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2.
Pediatr Clin North Am ; 68(3): 651-658, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34044991

RESUMO

The integrated behavioral health care model in primary care has the potential to reduce barriers to care experienced by children and families from ethnic minorities and low socioeconomic status. Limited access to pediatric behavioral health care is a significant problem, with up to 40% of children and adolescents with identified mental disorders and only 30% of them receiving care. Barriers include transportation, insurance, and shortage of specialists. Primary care provider bias, decreased knowledge and feelings of competence, and cultural beliefs and stigma also affect earlier diagnosis and treatment, particularly for Hispanic families with low English proficiency and African Americans.


Assuntos
Assistência Integral à Saúde , Acesso aos Serviços de Saúde , Serviços de Saúde Mental , Pediatria , Adolescente , Afro-Americanos , Criança , Assistência Integral à Saúde/economia , Assistência Integral à Saúde/normas , Competência Cultural , Grupos Étnicos , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/normas , Disparidades em Assistência à Saúde , Hispano-Americanos , Humanos , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/normas , Pediatria/economia , Pediatria/normas , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Racismo , Classe Social , Fatores Socioeconômicos
4.
CMAJ Open ; 9(2): E376-E383, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33863795

RESUMO

BACKGROUND: Heart failure (HF) poses a substantial global health burden, particularly in patients with chronic obstructive pulmonary disease (COPD). The objective of this study was to validate an electronic medical record-based definition of HF in patients with COPD in primary care practices in the province of British Columbia, Canada. METHODS: We conducted a cross-sectional retrospective chart review from Sept. 1, 2018, to Dec. 31, 2018, for a cohort of patients from primary care practices in BC whose physicians were recruited through the BC node of the Canadian Primary Care Sentinel Surveillance Network. Heart failure case definitions were developed by combining diagnostic codes, medication information and laboratory values available in primary care electronic medical records. These were compared with HF diagnoses identified through detailed chart review as the gold standard. Sensitivity, specificity, negative (NPV) and positive predictive values (PPV) were calculated for each definition. RESULTS: Charts of 311 patients with COPD were reviewed, of whom 72 (23.2%) had HF. Five categories of definitions were constructed, all of which had appropriate sensitivity, specificity and NPV. The optimal case definition consisted of 1 HF billing code or a specific combination of medications for HF. This definition had an excellent specificity (93.3%, 95% confidence interval [CI] 89.4%-96.1%), sensitivity (90.3%, 95% CI 81.0%-96.0%), PPV (80.2%, 95% CI 69.9%-88.3%) and NPV (97.0%, 95% CI 93.8%-98.8%). INTERPRETATION: This comprehensive case definition improves upon previous primary care HF definitions to include medication codes and laboratory data, along with previously used billing codes. A case definition for HF was derived and validated and can be used with data from electronic medical records to identify HF in patients with COPD in primary care accurately.


Assuntos
Insuficiência Cardíaca , Atenção Primária à Saúde , Doença Pulmonar Obstrutiva Crônica , Colúmbia Britânica/epidemiologia , Sistemas de Informação em Laboratório Clínico/estatística & dados numéricos , Estudos Transversais , Bases de Dados de Produtos Farmacêuticos/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Sistemas de Informação em Saúde/organização & administração , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Melhoria de Qualidade , Estudos Retrospectivos , Sensibilidade e Especificidade , Vigilância de Evento Sentinela
5.
Health Qual Life Outcomes ; 19(1): 116, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33836764

RESUMO

BACKGROUND: Currently, there are no outcome measures assessing the ability of people with non-specific low back pain to self-manage their illness. Inspired by the 'Patient Enablement Instrument', we developed the Patient Enablement Instrument for Back Pain (PEI-BP). The aim of this study was to describe the development of the Patient Enablement Instrument for Back Pain (PEI-BP) and investigate content validity, construct validity, internal consistency, test-retest reliability, measurement error, responsiveness and floor and ceiling effects. METHODS: The PEI-BP consists of 6 items that are rated on a 0-10 Numeric Rating Scale. Measurement properties were evaluated using the COSMIN taxonomy and were based on three cohorts from primary care with low back pain: The content validity cohort (N = 14) which participated in semi-structured interviews, the GLA:D® Back cohort (N = 272) and the test-retest cohort (N = 37) which both completed self-reported questionnaires. For construct validity and responsiveness, enablement was compared to disability (Oswestry Disability Index), back pain beliefs (Brief Illness Perception Questionnaire), fear avoidance (Fear-Avoidance Beliefs Questionnaire-physical activity), mental health (SF-36), educational level and number of previous episodes of low back pain. RESULTS: The PEI-BP was found to have acceptable content validity, construct validity, reliability (internal consistency, test-retest reliability and measurement error) and responsiveness. The Smallest Detectable Change was 10.1 points illustrating that a patient would have to change more than 1/6 of the scale range for it to be a true change. A skewed distribution towards the high scores were found at baseline indicating a potentially problematic ceiling effect in the current population. CONCLUSIONS: The PEI-BP can be considered a valid and reliable tool to measure enablement on people seeking care for non-specific LBP. Further testing of the PEI-BP in populations with more severe LBP is recommended. TRIAL REGISTRATION: Not applicable.


