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1.
J Ment Health Policy Econ ; 20(4): 167-175, 2017 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-29300703

RESUMEN

BACKGROUND: Treating youth with serious emotional disturbances (SED) is expensive often requiring institutional care. A significant amount of recent federal and state funding has been dedicated to expanding home and community-based services for these youth as an alternative to institutional care. High Fidelity Wraparound (Wrap) is an evolving, evidence-informed practice to help sustain community-based placements for youth with an SED through the use of intensive, customized care coordination among parents, multiple child-serving agencies, and providers. While there is growing evidence on the benefits of Wrap, few studies have examined health care spending associated with Wrap participation and none have examined spending patterns after the completion of Wrap. Merging health care spending data from multiple agencies and programs allows for a more complete picture of the health care costs of treating these youth in a system-of-care framework. AIMS OF STUDY: (i) To compare overall health care spending for youth who transitioned from institutional care into Wrap (the treatment group) versus youth not receiving Wrap (the control group) and (ii) to compare changes in health care spending, overall and by category, for both groups before (the pre-period) and after (the post-period) Wrap participation. METHODS: The treatment group (N=161) is matched to the control group (N=324) temporally based on the month the youth entered institutional care. Both total health care spending and spending by category are compared for each group pre- and post-Wrap participation. The post-period includes the time in which the youth was receiving Wrap services and one year afterwards to capture long-term cost impacts. RESULTS: In the year before Wrap participation, the treatment group averaged USD 8,433 in monthly health care spending versus USD 4,599 for the control group. Wrap participation led to an additional reduction of USD 1,130 in monthly health care spending as compared to the control group in the post-period. For youth participating in Wrap, these spending reductions were the result of decreases in mental health inpatient spending and general outpatient spending. DISCUSSION: Youth participating in Wrap had much higher average monthly costs than youth in the control group for the year prior to entering Wrap, suggesting that the intervention targeted youth with the highest mental health utilization and likely more complex needs. While both groups experienced reductions in spending, the treatment group experienced larger absolute reductions, but smaller relative reductions associated with participation. These differences were driven mainly by reductions in mental health inpatient spending. Larger reductions in general outpatient spending for the treatment group suggest spillover benefits in terms of physical health care spending. Further analysis is needed to assess how these spending changes impacted health outcomes. IMPLICATIONS FOR HEALTH POLICIES: Wrap or similar programs may lead to reductions in health care spending. This is the first study to find evidence of longer-term spending reductions for up to a year after Wrap participation. IMPLICATIONS FOR FURTHER RESEARCH: Randomized trials or some other source of plausibly exogenous variation in Wrap participation is needed to further assess the causal impact of Wrap on health care spending, outcomes, or broader system-of-care spending.


Asunto(s)
Síntomas Afectivos/economía , Síntomas Afectivos/terapia , Servicios Comunitarios de Salud Mental/economía , Costos de la Atención en Salud/estadística & datos numéricos , Trastornos Mentales/economía , Trastornos Mentales/terapia , Adaptación Psicológica , Adolescente , Adulto , Síntomas Afectivos/psicología , Niño , Servicios Comunitarios de Salud Mental/métodos , Femenino , Humanos , Masculino , Trastornos Mentales/psicología , Índice de Severidad de la Enfermedad , Apoyo Social , Tiempo , Adulto Joven
2.
J Clin Nurs ; 26(1-2): 266-279, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27291299

RESUMEN

AIMS AND OBJECTIVES: The aim was to investigate structural empowerment in nurse leaders in middle management positions. Objectives were to determine levels of empowerment of nurse leaders and to compare levels of empowerment between nurse leader groups. BACKGROUND: Access to formal and informal power, opportunity, resources, information and support are determinants of structural empowerment. Empowerment of nurse leaders in middle management positions is vital given their roles in enabling nursing teams to deliver high-quality care, benefitting both patient and workforce outcomes. DESIGN: Quantitative component of a mixed methods study using survey principles. METHODS: The Conditions of Work Effectiveness Questionnaire II was distributed to the total population (n = 517) of nurse leaders in an NHS Foundation Trust in England. Nurse leader groups comprised unit leaders (sisters, matrons) and senior staff nurses. Quantitative data entered on spss v 17/18, were analysed using descriptive and inferential statistics. RESULTS: Overall, the unit response rate was 44·1% (n = 228). Levels of total and global empowerment were moderate and moderate to high respectively. Groups did not differ significantly on these parameters or on five elements of total empowerment, but significantly higher scores were found for unit leaders' access to information. Significantly higher scores were found for senior staff nurses on selected aspects of informal power and access to resources, but scores were significantly lower than unit leaders for components of support. CONCLUSIONS: A moderately empowered population of nurse leaders differed in relation to access to information, aspects of support, resources and informal power, reflecting differences in roles, spheres of responsibility, hierarchical position and the constraints on empowerment imposed on unit leaders by financial and resource pressures. RELEVANCE TO CLINICAL PRACTICE: Empowerment of nurse leaders in middle management is vital in enabling nursing teams to deliver high-quality care. Roles, spheres of responsibility, hierarchical position and constraints imposed by financial and resource pressures influence nurse leader empowerment. Administrative support is needed to sustain practice engagement.


