Asunto(s)
Accesibilidad a los Servicios de Salud , Humanos , Accesibilidad a los Servicios de Salud/tendencias , COVID-19/epidemiología , Telemedicina/tendencias , Francia , Grupo de Atención al Paciente/tendencias , Unidades Móviles de Salud/organización & administración , Unidades Móviles de Salud/tendenciasRESUMEN
Reviews the book, Connections in the Clinic: Relational Narratives from Team-Based Primary Care edited by Randall Reitz, Laura E. Sudano, and Mark P. Knudson (2021). This book is an edited collection of poems and stories reflecting the personal nature of the mission, vision, and practice of integrated primary care. This collection reflects the biopsychosocial model, which has been growing steadily in research and practice over the last few decades. These stories from the frontlines illustrate the increased awareness of the strong mind-body-interpersonal and team connections that are a critical part of a successful primary care system. This book is intended to be inspirational for anyone working in a primary care clinic. The editors describe the central purpose of the book is to find meaning in the relationships that are created in team-based primary care. This is a book where these stories are collected to expand our recognition and appreciation of the full diversity of patterns in our personal and work lives. The collection of stories is intended to inspire readers to actively practice their own reflections and learnings and encourages sharing them with others. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Asunto(s)
Grupo de Atención al Paciente , Atención Primaria de Salud , Humanos , Grupo de Atención al Paciente/tendencias , Grupo de Atención al Paciente/normas , NarraciónRESUMEN
Increasing palliative care presence in the intensive care unit (ICU) improves symptom management, increases goals-of-care discussion, and reduces unnecessary procedures in ICU patients. An interdisciplinary study team developed a palliative care trigger program in a 17-bed surgical ICU (SICU). Surgical ICU patients who met 3 triggers (ICU length of stay > 10 days, repeat ICU admission, and metastatic cancer) automatically received a palliative care consult. The purpose of the current study was to survey SICU health care professionals before and after the institution of the palliative care trigger program. Overall, the palliative care trigger program was viewed positively by interdisciplinary team members with increased team communication and decreased resistance for the inclusion of palliative care in the SICU plan of care. The palliative care trigger program was successfully developed and implemented in a SICU and was accepted by the interdisciplinary team members caring for SICU patients. Team member feedback is being used to expand the palliative care trigger program to improve care for SICU patients.
Asunto(s)
Unidades de Cuidados Intensivos , Cuidados Paliativos , Humanos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Cuidados Paliativos/métodos , Cuidados Paliativos/estadística & datos numéricos , Encuestas y Cuestionarios , Grupo de Atención al Paciente/estadística & datos numéricos , Grupo de Atención al Paciente/tendencias , Grupo de Atención al Paciente/normas , Masculino , FemeninoRESUMEN
BACKGROUND AND PURPOSE: A Health and Disabilities Interprofessional Education (IPE) course was implemented to join three healthcare disciplines together to collaboratively plan, implement, and reflect on professional roles and responsibilities. The goal and purpose of this course was to create an advancement of interprofessional education and practice within health science professions early in their students' programs utilizing innovative teaching methods working directly with individuals with disabilities. EDUCATIONAL ACTIVITY AND SETTING: 72 students were assigned to interprofessional teams of 10-11 people. Through asynchronous and synchronous learning activities, student teams worked together to plan and conduct community-based client interviews. FINDINGS: Quantitative and qualitative evaluation methods were used to explore the impact of interprofessional experiential learning experiences. Qualitative data showed a greater awareness and understanding of the different roles and responsibilities in interprofessional teams as well as a greater appreciation for the value of interacting with persons with disabilities (PWD) during their training. Quantitative data showed a significant change in students' understanding of their roles and responsibilities as a member of an interprofessional team, their confidence with working with PWD in a future healthcare capacity, as well as their understanding of how the social determinants of health may influence the healthcare experience of a PWD. SUMMARY: Interprofessional education and experiential learning opportunities are good ways to facilitate "real" patient care experiences and team roles and responsibilities. This enables healthcare students to practice communication, build relationships, and understand the lived experience of their patients.
