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1.
Surg Clin North Am ; 99(6): 1141-1150, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31676053

RESUMEN

Although improved medical therapies have been associated with decreased rates of emergent intestinal resection for inflammatory bowel disease, prompt diagnosis and management remain of utmost importance to ensure appropriate patient care with reduced morbidity and mortality. Emergent indications for surgery include toxic colitis, acute obstruction, perforation, acute abscess, or massive hemorrhage. Given this broad spectrum of emergent presentations, a multidisciplinary team including surgeons, gastroenterologists, radiologists, nutritional support services, and enterostomal therapists are required for optimal patient care and decision making. Management of each emergency should be individualized based on patient age, disease type and duration, and patient goals of care.


Asunto(s)
Colectomía/métodos , Hemorragia Gastrointestinal/cirugía , Enfermedades Inflamatorias del Intestino/complicaciones , Obstrucción Intestinal/cirugía , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Abdomen Agudo/etiología , Abdomen Agudo/cirugía , Anastomosis Quirúrgica , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/diagnóstico , Colitis Ulcerosa/terapia , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/terapia , Urgencias Médicas , Femenino , Hemorragia Gastrointestinal/etiología , Humanos , Enfermedades Inflamatorias del Intestino/diagnóstico , Obstrucción Intestinal/etiología , Obstrucción Intestinal/fisiopatología , Perforación Intestinal/fisiopatología , Masculino , Grupo de Atención al Paciente/organización & administración , Pronóstico , Medición de Riesgo , Resultado del Tratamiento
2.
Br J Anaesth ; 123(5): 679-687, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31561883

RESUMEN

BACKGROUND: While increased surgical-provider volume has been associated with improved outcomes, research regarding volume-outcome relationships within high-volume institutions and the role of anaesthesiologists is limited. Further, the effect of anaesthesia-care-team composition remains understudied. This analysis aimed to identify the impact of anaesthesiologist and surgeon volume on adverse events after total joint arthroplasties. METHODS: We retrospectively identified 40 437 patients who underwent total joint arthroplasties at a high-volume institution from 2005 to 2014. The main effects of interest were anaesthesiologist and surgeon volume and experience along with anaesthesia-care-team composition. Multivariable logistic regression models were used to evaluate three outcomes: any complication, cardiopulmonary complication, and length of stay (>5 days). Odds ratios (ORs) and 99.75% confidence intervals (CIs) were reported. RESULTS: Across all three models, anaesthesiologist volume and experience, and anaesthesia-care-team composition were not significant predictors. Surgeon annual case volume >50 was associated with significantly reduced odds of any complication (annual case volume: 50-149; OR: 0.80; CI: 0.66-0.98) and prolonged length of stay (OR: 0.69; CI: 0.60-0.80). Surgeon experience >20 yr was associated with significantly reduced odds of prolonged length of stay (OR: 0.85; CI: 0.75-0.95). CONCLUSIONS: Anaesthesiologist volume and experience, and anaesthesia-care-team composition did not impact the odds of an adverse outcome, although a higher surgeon volume was associated with decreased odds of complications and prolonged length of stay. Further study is necessary to determine if these findings can be extrapolated to less specialised, lower volume surgical settings.


Asunto(s)
Anestesiología/estadística & datos numéricos , Artroplastia de Reemplazo de Cadera/normas , Artroplastia de Reemplazo de Rodilla/normas , Competencia Clínica/estadística & datos numéricos , Carga de Trabajo/estadística & datos numéricos , Anciano , Anestesia/métodos , Anestesia/normas , Anestesia/estadística & datos numéricos , Anestesiología/organización & administración , Anestesiología/normas , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Comorbilidad , Femenino , Hospitales de Alto Volumen/normas , Hospitales de Alto Volumen/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , New York/epidemiología , Grupo de Atención al Paciente/organización & administración , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento
3.
Soins Pediatr Pueric ; 40(310): 45-48, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31543235

RESUMEN

Paediatric palliative care has been set up after extensive discussion and observations regarding the need to provide different support to children with a serious and incurable disease as well as their families. The mobile palliative care team support children and their family in this specific process and train caregivers in the palliative approach.


