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1.
Can J Surg ; 63(5): E468-E474, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107816

RESUMO

BACKGROUND: The implementation of quality-of-care indicators aiming to improve colorectal cancer (CRC) outcomes has been previously described by Cancer Care Ontario. The aim of this study was to assess the quality-of-care indicators in CRC at a referral centre in a developing country and to determine whether improvement occurred over time. METHODS: We performed a retrospective study of our prospectively collected database of patients after CRC surgery from 2001 to 2016. We excluded patients who underwent local transanal excision, pelvic exenteration or palliative procedures. We evaluated trends over time using the Cochran-Armitage test for trend. RESULTS: A total of 343 patients underwent surgical resection of CRC over the study period. There was improvement of the following indicators over time: the proportion of patients detected by screening (p = 0.03), the proportion of patients with preoperative liver imaging (p = 0.001), the proportion of patients with stage II or III rectal cancer who received neoadjuvant chemotherapy (p = 0.03), the proportion of patients with pathology reports that indicated the number of lymph nodes examined and the number of positive nodes (p = 0.001), and the proportion of patients with pathology reports describing the details on margin status (p = 0.001). CONCLUSION: This study showed the feasibility of applying the Cancer Care Ontario indicators for evaluating outcomes in CRC treatment at a single centre in a developing country. Although there was an improvement of some of the quality-of-care indicators over time, policies and interventions must be implemented to improve the fulfillment of all indicators.


Assuntos
Neoplasias Colorretais/cirurgia , Países em Desenvolvimento , Recidiva Local de Neoplasia/epidemiologia , Avaliação de Resultados em Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/mortalidade , Estudos de Viabilidade , Feminino , Seguimentos , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Masculino , México , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
2.
Medicine (Baltimore) ; 99(38): e22254, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957373

RESUMO

The novel coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China in December 2019 and has subsequently escalated exponentially worldwide. As this virus has never been experienced previously, it poses a significant challenge to healthcare systems who are poorly equipped to handle the large number of gravely ill patients who seek medical attention. Additionally, treating providers are placing their own lives at risk due to the lack of adequate personal protective equipment. We are reporting the proactive measures that were implemented at our healthcare system in a metropolitan community in Kentucky to address COVID-19. The primary goal was to maintain a safe environment for providers, staff, and patients. Three key strategies were incorporated at our healthcare system, including.


Assuntos
Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Controle de Infecções/organização & administração , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Feminino , Implementação de Plano de Saúde , Número de Leitos em Hospital , Humanos , Kentucky/epidemiologia , Masculino , Saúde do Trabalhador , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Avaliação de Processos em Cuidados de Saúde
3.
PLoS One ; 15(9): e0239163, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946528

RESUMO

BACKGROUND: Trained community workers (CWs) successfully deliver health and social services, especially due to greater community acceptance. Orphans and vulnerable children (OVC) and their caregivers (CG) often need support from several sectors. We identified CW, program and referral characteristics that were associated with success of referrals provided to OVC and their CG in Tanzania in a cross-sectoral bi-directional referral system. METHODS: Data for this secondary analysis come from the first two years (2017-2018) of the USAID funded Kizazi Kipya project. Referral success was defined as feedback and service received within 90 days post-referral provision. We analyzed factors that are associated with the referral success of HIV related, education, nutrition, parenting, household economic strengthening, and child protection services among OVC and CG, using generalized estimating equations. RESULTS: During the study period, 19,502 CWs in 68 councils provided 146,996 referrals to 132,640 beneficiaries. OVC had much lower referral success for HIV related services (48.1%) than CG (81.2%). Adjusted for other covariates, CW age (26-49 versus 18-25 years, for OVC aOR = 0.83, 95%CI (0.78, 0.87) and CW gender (males versus females, for OVC aOR = 1.12, 95%CI (1.08, 1.16); CG aOR = 0.84, 95%CI (0.78, 0.90)) were associated with referral success. CWs who had worked > 1 year in the project (aOR = 1.52, 95%CI 1.46, 1.58) and those with previous work experience as CW (aOR = 1.57, 95%CI (1.42, 1.74) more successfully referred OVC. Referrals provided to OVC for all other services were more successful compared to HIV referrals, with aORs ranging from 2.99 to 7.22. Longer project duration in the district council was associated with increased referral success for OVC (aOR = 1.16 per month 95%CI 1.15,1.17), but decreased for CG (aOR = 0.96, 95%CI 0.94, 0.97). Referral success was higher for OVC and CGs with multiple (versus single) referrals provided within the past 30 days (aOR = 1.28 95%CI 1.21, 1.36) and (aOR = 1.17, 95%CI (1.06, 1.30)) respectively. CONCLUSION: CW characteristics, referral type and project maturity had different and often contrasting associations with referral success for OVC versus for CG. These findings could help policymakers decide on the recruitment and allocation of CWs in community based multi-sectoral intervention programs to improve referral successes especially for OVC.


