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1.
Pan Afr Med J ; 38: 124, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33912294

RESUMEN

Introduction: the phenomenon of unintended adolescent pregnancy continues to be a reproductive and public health concern in sub-Saharan Africa. Healthcare providers play an important role in influencing the use of contraceptives among adolescent girls. This study assessed knowledge and perceptions of healthcare providers regarding the use of modern contraceptives among adolescent girls in Umlazi township, KwaZulu-Natal province, South Africa. Methods: this was a descriptive study involving 35 healthcare providers covering all 10 primary healthcare clinics in Umlazi township. Data collected through a structured questionnaire were coded, entered into Epi data manager (version 4.6) and exported to STATA (version 15.0) for analysis. Results: of the thirty-five healthcare providers that participated in this study, professional nurses (54.3%) and enrolled nurses (17.1%) constituted the majority. The mean age of the participants was 42.11 years, with 88.6% being females. More than a third (37.1%) of healthcare providers did not know whether or not modern contraceptives make users promiscuous, while more than half (57%) had negative attitudes towards adolescents exploring contraceptive methods. Healthcare providers viewed health systems challenges, such as poor working conditions, long queues, and contraceptives stock-outs, as deterrents towards the provision of quality sexual behaviour counselling and modern contraceptive education to users. Conclusion: poor health systems and negative behaviours by healthcare providers influences the delivery of family planning services in primary healthcare clinics and serve as barriers to quality family planning services provided to younger women.


Asunto(s)
Anticoncepción/estadística & datos numéricos , Servicios de Planificación Familiar , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/estadística & datos numéricos , Adolescente , Adulto , Conducta Anticonceptiva/estadística & datos numéricos , Anticonceptivos/uso terapéutico , Consejo/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/métodos , Conducta Sexual , Sudáfrica , Encuestas y Cuestionarios
3.
BMC Fam Pract ; 22(1): 66, 2021 04 08.
Artículo en Inglés | MEDLINE | ID: mdl-33832436

RESUMEN

BACKGROUND: To estimate the prevalence of symptoms and signs related to a COVID-19 case series confirmed by polymerase chain reaction (PCR) for SARS-CoV-2. Risk factors and the associated use of health services will also be analysed. METHODS: Observational, descriptive, retrospective case series study. The study was performed at two Primary Care Health Centres located in Madrid, Spain. The subjects studied were all PCR SARS-CoV-2 confirmed cases older than 18 years, diagnosed from the beginning of the community transmission (March 13) until April 15, 2020. We collected sociodemographic, clinical, health service utilization and clinical course variables during the following months. All data was gathered by their own attending physician, and electronic medical records were reviewed individually. STATISTICAL ANALYSIS: A descriptive analysis was carried out and a Poisson regression model was adjusted to study associated factors to Health Services use. RESULTS: Out of the 499 patients studied from two health centres, 55.1% were women and mean age was 58.2 (17.3). 25.1% were healthcare professionals. The most frequent symptoms recorded related to COVID-19 were cough (77.9%; CI 95% 46.5-93.4), fever (77.7%; CI95% 46.5-93.4) and dyspnoea (54.1%, CI95% 46.6-61.4). 60.7% were admitted to hospital. 64.5% first established contact with their primary care provider before going to the hospital, with a mean number of 11.4 Healthcare Providers Encounters with primary care during all the follow-up period. The number of visit-encounters with primary care was associated with being male [IRR 1.072 (1.013, 1.134)], disease severity {from mild respiratory infection [IRR 1.404 (1.095, 1.801)], up to bilateral pneumonia [IRR 1.852 (1.437,2.386)]}, and the need of a work leave [IRR 1.326 (1.244, 1.413]. CONCLUSION: Symptoms and risk factors in our case series are similar to those in other studies. There was a high number of patients with atypical unilateral or bilateral pneumonia. Care for COVID has required a high use of healthcare resources such as clinical encounters and work leaves.