Asunto(s)
Hospitales Pediátricos/organización & administración , Unidades Móviles de Salud/organización & administración , Cuidados Paliativos/organización & administración , Grupo de Atención al Paciente/organización & administración , Niño , Humanos
4.
Urologiia ; (4 ()): 19-24, 2019 Sep.
Artículo en Ruso | MEDLINE | ID: mdl-31535793

RESUMEN

A multidisciplinary approach is currently a necessary and standard approach in treatment of cancer patients. The main goals of the multidisciplinary approach include coordinated highly effective interaction of medical specialists to timely identify, prescribe and conduct planned treatment, as well as prevention and correction of adverse events of treatment to achieve most lasting effect of treatment. The article discusses role of multidisciplinary team, including an oncologist, urologist, pathomorphologist, molecular genetics, radiologist, medical oncologist, radiation therapist, neurosurgeon, orthopedic surgeon, endovascular, thoracic and abdominal surgeons for effective treatment of oncourological patients. To solve existing problems, it is necessary to create common standards for the treatment of oncological diseases, develop and improve an oncological care system, improve logistics and improve skills of specialists or train specialists in the required profile.


Asunto(s)
Grupo de Atención al Paciente/organización & administración , Atención Dirigida al Paciente/organización & administración , Neoplasias Urológicas/terapia , Humanos , Grupo de Atención al Paciente/tendencias , Atención Dirigida al Paciente/tendencias , Médicos , Cirujanos , Resultado del Tratamiento
6.
Presse Med ; 48(7-8 Pt 1): 780-787, 2019.
Artículo en Francés | MEDLINE | ID: mdl-31383383

RESUMEN

Interprofessional simulation-based education is effective for learning non-technical critical care skills and strengthening interprofessional team collaboration to optimize quality of care and patient outcome. Implementation of interprofessional simulation sessions in initial and continuing education is facilitated by a team of "champions" from each discipline/profession to ensure educational quality and logistics. Interprofessional simulation training must be integrated into a broader interprofessional curriculum supported by managers, administrators and clinical colleagues from different professional programs. When conducting interprofessional simulation training, it is essential to account for sociological factors (hierarchy, power, authority, interprofessional conflicts, gender, access to information, professional identity) both in scenario design and debriefing. Teamwork assessment tools in interprofessional simulation training may be used to guide debriefing. The interprofessional simulation setting (in-situ or simulation centre) will be chosen according to the learning objectives and the logistics.


Asunto(s)
Cuidados Críticos/métodos , Educación Médica/métodos , Relaciones Interprofesionales , Grupo de Atención al Paciente , Entrenamiento Simulado , Competencia Clínica , Cuidados Críticos/normas , Curriculum/normas , Educación Médica/normas , Evaluación Educacional/métodos , Humanos , Ciencia de la Implementación , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/normas , Entrenamiento Simulado/métodos , Entrenamiento Simulado/organización & administración , Entrenamiento Simulado/normas
7.
Transplant Proc ; 51(7): 2492-2494, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31405741

RESUMEN

Heart transplantation, one of the treatment options for end-stage heart failure, is still regarded as the gold standard treatment to improve quality and length of life. However, the rapid increase in the number of patients waiting for heart transplantation and the inadequate number of donors makes heart transplantation a less feasible option and increases the need for ventricular assist devices as an alternative. The success of ventricular assist device implantation requires the collaboration of a multidisciplinary team consisting of cardiac surgeons, nurses, ventricular assist device coordinators, cardiologist, cardiac anesthesia specialists, perfusionists, and physiotherapists. Nurses working in different fields such as intensive care units, operating rooms, outpatient clinics, and ventricular assist device coordination units have important responsibilities in multidisciplinary teams. In this study, national and international studies on the responsibilities of nurses for the management and care of ventricular assist devices were reviewed. Nurses undertake many tasks, especially in the postoperative care of patients and in preparing them for discharge. Important responsibilities of nurses in the care of patients with ventricular assist devices include monitoring complications, managing equipment and emergency situations, establishing dressing change protocols, organizing daily life activities, determining rehabilitation needs, ensuring use of medicines, and providing comprehensive discharge education. Organizational and communication skills of nurses working with multidisciplinary teams are very important for the success of the ventricular assist device implantation process.


