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1.
Isr Med Assoc J ; 12(21): 796-800, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31814342

RESUMO

BACKGROUND: The use of graphic depictions (pictorials) to represent medical conditions is an accepted method that can complement standard methodology of comprehensive geriatric assessment. OBJECTIVES: To use the clinical pathway method to develop a comprehensive geriatric genogram assessment tool (CGGAT), which could supplement the written summary letter and recommendations. METHODS: We used the critical paths method to develop a tool to facilitate implementation of the comprehensive geriatric assessment recommendations. A multidisciplinary group of clinicians used the critical pathways method to develop a CGGAT. RESULTS: We used the CGGAT to depict the physical and functional status of patients and to complement the textual historical information, family dynamics, and current patient issues. CGGAT is a simple instrument that provides a visual structure and it can facilitate the sharing of information among team members, encourage interdisciplinary dialogue, enhance understanding and adherence on the part of patients and professionals, and reduce the burden on the clinicians who conduct the initial comprehensive geriatric assessment. CONCLUSIONS: We showed the benefits and obstacles related to the adaptation of this new tool and provide recommendations for further development.


Assuntos
Assistência Integral à Saúde/métodos , Gráficos por Computador , Procedimentos Clínicos , Avaliação Geriátrica/métodos , Idoso , Meio Ambiente , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Avaliação Nutricional , Equipe de Assistência ao Paciente/organização & administração , Testes Psicológicos
3.
Harefuah ; 158(10): 664-668, 2019 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-31576714

RESUMO

INTRODUCTION: Professional burnout of physicians is common and culminates in the residency period. Burnout affects the doctor's health and quality of life, and it is associated with worse patient outcomes and an increase in the incidence of medical errors. The Israeli Ministry of Health recently conducted a survey on the burnout of health professionals in Israel and showed the extent of the phenomena, calling on health organizations to provide actions in order to reduce or prevent it. In the Department of Family Medicine at Ben-Gurion University of the Negev, there is a four-year course for family medicine residents in which we teach various clinical and psychosocial topics essential for the family medicine profession. As part of this course, we set up a program to prevent burnout. Four "mini-courses" were chosen and integrated into the course curriculum for family medicine residents: "Healers' art™", "meaning in medicine ", narrative medicine and reflective writing, mindfulness, meditation and relaxation techniques. In addition, the Balint groups continued to exist during the 3rd and 4th year of residence. Health institutions and organizations are committed, as part of the interventions to improve medical quality and patient safety, to detect and monitor the burnout of doctors and to offer changes in the work environment and interventions to prevent burnout. Although it is difficult to examine the long-term effects of these courses, the residents were very satisfied with the burnout prevention courses. There is a need to step up interventions and build a research and follow-up program to assess the short and long-term outcomes of these experiences on the physicians' well-being and patients' safety.


Assuntos
Esgotamento Profissional , Medicina de Família e Comunidade , Internato e Residência , Esgotamento Psicológico , Humanos , Israel , Qualidade de Vida
4.
J Am Geriatr Soc ; 66(9): 1684-1691, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30183066

RESUMO

OBJECTIVES: To compare the prevalence of cardiovascular diseases and risk factors in Holocaust survivors with that of Jewish immigrants from Europe and America. DESIGN: Population-based, cross-sectional study. SETTING: Clalit, a large Israeli healthcare provider. PARTICIPANTS: Holocaust survivors (n=83,971) and a comparison group of Jewish individuals born in North or South America or European countries not under Nazi occupation or who immigrated to Israel before 1939 (n=16,058) (mean age 84±7, 61% female) MEASUREMENTS: Univariate and multivariable logistic regression analyses of cardiovascular diseases and risk factors. Matching the comparison group to Holocaust Survivors on propensity scores for exposure. RESULTS: The prevalence of ischemic heart disease (38.7% vs 31.3%), congestive heart failure (10.9% vs 9.1%), past stroke (15.7% vs 13.4%), and peripheral vascular disease (9.5% vs 7.9%) was higher in Holocaust survivors (p<.001 for all comparisons). Similar results were found for cardiovascular risk factors (diabetes mellitus (14.4% vs 13.6%), hypertension (89.3% vs 86.4%), dyslipidemia (75.9% vs 74.0%) (p<.001 for all comparisons). In multivariable analysis, matched on propensity scores and controlled for confounders, odds ratios for men and women were higher for diabetes (1.23, 1.55), dyslipidemia (1.53, 1.51), hypertension (1.56 , 1.94), stroke (1.18, 1.17), and ischemic heart disease (1.18, 1,40), but not congestive heart failure (0.95, 1.02). A Positive association was noted for peripheral vascular disease in males (1.20) but not females (0.96). CONCLUSION: Prevalence of cardiovascular diseases and risk factors was higher in Holocaust survivors. These associations were stronger in women in most cases.