Assuntos
Analgésicos/administração & dosagem , Analgésicos/uso terapêutico , Dor Lombar/tratamento farmacológico , Avaliação de Resultados em Cuidados de Saúde/normas , Atenção Primária à Saúde/normas , Autogestão/estatística & dados numéricos , Inquéritos e Questionários/normas , Estudos de Coortes , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Reprodutibilidade dos Testes , Suécia , Traduções
6.
BMJ ; 373: n379, 2021 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-33846159

RESUMO

Atrial fibrillation is a common chronic disease seen in primary care offices, emergency departments, inpatient hospital services, and many subspecialty practices. Atrial fibrillation care is complicated and multifaceted, and, at various points, clinicians may see it as a consequence and cause of multi-morbidity, as a silent driver of stroke risk, as a bellwether of an acute medical illness, or as a primary rhythm disturbance that requires targeted treatment. Primary care physicians in particular must navigate these priorities, perspectives, and resources to meet the needs of individual patients. This includes judicious use of diagnostic testing, thoughtful use of novel therapeutic agents and procedures, and providing access to subspecialty expertise. This review explores the epidemiology, screening, and risk assessment of atrial fibrillation, as well as management of its symptoms (rate and various rhythm control options) and stroke risk (anticoagulation and other treatments), and offers a model for the integration of the components of atrial fibrillation care.


Assuntos
Fibrilação Atrial/diagnóstico , Programas de Rastreamento/normas , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Acidente Vascular Cerebral/prevenção & controle , Antiarrítmicos/administração & dosagem , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Cateterismo Cardíaco , Eletrocardiografia , Carga Global da Doença , Estilo de Vida Saudável , Frequência Cardíaca/efeitos dos fármacos , Frequência Cardíaca/fisiologia , Humanos , Incidência , Programas de Rastreamento/métodos , Prevalência , Atenção Primária à Saúde/métodos , Medição de Risco/métodos , Fatores de Risco , Acidente Vascular Cerebral/etiologia
7.
BMC Pregnancy Childbirth ; 21(1): 269, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794799

RESUMO

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are a significant contributor to the high maternal mortality rate in Indonesia. At the moment, limited guidelines are available to assist primary care providers in managing HDP cases. A previous review of 16 international HDP guidelines has identified opportunities for improving HDP management in Indonesian primary care, but it has not determined the suitability of the recommendations in practice. This study aims to achieve consensus among the experts regarding the recommendations suitability and to develop HDP pathways in Indonesian primary care. METHODS: Maternal health experts, including GPs, midwives, nurses, medical specialists and health policy researchers from Indonesia and overseas were recruited for the study. They participated in a consensus development process that applied a mix of quantitative and qualitative questions in three Delphi survey rounds. At the first and second-round survey, the participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP management is appropriate for use in Indonesian primary care settings. The third-round survey presented the drafts of HDP pathways and sought participants' agreement and further suggestions. The participants' agreement scores were calculated with a statement needing a minimum of 70% agreement to be included in the HDP pathways. The participants' responses and suggestions to the free text questions were analysed thematically. RESULTS: A total of 52 participants were included, with 48, 45 and 37 of them completing the first, second and third round of the survey respectively. Consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. Agreement scores for the statements ranged from 70.8-100.0%, and potential implementation barriers of the pathways were identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. CONCLUSIONS: Most evidence-based management recommendations achieved consensus and were included in the developed HDP management pathways, which can potentially be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the developed HDP pathways in primary care practice.