Asunto(s)
Insuficiencia Cardíaca/enfermería , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar , Grupo de Atención al Paciente/organización & administración , Humanos , Unidades de Cuidados Intensivos/organización & administración , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios/enfermería
8.
Presse Med ; 48(7-8 Pt 1): e209-e215, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31421945

RESUMEN

AIM: Identified Palliative Care Beds (Lits Identifiés Soins Palliatifs - LISPs) is a French specificity. Primarily created to integrate palliative care culture into conventional hospital units, the relevance of this measure became a controversial issue. Nowadays, hospital teams continue to frequently encounter complex situations regarding medical care for palliative patients. To the best of our knowledge, there is only one study, a quantitative one, bridging the gap about that subject. It showed failure in practicing palliative care work around LISP. Our study is based on a qualitative method that complements the quantitative study. It aimed to describe difficulties that limit palliative care practices in managing adult patients in LISP. METHOD: This qualitative exploratory survey was conducted with a sample of health service professionals (n=20), from senior physicians to caregivers. Each semi-structured interview included open questions regarding their experiences, feelings and difficulties with palliative care practices on LISP. It also included closed questions concerning interviewee's demographics and career course. The data for this research were submitted to a two-stage analysis: first, a global review of each interview was performed to identify trends. Then, a detailed breakdown, question by question, was implemented. RESULTS: From a quantitative perspective, the interviews revealed 305 difficulties, indicating the gaps and barriers limiting the implementation of a palliative approach in these services. From a qualitative perspective, five topics raised our attention by their recurrence in discourses: (1) partial knowledge about palliative care definition and legislation mostly due to a lack of training; (2) need for time; (3) need for human resources; (4) need for communication; (5) hard time in transitioning from curative to palliative care. PERSPECTIVE: This survey gives the opportunity to understand health service professionals' difficulties in practicing palliative care in conventional medical services. It raises the central issue of the pricing reform on the health institutes activity. It also provides angles of inquiry to improve LISP effectiveness. This qualitative and descriptive study was designed to explore difficulties in practicing palliative care around LISP. Nevertheless, according to the size of the sample, results will need to be confirmed by a more extensive qualitative survey.


Asunto(s)
Continuidad de la Atención al Paciente , Unidades Hospitalarias/organización & administración , Cuidados Paliativos/organización & administración , Grupo de Atención al Paciente/organización & administración , Pautas de la Práctica en Medicina , Calidad de la Atención de Salud/organización & administración , Adulto , Actitud del Personal de Salud , Cuidadores/organización & administración , Cuidadores/normas , Barreras de Comunicación , Continuidad de la Atención al Paciente/organización & administración , Continuidad de la Atención al Paciente/normas , Prestación de Atención de Salud/métodos , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/normas , Arquitectura y Construcción de Instituciones de Salud/normas , Francia , Conocimientos, Actitudes y Práctica en Salud , Capacidad de Camas en Hospitales , Unidades Hospitalarias/normas , Humanos , Entrevistas como Asunto , Satisfacción en el Trabajo , Cuidados Paliativos/psicología , Cuidados Paliativos/normas , Grupo de Atención al Paciente/normas , Pautas de la Práctica en Medicina/organización & administración , Pautas de la Práctica en Medicina/normas , Investigación Cualitativa , Calidad de la Atención de Salud/normas , Estudios Retrospectivos , Encuestas y Cuestionarios
9.
Reumatol. clín. (Barc.) ; 15(4): 237-241, jul.-ago. 2019. tab
Artículo en Inglés | IBECS | ID: ibc-184417

RESUMEN

Objective: To describe patient's characteristics, the activity and patient's satisfaction with a multidisciplinary care unit in patients with psoriasis and psoriatic arthritis (PsA). Methods: A retrospective medical records review of patients with psoriasis or PsA attended in a multidisciplinary care unit was performed. Included patients were contacted to fulfill a satisfaction questionnaire. A specific electronic database was set up. Data regarding to patients and their baseline characteristics and the activity of the unit were collected. Descriptive analysis were performed. Results: A total of 112 patients with 154 visits were included in almost 3 years, 54% women, with a mean age of 51 years, 43.7% presented hyperlipidemia and 30.4% arterial hypertension. Half of patients were referred due to diagnostic doubts and the other half for therapeutic problems. After the evaluation of the patients, 66 patients (58.9%) met diagnostic criteria for PsA, and 13 (11.6%) of an inflammatory disease other than PsA, and 95% came back to their usual physician. The most ordered test were laboratory tests (75.6% of patients), followed by X-rays in 57 patients (51.3%). In general the number of patients with different treatments increased, and 55.4% and 42% of patients changed their topic and systemic treatments respectively. The level of satisfaction was very high and all of patients considered that their disease was better controlled in this multidisciplinary care unit. Conclusions: This multidisciplinary care unit has improved the care and satisfaction of patients with psoriasis or PsA, and increased collaboration between rheumatology and dermatology departments