Assuntos
Doenças Cardiovasculares/epidemiologia , Holocausto , Judeus/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/etiologia , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Israel/epidemiologia , Masculino , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia
5.
BMC Med Educ ; 18(1): 86, 2018 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-29716587

RESUMO

BACKGROUND: Involvement of clinicians in biomedical research is imperative for the future of healthcare. Several factors influence clinicians' inclination towards research: the medical school experience, exposure to research article reading and writing, and knowledge of research. This cohort study follows up medical students at time of graduation to explore changes in their inclination towards research and pursuing a research career compared to their inclination at time of entry into medical school. METHODS: Students from medical schools in six different countries were enrolled in their first year of school and followed-up upon graduation in their final year. Students answered the same self-administered questionnaire at both time points. Changes in inclination towards research and pursuing a research career were assessed. Factors correlated with these changes were analysed. RESULTS: Of the 777 medical students who responded to the study questionnaire at entry into medical school, 332 (42.7%) completed the follow-up survey. Among these 332 students, there was no significant increase in inclination towards research or pursuing a research career over the course of their medical schooling. Students from a United States based school, in contrast to those from schools other countries, were more likely to report having research role models to guide them (51.5% vs. 0%-26.4%) and to have published in a peer-reviewed journal (75.7% vs. 8.9%-45%). Absence of a role model was significantly associated with a decrease in inclination towards research, while an increased desire to learn more about statistics was significantly associated with an increase in inclination towards pursuing a research career. CONCLUSION: Most medical students did not experience changes in their inclination towards research or pursuing a research career over the course of their medical schooling. Factors that increased their inclination to undertaking research or pursuing a research career were availability of a good role model, and a good knowledge of both the research process and the analytical tools required.


Assuntos
Pesquisa Biomédica , Escolha da Profissão , Pesquisadores/educação , Estudantes de Medicina/psicologia , Adolescente , Adulto , Feminino , Humanos , Internacionalidade , Masculino , Mentores , Papel Profissional , Estudos Prospectivos , Pesquisa , Pesquisadores/psicologia , Faculdades de Medicina/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
6.
Eur J Cancer ; 95: 85-92, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29655060

RESUMO

BACKGROUND: The purpose of this study was to examine the incidence of malignant diseases among Holocaust survivors in Israel compared with European and American immigrants who did not experience the Holocaust. METHODS: Study subjects included Holocaust survivors born in European countries under Nazi occupation before 1945, who immigrated to Israel after 1945 and were alive as of the year 2000. Living survivors were identified based on recognition criteria in accordance with the Holocaust Survivor Benefits Law. The comparison group consisted of Clalit enrollees who were born before 1945 in European countries not under Nazi occupation and were alive in 2000 or were born in any European country or America, immigrated to Israel before 1939 and were alive in 2000. The incidence of malignant diseases was compared in univariate and Poisson regression models analyses, controlling for age, smoking, obesity, diabetes and place of residence. RESULTS: The study included 294,543 Holocaust survivors, and the mean age at the beginning of follow-up was 74 ± 8.7 years; 43% males. In multivariable analyses, the rate ratio (RR) values for males and females were 1.9 and 1.3 for colon cancer, 1.9 and 1.4 for lung cancer, 1.6 and 1.4 for bladder cancer and 1.2 and 1.3 for melanoma, respectively. For prostate cancer in males, the RR was 1.4, while for breast cancer in females, it was 1.2. CONCLUSIONS: The incidence of malignant diseases among Holocaust survivors residing in Israel was higher than that among non-Holocaust survivors. These associations remained statistically significant in a multivariable analysis and were stronger for males.


