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1.
BMC Health Serv Res ; 21(1): 575, 2021 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-34120603

RESUMO

BACKGROUND: In recent years, there has been a growing interest in health care personalization and customization (i.e. personalized medicine and patient-centered care). While some positive impacts of these approaches have been reported, there has been a dearth of research on how these approaches are implemented and combined for health care delivery systems. The present study undertakes a scoping review of articles on customized care to describe which patient characteristics are used for segmenting care, and to identify the challenges face to implement customized intervention in routine care. METHODS: Article searches were initially conducted in November 2018, and updated in January 2019 and March 2019, according to Prisma guidelines. Two investigators independently searched MEDLINE, PubMed, PsycINFO, Web of Science, Science Direct and JSTOR, The search was focused on articles that included "care customization", "personalized service and health care", individualized care" and "targeting population" in the title or abstract. Inclusion and exclusion criteria were defined. Disagreements on study selection and data extraction were resolved by consensus and discussion between two reviewers. RESULTS: We identified 70 articles published between 2008 and 2019. Most of the articles (n = 43) were published from 2016 to 2019. Four categories of patient characteristics used for segmentation analysis emerged: clinical, psychosocial, service and costs. We observed these characteristics often coexisted with the most commonly described combinations, namely clinical, psychosocial and service. A small number of articles (n = 18) reported assessments on quality of care, experiences and costs. Finally, few articles (n = 6) formally defined a conceptual basis related to mass customization, whereas only half of articles used existing theories to guide their analysis or interpretation. CONCLUSIONS: There is no common theory based strategy for providing customized care. In response, we have highlighted three areas for researchers and managers to advance the customization in health care delivery systems: better define the content of the segmentation analysis and the intervention steps, demonstrate its added value, in particular its economic viability, and align the logics of action that underpin current efforts of customization. These steps would allow them to use customization to reduce costs and improve quality of care.


Assuntos
Atenção à Saúde , Assistência Centrada no Paciente , Humanos
2.
Rev Bras Enferm ; 74(suppl 5): e20200910, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34105697

RESUMO

OBJECTIVE: Description and discussion dimensions of Integrated Care Model. METHODS: A descriptive study is done that describe a technological innovation, intervention strategies for professional performance. RESULTS: Integrated Care Model (ICM) has two main categories include individual and Group-and disease-specific Model. First, is used for risky patients or with comorbidities. In second category; Chronic Care Model (CCM) is common form of Integrated Care Model to improve resultants in the patients with chronic condition, to move from acute care to integrate, regular, long-lasting, preventative and community-based nursing. FINAL CONSIDERATIONS: It is important to consider patient as an active member of the treatment team. It seems to be essential to monitor performance of care system. On the other hand, offer multidisciplinary care leads to present desirable care, tailored to the specific needs of patients regarding safety, patient-centered care and their culture.


Assuntos
Planejamento Antecipado de Cuidados , Prestação Integrada de Cuidados de Saúde/organização & administração , Assistência de Longa Duração , Doença Crônica , Comorbidade , Comportamento Cooperativo , Humanos , Assistência de Longa Duração/organização & administração , Modelos de Enfermagem , Modelos Organizacionais , Avaliação de Resultados em Cuidados de Saúde , Assistência Centrada no Paciente/organização & administração
3.
Sensors (Basel) ; 21(10)2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34065312

RESUMO

Healthcare is a multi-actor environment that requires independent actors to have a different view of the same data, hence leading to different access rights. Ciphertext Policy-Attribute-based Encryption (CP-ABE) provides a one-to-many access control mechanism by defining an attribute's policy over ciphertext. Although, all users satisfying the policy are given access to the same data, this limits its usage in the provision of hierarchical access control and in situations where different users/actors need to have granular access of the data. Moreover, most of the existing CP-ABE schemes either provide static access control or in certain cases the policy update is computationally intensive involving all non-revoked users to actively participate. Aiming to tackle both the challenges, this paper proposes a patient-centric multi message CP-ABE scheme with efficient policy update. Firstly, a general overview of the system architecture implementing the proposed access control mechanism is presented. Thereafter, for enforcing access control a concrete cryptographic construction is proposed and implemented/tested over the physiological data gathered from a healthcare sensor: shimmer sensor. The experiment results reveal that the proposed construction has constant computational cost in both encryption and decryption operations and generates constant size ciphertext for both the original policy and its update parameters. Moreover, the scheme is proven to be selectively secure in the random oracle model under the q-Bilinear Diffie Hellman Exponent (q-BDHE) assumption. Performance analysis of the scheme depicts promising results for practical real-world healthcare applications.


