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1.
BMJ Open ; 10(8): e039305, 2020 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-32859666

RESUMO

INTRODUCTION: The Promoting Activity, Independence and Stability in Early Dementia (PrAISED) randomised controlled trial (RCT) is evaluating a home-based, face-to-face, individually tailored, activity and exercise programme for people living with dementia. Social distancing requirements following the COVID-19 pandemic necessitated rapid changes to intervention delivery. METHODS AND ANALYSIS: A mixed-methods process evaluation will investigate how the changes were implemented and the impact that these have on participants' experience. An implementation study will investigate how the intervention was delivered during the pandemic. A study on the mechanisms of impact and context will investigate how these changes were experienced by the PrAISED participants, their carers and the therapists delivering the intervention. The study will commence in May 2020. ETHICS AND DISSEMINATION: The PrAISED RCT and process evaluation have received ethical approval number 18/YH/0059. The PrAISED process evaluation will enable us to understand how distancing and isolation affected participants, their activity and exercise routines and whether the therapy programme could be continued with remote support. This will be valuable both in explaining trial results and also contribute to understanding and designing new ways of delivering home-based services and rehabilitation interventions for people with dementia and their carers. TRIAL REGISTRATION NUMBER: ISRCTN15320670; Pre-results.


Assuntos
Disfunção Cognitiva/terapia , Infecções por Coronavirus , Demência/terapia , Exercício Físico , Promoção da Saúde , Vida Independente , Pandemias , Pneumonia Viral , Avaliação de Processos em Cuidados de Saúde , Atividades Cotidianas , Betacoronavirus , Cuidadores , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Terapia por Exercício , Feminino , Serviços de Assistência Domiciliar , Humanos , Masculino , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Projetos de Pesquisa , Isolamento Social
2.
Z Evid Fortbild Qual Gesundhwes ; 153-154: 119-125, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32727700

RESUMO

OBJECTIVES: The aim of this paper is to describe a conceptual framework for how to consider health equity in the Grading Recommendations Assessment and Development Evidence (GRADE) guideline development process. STUDY DESIGN AND SETTING: Consensus-based guidance developed by the GRADE working group members and other methodologists. This is a German translation of the original paper published in English. RESULTS: We developed consensus-based guidance to help address health equity when rating the certainty of synthesized evidence (i.e., quality of evidence). When health inequity is determined to be a concern by stakeholders, we propose five methods for explicitly assessing health equity: (1) include health equity as an outcome; (2) consider patient-important outcomes relevant to health equity; (3) assess differences in the relative effect size of the treatment; (4) assess differences in baseline risk and the differing impacts on absolute effects; and (5) assess indirectness of evidence to disadvantaged populations and/or settings. CONCLUSION: The most important priority for research on health inequity and guidelines is to identify and document examples where health equity has been considered explicitly in guidelines. Although there is a weak scientific evidence base for assessing health equity, this should not discourage the explicit consideration of how guidelines and recommendations affect the most vulnerable members of society.


Assuntos
Equidade em Saúde , Consenso , Alemanha , Humanos , Avaliação de Processos em Cuidados de Saúde
3.
Psychother Psychosom ; 89(5): 314-319, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32554959

RESUMO

INTRODUCTION: Electroconvulsive therapy (ECT) is a critical procedure in psychiatric treatment, but as typically delivered involves the use of bag-mask ventilation (BMV), which during the COVID-19 pandemic exposes patients and treatment staff to potentially infectious aerosols. OBJECTIVE: To demonstrate the utility of a modified anesthesia protocol for ECT utilizing preoxygenation by facemask and withholding the use of BMV for only those patients who desaturate during the apneic period. METHODS: This chart review study analyzes patients who were treated with ECT using both the traditional and modified anesthesia protocols. RESULTS: A total of 106 patients were analyzed, of whom 51 (48.1%) required BMV using the new protocol. Of clinical factors, only patient BMI was significantly associated with the requirement for BMV. Mean seizure duration reduced from 52.0 ± 22.4 to 46.6 ± 17.1 s, but seizure duration was adequate in all cases. No acute physical, respiratory, or psychiatric complications occurred during treatment. CONCLUSIONS: A modified anesthesia protocol reduces the use of BMV by more than 50%, while retaining adequate seizure duration.


Assuntos
Aerossóis , Anestesia/normas , Protocolos Clínicos/normas , Infecções por Coronavirus/prevenção & controle , Eletroconvulsoterapia/normas , Oxigenoterapia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Avaliação de Processos em Cuidados de Saúde , Respiração Artificial/normas , Adulto , Índice de Massa Corporal , Feminino , Humanos , Masculino , Estudos Retrospectivos
4.
PLoS One ; 15(6): e0234383, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520968

