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Sekanina U, Tetzlaff B, Mazur A, Huckle T, Kühn A, Dano R, Höckelmann C, Scherer M, Balzer K, Köpke S, Hummers E, Müller C. Interprofessional collaboration in the home care setting: perspectives of people receiving home care, relatives, nurses, general practitioners, and therapists-results of a qualitative analysis. BMC PRIMARY CARE 2024; 25:79. [PMID: 38438843 PMCID: PMC10910757 DOI: 10.1186/s12875-024-02313-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/16/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND About one million people in need of home care in Germany are assisted by 15,400 home care services. Home healthcare is mostly a complex endeavour because interprofessional collaboration is often challenging. This might negatively impact patient safety. The project interprof HOME aims to develop an interprofessional person-centred care concept for people receiving home care in a multistep approach. In one of the work packages we explored how people receiving home care, relatives, nurses, general practitioners, and therapists (physiotherapists, occupational therapists, and speech therapists) perceive collaboration in this setting. METHODS Semi-structured interviews were conducted with 20 people receiving home care and with 21 relatives. Additionally, we worked with nine monoprofessional focus groups involving nurses of home care services (n = 17), general practitioners (n = 14), and therapists (n = 21). The data were analysed by content analysis. RESULTS Three main categories evolved: "perception of interprofessional collaboration", "means of communication", and "barriers and facilitators". People receiving home care and relatives often perceive little to no interprofessional collaboration and take over a significant part of the organisational coordination and information exchange. Interprofessional collaboration in steady care situations does exist at times and mostly occurs in coordination tasks. Contact and information exchange are rare, however, interprofessional personal encounters are sporadic, and fixed agreements and permanent contact persons are not standard. These trends increase with the complexity of the healthcare situation. Joint collaborations are often perceived as highly beneficial. Means of communications such as telephone, fax, or e-mail are used differently and are often considered tedious and time-consuming. No interprofessional formal written or electronic documentation system exists. Personal acquaintance and mutual trust are perceived as being beneficial, while a lack of mutual availability, limited time, and inadequate compensation hinder interprofessional collaboration. CONCLUSIONS Interprofessional collaboration in home care occurs irregularly, and coordination often remains with people receiving home care or relatives. While this individual care set-up may work sufficiently well in low complex care situations, it becomes vulnerable to disruptions with increasing complexity. Close interactions, joint collaboration, and fixed means of communication might improve healthcare at home. The findings were integrated into the development of the person-centred interprofessional care concept interprof HOME. TRIAL REGISTRATION This study is registered on the International Clinical Trails registry platform ClinicalTrials.gov as NCT05149937 on 03/11/2021.
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Affiliation(s)
- Uta Sekanina
- Department of General Practice, University Medical Center Goettingen, Humboldtallee 38, 37073, Göttingen, Germany.
| | - Britta Tetzlaff
- Department of General Practice and Primary Care, University Medical Center Hamburg- Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ana Mazur
- Department of General Practice, University Medical Center Goettingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Tilman Huckle
- Nursing Research Unit, Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Anja Kühn
- Nursing Research Unit, Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Richard Dano
- Institute of Nursing Science, Medical Faculty, University of Cologne, University Hospital Cologne, Gleueler Str. 176-178, 50935, Köln, Germany
| | - Carolin Höckelmann
- Institute of Nursing Science, Medical Faculty, University of Cologne, University Hospital Cologne, Gleueler Str. 176-178, 50935, Köln, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg- Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Katrin Balzer
- Nursing Research Unit, Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Medical Faculty, University of Cologne, University Hospital Cologne, Gleueler Str. 176-178, 50935, Köln, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Goettingen, Humboldtallee 38, 37073, Göttingen, Germany
| | - Christiane Müller
- Department of General Practice, University Medical Center Goettingen, Humboldtallee 38, 37073, Göttingen, Germany
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Fu J, Huang C, Li S, Xia Y. Evolutionary game analysis of rural public-private partnership older adult care project in the context of population aging in China. Front Public Health 2023; 11:1110082. [PMID: 37719740 PMCID: PMC10499553 DOI: 10.3389/fpubh.2023.1110082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 07/28/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Public-private partnership (PPP) older adult care project is an effective means to solve the dilemma of the aging population in China's rural areas, but there are some problems in the operation process, such as a low participation rate and poor service quality, resulting in the needs of rural older adult groups not being met. Methods To alleviate the pressure of the aging population in rural areas, this study establishes an evolutionary game model for the PPP older adult care project, then defines the interests of local government, the private sector, and rural older adult residents, based on which it discusses the strategic choices of the three parties in the evolutionary process, and finally analyzes the influencing factors of the strategic choices of the game parties through simulation. Results The results suggest that whether the private sector chooses to actively participate in the project will be influenced by the willingness of local government and rural older adult residents to participate in the project. Local government could play the role of supervisor through reward and punishment mechanisms. Whether older rural residents choose to participate in the project depends on the number of benefits they would receive. Discussion Based on these findings, local governments should clarify the responsibilities of relevant stakeholders, adopt a regulatory strategy combining subsidies and penalties, improve the participation efficiency of rural older adult residents, promote the effective operation of PPP older adult care projects, and improve the quality of rural older adult care services in the new era.
