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1.
Medicine (Baltimore) ; 99(50): e23687, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327358

RESUMO

To explore the effects of the project-achievement quality control circle in constructing a new health education model for patients with chronic hepatitis B.The quality control circle group was established and the theme of "constructing a new health education model for patients with chronic hepatitis B" was selected. The circle staff determined that this quality control circle was of project-achievement according to the quality control story judgment table, and then carry out activities in strict accordance with the 10 steps of project-achievement quality control circle, evaluate the tangible results and non-tangible results before and after the activity.After the implementation of the activity, the health education integrity of patients with chronic hepatitis B increased from 74.75 ±â€Š11.00 to 95.00 ±â€Š5.55 points (P < .001). The awareness of health education increased from 71.90 ±â€Š13.48 to 95.60 ±â€Š2.84 points (P < .001), the satisfaction rate of health education increased from 76.60 ±â€Š8.71 points to 98.00 ±â€Š2.03 points (P < .001), and the evaluation rate after health education increased from 10% to 100% (P < .001).The circle members have much more confidence in quality control circle activities, the use of techniques, and the knowledge related to scientific research.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Hepatite B Crônica/epidemiologia , Educação de Pacientes como Assunto/organização & administração , Melhoria de Qualidade/organização & administração , Conscientização , China/epidemiologia , Humanos , Educação de Pacientes como Assunto/normas , Satisfação do Paciente
2.
Ann Acad Med Singap ; 49(9): 652-660, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33241253

RESUMO

INTRODUCTION: Coronavirus Disease 2019 (COVID-19) has significantly affected the way healthcare is delivered in Singapore. Healthcare services such as renal transplantation had to rapidly adjust and meet the needs to (1) protect patients and staff, (2) ramp up, conserve or redeploy resources while (3) ensuring that critical services remained operational. This paper aims to describe the experience of the renal transplant programme at the Singapore General Hospital (SGH) in responding to the risks and constraints posed by the pandemic. METHODS AND MATERIALS: This is a review and summary of the SGH renal transplant programme's policy and protocols that were either modified or developed in response to the COVID-19 Pandemic. RESULTS: A multi-pronged approach was adopted to respond to the challenges of COVID-19. These included ensuring business continuity by splitting the transplant team into different locations, adopting video and tele-consults to minimise potential patient exposure to COVID-19, streamlining work processes using electronic forms, ensuring safe paths for patients who needed to come to hospital, ring-fencing and testing new inpatients at risk for COVID-19, enhancing precautionary measures for transplant surgery, ensuring a stable supply chain of immunosuppression, and sustaining patient and staff education programmes via video conferencing. CONCLUSIONS: Though the COVID-19 pandemic has reduced access to kidney transplantation, opportunities arose to adopt telemedicine into mainstream transplant practice as well as use electronic platforms to streamline work processes. Screening protocols were established to ensure that transplantation could be performed safely, while webinars reached out to empower patients to take precautions against COVID-19.


Assuntos
/prevenção & controle , Assistência à Saúde/organização & administração , Imunossupressores/provisão & distribução , Transplante de Rim , Telemedicina , Comunicação por Videoconferência , /diagnóstico , Assistência à Saúde/métodos , Rejeição de Enxerto/prevenção & controle , Humanos , Imunossupressores/uso terapêutico , Programas de Rastreamento , Política Organizacional , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Admissão e Escalonamento de Pessoal , Singapura/epidemiologia , Fluxo de Trabalho
3.
J Diabetes Sci Technol ; 14(6): 1107-1110, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33050727

RESUMO

With the recent pivot to telehealth as a direct result of the COVID-19 pandemic, there is an imperative to ensure that access to affordable devices and technologies with remote monitoring capabilities for people with diabetes becomes equitable. In addition, expanding the use of remote Diabetes Self-Management Education and Support (DSMES) and Medical Nutrition Therapy (MNT) services will require new strategies for achieving long-term, effective, continuous, data-driven care. The current COVID-19 pandemic has especially impacted underserved US communities that were already disproportionately impacted by diabetes. Historically, these same communities have faced barriers in accessing timely and effective diabetes care including access to DSMES and MNT services, and diabetes technologies. Our call to action encourages all involved to urge US Federal representatives to widen access to the array of technologies necessary for successful telehealth-delivered care beyond COVID-19.