Assuntos
Computação em Nuvem , Segurança Computacional , Atenção à Saúde , Humanos , Assistência Centrada no Paciente , Políticas
4.
BMC Med Educ ; 21(1): 313, 2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34078360

RESUMO

BACKGROUND: Large scale implementation of new strategies and healthcare delivery standards in academic medical centers (AMCs) requires training of healthcare workforce at different stages of their medical career. The patient-centered medical home (PCMH) model for healthcare delivery involves adoption by all members of the healthcare workforce, including seasoned professionals and trainees. Though widely known, the PCMH model has been implemented sporadically at large AMCs and methods to implement the model across healthcare workforce have not been well-documented. METHODS: To meet all PCMH standards and achieve sustainable level 3 recognition, the authors implemented in 2014-2015 a multi-pronged approach that capitalized on existing educational infrastructure among faculty, residents, and medical students. Within 18 months, the authors applied new interdisciplinary practices and policies, redesigned residency training in continuity practices and extensively modified medical school curricula. RESULTS: These innovative transformational education efforts addressed the six PCMH standards for faculty, residents, and undergraduate medical students. Faculty played a major role as system change agents and facilitators of learning. Residents learned to better understand patients' cultural needs, identify 'at-risk' patients, ensure continuity of care, and assess and improve quality of care. Medical students were exposed to PCMH core standards throughout their training via simulations, training in the community and with patients, and evaluation tasks. By implementing these changes across the healthcare workforce, the AMC achieved PCMH status in a short time, changed practice culture and improved care for patients and the community. Since then, the AMC has been able to maintain PCMH recognition annually with minimal effort. CONCLUSIONS: Successful strategies that capitalize on existing strengths in infrastructure complemented by innovative educational offerings and inter-professional partnerships can be adapted by other organizations pursuing similar transformation efforts. This widespread transformation across the healthcare workforce facilitate a deep-rooted change that enabled our academic medical center to sustain PCMH recognition.


Assuntos
Internato e Residência , Assistência Centrada no Paciente , Centros Médicos Acadêmicos , Atenção à Saúde , Humanos , Recursos Humanos
5.
Medicine (Baltimore) ; 100(21): e26119, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032757

RESUMO

ABSTRACT: In efforts to improve the delivery of quality primary care, patient-centered medical home (PCMH) model has been promoted. However, evidence on its association with health outcomes has been mixed. The aim of this study was to assess the performance of PCMH model on quality of care, patient experience, health expenditures.This was a cross-sectional study of the 2015-2016 Medical Expenditure Panel Survey-Medical Organization Survey linked data, including 5748 patient-provider pairs. We examined twenty-four quality of care measures (18 high-value and 6 low-value care services), health service utilization, patient experience (patient-provider communication, satisfaction), and health expenditure.Of 5748 patients, representing a weighted population of 56.2 million American adults aged 18 years and older, 44.2% were cared for by PCMH certified providers. 9.3% of those with PCMHs had at least one inpatient stay in the past year, which was comparable to the 11.4% among those with non-PCMHs. Similarly, 17.4% of respondents cared for by PCMH and 18.5% cared for by non-PCMH had at least one ED visit. Overall, we found no significant differences in quality of care measures (neither high-nor low-value of care) between the two groups. The overall satisfaction, the experience of access to care, and communication with providers were also comparable. Patients who were cared for by PCMHs had less total health expenditure (difference $217) and out-of-pocket spending (difference $91) than those cared for by non-PCMHs; however, none of these differences reached the statistical significance (adjusted P > 0.05 for all).This study found no meaningful difference in quality of care, patient experience, health care utilization, or health care expenditures between respondents cared for by PCMH and non-PCMH. Our findings suggest that the PCMH model is not superior in the quality of care delivered to non-PCMH providers.