Asunto(s)
Aceptación de la Atención de Salud/estadística & datos numéricos , Neumonía Viral , Atención Primaria de Salud , Evaluación de Síntomas , /diagnóstico , /fisiopatología , Demografía , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/etiología , Atención Primaria de Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , España/epidemiología , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos
4.
BMJ ; 373: n379, 2021 04 12.
Artículo en Inglés | MEDLINE | ID: mdl-33846159

RESUMEN

Atrial fibrillation is a common chronic disease seen in primary care offices, emergency departments, inpatient hospital services, and many subspecialty practices. Atrial fibrillation care is complicated and multifaceted, and, at various points, clinicians may see it as a consequence and cause of multi-morbidity, as a silent driver of stroke risk, as a bellwether of an acute medical illness, or as a primary rhythm disturbance that requires targeted treatment. Primary care physicians in particular must navigate these priorities, perspectives, and resources to meet the needs of individual patients. This includes judicious use of diagnostic testing, thoughtful use of novel therapeutic agents and procedures, and providing access to subspecialty expertise. This review explores the epidemiology, screening, and risk assessment of atrial fibrillation, as well as management of its symptoms (rate and various rhythm control options) and stroke risk (anticoagulation and other treatments), and offers a model for the integration of the components of atrial fibrillation care.


Asunto(s)
Fibrilación Atrial/diagnóstico , Tamizaje Masivo/normas , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/normas , Accidente Cerebrovascular/prevención & control , Antiarrítmicos/administración & dosificación , Anticoagulantes/uso terapéutico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/epidemiología , Fibrilación Atrial/terapia , Cateterismo Cardíaco , Electrocardiografía , Carga Global de Enfermedades , Estilo de Vida Saludable , Frecuencia Cardíaca/efectos de los fármacos , Frecuencia Cardíaca/fisiología , Humanos , Incidencia , Tamizaje Masivo/métodos , Prevalencia , Atención Primaria de Salud/métodos , Medición de Riesgo/métodos , Factores de Riesgo , Accidente Cerebrovascular/etiología
5.
BMC Cancer ; 21(1): 387, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33836694

RESUMEN

BACKGROUND: Cancer patients with brain metastases (BMs) require multidisciplinary care, and treatment facility may play a role. This study aimed to investigate the impact of receiving treatment at academic centers on the overall survival (OS) of cancer patients with brain metastases (BMs) regardless of the primary cancer site. METHODS: This retrospective analysis of the National Cancer Database (NCDB) included patients diagnosed with non-small cell lung cancer, small-cell lung cancer, other types of lung cancer, breast cancer, melanoma, colorectal cancer, and kidney cancer and had brain metastases at the time of diagnosis. The data were extracted from the de-identified file of the NCDB, a joint program of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The Cox proportional hazard model adjusted for age at diagnosis, race, sex, place of living, income, education, primary tumor type, year of diagnosis, chemotherapy, radiation therapy (RT), and surgery of the primary cancer site was used to determine treatment facility-associated hazard ratios (HR) for survival. Overall survival was the primary outcome, which was analyzed with multivariable Cox proportional hazards regression modeling. RESULTS: A total of 93,633 patients were analyzed, among whom 31,579/93,633 (34.09%) were treated at academic centers. Based on the log-rank analysis, patients who received treatment at an academic facility had significantly improved OS (median OS: 6.18, CI: 6.05-6.31 vs. 4.57, CI: 4.50-4.63 months; p < 0.001) compared to patients who were treated at non-academic facilities. In the multivariable Cox regression analysis, receiving treatment at an academic facility was associated with significantly improved OS (HR: 0.85, CI: 0.84-0.87; p < 0.001) compared to non-academic facility. CONCLUSIONS: In this extensive analysis of the NCDB, receiving treatment at academic centers was associated with significantly improved OS compared to treatment at non-academic centers.


Asunto(s)
Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/secundario , Instituciones de Salud , Evaluación del Impacto en la Salud , Atención Primaria de Salud , Neoplasias Encefálicas/epidemiología , Bases de Datos Factuales , Manejo de la Enfermedad , Análisis Factorial , Femenino , Encuestas de Atención de la Salud , Evaluación del Impacto en la Salud/estadística & datos numéricos , Humanos , Estimación de Kaplan-Meier , Masculino , Oportunidad Relativa , Evaluación de Resultado en la Atención de Salud , Atención Primaria de Salud/métodos , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Estados Unidos/epidemiología
9.
Lancet ; 397(10283): 1505-1518, 2021 04 17.
Artículo en Inglés | MEDLINE | ID: mdl-33773612

