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Tu Q, Lin S, Hyun K, Hafiz N, Manandi D, Koh AS, Redfern J. The effects of multidisciplinary collaborative care on cardiovascular risk factors among patients with diabetes in primary care settings: A systematic review and meta-analysis. Prim Care Diabetes 2024; 18:381-392. [PMID: 38852029 DOI: 10.1016/j.pcd.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/22/2024] [Accepted: 05/26/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Multidisciplinary collaborative care has been widely recommended as an effective strategy for managing diabetes; however, the cardiovascular risk factors of patients with diabetes are often inadequately managed in primary care settings. This study aimed to assess the effect of multidisciplinary collaboration on cardiovascular risk factors among patients with diabetes in primary care settings. METHODS Five databases (i.e., Medline, Embase, CINAHL, SCOPUS and CENTRAL) were systematically searched to retrieve randomised controlled trials. Studies were eligible for inclusion if the interventions included a multidisciplinary team with professionals from at least three health disciplines and focused on patients with diabetes in primary care settings. A random-effects model was used to calculate the pooled effects. RESULTS In total, 19 studies comprising 6538 patients were included in the meta-analysis. The results showed that compared with usual care, multidisciplinary collaborative care significantly reduced cardiovascular risk factors, including mean systolic blood pressure (-3.27 mm Hg, 95 % confidence interval [CI]: -4.72 to -1.82, p < 0.01), diastolic blood pressure (-1.4 mm Hg, 95 % CI: -2.32 to -0.47, p < 0.01), glycated haemoglobin (-0.42 %, 95 % CI: -0.59 to -0.25, p < 0.01), low-density lipoprotein (-0.16 mmol/L, 95 % CI: -0.26 to -0.06, p < 0.01) and high-density lipoprotein (0.06 mmol/L, 95 % CI: 0.00-0.12, p < 0.05). The subgroup analysis showed multidisciplinary collaboration was more effective in reducing cardiovascular risk factors when it comprised team members from a number of different disciplines, combined pharmacological and non-pharmacological components, included both face-to-face and remote interactions and was implemented in high-income countries. CONCLUSION Multidisciplinary collaborative care is associated with reduced cardiovascular risk factors among patients with diabetes in primary care. Further studies need to be conducted to determine the optimal team composition.
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Affiliation(s)
- Qiang Tu
- Faculty of Medicine and Health, The University of Sydney, Australia.
| | | | - Karice Hyun
- Faculty of Medicine and Health, The University of Sydney, Australia; Department of Cardiology, Concord Hospital, Sydney, Australia
| | - Nashid Hafiz
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Deborah Manandi
- Faculty of Medicine and Health, The University of Sydney, Australia
| | - Angela S Koh
- National Heart Centre, Singapore, Singapore; Duke-National University of Singapore, Singapore
| | - Julie Redfern
- Faculty of Medicine and Health, The University of Sydney, Australia; The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Lennips AJ, Peters VJT, Meijboom BR, Nissen AC, Bunt JEH. Continuity of care for children with anorexia nervosa in the Netherlands: a modular perspective. Eur J Pediatr 2024; 183:2463-2476. [PMID: 38470519 PMCID: PMC11035398 DOI: 10.1007/s00431-024-05497-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024]
Abstract
Care provision for children with anorexia nervosa is provided by outpatient care teams in hospitals, but the way these teams are organized differs per hospital and hampers the continuity of care. The aim of this study is to explore the organization and continuity of care for children with anorexia nervosa in the Netherlands by using a modular perspective.We conducted a qualitative, exploratory case study and took the healthcare provision for children with anorexia nervosa, provided by outpatient care teams, as our case. We conducted nine interviews with healthcare professionals involved in outpatient care teams from six hospitals. A thematic analysis was used to analyze the data.The modular perspective offered insights into the work practices and working methods of outpatient care teams. We were able to identify modules (i.e. the separate consultations with the various professionals), and components (i.e. elements of these consultations). In addition, communication mechanisms (interfaces) were identified to facilitate information flow and coordination among healthcare professionals. Our modular perspective revealed gaps and overlap in outpatient care provision, consequently providing opportunities to deal with unnecessary duplications and blind spots. Conclusion: A modular perspective can be applied to explore the organization of outpatient care provision for children with anorexia nervosa. We specifically highlight gaps and overlap in healthcare provision, which in turn leads to recommendations on how to support the three essential parts of continuity of care: informational continuity, relational continuity, and management continuity. What is Known: • Care provision for children with anorexia nervosa requires a network of health care professionals from different organizations, as a result the organization and provision of care faces challenges. What is New: • Modular care provision sheds light on the complexity and organization of outpatient care provision and supports the three dimensions of continuity of care as experienced by children with anorexia nervosa and their parents/caregivers.