Assuntos
Bem-Estar da Criança , Crianças Órfãs/estatística & dados numéricos , Agentes Comunitários de Saúde/organização & administração , Encaminhamento e Consulta/organização & administração , Serviço Social/organização & administração , Populações Vulneráveis/estatística & dados numéricos , Adolescente , Adulto , Cuidadores , Criança , Pré-Escolar , Agentes Comunitários de Saúde/estatística & dados numéricos , Feminino , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Estado Nutricional , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Tanzânia , Adulto Jovem
4.
Epidemiol Serv Saude ; 29(4): e2020499, 2020 09 04.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32901699

RESUMO

This article presents an experience report about integration between public and private health services, health service managers and the academy, for surveillance and control of the COVID-19 epidemic, in the municipality of Tubarão, Santa Catarina, Brazil. The city is home to a university and has a large flow of people from different parts of the country, as well as being one of the first municipalities in the state of Santa Catarina to report cases of community transmission of SARS-CoV-2. The measures adopted included the implementation of the COVID-19 Monitoring Committee, the Municipal Health Emergency Operations Center, and the COVID-19 Contingency Plan. After 100 days of pandemic, 5,979 cases had been reported, 431 (7.2%) had been confirmed, of which five (1.2%) died. Early decisions, such as the immediate suspension of business activities and crowded events, may have reduced the spread of the virus. The partnerships put into place have provided innovation and supported public service management in decision-making based upon scientific evidence.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Relações Interinstitucionais , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Parcerias Público-Privadas/organização & administração , Comitês Consultivos , Brasil/epidemiologia , Comunicação , Infecções por Coronavirus/transmissão , Implementação de Plano de Saúde , Humanos , Pneumonia Viral/transmissão , Vigilância da População/métodos
5.
PLoS One ; 15(9): e0236712, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915798

RESUMO

INTRODUCTION: The Reproductive Life Plan (RLP) is a clinical tool to help clients find strategies to achieve their reproductive goals. Despite much research on the RLP from high-income countries, it has never been studied in low- or middle income countries. Together with health workers called Mentor Mothers (MMs), we used a context-adapted RLP in disadvantaged areas in Eswatini. Our aim was to evaluate the implementation of the RLP in this setting. METHODOLOGY: MMs participated in focus group discussions (FGDs, n = 3 MMs n = 29) in January 2018 and at follow-up in May 2018 (n = 4, MMs n = 24). FGDs covered challenges in using the RLP, how to adapt it, and later experiences from using it. We used a deductive qualitative thematic analysis with the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, creating themes guided by its four constructs: facilitation, innovation, recipients and context. The MMs also answered a questionnaire to assess the implementation process inspired by normalization process theory. RESULTS: The RLP intervention was feasible and acceptable among MMs and fit well with existing practices. The RLP questions were perceived as advantageous since they opened up discussions with clients and enabled reflection. All except one MM (n = 23) agreed or strongly agreed that they valued the effect the RLP has had on their work. Using the RLP, the MMs observed progress in pregnancy planning among their clients and thought it improved the quality of contraceptive counselling. The clients' ability to form and achieve their reproductive goals was hampered by contextual factors such as intimate partner violence and women's limited reproductive health and rights. DISCUSSION: The RLP was easily implemented in these disadvantaged communities and the MMs were key persons in this intervention. The RLP should be further evaluated among clients and suitable approaches to include partners are required.


