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1.
BMC Complement Altern Med ; 19(1): 305, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711478

RESUMO

BACKGROUND: Patient-centered culturally sensitive health care (PC-CSHC) has emerged as a primary approach to health care. This care focuses on the cultural diversity of the patients rather than the views of the health care professionals. PC-CSHC enables the patient to feel comfortable, respected, and trusted in the health care delivery process. As users of traditional and complementary medicine (T&CM) rarely inform their conventional health care providers of such use, the providers need to identify the users of T&CM themselves to avoid negative interaction with conventional medicine and to be able to provide them with PC-CSHC. Since the patterns of traditional medicine (TM) use are different to those of complementary medicine (CM), the aim of this study was to investigate the prevalence, and the health- and sociodemographic associations for visits to TM- and CM providers in an urban population. METHOD: The data were collected through two self-administrated questionnaires from the seventh survey of the Tromsø Study, a population-based cohort study conducted in 2015-2016. All inhabitants of Tromsø aged 40 or above were invited (n = 32,591) and n = 21,083 accepted the invitation (response rate 65%). Pearson chi-square tests and one-way ANOVA tests were used to describe differences between the groups whereas binary logistic regressions were used for adjusted values. RESULTS: The results revealed that 2.5% of the participants had seen a TM provider, 8.5% had seen a CM provider whereas 1% had visited both a TM and a CM provider during a 12-month period. TM users tended to be older, claim that religion was more important to them, have poorer economy and health, and have lower education compared to CM users. We found that more than 90% of the participants visiting T&CM providers also used conventional medicine. CONCLUSION: A considerable number of the participants in this study employed parallel health care modalities including visits to conventional, traditional, and complementary medicine providers. To offer patient-centered culturally sensitive health care that is tailored to the patients' treatment philosophy and spiritual needs, conventional health care providers need knowledge about, and respect for their patients' use of parallel health care systems.


Assuntos
Terapias Complementares/psicologia , Medicina Tradicional/psicologia , Pacientes/psicologia , Adulto , Idoso , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/estatística & dados numéricos , Estudos de Coortes , Terapias Complementares/estatística & dados numéricos , Demografia , Feminino , Pessoal de Saúde/psicologia , Humanos , Masculino , Medicina Tradicional/estatística & dados numéricos , Pessoa de Meia-Idade , Noruega , Pacientes/estatística & dados numéricos , Prevalência , Religião , Confiança
2.
BMC Complement Altern Med ; 19(1): 300, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694613

RESUMO

BACKGROUND: Both doctors' and patients' opinions are important in the process of treatment and healthcare of Chinese medicine. This study is to compare patients' and doctors' treatment satisfaction over the course of two visits in a Chinese medicine outpatient setting, and to explain their respective views. METHODS: Patients' chief complaints were collected prior to the outpatient encounter. The doctor was then asked (through a questionnaire) to state what complaints he or she was prioritizing during the process of diagnosing disease and making a prescription for herbal medicine or acupuncture treatment. On the next visit, both the patient and the doctor completed a questionnaire assessing satisfaction with the treatment of Chinese medicine prescribed in the first visit and administered by the patient at home. A 5-point Likert scales was used to assess the patients' and doctors' satisfaction with treatment. The timing of the follow-up appointment was determined by the doctor. One chief specialist, one associate chief specialist and one attending practitioner in Chinese medicine, and 60 patients having a follow-up appointment with one of the doctors, participated in the study. RESULTS: For 11 patients, their most urgent complaint was different from what the doctor's choose to focus on in his or her treatment. And only one patient refused to comply due to his or her dissatisfaction with the treatment focus of the doctor. Overall, 59 patients completed the satisfaction assessment, and 53 patients visited their doctors for a follow-up appointment. Patients' total satisfaction was higher than their doctors' (mean 3.55 vs. 3.45), and correlation of patients' and doctors' treatment satisfaction was moderate (r = 0.63, P < 0.01). Both of the patients' and doctors' satisfaction ratings were correlated with treatment adherence (P < 0.001). The predictors of their treatment satisfaction were different. Doctors' satisfaction with treatment was a significant factor in the process of making further clinical decisions. CONCLUSION: Patients and doctors form their opinion about the treatment effects in different ways. When evaluating treatment satisfaction, doctor's opinions are also an important indicator of positive or negative clinical effects and affect the subsequent decisions-making.


