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1.
Ann Hematol ; 100(3): 601-606, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33388859

RESUMO

While recent medical advances have led to cure, remission, or long-term disease control for patients with hematologic malignancy, many still portend poor prognoses, and frequently are associated with significant symptom and quality of life burden for patients and families. Patients with hematological cancer are referred to palliative care (PC) services less often than those with solid tumors, despite higher inpatient mortality and shorter interval between first consultation and death. The complexity of individual prognostication, ongoing therapeutic goals of cure, the technical nature and complications of treatment, the intensity of medical care even when approaching end of life, and the speed of change to a terminal event all pose difficulties and hinder referral. A modified palliative care model is an unmet need in hemato-oncology, where PC is introduced early from the diagnosis of hematological malignancy, provided alongside care of curative or life-prolonging intent, and subsequently leads to death and bereavement care or cure and survivorship care depending on disease course. From current evidence, the historical prioritization of cancer care at the center of palliative medicine did not guarantee that those diagnosed with a hematological malignancy were assured of referral, timely or otherwise. Hopefully, this article can be a catalyst for debate that will foster a new direction in integration of clinical service and research, and subspecialty development at the interface of hemato-oncology and palliative care.


Assuntos
Prestação Integrada de Cuidados de Saúde , Neoplasias Hematológicas/terapia , Oncologia , Cuidados Paliativos , Equipe de Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/normas , Humanos , Comunicação Interdisciplinar , Oncologia/métodos , Oncologia/organização & administração , Oncologia/normas , Cuidados Paliativos/métodos , Cuidados Paliativos/organização & administração , Cuidados Paliativos/normas , Equipe de Assistência ao Paciente/normas , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normas
2.
J Nerv Ment Dis ; 209(2): 144-146, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33502141

RESUMO

ABSTRACT: To date, there is lack of specific effective treatment or vaccine for the SARS-CoV-2, and clinical and laboratory research is still ongoing to find successful drugs. Therefore, prevention to be infected through social distancing and isolation is the most effective way. However, all the other physical and mental illnesses continue to exist, if possible even more burdened by the emergency situation and social distancing. The COVID-19 pandemic, especially in many low- and middle-income countries, has caused a deeper gap in seeking psychiatric help. In this scenario, telepsychiatry could play a decisive role in implementing clinical care for frail patients and ensuring continuous mental care. Therefore, we felt the urge to write this article to express our hope that the old health care system at this time of crisis, as we know it, can offer the chance to implement pervasive care technologies that perfectly fit current psychiatric needs.


Assuntos
/prevenção & controle , Países em Desenvolvimento , Acesso aos Serviços de Saúde , Transtornos Mentais/terapia , Serviços de Saúde Mental , Telemedicina , Continuidade da Assistência ao Paciente/normas , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Humanos , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/normas , Aplicativos Móveis , Psiquiatria/organização & administração , Psiquiatria/normas , Telemedicina/organização & administração , Telemedicina/normas
4.
Rev. psiquiatr. infanto-juv ; 37(3): 20-28, jul.-sept. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-197399

RESUMO

INTRODUCCIÓN: En los últimos años ha crecido la preocupación y el interés, tanto en profesionales como en usuarios de los servicios de salud mental, por el proceso de transición que experimentan los pacientes desde las Unidades de Salud Mental del Niño y el Adolescente (USM-NA) a los servicios de Salud Mental de Adultos (CSM). Como resultado de ello, desde principios de siglo han surgido en distintos países numerosos estudios y proyectos para analizar esta situación y poder diseñar un modelo de mejores prácticas para la transición que asegure la continuidad de la atención y el trabajo realizado, aportando la mayor estabilidad posible a nuestros pacientes. OBJETIVO: Siguiendo con esta línea de actuación, el Plan Estratégico de Salud Mental de la Comunidad de Madrid 2018-2020 en su Línea estratégica 2 (Atención a la salud mental en niños y adolescentes) se plantea como objetivo la Implantación de Programas de Transición de los Servicios de Salud mental de Niños y Adolescentes a los de Adultos. Se siguieron las recomendaciones del Plan Estratégico de Salud Mental de la Comunidad de Madrid 2018-2020 en su Línea estratégica 2 y se realizaron reuniones de trabajo por un grupo de profesionales sensibilizados e implicados de forma voluntaria en la mejora de la atención a los pacientes en transición. RESULTADOS: Se presenta la Ficha de Transición que hemos diseñado como herramienta base del programa de transición en nuestra área de atención, siendo el resultado del trabajo multidisciplinar (trabajo social, enfermería, psicología y psiquiatría) de los profesionales, tanto de los CSM como de la USM-NA, que conforman el Grupo para la Transición del Área de Gestión Clínica de Psiquiatría y Salud Mental (AGCPSM) del Hospital 12 de Octubre