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Affiliation(s)
- Jianru Fu
- Management Science and Engineering Research Center, Jiangxi Normal University, Nanchang, Jiangxi, China
- College of Finance and Economics, Jiangxi Normal University, Nanchang, Jiangxi, China
| | - Chao Huang
- Management Science and Engineering Research Center, Jiangxi Normal University, Nanchang, Jiangxi, China
| | - Shicheng Li
- Management Science and Engineering Research Center, Jiangxi Normal University, Nanchang, Jiangxi, China
| | - Yihan Xia
- Management Science and Engineering Research Center, Jiangxi Normal University, Nanchang, Jiangxi, China
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Ma L, Wang X, Zou S, Lin M, Qiu S, Li W. A structural equation modelling analysis: interprofessional team collaboration, organizational career management, and post competency of community nurses. BMC Health Serv Res 2023; 23:327. [PMID: 37005581 PMCID: PMC10067220 DOI: 10.1186/s12913-023-09303-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/17/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND With the advent of an ageing society and an increase in the prevalence of chronic diseases, the role of primary health care has become increasingly important and reliant on multidisciplinary collaboration. As members of this interprofessional cooperative team, community nurses play a dominant role. Thus, the post competencies of community nurses study deserve our attention. In addition, organizational career management can affect nurses in some ways. This study aims to examine the current situation and relationship among interprofessional team collaboration, organizational career management and post-competency of community nurses. METHODS A survey was conducted among 530 nurses in 28 community medical institutions from November 2021 to April 2022 in Chengdu, Sichuan Province, China. Descriptive analysis was used for analysis, and a structural equation model was used to hypothesize and verify the model. A total of 88.2% of respondents met the inclusion criteria and did not meet the exclusion criteria. The main reason nurses gave for not participating was that they were too busy. RESULTS Among the competencies on the questionnaire, ensuring quality and helping roles scored the lowest. The teaching-coaching and diagnostic functions played a mediating role. Nurses with greater seniority and those who were transferred to administrative departments had lower scores, and the difference was statistically significant (p < 0.05). In the structural equation model, CFI = 0.992 and RMSEA = 0.049, which shows that the model fit well, suggesting that organizational career management had no statistically significant effect on post competency (β = -0.006, p = 0.932) but that interprofessional team collaboration had a statistically significant effect on post competency (β = 1.146, p < 0.001) and organizational career management had a statistically significant effect on interprofessional team collaboration (β = 0.684, p < 0.001). CONCLUSIONS Attention should be given to the improvement of community nurses' post competency in ensuring quality and performing helping, teaching-coaching, and diagnostic roles. Moreover, researchers should focus on the decline in community nurses' abilities, particularly for those with greater seniority or in administrative roles. The structural equation model shows that interprofessional team collaboration is a complete intermediary between organizational career management and post competency.