Assuntos
Computação em Nuvem/tendências , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus/terapia , Acesso aos Serviços de Saúde/tendências , Pneumonia Viral/epidemiologia , Telemedicina/tendências , Assistência de Saúde Universal , Infecções por Coronavirus/terapia , Democracia , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/terapia , Diabetes Mellitus/epidemiologia , Acesso aos Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde/organização & administração , Disparidades em Assistência à Saúde/tendências , Humanos , Invenções/tendências , Área Carente de Assistência Médica , Pandemias , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Educação de Pacientes como Assunto/tendências , Pneumonia Viral/terapia , Autogestão/métodos , Autogestão/tendências , Telemedicina/métodos , Telemedicina/organização & administração
5.
PLoS One ; 15(10): e0240600, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33057362

RESUMO

BACKGROUND: After a spinal cord injury (SCI), individuals must acquire their maximum level of independence before returning to their previous social and working conditions. The education provided during rehabilitation is one of the basic but complex aspects that influence the health perspectives of people with SCI. Gaining the perspective of SCI survivors experienced barriers and resources to enhance the education process may assist healthcare professionals in understanding this complex aspect of their practice. Through a qualitative descriptive analysis, this study aimed to identify the perceived barriers and facilitators of education provided during the rehabilitation of individuals with SCI. METHODS: A purposive sample of 22 adults with SCI and at least six months of home experience was recruited. Participants were assigned into four mini focus groups according to their level of independence. The focus groups were audio-recorded, transcribed verbatim, and analysed using a thematic analysis. RESULTS: Three themes were identified: the readiness to education, the individual characteristics, and the environmental and social characteristics influencing education. Participants perceived education to be an ongoing process made up of consecutive phases, each of which had to be overcome before participants felt ready to reappraise their health and well-being. This process was affected by individual, environmental, and social factors. CONCLUSIONS: Education is constantly provided by all members of the rehabilitation team. These must stress the relevance of the contents presented, increase SCI survivors' motivation to set achievable goals, and consider filling the gap that the patients perceive between rehabilitation centres and available community resources. The findings of this study promote the design of structured educational programmes, increasing knowledge, and improve the health perspective of SCI survivors, their families, and providers.


Assuntos
Motivação , Educação de Pacientes como Assunto/organização & administração , Autogestão/educação , Traumatismos da Medula Espinal/reabilitação , Sobreviventes/psicologia , Adulto , Idoso , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Autogestão/psicologia
6.
Nat Rev Immunol ; 20(10): 594-602, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32913283
7.
Med Care ; 58(11): 968-973, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32833935

RESUMO

BACKGROUND: African Americans are significantly more likely than non-African Americans to have diabetes, chronic kidney disease, and uncontrolled hypertension, increasing their risk for kidney function decline. OBJECTIVE: The objective of this study was to compare how African Americans and non-African Americans with diabetes responded to a multifactorial telehealth intervention designed to slow kidney function decline. RESEARCH DESIGN: Secondary analysis of a randomized trial. Primary care patients (N=281, 56% African American) were allocated to either: (1) a multifactorial, pharmacist-delivered phone-based telehealth intervention focused on behavioral and medication management of diabetic kidney disease; or (2) an education control. MEASURES: The primary study outcome was change in estimated glomerular filtration rate (eGFR). Linear mixed models were used to explore the moderating effect of race on the relationship between study arm and eGFR decline over time; the mean annual rate of eGFR decline was estimated by race and study arm. RESULTS: Findings demonstrated a differential intervention effect on kidney function over time by race (Pinteraction=0.005). Among African Americans, the intervention arm had significantly greater preservation of eGFR over time than the control arm (difference in the annual rate of eGFR decline=1.5 mL/min/1.73 m; 95% confidence interval: 0.04, 3.02). For non-African Americans, the intervention arm had a faster decline in eGFR over time than the control arm (difference in the annual rate of eGFR decline=-1.7 mL/min/1.73 m; 95% confidence interval: -3.3, -0.02). CONCLUSION: A multifactorial, pharmacist-delivered telehealth intervention for diabetic kidney disease may be more effective for slowing eGFR decline among African Americans than non-African Americans.