RESUMO

BACKGROUND: A number of instruments for identifying mental health problems in children are available, but there is limited knowledge about how to successfully implement their use in routine practice. The Strengths and Difficulties Questionnaire (SDQ) is an instrument with sound psychometric properties. Because using multi-informant SDQs when assessing young children has been emphasized, parent- and preschool teacher reports on the SDQ were introduced at Child Health Clinics in a Swedish municipality. This paper aimed to describe a facilitation programme developed to support the introduction of SDQ in clinical practice and evaluate how nurses perceived the facilitation strategies used. Moreover, the dose (delivery) and reach (response rate and population coverage) of the questionnaires were assessed. METHODS: The mixed-methods process evaluation was guided by Moore et al.'s framework. Process data were excerpted from monitoring data, the trial database, research group documents, study materials, group interviews with nurses, and a survey on nurses' opinions and experiences of the screening method and the implementation process. Data were analysed using descriptive statistics and qualitative content analysis. RESULTS: Facilitation strategies used included: educational meetings, educational outreach visits, newsletters, facilitative administrative support, and adaptations made in procedures and materials when required. Although nurses described a variety of barriers at the organisational and individual level, they were in favour of using the SDQ in clinical practice and emphasised the importance of the facilitation strategies used for its implementation. While dose levels (77-91%) indicated that nurses essentially delivered the intervention as intended, parental response rates remained between 54 and 63% and population coverage at around 50%, throughout the intervention period. CONCLUSION: The facilitation program was perceived to support the implementation of the SDQ at the yearly check-ups in the child healthcare setting, but further efforts are required to reach all families.


Assuntos
Saúde da Criança/classificação , Saúde Mental/classificação , Avaliação de Processos em Cuidados de Saúde/métodos , Pré-Escolar , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pais , Psicometria/métodos , Professores Escolares , Inquéritos e Questionários , Suécia/epidemiologia
5.
BMC Neurol ; 20(1): 219, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32471443

RESUMO

BACKGROUND: Almost half of the stroke patients admitted to geriatric rehabilitation has persisting problems after discharge. Currently, there is no evidence based geriatric rehabilitation programme available for older stroke patients, combining inpatient rehabilitation with adequate aftercare aimed at reducing the impact of persisting problems after discharge from a geriatric rehabilitation unit. Therefore, we developed an integrated multidisciplinary rehabilitation programme consisting of inpatient neurorehabilitation treatment using goal attainment scaling, home based self-management training, and group based stroke education for patients and informal caregivers. We performed a process evaluation to assess to what extent this programme was performed according to protocol. Furthermore, we assessed the participation of the patients in the programme, and the opinion of patients, informal caregivers and care professionals on the programme. METHODS: In this multimethod study, process data were collected by means of interviews, questionnaires, and registration forms among 97 older stroke patients, 89 informal caregivers, and 103 care professionals involved in the programme. RESULTS: A part of patients and informal caregivers did not receive all key elements of the programme. Almost all patients formulated rehabilitation goals, but among two thirds of the patients the goal attainment scaling method was used. Furthermore, the self-management training was considered rather complex and difficult to apply for frail elderly persons with stroke, and the percentage of therapy sessions performed in the patients' home environment was lower than planned. In addition, about a quarter of the patients and informal caregivers attended the education sessions. However, a majority of patients, informal caregivers and care professionals indicated the beneficial aspects of the programme. CONCLUSION: This study revealed that although the programme in general is perceived to be beneficial by patients, and informal and formal caregivers, the feasibility of the programme needs further attention. Because of persisting cognitive deficits and specific care needs in our frail and multimorbid target population, some widely used methods such as goal attainment scaling, and self-management training seemed not feasible in their current form. To optimize feasibility of the programme, it is recommended to tailor these elements more optimally to the population of frail older patients.


Assuntos
Assistência ao Convalescente/métodos , Cuidadores/educação , Educação de Pacientes como Assunto/métodos , Avaliação de Processos em Cuidados de Saúde , Reabilitação do Acidente Vascular Cerebral/métodos , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Projetos de Pesquisa , Inquéritos e Questionários
6.
Aust N Z J Public Health ; 44(3): 208-214, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32459394

RESUMO

OBJECTIVE: Schools are an important setting for skin cancer prevention. An intervention for implementation of school sun safety policy, Sun Safety Schools (SSS), was evaluated. METHODS: Primary schools (n=118) in California school districts that had already adopted a sun safety policy were enrolled in a study with a randomised controlled design. Half of the schools were randomised to SSS intervention (N=58). Parents completed an online post-test. RESULTS: More parents in intervention schools received information about sun safety (mean=26.3%, sd=3.1%, p=0.017) and children more frequently wore sun-protective clothing when not at school (mean=2.93, sd=0.03, p=0.033) than in control schools (mean=18.0%, sd=2.5%; mean=2.83, sd=0.03, respectively). In schools where principals reported implementing sun safety practices, parents reported that children spent less time outdoors at midday (mean=14.78 hours, sd=0.25, p=0.033) and fewer were sunburned (mean=12.7%, sd=1.1%, p=0.009) than in non-implementing schools (M=16.3 hours, sd=0.67; mean=21.2%, sd=3.8%, respectively). Parents who received sun safety information (mean=3.08, sd=0.04, p=0.008) reported more child sun protection than parents not receiving information (mean=2.96, sd=0.02). CONCLUSIONS: A school district sun protection policy and support for implementation increased dissemination of sun safety information to parents and student sun safety. Implications for public health: Technical assistance for sun safety policies may increase sun protection of children.


