clinic. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Peters VJT, Meijboom BR, Bunt JEH, Bok LA, van Steenbergen MW, de Winter JP, de Vries E. Providing person-centered care for patients with complex healthcare needs: A qualitative study. PLoS One 2020; 15:e0242418. [PMID: 33196659 PMCID: PMC7668580 DOI: 10.1371/journal.pone.0242418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022] Open
Abstract
Background People with chronic conditions have complex healthcare needs that lead to challenges for adequate healthcare provision. Current healthcare services do not always respond adequately to their needs. A modular perspective, in particular providing visualization of the modular service architecture, is promising for improving the responsiveness of healthcare services to the complex healthcare needs of people with chronic conditions. The modular service architecture provides a comprehensive representation of the components and modules of healthcare provision. In this study, we explore this further in a qualitative multiple case study on healthcare provision for children with Down syndrome in the Netherlands. Methods Data collection for four cases involved 53 semi-structured interviews with healthcare professionals and 21 semi-structured interviews with patients (the parents of children with Down syndrome as proxy). In addition, we gathered data by means of practice observations and analysis of relevant documents. The interviews were audio-recorded, transcribed verbatim and analyzed utilizing the Miles and Huberman approach. Results Our study shows that the perspectives on healthcare provision of professionals and patients differ substantially. The visualization of the modular service architecture that was based on the healthcare professionals’ perspective provided a complete representation of (para)medical outcomes relevant to the professionals’ own discipline. In contrast, the modular service architecture based on the patients’ perspective, which we define as a person-centered modular service architecture, provided a representation of the healthcare service that was primarily based on functional outcomes and the overall wellbeing of the patients. Conclusion Our study shows that visualization of the modular service architecture can be a useful tool to better address the complex needs and requirements of people with a chronic condition. We suggest that a person-centered modular service architecture that focuses on functional outcomes and overall wellbeing, enables increased responsiveness of healthcare services to people with complex healthcare needs and provision of truly person-centered care.
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Affiliation(s)
- Vincent J. T. Peters
- Department of Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
| | - Bert R. Meijboom
- Department of Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
- Department of Marketing, Innovation and Organization, Ghent University, Ghent, Belgium
- * E-mail:
| | - Jan Erik H. Bunt
- Department of Pediatrics, Elisabeth-Tweesteden Ziekenhuis, Tilburg, Noord-Brabant, The Netherlands
| | - Levinus A. Bok
- Department of Pediatrics, Máxima Medisch Centrum, Veldhoven, Noord-Brabant, The Netherlands
| | | | - J. Peter de Winter
- Department of Pediatrics, Spaarne Gasthuis, Haarlem, Noord-Holland, The Netherlands
| | - Esther de Vries
- Department of Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
- Department of Jeroen Bosch Academy Research, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, Noord-Brabant, The Netherlands
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Abstract
Coordinating care to meet the robust needs of children with medical complexity and their families is challenging, especially in the setting of a busy primary care practice. This article describes the experience of one family and pediatrician and highlights specific factors, such as a focus on building relationships, meaningful and structured information-sharing, and partnership with a complex care program, that can positively affect care. [Pediatr Ann. 2020;49(11):e486-e490.].
