Contributions of medical family therapy to the changing health care system

Medical family therapy is a form of professional practice that uses a biopsychosocial approach and systemic family therapy principles in the collaborative treatment of individuals and families dealing with medical problems. It emerged out of the experience of family therapists working in primary medical care settings in the 1980s and 1990s. This article describes how contemporary medical family therapy can contribute to a transformed health care system in four areas: the patient experience of health care, the health of the population, the containment of health care costs, and enhanced practice environments.

Evaluation of parental stress in neonatal intensive care unit in Iran: a national study

BACKGROUND

More attention is paid to the survival and treatment of the sick infant in the neonatal intensive care unit (NICU) and parental stress is not considered. The purpose of this study was to determine samples of the level of parental stress in the NICU.

METHOD

This study is a descriptive-analytical study in which Parental Stress and General Health were used in an analytical national survey in Iran. The research sample consists of 2456 parents of infants admitted to NICU. The sampling method was multi-stage random. We used 11- item parental stress questionnaire and 28-item general health questionnaire for the data collection.

RESULT

Baloch ethnicity with an average of 11.52 had the highest level of stress. The mean stress score of mothers was higher than fathers. The mean score of all dimensions of physical symptoms, anxiety, social functioning, depression, and total mental health score in mothers was higher than fathers. There was a statistically significant difference in the length of hospitalization in terms of different levels of parental stress scores (p < 0.002). Lack of decisive response to parents was one of the most stressful issues (8.1%).

CONCLUSION

Our result shows mothers' stress was higher than fathers. So that health policymakers should pay attention to stress risk factors to provide appropriate interventions according stress risk factors Future studies should design appropriate interventions to reduce parental stress, especially in high-risk mothers.

The Prevalence and Emergency Department Utilization of Patients Who Underwent Single and Double Inter-hospital Transfers in the Emergency Department: a Nationwide Population-based Study in Korea, 2016-2018

BACKGROUND

Inter-hospital transfer (IHT) for emergency department (ED) admission is a burden to high-level EDs. This study aimed to evaluate the prevalence and ED utilization patterns of patients who underwent single and double IHTs at high-level EDs in South Korea.

METHODS

This nationwide cross-sectional study analyzed data from the National Emergency Department Information System for the period of 2016-2018. All the patients who underwent IHT at Level I and II emergency centers during this time period were included. The patients were categorized into the single-transfer and double-transfer groups. The clinical characteristics and ED utilization patterns were compared between the two groups.

RESULTS

We found that 2.1% of the patients in the ED (n = 265,046) underwent IHTs; 18.1% of the pediatric patients (n = 3,556), and 24.2% of the adult patients (n = 59,498) underwent double transfers. Both pediatric (median, 141.0 vs. 208.0 minutes, P < 0.001) and adult (median, 189.0 vs. 308.0 minutes, P < 0.001) patients in the double-transfer group had longer duration of stay in the EDs. Patient's request was the reason for transfer in 41.9% of all IHTs (111,076 of 265,046). Unavailability of medical resources was the reason for transfer in 30.0% of the double transfers (18,920 of 64,054).

CONCLUSION

The incidence of double-transfer of patients is increasing. The main reasons for double transfers were patient's request and unavailability of medical resources at the first-transfer hospitals. Emergency physicians and policymakers should focus on lowering the number of preventable double transfers.

«Living with Rheumatoid Arthritis» in an Indigenous Qom Population in Argentina. A Qualitative Study

INTRODUCTION

Rheumatoid arthritis (RA) is a chronic disease which impacts patients' quality of life. The prevalence of RA in the qom population was 2.4% and represented an aggressive and disabling disease. The study goal was to describe the experience of the indigenous qom community individual suffering from RA, along with their experience with the local health care system in the city of Rosario, Santa Fe, Argentina.

METHODS

Qualitative Study using techniques of participant observation and semi-structured interviews; following a guideline developed by a multidisciplinary research group comprising anthropologists, rheumatologists, nurses, and psychologists. A triangulation strategy was implemented for the analysis.

RESULTS

A total of 33 interviews were conducted in 29 individuals with RA. The results showed a «normalization» of their symptoms and of their limitations in performing daily tasks. The individual relationships with the local health care system was complex and limited in several aspects (e.g. access to health care, continuity of treatment, complexity of medical care pathway and lack of cultural competence).

CONCLUSIONS

RA is a disease that has a negative impact on the daily lives of the qom people living in Rosario. Improving the relationship between this population and the local health care system as well as the implementation of multidisciplinary work should be priorities.

Vulnerable Strata to Non-Adherence and Overuse in Treatment for Patients with Cognitive Impairment

Background and purpose

Appropriate medication treatment could enable both cognitively impaired patients and caregivers to hold on their cognitive functioning and quality of life. Thus, medication management and the factors influencing how management for this condition is carried out must be identified. In this study we aimed to evaluate the frequency of medication nonadherence (MNA) or drug overuse for cognitive impairment (DOC) and to extract significant variables, including the demographic and social characteristics, vascular risk factors, and cognitive status, for the diagnosis of MNA and DOC in Korean patients.