Assuntos
Afro-Americanos/educação , Nefropatias Diabéticas/prevenção & controle , Gerenciamento Clínico , Comportamentos Relacionados com a Saúde/etnologia , Telemedicina/organização & administração , Adolescente , Adulto , Idoso , Grupos de Populações Continentais/educação , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/etnologia , Nefropatias Diabéticas/etnologia , Grupo com Ancestrais do Continente Europeu/educação , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Adesão à Medicação/etnologia , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/organização & administração , Farmacêuticos , Fatores Socioeconômicos , Telefone , Adulto Jovem
8.
BMC Public Health ; 20(1): 1050, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32615957

RESUMO

BACKGROUND: Faith-based health promotion has shown promise for supporting healthy lifestyles, but has limited evidence of reaching scale or sustainability. In one recent such effort, volunteers from a diverse range of faith organizations were trained as peer educators to implement diabetes self-management education (DSME) classes within their communities. The purpose of this study was to identify factors associated with provision of these classes within six months of peer-educator training. METHODS: This study used the Consolidated Framework for Implementation Research (CFIR) to identify patterns from interviews, observations, attendance records, and organizational background information. Two research team members thematically coded interview transcripts and observation memos to identify patterns distinguishing faith organizations that did, versus did not, conduct DSME classes within six months of peer-educator training. Bivariate statistics were also used to identify faith organizational characteristics associated with DSME class completion within this time frame. RESULTS: Volunteers from 24 faith organizations received peer-educator training. Of these, 15 led a DSME class within six months, graduating a total of 132 participants. Thematic analyses yielded two challenges experienced disproportionately by organizations unable to complete DSME within six months: [1] Their peer educators experienced DSME as complex, despite substantial planning efforts at simplification, and [2] the process of engaging peer educators and leadership within their organizations was often more difficult than anticipated, despite initial communication by Faith and Diabetes organizers intended to secure informed commitments by both groups. Many peer educators were overwhelmed by training content, the responsibility required to start and sustain DSME classes, and other time commitments. Other priorities competed for time in participants' lives and on organizational calendars, and scheduling processes could be slow. In an apparent dynamic of "crowding out," coordination was particularly difficult in larger organizations, which were less likely than smaller organizations to complete DSME classes despite their more substantial resources. CONCLUSIONS: Initial commitment from faith organizations' leadership and volunteers may not suffice to implement even relatively short and low cost health promotion programs. Faith organizations might benefit from realistic previews about just how challenging it is to make these programs a sufficiently high organizational and individual priority.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Organizações Religiosas , Promoção da Saúde/organização & administração , Educação de Pacientes como Assunto/organização & administração , Agentes Comunitários de Saúde/estatística & dados numéricos , Coleta de Dados , Educação em Saúde/organização & administração , Humanos , Liderança , Obesidade/terapia , Grupo Associado
9.
BMC Public Health ; 20(1): 820, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32487065