Asunto(s)
Personas con Discapacidad , Relaciones Interprofesionales , Humanos , Personas con Discapacidad/educación , Personas con Discapacidad/psicología , Aprendizaje Basado en Problemas/métodos , Investigación Cualitativa , Educación Interprofesional/métodos , Educación Interprofesional/normas , Estudiantes del Área de la Salud/psicología , Estudiantes del Área de la Salud/estadística & datos numéricos , Curriculum/tendencias , Curriculum/normas , Personal de Salud/educación , Personal de Salud/psicología , Grupo de Atención al Paciente/tendencias , Grupo de Atención al Paciente/normas , Conducta CooperativaRESUMEN
BACKGROUND: Early rehabilitation in intensive care units (ICUs) may be beneficial but is not routinely performed for adults with critical illness. In April 2018, the Japanese government introduced a health policy to provide financial incentives to hospitals that met the requirements of interdisciplinary collaboration and had teams specialized in ICU rehabilitation practices. OBJECTIVES: The present study aimed to investigate whether the health policy is associated with improved clinical practices of ICU rehabilitation. METHODS: Using a nationwide administrative inpatient database and hospital statistics data from Japan, we identified hospitals that admitted adult patients to the ICU within two days of hospital admission from April 2016 to March 2019. Using hospital-level propensity score matching, we created matched cohorts of 101,203 patients from 108 intervention hospitals that introduced the health policy, and 106,703 patients from 108 control hospitals that did not. We then conducted patient-level difference-in-differences analyses to examine changes in the percentage of patients from the intervention and control hospitals, who underwent early ICU rehabilitation within two days of ICU admission before and after the implementation of the health policy. RESULTS: In the intervention group, patients undergoing early ICU rehabilitation increased from 10% and 36% after the policy implementation. In the control group, it increased from 11% to 13%. The difference-in-difference in the percentage of patients who underwent early ICU rehabilitation between the two groups was 24% (95% confidence interval, 19%-29%). CONCLUSIONS: Early ICU rehabilitation can be facilitated by financial incentives for hospitals that engage in interdisciplinary collaboration with specialist teams. IMPLICATIONS FOR CLINICAL PRACTICE: Our Findings are relevant for hospital administrators, professional organizations, and policymakers in other nations considering strategies to support the additional deployment burdens of early ICU rehabilitation. Future studies need to explore the long-term effects and sustainability of the observed improvements in ICU rehabilitation practices.
Asunto(s)
Política de Salud , Unidades de Cuidados Intensivos , Humanos , Japón , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Política de Salud/tendencias , Puntaje de Propensión , Rehabilitación/estadística & datos numéricos , Rehabilitación/métodos , Rehabilitación/normas , Rehabilitación/tendencias , Adulto , Anciano de 80 o más Años , Grupo de Atención al Paciente/estadística & datos numéricos , Grupo de Atención al Paciente/tendenciasRESUMEN
Better integration is a priority for most international health systems. However, multiple interventions are often implemented simultaneously, making evaluation difficult and providing limited evidence for policy makers about specific interventions. We evaluate a common integrated care intervention, multi-disciplinary group (MDG) meetings for discussion of high-risk patients, introduced in one socio-economically deprived area in the UK in spring 2015. Using data from multiple waves of the national GP Patient Survey and Hospital Episode Statistics, we estimate its effects on primary and secondary care utilization and costs, health status and patient experience. We use triple differences, exploiting the targeting at people aged 65 years and over, parsing effects from other population-level interventions implemented simultaneously. The intervention reduced the probability of visiting a primary care nurse by three percentage points and decreased length of stay by 1 day following emergency care admission. However, since planned care use increased, overall costs were unaffected. MDG meetings are presumably fulfilling public health objectives by decreasing length of stay and detecting previously unmet needs. However, the effect of MDGs on health system cost is uncertain and health remains unchanged. Evaluations of specific integrated care interventions may be more useful to public decision makers facing budget constraints.
