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Ballmann S. [Discharge of infants with complex care needs from the neonatal intensive care unit : Ensuring continued inpatient care via the Bunter Kreis aftercare model]. Med Klin Intensivmed Notfmed 2024; 119:277-284. [PMID: 38600231 DOI: 10.1007/s00063-024-01133-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024]
Abstract
After discharge of premature infants with complex care needs from the neonatal intensive care unit, a care gap arises due to the transition from inpatient to outpatient care. Consequences can be rehospitalization, revolving door effects, and high costs. Therefore, following hospitalization or inpatient rehabilitation, the patient is intended to transition to sociomedical aftercare. The legal basis for this is formed by § 43 paragraph 2 of the Fifth Book of the German Social Code (SGB V). Over 80 aftercare institutions in Germany work according to the model of the Bunter Kreis. The comprehensive concept describes possibilities for networking which exceed the services provided by sociomedical aftercare. Simultaneously, depending on their stage of development, young adults can receive aftercare according to this model up to their 27th year of life. The interdisciplinary team at the Bunter Kreis comprises nurses, social workers, social education workers, psychologists, and specialist physicians. The largest group of supported persons, with 6000-8000 children per year, is comprised of premature and at-risk babies as well as multiple births, followed by 3000-5000 children with neurologic and syndromic diseases. Other common diseases are metabolic diseases, epilepsy, and diabetes, as well as children after trauma and with rare diseases. Overall, the various diseases sum up to around 20 clinical pictures. The current article presents the Bunter Kreis aftercare process based on case examples.
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Affiliation(s)
- Stephanie Ballmann
- Heilpädagogische Hilfe Osnabrück (HHO) Wohnen gGmbH, Ambulanter Pflegedienst, Buersche Straße 143, 49084, Osnabrück, Deutschland.
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Agudelo-Hernández F, Guapacha-Montoya M, Rojas-Andrade R. Mutual Aid Groups for Loneliness, Psychosocial Disability, and Continuity of Care. Community Ment Health J 2024; 60:608-619. [PMID: 38194119 DOI: 10.1007/s10597-023-01216-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024]
Abstract
The objective of the present study was to evaluate the effectiveness of mutual help groups in continuity of care, loneliness and psychosocial disability in a Colombian context. For this, a quasi-experimental design is used, with pre- and post-intervention assessments due to non-randomized participant allocation. The study involved 131 individuals with mental disorders. The Psychosocial Disability Scale, The Alberta Scale of Continuity of Services in Mental Health, the UCLA Scale and the Zarit Caregiver Burden Scale were employed. The intervention was based on the core components of mutual aid groups. Significant differences (p < 0.001) were observed for the study variables, particularly in Loneliness, Continuity of Care, and various domains of psychosocial disability. A large effect size was found for these variables after the intervention. Most variables exhibited a moderate to large effect. This study demonstrates the effectiveness of mutual groups facilitated by mental health personnel at the primary care level.
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Vijayasingham L, Ansbro É, Zmeter C, Abbas LA, Schmid B, Sanga L, Larsen LB, Perone SA, Perel P. Implementing and evaluating integrated care models for non-communicable diseases in fragile and humanitarian settings. J Migr Health 2024; 9:100228. [PMID: 38577626 PMCID: PMC10992697 DOI: 10.1016/j.jmh.2024.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/08/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024] Open
Abstract
In this commentary, we advocate for the wider implementation of integrated care models for NCDs within humanitarian preparedness, response, and resilience efforts. Since experience and evidence on integrated NCD care in humanitarian settings is limited, we discuss potential benefits, key lessons learned from other settings, and lessons from the integration of other conditions that may be useful for stakeholders considering an integrated model of NCD care. We also introduce our ongoing project in North Lebanon as a case example currently undergoing parallel tracks of program implementation and process evaluation that aims to strengthen the evidence base on implementing an integrated NCD care model in a crisis setting.
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Affiliation(s)
- Lavanya Vijayasingham
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Éimhín Ansbro
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Carla Zmeter
- Beirut Delegation, International Committee for the Red Cross (ICRC) Beirut, Lebanon
| | - Linda Abou Abbas
- Beirut Delegation, International Committee for the Red Cross (ICRC) Beirut, Lebanon
| | - Benjamin Schmid
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Leah Sanga
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | | | - Sigiriya Aebischer Perone
- International Committee for the Red Cross (ICRC), Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | - Pablo Perel
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
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Feldbusch H, Schmidt M, Steeb EM, Paschek N, Nemesch M, Sartory Y, Brenner R, Nöst S. Theoretical concepts and instruments for measuring hospital discharge readiness: A scoping review. Heliyon 2024; 10:e26554. [PMID: 38439820 PMCID: PMC10909674 DOI: 10.1016/j.heliyon.2024.e26554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
Background The Discharge Readiness of adult patients in a hospital setting is a multidimensional concept which is becoming increasingly important internationally as part of discharge planning. To date, there has been a lack of reviews of existing measurement instruments as well as theoretical concepts of discharge readiness. Objective To provide an overview of existing measurement instruments and theoretical concepts regarding readiness for hospital discharge in adult patients. Design and methods A scoping review was conducted in accordance with the Joanna Briggs Institute methodological manual and PRISMA ScR reporting principles. A literature search was conducted using the CINAHL and LIVIVO databases (including MEDLINE and PSYINDEX) in October 2021. After test screening, all identified articles were screened by two independent reviewers using predefined inclusion and exclusion criteria before the content was extracted and mapped. Results Of the 1823 records identified, 107 were included in this review. Of these, 30 studies were included as development or validation studies of measurement instruments assessing discharge readiness, 68 were included as empirical studies with readiness for hospital discharge as the primary outcome or key concept, and nine publications were included as theoretical papers or reviews. Five dimensions of readiness for hospital discharge were extracted:1) Physical, 2) Psychological, 3) Education and Knowledge, 4) Adequate Individual Support, and 5) Social and Organisational Determinants. Of the 47 instruments identified for measuring discharge readiness, 33 were validated. The Readiness for Hospital Discharge Scale (RHDS) was the most frequently used instrument. Conclusions The systematic measurement of readiness for hospital discharge, particularly from the patient's perspective combined with the nurse's perspective, might be useful in reducing negative outcomes such as readmissions. This review provides an overview of existing and validated instruments for the systematic assessment of discharge readiness in acute inpatient care, as well as an overview of the theoretical concepts of readiness for hospital discharge. Further research is needed on the relationship between organisational determinants and readiness for discharge.
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Affiliation(s)
- Hanna Feldbusch
- Baden-Württemberg Cooperative State University Stuttgart, School of Health Sciences and Management, Stuttgart, Germany
- Robert Bosch Hospital, Stuttgart, Germany
| | - Marita Schmidt
- Baden-Württemberg Cooperative State University Stuttgart, School of Health Sciences and Management, Stuttgart, Germany
| | | | | | | | | | | | - Stefan Nöst
- Baden-Württemberg Cooperative State University Stuttgart, School of Health Sciences and Management, Stuttgart, Germany
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Barbadillo-Villanueva S, Áreas Del Aguila V, Robustillo-Cortés MDLA, Gimeno-Gracia M, Sánchez Yáñez E, Hermenegildo-Caudevilla M, Navarro Aznárez H, Lázaro López A, Vicente E, Monte-Boquet E. Telematic interview in telepharmacy: consensus document for farmacotherapeutic monitoring and informed drug delivery. Farm Hosp 2024:S1130-6343(24)00018-7. [PMID: 38458852 DOI: 10.1016/j.farma.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 03/10/2024] Open
Abstract
Telepharmacy is defined as the practice of remote pharmaceutical care, using information and communication technologies. Given its growing importance in outpatient pharmaceutical care, the Spanish Society of Hospital Pharmacy developed a consensus document, "Guía de entrevista telemática en atención farmacéutica," as part of its strategy for the development and expansion of telepharmacy, with key recommendations for effective pharmacotherapeutic monitoring and informed dispensing and delivery of medications through telematic interviews. The document was developed by a working group of hospital pharmacists with experience in the field. It highlights the benefits of telematic interviewing for patients, hospital pharmacy professionals, and the healthcare system as a whole, reviews the various tools for conducting telematic interviews, and provides recommendations for each phase of the interview. These recommendations cover aspects such as tool/platform selection, patient selection, obtaining authorization and consent, assessing technological skills, defining objectives and structure, scheduling appointments, reviewing medical records, and ensuring humane treatment. Telematic interview is a valuable complement to face-to-face consultations but its novelty requires a strategic and formal framework that this consensus document aims to cover. The use of appropriate communication tools and compliance with recommended procedures ensure patient safety and satisfaction. By implementing telematic interviews, healthcare institutions can improve patient care, optimize the use of resources and promote continuity of care.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Esther Vicente
- Hospital General Universitario de Castellón, Castellón, Spain
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Abstract
This project explored the needs of mothers beyond the immediate postnatal period in Queensland, Australia, for the development of improved models of care. Data were collected through group and individual interviews. A qualitative methodology using thematic analysis captured the experience of 58 participants. Four key themes were generated: Caring for self, Being connected, Getting direction and Having options. Being connected with care providers and peers was highly valued by participants as was having a sense of direction. Having a relationship with a carer who knew them personally throughout pregnancy and postnatal care avoided retelling stories and facilitated information sharing. Relationship-based care enabled mothers to better meet their personal needs necessary to fulfil the parenting role. Yet, many points of disconnect were identified including inconsistencies in information and gaps in care. These findings demonstrate a range of unmet needs, situated within a lack of relational continuity. Maternity and child health professionals, service managers and policy makers must reorient systems by listening, acknowledging and keeping the voice of mothers at the centre of care.
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Affiliation(s)
- Robyn A Penny
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
| | - Leah Hardiman
- Mothers and Babies Queensland, Brisbane, QLD, Australia
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Fredericks-Younger J, Feldman CA, Allareddy V, Funkhouser E, McBurnie M, Meyerowitz C, Ragusa P, Chapman-Greene J, Coker M, Fine D, Gennaro ML, Subramanian G. Pragmatic Return to Effective Dental Infection Control through Triage and Testing (PREDICT): an observational, feasibility study to improve dental office safety. Pilot Feasibility Stud 2024; 10:44. [PMID: 38419131 PMCID: PMC10900666 DOI: 10.1186/s40814-024-01471-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 02/16/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, there was a substantial interruption of care, with patients and workers fearful to return to the dental office. As dental practice creates a highly aerosolized environment, the potential for spread of airborne illness is magnified. As a means to increase safety and mitigate risk, pre-visit testing for SARS-CoV-2 has the potential to minimize disease transmission in dental offices. The Pragmatic Return to Effective Dental Infection Control through Testing (PREDICT) Feasibility Study examined the logistics and impact of two different testing mechanisms (laboratory-based PCR viral testing and point-of-care antigen testing) in dental offices. METHODS Dental healthcare workers (DHCWs) and patients in four dental offices within the National Dental Practice-based Research Network participated in this prospective study. In addition to electronic surveys, participants in two offices completed POC testing, while participants in two offices used lab-based PCR methods to detect SARS-CoV-2 infection. Analysis was limited to descriptive measures, with median and interquartile ranges reported for Likert scale responses and mean and standard deviation for continuous variables. RESULTS Of the total 72 enrolled, 28 DHCWs and 41 patients completed the protocol. Two patients (4.9%) tested positive prior to their visit, while 2 DHCWs (12.5%) tested positive for SARS-CoV-2 infection at the start of the study. DHCWs and patients shared similar degree of concern (69% and 63%, respectively) for contracting COVID-19 from patients, while patients feared contracting COVID-19 from DHCWs less (49%). Descriptive statistics calculations revealed that saliva, tongue epithelial cells, and nasal swabs were the most desirable specimen collection method; both testing (LAB and POC) protocols took similar amounts of total time to complete; and DHCWs and patients reported feeling more comfortable when both groups were tested. CONCLUSIONS While a larger-scale, network study is necessary for generalizability of results, this feasibility study suggests that SARS-CoV-2 testing can be effectively implemented into dental practice workflows and positively impact perception of safety for DHCWs and patients. As new virulent infectious diseases emerge, preparing dental personnel to employ an entire toolbox of risk mitigation strategies, including testing, may have the potential to decrease dental practice closure time, maintaining continuity of dental care services for patients. TRIAL REGISTRATION ClinicalTrials.gov: NCT05123742.