Asunto(s)
Actitud del Personal de Salud , Enfermeras Administradoras/psicología , Poder Psicológico , Pautas de la Práctica en Enfermería , Adulto , Inglaterra , Femenino , Humanos , Masculino , Medicina Estatal , Encuestas y Cuestionarios
3.
Health Expect ; 19(4): 973-87, 2016 08.
Artículo en Inglés | MEDLINE | ID: mdl-26714263

RESUMEN

BACKGROUND: Continuity of care (COC) is central to the organization and delivery of mental health services. Traditional definitions have excluded service users, and this lack of involvement has been linked to poor conceptual clarity surrounding the term. Consequently, very little is known about the differences and similarities in the conceptualization of COC by mental health service users and professionals. OBJECTIVE: To explore and compare mental health service users' and professionals' definitions of COC. METHODS: Using an exploratory, qualitative design, five focus groups with 32 service users each met twice. Data were analysed thematically to generate a service user-defined model of COC. In a cross-sectional survey, health and social care professionals (n = 184) defined COC; responses were analysed thematically. Service user and professional definitions were conceptually mapped and compared to identify similarities and differences. RESULTS: There was crossover between the service user and professional derived models of COC. Both contained temporal, quality, systemic, staff, hospital and needs-related elements of COC. Service users prioritized access, information, peer support and avoiding services; health professionals most frequently referred to staff, cross-sectional and temporal COC. Service users alone identified service avoidance, peer support and day centres as COC elements; professionals alone identified cross-sectional working. CONCLUSIONS: Important similarities and differences exist in service user and professional conceptualizations of COC. Further research is necessary to explore these differences, prior to integrating service user and professional perspectives in a validated COC framework which could enable the development and evaluation of interventions to improve COC, informing policy and practice.


Asunto(s)
Continuidad de la Atención al Paciente/organización & administración , Servicios de Salud Mental/organización & administración , Estudios Transversales , Femenino , Grupos Focales , Humanos , Londres , Masculino , Persona de Mediana Edad , Investigación Cualitativa
4.
Int J Nurs Pract ; 21(5): 556-65, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25307531

RESUMEN

The purpose of this study was to evaluate grown-up congenital heart (GUCH) patients' experiences and satisfaction with the delivery of a nurse specialist service, including perceived priorities and recommendations for future service delivery. A service evaluation utilizing descriptive, cross-sectional survey principles was conducted over a 2 year period. Postal questionnaires were sent to three patient cohorts (general adult n = 747; pregnancy n = 202; learning disability n = 72). Quantitative data were analysed using descriptive statistics. The majority of respondents were satisfied with the nursing care provided, including information provision, time made available to discuss needs, emotional support, well-being, self-management and symptom distress. Priority areas included timely information and advice; specialist knowledge and expertise; effective care coordination, monitoring and support. Accessibility, contact and responsiveness were dominant. A majority of patients agreed that their first, second and third-rated priorities had been met. Findings identified strong commitment, support and satisfaction with the GUCH nurse specialist service.


Asunto(s)
Enfermería Cardiovascular , Cardiopatías Congénitas/enfermería , Cardiopatías Congénitas/psicología , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Adulto Joven
5.
Scand J Caring Sci ; 28(1): 193-203, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23240872

