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1.
Bull World Health Organ ; 97(8): 570-574, 2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31384075

RESUMEN

Problem: The measures for long-term care prevention that the Japanese government had introduced in 2006 were unsuccessful because of the failures to identify high-risk individuals and to enrol enough participants in the community prevention programme. Approach: The Japanese government shifted its primary strategy from a high-risk strategy to a community-based population strategy in 2015, by reforming the Long-term Care Insurance Act. This act is focusing on community-based care and social determinants of health. The Act and the government's plans for long-term care prevention are inspired by a social participation intervention called ikoino saron, that is gathering salons for people older than 65 years. These salons, managed by local volunteers, are held once or twice a month in communal spaces within walking distance of community members' homes and have a low participation fee. At the gatherings, older people can meet and interact with others through enjoyable, relaxing and sometimes educational programmes. Local setting: Japan has the world's largest ageing population, with 27.7% (35.2 million/126.7 million) of people older than 65 years. Relevant changes: Studies have shown that participation in the salons was associated with a halved incidence in long-term care needs and about one-third reduction in the risk of dementia onset. Evidence also suggests that financially vulnerable older adults were more likely to participate in such interventions. In 2017, 86.5% (1506/1741) of the Japanese municipalities had implemented the salons. Lessons learnt: Integrated care for long-term care prevention should consider interventions targeting the whole community in addition to high-risk individuals.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Promoción de la Salud/organización & administración , Envejecimiento Saludable , Participación Social , Anciano , Anciano de 80 o más Años , Demencia/prevención & control , Femenino , Humanos , Japón/epidemiología , Cuidados a Largo Plazo/organización & administración , Masculino , Determinantes Sociales de la Salud
3.
Cien Saude Colet ; 24(6): 2173-2183, 2019 Jun 27.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31269176

RESUMEN

Primary health centers (PHCs) should consider the demographic and epidemiological profile of the health region to respond to population aging and structure service delivery around networks based on macro and micro-level management to ensure the provision of comprehensive services. A normative evaluation of micro-level management in four PHCs in a health region in the Federal District of Brazil was conducted to inform the development of recommendations for enhancing the delivery of comprehensive and integrated long-term care for older persons. A management evaluation matrix was used where management stages were classified as advanced, intermediate and incipient. The findings show that none of the PHCs were at the advanced stage, three were at the intermediate stage, and one at the incipient stage. The lowest scores were obtained for the subdimensions care model (which was shown to be predominantly traditional) and humanization (fragmentation of care). Lack of infrastructure and staff absenteeism were shown to be constraining factors, while effective communication with local administrators was as facilitating factor. Improvements need to be made in micro-level management to enhance the delivery of comprehensive and timely care to older persons in this health region.


Asunto(s)
Atención Integral de Salud/organización & administración , Prestación de Atención de Salud/organización & administración , Servicios de Salud para Ancianos/organización & administración , Atención Primaria de Salud/organización & administración , Anciano , Envejecimiento , Brasil , Prestación Integrada de Atención de Salud/organización & administración , Humanos , Cuidados a Largo Plazo/organización & administración
4.
Farm Hosp ; 43(4): 140-145, 2019 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-31276444

RESUMEN

OBJECTIVE: To develop a clinical protocol for the use of antipsychotic drugs in dementia patients with  behavioral disturbances that includes prescribing and deprescribing criteria and to assess its  applicability in longterm care institutions. METHOD: The protocol was developed from an interdisciplinary perspective based on a literature  search of the published proposals on antipsychotic drug use in dementia patients. Its applicability to  the antipsychotic deprescribing process was assessed in a single center in a prospective before-after study  with a follow-up of 6 months after the intervention study. RESULTS: A protocol was developed that includes prescribing and deprescribing criteria. The  intervention was performed in 35 patients (21 [60%] female). Antipsychotic treatment was  completely withdrawn in 28 patients (80%) and was reduced to the minimum effective dose in 7  (20%). Treatment was  resumed in 2 patients due to worsening symptoms. The pre- and 6-month post-test results showed that  there were no significant changes in neuropsychiatric symptoms (12.91 ± 12.80 vs 13.76 ± 16.68; P = 0.124). Conclusions: The establishment of a protocol that includes prescribing and deprescribing criteria, in  combination with the incorporation of a pharmacist in the multidisciplinary team, can be effective in  improving the use of these drugs in elderly dementia patients in long-term care institutions.