Assuntos
Holocausto , Neoplasias/epidemiologia , Sobreviventes/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Israel/epidemiologia , Judeus/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
7.
Fam Pract ; 33(6): 626-632, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27591746

RESUMO

BACKGROUND: Receiving physician advice (PA) can increase patient's willingness to quit smoking and influence the 'stages of change' in quitting. However, less is known about this association among minority groups for whom cessation is more challenging. OBJECTIVE: We examined whether receiving advice on smoking cessation from a family physician is associated with the 'stages of change' in quitting smoking-i.e. pre-contemplation, contemplation, preparation or action-among Arab minority men in Israel with high smoking prevalence. METHODS: In 2011-12, a stratified random sample of 964 Arab men current and past smokers, aged 18-64, were interviewed face-to-face. We used ordered logistic regression models to examine the association between PA and stages of quitting smoking, adjusted for socioeconomic status, health status, sociodemographics, Health Maintenance Organizations (HMO) and smoking-related variables. RESULTS: About 40% of Arab men reported ever receiving PA to quit smoking. Participants with chronic disease(s) and higher nicotine dependence were more likely to receive PA. PA was significantly associated with the stages of change, but not with actual quitting. In multivariable analysis, receiving PA was associated with a greater likelihood of being at the contemplation or preparation stages of cessation, compared to pre-contemplation; odds ratio (OR) and 95% confidence interval (CI) were 1.95 (95% CI = 1.34-2.85) and 1.14 (95% CI = 1.09-2.076), respectively. CONCLUSIONS: Receiving PA among minority men is associated with advanced motivational stages of change in quitting smoking, but not with actual smoking cessation. Culturally, sensitive interventions and involvement of other health care providers may be considered for more comprehensive smoking cessation, in addition to PA.


Assuntos
Árabes/psicologia , Aconselhamento Diretivo , Medicina de Família e Comunidade , Grupos Minoritários/psicologia , Abandono do Hábito de Fumar/psicologia , Adolescente , Adulto , Fatores Etários , Doença Crônica/psicologia , Escolaridade , Humanos , Israel , Masculino , Estado Civil , Pessoa de Meia-Idade , Abandono do Hábito de Fumar/etnologia , Adulto Jovem
8.
Arch Gerontol Geriatr ; 64: 115-22, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26849347

RESUMO

AIM: To assess the effect of moving the geriatric consultation from the primary care clinic to another setting, on the rate of implementation of geriatric recommendations by family physicians. METHODS: A retrospective review of the computerized medical records of elderly patients in four primary care clinics. The rate of implementation of geriatric recommendations was compared between clinics in which a geriatric consultant was physically present (control clinics) and a clinic where the consultation took place elsewhere (study clinic). In addition, the results of the present study were compared to a previous study in which the geriatric consultation was carried out in the study clinic and the family doctor was an active participant. RESULTS: 127 computerized files were reviewed in the study clinic and 133 in the control clinics. The mean age of the patients was 81.1±6.3 years and 63.1% were women. The overall implementation of geriatric recommendations by family doctors in the study clinic was 55.9%, a statistically significant decrease compared to the previous study where the rate was 73.9% (p<0.0001). In contrast, there was no change in the implementation rate in the control clinics at 65.0% in the present study and 59.9% in the previous one (p=0.205). CONCLUSIONS: Direct, person-to-person contact between the geriatric consultant and the family doctor has a beneficial effect on the implementation of geriatric recommendations. This should be considered by healthcare policy makers when planning geriatric services in the community.