RESUMEN

Migraine is a highly disabling neurological disorder that directly affects more than 1 billion individuals worldwide. Available treatment options differ between countries and include acute, preventive, and non-pharmacological therapies. Because of major progress in the understanding of migraine pathogenesis, novel mechanism-based medications have emerged and expanded the armamentarium of treatments. We provide a comprehensive overview of the current standard of care that will enable informed clinical management. First, we discuss the efficacy, tolerability, and safety profile of various pharmacological therapies for acute and preventive treatment of migraine. Second, we review the current knowledge on non-pharmacological therapies, such as neuromodulation and biobehavioural approaches, which can be used for a multidisciplinary approach to clinical management. Third, we emphasise that any effective treatment strategy starts with building a therapeutic plan tailored to individual clinical characteristics, preferences, and needs. Finally, we explore the outlook of emerging mechanism-based treatments that could address unmet challenges in clinical management of migraine.


Asunto(s)
Carga Global de Enfermedades , Trastornos Migrañosos/epidemiología , Femenino , Humanos , Masculino , Trastornos Migrañosos/terapia , Prevalencia , Atención Primaria de Salud/métodos
10.
BMC Pregnancy Childbirth ; 21(1): 208, 2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-33722198

RESUMEN

BACKGROUND: Pregnancy is a risk factor for coronavirus disease 2019 (COVID-19). Pregnant women suffer from varying levels of pregnancy-related anxiety (PRA) which can negatively affect pregnancy outcomes. The aim of this study was to assess PRA and its associated factors during the COVID-19 pandemic. METHODS: This web-based cross-sectional study was conducted in 2020 on 318 pregnant women purposively recruited from primary healthcare centers in Sari and Amol, Iran. Data were collected using questionnaires (PRAQ, Edinburg, KAP of COVID-19, CDA-Q and Demographic questionnaire), which were provided to participants through the social media or were completed for them over telephone. Data were analyzed with the linear regression and the logistic regression analysis, at the significance level of 0.05 using the SPSS software (v. 21). RESULTS: Around 21% of participants had PRA, 42.1% had depression, and 4.4% had COVID-19 anxiety. The significant predictors of PRA were number of pregnancies (P = 0.008), practice regarding COVID-19 (P < 0.001), COVID-19 anxiety (P < 0.001), depression (P < 0.001), and social support (P = 0.025) which explained 19% of the total variance. Depression and COVID-19 anxiety increased the odds of PRA by respectively four times and 13%, while good practice regarding COVID-19 decreased the odds by 62%. CONCLUSION: Around 21% of pregnant women suffer from PRA during the COVID-19 pandemic and the significant predictors of PRA during the pandemic include number of pregnancies, practice regarding COVID-19, COVID-19 anxiety, depression, and social support. These findings can be used to develop appropriate strategies for the management of mental health problems during pregnancy in the COVID-19 pandemic.


Asunto(s)
Ansiedad , Complicaciones del Embarazo , Atención Primaria de Salud , Apoyo Social , Adulto , Ansiedad/diagnóstico , Ansiedad/epidemiología , Ansiedad/prevención & control , /prevención & control , Estudios Transversales , Depresión/diagnóstico , Depresión/epidemiología , Femenino , Humanos , Irán/epidemiología , Evaluación de Necesidades , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/prevención & control , Complicaciones del Embarazo/psicología , Mujeres Embarazadas/psicología , Atención Primaria de Salud/métodos , Atención Primaria de Salud/normas , Atención Primaria de Salud/tendencias , Factores de Riesgo , Estrés Psicológico/diagnóstico , Estrés Psicológico/epidemiología
11.
BMC Fam Pract ; 22(1): 31, 2021 02 03.
Artículo en Inglés | MEDLINE | ID: mdl-33535973