Assuntos
Comunicação , Educação em Saúde/organização & administração , Promoção da Saúde/métodos , Pais , Serviços de Saúde Escolar/organização & administração , Estudantes/psicologia , Queimadura Solar/prevenção & controle , Luz Solar/efeitos adversos , Adolescente , Austrália , Criança , Feminino , Política de Saúde , Humanos , Masculino , Política Organizacional , Avaliação de Processos em Cuidados de Saúde , Instituições Acadêmicas , Raios Ultravioleta/efeitos adversos
8.
BMC Public Health ; 20(1): 450, 2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32252713

RESUMO

BACKGROUND: SEA Change Portland is a systems-based approach implemented in Portland, Victoria that utilises local community resources to sustainably prevent and reduce the prevalence of childhood obesity. Action is implemented by community-led task teams with differing priority areas, and supported by a steering committee representative of four collaborating organisations. This study examines the SEA Change Portland process to identify significant events, enablers and barriers of its development and implementation to date as reported by key stakeholders involved in implementation during the first 12 months. METHODS: Semi-structured interviews were conducted with eight steering group members and three community task team members. Data was collected utilising open ended interview questions to gather in-depth information regarding program implementation, and the individual attitudes, beliefs and experiences of key stakeholders. RESULTS: Data were analysed under three key themes: collective impact, systems thinking and asset based community development (ABCD). Participants gave perceptions of significant events; factors positively and negatively affecting the process; reasons for becoming involved in the process; perceived efficacy of task teams, principles of diversity and areas of concern. Themes emerged from participant responses allowing were categorisation of their responses into four key process stages: initial lead up; process development; establishing community ownership of the obesity system; and community action. CONCLUSION: Collective impact was a crucial element in applying the systems thinking. Strong and equitable relationships between steering organisations and topic experts provided the initiative with a sustainable foundation, and ABCD promotes community ownership and future sustainability. Understanding the process of implementing a new whole-of-community systems approach to childhood obesity prevention such as SEA Change Portland has provided vital knowledge for other communities regarding enablers and barriers of this promising approach.


Assuntos
Participação da Comunidade/métodos , Obesidade Pediátrica/prevenção & controle , Criança , Feminino , Implementação de Plano de Saúde , Humanos , Masculino , Obesidade Pediátrica/epidemiologia , Prevalência , Avaliação de Processos em Cuidados de Saúde , Análise de Sistemas , Vitória/epidemiologia
9.
PLoS One ; 15(4): e0232094, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32320457

RESUMO

BACKGROUND: The World Health Organization has recommended HIV self-testing (HIVST) as an alternative testing strategy given the limitations of facility-based testing. While the benefits of HIV self-testing have been demonstrated at the individual level among men who have sex with men (MSM), limited data exist on if this testing approach can be effectively diffused through individuals' social or sexual networks. The objectives of this study were to examine patterns and correlates of HIVST distribution within Chinese MSM's sexual networks. METHODS: Data used for this analysis was a part of the process evaluation of an HIVST intervention trial among MSM in Nanjing, China. Between May and October 2017, we enrolled 400 men into the trial. Participants assigned to the intervention group (N = 200) were given three HIVST kits at baseline and could request more during the follow-up periods. We incorporated measures for process evaluation in the self-administered online follow-up surveys. This analysis reported findings from the three-month follow-up survey in the intervention group. Frequencies and percentages were used to describe characteristics of participants who distributed kits to their sexual partners as well as patterns of distribution. Multivariable logistic regression was conducted to identify independent correlates of participants who distributed the kits. RESULTS: Of the 177 participants retained (88.5%) at the three-month follow-up, 72 (40.7%) distributed one or more kits to either primary or casual partners. About half of distributors (51.4%) gave one HIVST kit to their sexual partners while 15.3% distributed 3 or more. Over half gave these kits (58.3%) to primary sexual partners while 27.8% reported giving the kits to both primary and casual partners. About half (54.2%) of distributors used the kits together with their partners. Compared to participants who had an HIV test in the past six months, those who tested over six months ago or never tested had significantly lower odds of distributing the kits (AOR = 0.484, 95% CI: 0.250-0.983, p = 0.032). Compared to those who had not used the kits themselves, participants who did had significantly higher odds of distributing the kits (AOR = 3.345, 95% CI: 1.488-7.517, p = 0.003). Participants who reported higher HIV testing efficacy had 2.051 fold greater odds (95% CI: 1.062-3.961, p = 0.033) of distributing the kits compared to those who had lower efficacy. CONCLUSION: Our study demonstrated that a sexual network-based approach to distributing HIVST among Chinese MSM is feasible and can be a promising strategy to improve the effectiveness of HIVST programs including its reach to untested men. Such approach should be complimented by intervention components that enhance HIV testing efficacy and improve experiences of HIVST.