Objetivo: Describir las características de los pacientes, la actividad registrada, así como la satisfacción percibida, de una consulta de atención multidisciplinar para pacientes con psoriasis o artritis psoriásica (APs). Métodos: Estudio observacional retrospectivo con revisión de historias clínicas de todos los pacientes atendidos en la consulta de atención multidisciplinar. Se contactó con todos ellos para que contestasen una encuesta de satisfacción. Varios investigadores recogieron datos sociodemográficos y clínicos, así como administrativos incluyendo el número de visitas en una base de datos especialmente generada para este proyecto. Se realizó un análisis descriptivo. Resultados: Se incluyó a 112 pacientes con 154 visitas en casi 3 años, 54% mujeres, y una edad media de 51 años; el 43,7% presentó hiperlipidemia y el 30,4% hipertensión arterial. La mitad fueron referidos por dudas diagnósticas y la otra por problemas terapéuticos. Tras su evaluación, 66 pacientes (58,9%) cumplieron los criterios diagnósticos de APs y 13 (11,6%) de una enfermedad inflamatoria distinta. El 95% regresó a su médico habitual. La pruebas complementarias más solicitadas fueron analíticas (75,6%) y radiografías simples (51,3%). En general, el número de pacientes con nuevos tratamientos aumentó y el 55,4 y el 42% de los pacientes cambiaron sus tratamientos tópico y sistémico, respectivamente. El nivel de satisfacción fue muy alto y todos los pacientes consideraron que su enfermedad estaba mejor controlada en esta unidad. Conclusiones: Esta consulta de atención multidisciplinar ha mejorado el manejo y satisfacción de pacientes con psoriasis o APs y ha incrementado la colaboración entre los servicios de Reumatología y Dermatología


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Psoriasis/terapia , Artritis Psoriásica/terapia , Unidades Hospitalarias/organización & administración , Grupo de Atención al Paciente/organización & administración , Satisfacción del Paciente/estadística & datos numéricos , Estudios Retrospectivos
10.
Implement Sci ; 14(1): 74, 2019 07 23.
Artículo en Inglés | MEDLINE | ID: mdl-31337394

RESUMEN

BACKGROUND: Quality improvement collaboratives (QICs) are widely used to improve healthcare, but there are few studies of long-term sustained improved outcomes, and inconsistent evidence about what factors contribute to success. The aim of the study was to open the black box of QICs and compare characteristics and activities in detail of two differing QICs in relation to their changed outcomes from baseline and the following 3 years. METHODS: Final reports of two QICs-one on heart failure care with five teams, and one on osteoarthritis care with seven teams, including detailed descriptions of improvement projects from each QIC's team, were analysed and coded by 18 QIC characteristics and four team characteristics. Goal variables from each team routinely collected within the Swedish Heart Failure Registry (SwedeHF) and the Better Management of Patients with OsteoArthritis Registry (BOA) at year 2013 (baseline), 2014, 2015 and 2016 were analysed with univariate statistics. RESULTS: The two QICs differed greatly in design. The SwedeHF-QIC involved eight experts and ran for 12 months, whereas the BOA-QIC engaged three experts and ran for 6 months. There were about twice as many activities in the SwedeHF-QIC as in the BOA-QIC and they ranged from standardisation of team coordination to better information and structured follow-ups. The outcome results were heterogeneous within teams and across teams and QICs. Both QICs were highly appreciated by the participants and contributed to their learning, e.g. of improvement methods; however, several teams had already reached goal values when the QICs were launched in 2013. CONCLUSIONS: Even though many QI activities were carried out, it was difficult to see sustained improvements on outcomes. Outcomes as specific measurable aspects of care in need of improvement should be chosen carefully. Activities focusing on adherence to standard care programmes and on increased follow-up of patients seemed to lead to more long-lasting improvements. Although earlier studies showed that data follow-up and measurement skills as well as well-functioning data warehouses contribute to sustained improvements, the present registries' functionality and QICs at this time did not support those aspects sufficiently. Further studies on QICs and their impact on improvement beyond the project time should investigate the effect of those elements in particular.


