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1.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(11): 1012-1015, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31770830

RESUMO

De-escalation strategy is the gradual transition of various complex, expensive, high-risk but effective treatments for critically ill patients to simple, safe, physiological but still effective ones. Chronic critical illness refers to patients suffering severe disease or surgical hit who later shift into a chronic state of relapse or even aggravation and stay in the intensive care unit for extended period. Risk factors for surgical related chronic critical illness include advanced age, malnutrition, multiple organ dysfunction and multiple hits. During the treatment of critically ill patients, the strategy of de-escalation therapy should always be implemented, including rational use of antibiotics, de-escalation of liquid therapy (i.e. de-resuscitation), timely removal of ventilator, rapid introduction and with drawal of continuous renal replacement measures, parenteral + enteral nutrition support therapy and timely cessation of sedation.


Assuntos
Tratamento Conservador/métodos , Cuidados Críticos/métodos , Estado Terminal/terapia , Doença Crônica/prevenção & controle , Doença Crônica/terapia , Humanos , Unidades de Terapia Intensiva , Suspensão de Tratamento
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(11): 1027-1033, 2019 Nov 25.
Artigo em Chinês | MEDLINE | ID: mdl-31770833

RESUMO

Objective: To understand the prevalence, diagnosis and treatment of chronic critical illness (CCI) in China. Methods: The clinical data of 472 adult patients admitted to ICU in 53 hospitals, including basic information, disease-related data, nutrition program, etc., were collected on May 10, 2019, by means of multi-center cross-sectional study. If surgical intervention was needed or the occurrence of the disease was directly related to the surgery, ICU patients were regarded as surgical ICU cases (n=211). In this study, the diagnostic criteria for CCI were: (1) admission to ICU >14 days;(2) combined with persistent organ dysfunction. The prevalence,distribution and treatment of CCI and surgery-related CCI were recorded and analyzed. The Mann-Whitney U test, chi-square test or Fisher exact test were used for comparative analysis. Results: Among the 472 ICU patients from 53 hospitals, 326 were male (69.1%) and 146 were female (30.9%). The prevalence of CCI was 30.7% (145/472). Among 211 surgery-related ICU patients, 57 developed CCI with a prevalence of 27.0%. As compared to non-CCI patients, higher APACHE II score [median (IQR) 13.5 (10.0, 18.3) vs. 11.0 (7.0, 16.0), U=2970.000, P=0.007], higher Charlson comorbidity index [median (IQR) 4.0 (2.0, 7.0) vs. 3.0 (1.0, 5.0), U= 3570.000, P=0.036] and higher ratio of breath dysfunction [68.4% (39/57) vs. 48.1% (74/154), χ(2)=6.939, P=0.008] and renal dysfunction [42.1% (24/57) vs. 18.2% (28/154), χ(2)=12.821, P<0.001] were found in surgery-related CCI patients. While SOFA score, Glasgow coma score and other visceral function were not significantly different between surgery-related CCI and non-CCI patients (all P>0.05). NUTRIC score showed that surgery-related CCI patients had higher nutritional risk [43.9% (25/57) vs. 26.6%(41/154), U=5.750, P=0.016] and higher ratio of mechanical ventilation [66.7% (38/57) vs. 52.3% (79/154), χ(2)=3.977, P=0.046] than non-CCI patients. On the survey day, the daily caloric requirements of 50.2% (106/211) of surgery-related ICU patients were calculated according to the standard adult caloric intake index (104.6 to 125.5 kJ·kg(-1)·d(-1), 1 kJ=0.239 kcal), and the daily caloric requirements of 46.4% (98/211) of patients were calculated by physicians according to the severity of the patient's condition. 60.2% (127/211) of nutritional support therapy was enteral nutrition (including a combination of enteral and parenteral nutrition), while the remaining patients received parenteral nutrition (24.6%, 52/211), simple glucose infusion (9.0%, 19/211), or oral diet (6.2%, 13/211). The target calorie of CCI group was 104.6 (87.9, 125.5) kJ·kg(-1)·d(-1), and the actual calorie intake accounted for 0.98 (0.80, 1.00) of the target calory. In the non-CCI group, the target calorie was 104.6 (87.9, 125.5) kJ·kg(-1)·d(-1), and the actual calorie consumed accounted for 0.91 (0.66, 1.00) of the target calorie. There was no statistically significant difference between two groups (P=0.248, P=0.150). Conclusion: The prevalence of CCI and surgery-related CCI in ICU is high, along with severe complications, respiratory and renal dysfunction and mechanical ventilation. Surgical patients admitted to ICU are at high nutritional risk, and active and correct nutritional support is essential for such patients.


