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1.
Presse Med ; 48(7-8 Pt 1): e209-e215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31421945

RESUMO

AIM: Identified Palliative Care Beds (Lits Identifiés Soins Palliatifs - LISPs) is a French specificity. Primarily created to integrate palliative care culture into conventional hospital units, the relevance of this measure became a controversial issue. Nowadays, hospital teams continue to frequently encounter complex situations regarding medical care for palliative patients. To the best of our knowledge, there is only one study, a quantitative one, bridging the gap about that subject. It showed failure in practicing palliative care work around LISP. Our study is based on a qualitative method that complements the quantitative study. It aimed to describe difficulties that limit palliative care practices in managing adult patients in LISP. METHOD: This qualitative exploratory survey was conducted with a sample of health service professionals (n=20), from senior physicians to caregivers. Each semi-structured interview included open questions regarding their experiences, feelings and difficulties with palliative care practices on LISP. It also included closed questions concerning interviewee's demographics and career course. The data for this research were submitted to a two-stage analysis: first, a global review of each interview was performed to identify trends. Then, a detailed breakdown, question by question, was implemented. RESULTS: From a quantitative perspective, the interviews revealed 305 difficulties, indicating the gaps and barriers limiting the implementation of a palliative approach in these services. From a qualitative perspective, five topics raised our attention by their recurrence in discourses: (1) partial knowledge about palliative care definition and legislation mostly due to a lack of training; (2) need for time; (3) need for human resources; (4) need for communication; (5) hard time in transitioning from curative to palliative care. PERSPECTIVE: This survey gives the opportunity to understand health service professionals' difficulties in practicing palliative care in conventional medical services. It raises the central issue of the pricing reform on the health institutes activity. It also provides angles of inquiry to improve LISP effectiveness. This qualitative and descriptive study was designed to explore difficulties in practicing palliative care around LISP. Nevertheless, according to the size of the sample, results will need to be confirmed by a more extensive qualitative survey.


Assuntos
Continuidade da Assistência ao Paciente , Unidades Hospitalares/organização & administração , Cuidados Paliativos/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Padrões de Prática Médica , Qualidade da Assistência à Saúde/organização & administração , Adulto , Atitude do Pessoal de Saúde , Cuidadores/organização & administração , Cuidadores/normas , Barreiras de Comunicação , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Assistência à Saúde/métodos , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Arquitetura de Instituições de Saúde/normas , França , Conhecimentos, Atitudes e Prática em Saúde , Número de Leitos em Hospital , Unidades Hospitalares/normas , Humanos , Entrevistas como Assunto , Satisfação no Emprego , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Equipe de Assistência ao Paciente/normas , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas , Estudos Retrospectivos , Inquéritos e Questionários
2.
Rech Soins Infirm ; (136): 80-89, 2019 03.
Artigo em Francês | MEDLINE | ID: mdl-31210504

RESUMO

BACKGROUND: Type 1 diabetes in children in Switzerland is becoming increasingly prevalent. The coordination of care seems to be a determining element and is essential for effective and efficient care. OBJECTIVE: Identify the difficulties and the levers of coordination faced by healthcare workers and families during the discovery of type 1 diabetes in children aged from birth to fifteen. METHOD: Qualitative analysis using semi-directed interviews. RESULTS: Three families and five healthcare workers participated in the study. Confirmation of the diagnosis was received badly and was a shock for the families. Nurses specializing in pediatric diabetes are recognized for being experts in diabetes care and education. Non-specialist nurses consider diabetes care to be stressful and complex. Collaboration between units is described as compartmentalized. ICT tools are not shared between units. Psychological support is considered to be unsatisfactory by the families. DISCUSSION: Interdisciplinary nurses need to work together and with a structured coordination of care.