Assuntos
Infecções por HIV/diagnóstico , Homossexualidade Masculina/estatística & dados numéricos , Autocuidado/estatística & dados numéricos , Adolescente , Adulto , China , Testes Diagnósticos de Rotina , Humanos , Masculino , Avaliação de Processos em Cuidados de Saúde , Parceiros Sexuais , Minorias Sexuais e de Gênero , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
10.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32127361

RESUMO

OBJECTIVES: To determine if a multicomponent intervention was associated with increased use of first-line antibiotics (cephalexin or sulfamethoxazole and trimethoprim) among children with uncomplicated urinary tract infections (UTIs) in outpatient settings. METHODS: The study was conducted at Kaiser Permanente Colorado, a large health care organization with ∼127 000 members <18 years of age. After conducting a gap analysis, an intervention was developed to target key drivers of antibiotic prescribing for pediatric UTIs. Intervention activities included development of new local clinical guidelines, a live case-based educational session, pre- and postsession e-mailed knowledge assessments, and a new UTI-specific order set within the electronic health record. Most activities were implemented on April 26, 2017. The study design was an interrupted time series comparing antibiotic prescribing for UTIs before versus after the implementation date. Infants <60 days old and children with complex urologic or neurologic conditions were excluded. RESULTS: During January 2014 to September 2018, 2142 incident outpatient UTIs were identified (1636 preintervention and 506 postintervention). Pyelonephritis was diagnosed for 7.6% of cases. Adjusted for clustering of UTIs within clinicians, the proportion of UTIs treated with first-line antibiotics increased from 43.4% preintervention to 62.4% postintervention (P < .0001). The use of cephalexin (first-line, narrow spectrum) increased from 28.9% preintervention to 53.0% postintervention (P < .0001). The use of cefixime (second-line, broad spectrum) decreased from 17.3% preintervention to 2.6% postintervention (P < .0001). Changes in prescribing practices persisted through the end of the study period. CONCLUSIONS: A multicomponent intervention with educational and process-improvement elements was associated with a sustained change in antibiotic prescribing for uncomplicated pediatric UTIs.


Assuntos
Assistência Ambulatorial , Antibacterianos/uso terapêutico , Anti-Infecciosos Urinários/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Adolescente , Fatores Etários , Cefalexina/uso terapêutico , Criança , Pré-Escolar , Cistite/tratamento farmacológico , Feminino , Humanos , Lactente , Análise de Séries Temporais Interrompida , Masculino , Avaliação de Processos em Cuidados de Saúde , Pielonefrite/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/epidemiologia
11.
J Med Internet Res ; 22(3): e15875, 2020 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-32196459

RESUMO

BACKGROUND: Globally, access to hearing health care is a growing concern with 900 million people estimated to suffer from disabling hearing loss by 2050. Hearing loss is one of the most common chronic health conditions, yet access to hearing health care is limited. Incorporating Web-based (voice calling, messaging, or emailing) service delivery into current treatment pathways could improve access and allow for better scalability of services. Current electronic health studies in audiology have focused on technical feasibility, sensitivity, and specificity of diagnostic hearing testing and not on patient satisfaction, experiences, and sustainable models along the entire patient journey. OBJECTIVE: This study aimed to investigate a hybrid (Web-based and face-to-face) hearing health service in terms of uptake, experience, and satisfaction in adult patients with hearing loss. METHODS: A nonprofit hearing research clinic using online and face-to-face services was implemented in Durban, South Africa, using online recruitment from the clinic's Facebook page and Google AdWords, which directed persons to an online Web-based hearing screening test. Web-based and face-to-face care pathways included assessment, treatment, and rehabilitation. To evaluate the service, an online survey comprising (1) a validated satisfaction measurement tool (Short Assessment of Patient Satisfaction), (2) a process evaluation of all the 5 steps completed, and (3) personal preferences of communication methods used vs methods preferred was conducted, which was sent to 46 patients who used clinic services. RESULTS: Of the patients invited, 67% (31/46) completed the survey with mean age 66 years, (SD 16). Almost all patients, 92% (30/31) reported that the online screening test assisted them in seeking hearing health care. Approximately 60% (18/31) of the patients accessed the online hearing screening test from an Android device. Patients stayed in contact with the audiologist mostly through WhatsApp instant messaging (27/31, 87%), and most patients (25/31, 81%) preferred to use this method of communication. The patients continuing with hearing health care were significantly older and had significantly poorer speech recognition abilities compared with the patients who discontinued seeking hearing health care. A statistically significant positive result (P=.007) was found between age and the number of appointments per patient. Around 61% (19/31) of patients previously completed diagnostic testing at other practices, with 95% (18/19) rating the services at the hybrid clinic as better. The net promoter score was 87, indicating that patients were highly likely to recommend the hybrid clinic to friends and family. CONCLUSIONS: This study applied Web-based and face-to-face components into a hybrid clinic and measured an overall positive experience with high patient satisfaction through a process evaluation. The findings support the potential of a hybrid clinic with synchronous and asynchronous modes of communication to be a scalable hearing health care model, addressing the needs of adults with hearing loss globally.


