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Rees M, Collins CE, Majellano EC, McDonald VM. Healthcare Professionals' Perspectives of Nonsurgical Care of Older Inpatients with Class II or III Obesity and Comorbidities: A Qualitative Study. J Multidiscip Healthc 2023; 16:3339-3355. [PMID: 38024134 PMCID: PMC10640832 DOI: 10.2147/jmdh.s421520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Older people with Class II or III obesity and comorbidities experience complex care needs with frequent hospital admissions. In 2019/20 the National Health Service in England reported a 17% increase in hospital admissions of patients with obesity compared to 2018/19. Gaps in care for this population have been identified. Purpose The purpose of this study was to understand the experiences and perspectives of healthcare professionals delivering non-surgical care to older people with Classes II or III obesity admitted to a tertiary care hospital. Methods Healthcare professionals delivering non-surgical care to older people admitted with Class II or III obesity with comorbidities were recruited from an Australian tertiary referral hospital. Qualitative semi-structured interviews were conducted with 24 healthcare professionals from seven disciplines between August and December 2019. The interviews were audio-recorded, transcribed, and reviewed by participants for accuracy. Thematic inductive data analysis was deductively mapped to the Theoretical Domains Framework (TDF). Results Four major themes of Barriers, Facilitators, Current Practice, and Recommendations and 11 subthemes were identified and mapped to nine domains in the TDF. The Barriers subtheme identified perceived patient related factors, health system issues, and provider issues, while the Facilitators subtheme included a patient centred approach, knowledge, and resources in the subacute setting. The major Current Practice theme explored factors influencing clinical management, and the Recommendations subthemes included engaging patients, access to quality care, education and support, and obesity as a chronic disease. Conclusion This novel application of the TDF provided broad insights related to the barriers and facilitators in delivering non-surgical care to this hospital population, from the perspective of healthcare professionals. Understanding how these barriers interact can provide strategies to influence behaviour change and assist in the development of a holistic multidisciplinary model of care.
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Affiliation(s)
- Merridie Rees
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
| | - Clare E Collins
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Eleanor C Majellano
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Medical and Interventional Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Vanessa M McDonald
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- Medical and Interventional Services, Hunter New England Local Health District, Newcastle, NSW, Australia
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Ogundeji KD, Risenga PR, Thupayagale-Tshweneagae G. Cost of wound dressing: Implication for enrollment into the National Health Insurance scheme, Nigeria. Curationis 2023; 46:e1-e6. [PMID: 37782236 PMCID: PMC10476457 DOI: 10.4102/curationis.v46i1.2390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 02/23/2023] [Accepted: 03/23/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Enrollment into the National Health Insurance scheme (NHIS) still poses a challenge in Nigeria despite the established Group, Individual and Family Social Health Insurance Programme (GIFSHIP) during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES This study examined the direct cost of wound dressing and enrollment into the health insurance scheme among hospitalised patients. METHOD A descriptive cross-sectional research design was utilised to investigate the cost of wound dressing and enrollment into health insurance scheme among hospitalised patients in three selected hospitals of South-West Nigeria. The study was conducted from March 2021 to June 2021, and 190 patients were recruited via an interviewer-administered questionnaire. Ethical approvals were obtained from the hospitals while COVID-19 preventive protocols and ethical principles of autonomy, confidentiality and non-maleficence were observed. RESULTS Majority of the respondents (91%) were not on any healthcare insurance scheme, only 4.2% were enrolled in NHIS while over 70% could not personally pay for their wound dressing. The minimum average cost of wound dressing materials per week and per acute care episode was ₦10 000.00 (Nigerian naira) and ₦50 000.00, respectively, while the minimum average cost for hospitalisation per week and per acute care episode was ₦18 000.00 and ₦130 000.00, respectively, ($1.00 equaled ₦600.00, June 2022). CONCLUSION A lack of health insurance coverage is a precursor of 'out of pocket' payment. A political will is required to scale up enrollment of the indigenous population into the NHIS in Nigeria.Contribution: Many hospitalised patients are not enrolled in the NHIS and they are at a higher risk of catastrophic healthcare expenditure.
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Affiliation(s)
- Kolawole D Ogundeji
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria, South Africa; and, Department of Nursing, School of Nursing, Kampala International University, Bushenyi-Ishaka.
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Høyland SA, Holte KA, Islam K, Øygaarden O, Kjerstad E, Høyland SA, Waernes HR, Gürgen M, Conde KB, Hovland KS, Rødseth E, Carayon P, Fallon M, Ivins N, Bradbury S, Husebø SIE, Harding KG, Ternowitz T. A cross-sector systematic review and synthesis of knowledge on telemedicine interventions in chronic wound management-Implications from a system perspective. Int Wound J 2022; 20:1712-1724. [PMID: 36261052 PMCID: PMC10088836 DOI: 10.1111/iwj.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/09/2022] [Accepted: 10/09/2022] [Indexed: 11/29/2022] Open
Abstract
Based on initially identified needs for further telemedicine (TM) and chronic wound management research, the objective of this article is twofold: to conduct a systematic review of existing knowledge on TM interventions in chronic wound management-including barriers and opportunities-across the specialist and primary care sectors, and to incorporate the review findings into a system framework that can be further developed and validated through empirical data. We conclude that there is a pressing need for broader and more comprehensive empirical explorations into quality improvement and integration of TM in chronic wound management, including using system frameworks that can capture cross-sector system perspectives and associated implications. Of practical consideration, we suggest that the design and execution of TM improvement interventions and associated research projects should be conducted in close cooperation with managers and practitioners knowledgeable about barriers and opportunities that can influence the implementation of important interventions within chronic wound management.