Assuntos
Assistência Ambulatorial/psicologia , Medicina Tradicional Chinesa/psicologia , Pacientes Ambulatoriais/psicologia , Satisfação do Paciente , Médicos/psicologia , Adulto , Idoso , Tomada de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
3.
BMC Complement Altern Med ; 19(1): 251, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31500604

RESUMO

BACKGROUND: While traditional, complementary and alternative medicine (TCAM) is gaining increased interest worldwide, the structural factors associated with the usage of TCAM at the social level have not been sufficiently explored. We aim to understand the social structure of uncertainty in society that affects the TCAM usage for men and women. METHODS: We studied 32 countries using data from the International Social Survey Programme and the World Bank. In this study, we defined TCAM usage as visits to an alternative/traditional/folk health care practitioner during the past 12 months. We performed a correlation analysis and used a generalized linear model . RESULTS: The prevalence of TCAM usage in terms of visits to practitioners was 26.1% globally, while usage varied across the 32 countries. Generalized linear models showed that unemployment rate was associated with the prevalence of TCAM usage in terms of visits to practitioners. CONCLUSIONS: At the social-structural level TCAM usage involving visits to practitioners was related to job insecurity. Job insecurity led to a decrease in TCAM usage regarding visits to practitioners. These findings suggest that it is necessary to consider the social-structural factors of uncertainty in society when designing health policies related to TCAM.


Assuntos
Terapias Complementares/psicologia , Medicina Tradicional/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/estatística & dados numéricos , Terapias Complementares/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Medicina Tradicional/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e Questionários , Incerteza , Adulto Jovem
4.
Inquiry ; 56: 46958019865434, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31375038

RESUMO

The outpatient sector represents a growing share of health care. This review examines how patients choose their physician for continuous outpatient care and why they are willing to bypass the nearest physician. It was conducted according to the PRISMA extension for scoping reviews (PRISMA-ScR). Three databases (PubMed/Medline, ScienceDirect, and Ovid Medline) were searched, focusing on articles in which distance influenced the choice of physician. In all, 1,308 articles were accessed, and 17 selected for final review. First, we extracted methods for assessing distance traveled and bypassing. Second, we identified determinants that directly influence the traveled distance and transferred all into a conceptual framework. The center of this framework is the individual "willingness-to-go", which reflects the willingness of patients to accept additional distances. Our findings can support studies on patient mobility and physician choice, which are essential for examining both the distribution and use of medical services, as well as for adequate need related planning.


Assuntos
Assistência Ambulatorial/psicologia , Comportamento de Escolha , Acesso aos Serviços de Saúde , Relações Profissional-Paciente , Viagem , Pesquisa sobre Serviços de Saúde , Humanos , Satisfação do Paciente
5.
Ir Med J ; 112(5): 934, 2019 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-31411016

RESUMO

Aim To evaluate doctor patient communication within gynaecological oncology services in Ireland. Methods An anonymous and confidential 20 question survey was designed by the patient advocacy group ISGOPPI and distributed in three gynaecological oncology outpatient clinics in tertiary referral centres. Results A total of 84 patients completed the survey in the 3 Dublin hospitals. Doctors surveyed ranged from senior house officer to consultant level. Overall women were very satisfied with the communication they had received from their doctor. 85% felt that they the doctor listened to them and took their opinion into account. 84% of patients felt that the doctor's body language was appropriate throughout the consultation. One of the main issues for women surveyed was waiting times. 33% of women waited over an hour to see their doctor and over 30% of women did not receive contact details of the clinical nurse specialist. Conclusion Overall our study shows that patients in gynae-oncology clinics are satisfied with the communication from their doctors. The main issues for patients were waiting times and contact details for follow up questions.