Assuntos
Testes Auditivos/métodos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Idoso , Feminino , Humanos , Internet , Masculino , Avaliação de Processos em Cuidados de Saúde , Inquéritos e Questionários
12.
Pediatrics ; 145(3)2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32075871

RESUMO

When parents or guardians hope for a miracle for their child who is critically ill, ethical and professional challenges can arise. Often, although not always, the parent or guardian's hope for a miracle entails a request for continued life-sustaining interventions. Striking a balance between the pediatrician's conception of good medicine and the parent or guardian's authority requires a response that is sensitive, practical, and ethically sound. In this article, we recommend 3 cumulative steps that promote such a response. First, we recommend ways of exploring essential issues through open inquiry, interdisciplinary dialogue, and self-reflection. As part of this exploration, pediatricians will discover that parents or guardians often have unique ideas about what a miracle might be for their child. The second step includes analyzing this diversity and seeking understanding. We classify the hope for a miracle into 3 distinct categories: integrated, seeking, and adaptive. After the pediatrician has categorized the parent or guardian's hope, they can consider specific recommendations. We detail context-specific responses for each kind of hope. By attending to these nuances, not only will the parent or guardian's perspective be heard but also the pediatrician's recommendation can strike a balance between advocating for their conception of good medicine and respecting the parent or guardian's beliefs.


Assuntos
Estado Terminal , Esperança , Pais , Avaliação de Processos em Cuidados de Saúde , Relações Profissional-Família , Doente Terminal , Criança , Comunicação , Humanos , Tutores Legais , Futilidade Médica/ética , Equipe de Assistência ao Paciente , Pediatras
13.
Am Surg ; 86(1): 15-20, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-32077411

RESUMO

The American College of Surgeons Committee on Trauma requires that trauma centers with greater than 10 per cent injured patients admitted to non-trauma services (NTSs) have processes to review these for appropriateness of care. We previously described an algorithm to determine the appropriateness of NTS admissions. Our objective was to determine if the outcome and process of care was similar between TS- and NTS-admitted patients. We conducted a retrospective analysis of our trauma registry. NTS-appropriate patients by algorithm were included. Differences between patients admitted to a TS and an NTS were compared. Nine hundred forty-one patients met the algorithm criteria as appropriate for the NTS; 694 were admitted to TS and 247 to NTS. Contact with TS was the most common association with admission to TS. NTS patients were older and had similar Injury Severity Scores, and a similar proportion had three or greater pre-existing comorbidities. NTS-admitted patients had similar risk for mortality and complications, but longer length of stay, and were less likely to have a desirable discharge disposition. Minimally injured elderly patients constitute most of NTS and a large proportion of TS admissions. NTS admission seems appropriate with respect to mortality and complications. Differences in the care process may have accounted for longer length of stay and differences in disposition destination.


Assuntos
Hospitalização , Avaliação de Processos em Cuidados de Saúde , Centros de Traumatologia/organização & administração , Adulto , Idoso , Algoritmos , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
14.
BMC Public Health ; 20(1): 180, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32019559

RESUMO

BACKGROUND: This study uses the RE-AIM framework to provide a process evaluation of a workplace-based cluster randomised trial comparing an ergonomic plus exercise intervention to an ergonomic plus health promotion intervention; and to highlight variations across organisations; and consider the implications of the findings for intervention translation. METHOD: This study applied the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) methodology to examine the interventions' implementation and to explore the extent to which differences between participating organisations contributed to the variations in findings. Qualitative and quantitative data collected from individual participants, research team observations and organisations were interrogated to report on the five RE-AIM domains. RESULTS: Overall reach was 22.7% but varied across organisations (range 9 to 83%). Participants were generally representative of the recruitment pool though more females (n = 452 or 59%) were recruited than were in the pool (49%). Effectiveness measures (health-related productivity loss and neck pain) varied across all organisations, with no clear pattern emerging to indicate the source of the variation. Organisation-level adoption (66%) and staffing level adoption (91%) were high. The interventions were implemented with minimal protocol variations and high staffing consistency, but organisations varied in their provision of resources (e.g. training space, seniority of liaisons). Mean adherence of participants to the EET intervention was 56% during the intervention period, but varied from 41 to 71% across organisations. At 12 months, 15% of participants reported regular EET adherence. Overall mean (SD) adherence to EHP was 56% (29%) across organisations during the intervention period (range 28 to 77%), with 62% of participants reporting regular adherence at 12 months. No organisations continued the interventions after the follow-up period. CONCLUSION: Although the study protocol was implemented with high consistency and fidelity, variations in four domains (reach, effectiveness, adoption and implementation) arose between the 14 participating organisations. These variations may be the source of mixed effectiveness across organisations. Factors known to increase the success of workplace interventions, such as strong management support, a visible commitment to employee wellbeing and participant engagement in intervention design should be considered and adequately measured for future interventions. TRIAL REGISTRATION: ACTRN12612001154897; 29 October 2012.