Assuntos
Consenso , Procedimentos Clínicos/normas , Hipertensão Induzida pela Gravidez/terapia , Atenção Primária à Saúde/normas , Técnica Delfos , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Feminino , Humanos , Indonésia , Guias de Prática Clínica como Assunto , Gravidez , Atenção Primária à Saúde/métodos
8.
Ann Agric Environ Med ; 28(1): 142-148, 2021 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-33775080

RESUMO

INTRODUCTION: The quality of medical services and health care are complex problems with a number of various definitions, conceptual approaches, measurement tools and techniques. The most important influence on quality in primary health care has the (immaterial) human factor, the relationship between patient and doctor, medical personnel and the primary health care institution, and the skill to use new technologies to improve quality in health care. OBJECTIVE: The aim of the study is to discover the determinants of primary health care patients' dissatisfaction with the quality of medical services. MATERIAL AND METHODS: Patients with medical appointments on the day of the survey and gave their consent to participate were included in the study. A total of 901 patients of primary health care institutions [591 (65.59%) women and 310 (34.41%) men] in the Swietokrzyskie Province took part. The diagnostic poll method based on a questionnaire examining the patients' satisfaction with the quality of health services was used. Logistic regression identified the determinants of dissatisfaction of the patients. RESULTS: The determinants that mostly affected the patients' dissatisfaction with medical services were: rudeness of the doctor (p=0.0001), rudeness of the rest of medical staff (p=0.0001), non-comprehensibility of information about health by the patient (p=0.004), no clear identification of the patient in the health care system (p=0.01), and difficult access to information regarding the health condition (medical documentation) (p=0.018). CONCLUSIONS: Primary health care patients who participated in the study pointed to the attitude of the doctor towards a patient during a visit, and the attitude of the remaining medical personnel among the determinants of dissatisfaction with medical services.


Assuntos
Pessoal de Saúde/psicologia , Satisfação do Paciente , Pacientes/psicologia , Atenção Primária à Saúde/normas , Adulto , Idoso , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
9.
Pan Afr Med J ; 38: 35, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33777303

RESUMO

Introduction: unsafe injection practices are commonplace in low-income countries, and place health care workers at risk of blood-borne infections. A safe injection strategy requires a synchronized approach to deal with change in behavior of users and service providers towards safer practice. There is general lack of data on injection safety practices in Cross River State. This was a baseline study to compare the knowledge and practice of safe injection practices among primary health care (PHC) workers in urban and rural health facilities in Cross River State, Nigeria. Methods: this was a cross-sectional comparative study among PHC workers in randomly selected rural and urban Local Government Areas (LGAs). Using multistage sampling technique, a total of 320 respondents: 160 from the urban LGAs and 160 from the rural LGAs were interviewed. Semi-structured interviewer administered questionnaires were used to obtain data. Data analysis was done using STATATM version 14.0. Associations were tested using Chi square, and multivariate logistic regression analysis. Results: in this study, there was no difference in the baseline knowledge (58.8% vs. 55.0%, P=0.499) and practice (33.1% vs. 34.4%, P=0.813) of injection safety between PHC workers in the urban and rural locations. In the multivariate logistic regression model, the senior health workers had a two-fold increased odds of practicing safe injection compared to their junior counterparts [OR=2.21 (95% CI: 1.28,3.84)]. Conclusion: in both the urban and rural locations, there was good knowledge but poor practice of injection safety among respondents in the LGAs; hence, the need to organize periodic injection safety training and retraining of PHC workers targeting junior workers to improve on the practices of injection safety.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Injeções/normas , Atenção Primária à Saúde/normas , Adulto , Estudos Transversais , Feminino , Pessoal de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Serviços de Saúde Rural/normas , Inquéritos e Questionários , Serviços Urbanos de Saúde/normas , Adulto Jovem
10.
BMC Pregnancy Childbirth ; 21(1): 208, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33722198

RESUMO

BACKGROUND: Pregnancy is a risk factor for coronavirus disease 2019 (COVID-19). Pregnant women suffer from varying levels of pregnancy-related anxiety (PRA) which can negatively affect pregnancy outcomes. The aim of this study was to assess PRA and its associated factors during the COVID-19 pandemic. METHODS: This web-based cross-sectional study was conducted in 2020 on 318 pregnant women purposively recruited from primary healthcare centers in Sari and Amol, Iran. Data were collected using questionnaires (PRAQ, Edinburg, KAP of COVID-19, CDA-Q and Demographic questionnaire), which were provided to participants through the social media or were completed for them over telephone. Data were analyzed with the linear regression and the logistic regression analysis, at the significance level of 0.05 using the SPSS software (v. 21). RESULTS: Around 21% of participants had PRA, 42.1% had depression, and 4.4% had COVID-19 anxiety. The significant predictors of PRA were number of pregnancies (P = 0.008), practice regarding COVID-19 (P < 0.001), COVID-19 anxiety (P < 0.001), depression (P < 0.001), and social support (P = 0.025) which explained 19% of the total variance. Depression and COVID-19 anxiety increased the odds of PRA by respectively four times and 13%, while good practice regarding COVID-19 decreased the odds by 62%. CONCLUSION: Around 21% of pregnant women suffer from PRA during the COVID-19 pandemic and the significant predictors of PRA during the pandemic include number of pregnancies, practice regarding COVID-19, COVID-19 anxiety, depression, and social support. These findings can be used to develop appropriate strategies for the management of mental health problems during pregnancy in the COVID-19 pandemic.


