RESUMO
PURPOSE: To identify elements of timely integration of palliative care (PC) into hospital oncology care from best practices. Thereafter, to assess the level of consensus among oncology and PC specialists and patient and relative representatives on the characteristics of timely integration of PC. METHODS: A three-round modified Delphi study was conducted. The expert panel consisted of 83 healthcare professionals (HCPs) from 21 Dutch hospitals (43 physicians, 40 nurses), 6 patient and 2 relative representatives. In the first round, four elements of integrated PC were considered: (1) identification of potential PC needs, (2) advance care planning (ACP), (3) routine symptom monitoring and (4) involvement of the specialist palliative care team (SPCT). In subsequent rounds, the panellists assessed which characteristics were triggers for initiating an element. A priori consensus was set at ≥ 70%. RESULTS: A total of 71 (78%) panellists completed the first questionnaire, 65 (71%) the second and 49 (54%) the third. Panellists agreed that all patients with incurable cancer should have their PC needs assessed (97%), symptoms monitored (91%) and ACP initiated (86%). The SPCT should be involved at the patient's request (86%) or when patients suffer from increased symptom burden on multiple dimensions (76%). Patients with a life expectancy of less than 3 months should be offered a consultation (71%). CONCLUSION: The expert panel agreed that timely integration of PC into oncology is important for all patients with incurable cancer, using early identification, ACP and routine symptom monitoring. Involvement of the SPCT is particularly needed in patients with multidimensional symptom burden and in those nearing death.
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Técnica Delphi , Neoplasias , Cuidados Paliativos , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Neoplasias/terapia , Masculino , Países Baixos , Feminino , Pessoa de Meia-Idade , Inquéritos e Questionários , Planejamento Antecipado de Cuidados/organização & administração , Adulto , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/métodos , Consenso , Fatores de Tempo , Equipe de Assistência ao Paciente/organização & administraçãoRESUMO
Perinatal mental illness is an important public health issue, with one in five birthing persons experiencing clinically significant symptoms of anxiety and/or depression during pregnancy or the postpartum period. The purpose of this study was to develop a consensus-based model of integrated perinatal mental health care to enhance service delivery and improve parent and family outcomes. We conducted a three-round Delphi study using online surveys to reach consensus (≥75% agreement) on key domains and indicators of integrated perinatal mental health care. We invited modifications to indicators and domains during each round and shared a summary of results with participants following rounds one and two. Descriptive statistics were generated for quantitative data and a thematic analysis of qualitative data was undertaken. Study participants included professional experts in perinatal mental health (e.g., clinicians, researchers) (n = 36) and people with lived experience of perinatal mental illness within the past 5 years from across Canada (e.g., patients, family members) (n = 11). Consensus was reached and all nine domains of the proposed model for integrated perinatal mental health care were retained. Qualitative results informed the modification of indicators and development of an additional domain and indicators capturing the need for antiracist, culturally safe care. The development of an integrated model of perinatal mental health benefitted from diverse expertise to guide the focus of included domains and indicators. Engaging in a consensus-building process helps to create the conditions for change within health services.