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Penela-Sánchez D, Ricart S, Vidiella N, García-García JJ. [A study of paediatric patients with complex chronic conditions admitted to a paediatric department over a 12 month period]. An Pediatr (Barc) 2020; 95:S1695-4033(20)30287-3. [PMID: 32972856 DOI: 10.1016/j.anpedi.2020.07.028] [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: 04/07/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The number of patients with complex chronic conditions (CCC) has increased in the last 20 years or so. There is limited data as regards the prevalence of CCC in the paediatric population and its impact on hospital admissions. The main objectives of this study are to determine the proportion of CCC in the paediatric hospital population and compare them with other groups of patients admitted (acute and chronic). PATIENTS AND METHODS A descriptive, retrospective study was carried out in a tertiary maternity-paediatric hospital (from December 2016 to November 2017). All patients admitted into the Paediatric Department were recruited with a fortnightly frequency. A series of demographic, clinical, and pregnancy data were collected. In order to identify the level of complexity of the patients, the Clinical Risk Group (CRG) was used, with 3groups being created: acute, chronic, and CCC. Statistics analysis was performed using SPSS v24. RESULTS A total of 1,433 patients were included. The proportion of CCC on the Paediatric Ward was 14.4%. The CCC were older patients, mainly admitted due to decompensation or progression of their underlying disease, had a longer admission time, and required support in the Paediatric Intensive Care Unit more often than that of the other sub-groups. Just under half (44.7%) of the CCC were carriers of a technological device. Of the total of long stays (>1 month), 71.3% had CCC. CONCLUSIONS Patients with CCC require long hospital stays, a greater need of intensive care, and use of technology. New approaches to treatment and follow-up need to be established. They should be cost-effective, and at the same time decrease the impact of the disease on the children and their family.
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Affiliation(s)
| | - Sílvia Ricart
- Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, España
| | - Nereida Vidiella
- Servicio de Pediatría, Hospital Verge de la Cinta, Tortosa (Tarragona), España
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Li L, Bird M, Carter N, Ploeg J, Gorter JW, Strachan PH. Experiences of youth with medical complexity and their families during the transition to adulthood: a meta-ethnography. JOURNAL OF TRANSITION MEDICINE 2020. [DOI: 10.1515/jtm-2020-0002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractYouth with medical complexity (YMC) are a small subset of youth who have a combination of severe functional limitations and extensive health service use. As these youth become adults, they are required to transition to adult health, education, and social services. The transition to adult services is especially difficult for YMC due to the sheer number of services that they access. Service disruptions can have profound impacts on YMC and their families, potentially leading to an unsuccessful transition to adulthood. This meta-ethnography aims to synthesize qualitative literature exploring how YMC and their families experience the transition to adulthood and transfer to adult services. An in-depth understanding of youth and family experiences can inform interventions and policies to optimize supports and services to address the needs of this population at risk for unsuccessful transition to adulthood. Using Noblit and Hare’s approach to meta-ethnography, a comprehensive search of Medline, CINAHL, Embase, PsycINFO, Social Sciences Index, and Sociological Abstracts databases, supplemented by hand searching, was conducted to identify relevant studies. Included studies focused on the transition to adulthood or transfer to adult services for YMC, contained a qualitative research component, and had direct quotes from youth or family participants. Studies were critically appraised, and data were analyzed using meta-ethnographic methods of reciprocal translation and line of argument synthesis. Conceptual data from ten studies were synthesized into six overarching constructs: (1) the nature and process of transition, (2) changing relationships, (3) goals and expectations, (4) actions related to transition, (5) making sense of transition, and (6) contextual factors impacting transition. A conceptual model was developed that explains that youth and families experience dynamic interactions between their goals, actions, and relationships, which are bounded and influenced by the nature, process, and context of transition. Despite the tremendous barriers faced during transition, YMC and their families often demonstrate incredible resilience, perseverance, and resourcefulness in the pursuit of their goals. Implications for how the conceptual model can inform practice, policy, and research are shared. These implications include the need to address emotional needs of youth and families, support families in realizing their visions for the future, promote collaboration among stakeholders, and develop policies to incentivize and support providers in implementing current transition guidelines.