Assuntos
Estado Terminal/epidemiologia , Estado Terminal/terapia , Adulto , China/epidemiologia , Doença Crônica/epidemiologia , Doença Crônica/terapia , Estudos Transversais , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Apoio Nutricional/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/efeitos adversos
3.
Rev Infirm ; 68(254): 27-28, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31587847

RESUMO

The doctor-patient relationship tends to reconfigure. The chronic patient is recognised for the ability to perform certain healthcare activities, but also for a type of expertise related to his or her personal experience with illness. However, what are the individual and collective benefits of this expertise? How is it enhanced by connected medical systems?


Assuntos
Doença Crônica/terapia , Relações Médico-Paciente , Autocuidado/psicologia , Doença Crônica/psicologia , Humanos
4.
Sante Publique ; Vol. 31(3): 459-467, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640334

RESUMO

INTRODUCTION: Patient education is an important component in the management and monitoring of chronic diseases. It plays an important role in the decline of the disease severity, mortality and socioeconomic burden and the complications of these chronic diseases. In Côte d'Ivoire, there are few studies to evaluate the reality of this activity. OBJECTIVE: To explore the practice of patient education in Ivory Coast. METHOD: This qualitative study has been carried out by means of semi-structured interviews with 24 healthcare professionals including 14 health managers for individual interviews and 10 care providers for focus group discussion. RESULTS: There are various representations of therapeutic patient education among health professionals. There was no real distinction between patient education and the broader concept of health education. Absence of national patient education policy, the lack of training in TPE and lack of experience of educational practice lead health professionals to realize an unstructured educational activity. CONCLUSION: These results show the need for Côte d'Ivoire to have a national policy of patient education to educate patients in accordance with international recommendations.


Assuntos
Doença Crônica/terapia , Pessoal de Saúde/psicologia , Educação de Pacientes como Assunto/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Costa do Marfim , Humanos , Pesquisa Qualitativa
5.
Ig Sanita Pubbl ; 75(3): 231-244, 2019.
Artigo em Italiano | MEDLINE | ID: mdl-31645064

RESUMO

The increase of chronic diseases prevalence has created the need to adapt care models. Telemedicine applications play an increasingly important role in health care and provide tools that are indispensable for home health care, remote patient monitoring, disease management, and lastly are enable patients to have more control of their own well being. The paper presents an Italian Healthcare Local Authority Experience. The objective of paper was to evaluate the impact of telemedicine on patients with long-term conditions at high risk for rehospitalization or an emergency department visit, in terms of target disease control (diabetes, hypertension, heart failure, and chronic obstructive pulmonary disease). The outcomes are highly positive. They register the decrease of access to emergency care, the reduction of waiting list for the next visits and the increase of customer satisfaction.


Assuntos
Doença Crônica/terapia , Serviços de Assistência Domiciliar , Telemedicina , Diabetes Mellitus , Humanos , Readmissão do Paciente , Doença Pulmonar Obstrutiva Crônica
6.
Rev Med Suisse ; 15(669): 1968-1971, 2019 Oct 30.
Artigo em Francês | MEDLINE | ID: mdl-31663696

RESUMO

We have been studying multimorbidity in epidemiology and clinical practice since the 1970s. Growing experience shows that the concept of multimorbidity is helpful for epidemiologists to describe population-level changes, but of little use to patients and clinicians who 'diagnose' multimorbidity. Several large, rigorous clinical trials show that organizational changes in primary care can improve the care of these complex patients, but do not improve directly health-related quality of life. This article describes the history of multimorbidity and results of recent randomized trials to prompt a discussion of new approaches to improve the experience of people living with multiple chronic diseases.