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Affiliation(s)
- A J Lennips
- Department of Health Services Management & Organization, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
- Department of Information Systems and Operations Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, the Netherlands.
| | - V J T Peters
- Department of Information Systems and Operations Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, the Netherlands
- Department of Tranzo, Tilburg University, Tilburg, the Netherlands
| | - B R Meijboom
- Department of Information Systems and Operations Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, the Netherlands
- Department of Tranzo, Tilburg University, Tilburg, the Netherlands
| | - A C Nissen
- Department of Pediatrics, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - J E H Bunt
- Department of Pediatrics, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
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Kang L, Li C, Du H. Predictors of Medical Care Delay or Avoidance Among Chinese Adults During the COVID-19 Pandemic. Patient Prefer Adherence 2023; 17:3067-3080. [PMID: 38027085 PMCID: PMC10680038 DOI: 10.2147/ppa.s436794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Medical care delay or avoidance increases morbidity and mortality risk and is costly for the national healthcare system. The objective of this study was to identify factors associated with medical care delay or avoidance among Chinese adults during the COVID-19 pandemic. Materials and Methods A cross-sectional analysis was conducted using data from the 2020 China Family Panel Study (CFPS). The CFPS was conducted from July to December 2020 during the COVID-19 pandemic. The final sample included 4369 adults. A logistic regression model was employed to identify the factors associated with medical care delay or avoidance. Results The empirical results indicate that regardless of rural-urban residence, older adults and adults with chronic conditions were less likely to delay or avoid medical care during the pandemic. However, individuals who had completed more than three years of college showed a higher likelihood of delaying or avoiding medical care. In urban areas, larger family sizes, greater general trust in physicians, and higher provider structural quality were associated with a decreased probability of delaying or avoiding medical care during the pandemic. In contrast, employed adults were more likely to delay or avoid medical care. In rural areas, current smokers were more likely to delay or avoid medical care during the pandemic. Conclusion This study has identified several factors affecting medical care delay or avoidance, some of which are amenable to policy changes. Policymakers can help improve the utilization of health facilities and patient health outcomes by implementing a series of reforms.
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Affiliation(s)
- Lili Kang
- School of Health Management, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Changle Li
- School of Health Management, Fujian Medical University, Fuzhou, People’s Republic of China
| | - Huifeng Du
- School of Health Management, Inner Mongolia Medical University, Hohhot, People’s Republic of China
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Peters VJT, de Winter JP. Navigating the path home: pioneering hospital-to-home transitions for children with medical complexity. Eur J Pediatr 2023; 182:3803-3804. [PMID: 37368005 DOI: 10.1007/s00431-023-05084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Affiliation(s)
- Vincent J T Peters
- Department of Management, Tilburg University, Tilburg, The Netherlands.
- Department of Tranzo, Tilburg University, Tilburg, The Netherlands.