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Affiliation(s)
- Lin Li
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Marissa Bird
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Nancy Carter
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Canadian Centre for Advanced Practice Nursing Research, McMaster University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Aging, Community and Health Research Unit, McMaster University, Hamilton, Ontario, Canada
| | - Jan Willem Gorter
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
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What Do Parents Expect in the 21st Century? A Qualitative Analysis of Integrated Youth Care. Int J Integr Care 2020; 20:8. [PMID: 32874167 PMCID: PMC7442175 DOI: 10.5334/ijic.5419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Introduction: To provide integrated Youth Care responsive to the needs of families with multiple problems across life domains, it is essential to incorporate parental perspectives into clinical practice. The aim of this study is to advance our understanding of key components of integrated Youth Care from a parental perspective. Methods: Semi-structured interviews were administered to 21 parents of children receiving Youth Care from integrated care teams in the Netherlands. Qualitative content analysis was conducted by means of a grounded theory approach following qualitative reporting guidelines. Results and discussion: Parental perspectives were clustered into six key components: a holistic, family-centred approach; addressing a broad range of needs in a timely manner; shared decision making; interprofessional collaboration; referral; and privacy. Parents emphasized the importance of a tailored, family-centred approach, addressing needs across several life domains, and active participation in their own care process. However, they simultaneously had somewhat opposing expectations regarding these key components, for example, concerning the changing roles of professionals and parents in shared decision making and the value of involving family members in a care process. Professionals should be aware of these opposing expectations by explicitly discussing mutual expectations and changing roles in decision making during a care process. To enable parents to make their own decisions, professionals should transparently propose different options for support guided by an up-to-date care plan.
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Kamzan A, Jun-Ihn E, Kulkarni D. On the Front Lines of Pediatric Complex Care: Are We Preparing Emergency Medicine Residents? Hosp Pediatr 2020; 10:712-714. [PMID: 32680917 DOI: 10.1542/hpeds.2020-0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Audrey Kamzan
- Department of Pediatrics, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Esther Jun-Ihn
- Department of Pediatrics, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Deepa Kulkarni
- Department of Pediatrics, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California
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Laugesen B, Lauritsen MB, Jørgensen R, Sørensen EE, Rasmussen P, Grønkjær M. The Complexities of Everyday Life and Healthcare Utilization in Danish Children With ADHD: A Mixed Methods Study. J Pediatr Nurs 2020; 52:e33-e41. [PMID: 32008832 DOI: 10.1016/j.pedn.2020.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To explore and describe everyday life and hospital-based healthcare experiences and utilization in families of children with ADHD in Denmark. DESIGN AND METHODS The present work is a multistage, mixed methods study. The design consists of three individual studies: a meta-synthesis, a focused ethnographic study, and a historical cohort study. RESULTS The integrated findings show that: 1) parental stressors affect everyday life and hospital-based service use; 2) parents have concerns for their child from early childhood and fight to have their concerns recognized; and 3) healthcare professionals are important for parents to navigate the persistent challenges of everyday life. CONCLUSIONS Having a child with ADHD pervades everyday life and children with ADHD use more medical and psychiatric services in hospitals during the first 12 years of life than children without ADHD. The findings demonstrate a vulnerable everyday life experience and highlight the importance of the families being recognized, accepted, and respected in hospital-based healthcare services from early childhood. PRACTICE IMPLICATIONS Healthcare professionals need to recognize the challenges the family of a child with ADHD faces and to acknowledge that ADHD pervades all aspects of everyday life and all other healthcare issues. It is important for healthcare professionals, regardless of specialty, to engage with individual families and to positively contribute to the medical and psychiatric healthcare experience.
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Affiliation(s)
- Britt Laugesen
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark.
| | | | - Rikke Jørgensen
- Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Denmark
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
| | | | - Mette Grønkjær
- Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Denmark
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Children With Complex Chronic Conditions: A Multifaceted Contemporary Medical Challenge Not Restricted to PICUs. Pediatr Crit Care Med 2020; 21:298-299. [PMID: 32142032 DOI: 10.1097/pcc.0000000000002228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chong PH, Soo J, Yeo ZZ, Ang RQ, Ting C. Who needs and continues to need paediatric palliative care? An evaluation of utility and feasibility of the Paediatric Palliative Screening scale (PaPaS). BMC Palliat Care 2020; 19:18. [PMID: 32041616 PMCID: PMC7011544 DOI: 10.1186/s12904-020-0524-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 02/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background While the populations of children who can benefit from paediatric palliative care (PPC) have been broadly defined, identifying individual patients to receive PPC has been problematic in practice. The Paediatric Palliative Screening scale (PaPaS) is a multi-dimensional tool that assesses palliative care needs in children and families to facilitate timely referrals. This study evaluates its use to manage new referrals and ongoing review of patients receiving home-based PPC in Singapore. Methods Using a retrospective cohort study design, 199 patients admitted to receive PPC via clinician screening were scored using PaPaS. Eighty-four patients in two groups were scored again at one of two following milestones: one-year service continuation mark or point of discharge before a year. Accuracy measures were compared against clinical assessment. Results 96.98% of patients scored 15 and above on admission (indicating need for PPC). Patients assessed at following milestones were effectively stratified; those who continued to receive service after 1 year scored significantly higher (M = 19.23) compared to those who were discharged within a year (M = 7.86). Sensitivity and specificity for PaPaS were calculated at 82.54 and 100% respectively. Overall congruence with clinician-based decisions supports the utility of PaPaS as a screening tool in PPC. Recommendations to improve the scale further are proposed. Conclusion The PaPaS is a practical screening tool that signposts PPC needs within the clinical setting. This facilitates early referrals to PPC, without having to specify individual prognoses that are often uncertain. Other benefits include optimised continuity of care and implications for resource allocation.