Assuntos
Assistência Ambulatorial , Comunicação , Relações Médico-Paciente , Assistência Ambulatorial/métodos , Assistência Ambulatorial/psicologia , Feminino , Ginecologia , Humanos , Irlanda , Oncologia , Satisfação do Paciente/estatística & dados numéricos , Inquéritos e Questionários
6.
Rev Peru Med Exp Salud Publica ; 36(2): 167-177, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31460627

RESUMO

OBJECTIVES.: To assess the psychometric properties of a scale to measure the satisfaction of individuals seeking services at outpatient clinics (ESCOMA) in public healthcare centers in Peru. MATERIALS AND METHODS.: We carried out a study based on a dataset from Questionnaire 1 of the National Health Users Satisfaction Survey (ENSUSALUD) 2016. ENSUSALUD applied an initial scale of 19 items constructed based on bibliographic review, expert judgment and a pilot study. We first performed an exploratory factor analysis (EFA) in two random subsamples to assess the scale's internal structure. We then developed a confirmatory factor analysis (CFA) using robust maximum likelihood estimation. Lastly, we analyzed measurement invariance and assessed reliability using McDonald's Omega Coefficient (ω). RESULTS: : We randomly divided 13,814 observations into two subsamples for the EFA. Based on this analysis, we selected a best-fitting CFA model, which comprised three factors and 18 items. We found acceptable goodness-of-fit indices for the CFA (CFI = 0.945, TLI = 0.937, SRMR = 0.036). The three resulting factors were a) administrative processes, b) infrastructure and c) medical care. We found strong invariance for age, sex, educational level and area of residence, and partial invariance for type of institution. All reliability coefficients indicated adequate fit (0.86<ω<0.92). CONCLUSIONS.: The ESCOMA demonstrates validity, reliability, and measurement invariance at different levels of care in a nationally representative Peruvian sample.


Assuntos
Assistência Ambulatorial/psicologia , Satisfação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Adolescente , Adulto , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Projetos Piloto , Psicometria , Reprodutibilidade dos Testes , Adulto Jovem
7.
BMC Health Serv Res ; 19(1): 481, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299969

RESUMO

BACKGROUND: Theoretical models have sought to comprehend and conceptualise how people seek help from health professionals but it is unclear if such models apply to urgent care. Much previous research does not explain the complex interactions that influence how people make sense of urgent care and how this shapes service use. This paper aims to conceptualise the complexity of sense-making and help-seeking behaviour in peoples' everyday evaluations of when and how to access modern urgent care provision. METHODS: This study comprised longitudinal semi-structured interviews undertaken in the South of England. We purposively sampled participants 75+, 18-26 years, and from East/Central Europe (sub-sample of 41 received a second interview at + 6-12 months). Framework analysis was thematic and comparative. RESULTS: The amount and nature of the effort (work) undertaken to make sense of urgent care was an overarching theme of the analysis. We distinguished three distinct types of work: illness work, moral work and navigation work. These take place at an individual level but are also shared or delegated across social networks and shaped by social context and time. We have developed a conceptual model that shows how people make sense of urgent care through work which then influences help-seeking decisions and action. CONCLUSIONS: There are important intersections between individual work and their social networks, further shaped by social context and time, to influence help-seeking. Recognising different, hidden or additional work for some groups may help design and configure services to support patient work in understanding and navigating urgent care.


Assuntos
Assistência Ambulatorial/psicologia , Assistência Ambulatorial/estatística & dados numéricos , Comportamento de Busca de Ajuda , Adolescente , Adulto , Inglaterra , Feminino , Humanos , Masculino , Modelos Teóricos , Pesquisa Qualitativa , Adulto Jovem
8.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31097465