Assuntos
Implementação de Plano de Saúde/normas , Avaliação de Programas e Projetos de Saúde , Educação Sexual/métodos , Adulto , Essuatíni , Feminino , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Reprodutivo/psicologia , Comportamento Reprodutivo/estatística & dados numéricos , Educação Sexual/normas , Inquéritos e Questionários , Populações Vulneráveis
6.
BMJ Open Qual ; 9(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32978176

RESUMO

INTRODUCTION: Effective implementation of standard precautions specific to COVID-19 is a challenge for hospitals within the existing constraints of time and resources. AIM: To rapidly design and operationalise personal protective equipment (PPE) donning and doffing areas required for a COVID-19 care facility. METHODS: Literature review was done to identify all issues pertaining to donning and doffing in terms of Donabedian's structure, process and outcome. Training on donning and doffing was given to hospital staff. Donning and doffing mock drills were held. 5S was used as a tool to set up donning and doffing areas. Instances of donning and doffing were observed for protocol deviations and errors. Plan-do-study-act cycles were conducted every alternate day for 4 weeks. The initiative was reported using Standards for QUality Improvement Reporting Excellence (SQUIRE) guidelines. RESULTS: Best practices in donning and doffing were described. Our study recommends a minimum area of 16 m2 each for donning and doffing rooms. Verbally assisted doffing was found most useful than visual prompts. DISCUSSION: Challenges included sustaining the structure and process of donning and doffing, varied supplies of PPE which altered sequencing of donning and/or doffing, and training non-healthcare workers such as plumbers, electricians and drivers who were required during emergencies in the facility. CONCLUSION: Our study used evidence-based literature and quality improvement (QI) tools to design and operationalise donning and doffing areas with focus on people, task and environment. Our QI will enable healthcare facilities to rapidly prototype donning and doffing areas in a systematic way.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pessoal de Saúde/organização & administração , Controle de Infecções/normas , Saúde do Trabalhador/normas , Pandemias/prevenção & controle , Equipamento de Proteção Individual/normas , Pneumonia Viral/prevenção & controle , Adulto , Betacoronavirus , Infecções por Coronavirus/transmissão , Feminino , Pessoal de Saúde/normas , Implementação de Plano de Saúde , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/transmissão , Roupa de Proteção/normas , Melhoria de Qualidade , Dispositivos de Proteção Respiratória/normas , Adulto Jovem
8.
Plast Reconstr Surg ; 146(2): 343-354, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740587

RESUMO

Routine measurement of outcome of clinical care is increasingly considered important, but implementation in practice is challenging. This article describes (1) how the authors created and implemented a routine outcome measurement cohort of patients with hand and wrist conditions and (2) how these data are used to improve the quality of care and facilitate scientific research. Starting in 2011, routine outcome measurement was implemented at all practice sites (currently 22) of a specialized treatment center for hand and wrist conditions across The Netherlands. The authors developed five "measurement tracks," including measurements administered at predetermined time points covering all hand and wrist disorders and treatments. An online system automatically distributes measurements among patients, which can be accessed by health care professionals. Using this system, the total number of yearly assigned tracks increased up to over 16,500 in 2018, adding up to 85,000 tracks in 52,000 patients in total. All surgeons, therapists, and other staff have direct access to individual patient data and patients have access to their treatment information using a secure patient portal. The data serve as a basis for studies on, among others, comparative effectiveness, prediction modeling, and clinimetric analyses. In conclusion, the authors present the design and successful implementation of a routine outcome measurement system that was made feasible using a highly automated data collection infrastructure, tightly linked to the patient journey and the workflow of health care professionals. The system serves not only as a tool to improve care but also as a basis for scientific research studies.


Assuntos
Implementação de Plano de Saúde , Doenças Musculoesqueléticas/terapia , Sistemas On-Line , Ortopedia/organização & administração , Avaliação de Resultados em Cuidados de Saúde/organização & administração , Estudos de Coortes , Coleta de Dados/métodos , Mãos/fisiopatologia , Humanos , Doenças Musculoesqueléticas/fisiopatologia , Países Baixos , Ortopedia/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Medição da Dor , Melhoria de Qualidade , Punho/fisiopatologia
9.
Transplantation ; 104(8): e236-e242, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732842

RESUMO

BACKGROUND: Proper care of young children in need of kidney transplant (KT) requires many skilled professionals and an expensive hospital structure. Small children have lesser access to KT. METHODS: We describe a strategy performed in Brazil to enable and accelerate KT in children ≤15 kg based on the establishment of one specialized transplant center, focused on small children, and cooperating with distant centers throughout the country. Actions on 3 fronts were implemented: (a) providing excellent medical assistance, (b) coordinating educational activities to disseminate expertise and establish a professional network, and (c) fostering research to promote scientific knowledge. We presented the number and outcomes of small children KT as a result of this strategy. RESULTS: Three hundred forty-six pediatric KTs were performed in the specialized center from 2009 to 2017, being 130 in children ≤15 kg (38%, being 41 children ≤10 kg) and 216 in >15 kg (62%). Patient survival after 1 and 5 years of the transplant was 97% and 95% in the "small children" group, whereas, in the "heavier children" group, it was 99% and 96% (P = 0.923). Regarding graft survival, we observed in the "small children" group, 91% and 87%, whereas in the "heavier children" group, 94% and 87% (P = 0.873). These results are comparable to the literature data. Groups were similar in the incidence of reoperation, vascular thrombosis, posttransplant lymphoproliferative disease, and estimated glomerular filtration rate. CONCLUSIONS: The strategy allowed an improvement in the number of KT in small children with excellent results. We believe this experience may be useful in other locations.