Assuntos
Consultores , Geriatria/métodos , Médicos de Família , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Serviços de Saúde Comunitária , Continuidade da Assistência ao Paciente , Feminino , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Papel do Médico , Estudos Retrospectivos
9.
Isr J Psychiatry Relat Sci ; 53(1): 63-70, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28856882

RESUMO

BACKGROUND: Approximately half the patients seeking mental health (MH) treatment consult primary care practitioners (PCPs). Previous research indicates that patients often do not receive correct MH diagnoses or appropriate treatment from PCPs. The present study examines whether a specialization in family medicine compared to other or no PCP residency programs enhances physicians' ability to detect, diagnose and treat MH problems. METHODS: Face-to-face interviews with 49 physicans in eight clinics in Israel. Two case vignettes and questionnaires assess MH awareness and factors influencing treatment. RESULTS: Significantly more family practitioners (FPs) compared to others correctly diagnosed depression and anxiety vignettes were aware of patients' MH problems and prescribed psychotropic drugs. LIMITATIONS: Small sample size, indirect examination of PCPs' skills using vignettes and the absence of psychotherapy options. CONCLUSIONS: FPs are more likely than other PCPs to detect, diagnose and treat MH problems. To improve MH detection among a broad range of PCPs, an expanded MH curriculum should be encouraged. Additional MH training should be available for all PCPs.

10.
Isr J Psychiatry Relat Sci ; 52(2): 137-44, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26431419

RESUMO

OBJECTIVES: The objective of this study was to highlight and assess the important topic of the voluntary departure of the physician from his/her clinic. We used the topic of the voluntary departure of a family physician from the clinic as an example. The physician's leaving challenges the personal credo regarding the continuity of care, which is a basic concept in Family Medicine, and other professions, too: Psychiatrists are also devoted to long-term doctor-patient care. Leaving a place of work is a significant life event that can be accompanied by stress and even a crisis for the doctor, patients, and staff. METHODS: In this article, we will present four stories, of four family physicians who voluntarily left their practices, written from a reflective point of view, either before or after the actual departure. The stories will be analyzed in a qualitative way, and the central themes and narratives will be defined. RESULTS: The personal departure stories revealed important personal and systemic themes that emerge from and influence the departure process. Among the themes were: practical and emotional work circumstances; leaving as a grief process; and reactions of patients, staff, and management. CONCLUSION: Qualitative analysis revealed that the voluntary departure of the family physician has complex personal and systemic implications. PRACTICAL IMPLICATIONS: The combination of Balint group discussions and written reflections can help the physician better cope with the departure and also help patients and staff deal with the separation process.


Assuntos
Medicina de Família e Comunidade , Relações Médico-Paciente , Médicos/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Narrativas Pessoais como Assunto
11.
Ann Hematol ; 94(11): 1777-84, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26211919

RESUMO

There are inequalities in health indicators among different ethnic groups living in the same region and receiving the same medical services. Anemia is a global problem. Although the prevalence of anemia is not high in Israel, differences among ethnic groups have not been studied. Our objective was to assess anemia among Bedouin and Jewish women of childbearing age in southern Israel. A retrospective observational study was conducted based on data from computerized medical records. Seven thousand eight hundred seventy-one women in the study clinics underwent complete blood counts and had blood hemoglobin levels of 11 g/dl or below. The Jewish patients were older (31.7 vs. 29.7 years, P < 0.001), practiced birth control more (24.2 vs. 9.9 %, P < 0.001), and adhered to it more (81.1 vs. 61.9 %, P < 0.001). Bedouin women had more children (3.7 vs. 1.9, P < 0.001), and more Bedouin women were pregnant during the study period (49.3 vs. 35.0 %, P < 0.001). The most prevalent types of anemia were iron deficiency and anemia of chronic disease. Two types of anemia were proportionally higher among Jewish women, anemia of chronic disease (18.1 vs. 9.7 %, P < 0.001) and folic acid deficiency (3.3 vs. 2.2 %, P > 0.001). The adherence rates for treatment were very low. Three factors associated with severe anemia (hemoglobin below 8 g/dl) were being Bedouin (odds ratio (OR) = 1.295, P < 0.001), use of birth control (OR = 0.419, P < 0.001), and pregnancy (OR = 0.447, P < 0.001). Being a Bedouin woman is a risk factor for severe anemia, and adherence to treatment for anemia is very low in both groups. These findings should be addressed in a national program to reduce health inequalities.