Asunto(s)
Conducta Cooperativa , Insuficiencia Cardíaca/terapia , Osteoartritis/terapia , Grupo de Atención al Paciente/organización & administración , Mejoramiento de la Calidad/organización & administración , Sistema de Registros , Humanos , Evaluación de Programas y Proyectos de Salud , Suecia , Factores de Tiempo
11.
Am Surg ; 85(6): 663-670, 2019 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-31267909

RESUMEN

Ineffective communication between surgical trainees and attending surgeons is a significant contributor to patient harm. The aim of this study was to evaluate a tool to improve resident-to-attending communication regarding changes in patient clinical status. Ten critical patient events were compiled into a list of triggers for direct attending surgeon notification at a single academic institution. Residents and faculty were surveyed to assess communication before and after implementation of the list. Institution of the triggers list was associated with a nonstatistically significant increase in resident-to-attending notification regarding 7 of 10 critical patient events. There was no reported change in frequency of calls associated with the list's implementation. Most residents felt that the list improved patient care and increased their comfort with calling attending surgeons. Comments were generally positive; however, both groups expressed concern that the list could negatively impact resident autonomy and supervision. Implementing a list of triggers for attending notification of critical patient events subjectively improved resident-to-attending communication in an environment with high baseline levels of communication.


Asunto(s)
Internado y Residencia/organización & administración , Cuerpo Médico de Hospitales/organización & administración , Grupo de Atención al Paciente/organización & administración , Mejoramiento de la Calidad , Encuestas y Cuestionarios , Centros Médicos Académicos , Adulto , Educación de Postgrado en Medicina/organización & administración , Femenino , Humanos , Comunicación Interdisciplinaria , Relaciones Interprofesionales , Masculino , Errores Médicos/prevención & control , Persona de Mediana Edad , Ohio
12.
Women Birth ; 32(5): 449-459, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31345659

RESUMEN

PROBLEM: It is not well known how to prepare new multidisciplinary teams aiming to provide culturally safe maternity care for Aboriginal and Torres Strait Islander families in an urban setting. BACKGROUND: National policies recommend increasing the Aboriginal and Torres Strait Islander workforce and cultural competencies of the non-Indigenous workforce as key drivers of culturally safe care. QUESTION: What are the key learnings from staff experiences establishing multidisciplinary teams aiming to provide culturally safe maternity care that aims to privilege Indigenous ways of knowing, being and doing? METHODS: As part of a larger participatory action research project, semi-structured qualitative interviews were conducted December 2014-April 2015 with 21 Aboriginal and Torres Strait Islander and non-Indigenous healthcare staff. Thematic analysis was used to identify learnings for practice. FINDINGS: Four key learnings were identified for forming new teams aiming to provide culturally safe care: (a) having a shared understanding of what characterises cultural safety in the local program context; (b) understanding and valuing different roles and knowledges people bring to the team; (c) acknowledging the influence of race and culture on staff behaviour; and (d) acting on individual and organisational responsibilities for continuous improvement towards cultural safety. DISCUSSION: We present recommendations from our participatory action research approach to respond to these learnings in practice. CONCLUSION: A deliberate workforce investment at the early stages of team development is crucial when aiming to provide culturally safe maternity care that can respond to the unique needs of Aboriginal and Torres Strait Islander women and families.