Assuntos
Ansiedade , COVID-19 , Complicações na Gravidez , Atenção Primária à Saúde , Apoio Social , Adulto , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/prevenção & controle , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/psicologia , Estudos Transversais , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Determinação de Necessidades de Cuidados de Saúde , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/psicologia , Gestantes/psicologia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/tendências , Fatores de Risco , SARS-CoV-2 , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologia
12.
Semergen ; 47(4): 248-255, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-33781673

RESUMO

OBJECTIVES: To assess telemedicine satisfaction of patients from a primary health care center during COVID-19 pandemics. This work could bring information on its acceptance. MATERIALS AND METHODS: Transversal study with 253 individuals. A questionnaire was performed using Likert scale (1-very unsatisfied, 5-very satisfied) on patients with diabetes, hypertension and in subjects with other pathologies, whose consultations occurred between 01/04/2020 and 01/05/2020. Collected data included sociodemographics, previous telemedicine appointments, satisfaction levels of teleconsultation and doubt clarification, and interest in further telemedicine follow-up. In addition, a comparative analysis was performed between the periods January-February and April-May of 2020 in relation to age, sex, hypertension, diabetes and the type of contact (presential or remote). Statistics were performed using SPSS® and Excel®. RESULTS AND DISCUSSION: Diabetes follow-up appointments accounted for 34.4% of total consultations. Globally there was a high level of satisfaction and interest in future telemedicine follow-up. However, diabetic and older patients were less interested in this type of follow-up. Statistically significant differences about satisfaction were found in age, sex and presence/absence of diabetes. 70.6% of healthy patients preferred contact by e-mail over telephone. A selection bias is present because no randomization was made. The higher prevalence of diabetes consultations and the lack of adjustment for confounding factors can also affect results. Number of consults between January-February and April-May was compared and the main result was the significant reduction in the number of face-to-face consultations for diabetes (-50.1%) and hypertension (-94.1%). Presential consultations decreased by 72.6% and non-presential consultations increased by 61.9%. There was a selection bias because the sample was not random. The higher prevalence of diabetes consults and the lack of adjustment for confounders could affect results. CONCLUSIONS: This study allowed us to confirm the importance of telemedicine in primary health care, especially during pandemics. Participants recognized the usefulness of telemedicine and allowed future similar consultations.


Assuntos
COVID-19/psicologia , Satisfação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Telemedicina/normas , Adulto , Assistência ao Convalescente/métodos , Assistência ao Convalescente/psicologia , Fatores Etários , Idoso , Diabetes Mellitus/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Inquéritos e Questionários
13.
Lancet Glob Health ; 9(3): e331-e339, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33607031