Assuntos
Anemia/etnologia , Árabes/estatística & dados numéricos , Judeus/estatística & dados numéricos , Adolescente , Adulto , Anemia/epidemiologia , Doença Crônica , Feminino , Humanos , Israel/epidemiologia , Pessoa de Meia-Idade , Gravidez , Complicações Hematológicas na Gravidez/etnologia , Prevalência , Estudos Retrospectivos , Fatores Socioeconômicos , Adulto Jovem
12.
J Diabetes ; 7(4): 531-9, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25223990

RESUMO

BACKGROUND: An increase in the prevalence of type 2 diabetes mellitus occurs in immigrants from developing regions to Western countries. However, the dynamics of these transitions in relation to the duration of residence in the new environment are not clearly defined. METHODS: Data concerning cardiovascular risk factors were retrospectively extracted from medical charts of 736 Ethiopian immigrants and 575 randomly-chosen, age and sex matched non-Ethiopian subjects ("reference group"). Ethiopian immigrants were designated "established" (≥ 20 years of residence), "intermediate" (10-15 years of residence), or "recent" (<10 years of residence). RESULTS: Compared to non-Ethiopians, the age- and sex-adjusted odds ratio (OR) for diabetes was 1.00 (95%CI: 0.66-1.49) for established, 0.55 (95%CI: 0.29-1.03) for intermediate, and 0.15 (95%CI: 0.04-0.50) for recent immigrants (P < 0.001). The corresponding OR for hypertension was 0.94 (95%CI: 0.68-1.31), 0.42 (95%CI: 0.26-0.69), and 0.14 (95%CI: 0.06-0.30) for the established, intermediate, and recent immigrants respectively (P < 0.001). In contrast to the gradual increase in prevalence of diabetes and hypertension, the Ethiopian immigrants maintained their lower body mass index (BMI) (28.7 ± 5 vs 25.5 ± 5 kg/m(2) respectively, P < 0.001) and serum low-density-lipoprotein cholesterol (129 ± 36 vs 118 ± 34 mg/dL, P < 0.001) compared to the non-Ethiopians even after 20 years of residence in Israel. CONCLUSIONS: The prevalence of diabetes and hypertension among the immigrants increased to about half that of the local population within 15 years and became equal to that of the local population after a time-lag of 20 years. These metabolic derangements occurred despite maintaining desirable BMI levels, reinforcing the need for re-defining optimal BMI ranges in relation to the ethnic origin.


Assuntos
Migração Humana , Metabolismo , África , Humanos
13.
Isr J Health Policy Res ; 2(1): 31, 2013 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-23947591

RESUMO

BACKGROUND: Compassion fatigue among health care professionals has gained interest over the past decade. Compassion fatigue, as well as burnout, has been associated with depersonalization and suboptimal patient care. Professional caregivers in general are exposed to the risk of compassion fatigue (CF), burnout (BO) and low levels of compassion satisfaction (CS). While CF has been studied in health care professionals, few publications address its incidence among family physicians, specifically. The objectives of this study were to assess the prevalence and severity of CF among family practitioners (FPs) in the Negev (Israel's southern region), evaluating the correlations between CF, BO and CS and their relations with socio-demographic variables and work related characteristics. METHODS: Self-report anonymous Compassion Satisfaction and Fatigue Test questionnaires (CSFT) measuring CF, BO, and CS were distributed among 194 family physicians at Clalit Health Services clinics in the Negev between July 2007 and April 2008. Correlations between CF, BO and CS were assessed. Multivariable logistic regression models with backward elimination were constructed. RESULTS: 128 (66%) physicians responded. 46.1% of respondents scored extremely high and high for CF, 21.1% scored low for CS and 9.4% scored high for BO. Strong correlations were found between BO and CF (r = 0.769, p < 0.001), and between BO and CS (r = -0.241, p = 0.006), but no correlation was found between CS and CF. The logistic regression model showed that the only factor associated with a significantly increased risk for CF was former immigration to Israel. Increased risk for BO was associated with female gender, history of personal trauma and lack of academic affiliation. Higher CS was associated with holding management positions and teaching residents. CONCLUSIONS AND POLICY RECOMMENDATIONS: Family physicians in the Negev are at high risk for CF, with the potential for CF- associated patient dissatisfaction, compromised patient safety and increased medical error. We propose creation of a CF educational and early intervention treatment program for family physicians and other health care professionals. Such programs would train facilitators of physician well-being and resiliency building. We also recommend analyzing contributing variables and organizational factors related to higher CF. Policy recommendations include integrating such programs within required risk management continuing medical education.