Asunto(s)
Antipsicóticos/uso terapéutico , Demencia/tratamiento farmacológico , Deprescripciones , Anciano , Anciano de 80 o más Años , Antipsicóticos/administración & dosificación , Síntomas Conductuales , Demencia/psicología , Progresión de la Enfermedad , Femenino , Humanos , Cuidados a Largo Plazo/organización & administración , Masculino , Casas de Salud , Grupo de Atención al Paciente , Estudios Prospectivos
5.
J Clin Nurs ; 28(19-20): 3575-3581, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31162750

RESUMEN

AIMS AND OBJECTIVES: To explore staff reactions to residents' behaviour consisting in exposing their genitals in public, and to differentiate between what is perceived as common practice (what most staff do) and best practice (the best possible approach). BACKGROUND: The presence of inappropriate sexual behaviours (ISBs) in long-term care facilities poses practical and ethical dilemmas since they may impinge on the rights of others (staff and residents) and thus need to be adequately monitored and managed. However, no studies have focused on how staff handle ISBs, and particularly exposing oneself in public. METHODS: A total of 2,175 people working in 152 Spanish LTC facilities participated in the study. They were presented with a vignette describing a resident exposing his/her genitals in public, and they were asked what they think most of their workmates would do and what they think should be done in that situation. The STROBE checklist was used to enhance the quality and transparency of the research. RESULTS: Approximately one-third of participants (32.4%) reported having experienced behaviours such as the one described in the vignette. Staff reactions underline the predominance of restrictive practices. However, if prompted to think in terms of best practice, supportive reactions increased in frequency. Finally, factors such as work position have an influence on perceived common and best practices, with care assistants generally holding more restrictive views than directors or technical staff. CONCLUSIONS: Around one-third of staff members, and particularly those in managerial or technical positions, had witnessed residents exposing their genitals in public. However, there is no common ground among staff regarding the best way to handle the situation. RELEVANCE TO CLINICAL PRACTICE: Our findings stress the importance of organisational policies and workplace training in the management of challenging behaviours such as exposing oneself.


Asunto(s)
Actitud del Personal de Salud , Cuidados a Largo Plazo/organización & administración , Conducta Sexual/psicología , Instituciones de Cuidados Especializados de Enfermería/organización & administración , Adulto , Femenino , Humanos , Masculino , Personal de Enfermería/psicología
6.
Artículo en Inglés | MEDLINE | ID: mdl-31167383

RESUMEN

Despite a rapid increase in both the number of long-term care facilities (LTCFs) and their residents in recent years, the concept of pharmacist-involved medication management is relatively new in South Korea. The objective of this study was to identify the perspectives of non-pharmacy professionals regarding the development of pharmacist-involved medication management in LTCFs. Employing a snowball sampling strategy, this study relied on semi-structured, one-on-one, in-depth interviews with twelve non-pharmacy professionals in LTCFs. The inductive thematic analysis and the constant comparative method were employed for the analysis. Participants revealed the need for pharmacist-involved medication management systems in LTCFs at the intrinsic and environmental levels. Through pharmacist-involved medication management, participants desired "medication review/reconciliation" and "pharmaceutical education/counseling". The barriers to be overcome included "the authorization of pharmacists' roles", "the financial stability of LTCFs", "role awareness among coworkers", and "the professional development of pharmacists". In this study, we advanced our understanding of non-pharmacy professionals' perceptions of pharmacist-involved medication management in LTCFs. The results of this study can be applied in other Asian countries where the development of pharmacist-involved medication management for the institutionalized elderly is relatively new.


