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Rev Infirm ; 69(257): 20-22, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-32146958


The follow-up of a patient with cystic fibrosis requires specific skills. The implementation of a comprehensive management approach gives convincing results in terms of survivability and quality of life. This is why the Cystic Fibrosis Resource and Competence Centres (CRCMs) bring together multidisciplinary teams in which nurse coordinators play a key role with patients, relatives and other healthcare professionals.

Assistência Integral à Saúde/organização & administração , Fibrose Cística/terapia , Criança , Humanos , Equipe de Assistência ao Paciente/organização & administração
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-31702983


CONTEXT: Geriatric hip fractures are increasingly common and confer substantial morbidity and mortality. Fragmentation in geriatric hip fracture care remains a barrier to improved outcomes. OBJECTIVE: To evaluate the impact of a comprehensive geriatric hip fracture program on long-term mortality. DESIGN: We conducted a retrospective cohort study of patients aged 65 years and older admitted to our academic medical center between January 1, 2012, and March 31, 2016 with an acute fragility hip fracture. Mortality data were obtained for in-state residents from the state public health department. MAIN OUTCOME MEASURES: Mortality within 1 year of index admission and overall survival based on available follow-up data. RESULTS: We identified 243 index admissions during the study period, including 135 before and 108 after program implementation in October 2014. The postintervention cohort trended toward a lower unadjusted 1-year mortality rate compared with the preintervention cohort (15.7% vs 24.4%, p = 0.111), as well as lower adjusted mortality at 1 year (relative risk = 0.73, 95% confidence interval = 0.46-1.16, p = 0.18), although the differences were not statistically significant. The postintervention cohort had significantly higher overall survival than did the preintervention cohort (hazard ratio for death = 0.43, 95% confidence interval = 0.25-0.74, p = 0.002). CONCLUSION: Fixing fragmentation in geriatric hip fracture care such as through an orthogeriatric model is essential to improving overall survival for this patient population.

Assistência Integral à Saúde/métodos , Serviços de Saúde para Idosos , Fraturas do Quadril/terapia , Idoso , Idoso de 80 Anos ou mais , Assistência Integral à Saúde/organização & administração , Serviços de Saúde para Idosos/organização & administração , Fraturas do Quadril/mortalidade , Humanos , Masculino , Estudos Retrospectivos , Análise de Sobrevida
J Community Health Nurs ; 36(3): 139-146, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291772


Patients that cannot come to their family medicine practice (i.e. who have difficulties with access) do not receive the same preventive screening activities and management of their chronic diseases as those who can. Community nurses who provide healthcare to patients in their homes were trained in additional competencies, including screening for risk factors for selected diseases and the management of patients with selected chronic diseases. The presented model enables equal management of all registered patients, regardless of accessibility. It also fosters exchange of information within the team members and thus improves the quality of the team management of patients.

Enfermagem em Saúde Comunitária/métodos , Assistência Integral à Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Adulto , Asma/terapia , Enfermagem em Saúde Comunitária/educação , Enfermagem em Saúde Comunitária/organização & administração , Assistência Integral à Saúde/métodos , Disparidades em Assistência à Saúde , Humanos , Pessoa de Meia-Idade , Modelos Organizacionais , Doença Pulmonar Obstrutiva Crônica/terapia , Eslovênia
Public Health Genomics ; 22(1-2): 8-15, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31330522


Health systems around the world seek to address patients' unmet health needs for a range of acute and chronic diseases. Simultaneously, governments strive to keep healthcare spending sustainable, while providing equal access to high-quality care. This has fuelled debate around what constitutes a valuable healthcare intervention in a health system and the corollary consideration of what governments are willing to pay for a certain health intervention. Until recently, the value of information in general, and the value of diagnostic information (VODI) specifically, was not part of the discussion.However, investment in diagnostic information can be a key development as information may guide more effective and efficient healthcare and help maintain an affordable health system. This paper therefore explores ways to best define, evaluate, and reward the value created from diagnostics in healthcare and how to include these value considerations in decision-making processes for diagnostics. The authors ultimately call for a holistic VODI framework that accounts for the full range of potential benefits of diagnostic testing, beyond the traditional clinical and health economic domains, and that is essential to recognise, measure, and fully leverage the benefits of diagnostics for patients, health systems, and society.