Asunto(s)
Prestación Integrada de Atención de Salud , Hospitalización , Grupo de Atención al Paciente , Anciano , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/tendencias , Costos de la Atención en Salud , Humanos , Tiempo de Internación , Aceptación de la Atención de Salud , Grupo de Atención al Paciente/economía , Grupo de Atención al Paciente/tendencias , Áreas de Pobreza , Factores de Riesgo , Factores Socioeconómicos , Reino UnidoAsunto(s)
COVID-19/epidemiología , Cuidados Críticos , Manejo de Atención al Paciente , Rol del Médico/psicología , Condiciones Sociales/tendencias , Heridas y Lesiones/cirugía , Cuidados Críticos/ética , Cuidados Críticos/organización & administración , Cuidados Críticos/psicología , Servicios Médicos de Urgencia/tendencias , Humanos , Modelos Organizacionales , Manejo de Atención al Paciente/ética , Manejo de Atención al Paciente/organización & administración , Manejo de Atención al Paciente/tendencias , Grupo de Atención al Paciente/ética , Grupo de Atención al Paciente/tendencias , SARS-CoV-2 , Responsabilidad Social , Factores Socioeconómicos , Estados Unidos , ViolenciaRESUMEN
This article is the second in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
Asunto(s)
Cuidadores , Toma de Decisiones Conjunta , Planificación de Atención al Paciente , Grupo de Atención al Paciente/tendencias , Anciano , Cuidadores/educación , Cuidadores/psicología , Enfermería Basada en la Evidencia , Hospitalización , Humanos , Prioridad del PacienteRESUMEN
When a diverse group of individuals is working together in the contemporary fertility clinic to provide time-sensitive and complex care for patients, a high degree of coordination and collaboration must take place. When performed dynamically, this process is referred to as teaming. Although the positive impact of teamwork in health care settings has been well established in the literature, the concept of teaming has limited foundation in the clinic. This review will provide an overview of how teaming can be used to improve patient care in today's fertility clinics. Approaches to integrating teaming into the clinic that will be discussed include framing, the creation of a psychologically safe environment for staff input, and facilitating collaborative constructs to support teaming. Best practices to implement teaming and how to address challenges to teaming in today's clinical environment will also be addressed.
Asunto(s)
Clínicas de Fertilidad , Cultura Organizacional , Grupo de Atención al Paciente/organización & administración , Instituciones de Atención Ambulatoria/organización & administración , Instituciones de Atención Ambulatoria/tendencias , Calibración/normas , Atención a la Salud/organización & administración , Atención a la Salud/normas , Atención a la Salud/tendencias , Femenino , Clínicas de Fertilidad/organización & administración , Clínicas de Fertilidad/tendencias , Humanos , Masculino , Atención al Paciente/normas , Atención al Paciente/tendencias , Grupo de Atención al Paciente/normas , Grupo de Atención al Paciente/tendencias , Medicina de Precisión/métodos , Medicina de Precisión/tendencias , EmbarazoRESUMEN
OBJECTIVES: Major Lower Limb Amputation (MLLA) is associated with significant peri- and post-operative pain and has been identified as a research priority by patient and healthcare groups. The PReliMinAry survey was designed to evaluate existing MLLA analgesia strategies; identifying areas of equipoise and informing future research. METHODS: A targeted multi-national, multi-disciplinary survey was conducted via SurveyMonkey® (October 5, 2020-November 3, 2020) and advertised via social media and society email lists. The 10-questions explored 'pain-team' services, pre-operative neuroleptic medication, pre-incision peripheral nerve blocks and catheters, surgically placed nerve catheters, post-operative adjunctive regimens, future research engagement and equipoise. RESULTS: Seventy-six responses were received from 60 hospitals worldwide. Twelve hospitals(20%) had a dedicated MLLA pain team, 7(12%) had none. Most pain teams (n = 52; 87%) assessed pain with a 0-10 numerical rating scale. Over half of respondents "never" preloaded patients with oral neuroleptic agents(n= 42/76; 55%). Forty-seven hospitals(78%) utilized patient controlled opioid analgesia. Most hospitals are able to provide pre-incision loco-regional peripheral nerve blocks, nerve catheters and surgical nerve catheters (95%, 77%, and 90% respectively), but use was variable. Ultrasound(US) guided peripheral nerve catheters were "infrequently" or "never" used in 57% of hospitals, whilst 23% "infrequently" or "never" utilize surgically placed nerve catheters. CONCLUSIONS: The survey revealed a preference towards 'single-shot' nerve blocks and surgical catheters. A difference between the use of US guided nerve catheters and those surgically placed likely reflects the difference of literature evaluating these techniques. Most respondents felt there was equipoise surrounding future trials evaluating nerve blocks/catheters, but less so for surgical catheters.