Assuntos
Prática Avançada de Enfermagem , Continuidade da Assistência ao Paciente/organização & administração , Diabetes Mellitus Tipo 1/enfermagem , Família/psicologia , Papel do Profissional de Enfermagem , Adolescente , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Pesquisa Qualitativa , Suíça
3.
Med. infant ; 26(2): 130-139, Junio 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1015635

RESUMO

Introducción: Los grandes avances en el diagnóstico y tratamiento de los pacientes con cardiopatías congénitas en las últimas décadas han permitido que mas del 90% lleguen a la adolescencia y edad adulta. Sin embargo, muchos de ellos requirieran seguimiento e intervenciones de por vida, por lo que necesitaran ser transferidos desde el hospital pediátrico al de adultos. Material y Métodos: Se incluyeron los pacientes mayores de 15 años que consultaron en el área ambulatoria del servicio de cardiología del Hospital Garrahan durante el periodo agosto 2017 - agosto 2018. Las variables analizadas fueron: procedencia, cardiopatía de base y variedad pronostica ,procedimientos intervencionistas factores asociados como síndrome genéticos y otras comorbilidades, cobertura social, nivel educativo, terapéutica medicamentosa, clase funcional, embarazos, prevalencia de cardiopatías en la descendencia y transición-transferencia al hospital de adultos. Resultados: Registramos 704 consultas de 309 pacientes con una edad media de 19,17 años (DS +- 4,62; (rango 15- 49,4 años). Fueron 112 mujeres y 197 varones. El 51,1 % provenían de Buenos Aires,40 % de las provincias del interior y 8,1% CABA. El 92% de los pacientes tenía cardiopatías de moderada y severa complejidad, y el 93,5% eran operadas. El 13,2 % eran síndromes genéticos. El 48.5% tenían comorbilidades, siendo los trastornos electrofisiológicos los más frecuentes en el 72,66% de los casos. El 63% tenía cobertura social pero solo el 2,6% prepagos con cobertura en centros alta complejidad. El 23.6% recibía terapia combinada con 2 o más drogas. El 48,78% ya presentaban antecedente de algún tipo de reintervención, 98,5% de estas se vincularon a las cardiopatías moderadas a complejas. Registramos 15 embarazos con 14 recién nacidos vivos, 1 con cardiopatía congénita. El proceso de transición ­ transferencia en el 55% (170 p) se había iniciado, siendo efectiva (8p), frustra (9p), compartida (49 p), y en proceso (103 p). Hubo un solo fallecimiento durante el periodo de estudio, vinculado a cardiopatía compleja, múltiples reintervenciones y endocarditis. Conclusiones: El 92% de los pacientes en nuestro estudio, tienen cardiopatías operadas de moderada y severa complejidad. Los trastornos electrofisiológicos y la necesidad de reintervenciones durante el seguimiento alejado han sido las complicaciones más frecuentes de esta población. El proceso de transición y transferencia desde el hospital pediátrico al de adultos es deficitario, principalmente por falta de cobertura y experiencia sobre todo para la atención continua de las cardiopatías moderadas y complejas (AU)


Introduction: In recent decades, important advances in the diagnosis and treatment of patients with congenital heart defects have allowed more than 90% of them to reach adolescence and adulthood. However, many patients required lifelong follow-up and interventions, and therefore the need to be transitioned from pediatric to adult care. Material and Methods: Patients older than 15 years who consulted at the outpatient clinic of the department of cardiology at Garrahan Hospital from August 2017 to August 2018 were included. The variables analyzed were place of origin, underlying heart disease, and diagnosis, interventions, associated factors, such as genetic syndromes and other comorbidities, insurance coverage, educational level, pharmacological treatment, functional class, pregnancies, prevalence of heart disease in offspring, and transition-transfer to adult hospital. Results: We recorded 704 consultations from 309 patients with an average age of 19.17 years (SD +- 4.62; range 15-49.4 years); 112 patients were female and 197 male. Overall, 51.1% came from the province of Buenos Aires, 40% from the other provinces, and 8.1% from the city of Buenos Aires. Of the patients, 92% had moderate and severe heart disease, and 93.5% had undergone surgery. Genetic syndromes were identified in 13.2%. Overall, 48.5% had comorbidities, of which electrophysiological disorders were the most common in 72.66% of cases. 63% had social insurance coverage but only 2.6% had a prepaid insurance with coverage in tertiary-level centers. Overall, 23.6% received combination therapy with 2 or more drugs. 48.78% had undergone some type of previous reintervention, 98.5% of whom had moderate-to-severe heart disease. We recorded 15 pregnancies with 14 live neonates, one of whom had congenital heart defects. The transition - transfer had been initiated in 55% (170 p) and was effective (8p), frustrated (9p), shared (49 p), or in progress (103 p). There was only one death during the study period, related to severe heart disease, multiple reinterventions, and endocarditis. Conclusions: 92% of patients in our study have moderate or severe operated heart disease. Electrophysiological disorders and the need for reintervention during the long-term follow-up were the most common complications of this population. The process of transition and transfer from pediatric to adult care is deficient, mainly due to lack of insurance coverage and experience especially for the ongoing care of moderate-to-severe heart disease