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Affiliation(s)
- Janine Fredericks-Younger
- School of Dental Medicine, Rutgers University, Office of Academic Affairs, 110 Bergen Street, Rm B813, Newark, NJ, 07103, USA.
| | - Cecile A Feldman
- School of Dental Medicine, Rutgers University, Office of Academic Affairs, 110 Bergen Street, Rm B813, Newark, NJ, 07103, USA
- School of Public Health, Rutgers University, Office of Academic Affairs, 110 Bergen Street, Rm B813, Newark, NJ, 07103, USA
| | | | | | - MaryAnn McBurnie
- Kaiser Permanente, Center for Health Research, Portland, OR, USA
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, Rochester, USA
| | - Pat Ragusa
- Eastman Institute for Oral Health, University of Rochester, Rochester, USA
| | - Julie Chapman-Greene
- School of Dental Medicine, Rutgers University, Office of Academic Affairs, 110 Bergen Street, Rm B813, Newark, NJ, 07103, USA
| | - Modupe Coker
- School of Dental Medicine, Rutgers University, Office of Academic Affairs, 110 Bergen Street, Rm B813, Newark, NJ, 07103, USA
| | - Daniel Fine
- School of Dental Medicine, Rutgers University, Office of Academic Affairs, 110 Bergen Street, Rm B813, Newark, NJ, 07103, USA
| | - Maria Laura Gennaro
- New Jersey Medical School, PHRI Center, Rutgers University, Office of Academic Affairs, 110 Bergen Street, Rm B813, Newark, NJ, 07103, USA
| | - Gayathri Subramanian
- School of Dental Medicine, Rutgers University, Office of Academic Affairs, 110 Bergen Street, Rm B813, Newark, NJ, 07103, USA
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Siddiqui ST, La Manna A, Connors E, Smith R, Vance K, Budesa Z, Goulka J, Beletsky L, Wood CA, Marotta P, Winograd RP. An evaluation of first responders' intention to refer to post-overdose services following SHIELD training. Harm Reduct J 2024; 21:39. [PMID: 38351046 PMCID: PMC10863209 DOI: 10.1186/s12954-024-00957-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/06/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND First responders [law enforcement officers (LEO) and Fire/Emergency Medical Services (EMS)] can play a vital prevention role, connecting overdose survivors to treatment and recovery services. This study was conducted to examine the effect of occupational safety and harm reduction training on first responders' intention to refer overdose survivors to treatment, syringe service, naloxone distribution, social support, and care-coordination services, and whether those intentions differed by first responder profession. METHODS First responders in Missouri were trained using the Safety and Health Integration in the Enforcement of Laws on Drugs (SHIELD) model. Trainees' intent to refer (ITR) overdose survivors to prevention and supportive services was assessed pre- and post-training (1-5 scale). A mixed model analysis was conducted to assess change in mean ITR scores between pre- and post-training, and between profession type, while adjusting for random effects between individual trainees and baseline characteristics. RESULTS Between December 2020 and January 2023, 742 first responders completed pre- and post-training surveys. SHIELD training was associated with higher first responders' intentions to refer, with ITR to naloxone distribution (1.83-3.88) and syringe exchange (1.73-3.69) demonstrating the greatest changes, and drug treatment (2.94-3.95) having the least change. There was a significant increase in ITR score from pre- to post-test (β = 2.15; 95% CI 1.99, 2.30), and LEO-relative to Fire/EMS-had a higher score at pre-test (0.509; 95% CI 0.367, 0.651) but a lower score at post-test (0.148; 95% CI - 0.004, 0.300). CONCLUSION Training bundling occupational safety with harm reduction content is immediately effective at increasing first responders' intention to connect overdose survivors to community substance use services. When provided with the rationale and instruction to execute referrals, first responders are amenable, and their positive response highlights the opportunity for growth in increasing referral partnerships and collaborations. Further research is necessary to assess the extent to which ITR translates to referral behavior in the field.
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Affiliation(s)
- Saad T Siddiqui
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA.
| | - Anna La Manna
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Elizabeth Connors
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Ryan Smith
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Kyle Vance
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Zach Budesa
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Jeremiah Goulka
- SHIELD Training Initiative, Northeastern University, Boston, USA
| | - Leo Beletsky
- SHIELD Training Initiative, Northeastern University, Boston, USA
| | - Claire A Wood
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
| | - Phillip Marotta
- Department of Social Work, Brown School, Washington University in St. Louis, St. Louis, USA
| | - Rachel P Winograd
- Missouri Institute of Mental Health, University of Missouri-St. Louis, 1 University Blvd, 206 Benton Hall, St. Louis, MO, 63121, USA
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Trillo-Calvo E, de Miguel Díez J, González Villaescusa C, Panero Hidalgo P, Cimas Hernando JE, Villanueva Pérez M, Plaza Zamora FJ, Sanz Almazán M, Figueira-Gonçalves JM. COPD patient profiles in primary care. Referral criteria. Semergen 2024; 50:102192. [PMID: 38306821 DOI: 10.1016/j.semerg.2024.102192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 02/04/2024]
Abstract
COPD is a disease with a high prevalence that diminishes the quality of life of many patients. Despite this, there are still high rates of under-diagnosis in Spain, partly due to a lack of recognition of the pathology by patients. In this context, the role played by primary care teams becomes fundamental, as they are one of the first lines of entry into the health system. In this paper we explain the different COPD profiles that may be present, and update the tools for diagnosis and treatment, which, together with an attitude of active suspicion of the disease, can help in the correct management of patients, whether they are undiagnosed or have subsequent complications.
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Affiliation(s)
- E Trillo-Calvo
- Institute for Health Research, Aragón, Centro de Salud Campo de Belchite, Zaragoza, Spain
| | - J de Miguel Díez
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain.
| | - C González Villaescusa
- Servicio de Neumología, Hospital Clínico Universitario de Valencia, Spain; Instituto de Investigación Sanitaria INCLIVA, Spain
| | | | - J E Cimas Hernando
- Departamento de Medicina de la Universidad de Oviedo, Centro de Salud de Contrueces-Vega, Gijón, Spain
| | - M Villanueva Pérez
- EAP Ribes-Olivella (SAP Alt Penedés Garraf), Institut Català de la Salut, Barcelona, Spain
| | | | | | - J M Figueira-Gonçalves
- Servicio de Respiratorio, Unidad de Investigación, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain; Instituto Canario de Enfermedades Tropicales y Salud Pública, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
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V Carvalho AS, Broekema B, Brito Fernandes Ó, Klazinga N, Kringos D. Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review. BMC Emerg Med 2024; 24:19. [PMID: 38273229 PMCID: PMC10811879 DOI: 10.1186/s12873-024-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic severely impacted care for non-COVID patients. Performance indicators to monitor acute care, timely reported and internationally accepted, lacked during the pandemic in OECD countries. This study aims to summarize the performance indicators available in the literature to monitor changes in the quality of acute care in OECD countries during the first year and a half of the pandemic (2020-July 2021) and to assess their trends. METHODS Scoping review. Search in Embase and MEDLINE (07-07-2022). Acute care performance indicators and indicators related to acute general surgery were collected and collated following a care pathway approach. Indicators assessing identical clinical measures were grouped under a common indicator title. The trends from each group of indicators were collated (increase/decrease/stable). RESULTS A total of 152 studies were included. 2354 indicators regarding general acute care and 301 indicators related to acute general surgery were included. Indicators focusing on pre-hospital services reported a decreasing trend in the volume of patients: from 225 indicators, 110 (49%) reported a decrease. An increasing trend in pre-hospital treatment times was reported by most of the indicators (n = 41;70%) and a decreasing trend in survival rates of out-of-hospital cardiac arrest (n = 61;75%). Concerning care provided in the emergency department, most of the indicators (n = 752;71%) showed a decreasing trend in admissions across all levels of urgency. Concerning the mortality rate after admission, most of the indicators (n = 23;53%) reported an increasing trend. The subset of indicators assessing acute general surgery showed a decreasing trend in the volume of patients (n = 50;49%), stability in clinical severity at admission (n = 36;53%), and in the volume of surgeries (n = 14;47%). Most of the indicators (n = 28;65%) reported no change in treatment approach and stable mortality rate (n = 11,69%). CONCLUSION This review signals relevant disruptions across the acute care pathway. A subset of general surgery performance indicators showed stability in most of the phases of the care pathway. These results highlight the relevance of assessing this care pathway more regularly and systematically across different clinical entities to monitor disruptions and to improve the resilience of emergency services during a crisis.
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Affiliation(s)
- Ana Sofia V Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Bente Broekema
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Pediatrics, Dijklander Hospital, Location Hoorn, Maelsonstraat 3, Hoorn, 1624 NP, The Netherlands
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Herbold J, Elmohsen E, Gutierrez G, Helgesen M, Babyar S. Prediction of Discharge Destination After Inpatient Rehabilitation for Stroke Using Mobility and Self-Care Assessment in Section GG of the Inpatient Rehabilitation Facility - Patient Assessment Instrument. Arch Rehabil Res Clin Transl 2023; 5:100292. [PMID: 38163021 PMCID: PMC10757179 DOI: 10.1016/j.arrct.2023.100292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective To determine the ability of Section GG of the Inpatient Rehabilitation Facility - Patient Assessment Inventory (Section GG)'s quantification of mobility and self-care to predict discharge destination for persons with stroke after inpatient rehabilitation. Design Retrospective, observational cohort study. Setting 150-bed inpatient rehabilitation facility within a metropolitan health system. Participants Consecutive sample of adults and older adults with stroke admitted for inpatient rehabilitation from January 2020 to June 2021 (N=1051). Subjects were excluded for discharge to acute care or hospice or if they had COVID-19. Intervention None. Main Outcome Measures Section GG self-care and mobility scores used in reimbursement formulation by Centers for Medicare and Medicaid at admission to inpatient rehabilitation; age; sex; prior living situation; discharge setting. Logistic regression examined binary comparisons of discharge destinations. Receiver operating characteristic (ROC) curves determined cut-off admission Section GG scores for binary comparisons. Results Logistic regression demonstrated that presence of a caregiver in the home was consistently the strongest predictor (P<.001) and admission Section GG scores were significant secondary factors in determining the discharge destination. An admission Section GG cut-off score of 33.5 determined home with homecare vs skilled nursing facility and a cut-off of 36.5 determined discharge to home with outpatient care vs skilled nursing facility. Conclusion Clinicians responsible for discharge decisions for patients with stroke after inpatient rehabilitation might start by determining the presence of a caregiver in the home and then use Section GG cut-off scores to guide decisions about home (with or without homecare) vs SNF destinations. Such guidance is not advised for the home with outpatient services vs home with homecare decision; clinical judgment is needed to determine the best discharge plan because this ROC had a less robust area under the curve. Sex and race/ethnicity were not determining factors for binary choices of discharge destinations.
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Affiliation(s)
- Janet Herbold
- Post Acute Services, Burke Rehabilitation Hospital, White Plains, NY
| | - Ebrahim Elmohsen
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Gino Gutierrez
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Michael Helgesen
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
| | - Suzanne Babyar
- Post Acute Services, Burke Rehabilitation Hospital, White Plains, NY
- Department of Physical Therapy, Hunter College, The City University of New York, New York, NY
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Stresser FA, Parise GK, Macedo FJ, Sassi LM, Schussel JL. Use of Leukocyte- and Platelet-Rich Fibrin to Prevent Osteonecrosis of the Jaws Associated with the Use of Bisphosphonate Therapy: A Case Series. J Maxillofac Oral Surg 2023; 22:1159-1165. [PMID: 38105812 PMCID: PMC10719174 DOI: 10.1007/s12663-023-02001-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/16/2023] [Indexed: 12/19/2023] Open
Abstract
Medication-related osteonecrosis of the jaws (MRONJ) consists of an area of exposed intraoral or extraoral bone that affects patients with a history of use of antiresorptive and antiangiogenic medications, and who have not undergone head and neck radiotherapy. Leukocyte- and platelet-rich fibrin (L-PRF) is an autologous material of great potential, used as an adjuvant in surgical treatments, especially where healing is compromised. The aim of this article is to report three cases of the use of L-PRF in the prevention of MRONJ in three female Caucasian under bisphosphonates therapy. Patient 1, 86 years old, with osteoporosis, complained of intense pain in tooth 33, which presented edema and periapical lesion and association with MRONJ. Patient 2, 61 years old, undergoing treatment for bone metastases due to breast cancer, reported pain symptoms in tooth 47, as well as suppuration in the dental element, grade I mobility, pain on periapical palpation and radiographically an endoperiodontal lesion was evidenced. Patient 3, 56 years old, also undergoing treatment for breast cancer, presented with severe pain in tooth 36. On clinical examination, she presented pain, mobility and suppuration, and radiographs indicated a furcation lesion on tooth 36. The treatment option in the three cases was the extraction of the affected teeth and the use of L-PRF to promote healing. All patients present a favorable outcome in follow-up. The use of L-PRF can be an adjuvant in the prevention of MRONJ; however, further studies are needed to prove its effectiveness.
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Affiliation(s)
- Fernanda Aparecida Stresser
- Post graduation Program in Dentistry, Department of Stomatology, School of Dentistry, Federal University of Paraná - UFPR, Av. Pref. Lothário Meissner 632, Jd Botânico, Curitiba, PR 80210170 Brazil
| | - Guilherme Klein Parise
- Post graduation Program in Dentistry, Department of Stomatology, School of Dentistry, Federal University of Paraná - UFPR, Av. Pref. Lothário Meissner 632, Jd Botânico, Curitiba, PR 80210170 Brazil
| | - Fernanda Joly Macedo
- Department of Oral and Maxillofacial Surgery, Erasto Gaertner Hospital, Curitiba, PR Brazil
| | - Laurindo Moacir Sassi
- Department of Oral and Maxillofacial Surgery, Erasto Gaertner Hospital, Curitiba, PR Brazil
| | - Juliana Lucena Schussel
- Post graduation Program in Dentistry, Department of Stomatology, School of Dentistry, Federal University of Paraná - UFPR, Av. Pref. Lothário Meissner 632, Jd Botânico, Curitiba, PR 80210170 Brazil
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Frank M, Loh R, Everhart R, Hurley H, Hanratty R. No health without access: using a retrospective cohort to model a care continuum for people released from prison at an urban, safety net health system. Health Justice 2023; 11:49. [PMID: 37979038 PMCID: PMC10656837 DOI: 10.1186/s40352-023-00248-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 11/06/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Release from prison is characterized by discontinuity of healthcare services and results in poor health outcomes, including an increase in mortality. Institutions capable of addressing this gap in care seldom collaborate in comprehensive, data-driven transition of care planning. This study harnesses information from a data exchange between correctional facilities and community-based healthcare agencies in Colorado to model a care continuum after release from prison. METHODS We merged records from Denver Health (DH), an urban safety-net healthcare system, and the Colorado Department of Corrections (CDOC), for people released from January 1 to June 30, 2021. The study population was either (a) released to the Denver metro area (Denver and its five neighboring counties), or (b) assigned to the DH Regional Accountable Entity, or (c) assigned to the DH medical home based on Colorado Department of Healthcare Policy and Financing attribution methods. Outcomes explored were outpatient, acute care, and inpatient utilization in the first 180 days after release. We used Pearson's chi-squared tests or Fisher exact for univariate comparisons and logistic regression for multivariable analysis. RESULTS The care continuum describes the healthcare utilization at DH by people released from CDOC. From January 1, 2021, to June 30, 2021, 3242 people were released from CDOC and 2848 were included in the data exchange. 905 individuals of the 2848 were released to the Denver metro area or attributed to DH. In the study population of 905, 78.1% had a chronic medical or psychological condition. Within 180 days of release, 31.1% utilized any health service, 24.5% utilized at least one outpatient service, and 17.1% utilized outpatient services two or more times. 10.1% utilized outpatient services within the first 30 days of release. CONCLUSIONS This care continuum highlights drop offs in accessing healthcare. It can be used by governmental, correctional, community-based, and healthcare agencies to design and evaluate interventions aimed at improving the health of a population at considerable risk for poor health outcomes and death.
