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1.
Gesundheitswesen ; 82(1): e1-e8, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-30332707

RESUMO

BACKGROUND: Revision of the evaluation concept of Germany's sixth national health target entitled "Depressive illnesses - prevention, early diagnosis, sustainable treatment" developed in 2006. OBJECTIVES: Analysis of available of data since 2006 to determine if the objectives of the health target and its sub-goals (awareness, prevention, diagnosis/indication/therapy, health care structure, patient empowerment, rehabilitation) were achieved. MATERIALS AND METHODS: The 6 sub-goals were screened in terms of indicators of progress towards goal over the last decade, and then examined for accessible data sources. RESULTS: The sub-goal prevention yielded routine data from t0 onwards (start of activities). The other sub-goals awareness, diagnosis, and health care provided selective data sources, generated mostly by scientific studies. An important milestone within the sub-goal of diagnosis/indication/therapy was the development of the National Clinical Practice guideline for depression. Data were sparse in the areas rehabilitation and patient empowerment. CONCLUSIONS: The six sub-goals are still valid. Yet, the validity of the data in terms of the evaluation of the health target is limited mainly because of the cross-sectional designs of studies. Prospective systematic surveys are required to further evaluate the national health target and its implementation for both qualitative and quantitative longitudinal indicators.


Assuntos
Transtorno Depressivo , Programas Nacionais de Saúde , Estudos Transversais , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/terapia , Diagnóstico Precoce , Alemanha , Metas , Implementação de Plano de Saúde , Humanos , Estudos Prospectivos
2.
Rev Med Chil ; 147(6): 776-786, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859831

RESUMO

Invasive meningococcal disease is challenging for public health, mainly when it manifests with sudden changes in incidence, serogroups and hypervirulent clones that spread in the population, causing great alarm due to its sequelae and often fatal course, a situation that occurred in Chile, starting at week 26 of the year 2012. To face this scenario, an organization of multidisciplinary teams was required, called W-135 Action Plan in Chile, which included sanitary alerts, education, reinforcement of the epidemiological surveillance of suspicious cases, immediate diagnosis through state-of-the-art techniques, blocking of contacts, communication plans, and, from the 42nd week, ON the vaccination campaign was started for children aged from 9-months-old to less than 5 years of age. The vaccination strategy had a great impact on the decrease in incidence (1.3 to 0.1/100,000) and case fatality rate in the vaccinated population (23% to 0%), with a high safety profile, leading to its subsequent inclusion in the national immunization program. The ability to develop molecular, clinical and epidemiological studies allowed us to better understand the situation, supporting public health policy decisions for its control. The W-135 Action Plan implemented by the Ministry of Health in Chile, to manage the outbreak of meningococcal disease by Neisseria meningitidis serogroup W, demonstrated that the coordination of these efforts, through an organized Action Plan, allows the implementation of campaigns at the national level achieving high coverage of risk populations in short periods of time, generating a positive impact on the health of the population.


Assuntos
Implementação de Plano de Saúde/métodos , Vacinação em Massa/métodos , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Chile/epidemiologia , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Neisseria meningitidis Sorogrupo W-135 , Estações do Ano , Cobertura Vacinal , Adulto Jovem
3.
Medicine (Baltimore) ; 98(44): e17752, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689831