Assuntos
Doença Crônica , Multimorbidade/tendências , Atenção Primária à Saúde/métodos , Doença Crônica/epidemiologia , Doença Crônica/terapia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Rev Lat Am Enfermagem ; 27: e3203, 2019.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-31664411

RESUMO

OBJECTIVE: Evaluate the effect of interprofessional education on the climate of Primary Health Care teams and on the acquisition of knowledge about management of chronic non-communicable diseases. METHOD: Quasi-experimental study of interprofessional education intervention. Seventeen Primary Health Care teams (95 professionals) participated in the study, of which nine teams (50 professionals) composed the intervention group and eight teams (45 participants) composed the control group. The team climate inventory scale and a questionnaire on knowledge about management of chronic conditions in Primary Health Care were applied before and after intervention. Type I error was fixed as statistically significant (p<0.05). RESULTS: In the analysis of knowledge about management of chronic conditions, the teams that participated in the interprofessional education intervention presented higher mean post-intervention increase than the teams of the control group (p < 0.001). However, in the analysis of both groups, there was no significant variation in the teamwork climate scores (0.061). CONCLUSION: The short interprofessional education intervention carried out during team meetings resulted in improved apprehension of specific knowledge on chronic conditions. However, the short intervention presented no significant impacts on teamwork climate.


Assuntos
Doença Crônica/terapia , Pessoal de Saúde/educação , Práticas Interdisciplinares/organização & administração , Atenção Primária à Saúde/organização & administração , Emprego , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Fatores de Tempo
10.
Niger J Clin Pract ; 22(9): 1180-1188, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489851

RESUMO

Background: Assessment of health-related quality of life (HRQOL) in resource-limited settings is critical to evaluate and improve the burden of morbidity and mortality associated with chronic medical disorders. There is a dearth of data on HRQOL among patients suffering from chronic medical disorders in Nigeria. This study assessed the HRQOL of participants with diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, and cancer in a hospital setting with limited resources and highlighted associated factors. Methods: The WHOQOL-BREF instrument was used to study a cross section of the participants at the University of Nigeria Teaching Hospital, Enugu. Data were analyzed using Statistical Package for Social Sciences (SPSS). Results: The distribution of the 613 study population was diabetes mellitus 120, HIV 389, and various cancers 104. Majority (67.9%) earned less than $1 per day and only 7.5% had any form of health insurance. The HIV group had higher QoL scores. Younger age, higher educational status, being employed, and having a care giver were positively associated with higher QoL. Patients with no comorbidities (76.6%) had an overall higher QoL score. Conclusion: Majority of the patients living with chronic medical diseases in Enugu, Nigeria were poor, vulnerable, and without access to health insurance. People living HIV generally had better quality life than those with other health conditions. There is a huge unmet need for people living with chronic medical conditions in Nigeria, which require strategies to counteract.


Assuntos
Doença Crônica/terapia , Assistência à Saúde/métodos , Diabetes Mellitus Tipo 2/psicologia , Infecções por HIV/psicologia , Neoplasias/psicologia , Qualidade de Vida , Adolescente , Adulto , Idoso , Doença Crônica/psicologia , Comorbidade , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Recursos em Saúde , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Nigéria/epidemiologia , Inquéritos e Questionários , Adulto Jovem
11.
Ann Agric Environ Med ; 26(3): 489-495, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31559809