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Affiliation(s)
- Michael Frank
- Denver Health and Hospital Authority, Denver, CO, USA.
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Ryan Loh
- Denver Health and Hospital Authority, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rachel Everhart
- Denver Health and Hospital Authority, Denver, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hermione Hurley
- Denver Health and Hospital Authority, Denver, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rebecca Hanratty
- Denver Health and Hospital Authority, Denver, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Cam H, Wennlöf B, Gillespie U, Franzon K, Nielsen EI, Ling M, Lindner KJ, Kempen TGH, Kälvemark Sporrong S. The complexities of communication at hospital discharge of older patients: a qualitative study of healthcare professionals' views. BMC Health Serv Res 2023; 23:1211. [PMID: 37932683 PMCID: PMC10626684 DOI: 10.1186/s12913-023-10192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Hospital discharge of older patients is a high-risk situation in terms of patient safety. Due to the fragmentation of the healthcare system, communication and coordination between stakeholders are required at discharge. The aim of this study was to explore communication in general and medication information transfer in particular at hospital discharge of older patients from the perspective of healthcare professionals (HCPs) across different organisations within the healthcare system. METHODS We conducted a qualitative study using focus group and individual or group interviews with HCPs (physicians, nurses and pharmacists) across different healthcare organisations in Sweden. Data were collected from September to October 2021. A semi-structured interview guide including questions on current medication communication practices, possible improvements and feedback on suggestions for alternative processes was used. The data were analysed thematically, guided by the systematic text condensation method. RESULTS In total, four focus group and three semi-structured interviews were conducted with 23 HCPs. Three main themes were identified: 1) Support systems that help and hinder describes the use of support systems in the discharge process to compensate for the fragmentation of the healthcare system and the impact of these systems on HCPs' communication; 2) Communication between two separate worlds depicts the difficulties in communication experienced by HCPs in different healthcare organisations and how they cope with them; and 3) The large number of medically complex patients disrupts the communication reveals how the highly pressurised healthcare system impacts on HCPs' communication at hospital discharge. CONCLUSIONS Communication at hospital discharge is hindered by the fragmented, highly pressurised healthcare system. HCPs are at risk of moral distress when coping with communication difficulties. Improved communication methods at hospital discharge are needed for the benefit of both patients and HCPs.
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Affiliation(s)
- Henrik Cam
- Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden.
- Department of Pharmacy, Uppsala University, Uppsala, Sweden.
| | - Björn Wennlöf
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
- Närvården Viksäng-Irsta, Region Västmanland, Västerås, Sweden
| | - Ulrika Gillespie
- Hospital Pharmacy Department, Uppsala University Hospital, Uppsala, Sweden
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Kristin Franzon
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | - Mia Ling
- Department of Pharmacy, Region Västmanland, Västerås, Sweden
| | | | - Thomas Gerardus Hendrik Kempen
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Sofia Kälvemark Sporrong
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
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Vidler M, Kinshella MLW, Sevene E, Lewis G, von Dadelszen P, Bhutta Z. Transitioning from the "Three Delays" to a focus on continuity of care: a qualitative analysis of maternal deaths in rural Pakistan and Mozambique. BMC Pregnancy Childbirth 2023; 23:748. [PMID: 37872504 PMCID: PMC10594808 DOI: 10.1186/s12884-023-06055-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/07/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The Three Delays Framework was instrumental in the reduction of maternal mortality leading up to, and during the Millennium Development Goals. However, this paper suggests the original framework might be reconsidered, now that most mothers give birth in facilities, the quality and continuity of the clinical care is of growing importance. METHODS The paper explores the factors that contributed to maternal deaths in rural Pakistan and Mozambique, using 76 verbal autopsy narratives from the Community Level Interventions for Pre-eclampsia (CLIP) Trial. RESULTS Qualitative analysis of these maternal death narratives in both countries reveals an interplay of various influences, such as, underlying risks and comorbidities, temporary improvements after seeking care, gaps in quality care in emergencies, convoluted referral systems, and arrival at the final facility in critical condition. Evaluation of these narratives helps to reframe the pathways of maternal mortality beyond a single journey of care-seeking, to update the categories of seeking, reaching and receiving care. CONCLUSIONS There is a need to supplement the pioneering "Three Delays Framework" to include focusing on continuity of care and the "Four Critical Connection Points": (1) between the stages of pregnancy, (2) between families and health care workers, (3) between health care facilities and (4) between multiple care-seeking journeys. TRIAL REGISTRATION NCT01911494, Date Registered 30/07/2013.
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Affiliation(s)
- Marianne Vidler
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada.
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, Canada
| | - Esperanca Sevene
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Centro de Investigação Em Saúde da Manhiça, Manhiça, Mozambique
| | | | | | - Zulfiqar Bhutta
- Department of Pediatrics, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
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Yaghoubi M, Behzadnezhad MM, Shaarbafchizadeh N, Javadi M, Alizade M. Post-discharge follow-up system in psychiatric patients: A case study of Farabi Hospital in Isfahan. J Educ Health Promot 2023; 12:302. [PMID: 38023088 PMCID: PMC10670944 DOI: 10.4103/jehp.jehp_748_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/26/2022] [Indexed: 12/01/2023]
Abstract
BACKGROUND Mental illness is one of the most common problems in human societies and the continuation of care and post-discharge follow-up. This study was conducted to define a post-discharge follow-up framework for Farabi Hospital in Isfahan. MATERIAL AND METHODS This was a multistage study, including, interviews literature review, and focus group discussions. Participants included 18 purposefully selected nurses, physicians, and managers, directly involved in the discharge process of Farabi Hospital in Isfahan. The interviews were semi-structured. Data were organized using MAXQDA10 software. The initial framework was set through the extraction of semantic main and secondary codes. The framework was finalized through three several focus group discussion sessions. RESULTS Results included of 17 sub-categories and seven main categories as "education," organizational arrangement," "team-building," "patient and family participation and trust," "engaging some supportive institutions of community," "process management" and "information management." CONCLUSIONS To implement a post-discharge follow-up system for psychiatric patients in Farabi Hospital of Isfahan must be concentrated to patient and family education, team building, organizational arrangements, participation, and trust of patients and family, while engaging community health centers and notice to information and management and process management.
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Affiliation(s)
- Maryam Yaghoubi
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Nasrin Shaarbafchizadeh
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Javadi
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Alizade
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Public Administration, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
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Ouanhnon L, Bugat MER, Druel V, Grosclaude P, Delpierre C. Link between the referring physician and breast and cervical cancers screening: a cross-sectional study in France. BMC Prim Care 2023; 24:167. [PMID: 37644404 PMCID: PMC10464303 DOI: 10.1186/s12875-023-02122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The aims of the "médecin traitant" or referring physician (RP) reform, introduced in France in 2004, were to improve the organisation and quality of care and to allow for greater equity, particularly in terms of prevention. The objective of our study was to evaluate the effect of having a declared RP on the uptake of screening for breast and cervical cancers, and to explore the mechanisms involved. METHODS We used an existing dataset of 1,072,289 women, which combines data from the Health Insurance information systems, with census data. We built multivariable logistic regression models to study the effect of having a RP on the uptake of mammography and pap smear, adjusted for age, socio-economic level, health status and healthcare provision. We secondarily added to this model the variable "having consulted a General Practitioner (GP) within the year". Finally, we evaluated the interaction between the effect of having a referring physician and the area of residence (metropolitan/urban/rural). RESULTS Patients who had a declared RP had a significantly higher uptake of mammography and pap smear than those who did not. The strength of the association was particularly important in very urban areas. The effect of having visited a GP seemed to explain a part of the correlation between having a RP and uptake of screening. CONCLUSIONS Lower rates of gynaecological screening among women without an RP compared to those with an RP may partly reflect a specific behaviour pattern in women less adherent to the health care system. However, this result also shows the importance of the RP, who assumes the key role of relaying public health information in a more personalised and adapted way.
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Affiliation(s)
- Lisa Ouanhnon
- Département Universitaire de Médecine Générale, Université Toulouse 3 Paul Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France.
- Equity Team : Labelled By the French League Against Cancer, UMR 1295 CERPOP, Inserm, Université Toulouse III, Toulouse, France.
| | - Marie-Eve Rouge Bugat
- Département Universitaire de Médecine Générale, Université Toulouse 3 Paul Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France
- Equity Team : Labelled By the French League Against Cancer, UMR 1295 CERPOP, Inserm, Université Toulouse III, Toulouse, France
| | - Vladimir Druel
- Département Universitaire de Médecine Générale, Université Toulouse 3 Paul Sabatier, 37 allées Jules Guesde, 31000, Toulouse, France
- Equity Team : Labelled By the French League Against Cancer, UMR 1295 CERPOP, Inserm, Université Toulouse III, Toulouse, France
| | - Pascale Grosclaude
- Equity Team : Labelled By the French League Against Cancer, UMR 1295 CERPOP, Inserm, Université Toulouse III, Toulouse, France
- Institut Claudius Regaud, IUCT-O, Registre Des Cancers du Tarn, F-31059, Toulouse, France
| | - Cyrille Delpierre
- Equity Team : Labelled By the French League Against Cancer, UMR 1295 CERPOP, Inserm, Université Toulouse III, Toulouse, France
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Holmen IC, Waibel S, Kaarboe O. Emerging integrated care models for children and youth with mental health difficulties in Norway: a horizon scanning study. BMC Health Serv Res 2023; 23:860. [PMID: 37580679 PMCID: PMC10426212 DOI: 10.1186/s12913-023-09858-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 07/27/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The implementation of Integrated Care Models (ICMs) represents a strategy for addressing the increasing issues of system fragmentation and improving service customization according to user needs. Available ICMs have been developed for adult populations, and less is known about ICMs specifically designed for children and youth. The study objective was to summarize and assess emerging ICMs for mental health services targeting children and youth in Norway. METHODS A horizon scanning study was conducted in the field of child and youth mental health. The study encompassed two key components: (i) the identification of ICMs through a review of both scientific and grey literature, as well as input from key informants, and (ii) the evaluation of selected ICMs using semi-structured interviews with key informants. The aim of the interviews was to identify factors that either promote or hinder the successful implementation or scale up of these ICMs. RESULTS Fourteen ICMs were chosen for analysis. These models encompassed a range of treatment philosophies, spanning from self-care and community care to specialized care. Several models placed emphasis on the referral process, prioritizing low-threshold access, and incorporating other sectors such as housing and child welfare. Four of the selected models included family or parents in their target group and five models extended their services to children and youth beyond the legal age of majority. Nine experts in the field willingly participated in the interview phase of the study. Identified challenges and facilitating factors associated with implementation or scale up of ICMs were related to the Norwegian healthcare system, mental health care delivery, as well as child and youth specific factors. CONCLUSION Care delivery targeting children and youth's mental health requires further adaptation to accommodate the intricate nature of their lives. ICMs have been identified as a means to address this complexity by offering accessible services and adopting a holistic approach. This study highlights a selection of promising ICMs that appear capable of meeting some of the specific needs of children and youth. However, it is recommended to subject these models to further assessment and refinement to ensure their effectiveness and the fulfilment of their intended outcomes.
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Affiliation(s)
| | - Sina Waibel
- Faculty of Medicine, University of British Columbia, 317 – 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Oddvar Kaarboe
- Department of Economics and IGS, University of Bergen, Bergen, Norway
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Reid N, Gamage T, Duckett SJ, Gray LC. Hospital utilisation in Australia, 1993-2020, with a focus on use by people over 75 years of age: a review of AIHW data. Med J Aust 2023; 219:113-119. [PMID: 37414741 DOI: 10.5694/mja2.52026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES To assess Australian hospital utilisation, 1993-2020, with a focus on use by people aged 75 years or more. DESIGN Review of Australian Institute of Health and Welfare (AIHW) hospital utilisation data. SETTING, PARTICIPANTS Tertiary data from all Australian public and private hospitals for the financial years 1993-94 to 2019-20. MAIN OUTCOME MEASURES Numbers and population-based rates of hospital separations and bed utilisation (bed-days) (all and multiple day admissions) and mean hospital length of day (multiple day admissions), overall and by age group (under 65 years, 65-74 years, 75 years or more). RESULTS Between 1993-94 and 2019-20, the Australian population grew by 44%; the number of people aged 75 years or more increased from 4.6% to 6.9% of the population. The annual number of hospital separations increased from 4.61 million to 11.33 million (146% increase); the annual hospital separation rate increased from 261 to 435 per 1000 people (66% increase), most markedly for people aged 75 years or more (from 745 to 1441 per 1000 people; 94% increase). Total bed utilisation increased from 21.0 million to 29.9 million bed-days (42% increase), but the bed utilisation rate did not change markedly (1993-94, 1192 bed-days per 1000 people; 2019-20, 1179 bed-days per 1000 people), primarily because the mean hospital length of stay for multiple day admissions declined from 6.6 days to 5.4 days; for people aged 75 years or more it declined from 12.2 to 7.1 days. However, declines in stay length have slowed markedly since 2017-18. Total bed utilisation was 16.8% lower than projected from 1993-94 rates, and was 37.3% lower for people aged 75 years or more. CONCLUSION Hospital bed utilisation rates declined although admission rates increased during 1993-94 to 2019-20; the proportion of beds occupied by people aged 75 years or more increased slightly during this period. Containing hospital costs by limiting bed availability and reducing length of stay may no longer be a viable strategy.