Assuntos
Rejeição de Enxerto/epidemiologia , Hospitais Pediátricos/organização & administração , Falência Renal Crônica/cirurgia , Transplante de Rim/estatística & dados numéricos , Tempo para o Tratamento/organização & administração , Adolescente , Peso Corporal/fisiologia , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Taxa de Filtração Glomerular/fisiologia , Rejeição de Enxerto/etiologia , Rejeição de Enxerto/fisiopatologia , Sobrevivência de Enxerto/fisiologia , Implementação de Plano de Saúde , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Incidência , Falência Renal Crônica/mortalidade , Falência Renal Crônica/fisiopatologia , Transplante de Rim/efeitos adversos , Masculino , Avaliação de Programas e Projetos de Saúde , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
10.
Lancet HIV ; 7(10): e721-e730, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32861269

RESUMO

When used appropriately, pre-exposure prophylaxis (PrEP) substantially reduces the risk of HIV acquisition. Early implementation outcomes often suggest poor PrEP adherence and persistence; however, this intervention is time-limited and the need for PrEP fluctuates as risk behaviours change. In this Viewpoint we examine the current guidelines and early programmatic outcomes after starting, stopping, and restarting PrEP, and we review the implications of PrEP in relation to HIV testing algorithms. Guidelines suggest to discontinue PrEP when a person is no longer at risk for HIV, but effectively implementing this strategy requires support tools to make the decision of stopping and restarting PrEP that considers the complex relationship between risk perceptions and risk behaviours. Safely discontinuing PrEP also requires greater understanding of the daily dosing duration that is needed to protect the person after their last HIV exposure. Additionally, clear strategies are needed to re-engage a person as their HIV exposure risk changes over time.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/efeitos adversos , Tomada de Decisão Clínica , Gerenciamento Clínico , Infecções por HIV/diagnóstico , Implementação de Plano de Saúde , Humanos , Guias de Prática Clínica como Assunto , Profilaxia Pré-Exposição/métodos , Retratamento , Medição de Risco , Tempo para o Tratamento
11.
PLoS One ; 15(8): e0237585, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790752

RESUMO

INTRODUCTION: Patients and policy makers alike have high expectations for the use of digital technologies as tools to improve health care service quality at a sustainable cost. Many countries within the Organisation for Economic Co-operation and Development (OECD) are investing in telemedicine initiatives, and a large and growing body of peer-reviewed studies on the topic has developed, as a consequence. Nonetheless, telemedicine is still not used at scale within the OECD. Seeking to provide a snapshot of the evidence on the use of telemedicine in the OECD, this umbrella review of systematic reviews summarizes findings on four areas of policy relevance: clinical and cost-effectiveness, patient experience, and implementation. METHODS: This review followed a prior written, unregistered protocol. Four databases (PubMed/Medline, CRD, and Cochrane Library) were searched for systematic reviews or meta-analyses published between January 2014 and February 2019. Based on the inclusion criteria, 98 systematic reviews were selected for analysis. Due to substantial heterogeneity, a meta-analysis was not conducted. The quality of included reviews was assessed using the AMSTAR 2 tool. RESULTS: Most reviews (n = 53) focused on effectiveness, followed by cost-effectiveness (n = 18), implementation (n = 17) and patient experience (n = 15). Eighty-three percent of clinical effectiveness reviews found telemedicine at least as effective as face-to-face care, and thirty-nine percent of cost-effectivenss reviews found telemedicine to be cost saving or cost-effective. Patients reported high acceptance of telemedicine and the most common barriers to implementation were usability and lack of reimbursement. However, the methodological quality of most reviews was low to critically low which limits generalizability and applicability of findings. CONCLUSION: This umbrella review finds that telemedicine interventions can improve glycemic control in diabetic patients; reduce mortality and hospitalization due to chronic heart failure; help patients manage pain and increase their physical activity; improve mental health, diet quality and nutrition; and reduce exacerbations associated with respiratory diseases like asthma. In certain disease and specialty areas, telemedicine may be a less effective way to deliver care. While there is evidence that telemedicine can be cost-effective, generalizability is hindered by poor quality and reporting standards. This umbrella review also finds that patients report high levels of acceptance and satisfaction with telemedicine interventions, but that important barriers to wider use remain.