RESUMO

BACKGROUND AND OBJECTIVES: Pediatric ambulatory asthma control is suboptimal, reducing quality of life (QoL) and causing emergency department (ED) and hospital admissions. We assessed the impact of the electronic-AsthmaTracker (e-AT), a self-monitoring application for children with asthma. METHODS: Prospective cohort study with matched controls. Participants were enrolled January 2014 to December 2015 in 11 pediatric clinics for weekly e-AT use for 1 year. Analyses included: (1) longitudinal changes for the child (QoL, asthma control, and interrupted and missed school days) and parents (interrupted and missed work days and satisfaction), (2) comparing ED and hospital admissions and oral corticosteroid (OCS) use pre- and postintervention, and (3) comparing ED and hospital admissions and OCS use between e-AT users and matched controls. RESULTS: A total of 327 children and parents enrolled; e-AT adherence at 12 months was 65%. Compared with baseline, participants had significantly (P < .001) increased QoL, asthma control, and reduced interrupted and missed school and work days at all assessment times. Compared with 1 year preintervention, they had reduced ED and hospital admissions (rate ratio [RR]: 0.68; 95% confidence interval [CI]: 0.49-0.95) and OCS use (RR: 0.74; 95% CI: 0.61-0.91). Parent satisfaction remained high. Compared with matched controls, participants had reduced ED and hospital admissions (RR: 0.41; 95% CI: 0.22-0.75) and OCS use (RR: 0.65; 95% CI: 0.46-0.93). CONCLUSIONS: e-AT use led to high and sustained participation in self-monitoring and improved asthma outcomes. Dissemination of this care model has potential to broadly improve pediatric ambulatory asthma care.


Assuntos
Assistência Ambulatorial/métodos , Asma/terapia , Gerenciamento Clínico , Pais , Autogestão/métodos , Adolescente , Assistência Ambulatorial/psicologia , Instituições de Assistência Ambulatorial , Asma/psicologia , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Pais/psicologia , Estudos Prospectivos , Autogestão/psicologia
9.
BMC Psychiatry ; 19(1): 124, 2019 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023274

RESUMO

BACKGROUND: The transition phase from inpatient to outpatient care for patients suffering from Major Depressive Disorder represents a vulnerable period associated with a risk of depression worsening and suicide. Our group has recently found that the sleep-wake cycle in discharged depressive patients became irregular and exhibited a drift towards later hours, associated with worsening of depression. In contrast, an advancement of sleep phase has earlier been shown to have an antidepressant effect. Thus, methods to prevent drift of the sleep-wake cycle may be promising interventions to prevent or reduce worsening of depression after discharge. METHODS: In this trial, we apply a new treatment intervention, named Circadian Reinforcement Therapy (CRT), to patients discharged from inpatient psychiatric wards. CRT consists of a specialized psychoeducation on the use of regular time signals (zeitgebers): daylight exposure, exercise, meals, and social contact. The aim is to supply stronger and correctly timed zeitgebers to the circadian system to prevent sleep drift and worsening of depression. The CRT is used in combination with an electronic self-monitoring system, the Monsenso Daybuilder System (MDB). By use of the MDB system, all patients self-monitor their sleep, depression level, and activity (from a Fitbit bracelet) daily. Participants can inspect all their data graphically on the MDB interface and will have clinician contact. The aim is to motivate patients to keep a stable sleep-wake cycle. In all, 130 patients referred to an outpatient service will be included. Depression rating is blinded. Patients will be randomized 1:1 to a Standard group or a CRT group. The intervention period is 4 weeks covering the transition phase from inpatient to outpatient care. The primary outcome is score change in interviewer rated levels of depression on the Hamilton Depression Rating Scale. A subset of patients will be assessed with salivary Dim Light Melatonin Onset (DLMO) as a validator of circadian timing. The trial was initiated in 2016 and will end in 2020. DISCUSSION: If the described intervention is beneficial it could be incorporated into usual care algorithms for depressed patients to facilitate a better and safer transition to outpatient treatment. TRIAL REGISTRATION: Posted prospectively at ClinicalTrials.gov at February 10, 2016 with identifier NCT02679768 .