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Affiliation(s)
- Natasha Reid
- Centre for Health Services Research, the University of Queensland, Brisbane, QLD
| | - Thakeru Gamage
- Centre for Health Services Research, the University of Queensland, Brisbane, QLD
| | | | - Leonard C Gray
- Centre for Health Services Research, the University of Queensland, Brisbane, QLD
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Amsallem A, Berthou-Contreras J, Joret N, Koeberlé S, Limat S, Clairet AL. [Prescriptions of statins in the elderly according to the type of healthcare establishment: An example of the usefulness of territorial hospital groups]. Ann Pharm Fr 2023; 81:346-353. [PMID: 35728628 DOI: 10.1016/j.pharma.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The challenge of territorial hospital groups is to develop coherent care pathways for optimal patient care. Following the creation of a territorial pharmaceutical team, a common prescription review process was initiated in our health area. The objective of this study is to analyze the uses of statins in the elderly. METHOD The study included all statin-treated patients older than 75 years at the five participating institutions (including long-term nursing homes). In a prospective multicenter study, the benefit/risk ratio of statin prescription has been assessed up. Depending on the clinical situation, a proposal to stop or adjust the dosage could be made. RESULTS Nine hundred and forty-seven patients were included. Among them, 184 were treated with a statin. Forty-seven patients (26%) are treated in primary prevention and 137 patients (74%) in secondary prevention. Dosages are lower for long stays. Fifteen treatments interruption were accepted out of 44 proposals, mostly for long stays. The reasons given to continue treatment are the need for a new evaluation by a cardiologist or a high cardiovascular risk. CONCLUSION The variability of results according to the type healthcare institution makes territorial medical and pharmaceutical collaboration relevant. The challenge is to develop a coherent care pathway for optimal care of elderly patients, with congruent objectives.
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Affiliation(s)
- A Amsallem
- Pôle pharmaceutique, CHRU Jean-Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France
| | - J Berthou-Contreras
- Pôle pharmaceutique, CHRU Jean-Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France
| | - N Joret
- Pôle pharmaceutique, CHRU Jean-Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France
| | - S Koeberlé
- Service de court séjour gériatrique, CHRU Jean-Minjoz, Besançon, France; Équipe « Éthique et progrès médical », Inserm, CIC 1431, université Bourgogne Franche-Comté, Besançon, France
| | - S Limat
- Pôle pharmaceutique, CHRU Jean-Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France; Inserm, EFS BFC, UMR 1098, université de Bourgogne Franche-Comté, Besançon, France
| | - A-L Clairet
- Pôle pharmaceutique, CHRU Jean-Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France; Inserm, EFS BFC, UMR 1098, université de Bourgogne Franche-Comté, Besançon, France.
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Leithaus M, Fakha A, Flamaing J, Verbeek H, Deschodt M, van Pottelbergh G, Goderis G. Stakeholders' experiences and perception on transitional care initiatives within an integrated care project in Belgium: a qualitative interview study. BMC Geriatr 2023; 23:41. [PMID: 36690954 PMCID: PMC9868499 DOI: 10.1186/s12877-023-03746-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/11/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In 2015, a plan for integrated care was launched by the Belgium government that resulted in the implementation of 12 integrated care pilot project across Belgium. The pilot project Zorgzaam Leuven consists of a multidisciplinary local consortium aiming to bring lasting change towards integrated care for the region of Leuven. This study aims to explore experiences and perceptions of stakeholders involved in four transitional care actions that are part of Zorgzaam Leuven. METHODS This qualitative case study is part of the European TRANS-SENIOR project. Four actions with a focus on improving transitional care were selected and stakeholders involved in those actions were identified using the snow-ball method. Fourteen semi-structured interviews were conducted and inductive thematic analysis was performed. RESULTS Professionals appreciated to be involved in the decision making early onwards either by proposing own initiatives or by providing their input in shaping actions. Improved team spirit and community feeling with other health care professionals (HCPs) was reported to reduce communication barriers and was perceived to benefit both patients and professionals. The actions provided supportive tools and various learning opportunities that participants acknowledged. Technical shortcomings (e.g. lack of integrated patient records) and financial and political support were identified as key challenges impeding the sustainable implementation of the transitional care actions. CONCLUSION The pilot project Zorgzaam Leuven created conditions that triggered work motivation for HCPs. It supported the development of multidisciplinary care partnerships at the local level that allowed early involvement and increased collaboration, which is crucial to successfully improve transitional care for vulnerable patients.
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Affiliation(s)
- Merel Leithaus
- Academic Center for Nursing and Midwifery, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Amal Fakha
- Academic Center for Nursing and Midwifery, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Johan Flamaing
- Division of Gerontology and Geriatrics, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Verbeek
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Mieke Deschodt
- Division of Gerontology and Geriatrics, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
- Competence Center of Nursing, University Hospitals Leuven, Leuven, Belgium
| | - Gijs van Pottelbergh
- Academic Center for General Practice, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
| | - Geert Goderis
- Academic Center for General Practice, Department of Public Health & Primary Care, KU Leuven, Leuven, Belgium
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22
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Riiser S, Baste V, Haukenes I, Smith-Sivertsen T, Hetlevik Ø, Ruths S. Practice characteristics influencing variation in provision of depression care in general practice in Norway; a registry-based cohort study (The Norwegian GP-DEP study). BMC Health Serv Res 2022; 22:1201. [PMID: 36163036 PMCID: PMC9511786 DOI: 10.1186/s12913-022-08579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is growing evidence of variation in treatment for patients with depression, not only across patient characteristics, but also with respect to the organizational and structural framework of general practitioners' (GPs') practice. However, the reasons for these variations are sparsely examined. This study aimed to investigate associations of practice characteristics with provision of depression care in general practices in Norway. METHODS A nationwide cohort study of residents aged ≥ 18 years with a new depression episode in general practice during 2009-2015, based on linked registry data. Exposures were characteristics of GP practice: geographical location, practice list size, and duration of GP-patient relationship. Outcomes were talking therapy, antidepressant medication and sick listing provided by GP during 12 months from date of diagnosis. Associations between exposure and outcome were estimated using generalized linear models, adjusted for patients' age, gender, education and immigrant status, and characteristics of GP practice. RESULTS The study population comprised 285 113 patients, mean age 43.5 years, 61.6% women. They were registered with 5 574 GPs. Of the patients, 52.5% received talking therapy, 34.1% antidepressant drugs and 54.1% were sick listed, while 17.3% received none of the above treatments. Patients in rural practices were less likely to receive talking therapy (adjusted relative risk (adj RR) = 0.68; 95% confidence interval (CI) = 0.64-0.73) and more likely to receive antidepressants (adj RR = 1.09; 95% CI = 1.04-1.14) compared to those in urban practices. Patients on short practice lists were more likely to receive medication (adj RR = 1.08; 95% CI = 1.05-1.12) than those on long practice lists. Patients with short GP-patient relationship were more likely to receive talking therapy (adj RR = 1.20; 95% CI = 1.17-1.23) and medication (adj RR = 1.08; 95% CI = 1.04-1.12), and less likely to be sick-listed (RR = 0.88; 95% CI = 0.87-0.89), than patients with long GP-patient relationship. CONCLUSIONS Provision of GP depression care varied with practice characteristics. Talking therapy was less commonly provided in rural practices and among those with long-lasting GP-patient relationship. These differences may indicate some variation, and therefore, its reasons and clinical consequences need further investigation.
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Affiliation(s)
- Sharline Riiser
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Valborg Baste
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Inger Haukenes
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tone Smith-Sivertsen
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Øystein Hetlevik
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Sabine Ruths
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Chao YH, Huang WY, Tang CH, Pan YA, Chiou JY, Ku LJE, Wei JCC. Effects of continuity of care on hospitalizations and healthcare costs in older adults with dementia. BMC Geriatr 2022; 22:724. [PMID: 36056303 PMCID: PMC9438333 DOI: 10.1186/s12877-022-03407-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction People with dementia have high rates of hospitalization, and a share of these hospitalizations might be avoidable with appropriate ambulatory care, also known as potentially preventable hospitalization (PAH). This study investigates the associations between continuity of care and healthcare outcomes in the following year, including all-cause hospitalization, PAHs, and healthcare costs in patients with dementia. Methods This is a longitudinal retrospective cohort study of 69,658 patients with dementia obtained from the Taiwan National Health Insurance Research Database. The Continuity of Care Index (COCI) was calculated to measure the continuity of dementia-related visits across physicians. The PAHs were classified into five types as defined by the Medicare Ambulatory Care Indicators for the Elderly (MACIEs). Logistic regression models were used to examine the effect of COCI on all-cause hospitalizations and PAHs, while generalized linear models were used to analyze the effect of COCI on outpatient, hospitalization, and total healthcare costs. Results The high COCI group was significantly associated with a lower likelihood of all-cause hospitalization than the low COCI group (OR = 0.848, 95%CI: 0.821–0.875). The COCI had no significant effect on PAHs but was associated with lower outpatient costs (exp(β) = 0.960, 95%CI: 0.941 ~ 0.979), hospitalization costs (exp(β) = 0.663, 95%CI: 0.614 ~ 0.717), total healthcare costs (exp(β) = 0.962, 95%CI: 0.945–0.980). Conclusion Improving continuity of care for dementia-related outpatient visits is recommended to reduce hospitalization and healthcare costs, although there was no statistically significant effect of continuity of care found on PAHs.
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Affiliation(s)
- Yung-Hsiang Chao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wen-Yen Huang
- Department of Public Health, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan
| | - Chia-Hong Tang
- Department of Public Health, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.,Department of Psychiatric, Tainan Hospital, Ministry of Health and Welfare, Tainan City, Taiwan
| | - Yu-An Pan
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jeng-Yuan Chiou
- School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan
| | - Li-Jung Elizabeth Ku
- Department of Public Health, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.,Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
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24
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Nishat F, Lunsky Y, Tarasoff LA, Brown HK. Continuity of primary care and prenatal care adequacy among women with disabilities in Ontario: A population-based cohort study. Disabil Health J 2022; 15:101322. [PMID: 35440405 PMCID: PMC9743244 DOI: 10.1016/j.dhjo.2022.101322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/19/2022] [Accepted: 03/19/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Women with disabilities experience elevated risks for pregnancy complications and report barriers accessing prenatal care. Emerging evidence highlights the significant role primary care providers play in promoting preventive services like prenatal care. OBJECTIVE To examine the relationship between continuity of primary care (COC) and prenatal care adequacy among women with disabilities. METHODS We conducted a population-based study using health administrative data in Ontario, Canada. The study population included 15- to 49-year-old women with physical (n = 106,555), sensory (n = 32,194), intellectual/developmental (n = 1515), and multiple (n = 6543) disabilities who had a singleton livebirth or stillbirth in 2003-2017 and ≥ 3 primary care visits < 2 years before conception. COC was measured using the Usual Provider of Care Index. Nominal logistic regression was used to compute adjusted odds ratios (aOR) for prenatal care adequacy, measured using the Revised-Graduated Prenatal Care Utilization Index, for women with low versus moderate/high COC, controlling for other social and medical characteristics. RESULTS Women with disabilities with low COC, versus those with moderate/high COC, had increased odds of no (aOR 1.42, 95% CI 1.29-1.56), inadequate (aOR 1.19, 95% CI 1.16-1.23), and intensive prenatal care (aOR 1.22, 95% CI 1.19-1.25) versus adequate. In additional analyses, women with low COC and no/inadequate prenatal care were the most socially disadvantaged among the cohort, and those with low COC and intensive prenatal care had the greatest medical need. CONCLUSION Improving primary care access for women with disabilities, particularly those experiencing social disadvantage, could lead to better prenatal care access.
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Affiliation(s)
- Fareha Nishat
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health: 155 College St, Toronto, Ontario, Canada M5T 3M7; ICES: 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5
| | - Yona Lunsky
- ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health: 155 College St, Toronto, Ontario, Canada M5T 3M7; ICES: 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5,Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; ICES: 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5; Centre for Addiction & Mental Health: 1001 Queen St W, Toronto, Ontario, Canada M6J 1H4
| | - Lesley A. Tarasoff
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction & Mental Health, Toronto, Ontario, Canada; ICES: 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5; Centre for Addiction & Mental Health: 1001 Queen St W, Toronto, Ontario, Canada M6J 1H4,Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada; ICES: 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5; Centre for Addiction & Mental Health: 1001 Queen St W, Toronto, Ontario, Canada M6J 1H4; Department of Health & Society: 1265 Military Trail, Toronto, Ontario, Canada, M1C 1A5
| | - Hilary K. Brown
- ICES, Toronto, Ontario, Canada; Dalla Lana School of Public Health: 155 College St, Toronto, Ontario, Canada M5T 3M7; ICES: 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5,Department of Health & Society, University of Toronto Scarborough, Toronto, Ontario, Canada; ICES: 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5; Centre for Addiction & Mental Health: 1001 Queen St W, Toronto, Ontario, Canada M6J 1H4; Department of Health & Society: 1265 Military Trail, Toronto, Ontario, Canada, M1C 1A5
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25
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Coster JE, Ter Maat GH, Pentinga ML, Reyners AKL, van Veldhuisen DJ, de Graeff P. A pilot study on the effect of advance care planning implementation on healthcare utilisation and satisfaction in patients with advanced heart failure. Neth Heart J 2022. [PMID: 35727493 DOI: 10.1007/s12471-022-01705-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Patients with advanced heart failure may benefit from palliative care, including advance care planning (ACP). ACP, which can include referral back to the general practitioner (GP), may prevent unbeneficial hospital admissions and interventional/surgical procedures that are not in accordance with the patient's personal goals of care. AIM To implement ACP in patients with advanced heart failure and explore the effect of ACP on healthcare utilisation as well as the satisfaction of patients and cardiologists. METHODS In this pilot study, we enrolled 30 patients with New York Heart Association class III/IV heart failure who had had at least one unplanned hospital admission in the previous year because of heart failure. A structured ACP conversation was held and documented by the treating physician. Primary outcome was the number of visits to the emergency department and/or admissions within 3 months after the ACP conversation. Secondary endpoints were the satisfaction of patients and cardiologists as established by using a five-point Likert scale. RESULTS Median age of the patients was 81 years (range 33-94). Twenty-seven ACP documents could be analysed (90%). Twenty-one patients (78%) did not want to be readmitted to the hospital and subsequently none of them were readmitted during follow-up. Twenty-two patients (81%) discontinued all hospital care. All patients who died during follow-up (n = 12, 40%) died at home. Most patients and cardiologists indicated that they would recommend the intervention to others (80% and 92% respectively). CONCLUSION ACP, and subsequent out-of-hospital care by the GP, was shown to be applicable in the present study of patients with advanced heart failure and evident palliative care needs. Patients and cardiologists were satisfied with this intervention.