INTRODUCTION: During the last years there has been growing concern and interest, in both professionals and users of the mental health services, for the transition process experienced by patients from Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS). As a result, since the beginning of the century, numerous studies and projects have emerged in different countries to analyze this situation and to enable the design of a best-practice model for the transition that ensures the continuity of the attention and the accomplished work, providing the greatest possible stability to our patients. Objetive: Following this line of action, the Strategic Plan for Mental Health of the Community of Madrid 2018-2020 in its Strategic Line 2 (Mental health care in children and adolescents) sets the objective of the Implementation of Services Transition Programs of Mental Health of Children and Adolescents to those of Adults. RESULTS: We present the Transition Card that we have designed, base tool of the transition program in our attention area, as a result of the multidisciplinary work (social work, nursing, psychology and psychiatry) of the professionals, both of the AMHS and the CAMHS, who make up the Group for the Transition of the Area of Clinical Management of Psychiatry and Mental Health (AGCPSM) of Hospital 12 de Octubre


Assuntos
Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Transição para Assistência do Adulto , Serviços de Saúde Mental/organização & administração , Serviços de Saúde do Adolescente , Serviços de Saúde da Criança , Modelos Teóricos , Registros Médicos , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas
6.
BMC Cancer ; 20(1): 641, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32650756

RESUMO

BACKGROUND: The COVID-19 pandemic has caused a global health crisis. Numerous cancer patients from non-Western countries, including the United Arab Emirates (UAE), seek cancer care outside their home countries and many are sponsored by their governments for treatment. Many patients interrupted their cancer treatment abruptly and so returned to their home countries with unique challenges. In this review we will discuss practical challenges and recommendations for all cancer patients returning to their home countries from treatment abroad. METHOD: Experts from medical, surgical and other cancer subspecialties in the UAE were invited to form a taskforce to address challenges and propose recommendations for patients returning home from abroad after medical tourism during the SARS-COV-19 Pandemic. RESULTS: The taskforce which consisted of experts from medical oncology, hematology, surgical oncology, radiation oncology, pathology, radiology and palliative care summarized the current challenges and suggested a practical approaches to address these specific challenges to improve the returning cancer patients care. Lack of medical documentation, pathology specimens and radiology images are one of the major limitations on the continuation of the cancer care for returning patients. Difference in approaches and treatment recommendations between the existing treating oncologists abroad and receiving oncologists in the UAE regarding the optimal management which can be addressed by early and empathic communications with patients and by engaging the previous treating oncologists in treatment planning based on the available resources and expertise in the UAE. Interruption of curative radiotherapy (RT) schedules which can potentially increase risk of treatment failure has been a major challenge, RT dose-compensation calculation should be considered in these circumstances. CONCLUSION: The importance of a thorough clinical handover cannot be overstated and regulatory bodies are needed to prevent what can be considered unethical procedure towards returning cancer patients with lack of an effective handover. Clear communication is paramount to gain the trust of returning patients and their families. This pandemic may also serve as an opportunity to encourage patients to receive treatment locally in their home country. Future studies will be needed to address the steps to retain cancer patients in the UAE rather than seeking cancer treatment abroad.


Assuntos
Continuidade da Assistência ao Paciente/normas , Infecções por Coronavirus/epidemiologia , Oncologia/normas , Turismo Médico , Neoplasias/terapia , Pneumonia Viral/epidemiologia , Comitês Consultivos , Betacoronavirus , Consenso , Humanos , Oncologia/organização & administração , Pandemias , Emirados Árabes Unidos
7.
Diabetes Res Clin Pract ; 166: 108290, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32615279