Assuntos
Gastos em Saúde , Satisfação do Paciente , Assistência Centrada no Paciente/economia , Assistência Centrada no Paciente/normas , Qualidade da Assistência à Saúde , Comunicação , Estudos Transversais , Acesso aos Serviços de Saúde , Humanos , Relações Médico-Paciente , Estados Unidos
6.
Nurse Educ Pract ; 53: 103077, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33991966

RESUMO

AIM: This review aimed to explore the impact of ageing simulation for healthcare professional education to promote person-centred care towards older people. BACKGROUND: Ageing simulation is an emerging educational approach to facilitate the learning of healthcare professionals on ageing and older people. However, there is limited evidence available exploring its use and impact on the person-centred care of older people. DESIGN: An integrative review approach was used. METHODS: Four databases were searched from January 2010 to April 2020 including CINAHL, MEDLINE, Web of Science and PsychINFO, 21 papers were identified and analysed. RESULTS: Three interrelating themes were identified to outline the findings across the reviewed studies: ageing simulation use (theme 1), characteristics (theme 2) and impact (theme 3). Results showed literature available on ageing simulation is varied, ranged in study quality and applied several ageing simulation iterations making comparisons across the studies difficult. CONCLUSIONS: Despite these challenges it was clear ageing simulation is a promising educational approach currently being used to promote person-centred care for older people in healthcare professionals. Ageing simulation successfully improved the ageing knowledge, empathy levels and attitudes towards older people of healthcare professionals.


Assuntos
Envelhecimento , Pessoal de Saúde , Idoso , Atitude do Pessoal de Saúde , Empatia , Humanos , Assistência Centrada no Paciente
7.
BMJ Open ; 11(5): e042726, 2021 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-33947726

RESUMO

INTRODUCTION: This study protocol outlines the evaluation of the pictorial support in person-centred care for children (PicPecc). PicPecc is a digital tool used by children aged 5-17 years to self-report symptoms of acute lymphoblastic leukaemia, who undergo high-dose methotrexate treatments. The design of the digital platform follows the principles of universal design using pictorial support to provide accessibility for all children regardless of communication or language challenges and thus facilitating international comparison. METHODS AND ANALYSIS: Both effect and process evaluations will be conducted. A crossover design will be used to measure the effect/outcome, and a mixed-methods design will be used to measure the process/implementation. The primary outcome in the effect evaluation will be self-reported distress. Secondary outcomes will be stress levels monitored via neuropeptides, neurosteroids and peripheral steroids indicated in plasma blood samples; frequency of in-app estimation of high levels of distress by the children; children's use of analgesic medicine and person centeredness evaluated via the questionnaire Visual CARE Measure. For the process evaluation, qualitative interviews will be carried out with children with cancer, their legal guardians and case-related healthcare professionals. These interviews will address experiences with PicPecc in terms of feasibility and frequency of use from the child's perspective and value to the caseworker. Interview transcripts will be analysed using an interpretive description methodology. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Swedish Ethical Review Authority (reference 2019-02392; 2020-02601; 2020-06226). Children, legal guardians, healthcare professionals, policymaking and research stakeholders will be involved in all stages of the research process according to Medical Research Council's guidelines. Research findings will be presented at international cancer and paediatric conferences and published in scientific journals. TRIAL REGISTRATION: ClinicalTrials.gov; NCT04433650.


Assuntos
Comunicação , Assistência Centrada no Paciente , Criança , Estudos Cross-Over , Humanos , Autorrelato , Suécia
8.
BMC Health Serv Res ; 21(1): 458, 2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985502

RESUMO

BACKGROUND: One of the main elements of patient-centered care is an enhancement of patient preparedness. Thus, pre-visit planning assessment tools was emerged to prepare and involve patients in their treatment process. OBJECTIVE: The main objective of this article was to review the applied tools and techniques for consideration of putting pre-visit planning into practice. METHODS: Web of Science, Scopus, IEEE, and PubMed databases were searched using keywords from January 2001 to November 2020. The review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Then, qualitative analysis was done to suggest an appropriate framework by mapping the main concepts. RESULTS: Out of 385 citations were retrieved in initial database searches, 49 studies from ten countries were included. Applied pre-visit techniques can be classified into eight categories. Our results showed that almost 81% of studies were related to procedures that were done between each visit, while 42% of articles were related to before visits. Accordingly, the main approach of included articles was patient preparedness. While 38 studies reported this approach is effective, three studies reported the effectiveness of such tools as moderate, only two articles believed it had a low effect on improving patient-centered care. CONCLUSION: This survey summarized the characteristics of published studies on pre-visit planning in the proposed framework. This approach could enhance the quality of patient care alongside enhancement patient-provider communication. However, such an approach can also be helpful to control pandemic diseases by reducing unnecessary referrals.