RESUMEN

BACKGROUND: Multidisciplinary inputs are of vital importance in the comprehensive care management and rehabilitation of individuals with long-term neurological conditions. Although many ordinal measures of disability correlate with patient dependency and care, few are based on numbers of different health professionals required, or their skill-mix, for assistance associated with levels of dependency. AIM AND OBJECTIVES: To develop an instrument to assess dependency in adult patients suffering from severe and complex neurological disability for use by multidisciplinary teams. Objectives were to establish content validity, construct validity, inter-rater reliability and internal consistency, and to demonstrate preliminary clinical utility from the perspective of professional staff. DESIGN AND METHODS: A mixed methods design utilised qualitative and quantitative approaches. Stage I involved developmental fieldwork using focus groups (n = 3), questionnaires (n = 70), expert panel (n = 20) and direct observation (n = 12). In stage 2, intensive refinement through direct observation, construct validity and reliability testing (n = 100) of the instrument was completed. The research complied with the research governance and ethical standards set by the Department of Health (UK). RESULTS: In the final format, an instrument was developed which comprised two sections. Section 1: an ordinal scaled basic care section, with 15 categories of dependency and level of descriptors based on numbers, grade and time taken by staff providing assistance. Factor analysis identified one dominant and four subsidiary factors which explained 67% of the total variance. Overall inter-rater agreement was 0.87 (kappa coefficient: range 0.67-1.0), and Cronbach's coefficient alpha was 0.733. Section 2: comprised a nominally measured specialist care section for inputs from nurses and therapists. The mean time taken to complete assessments was 12 minutes. CONCLUSION: The instrument satisfied preliminary selective criteria for validity and reliability. Further research is necessary to satisfy other requirements of psychometric testing and clinical utility.


Asunto(s)
Enfermedades del Sistema Nervioso/diagnóstico , Examen Físico , Adulto , Humanos , Enfermedades del Sistema Nervioso/fisiopatología , Reproducibilidad de los Resultados
6.
BMC Health Serv Res ; 13: 254, 2013 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-23822089

RESUMEN

BACKGROUND: Organizational culture is manifest in patterns of behaviour underpinned by beliefs, values, attitudes and assumptions, which can influence working practices. Cultural factors and working practices have been suggested to influence the transition of young people moving from child to adult mental health services. Failure to manage and integrate transitional care effectively can lead to young people losing contact with health and social care systems, resulting in adverse effects on health, well-being and potential. METHODS: The study aim was to identify the organisational factors which facilitate or impede transition of young people from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) from the perspective of health professionals and representatives of voluntary organisations. Specific objectives were (i) to explore organizational cultures, structures, processes and resources which influence transition from child to adult mental health services; (ii) identify factors which constitute barriers and facilitators to transition and continuity of care and (iii) make recommendations for service improvements. Within an exploratory, qualitative design thirty four semi-structured interviews were conducted with health and social care professionals working in CAMHS and AMHS in four NHS Mental Health Trusts and four voluntary organizations, in England. RESULTS: A cultural divide appears to exist between CAMHS and AMHS, characterized by different beliefs, attitudes, mutual misperceptions and a lack of understanding of different service structures. This is exacerbated by working practices relating to communication and information transfer which could impact negatively on transition, relational, informational and cross boundary continuity of care. There is also evidence of a cultural shift, with some positive approaches to collaborative working across services and agencies, involving joint posts, parallel working, shared clinics and joint meetings. CONCLUSIONS: Cultural factors embodied in mutual misperceptions, attitudes, beliefs exist between CAMHS and AMHS. Working practices can exert either positive or negative effects on transition and continuity of care. Implementation of shared education and training, standardised approaches to record keeping and information transfer, supported by compatible IT resources are recommended, alongside management strategies which evaluate the achievement of outcomes related to transition and continuity of care.


Asunto(s)
Servicios Comunitarios de Salud Mental , Conocimientos, Actitudes y Práctica en Salud , Cultura Organizacional , Relaciones Profesional-Paciente , Transición a la Atención de Adultos , Adolescente , Servicios de Salud del Adolescente/normas , Adulto , Niño , Servicios Comunitarios de Salud Mental/normas , Continuidad de la Atención al Paciente/normas , Personal de Salud , Humanos , Entrevistas como Asunto , Investigación Cualitativa , Medicina Estatal , Reino Unido , Agencias Voluntarias de Salud , Recursos Humanos
7.
J Nurs Manag ; 21(2): 206-16, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23410515

RESUMEN

AIM: This paper reports upon the development, delivery and evaluation of a leadership programme for aspiring Ward Leaders in one National Health Service Trust in England. BACKGROUND: The ward sister role is fundamental to quality patient care and clinical leadership, however the role is increasingly difficult to recruit to. A lack of formal preparation and skills development for the role has been widely acknowledged. METHOD: An evaluation of a programme of education for leadership. Three cohorts (n = 60) completed the programme. Semi-structured questionnaires were completed by participants (n = 36: 60%) at the conclusion of the programme. Qualitative data from questionnaires was analysed using a thematic approach. RESULTS: Participants reported increased political, organizational and self-awareness, increased confidence, feelings of empowerment and the ability to empower others. Opportunities for networking with peers were valued within the action learning approach. For some participants, career intentions were clarified through reflection. CONCLUSION: The majority of participants had benefited from the leadership programme and valued this development as an empowering preparation for future careers. IMPLICATIONS FOR NURSING MANAGEMENT: Investment in leadership preparation for future ward sister roles is strongly recommended as part of a strategy designed to enhance quality improvement, career path development, workforce empowerment and retention.


