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1.
Res Social Adm Pharm ; 17(1): 1838-1844, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33317762

RESUMO

BACKGROUND: The newly emerged coronavirus pandemic (COVID-19) has collapsed the entire global health care system. Due to these settings, a lot of strategic changes are adopted by healthcare facilities to ensure continuity in patient-centered services. OBJECTIVE: This study aims to evaluate the effectiveness of structural and operational changes made in ambulatory care pharmacy services during the COVID-19 pandemic. METHODS: A retrospective comparative study was conducted to evaluate the impact and effectiveness of patient-centered interventions and consequent access to medication management care within Johns Hopkins Aramco Health Care ambulatory care pharmacy services during the COVID-19 pandemic by comparing patient-centered key performance indicators before and during COVID-19 pandemic for a total of 4 months. RESULTS: As a result of the structural and operational changes made in patient-centered ambulatory care pharmacy services during the COVID-19 pandemic, a 48% prescriptions requests and 90% prescriptions fills are increased through online health portal application. A three-fold increase in the pharmacy call center utilization resulted in around 10% abandoned calls. In the number of physical visits to ambulatory care pharmacies, a 37% reduction was also noted. The decrease in staff schedule efficiency and an increase in average prescription waiting time were also noticed. The prescription collection through remote area pick up locations, and medication home delivery services were successful during COVID-19 pandemic as supported by statistical data. CONCLUSION: The access to ambulatory care pharmacy services during COVID-19 pandemic has been successfully maintained via medication home delivery, remote area pickup locations, pharmacy call-center consultations and refill requests, online health portal application services, and other measures, while reducing the number of physical visits to the JHAH hospital/clinic to ensure compliance with infection control and prevention measures.


Assuntos
Assistência Ambulatorial/organização & administração , Assistência Centrada no Paciente/organização & administração , Assistência Farmacêutica/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Instituições de Assistência Ambulatorial/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Assistência Centrada no Paciente/estatística & dados numéricos , Assistência Farmacêutica/estatística & dados numéricos , Estudos Retrospectivos
2.
Indian J Tuberc ; 67(4S): S23-S32, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308668

RESUMO

Despite considerable progress over the years, tuberculosis (TB) still remains the top cause of death among the infectious diseases and has devastating socio-economic consequences for people in low- and middle-income countries. To add to this, the emergence of the COVID-19 pandemic has worsened delivery of TB care across the globe. As a global community, we have committed to end the TB epidemic by 2030. The World Health Organization has framed a strategy to achieve this goal which consists of three pillars namely i) integrated patient-centred care and prevention, ii) bold policies and systems and iii) intensified research and innovation. An analysis of the performance of national tuberculosis programmes (NTPs) across the globe against the ten priority indicators recommended for monitoring the end TB strategy show that there are huge gaps at every step in the cascade of care of TB patients. In our view, these gaps reflect suboptimal implementation of existing strategies known to be efficacious and operational research (OR) is one of the best available tools to plug the gaps. In this paper, we define what operational research is and how it differs from other kinds of research. We also share our views and experiences about how operational research can be used by NTPs to identify implementation gaps and their reasons, and develop and test possible solutions - which are then integrated to make changes to policy and practice and eventually improve programme outcomes. OR can be defined as research into interventions, strategies and tools which produces practical useable knowledge that can be used to enhance the quality, coverage, effectiveness and efficiency of disease control programmes, health services or health systems in which the research is conducted. The key steps in integrating operational research in the NTPs include: i) securing political commitment reflected by inclusion of OR in the national strategic plans of NTPs and earmarked funding, ii) having a critical mass of dedicated and trained human resources in OR within the NTP, iii) setting research priorities and steering the direction of research in the country, iv) using output-oriented models of capacity building such as the Structured Operational Research Training Initiative (SORT IT) model and building communities of practice, v) harnessing existing capacity in the country by forging partnerships with academia, vi) NTP-led nationwide, multicentre OR studies, vii) providing access to anonymized patient and programme surveillance data, vii) creating a forum for evidence dissemination and fostering policy change and ix) monitoring and accountability. In conclusion, ending the TB epidemic will not be possible without new tools (diagnostics, drugs, vaccines) and a multi-sectoral response involving stakeholders beyond the health ministry, including private providers, patients and communities. However, timely conduct of operational research to fine-tune programme implementation and ensuring proper deployment of new tools will be equally crucial to maximize the effectiveness and efficiency of interventions and ultimately contribute towards ending TB.