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Affiliation(s)
- Poh Heng Chong
- HCA Hospice Care, 705 Serangoon Road, #03-01 Block A @ Kwong Wai Shiu Hospital, Singapore, 328127, Singapore.
| | - Janice Soo
- Ministry of Health Holdings, Singapore, Singapore
| | - Zhi Zheng Yeo
- HCA Hospice Care, 705 Serangoon Road, #03-01 Block A @ Kwong Wai Shiu Hospital, Singapore, 328127, Singapore
| | - Raymond Qishun Ang
- HCA Hospice Care, 705 Serangoon Road, #03-01 Block A @ Kwong Wai Shiu Hospital, Singapore, 328127, Singapore
| | - Celene Ting
- HCA Hospice Care, 705 Serangoon Road, #03-01 Block A @ Kwong Wai Shiu Hospital, Singapore, 328127, Singapore
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Kearney S, Donohoe A, McAuliffe E. Living with epidermolysis bullosa: Daily challenges and health-care needs. Health Expect 2019; 23:368-376. [PMID: 31868299 PMCID: PMC7104643 DOI: 10.1111/hex.13006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND & OBJECTIVE Epidermolysis bullosa (EB) is the term used for a group of genetic skin fragility disorders. For those living with EB, pain represents a constant challenge, with blistering and tasks such as changing dressings, adding to the distress. This paper focuses on describing and exploring the health-care needs of children, adults and families who are affected by EB. The specific aim of the paper is to identify the needs of the EB population with a view towards informing the development of a community liaison service to support adults living with EB and the parents/carers of children living with EB. SETTING AND PARTICIPANTS Interviews with six adults and the parents of eight children with EB were conducted. The data were analysed thematically. All participants were resident on the island of Ireland and are therefore reflecting on services in this geographic region. RESULTS Participants' needs were grouped into five themes: support managing physical health-care issues; access to community/home-based services; EB-specific information and psychosocial support; effective interaction with health-care professionals; and advice regarding benefits and entitlements. DISCUSSION AND CONCLUSIONS This article represents the health-care needs and preferences of a broad spectrum of those with EB, highlighting the need for a comprehensive service regardless of the severity of the condition.
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Affiliation(s)
- Sandra Kearney
- IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Ann Donohoe
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eilish McAuliffe
- IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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van den Driessen Mareeuw FA, Coppus AMW, Delnoij DMJ, de Vries E. Quality of health care according to people with Down syndrome, their parents and support staff-A qualitative exploration. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:496-514. [PMID: 31833622 PMCID: PMC7187228 DOI: 10.1111/jar.12692] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 11/07/2019] [Accepted: 11/26/2019] [Indexed: 01/04/2023]
Abstract
Background People with Down syndrome (PDS) have complex healthcare needs. Little is known about the quality of health care for PDS, let alone how it is appraised by PDS and their caregivers. This study explores the perspectives of PDS, their parents and support staff regarding quality in health care for PDS. Method The present authors conducted semi‐structured interviews with 18 PDS and 15 parents, and focus groups with 35 support staff members (of PDS residing in assisted living facilities) in the Netherlands. Results According to the participants, healthcare quality entails well‐coordinated health care aligned with other support and care systems, a person‐centred and holistic approach, including respect, trust and provider–patient communication adapted to the abilities of PDS. Conclusions Our findings may be used to improve health care for PDS, and provide insight into how health care could match the specific needs of PDS.