Assuntos
Análise Custo-Benefício , Implementação de Plano de Saúde , Organização para a Cooperação e Desenvolvimento Econômico/organização & administração , Autocuidado/economia , Autocuidado/métodos , Telemedicina/economia , Telemedicina/legislação & jurisprudência , Doença Crônica , Gerenciamento Clínico , Humanos
12.
Lancet HIV ; 7(8): e582-e592, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32763221

RESUMO

Pregnancy is a high-risk period for HIV acquisition in African women, and pregnant women who become acutely infected with HIV account for up to a third of vertical HIV transmission cases in African settings. To protect women and eliminate vertical transmission, WHO recommends offering oral pre-exposure prophylaxis (PrEP) based on tenofovir to HIV-negative pregnant and post-partum women with a substantial risk of HIV acquisition. PrEP implementation for pregnant and post-partum women lags behind implementation for other high-risk populations. Unique considerations for PrEP implementation arise during pregnancy and post partum, including the integration of provider training with clinical delivery and monitoring of PrEP exposure and outcomes within existing maternal health systems, yet scarce implementation data are available to generate evidence in this context.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição , Fármacos Anti-HIV/uso terapêutico , Feminino , Implementação de Plano de Saúde , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Masculino , Cuidado Pós-Natal , Gravidez
13.
PLoS One ; 15(8): e0236169, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745081

RESUMO

In line with the Sustainable Development Goals (SDGs) and the target for achieving Universal Health Coverage (UHC), state level initiatives to promote health with "no-one left behind" are underway in India. In Kerala, reforms under the flagship Aardram mission include upgradation of Primary Health Centres (PHCs) to Family Health Centres (FHCs, similar to the national model of health and wellness centres (HWCs)), with the proactive provision of a package of primary care services for the population in an administrative area. We report on a component of Aardram's monitoring and evaluation framework for primary health care, where tracer input, output, and outcome indicators were selected using a modified Delphi process and field tested. A conceptual framework and indicator inventory were developed drawing upon literature review and stakeholder consultations, followed by mapping of manual registers currently used in PHCs to identify sources of data and processes of monitoring. The indicator inventory was reduced to a list using a modified Delphi method, followed by facility-level field testing across three districts. The modified Delphi comprised 25 participants in two rounds, who brought the list down to 23 approved and 12 recommended indicators. Three types of challenges in monitoring indicators were identified: appropriateness of indicators relative to local use, lack of clarity or procedural differences among those doing the reporting, and validity of data. Further field-testing of indicators, as well as the revision or removal of some may be required to support ongoing health systems reform, learning, monitoring and evaluation.


Assuntos
Reforma dos Serviços de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Indicadores de Qualidade em Assistência à Saúde , Desenvolvimento Sustentável , Cobertura Universal do Seguro de Saúde/organização & administração , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Academias de Ginástica/organização & administração , Academias de Ginástica/estatística & dados numéricos , Reforma dos Serviços de Saúde/estatística & dados numéricos , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/estatística & dados numéricos , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Humanos , Índia , Atenção Primária à Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
14.
PLoS One ; 15(8): e0237342, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760163

RESUMO

OBJECTIVES: To explore how to integrate the "best" practice into nursing of venous thromboembolism (VTE) based on the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. METHODS: A mixed-methods design was used. A steering group for clinical evidence implementation (EI) was established to conduct pre-implementation baseline surveys, a thorough analysis of the evidence, and an analysis of the survey results. The hindering and enabling factors associated with the clinical implementation of the evidence were analysed based on the three core elements of i-PARIHS, to formulate the clinical implementation plan for VTE nursing evidence. On-site expert reviews and focus group interviews were used to evaluate the feasibility of the draft plan, make adjustments, and finalize the evidence-based practice plan, which was then put into practice and evaluated. RESULTS: A new nursing process, a health education manual and a nursing quality checklist on VTE has been established and proved to be appropriate through the implementation. Compliance with evidence related to VTE nursing increased significantly in the two units, with better compliance in unit B than unit A. The knowledge, attitude and behaviour scores for VTE nursing increased substantially in both nurses and patients. CONCLUSION: The EI programme of incorporating the "best" evidence on VTE nursing into clinical practice using the i-PARIHS framework demonstrated feasibility, appropriateness and effectiveness and could serve as a reference.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Enfermagem Baseada em Evidências/organização & administração , Implementação de Plano de Saúde/organização & administração , Unidades de Terapia Intensiva/organização & administração , Tromboembolia Venosa/terapia , Adulto , Prestação Integrada de Cuidados de Saúde/métodos , Enfermagem Baseada em Evidências/métodos , Estudos de Viabilidade , Feminino , Grupos Focais , Educação em Saúde/métodos , Educação em Saúde/organização & administração , Pesquisa sobre Serviços de Saúde , Médicos Hospitalares/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos
15.
PLoS One ; 15(8): e0237320, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780775