Asunto(s)
Liderazgo , Enfermeras Administradoras , Medicina Estatal/organización & administración , Humanos , Enfermeras Administradoras/organización & administración , Desarrollo de Programa , Calidad de la Atención de Salud , Medicina Estatal/normas , Reino Unido
8.
Eval Health Prof ; 46(4): 320-333, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37178060

RESUMEN

Implementation fidelity has been an important issue in the service provision and associated outcomes of Wraparound, an intensive, individualized care planning process that uses a team-based approach to integrate youth into the community to minimize the need for intensive, institutional services. In response to the growing need to monitor fidelity to the Wraparound process, a variety of instruments have been created and tested. In this study, the authors present the results of several analyses designed to better understand the measurement characteristics of the Wraparound Fidelity Index Short Form (WFI-EZ), a multi-informant fidelity instrument. The results from our analysis of 1027 WFI-EZ responses indicate that the internal consistency of the instrument is very good, although the negatively worded items did not appear to function as well as positively worded items. Results from two confirmatory factor analyses were unable to validate the original domains identified by the instrument developers, but for certain outcomes the WFI-EZ demonstrated deseriable predictive validity. Preliminary evidence is also provided that WFI-EZ responses likely differ by respondent type. We conclude by discussing the implications of using the WFI-EZ in programming, policy, and practice considering the findings of our study.


Asunto(s)
Servicios Comunitarios de Salud Mental , Implementación de Plan de Salud , Adolescente , Humanos , Servicios Comunitarios de Salud Mental/métodos
9.
J Law Med Ethics ; 51(4): 817-823, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-38477279

RESUMEN

The social ecological model (SEM) is a conceptual framework that recognizes individuals function within multiple interactive systems and contextual environments that influence their health. Medical Legal Partnerships (MLPs) address the social determinants of health through partnerships between health providers and civil legal services. This paper explores how the conceptual framework of SEM can be applied to the MLP model, which also uses a multidimensional approach to address an individual's social determinants of health.


Asunto(s)
Servicios Legales , Humanos
10.
BMC Health Serv Res ; 12: 203, 2012 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-22805234

RESUMEN

BACKGROUND: London has the largest proportion of tuberculosis (TB) cases of any western European capital, with almost half of new cases drug-resistant. Prevalence varies considerably between and within boroughs with research suggesting inadequate control of TB transmission in London. Economic pressures may exacerbate the already considerable challenges for service organisation and delivery within this context. This paper presents selected findings from an evaluation of London's TB services' organisation, delivery, professional workforce and skill mix, intended to support development of a strategic framework for a pan-London TB service. These may also interest health service professionals and managers in TB services in the UK, other European cities and countries and in services currently delivered by multiple providers operating independently. METHODS: Objectives were: 1) To establish how London's TB services are structured and delivered in relation to leadership, management, organisation and delivery, coordination, staffing and support; 2) To identify tools/models for calculating skill mix as a basis for identifying skill mix requirements in delivering TB services across London; 3) To inform a strategic framework for the delivery of a pan-London TB service, which may be applicable to other European cities. The multi-method service audit evaluation comprised documentary analysis, semi-structured interviews with TB service users (n = 10), lead TB health professionals and managers (n = 13) representing London's five sectors and focus groups with TB nurses (n = 8) and non-London network professionals (n = 2). RESULTS: Findings showed TB services to be mainly hospital-based, with fewer community-based services. Documentary analysis and professionals' interviews suggested difficulties with early access to services, low suspicion index amongst some GPs and restricted referral routes. Interviews indicated lack of managed accommodation for difficult to treat patients, professional workforce shortages, a need for strategic leadership, nurse-led clinics and structured career paths for TB nurses and few social care/outreach workers to support patients with complex needs. CONCLUSIONS: This paper has identified key issues relating to London's TB services' organisation, delivery, professional workforce and skill mix. The majority of these present challenges which need to be addressed as part of the future development of a strategic framework for a pan-London TB service. More consistent strategic planning/co-ordination and sharing of best practice is needed, together with a review of pan-London TB workforce development strategy, encompassing changing professional roles, skills development needs and patient pathways. These findings may be relevant with the development of TB services in other European cities.