Assuntos
Pandemias , Assistência Centrada no Paciente , Comunicação , Humanos
9.
Eur J Radiol ; 140: 109754, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33964705

RESUMO

PURPOSE: To investigate how patients value radiologists, using data from the Dutch healthcare assessment website. METHOD: The Dutch healthcare assessment website was searched for patient reviews about radiologists in The Netherlands. The scores (scale of 1-10) assigned to the most recent review of each radiologist were extracted. All written reviews were assessed using standardized coding taxonomy, in the domains "clinical competencies" (including quality and safety of clinical care) and "relationships" (including communication with patients and humaneness/caring). For each category, it was assessed whether the review was positive or negative with regard to the performance of the radiologist. RESULTS: 217 of 941 radiologists (23 %) had been reviewed between 2017 and 2021. The total number of institutions to which these radiologists were affiliated was 75 (6 academic and 69 non-academic institutions). Median score assigned to each review was 9.6 (interquartile range 1.3, range 1-10). 74 of 217 radiologists (34 %) were given a maximum review score of 10. 29 of 217 radiologists (13 %) were given a review score of 5 or lower. The far majority of reviews concerned the categories communication (36 % of all positive patient reviews and 30 % of all negative patient reviews) and humaneness/caring (45 % of all positive patient reviews and 49 % of all negative patient reviews). CONCLUSION: Radiologists are generally highly valued by patients, although there is room for improvement to decrease the number of negative patient experiences. Communication and empathy appear to be the most important skills on which radiologists are judged from a patient's perspective.


Assuntos
Empatia , Radiologia , Comunicação , Humanos , Países Baixos , Assistência Centrada no Paciente
10.
Front Health Serv Manage ; 37(4): 17-27, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34036947

RESUMO

SUMMARY: While the term systemness has been used in the healthcare sector for decades, its definition varies from organization to organization. Still, the goals are consistent: to improve patient experience, lower costs, reduce risk, and provide insights into a wide range of care and management issues. Most health systems face similar challenges, such as margin enhancement, quality improvement, increased access, and fending off disruptive competition. Systemness is a way to address these challenges while improving the overall interdependence of the organization. Although embraced by and advantageous to healthcare organizations, systemness efforts often fail. The obstacles are surmountable when organizations thoroughly analyze the achievable scale of systemness, community resources, and current mindset regarding the good of the whole. Leaders must play a vital role in promoting systemness by providing education and a routine review of day-to-day organizational activities. Sometimes, systemness requires a change in leadership or an updating of leadership skills.Organizations must recognize and assess their culture as it relates to principles of independence versus interdependence, and refocus clinical standardization through best-practice protocols and policies as COVID-19 affects the already-fractured healthcare sector. Fortunately, current and developing artificial intelligence, wearables, at-home testing, and improved technologies promise to provide a needed break for a contracting physician field and fatigued front line, and they present an opportunity for those organizations poised to meet the systemness challenge.


Assuntos
COVID-19/diagnóstico , COVID-19/terapia , Atenção à Saúde/organização & administração , Colaboração Intersetorial , Assistência Centrada no Paciente/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Humanos , Cultura Organizacional , Objetivos Organizacionais , SARS-CoV-2
11.
J Gerontol Nurs ; 47(5): 9-13, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34039094

RESUMO

The coronavirus disease 2019 (COVID-19) has challenged the way nursing homes deliver person-centered care (PCC). Preferences for Activity and Leisure (PAL) Cards are a tool to communicate residents' important preferences to staff. Monthly interviews (N = 32) were conducted with champions who were conducting a PAL Card quality improvement project in Tennessee nursing homes (N = 11) between March and August 2020. Three major themes emerged: Structural Changes (e.g., halting admissions, adding an isolation unit), Resident Burden (e.g., physical isolation, loneliness), and Provider Burnout (e.g., increased workload, mental exhaustion). Further, providers expressed the benefits to using PAL Cards, specifically in regard to blunting the negative impact of each theme. Results showed the overall negative impact of COVID-19 on nursing home communities. Nursing staff experienced greater burden than other staff, reflecting their prominent role in providing direct care to residents with COVID-19. Staff reported that PAL Cards helped promote PCC. [Journal of Gerontological Nursing, 47(5), 9-13.].