RESUMO

Dispatcher assisted cardiopulmonary resuscitation (DACPR) by Emergency medical services has been shown to improve rates of early out of hospital cardiac arrest (OHCA) recognition and early cardiopulmonary resuscitation (CPR) for OHCA. This study measures the impact of introducing DACPR on OHCA recognition, CPR rates and on patient outcomes in a pilot region in Kuwait.EMS treated OHCA data over 10 months period (February 21-December 31, 2017) before and after the intervention was prospectively collected and analyzed.Comprehensive DACPR in the form of: a standardized dispatch protocol, 1-day training package and quality assurance and improvement measures were applied to Kuwait EMS central Dispatch unit only for pilot region. Primary outcomes: OHCA recognition rate, CPR instruction rate, and Bystander CPR rate. Secondary outcome: survival to hospital discharge.A total of 332 OHCA cases from the EMS archived data were extracted and after exclusion 176 total OHCA cases remain. After DACPR implementation OHCA recognition rate increased from 2% to 12.9% (P = .037), CPR instruction rate increased from 0% to 10.4% (P = .022); however, no significant change was noted for bystander CPR rates or prehospital return of spontaneous circulation. Also, survival to hospital discharge rate did not change significantly (0% before, and 0.8% after, P = .53)In summary, DACPR implementation had positive impacts on Kuwait EMS system operational outcomes; early OHCA recognition and CPR instruction rates in a pilot region of Kuwait. Expanding this initiative to other regions in Kuwait and coupling it with other OHCA system of care interventions are needed to improve OHCA survival rates.


Assuntos
Reanimação Cardiopulmonar/educação , Operador de Emergência Médica/educação , Serviços Médicos de Emergência/métodos , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Reanimação Cardiopulmonar/métodos , Feminino , Implementação de Plano de Saúde , Humanos , Kuweit , Masculino , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Resultado do Tratamento
5.
BMC Public Health ; 19(1): 1455, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694590

RESUMO

BACKGROUND: The development of school-based programs for preventing adolescent sexual harassment often lacks an evidence-based approach and use of proper theories. Appropriate stakeholders are often not involved in the development process. To help improve this process, we used the Intervention Mapping framework to retrospectively evaluate the development of two school-based programs, Benzies & Batchies and Boys, each of which was intended to prevent sexual harassment among adolescent students of a lower educational level in the Netherlands. The two interventions were among the first school-based programs targeting sexual harassment, and were implemented in Dutch secondary schools. METHODS: As well as doing desk research into the context and content of the interventions, we used semi-structured focused interviews with the initial developers to gather their opinions on and experiences with the development process, whereby the topics were based on the six steps of the IM framework. To better suit the needs of the respondents, we had adapted the language of our topics and had used open-ended questions The data we had gathered from the desk research and face-to-face consultations were checked against a planning tool that was based on 19 tasks within the six steps of IM. RESULTS: Although both programs had been developed in practice and lacked a thorough theoretical foundation, the methods and materials used represented aspects of behavior-change theories. The developers of Benzies & Batchies completed slightly more planning criteria within the six steps of the planning process, and used more change methods than the developers of Boys did. CONCLUSIONS: We recommend that parents should also be involved in the development of sex and relationship education programs, and should be allowed to participate in the program itself. To meet the needs of intervention developers, greater insight is needed into the importance of the individual steps in the Intervention Mapping framework. In our view, the development of practice-based interventions will improve if future intervention developers combine evidence-based theories with their practice-based experience. This will increase the success and effectiveness of their interventions.


Assuntos
Terapia Comportamental/métodos , Implementação de Plano de Saúde/organização & administração , Serviços de Saúde Escolar/organização & administração , Assédio Sexual/prevenção & controle , Adolescente , Feminino , Humanos , Masculino , Países Baixos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Estudantes/psicologia
7.
Medicine (Baltimore) ; 98(39): e17209, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574830

RESUMO

BACKGROUND: This study is to summarize the status of knowledge, attitudes, implementation, facilitators, and barriers of evidence-based practice (EBP) in community nurses (CNs). EBP has been widely adopted but the knowledge, attitudes, and implementation of EBP among CNs, and the facilitators and barriers they perceived have not been clearly confirmed. METHODS: A literature search was conducted using combined keywords in 3 English databases and 3 Chinese databases of peer-reviewed publications covering the dates of publication from 1996 to July, 2018. Twenty articles were included. The information of the knowledge, attitudes, implementation, and the perceived facilitators and barriers of EBP in CNs was extracted and summarized. RESULTS: CNs had positive attitudes toward EBP, but insufficient knowledge and unprepared implementation. The most cited facilitators were academic training, management functions, and younger age. Inadequate time and resources were recognized as main barriers hindering the transforming from knowledge and attitudes to implementation. Developed interventions mainly focused on knowledge facilitation rather than the elimination of objective barriers. CONCLUSIONS: Findings demonstrate a compelling need for improvement in knowledge and implementation of EBP in CNs, compared with the better attitudes. Except education, knowledge translating into implementation needs more coordination with authorities to magnify the facilitators and overcome the barriers. Further studies need to concentrate on deficient knowledge and implementation of EBP among CNs. Policy makers can use the facilitators and barriers found by this review to modify nursing education, current scientific resources supplement, practice supports for care improving.