Assistência Integral à Saúde/organização & administração , Assistência à Saúde , Diagnóstico , Informática Médica , Medicina de Precisão/métodos , Tomada de Decisão Clínica/métodos , Assistência à Saúde/normas , Assistência à Saúde/tendências , Humanos , Informática Médica/métodos , Informática Médica/tendências , Qualidade da Assistência à Saúde
Cien Saude Colet ; 24(6): 2173-2183, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269176


Primary health centers (PHCs) should consider the demographic and epidemiological profile of the health region to respond to population aging and structure service delivery around networks based on macro and micro-level management to ensure the provision of comprehensive services. A normative evaluation of micro-level management in four PHCs in a health region in the Federal District of Brazil was conducted to inform the development of recommendations for enhancing the delivery of comprehensive and integrated long-term care for older persons. A management evaluation matrix was used where management stages were classified as advanced, intermediate and incipient. The findings show that none of the PHCs were at the advanced stage, three were at the intermediate stage, and one at the incipient stage. The lowest scores were obtained for the subdimensions care model (which was shown to be predominantly traditional) and humanization (fragmentation of care). Lack of infrastructure and staff absenteeism were shown to be constraining factors, while effective communication with local administrators was as facilitating factor. Improvements need to be made in micro-level management to enhance the delivery of comprehensive and timely care to older persons in this health region.

Assistência Integral à Saúde/organização & administração , Assistência à Saúde/organização & administração , Serviços de Saúde para Idosos/organização & administração , Atenção Primária à Saúde/organização & administração , Idoso , Envelhecimento , Brasil , Prestação Integrada de Cuidados de Saúde/organização & administração , Humanos , Assistência de Longa Duração/organização & administração
Cien Saude Colet ; 24(5): 1809-1820, 2019 May 30.
Artigo em Português | MEDLINE | ID: mdl-31166514


Ensuring access to dental care services requires the development of healthsurveillance practices to ensure comprehensive health care. The objective of this study was toinvestigate the association between social and economic indicators of Brazilian municipalities, work process characteristics, and performance of a list of curative dental procedures by oral health teams. It involved an exploratory, cross-sectional study withmulticenter data collection from 11,374 oral health teams assessed by the National Program for Improvement of Access to and Quality of Primary Healthcare. Multilevel Poisson regression was used to obtain the prevalence of curative dental procedures, which was 69.51%. The social/economic and work variables that remained associated with the outcome included municipalities in which the proportion of primary care-sensitive admissions was below 28% and that of tooth extractions below 8%; and oral health teams classified as type II (including oral health assistant and technician) that had different materials available and better work processes. This multilevel analysis, which took into consideration the performance of curative dental care in Brazil, reveals a worrying oral healthcare scenario.

Assistência Odontológica/organização & administração , Serviços de Saúde Bucal/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Brasil , Assistência Integral à Saúde/organização & administração , Estudos Transversais , Serviços de Saúde Bucal/normas , Acesso aos Serviços de Saúde , Humanos , Programas Nacionais de Saúde/organização & administração , Saúde Bucal , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde
R I Med J (2013) ; 102(5): 30-32, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31167525