Asunto(s)
Atención a la Salud/organización & administración , Planificación en Salud/organización & administración , Tuberculosis/prevención & control , Grupos Focales , Investigación sobre Servicios de Salud , Humanos , Entrevistas como Asunto , Londres/epidemiología , Auditoría Médica , Prevalencia , Competencia Profesional , Tuberculosis/epidemiología
11.
BMC Health Serv Res ; 12: 145, 2012 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-22682145

RESUMEN

BACKGROUND: Despite the importance of continuity of care [COC] in contemporary mental health service provision, COC lacks a clearly agreed definition. Furthermore, whilst there is broad agreement that definitions should include service users' experiences, little is known about this. This paper aims to explore a new construct of service user-defined COC and its relationship to a range of health and social outcomes. METHODS: In a cross sectional study design, 167 people who experience psychosis participated in structured interviews, including a service user-generated COC measure (CONTINU-UM) and health and social assessments. Constructs underlying CONTINU-UM were explored using factor analysis in order to understand service user-defined COC. The relationships between the total/factor CONTINU-UM scores and the health and social measures were then explored through linear regression and an examination of quartile results in order to assess whether service user-defined COC is related to outcome. RESULTS: Service user-defined COC is underpinned by three sub-constructs: preconditions, staff-related continuity and care contacts, although internal consistency of some sub-scales was low. High COC as assessed via CONTINU-UM, including preconditions and staff-related COC, was related to having needs met and better therapeutic alliances. Preconditions for COC were additionally related to symptoms and quality of life. COC was unrelated to empowerment and care contacts unrelated to outcomes. Service users who had experienced a hospital admission experienced higher levels of COC. A minority of service users with the poorest continuity of care also had high BPRS scores and poor quality of life. CONCLUSIONS: Service-user defined continuity of care is a measurable construct underpinned by three sub-constructs (preconditions, staff-related and care contacts). COC and its sub-constructs demonstrate a range of relationships with health and social measures. Clinicians have an important role to play in supporting service users to navigate the complexities of the mental health system. Having experienced a hospital admission does not necessarily disrupt the flow of care. Further research is needed to test whether increasing service user-defined COC can improve clinical outcomes. Using CONTINU-UM will allow researchers to assess service users' experiences of COC based on the elements that are important from their perspective.


Asunto(s)
Continuidad de la Atención al Paciente/normas , Trastornos Mentales/terapia , Servicios de Salud Mental , Adulto , Estudios Transversales , Análisis Factorial , Femenino , Grupos Focales , Necesidades y Demandas de Servicios de Salud , Humanos , Londres , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Investigación Cualitativa
12.
J Public Health Manag Pract ; 18(4): E1-3, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22635198

RESUMEN

Addressing the legal issues of patients of low socioeconomic status can be useful in increasing organizational reimbursements, reducing costs and improving access to care. Medical-legal partnership is an addition to the health care armamentarium that directly addresses this goal. A medical-legal partnership is an interdisciplinary collaboration between a medical entity such as a hospital or clinic and a legal entity such as a law school or legal aid society that addresses barriers to access to care and limitations to well-being experienced by patients of low socioeconomic status. The Health Law Partnership is one such medical legal partnership that provides a holistic, interdisciplinary approach to health care. An evaluation of the legal and educational services provided by Health Law Partnership showed that Health Law Partnership secured otherwise unreimbursed Medicaid payments for services over a 4-year period from 2006 to 2010, increased physician satisfaction, and saved hospital employers approximately $10 000 in continuing education costs annually.


Asunto(s)
Ahorro de Costo , Relaciones Interinstitucionales , Abogados , Grupo de Atención al Paciente/economía , Satisfacción Personal , Médicos/psicología , Niño , Preescolar , Educación Continua/economía , Salud de la Familia/economía , Salud de la Familia/legislación & jurisprudencia , Financiación Gubernamental/estadística & datos numéricos , Georgia , Humanos , Cobertura del Seguro/economía , Cobertura del Seguro/estadística & datos numéricos , Medicaid/economía , Indigencia Médica , Innovación Organizacional , Grupo de Atención al Paciente/organización & administración , Pediatría/legislación & jurisprudencia , Médicos/estadística & datos numéricos , Estudios Retrospectivos , Estados Unidos
13.
Br J Psychiatry ; 197(4): 305-12, 2010 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-20884954