RESUMO

BACKGROUND: Mobile Health (mHealth) is becoming an important tool to improve health outcomes in maternal, newborn and child health (MNCH). Studies of mHealth interventions, have demonstrated their effectiveness in improving uptake of recommended maternal services such as antenatal visits. However, evidence of impact on maternal health outcomes is still limited. METHODS: A pseudo-randomized controlled trial (single blind) was conducted to assess the impact of a voice-message based maternal intervention on maternal health knowledge, attitudes, practices and outcomes over time: Pregnancy (baseline/Time 1); Post-partum (Time 2) and when the infant turned one year old (Time 3). Women assigned to the mMitra intervention arm received gestational age- and stage-based educational voice messages via mobile phone in Hindi and Marathi, while those assigned to the control group did not. Both groups received standard care. RESULTS: Two thousand sixteen women were enrolled. Interviews were conducted with 1516 women in the intervention group and 500 women in the control group at baseline and post-partum. The intervention group performed significantly better than controls on four maternal health practice indicators: receiving the tetanus toxoid injection (OR: 1.6, 95% Confidence Interval (CI): 1.05-2.4, p = 0.028), consulting a doctor if spotting or bleeding (OR: 1.72, 95%CI: 1.07-2.75, p = 0.025), saving money for delivery expenses (OR: 1.79, 95%CI: 1.38-2.33, p = 0.0001), and delivering in hospital (OR: 2.5, 95%CI: 1.49-4.35, p = 0.001). The control group performed significantly better than the intervention group on two practice indicators: resting regularly during pregnancy (OR: 0.7, 95%CI: 0.54-0.88, p = 0.002) and having at-home deliveries attended by a skilled birth attendant (OR: 0.46, 95%CI: 0.23-0.91, p = 0.027). Both groups' knowledge improved from Time 1 to Time 2. Only one knowledge indicator, on seeking medical care during pregnancy, was statistically increased in the intervention group compared to controls. Anemia status at or near the time of delivery was unable to be assessed due to missing data from maternal health cards. CONCLUSIONS: This study provides evidence that in low-resource settings, mobile voice messages providing tailored and timed information about pregnancy can positively impact maternal health care practices proven to improve maternal health outcomes. Additional research is needed to assess whether voice messaging can motivate behavior change better than text messaging, particularly in low literacy settings. TRIAL REGISTRATION: The mMitra impact evaluation is registered with ISRCTN under Registration # 88968111, assigned on 6 September 2018 (See https://www.isrctn.com/ISRCTN88968111).


Assuntos
Serviços de Saúde Materna/organização & administração , Mães/educação , Educação de Pacientes como Assunto/organização & administração , Cuidado Pós-Natal/organização & administração , Gestantes/educação , Cuidado Pré-Natal/organização & administração , Telemedicina/organização & administração , Envio de Mensagens de Texto , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Lactente , Recém-Nascido , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Método Simples-Cego , Adulto Jovem
10.
Farm Hosp ; 44(7): 61-65, 2020 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-32533674

RESUMO

Hospital Pharmacy Service (HPS) in Spain have been impacted by the health  crisis caused by the COVID-19 pandemic. Thus, the outbreak has forced HPSs to adapt their outpatient consultation services to Telepharmacy to optimize clinical  outcomes and reduce the risk of contagion. The purpose of this article is to  describe and analyze the experience of HPSs with outpatient Telepharmacy  during the COVID-19 pandemic and expose the lessons learned. Measures have  been adopted in on-site outpatient pharmacy clinics to prevent exposure of  patients and professionals to the virus. These measures are based on national  and international recommendations on social distancing and hygiene. With  regard to remote outpatient pharmacy services, teleconsultation with drug  dispensing has been promoted based on five basic procedures, each with its  advantages and limitations: home drug delivery from HPSs, with the advantage  of universal access and the limitation of entailing a substantial investment in  resources; HPS coordination with primary care pharmacists, which requires no  investments but with limited access to some geographic areas; HPS coordination with community pharmacists based on a large network of pharmacies, which  requires the patient to go to the pharmacy, without confidentiality being  guaranteed for any patient; geolocation and hospital-based medication  dispensing, which provides universal access and direct traceability, but entails  investment in human resources; and HPS coordination with associations of  patients, which does not entail any additional cost but limits the information  available on the diseases of society members. Three main lessons have been learned during the pandemic: the satisfactory capacity of HPS to provide outpatient pharmacy consultation services in the setting of a public health crisis; the usefulness of Telepharmacy for the clinical follow-up, healthcare coordination, outpatient counseling, and informed dispensing and delivery of  medication (with a high level of satisfaction among patients); and the need to  foster Telepharmacy as a complementary tool through a mixed model of  outpatient pharmacy consultation service that incorporates the advantages of  each procedure and adapts to the individual needs of each patient in a context of humanized healthcare.