Methods

We investigated patients aged over 50 years between March 2019 and June 2019 via the cognitive enHancement of patIents with acQuired cognitive impairment (HIQ) campaign. MNA was defined as a participant who was classified as having cognitive impairment but did not take any cognition-related drugs, whereas DOC was defined as a participant who had normal cognition but was taking cognition-related drugs.

Results

We included 10,767 patients. The MNA group consisted of 337 participants, whereas the DOC group comprised 1,107 participants. The factors that could differentiate the MNA group from the normal-behavior group were age, education, sex, and the total Korean version of Mini-Mental State Examination (K-MMSE) score. The factors that could differentiate the DOC group from the normal medication-behavior group were age, sex, residential distinction, experience of a dementia screening test, and the total K-MMSE score.

Conclusions

The underlying factors contributing to inadequate dementia-medication management must be understood, and intervention or support is needed to enable safe medication management.

«Living with rheumatoid arthritis» in an indigenous qom population in Argentina. A qualitative study

INTRODUCTION

Rheumatoid arthritis (RA) is a chronic disease which impacts patients' quality of life. The prevalence of RA in the qom population was 2.4% and represented an aggressive and disabling disease. The study goal was to describe the experience of the indigenous qom community individual suffering from RA, along with their experience with the local health care system in the city of Rosario, Santa Fe, Argentina.

METHODS

Qualitative Study using techniques of participant observation and semi-structured interviews; following a guideline developed by a multidisciplinary research group comprising anthropologists, rheumatologists, nurses, and psychologists. A triangulation strategy was implemented for the analysis.

RESULTS

A total of 33 interviews were conducted in 29 individuals with RA. The results showed a "normalization" of their symptoms and of their limitations in performing daily tasks. The individuals' relationship with the local health care system was complex and limited in several aspects (e.g. access to health care, continuity of treatment, complexity of medical care pathway and lack of cultural competence).

CONCLUSIONS

RA is a disease that has a negative impact on the daily lives of the qom people living in Rosario. Improving the relationship between this population and the local health care system as well as the implementation of multidisciplinary work should be priorities.

Implementation Initiatives to Improve Low Back Pain Care in Australia: A Scoping Review

OBJECTIVE

This scoping review aimed to comprehensively review strategies for implementation of low back pain (LBP) guidelines, policies, and models of care in the Australian health care system.

METHODS

A literature search was conducted in MEDLINE, EMBASE, CINAHL, Allied and Complementary Medicine Database, and Web of Science to identify studies that aimed to implement or integrate evidence-based interventions or practices to improve LBP care within Australian settings.

RESULTS

Twenty-five studies met the inclusion criteria. Most studies targeted primary care settings (n = 13). Other settings included tertiary care (n = 4), community (n = 4), and pharmacies (n = 3). One study targeted both primary and tertiary care settings (n = 1). Only 40% of the included studies reported an underpinning framework, model, or theory. The implementation strategies most frequently used were evaluative and iterative strategies (n = 14, 56%) and train and educate stakeholders (n = 13, 52%), followed by engage consumers (n = 6, 24%), develop stakeholder relationships (n = 4, 16%), change in infrastructure (n = 4, 16%), and support clinicians (n = 3, 12%). The most common implementation outcomes considered were acceptability (n = 11, 44%) and adoption (n = 10, 40%), followed by appropriateness (n = 7, 28%), cost (n = 3, 12%), feasibility (n = 1, 4%), and fidelity (n = 1, 4%). Barriers included time constraints, funding, and teamwork availability. Facilitators included funding and collaboration between stakeholders.

CONCLUSIONS

Implementation research targeting LBP appears to be a young field, mostly focusing on training and educating stakeholders in primary care. Outcomes on sustainability and penetration of evidence-based interventions are lacking. There is a need for implementation research guided by established frameworks that consider interrelationships between organizational and system contexts beyond the clinician-patient dyad.

Stop Discussing New Medical Specialty Boards

The Korean society is rapidly aging and the health care needs for aged people are increasing. In this context, some physicians claim to establish new medical specialty board (MSB) for geriatric medical experts but also MSB for primary medical care specialists, clinical pharmacologists, and public health experts. In Korea, basic concept for the specialty board system is still under debates and the legal support for the system is poor. At present, doctors with MSBs in private sectors supply 92.4% of primary medical care but the National Health Care System requires more primary care physicians than specialists in Korea. Therefore, the government must invest in the education of doctors more to improve the public health care system. The proposal of the new MSB for geriatric medicine must be gradually developed according to the national long-term health plan, social needs, and national budget for the public benefit. Please stop discussing unprepared new MSBs.