Assuntos
Consenso , Técnica Delphi , Saúde Mental , Assistência Perinatal , Humanos , Feminino , Gravidez , Prestação Integrada de Cuidados de Saúde/métodos , Serviços de Saúde Mental/organização & administração , Adulto , Canadá , Transtornos Mentais/terapiaRESUMO
OBJECTIVES: Many associations have recently recommended early integration of oncology and palliative care for more standard cancer care and better quality of life. We aimed to create a questionnaire to assess the opinion of medical oncologists and nurses about the clinical impact of the integrated palliative care and oncology (PCO) program. METHODS: A novel semi-structured questionnaire called Impact of Early Integration of Palliative Care Oncology (IEI PCO) questionnaire was developed and tested for validity and reliability then distributed to the oncologists and nurses working in Kuwait Cancer Control Center. RESULTS: After the pilot stage, testing the final questionnaire for validity and reliability was done with satisfactory results. Finally, the complete questionnaires were 170 out of 256 (response rate 66.41%). More awareness about the available palliative care services and the new available PCO services (p-value < 0.001 for all). Most of the oncologists and nurses agreed with the currently available structure of PCO, appreciated the patients' discharge plan and continuity of care of palliative medicine, admitted less work burden, a better attitude, and higher satisfaction (p-value for all < 0.001) toward palliative care. Significant improvements in symptoms were appreciated by oncologists and nurses after the integration of palliative care (p-value for all < 0.001. Oncologists and nurses valued repeated honest communication, discussion of the goals of care, dealing more effectively with ending active treatment, and higher acceptance of patients and families of PC policy of transfer, and significant progress in the care of end-of-life symptoms (p-value for all < 0.001). CONCLUSIONS: The IEI PCO questionnaire demonstrated the psychometric criteria for content, face, and construct validity and reliability. It provides a valuable tool to assess the impact of PCO integration. The opinion of medical oncologists and nurses was significantly positive toward the early integration of PCO in Kuwait in most aspects of care. This integration led to improved symptom control, end-of-life care, communication, and planned discharge and follow-up plans. Moreover, decreases the work burden, improves attitude, higher satisfaction of the oncology staff, and continuity of care.
Assuntos
Oncologistas , Cuidados Paliativos , Humanos , Inquéritos e Questionários , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Feminino , Masculino , Kuweit , Reprodutibilidade dos Testes , Adulto , Pessoa de Meia-Idade , Oncologistas/psicologia , Oncologistas/normas , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Psicometria/instrumentação , Psicometria/métodos , Oncologia/métodos , Oncologia/normas , Atitude do Pessoal de Saúde , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/normasRESUMO
This article extends the use of the ecocycle planning framework to describe challenges ahead for the integrated care and Collaborative Family Healthcare Association (CFHA). The authors make the case that to remain agile and adaptable, there are contextual, ecological, and moral challenges that integrated care and CFHA should keep in the forefront as they navigate the future of an inequitable health care system that is morphing at a rapid pace. These influences include but are not limited to challenges of social determinants of health, artificial intelligence, generational differences in technology among older and younger populations, the moral issue of poverty, challenges to retain an integrated care workforce, and rethinking development of evidence-based supported treatments for integrated care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Assuntos
Prestação Integrada de Cuidados de Saúde , Humanos , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/tendências , Determinantes Sociais da SaúdeAssuntos
COVID-19 , Prestação Integrada de Cuidados de Saúde , Infecções por HIV , Transmissão Vertical de Doenças Infecciosas , Assistência Perinatal , Complicações Infecciosas na Gravidez , SARS-CoV-2 , Humanos , Gravidez , Feminino , COVID-19/epidemiologia , COVID-19/prevenção & controle , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Assistência Perinatal/métodos , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/organização & administração , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Recém-NascidoRESUMO
BACKGROUND: Integrated care is essential for improving the management and health outcomes for people with Parkinson's disease (PD); reliable and objective measures of care integration are few. OBJECTIVE: The aim of this study was to test the psychometric properties of the Rainbow Model of Integrated Care Measurement Tool (RMIC-MT, provider version) for healthcare professionals involved in PD care. METHODS: A cross-sectional survey was administered online to an international network representing 95 neurology centers across 41 countries and 588 healthcare providers. Exploratory factor analysis with principal axis extraction method was used to assess construct validity. Confirmatory factor analysis was used to evaluate model fit of the RMIC-MT provider version. Cronbach's alpha was used to assess the internal consistency reliability. RESULTS: Overall, 371 care providers (62% response rate) participated in this study. No item had psychometric sensitivity problems. Nine factors (professional coordination, cultural competence, triple aims outcome, system coordination, clinical coordination, technical competence, community-centeredness, person-centeredness, and organizational coordination) with 42 items were determined by exploratory factor analysis. Cronbach's alpha ranged from 0.76 (clinical coordination) to 0.94 (system coordination) and showed significant correlation among all items in the scale (>0.4), indicating good internal consistency reliability. The confirmatory factor analysis model passed most goodness-of-fit tests, thereby confirming the factor structure of nine categories with a total of 40 items. CONCLUSIONS: The results provide evidence for the construct validity and other psychometric properties of the provider version of the RMIC-MT to measure integrated care in PD. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Assuntos
Prestação Integrada de Cuidados de Saúde , Doença de Parkinson , Humanos , Reprodutibilidade dos Testes , Doença de Parkinson/terapia , Estudos Transversais , Inquéritos e Questionários , Psicometria , Prestação Integrada de Cuidados de Saúde/métodosRESUMO
A transition of care is defined as a change in level of health care services, as patient care needs change from one location to another during acute or chronic illness. The location of services can vary from the hospital, skilled nursing facility, an outpatient setting, a primary care provider's office, or home health. Care coordination gaps can occur due to a lack of information exchange through the electronic health record, a lack of evidence-based standards, and poor communication among providers. Often, clinicians work with a silo mentality, resulting in poor health outcomes and negatively impacting the patient care experience. Patients with chronic kidney disease (CKD) are vulnerable to suboptimal integrated care coordination during transitions of care, as individuals seek treatment from diverse practitioners within multiple settings to meet their medical needs. This article discusses methods to improve integrated care, emphasizing the use of technology-based interventions to facilitate care transitions for patients with CKD.