According to the Centers for Medicare & Medicaid Services (CMS), the future of older adult care in the United States has arrived in a provider-sponsored health plan model that integrates medical, behavioral, and social care for frail elders. This approach gives the provider complete control over patient outcomes and total cost of care and enables participants to live safely in the community - rather than a nursing home - for an extra four years, on average. This article reviews the Program of All-inclusive Care for the Elderly (PACE) model, whose roots go back to the 1970s in California, and offers case studies on two PACE-RI participants with chronic healthcare needs. In both examples, the patients reduced hospitalizations and increased mental and physical health, all while alleviating caregiver stress. With the older population slated to double by 2060, the time has come to expand PACE to more people. A few years ago, the acting administrator of the Centers for Medicare & Medicaid Services (CMS) said he was "glimpsing into our future" when he visited a provider-sponsored health plan that integrated medical, behavioral, and social care for frail elders, allowing them to remain in the community rather than live in a nursing home.[1] This approach to aging services successfully braided Medicare and Medicaid funding and gave the provider complete control over patient outcomes and total cost of care over a significant period - the key elements to delivering "value-based care." What is noteworthy is that this program of the "future" has been in Rhode Island since 2005 and in other parts of the country since 1973! It helps its medically complex participants live at home for an extra four years on average and retain a much higher quality of life, all while controlling associated costs for the government through capitated payment arrangements.[5] The program is called PACE - short for Program of All-inclusive Care for the Elderly - and it is a comprehensive and community-based model of care that coordinates medical, behavioral, and social services for individuals ages fifty-five and older who have high care needs but can remain safely in the community. PACE is currently offered in 31 states.[2] The model is backed by the National PACE Association and serves 50,000 seniors in 126 sponsoring organizations at 260 PACE centers across the country. While PACE has already had some success at scaling its integrated services, emerging demographics and heightened outreach poise the program for significant growth.

Assistência Integral à Saúde/economia , Assistência Integral à Saúde/organização & administração , Serviços de Saúde para Idosos/economia , Serviços de Saúde para Idosos/organização & administração , Idoso , Idoso Fragilizado , Humanos , Comunicação Interdisciplinar , Medicaid , Medicare , Modelos Teóricos , Rhode Island , Estados Unidos
R I Med J (2013) ; 102(5): 33-36, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31167526


The Rhode Island Medical Navigator Partnership (RIMNP) is an interdisciplinary student organization homed at the Warren Alpert Medical School of Brown University with the tripartite mission of (1) improving access to care for patients experiencing homelessness, (2) sensitizing students to issues of homelessness through experiential learning, and (3) providing educational opportunities for providers. Centered on the lived experiences of people who are homeless, the RIMNP aims to combat structural violence and foster providers' structural competence through integrated direct service and advocacy. This article describes the RIMNP's efforts to bridge gaps in the health and social services landscape in Rhode Island, and ultimately concludes with a discussion of how similar models may be implemented at other academic institutions.

Assistência Integral à Saúde/organização & administração , Educação de Graduação em Medicina/organização & administração , Relações Interprofissionais , Modelos Organizacionais , Defesa do Paciente , Acesso aos Serviços de Saúde , Pessoas em Situação de Rua , Humanos , Rhode Island , Faculdades de Medicina , Estudantes de Medicina
Gerokomos (Madr., Ed. impr.) ; 30(2): 61-66, jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183943


Introducción: Las personas mayores representan uno de los segmentos poblacionales con mayor proyección de crecimiento a nivel mundial y nacional. El conocimiento del concepto de fragilidad permite que los trabajadores de la salud que están en contacto con estas personas puedan identificarlas y establecer intervenciones para evitar el exceso de declive funcional de estas, evitando resultados adversos en salud. Objetivo: Caracterizar a la población de mayores frágiles que viven en la comunidad y que son atendidos en la atención primaria de salud (APS). Métodos: Estudio observacional, descriptivo, transversal; muestra de 538 personas mayores que viven en la comunidad, usuarias de APS de las comunas de La Pintana y Puente Alto, Chile. Resultados: El perfil clínico de la población de personas mayores frágiles que viven en la comunidad corresponde a mujeres de edad avanzada, baja escolaridad, con peores resultados en su evaluación funcional, cognitiva y afectiva, que toman más medicamentos, tienen más enfermedades crónicas y han sido más veces hospitalizadas en el último año respecto a las personas mayores clasificadas como no frágiles. Conclusiones: Las características sociodemográficas, de salud y la valoración geriátrica integral de las personas mayores frágiles son aspectos necesarios que se han de evaluar para poder detectar a aquellos mayores susceptibles de intervenir y evitar una posterior discapacidad. La fragilidad puede ser modificada, razón por la cual se sugiere considerar el perfil establecido con el fin de poner énfasis en dichas personas y evitar así los resultados adversos asociados a la condición de fragilidad