Assuntos
/epidemiologia , Países em Desenvolvimento , Pesquisa Operacional , Assistência Centrada no Paciente/organização & administração , Tuberculose/epidemiologia , Tuberculose/terapia , /prevenção & controle , Humanos
4.
PLoS One ; 15(10): e0239190, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33001986

RESUMO

BACKGROUND: People with HIV with co-occurring substance use and mental health diagnoses who are unstably housed have poorer outcomes for retention in care and viral suppression. Navigation models are a potential strategy to help this vulnerable population obtain the necessary medical and non-medical services across multiple service systems. The Health Resources and Services Administration's Special Projects of National Significance: "Building a Medical Home for Multiply-Diagnosed HIV-positive Homeless Populations initiative 2012-2017 found that navigation models may be an effective intervention to support people with HIV with unstable housing improve HIV health outcomes. However, there is limited information about the mechanisms by which this intervention works. In this article, we explore the participant and program factors for achieving stable housing at 6 months and how these factors influence HIV health outcomes. METHODS AND FINDINGS: This was a prospective study of 471 unstably housed people with HIV enrolled in a navigation intervention across nine sites in the United Stated from 2013-2017. All sites provided HIV primary medical care. Eight sites were located in urban areas and one site served a predominantly rural population. Two sites were federally qualified health centers, three were city or county health departments, one site was a comprehensive HIV/AIDS service organization, and three sites were outpatient or mobile clinics affiliated with a university -based or hospital system. Data were collected via interview and medical chart review at baseline, post 6 and 12 months. Type and dose of navigation activities were collected via a standardized encounter form. We used a path analysis model with housing stability at 6 months as the mediator to examine the direct and indirect effects of participant's socio-demographics and risk factors and navigation on viral suppression and retention in care at 12 months. Housing stability at 6 months was associated with male gender, younger age, viral suppression at baseline, having a lower risk for opiate use, recent homelessness, lower risk of food insecurity, and a longer length of time living with HIV. Participants who increased self-efficacy with obtaining help by 6 months had significantly higher odds of achieving housing stability. Stable housing, fewer unmet needs, moderate to high risk for opiate use, and viral suppression at baseline had a direct effect on viral suppression at 12 months. The intensity of navigation contact had no direct effect on housing stability and a mixed direct effect on viral suppression. Recent diagnosis with HIV, women, greater social support, increased self-efficacy and higher intensity of navigation contact had a direct effect on improved retention in HIV primary care at 12 months. CONCLUSIONS: In this sample of people with HIV who are experiencing homelessness, housing stability had a significant direct path to viral suppression. Navigation activities did not have a direct effect on the path to housing stability but were directly related to retention in care. These results identify key populations and factors to target resources and policies for addressing the health and social unmet needs of people with HIV to achieve housing stability and HIV health outcomes.


Assuntos
Infecções por HIV/terapia , Pessoas em Situação de Rua , Habitação , Assistência Centrada no Paciente , Adulto , Feminino , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Navegação de Pacientes , Assistência Centrada no Paciente/organização & administração , Estudos Prospectivos , Retenção nos Cuidados , Apoio Social , Resposta Viral Sustentada , Estados Unidos
6.
Aust Health Rev ; 44(5): 741-747, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862832