RESUMEN

BACKGROUND: Interprofessional primary care (IPC) teams provide comprehensive and coordinated care and are ideally equipped to support those populations most at risk of adverse health outcomes during the COVID-19 pandemic, including older adults, and patients with chronic physical and mental health conditions. There has been little focus on the experiences of healthcare teams and no studies have examined IPC practice during the early phase of the COVID-19 pandemic. The objective of the study was to describe the state of interprofessional health provider practice within IPC teams during the COVID-19 pandemic. METHODS: Observational cross-sectional design. A web-based survey was deployed to IPC providers working in team-based primary care clinics in the province of Ontario, Canada. The survey included 26 close-ended and six open-ended questions. Close-ended questions were analyzed using descriptive statistics. Content analysis was used to analyze the open-ended questions. RESULTS: 445 surveys were included in the final analysis. Service delivery shifted from in-person care (77% pre-COVID-19) to telephone (76.5% during the COVID-19 pandemic). Less than half of the respondents (40%) reported receiving any training for virtual delivery. Wait times to access team members were reported to have decreased. There has also been a shift in what IPC providers report as the most commonly seen conditions, with increases in visits related to mental health concerns, acute infections (including COVID-19), social isolation, and resource navigation. Respondents also reported a reduction in healthcare provision for multiple chronic conditions including diabetes, cardiovascular disease, and chronic pain. CONCLUSIONS: IPC teams are rapidly shifting their practice to supporting their patients during the pandemic. A surge in mental health issues has been seen and is expected to continue to increase in response to COVID-19. Understanding early experiences can help plan for future pandemic waves.


Asunto(s)
/epidemiología , Relaciones Interprofesionales , Atención Primaria de Salud/métodos , Estudios Transversales , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Ontario/epidemiología , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Encuestas y Cuestionarios
12.
Br J Gen Pract ; 71(704): e166-e177, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33558332

RESUMEN

BACKGROUND: To reduce contagion of COVID-19, in March 2020 UK general practices implemented predominantly remote consulting via telephone, video, or online consultation platforms. AIM: To investigate the rapid implementation of remote consulting and explore impact over the initial months of the COVID-19 pandemic. DESIGN AND SETTING: Mixed-methods study in 21 general practices in Bristol, North Somerset and South Gloucestershire. METHOD: Longitudinal observational quantitative analysis compared volume and type of consultation in April to July 2020 with April to July 2019. Negative binomial models were used to identify if changes differed among different groups of patients. Qualitative data from 87 longitudinal interviews with practice staff in four rounds investigated practices' experience of the move to remote consulting, challenges faced, and solutions. A thematic analysis utilised Normalisation Process Theory. RESULTS: There was universal consensus that remote consulting was necessary. This drove a rapid change to 90% remote GP consulting (46% for nurses) by April 2020. Consultation rates reduced in April to July 2020 compared to 2019; GPs and nurses maintained a focus on older patients, shielding patients, and patients with poor mental health. Telephone consulting was sufficient for many patient problems, video consulting was used more rarely, and was less essential as lockdown eased. SMS-messaging increased more than three-fold. GPs were concerned about increased clinical risk and some had difficulties setting thresholds for seeing patients face-to-face as lockdown eased. CONCLUSION: The shift to remote consulting was successful and a focus maintained on vulnerable patients. It was driven by the imperative to reduce contagion and may have risks; post-pandemic, the model will need adjustment.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Pautas de la Práctica en Enfermería/tendencias , Pautas de la Práctica en Medicina/tendencias , Atención Primaria de Salud , Consulta Remota/organización & administración , Adulto , Anciano de 80 o más Años , Actitud del Personal de Salud , /prevención & control , Gestión del Cambio , Transmisión de Enfermedad Infecciosa/prevención & control , Femenino , Médicos Generales/estadística & datos numéricos , Humanos , Recién Nacido , Masculino , Atención Primaria de Salud/métodos , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/tendencias , Reino Unido/epidemiología
14.
J Am Board Fam Med ; 34(Suppl): S147-S151, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33622830

RESUMEN

PURPOSE: Examine use of office resources by primary care patients who were initially evaluated through telehealth, telephone, or in-person encounters. METHODS: Retrospective electronic health record review on patients seen in March 2020 for evaluation of potential COVID-19 symptoms, to assess the total number of interactions with physicians and office staff. RESULTS: Of 202 patients, 89 (44%) had initial telehealth, 55 (27%) telephone, and 52 (26%) in-person encounters. Patients initially evaluated through telehealth, telephone, and in-person encounters had a mean of 6.1 (S.D. = 3.7), 5.2 (S.D. = 3.6), and 4.5 (S.D. = 3.0) total interactions with the office, respectively (P = .03), and 9%, 12.7%, and 19.2%, respectively, had a subsequent in-person or emergency department visit (P = .22). Multivariable analysis showed no differences in number of office interactions based on initial visit type; older patients (95% CI = 0.00-0.07) and those with subjective fevers (95% CI = 1.01-3.01) or shortness of breath (95% CI = 0.23-2.28) had more interactions with the office. CONCLUSION: Primary care providers used virtual visits to care for most patients presenting with potential COVID-19 symptoms, with many patients choosing telephone over telehealth visits. Virtual visits can successfully limit patient exposure to other people, and consideration could be given to increasing its use for patients with potential symptoms of COVID-19.