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Affiliation(s)
- Francine A van den Driessen Mareeuw
- Tranzo, Scientific Center for Care and Wellbeing, Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Jeroen Bosch Hospital, ME's-Hertogenbosch, The Netherlands
| | - Antonia M W Coppus
- Department for Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.,Dichterbij, Center for the Intellectually Disabled, Gennep, The Netherlands
| | - Diana M J Delnoij
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.,National Health Care Institute, Diemen, The Netherlands
| | - Esther de Vries
- Tranzo, Scientific Center for Care and Wellbeing, Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Jeroen Bosch Hospital, ME's-Hertogenbosch, The Netherlands
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Kim C, Lehmann CU, Hatch D, Schildcrout JS, France DJ, Chen Y. Provider Networks in the Neonatal Intensive Care Unit Associate with Length of Stay. ... IEEE CONFERENCE ON COLLABORATION AND INTERNET COMPUTING. IEEE CONFERENCE ON COLLABORATION AND INTERNET COMPUTING 2019; 2019:127-134. [PMID: 32637942 PMCID: PMC7339831 DOI: 10.1109/cic48465.2019.00024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We strive to understand care coordination structures of multidisciplinary teams and to evaluate their effect on post-surgical length of stay (PSLOS) in the Neonatal Intensive Care Unit (NICU). Electronic health record (EHR) data were extracted for 18 neonates, who underwent gastrostomy tube placement surgery at the Vanderbilt University Medical Center NICU. Based on providers' interactions with the EHR (e.g. viewing, documenting, ordering), provider-provider relations were learned and used to build patient-specific provider networks representing the care coordination structure. We quantified the networks using standard network analysis metrics (e.g., in-degree, out-degree, betweenness centrality, and closeness centrality). Coordination structure effectiveness was measured as the association between the network metrics and PSLOS, as modeled by a proportional-odds, logistical regression model. The 18 provider networks exhibited various team compositions and various levels of structural complexity. Providers, whose patients had lower PSLOS, tended to disperse patient-related information to more colleagues within their network than those, who treated higher PSLOS patients (P = 0.0294). In the NICU, improved dissemination of information may be linked to reduced PSLOS. EHR data provides an efficient, accessible, and resource-friendly way to study care coordination using network analysis tools. This novel methodology offers an objective way to identify key performance and safety indicators of care coordination and to study dissemination of patient-related information within care provider networks and its effect on care. Findings should guide improvements in the EHR system design to facilitate effective clinical communications among providers.
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Affiliation(s)
- Cindy Kim
- Department of Mathematics, Vanderbilt University, Nashville, TN
| | | | - Dupree Hatch
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Daniel J France
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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Doucet S, Luke A, Splane J, Azar R. Patient Navigation as an Approach to Improve the Integration of Care: The Case of NaviCare/SoinsNavi. Int J Integr Care 2019; 19:7. [PMID: 31798358 PMCID: PMC6857520 DOI: 10.5334/ijic.4648] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 10/30/2019] [Indexed: 11/28/2022] Open
Abstract
Children and youth with complex care needs require more and varied healthcare services than the average population, as well as a high degree of coordinated care. Evidence has shown that these individuals and their families have better outcomes if they have access to integrated care. Patient navigation can serve as a novel approach to improve the integration of care for individuals with complex care needs in an increasingly fragmented system. NaviCare/SoinsNavi is an example of a navigation centre for children and youth with complex care needs, their families, and the care team. This research-based service is aimed at facilitating more convenient and integrated care using a personalized family-centred approach. NaviCare/SoinsNavi employs two patient navigators who work with clients to formulate and prioritize goals based on their unmet needs. The centre serves as a living laboratory, which provides researchers, knowledge users, and clients a real life setting where innovative ideas can be explored, evaluated, modified as needed throughout the research process, and moved into policy in an efficient manner. Patient navigation programs can contribute to decreasing fragmentation, improving access, and promoting integrated care across disciplines, settings, and sectors for individuals across the lifespan.