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Affiliation(s)
- Li Ma
- Institute of Hospital Management, Outpatient Department, West China School of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinwei Wang
- School of Business, Sichuan University, Chengdu, Sichuan, China
| | - Shiyue Zou
- The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Min Lin
- The First People's Hospital of Longquanyi District, Chengdu, Sichuan, China
| | - Shi Qiu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, Institute of Respiratory Health, Frontiers Science Center for Disease-Related Molecular Network/Precision Medicine Research Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Ohta R, Sano C. The Effectiveness of Family Medicine-Driven Interprofessional Collaboration on the Readmission Rate of Older Patients. Healthcare (Basel) 2023; 11:healthcare11020269. [PMID: 36673637 PMCID: PMC9859164 DOI: 10.3390/healthcare11020269] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
Interprofessional collaboration (IPC) for older patient care among family physicians, dentists, therapists, nutritionists, nurses, and pharmacists in the rural hospital care of older patients could improve the hospital readmission rate. However, there is a lack of interventional studies on IPC for improving the readmission rate among Japanese older patients in rural hospitals. This quasi-experimental study was performed on patients >65 years who were discharged from a rural community hospital. The intervention was IPC implementation with effective information sharing and comprehensive management of older patients’ conditions for effective discharge and readmission prevention; implementation started on 1 April 2021. The study lasted 2 years, from 1 April 2021 to 31 March 2022 for the intervention group and from 1 April 2020 to 31 March 2021 for the comparison group. The average participant age was 79.86 (standard deviation = 15.38) years and the proportion of men was 45.0%. The Cox hazard model revealed that IPC intervention could reduce the readmission rate after adjustment for sex, serum albumin, polypharmacy, dependent condition, and Charlson Comorbidity Index score (hazard ratio = 0.66, 95% confidence interval: 0.54−0.81). Rural IPC intervention can improve inpatient care for older patients and decrease readmission rates. Thus, for effective rural IPC interventions, family physicians in hospitals should proactively collaborate with various medical professionals to improve inpatient health outcomes.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 699-1221 96-1 Iida, Daito-cho, Unnan 699-1221, Japan
- Correspondence: ; Tel.: +81-90-5060-5330
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Japan
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Tabata R, Yamaguchi H, Ookura Y, Tani K. Complementary and alternative medicines chosen for specific health problems: Internet survey using the I-CAM-Q in Japan: A STROBE-compliant cross-sectional study. Medicine (Baltimore) 2022; 101:e31098. [PMID: 36254091 PMCID: PMC9575747 DOI: 10.1097/md.0000000000031098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study investigated the different complementary and alternative medicines (CAMs) adopted by people in Japan, as well as the health problems treated with CAMs. Understanding more about this topic will facilitate the appropriate incorporation of CAMs into conventional medicine when treating health problems. Data were collected through an online survey based on the International Questionnaire to Measure Use of Complementary and Alternative Medicine (I-CAM-Q). The study examined CAM utilization among people aged 20 years or older; 164 valid responses were collected (18.9%). We adopted a cross-sectional design. We then compared the relationships between the specific health problems reported by participants, their self-help practices, and the kinds of healthcare specialists consulted. We also examined participants' reasons for using CAMs and their responses regarding the usefulness of the CAMs adopted. We found that self-help/CAM practices differed for specific health problems. Participants with musculoskeletal and heart problems were more likely to use poultices. Those with respiratory and digestive problems were more likely to practice yoga, tai chi, and qigong. Those with digestive and neurological problems were more likely to use aromatherapy. The I-CAM-Q questionnaire also revealed the purpose and usefulness of the CAMs utilized as well as the participants' attitudes regarding conventional medicine. The study showed that participants find physicians less helpful than other options for treating their health problems. Additionally, when asked whether it was helpful to consult with a specific professional for health problems, there was a higher percentage of participants who answered "Very helpful" for professionals, like massage, judo, acupuncture, and moxibustion therapists, than for physicians. The results of this study will help to inform medical providers of the most appropriate types of CAMs for dealing with various health problems.