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26
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Toromo JJ, Apondi E, Nyandiko WM, Omollo M, Bakari S, Aluoch J, Kantor R, Fortenberry JD, Wools-Kaloustian K, Elul B, Vreeman RC, Enane LA. "I have never talked to anyone to free my mind" - challenges surrounding status disclosure to adolescents contribute to their disengagement from HIV care: a qualitative study in western Kenya. BMC Public Health 2022; 22:1122. [PMID: 35658924 PMCID: PMC9167528 DOI: 10.1186/s12889-022-13519-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Adolescents living with HIV (ALHIV, ages 10–19) experience complex barriers to care engagement. Challenges surrounding HIV status disclosure or non-disclosure to adolescents may contribute to adolescent disengagement from HIV care or non-adherence to ART. We performed a qualitative study to investigate the contribution of disclosure challenges to adolescent disengagement from HIV care. Methods This was a qualitative study performed with disengaged ALHIV and their caregivers, and with healthcare workers (HCW) in the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya. Inclusion criteria for ALHIV were ≥1 visit within the 18 months prior to data collection at one of two clinical sites and nonattendance ≥60 days following their last scheduled appointment. HCW were recruited from 10 clinics. Analysis was conducted by multiple independent coders, and narratives of disclosure and care disengagement were closely interrogated. Overarching themes were elucidated and summarized. Results Interviews were conducted with 42 disengaged ALHIV, 32 caregivers, and 28 HCW. ALHIV were average age 17.0 (range 12.9–20.9), and 95% indicated awareness of their HIV diagnosis. Issues surrounding disclosure to ALHIV presented important barriers to HIV care engagement. Themes centered on delays in HIV status disclosure; hesitancy and reluctance among caregivers to disclose; struggles for adolescents to cope with feelings of having been deceived prior to full disclosure; pervasive HIV stigma internalized in school and community settings prior to disclosure; and inadequate and unstructured support after disclosure, including for adolescent mental health burdens and for adolescent-caregiver relationships and communication. Both HCW and caregivers described feeling inadequately prepared to optimally handle disclosure and to manage challenges that may arise after disclosure. Conclusions Complex challenges surrounding HIV status disclosure to adolescents contribute to care disengagement. There is need to enhance training and resources for HCW, and to empower caregivers to support children and adolescents before, during, and after HIV status disclosure. This should include counseling caregivers on how to provide children with developmentally-appropriate and accurate information about their health from an early age, and to support adolescent-caregiver communication and relationships. Optimally integrating peer support can further promote ALHIV wellbeing and retention in care. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13519-9.
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Affiliation(s)
- Judith J Toromo
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - Edith Apondi
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Winstone M Nyandiko
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya
| | - Mark Omollo
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Salim Bakari
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Josephine Aluoch
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya
| | - Rami Kantor
- Division of Infectious Diseases, Department of Medicine, Brown University Apert Medical School, Providence, RI, USA
| | - J Dennis Fortenberry
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kara Wools-Kaloustian
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Batya Elul
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rachel C Vreeman
- Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.,Department of Child Health and Paediatrics, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya.,Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Arnhold Institute for Global Health, New York, NY, USA
| | - Leslie A Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA. .,Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.
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27
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Newton JC, O'Connor M, Saunders C, Ali S, Nowak AK, Halkett GKB. "Who can I ring? Where can I go?" Living with advanced cancer whilst navigating the health system: a qualitative study. Support Care Cancer 2022. [PMID: 35536328 DOI: 10.1007/s00520-022-07107-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/29/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND People with advanced cancer often experience greater physical and psychosocial morbidity compared to those with early disease. Limited research has focused on their experiences within the Australian health system. The aim of this study was to explore the lived experiences of adults receiving care for advanced cancer. METHODS A qualitative design with a descriptive phenomenological approach was used to explore the lived experiences of people with advanced cancer following their diagnosis. Twenty-three people living with an advanced solid malignancy receiving care were referred by their oncologists to take part in an interview conducted at their home, the hospital, or over the phone. RESULTS Three key themes emerged relating to participants' experiences of living with advanced cancer: (1) living with a life-limiting diagnosis and uncertainty, (2) living with symptom burden and side effects, and (3) living within the health system, with two subthemes, the patient-clinician relationship, and care coordination. Participant relationships with their health professionals were particularly important and had a defining impact on whether patient experiences living with cancer were positive or negative. CONCLUSION People with advanced cancer experienced broad variation in their experiences navigating the health system, and their relationships with clinicians and other health professionals were important factors affecting their perceptions of their experiences. Attention to the coordination of care for people with advanced cancer is necessary to improve their experiences and improve symptom control and the management of their psychosocial burden.
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Trindade LF, Boell JEW, Lorenzini E, Montañez WC, Malkiewiez M, Pituskin E, Kolankiewicz ACB. Effectiveness of care transition strategies for colorectal cancer patients: a systematic review and meta-analysis. Support Care Cancer 2022. [PMID: 35459953 DOI: 10.1007/s00520-022-07033-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Implementing effective strategies to transition care for individuals with colorectal cancer is an important tool to qualify care for affected individuals, as well as contribute to the dispensation of continuous and quality care to patients. OBJECTIVE To evaluate the effectiveness of strategies to transition from hospital care to the community compared to usual care for colorectal cancer patients to reduce hospital stay, readmissions at 30 days, and visit to the emergency department up to 30 days. METHOD Systematic review and meta-analysis followed the recommendations of PRISMA statement, with protocol registered in PROSPERO (CRD 42,020,162,249). Searches were carried out in May 2020 in the following databases: PubMed/MEDLINE, LILACS, EMBASE, and Cochrane Central. Meta-analysis was performed using a random-effects model. The measure of effect used for dichotomous outcomes was relative risk, and for continuous outcomes, the difference of means was used, with their confidence intervals of 95%. Heterogeneity was evaluated using inconsistency statistics. RESULTS Of 631 identified studies, seven studies were included. The meta-analysis of the studies showed a reduction in readmissions at 30 days of 32% and a significant reduction in hospital stay time of approximately one and a half days, both of which were analyzed in favor of the group of care transition interventions. CONCLUSION The findings showed effective care transition strategies for the transition of colorectal cancer patients, such as post-discharge active surveillance program, standardized protocol of improved recovery, and telephone follow-up. TRIAL REGISTRATION CRD42020162249.
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Amin R, Gershon A, Buchanan F, Pizzuti R, Qazi A, Patel N, Pinto R, Moretti ME, Ambreen M, Rose L. The Transitions to Long-term In Home Ventilator Engagement Study (Transitions to LIVE): study protocol for a pragmatic randomized controlled trial. Trials 2022; 23:125. [PMID: 35130935 PMCID: PMC8822764 DOI: 10.1186/s13063-022-06035-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background overview and rationale We co-developed a multi-component virtual care solution (TtLIVE) for the home mechanical ventilation (HMV) population using the aTouchAway™ platform (Aetonix). The TtLIVE intervention includes (1) virtual home visits; (2) customizable care plans; (3) clinical workflows that incorporate reminders, completion of symptom profiles, and tele-monitoring; and (4) digitally secure communication via messaging, audio, and video calls; (5) Resource library including print and audiovisual material. Objectives and brief methods Our primary objective is to evaluate the TtLIVE intervention compared to a usual care control group using an eight-center, pragmatic, parallel-group single-blind (outcome assessors) randomized controlled trial. Eligible patients are children and adults newly transitioning to HMV in Ontario, Canada. Our target sample size is 440 participants (220 each arm). Our co-primary outcomes are a number of emergency department (ED) visits in the 12 months after randomization and change in family caregiver (FC) reported Pearlin Mastery Scale score from baseline to 12 months. Secondary outcomes also measured in the 12 months post randomization include healthcare utilization measured using a hybrid Ambulatory Home Care Record (AHCR-hybrid), FC burden using the Zarit Burden Interview, and health-related quality of life using the EQ-5D. In addition, we will conduct a cost-utility analysis over a 1-year time horizon and measure process outcomes including healthcare provider time using the Care Coordination Measurement Tool. We will use qualitative interviews in a subset of study participants to understand acceptability, barriers, and facilitators to the TtLIVE intervention. We will administer the Family Experiences with Care Coordination (FECC) to interview participants. We will use Poisson regression for a number of ED visits at 12 months. We will use linear regression for the Pearlin Mastery scale score at 12 months. We will adjust for the baseline score to estimate the effect of the intervention on the primary outcomes. Analysis of secondary outcomes will employ regression, causal, and linear mixed modeling. Primary analysis will follow intention-to-treat principles. We have Research Ethics Board approval from SickKids, Children’s Hospital Eastern Ontario, McMaster Children’s Hospital, Children’s Hospital-London Health Sciences, Sunnybrook Hospital, London Health Sciences, West Park Healthcare Centre, and Ottawa Hospital. Discussion This pragmatic randomized controlled single-blind trial will determine the effectiveness and cost-effectiveness of the TtLIVE virtual care solution compared to usual care while providing important data on patient and family experience, as well as process measures such as healthcare provider time to deliver the intervention. Trial registration ClinicalTrials.gov NCT04180722. Registered on November 27, 2019.
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Affiliation(s)
- Reshma Amin
- The Hospital for Sick Children, 555 University Ave, Toronto, M5G 1X8, Canada. .,Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, M5T 3M6, Canada. .,Child Health and Evaluative Science, SickKids Research Institute, 686 Bay Street, Toronto, Ontario, Canada.
| | - Andrea Gershon
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, M5T 3M6, Canada.,Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, M4N 3 M5, Canada.,IC/ES, 2075 Bayview Ave, Toronto, M4N 3 M5, Canada
| | - Francine Buchanan
- Ontario Child Health Support Unit, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 1X8, Canada
| | - Regina Pizzuti
- Ontario Ventilator Equipment Pool, Kingston Health Sciences Centre, 640 Cataraqui Woods Dr, Kingston, K7P 2Y5, Canada
| | - Adam Qazi
- The Hospital for Sick Children, 555 University Ave, Toronto, M5G 1X8, Canada
| | - Nishali Patel
- The Hospital for Sick Children, 555 University Ave, Toronto, M5G 1X8, Canada.,Department of Health Metric Sciences, University of Washington, Seattle, WA, 98105, USA
| | - Ruxandra Pinto
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, M4N 3 M5, Canada
| | - Myla E Moretti
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, M5T 3M6, Canada.,Ontario Child Health Support Unit, The Hospital for Sick Children, 555 University Ave, Toronto, M5G 1X8, Canada
| | - Munazzah Ambreen
- The Hospital for Sick Children, 555 University Ave, Toronto, M5G 1X8, Canada
| | | | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK.,Critical Care Directorate and Lane Fox Respiratory Unit, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
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Eggli Y, Halfon P, Piaget-Rossel R, Bischoff T. Measuring medically unjustified hospitalizations in Switzerland. BMC Health Serv Res 2022; 22:158. [PMID: 35130896 PMCID: PMC8822832 DOI: 10.1186/s12913-022-07569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Inappropriate use of acute hospital beds is a major topic in health politics. We present here a new approach to measure unnecessary hospitalizations in Medicine and Pediatrics. Methods The necessity of a hospital admission was determined using explicit criteria related to the recorded diagnoses. Two indicators (i.e. “unjustified” and “sometimes justified” stays) were applied to more than 800,000 hospital stays and a random sample of 200 of them was analyzed by two clinicians, using routine data available in medical statistics. The validation of the indicators focused on their precision, validity and adjustment, as well as their usefulness (i.e. interest and risk of abuse). Results Rates, adjusted for case mix (i.e. age of patient, admission planned or not), showed statistically significant differences among hospitals. Only 6.5% of false positives were observed for “unjustified stays” and 17% for “sometimes justified stays”. Respectively 7 and 12% of stays had an unknown status, due to a lack of sufficiently precise data. Considering true positives only, almost one third of medical and pediatric stays were classified as not strictly justified from a medical point of view in Switzerland. Among these stays, about one fifth could have probably been avoided without risk. To enable a larger ambulatory shift, recommendations were made to strengthen the ambulatory care, notably regarding post-emergency follow-up, cardiac and pulmonary functions’ monitoring, pain management, falls prevention, and specialized at-home services that should be offered. Conclusion We recommend using “unjustified stays” and “sometimes justified stays” indicators to monitor inappropriate hospitalizations. The latter could help the planning of reinforced ambulatory care measures to pursue the ambulatory shift. Nonetheless, we clearly advise against the use of these two indicators for hospitals financing purposes. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07569-3.