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Affiliation(s)
- Shelley Doucet
- Jarislowsky Chair in Interprofessional Patient-Centred Care, Department of Nursing and Health Sciences, University of New Brunswick Saint John, CA
- Centre for Research in Integrated Care (CRIC), University of New Brunswick Saint John, CA
- Centre for Research in Integrated care (CRIC), New Brunswick, CA
| | - Alison Luke
- Centre for Research in Integrated Care (CRIC), University of New Brunswick Saint John, CA
- Centre for Research in Integrated care (CRIC), New Brunswick, CA
| | - Jennifer Splane
- Centre for Research in Integrated care (CRIC), New Brunswick, CA
- University of New Brunswick, Saint John, New Brunswick, CA
| | - Rima Azar
- Department of Psychology, Mount Allison University, CA
- NaviCare/SoinsNavi, Sackville, New Brunswick, CA
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Luzi D, Pecoraro F, Tamburis O, O’Shea M, Larkin P, Berry J, Brenner M. Modelling collaboration of primary and secondary care for children with complex care needs: long-term ventilation as an example. Eur J Pediatr 2019; 178:891-901. [PMID: 30937604 PMCID: PMC6511355 DOI: 10.1007/s00431-019-03367-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/04/2019] [Accepted: 03/18/2019] [Indexed: 11/30/2022]
Abstract
Children dependent on long-term ventilation need the planning, provision and monitoring of complex services generally provided at home by professionals belonging to different care settings. The collaboration among professionals improves the efficiency and the continuity of care especially when treating children with complex care needs. In this paper, the Unified Modelling Language (UML) has been adopted to detect the variety of the patterns of collaboration as well as to represent and compare the different processes of care across the 30 EU/EEA countries of the MOCHA project.Conclusion: Half of the analysed countries have a multidisciplinary team with different degrees of team composition, influencing organisational features such as the development of the personalised plan as well as the provision of preventive and curative services. This approach provides indications on the efficiency in performing and organising the delivery of care in terms of family involvement, interactions among professionals and availability of ICT. What is known: • Children with CCNs require a coordination of efforts before and after discharge in a continuum of care delivery dependent on the level of integrated care solutions adopted at country level. What is new: •The adoption of a business process method contributes to perform a cross-country analysis highlighting the variability of team composition and its influence on the delivery of care. • This approach provides indications on the efficiency in performing and organising the delivery of care in terms of family involvement, interactions among professionals and availability of ICT.
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Affiliation(s)
- Daniela Luzi
- National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32 – 00185, Rome, Italy
| | - Fabrizio Pecoraro
- National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32 - 00185, Rome, Italy.