RESUMO

BACKGROUND: Many governments have introduced pay-for-performance programmes to incentivise health providers to improve quality of care. Evidence on whether these programmes reduce or exacerbate disparities in health care is scarce. In this study, we aimed to assess socioeconomic inequalities in the performance of family health teams under Brazil's National Programme for Improving Primary Care Access and Quality (PMAQ). METHODS: For this longitudinal study, we analysed data on the quality of care delivered by family health teams participating in PMAQ over three rounds of implementation: round 1 (November, 2011, to March, 2013), round 2 (April, 2013, to September, 2015), and round 3 (October, 2015, to December, 2019). The primary outcome was the percentage of the maximum performance score obtainable by family health teams (the PMAQ score), based on several hundred (ranging from 598 to 914) indicators of health-care delivery. Using census data on household income of local areas, we examined the PMAQ score by income ventile. We used ordinary least squares regressions to examine the association between PMAQ scores and the income of each local area across implementation rounds, and we did an analysis of variance to assess geographical variation in PMAQ score. FINDINGS: Of the 40 361 family health teams that were registered as ever participating in PMAQ, we included 13 934 teams that participated in the three rounds of PMAQ in our analysis. These teams were located in 11 472 census areas and served approximately 48 million people. The mean PMAQ score was 61·0% (median 61·8, IQR 55·3-67·9) in round 1, 55·3% (median 56·0, IQR 47·6-63·4) in round 2, and 61·6% (median 62·7, IQR 54·4-69·9) in round 3. In round 1, we observed a positive socioeconomic gradient, with the mean PMAQ score ranging from 56·6% in the poorest group to 64·1% in the richest group. Between rounds 1 and 3, mean PMAQ performance increased by 7·1 percentage points for the poorest group and decreased by 0·8 percentage points for the richest group (p<0·0001), with the gap between richest and poorest narrowing from 7·5 percentage points (95% CI 6·5 to 8·5) to -0·4 percentage points over the same period (-1·6 to 0·8). INTERPRETATION: Existing income inequalities in the delivery of primary health care were eliminated during the three rounds of PMAQ, plausibly due to a design feature of PMAQ that adjusted financial payments for socioeconomic inequalities. However, there remains an important policy agenda in Brazil to address the large inequities in health. FUNDING: UK Medical Research Council, Newton Fund, and CONFAP (Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa).


Assuntos
Saúde da Família/normas , Atenção Primária à Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Reembolso de Incentivo/estatística & dados numéricos , Brasil , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/normas , Humanos , Estudos Longitudinais , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/normas , Indicadores de Qualidade em Assistência à Saúde , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/normas , Fatores Socioeconômicos
14.
J Am Board Fam Med ; 34(Suppl): S203-S209, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33622839

RESUMO

The Coronavirus disease 2019 (COVID-19) pandemic has laid bare the dis-integrated health care system in the United States. Decades of inattention and dwindling support for public health, coupled with declining access to primary care medical services have left many vulnerable communities without adequate COVID-19 response and recovery capacity. "Health is a Community Affair" is a 1966 effort to build and deploy local communities of solution that align public health, primary care, and community organizations to identify health care problem sheds, and activate local asset sheds. After decades of independent effort, the COVID-19 pandemic offers an opportunity to reunite and align the shared goals of public health and primary care. Imagine how different things might look if we had widely implemented the recommendations from the 1966 report? The ideas and concepts laid out in "Health is a Community Affair" still offer a COVID-19 response and recovery approach. By bringing public health and primary care together in community now, a future that includes a shared vision and combined effort may emerge.


Assuntos
COVID-19/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Atenção Primária à Saúde/normas , Saúde Pública/normas , COVID-19/epidemiologia , Comportamento Cooperativo , Prestação Integrada de Cuidados de Saúde/tendências , Humanos , Pandemias , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/tendências , Saúde Pública/economia , Saúde Pública/tendências , SARS-CoV-2 , Estados Unidos/epidemiologia
15.
Dis Mon ; 67(5): 101116, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33602543

RESUMO

Diabetes is one of the leading causes of morbidity and mortality in the United States. Patients with diabetes are at risk for multiple ophthalmologic complications including, but not limited to, cataracts, glaucoma, and retinopathy. Eye-exams are an important screening tool for patients with diabetes in order to prevent the more severe and vision-threatening sequela of disease. Early detection and treatment of diabetic retinopathy can result in a significant decrease in vision-loss. However, recent estimates demonstrate that few diabetic patients meet the recommended screening guidelines. Appropriate referral and follow-up is important for monitoring the ophthalmologic conditions associated with diabetes. Our purpose is to review current recommendations for ophthalmic screening for patients with diabetes in a clear and concise manor for primary care physicians.


Assuntos
Retinopatia Diabética/diagnóstico , Atenção Primária à Saúde/normas , Humanos , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta , Acuidade Visual
16.
Med J Aust ; 214(5): 212-217, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33580553