Introduction: Elderly represent one of the population segments with the greatest growth projection at the global and national levels. Knowledge of the concept of fragility allows health care workers who are in contact with the elderly to identify and establish interventions to avoid excessive functional decline and adverse health outcomes. Objective: To characterize the population of fragile elderly living in the community who are treated in primary health care. Methods: Observational, descriptive, cross-sectional study of 538 elderly living in the community, users of primary health center of La Pintana and Puente Alto in Chile. Results: The clinical profile of the elderly population living in the community corresponds to older people, low schooling, women, with functional, cognitive and affective results, take more medication, have more chronic diseases, and have Been hospitalized in the past year with respect to elderly classified as non-fragile. Conclusions: The clinical profile reported in this study will be useful in the clinical setting in order to prevent discapacity. Fragility can be modified, avoiding functional decline, institutionalization and PM death. It is suggested to consider the established profile in order to emphasize people and thus avoid the adverse results associated with the fragility condition

Humanos , Idoso Fragilizado , Atenção Primária à Saúde , Assistência Integral à Saúde/métodos , Envelhecimento Cognitivo/fisiologia , Serviços de Saúde para Idosos , Assistência Integral à Saúde/organização & administração , Análise de Dados , Enfermagem em Saúde Comunitária/organização & administração , Assistência à Saúde/organização & administração
Health Serv Res ; 54(3): 689-699, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30941764


OBJECTIVE: To develop an online survey of care coordination with primary care providers as experienced by medical specialists, evaluate its psychometric properties, and test its construct validity. DATA SOURCES: Physicians (N = 633) from 13 medical specialties across the Veterans Health Administration. STUDY DESIGN: We developed the survey based on prior work (literature review, specialist interviews) and by adapting existing measures and developing new items. Multitrait scaling analysis and confirmatory factor analysis were used to assess scale structure. We used multiple linear regression to examine the relationship of the final coordination scales to specialists' overall experience of care coordination. DATA COLLECTION: November 2016-December 2016. PRINCIPAL FINDINGS: Results suggest a 13-item, four-factor survey [Relationships (k = 4), Roles and Responsibilities (k = 4), Communication (k = 3), and Data Transfer (k = 2)] that measures the medical specialist experience of coordination with good internal consistency reliability, convergent validity, discriminant validity, and goodness of fit. Together, the four scales explained nearly 50 percent of the variance in specialists' overall experience of care coordination. CONCLUSIONS: The 13-item Coordination of Specialty Care-Specialist Survey (CSC-Specialist) is the first of its kind. It can be used alone or embedded in other surveys to measure four domains of care coordination as experienced by medical specialists.

Assistência Integral à Saúde/organização & administração , Médicos/psicologia , Especialização , Inquéritos e Questionários/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Estados Unidos , United States Department of Veterans Affairs
Nefrología (Madrid) ; 39(2): 192-197, mar.-abr. 2019. mapas, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181327


La coordinación entre nefrología y atención primaria se recoge bien en documentos sobre el manejo de la enfermedad renal crónica (ERC), pero se conoce menos el impacto real. Objetivo: Evaluar la eficiencia de un programa de nefrología extrahospitalaria (PNE) implantado progresivamente en 10 años respecto la demanda de atención a la ERC en el Área Integral de Salud Barcelona Esquerra, 524.395 habitantes, más de un tercio de la población barcelonesa. Material y métodos: Se ha recogido el n.° y la edad de las visitas en nefrología entre 2004 y 2014 y establecido un índice de derivación (ID) entre el n. de visitas y la ERC estimada en población atendida según la implantación del PNE. Resultados: La población adulta descendió entre 2006 y 2014, pero el n.° de habitantes ≥ 65 años aumentó de 107.025 a 113.461, así la ERC estimada. Insuficiencia renal fue el motivo de > 70% de las visitas de nefrología. La media de edad fue 74 años en 2004-2009 y 70 años en 2010-2014. El ID mostró dos tendencias en el periodo analizado según el PNE incluyera consultoría presencial o no. Conclusiones: El descenso del ID sugiere mejor resolución de la atención primaria. La mejora mayor en las Àreas Básicas de Salud de referencia (con ID reducido hasta > 44%) coincide con la implantación del PNE. Precocidad y contención del PNE superan la brecha entre la atención primaria y la hospitalaria a fin de dar respuesta a la cronicidad, el envejecimiento y la dependencia