RESUMO

INTRODUCTION AND OBJECTIVE: Deficits of vitamin resources constitute a significant public health problem, especially among the elderly population. The aim of the research was to determine the level of vitamin 25 (OH) D and vitamins from group B in the chronically ill elderly in domiciliary care, depending on functional capacity and coexisting diseases. MATERIAL AND METHODS: The pilot study included 137 patients staying in long-term domiciliary care. Samples of the participants' venous blood was obtained for laboratory tests. Centrifuged serum was used to determine the level of the following biochemical parameters: vitamin 25 (OH)D, B12, folic acid and total protein, albumin, triglycerides, total cholesterol and HDL cholesterol. Assessment of the functional status of patients was made by using the Barthel scale. RESULTS: More than ¾ of the patients with functional deficit (according to Barthel's score 0-85 points) were deficient in vitamin 25 (OH)D, while folic acid values were below the reference values in more than half of the patients. Respondents with lower functional efficiency were characterised by a reduced average value of vitamin 25 (OH)D and folic acid. CONCLUSIONS: The studied group of the chronically ill elderly was characterised by a deficiency of vitamin D3 and folic acid. Subjects with a functional impairment deficit show a reduced mean value of vitamin 25 (OH)D and folic acid in the blood serum, compared to the group of patients with higher mobility.


Assuntos
Envelhecimento/sangue , Doença Crônica/terapia , Vitamina B 12/sangue , Vitamina D/sangue , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Feminino , Ácido Fólico/sangue , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Locomoção , Masculino , Atividade Motora , Projetos Piloto , Triglicerídeos/sangue
12.
Psychiatr Danub ; 31(Suppl 3): 622-625, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488803

RESUMO

Doctors play an important role in a multidisciplinary team, however therapeutic relationships are not limited to between a doctor and a patient. In Community Mental Health Teams, patients are allocated a care coordinator - usually a community psychiatric nurse or a social worker - and they usually become the healthcare provider the patient is most regularly in contact with. Similarly, a practice nurse in General Practice may be the healthcare professional a patient is most familiar with. In these instances, the patient-provider relationship may be stronger than the doctor-patient relationship. Non-doctor and patient relationships play an increasingly important role in improving the patient experience and contributing to information gathering, shared-decision making, and establishment and adherence to treatment plans. Care coordinators may be in a more superior position than doctors to accurately recognise the ongoing and changing needs of a person with mental illness. Patients value continuity of care, compassion, and mutual trust and respect: these qualities can potentially all be provided by any trained healthcare professional. In this paper, we will review the literature on the emerging role of the care coordinator and other healthcare professionals in the management of chronic mental illness in the community.


Assuntos
Serviços Comunitários de Saúde Mental/organização & administração , Transtornos Mentais/terapia , Médicos , Doença Crônica/terapia , Continuidade da Assistência ao Paciente , Empatia , Humanos , Relações Médico-Paciente
13.
Artigo em Alemão | MEDLINE | ID: mdl-31428831

RESUMO

BACKGROUND: The number of patients in emergency rooms without a medical emergency is increasing. Outpatient services for mutual support and relief between the in-patient and out-patient sector are not yet fully established. AIM OF THE WORK: The aim was to determine the extent to which patients in emergency rooms have real medical emergencies by comparing patients with at least two and those with a maximum of one chronic illness. An additional aim was to identify factors influencing the previous use of outpatient structures. MATERIAL AND METHODS: The study participants included emergency room patients from the cross-sectional study "PiNo-Nord." All persons in five emergency rooms in northern Germany between October 2015 and July 2016 who were not treated as "immediate" or "very urgent" were interviewed. An exploratory data analysis and multivariate logistic regression were performed. RESULTS: The 293 patients with ≥2 chronic diseases were just as often a medical emergency compared to the 847 patients with a maximum of 1 chronic disease. The most frequent occasions for consultation were musculoskeletal trauma (33%, n = 293 vs. 42%, n = 847) or trauma of the skin (11%, n = 293 vs. 13%, n = 847). In both groups, the general practitioner or specialist caregiver, as well as diagnostic or treatment options, rarely played a role in visiting the emergency department. The strongest predictors of previous outpatient treatment were the duration of the appeal in the last six months, a high subjective treatment urgency, the presence of at least two chronic conditions, and a consultation event concerning the musculoskeletal injuries. CONCLUSIONS: In both patient groups, no evidence of unnecessary visits to the emergency room was found. For the most part, outpatient structures are used in advance and the emergency department is only visited in the event of an actual medical emergency.