Assuntos
COVID-19/enfermagem , Comunicação , Enfermagem Geriátrica/normas , Casas de Saúde/normas , Recursos Humanos de Enfermagem no Hospital/psicologia , Assistência Centrada no Paciente/normas , Guias de Prática Clínica como Assunto , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Instituição de Longa Permanência para Idosos/normas , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Instituições de Cuidados Especializados de Enfermagem/normas , Tennessee
12.
BMC Health Serv Res ; 21(1): 478, 2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34016113

RESUMO

BACKGROUND: The quality of the discharge process and effective care transitions between settings of care are critical to minimize gaps in patient care and reduce hospital readmissions. Few studies have explored which care transition components and strategies are most valuable to patients and providers. This study describes the development, pilot testing, and psychometric analysis of surveys designed to gain providers' perspectives on current practices in delivering transitional care services. METHODS: We underwent a comprehensive process to develop items measuring unique aspects of care transitions from the perspectives of the three types of providers (downstream, ambulatory, and hospital providers). The process involved 1) an environmental scan, 2) provider interviews, 3) survey cognitive testing, 4) pilot testing, 5) a Stakeholder Advisory Group, 6) a Scientific Advisory Council, and 7) a collaborative Project ACHIEVE (Achieving Patient-Centered Care and Optimized Health in Care Transitions by Evaluating the Value of Evidence) research team. Three surveys were developed and fielded to providers affiliated with 43 hospitals participating in Project ACHIEVE. Web-based survey administration resulted in 948 provider respondents. We assessed response variability and response missingness. To evaluate the composites' psychometric properties, we examined intercorrelations of survey items, item factor loadings, model fit indices, internal consistency reliability, and intercorrelations between the composite measures and overall rating items. RESULTS: Results from psychometric analyses of the three surveys provided support for five composite measures: 1) Effort in Coordinating Patient Care, 2) Quality of Patient Information Received, 3) Organizational Support for Transitional Care, 4) Access to Community Resources, and 5) Strength of Relationships Among Community Providers. All factor loadings and reliability estimates were acceptable (loadings ≥ 0.40, α ≥ 0.70), and the fit indices showed a good model fit. All composite measures positively and significantly correlated with the overall ratings (0.13 ≤ r ≤ 0.71). CONCLUSIONS: We determined that the items and composite measures assessing the barriers and facilitators to care transitions within this survey are reliable and demonstrate satisfactory psychometric properties. The instruments may be useful to healthcare organizations and researchers to assess the quality of care transitions and target areas of improvement across different provider settings.


Assuntos
Transferência de Pacientes , Assistência Centrada no Paciente , Humanos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
13.
Stud Health Technol Inform ; 281: 751-752, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042677

RESUMO

Citizens of the Netherlands receive excellent care, when they need it, insurance based funded according to the solidarity principle. Maintaining this system is a huge challenge, as we live longer and the demand for care is growing. With an increasing percentage of multi-morbidity in all age groups the need for integrated network organized care is growing at equal pace. Gradually the need to shift focus to prevention is increasingly understood, but a challenging business model is still lacking. The involvement of citizens in maintaining their health requires a focus on managing the social determinants of health. The concept of the holistic problem list and the overarching care plan provides a unique way to combine both health and disease management. Our vision is to bring control to the patient and promote coordination of all active problems across the health and social care network.


Assuntos
Autocuidado , Apoio Social , Humanos , Países Baixos , Assistência Centrada no Paciente
14.
Health Qual Life Outcomes ; 19(1): 133, 2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33902607

RESUMO

BACKGROUND: The use of Patient Reported Outcome Measures (PROMS) in clinical practice has the potential to promote patient-centred care and improve patients' quality of life. Individualized PROMs may be particularly helpful in identifying, prioritizing and monitoring health problems of patients with multimorbidity. We aimed to develop an intervention centred around PROMs feedback as part of Primary Care annual reviews for patients with multimorbidity and evaluate its feasibility and acceptability. METHODS: We developed a nurse-oriented intervention including (a) training of nurses on PROMs; (b) administration to patients with multimorbidity of individualized and standardized PROMS; and (c) feedback to both patients and nurses of PROMs scores and interpretation guidance. We then tailored the intervention to patients with two or more highly prevalent conditions (asthma, COPD, diabetes, heart failure, depression, and hip/knee osteoarthritis) and designed a non-controlled feasibility and acceptability evaluation in a convenience sample of primary care practices (5). PROMs were administered and scores fed back immediately ahead of scheduled annual reviews with nurses. Patients and nurses rated the acceptability of the intervention using with a brief survey including optional free comments. Thematic analysis of qualitative interviews with a sample of participating patients (10) and nurses (4) and of survey free comments was conducted for further in-depth evaluation of acceptability. Feasibility was estimated based on rates of participation and completion. RESULTS: Out of 68 recruited patients (mean age 70; 47% female), 68 completed the PROMs (100%), received feedback (100%) and confirmed nurse awareness of their scores (100%). Most patients (83%) "agreed"/"strongly agreed" that the PROMs feedback had been useful, a view supported by nurses in 89% of reviews. Thematic analysis of rich qualitative data on PROMS administration, feedback and role in annual reviews indicated that both patients and nurses perceived the intervention as acceptable and promising, emphasizing its comprehensiveness and patient-centredness. CONCLUSIONS: We have developed and tested an intervention focusing on routine PROM assessment of patients with multimorbidity in Primary Care. Preliminary findings support its feasibility and a high degree of acceptability from both patients and nurses. The next step is to conduct a full-scale trial for evaluating the effectiveness of the proposed intervention.