Asunto(s)
Cuidados a Largo Plazo/organización & administración , Administración del Tratamiento Farmacológico/organización & administración , Farmacéuticos/organización & administración , Rol Profesional , Anciano , Actitud del Personal de Salud , Consejo , Instituciones de Salud , Humanos , Entrevistas como Asunto , Cuidados a Largo Plazo/normas , Administración del Tratamiento Farmacológico/normas , Farmacéuticos/normas , Investigación Cualitativa , República de Corea
7.
Healthc Q ; 22(1): 14-21, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31244463

RESUMEN

Scandinavian countries are widely acknowledged as leaders in innovative models of care for their aging populations. To learn what might be potentially applicable to the health system in Canada, the Canadian Frailty Network (CFN) led a contingent of government, administrative, research and patient representatives to Denmark to directly observe Danish approaches for providing healthcare for older adults living with frailty. In this paper and based on what we learned from these observations, we discuss healthcare challenges faced by Canada's aging population for which Danish strategies provide clues as to where and how to improve care and system efficiencies, thereby maximizing the value of Canadian healthcare.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Anciano Frágil , Anciano , Anciano de 80 o más Años , Canadá , Disfunción Cognitiva , Dinamarca , Política de Salud , Administración Hospitalaria/métodos , Humanos , Vida Independiente , Cuidados a Largo Plazo/métodos , Cuidados a Largo Plazo/organización & administración , Desnutrición/prevención & control , Centros de Rehabilitación/organización & administración
8.
Artículo en Inglés | MEDLINE | ID: mdl-31212782

RESUMEN

Since the early 1960s, long-term care (LTC) has attracted a broad range of attention from public health practitioners and researchers worldwide and produced a large volume of literature. We conducted a comprehensive scientometric review based on 14,019 LTC articles retrieved from the Web of Science Core Collection database from 1963 to 2018, to explore the status and trends of global LTC research. Using CiteSpace software, we conducted collaboration analysis, document co-citation analysis, and keyword co-occurrence analysis. The results showed a rapid increase in annual LTC publications, while the annual citation counts exhibited an inverted U-shaped relationship with years. The most productive LTC research institutions and authors are located primarily in North American and European countries. A simultaneous analysis of both references and keywords revealed that common LTC hot topics include dementia care, quality of care, prevalence and risk factors, mortality, and randomized controlled trial. In addition, LTC research trends have shifted from the demand side to the supply side, and from basic studies to practical applications. The new research frontiers are frailty in elderly people and dementia care. This study provides an in-depth understanding of the current state, popular themes, trends, and future directions of LTC research worldwide.


Asunto(s)
Investigación Biomédica/estadística & datos numéricos , Investigación Biomédica/tendencias , Salud Global/estadística & datos numéricos , Cuidados a Largo Plazo/organización & administración , Proyectos de Investigación/tendencias , Anciano , Anciano de 80 o más Años , Europa (Continente) , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Proyectos de Investigación/estadística & datos numéricos
9.
Geriatr Gerontol Int ; 19(7): 679-683, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31037823

RESUMEN

AIM: Improving the availability of dental care is essential to maintain older adults' general health and wellbeing. Domiciliary dental care is a feasible alternative. The present study aimed to investigate factors affecting the use of domiciliary dental care among home-dwelling dependent older adults. METHODS: A retrospective nested case-control study was carried out. We identified long-term care recipients who used home care services between April 2012 and March 2014 using Japan's nationwide long-term care service claim database. One-to-one case-control matching was carried out between those with and without domiciliary dental care, based on sex, age and the time home care service use was started. We carried out multivariable conditional logistic regression analyses to assess various factors associated with using domiciliary dental care. RESULTS: We identified 3 377 998 eligible homebound long-term care beneficiaries aged ≥65 years. Of these, 278 302 (8.2%) received domiciliary dental care. Factors associated with a higher probability of receiving domiciliary dental care were: higher level of care need (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.93-2.06), exemption from out-of-pocket payment (OR 1.35, 95% CI 1.32-1.39]), living in a group home (OR 7.93, 95% CI 7.71-8.16), using other domiciliary services such as physician visits (OR 3.15, 95% CI 3.08-3.22) and a large number of dental clinics providing domiciliary dental care in their municipality (OR 1.74, 95% CI 1.70-1.77). Significant barriers to receiving domiciliary dental care were living alone (OR 0.64, 95% CI 0.62-0.66) and dementia (OR 0.89, 95% CI 0.88-0.91). CONCLUSIONS: Our findings might help to improve the availability of dental care in this population. Geriatr Gerontol Int 2019; 19: 679-683.