RESUMO

Objective A pilot study to: (1) describe the ability of emergency physicians to provide primary consults at an Australian, major metropolitan, adult emergency department (ED) during the COVID-19 pandemic when compared with historical performance; and (2) to identify the effect of system and process factors on productivity. Methods A retrospective cross-sectional description of shifts worked between 1 and 29 February 2020, while physicians were carrying out their usual supervision, flow and problem-solving duties, as well as undertaking additional COVID-19 preparation, was documented. Effect of supervisory load, years of Australian registration and departmental flow factors were evaluated. Descriptive statistical methods were used and regression analyses were performed. Results A total of 188 shifts were analysed. Productivity was 4.07 patients per 9.5-h shift (95% CI 3.56-4.58) or 0.43 patients per h, representing a 48.5% reduction from previously published data (P<0.0001). Working in a shift outside of the resuscitation area or working a day shift was associated with a reduction in individual patient load. There was a 2.2% (95% CI: 1.1-3.4, P<0.001) decrease in productivity with each year after obtaining Australian medical registration. There was a 10.6% (95% CI: 5.4-15.6, P<0.001) decrease in productivity for each junior physician supervised. Bed access had no statistically significant effect on productivity. Conclusions Emergency physicians undertake multiple duties. Their ability to manage their own patients varies depending on multiple ED operational factors, particularly their supervisory load. COVID-19 preparations reduced their ability to see their own patients by half. What is known about the topic? An understanding of emergency physician productivity is essential in planning clinical operations. Medical productivity, however, is challenging to define, and is controversial to measure. Although baseline data exist, few studies examine the effect of patient flow and supervision requirements on the emergency physician's ability to perform primary consults. No studies describe these metrics during COVID-19. What does this paper add? This pilot study provides a novel cross-sectional description of the effect of COVID-19 preparations on the ability of emergency physicians to provide direct patient care. It also examines the effect of selected system and process factors in a physician's ability to complete primary consults. What are the implications for practitioners? When managing an emergency medical workforce, the contribution of emergency physicians to the number of patients requiring consults should take into account the high volume of alternative duties required. Increasing alternative duties can decrease primary provider tasks that can be completed. COVID-19 pandemic preparation has significantly reduced the ability of emergency physicians to manage their own patients.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Eficiência Organizacional/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/tendências , Corpo Clínico Hospitalar/organização & administração , Assistência Centrada no Paciente/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Agendamento de Consultas , Austrália , Betacoronavirus/patogenicidade , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Previsões , Humanos , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Corpo Clínico Hospitalar/tendências , Pessoa de Meia-Idade , Pandemias/estatística & dados numéricos , Assistência Centrada no Paciente/estatística & dados numéricos , Projetos Piloto , Estudos Retrospectivos
8.
Intern Med J ; 50(10): 1267-1271, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32945570

RESUMO

During a pandemic when hospitals are stretched and patients need isolation, the role of hospital-in-the-home (HITH) providing acute medical care at home has never been more relevant. We aimed to define and address the challenges to acute home care services posed by the COVID-19 pandemic. Planning for service operation involves staffing, equipment availability and cleaning, upskilling in telehealth and communication. Planning for clinical care involves maximising cohorts of patients without COVID-19 and new clinical pathways for patients with COVID-19. The risk of SARS-CoV-2 transmission, specific COVID-19 clinical pathways and the well-being of patients and staff should be addressed in advance.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Serviços de Assistência Domiciliar/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Australásia/epidemiologia , Betacoronavirus , Comunicação , Equipamentos e Provisões Hospitalares/provisão & distribução , Mão de Obra em Saúde/organização & administração , Humanos , Controle de Infecções/organização & administração , Exposição Ocupacional/prevenção & controle , Pandemias , Assistência Centrada no Paciente/organização & administração , Carga de Trabalho
9.
J Interprof Care ; 34(5): 614-621, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32935607

RESUMO

The COVID-19 pandemic was declared by the World Health Organization on 11 March 2020. The rapid spread of SARS-CoV-2 required an equally rapid response from health-care organizations to find innovative ways to utilize the existing workforce to care for people with COVID-19. Using an evaluative case study, a unique insight into the collaborative allied health and nursing professions' response to COVID-19 at a specialist cardiothoracic hospital in the United Kingdom is presented. The aim of the case study was to evaluate how an interprofessional workforce from the wider organization could be supported to work in critical care as part of a crisis response. In identifying the key enablers to setting up an interprofessional Essential Care Team and learning from the lived experiences of those involved, this case study has demonstrated that, in supported, interprofessional teams the wider organizational workforce can be facilitated to effectively and safely provide critical care services. The lessons learned from this study will support future pandemic responses and aid the identification of further opportunities for interprofessional learning and practice. Ultimately, the study highlights that by identifying and investing in the key enablers, health-care organizations can be better prepared to respond to a global crisis.