| | - J Peter de Winter
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, Hoofddorp, The Netherlands
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Leuven Child and Youth Institute, KU Leuven, Leuven, Belgium
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5
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Stenmarker M, Björk M, Golsäter M, Enskär K. Everyday life during the childhood cancer trajectory-childhood cancer survivors' descriptions of the role of caring support. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1098933. [PMID: 37397267 PMCID: PMC10313101 DOI: 10.3389/fresc.2023.1098933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
Background Being diagnosed with cancer in childhood often has a direct impact on the child's opportunities to participate in activities and the child's sense of belonging in different life situations. Experiences of illness in youth affect the lives of these individuals in numerous ways and they need pronounced support to regain their normal life after treatment. Purpose To illustrate how childhood cancer survivors describe the role of the caring support provided by healthcare professionals at diagnosis and during the cancer trajectory. Methods A mixed methods approach was applied. Swanson's Theory of Caring was used to deductively analyze the answers in a study-specific questionnaire with Likert scales (1-5). Descriptive and comparative statistics and exploratory factor analyses were performed. Results Sixty-two former patients, diagnosed with solid tumors/lymphoma in 1983 to 2003 in Sweden, participated. The mean time passed since treatment was 15.7 years. Swanson's caring processes Being with and Doing for were the most prominent loading categorical factor indicators. Higher scores for healthcare professionals being emotionally present (Being with), doing for others what they would do for themselves (Doing for) and being willing to understand the sick child's situation (Knowing) were highlighted by survivors older than 30 years, compared to those younger than 30 years (p = 0.041, p = 0.045, and p = 0.013, respectively). An increased vulnerability regarding their ability to cope with difficulties (Maintain belief) was found among participants who were treated during adolescence, related to schoolchildren (p = 0.048), and among those who had been treated with extra-cranial irradiation in comparison with no extra-cranial irradiation (p = 0.004). The role of having a partner in comparison with being single was underlined among those who felt they had acquired the tools they needed to take care of themselves (Enabling) (p = 0.013). The total explained variance was 63%. Conclusions A person-centered care approach during treatment for childhood cancer, reflected by a caring model, highlights the role of healthcare professionals being emotionally present, involving children, performing actions, and with an approach that has potential long-term implications. Childhood cancer patients and survivors need not only clinically competent professionals, but professionals who provide caring interactions with compassion.
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Affiliation(s)
- Margaretha Stenmarker
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Region Jönköping County, Jönköping, Sweden
- Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria Björk
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
- CHILD—Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Marie Golsäter
- CHILD—Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Child Health Services, Region Jönköping County, Jönköping, Sweden
| | - Karin Enskär
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Peters VJT, de Winter JP. Integrated care for children living with complex care needs: navigating the long and winding road. Eur J Pediatr 2023; 182:1437-1438. [PMID: 36862224 DOI: 10.1007/s00431-023-04892-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Vincent J T Peters
- Department of Management, Tilburg University, Tilburg, Netherlands.
- Department of Tranzo, Tilburg University, Tilburg, Netherlands.
| | - J Peter de Winter
- Department of Pediatrics, Spaarne Gasthuis, Haarlem and Hoofddorp, Hoofddorp, The Netherlands
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Leuven Child and Youth Institute, KU Leuven, Leuven, Belgium
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Younas A, Inayat S, Masih S. Nurses' perceived barriers to the delivery of person-centred care to complex patients: A qualitative study using theoretical domains framework. J Clin Nurs 2023; 32:368-381. [PMID: 35132737 DOI: 10.1111/jocn.16245] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES To determine nurses' perceived barriers to the delivery of person-centred care to complex patients with multiple chronic conditions in acute care settings. BACKGROUND Complex patients have multiple physical and mental health problems, and their life is also greatly affected by sociocultural and economic determinants of health. These patients require person-centred care, but nurses often find it challenging to provide effective care to these patients due to their complex health needs. DESIGN A descriptive qualitative design was used. The COREQ guidelines were followed for reporting. METHODS Semi-structured interviews were conducted with a purposive sample of 19 nurses in two hospitals. Data were analysed using deductive thematic analysis guided by the Theoretical Domains Framework, which entails 14 domains about factors affecting behaviours. RESULTS The key barriers were identified under environmental context and resources, social influences, emotions, knowledge and skills domains. Deep-rooted social issues delay patients' health-seeking and nurses' abilities to understand patients' needs and discern appropriate care. Interpersonal hostility influenced nurse-patient-families interactions, and doctor-nurses conflicts affected collaborative efforts towards optimal care. CONCLUSIONS Nurses' perceived barriers to care were intertwined with the deep-rooted social and cultural beliefs about nurses' image, patients' expectations and families' preference for home remedies over specialised nursing care. These barriers to person-centred care demonstrate an intricate interplay of personal, social and organisational issues and power struggles. Multifaceted implementation strategies targeting environmental context and resources, social influences, emotions, knowledge and skills domains may be beneficial to enable nurses to provide better person-centred care to complex patients. RELEVANCE TO CLINICAL PRACTICE Designing implementation facilitation teams, organising person-centred care grand rounds, and allocation of stress management resources to address hostility, social-cultural influences, and organisational barriers is essential. Nurses could focus on their self-awareness and collaborative skills to address emotional and interprofessional conflicts.