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Affiliation(s)
- Yves Eggli
- Primary Care and Public Health Center (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland.
| | - Patricia Halfon
- Primary Care and Public Health Center (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Romain Piaget-Rossel
- Primary Care and Public Health Center (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Thomas Bischoff
- Primary Care and Public Health Center (Unisanté), University of Lausanne, Route de la Corniche 10, 1010, Lausanne, Switzerland
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Greene GJ, Reidy E, Felt D, Marro R, Johnson AK, Phillips G, Green E, Stonehouse P. Implementation and evaluation of patient navigation in Chicago: Insights on addressing the social determinants of health and integrating HIV prevention and care services. Eval Program Plann 2022; 90:101977. [PMID: 34373116 DOI: 10.1016/j.evalprogplan.2021.101977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/12/2021] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
Patient navigation is a primary element in linkage to HIV pre-exposure prophylaxis (PrEP) care and linkage to or re-engagement in HIV care, depending on the HIV status of the individual. However, there is a dearth of literature describing navigation services in these areas. In the context of Chicago Project PrIDE, this project conducted process and implementation evaluations with eight agencies leading demonstration projects to address these gaps. The evaluation team conducted semi-structured, individual interviews with agency staff (N = 20) assessing navigation implementation and fit, as well as project successes and challenges. Additionally, agency staff collected patient surveys (N = 300) assessing services provided, service quality, and satisfaction. The interview transcripts were coded and analyzed thematically and descriptive analyses were performed on the survey data. Analyses indicated that screening for social determinants of health, providing healthcare engagement guidance, and providing service referrals were frequently cited navigation activities. Most staff members indicated that navigation fits well within their agencies, and that limited staff and clinic capacity were often barriers to navigation. Patient navigation to support engagement in HIV prevention and care services is critical due to the extensive support provided by navigators to address social determinants of health impacting HIV disparity populations.
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Affiliation(s)
- George J Greene
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA.
| | - Emma Reidy
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Dylan Felt
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Rachel Marro
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Amy K Johnson
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, The Potocsnak Family Division of Adolescent and Young Adult Medicine, 225 E. Chicago Ave., Box 161, Chicago, IL, 60611, USA
| | - Gregory Phillips
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Evelyn Green
- Chicago Department of Public Health, 333 S. State St., Suite 200, Chicago, IL, 60604, USA
| | - Patrick Stonehouse
- Chicago Department of Public Health, 333 S. State St., Suite 200, Chicago, IL, 60604, USA
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Díaz-Fernández S. The mental health nurse as case manager of a patient with severe schizophrenia. Enferm Clin (Engl Ed) 2022; 32:60-64. [PMID: 35078753 DOI: 10.1016/j.enfcle.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/24/2021] [Indexed: 06/14/2023]
Abstract
Community-based programmes for people with severe mental illness (SMI), with a case management methodology, have shown high treatment adherence and a decrease in psychiatric hospitalizations. There is a need for continuity of care through a good therapeutic relationship, maintained throughout the care process until reaching clinical stabilization. The proposed case shows the treatment of a woman with a diagnosis of schizophrenia who began treatment in a mental health centre and was later referred to a case managed SMI programme. A nursing assessment was carried out from the beginning and a care plan was made based on the NANDA (North American Nursing Diagnosis Association), NOC (Nursing Outcomes Classification), NIC (Nursing Interventions Classification) taxonomy. The outcomes over the years are remarkable, achieving among other objectives not only clinical stabilization but also a normal life.
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Affiliation(s)
- Silvia Díaz-Fernández
- Facultad de Ciencias de la Salud, Universidad Camilo José Cela, Villanueva de la Cañada, Madrid, Spain; Área de Gestión Clínica de Salud Mental-V, Hospital Universitario de Cabueñes (HUCAB), Servicio de Salud del Principado de Asturias (SESPA), Gijón, Asturias, Spain; Instituto para la Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
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Schmidt EM, Wright D, Cherkasova E, Harris AHS, Trafton J. Evaluating and Improving Engagement in Care After High-Intensity Stays for Mental or Substance Use Disorders. Psychiatr Serv 2022; 73:18-25. [PMID: 34106740 DOI: 10.1176/appi.ps.202000287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This interrupted time-series analysis examined whether activating a quality measure, supported by education and a population management tool, was associated with higher postdischarge engagement (PDE) in outpatient care after inpatient and residential stays for mental or substance use disorder care. METHODS Discharges from October 2016 to May 2019 were identified from national Veterans Health Administration (VHA) records representing all 140 VHA health care systems. Engagement was defined as multiple mental or substance use disorder outpatient visits in the 30 days postdischarge. The number of such visits required to meet the engagement definition depended on a patient's suicide risk and acuity level of inpatient or residential treatment. Health care system-level performance was calculated as the percentage of qualifying discharges with 30-day PDE. A segmented mixed-effects linear regression model tested whether monthly health care system performance changed significantly after activation of the PDE measure (activation rollout period, October-December 2017). RESULTS A total of 322,344 discharges qualified for the measure. In the regression model, average health care system performance was 65.6% at the beginning of the preactivation period (October 2016) and did not change significantly in the following 12 months. Average health care system performance increased by 5.7% (SE=0.8%, p<0.001) after PDE measure activation and did not change significantly thereafter-a difference representing 11,464 more patients engaging in care than would have without activation of the measure. CONCLUSIONS Results support use of this measure, along with education, technical assistance, and population management tools, to improve engagement after discharge from residential and inpatient mental and substance use disorder treatment.
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Affiliation(s)
- Eric M Schmidt
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration (VHA), U.S. Department of Veterans Affairs (VA), Menlo Park, California (Schmidt, Wright, Cherkasova, Trafton); Center for Innovation to Implementation, Health Services Research and Development (HSR&D), VHA, VA Palo Alto Health Care System, Menlo Park, California (Schmidt, Harris); Department of Surgery (Harris) and Department of Psychiatry and Behavioral Sciences (Trafton), School of Medicine, Stanford University, Stanford, California
| | - David Wright
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration (VHA), U.S. Department of Veterans Affairs (VA), Menlo Park, California (Schmidt, Wright, Cherkasova, Trafton); Center for Innovation to Implementation, Health Services Research and Development (HSR&D), VHA, VA Palo Alto Health Care System, Menlo Park, California (Schmidt, Harris); Department of Surgery (Harris) and Department of Psychiatry and Behavioral Sciences (Trafton), School of Medicine, Stanford University, Stanford, California
| | - Elena Cherkasova
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration (VHA), U.S. Department of Veterans Affairs (VA), Menlo Park, California (Schmidt, Wright, Cherkasova, Trafton); Center for Innovation to Implementation, Health Services Research and Development (HSR&D), VHA, VA Palo Alto Health Care System, Menlo Park, California (Schmidt, Harris); Department of Surgery (Harris) and Department of Psychiatry and Behavioral Sciences (Trafton), School of Medicine, Stanford University, Stanford, California
| | - Alex H S Harris
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration (VHA), U.S. Department of Veterans Affairs (VA), Menlo Park, California (Schmidt, Wright, Cherkasova, Trafton); Center for Innovation to Implementation, Health Services Research and Development (HSR&D), VHA, VA Palo Alto Health Care System, Menlo Park, California (Schmidt, Harris); Department of Surgery (Harris) and Department of Psychiatry and Behavioral Sciences (Trafton), School of Medicine, Stanford University, Stanford, California
| | - Jodie Trafton
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration (VHA), U.S. Department of Veterans Affairs (VA), Menlo Park, California (Schmidt, Wright, Cherkasova, Trafton); Center for Innovation to Implementation, Health Services Research and Development (HSR&D), VHA, VA Palo Alto Health Care System, Menlo Park, California (Schmidt, Harris); Department of Surgery (Harris) and Department of Psychiatry and Behavioral Sciences (Trafton), School of Medicine, Stanford University, Stanford, California
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Agarwal A, Pain T, Levesque JF, Girgis A, Hoffman A, Karnon J, King MT, Shah KK, Morton RL. Patient-reported outcome measures (PROMs) to guide clinical care: recommendations and challenges. Med J Aust 2021; 216:9-11. [PMID: 34897693 PMCID: PMC9299767 DOI: 10.5694/mja2.51355] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Tilley Pain
- Townsville General Hospital, Townsville, QLD
| | - Jean-Frederic Levesque
- Agency for Clinical Innovation, NSW Health, Sydney, NSW.,Centre for primary Health Care and Equity, UNSW Sydney, Sydney, NSW
| | - Afaf Girgis
- Ingham Institute for Applied Medical Research, UNSW Sydney, Sydney, NSW
| | | | | | | | - Karan K Shah
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW
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Okhovat F, Abdeyazdan Z, Namnabati M. Follow-up Plan as a Necessity for Nursing Care: A Decrease of Stress in Mothers with their Children in Pediatric Surgical Units. J Caring Sci 2021; 10:191-195. [PMID: 34849364 PMCID: PMC8609124 DOI: 10.34172/jcs.2021.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/21/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction: Children are vulnerable to damage. Health problems in children, especially if necessitate hospitalization, can cause stress in their parents that may persist even long after discharge. This study aimed to investigate the effect of implementing follow-up care plans on stress in mothers of children discharged from pediatric surgical units.
Methods: A quasi-experimental study was conducted on 64 mothers whose children were hospitalized in the surgical wards of two educational hospitals affiliated to Isfahan University of Medical Sciences, Iran. The participants were randomly assigned into two groups of control and experimental. The data collection tools included a demographic data questionnaire and stress response inventory (SRI). The interventions were performed using a four-stage follow-up care plan. The data were analyzed using SPSS software version 13 and descriptive statistics, independent t-test, repeated measures analysis of variance (ANOVA), and least significant difference (LSD) test.
Results: The mean (SD) stress scores of the experimental group were 64.1 (28.8), 20.4 (12.4), and 11.6 (7.5) before, one week, and one month after the intervention, respectively. In the control group, these scores were 61.2 (29.2), 59.9 (25.5), and 46.7 (19.1), respectively. The results showed the mean score was significantly lower than that of the control group at one week and one month after the intervention in the experimental group.
Conclusion: Our results demonstrated that a follow-up care plan can decrease the stress levels of mothers as a continuity of patient care even after discharge.
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Affiliation(s)
- Forogh Okhovat
- Department of Nursing, Shahrekord Branch, Islamic Azad University, Sharekord, Iran
| | - Zahra Abdeyazdan
- Department of Infant and Pediatric. Nursing and Midwifery Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahboobeh Namnabati
- Department of Infant and Pediatric. Nursing and Midwifery Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Brajcich BC, Shallcross ML, Johnson JK, Joung RHS, Iroz CB, Holl JL, Bilimoria KY, Merkow RP. Barriers to Post-Discharge Monitoring and Patient-Clinician Communication: A Qualitative Study. J Surg Res 2021; 268:1-8. [PMID: 34274626 PMCID: PMC8822471 DOI: 10.1016/j.jss.2021.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/06/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION As postoperative length of stay has decreased for many operations, the proportion of complications occurring post-discharge is increasing. Early identification and management of these complications requires overcoming barriers to effective post-discharge monitoring and communication. The aim of this study was to identify barriers to post-discharge monitoring and patient-clinician communication through a qualitative study of surgical patients and clinicians. MATERIALS AND METHODS Semi-structured interviews and focus groups were held with gastrointestinal surgery patients and clinicians. Participants were asked about barriers to post-discharge monitoring and communication. Each transcript was coded by 2 of 4 researchers, and recurring themes related to communication and care barriers were identified. RESULTS A total of 15 patients and 17 clinicians participated in interviews and focus groups. Four themes which encompassed barriers to post-discharge monitoring and communication were identified from patient interviews, and 4 barriers were identified from clinician interviews and focus groups. Patient-identified barriers included education and expectation setting, technology access and literacy, availability of resources and support, and misalignment of communication preferences, while clinician-identified barriers included health education, access to clinical team, healthcare practitioner time constraints, and care team experience and consistency. CONCLUSIONS Multiple barriers exist to effective post-discharge monitoring and patient-clinician communication among surgical patients. These barriers must be addressed to develop an effective system for post-discharge care after surgery.
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Affiliation(s)
- Brian C Brajcich
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern Medicine, Chicago, Illinois; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois
| | - Meagan L Shallcross
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern Medicine, Chicago, Illinois
| | - Julie K Johnson
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern Medicine, Chicago, Illinois
| | - Rachel Hae-Soo Joung
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern Medicine, Chicago, Illinois
| | - Cassandra B Iroz
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern Medicine, Chicago, Illinois
| | - Jane L Holl
- Biological Sciences Division, The University of Chicago, Chicago, Illinois
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern Medicine, Chicago, Illinois; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois
| | - Ryan P Merkow
- Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern Medicine, Chicago, Illinois; Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.
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Milch V, Wang R, Der Vartanian C, Austen M, Hector D, Anderiesz C, Keefe D. Cancer Australia consensus statement on COVID-19 and cancer care: embedding high value changes in practice. Med J Aust 2021; 215:479-484. [PMID: 34689343 PMCID: PMC8662192 DOI: 10.5694/mja2.51304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 12/18/2022]
Abstract
Introduction Driven by the need to reduce risk of SARS‐CoV‐2 infection and optimise use of health system resources, while maximising patient outcomes, the COVID‐19 pandemic has prompted unprecedented changes in cancer care. Some new or modified health care practices adopted during the pandemic will be of long term value in improving the quality and resilience of cancer care in Australia and internationally. The Cancer Australia consensus statement is intended to guide and enhance the delivery of cancer care during the pandemic and in a post‐pandemic environment. This article summarises the full statement, which is available at https://www.canceraustralia.gov.au/covid‐19/covid‐19‐recovery‐implications‐cancer‐care. Main recommendations The statement is informed by a desktop literature review and input from cancer experts and consumers at a virtual roundtable, held in July 2020, on key elements of cancer care that changed during the pandemic. It describes targeted strategies (at system, service, practitioner and patient levels) to retain, enhance and embed high value changes in practice. Principal strategies include:
implementing innovative models of care that are digitally enabled and underpinned by clear governance, policies and procedures to guide best practice cancer care; enabling health professionals to deliver evidence‐based best practice and coordinated, person‐centred cancer care; and empowering patients to improve health literacy and enhancing their ability to engage in informed, shared decision making.
Changes in management as a result of this statement Widespread adoption of high value health care practices across all levels of the cancer control sector will be of considerable benefit to the delivery of optimal cancer care into the future.