Assuntos
Terapia Comportamental/métodos , Ritmo Circadiano/fisiologia , Transtorno Depressivo Maior/terapia , Exercício/fisiologia , Alta do Paciente , Autocuidado/métodos , Sono/fisiologia , Assistência Ambulatorial/métodos , Assistência Ambulatorial/psicologia , Terapia Combinada/métodos , Transtorno Depressivo Maior/psicologia , Exercício/psicologia , Feminino , Monitores de Aptidão Física , Humanos , Relações Interpessoais , Masculino , Fototerapia/métodos , Método Simples-Cego , Terapia Assistida por Computador/instrumentação , Terapia Assistida por Computador/métodos
10.
Cardiology ; 142 Suppl 1: 1-10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30947179

RESUMO

OBJECTIVES: The management of heart failure (HF) is most effective when established treatment guidelines and recommendations are followed. We aimed to develop a "Toolbox" of resources to facilitate the care of patients with acute HF and chronic HF with reduced ejection fraction delivered by healthcare professionals across Asia-Pacific, the Middle East and Africa (henceforth referred to as the "Region"). METHODS: We convened a group of cardiologists from across the Region to develop a set of checklists, algorithms, and other practical resources. These resources are based on our experiences, current evidence, and international guidelines. RESULTS: The HF Toolbox comprises three simplified sets of resources for use in the Emergency Room (ER), hospital and outpatient settings. Resources include admission and discharge checklists, treatment algorithms, recommendations for forming a multidisciplinary team, patient education, and self-management materials, and key performance indicators to monitor whether standards of care are met or maintained, or should be improved. CONCLUSIONS: The HF Toolbox provides practical resources to simplify the management of patients with HF and to support the formation of HF programs in the Region. The Toolbox is aligned with current guideline recommendations and can support the management of patients from presentation in the ER, through hospital admission to outpatient care.


Assuntos
Assistência Ambulatorial , Conhecimentos, Atitudes e Prática em Saúde , Insuficiência Cardíaca , Administração dos Cuidados ao Paciente , África , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/normas , Ásia , Prática Clínica Baseada em Evidências/métodos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Administração dos Cuidados ao Paciente/métodos , Administração dos Cuidados ao Paciente/normas , Guias de Prática Clínica como Assunto , Melhoria de Qualidade , Simplificação do Trabalho
11.
BMC Geriatr ; 19(1): 82, 2019 03 13.
Artigo em Inglês | MEDLINE | ID: mdl-30866827

RESUMO

BACKGROUND: Informal caregivers are an essential pillar for ensuring and maintaining the outpatient care of the frail elderly. Due to demographic changes, including an increase in the number of people in need of care as well as changing social structures (full-time employment of women, increasing number of single households, etc.) these informal care structures are fraught by considerable challenges. To support and facilitate informal caregivers in their role of nursing, it is important to identify their preferences, needs, and thus create a preference-oriented system. METHODS: A systematic review was conducted to identify preferences and needs regarding the organization of informal care. The database searches were performed by using EMBASE, Scopus and Dimdi. RESULTS: A total of 44 studies were included in the present review. Studies from 17 different countries provide broad international perspectives. Besides the preferences for long-term care structure, the following four principal topics were identified: (1) informational needs; (2) support needs; (3) organizational needs, and (4) needs for societal recognition. CONCLUSION: To meet the current challenges in the outpatient or home-based care of elders, it is essential to strengthen the role of informal caregivers. Therefore, it is necessary to adopt and further develop informal care structures according to the needs of informal caregivers. However, demographic, financial and cultural aspects of each country need to be considered as these may influence the preferences and needs of informal caregivers.


Assuntos
Assistência Ambulatorial/métodos , Assistência Ambulatorial/psicologia , Cuidadores/psicologia , Idoso Fragilizado/psicologia , Necessidades e Demandas de Serviços de Saúde , Preferência do Paciente/psicologia , Idoso , Idoso de 80 Anos ou mais , Serviços de Assistência Domiciliar , Humanos , Assistência de Longa Duração/métodos , Assistência de Longa Duração/psicologia
12.
Encephale ; 45(4): 333-339, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-30879782