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Affiliation(s)
- Ryo Tabata
- Department of General Medicine, University of Tokushima Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Harutaka Yamaguchi
- Department of General Medicine, University of Tokushima Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshihiro Ookura
- Department of General Medicine and Primary Care, Tokushima University Hospital, Tokushima, Japan
| | - Kenji Tani
- Department of General Medicine and Primary Care, Tokushima University Hospital, Tokushima, Japan
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Ohta R, Yawata M, Sano C. Doctor Clerk Implementation in Rural Community Hospitals for Effective Task Shifting of Doctors: A Grounded Theory Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9944. [PMID: 36011579 PMCID: PMC9408635 DOI: 10.3390/ijerph19169944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
With the diversification of medical care and work reform, doctor clerks play a major role today and are recruited to mitigate the burden of doctors worldwide. Their recruitment can improve the working conditions of physicians, facilitate task shifting in rural community hospitals, improve patient care, and help address the lack of healthcare resources. This study used a qualitative method to investigate difficulties in the implementation of doctor clerks and ascertain the features of effective implementation by collecting ethnographic data through field notes and semi-structured interviews with workers. We observed and interviewed 4 doctor clerks, 10 physicians, 14 nurses, 2 pharmacists, 1 nutritionist, and 2 therapists for our study. We clarified the doctor clerk process in rural hospitals through four themes: initial challenge, balance between education and expansion, vision for work progression, and drive for quality of care. We further clarified effectiveness, difficulties, and enhancing factors in implementation. Doctor clerk recruitment and bridging of discrepancies among medical professionals can mitigate professional workloads and improve staff motivation, leading to better interprofessional collaboration and patient care.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Japan
| | - Miyuki Yawata
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Japan
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo 693-8501, Japan
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Ohta R, Ryu Y, Sano C. The Relationship Between the Presence of White Nails and Readmission Among Rural Older Admitted Patients: A Prospective Cohort Study. Cureus 2022; 14:e24297. [PMID: 35602847 PMCID: PMC9120933 DOI: 10.7759/cureus.24297] [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] [Accepted: 04/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background Nail changes can indicate systemic changes within the body. According to previous studies, white nails, characterized by the whitening of the proximal nails with the absence of a lunula, were related to in-hospital mortality in rural community hospitals. Hence, this study aimed to investigate the relationship between the presence of white nails and readmissions among rural older patients who had previously been discharged from rural community hospitals. Methodology The relationship between white nails and readmissions among admitted older patients discharged from community hospitals was investigated. This was a single-center prospective study. All patients >65 years admitted from April 2020 to March 2021 and readmitted between April 2020 and June 2021 were included in the study. Upon admission, all patients’ nails were evaluated by trained evaluators for whitening. The presence of white nails was correlated with readmission using a multivariate logistic regression model. Results Approximately 28.7% of all participants were readmitted to the hospital during the study period; 41.1% had white nails, and 24.6% did not. Cox hazard model was used to analyze the relationship between readmission and white nails. Of all 637 participants, 24.8% had white nails. Significant variables for readmission were cancer (hazard ratio, HR = 1.52, p = 0.033), dementia (HR = 1.52, p = 0.037), heart failure (HR = 1.53, p = 0.033), home discharge (HR = 0.32, p ≤ 0.001), duration of previous hospitalization (HR = 0.99, p = 0.0026), and white nails (HR = 2.07, p ≤ 0.001). Conclusions White nails may be associated with readmission among previously admitted older patients. Identifying white nails in older admitted patients may enhance awareness of readmission risk; however, this needs further research.
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Exploring the Competencies of Japanese Expert Nurse Practitioners: A Thematic Analysis. Healthcare (Basel) 2021; 9:healthcare9121674. [PMID: 34946398 PMCID: PMC8701295 DOI: 10.3390/healthcare9121674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 12/29/2022] Open
Abstract
Nurse practitioners (NPs) provide medical care equivalent to that of physicians and facilitate access to healthcare. Although Japan’s first NP graduated in 2010, how Japanese expert NPs work effectively in clinical contexts is yet to be investigated. We aimed to identify the competencies that make expert NPs in Japan effective. Twelve Japanese expert NPs were purposely selected. The average age of the participants was 44.8 years, average NP experience was 7.5 years, and eight participants were women. Semi-structured interviews were conducted online from March to May 2021. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Thematic analysis revealed five themes: working in physicians’ contexts, interprofessional collaboration, involvement in nurses’ work, contribution to healthcare, and personal qualities for effective working. Japanese expert NPs can function effectively in clinical settings by flexibly and humbly collaborating with other medical professionals who have autonomous positions. They can improve the quality of healthcare by proposing practical solutions to problems faced by patients and medical organizations. These explored competencies can be applied to other aging and more complex societal contexts, and in updating the required competencies of Japanese NPs.