Asunto(s)
Amputación Quirúrgica/efectos adversos , Analgésicos/uso terapéutico , Disparidades en Atención de Salud/tendencias , Bloqueo Nervioso/tendencias , Manejo del Dolor/tendencias , Dolor Postoperatorio/prevención & control , Pautas de la Práctica en Medicina/tendencias , Cateterismo/tendencias , Encuestas de Atención de la Salud , Humanos , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Grupo de Atención al Paciente/tendencias , Equipoise Terapéutico , Resultado del Tratamiento , Ultrasonografía Intervencional/tendenciasRESUMEN
Objetivo: descrever as percepções dos profissionais da saúde sobre a presença do acompanhante no processo do nascimento. Método: estudo descritivo, qualitativo, realizado em um hospital escola, com 29 profissionais da saúde. A coleta de dados foi realizada por meio de entrevistas, entre maio a julho de 2018, sendo analisadas com abordagem baseada no Discurso do Sujeito Coletivo. Resultados: após análise emergiram quatro Ideias Centrais: experiências positivas e a participação do acompanhante, o ambiente desconhecido gera sentimento de insegurança no acompanhante, a presença do acompanhante causa desconforto na equipe de saúde e o profissional barra o acompanhante pela presunção de que ele irá atrapalhar. Conclusão: as percepções dos profissionais se mostraram conflitantes, sendo que alguns percebem a importância e os benefícios do acompanhante no nascimento, e outros apontaram que ele atrapalha a equipe de saúde, pela ansiedade e estresse, prejudicando a equipe de saúde e interferindo de maneira negativa
Objective: to describe the perceptions of health professionals about the presence of a companion in the birth process. Method: a descriptive, qualitative study, carried out in a teaching hospital, with 29 health professionals. Data collection was carried out through interviews, between May and July 2018, being analyzed using an approach based on the Collective Subject Discourse. Results:after analysis, four Central Ideas emerged: positive experiences and the companion's participation, the unknown environment generates feelings of insecurity in the companion, the presence of the companion causes discomfort in the health team and the professional stops the companion due to the presumption that it will hinder. Conclusion: the perceptions of the professionals were conflicting, with some perceiving the importance and benefits of the companion at birth, and others pointed out that it disturbs the health team, due to anxiety and stress, harming the health team and interfering in a negative way
Objetivo: describir las percepciones de los profesionales de la salud sobre la presencia de un acompañante en el proceso del parto. Método: estudio descriptivo, cualitativo, realizado en un hospital universitario, con 29 profesionales de la salud. La recolección de datos se realizó a través de entrevistas, entre mayo y julio de 2018, siendo analizadas con un enfoque basado en el Discurso Colectivo del Sujeto. Resultados: luego del análisis surgieron cuatro Ideas Centrales: experiencias positivas y la participación del acompañante, el entorno desconocido genera sentimientos de inseguridad en el acompañante, la presencia del acompañante provoca malestar en el equipo de salud y el profesional detiene al acompañante por presunción de que dificultará. Conclusión: las percepciones de los profesionales fueron conflictivas, algunos percibieron la importancia y los beneficios del acompañante al nacer, y otros señalaron que perturba al equipo de salud, por ansiedad y estrés, perjudicando al equipo de salud e interfiriendo de manera negativa
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Grupo de Atención al Paciente/tendencias , Parto Humanizado , Chaperones Médicos/tendencias , Relaciones Paciente-Hospital , Investigación Cualitativa , Hospitales de EnseñanzaRESUMEN
Abstract Pharmaceutical education should enable the development of competences for community pharmacy practice, which is an important field for the pharmacist workforce. The aim of this study was to evaluate the competences perceived by pharmacy interns from a Brazilian pharmacy school for community pharmacy practice. This study adopted a combined quantitative and qualitative approach. The study cohort included undergraduate students who undertook internships in community pharmacy in the final year of the pharmacy course. Students responded to an 11-item structured questionnaire according to a five-point Likert scale that included perceptions of their competences for community pharmacy practice. Among the 693 possible answers, 605 (87.3%) agreed that the course promoted the development of competences for professional practice in community pharmacy. Less than 70% of students perceived themselves as prepared to respond to symptoms and provide non-prescription medicines. Qualitative analysis of the comments revealed three themes: the need to improve patient information skills, improve practice as a member of a health care team, and improve dispensing according to legal requirements. These findings may support improvements in undergraduate pharmacy programs, such as the inclusion of experiential learning, active learning methods, interprofessional education, and development of clinical skills.