Assuntos
Assistência Ambulatorial/organização & administração , Betacoronavirus , Infecções por Coronavirus , Assistência à Saúde/organização & administração , Pandemias , Serviço de Farmácia Hospitalar/organização & administração , Pneumonia Viral , Telemedicina/organização & administração , Assistência à Saúde/estatística & dados numéricos , Aconselhamento Diretivo/organização & administração , Aconselhamento à Distância/organização & administração , Previsões , Geografia Médica , Necessidades e Demandas de Serviços de Saúde , Serviços de Assistência Domiciliar/organização & administração , Hospitais Universitários/organização & administração , Humanos , Sistemas de Medicação no Hospital/organização & administração , Pacientes Ambulatoriais , Educação de Pacientes como Assunto/organização & administração , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Espanha
11.
Nutr. hosp ; 37(3): 609-615, mayo-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193870

RESUMO

Educar y sensibilizar al consumidor para moderar el consumo de alcohol es clave para potenciar un estilo de vida saludable. Los profesionales de la salud (PS) en general, y los farmacéuticos comunitarios o los médicos y enfermeros de Atención Primaria (AP) en particular, son influenciadores clave en la educación para prevenir conductas de riesgo. El desconocimiento por parte del consumidor de conceptos como la unidad de bebida estándar, las recomendaciones de consumo, o las equivalencias de alcohol en las bebidas consumidas, puede generar consumos de riesgo alto, dado que el alcohol es alcohol y no depende de la bebida que lo contiene. Asimismo, los PS no suelen estar familiarizados con estos conceptos y con el uso de herramientas para la detección precoz, como puede ser el cuestionario AUDIT (Alcohol Use Disorders Identification Test). Proponemos un abordaje multidisciplinar (médicos y enfermeros de AP, farmacia comunitaria, dietistas-nutricionistas) para educar al consumidor sobre el riesgo asociado al consumo de alcohol, sustentado en la elaboración de un protocolo de actuación consensuado entre las sociedades científicas de estos colectivos profesionales, cuyo objetivo fundamental es contribuir a la formación óptima y actualizada de los PS. Este protocolo de actuación pretende, por tanto, prevenir conductas de riesgo mediante la educación del consumidor y la detección de hábitos de consumo de alto riesgo. Asimismo, este abordaje multidisciplinar y coordinado debe servir para impulsar la comunicación entre los distintos colectivos a la hora de proporcionar información relevante para abordar el consumo de riesgo desde la AP de Salud


Educating and increasing awareness in the consumer to achieve a moderate alcohol consumption is key to promote a healthy lifestyle. Health care professionals (HCP), in particular community pharmacists and Primary Care (PC) physicians and nurses, are key influencers in the education to prevent risk behaviors. A consumer's poor knowledge of concepts such as standard unit, the recommendations on alcohol use, or the alcohol equivalence in the drinks consumed, can lead to a high-risk use, since "alcohol is alcohol" no matter what beverage contains it. Moreover, HCPs are usually not familiar with these concepts and with early detection tools such as the AUDIT (Alcohol Use Disorders Identification Test). We propose a multidisciplinary approach (PC physicians and nurses, community pharmacy, dietists-nutritionists) to educate consumers on the risks associated with the use of alcohol, supported by the development of a protocol of action subscribed by the scientific societies of these professional groups, with the main objective of contributing to optimal and updated training for HCPs. Thus, this protocol of action aims to prevent risk behaviors through consumer education, and to detect high-risk alcohol use. Moreover, this multidisciplinary and coordinated approach should help to boost communication between the different collectives involved when providing relevant information to tackle risky alcohol use from PC


Assuntos
Humanos , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/epidemiologia , Comunicação Interdisciplinar , Pessoal de Saúde/organização & administração , Atenção Primária à Saúde , Estilo de Vida , Assunção de Riscos , Diagnóstico Precoce , Inquéritos e Questionários , Defesa do Consumidor/educação , Informação de Saúde ao Consumidor/métodos , Educação de Pacientes como Assunto/organização & administração , Consumo de Bebidas Alcoólicas/prevenção & controle
12.
Eur J Oncol Nurs ; 47: 101765, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32563842

