RESUMO
AIM: To assess the acceptability for GPS to use the French shared Electronic Health Record (Dossier Médical Partagé, "DMP") when caring for Homeless People (HP). METHODS: Mixed, sequential, qualitative-quantitative study. The qualitative phase consisted of semi-structured interviews with GPs involved in the care of HP. During the quantitative phase, questionnaires were sent to 150 randomized GPs providing routine healthcare in Marseille. Social and practical acceptability was studied by means of a Likert Scale. RESULTS: 19 GPs were interviewed during the qualitative phase, and 105 GPs answered the questionnaire during the quantitative phase (response rate: 73%). GPs had a poor knowledge about DMP. More than half (52.5%) of GPs were likely to effectively use DMP for HP. GPs felt that the "DMP" could improve continuity, quality, and security of care for HP. They perceived greater benefits of the use the DMP for HP than for the general population, notably in terms of saving time (p = 0.03). However, GPs felt that HP were vulnerable and wanted to protect their patients; they worried about security of data storage. GPs identified specific barriers for HP to use DMP: most of them concerned practical access for HP to DMP (lack of social security card, or lack of tool for accessing internet). CONCLUSION: A shared electronic health record, such as the French DMP, could improve continuity of care for HP in France. GPs need to be better informed, and DMP functions need to be optimized and adapted to HP, so that it can be effectively used by GPs for HP.
Assuntos
Registros Eletrônicos de Saúde , Serviços Hospitalares Compartilhados , Pessoas Mal Alojadas , Adulto , Idoso , Idoso de 80 Anos ou mais , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Análise Custo-Benefício , Registros Eletrônicos de Saúde/economia , Registros Eletrônicos de Saúde/organização & administração , Registros Eletrônicos de Saúde/normas , Feminino , Pessoas Mal Alojadas/estatística & dados numéricos , Serviços Hospitalares Compartilhados/economia , Serviços Hospitalares Compartilhados/organização & administração , Serviços Hospitalares Compartilhados/normas , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Acesso dos Pacientes aos Registros/normas , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Adulto JovemRESUMO
Acute myeloid leukemia (AML) is frequently treated with induction and consolidation chemotherapy. Consolidation chemotherapy can be delivered on an ambulatory basis, requiring some patients to travel long distances for treatment at specialized centers. We developed a shared care model where patients receive consolidation chemotherapy at a quaternary center, but post-consolidation supportive care at local hospitals. To evaluate the impact of our model on patient travel and outcomes we conducted a retrospective analysis of AML and acute promyelocytic leukemia patients receiving consolidation over four years at our quaternary center. 73 patients received post-consolidation care locally, and 344 at the quaternary center. Gender, age and cytogenetic risk did not significantly differ between groups. Shared care patients saved mean round trip distance of 146.5km±99.6 and time of 96.7min±63.4 compared to travelling to quaternary center. There was no significant difference in overall survival between groups, and no increased hazard of death for shared care patients. 30, 60, and 90day survival from start of consolidation was 98.6%, 97.2%, and 95.9% for shared care and 98.8%, 97.1%, and 95.3% for quaternary center patients. Thus, a model utilizing regional partnerships for AML post-consolidation care reduces travel burden while maintaining safety.
Assuntos
Centros Comunitários de Saúde , Quimioterapia de Consolidação/métodos , Serviços Hospitalares Compartilhados/normas , Leucemia Mieloide Aguda/terapia , Viagem , Centros Comunitários de Saúde/economia , Centros Comunitários de Saúde/estatística & dados numéricos , Quimioterapia de Consolidação/economia , Quimioterapia de Consolidação/mortalidade , Serviços Hospitalares Compartilhados/economia , Humanos , Leucemia Mieloide Aguda/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Viagem/economia , Resultado do TratamentoAssuntos
Serviços Hospitalares Compartilhados/economia , Serviços Hospitalares Compartilhados/organização & administração , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/organização & administração , Serviços Hospitalares Compartilhados/normas , Humanos , Injeções IntravenosasAssuntos
Eficiência Organizacional , Serviço Hospitalar de Nutrição/organização & administração , Serviços Hospitalares Compartilhados/organização & administração , Sistemas Multi-Institucionais/organização & administração , Redução de Custos , Manipulação de Alimentos/economia , Manipulação de Alimentos/métodos , Manipulação de Alimentos/normas , Serviço Hospitalar de Nutrição/economia , Serviço Hospitalar de Nutrição/normas , Serviços Hospitalares Compartilhados/economia , Serviços Hospitalares Compartilhados/normas , Mississippi , Sistemas Multi-Institucionais/economia , Ohio , Estados UnidosRESUMO
In the past, group purchasing organizations sought to sign up as many hospitals as possible. The purchasing power of these organizations is often quite impressive. However, unless these groups enhance market share for the manufacturers, they cannot expect significant price breaks. The quality, compliance, of the group is, therefore, as important as the membership numbers. The author details quality assessment criteria for members of group purchasing organizations and recommends their review by both members and non-members alike. This assessment focusing on both internal and external factors will indicate the hospital's value to a purchasing group and, by extension, the material manager's benefit to the hospital.
Assuntos
Serviços Hospitalares Compartilhados/normas , Administração de Materiais no Hospital/organização & administração , Serviço Hospitalar de Compras/economia , Estados UnidosAssuntos
Serviços Contratados/normas , Administração Financeira/normas , Sistemas de Informação/organização & administração , Sistemas de Informação Administrativa/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Computadores , Comportamento do Consumidor , Coleta de Dados , Estudos de Avaliação como Assunto , Número de Leitos em Hospital , Serviços Hospitalares Compartilhados/normas , Estados UnidosRESUMO
Many hospitals are concerned about the loss of control which is associated with contracting for linen service. On the the hand, many laundries do not have the resources or experience to serve hospitals in a comprehensive and trouble-free manner. In many communities a joint venture, such as the one described here, can successfully combine the interests of the hospital and laundry communities without causing the hospitals to lose control of the service and without requiring the laundry operator to have detailed knowledge of hospital operations. As more hospitals opt for contract service, and if this service is to be provided at the lowest total cost, the hospitals and the laundries must come to grips with the problems surrounding the laundry-hospital interface. A joint venture, such as that described here, is one way to accomplish this.