Assuntos
Doença Crônica/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Alta do Paciente , Doença Crônica/epidemiologia , Estudos Transversais , Alemanha , Humanos , Encaminhamento e Consulta
14.
Implement Sci ; 14(1): 76, 2019 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382994

RESUMO

BACKGROUND: Translating research into practice is an important issue for implementing health interventions effectively for Indigenous communities. He Pikinga Waiora (HPW) is a recent implementation framework that provides a strong foundation for designing and implementing health interventions in Indigenous communities for non-communicable diseases around community engagement, culture-centred approach, systems thinking and integrated knowledge translation. This study addresses the following research question: How are the elements of the HPW Implementation Framework reflected in studies involving the implementation of a non-communicable disease health intervention in an Indigenous community? METHODS: A systematic review was conducted using multiple databases. Studies were included if they involved the implementation or evaluation of a health intervention targeting non-communicable diseases for Indigenous communities in Australia, Canada, New Zealand or the United States of America. Published quantitative and qualitative literature from 2008 to 2018 were included. Methodological appraisal of the included articles was completed using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information. Data on the population, topic, methods, and outcomes were detailed for each individual study. Key data extracted included the HPW elements along with study characteristics, who delivered the intervention and health outcomes. Data analysis involved a qualitative synthesis of findings as guided by a coding scheme of the HPW elements. RESULTS: Twenty-one studies were included. Health topics included diabetes, nutrition, weight loss, cancer and general health. The key themes were as follows: (a) two thirds of studies demonstrated high levels of community engagement; (b) from the culture-centred approach, two-thirds of studies reflected moderate to high levels of community voice/agency although only a third of the studies included structural changes and researcher reflexivity; (c) about a quarter of studies included multi-level outcomes and activities consistent with systems thinking, 40% had individual-level outcomes with some systems thinking, and 33% included individual-level outcomes and limited systems thinking; and (d) almost 40% of studies included high levels of end user (e.g., policy makers and tribal leaders) engagement reflective of integrated knowledge translation, but nearly half had limited end-user engagement. CONCLUSIONS: The HPW Implementation Framework is a comprehensive model for potentially understanding implementation effectiveness in Indigenous communities. The review suggests that the studies are reflective of high levels of community engagement and culture-centredness. The long-term sustainability and translation of evidence to practice may be inhibited because of lower levels of systems thinking and integrated knowledge translation. REGISTRATION: Not registered.


Assuntos
Doença Crônica/terapia , Assistência à Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Doença Crônica/etnologia , Acesso aos Serviços de Saúde , Humanos
15.
Med. clín (Ed. impr.) ; 153(3): 93-99, ago. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-183430

RESUMO

Background and objective: The objective of the study was to evaluate the effects of a multidisciplinary intervention on the outcomes of polypathological patients (PP). Methods: A multicenter quasi-experimental pre-post study with a 12-month follow up was performed. In-hospital, at discharge and outpatient clinics patients who met criteria of PP between March 2012 and October 2013 were included. The multidisciplinary approach was defined by 11 interventions performed by general practitioners, internal medicine physicians, team care nurses and hospital pharmacists. The primary outcome was reduction in the number of hospital admissions and days of hospitalization. Secondary outcomes included mortality and the effects of 11 interventions on mortality. Results: 420 patients were included. Mean patient age was 77.3 (SD: 8.90) and average number of PP defining categories was 2.99 (SD: 1.00). Number of hospital admissions and days of hospitalization decreased significantly after intervention: 1.52 (SD: 1.35) versus 0.82 (SD: 1.29), p<0.001, and 13.77 (SD: 15.20) versus 7.21 (SD: 12.90), p<0.001 respectively. 12-month mortality was 37.7%. PP who failed to receive a structured medical visit from the internal medicine physician and educational workshops from the team care nurses had a higher risk of exitus in the next 12 months, HR: 1.68; 95% CI: 1.15-2.46, p=0.007 and HR: 2.86; 95% CI: 1.92-4.27, p<0.001, respectively. Conclusions: This multidisciplinary intervention reduced the risk of PP hospital admission and days of hospitalization. Educational workshop programs for PP and their caregivers and structured IM medical visits were associated with improvements of survival