Assuntos
Humanos , Adolescente , Ambulatório Hospitalar/estatística & dados numéricos , Planejamento de Assistência ao Paciente , Transferência de Pacientes/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Transição para Assistência do Adulto/organização & administração , Cardiopatias Congênitas/terapia , Estudos Retrospectivos , Estudo Observacional
4.
Malawi Med J ; 31(1): 2-11, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31143390

RESUMO

Introduction: The World Health Organization (WHO) recommends that every woman be checked after the delivery of a child. However, only 42% of Malawian women are checked by a skilled health worker within 48 hours after delivery. This study aimed at identifying factors associated with postnatal care (PNC) utilization among Malawian women by using nationally representative data. Methods: Secondary data from the 2015-2016 Malawi Demographic and Health Survey (MDHS) was used for the study. A logistic regression model was used to find the adjusted odds of utilizing PNC services among the women. All the analyses controlled for the survey clusters and weighting. All the analyses were conducted in STATA version 14 at a significance level of 5%. Results: Out of the 6,693 women who had a live birth 24 months prior to the 2015-2016 MDHS, only 48.4% were checked by a skilled health worker within 42 days after delivery. Uptake of PNC was significantly associated with older age, being employed, living in an urban area, delivery through caesarean section, a timely first antenatal care (ANC) visit, uptake of recommended number of ANC visits, and receiving the adequate number of tetanus injections. Conclusion: Interventions to increase utilization of PNC services should be tailored to appropriate populations. Particularly, special focus has to be made towards younger women, the women who reside in the rural areas, who are not employed, and who are generally not well to do. Behavioural change interventions must also target women with low perceived risk after delivery. Information should also be consistently provided by health workers in communities and health facilities to women on perinatal care in order to change the women's risk perception on all levels of pregnancy care and to encourage utilization of relevant health services.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Serviços de Saúde Materna/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Cuidado Pré-Natal , Características de Residência , Adolescente , Adulto , Feminino , Pesquisas sobre Serviços de Saúde , Instalações de Saúde , Humanos , Recém-Nascido , Serviços de Saúde Materna/organização & administração , Gravidez , Fatores Socioeconômicos , Adulto Jovem
5.
Aten. prim. (Barc., Ed. impr.) ; 51(5): 310-313, mayo 2019.
Artigo em Espanhol | IBECS | ID: ibc-180880

RESUMO

Desde el modelo de atención primaria integral y bajo el principio de la continuidad asistencial, se propone el desarrollo de cauces de comunicación e integración entre el primer y segundo nivel asistencial en relación con la atención a la salud mental. Se presenta la experiencia pionera instaurada en el Servicio Sanitario de Lanzarote en la que se ha desplazado la figura del psicólogo clínico a los centros de salud para desarrollar un programa conjunto y comunitario desde la atención primaria. Las líneas de actuación se han centrado en el trabajo directo con el paciente así como con el personal, tanto a nivel individual como grupal. El objetivo es la sensibilización y normalización del tratamiento para la enfermedad mental desde los centros de salud. Se ha llevado a cabo dicho trabajo con una valoración positiva por parte de pacientes y personal del centro, que al mismo tiempo ha reclamado mayor accesibilidad para una instauración plena del modelo de trabajo conjunto centrado en la promoción, prevención, detección y tratamiento para la salud mental


From the model of Integral Primary Care and under the principle of continuity of care, the development of channels of communication and integration between the first and second level of care in relation to mental health care is proposed. It presents the pioneering experience established in the Health Service of Lanzarote in which the figure of the clinical psychologist has been moved to the Health Centres to develop a joint community program from the Primary Care. The lines of action have focused on direct work with the patient, as well as with the staff, both individually and as a group. The objective is the sensitisation and standardisation of the treatment for mental disease in Health Centres. This work has been carried out with a positive assessment by patients and staff of the centres, which at the same time has demanded greater accessibility for a full implementation of the joint work model focused on the promotion, prevention, detection, and treatment for health mental