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The Relationship between the Presence of White Nails and Mortality among Rural, Older, Admitted Patients: A Prospective Cohort Study. Healthcare (Basel) 2021; 9:healthcare9121611. [PMID: 34946339 PMCID: PMC8702063 DOI: 10.3390/healthcare9121611] [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: 10/18/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
White nails are a sign of various physical deteriorations, including poor nutrition, organ damage, and aging. During a physical examination, white nails can be a helpful health indicator in older patients with vague and multiple symptoms. In this prospective cohort study of patients admitted to the Department of General Medicine in a rural community hospital, we investigated the relationship between white nails and patient mortality. Patient data, including age, sex, condition, and bloodwork results, were collected. Trained family physicians confirmed the presence of white nails. Logistic regression analysis was performed to determine the relationship between white nails and death during hospitalization. Of 711 study participants, 74 died during hospitalization. White nails, male sex, and caregiver dependence were associated with high in-hospital mortality (odds ratio (OR) = 3.47, p < 0.001; OR 2.05, p = 0.01; OR 1.92, p = 0.049, respectively). High albumin concentration was associated with low in-hospital mortality (OR = 0.44, p < 0.001). White nails, along with serum albumin concentration, male sex, and caregiver dependence, are associated with mortality. The identification of white nails can predict the deterioration of patients. Various professionals should learn to identify the presence of white nails to facilitate the care of elderly patients.
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Exploring the perceived challenges and support needs of Indonesian mental health stakeholders: a qualitative study. Int J Ment Health Syst 2021; 15:81. [PMID: 34749767 PMCID: PMC8573764 DOI: 10.1186/s13033-021-00504-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 10/28/2021] [Indexed: 11/20/2022] Open
Abstract
Background Despite the large treatment gap in Indonesia, limited studies have attempted to explore both service users’ and providers’ evaluations of the current mental health system holistically. This study aims to explore the perceived challenges and support needs of Indonesian mental health stakeholders. Methods This qualitative study collected data from 17 participants from two mental health stakeholders in Yogyakarta (i.e., health professionals and service users) through a semi-structured interview. Thematic analysis was used to analyze the data. Results Findings reveal that service providers and users shared equally strong concerns regarding challenges and needs for improving mental health literacy, accessibility to services, and government support. However, a distinct emphasis was made in several areas—with service providers hinting more towards issues with interprofessional collaboration. In contrast, service users emphasized the negative attitude of health professionals and poor accessibility to service information. Conclusion The mental health service system is challenged by the lack of accessibility to service information, the limited spread of mental health practitioners, stigma, and lack of mental health literacy among both the public and professionals. A need for improvement in mental health promotion, accessibility, and quality of mental health workers is highlighted to satisfy the needs of both service users and providers.
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Recognition of Anemia in Elderly People in a Rural Community Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111179. [PMID: 34769698 PMCID: PMC8583314 DOI: 10.3390/ijerph182111179] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/23/2021] [Accepted: 10/24/2021] [Indexed: 11/30/2022]
Abstract
Anemia in the elderly is a common disease associated with increased mortality and hospitalization rates. It is not clear how adequately elderly patients are assessed and treated in actual clinical practice. This study clarifies the frequency of anemia recognition before assessment and the factors related to recognition among older people in a rural community hospital. This cross-sectional study evaluated 156 elderly patients aged > 65 years. Data on several different variables were collected from patient medical records. Anemia was defined as a hemoglobin level < 11 g/dL. Patients were classified into “anemia recognition” and “no anemia recognition” groups. Statistical analysis of the data included multivariable logistic regression to examine the association between anemia recognition and other factors. The anemia recognition group comprised 63 (40.4%) patients. Age was significantly associated with the recognition of anemia (adjusted odds ratio = 0.70, 95% confidence interval: 0.53–0.92, p = 0.011). Appropriate medical care should be provided to the elderly; however, it may be limited according to age.