The coordination between nephrology and primary care is well documented in the management of chronic kidney disease (CKD), but the real impact is uncertain Objective: To evaluate the efficiency of an outpatient nephrology program (ONP) implanted progressively over the course of 10 years regarding the demand for CKD care in the Integral Health Area of Barcelona Esquerra, accounting for 524,395 inhabitants, which is more than a third of the population of Barcelona. Material and methods: The number and age of the new referrals to nephrology between 2004 and 2014 were identified and a referral index (RI) was established between the number of new referrals and the estimated prevalence of CKD in the population treated, based on the implementation of the ONP. Results: The adult population decreased between 2006 and 2014, but the number of inhabitants aged 65 years or above increased from 107,025 to 113,461 and so did the estimated CKD. Renal insufficiency was the reason for more than 70% of the referrals made to nephrology. The average age was 74 years old between 2004-2009 and 70 between 2010-2014. The RI showed two trends in the analysed period, depending on whether or not the ONP included the face-to-face consultancy. Conclusions: The decrease in RI suggests a better resolution at primary care. The major improvement in the Basic Health Areas of reference (with RI reduced by more than 44%) coincides with the implementation of the ONP. The implantation of ONP overcome the gap between primary and hospital care in order to respond to chronicity, aging and dependence

Humanos , Idoso , Nefrologia/organização & administração , Assistência Integral à Saúde/organização & administração , Atenção Primária à Saúde , Assistência Ambulatorial/estatística & dados numéricos , Visita a Consultório Médico/tendências , Necessidades e Demandas de Serviços de Saúde/organização & administração , Visita a Consultório Médico/estatística & dados numéricos
Rev. bras. cir. plást ; 34(1): 73-78, jan.-mar. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-994548


Introdução: A amiloidose é caracterizada pela deposição de proteínas nos órgãos e tecidos, e tem sido associada à síndrome do túnel do carpo (STC) quando ocorre no punho. O objetivo é descrever uma série de casos de pacientes submetidos à cirurgia para STC associado à amiloidose. Métodos: O estudo incluiu 12 pacientes que se submeteram à cirurgia para tratar a STC cuja biópsia identificou amiloidose; o seguimento foi de cinco anos. Os pacientes foram avaliados por testes clínicos, eletroneuromiografia, imagens radiológicas e biópsia. Resultados: Todos os pacientes apresentaram queixas musculoesqueléticas, sintomas severos de compressão do nervo mediano, alterações nos testes neurofisiológicos. Realizou-se a cirurgia, sinovectomia e biópsia. No pós-operatório, cinco pacientes (41%) desenvolveram dor crônica e distrofia simpático-reflexa. Conclusão: Observou-se maior frequência de dor pós-operatória na amostra, o que revela a necessidade de atenção na abordagem e tratamento dessa associação.

Introduction: Amyloidosis features protein deposition in the organs and tissues and has been associated with carpal tunnel syndrome (CTS) when it occurs in the wrist. The objective is to describe a case series of patients undergoing surgery for CTS associated with amyloidosis. Methods: The study included 12 patients who underwent surgery to treat CTS in whom amyloidosis was proven by biopsy; the follow-up period was 5 years. The patients were evaluated by clinical tests, electroneuromyography, radiological images, and biopsy. Results: All patients presented with musculoskeletal complaints, severe symptoms of median nerve compression, and changes on neurophysiological tests. Surgery, synovectomy, and biopsy were performed. In the postoperative period, five patients (41%) developed chronic pain and reflex sympathetic dystrophy. Conclusion: A higher frequency of postoperative pain was observed in the patients, demonstrating the need for caution in the approach and treatment of this association.