Asunto(s)
Cuidado Dental para Ancianos , Accesibilidad a los Servicios de Salud/organización & administración , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Personas Imposibilitadas , Cuidados a Largo Plazo , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Cuidado Dental para Ancianos/métodos , Cuidado Dental para Ancianos/estadística & datos numéricos , Femenino , Humanos , Revisión de Utilización de Seguros , Japón/epidemiología , Cuidados a Largo Plazo/métodos , Cuidados a Largo Plazo/organización & administración , Cuidados a Largo Plazo/estadística & datos numéricos , Masculino , Estudios Retrospectivos
10.
BMC Health Serv Res ; 19(1): 310, 2019 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-31092244

RESUMEN

BACKGROUND: Europe's ageing society leads to an increased demand for long-term care, thereby putting a strain on the sustainability of health care systems. The 'Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of Community Care' (IBenC) project aims to develop a new benchmark methodology based on quality of care and cost of care utilization to identify best practices in home care. The study's baseline data, methodology, and rationale are reported. METHODS: Home care organizations in Belgium, Finland, Germany, Iceland, Italy, and the Netherlands, home care clients of 65 years and over receiving home care, and professionals working in these organizations were included. Client data were collected according to a prospective longitudinal design with the interRAI Home Care instrument. Assessments were performed at baseline, after six and 12 months by trained (research) nurses. Characteristics of home care organizations and professionals were collected cross-sectionally with online surveys. RESULTS: Thirty-eight home care organizations, 2884 home care clients, and 1067 professionals were enrolled. Home care clients were mainly female (66.9%), on average 82.9 years (± 7.3). Extensive support in activities of daily living was needed for 41.6% of the sample, and 17.6% suffered cognitive decline. Care professionals were mainly female (93.4%), and over 45 years (52.8%). Considerable country differences were found. CONCLUSION: A unique, international, comprehensive database is established, containing in-depth information on home care organizations, their clients and staff members. The variety of data enables the development of a novel cost-quality benchmark method, based on interRAI-HC data. This benchmark can be used to explore relevant links between organizational efficiency and organizational and staff characteristics.


Asunto(s)
Actividades Cotidianas , Benchmarking , Servicios de Atención de Salud a Domicilio/normas , Cuidados a Largo Plazo/normas , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Europa (Continente) , Femenino , Encuestas de Atención de la Salud , Personal de Salud/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos , Cuidados a Largo Plazo/organización & administración , Masculino , Calidad de la Atención de Salud , Encuestas y Cuestionarios
11.
Geriatr Gerontol Int ; 19(7): 641-646, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31099138

RESUMEN

AIM: To determine the characteristics associated with developing a new need for long-term care among older Taiwanese adults. METHODS: We analyzed the 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging. A total of 1986 persons who were aged ≥70 years and had no disability in activities of daily living or need for long-term care at the baseline served as the study participants. We first identified the potential variables associated with developing a need for long-term care in demographic, socioeconomic, anthropometric, functional status, mental health, medical and global domains based on the literature and our earlier studies. We then carried out univariable logistic regression analyses to identify the variables most strongly associated with developing a new need for long-term care within each domain. Variables showing the strongest association were further analyzed in a forward stepwise multivariable logistic regression model to determine the significant predictors. RESULTS: The multivariable model identified age, sex, doing heavy housework, walking 200 m, carrying out calculation, appetite status, frequency of hospitalizations during the past 12 months, living arrangement and weight loss as significant (P < 0.05) predictors. CONCLUSIONS: The present study identified nine characteristics that predict the subsequent 4-year new need for long-term care of ≥70-year-old Taiwanese adults. Age, sex and functional status are the most powerful predictors. The results are useful for identifying older individuals at risk of developing a new need for long-term care within the next 4 years, enabling implementation of preventive strategies or timely care planning. Geriatr Gerontol Int 2019; 19: 641-646.