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Kuroda M, Ohta R, Kuroda K, Yamashiro S, Kita K. The Seamless Communication on a Rural Island in Japan: A Qualitative Study from the Perspective of Healthcare Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189479. [PMID: 34574410 PMCID: PMC8470606 DOI: 10.3390/ijerph18189479] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/31/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022]
Abstract
On remote islands, interprofessional collaboration is essential to support older adults who live at home, despite the limited number of healthcare professionals (HCPs). Therefore, it is important for HCPs to collect and share information about older adults with health problems. This study aimed to clarify how rural HCPs collaborate using limited resources to support older adults in remote islands. We conducted semi-structured interviews with 10 healthcare providers for older adults on Zamami Island of Okinawa, Japan. We performed a qualitative analysis using the steps for coding and theorization method. Four themes were extracted: “Collection and communication of information between residents”, “Communication of information from non-HCPs to HCPs”, “Sharing of information between HCPs”, and “HCPs taking action to initiate their approach”. Islanders take care of each other and know each other’s health status, while HCPs gather their health information. When necessary, HCPs on the island gain essential information regarding older adult patients from islanders not only through work, but also through personal interactions. Afterward, HCPs approach older adults who need health care. The human connections on this remote island serve as social capital and enable flexibility in both gathering information and seamless communication among islanders who also serve as informal resources that contribute support for older adults.
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Affiliation(s)
- Moe Kuroda
- Department of General Medicine, Toyama University Hospital, Toyama 930-0194, Japan; (K.K.); (S.Y.); (K.K.)
- Correspondence: ; Tel.: +81-76-434-2281
| | - Ryuichi Ohta
- Department of Community Care Medicine, Unnan City Hospital, Unnan 699-1221, Japan;
| | - Kaku Kuroda
- Department of General Medicine, Toyama University Hospital, Toyama 930-0194, Japan; (K.K.); (S.Y.); (K.K.)
- Department of Family Medicine, SUNY Upstate Medical University, Syracuse, NY 13215, USA
| | - Seiji Yamashiro
- Department of General Medicine, Toyama University Hospital, Toyama 930-0194, Japan; (K.K.); (S.Y.); (K.K.)
- Department of Primary Care, Toyama University Hospital, Toyama 930-0194, Japan
| | - Keiichiro Kita
- Department of General Medicine, Toyama University Hospital, Toyama 930-0194, Japan; (K.K.); (S.Y.); (K.K.)
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The Contribution of Temporal Flat Lateral Position on the Mortality and Discharge Rates of Older Patients with Severe Dysphagia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168443. [PMID: 34444198 PMCID: PMC8394130 DOI: 10.3390/ijerph18168443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 01/31/2023]
Abstract
Severe dysphagia leads to mortality in older patients and hinders their discharge from hospitals. The temporal flat lateral position (TFLP) enables them to continuously eat, thus resolving the aforementioned issues. We aimed to explore the effect of TFLP on the mortality and discharge rates of older patients with severe dysphagia. This interventional study comprised a historical control of patients admitted to a rural community hospital from January 2019 to December 2020 and diagnosed with severe dysphagia. The primary outcomes included the mortality and the rate of discharge from the hospital. While the intervention group was treated with TFLP, the control group underwent no treatment. We selected 79 participants (intervention group = 26, control group = 53), with an average age of 87.9 years. The discharge rate was significantly higher in the intervention group than in the control group (57.7% vs. 26.4%, p = 0.012). The mortality rate was also significantly lower in the intervention group compared to the control group (34.6% vs. 71.7%, p = 0.003). TFLP can improve the discharge and mortality rates in community hospitals, thereby improving patient outcomes. Clinicians should focus on practical education and the implementation of TFLP in communities in order to promote it.
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Family Medicine Education at a Rural Hospital in Japan: Impact on Institution and Trainees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116122. [PMID: 34204070 PMCID: PMC8201291 DOI: 10.3390/ijerph18116122] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/21/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022]
Abstract
Family medicine is vital in Japan as its society ages, especially in rural areas. However, the implementation of family medicine educational systems has an impact on medical institutions and requires effective communication with stakeholders. This research—based on a mixed-method study—clarifies the changes in a rural hospital and its medical trainees achieved by implementing the family medicine educational curriculum. The quantitative aspect measured the scope of practice and the change in the clinical performance of family medicine trainees through their experience of cases—categorized according to the 10th revision of the International Statistical Classification of Disease and Related Health Problems. During the one-year training program, the trainees’ scope of practice expanded significantly in both outpatient and inpatient departments. The qualitative aspect used the grounded theory approach—observations, a focus group, and one-on-one interviews. Three themes emerged during the analysis—conflicts with the past, driving unlearning, and organizational change. Implementing family medicine education in rural community hospitals can improve trainees’ experiences as family physicians. To ensure the continuity of family medicine education, and to overcome conflicts caused by system and culture changes, methods for the moderation of conflicts and effective unlearning should be promoted in community hospitals.