14.
Can J Aging ; 32(3): 287-97, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23915947

RESUMO

Discordance between self-reports and medical records reflects patient and provider factors that have implications for management and research. This study investigated discordance and socio-demographic factors that explain concordance. A purposive sample of 402 disabled older persons was interviewed using a structured questionnaire. The highest concordances were found for diabetes, cardiovascular accident (CVA), and cancer while the lowest were evident for arthritis, and renal and gastrointestinal conditions. Significant explanatory factors included (a) age for explaining concordance in hypertension; (b) ethnicity in explaining concordance in arthritis and cancer; (c) marital status in explaining concordance in thyroid diseases; (d) education in explaining concordance in gastrointestinal conditions; and (e) functional status in explaining concordance in respiratory, gastrointestinal, and thyroid diseases. Co-morbidity increased concordance for all health conditions and decreased concordance for hypertension. Further investigation is needed to examine the reasons for the disparities between the two sources of information.


Assuntos
Comorbidade , Pessoas com Deficiência/estatística & dados numéricos , Autorrelato/normas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Escolaridade , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Inquéritos e Questionários
15.
Gerontologist ; 53(1): 123-32, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22421915

RESUMO

PURPOSE: Based on the medical offset effect, the goal of the study was to examine the extent to which users and nonusers of adult day care centers (ADCC) differ in frequency of use of out-patient health services (visits to specialists) and in-patient health services (number of hospital admissions, length of hospitalizations, and visits to emergency departments). DESIGN AND METHODS: A case-control study was used with a sample of 800 respondents, of whom 400 were users of 13 day care centers in the southern region of Israel and 400 were nonusers, matched by age, gender, and active family physician. Data collection included face-to-face interviews using a structured questionnaire. Data on health care service utilization were drawn from the central computerized data of one of the health care organizations in Israel. RESULTS: Although users of ADCC significantly differed from nonusers in socioeconomic characteristics, they did not significantly differ from nonusers in the magnitude of health care services' utilization. Utilization of health care services was rather connected with morbidity rather than with use of ADCC. Therefore, no offset effect was found. IMPLICATIONS: The current form of ADCC in Israel focuses mainly on meeting social needs of the participants and therefore do not meet the their actual health needs. Therefore, inclusion of health services within ADCC may have an offset effect, but this necessitates further examination.


Assuntos
Hospital Dia/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Pessoas com Deficiência , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Entrevistas como Assunto , Israel , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários
17.
J Appl Gerontol ; 32(5): 561-81, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25474762

RESUMO

The article aims to (a) examine the reasons for nonuse of ADCC, and (b) explore the reasons for use of adult day care centers (ADCCs) among users. The sample includes 819 respondents of whom 417 are users of 13 day care centers and 402 are nonusers, matched by age, gender, and family physician in the southern region of Israel. Data collection includes interviews that used a structured questionnaire. The most frequent reasons for nonuse of ADCCs are accessibility barriers, characteristics of participants and of the ADCCs, "no need for this service," and personal difficulties. Those who use this service report that it improved their well-being, met their needs, enabled them to establish social relationships, and alleviated their family caregivers' burden. ADCCs should be more responsive to the needs of various constituencies of frail older adults and be more accessible to those who do not use this type of service.