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Affiliation(s)
| | | | | | | | | | - Cleola Anderiesz
- Cancer Australia, Sydney, NSW.,Centre for Health Policy, University of Melbourne, Melbourne, VIC
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Cam H, Kempen TGH, Eriksson H, Abdulreda K, Franzon K, Gillespie U. Assessment of requests for medication-related follow-up after hospital discharge, and the relation to unplanned hospital revisits, in older patients: a multicentre retrospective chart review. BMC Geriatr 2021; 21:618. [PMID: 34724895 PMCID: PMC8561898 DOI: 10.1186/s12877-021-02564-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The discharge of older hospitalised patients is critical in terms of patient safety. Inadequate transfer of information about medications to the next healthcare provider is a known problem, but there is a lack of understanding of this problem in settings where shared electronic health records are used. The aims of this study were to evaluate the prevalence of patients for whom hospitals sent adequate requests for medication-related follow-up at discharge, the proportion of patients with unplanned hospital revisits because of inadequate follow-up requests, and the association between medication reviews performed during hospitalisation and adequate or inadequate follow-up requests. METHODS We conducted a retrospective chart review. The study population was randomly selected from a cluster-randomised crossover trial which included patients 65 years or older who had been admitted to three hospitals in Sweden with shared electronic health records between hospital and primary care. Each patient was assessed with respect to the adequacy of the request for follow-up. For patients where the hospitals sent inadequate requests, data about any unplanned hospital revisits were collected, and we assessed whether the inadequate requests had contributed to the revisits. The association between medication reviews and adequate or inadequate requests was analysed with a Chi-square test. RESULTS A total of 699 patients were included. The patients' mean age was 80 years; an average of 10 medications each were prescribed on hospital admission. The hospitals sent an adequate request for 418 (60%) patients. Thirty-eight patients (14%) had a hospital revisit within six months of discharge which was related to an inadequate request. The proportion of adequate or inadequate requests did not differ between patients who had received a medication review during hospitalisation and those who had not (p = 0.83). CONCLUSIONS The prevalence of patients for whom the hospitals sent adequate follow-up requests on discharge was low. More than one in every ten who had an inadequate request revisited hospital within six months of discharge for reasons related to the request. Medication reviews conducted during hospitalisation did not affect the proportion of adequate or inadequate requests sent. A communication gap still exists despite the usage of a shared electronic health record between primary and secondary care levels.
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Affiliation(s)
- Henrik Cam
- Hospital Pharmacy Department, Uppsala University Hospital, SE-751 85, Uppsala, Sweden. .,Department of Pharmacy, Uppsala University, Uppsala, Sweden.
| | - Thomas Gerardus Hendrik Kempen
- Department of Pharmacy, Uppsala University, Uppsala, Sweden.,Academic Primary Health Care Centre, Region Uppsala, Uppsala, Sweden
| | | | | | - Kristin Franzon
- Geriatric Department, Uppsala University Hospital, Uppsala, Sweden.,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ulrika Gillespie
- Hospital Pharmacy Department, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.,Department of Pharmacy, Uppsala University, Uppsala, Sweden
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Robinson-Lane SG, Sutton NR, Chubb H, Yeow RY, Mazzara N, DeMarco K, Kim T, Chopra V. Race, Ethnicity, and 60-Day Outcomes After Hospitalization With COVID-19. J Am Med Dir Assoc 2021; 22:2245-2250. [PMID: 34716006 PMCID: PMC8490827 DOI: 10.1016/j.jamda.2021.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/19/2021] [Accepted: 08/22/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine racial and ethnic disparities in clinical, financial, and mental health outcomes within a diverse sample of hospitalized COVID-19-positive patients in the 60 days postdischarge. DESIGN A cross-sectional study. SETTING AND PARTICIPANTS A total of 2217 adult patients who were hospitalized with a COVID-19-positive diagnosis as evidenced by test (reverse-transcriptase polymerase chain reaction), a discharge diagnosis of COVID-19 (ICD-10 code U07.1), or strong documented clinical suspicion of COVID-19 but no testing completed or recorded owing to logistical constraints (n=24). METHODS Patient records were abstracted for the Mi-COVID19 data registry, including the hospital and insurer data of patients discharged from one of 38 participating hospitals in Michigan between March 16, 2020, and July 1, 2020. Registry data also included patient responses to a brief telephone survey on postdischarge employment, mental and emotional health, persistence of COVID-19-related symptoms, and medical follow-up. Descriptive statistics were used to summarize data; analysis of variance and Pearson chi-squared test were used to evaluate racial and ethnic variances among patient outcomes and survey responses. RESULTS Black patients experienced the lowest physician follow-up postdischarge (n = 65, 60.2%) and the longest delays in returning to work (average 35.5 days). More than half of hospital readmissions within the 60 days following discharge were among nonwhite patients (n = 144, 55%). The majority of postdischarge deaths were among white patients (n = 153, 21.5%), most of whom were discharged on palliative care (n = 103). Less than a quarter of patients discharged back to assisted living, skilled nursing facilities, or subacute rehabilitation facilities remained at those locations in the 60 days following discharge (n = 48). CONCLUSIONS AND IMPLICATIONS Increased attention to postdischarge care coordination is critical to reducing negative health outcomes following a COVID-19-related hospitalization.
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Affiliation(s)
- Sheria G. Robinson-Lane
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA,Address correspondence to Sheria Robinson-Lane, PhD, RN, Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, 400 N Ingalls, RM 4305, Ann Arbor, MI 48109, USA
| | - Nadia R. Sutton
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Heather Chubb
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Raymond Y. Yeow
- Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Nicholas Mazzara
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Kayla DeMarco
- Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Tae Kim
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Vineet Chopra
- The Patient Safety Enhancement Program, Division of Hospital Medicine, Department of Medicine, Michigan Medicine, Ann Arbor, MI, USA
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Groot LJJ, Schers HJ, Burgers JS, Schellevis FG, Smalbrugge M, Uijen AA, van de Ven PM, van der Horst HE, Maarsingh OR. Optimising personal continuity for older patients in general practice: a study protocol for a cluster randomised stepped wedge pragmatic trial. BMC Fam Pract 2021; 22:207. [PMID: 34666678 PMCID: PMC8526277 DOI: 10.1186/s12875-021-01511-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022]
Abstract
Background Continuity of care, in particular personal continuity, is a core principle of general practice and is associated with many benefits such as a better patient-provider relationship and lower mortality. However, personal continuity is under pressure due to changes in society and healthcare. This affects older patients more than younger patients. As the number of older patients will double the coming decades, an intervention to optimise personal continuity for this group is highly warranted. Methods Following the UK Medical Research Council framework for complex Interventions, we will develop and evaluate an intervention to optimise personal continuity for older patients in general practice. In phase 0, we will perform a literature study to provide the theoretical basis for the intervention. In phase I we will define the components of the intervention by performing surveys and focus groups among patients, general practitioners, practice assistants and practice nurses, concluded by a Delphi study among members of our group. In phase II, we will test and finalise the intervention with input from a pilot study in two general practices. In phase III, we will perform a stepped wedge cluster randomised pragmatic trial. The primary outcome measure is continuity of care from the patients’ perspective, measured by the Nijmegen Continuity Questionnaire. Secondary outcome measures are level of implementation, barriers and facilitators for implementation, acceptability and feasibility of the intervention. In phase IV, we will establish the conditions for large-scale implementation. Discussion This is the first study to investigate an intervention for improving personal continuity for older patients in general practice. If proven effective, our intervention will enable General practitioners to improve the quality of care for their increasing population of older patients. The pragmatic design of the study will enable evaluation in real-life conditions, facilitating future implementation. Trial registration number Netherlands Trial Register, trial NL8132. Registered 2 November 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01511-y.
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Affiliation(s)
- Lex J J Groot
- Department of General Practice, Amsterdam University Medical Centre, location VU University Medical Centre, van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands.
| | - Henk J Schers
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525, EZ, Nijmegen, The Netherlands
| | - Jako S Burgers
- MUMC+/ Maastricht University, Department of General Practice, Care and Public Health Research Institute (CAPHRI), Universiteitssingel 40, 6229, ER, Maastricht, the Netherlands
| | - Francois G Schellevis
- Department of General Practice, Amsterdam University Medical Centre, location VU University Medical Centre, van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam University Medical Centre, location VU University Medical Centre, De Boelelaan 1109, 1081, HV, Amsterdam, the Netherlands
| | - Annemarie A Uijen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525, EZ, Nijmegen, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, De Boelelaan 1089a, 1081, HV, Amsterdam, the Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice, Amsterdam University Medical Centre, location VU University Medical Centre, van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Otto R Maarsingh
- Department of General Practice, Amsterdam University Medical Centre, location VU University Medical Centre, van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands
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Keep M. The silence around miscarriage hurts health care and bereaved parents. Med J Aust 2021; 215:343-344.e1. [PMID: 34564858 DOI: 10.5694/mja2.51272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/18/2021] [Indexed: 11/17/2022]
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Davis KM, Eckert MC, Hutchinson A, Harmon J, Sharplin G, Shakib S, Caughey GE. Effectiveness of nurse-led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface: A quantitative systematic review. Int J Nurs Stud 2021; 121:103986. [PMID: 34242979 DOI: 10.1016/j.ijnurstu.2021.103986] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Globally, chronic disease is a leading cause of illness, disability and death and an important driver of health system utilization and spending. Continuity of care is a significant component of quality healthcare. However, an association between nurse-led services, interventions, patient outcomes and continuity of care at the primary and secondary interface as an outcome, has not been established for people with chronic disease. OBJECTIVE To identify the effectiveness of nurse-led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface. DESIGN Quantitative systematic review. DATA SOURCES Systematic searches of Medline, Cochrane, Embase, Emcare, JBI and Scopus databases were conducted of studies published between 1946 and May 2019 using the search terms "nurse", "continuity of care" and "chronic disease". REVIEW METHODS Quality of the included studies was assessed using the Cochrane risk of bias tool for randomized controlled trials and Joanna Briggs Institute quality appraisal checklists. A second reviewer screened 10% of full text articles and all articles in critical appraisal. Studies were excluded from the review if they were of poor methodological quality or the description of the effect of the nurse-led service was inadequately reported. RESULTS Fourteen studies were included in the review (n=4,090 participants). All studies incorporated recognized continuity of care interventions. The nurse-led services were associated with fewer hospitalizations, reduced by 2-8.9% and re-admissions reduced by 14.8-51% (n=886). Reporting of positive patient experiences and improvement in symptoms and lifestyle was also evident. An association of nurse-led services with improved continuity of care between primary and secondary health services as an outcome per se could not be concluded. CONCLUSION Nurse-led services for adults provide coordinated interventions that support continuity of care for people with chronic disease in both the primary and secondary healthcare settings that are associated with reduced hospitalizations or readmissions and patient satisfaction. However, the limited use of validated continuity of care outcome measurement tools precluded establishing correlations between interventions, patient outcomes and continuity of care as a specific outcome.
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Affiliation(s)
- K M Davis
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia.
| | - M C Eckert
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia. https://twitter.com/@DrJoanneHarmon
| | - A Hutchinson
- UniSA, Clinical and Health Sciences, University of South Australia
| | - J Harmon
- UniSA, Clinical and Health Sciences, University of South Australia. https://twitter.com/marioneckert5
| | - G Sharplin
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia
| | - S Shakib
- Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - G E Caughey
- Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
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Wang N, Albaroudi A, Benjenk I, Chen J. Exploring hospital-based health information technology functions for patients with Alzheimer's Disease and related Dementias. Prev Med Rep 2021; 23:101459. [PMID: 34258173 PMCID: PMC8256283 DOI: 10.1016/j.pmedr.2021.101459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 12/29/2022] Open
Abstract
This study investigated whether hospital-adopted health information technology (HIT) is associated with a reduction in the frequency of preventable emergency department (ED) visits for patients with Alzheimer's Disease and Related Dementias (ADRD). We used data from the 2015 State Emergency Department Databases, Area Health Resources File, and the American Hospital Association Annual Survey Information Technology Supplement. We employed multivariable logistic regression models to examine the variation of the likelihood of having preventable ED visits by hospitals' adoption of HIT functions and adjusted for patient, hospital, and county-level factors. We focused on hospital-HIT functions related to patient engagement, routine integration and availability of electronic clinical information, frequency of hospital reported use of electronic patient information, and the provision of electronic notification to the patient's primary care provider. Approximately 23% of ADRD patients went to a hospital that often used electronic records from outside providers, and 75% of ADRD patients went to a hospital that provided electronic notification to the patient's primary care provider. Regression results showed that hospital reported use of electronic patient health information from outside providers (OR = 0.88; p < 0.001), provision of electronic notification to the patient's primary care physician inside and outside of the system (OR = 0.91; p = 0.013), and hospital-HIT patient engagement functionalities (OR = 0.90; p < 0.001) were associated with significantly lower preventable ED visit rates. The results of our study suggest that certain types of HIT functionalities may be useful for reducing preventable ED visits for ADRD patients.