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Prestação Integrada de Cuidados de Saúde , Insuficiência Renal Crônica , Humanos , Insuficiência Renal Crônica/terapia , Transferência de Pacientes , Registros Eletrônicos de Saúde , Prestação Integrada de Cuidados de Saúde/métodosRESUMO
OBJECTIVE: To evaluate the value of the person-centred, integrated care programme Care Chain Frail Elderly (CCFE) compared with usual care, using multicriteria decision analysis (MCDA). DESIGN: In a 12-month quasi-experimental study, triple-aim outcomes were measured at 0, 6 and 12 months by trained interviewers during home-visits. SETTING: Primary care, community-based elderly care. PARTICIPANTS: 384 community-dwelling frail elderly were enrolled. The 12-month completion rate was 70% in both groups. Propensity score matching was used to balance age, gender, marital status, living situation, education, smoking status and 3 month costs prior to baseline between the two groups. INTERVENTION: The CCFE is an integrated care programme with unique features like the presence of the elderly and informal caregiver at the multidisciplinary team meetings, and a bundled payment. PRIMARY AND SECONDARY OUTCOMES MEASURES: The MCDA results in weighted overall value scores that combines the performance on physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centredness, continuity of care and costs, with importance weights of patients, informal caregivers, professionals, payers and policy-makers. RESULTS: At 6 months, the overall value scores of CCFE were higher in all stakeholder groups, driven by enjoyment of life (standardised performance scores 0.729 vs 0.685) and person-centredness (0.749 vs 0.663). At 12 months, the overall value scores in both groups were similar from a patient's perspective, slightly higher for CCFE from an informal caregiver's and professional's perspective, and lower for CCFE from a payer's and policy-maker's perspective. The latter was driven by a worse performance on physical functioning (0.682 vs 0.731) and higher costs (22 816 vs 20 680). CONCLUSIONS: The MCDA indicated that the CCFE is the preferred way of delivering care to frail elderly at 6 months. However, at 12 months, MCDA results showed little difference from the perspective of patients, informal caregivers and professionals, while payers and policy-makers seemed to prefer usual care.
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Prestação Integrada de Cuidados de Saúde , Idoso Fragilizado , Idoso , Cuidadores/psicologia , Técnicas de Apoio para a Decisão , Prestação Integrada de Cuidados de Saúde/métodos , Idoso Fragilizado/psicologia , Humanos , Vida IndependenteRESUMO
There is a need for an effective and efficient way to incorporate and establish evidence-based interventions in daily healthcare. Dissemination and implementation (D&I) research seeks to obtain generalized knowledge to promote that. Implementation science methodologies can be used to scientifically analyze and generalize the themes previously consid-ered as D&I activities. In this article, the author introduces D&I research, and describes its current status and future perspective in Japan. The promotion of community-based integrated care can help explore the opportunities for pharmacists to play an active role in D&I research, and conduct research using implementation science methodologies to improve the quality of healthcare.