Introducción y objetivo: El objetivo del estudio fue evaluar los resultados en salud tras la implantación de una intervención multidisciplinar a pacientes pluripatológicos (PP). Metodología: Se realizó un estudio multicéntrico antes-después cuasi-experimental, con seguimiento a 12 meses. Se incluyeron pacientes que cumplían los criterios de PP entre marzo de 2012 y octubre de 2013, tanto en el ámbito hospitalario como en atención primaria. El enfoque multidisciplinar fue definido por 11 intervenciones realizadas por médicos de familia, médicos internistas, enfermeras y farmacéuticos hospitalarios. El resultado fundamental fue la reducción en el número de ingresos hospitalarios y días de hospitalización al año de seguimiento. Los resultados secundarios incluyeron la mortalidad y los efectos de las intervenciones sobre la misma. Resultados: Se incluyeron 420 pacientes. La edad media de los pacientes fue de 77,3 (DE: 8,90) y la media de categorías definitorias de PP fue de 2,99 (DE: 1,00). El número de ingresos hospitalarios y los días de hospitalización disminuyeron significativamente después de la intervención: 1,52 (DE: 1,35) versus 0,82 (DE: 1,29), p<0,001 y 13,77 (DE: 15,20) versus 7,21 (DE: 12,90), p<0,001, respectivamente. La mortalidad a los 12 meses fue del 37,7%. Los PP que no recibieron la visita médica estructurada del médico internista tras la inclusión y los talleres educativos de las enfermeras tuvieron un mayor riesgo de exitus en los 12 meses de seguimiento, HR: 1,68; IC del 95%: 1,15-2,46, p=0,007 y HR: 2,86; IC del 95%: 1,92-4,27, p<0,001, respectivamente. Conclusiones: Esta intervención multidisciplinaria reduce el riesgo de ingreso y los días de ingreso hospitalario en PP. Los programas de talleres educativos para PP y sus cuidadores, y las visitas médicas estructuradas por parte de medicina interna se asociaron con una mayor supervivencia


Assuntos
Humanos , Masculino , Idoso , Pesquisa Interdisciplinar , Múltiplas Afecções Crônicas/epidemiologia , Hospitalização , Doença Crônica/terapia , Equipe de Assistência ao Paciente , Serviços de Saúde , Planejamento de Assistência ao Paciente/organização & administração , Comunicação Interdisciplinar
17.
Soins Pediatr Pueric ; 40(309): 35-38, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31331600

RESUMO

Therapeutic education in paediatrics forms part of the child's care pathway, from the discovery of the chronic disease, through to adulthood. Around fifteen years ago, this specific healthcare activity resulted in the creation of a multiple pathology therapeutic education centre at Robert-Debré university hospital in Paris. The centre has continued to develop over the years and further improved its interventions.


Assuntos
Doença Crônica/terapia , Educação de Pacientes como Assunto/organização & administração , Pediatria , Criança , Hospitais Universitários , Humanos , Paris
18.
BMC Health Serv Res ; 19(1): 496, 2019 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-31311531

RESUMO

BACKGROUND: Although there is evidence with respect to the effectiveness of Chronic Care Model (CCM)-based programs in terms of improved patient outcomes, less attention has been given to the effect of high-quality care on productivity of patient-professional interactions, especially among frail older persons. The aim of our study was therefore to examine whether frail community-dwelling older persons' perspectives on quality of primary care according to the dimensions of the CCM are associated with the productivity of the patient-professional interactions. METHODS: Our study was part of a large-scale evaluation study with a matched quasi-experimental design to compare outcomes of frail community-dwelling older persons that participated in a proactive, integrated primary care approach based on (elements of) the CCM and those that received usual primary care. Frail older persons' perceptions of quality of care were assessed with the Patient Assessment of Chronic Illness Care Short version (PACIC-S). Productive interactions with general practitioners (GPs) and practice nurses were assessed using a relational coproduction instrument. Measurements were performed at baseline (T0) and 12 months thereafter (T1). In total, 232 frail older persons were participating in the intervention group at T0 and matched to 232 frail older persons in the control group. At T1, 182 persons were in the intervention group and 176 in the control group. RESULTS: Paired sample t-tests showed significant improvements in overall quality of care, the majority of underlying quality of care items, and productive interactions within the intervention group and control group over time. Multilevel analyses revealed that productive interaction with the GP and practice nurse at T1 was significantly related to perceived productive interaction with them at T0, the perceived quality of primary care at T0, and the change in perceived quality of primary care over time (between T0 and T1). CONCLUSIONS: Frail community-dwelling older persons' perspectives on quality of primary care were associated with perceived productivity of their interactions with the GP and practice nurse in both the intervention group and the control group. We found no significant differences in overall perceived quality of care and perceived patient-professional interaction between the intervention group and control group at baseline and follow-up. In times of population aging it is necessary to invest in high-quality care delivery for frail older persons and productive interactions with them.