| | - Oscar Tamburis
- National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32 – 00185, Rome, Italy
| | - Miriam O’Shea
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Philip Larkin
- Centre Hospitalier Universitaire Vaudois, Faculté de Biologie et de Médecine, Institut Universitaire de Formation et de Recherche en Soins, University of Lausanne, Lausanne, Switzerland
| | - Jay Berry
- Boston Children’s Hospital, Boston, USA
| | - Maria Brenner
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Majnemer A, O'Donnell M, Ogourtsova T, Kasaai B, Ballantyne M, Cohen E, Collet JP, Dewan T, Elsabbagh M, Hanlon-Dearman A, Filliter JH, Lach L, McElroy T, McGrath P, McKellin W, Miller A, Patel H, Rempel G, Shevell M, Wittmeier K. BRIGHT Coaching: A Randomized Controlled Trial on the Effectiveness of a Developmental Coach System to Empower Families of Children With Emerging Developmental Delay. Front Pediatr 2019; 7:332. [PMID: 31440489 PMCID: PMC6694748 DOI: 10.3389/fped.2019.00332] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/23/2019] [Indexed: 11/24/2022] Open
Abstract
Background: In preschool-aged children with, or at elevated risk for, developmental disabilities, challenges and needs arise from vulnerabilities linked to critical and newly emerging cognitive, speech, motor, behavioral, and social skills. For families, this can be a stressful period as they witness the gradual unfolding of their child's differences and await to receive care. Nationally and internationally, service delivery models during this critical period are not standardized nor are they nimble or sufficient enough, leading to long wait times, service gaps and duplications. Given these struggles, there is a need to examine whether "health coaching", a structured educational program that is deliverable by different and more accessible means, can be effective in empowering families, by delivering information, providing social supports, and decreasing the demands on the overwhelmed health and developmental services. The primary objective is to evaluate the feasibility and the effectiveness of a coaching intervention (in comparison to usual and locally available care), for parents of children with emerging developmental delays. Method/Design: A multi-centered pragmatic randomized controlled trial design will be used. Families will be recruited from a representative sample of those awaiting publicly-funded regional child health services for children with developmental delays in four Canadian provinces. The target sample size is 392 families with children aged 1.5 to 4.5 years at recruitment date. Families will be randomly assigned to receive either the BRIGHT Coaching intervention (coach supported, hardcopy and online self-managed educational resources: 14 sessions, 2 sessions every 4 weeks for 6-9 months) or usual care that is locally available. In addition to the feasibility and acceptability measures, outcomes related to family empowerment, parental satisfaction and efficacy with caregiver competency will be evaluated at baseline, post-treatment (8 months), and follow-up (12 months). Discussion: This manuscript presents the background information, design, description of the interventions and of the protocol for the randomized controlled trial on the effectiveness of BRIGHT Coaching intervention for families of children with emerging developmental delays. Trial Registration: ClinicalTrials.gov, U.S. National Library of Medicine, National Institutes of Health #NCT03880383, 03/15/2019. Retrospectively registered.
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Affiliation(s)
- Annette Majnemer
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Montreal Children's Hospital, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Maureen O'Donnell
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Child-Health BC, Vancouver, BC, Canada
| | - Tatiana Ogourtsova
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Montreal Children's Hospital, Research Institute of the McGill University Health Center, Montreal, QC, Canada.,Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bahar Kasaai
- Montreal Children's Hospital, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | | | - Eyal Cohen
- Hospital for Sick Children, Toronto, ON, Canada
| | - Jean-Paul Collet
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Mayada Elsabbagh
- Montreal Children's Hospital, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Ana Hanlon-Dearman
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Jillian Helen Filliter
- IWK Health Centre, Halifax, NS, Canada.,Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Lucyna Lach
- McGill University Health Centre, Montreal, QC, Canada
| | - Theresa McElroy
- Child-Health BC, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - William McKellin
- Rare Disease Foundation, Vancouver, BC, Canada.,Department of Anthropology, University of British Columbia, Vancouver, BC, Canada
| | - Anton Miller
- Child and Family Research Institute, Vancouver, BC, Canada
| | - Hema Patel
- Montreal Children's Hospital, Research Institute of the McGill University Health Center, Montreal, QC, Canada.,McGill University Health Centre, Montreal, QC, Canada
| | - Gina Rempel
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Winnipeg, Winnipeg, MB, Canada
| | - Michael Shevell
- Montreal Children's Hospital, Research Institute of the McGill University Health Center, Montreal, QC, Canada.,McGill University Health Centre, Montreal, QC, Canada
| | - Kristy Wittmeier