RESUMO

AIM: This study explores the General Practice (GP) experience of Gestational Diabetes Mellitus (GDM). Much has been written about patient perspectives, yet little is known about the GP perspective at initial diagnosis and management. GDM is increasingly managed in the secondary and tertiary sector, the confidence of GPs and their role in ongoing care has not been examined. Given GDM's poor follow up rates, all aspects of the patient journey warrant close examination. METHODS: Through purposive and snowball sampling, we conducted semi-structured interviews with GPs in Brisbane, Australia between April and October 2018. Data collection, until saturation, and analysis were concurrent, and the Leximancer analysis tool assisted with content analysis and suggestion of themes. RESULTS: Dominant themes include uncertainty/urgency and feeling under-utilised. GPs have a pragmatic approach in the face of uncertainty, and adopt one of several strategies to meet patient needs. A key issue that may impact on long term follow up and high quality GP-patient relationships is concern about the patient being 'taken away' by the hospital. Communication with the hospital is generally perceived as poor. CONCLUSIONS: The experience of GPs in the initial diagnosis and management of GDM may assist in improving GDM follow up.


Assuntos
Diabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Clínicos Gerais , Padrões de Prática Médica , Atenção Primária à Saúde , Adulto , Austrália/epidemiologia , Continuidade da Assistência ao Paciente/normas , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Diabetes Gestacional/epidemiologia , Feminino , Seguimentos , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/normas , Clínicos Gerais/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Parto , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/normas , Cuidado Pré-Natal/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Encaminhamento e Consulta/estatística & dados numéricos
8.
Head Neck ; 42(7): 1507-1515, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32584447

RESUMO

INTRODUCTION: The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has altered the health care environment for the management of head and neck cancers. The purpose of these guidelines is to provide direction during the pandemic for rational Head and Neck Cancer management in order to achieve a medically and ethically appropriate balance of risks and benefits. METHODS: Creation of consensus document. RESULTS: The process yielded a consensus statement among a wide range of practitioners involved in the management of patients with head and neck cancer in a multihospital tertiary care health system. CONCLUSIONS: These guidelines support an ethical approach for the management of head and neck cancers during the COVID-19 epidemic consistent with both the local standard of care as well as the head and neck oncological literature.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Neoplasias de Cabeça e Pescoço/terapia , Controle de Infecções/normas , Oncologia/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Assistência Ambulatorial/normas , Terapia Combinada , Continuidade da Assistência ao Paciente/normas , Infecções por Coronavirus/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Sistemas Multi-Institucionais , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Cuidados Paliativos/normas , Segurança do Paciente , Pennsylvania , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Assistência Terminal/normas , Centros de Atenção Terciária
9.
Mol Genet Metab ; 130(4): 227-229, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32561366

RESUMO

Fabry disease is an X-linked disease due to a deficiency of the lysosomal enzyme alpha-galactosidase A. Clinical symptoms in classically affected males include acroparesthesia, anhydrosis and angiokeratoma, which may present during childhood followed by cardiac, cerebral and renal complications. Even though pulmonary involvement is not widely appreciated by clinicians, an obstructive lung disease is another recognized component of Fabry disease. Coronavirus Disease-19 (COVID-19), caused by the SARS-CoV-2 virus was labeled as a global pandemic and patients with Fabry disease can be considered at high risk of developing severe complications. The impact of COVID-19 on patients with Fabry disease receiving enzyme replacement therapy is still unknown. Many patients who receive treatment in the hospital experienced infusion disruptions due to fear of infection. Effects of temporary treatment interruption was described in more detail in other lysosomal storage diseases, but the recommencement of therapy does not fully reverse clinical decline due to the temporary discontinuation. When possible, home-therapy seems to be the most efficient way to maintain enzyme replacement therapy access during pandemic. Sentence take-home message: Home-therapy, when possible, seems to be the most efficient way to maintain enzyme replacement therapy access during pandemic in patients with Fabry disease.


Assuntos
Betacoronavirus/patogenicidade , Continuidade da Assistência ao Paciente/normas , Infecções por Coronavirus/prevenção & controle , Terapia de Reposição de Enzimas/normas , Doença de Fabry/terapia , Terapia por Infusões no Domicílio/normas , Pneumopatias Obstrutivas/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Terapia de Reposição de Enzimas/estatística & dados numéricos , Doença de Fabry/complicações , Doença de Fabry/diagnóstico , Feminino , Terapia por Infusões no Domicílio/estatística & dados numéricos , Humanos , Controle de Infecções/normas , Infusões Intravenosas , Isoenzimas/administração & dosagem , Pneumopatias Obstrutivas/diagnóstico , Pneumopatias Obstrutivas/etiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Proteínas Recombinantes/administração & dosagem , Índice de Gravidade de Doença , Fatores de Tempo , alfa-Galactosidase/administração & dosagem
11.
J Gynecol Obstet Hum Reprod ; 49(7): 101805, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32407898