Assuntos
Humanos , Psicologia Clínica/tendências , Atenção Primária à Saúde/organização & administração , Serviços de Saúde Mental/organização & administração , Transtornos Mentais/epidemiologia , Psicoterapia/estatística & dados numéricos , Pessoal de Saúde/tendências , Colaboração Intersetorial , Continuidade da Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/organização & administração
6.
Actas urol. esp ; 43(4): 176-181, mayo 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-181082

RESUMO

Objetivo: Analizar la evolución y adecuación de las derivaciones de Atención Primaria a Urología tras la implantación de protocolos sobre las enfermedades urológicas más frecuentes y la instauración de un programa de formación continuada. Material y métodos: En el 2011 se creó un grupo de trabajo Atención Primaria-Urología. Se instauraron inicialmente protocolos de actuación y práctica clínica en enfermedad prostática (HBP y PSA), que se apoyaron con sesiones formativas a los médicos de Atención Primaria. Tras analizar su efecto, en el 2015 se añadieron otros 3(enfermedad escrotal, infecciones urinarias e incontinencia urinaria). Analizamos y comparamos las derivaciones y su adecuación antes y después de la instauración. Resultados: El motivo más frecuente de derivación son los síntomas del tracto urinario inferior (STUI) por HBP que, inicialmente, suponían un 22,8% del total, y que han disminuido al 16,9%. Tras la introducción de los demás algoritmos, observamos una disminución de las derivaciones sobre enfermedad escrotal (del 13-14 al 7,8%), que permanecen estables (en torno al 10%) las relacionadas con infecciones urinarias y que aumentan las derivaciones por incontinencia urinaria (del 3 al 10,3%). La adecuación a los protocolos fue mejorando progresivamente en las relacionadas con STUI (del 46 al 65,3%); en PSA (del 55 al 84,4%) y en incontinencia urinaria (del 66,2 al 73,1%). Descendió la adecuación en cuanto a enfermedad escrotal (del 67,1 al 63,3%) y se mantuvo similar en ITU (en torno al 76%). Conclusiones: El trabajo conjunto entre Urología y Atención Primaria consigue mejorar la adecuación de las derivaciones en las enfermedades urológicas más frecuentes


Objective: To analyse the evolution and adequacy of referrals from Primary Care to Urology, after the implementation of referral protocols on the most frequent urological diseases and the establishment of a continuing education program. Material and methods: A Primary Care-Urology work group was created in 2011. Initially, performance and clinical practice protocols in prostatic pathology (BPH and PSA) were established. These were supported by training sessions for primary care physicians. After analysing the effect of the mentioned joint work, 3more (scrotal pathology, urinary tract infections and urinary incontinence) were included. We analysed and compared the referrals and their adequacy before and after the establishment of the protocols. Results: The most common referral causes were symptoms of the lower urinary tract due to BPH, which initially represented 22.8% of the total, and decreased to 16.9%. After the introduction of the new algorithms, we observed a decrease in referrals for scrotal pathology (13-14% to 7.8%), an increase in urinary incontinence referrals (3% al 10.3%) and those related to urinary tract infections remained stable. The adequacy to the protocols improved progressively: LUTS from 46% to 65.3%; PSA from 55% to 84.4% and urinary incontinence from 66.2% to 73.1%. Adequacy in scrotal pathology decreased (de 67.1% a 63.3%), while in UTI it stayed much the same (around 76%). Conclusions: The joint work between Urology and Primary Care achieves an improvement in referrals adequacy regarding the most frequent urological pathologies


Assuntos
Atenção Primária à Saúde/organização & administração , Educação Continuada/métodos , Continuidade da Assistência ao Paciente/organização & administração , Unidade Hospitalar de Urologia , Encaminhamento e Consulta/tendências , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/normas
9.
Indian J Ophthalmol ; 67(5): 612-617, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31007219