- University of Manitoba, Winnipeg, MB, Canada.,Winnipeg Health Sciences Centre, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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Marshall J, Ramakrishnan R, Slotnick AL, Tanner JP, Salemi JL, Kirby RS. Family-Centered Perinatal Services for Children With Down Syndrome and Their Families in Florida. J Obstet Gynecol Neonatal Nurs 2018; 48:78-89. [PMID: 30529051 DOI: 10.1016/j.jogn.2018.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine the experiences of parents or caregivers of children with Down syndrome related to prenatal care, the birth setting, primary and specialty care, and care coordination. DESIGN Cross-sectional, mixed-methods study. SETTING Florida. PARTICIPANTS English- or Spanish-speaking parents/primary caregivers (N = 101) of children who were 0 to 18 years old, had a diagnosis of Down syndrome, and were born in Florida. METHODS Participants were identified through snowball sampling and completed an online version of the Family Experiences Survey. Analyses included descriptive statistics, Fisher exact tests, and content analysis of the open-ended questions. RESULTS Fewer than half of the 101 respondents reported receipt of adequate information after diagnosis of Down syndrome during the prenatal period (n = 18, 19.3%) or in the birth setting (n = 35, 41.2%). Most participants (52.9%-95.4%) reported that they received adequate time and specific information needed and that providers were sensitive to their feelings, values, and family customs during the prenatal period, in the birth setting, and during primary and specialty care. However, fewer than 60% of participants (19.3%-59.1%) recalled that they received information about Down syndrome or helpful programs such as Children's Medical Services, Early Steps, or Healthy Start either from prenatal care providers or in the birth settings. CONCLUSION Our findings highlight the critical role that perinatal care providers play in the establishment of access to and use of specialty care services for neonates with Down syndrome and emphasize the need for family-centered care in prenatal and birth settings.
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Giroux CM, Wilson LA, Corkett JK. Parents as partners: investigating the role(s) of mothers in coordinating health and education activities for children with chronic care needs. J Interprof Care 2018; 33:243-251. [PMID: 30303428 DOI: 10.1080/13561820.2018.1531833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Interprofessional collaboration (IPC) between health professionals, and educators is an essential component of academic success and well-being for children who experience chronic illnesses. This study sought to understand parents' roles in and perceptions of IPC between their child's healthcare professionals and educators. We recruited 23 mothers to participate in our study. Data were analyzed using a combination of univariate analyses and content analysis. Overall, parents reported that they could effectively communicate their child's health and educational needs with health and educational professionals, but statistical analysis determined moderately increased challenges presenting information across professions. Most participants (n = 19) indicated that IPC between health and educational professionals could be improved. Effectively engaging parents as partners in IPC can promote more seamless collaboration and communication of a child's needs and offer a greater likelihood of achieving a child's health and educational goals.
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Affiliation(s)
| | - Lindsay A Wilson
- b School of Epidemiology, Public Health, and Preventative Medicine , University of Ottawa , Canada
| | - Julie K Corkett
- c Schulich School of Education , Nipissing University , North Bay , Canada
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50
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Altman L, Breen C, Ging J, Burrett S, Hoffmann T, Dickins E, Brown K, Zurynski Y, Woolfenden S. "Dealing with the Hospital has Become too Difficult for Us to Do Alone" - Developing an Integrated Care Program for Children with Medical Complexity (CMC). Int J Integr Care 2018; 18:14. [PMID: 30245608 PMCID: PMC6144526 DOI: 10.5334/ijic.3953] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 08/15/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Children with medical complexity (CMC) require highly specialised care, often from multiple providers and over many years. This paper describes the first 18 months of development of the Kids Guided Personalised Services (GPS) Integrated Care Program (the Program). This Program aims to improve health care experience; communication and to streamline provision of care. DISCUSSION Key enablers across the Program were put in place and 5 individual project streams were used to implement change. An extensive formative evaluation process was undertaken to truly understand all perspectives in developing the Program. CONCLUSION/KEY LESSONS This Program supports families who are caring for CMC by developing shared care models that bring together local health services with the tertiary hospitals. The methodology used has resulted in comprehensive system change and transformation; reduced presentations to the Emergency Department (ED), avoidable admissions and travel time. A challenge remains in meaningfully engaging primary health care providers.
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Affiliation(s)
| | | | | | | | | | | | | | - Yvonne Zurynski
- Sydney Children’s Hospitals Network, AU
- Macquarie University, AU
- University of Sydney, AU
| | - Susan Woolfenden
- Sydney Children’s Hospitals Network, AU
- University of New South Wales, AU
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