Assuntos
Atitude do Pessoal de Saúde , Prática Clínica Baseada em Evidências , Conhecimentos, Atitudes e Prática em Saúde , Implementação de Plano de Saúde , Enfermeiras de Saúde Comunitária/psicologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
Medicine (Baltimore) ; 98(41): e17289, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593081

RESUMO

INTRODUCTION: Fibromyalgia (FM) is a chronic condition characterized by chronic pain, fatigue and loss of function which significantly impairs quality of life. Although treatment of FM remains disputed, some studies point at the efficacy of interdisciplinary therapy. This study aims to analyze the effectiveness, cost-utility and benefits of a multicomponent therapy on quality of life (main variable), functional impact, mood and pain in people suffering from FM that attend primary care centers (PCCs) of the Catalan Institute of Health (ICS). METHODS AND ANALYSIS: A 2-phase, mixed methods study has been designed following Medical Research Council guidance. Phase 1: Pragmatic randomized clinical trial with patients diagnosed with FM that attend one of the 11 PCCs of the ICS Gerència Territorial Terres de l'Ebre. We estimate a total sample of 336 patients. The control group will receive usual clinical care, while the multicomponent therapy group (MT group) will receive usual clinical care plus group therapy (consisting of health education, exercise and cognitive-behavioural therapy) during 12 weeks in 2-hourly weekly sessions. ANALYSIS: the standardized mean response and the standardized effect size will be assessed at 3, 9, and 15 months after the beginning of the study using multiple linear regression models. Utility measurements will be used for the economic analysis. Phase 2: Qualitative socio constructivist study to evaluate the intervention according to the results obtained and the opinions and experiences of participants (patients and professionals). We will use theoretical sampling, with 2 discussion groups of participants in the multicomponent therapy and 2 discussion groups of professionals of different PCCs. A thematic content analysis will be carried out. ETHICS AND DISSEMINATION: This study protocol has been approved by the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (code P18/068). Articles will be published in international, peer-reviewed scientific journals. TRIAL REGISTRATION: Clinical-Trials.gov: NCT04049006.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia por Exercício/métodos , Fibromialgia/terapia , Educação de Pacientes como Assunto/métodos , Atenção Primária à Saúde/métodos , Qualidade de Vida , Adulto , Terapia Cognitivo-Comportamental/economia , Terapia Combinada , Análise Custo-Benefício , Terapia por Exercício/economia , Estudos de Viabilidade , Feminino , Fibromialgia/economia , Fibromialgia/psicologia , Implementação de Plano de Saúde , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Cooperação do Paciente , Educação de Pacientes como Assunto/economia , Atenção Primária à Saúde/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
9.
BMC Health Serv Res ; 19(1): 663, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521159

RESUMO

BACKGROUND: Although opioid agonist therapy is effective in treating opioid use disorders (OUD), retention in opioid agonist therapy is suboptimal, in part, due to quality of care issues. Therefore, we sought to describe the planning and implementation of a quality improvement initiative aimed at closing gaps in care for people living with OUD through changes to workflow and care processes in Vancouver, Canada. METHODS: The Best-practice in Oral Opioid agoniSt Therapy (BOOST) Collaborative followed the Institute for Healthcare Improvement's Breakthrough Series Collaborative methodology over 18-months. Teams participated in a series of activities and events to support implementing, measuring, and sharing best practices in OAT and OUD care. Teams were assigned monthly implementation scores to monitor their progress on meeting Collaborative aims and implementing changes. RESULTS: Seventeen health care teams from a range of health care practices caring for a total of 4301 patients with a documented diagnosis of OUD, or suspected OUD based on electronic medical record chart data participated in the Collaborative. Teams followed the Breakthrough Series Collaborative methodology closely and reported monthly on a series of standardized process and outcome indicators. The majority of (59%) teams showed some improvement throughout the Collaborative as indicated by implementation scores. CONCLUSIONS: Descriptive data from the evaluation of this initiative illustrates its success. It provides further evidence to support the implementation of quality improvement interventions to close gaps in OUD care processes and treatment outcomes for people living with OUD. This system-level approach has been spread across British Columbia and could be used by other jurisdictions facing similar overdose crises.