Asunto(s)
Certificado de Necesidades/organización & administración , Evaluación Geriátrica , Cuidados a Largo Plazo/organización & administración , Salud Mental/estadística & datos numéricos , Rendimiento Físico Funcional , Factores de Edad , Anciano , Evaluación de la Discapacidad , Femenino , Evaluación Geriátrica/métodos , Evaluación Geriátrica/estadística & datos numéricos , Disparidades en el Estado de Salud , Humanos , Estudios Longitudinales , Masculino , Servicios Preventivos de Salud/métodos , Factores Sexuales , Factores Socioeconómicos , Taiwán/epidemiología
12.
Prof Case Manag ; 24(3): 114-129, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30946248

RESUMEN

PURPOSE/OBJECTIVES: The Centers for Medicare & Medicaid Services (CMS) announced that beginning in 2019, Medicare Advantage (MA) health plans may begin offering additional benefits for nonmedical home services. In 2019, this change impacts the Long-Term Services and Supports (LTSS) landscape dramatically. This 2-part article describes LTSS, its traditional demographic and health care footprint, the regulatory and accreditation landscape, quality measurement and outcomes, and the critical importance of maintaining care continuity for individuals receiving LTSS. The objectives are to: PRIMARY PRACTICE SETTING(S):: Applicable to all health care sectors where case management is practiced. FINDINGS/CONCLUSIONS: Historically, once Medicare recognizes a product or service, managed health plans and commercial insurance carriers follow suit. Professional case managers must become fluent in the language of LTSS, the implications of these CMS changes, and the impact on case management practice across the care continuum. IMPLICATIONS FOR PROFESSIONAL CASE MANAGEMENT PRACTICE: Professional case managers should understand LTSS, especially as it pertains to care transitions and continuity of health care services to our most vulnerable clients.


Asunto(s)
Manejo de Caso/organización & administración , Gestores de Casos/educación , Servicios de Atención de Salud a Domicilio/organización & administración , Cuidados a Largo Plazo/organización & administración , Medicaid/organización & administración , Medicare/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Manejo de Caso/normas , Curriculum , Educación Médica Continua , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos
14.
J Gerontol Nurs ; 45(6): 15-21, 2019 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-30985906

RESUMEN

Intentional rounding (IR) is a strategy used by predominately acute care nursing staff to proactively address patients' needs at regular and consistent intervals. The current project piloted the use of IR with certified nursing assistants (CNAs) on a 60-bed unit of a 120-bed skilled nursing facility (SNF). Using a pre/post intervention design and the Plan-Do-Study-Act (PDSA) framework, the authors measured knowledge of IR's "4Ps" (potty, position, possessions, and pain) and the incidence of falls and lost possessions. Uptake of IR over 10 weeks of implementation and CNAs' perceptions of intervention were also assessed. The pilot showed positive outcomes for each of the five aims. Data suggest that IR was well received by CNAs and changed practice patterns regarding quality, safety, and satisfaction. Based on these findings, replication of this project in other SNFs is recommended, given the current small and underpowered study. [Journal of Gerontological Nursing, 45(6), 15-21.].