Assuntos
Pessoal Técnico de Saúde , Comportamento Cooperativo , Infecções por Coronavirus/enfermagem , Cuidados de Enfermagem , Assistência Centrada no Paciente/organização & administração , Pneumonia Viral/enfermagem , Betacoronavirus , Humanos , Observação , Estudos de Casos Organizacionais , Pandemias , Equipe de Assistência ao Paciente , Reino Unido
11.
J Gerontol Nurs ; 46(9): 9-13, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32845343

RESUMO

With the onset of the COVID-19 pandemic, telehealth was thrust to the forefront, becoming one of the most predominant forms of care almost overnight. Despite years of research, practice, and policymaking, tenets for providing telehealth in an interdisciplinary, family- and person-centered fashion, and across a wide breadth of settings remain underdeveloped. In addition, although telehealth has the potential to increase equity in care, it can also further exacerbate disparities. The current article discusses the opening created by the pandemic and provides recommendations for how to make permanent changes in telehealth policy and practice to allow for interdisciplinary, person- and family-centered care while also taking care to address issues of equity and ethics and privacy issues related to telehealth and remote monitoring. [Journal of Gerontological Nursing, 46(9), 9-13.].


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Enfermagem Geriátrica/organização & administração , Política de Saúde , Assistência Centrada no Paciente/organização & administração , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle
12.
PLoS One ; 15(7): e0235165, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735588

RESUMO

INTRODUCTION: Patient-reported experience measures (PREMs) are central to inform on the responsiveness of health systems to citizens' health care needs and expectations. At their current form, PREMs do not reflect the weights that patients assign to varying aspects of the care experience. We aimed to investigate patients' preferences and willingness to pay (WTP) for attributes of the care experience in outpatient settings. METHODS: A discrete choice experiment was conducted among a representative sample of the general adult population of Hungary (n = 1000). Choice set attributes and levels were defined based on OECD's standardized PREMs (e.g. a doctor spending enough time in consultation, providing easy to understand explanations, giving opportunity to ask questions, and involving in decision making) and a price attribute. Conditional and mixed logit analyses were conducted. WTP estimates were computed in preference and WTP space. RESULTS: The respondents most preferred attribute was that of a doctor spending enough time in consultation, followed by involvement in decision making. Moreover, waiting times had a less important effect on respondents' choice preference compared with aspects of the doctor-patient relationship. Estimates in the WTP space varied from €4.38 (2.85-5.90) for waiting an hour less at a doctor's office to €36.13 (32.07-40.18) for a consultation where a doctor spends enough time with a patient relative to a consultation where a doctor does not. CONCLUSIONS: A preference-based PREMs approach provide insight on the value patients assign to different aspects of their care experience. This can inform the decisions of policy-makers and other stakeholders to coordinate efforts and resource allocation in a more targeted manner, by acting on attributes of the care experience that have a greater impact on the implementation of patient-centered care.


Assuntos
Assistência Ambulatorial/psicologia , Preferência do Paciente/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Relações Médico-Paciente , Adolescente , Adulto , Idoso , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Tomada de Decisão Compartilhada , Feminino , Política de Saúde , Humanos , Hungria , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente/organização & administração , Alocação de Recursos/organização & administração , Adulto Jovem
14.
Value Health ; 23(8): 1012-1019, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32828212

RESUMO

OBJECTIVE: Patient-centered care (PCC) could reduce gender inequities in quality of care. Little is known about how to implement patient-centered care for women (PCCW). We aimed to generate consensus recommendations for achieving PCCW. METHODS: We used a 2-round Delphi technique. Panelists included 21 women of varied age, ethnicity, education, and urban/rural residence; and 21 health professionals with PCC or women's health expertise. Panelists rated recommendations, derived from prior research and organized by a 6-domain PCC framework, on a 7-point Likert scale in an online survey. We used summary statistics to report response frequencies and defined consensus as when ≥85% panelists chose 5 to 7. RESULTS: The response rate was 100%. In round 1, women and professionals retained 46 (97.9%) and 42 (89.4%) of 47 initial recommendations, respectively. The round 2 survey included 6 recommendations for women and 5 recommendations for professionals (did not achieve consensus in round 1 or were newly suggested). In round 2, women retained 2 of 6 recommendations and professionals retained 3 of 5 recommendations. Overall, 49 recommendations were generated. Both groups agreed on 44 (94.0%) recommendations (13 retained by 100% of both women and clinicians): fostering patient-physician relationship (n = 11), exchanging information (n = 10), responding to emotions (n = 4), managing uncertainty (n = 5), making decisions (n = 8), and enabling patient self-management (n = 6). CONCLUSION: The recommendations represent the range of PCC domains, are based on evidence from primary research, and reflect high concordance between women and professional panelists. They can inform the development of policies, guidelines, programs, and performance measures that foster PCCW.