RESUMO

BACKGROUND: Patient satisfaction with health care is an important indicator of health care quality. The main objective was to identify factors associated with early outpatient satisfaction with care 45 days after study inclusion for alcohol and opioid dependence. The secondary objective was to study the reproducibility of the satisfaction during the care. METHODS: A longitudinal study was conducted. Satisfaction was assessed during the early care process 15 and 45 days after study inclusion using the quality of care satisfaction questionnaire in outpatient consultation EQS-C. Multiple linear regression was performed to identify the variables associated with satisfaction level. The reproducibility of the questionnaire between the two measurements (15 and 45 days after inclusion) was tested by intraclass correlation coefficient. RESULTS: A total of 189 outpatients were included, and 90 patients completed the satisfaction questionnaire both at 15 and 45 days after inclusion. The level of early satisfaction with care was high. If patients without a history of previous care for substance dependence were at first more satisfied at 45 days (ß=6.8; P=0.05) than those who had received care previously, only the total score of the satisfaction with care at 15 days is associated with satisfaction with care at 45 days when taken into account in the model (ß=0,7; P<0.0001). The results indicated good total satisfaction reproducibility with an intraclass correlation coefficient ICC=0.68. CONCLUSION: We recommend an early measure of satisfaction with care among outpatients with substance dependence.


Assuntos
Assistência Ambulatorial , Satisfação do Paciente/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/normas , Assistência Ambulatorial/estatística & dados numéricos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Qualidade da Assistência à Saúde , Qualidade de Vida , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Fatores de Tempo
14.
Psychiatry Res ; 273: 613-623, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30731430

RESUMO

Children's mental health problems substantially impact their functioning. For clinically treated children and adolescents, we explored the impact of mental health treatment on functioning and identified predictors of functional improvement. Outpatient clinical data from a regional publicly funded specialist outpatient treatment clinic were analyzed. The Child and Adolescent Functional Assessment Scale (CAFAS) was used to assess outcomes. Non-parametric tests were used to compare baseline and exit scores. Logistic regression analysis was used separately for children and adolescents to examine predictors of improvement. Total CAFAS scores at exit showed a significant decrease from initial scores for both age groups, indicating improvements in clients' functioning. Children and adolescents had shared predictors for initial level of dysfunction, length of treatment and the presence of pervasive behavioral impairment (PBI). Primary presenting problem, caregiver support and area of residence were only associated with outcome among children. Clients with higher initial levels of dysfunction and PBI require longer treatment cycles to reach an acceptable outcome. Shortening the length of treatment cycles may improve the efficiency of resource use but can be detrimental to some clients. Personalized treatment should be tailored to the clients with specific characteristics and needs.


Assuntos
Instituições de Assistência Ambulatorial , Assistência Ambulatorial/métodos , Serviços Comunitários de Saúde Mental/métodos , Transtornos do Neurodesenvolvimento/terapia , Recuperação de Função Fisiológica , Adolescente , Assistência Ambulatorial/psicologia , Criança , Estudos de Coortes , Feminino , Previsões , Humanos , Masculino , Transtornos do Neurodesenvolvimento/epidemiologia , Transtornos do Neurodesenvolvimento/psicologia , Pacientes Ambulatoriais/psicologia , Estudos Prospectivos , Psicoterapia/métodos , Recuperação de Função Fisiológica/fisiologia , Saskatchewan/epidemiologia
15.
Bull Tokyo Dent Coll ; 60(1): 53-60, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30700644

RESUMO

The purpose of this study was to survey parental satisfaction with ambulatory anesthesia during dental treatment in disabled patients. Factors associated with parental preference for general anesthesia during future dental treatment in such patients were also investigated. A questionnaire was mailed to the parents of 181 disabled individuals who underwent dental treatment under ambulatory anesthesia at Tokyo Dental College Suidobashi Hospital between 2012 and 2016. A total of 71 responses were received (39.2%). The mean patient age was 18 years, and disabilities included autism spectrum disorder, intellectual disability, cerebral palsy, and epilepsy. The items surveyed included dental treatment details, number of times patients received general anesthesia, type of anesthetic used, anesthesia induction method, durations of treatment and anesthesia, and the presence or absence of intraoperative or postoperative complications. Questionnaire items queried problems related to dental care, anesthesia history, preoperative anxiety, length of fasting period, induction of general anesthesia, nursing and hospital room environment, postoperative anxiety, overall evaluation, and whether the parent would prefer general anesthesia during future dental treatment. The patients were divided into 2 groups: those whose parents preferred general anesthesia during future dental treatment and those whose parents did not. The results revealed that, where disabled individuals had previously received general anesthesia during dental treatment, the parents were more likely to prefer general anesthesia during future dental treatment.