Asunto(s)
/diagnóstico , Atención Primaria de Salud/métodos , Telemedicina/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Visita a Consultorio Médico/estadística & datos numéricos , Pandemias , Estudios Retrospectivos , Teléfono/estadística & datos numéricos , Adulto Joven
15.
J Am Board Fam Med ; 34(Suppl): S170-S178, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33622833

RESUMEN

To respond to the COVID-19 pandemic and recover from its aftermath, primary care teams will face waves of overwhelming demand for information and the need to significantly transform care delivery. INNOVATION: Oregon Health & Science University's primary care team envisioned and implemented the COVID-19 Connected Care Center, a statewide telephone "hotline" service. RESULTS: The hotline has taken more than 5825 calls from patients in 33 of Oregon's 36 counties in less than 3 months. In preliminary survey data, 86% of patients said their questions were answered during the call, 90% would recommend this service, and 70% reported a reduction in stress levels about coronavirus. In qualitative interviews, patients reported their questions answered, short wait times, nurses spent time as needed, and appropriate follow-up was arranged. CONCLUSION: Academic health centers may have the capacity to leverage their extensive resources to rapidly launch a multiphased pandemic response that meets peoples' need for information and access to primary care, while minimizing risk of infection and emergency department use and rapidly supporting primary care teams to make the necessary operational changes to do the same in their communities. Such efforts require external funding in a fee-for-service payment model.


Asunto(s)
Líneas Directas/estadística & datos numéricos , Atención Primaria de Salud/métodos , Telemedicina/organización & administración , Centros Médicos Académicos , /epidemiología , Planes de Aranceles por Servicios , Líneas Directas/organización & administración , Humanos , Oregon/epidemiología , Pandemias , Atención Primaria de Salud/economía , Investigación Cualitativa , Telemedicina/economía , Triaje/métodos
16.
J Am Board Fam Med ; 34(Suppl): S152-S161, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33622831

RESUMEN

INTRODUCTION: With the emergence of COVID-19, many primary care offices closed their physical space to limit exposure. Despite decades of telemedicine in clinical practice, it is rare to find it used in small-metro and academic settings. Following the decision to limit face-to-face care, we tracked our practice's transition to telemedicine. METHODS: This was a prospective quality improvement project following Plan-Do-Study-Act (PDSA) cycles to optimize the use of telemedicine (both telephone and video in this practice) encounters. Central to the PDSA cycles was the use of a post-encounter questionnaire to track patient, appointment, and physician factors. Throughout the cycles, inferential statistics were used to inform process improvement. RESULTS: In Cycle 2, a logistic regression model showed length of encounter, need for physical examination, and physician satisfaction correctly predicted a physician's preferred medium (χ2(3) = 40.56, P < .001). In Cycle 3, a χ2 test showed the reason for visit predicted the preferred medium (χ2(4) = 47.30, P < .001). In cycle 4, week of telemedicine, need for physical examination, length of encounter and physician satisfaction predicted the preferred medium (χ2(9) = 172.52, P < .001). DISCUSSION: Using the variables that predicted preference for telemedicine, we were able to adjust our processes through PDSA cycles. CONCLUSION: Early use of the PDSA cycle allows for informed quality improvement at the local level. Our findings highlight factors to consider when implementing telemedicine such as need for physical examination and type or length of encounter. In addition, physician satisfaction can encourage use of telemedicine, and tools for learning and practicing telemedicine should be available.