Assuntos
Multimorbidade , Medidas de Resultados Relatados pelo Paciente , Padrões de Prática em Enfermagem , Atenção Primária à Saúde/organização & administração , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Assistência Centrada no Paciente/organização & administração , Pesquisa Qualitativa , Qualidade de Vida
15.
BMC Health Serv Res ; 21(1): 310, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827714

RESUMO

BACKGROUND: Improving the transitional care of older people, especially hospital-to-home transitions, is a salient concern worldwide. Current research in the field highlights person-centered care as crucial; however, how to implement and enact this ideal in practice and thus achieve more person-centered patient pathways remains unclear. The aim of this study was to explore health care providers' (HCPs') perceptions and experiences of what is important to achieve more person-centered patient pathways for older people. METHODS: This was a qualitative study. We performed individual semistructured interviews with 20 HCPs who participated in a Norwegian quality improvement collaborative. In addition, participant observation of 22 meetings in the quality improvement collaborative was performed. RESULTS: A thematic analysis resulted in five themes which outline central elements of the HCPs' perceptions and experiences relevant to achieving more person-centered patient pathways: 1) Finding common ground through the mapping of the patient journey; 2) the importance of understanding the whole patient pathway; 3) the significance of getting to know the older patient; 4) the key role of home care providers in the patient pathway; and 5) ambiguity toward checklists and practice implementation. CONCLUSIONS: The findings can assist stakeholders in understanding factors important to practicing person-centered transitional care for older people. Through collaborative knowledge sharing the participants developed a more shared understanding of how to achieve person-centered patient pathways. The importance of assuming a shared responsibility and a more holistic understanding of the patient pathway by merging different ways of knowing was highlighted. Checklists incorporating the What matters to you? question and the mapping of the patient journey were important tools enabling the crossing of knowledge boundaries both between HCPs and between HCPs and the older patients. Home care providers were perceived to have important knowledge relevant to providing more person-centered patient pathways implying a central role for them as knowledge brokers during the patient's journey. The study draws attention to the benefits of focusing on the older patients' way of knowing the patient pathway as well as to placing what matters to the older patient at the heart of transitional care.


Assuntos
Serviços de Assistência Domiciliar , Assistência Centrada no Paciente , Idoso , Idoso de 80 Anos ou mais , Pessoal de Saúde , Humanos , Noruega , Percepção , Pesquisa Qualitativa
16.
BMC Med Educ ; 21(1): 225, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882935

RESUMO

BACKGROUND: Enhancing medical students' practice of patient-centered care is a goal of medical schools. In addition to exploring the demographic and academic factors of the students, it is necessary to identify other attitudes and perceptions that may influence the student's patient-centered attitude and inclination toward communication skill learning. This study aimed to assess patient-centered attitudes among dental students in Korea and identify the association between the students' characteristics and empathy, communication skill learning attitude, and patient-centered attitude. METHODS: Data were collected via a cross-sectional online survey, and 312 dental students were included in the analyses. The study participants completed the Patient-Practitioner Orientation Scale (PPOS), the Interpersonal Reactivity Index (IRI), and the Communication Skills Attitude Scale (CSAS). Analyses were performed using independent samples' t-tests, hierarchical multi-variable regression, and ANOVA with a post-hoc Tukey test. RESULTS: The students tend to be moderately patient-oriented toward the sharing subscale of PPOS score (M = 3.78, standard deviation [SD] = 0.54) and slightly more patient-centered toward the caring subscale of PPOS score (M = 4.41, SD = 0.52) of patient-centered attitudes. Being a female and a shorter academic period in dentistry were associated with attitudes toward patient-centered care. Empathy and positive attitude toward learning communication skills were also related to a patient-centered attitude, and among aspects of empathy, "empathic concern" had the greatest significant impact on patient-centered attitude. CONCLUSIONS: Gender, academic period, empathy, and attitudes on learning communication skills were important influencing factors of patient-centered attitudes. Patient-centered attitude can and must be taught. Education programs should focus on enhancing empathy, emphasizing positive attitudes on learning communication skills, and conducting follow-up educational sessions to prevent students from becoming less patient-centered with an increase in duration of their academic period.