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Ohta R, Ueno A, Kitayuguchi J, Moriwaki Y, Otani J, Sano C. Comprehensive Care through Family Medicine: Improving the Sustainability of Aging Societies. Geriatrics (Basel) 2021; 6:geriatrics6020059. [PMID: 34199871 PMCID: PMC8293036 DOI: 10.3390/geriatrics6020059] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/21/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023] Open
Abstract
Comprehensive care through family medicine can enhance the approach to multimorbidity, interprofessional collaboration, and community care, and make medical care more sustainable for older people. This study investigated the effect of implementing family medicine and the comprehensiveness of medical care in one of the most rural communities. This implementation research used medical care data from April 2015 to March 2020. Patients' diagnoses were categorized according to the 10th revision of the International Statistical Classification of Disease and Related Health Problems (ICD-10). In 2016, family medicine was implemented in only one general hospital in Unnan. The comprehensiveness rate improved in all ICD-10 disease categories during the study period, especially in the following categories-infections; neoplasms; endocrine, nutritional, and metabolic diseases; mental disorders; nervous system; circulatory system; respiratory system; digestive system; skin and subcutaneous tissue; musculoskeletal system and connective tissue; and the genitourinary system. Implementing family medicine in rural Japanese communities can improve the comprehensiveness of medical care and resolve the issue of fragmentation of care by improving interprofessional collaboration and community care. It can be a solution for the aging of both patient and healthcare professionals. Future research can investigate the relationship between family medicine and patient health outcomes for improved healthcare sustainability.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, Unnan 699-1221, Shimane, Japan; (Y.M.); (J.O.)
- Correspondence: ; Tel.: +81-90-5060-5330
| | - Akinori Ueno
- Unnan Public Health Center, Unnan 699-1311, Shimane, Japan;
| | - Jun Kitayuguchi
- Physical Education and Medicine Research Center Unnan, Unnan 699-1105, Shimane, Japan;
| | - Yoshihiro Moriwaki
- Community Care, Unnan City Hospital, Unnan 699-1221, Shimane, Japan; (Y.M.); (J.O.)
| | - Jun Otani
- Community Care, Unnan City Hospital, Unnan 699-1221, Shimane, Japan; (Y.M.); (J.O.)
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, Izumo 693-8501, Shimane, Japan;
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16
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Maejima S, Ohta R, Sano C. The Implementation of a Clinical Ladder in Rural Japanese Nursing Education: Effectiveness and Challenges. Healthcare (Basel) 2021; 9:healthcare9040469. [PMID: 33920946 PMCID: PMC8071243 DOI: 10.3390/healthcare9040469] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/01/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
The clinical ladder is an essential tool for nursing education, enabling nurses to ascend from novice to expert. The learning content for nurses can depend on their clinical situations. The aging of societies has changed the demand for nurses at community hospitals because of the multimorbidity of older patients. At the same time, the gap in nursing education between urban and rural hospitals is wide, as rural hospitals often lack the application of the clinical ladder. This study investigates the effectiveness of using the clinical ladder in a rural Japanese community hospital using the clinical ladder scale and interviews. Through its application, we found that both novice nurses and nursing educators came to recognize the effectiveness and importance of the ladder. However, unfamiliarity with assessments, working conditions, and Japanese culture inhibited the smooth application of the ladder. For the effective application of the clinical ladder, continual training on assessments and the ladder’s effectiveness in clinical situations, along with consideration of educational background, should be enhanced through the monitoring of the clinical ladder.
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Affiliation(s)
- Satoko Maejima
- Department of Nursing, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan City 699-1221, Japan;
| | - Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan City 699-1221, Japan
- Correspondence:
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Japan;
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