Humanos , Complicações Pós-Operatórias/reabilitação , Complicações Pós-Operatórias/terapia , Síndrome do Túnel Carpal/cirurgia , Síndrome do Túnel Carpal/terapia , Assistência Integral à Saúde/métodos , Assistência Integral à Saúde/organização & administração , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/reabilitação , Proteínas Amiloidogênicas/análise , Proteínas Amiloidogênicas/efeitos adversos
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 54(1): 27-33, ene.-feb. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182219


El aumento creciente de la población mundial y el envejecimiento generalizado se han acompañado de un incremento en la prevalencia de cáncer en el anciano. El envejecimiento se asocia a determinados cambios fisiológicos, algunos de los cuales se potencian por la propia neoplasia. Junto a esto, el anciano oncológico suele tener más problemas que el resto de los individuos de edad avanzada, y es habitual que presente multitud de déficits. Estas características hacen necesario un manejo especial del mismo, utilizando, para ello, la principal herramienta empleada en Geriatría, la valoración geriátrica integral. Con este manuscrito se pretende analizar cuál es la trascendencia de la valoración geriátrica integral en dicho grupo poblacional, prestando especial atención a su capacidad para predecir la toxicidad a la quimioterapia y la supervivencia del anciano oncológico, y su capacidad para clasificar a estos pacientes en grupos que faciliten la toma de decisiones posterior

The growing increase in world population and generalised aging have been accompanied by an increase in the prevalence of cancer in the elderly. Aging is associated with certain physiological changes, some of which are enhanced by the neoplasm itself. Along with this, the elderly oncology patient usually has more problems than the rest of the elderly, and has a multitude of deficits. These characteristics require a special handling of the older patient with cancer, by using the main tool used in Geriatrics, the comprehensive geriatric assessment. This article analyses the importance of the comprehensive geriatric assessment in this population group, paying special attention to its ability to predict the toxicity of chemotherapy and the survival of the elderly oncology, as well as its ability to classify these patients into groups that help in the decision making process

Humanos , Idoso , Avaliação Geriátrica/métodos , Neoplasias/epidemiologia , Assistência Integral à Saúde/organização & administração , Fragilidade/epidemiologia , Múltiplas Afecções Crônicas/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle
Gac. sanit. (Barc., Ed. impr.) ; 33(1): 66-73, ene.-feb. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-183629


Objective: To analyse doctors' opinions on clinical coordination between primary and secondary care in different healthcare networks and on the factors influencing it. Methods: A qualitative descriptive-interpretative study was conducted, based on semi-structured interviews. A two-stage theoretical sample was designed: 1) healthcare networks with different management models; 2) primary care and secondary care doctors in each network. Final sample size (n = 50) was reached by saturation. A thematic content analysis was conducted. Results: In all networks doctors perceived that primary and secondary care given to patients was coordinated in terms of information transfer, consistency and accessibility to SC following a referral. However, some problems emerged, related to difficulties in acceding non-urgent secondary care changes in prescriptions and the inadequacy of some referrals across care levels. Doctors identified the following factors: 1) organizational influencing factors: coordination is facilitated by mechanisms that facilitate information transfer, communication, rapid access and physical proximity that fosters positive attitudes towards collaboration; coordination is hindered by the insufficient time to use mechanisms, unshared incentives in prescription and, in two networks, the change in the organizational model; 2) professional factors: clinical skills and attitudes towards coordination. Conclusions: Although doctors perceive that primary and secondary care is coordinated, they also highlighted problems. Identified factors offer valuable insights on where to direct organizational efforts to improve coordination

Objetivo: Analizar la opinión de los médicos sobre la coordinación entre la atención primaria (AP) y la atención especializada (AE) en diferentes redes de servicios de salud, e identificar los factores relacionados. Método: Estudio cualitativo descriptivo-interpretativo basado en entrevistas semiestructuradas. Se diseñó una muestra teórica en dos etapas: 1) redes de servicios de salud con diferentes modelos de gestión; 2) en cada red, médicos de AP y AE. El tamaño muestral se alcanzó por saturación (n = 50). Se realizó un análisis temático de contenido. Resultados: En las tres redes, los médicos expresaron que la atención está coordinada en términos de intercambio de información, consistencia y accesibilidad de AE tras derivación urgente. Sin embargo, emergieron problemas relacionados con el acceso no urgente y cambios en prescripciones, y en dos redes la inadecuación clínica de las derivaciones entre ambos niveles. Se identificaron los siguientes factores relacionados: 1) organizativos: facilitan la coordinación, la existencia de mecanismos de transferencia de información, de comunicación y de acceso rápido, y la proximidad física que promueve actitudes positivas a la colaboración; la obstaculizan el tiempo insuficiente para el uso de mecanismos, incentivos no compartidos en la prescripción y, en dos redes, un cambio del modelo organizativo; 2) relacionados con los profesionales: habilidades clínicas y actitudes frente a la coordinación. Conclusiones: Aunque los médicos perciben que la atención entre niveles está coordinada, también señalan problemas. Los factores identificados muestran hacia dónde dirigir los esfuerzos organizativos para su mejora