Asunto(s)
Continuidad de la Atención al Paciente , Competencia Cultural , Asistencia Sanitaria Culturalmente Competente , Investigación sobre Servicios de Salud/organización & administración , Servicios de Salud Materna/organización & administración , Bienestar Materno/etnología , Grupo de Atención al Paciente/organización & administración , Adulto , Investigación Participativa Basada en la Comunidad , Femenino , Servicios de Salud del Indígena , Disparidades en Atención de Salud , Humanos , Entrevistas como Asunto , Obstetricia , Grupo de Ascendencia Oceánica , Investigación Cualitativa
13.
Br J Nurs ; 28(11): 715-720, 2019 Jun 13.
Artículo en Inglés | MEDLINE | ID: mdl-31188669

RESUMEN

The number of people diagnosed and living with cancer in the UK continues to rise, placing increasing demands on specialist cancer care services. The incidence and prevalence of neuroendocrine tumours (NETs) has increased. An NET remains a rare cancer requiring specialist care and the clinical nurse specialist (CNS) team is ideally placed to support these patients. Oncology clinics are becoming increasingly pressured and the need to think of innovative ways of reducing pressure while maintaining and enhancing the patient's experience is important. A new multidisciplinary team (MDT) systemic anti-cancer therapy (SACT) clinic for NET patients was developed that incorporated a CNS SACT non-medical prescriber (NMP) to improve patient experience and reduce the number of oncologist clinic reviews. Methods and analysis: the clinic was designed and a protocol developed to help ensure safe practice and support for the CNS NMP. The patient experience was prioritised and the medical team was involved in the design. All NMP SACT prescriptions were reviewed and questionnaires were given to patients after 3 months. A questionnaire was also given to all oncologists within the clinic and to the oncology pharmacist for analysis. Findings: 29 SACT NMP prescriptions for 15 patients were written. Patient and medical colleague feedback was positive. Discussion: this experience has helped to highlight the positive impact of innovative clinics that combine the expertise of both independent nurse practitioners and the medical team. This has paved the way for further clinics of this kind within the author's trust and the NET service.


Asunto(s)
Instituciones Oncológicas/organización & administración , Tumores Neuroendocrinos/terapia , Enfermeras Clínicas , Grupo de Atención al Paciente/organización & administración , Encuestas de Atención de la Salud , Humanos , Tumores Neuroendocrinos/epidemiología , Rol de la Enfermera , Investigación en Evaluación de Enfermería , Reino Unido/epidemiología
15.
Healthc Q ; 22(1): 30-35, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31244465

RESUMEN

Older adults and their families often struggle in navigating an increasingly fragmented healthcare system when it becomes increasingly difficult to receive care beyond their homes in the face of advanced illness, frailty and complex care needs. The provision of integrated home-based primary care has demonstrated improved patient and caregiver experiences and reduced healthcare costs when primary care providers collaborate in delivering care as part of larger interprofessional teams. In this trans-Canada portrait of five urban home-based primary care programs, their core features are highlighted to provide a roadmap on how to integrate this form of care into a Patient's Medical Home in partnership with acute and home-care providers.


Asunto(s)
Anciano Frágil , Servicios de Atención de Salud a Domicilio/organización & administración , Atención Primaria de Salud/organización & administración , Anciano , Anciano de 80 o más Años , Canadá , Cuidadores , Servicio de Urgencia en Hospital/estadística & datos numéricos , Visita Domiciliaria , Humanos , Grupo de Atención al Paciente/organización & administración , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/organización & administración , Atención Primaria de Salud/métodos
16.
Healthc Q ; 22(1): 36-41, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31244466

RESUMEN

Collaborative interprofessional primary care (PC) teams are widely seen as an essential attribute of high-performing PC systems (Aggarwal and Hutchinson 2012). Effective PC teams play a key role in the mobilization of healthcare resources and navigation of the health and social care system for their patients. In Ontario, the establishment of Family Health Teams has resulted in the implementation of unique programs that deliver services to palliative and elderly patients with a focus on keeping them at home and out of hospital. Case studies cited in this article highlight two innovative programs in Family Health Teams and provide perspectives on lessons for successful implementation.