Assuntos
Exercício Físico , Promoção da Saúde/métodos , Saúde do Trabalhador , Avaliação de Processos em Cuidados de Saúde , Adulto , Eficiência , Ergonomia , Feminino , Humanos , Masculino , Cervicalgia/prevenção & controle , Avaliação de Programas e Projetos de Saúde
15.
JAMA Netw Open ; 3(2): e1920548, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32022882

RESUMO

Importance: Management of antithrombotic medications presents a challenge for many clinicians and patients before procedures. Anticoagulation clinic involvement may improve preprocedure coordination, satisfaction on the part of patients and clinicians, last-minute procedure cancellations, and patient safety. Objective: To assess the implementation of an electronic medical record (EMR) best practice alert (BPA) and anticoagulation clinic referral process to assist with management of antithrombotic medication before gastrointestinal endoscopic procedures. Design, Setting, and Participants: This multimodal evaluation of a quality improvement intervention using EMRs and survey data included patients using oral antithrombotic medications who were scheduled for elective gastrointestinal endoscopic procedures at an academic medical center along with the clinicians who ordered these procedures. Data were collected from November 1, 2017, through December 19, 2018. Data were analyzed in September 2019. Exposures: Following a multidisciplinary intervention, a BPA and referral process for periprocedural antithrombotic medication management was implemented in November 2017. Main Outcomes and Measures: The following implementation outcomes were assessed through EMR review and surveys through December 2018: use of BPAs, patient and clinician satisfaction with preprocedure anticoagulation management, procedure cancelation rates, reach, and spread by patient and clinician characteristics. Multilevel logistic regression was used to estimate variance in BPA use at the clinician level. Results: A total of 2082 patients (mean [SD] age, 64.1 [11.9] years) and 144 clinicians were included in the analysis. The BPA was used broadly across the health system, resulting in anticoagulation clinic referral for 1389 patients (66.7%). Referral was more common for patients using anticoagulant vs antiplatelet medications (1041 of 1524 [68.3%] vs 346 of 556 [62.2%]; adjusted odds ratio [aOR], 1.51; 95% CI, 1.15-1.98) and for procedures ordered by gastroenterologists vs primary care clinicians (933 of 1241 [75.2%] vs 365 of 618 [59.1%]; aOR, 2.15; 95% CI, 1.46-3.17). Individual clinician behavior patterns explained 26.5% (95% CI, 18.7%-36.1%) of variation in anticoagulation clinic referrals. Implementation of the intervention was associated with high patient satisfaction and improvements in multidimensional measures of clinician satisfaction (clinician response rate, 44.2% [144 of 326]). In multivariable analysis, the odds of altered or canceled procedures because of medication mismanagement declined after implementation (8 of 50 [16.0%] vs 1 of 52 [1.9%]; aOR, 0.11; 95% CI, 0.01-0.96; P = .02). Conclusions and Relevance: A newly implemented BPA and anticoagulation clinic referral process was broadly adopted and used, had high satisfaction by patients and clinicians, and was associated with fewer disruptions to planned procedures caused by medication mismanagement.


Assuntos
Registros Eletrônicos de Saúde , Endoscopia Gastrointestinal , Sistemas de Registro de Ordens Médicas/normas , Cuidados Pré-Operatórios/normas , Encaminhamento e Consulta/normas , Idoso , Feminino , Fibrinolíticos/uso terapêutico , Implementação de Plano de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Guias de Prática Clínica como Assunto , Cuidados Pré-Operatórios/métodos , Avaliação de Processos em Cuidados de Saúde , Melhoria de Qualidade
16.
Rev. bras. promoç. saúde (Impr.) ; 33: 1-12, 03/01/2020.
Artigo em Espanhol | LILACS | ID: biblio-1099492

RESUMO

Objetivo: Evaluar los procesos de una intervención de actividad física durante el embarazo y postparto. Métodos: En el contexto de un programa social que combate la pobreza extrema, las beneficiarias (n=927) recibieron una intervención que consistió en la promoción de la práctica de actividad física, a través de consejería, talleres y materiales educativos. En 2008-9, 2010 y 2012 se visitaron unidades de salud urbanas y rurales, seleccionadas aleatoriamente, de cuatro entidades federativas de México. Se recolectó información de procesos a través de prestadores de servicios de salud, observación en consulta y aplicación de encuestas de salida a beneficiarias. Se estudiaron cuatro indicadores de implementación de la intervención: fidelidad a actividades planeadas; dosis entregada a la población; alcance de la población objetivo; y recepción de la intervención por embarazadas y en el posparto de las participantes. Resultados: Se visitaron unidades de salud en la etapa inicial (n=91), intermedia (n=47) y final (n=82) del estudio. La dosis liberada presentó un nivel del 81-86% de implementación. La fidelidad presentó <50% de implementación; se observaron mejoras significativas en la mayoría de los aspectos evaluados entre las diferentes etapas del estudio como en la capacitación de los prestadores de servicios de salud, el suministro de materiales, la consejería e la impartición de talleres en las unidades de salud. Conclusión: Se observaron importantes retos de implementación y contextuales para la implementación efectiva de la intervención de actividad física en los servicios de salud.