Asunto(s)
Humanos , Masculino , Femenino , Percepción/ética , Farmacia , Práctica Profesional/ética , Facultades de Farmacia/clasificación , Estudiantes de Farmacia/clasificación , Educación en Farmacia , Estudios de Evaluación como Asunto , Grupo de Atención al Paciente/tendencias , Farmacéuticos , Competencia Profesional/normas , Encuestas y Cuestionarios , Competencia Clínica/normas , Servicios Comunitarios de Farmacia/estadística & datos numéricosRESUMEN
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.
Asunto(s)
Prestación Integrada de Atención de Salud/métodos , Grupo de Atención al Paciente/tendencias , Estomatitis/terapia , Adulto , Anestesia Local , Quimioradioterapia , Prestación Integrada de Atención de Salud/tendencias , Diagnóstico Bucal , Femenino , Neoplasias de Cabeza y Cuello/complicaciones , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente/estadística & datos numéricos , Farmacéuticos , Estudios Retrospectivos , Estomatitis/metabolismo , Pérdida de PesoRESUMEN
Background The multidisciplinary Heart Team (HT) is recommended for management decisions for transcatheter aortic valve replacement (TAVR) candidates, and during TAVR procedures. Empiric evidence to support these recommendations is limited. We aimed to explore temporal trends, drivers, and outcomes associated with HT utilization. Methods and Results TAVR candidates were identified in Ontario, Canada, from April 1, 2012 to March 31, 2019. The HT was defined as having a billing code for both a cardiologist and cardiac surgeon during the referral period. The procedural team was defined as a billing code during the TAVR procedure. Hierarchical logistical models were used to determine the drivers of HT. Median odds ratios were calculated to quantify the degree of variation among hospitals. Of 10 412 patients referred for TAVR consideration, 5489 (52.7%) patients underwent a HT during the referral period, with substantial range between hospitals (median odds ratio of 1.78). Utilization of a HT for TAVR referrals declined from 69.9% to 41.1% over the years of the study. Patient characteristics such as older age, frailty and dementia, and hospital characteristics including TAVR program size, were found associated with lower HT utilization. In TAVR procedures, the procedural team included both cardiologists and cardiac surgeons in 94.9% of cases, with minimal variation over time or between hospitals. Conclusions There has been substantial decline in HT utilization for TAVR candidates over time. In addition, maturity of TAVR programs was associated with lower HT utilization.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Cardiólogos/tendencias , Grupo de Atención al Paciente/tendencias , Pautas de la Práctica en Medicina/tendencias , Cirujanos/tendencias , Reemplazo de la Válvula Aórtica Transcatéter/tendencias , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/fisiopatología , Femenino , Humanos , Masculino , Ontario , Evaluación de Programas y Proyectos de Salud , Derivación y Consulta/tendencias , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Resultado del TratamientoRESUMEN
Despite being collectively among the most frequent congenital developmental conditions worldwide, differences of sex development (DSD) lack recognition and research funding. As a result, what constitutes optimal management remains uncertain. Identification of the individual conditions under the DSD umbrella is challenging and molecular genetic diagnosis is frequently not achieved, which has psychosocial and health-related repercussions for patients and their families. New genomic approaches have the potential to resolve this impasse through better detection of protein-coding variants and ascertainment of under-recognized aetiology, such as mosaic, structural, non-coding or epigenetic variants. Ultimately, it is hoped that better outcomes data, improved understanding of the molecular causes and greater public awareness will bring an end to the stigma often associated with DSD.