Asunto(s)
Actitud del Personal de Salud , Atención Primaria de Salud/métodos , Telemedicina/organización & administración , Humanos , Pandemias , Pautas de la Práctica en Medicina , Estudios Prospectivos , Mejoramiento de la Calidad , Encuestas y Cuestionarios
17.
J Am Board Fam Med ; 34(Suppl): S162-S169, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33622832

RESUMEN

The Coronavirus disease 2019 (COVID 19) pandemic has resulted in a rapid shift to telehealth and many services that need in-person care have been avoided. Yet, as practices and payment policies return to a new normal, there will be many questions about what proportion of visits should be done in-person vs telehealth. Using the 2016 National Ambulatory Medical Survey (NAMCS), we estimated what proportion of visits were amenable to telehealth before COVID-19 as a guide. We divided services into those that needed in-person care and those that could be done via telehealth. Any visit that included at least 1 service where in-person care was needed was counted as an in-person only visit. We then calculated what proportion of reported visits and services in 2016 could have been provided via telehealth, as well as what proportion of in-person only services were done by primary care. We found that 66% of all primary care visits reported in NAMCS in 2016 required an in-person service. 90% of all wellness visits and immunizations were done in primary care offices, as were a quarter of all Papanicolaou smears. As practices reopen, patients will need to catch up on many of the in-person only visits that were postponed such as Papanicolaou smears and wellness visits. At the same time, patients and clinicians now accustomed to telehealth may have reservations about returning to in-person only visits. Our estimates may provide a guide to practices as they navigate how to deliver care in a post-COVID-19 environment.


Asunto(s)
Visita a Consultorio Médico/estadística & datos numéricos , Atención Primaria de Salud/métodos , Telemedicina/estadística & datos numéricos , Atención Ambulatoria/estadística & datos numéricos , Humanos , Pandemias , Telemedicina/tendencias
18.
J Am Board Fam Med ; 34(Suppl): S229-S232, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33622844

RESUMEN

The threat to the public health of the United States from the COVID-19 pandemic is causing rapid, unprecedented shifts in the health care landscape. Community health centers serve the patient populations most vulnerable to the disease yet often have inadequate resources to combat it. Academic medical centers do not always have the community connections needed for the most effective population health approaches. We describe how a bridge between a community health center partner (Roots Community Health Center) and a large academic medical center (Stanford Medicine) brought complementary strengths together to address the regional public health crisis. The 2 institutions began the crisis with an overlapping clinical and research faculty member (NKT). Building on that foundation, we worked in 3 areas. First, we partnered to reach underserved populations with the academic center's newly developed COVID test. Second, we developed and distributed evidence-based resources to these same communities via a large community health navigator team. Third, as telemedicine became the norm for medical consultation, the 2 institutions began to research how reducing the digital divide could help improve access to care. We continue to think about how best to create enduring partnerships forged through ongoing deeper relationships beyond the pandemic.


Asunto(s)
Centros Médicos Académicos/organización & administración , Centros Comunitarios de Salud/organización & administración , Atención Primaria de Salud/métodos , /epidemiología , California/epidemiología , Conducta Cooperativa , Humanos , Pandemias , Telemedicina/organización & administración
20.
Health Qual Life Outcomes ; 19(1): 43, 2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33541383

RESUMEN

BACKGROUND: Multimorbidity is a complex health situation that requires interventions tailored to patient needs; the outcomes of such interventions are difficult to evaluate. The purpose of this study was to describe the outcomes of patient-centred interventions for people with multimorbidity from the patients' and healthcare providers' perspectives. METHODS: This study followed a qualitative descriptive design. Nine patients with multimorbidity and 18 healthcare professionals (nurses, general practitioners, nutritionists, and physical and respiratory therapists), participating in a multimorbidity-adapted intervention in primary care were recruited. Data were collected using semi-structured interviews with 12 open-ended questions. Triangulation of disciplines among interviewers, research team debriefing, data saturation assessment and iterative data collection and analysis ensured a rigorous research process. RESULTS: Outcome constructs described by participants covered a wide range of themes and were grouped into seven outcome domains: Health Management, Physical Health, Functional Status, Psychosocial Health, Health-related Behaviours, General Health and Health Services. The description of constructs by stakeholders provides valuable insight on how outcomes are experienced and worded by patients. CONCLUSION: Participants described a wide range of outcome constructs, which were relevant to and observable by patients and were in line with the clinical reality. The description provides a portrait of multimorbidity-adapted intervention outcomes that are significant for the selection and development of clinical research outcome measures.


Asunto(s)
Enfermedad Crónica/terapia , Multimorbilidad , Medición de Resultados Informados por el Paciente , Atención Dirigida al Paciente/métodos , Atención Primaria de Salud/métodos , Adulto , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Investigación Cualitativa , Calidad de Vida
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