RESUMO

Ghana Health Service (GHS) has strengthened community-based surveillance (CBS) to facilitate early detection and rapid reporting of health events of all origins. Since June 2017, GHS has employed an event-based surveillance approach at the community level in a phased manner. CBS coverage has broadened from 2 to 30 districts across Ghana. Through this effort, capacity was built across all administrative levels in these districts to detect, report, triage, and verify signals, and to perform risk assessment and investigate events. Data were collected and analyzed during an evaluation of initial 2-district implementation in March 2018 and during expanded 30-district implementation in March 2019. Between September 2018 and March 2019, 317 health events were detected through CBS. These events included vaccine-preventable disease cases, acute hemorrhagic conjunctivitis outbreaks, clusters of unexpected animal deaths, and foodborne illness clusters. Eighty-nine percent of the 317 events were reported to district-level public health staff within 24 hours of detection at the community level, and 87% of all detected events were responded to within 48 hours of detection. CBS detected 26% of all suspected vaccine-preventable disease cases that were reported from implementing districts through routine disease surveillance. GHS strengthened CBS in Ghana to function as an early warning system for health events of all origins, advancing the Global Health Security Agenda.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Participação da Comunidade , Saúde Global , Implementação de Plano de Saúde/organização & administração , Programas Nacionais de Saúde/organização & administração , Controle de Doenças Transmissíveis/métodos , Doenças Transmissíveis/epidemiologia , Conjuntivite Hemorrágica Aguda/epidemiologia , Conjuntivite Hemorrágica Aguda/prevenção & controle , Surtos de Doenças/prevenção & controle , Doenças Transmitidas por Alimentos/epidemiologia , Doenças Transmitidas por Alimentos/prevenção & controle , Gana , Humanos , Governo Local , Medição de Risco/métodos
17.
Appl Clin Inform ; 11(3): 452-459, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32610350

RESUMO

BACKGROUND: Relaxation of laws and regulations around privacy and billing during the COVID-19 pandemic provide expanded opportunities to use telehealth to provide patient care at a distance. Many health systems have transitioned to providing outpatient care via telehealth; however, there is an opportunity to utilize telehealth for inpatients to promote physical distancing. OBJECTIVE: This article evaluates the use of a rapidly implemented, secure inpatient telehealth program. METHODS: We assembled a multidisciplinary team to rapidly design, implement, and iteratively improve an inpatient telehealth quality improvement initiative using an existing videoconferencing system at our academic medical center. We assigned each hospital bed space a unique meeting link and updated the meeting password for each new patient. Patients and families were encouraged to use their own mobile devices to join meetings when possible. RESULTS: Within 7 weeks of go-live, we hosted 1,820 inpatient telehealth sessions (13.3 sessions per 100 bedded days). We logged 104,647 minutes of inpatient telehealth time with a median session duration of 22 minutes (range 1-1,961). There were 5,288 participant devices used with a mean of 3 devices per telehealth session (range 2-22). Clinicians found they were able to build rapport and perform a reasonable physical exam. CONCLUSION: We successfully implemented and scaled a secure inpatient telehealth program using an existing videoconferencing system in less than 1 week. Our implementation provided an intuitive naming convention for providers and capitalized on the broad availability of smartphones and tablets. Initial comments from clinicians suggest the system was useful; however, further work is needed to streamline initial setup for patients and families as well as care coordination to support clinician communication and workflows. Numerous use cases identified suggest a role for inpatient telehealth will remain after the COVID-19 crisis underscoring the importance of lasting regulatory reform.


Assuntos
Betacoronavirus/fisiologia , Infecções por Coronavirus/epidemiologia , Implementação de Plano de Saúde , Pacientes Internados , Pandemias , Pneumonia Viral/epidemiologia , Telemedicina , Retroalimentação , Hospitais , Humanos
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