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Affiliation(s)
- Sindre Aske Høyland
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Kari Anne Holte
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Kamrul Islam
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Olaug Øygaarden
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | - Egil Kjerstad
- Division for Health and Social Sciences, NORCE Norwegian Research Centre, Stavanger, Norway
| | | | | | - Marcus Gürgen
- Department for Dermatology, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Eirin Rødseth
- Department for Personal E-Health, Norwegian Centre for E-health Research, Tromsø, Norway
| | - Pascale Carayon
- Department for Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Nicola Ivins
- Welsh Wound Innovation Centre WWIC, Ynysmaerdy, Wales
| | | | | | - Keith G Harding
- School of Medicine, Cardiff University, Cardiff, UK.,Skin Research Institute of Singapore (SRIS), Novena, Singapore
| | - Thomas Ternowitz
- Department for Dermatology, Stavanger University Hospital, Stavanger, Norway
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Greenidge AR, Quimby KR, Rose AMC, Speede A, Hambleton IR, Anderson SG, Landis RC. Direct healthcare services cost of non-healing diabetic foot wounds in an African origin population in Barbados. Diabet Med 2022; 39:e14773. [PMID: 34936707 DOI: 10.1111/dme.14773] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022]
Affiliation(s)
- André R Greenidge
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Kim R Quimby
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Angela M C Rose
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Amy Speede
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Ian R Hambleton
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - Simon G Anderson
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
| | - R Clive Landis
- Edmund Cohen Laboratory for Vascular Research, George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Cave Hill Campus, Barbados
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Grigoryan AY, Terekhov AG. [Modern concept about trophic venous ulcers]. Khirurgiia (Mosk) 2022:73-80. [PMID: 35080830 DOI: 10.17116/hirurgia202201173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Venous trophic ulcer is a common complication of chronic venous diseases that have a negative impact on the quality of life and result negative socio-economic consequences. There are three main theories of development of venous trophic ulcers. The criterion is visible trophic changes of skin (CEAP class C4). If correction of etiological factor of ulcer is impossible, local management is preferred. There are various wound coverings which can be used for the treatment of trophic ulcers. However, data on their effectiveness are sometimes unavailable. Therefore, it is necessary to systematize knowledge about modern measures and methods of exposure to trophic ulcers. The authors also discuss current understanding of pathophysiology, symptoms and diagnosis of venous trophic ulcers.
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Weller CD, Richards C, Turnour L, Team V. Understanding factors influencing venous leg ulcer guideline implementation in Australian primary care. Int Wound J 2020; 17:804-818. [PMID: 32150790 DOI: 10.1111/iwj.13334] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to gain a better understanding of the venous leg ulcer (VLU) management in primary health care settings located in Melbourne metropolitan and rural Victoria, Australia. We explored health professionals' perspective on the use of the Australian and New Zealand Venous Leg Ulcer Clinical Practice Guideline (VLU CPG) to identify the main challenges of VLU CPG uptake in clinical practice. We conducted semi-structured interviews with 15 general practitioners (GPs) and 20 practice nurses (PNs), including two Aboriginal health nurses. The Theoretical Domains Framework guided data collection and analysis. Data were analysed using a theory-driven analysis. We found a lack of awareness of the VLU CPGs, which resulted in suboptimal knowledge and limited adherence to evidence-based recommendations. Environmental factors, such as busy nature of clinical environment and absence of handheld Doppler ultrasound, as well as social and professional identity factors, such as reliance on previous experience and colleague's advice, influenced the uptake of the VLU CPGs in primary care. Findings of this study will inform development of interventions to increase the uptake of the VLU CPG in primary care settings and to reduce the evidence-practice gap in VLU management by health professionals.
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Affiliation(s)
- Carolina D Weller
- Monash Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Catelyn Richards
- Monash Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Louise Turnour
- Monash Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Victoria Team
- Monash Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
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Pacella RE, Tulleners R, McCosker L, Cheng Q, Harding K, Edwards H, Yelland S, Dyer A, McGuiness W, Graves N. Reimbursement for the cost of compression therapy for the management of venous leg ulcers in Australia. Int Wound J 2019; 16:1069-1072. [PMID: 31140713 DOI: 10.1111/iwj.13152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 05/12/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Rosana E Pacella
- University of Chichester, Chichester, UK.,School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ruth Tulleners
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Laura McCosker
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Qinglu Cheng
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Helen Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Anthony Dyer
- Wound Innovations, Brisbane, Queensland, Australia
| | - William McGuiness
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Nicholas Graves
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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