Assuntos
Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/tendências , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/tendências , Ciência da Implementação , Melhoria de Qualidade , Qualidade da Assistência à Saúde , Pesquisa , Promoção da Saúde , Humanos , Japão , Farmacêuticos , Papel ProfissionalRESUMO
BACKGROUND: Lower limb disorders including lymphoedema create a huge burden for affected persons in their physical and mental health, as well as socioeconomic and psychosocial consequences for them, their families and communities. As routine health services for the integrated management and prevention of lower limb disorders are still lacking, the 'Excellence in Disability Prevention Integrated across Neglected Tropical Diseases' (EnDPoINT) study was implemented to assess the development and delivery of an integrated package of holistic care-including physical health, mental health and psychosocial care-within routine health services for persons with lower limb disorders caused by podoconiosis, lymphatic filariasis and leprosy. METHODOLOGY/PRINCIPAL FINDINGS: This study was part of the first of three phases within EnDPoINT, involving the development of the integrated care package. Focus group discussions and key informant interviews were undertaken with 34 participants between January-February 2019 in Awi zone, Ethiopia, in order to assess the draft care package's feasibility, acceptability and appropriateness. Persons affected by lower limb disorders such as lymphoedema experience stigma, exclusion from families, communities and work as well as physical and financial hardship. Beliefs in disease causation inhibit affected persons from accessing care. Ignorance was a barrier for health care providers as well as affected persons. Training and education of affected persons, communities and caregivers is important in improving care access. It also requires time, space, materials and financial resources. Both top-down and grass roots input into service development are key, as well as collaboration across stakeholders including charities, community leaders and "expert patients". CONCLUSIONS/SIGNIFICANCE: This study highlighted the need for the EnDPoINT integrated care package and provided suggestions for solutions according to its three aspects of integrated care (integration into routine care; integration of mental health and psychosocial care; and integration of care across the three diseases), thereby giving support for its feasibility, acceptability and appropriateness.
Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Filariose Linfática/epidemiologia , Elefantíase/epidemiologia , Hanseníase/epidemiologia , Linfedema/psicologia , Adulto , Elefantíase/psicologia , Elefantíase/terapia , Filariose Linfática/psicologia , Filariose Linfática/terapia , Etiópia/epidemiologia , Feminino , Grupos Focais , Serviços de Saúde , Saúde Holística , Humanos , Hanseníase/psicologia , Hanseníase/terapia , Extremidade Inferior/patologia , Linfedema/epidemiologia , Linfedema/terapia , Masculino , Pessoa de Meia-Idade , Reabilitação Psiquiátrica , Estigma Social , Adulto JovemRESUMO
BACKGROUND: Information about telehealth versus in-office visits and how patient experience before compared to during the COVID-19 pandemic is important for healthcare planning. OBJECTIVE: To compare patient experience by visit type and before and during the pandemic. DESIGN: Survey of patients assessing ambulatory care before and during the pandemic. PARTICIPANTS: A total of 58,500 adult patients (13,928 primary care and 44,581 specialty physician visits) at a large integrated health system with 197 clinics on the west coast of the United States. The majority were female (59%), 55 or older (65%), and non-Hispanic White (55%), and had an in-office visit (87%) while 10% had a tele-video and 3% a phone visit. MAIN MEASURES: Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey 3.0 doctor communication, care coordination, access, and office staff composites; an overall rating of the doctor; and whether the patient would recommend the doctor to family and friends. KEY RESULTS: Patient experience with telehealth visits was as positive as or more positive than that with traditional office-based visits. Doctor communication on tele-video visits was viewed as slightly more positive than that of in-office or phone visits. Tele-video visits were also slightly more positive than in-office visits for care coordination, overall rating of the doctor, and willingness to recommend to family and friends. Office staff were viewed less positively on the phone than tele-video or in-office visits. Patient experience was similar before and during the COVID-19 pandemic (e.g., on a 0-100 possible range with a higher score being better, doctor communication was 94.4 before and 94.9 during). CONCLUSIONS: The positive experiences with telehealth, especially tele-video, may be due to patient appreciation of efforts made to maintain access, the focused nature of telehealth visits, and help by staff for navigation technical issues. Lessons learned about delivering responsive telehealth care can be used to ensure high-quality care after the pandemic.
