RESUMO
BACKGROUND: National guidelines for treatment of asthma include recommendations for providing written asthma action plans (AAPs) to improve outcomes through patient self-management. However, AAP completion rates remain limited in practice. METHODS: We developed a team-based approach for the delivery of care to asthma patients in a primary care setting that involved integration of an electronic clinical quality management system and provision of written AAPs by registered nurses. RESULTS: The percentage of patients with AAPs increased after implementation of clinical reminders and nurse-led provision of written AAPs. CONCLUSION: Proper training, use of an electronic clinical reminder system, and enhanced engagement of registered nurses can improve AAP completion rates in a team-based primary care setting.
Assuntos
Asma/terapia , Comportamento Cooperativo , Gerenciamento Clínico , Comunicação Interdisciplinar , Planejamento de Assistência ao Paciente , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Centros Médicos Acadêmicos , Instituições de Assistência Ambulatorial , Registros Eletrônicos de Saúde , Medicina Baseada em Evidências , Fidelidade a Diretrizes , Humanos , Michigan , Planos de Incentivos Médicos/organização & administração , Padrões de Prática Médica , Melhoria de Qualidade/organização & administração , Sistemas de Alerta , Autocuidado/métodos , Gestão da Qualidade Total/organização & administraçãoRESUMO
Macrocytosis, generally defined as a mean corpuscular volume greater than 100 fL, is frequently encountered when a complete blood count is performed. The most common etiologies are alcoholism, vitamin B12 and folate deficiencies, and medications. History and physical examination, vitamin B12 level, reticulocyte count, and a peripheral smear are helpful in delineating the underlying cause of macrocytosis. When the peripheral smear indicates megaloblastic anemia (demonstrated by macro-ovalocytes and hyper-segmented neutrophils), vitamin B12 or folate deficiency is the most likely cause. When the peripheral smear is non-megaloblastic, the reticulocyte count helps differentiate between drug or alcohol toxicity and hemolysis or hemorrhage. Of other possible etiologies, hypothyroidism, liver disease, and primary bone marrow dysplasias (including myelodysplasia and myeloproliferative disorders) are some of the more common causes.