RESUMO

Introduction: In the context of the stage 3 SARS-Cov-2 epidemic situation, it is necessary to put forward a method of rapid response for an HAS position statement in order to answer to the requests from the French Ministry of Solidarity and Health, healthcare professionals and/or health system users' associations, concerning post-natal follow-up for women and neonates during the COVID-19 pandemic. Methods: A simplified 7-step process that favours HAS collaboration with experts (healthcare professionals, health system users' associations, scientific societies etc.), the restrictive selection of available evidence and the use of digital means of communication. A short and specific dissemination format, which can be quickly updated in view of the changes in available data has been chosen.


Assuntos
Betacoronavirus , Continuidade da Assistência ao Paciente/normas , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Cuidado Pós-Natal/normas , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/normas , Betacoronavirus/isolamento & purificação , Aleitamento Materno/métodos , Continuidade da Assistência ao Paciente/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , França/epidemiologia , Humanos , Recém-Nascido , Disseminação de Informação/métodos , Triagem Neonatal/normas , Pandemias/prevenção & controle , Alta do Paciente/normas , Isolamento de Pacientes , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Cuidado Pós-Natal/organização & administração , Gravidez , Terceiro Trimestre da Gravidez , Gestantes
12.
Oncologist ; 25(7): e1013-e1020, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32412693

RESUMO

Northern Italy has been one of the European regions reporting the highest number of COVID-19 cases and deaths. The pandemic spread has challenged the National Health System, requiring reallocation of most of the available health care resources to treat COVID-19-positive patients, generating a competition with other health care needs, including cancer. Patients with cancer are at higher risk of developing critical illness after COVID-19 infection. Thus, mitigation strategies should be adopted to reduce the likelihood of infection in all patients with cancer. At the same time, suboptimal care and treatments may result in worse cancer-related outcome. In this article, we attempt to estimate the individual risk-benefit balance to define personalized strategies for optimal breast cancer management, avoiding as much as possible a general untailored approach. We discuss and report the strategies our Breast Unit adopted from the beginning of the COVID-19 outbreak to ensure the continuum of the best possible cancer care for our patients while mitigating the risk of infection, despite limited health care resources. IMPLICATIONS FOR PRACTICE: Managing patients with breast cancer during the COVID-19 outbreak is challenging. The present work highlights the need to estimate the individual patient risk of infection, which depends on both epidemiological considerations and individual clinical characteristics. The management of patients with breast cancer should be adapted and personalized according to the balance between COVID-19-related risk and the expected benefit of treatments. This work also provides useful suggestions on the modality of patient triage, the conduct of clinical trials, the management of an oncologic team, and the approach to patients' and health workers' psychological distress.


Assuntos
Betacoronavirus/patogenicidade , Neoplasias da Mama/terapia , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Oncologia/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Fatores Etários , Idoso , Ensaios Clínicos como Assunto/organização & administração , Ensaios Clínicos como Assunto/normas , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Feminino , Humanos , Controle de Infecções/organização & administração , Itália/epidemiologia , Oncologia/normas , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Projetos de Pesquisa/normas , Medição de Risco , Fatores de Risco , Telemedicina/organização & administração , Telemedicina/normas
14.
Rev Bras Enferm ; 73(3): e20180453, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32267414

RESUMO

OBJECTIVES: to understand the practice of the nurse in healthcare management of children with chronic condition in the hospital setting. METHODS: analytical study of qualitative approach with theoretical and methodological reference of institutional ethnography. Developed in the pediatric unit of a university hospital, in a municipality in Northeastern Brazil. Data collections techniques were: participant observation, documentary analysis and semi-structured interview. Participants of the study totaled twenty professionals, including nurses, social workers, psychologists, pharmacists, nutritionists, physiotherapists, and doctors. For data analysis, it was used the Bardin's Content Analysis with interface of the Atlas.ti software. RESULTS: categories of analysis were "Nurse as mediator of healthcare management"; "Nursing process as a mechanism of healthcare management". FINAL: considerations: the nurse proved to be essential for healthcare management of the child with chronic condition, acting as mediator of the relationship between the doctor, the members of the health team, the user and their family.