Assuntos
Anestesia Dentária/métodos , Assistência Odontológica para Pessoas com Deficiências/métodos , Pais , Satisfação do Paciente , Adolescente , Adulto , Assistência Ambulatorial/métodos , Assistência Ambulatorial/psicologia , Anestesia Dentária/psicologia , Transtorno do Espectro Autista/complicações , Paralisia Cerebral/complicações , Criança , Assistência Odontológica para Pessoas com Deficiências/psicologia , Epilepsia/complicações , Feminino , Humanos , Deficiência Intelectual/complicações , Masculino , Pessoa de Meia-Idade , Pais/psicologia , Inquéritos e Questionários , Adulto Jovem
16.
BMC Psychiatry ; 19(1): 46, 2019 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-30691421

RESUMO

BACKGROUND: Anxiety and depressive disorders are common mental disorders. A substantial part of patients does not achieve symptomatic remission after treatment in specialized services. Current care as usual (CAU) for these patients consists of long-term supportive contacts. Termination of CAU is often not considered to be an option due to persistent symptoms, a low level of functioning, and the absence of further treatment options. A new intervention, ZemCAD, offers a program focused on rehabilitation and self-management, followed by referral back to primary care. METHODS: This multicenter randomized controlled trial was carried out in twelve specialized outpatient mental health care services in the Netherlands. Consenting and eligible patients were invited for the MINI interview and the baseline questionnaire. Assessments were done at 6 (T1), 12 (T2) and 18 (T3) months post baseline. We used linear mixed model analysis (LMM) to ascertain the effectiveness of the ZemCAD group relative to the CAU group on quality of life, symptom severity and empowerment. RESULTS: In total 141 patients were included. The results at 18-month follow-up regarding to quality of life and symptom severity, showed no significant differences between the ZemCAD group and the CAU group, except on the 'social relationships'-domain (d = 0.37). With regard to empowerment a significant difference between both groups was observed in the total empowerment score and one empowerment dimension (d = 0.45 and d = 0.39, respectively). After the ZemCAD intervention, more patients went from specialized outpatient mental health services back to a less specialized health care setting with less intensive treatment, such as primary care. CONCLUSION: The findings in this study suggest that patients with chronic and treatment-resistant anxiety and depression using the ZemCAD intervention improve on empowerment but not on symptom severity or quality of life. Since little is known about the effects of rehabilitation and self-management in patients with chronic and treatment resistant anxiety and depressive disorders, this is a first attempt to provide a proof-of-concept study in this under-researched but important field. TRIAL REGISTRATION: Netherlands Trial Register: NTR3335 , registered 7 March 2012.


Assuntos
Transtornos de Ansiedade/terapia , Transtorno Depressivo Resistente a Tratamento/terapia , Serviços de Saúde Mental , Qualidade de Vida/psicologia , Autogestão/métodos , Adulto , Idoso , Assistência Ambulatorial/métodos , Assistência Ambulatorial/psicologia , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/psicologia , Doença Crônica , Transtorno Depressivo Resistente a Tratamento/epidemiologia , Transtorno Depressivo Resistente a Tratamento/psicologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Autogestão/psicologia , Inquéritos e Questionários , Resultado do Tratamento
17.
Radiology ; 291(1): 102-109, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30667330

RESUMO

Purpose To assess the impact of a patient experience improvement program on national ranking in patient experience in a large academic radiology department. Materials and Methods This Health Insurance Portability and Accountability Act-compliant study was exempted from institutional review board approval. After initiating an electronic patient experience survey, 26 210 surveys and 22 213 comments were received from May 2017 to April 2018. During the study period, a multifaceted quality improvement initiative was instituted, focused on improving patient experience in the radiology department. The primary outcome was national percentile ranking as measured with the survey. Secondary outcome was the change in departmental percentile ranking compared with the overall hospital ranking for patient experience measured with a similar survey. Results The overall raw score for the department increased from 92.8 to 93.6 of 100 (P < .001), and the national ranking improved from the 35th to 50th percentile (P = .001). Improvements in raw scores related to personnel were primarily responsible for the increase in overall raw score and ranking. Of the 22 213 comments received, 3458 (15.6%) were negative. The percentage of negative comments was highly correlated with lower monthly percentile ranking (Pearson correlation coefficient of -0.69; P = .01). Conclusion It is feasible to develop a large-scale electronic survey to assess patient experience in the radiology department, to identify improvement opportunities, and to measurably improve patient experience. Changes in the percentage of negative comments were correlated with changes in a practice's national percentile rank in patient experience. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Kruskal and Sarwar in this issue.