Assuntos
Assistência Centrada no Paciente/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Saúde da Mulher , Adulto , Fatores Etários , Comunicação , Técnica Delfos , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/métodos , Relações Médico-Paciente , Autogestão/métodos , Fatores Socioeconômicos
15.
Farm. hosp ; 44(4): 174-181, jul.-ago. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195094

RESUMO

En la práctica asistencial de los farmacéuticos de hospital resulta imprescindible la utilización de las tecnologías de la información y comunicación en el ámbito de la Telefarmacia. Por lo tanto, la Sociedad Española de Farmacia Hospitalaria considera oportuno definir el término y condiciones de Telefarmacia y comunicar su posicionamiento institucional a través de este documento de posicionamiento: "La Telefarmacia es la práctica farmacéutica a distancia a través del uso de las tecnologías de la información y comunicación". La Telefarmacia incluye como principales actividades: validación terapéutica, documentación clínica, consulta de atención farmacéutica, monitorización terapéutica, seguimiento de la adherencia, formación/información sobre medicamentos, coordinación con profesionales sanitarios y evaluación de resultados en salud. Los procedimientos asistenciales en el ámbito de la Telefarmacia deben regirse por un Procedimiento Normalizado de Trabajo, con documentación en la historia clínica y sin discriminación de acceso a pacientes candidatos. Se consideran cuatro procedimientos principales de Telefarmacia: seguimiento farmacoterapéutico; información y/o formación a pacientes y cuidadores; coordinación con el equipo multidisciplinar a nivel intra y extrahospitalario; dispensación y entrega informada de medicamentos a distancia. La implantación de la Telefarmacia requiere adecuación de medios humanos (formación, capacitación) y tecnológicos (validación, interoperatividad, confidencialidad). Asimismo, debe dar cumplimiento a la legalidad y normativa vigente, tanto a nivel autonómico como estatal. Los procedimientos de Telefarmacia deben también ajustarse a las consideraciones éticas y los códigos deontológicos pertinentes. Debe fomentarse la evaluación de la Telefarmacia a través del uso de indicadores y de la investigación de su repercusión sobre los resultados en salud. Por tanto, la Sociedad Española de Farmacia Hospitalaria considera que la Telefarmacia es una herramienta complementaria y necesaria para la provisión de una Atención Farmacéutica Especializada con el objetivo final de mejorar los resultados en salud y maximizar la seguridad y satisfacción de los pacientes


The use of information and communication technologies have nowadays become part and parcel of hospital pharmacy practice. Against this background, it is hardly surprising that Telepharmacy has sparked the interest of a large number of stakeholders. In this respect, the Spanish Society of Hospital Pharmacy has developed a definition of the concept and outlined the conditions under which Telepharmacy should operate. It has also shared its institutional stance on the subject through a position statement that states that Telepharmacy is the provision of pharmaceutical care at a distance through information and communication technologies. Telepharmacy practice includes activities such as therapeutic validation, drafting of clinical documents, provision of pharmaceutical care, therapeutic follow-up, adherence monitoring, drug education and information, coordination between healthcare providers and evaluation of health outcomes. The clinical tasks performed as part of Telepharmacy practice must adhere to a standardized procedure and revolve around the patient's clinical record. Access to Telepharmacy must be provided without discrimination. The service comprises four main activities: pharmacotherapeutic follow-up; patient and caregiver-directed education and information-dissemination; coordination with healthcare providers from the same or different hospitals; and remote informed home drug delivery. Implementation of Telepharmacy requires an adjustment of human (training and capacity-building) and technological resources (validation, interoperability, confidentiality). It must also comply with the laws and regulations in force both at a regional and a national level. Telepharmacy procedures must also be adapted to the relevant ethical standards and codes of good practice. Appropriate indicators must be used to evaluate the performance of Telepharmacy and its impact on health outcomes. According to Spanish Society of Hospital Pharmacy Telepharmacy is a necessary complemetary tool to provide specialized pharmaceutical care and thereby improve health outcomes and maximize patient safety and satisfaction