RESUMO

PURPOSE: To analyse the importance and performance of key elements in patient-centered care coordination, education and counseling of patients treated with oral anticancer drugs. METHOD: In four Belgian non-academic hospitals, the importance and performance of a set of 82 key elements was cross-sectionally evaluated by primary and secondary healthcare professionals and by patients. These key elements were divided in 6 themes: coordination of care, style and content of patient contacts, medication counseling at treatment initiation, follow-up of treatment, psychosocial support, and involvement of family and friends. Participants were asked to indicate for each key element if it was implemented in the current care process for patients on oral anticancer drugs ('yes', 'no', 'I don't know') and if they considered it important that the component was implemented or would be in the future ('yes' or 'no'). Three levels of performance were defined, based on the number of participants who had answered 'yes' or 'no': 'systematically performed' (≥90% of participants), 'not systematically performed' (≥75% and <90%) and 'not performed' (<75%). Importance-rates were based on the number of 'yes' or 'no'. RESULTS: In total, 85 participants evaluated the key elements. More than half of key elements, 13/82 (15.9%) and 35/82 (42.6%) respectively, were considered as 'not' or 'not systematically performed'. The majority of these elements concerned coordination of care, medication counseling at treatment initiation and follow-up of treatment. Especially key elements on involving primary care and on discussing adherence had low performance rates. Nearly all key elements were assigned an importance score of ≥90%. CONCLUSIONS: Performance of key elements of patient-centered care coordination, education and counseling of patients treated with oral anticancer drugs proved moderate. Our findings suggest that strategies are needed to prioritize and operationalize key elements to coordinate transmural care and to provide effective education and counseling.


Assuntos
Antineoplásicos/administração & dosagem , Aconselhamento/organização & administração , Neoplasias/tratamento farmacológico , Educação de Pacientes como Assunto/organização & administração , Assistência Centrada no Paciente/organização & administração , Administração Oral , Adulto , Bélgica , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Hospitais , Humanos , Masculino , Análise e Desempenho de Tarefas
13.
PLoS One ; 15(6): e0234425, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32542028

RESUMO

BACKGROUND: Amid the ongoing U.S. opioid crisis, achieving safe and effective chronic pain management while reducing opioid-related morbidity and mortality is likely to require multi-level efforts across health systems, including the Military Health System (MHS), Department of Veterans Affairs (VA), and civilian sectors. OBJECTIVE: We conducted a series of qualitative panel discussions with national experts to identify core challenges and elicit recommendations toward improving the safety of opioid prescribing in the U.S. DESIGN: We invited national experts to participate in qualitative panel discussions regarding challenges in opioid risk mitigation and how best to support providers in delivery of safe and effective opioid prescribing across MHS, VA, and civilian health systems. PARTICIPANTS: Eighteen experts representing primary care, emergency medicine, psychology, pharmacy, and public health/policy participated. APPROACH: Six qualitative panel discussions were conducted via teleconference with experts. Transcripts were coded using team-based qualitative content analysis to identify key challenges and recommendations in opioid risk mitigation. KEY RESULTS: Panelists provided insight into challenges across multiple levels of the U.S. health system, including the technical complexity of treating chronic pain, the fraught national climate around opioids, the need to integrate surveillance data across a fragmented U.S. health system, a lack of access to non-pharmacological options for chronic pain care, and difficulties in provider and patient communication. Participating experts identified recommendations for multi-level change efforts spanning policy, research, education, and the organization of healthcare delivery. CONCLUSIONS: Reducing opioid risk while ensuring safe and effective pain management, according to participating experts, is likely to require multi-level efforts spanning military, veteran, and civilian health systems. Efforts to implement risk mitigation strategies at the patient level should be accompanied by efforts to increase education for patients and providers, increase access to non-pharmacological pain care, and support use of existing clinical decision support, including state-level prescription drug monitoring programs.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica/terapia , Manejo da Dor/métodos , Padrões de Prática Médica/organização & administração , Programas de Monitoramento de Prescrição de Medicamentos/organização & administração , Analgésicos Opioides/normas , Sistemas de Apoio a Decisões Clínicas/organização & administração , Prescrições de Medicamentos/normas , Feminino , Humanos , Colaboração Intersetorial , Masculino , Serviços de Saúde Militar/normas , Epidemia de Opioides , Educação de Pacientes como Assunto/organização & administração , Padrões de Prática Médica/normas , Uso Indevido de Medicamentos sob Prescrição/prevenção & controle , Programas de Monitoramento de Prescrição de Medicamentos/normas , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Pesquisa Qualitativa , Estados Unidos/epidemiologia , United States Department of Veterans Affairs/organização & administração , United States Department of Veterans Affairs/normas
15.
Diabetes Technol Ther ; 22(6): 440-443, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-291219