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COVID-19 , Prestação Integrada de Cuidados de Saúde , Satisfação do Paciente , Telemedicina , Adulto , COVID-19/epidemiologia , Prestação Integrada de Cuidados de Saúde/métodos , Feminino , Humanos , Masculino , Pandemias , Avaliação de Resultados da Assistência ao Paciente , Satisfação do Paciente/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
Behavioral health providers (BHPs) have long been incorporated into clinical medical settings, however, they have yet to be included in inpatient hospital settings. Inclusion of BHPs in this setting is logical given the high rates of psychosocial problems experienced by hospitalized patients and because BHPs can effectively treat psychosocial challenges, including mental health disorders and behavioral health difficulties. We worked to determine the feasibility of incorporating BHPs onto the inpatient medical team and to discover if integrating BHPs onto the team could decrease the barriers present in standard consult-liaison models of care. Researchers collected information on patient and provider satisfaction with BHP services and tracked admission diagnosis, reasons for referral, and interventions delivered. Results indicated that the integration of BHPs onto the inpatient team is feasible and reduces numerous barriers. The incorporation of BHPs onto inpatient medical teams can mitigate barriers experienced within the current consult-liaison model.
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Prestação Integrada de Cuidados de Saúde , Transtornos Mentais , Humanos , Prestação Integrada de Cuidados de Saúde/métodos , Estudos de Viabilidade , Pacientes Internados , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapiaRESUMO
The purpose of this study was to examine patient and provider experiences of integrated behavioral health care at a Federally Qualified Health Center (FQHC). Using a mixed methodology design, both patients (n = 186) and providers (n = 17) completed a survey regarding satisfaction with care and the extent of integration at the clinic, as well as attended a focus group or interview (n = 11 patients; n = 12 providers) regarding their satisfaction and experiences. Both patients and providers found integration to be acceptable and satisfactory and the integration of services among different health care providers occurred fairly regularly. Themes from the provider and patient interviews/focus groups highlighted both positive aspects of the integration and specific challenges within the clinic. This more nuanced perspective of integration both replicates and extends upon previous research regarding satisfaction with integrated care and emphasizes the complexities and challenges of integration within community health clinics.
Assuntos
Prestação Integrada de Cuidados de Saúde , Atenção Primária à Saúde , Instituições de Assistência Ambulatorial , Prestação Integrada de Cuidados de Saúde/métodos , Pessoal de Saúde , Humanos , Saúde PúblicaRESUMO
BACKGROUND: The 2016 National Academies of Science, Engineering and Medicine call for a national integrated, military-civilian trauma action plan to achieve zero preventable deaths and disability after injury included a proposal to establish a National Trauma Research Action Plan to "strengthen trauma research and ensure that the resources available for this research are commensurate with the importance of injury and the potential for improvement in patient outcomes." The Department of Defense funded the Coalition for National Trauma Research to generate a comprehensive research agenda spanning the continuum of trauma/burn care from prehospital to rehabilitation. The Burn/Reconstructive Surgery group represents one focus area for this research agenda development. METHODS: Experts in burn and reconstructive surgery research identified gaps in knowledge, generated research questions and prioritized questions using a consensus driven Delphi survey approach. Participants were identified using established Delphi recruitment guidelines to ensure heterogeneity and generalizability with military and civilian representatives. Literature reviews informed the panel. Panelists were encouraged to use a PICO format to generate research questions: Patient/Population; Intervention; Compare/Control; Outcome. Participants ranked the priority of each question on a nine-point Likert scale, which was categorized to represent low, medium, and high priority items. Consensus was defined based on ≥60% panelist agreement. RESULTS: Subject matter experts generated 949 research questions in 29 Burn & 26 Reconstruction topics. Five hundred ninety-seven questions reached consensus. Of these, 338 (57%) were high-priority, 180 (30%), medium-priority, and 78 (13%) low-priority questions. CONCLUSION: Many high-priority questions translate to complex wound management and outcomes. Panel recognition that significant gaps in knowledge exist in understanding functional outcomes after injury underscores the importance of long-term recovery metrics even when studying acute injury or interventions such as resuscitation or inhalation injury. Funding agencies and burn/reconstructive surgery researchers should consider these gaps when they prioritize future research. LEVEL OF EVIDENCE: Expert consensus, Level IV.