RESUMO

Purpose: To investigate the quality of discharge teaching, readiness for hospital discharge (RHD), and post-discharge outcomes (PDO) of cataract patients in a day ward and to explore the relationships among these three variables. Methods: This cross-sectional study used an opportunistic sample from the ophthalmic day ward in a general hospital in Sichuan province, China. Data were collected using four questionnaires. Results: The total average score on the Quality of Discharge Teaching Scale was 192.95, and the dimension with the lowest score was "guidance obtained practically." The total average score on the Readiness for Hospital Discharge Scale was 175.51, and the dimension with the lowest score was "knowledge of disease." The total average score on the Post-Discharge Outcome Questionnaire was 77.08, and the four dimensions with the lowest scores were "compliance behaviors," "avoiding excessive use of eye," "avoiding strenuous exercise," and "regular check-up." Pearson correlation coefficients indicated low to moderate correlations between discharge teaching quality and PDO (0.245, P < 0.01), RHD and PDO (0.271, P < 0.01), and discharge teaching quality and PDO (0.559, P < 0.01). Conclusion: The quality of discharge teaching among cataract patients who underwent day surgery was relatively high, and patient preparation for discharge and PDO were good. However, medical staff should focus more attention on patients' individualized needs for discharge teaching while emphasizing the importance of compliance behavior.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Catarata , Continuidade da Assistência ao Paciente/organização & administração , Cooperação do Paciente , Alta do Paciente , Educação de Pacientes como Assunto/normas , Qualidade da Assistência à Saúde , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Inquéritos e Questionários
10.
J Grad Med Educ ; 11(2): 202-206, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31024654

RESUMO

Background: Improving continuity is challenging in residency training practices. Studies have shown that empanelment enables high-performing primary care and is foundational to improve accountability and continuity. Objective: An empanelment process was created in a large, urban, residency training practice as an effective approach to enhancing continuity among residents and their patients. Methods: In 2016, we formed an empanelment committee that included stakeholders from the department of medicine, the internal medicine residency program, and hospital and IT leadership. This committee set goal panel sizes, selected an empanelment algorithm, determined which patients needed re-empanelment, and facilitated medical record integration. Empanelment was followed and reassessed quarterly for 2 years. We measured anticipated visit demand using visits in the prior year and continuity using the continuity for physician formula. Results: Of 18 495 active patients in July 2016, 8411 (45%) were assigned a new PCP in the empanelment process. At baseline, panel sizes and expected visit demand were highly variable among residents (from 40 to 107 and 120 to 480, respectively). Empanelment led to more equivalent panel sizes and expected visit demand across same year residents (eg, PGY-3: 80-100 and 320-440, respectively). Continuity for all PCPs in the practice improved from 63% before empanelment to over 80% after empanelment, and improved from 55% to 72% for individual residents. Conclusions: In a large and complex practice environment, we were able to empanel resident clinic patients to improve continuity and maintain it over 2 years.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Medicina Interna/educação , Internato e Residência/organização & administração , Instituições de Assistência Ambulatorial , Educação de Pós-Graduação em Medicina , Humanos , Medicina Interna/organização & administração , Cidade de Nova Iorque , Pacientes Ambulatoriais/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos
11.
BMC Health Serv Res ; 19(1): 224, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975144

RESUMO

BACKGROUND: Researchers have shown that hospitalisation can decrease older persons' ability to manage life at home after hospital discharge. Inadequate practices of discharge can be associated with adverse outcomes and an increased risk of readmission. This review systematically summarises qualitative findings portraying older persons' experiences adapting to daily life at home after hospital discharge. METHODS: A metasummary of qualitative findings using Sandelowski and Barroso's method. Data from 13 studies are included, following specific selection criteria, and categorised into four main themes. RESULTS: Four main themes emerged from the material: (1) Experiencing an insecure and unsafe transition, (2) settling into a new situation at home, (3) what would I do without my informal caregiver? and (4) experience of a paternalistic medical model. CONCLUSIONS: The results emphasise the importance of assessment and planning, information and education, preparation of the home environment, the involvement of the older person and caregivers and supporting self-management in the discharge and follow-up care processes at home. Better communication between older persons, hospital providers and home care providers is needed to improve the coordination of care and facilitate recovery at home. The organisational structure may need to be redefined and reorganised to secure continuity of care and the wellbeing of older persons in transitional care situations.