Asunto(s)
Servicios de Atención de Salud a Domicilio/organización & administración , Cuidados Paliativos/organización & administración , Anciano , Anciano de 80 o más Años , Servicios de Salud Comunitaria/organización & administración , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Humanos , Ontario , Estudios de Casos Organizacionales , Cuidados Paliativos/estadística & datos numéricos , Grupo de Atención al Paciente/organización & administración , Cuidado Terminal/organización & administración
17.
Int J Med Inform ; 128: 46-52, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31160011

RESUMEN

OBJECTIVE: To develop methods for measuring electronic communication networks in virtual care teams using electronic health records (EHR) access-log data. METHODS: For a convenient sample of 100 surgical colorectal cancer patients, we used time-stamped EHR access-log data extracted from an academic medical center's EHR system to construct communication networks among healthcare professionals (HCPs) in each patient's virtual care team. We measured communication linkages between HCPs using the inverse of the average time between access events in which the source HCPs sent information to and the destination HCPs retrieved information from the EHR system. Social network analysis was used to examine and visualize communication network structures, identify principal care teams, and detect meaningful structural differences across networks. We conducted a non-parametric multivariate analysis of variance (MANOVA) to test the association between care teams' communication network structures and patients' cancer stage and site. RESULTS: The 100 communication networks showed substantial variations in size and structures. Principal care teams, the subset of HCPs who formed the core of the communication networks, had higher proportions of nurses, physicians, and pharmacists and a lower proportion of laboratory medical technologists than the overall networks. The distributions of conditional uniform graph quantiles suggested that our network-construction technique captured meaningful underlying structures that were different from random unstructured networks. MANOVA results found that the networks' topologies were associated with patients' cancer stage and site. CONCLUSIONS: This study demonstrates that it is feasible to use EHR access-log data to measure and examine communication networks in virtual care teams. The proposed methods captured salient communication patterns in care teams that were associated with patients' clinical differences.


Asunto(s)
Comunicación , Redes de Comunicación de Computadores/organización & administración , Registros Electrónicos de Salud/estadística & datos numéricos , Personal de Salud/normas , Grupo de Atención al Paciente/organización & administración , Atención Primaria de Salud/organización & administración , Telemedicina/organización & administración , Humanos
19.
Cien Saude Colet ; 24(5): 1585-1596, 2019 May 30.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31166494

RESUMEN

Therapeutic communities emerged to respond to individuals with substance use disorders. The studies carried out emphasize the importance of the Occupational Therapist in the process of constructing occupational meaning. However, there is a paucity of studies addressing the relevance of this profession in this specific context. To understand the intervention of Occupational Therapy in the Therapeutic Community "Clínica do Outeiro - Portugal", describing the perception of individuals with substance use disorders, Occupational Therapists and other team members. Descriptive-exploratory study with a qualitative approach, by means of a case study research. We used interviews with clients and Occupational Therapists and focus group with the multidisciplinary team to collect data. Occupational Therapy is characterized by the greater proximity it establishes with users, as well as by the dynamism, creativity and motivation it infuses, playing a preponderant role in the (re) structuring of routines, performance of ADL and IADL, leisure and social participation of individuals with substance use disorders. The OT emerges as essential in this community, as a professional who is dedicated to the work of adapting and including the individual in the therapeutic community through the acquisition of the necessary occupational performance skills essential for everyday life in society.


Asunto(s)
Motivación , Terapia Ocupacional/métodos , Trastornos Relacionados con Sustancias/rehabilitación , Grupos Focales , Humanos , Entrevistas como Asunto , Grupo de Atención al Paciente/organización & administración , Portugal , Comunidad Terapéutica
20.
Cien Saude Colet ; 24(5): 1637-1646, 2019 May 30.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31166499

RESUMEN

Changes in the demographic profile over recent decades, especially population aging, have implications for Brazilian public policies. This study aims to analyze how family health strategy teams implement and carry out care for the elderly in a Brazilian municipality. The qualitative field research was conducted by collecting data through semistructured interviews using Minayo as a point of reference and employing thematic content analysis. One observation was that the National Health Policy for Elderly People (Política Nacional de Saúde da Pessoa Idosa - PNSPI) has been facing challenges in its implementation at the municipal level in terms of the lack of specific actions by the PNSPI, limited actions or lack of accessibility, lack of training for health professionals, hiring and management of workers, intersectoral actions, and management. It was concluded that a better outlook for the implementation of the PNSPI in the context of the aging population will require strengthening actions through the precepts of comanagement, an expanded clinic, and health education to increase individuals' independence.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Salud de la Familia , Personal de Salud/organización & administración , Política de Salud , Adulto , Anciano , Brasil , Educación en Salud , Humanos , Entrevistas como Asunto , Grupo de Atención al Paciente/organización & administración , Política Pública
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