Asunto(s)
Enfermería Geriátrica/organización & administración , Asistentes de Enfermería , Casas de Salud , Rondas de Enseñanza/organización & administración , Humanos , Cuidados a Largo Plazo/organización & administración , Proyectos Piloto
15.
PLoS One ; 14(3): e0197789, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30822307

RESUMEN

BACKGROUND AND OBJECTIVES: Nursing or care home characteristics may have a long-term impact on the residents' mortality risks that has not been studied previously. The study's main objective was to assess the association between facility ownership and long-term, all-cause mortality. RESEARCH DESIGN AND METHODS: We conducted a mortality follow-up study on a cohort of 611 nursing-home residents in the city Madrid, Spain, from their 1998-1999 baseline interviews up to September 2013. Residents lived in three types of facilities: public, subsidized and private, which were also sub-classified according to size (number of beds). Residents' information was collected by interviewing the residents themselves, their caregivers and facility physicians. We used time-to-event multivariable models and inverse probability weighting to estimate standardized mortality risk differences. RESULTS: After a 3728 person-year follow-up (median/maximum of 4.8/15.2 years), 519 participants had died. In fully-adjusted models, the standardized mortality risk difference at 5 years of follow-up between medium-sized private facilities and large-sized public facilities was -18.9% (95% confidence interval [CI]: -33.4 to -4.5%), with a median survival (95% CI) of 3.6 (0.5 to 6.8) additional years. The fully-standardized 5-year mortality difference (95% CIs) between for-profit private facilities and not-for-profit public institutions was -15.1% (-31.1% to 0.9%), and the fully-standardized median survival difference (95% CIs) was 3.0 (-1.7 to 7.7) years. DISCUSSION AND IMPLICATIONS: These results are compatible with an association between factors related with the ownership of facilities and the long-term mortality risk of their residents. One of these factors, the facility size, could partly explain this association.


Asunto(s)
Instituciones Privadas de Salud/organización & administración , Hogares para Ancianos/organización & administración , Mortalidad , Casas de Salud/organización & administración , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Instituciones Privadas de Salud/estadística & datos numéricos , Hogares para Ancianos/estadística & datos numéricos , Humanos , Cuidados a Largo Plazo/organización & administración , Cuidados a Largo Plazo/estadística & datos numéricos , Masculino , Casas de Salud/estadística & datos numéricos , Propiedad , España/epidemiología
16.
Artículo en Inglés | MEDLINE | ID: mdl-30836681

RESUMEN

Chronic kidney disease (CKD) has been redefined in the new millennium as any alteration of kidney morphology, function, blood, or urine composition lasting for at least 3 months. This broad definition also encompasses diseases or conditions that are associated with normal kidney function, such as a kidney scarring from an acute pyelonephritis episode or a single kidney, as a result of kidney donation. CKD is a relevant public health problem. According to the 2015 Global Burden of Disease Study, it was the 12th leading cause of death, leading to 1.1 million deaths, worldwide, each year. The role of CKD as a cause of death is evident where renal replacement therapy (RRT) is not available, however, its role in increasing death risk is not easily calculated. RRT consumes about 3⁻5% of the global healthcare budget where dialysis is available without restrictions. While the prevalence of CKD is increasing overall as lifespans extend, being linked to diabetes, hypertension, obesity, and atherosclerosis, CKD is at least partly preventable and its effects may be at least partly counterbalanced by early and appropriate care. We will welcome papers on all aspects of CKD, including organization, cost, and models of care. Papers from developing countries will be particularly welcomed.


Asunto(s)
Bioética , Organizaciones de Planificación en Salud/normas , Cuidados a Largo Plazo/organización & administración , Insuficiencia Renal Crónica/terapia , Organizaciones de Planificación en Salud/tendencias , Humanos , Masculino , Diálisis Renal/economía , Diálisis Renal/ética , Insuficiencia Renal Crónica/economía , Insuficiencia Renal Crónica/epidemiología , Terapia de Reemplazo Renal/economía , Terapia de Reemplazo Renal/ética
17.
JAMA Netw Open ; 2(3): e190230, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30821830