Assuntos
Atividades Cotidianas/psicologia , Adaptação Psicológica , Atitude Frente a Saúde , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Comunicação , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/normas , Feminino , Serviços de Assistência Domiciliar/organização & administração , Serviços de Assistência Domiciliar/normas , Hospitalização , Hospitais , Humanos , Masculino , Alta do Paciente , Participação do Paciente , Relações Profissional-Paciente , Autocuidado/normas , Cuidado Transicional/organização & administração , Cuidado Transicional/normas
12.
Rev Med Inst Mex Seguro Soc ; 56(6): 513-515, 2019 Mar 15.
Artigo em Espanhol | MEDLINE | ID: mdl-30889337
13.
BMC Health Serv Res ; 19(1): 145, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832649

RESUMO

BACKGROUND: An important goal of the patient-centered medical home is increasing timely access for urgent needs, while maintaining continuity. In academic primary care clinics, meeting this goal, along with training medical residents and associated professionals, is challenging. METHODS: The aim of this study was to understand how academic primary care clinics provide continuity to patients requesting same-day access and identify factors that may affect site-level success. We conducted qualitative interviews from December 2013-October 2014 with primary care leadership involved with residency programs at 19 Veterans Health Administration academically-affiliated medical centers. Interview recordings were transcribed verbatim. To analyze the data, we created comprehensive, structured transcript summaries for each site. Site summaries were then entered into NVivo 10 software and coded by main categories to facilitate within-case and cross-case analyses. Themes and patterns across sites were identified using matrix analysis. RESULTS: Interviewees found it challenging to provide continuity for same-day in-person visits. Most sites took a team-based approach to ensure continuity and provide coverage for same-day access, notably using NPs, PAs, and RNs in their coverage algorithms. Further, they reported several adaptations that increased multiple types of continuity for walk-in patients, urgent care between in-person visits, and follow-up care. While this study focused on longitudinal continuity, both by individual PCPs or by a team of professionals, informational continuity and continuity of supervision, as well as, to a lesser extent, relational and management continuity, were also addressed in our interviews. Finally, most interviewees reported clinic intention to provide patient-centered, team-based care and a robust educational experience for trainees, and endeavored to structure their clinics in ways that align these two missions. CONCLUSIONS: In contending with the tension between providing continuity and educating new clinicians, clinics have re-conceptualized continuity as team-based, creating alternative strategies to same-day visits with a usual provider, coupled with communication strategies. Understanding the effect of these strategies on different types of continuity as well as patient experience and outcomes are key next steps in the further development and dissemination of effective models for improving continuity and the transition to team-based care in the academic clinic setting.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente , Centros Médicos Acadêmicos , Assistência Ambulatorial/organização & administração , Comunicação , Humanos , Internato e Residência , Atenção Primária à Saúde , Estados Unidos , United States Department of Veterans Affairs , Veteranos
14.
BMC Health Serv Res ; 19(1): 206, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30925879

RESUMO

BACKGROUND: Hospitalisations are a critical event in the care process. Insufficient communication and uncoordinated follow-up care often impede the recovery process of the patient resulting in a high number of rehospitalisations and increased health care costs. The overall aim of this study is the development, implementation and evaluation of a structured programme (VESPEERA) to improve the admission and discharge process. METHODS: We will conduct an open quasi-experimental multi-centre study with four intervention arms. A cohort selected from insurance claims data will serve as a control group reflecting usual care. The intervention will be implemented in 25 hospital departments and 115 general practices in 9 districts in Baden-Wurttemberg. Eligibility criteria for patients are: age > 18 years, hospital admission or hospitalisation, insurance at the sickness fund "AOK Baden-Wurttemberg", enrolment in general practice-centred care contract. Each study arm will receive different intervention components based on the point of study enrolment and the patient's medical need. The interventions comprise a) a structured assessment in the general practice prior to admission resulting in an admission letter b) a discharge conversation by phone between hospital and general practice, c) a structured assessment and care plan post-discharge and d) telephone monitoring for patients with a high risk of rehospitalisation. The assessments are supported by a software tool ("CareCockpit"), originally developed for structured case management programmes. The primary outcome (rehospitalisation due to the same indication within 90 days) and a range of secondary outcomes (rehospitalisation due to the same indication within 30 days; hospitalisations due to ambulatory care-sensitive conditions; delayed prescription of medication and medical products/ devices and referral to other health practitioner/s after discharge; utilisation of emergency or rescue services within 3 months; average care cost per year and patient participating in the VESPEERA programme) and quality indicators will be determined based on insurance claims data and CareCockpit data. Additionally, a patient survey on satisfaction with cross-sectoral care and health related quality of life will be conducted. DISCUSSION: Based on the results, area-wide implementation in usual care is well sought. This study will contribute to an improvement of cross-sectoral care during the admission and discharge process. TRIAL REGISTRATION: DRKS00014294 on DRKS / Universal Trial Number (UTN): U1111-1210-9657, Date of registration 12/06/2018.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Assistência à Saúde/organização & administração , Hospitalização/estatística & dados numéricos , Alta do Paciente , Melhoria de Qualidade/organização & administração , Adulto , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
15.
BMC Health Serv Res ; 19(1): 204, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30925880