Assuntos
Satisfação do Paciente , Radiologia/normas , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/normas , Estudos de Viabilidade , Hospitais Urbanos/normas , Humanos , Serviço Hospitalar de Radiologia/normas , Atenção Terciária à Saúde/normas , Fatores de Tempo , Estados Unidos
18.
J Autism Dev Disord ; 49(2): 495-508, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30143951

RESUMO

Individuals with Autism Spectrum Disorder (ASD) and/or intellectual and developmental disabilities (DD) often struggle with behavior management and emotion-regulation (ER). In this manuscript, we describe the results of a chart review examining a group treatment program designed to address ER deficits in youth with ASD and/or DD. The intensive 5 week program utilizes cognitive behavior, applied behavior analysis, and mindfulness techniques and includes biweekly child and parent groups. Results indicate that this program is feasible and associated with high caregiver satisfaction. Pre-and-post outcome results indicate statistically significant improvement on behavioral measures, but did not demonstrate significant improvment on the Pediatric Quality of Life Family Impact Module. Based on overall positive outcomes, a randomized controlled trial of the program is indicated.


Assuntos
Assistência Ambulatorial/psicologia , Transtorno do Espectro Autista/psicologia , Emoções/fisiologia , Pacientes Ambulatoriais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Psicoterapia de Grupo , Adolescente , Assistência Ambulatorial/métodos , Assistência Ambulatorial/tendências , Transtorno do Espectro Autista/terapia , Criança , Deficiências do Desenvolvimento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pais/psicologia , Psicoterapia de Grupo/métodos , Psicoterapia de Grupo/tendências , Qualidade de Vida/psicologia
20.
Drug Alcohol Depend ; 194: 230-237, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30466040

RESUMO

Background Psychiatry inpatients frequently have co-occurring substance use and mental health disorders, which are related to poor post-discharge outcomes. Telephone monitoring is effective in specialty substance use disorder treatment settings in increasing continuing care and 12-step program utilization and improving substance use outcomes. This study examined the effectiveness of telephone monitoring among psychiatry inpatients with co-occurring substance use and mental health disorders. Methods This randomized controlled trial (n = 406) compared usual care to usual care plus telephone monitoring (one in-person session during the inpatient stay, followed by weekly telephone contact for three months post-discharge). Follow-ups were conducted at end-of-intervention (three months post-baseline) and nine and 15 months post-baseline (73% followed). Primary outcomes were number of days out of the past 30 of drinking alcohol, using drugs, and experiencing psychological problems. Secondary outcomes were outpatient substance use treatment, and 12-step group, utilization. Results Longitudinal modeling found that patients in both conditions improved over time on each primary outcome. Improvement was comparable between conditions on alcohol and drug use and psychological problems. Receipt of outpatient treatment decreased over the follow-up period and was not related to condition. Likelihood of attending 12-step group meetings did not change over follow-ups, and was not related to condition. Conclusions Improvement over time was evident regardless of condition assignment. Patients maintained attendance at 12-step groups from pre- to post-discharge. Short-term telephone monitoring in addition to usual care for patients with co-occurring substance use and mental health disorders may not be sufficiently intensive to achieve additional improvements on outcomes.


Assuntos
Pacientes Internados/psicologia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Telefone , Adulto , Assistência Ambulatorial/métodos , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/tendências , Comorbidade , Diagnóstico Duplo (Psiquiatria) , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Transtornos Mentais/epidemiologia , Saúde Mental/tendências , Pessoa de Meia-Idade , Alta do Paciente/tendências , Psiquiatria/métodos , Psiquiatria/tendências , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
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