Assuntos
Humanos , Telemedicina/normas , Assistência Farmacêutica/organização & administração , Assistência Centrada no Paciente/organização & administração , Telemedicina/métodos , Sociedades Médicas/organização & administração , Assistência Farmacêutica/normas , Tecnologia da Informação , Consulta Remota/organização & administração , Consulta Remota/normas
16.
Washington; Organización Panamericana de la Salud; 2020; 20200729. 115 p.
Monografia em Inglês, Espanhol | BIGG - guias GRADE | ID: biblio-1116760

RESUMO

Esta guía de práctica clínica provee recomendaciones informadas por la evidencia para la identificación de marcadores y factores de riesgo de mortalidad de los pacientes críticos, control de la infección, recolección de muestras, cuidado de soporte (ventilatorio y hemodinámico), tratamiento farmacológico, rehabilitación temprana, uso de imágenes diagnósticas, prevención de complicaciones y criterios de egreso. Las recomendaciones están dirigidas a todo el personal de salud que atiende a los pacientes en el servicio de urgencias y de emergencias y la unidad de cuidados intensivos (médicos especialistas en medicina de urgencias, neumología, medicina intensiva, medicina interna, anestesiología, infectología, terapistas respiratorios, terapistas físicos, enfermeras y químicos farmacéuticos). La guía está elaborada para su uso por tomadores de decisiones y miembros de entidades gubernamentales relacionados con el manejo de pacientes con COVID-19 en las UCI de la Región de las Américas.


These clinical practice guidelines (short version) were developed in order to provide recommendations for the management of critically ill adult patients with COVID-19 treated in intensive care units (ICUs). These clinical practice guidelines provide evidence-informed recommendations for identifying markers and mortality risk factors in critically ill patients, as well as infection control, sample collection, supportive care (respiratory and hemodynamic), pharmacological treatment, early rehabilitation, diagnostic imaging use, prevention of complications, and discharge requirements. The recommendations are for all healthcare staff who deal with patients in emergency departments and ICUs. These guidelines are also intended for use by decision-makers and government entities involved in the management of patients with COVID-19 in ICUs in the Region of the Americas. This document is the result of a rapid guideline adaptation process. The information presented reflects published evidence as of the date of inclusion in the document. The recommendations are based on the evidence available and the quality thereof (GRADE methodology) at the time the guidelines were published. However, PAHO recognizes that there are numerous research projects under way and will periodically update these reviews and the applicable recommendations.


Assuntos
Humanos , Adulto , Administração dos Cuidados ao Paciente/organização & administração , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Cuidados Críticos , Betacoronavirus , Unidades de Terapia Intensiva/organização & administração , Antivirais/uso terapêutico , Plasma/imunologia , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Assistência Centrada no Paciente/organização & administração , Fatores Imunológicos/uso terapêutico , Antibacterianos/uso terapêutico
17.
Nurs Outlook ; 68(5): 601-610, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32620272

RESUMO

BACKGROUND/PURPOSE: The patient-centered medical home (PCMH) is an enhanced model of primary care. This study examined to what extent nurse practitioner (NP)-led PCMHs differed from traditional physician-led PCMHs. METHODS: We tested for differences between 391 NP-led PCMHs and 11,479 physician-led PCMHs, as well as across two distinct clusters identified by the Two-Step cluster analysis procedure using a sample of 136 practices. FINDINGS: NP-led PCMHs were more likely to serve vulnerable populations in rural and underserved areas than physician-led PCMHs. NP-led PCMHs tended to be more responsive to population health needs in the areas during the recognition process, while physician-led PCMHs emphasized practice improvements through enhanced access to care and management of patient information data. DISCUSSION: The findings suggest possible differences in capabilities, priorities and needs of the population served across practices. This is an important guide as policymakers track the adoption of PCMHs.