RESUMO

BACKGROUND: During transitions from hospital to home, up to half of all patients experience medication-related problems, such as adverse drug events. To reduce these problems, knowledge of patient experiences with medication use during this transition is needed. This study aims to identify the perspectives of patients on barriers and facilitators with medication use, during the transition from hospital to home. METHODS: A qualitative study was conducted in 2017 among patients discharged from two hospitals using a semi-structured interview guide. Patients were asked to identify all barriers they experienced with medication use during transitions from hospital to home, and facilitators needed to overcome those barriers. Data were analyzed following thematic content analysis and visualized using an "Ishikawa" diagram. RESULTS: In total, three focus groups were conducted with 19 patients (mean age: 70.8 (SD 9.3) years, 63% female). Three barriers were identified; lack of personalized care in the care continuum, insufficient information transfer (e.g. regarding changes in pharmacotherapy), and problems in care organization (e.g. medication substitution). Facilitators to overcome these barriers included a personal medication-counselor in the care continuum to guide patients with medication use and overcome communication barriers, and post-discharge follow-up care (e.g. home visits from healthcare providers). CONCLUSIONS: During transitions from hospital to home patients experience individual-, healthcare provider- and organization level barriers. Future research should focus on personal-medication counselors in the care continuum and post-discharge follow-up care as it may overcome communication, emotional, information and organization barriers with medication use.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Alta do Paciente/estatística & dados numéricos , Idoso , Comunicação , Feminino , Grupos Focais , Humanos , Masculino , Conduta do Tratamento Medicamentoso , Educação de Pacientes como Assunto , Pesquisa Qualitativa
16.
Infect Dis (Lond) ; 51(4): 277-286, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30786803

RESUMO

BACKGROUND/OBJECTIVES: Inadequate HIV care for hard-to-reach populations may result in failing the UNAIDS 90-90-90 goal. Therefore, we aimed to review the HIV continuum of care and hard-to-reach populations for each step of the continuum in Central, Eastern and South Eastern Europe. METHODS: Euro-guidelines in Central and Eastern Europe (ECEE) Network Group were created in February 2016. The aim of the network was to review the standards of HIV care in the countries of the region. Information about each stage of HIV continuum of care and hard-to-reach populations for each stage was collected through on-line surveys. Respondents were ECEE members chosen based on their expertise and involvement in national HIV care. Data sources (year 2016) used by respondents included HIV Clinics electronic databases, Institutes of Public Health, Centres for AIDS Prevention, and HIV Programme Reviews. RESULTS: The percentage of people living with HIV (PLHIV) linked to HIV care after HIV diagnosis was ranged between 80% and 96% in Central Europe, 51% and 92% in Eastern Europe and 80% and 100% in South-Eastern Europe. The percentage of PLHIV who are on ART was ranged from 80% to 93% in Central Europe, 18% to 92% in Eastern Europe and 80% to 100% in South-Eastern Europe. The percentage of people virologically suppressed while on ART was reported as 70-95%, 12-95% and 62-97% in Central, Eastern, and South Eastern Europe, respectively. All three regions reported people who inject drugs (PWID) as hard-to-reach population across all HIV continuum stages. Migrants were the second most reported hard-to-reach population. The proportion of late presenters among newly diagnosed ranged between 20% and 55%, 40% and 55% and 48% and 60% in Central, Eastern and South Eastern Europe, respectively. Four countries reported ARVs' delivery delays resulting in treatment interruptions in 2016: two (25%) in South-Eastern, one (20%) in Central and 1 (16.7%) in Eastern Europe. CONCLUSION: Irrespective of the diversity in national HIV epidemics, countries from all three regions reported PWIDs as hard-to-reach population across all HIV continuum stages. Some countries are close to the UNAIDS 2020 goals, others need to strive for progress. However, differences in data sources and variations in definitions limit the utility of continuum of care as a comparative tool.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Continuidade da Assistência ao Paciente/organização & administração , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Usuários de Drogas/estatística & dados numéricos , Infecções por HIV/epidemiologia , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Terapia Antirretroviral de Alta Atividade , Europa (Continente)/epidemiologia , Infecções por HIV/tratamento farmacológico , Humanos , Abuso de Substâncias por Via Intravenosa/virologia , Inquéritos e Questionários
17.
Med Care ; 57(4): 300-304, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30807454