Assuntos
Centros Comunitários de Saúde/organização & administração , Implementação de Plano de Saúde/organização & administração , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/reabilitação , Melhoria de Qualidade/organização & administração , Canadá , Pesquisa sobre Serviços de Saúde , Humanos , Equipe de Assistência ao Paciente
10.
BMC Health Serv Res ; 19(1): 667, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521160

RESUMO

BACKGROUND: Combined lifestyle interventions (CLIs) are designed to help people who are overweight or obese maintain a healthy new lifestyle. The CooL intervention is a CLI in the Netherlands, in which lifestyle coaches counsel adults and children (and/or their parents) who are obese or at high risk of obesity to achieve a sustained healthier lifestyle. The intervention consists of coaching on lifestyle in group and individual sessions, addressing the topics of physical activity, dietary behaviours, sleep, stress management and behavioural change. The aim of this study was to evaluate the implementation process of the Coaching on Lifestyle (CooL) intervention and its facilitating and impeding factors. METHODS: Mixed methods were used in this action-oriented study. Both quantitative (number of referrals, attendance lists of participants and questionnaires) and qualitative (group and individual interviews, observations, minutes and open questions) data were collected among participants, lifestyle coaches, project group members and other stakeholders. The Consolidated Framework for Implementation Research was used to analyse the data. RESULTS: CooL was evaluated by stakeholders and participants as an accessible and useful programme, because of its design and content and the lifestyle coaches' approach. However, stakeholders indicated that the lifestyle coaches need to become more familiar in the health care network and public sectors in the Netherlands. Lifestyle coaching is a novel profession and the added value of the lifestyle coach is not always acknowledged by all health care providers. Lifestyle coaches play a crucial role in ensuring the impact of CooL by actively networking, using clear communication materials and creating stakeholders' support and understanding. CONCLUSION: The implementation process needs to be strengthened in terms of creating support for and providing clear information about lifestyle coaching. The CooL intervention was implemented in multiple regions, thanks to the efforts of many stakeholders. Lifestyle coaches should engage in networking activities and entrepreneurship to boost the implementation process. It takes considerable time for a lifestyle coach to become fully incorporated in primary care. TRIAL REGISTRATION: NTR6208 ; date registered: 13-01-2017; retrospectively registered; Netherlands Trial Register.


Assuntos
Implementação de Plano de Saúde , Tutoria , Obesidade/terapia , Sobrepeso/terapia , Comportamento de Redução do Risco , Estilo de Vida Saudável , Humanos , Países Baixos , Obesidade/prevenção & controle , Sobrepeso/prevenção & controle , Projetos Piloto
11.
BMC Health Serv Res ; 19(1): 638, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488146