Assuntos
Queimaduras , Pesquisa sobre Serviços de Saúde , Procedimentos de Cirurgia Plástica , Pesquisa/organização & administração , Ferimentos e Lesões/terapia , Queimaduras/reabilitação , Queimaduras/terapia , Consenso , Prestação Integrada de Cuidados de Saúde/métodos , Técnica Delphi , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Humanos , Melhoria de Qualidade/organização & administração , Procedimentos de Cirurgia Plástica/métodos , Procedimentos de Cirurgia Plástica/reabilitação , Projetos de PesquisaRESUMO
BACKGROUND: Delays in cancer diagnosis have been associated with reduced survival, decreased quality of life after treatment, and suboptimal patient experience. The objective of the study was to explore the perspectives of a group of family physicians and other specialists regarding potentially avoidable delays in diagnosing cancer, and approaches that may help expedite the process. METHODS: We conducted a qualitative study using interviews with physicians practising in primary and outpatient care settings in Alberta between July and September 2019. We recruited family physicians and specialists who were in a position to discuss delays in cancer diagnosis by email via the Cancer Strategic Clinical Network and the Alberta Medical Association. We conducted semistructured interviews over the phone, and analyzed data using thematic analysis. RESULTS: Eleven family physicians and 22 other specialists (including 7 surgeons or surgical oncologists, 3 pathologists, 3 radiologists, 2 emergency physicians and 2 hematologists) participated in interviews; 22 were male (66.7%). We identified 4 main themes describing 9 factors contributing to potentially avoidable delays in diagnosis, namely the nature of primary care, initial presentation, investigation, and specialist advice and referral. We also identified 1 theme describing 3 suggestions for improvement, including system integration, standardized care pathways and a centralized advice, triage and referral support service for family physicians. INTERPRETATION: These findings suggest the need for enhanced support for family physicians, and better integration of primary and specialty care before cancer diagnosis. A multifaceted and coordinated approach to streamlining cancer diagnosis is required, with the goals of enhancing patient outcomes, reducing physician frustration and optimizing efficiency.
Assuntos
Procedimentos Clínicos/normas , Diagnóstico Tardio/prevenção & controle , Neoplasias , Médicos de Família/estatística & dados numéricos , Atenção Primária à Saúde , Especialização/estatística & dados numéricos , Triagem , Alberta/epidemiologia , Prestação Integrada de Cuidados de Saúde/métodos , Necessidades e Demandas de Serviços de Saúde , Humanos , Neoplasias/diagnóstico , Neoplasias/terapia , Papel do Médico , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Pesquisa Qualitativa , Melhoria de Qualidade , Encaminhamento e Consulta/organização & administração , Tempo para o Tratamento/normas , Triagem/organização & administração , Triagem/normasRESUMO
The present study aimed to assess the effectiveness and impact on treatment coverage of integrating severe acute malnutrition (SAM) treatment at the health hut level by community health workers (CHWs). This study was a non-randomized controlled trial, including two rural communes in the health district of Mayahi: Maïreyreye (control) and Guidan Amoumoune (intervention). The control group received outpatient treatment for uncomplicated SAM from health facilities (HFs), while the intervention group received outpatient treatment for uncomplicated SAM from HFs or CHWs. A total of 2789 children aged 6-59 months with SAM without medical complications were included in the study. The proportion of cured children was 72.1% in the control group, and 77.2% in the intervention group. Treatment coverage decreased by 8.3% in the control area, while the group of CHWs was able to mitigate that drop and even increase coverage by 3%. This decentralized treatment model of acute malnutrition with CHWs allowed an increase in treatment coverage while maintaining a good quality of care. It also allowed the early inclusion of children in less severe conditions. These results may enhance the Niger Ministry of Health to review the management of SAM protocol and allow CHWs to treat acute malnutrition.