RESUMO

OBJECTIVE: To investigate whether integrating pharmacists into general practices reduces the number of unplanned re-admissions of patients recently discharged from hospital. DESIGN, SETTING: Stepped wedge, cluster randomised trial in 14 general practices in southeast Queensland. PARTICIPANTS: Adults discharged from one of seven study hospitals during the seven days preceding recruitment (22 May 2017 - 14 March 2018) and prescribed five or more long term medicines, or having a primary discharge diagnosis of congestive heart failure or exacerbation of chronic obstructive pulmonary disease. INTERVENTION: Comprehensive face-to-face medicine management consultation with an integrated practice pharmacist within seven days of discharge, followed by a consultation with their general practitioner and further pharmacist consultations as needed. MAJOR OUTCOMES: Rates of unplanned, all-cause hospital re-admissions and emergency department (ED) presentations 12 months after hospital discharge; incremental net difference in overall costs. RESULTS: By 12 months, there had been 282 re-admissions among 177 control patients (incidence rate [IR], 1.65 per person-year) and 136 among 129 intervention patients (IR, 1.09 per person-year; fully adjusted IR ratio [IRR], 0.79; 95% CI, 0.52-1.18). ED presentation incidence (fully adjusted IRR, 0.46; 95% CI, 0.22-0.94) and combined re-admission and ED presentation incidence (fully adjusted IRR, 0.69; 95% CI, 0.48-0.99) were significantly lower for intervention patients. The estimated incremental net cost benefit of the intervention was $5072 per patient, with a benefit-cost ratio of 31:1. CONCLUSION: A collaborative pharmacist-GP model of post-hospital discharge medicines management can reduce the incidence of hospital re-admissions and ED presentations, achieving substantial cost savings to the health system. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12616001627448 (prospective).


Assuntos
Clínicos Gerais , Modelos Organizacionais , Readmissão do Paciente/estatística & dados numéricos , Farmacêuticos , Corporações Profissionais/organização & administração , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Reconciliação de Medicamentos , Pessoa de Meia-Idade , Atenção Primária à Saúde/normas , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Qualidade de Vida , Queensland
18.
Nurs Outlook ; 69(3): 447-457, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33386146

RESUMO

BACKGROUND: Leaders from a university, Area Health Education Center, and primary care centers (PCCs) collaborated to integrate Interprofessional Collaborative Practice (IPCP) in PCCs. PURPOSE: Describe the facilitators and barriers of IPCP implementation in rural clinics and the impact on decision-making and safety culture. METHODS: The implementation team used engagement strategies to support the development of IPCP. PCC team participants completed surveys measuring collaboration and satisfaction with care decisions and safety culture. Qualitative data were analyzed to describe facilitators and barriers to IPCP. FINDINGS: Significant improvement (p < .035) in the Global Amount of Collaboration made over time. Barriers to IPCP included high turnover, hierarchical culture, lack of role clarity, competing time demands, limited readiness for change, and physical space limitations. Facilitators included structured huddles, alignment of IPCP with organizational goals, and academic-practice partnership. DISCUSSION: Partnering with academic-practice partnerships may facilitate collaboration and team learning as PCCs incorporate IPCP into practice.


Assuntos
Comportamento Cooperativo , Relações Interprofissionais , Equipe de Assistência ao Paciente/normas , Atenção Primária à Saúde/normas , Competência Profissional/normas , Serviços de Saúde Rural/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Competência Profissional/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos
19.
Nurs Outlook ; 69(3): 380-388, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33422289

RESUMO

BACKGROUND: Population aging and physician shortages have motivated recommendations of increased use of registered nurses in care provision; little is known about RN and NP employment in primary care and geriatric practices or service types each provide. PURPOSE: Determine current RN and NP employment frequency in practices in the U.S., identify services provided by RNs, and whether NP presence in practice is associated with the types and frequency of services provided by RNs. METHODS: National survey of 410 primary care and geriatric clinicians. FINDINGS: Only half of practices employed RNs. RNs most frequently provide teaching or education for chronic disease management. RNs provide significantly more primary care and geriatric services when practices employed a NP. DISCUSSION: Reasons for RN underuse in practices should be identified, clinical placements in such practices should increase, and NP education programs should include care models using RNs to their full scope of practice.


Assuntos
Competência Clínica/normas , Enfermagem Geriátrica/normas , Profissionais de Enfermagem/normas , Papel do Profissional de Enfermagem , Enfermeiras e Enfermeiros/normas , Médicos/normas , Atenção Primária à Saúde/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica/estatística & dados numéricos , Feminino , Enfermagem Geriátrica/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/estatística & dados numéricos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estados Unidos
20.
Drug Ther Bull ; 59(2): 24-28, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33509906

RESUMO

Topics for DTB review articles are selected by DTB's editorial board to provide concise overviews of medicines and other treatments to help patients get the best care. Articles include a summary of key points and a brief overview for patients. Articles may also have a series of multiple choice CME questions.


Assuntos
Erros de Medicação/prevenção & controle , Segurança do Paciente/normas , Padrões de Prática Médica/normas , Atenção Primária à Saúde/normas , Prática Clínica Baseada em Evidências , Humanos , Modelos Educacionais , Reino Unido
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