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Affiliation(s)
- Ahtisham Younas
- Swat College of Nursing, Swat, Pakistan.,Faculty of Nursing, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Shahzad Inayat
- Isra College of Nursing, Al-Nafees Medical College, Isra University, Islamabad, Pakistan
| | - Samuel Masih
- College of Nursing, Bashir Institute of Health Sciences, Islamabad, Pakistan
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Maas VK, Dibbets FH, Peters VJT, Meijboom BR, van Bijnen D. The never-ending patient journey of chronically ill patients: A qualitative case study on touchpoints in relation to patient-centered care. PLoS One 2023; 18:e0285872. [PMID: 37195966 DOI: 10.1371/journal.pone.0285872] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 05/03/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Healthcare professionals caring for chronically ill patients increasingly want to provide patient-centered care (PCC). By understanding each individual patient journey, they can significantly improve the quality of PCC. A patient journey consists of patient interactions, so-called touchpoints, with healthcare professionals distributed over three periods: pre-service, service, and post-service period. The aim of this study was to ascertain chronically ill patients' needs for digital alternatives for touchpoints. Specifically, we aimed to explore which digital alternatives patients would like to see implemented into their patient journey to help healthcare professionals providing PCC. METHODS Eight semi-structured interviews were conducted either face-to-face or via Zoom. Participants were included if they had visited the department of internal medicine and had received treatment for either arteriosclerosis, diabetes, HIV, or kidney failure. The interviews were analyzed utilizing a thematic analysis approach. RESULTS The results suggest that the patient journey of chronically ill patients is a continuous cycle. Furthermore, the results showed that chronically ill patients would like to see digital alternatives for touchpoints implemented into their patient journey. These digital alternatives consisted of video calls, digitally checking in before a physical appointment, digitally self-monitoring one's medical condition and personally uploading monitoring results into the patient portal, and viewing their own medical status in a digital format. Particularly, patients who were familiar with their healthcare professional(s) and were in a stable condition mostly opted for digital alternatives. CONCLUSION In the cyclical patient journey, digitalization can help put the wishes and needs of the chronically ill patients at the center of care. It is recommended that healthcare professionals implement digital alternatives for touchpoints. Most chronically ill patients consider digital alternatives to lead to more efficient interactions with their healthcare professionals. Furthermore, digital alternatives support patients to be better informed about the progress of their chronical illness.
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Affiliation(s)
- Vera K Maas
- Department of Internal Medicine, Catharina Ziekenhuis, Eindhoven, Noord-Brabant, the Netherlands
| | - Frederik H Dibbets
- Department of Management, Tilburg School of Economics and Management, Tilburg University, Tilburg, Noord-Brabant, the Netherlands
| | - Vincent J T Peters
- Department of Internal Medicine, Catharina Ziekenhuis, Eindhoven, Noord-Brabant, the Netherlands
- 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
| | - Daniëlle van Bijnen
- Department of Internal Medicine, Catharina Ziekenhuis, Eindhoven, Noord-Brabant, the Netherlands
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Handor R, Persoon A, van Lieshout F, Lovink M, Vermeulen H. The Required Competencies of Bachelor- and Master-Educated Nurses in Facilitating the Development of an Effective Workplace Culture in Nursing Homes: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12324. [PMID: 36231624 PMCID: PMC9564543 DOI: 10.3390/ijerph191912324] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/06/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Nursing home care is undergoing significant changes. This requires innovative teams operating in an effective workplace culture characterized by person-centeredness and offering evidence-based care. A pivotal role for bachelor- and master-educated nurses (BNs/MNs) is foreseen to facilitate such cultures; however, there is currently no comprehensive overview of what competencies this requires. OBJECTIVES To identify what competencies are required from BNs/MNs in facilitating the development of an effective workplace culture in nursing homes. METHODS AND DESIGN We conducted an integrative review (IR) using Whittemore and Knafl's method. We searched the PubMed, CINAHL, and PsycINFO databases for studies published between January 2010 and December 2021 in English. Two independent reviewers determined whether studies met inclusion: bachelor- or master-educated nurse; nursing home; professional competencies; and mixed methods or qualitative and qualitative studies. We applied the CASP appraisal tool and analyzed the data by applying content analysis. RESULTS Sixteen articles were included. Five themes were identified representing required competencies for BNs/MNs facilitating: (1) learning cultures in nursing practice; (2) effective work relationships within teams; (3) leadership capability within teams; (4) implementation of guidelines, standards, and protocols; (5) a work environment acknowledging grief and loss of residents within teams. CONCLUSIONS It shows that the BN/MN applies five competencies associated with a facilitator role to promote the development of an effective workplace culture to achieve a safe, high-level quality of care, satisfaction, and well-being. An overarching leadership as a change champion will support teams to achieve a quality that should guide the transformation in nursing care.