Objetivo: Avaliar os processos de uma intervenção de atividade física durante a gravidez e o pós-parto. Métodos: No contexto de um programa social de combate à pobreza extrema, as beneficiárias (n=927) receberam uma intervenção que consistia na promoção da prática de atividade física por meio de aconselhamento, oficinas e materiais educacionais. Em 2008-9, 2010 e 2012, foram visitadas unidades de saúde urbanas e rurais, selecionadas aleatoriamente, de quatro entidades federais do México. As informações do processo foram coletadas por prestadores de serviços de saúde, durante observação de consultas e através da aplicação de questionários às beneficiárias. Foram estudados quatro indicadores de implementação da intervenção: fidelidade às atividades planejadas, dose entregue à população, escopo da população-alvo, e acolhimento da intervenção por gestantes e puérperas. Resultados: As unidades de saúde foram visitadas nas etapas inicial (n = 91), intermediária (n = 47) e final (n = 82) do estudo. A dose liberada mostrou um nível de implementação de 81-86%. A fidelidade apresentou <50% de implementação e melhorias significativas foram observadas na maioria dos aspectos avaliados entre as diferentes etapas do estudo, como treinamento de prestadores de serviços de saúde, fornecimento de materiais, aconselhamento e realização de oficinas nas unidades de saúde. Conclusão: Importantes implementações e desafios contextuais foram observados para a efetiva implementação da intervenção de atividade física para beneficiárias dos serviços de saúde investigados.


Objective: To evaluate the process of an intervention on physical activity during pregnancy and postpartum. Methods: In the context of a social program that fights extreme poverty, the beneficiaries (n=927) receive an intervention that consists of the promotion of the practice of physical activity, through counseling, workshops, and educational materials. During 2008-9, 2010 and 2012, we visited health units from urban and rural areas, randomly selected from four states of Mexico. Health service providers collected process data during observation of consultations and through the application of questionnaires to the beneficiaries. Four indicators of implementation of the intervention were studied: fidelity to the planned activities, dose delivered to the population, scope of the target population, and reception of the intervention by pregnant women and postpartum women. Results: Health units were visited in the initial (n=91), intermediate (n=47), and final (n=82) stages of the study. The delivered dose showed an implementation level of 81-86%. Fidelity had <50% implementation and significant improvements were observed in most analyzed aspects between the different stages of the study, such as training of health service providers, the supply of materials, counseling, and workshops in health units. Conclusion: Important Implementation and contextual challenges were observed for the effective fulfillment of the intervention of physical activity into primary healthcare services.


Assuntos
Atenção Primária à Saúde , Gravidez , Avaliação de Processos em Cuidados de Saúde , Programas Sociais , Atividade Motora
17.
BMC Public Health ; 20(1): 98, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31973701

RESUMO

BACKGROUND: A cluster-Randomised Controlled Trial evaluation of the impact of the Community Health Clubs (CHCs) in the Community Based Environmental Health Promotion Programme in Rwanda in 2015 appeared to find little uptake of 7 hygiene indicators 1 year after the end of the intervention, and low impact on prevention of diarrhoea and stunting. METHODS: Monitoring data was revisited through detailed community records with all the expected inputs, outputs and external determinants analysed for fidelity to the research protocol. Five household inventory observations were taken over a 40-month period including 2 years after the end of the cRCT in a random selection of the 50 intervention CHCs and data compared to that of the trial. Focus Group Discussion with all Environmental Health Officers of the Ministry of Health provided context to understand the long-term community dynamics of hygiene behaviour change. RESULTS: It was found that the intervention had been jeopardised by external determinants with only 54% fidelity to protocol. By the end of the designated intervention period in June 2014, the treatment had reached only 58% of households with 41% average attendance at training sessions by the 4056 registered members and 51% mean completion rate of 20+ sessions. Therefore only 10% of 50 CHCs provided the full so-called 'Classic' training as per-protocol. However, sustainability of the CHCs was high, with all 50 being active 2 years after the end of the cRCT and over 80% uptake of recommended practices of the same 7 key indicators as the trial was achieved by 2017. CONCLUSIONS: The cRCT conclusion that the case study of Rusizi District does not encourage the use of the CHC model for scaling up, raises concerns over the possible misrepresentation of the potential of the holistic CHC model to achieve health impact in a more realistic time frame. It also questions the appropriateness of apparently rigorous quantitative research, such as the cluster-Randomised Controlled Trial as conducted in Rusizi District, to adequately assess community dynamics in complex interventions.