RESUMO

BACKGROUND: Hospitals affiliated with Accountable Care Organizations (ACOs) may have a greater capacity to collaborate with providers across the care continuum to coordinate care, due to formal risk sharing and payment arrangements. However, little is known about the extent to which ACO affiliated hospitals implement care coordination strategies. OBJECTIVES: To compare the implementation of care coordination strategies between ACO affiliated hospitals (n=269) and unaffiliated hospitals (n=502) and examine whether the implementation of care coordination strategies varies by hospital payment model types. MEASURES: We constructed a care coordination index (CCI) comprised of 12 indicators that describe evidence-based care coordination strategies. Each indicator was scored on a 5-point Likert scale from 1="not used at all" to 5="used widely" by qualified representatives from each hospital. The CCI aggregates scores from each of the 12 individual indicators to a single summary score for each hospital, with a score of 12 corresponding to the lowest and 60 the highest use of care coordination strategies. RESEARCH DESIGN: We used state-fixed effects multivariable linear regression models to estimate the relationship between ACO affiliation, payment model type, and the use care coordination strategies. RESULTS: We found ACO affiliated hospitals reported greater use of care coordination strategies compared to unaffiliated hospitals. Fee-for-service shared savings and partial or global capitation payment models were associated with a greater use of care coordination strategies among ACO affiliated hospitals. CONCLUSION: Our findings suggest ACO affiliation and multiple payment model types are associated with the increased use of care coordination strategies.


Assuntos
Organizações de Assistência Responsáveis/organização & administração , Continuidade da Assistência ao Paciente/organização & administração , Hospitais/estatística & dados numéricos , Planejamento Estratégico/economia , Organizações de Assistência Responsáveis/estatística & dados numéricos , Continuidade da Assistência ao Paciente/economia , Humanos
18.
Soins ; 64(832): 58-62, 2019 Jan - Feb.
Artigo em Francês | MEDLINE | ID: mdl-30771854

RESUMO

A literature review was undertaken to describe the experience of people with cancer with regard to the different transitions of their care pathway. It enables all these transitions to be identified, documented and mapped out. The aim is to improve the quality of the care provided to this vulnerable population, all along the pathway.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Neoplasias/terapia , Humanos
20.
Nord J Psychiatry ; 73(1): 36-43, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30636468

RESUMO

BACKGROUND: Continuity of mental health care is central to improve the conditions of people with enduring mental disorders. In Denmark, several government-funded projects on the improvement of continuity of mental health care have been initiated since 2009. AIM: The aim of this study was to investigate how national intervention projects on continuity of mental health care have addressed major barriers for continuity of care and extract general learning points from the projects on the improvement of continuity of care. METHOD: The study was designed as a thematic document analysis of external evaluations of 14 major national projects on the improvement of continuity of routine mental health care from 2009 to 2017. The data material was processed through thematic coding and comparative analysis. RESULTS: The analysis was organized around four main barriers for continuity: Lack of models for collaboration, different professional cultures and methods, lack of channels of communication, and intersectoral differences in management, economy, and legislation. The first three barriers were addressed in a predominant part of the projects through development of collaborative models, common tools and communication systems. The latter structural barrier was not addressed in any of the projects. CONCLUSION: There is an ongoing need to address barriers for continuity of mental health care. So far, there has been a much larger focus on organizational, cultural and communicational aspects of continuity than on structural aspects. The study calls for an increased focus on how changes in existing managerial, economic and legislative structures can improve continuity of care.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Adolescente , Adulto , Criança , Comunicação , Dinamarca , Humanos , Colaboração Intersetorial , Cultura Organizacional
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