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Affiliation(s)
- Rachida Handor
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Anke Persoon
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Famke van Lieshout
- Department of People and Health Studies, Fontys University of Applied Sciences, 5600 AH Eindhoven, The Netherlands
| | - Marleen Lovink
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Hester Vermeulen
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, 6500 HB Nijmegen, The Netherlands
- School of Health Studies, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands
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10
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van den Driessen Mareeuw FA, Coppus AMW, Delnoij DMJ, de Vries E. Good health care for a good life? The case of down syndrome. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2022. [DOI: 10.1111/jppi.12443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - 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 & Management Erasmus University The Netherlands
- National Health Care Institute The Netherlands
| | - Esther de Vries
- Tranzo, Scientific Center for Care and Wellbeing Tilburg University Tilburg The Netherlands
- Jeroen Bosch Hospital Hertogenbosch The Netherlands
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11
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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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12
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Bartels EA, Meijboom BR, Venrooij LMWNV, de Vries E. How service modularity can provide the flexibility to support person-centered care and shared decision-making. BMC Health Serv Res 2021; 21:1245. [PMID: 34789259 PMCID: PMC8600923 DOI: 10.1186/s12913-021-07267-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022] Open
Abstract
Background Today’s healthcare provision is facing several challenges, that cause the level of complexity to increase at a greater rate than the managerial capacity to effectively deal with it. One of these challenges is the demand for person-centered care in an approach that is tuned towards shared decision-making. Flexibility is needed to adequately respond to individual needs. Methods We elaborate on the potential of service modularity as a foundation for person-centered care delivered in a shared decision-making context, and examine to what extent this can improve healthcare. We primarily focused on theory building. To support our effort and gain insight into how service modularity is currently discussed and applied in healthcare, we conducted a scoping review. Results Descriptions of actual implementations of modularity in healthcare are rare. Nevertheless, applying a modular perspective can be beneficial to healthcare service improvement since those service modularity principles that are still missing can often be fulfilled relatively easily to improve healthcare practice. Service modularity offers a way towards flexible configuration of services, facilitating the composition of tailored service packages. Moreover, it can help to provide insight into the possibilities of care for both healthcare professionals and patients. Conclusions We argue that applying a modular frame to healthcare services can contribute to individualized, holistic care provision and can benefit person-centered care. Furthermore, insight into the possibilities of care can help patients express their preferences, increasing their ability to actively participate in a shared decision-making process. Nevertheless, it remains essential that the healthcare professional actively collaborates with the patient in composing the care package, for which we propose a model. Altogether, we posit this can improve healthcare practice, especially for the people receiving care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07267-6.
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Affiliation(s)
- E A Bartels
- Department of Management, Tilburg University, PO Box 90153, 5000LE, Tilburg, The Netherlands
| | - B R Meijboom
- Department of Management, Tilburg University, PO Box 90153, 5000LE, Tilburg, The Netherlands. .,Tranzo, Tilburg University, PO Box 90153, 5000LE, Tilburg, The Netherlands. .,Department of Marketing, Innovation and Organization, Ghent University, Tweekerkenstraat 2, 9000, Ghent, Belgium.
| | - L M W Nahar-van Venrooij
- Jeroen Bosch Academy Research, Jeroen Bosch Ziekenhuis, PO Box 90153, B1.02.014, 5200ME, 's-Hertogenbosch, The Netherlands
| | - E de Vries
- Tranzo, Tilburg University, PO Box 90153, 5000LE, Tilburg, The Netherlands.,Jeroen Bosch Academy Research, Jeroen Bosch Ziekenhuis, PO Box 90153, B1.02.014, 5200ME, 's-Hertogenbosch, The Netherlands
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