Assuntos
Empatia , Estudantes de Medicina , Atitude do Pessoal de Saúde , Comunicação , Estudos Transversais , Feminino , Humanos , Assistência Centrada no Paciente , Relações Médico-Paciente , República da Coreia , Estudantes de Odontologia , Inquéritos e Questionários
17.
BMC Oral Health ; 21(1): 167, 2021 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789643

RESUMO

BACKGROUND: Studies have questioned the necessity of restoring cavitated carious lesion on primary teeth, once the control of biofilm is the most important factor to arrest these lesions. This randomized clinical trial aimed to compare the survival of teeth treated with a non-restorative cavity control (NRCC) compared to resin composite restorations (RCR) on proximal carious lesion in anterior primary teeth, as well as the impact of these treatments on patient-centered outcomes. METHODS: A randomized clinical trial with two parallels arms (1:1) will be conducted. Children between 3 and 6 years old will be selected from the Center of Clinic Research of Pediatric Dentistry of Ibirapuera University (UNIB), a dental trailer (FOUSP) located on Educational Complex Professor Carlos Osmarinho de Lima, the Pediatric Dentistry Clinic of Santa Cecília University and from the Pediatric Dentistry Clinic of University Center UNINOVAFAPI. One hundred and forty-eight teeth will be randomly distributed in two experimental groups: (1) Selective removal of carious tissue and RCR; or (2) NRCC through cavity enlargement using a metallic sandpaper. The primary outcome will be tooth survival after 6, 12, 18 and 24 months. The duration and the cost of dental treatments will be considered for the estimation of the cost-effectiveness of the evaluated treatments. The discomfort reported by the participants will be measured after each treatment using the FIS scale. The participants' satisfaction and perception of the parents/legal guardians will be evaluated through questionnaires. For the primary outcome, Kaplan-Meier's survival and Long-Rank test will be used for comparison between the two groups. All the variables will be modeled by Cox regression with shared fragility. Significance will be considered at 5%. DISCUSSION: The NRCC could be an option to manage carious lesions on proximal surfaces of primary teeth, and the approach could be well accepted by the children and parents/legal guardians. Trial registration Clinicaltrials.gov registration: NCT03785730, Registered on December 18th 2018, first participant recruited 30/04/2019, https://clinicaltrials.gov/ct2/show/NCT03785730 . Ethics Reference No: 91569118.8.0000.5597. Trial Sponsor: Universidade Ibirapuera. The Trial was prospectively registered.


Assuntos
Cárie Dentária , Restauração Dentária Permanente , Criança , Pré-Escolar , Resinas Compostas , Cárie Dentária/terapia , Humanos , Assistência Centrada no Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Dente Decíduo
18.
Anticancer Res ; 41(4): 1895-1901, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813394

RESUMO

BACKGROUND/AIM: We created a novel, preoperative wellness program (WP) that promotes recovery. This study assessed its impact on patient outcomes after pancreatectomy. PATIENTS AND METHODS: Pancreatoduodenectomies (PD) and distal pancreatectomies (DP) performed from 2015 to 2018 were reviewed using our institutional NSQIP database. Patients in the WP had their medical conditions optimized and were provided with the following: chlorhexidine, topical mupirocin, incentive spirometer, and immune-nutrition supplements. RESULTS: Out of a total of 669 pancreatectomy patients (411 PD, 258 DP), 308 were enrolled in the WP (188 PD, 120 DP). In the PD subgroup, on multivariable analysis (MVA), the WP patients had shorter lengths of hospital stay (LOS) (12 vs. 10 days, p<0.001). On MVA, WP patients had less post-op transfusion (20 vs. 10%, p=0.027). For the combined groups on MVA, LOS continued to be significant (OR=0.89, 95%CI=0.82-0.97, p<0.007). CONCLUSION: A preoperative patient centered WP may reduce the length of stay.