Assuntos
Área Carente de Assistência Médica , Profissionais de Enfermagem/estatística & dados numéricos , Assistência Centrada no Paciente/organização & administração , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Registros Eletrônicos de Saúde , Humanos , Profissionais de Enfermagem/provisão & distribução , Médicos/provisão & distribução , Serviços de Saúde Rural
19.
Oncology (Williston Park) ; 34(5): 156-162, 2020 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-32644174

RESUMO

The coronavirus disease 2019 pandemic has rapidly placed tremendous stress on health systems around the world. In response, multiple health systems have postponed elective surgeries in order to conserve hospital beds and personal protective equipment, minimize patient traffic, and prevent unnecessary utilization and exposure of healthcare workers. The American College of Surgeons released the following statement on March 13, 2020: "Each hospital, health system and surgeon should thoughtfully review all scheduled elective procedures with a plan to minimize, postpone, or cancel electively scheduled operations, endoscopes, or other invasive procedures until we have passed the predicted inflection point in the exposure graph and can be confident that our health care infrastructure can support a potentially rapid and overwhelming uptick in critical patient care needs." In our state, North Carolina, Governor Roy Cooper requested that all hospitals postpone elective and non-urgent procedures and surgeries effective March 23, 2020.


Assuntos
Infecções por Coronavirus , Procedimentos Cirúrgicos Eletivos/métodos , Excisão de Linfonodo/métodos , Serviço Hospitalar de Oncologia , Pandemias , Pneumonia Viral , Prostatectomia/métodos , Neoplasias da Próstata , Risco Ajustado/métodos , Gestão de Riscos , Betacoronavirus , Gestão de Mudança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , North Carolina , Serviço Hospitalar de Oncologia/organização & administração , Serviço Hospitalar de Oncologia/tendências , Pandemias/prevenção & controle , Seleção de Pacientes , Assistência Centrada no Paciente/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Gestão de Riscos/métodos , Gestão de Riscos/tendências
20.
BMC Public Health ; 20(1): 1013, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590963

RESUMO

BACKGROUND: Migrants experience disparities in healthcare quality, in particular women migrants. Despite international calls to improve healthcare quality for migrants, little research has addressed this problem. Patient-centred care (PCC) is a proven approach for improving patient experiences and outcomes. This study reviewed published research on PCC for migrants. METHODS: We conducted a scoping review by searching MEDLINE, CINAHL, SCOPUS, EMBASE and the Cochrane Library for English-language qualitative or quantitative studies published from 2010 to June 2019 for studies that assessed PCC for adult immigrants or refugees. We tabulated study characteristics and findings, and mapped findings to a 6-domain PCC framework. RESULTS: We identified 581 unique studies, excluded 538 titles/abstracts, and included 16 of 43 full-text articles reviewed. Most (87.5%) studies were qualitative involving a median of 22 participants (range 10-60). Eight (50.0%) studies involved clinicians only, 6 (37.5%) patients only, and 2 (12.5%) both patients and clinicians. Studies pertained to migrants from 19 countries of origin. No studies evaluated strategies or interventions aimed at either migrants or clinicians to improve PCC. Eleven (68.8%) studies reported barriers of PCC at the patient (i.e. language), clinician (i.e. lack of training) and organization/system level (i.e. lack of interpreters). Ten (62.5%) studies reported facilitators, largely at the clinician level (i.e. establish rapport, take extra time to communicate). Five (31.3%) studies focused on women, thus we identified few barriers (i.e. clinicians dismissed their concerns) and facilitators (i.e. women clinicians) specific to PCC for migrant women. Mapping of facilitators to the PCC framework revealed that most pertained to 2 domains: fostering a healing relationship and exchanging information. Few facilitators mapped to the remaining 4 domains: address emotions/concerns, manage uncertainty, make decisions, and enable self-management. CONCLUSIONS: While few studies were included, they revealed numerous barriers of PCC at the patient, clinician and organization/system level for immigrants and refugees from a wide range of countries of origin. The few facilitators identified pertained largely to 2 PCC domains, thereby identifying gaps in knowledge of how to achieve PCC in 4 domains, and an overall paucity of knowledge on how to achieve PCC for migrant women.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Assistência Centrada no Paciente/organização & administração , Refugiados/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adulto , Feminino , Humanos , Qualidade da Assistência à Saúde , Isolamento Social/psicologia , Apoio Social , Serviços de Saúde da Mulher/organização & administração
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