Assuntos
Doença Crônica/enfermagem , Continuidade da Assistência ao Paciente/normas , Papel do Profissional de Enfermagem , Administração dos Cuidados ao Paciente/métodos , Antropologia Cultural/métodos , Brasil , Doença Crônica/tendências , Humanos , Enfermeiras e Enfermeiros/tendências , Pesquisa Qualitativa
17.
Br J Cancer ; 123(1): 3-4, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32303717

RESUMO

In response to our current global pandemic, unprecedented healthcare changes may have significant consequences for cancer patients in the United Kingdom. We explore why cancer patients may be more susceptible to severe infection and complications, highlighting various interventions that may help to ensure continuity of care in this unique cohort.


Assuntos
Betacoronavirus/patogenicidade , Continuidade da Assistência ao Paciente/normas , Infecções por Coronavirus/complicações , Assistência à Saúde/normas , Neoplasias/prevenção & controle , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto/normas , Infecções por Coronavirus/virologia , Humanos , Neoplasias/virologia , Pandemias , Pneumonia Viral/virologia
18.
Arch Osteoporos ; 15(1): 63, 2020 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-32335759

RESUMO

The coordination of Fracture Liaison Services (FLS) with Primary Care (PC) is necessary for the continuity of care of patients with fragility fractures. This study proposes a Best Practice Framework (BPF) and performance indicators for the implementation and follow-up of FLS-PC coordination in clinical practice in Spain. PURPOSE: To develop a BPF for the coordination of FLS with PC in Spain and to improve the continuity of care for patients with fragility fractures. METHODS: A Steering Committee selected experts from seven Spanish FLS and related PC doctors and nurses to participate in a best practice workshop. Selection criteria were an active FLS with an identified champion and prior contact with PC centres linked to the hospital. The main aim of the workshop was to review current FLS practices in Spain and their integration with PC. A BPF document with processes, tools, roles, and metrics was then generated. RESULTS: Spanish FLS consists of a multidisciplinary team of physicians/nurses but with low participation of other professionals and PC staff. Evaluation and treatment strategies are widely variable. Four desired standards were agreed upon: (1) Effective channels for FLS-PC communication; (2) minimum contents of an FLS clinical report and its delivery to PC; (3) adherence monitoring 3 months after FLS baseline visit; and (4) follow-up by PC. Proposed key performance indicators are (a) number of FLS-PC communications, including consensus protocols; (b) confirmation FLS report received by PC; (c) medical/nursing PC appointment after FLS report received; and (d) number of training sessions in PC. CONCLUSIONS: The BPF provides a comprehensive approach for FLS-PC coordination in Spain, to promote the continuity of care in patients with fragility fractures and improve secondary prevention. The implementation of BPF recommendations and performance indicator tracking will benchmark best FLS practices in the future.


Assuntos
Benchmarking , Continuidade da Assistência ao Paciente/normas , Fraturas por Osteoporose/terapia , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Feminino , Implementação de Plano de Saúde , Humanos , Masculino , Espanha
20.
Hawaii J Health Soc Welf ; 79(3): 91-97, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32190842

RESUMO

Ambulatory care sensitive conditions (ACSCs) are conditions that can generally be managed in community-based healthcare settings, and, if managed well, should not require hospital admission. A 5-year, mixed methods study was recently concluded that (1) documented disparities in hospitalizations for ACSCs in Hawai'i through quantitative analysis of state-wide hospital discharge data; and (2) identified contributing factors for these hospitalizations through patient interviews. This Public Health Insights article provides deeper context for, and consideration of, a striking study finding: the differences between typical measures of access to care and the quality of patient/provider interactions as reported by study participants. The themes that emerged from the patients' stories of their own potentially preventable hospital admissions shed light on the importance of being heard, trust, communication, and health knowledge in their relationships with their providers. We conclude that improving the quality of the relationship and level of engagement between the patient and community/outpatient providers may help reduce hospitalizations for ACSCs in Hawai'i and beyond. These interpersonal-level goals should be supported by systems-level efforts to improve health care delivery and address health disparities.


Assuntos
Atitude do Pessoal de Saúde , Disparidades nos Níveis de Saúde , Relações Médico-Paciente , Adulto , Idoso , Assistência Ambulatorial/psicologia , Doenças Cardiovasculares/terapia , Continuidade da Assistência ao Paciente/normas , Diabetes Mellitus/terapia , Hawaii , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
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