Assuntos
Assistência Ambulatorial/métodos , Agentes Comunitários de Saúde , Prestação Integrada de Cuidados de Saúde/métodos , Atenção Primária à Saúde/métodos , Desnutrição Aguda Grave/terapia , Pré-Escolar , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Masculino , Níger , Avaliação de Resultados em Cuidados de Saúde , População Rural , Resultado do TratamentoRESUMO
OBJECTIVES: This retrospective study examined how a pharmacist-involved education program in a multidisciplinary team (PEMT) for oral mucositis (OM) affected head-and-neck cancer (HNC) patients receiving concurrent chemoradiotherapy (CCRT). MATERIALS AND METHODS: Total samples data of 53 patients during the stipulated timeframe were retrospectively collected from electronic medical records from February 2017 to January 2019. We compared the presence/absence of OM (OM: yes/no) between patients with and without PEMT (PEMT: yes/no) as the primary endpoint and OM severity as the secondary endpoint. The following information was surveyed: age, gender, weight loss, steroid or immunosuppressant use, hematological values (albumin, white blood cell count, blood platelets, and neutrophils), cancer grade, primary cancer site, type and use of mouthwash and moisturizer, opioid use (yes/no, days until the start of opioid use, and dose, switch to tape), and length of hospital day (LOD). The two groups were compared using Fisher's exact test for qualitative data and the Mann-Whitney U test for quantitative data, and a significance level of p<0.05 was set. RESULTS: The group managed by PEMT had significantly lower weight loss and a significantly lower incidence of local anesthetic and opioid use and switch to tape compared with the group not managed by PEMT (p<0.05). The two groups showed no significant difference in OM (yes/no) or OM severity. The PEMT group had significantly shorter LOD at 57 (53-64) days compared with the non-PEMT group at 63.5 (57-68) days (p<0.05). CONCLUSIONS: Our results showed that PEMT did not improve OM (yes/no) or OM severity in HNC patients undergoing CCRT. However, the PEMT group had a lower incidence of grades 3 and 4 OM than the non-PEMT group, although not significantly. In addition, PEMT contributed to oral pain relief and the lowering of the risk for OM by reduction in weight loss.
Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Equipe de Assistência ao Paciente/tendências , Estomatite/terapia , Adulto , Anestesia Local , Quimiorradioterapia , Prestação Integrada de Cuidados de Saúde/tendências , Diagnóstico Bucal , Feminino , Neoplasias de Cabeça e Pescoço/complicações , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/estatística & dados numéricos , Farmacêuticos , Estudos Retrospectivos , Estomatite/metabolismo , Redução de PesoAssuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Transtornos Relacionados ao Uso de Álcool/terapia , Hospitalização/estatística & dados numéricos , Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Austrália/epidemiologia , Efeitos Psicossociais da Doença , Prestação Integrada de Cuidados de Saúde/métodos , Tratamento Farmacológico/métodos , Guias como Assunto , Hospitalização/tendências , Humanos , Atenção Primária à Saúde/normas , Intervenção Psicossocial/métodos , Sistemas de Apoio Psicossocial , Estigma SocialRESUMO
BACKGROUND: The multidimensional and complex care needs of patients with idiopathic pulmonary fibrosis (IPF) call for appropriate care models. This systematic review aimed to identify care models or components thereof that have been developed for patients with IPF in the outpatient clinical care, to describe their characteristics from the perspective of chronic integrated care and to describe their outcomes. METHODS: A systematic review was conducted using state-of-the-art methodology with searches in PubMed/Medline, Embase, CINAHL and Web Of Science. Researchers independently selected studies and collected data, which were described according to the Chronic Care Model (CCM). RESULTS: Eighteen articles were included describing 13 new care models or components. The most commonly described CCM elements were 'delivery system design' (77%) and 'self-management support' (69%), with emphasis on team-based and multidisciplinary care provision and education. The most frequently described outcome was health-related quality of life. CONCLUSIONS: Given the high need for integrated care and the scarcity and heterogeneity of data, developing, evaluating and implementing new models of care for patients with IPF and the comprehensive reporting of these endeavours should be a priority for research and clinical care.