RESUMO

Today, in the United States, we have a health care system that is designed to treat symptoms, not people-and to do so as cheaply as possible with the dual goals of minimizing costs and preventing hospital visits. We are failing on all fronts. We spend more money on health care per capita than our Organization for Economic Co-operation and Development (OECD) peers, and our outcomes are mediocre at best. Medicine is not personal, health care professionals often have their hands tied by payers, and geography has too much influence on the quality of care available. This has to end, especially since we have the technology to create a truly patient-focused, whole-person approach-one that treats physical and mental health equally and meets people where they are in every sense. Telemedicine can level the playing field and enable higher quality, decentralized care that-when needed-brings specialty care to the masses. Other technologies have an important role, too. For patients with insulin-dependent diabetes (type 1 diabetes), widespread uptake of continuous glucose monitors may be the game-changer we need right now that can facilitate telemedicine to remote places and remove health care disparities. Both health professionals and patients will win-and ultimately payers will, too.


Assuntos
Infecções por Coronavirus/prevenção & controle , Diabetes Mellitus Tipo 1/terapia , Disparidades em Assistência à Saúde , Organizações sem Fins Lucrativos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/organização & administração , Betacoronavirus , Infecções por Coronavirus/complicações , Diabetes Mellitus Tipo 1/virologia , Humanos , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Pneumonia Viral/complicações , Telemedicina/métodos , Estados Unidos
16.
Diabetes Technol Ther ; 22(6): 440-443, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-237191

RESUMO

Today, in the United States, we have a health care system that is designed to treat symptoms, not people-and to do so as cheaply as possible with the dual goals of minimizing costs and preventing hospital visits. We are failing on all fronts. We spend more money on health care per capita than our Organization for Economic Co-operation and Development (OECD) peers, and our outcomes are mediocre at best. Medicine is not personal, health care professionals often have their hands tied by payers, and geography has too much influence on the quality of care available. This has to end, especially since we have the technology to create a truly patient-focused, whole-person approach-one that treats physical and mental health equally and meets people where they are in every sense. Telemedicine can level the playing field and enable higher quality, decentralized care that-when needed-brings specialty care to the masses. Other technologies have an important role, too. For patients with insulin-dependent diabetes (type 1 diabetes), widespread uptake of continuous glucose monitors may be the game-changer we need right now that can facilitate telemedicine to remote places and remove health care disparities. Both health professionals and patients will win-and ultimately payers will, too.


Assuntos
Infecções por Coronavirus/prevenção & controle , Diabetes Mellitus Tipo 1/terapia , Disparidades em Assistência à Saúde , Organizações sem Fins Lucrativos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/organização & administração , Betacoronavirus , Infecções por Coronavirus/complicações , Diabetes Mellitus Tipo 1/virologia , Humanos , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Pneumonia Viral/complicações , Telemedicina/métodos , Estados Unidos
17.
Diabetes Technol Ther ; 22(6): 440-443, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-232514

RESUMO

Today, in the United States, we have a health care system that is designed to treat symptoms, not people-and to do so as cheaply as possible with the dual goals of minimizing costs and preventing hospital visits. We are failing on all fronts. We spend more money on health care per capita than our Organization for Economic Co-operation and Development (OECD) peers, and our outcomes are mediocre at best. Medicine is not personal, health care professionals often have their hands tied by payers, and geography has too much influence on the quality of care available. This has to end, especially since we have the technology to create a truly patient-focused, whole-person approach-one that treats physical and mental health equally and meets people where they are in every sense. Telemedicine can level the playing field and enable higher quality, decentralized care that-when needed-brings specialty care to the masses. Other technologies have an important role, too. For patients with insulin-dependent diabetes (type 1 diabetes), widespread uptake of continuous glucose monitors may be the game-changer we need right now that can facilitate telemedicine to remote places and remove health care disparities. Both health professionals and patients will win-and ultimately payers will, too.