Assuntos
Monitoramento Epidemiológico , Academias de Ginástica/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Higiene , Avaliação de Processos em Cuidados de Saúde/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , Feminino , Grupos Focais , Humanos , Ruanda
18.
World Neurosurg ; 134: e664-e671, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31698120

RESUMO

BACKGROUND: Venous thromboembolism (VTE) is a cause of considerable morbidity and mortality in hospitalized patients. An evidence-based algorithm was developed and implemented at our institution to guide perioperative VTE prophylaxis management. OBJECTIVE: We evaluated compliance with prescription of risk-appropriate VTE prophylaxis and administration of prescribed VTE prophylaxis in neurosurgery patients. METHODS: This was a retrospective analysis of postoperative neurosurgery patients at a single institution with subsequent diagnosis of acute VTE during their inpatient stay. Descriptive statistics were used to characterize pharmacologic VTE prophylaxis and prescribing patterns. RESULTS: The incidence of VTE in our neurosurgery population was 248/13,913 (1.8%). Of the 123 patients, the median time to VTE diagnosis was 96 hours after surgery (interquartile range [IQR], 58-188 hours). A total of 108 patients (87.8%) were prescribed risk-appropriate VTE prophylaxis, among whom 61 (56.5%) received all doses as prescribed. Fifty-three patients (43.1%) missed ≥1 dose of prescribed prophylaxis and the median missed doses was 3 (IQR, 0-3). The median time to first dose of pharmacologic VTE prophylaxis was 42 hours (IQR, 28-51). More than half (n = 63, 51.2%) of the VTE risk assessments contained ≥1 error, of which 15 (23.8%) would have resulted in a change in recommendation. CONCLUSIONS: Our evidence-based VTE prophylaxis algorithm was not accurately completed in more than half of patients. Many patients who developed VTE had a defect in their VTE prophylaxis management during their inpatient stay. Research to improve optimal VTE prevention practice in neurosurgery patients is needed.


Assuntos
Anticoagulantes/uso terapêutico , Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias/prevenção & controle , Avaliação de Processos em Cuidados de Saúde , Embolia Pulmonar/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Trombose Venosa/prevenção & controle , Idoso , Algoritmos , Quimioprevenção , Enoxaparina/uso terapêutico , Feminino , Fidelidade a Diretrizes , Heparina/uso terapêutico , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo
19.
Pediatr Cardiol ; 41(2): 327-333, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31865442

RESUMO

Neurodevelopmental (ND) impairment is common in children with congenital heart disease (CHD). While routine ND surveillance and evaluation of high-risk patients has become the standard-of-care, capture rate, barriers to referral, and potential patient benefits remain incompletely understood. Electronic data warehouse records from a single center were reviewed to identify all eligible and evaluated patients between July 2015 and December 2017 based on current guidelines for ND screening in CHD. Diagnoses, referring provider, and payor were considered. Potential benefit of the evaluation was defined as receipt of new diagnosis, referral for additional evaluation, or referral for a new service. Contingencies were assessed with Fisher's exact test. In this retrospective, cohort study, of 3434 children identified as eligible for ND evaluation, 135 were evaluated (4%). Appropriate evaluation was affected by diagnostic bias against coarctation of the aorta (CoArc) and favoring hypoplastic left heart syndrome (HLHS) (1.8 vs. 11.9%, p<0.01). Referrals were disproportionally made by a select group of cardiologists, and the rate of ND appointment non-compliance was higher in self-pay compared to insured patients (78% vs 27%, p<0.01). Potential benefit rate was 70-80% amongst individuals with the three most common diagnoses requiring neonatal surgery (CoArc, transposition of the great arteries, and HLHS). Appropriate ND evaluation in CHD is impacted by diagnosis, provider, and insurance status. Potential benefit of ND evaluation is high regardless of diagnosis. Strategies to improve access to ND evaluations and provider understanding of the at-risk population will likely improve longitudinal ND surveillance and clinical benefit.


Assuntos
Deficiências do Desenvolvimento/diagnóstico , Cardiopatias Congênitas/complicações , Adolescente , Viés , Criança , Pré-Escolar , Estudos de Coortes , Deficiências do Desenvolvimento/etiologia , Feminino , Humanos , Lactente , Masculino , Avaliação de Processos em Cuidados de Saúde/normas , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco
20.
Dimens Crit Care Nurs ; 39(1): 58-68, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31789987

RESUMO

Traumatic brain injury (TBI) remains a major cause of death and disability each year in the United States. Implementation of preestablished evidence-based guidelines has been associated with a decrease in overall TBI mortality and disability. OBJECTIVES: An electronic clinical monitoring tool was developed for monitoring compliance with evidence-based TBI treatment protocols to improve the overall care and outcomes in this patient population. METHODS: This project was designed as a process improvement project. For the preimplementation cohort of TBI patients, aggregate compliance data (by patient) were obtained from the Brain Trauma Foundation Trial patient registry maintained at Conemaugh Memorial Medical Center for the time between 2011 and 2012. The postimplementation cohort includes all patients older than 18 years who have sustained a TBI requiring clinical monitoring devices. RESULTS: There was a statistical significance between groups; the TBI-2017 group demonstrated better compliance with anticonvulsant use and cerebral perfusion pressure maintenance. In addition, overall compliance was better in the TBI-2017 cohort compared with the TBI-2012 cohort. CONCLUSIONS: Traumatic brain injury-specific education and frequent assessments improved compliance between TBI-2012 and TBI-2017, resulting in a higher percentage in overall survivors in the latter group.


Assuntos
Lesões Encefálicas/terapia , Fidelidade a Diretrizes , Monitorização Ambulatorial/instrumentação , Cooperação do Paciente , Educação de Pacientes como Assunto , Avaliação de Processos em Cuidados de Saúde , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade
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