Assuntos
Promoção da Saúde , Tempo de Internação , Pancreatectomia , Pancreaticoduodenectomia , Assistência Centrada no Paciente , Cuidados Pré-Operatórios , Idoso , Bases de Dados Factuais , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatectomia/efeitos adversos , Pancreaticoduodenectomia/efeitos adversos , Alta do Paciente , Complicações Pós-Operatórias/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
19.
Artigo em Inglês | MEDLINE | ID: mdl-33894116

RESUMO

World Kidney Day (WKD) is a global campaign to raise awareness of the importance of our kidneys to overall health and to reduce the frequency and impact of kidney disease and associated health problems worldwide. Kidney disease is a non-communicable disease (NCD) and currently affects around 850 million people worldwide. One in ten adults has chronic kidney disease (CKD). The global burden of CKD is increasing, and is projected to become the 5th most common cause of years of life lost globally by 2040. CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume 2-3% of the annual healthcare budget in high-income countries. Crucially, kidney disease can be prevented and progression to end-stage kidney disease can be delayed with appropriate access to basic diagnostics and early treatment. This year World Kidney Day continues to raise awareness of the increasing burden of kidney diseases worldwide and to strive for kidney health for everyone, everywhere. During the pandemic with COVID 19 patients kidneys are also damaged, apart from the respiratory tract and other organs. It can lead to an increase in acute renal failure and consequent chronic kidney insufficiency, as well as number of deaths. Therefore, it is important to evaluate the renal function in each patient with COVID 19 virus. In the Republic of North Macedonia from 2006 to present day nephrologists and other medical personnel devoted to the early diagnosis, prevention and treatment of renal disease have participated in the activities of the World Kidney Day. These activities were supported by the Macedonian Society of Nephrology, Dialysis, Transplantation and Artificial Organs, the Department of Nephrology at the Medical Faculty, the Macedonian Academy of Sciences and Arts, the Government of the Republic of North Macedonia, non-governmental nephrology organizations (NEFRON) and the media. There were lectures and presentation devoted to the various theme of the WKD, publications in journals, as well as activities for examination of the renal function of patients in the medical centers. The activities during the WKD contributed to the improvement of the nephrological protection of the citizens of the Republic of N. Macedonia.


Assuntos
Qualidade de Vida , Insuficiência Renal Crônica/fisiopatologia , Injúria Renal Aguda/fisiopatologia , COVID-19/fisiopatologia , Humanos , Transplante de Rim , Nefrologia , Assistência Centrada no Paciente , Diálise Renal , Insuficiência Renal Crônica/terapia , República da Macedônia do Norte , SARS-CoV-2
20.
BMC Pregnancy Childbirth ; 21(1): 290, 2021 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-33838658

RESUMO

BACKGROUND: Research suggests that women's experience of antenatal care is an important component of high-quality antenatal care. Person-centered antenatal care (PCANC) reflects care that is both respectful of, and responsive to, the preferences, needs, and values of pregnant women. Little is known in Rwanda about either the extent to which PCANC is practiced or the factors that might determine its use. This is the first study to quantitatively examine the extent of and the factors associated with PCANC in Rwanda. METHODS: We used quantitative data from a randomized control trial in Rwanda. A total of 2150 surveys were collected and analyzed from 36 health centers across five districts. We excluded women who were less than 16 years old, were referred to higher levels of antenatal care or had incomplete survey responses. Both bivariate and multivariate logistic regression analyses were used to test the hypothesis that certain participant characteristics would predict high PCANC. RESULTS: PCANC level was found to be sub-optimal with one third of women leaving antenatal care (ANC) with questions or confused and one fourth feeling disrespected. In bivariate analysis, social support, greater parity, being in the traditional care (control group), and being from Burera district significantly predict high PCANC. Additionally, in the multivariate analysis, being in the traditional care group and the district in which women received care were significantly associated with PCANC. CONCLUSIONS: This quantitative analysis indicates sub-optimal levels of PCANC amongst our study population in Rwanda. We find lower levels of PCANC to be regional and defined by the patient characteristics parity and social support. Given the benefits of PCANC, improvements in PCANC through provider training in Rwanda might promote an institutional culture shift towards a more person-centered model of care.


Assuntos
Satisfação do Paciente/estatística & dados numéricos , Assistência Centrada no Paciente/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Estudos Multicêntricos como Assunto , Paridade , Assistência Centrada no Paciente/organização & administração , Gravidez , Cuidado Pré-Natal/organização & administração , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde/organização & administração , Ensaios Clínicos Controlados Aleatórios como Assunto , Ruanda , Fatores Socioeconômicos , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
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