RESUMEN

Importance: Collaborative chronic care models (CCMs) have extensive randomized clinical trial evidence for effectiveness in serious mental illnesses, but little evidence exists regarding their feasibility or effect in typical practice conditions. Objective: To determine the effectiveness of implementation facilitation in establishing the CCM in mental health teams and the impact on health outcomes of team-treated individuals. Design, Setting, and Participants: This quasi-experimental, randomized stepped-wedge implementation trial was conducted from February 2016 through February 2018, in partnership with the US Department of Veterans Affairs (VA) Office of Mental Health and Suicide Prevention. Nine facilities were enrolled from all VA facilities in the United States to receive CCM implementation support. All veterans (n = 5596) treated by designated outpatient general mental health teams were included for hospitalization analyses, and a randomly selected sample (n = 1050) was identified for health status interviews. Individuals with dementia were excluded. Clinicians (n = 62) at the facilities were surveyed, and site process summaries were rated for concordance with the CCM process. The CCM implementation start time was randomly assigned across 3 waves. Data analysis of this evaluable population was performed from June to September 2018. Interventions: Internal-external facilitation, combining a study-funded external facilitator and a facility-funded internal facilitator working with a designated team for 1 year. Main Outcomes and Measures: Facilitation was hypothesized to be associated with improvements in both implementation and intervention outcomes (hybrid type II trial). Implementation outcomes included the clinician Team Development Measure (TDM) and proportion of CCM-concordant team care processes. The study was powered for the primary health outcome, mental component score (MCS). Hospitalization rate was derived from administrative data. Results: The veteran population (n = 5596) included 881 women (15.7%), and the mean (SD) age was 52.2 (14.5) years. The interviewed sample (n = 1050) was similar but was oversampled for women (n = 210 [20.0%]). Facilitation was associated with improvements in TDM subscales for role clarity (53.4%-68.6%; δ = 15.3; 95% CI, 4.4-26.2; P = .01) and team primacy (50.0%-68.6%; δ = 18.6; 95% CI, 8.3-28.9; P = .001). The percentage of CCM-concordant processes achieved varied, ranging from 44% to 89%. No improvement was seen in veteran self-ratings, including the primary outcome. In post hoc analyses, MCS improved in veterans with 3 or more treated mental health diagnoses compared with others (ß = 5.03; 95% CI, 2.24-7.82; P < .001). Mental health hospitalizations demonstrated a robust decrease during facilitation (ß = -0.12; 95% CI, -0.16 to -0.07; P < .001); this finding withstood 4 internal validity tests. Conclusions and Relevance: Implementation facilitation that engages clinicians under typical practice conditions can enhance evidence-based team processes; its effect on self-reported overall population health status was negligible, although health status improved for individuals with complex conditions and hospitalization rate declined. Trial Registration: ClinicalTrials.gov Identifier: NCT02543840.


Asunto(s)
Cuidados a Largo Plazo , Trastornos Mentales , Servicios de Salud Mental/organización & administración , Grupo de Atención al Paciente/organización & administración , Atención Primaria de Salud , Veteranos/psicología , Adulto , Femenino , Disparidades en el Estado de Salud , Humanos , Cuidados a Largo Plazo/métodos , Cuidados a Largo Plazo/organización & administración , Masculino , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Salud Mental/normas , Modelos Organizacionales , Atención Primaria de Salud/métodos , Atención Primaria de Salud/organización & administración , Mejoramiento de la Calidad , Estados Unidos , United States Department of Veterans Affairs/estadística & datos numéricos
18.
BMC Health Serv Res ; 19(1): 159, 2019 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-30866917