RESUMEN

BACKGROUND: Many adolescents with mental health problems experience transition of care from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). AIMS: As part of the TRACK study we evaluated the process, outcomes and user and carer experience of transition from CAMHS to AMHS. METHOD: We identified a cohort of service users crossing the CAMHS/AMHS boundary over 1 year across six mental health trusts in England. We tracked their journey to determine predictors of optimal transition and conducted qualitative interviews with a subsample of users, their carers and clinicians on how transition was experienced. RESULTS: Of 154 individuals who crossed the transition boundary in 1 year, 90 were actual referrals (i.e. they made a transition to AMHS), and 64 were potential referrals (i.e. were either not referred to AMHS or not accepted by AMHS). Individuals with a history of severe mental illness, being on medication or having been admitted were more likely to make a transition than those with neurodevelopmental disorders, emotional/neurotic disorders and emerging personality disorder. Optimal transition, defined as adequate transition planning, good information transfer across teams, joint working between teams and continuity of care following transition, was experienced by less than 5% of those who made a transition. Following transition, most service users stayed engaged with AMHS and reported improvement in their mental health. CONCLUSIONS: For the vast majority of service users, transition from CAMHS to AMHS is poorly planned, poorly executed and poorly experienced. The transition process accentuates pre-existing barriers between CAMHS and AMHS.


Asunto(s)
Continuidad de la Atención al Paciente/organización & administración , Investigación sobre Servicios de Salud , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Evaluación de Procesos y Resultados en Atención de Salud , Adolescente , Servicios de Salud del Adolescente/organización & administración , Adulto , Niño , Estudios de Cohortes , Continuidad de la Atención al Paciente/normas , Inglaterra , Femenino , Humanos , Relaciones Interprofesionales , Masculino , Registros Médicos , Trastornos Mentales/epidemiología , Investigación Cualitativa , Derivación y Consulta/organización & administración
14.
Cochrane Database Syst Rev ; (4): CD006597, 2009 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-19821376

RESUMEN

BACKGROUND: The number, type and roles of specialist nurses dedicated to the care and management of patients with inflammatory bowel disease is increasing. Despite this increase, there has been little evidence to date to demonstrate the effectiveness of specialist nursing interventions. This review aims to identify and evaluate the impact of specialist nursing interventions on management of inflammatory bowel disease, access to treatment, remission, morbidity and quality of life. OBJECTIVES: To identify and evaluate the impact of specialist nursing interventions for improving the care and management of patients with inflammatory bowel disease (IBD). SEARCH STRATEGY: A comprehensive search of databases including the Cochrane Library, MEDLINE, and British Nursing Index was carried out to identify trials. References from relevant papers were searched and hand searching was undertaken of relevant publications including gastroenterology conference proceedings to identify additional trials (date of last search 30 September 2008). SELECTION CRITERIA: Randomised controlled trials, controlled before and after studies and interrupted time series studies of gastroenterology and IBD specialist nurses intending to improve access and outcomes for patients with ulcerative colitis and Crohn's disease were considered for inclusion. DATA COLLECTION AND ANALYSIS: Two investigators independently extracted data and assessed trial quality. Any discrepancies were resolved by consensus. MAIN RESULTS: One randomised controlled trial of 100 IBD patients receiving a specialist nurse delivered counselling package (n = 50) or routine outpatient clinic follow-up (n = 50), with assessments at entry and six and 12 months, was included in this review. This study was of low methodological quality. Disease remission, patient compliance, clinical improvement, utilisation of nurse-led services, patient satisfaction, hospital admission, outpatient attendance, progression to surgery, length of hospital stay and cost effectiveness data were not reported. Pooled mean mental health scores at 6 months were higher in patients who received nurse-led counselling compared to patients who received routine follow-up. However, this difference was not statistically significant (WMD 3.67; 95% CI -0.44 to 7.77; P = 0.08). Other pooled assessments of physical and psychological well-being showed no statistically significant differences. AUTHORS' CONCLUSIONS: Although specialist nurse counselling interventions might provide benefit for IBD patients the one included study was of low quality and the results of this study should be interpreted with caution. Higher quality trials of gastroenterology and IBD specialist nursing interventions are needed to assess the impact of specialist nursing interventions on the care and management of patients with inflammatory bowel disease.


Asunto(s)
Enfermedades Inflamatorias del Intestino/enfermería , Pautas de la Práctica en Enfermería , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
15.
Qual Prim Care ; 17(6): 387-95, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-20051189