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Colaboração Intersetorial , Atenção Primária à Saúde/tendências , Atenção Secundária à Saúde/tendências , Assistência Integral à Saúde/organização & administração , Pesquisa Qualitativa , Entrevistas como Assunto/estatística & dados numéricos , Relações Interprofissionais , Eficiência Organizacional/tendências , Médicos/estatística & dados numéricos
J Telemed Telecare ; 25(10): 602-610, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30016895


INTRODUCTION: We report on an evaluation of the Just Right approach for planning care for adults with learning disabilities and how it can support culture change. Just Right combines installing a telemonitoring system with training for care managers in person-centred care planning and the interpretation of charts that summarise activity data for their setting. By providing insights into the needs of individuals Just Right allows existing care provision to be reviewed to ensure it is 'just right'. The Just Right approach can also potentially identify over-care and resources that can released. METHODS: A mixed-methods approach was used, triangulating qualitative and quantitative baseline and follow-up data. Qualitative data were collected before and after implementation from focus groups on barriers, enablers, success outcomes and impacts. A theory of change was developed. Detailed data on individual adults with learning disabilities were collected before and after installation of equipment using a linked online survey completed by their care managers. RESULTS: Nine commissioning local authorities were recruited with 33 care providers serving 417 adults with learning disabilities. Issues relating to implementation included staff acceptance, culture, consent, safeguarding, local authority engagement, interpretation of data and residential setting. Changes to care were identified for 20.3% of individuals, with 66% of providers not identifying any changes because Just Right confirmed that they were providing the right level of support. DISCUSSION: By combining telemonitoring and person-centred care planning, Just Right provides a holistic approach and necessary information for conversations amongst stakeholders about the care needs of adults with learning disabilities. Depending on how it is introduced, and the nature of conversations held, the Just Right approach can potentially change culture, leading to improved outcomes.

Assistência Integral à Saúde/organização & administração , Autocuidado/métodos , Telemedicina/organização & administração , Adulto , Comunicação , Grupos Focais , Humanos , Resolução de Problemas , Pesquisa Qualitativa
J Interprof Care ; 33(2): 226-234, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30257120


Interprofessional care and consumer-oriented services are embodied in modern healthcare policy and practice. The views, needs, and values of consumers are essential to ensuring translation of policy to practice. This is particularly pertinent for people diagnosed with mental illness who experience a higher risk of physical health problems and premature death. A qualitative, exploratory research project was conducted, involving focus groups with members of a mental health consumer group in the Australian Capital Territory. Participants were asked about their experiences and opinions in relation to physical health and care and treatment provided. Focus group transcripts were thematically analysed. Three themes arose via analysis: (1) Meeting diverse physical healthcare needs, where mental health consumers connect with many types of healthcare providers, conventional and non-conventional, (2) centre of the interprofessional team for holistic care, where there is preference for a consumer-centred group effort in addressing health issues as the model of care, and (3) more gateways, less gatekeeping, where points of access were affected by cost, place and gatekeepers could be enabling. People with mental illness seek enhanced collaboration between a broader range of health professionals, with potential to contribute to their overall health and well-being.

Assistência Integral à Saúde/organização & administração , Comunicação Interdisciplinar , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Preferência do Paciente , Austrália , Comportamento Cooperativo , Assistência à Saúde/organização & administração , Comportamentos Relacionados com a Saúde , Nível de Saúde , Saúde Holística , Humanos , Pesquisa Qualitativa