Assuntos
Idoso Fragilizado/psicologia , Relações Enfermeiro-Paciente , Relações Médico-Paciente , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/terapia , Feminino , Idoso Fragilizado/estatística & dados numéricos , Clínicos Gerais/psicologia , Pesquisa sobre Serviços de Saúde , Humanos , Vida Independente , Masculino , Enfermeiras e Enfermeiros/psicologia
19.
Chirurgia (Bucur) ; 114(3): 326-330, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264570

RESUMO

Health literacy (HL) in the pediatric setting has been associated with poor health outcomes and plays an important role in the existing health disparities. Low parents caregivers HL influences health outcomes mainly in chronically ill children. Trying to identify the role of HL in the pediatric surgical and dentistry setting, we conducted a review of the relevant literature. The paucity of studies and the heterogeneity of the methodology do not lead to specific results. The need for more and larger studies in the field is evident and crucial in order to ameliorate the quality of surgical care in pediatric patients.


Assuntos
Doença Crônica/terapia , Alfabetização em Saúde , Procedimentos Cirúrgicos Operatórios , Criança , Humanos , Pais , Qualidade da Assistência à Saúde
20.
Int J Equity Health ; 18(1): 107, 2019 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272466

RESUMO

PURPOSE: Chronic disease is a global concern. While ample research has aimed to identify the epidemiology of multimorbidity and patient complexity using administrative data, little attention has been paid to the processes of care that treating complex patients entail. Consequently, the concept of patient complexity itself does not directly speak to how challenging it may be to care for a given patient. The purpose of this study was to investigate how primary care providers define, encounter, and manage complex patients, especially those with chronic pain. To our knowledge, this is the first study to move beyond general narrative descriptions of complexity towards an interrogation that is grounded in the work practices of caring for these patients. METHODS: We undertook an institutional ethnography (IE) in Ontario, Canada. IE uses people's everyday work problems as the starting point for an exploration of the often-invisible social relations that orient experiences. Grounded in the everyday experience of primary care providers, we draw here on 51 interviews that were collected as part of our larger IE study, to interrogate the utility of definitions of patient complexity as medical multimorbidity. FINDINGS: Care providers consider patients challenging due to their socio-economic status more so than their medical problems alone. Our data shows that patients' issues are often bound up with poverty, trauma, and mental health concerns, and are challenging for health care providers in part because the interventions needed exceed the scope of their medical expertise, while social issues render the treatment of potentially straightforward medical problems complicated. This was especially so for patients with chronic pain. CONCLUSION: Defining patient complexity as morbidity alone is inadequate; such models neglect syndromes and conditions that are not included in formal disease classifications. Chronic pain should be included among the chronic conditions that are considered to constitute multimorbidity. In order to provide effective patient-centered care, discussions of patient complexity must also attend to the complex social and economic circumstances in which many patients live and include broader issues of inequity and social justice. This approach would enable policies to better support primary care providers who struggle to manage their patients with complex needs across domains of physiological health, mental health, and the quality of their living conditions, and in so doing improve the care that patients receive.


Assuntos
Doença Crônica/terapia , Gerenciamento Clínico , Necessidades e Demandas de Serviços de Saúde/organização & administração , Feminino , Pessoal de Saúde/organização & administração , Humanos , Narração , Ontário , Assistência Centrada no Paciente/organização & administração , Atenção Primária à Saúde/organização & administração
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