RESUMEN

BACKGROUND: Revalidation of the medical profession is under review and a system has been proposed to ensure doctors meet standards of practice and professionalism. The current appraisal system allows clinicians to chart their progress and identify developmental needs in order to improve performance. Appraisal is now an annual compulsory requirement for all doctors. AIM AND OBJECTIVES: The aim of the study was to investigate the experiences of general practitioners (GPs) of the current appraisal process. The specific objectives were to consider the impact the appraisal process had exerted on their learning, practice and individual continuing professional development (CPD). METHODS: We employed a cross-sectional design using a postal questionnaire sent to all doctors who work as GPs (n = 385) in West Kent. MAIN RESULTS: Questionnaires were returned from 71.7% of doctors (n = 276). The key findings obtained were that 47.5% (n = 131) of doctors stated that taking part in the appraisal process had enhanced their learning, 40.2% (n = 111) felt that the appraisal process had improved their practice and 55.8% (n = 154) stated that the appraisal process had encouraged their CPD. Qualitative findings derived from thematic analysis of open questions revealed that participants viewed the role of the appraiser as respected peer to be vital and there was a need for independence in the appraiser's appointment. The time-consuming nature of the appraisal process was emphasised, with little protected time for preparation of documentation and engagement in CPD. Concerns were expressed about links between appraisal and revalidation. CONCLUSIONS: Many doctors considered that the appraisal process had enhanced their learning, improved their practice and encouraged their CPD. A vital, independent role for the appraiser was emphasised as was a need to review the time-consuming nature of the current appraisal process, together with identifying protected time to complete this and CPD engagement. As the role of appraisal within the revalidation process changes it is recognised that ensuring the quality, consistency and nature of appraisal will be essential to maintain the confidence of patients and doctors.


Asunto(s)
Actitud del Personal de Salud , Educación Médica Continua/organización & administración , Evaluación del Rendimiento de Empleados/organización & administración , Médicos de Familia , Garantía de la Calidad de Atención de Salud/organización & administración , Estudios Transversales , Demografía , Documentación , Eficiencia , Femenino , Humanos , Aprendizaje , Masculino , Investigación Cualitativa , Factores de Tiempo
16.
Qual Prim Care ; 16(3): 147-55, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-18700095

RESUMEN

OBJECTIVES: To identify and explore leadership roles and responsibilities for implementing the workforce development strategy; to identify approaches used to implement and disseminate the strategy; and to identify and explore challenges and achievements in the first 18 months following implementation. DESIGN: A formative evaluation with qualitative methods was used. Documentary analysis, interviews (n = 29) and two focus groups (n = 12) were conducted with a purposive sample of individuals responsible for strategy implementation. Data were transcribed and analysed thematically using framework analysis. SETTING: Regional health area in Kent, Surrey and Sussex: 24 primary care trusts (PCTs) and 900 general practices. RESULTS: Primary care workforce tutors, lifelong learning advisors, GP tutors, patch associate GP deans and chairs of PCT education committees all had vital leadership roles, some existing and others newly developed. Approaches used to implement the strategy encompassed working within and across organisational boundaries, communication and dissemination of information. Challenges encountered by implementers were resistance to change - evident in some negative attitudes to uptake of training and development opportunities - and role diversity and influence. Achievements included successes in embedding appraisal and protected learning time, and changes in educational practices and services. CONCLUSIONS: The use of key leadership roles and change-management approaches had brought about early indications of positive transition in lifelong learning cultures.


Asunto(s)
Educación Continua/organización & administración , Personal de Salud/educación , Liderazgo , Atención Primaria de Salud/organización & administración , Desarrollo de Personal/organización & administración , Competencia Clínica , Comunicación , Conocimientos, Actitudes y Práctica en Salud , Humanos , Innovación Organizacional
17.
Health Serv Manage Res ; 31(4): 180-194, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-29376412

RESUMEN

INTRODUCTION: International health policies recognise patient empowerment, resulting in diverse empowerment models and systems. Research on organisational systems for implementing patient empowerment between countries or from organisational stakeholders' perspective, however, is limited. Aims and methodology: This paper explores and compares organisational systems and structures for patient empowerment implementation in six acute public hospitals in England and Greece (three in each country), their cross-case and cross-national similarities and differences. It uses a comparative, qualitative, explanatory embedded case study design. Semi-structured interviews with a representative sample of stakeholders (n = 33) and documentary sources (n = 79) were analysed with framework. RESULTS: Two main patient empowerment themes were identified: (1) organisational leadership, systems, structures; (2) operational structures, services, mechanisms and activities. Generic organisational systems and structures for patient empowerment varied across-cases, but with common organisation of empowerment roles in England and common leadership in Greece. Operational structures, services and mechanisms supporting empowerment varied across-cases and cross-nationally, but with similarities in the main services. CONCLUSION: Implementation of patient empowerment was weaker in Greece than in England, attributable to differing approaches to strategic and operational leadership, limited development of strategies and influential organisational structures. Overall, patient empowerment is well-embedded in organisations with a highly visible patient empowerment profile; commitment to policies and strategy implementation at different levels; strategic and operational leadership investing in dedicated roles with clear authority for patient empowerment, influential empowerment structures and mechanisms.