Assuntos
Hospital Dia/estatística & dados numéricos , Atividades Cotidianas , Idoso/psicologia , Idoso/estatística & dados numéricos , Idoso de 80 Anos ou mais , Hospital Dia/psicologia , Feminino , Idoso Fragilizado/psicologia , Idoso Fragilizado/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Israel , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e Questionários
18.
Geriatr Gerontol Int ; 12(4): 725-32, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22360493

RESUMO

BACKGROUND: Geriatric consultation services are generally beneficial in improving the health and well-being of the elderly. We prospectively studied whether the active participation of family physicians (FPs) in the process of geriatric consultation would improve implementation rates and benefit the health care of the elderly. METHODS: We carried out a comparative prospective intervention study in three urban academic family medicine clinics. Patients in the control clinics were evaluated by the consultant geriatrician, and a summary of the findings and recommendations were presented to the FP in a brief meeting. In the intervention clinic, the referring FP joined the geriatrician throughout the geriatric assessment. The percentage of implementation of suggested recommendations was evaluated. Information regarding the utilization of health services was provided from computerized data. RESULTS: Of the 212 patients included in the study, 107 were in the intervention group and 105 were controls. The overall rate of implementation was significantly higher for patients in the intervention group (329/445; 73.9%) than for patients in the control group (232/387; 59.9%), P < 0.0001. In the year after the geriatric assessment, those in the intervention group visited the FP less often. CONCLUSIONS: A model co-consultation actively involving the FP in the process of assessment of the older patient by the geriatrician improves the degree of implementation of recommendations without an increase in related heath care utilization and costs. This model should be further developed and studied.


Assuntos
Avaliação Geriátrica , Papel do Médico , Médicos de Família , Encaminhamento e Consulta , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Feminino , Humanos , Israel , Masculino , Estudos Prospectivos
19.
Int Psychogeriatr ; 24(3): 439-48, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21996017

RESUMO

BACKGROUND: Loneliness is widespread among older adults, in particular among those who are chronically ill and functionally limited. The aims of the paper are: (i) to examine the extent to which users of day care centers experience loneliness compared to their peers who are non-users; and (ii) to explore the relationships between length of use and frequency of weekly attendance at day care centers and loneliness among users of day care centers. METHODS: A case-control study was used with a sample of 817 respondents of whom 417 were users of 13 day care centers and 400 were non-users, matched by age, gender, and family physician in the southern region of Israel. Data collection included face-to-face interviews using a structured questionnaire. RESULTS: The vast majority in both groups (79.3% and 76.3%, respectively) reported moderate to severe levels of loneliness. Perceived economic status and self-rated health were the most significant variables in explaining loneliness. No significant differences were found between users and non-users of day care centers in the level of loneliness. Attendance at day care centers, as well as length and frequency of use, had no significant association with loneliness. CONCLUSION: More research, which will include quasi-experimental and longitudinal research designs, is necessary to examine the causal relationships between attendance at day care centers and loneliness. This can provide information on the effectiveness of day care centers in reducing loneliness among frail older adults.


Assuntos
Hospital Dia/psicologia , Idoso Fragilizado/psicologia , Solidão/psicologia , Atividades Cotidianas/classificação , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Hospital Dia/estatística & dados numéricos , Feminino , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Grupo Associado , Fatores Sexuais , Apoio Social , Fatores Socioeconômicos , Revisão da Utilização de Recursos de Saúde
20.
Ann Fam Med ; 9(6): 549-51, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22084267

RESUMO

The cornerstone of family medicine is the belief in both the continuity and availability of care. These beliefs are challenged when a doctor leaves his or her clinic because of personal reasons. In the example described in this article, the involvement of colleagues in a Balint group led a doctor to a flash insight into her conflicting feelings related to leaving her clinic. The group process helped her to prepare and deal with her own feelings and needs, as well as those of her patients and staff. Balint groups are a secure place to explore and gain insight into the emotional aspects of attachment and separation of physicians from their patients.


Assuntos
Ansiedade de Separação/psicologia , Processos Grupais , Relações Médico-Paciente , Médicos de Família/psicologia , Continuidade da Assistência ao Paciente , Emoções , Feminino , Humanos , Masculino , Apego ao Objeto
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