RESUMEN

BACKGROUND: Better management of long-term conditions remains a policy priority, with a focus on improving outcomes and reducing use of expensive hospital services. A number of interventions have been tested, but many have failed to show benefit in rigorous comparative research. In 2016, the NHS Test Beds scheme was launched to implement and test interventions combining digital technologies and pathway redesign in routine health care settings, with each intervention comprising multiple innovations to better realise benefit from their 'combinatorial' effect. We present the evaluation of one of the NHS Test Beds, which combined risk stratification algorithms, practice-based quality improvement and health monitoring and coaching to improve management of long-term conditions in a single health economy in the north-west of England. METHODS: The NHS Test Bed was implemented in one clinical commissioning group in the north-west of England (patient population 235,800 served by 36 general practices). Routine administrative data on hospital use (the primary outcome) and a selection of secondary outcomes (data from both hospital and primary care) were collected in the intervention site, and from a comparator area in the same region. We used difference-in-differences analysis to compare outcomes in the NHS Test Bed area and the comparator after initiation of the combinatorial intervention. RESULTS: Tests confirmed the existence of parallel trends in the intervention and comparator sites for hospital outcomes for the period April 2016 to March 2017, and for some of the planned primary care outcomes. Based on 10 months of post-intervention secondary care data and 13 months post-intervention primary care data, we found no significant impact on primary outcomes between the intervention and comparator site, and a significant impact on only one secondary outcome. CONCLUSION: A combinatorial digital and organisational intervention to improve the management of long-term conditions was implemented across a whole health economy, but we found no evidence of a positive impact on health care utilisation outcomes in hospital and primary care.


Asunto(s)
Enfermedad Crónica/terapia , Cuidados a Largo Plazo/organización & administración , Inglaterra , Utilización de Instalaciones y Servicios , Hospitalización/estadística & datos numéricos , Humanos , Cuidados a Largo Plazo/normas , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/normas , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la Calidad , Telemedicina/estadística & datos numéricos
19.
J Adv Nurs ; 75(6): 1306-1315, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30697772

RESUMEN

AIM: To identify the conditions needed to implement nurse practitioners (NP) in long-term care (LTC) in Québec, Canada. DESIGN: A qualitative descriptive study was undertaken. METHODS: Semi-structured interviews (N = 91) and socio-demographic questionnaires were completed with providers and managers from May 2016-March 2017. Nurse practitioner activity logs were compiled at three sites. Content analysis was used. RESULTS: All sites initially implemented a shared care model but not all sites successfully implemented a consultative model. The progression was influenced by physicians' level of comfort in moving towards a consultative model. Weekly meetings with physicians and nurse managers and an office for NPs located near healthcare teams facilitated communication and improved implementation. Half-time NP positions facilitated recruitment. Improvements were noted in timely care for residents, family involvement and quality of documentation of the healthcare team. Regulatory restrictions on prescribing medications used frequently in LTC and daily physician presence at some sites limited implementation. CONCLUSION: The project fostered an understanding of the conditions needed to successfully implement NPs in LTC. An examination of the perspective of residents and families is needed.


Asunto(s)
Cuidados a Largo Plazo/organización & administración , Enfermeras Practicantes/organización & administración , Grupo de Atención al Paciente/organización & administración , Atención Primaria de Salud/organización & administración , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Quebec , Factores Socioeconómicos
20.
Am J Nurs ; 119(2): 32-41, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30640208

RESUMEN

: Hodgkin lymphoma (HL) is a highly curable cancer. Advances in diagnosis and treatment have resulted in excellent cure rates, producing an ever-increasing number of HL survivors who live decades beyond their initial cancer treatment. These survivors, however, are at risk for late effects secondary to the cancer treatments they received years earlier, most notably, subsequent primary cancers, cardiovascular disease, pulmonary toxicity, and endocrine dysfunction. Monitoring and managing such late treatment effects may significantly challenge survivors' long-term health care providers, who may need to take on increased survivorship care. For physicians and nurses working outside of oncology settings, who are increasingly called upon to collaborate with oncologists when caring for HL survivors, understanding the late treatment effects and potential risk factors facing this growing patient population is essential to the provision of comprehensive long-term care. The authors provide an overview of HL, review the most commonly encountered late adverse effects of treatment, and discuss current recommendations for survivor surveillance and screening.


Asunto(s)
Supervivientes de Cáncer/estadística & datos numéricos , Enfermedad de Hodgkin/terapia , Cuidados a Largo Plazo/organización & administración , Grupo de Atención al Paciente/organización & administración , Femenino , Humanos , Masculino , Enfermería Oncológica/organización & administración , Medición de Resultados Informados por el Paciente , Factores de Riesgo
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