Asunto(s)
Política de Salud , Ciencia de la Implementación , Participación del Paciente , Poder Psicológico , Inglaterra , Grecia , Hospitales Públicos , Humanos , Entrevistas como Asunto , Liderazgo , Estudios de Casos Organizacionales , Investigación Cualitativa
18.
Patient Prefer Adherence ; 11: 1657-1669, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29033553

RESUMEN

BACKGROUND: Comparison of patient empowerment (PE) policies in European countries can provide evidence for improvement and reform across different health systems. It may also influence patient and public involvement, patient experience, preference, and adherence. OBJECTIVE: The objective of this study was to compare PE within national policies, systems, and structures in England and Greece for achieving integrated people-centered health services. METHODS: We performed a critical search and review of policy and legislation papers in English and Greek languages. This included 1) general health policy and systems papers, 2) PE, patient and/or public involvement or patients' rights policy and legislation (1990-2015), and 3) comparative or discussion papers for England and/or Greece. RESULTS: A total of 102 papers on PE policies, systems, and structures were identified initially; 80 papers were included, in which 46 were policy, legislative, and discussion papers about England, 21 were policy, legislation, and discussion papers about Greece, and 13 were comparative or discussion papers including both the countries. In England, National Health Service policies emphasized patient-centered services, involvement, and empowerment, with recent focus on patients' rights; while in Greece, they emphasized patients' rights and quality of services, with recent mentions on empowerment. The health ombudsman is a very important organization across countries; however, it may be more powerful in Greece, because of the nonexistence of local mediating bodies. Micro-structures at trusts/hospitals are comparable, but legislation gives more power to the local structures in Greece. CONCLUSION: PE policies and systems have been developed and expressed differently in these countries. However, PE similarities, comparable dimensions and mechanisms, were identified. For both the countries, comparative research and these findings could be beneficial in building connections and relationships, contributing to wider European and international developments on PE, involvement, and patients' rights and further impact on patient preferences and adherence.

19.
Acad Med ; 92(9): 1254-1258, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28177959

RESUMEN

PROBLEM: Screening tools exist to help identify patient issues related to social determinants of health (SDH), but solutions to many of these problems remain elusive to health care providers as they require legal solutions. Interprofessional medical-legal education is essential to optimizing health care delivery. APPROACH: In 2011, the authors implemented a four-session didactic interprofessional curriculum on medical-legal practice for third-year medical students at Morehouse School of Medicine. This program, also attended by law students, focused on interprofessional collaboration to address client/patient SDH issues and health-harming legal needs. In 2011-2014, the medical students participated in pre- and postintervention surveys designed to determine their awareness of SDH's impact on health as well as their attitudes toward screening for SDH issues and incorporating resources, including a legal resource, to address them. Mean ratings were compared between pre- and postintervention respondent cohorts using independent-sample t tests. OUTCOMES: Of the 222 medical students who participated in the program, 102 (46%) completed the preintervention survey and 100 (45%) completed the postintervention survey. Postintervention survey results indicated that students self-reported an increased likelihood to screen patients for SDH issues and an increased likelihood to refer patients to a legal resource (P < .001). NEXT STEPS: Incorporating interprofessional medical-legal education into undergraduate medical education may result in an increased likelihood to screen patients for SDH and to refer patients with legal needs to a legal resource. In the future, an additional evaluation to assess the curriculum's long-term impact will be administered prior to graduation.


Asunto(s)
Curriculum , Educación de Pregrado en Medicina , Determinantes Sociales de la Salud/legislación & jurisprudencia , Adulto , Actitud del Personal de Salud , Evaluación Educacional , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Estados Unidos
20.
BJPsych Bull ; 40(3): 142-8, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27280035

RESUMEN

Aims and method The Transitions of Care from Child and Adolescent Mental Health Services to Adult Mental Health Services (TRACK) study was a multistage, multicentre study of adolescents' transitions between child and adult mental health services undertaken in England. We conducted a secondary analysis of the TRACK study data to investigate healthcare provision for young people (n = 64) with ongoing mental health needs, who were not transferred from child and adolescent mental health services (CAMHS) to adult mental health services mental health services (AMHS). Results The most common outcomes were discharge to a general practitioner (GP; n = 29) and ongoing care with CAMHS (n = 13), with little indication of use of third-sector organisations. Most of these young people had emotional/neurotic disorders (n = 31, 48.4%) and neurodevelopmental disorders (n = 15, 23.4%). Clinical implications GPs and CAMHS are left with the responsibility for the continuing care of young people for whom no adult mental health service could be identified. GPs may not be able to offer the skilled ongoing care that these young people need. Equally, the inability to move them decreases the capacity of CAMHS to respond to new referrals and may leave some young people with only minimal support.

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