Assuntos
Infecções por Coronavirus/prevenção & controle , Diabetes Mellitus Tipo 1/terapia , Disparidades em Assistência à Saúde , Organizações sem Fins Lucrativos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/organização & administração , Betacoronavirus , Infecções por Coronavirus/complicações , Diabetes Mellitus Tipo 1/virologia , Humanos , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/organização & administração , Pneumonia Viral/complicações , Telemedicina/métodos , Estados Unidos
18.
Soins Gerontol ; 25(143): 12-14, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32444074

RESUMO

A nurse clinician in urodynamics - advanced practice shares her experience in implementing self-bladder education sessions for bladder retention. The objective is to promote autonomy in the elderly person with bladder retention while developing collaborative work with the referring health care team to promote the transfer of knowledge. This requires a stance of listening and positive reinforcement in order to achieve a therapeutic collaboration with the patient and/or his or her entourage.


Assuntos
Enfermeiras Clínicas/psicologia , Relações Enfermeiro-Paciente , Educação de Pacientes como Assunto/organização & administração , Retenção Urinária/enfermagem , Idoso , Humanos , Equipe de Assistência ao Paciente/organização & administração , Autonomia Pessoal , Autocuidado , Retenção Urinária/terapia
19.
J Surg Res ; 253: 139-146, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32353639

RESUMO

BACKGROUND: Unplanned readmission rates in necrotizing pancreatitis (NP) are among the highest of any medical disease (72%). Recent work has identified several potentially preventable causes of unplanned readmission in NP. We hypothesized that intensive outpatient communication would identify developing problems and decrease unplanned hospital readmission. MATERIALS AND METHODS: A review of NP patients treated at a single institution between 2016 and 2019 compared patients 2 y before (NP-pre, 2016-2018) and 1 y after (NP-post, 2018-2019) the establishment of a dedicated pancreatitis nurse coordinator. Unplanned hospital readmission and emergency room visits were compared between groups. RESULTS: A total of 178 NP patients were treated-112 patients in the NP-pre group and 66 patients in the NP-post group. No differences between groups were observed in age, sex, comorbidities, pancreatitis etiology, NP severity, or mortality. A mean of 5.4 ± 0.2 outpatient communications per patient with the pancreatitis nurse coordinator was documented in the NP-post group. Unplanned readmission rates decreased significantly from 64% (NP-pre) to 45% (NP-post; P = 0.02). The frequency of readmission decreased from 1.6 readmissions per patient (NP-pre) to 0.8 readmissions per patient (NP-post; P = 0.001). Readmissions because of symptomatic necrosis, failure to thrive, nonnecrosis infection, and drain dysfunction decreased (P < 0.05). Overall disease duration was similar (NP-pre, 4.6 ± 0.3 mo; NP-post, 5.0 ± 0.3 mo; P = 0.4); however, the mean number of unplanned inpatient days decreased from 15.4 ± 2.2 d (NP-pre) to 7.8 ± 1.6 d (NP-post; P = 0.02). CONCLUSIONS: Improved outpatient communication identifies treatable problems and significantly decreases unplanned readmission in NP patients.


Assuntos
Assistência Ambulatorial/organização & administração , Papel do Profissional de Enfermagem , Pancreatite Necrosante Aguda/terapia , Educação de Pacientes como Assunto/organização & administração , Readmissão do Paciente/estatística & dados numéricos , Feminino , Implementação de Plano de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/organização & administração , Alta do Paciente/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos
20.
Pan Afr Med J ; 35(Suppl 1): 9, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32373260
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