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Affiliation(s)
- Nianyang Wang
- Department of Health Policy and Management, University of Maryland, School of Public Health, College Park, MD, USA
| | - Asmaa Albaroudi
- Department of Health Policy and Management, University of Maryland, School of Public Health, College Park, MD, USA
| | - Ivy Benjenk
- Department of Health Policy and Management, University of Maryland, School of Public Health, College Park, MD, USA
| | - Jie Chen
- Department of Health Policy and Management, University of Maryland, School of Public Health, College Park, MD, USA
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Benipal H, Holbrook A, Paterson JM, Douketis J, Foster G, Ma J, Thabane L. Derivation and validation of predictors of oral anticoagulant-related adverse events in seniors transitioning from hospital to home. Thromb Res 2021; 206:18-28. [PMID: 34391064 DOI: 10.1016/j.thromres.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/20/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Oral anticoagulant (OAC)-related adverse events are high post-hospitalization. We planned to develop and validate a prediction model for OAC-related harm within 30 days of hospitalization. METHODS We undertook a population-based study of adults aged ≥66 years who were discharged from hospital on an OAC from September 2010 to March 2015 in Ontario, Canada. The primary outcome was a composite of time to first hospitalization or emergency department visit for a hemorrhagic or thromboembolic event, or mortality within 30 days of hospital discharge. Cox proportional hazards regression was used to build the model. RESULTS We included 120,721 patients of which 5423 experienced the outcome. Most patients were aged ≥75 years (59.5%) and were female (55.6%). Sixty percent of the cohort had a follow-up visit with a healthcare provider within 7 days of discharge. Patients discharged on a direct acting OAC versus warfarin (apixaban: Hazard Ratio [HR] 0.82, 95% confidence interval [CI] 0.71-0.94; dabigatran: HR 0.73, 95% CI 0.63-0.84; rivaroxaban: HR 0.79, 95% CI 0.71-0.88), were prevalent users of the dispensed OAC versus incident users (HR 0.82, 95% CI 0.69-0.96), had a joint replacement in the past 35 days (HR 0.40, 95% CI 0.33-0.50) or major surgery during index hospital stay (HR 0.69, 95% CI 0.60-0.80) had a lower risk for the outcome. The Cox model was stable with acceptable discrimination but poor goodness-of-fit. CONCLUSIONS A model for OAC-related harm in the early post-discharge period was developed. External validation studies are required to understand the model's poor calibration.
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Affiliation(s)
- Harsukh Benipal
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada.
| | - Anne Holbrook
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada; Division of Clinical Pharmacology & Toxicology, Department of Medicine, McMaster University, SJHH G623, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
| | - J Michael Paterson
- ICES, G1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, Ontario M5T 3M6, Canada.
| | - James Douketis
- Division of Hematology and Thromboembolism, Department of Medicine, HSC-3V50, McMaster University, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada; Thrombosis and Atherosclerosis Research Institute, David Braley Research Institute C5-121, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.
| | - Gary Foster
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada; Biostatistics Unit, St Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
| | - Jinhui Ma
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada.
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, Ontario L8S 4K1, Canada; Biostatistics Unit, St Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada.
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45
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Welberry HJ, Jorm LR, Schaffer AL, Barbieri S, Hsu B, Harris MF, Hall J, Brodaty H. Psychotropic medicine prescribing and polypharmacy for people with dementia entering residential aged care: the influence of changing general practitioners. Med J Aust 2021; 215:130-136. [PMID: 34198357 DOI: 10.5694/mja2.51153] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/26/2021] [Accepted: 05/11/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To examine relationships between changing general practitioner after entering residential aged care and overall medicines prescribing (including polypharmacy) and that of psychotropic medicines in particular. DESIGN Retrospective data linkage study. SETTING, PARTICIPANTS 45 and Up Study participants in New South Wales with dementia who were PBS concession card holders and entered permanent residential aged care during January 2010 - June 2014 and were alive six months after entry. MAIN OUTCOME MEASURES Inverse probability of treatment-weighted numbers of medicines dispensed to residents and proportions of residents dispensed antipsychotics, benzodiazepines, and antidepressants in the six months after residential care entry, by most frequent residential care GP category: usual (same as during two years preceding entry), known (another GP, but known to the resident), or new GP. RESULTS Of 2250 new residents with dementia (mean age, 84.1 years; SD, 7.0 years; 1236 women [55%]), 625 most frequently saw their usual GPs (28%), 645 saw known GPs (29%), and 980 saw new GPs (44%). The increase in mean number of dispensed medicines after residential care entry was larger for residents with new GPs (+1.6 medicines; 95% CI, 1.4-1.9 medicines) than for those attended by their usual GPs (+0.7 medicines; 95% CI, 0.4-1.1 medicines; adjusted rate ratio, 2.42; 95% CI, 1.59-3.70). The odds of being dispensed antipsychotics (adjusted odds ratio [aOR], 1.59; 95% CI, 1.18-2.12) or benzodiazepines (aOR, 1.69; 95% CI, 1.25-2.30), but not antidepressants (aOR, 1.32; 95% CI, 0.98-1.77), were also higher for the new GP group. Differences between the known and usual GP groups were not statistically significant. CONCLUSIONS Increases in medicine use and rates of psychotropic dispensing were higher for people with dementia who changed GP when they entered residential care. Facilitating continuity of GP care for new residents and more structured transfer of GP care may prevent potentially inappropriate initiation of psychotropic medicines.
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Affiliation(s)
- Heidi J Welberry
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
| | - Andrea L Schaffer
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
| | - Sebastiano Barbieri
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
| | - Benjumin Hsu
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
| | - Mark F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW
| | - John Hall
- University of New South Wales, Sydney, NSW
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, University of New South Wales, Sydney, NSW.,Centre for Healthy Brain Ageing, University of New South Wales, Sydney, NSW
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Abstract
The increasing survival rate after discharge from the intensive care unit (ICU) has revealed long-term impairments in the cognitive, psychiatric, and physical domains among survivors. However, clinicians often fail to recognize this post-ICU syndrome (PICS) and its debilitating effects on family members (PICS-F). This study describes two cases of PICS to illustrate the different impairments that may occur in ICU survivors. The PICS risk factors for each domain and the interactions among risk factors are also described. In terms of diagnostic evaluation, limited evidence-based or validated tools are available to assist with screening for PICS. Clinicians should be aware to monitor for its symptoms on the basis of cognitive, psychiatric, and physical domains. The Montreal Cognitive Assessment is recommended to screen for cognition, as it has a high sensitivity and can evaluate executive function. Mood disorders should also be screened. For mobile patients, a 6-minute walk test should be performed. PICS can be prevented by applying the ABCDEF bundle ABCDEF bundle in ICU described in this paper. Finally, the family members of patients in the ICU should be involved in patient care and a tactful communication approach is required to reduce the risk of PICS-F.
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Affiliation(s)
- Muhammad Hanif Ahmad
- Geriatrics and Palliative Unit, Department of Internal Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Brunei Darussalam
| | - Shyh Poh Teo
- Geriatrics and Palliative Unit, Department of Internal Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Brunei Darussalam
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47
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Engel M, Stoppelenburg A, van der Ark A, Bols FM, Bruggeman J, Janssens-van Vliet ECJ, Kleingeld-van der Windt JH, Pladdet IE, To-Baert AEMJ, van Zuylen L, van der Heide A. Development and implementation of a transmural palliative care consultation service: a multiple case study in the Netherlands. BMC Palliat Care 2021; 20:81. [PMID: 34090394 PMCID: PMC8180007 DOI: 10.1186/s12904-021-00767-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background In the Netherlands, healthcare professionals attending patients in the last phase of life, can consult an expert palliative care team (PCT) in case of complex problems. There are two types of PCTs: regional PCTs, which are mainly consulted by general practitioners, and hospital PCTs, which are mainly consulted by healthcare professionals in the hospital. Integration of these PCTs is expected to facilitate continuity of care for patients receiving care in different settings. We studied facilitators and barriers in the process of developing and implementing an integrated transmural palliative care consultation service. Methods A multiple case study was performed in four palliative care networks in the southwest Netherlands. We aimed to develop an integrated transmural palliative care consultation service. Researchers were closely observing the process and participated in project team meetings. A within-case analysis was conducted for each network, using the Consolidated Framework for Implementation Research (CFIR). Subsequently, all findings were pooled. Results In each network, project team members thought that the core goal of a transmural consultation service is improvement of continuity of palliative care for patients throughout their illness trajectory. It was nevertheless a challenge for hospital and non-hospital healthcare professionals to arrive at a shared view on goals, activities and working procedures of the transmural consultation service. All project teams experienced the lack of evidence-based guidance on how to organise the service as a barrier. The role of the management of the involved care organisations was sometimes perceived as unsupportive, and different financial reimbursement systems for hospital and out-of-hospital care made implementation of a transmural consultation service complex. Three networks managed to develop and implement a transmural service at some level, one network did not manage to do so. Conclusions Healthcare professionals are motivated to collaborate in a transmural palliative care consultation service, because they believe it can contribute to high-quality palliative care. However, they need more shared views on goals and activities of a transmural consultation service, more guidance on organisational issues and appropriate financing. Further research is needed to provide evidence on benefits and costs of different models of integrated transmural palliative care consultation services.
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Affiliation(s)
- Marijanne Engel
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Arianne Stoppelenburg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Center of Expertise in Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrée van der Ark
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Floor M Bols
- Department of Palliative Care, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | | | | | | | | | | | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Kowalkowski M, Eaton T, McWilliams A, Tapp H, Rios A, Murphy S, Burns R, Gutnik B, O'Hare K, McCurdy L, Dulin M, Blanchette C, Chou SH, Halpern S, Angus DC, Taylor SP. Protocol for a two-arm pragmatic stepped-wedge hybrid effectiveness-implementation trial evaluating Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship (ENCOMPASS). BMC Health Serv Res 2021; 21:544. [PMID: 34078374 PMCID: PMC8170654 DOI: 10.1186/s12913-021-06521-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Sepsis survivors experience high morbidity and mortality, and healthcare systems lack effective strategies to address patient needs after hospital discharge. The Sepsis Transition and Recovery (STAR) program is a navigator-led, telehealth-based multicomponent strategy to provide proactive care coordination and monitoring of high-risk patients using evidence-driven, post-sepsis care tasks. The purpose of this study is to evaluate the effectiveness of STAR to improve outcomes for sepsis patients and to examine contextual factors that influence STAR implementation. METHODS This study uses a hybrid type I effectiveness-implementation design to concurrently test clinical effectiveness and gather implementation data. The effectiveness evaluation is a two-arm, pragmatic, stepped-wedge cluster randomized controlled trial at eight hospitals in North Carolina comparing clinical outcomes between sepsis survivors who receive Usual Care versus care delivered through STAR. Each hospital begins in a Usual Care control phase and transitions to STAR in a randomly assigned sequence (one every 4 months). During months that a hospital is allocated to Usual Care, all eligible patients will receive usual care. Once a hospital transitions to STAR, all eligible patients will receive STAR during their hospitalization and extending through 90 days from discharge. STAR includes centrally located nurse navigators using telephonic counseling and electronic health record-based support to facilitate best-practice post-sepsis care strategies including post-discharge review of medications, evaluation for new impairments or symptoms, monitoring existing comorbidities, and palliative care referral when appropriate. Adults admitted with suspected sepsis, defined by clinical criteria for infection and organ failure, are included. Planned enrollment is 4032 patients during a 36-month period. The primary effectiveness outcome is the composite of all-cause hospital readmission or mortality within 90 days of discharge. A mixed-methods implementation evaluation will be conducted before, during, and after STAR implementation. DISCUSSION This pragmatic evaluation will test the effectiveness of STAR to reduce combined hospital readmissions and mortality, while identifying key implementation factors. Results will provide practical information to advance understanding of how to integrate post-sepsis management across care settings and facilitate implementation, dissemination, and sustained utilization of best-practice post-sepsis management strategies in other heterogeneous healthcare delivery systems. TRIAL REGISTRATION NCT04495946 . Submitted July 7, 2020; Posted August 3, 2020.
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Affiliation(s)
- Marc Kowalkowski
- Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA.
| | - Tara Eaton
- Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA
| | - Andrew McWilliams
- Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA.,Department of Internal Medicine, Atrium Health, Charlotte, USA
| | - Hazel Tapp
- Department of Family Medicine, Atrium Health, Charlotte, USA
| | - Aleta Rios
- Ambulatory Care Management, Atrium Health, Charlotte, USA
| | | | - Ryan Burns
- Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA
| | - Bella Gutnik
- Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA
| | | | - Lewis McCurdy
- Division of Infectious Disease, Department of Internal Medicine, Atrium Health, Charlotte, USA
| | - Michael Dulin
- Academy for Population Health Innovation, University of North Carolina Charlotte & Mecklenburg County Public Health Department, Charlotte, USA.,Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, USA
| | - Christopher Blanchette
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, USA.,Health Economics and Outcomes Research Strategy, Novo Nordisk, Plainsboro Township, USA
| | - Shih-Hsiung Chou
- Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28203, USA
| | - Scott Halpern
- Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Derek C Angus
- Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, University of Pittsburgh, Pittsburgh, USA.,Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, USA
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de Moel-Mandel C, Sundararajan V. The impact of practice size and ownership on general practice care in Australia. Med J Aust 2021; 214:408-410.e1. [PMID: 33966270 DOI: 10.5694/mja2.51038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022]
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50
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Rousselot N, Joseph JP, Noïze P, Berdaï D, Fourrier-Réglat A, Bosco-Levy P. Ambulatory drug changes in the elderly after hospital discharge: A cohort study. Therapie 2021:S0040-5957(21)00112-8. [PMID: 34045080 DOI: 10.1016/j.therap.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/15/2021] [Accepted: 04/29/2021] [Indexed: 11/20/2022]
Abstract
AIM To describe the ambulatory changes in drug prescriptions 3 months after hospital discharge among elderly patients aged 75 and over, and to identify the reasons for these changes. METHODS A prospective cohort study was conducted on subjects, discharged between 09/2016 and 01/2017 from the Bordeaux University Hospital. Prescription forms were collected from patients' pharmacists. The main outcome was the occurrence of at least one significant change (SC) defined as an initiation, a discontinuation, a switch or change in drug daily dosage as regards the drugs prescribed upon hospital discharge and those prescribed 3 months after. Whenever drug SC occurred, general practitioners were requested to elicit reasons for such changes. RESULTS Among the 126 patients included in our study, 73 underwent a 3-month follow-up period, without death or being re-hospitalised. 87.7% of them had at least one SC 3 months after discharge, with an average of 3.1±2.5 SC per patient. Main changes involved: discontinuation or dose decrease of anxiolytics, hypnotics, antalgics, betablockers and calcium channel blockers; start or dose increase of diuretics, ACE inhibitors and angiotensin receptor blockers. In patients with a 3-month follow-up period, 27.4% underwent at least one ADR-induced SC. CONCLUSION Most elderly patients experience drug prescription changes after discharge. Some, according to drug iatrogenic, could be avoided through better cooperation between hospital and ambulatory prescribers.
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