RESUMO

BACKGROUND: The Choosing Wisely campaign has spread to many countries. Methods for developing recommendations are inconsistent. We describe our process of developing such recommendations from a comprehensive national set of clinical practice guidelines (Current Care, CC) and the results of a one-year Choosing Wisely Finland project. METHODS: Two of the authors drafted the quality and process criteria for all the Choosing Wisely Finland recommendations. The quality criteria were relevance, feasibility, evidence-based and strength. These were discussed in editors' meetings and subsequently revised. Two different processes for developing recommendations within national clinical practice guidelines were designed and piloted (processes A and B). Process A was based on a published guideline. The recommendations are drafted by an editor and revised and approved by the guideline development group. In process B the development of the recommendations is integrated with guideline production or update. Choosing Wisely recommendations were then drafted for half of the published CC Guidelines. An additional process (process C) was designed for producing independent recommendations outside a guideline. RESULTS: At least one Choosing Wisely recommendation could be identified from 39 out of 52 reviewed guidelines. Of the 106 recommendations drafted, 62 (58%) were accepted for publication. The main reasons for rejection were inability to give a strong recommendation (n = 18, 41%) and insufficient relevance (n = 14, 32%). Two thirds (n = 41, 66%) of the published recommendations were based on high to moderate level of evidence, and 18% (n = 11) on low or very low level of evidence, whereas for the rest, the quality of evidence was not critically appraised. CONCLUSIONS: Choosing Wisely recommendations can be produced systematically from existing clinical practice guidelines. The rigorous methods of evidence-based medicine ensure high-quality recommendations. We welcome the use of our processes and methods describes in this article by other guideline-producing organizations.


Assuntos
Tomada de Decisão Clínica , Medicina Baseada em Evidências/normas , Guias de Prática Clínica como Assunto , Finlândia , Implementação de Plano de Saúde , Humanos , Sobremedicalização/prevenção & controle , Melhoria de Qualidade
12.
BMC Infect Dis ; 19(1): 767, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477055

RESUMO

BACKGROUND: Tuberculosis (TB) is among the world's top public health challenges and the leading killer of people with HIV, yet is a treatable disease. This study aimed to assess, in a real-world setting, the implementation of antiretroviral therapy (ART) and Cotrimoxazole preventive therapy (CPT) policy, specific interventions proven to benefit patients in HIV-associated TB care. METHODS: This retrospective cohort study was conducted in Botswana in the Serowe/Palapye district, a largely urban district with a high burden of HIV-associated TB with a high case fatality, at Segkoma and Palapye hospitals and their feeder clinics. Between 1 January 2013 and 31 December 2013, confirmed HIV-positive patients aged ≥15 years with a confirmed TB diagnosis and medical record available were included in the analysis. The Kaplan-Meier method was used to compare time to death for the group of patients on ART and the group of patients not on ART during TB treatment. Cox proportional hazard regression was undertaken to identify predictors of mortality. RESULTS: Of the 300 patients included in the study, 217 (72%) were ART experienced at TB diagnosis. Of these, 86 (40%) had TB within 3 months following ART initiation. Of the 83 (28%) patients who were ART-naïve at TB diagnosis, 40 (48%) were commenced on ART during TB treatment, with 24 (60%) patients commencing within 4 weeks following TB treatment initiation. The overall ART uptake was 84%, while cotrimoxazole preventive therapy uptake was 100%. There were 45 deaths (15%), ART-experienced patients during TB treatment accounted for 30 deaths (30/257; 14%), while those who were not ART-experienced during TB treatment accounted for 15 deaths (15/43; 35%). There was a significant difference in survival time between patients with no ART use during TB treatment and those with ART use during TB treatment (log rank p < 0.001). Patients with no ART use during TB treatment were more likely to die within the first 2 months. CONCLUSION: The implementation of CPT policy is a substantial success. Strengthening the implementation of ART policy could improve survival among HIV-associated TB patients.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Antirretrovirais/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Tuberculose/tratamento farmacológico , Tuberculose/mortalidade , Adulto , Botsuana/epidemiologia , Coinfecção/tratamento farmacológico , Coinfecção/mortalidade , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , HIV/fisiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Implementação de Plano de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tuberculose/complicações , Tuberculose/virologia
13.
Lima; Perú. Ministerio de Salud; 20190900. 18 p. graf, tab.
Monografia em Espanhol | LILACS, LIPECS | ID: biblio-1016361

RESUMO

La directiva sanitaria contiene: la finalidad, objetivos, base legal, ámbito de aplicación, disposiciones generales y las responsabilidades que se establece para los procedimientos para la sustentación e implementación de los servicios complementarios en salud y de está manera contribuir a la mejora del acceso a los servicios de salud mediante la prestación de servicios complementarios de salud.


Assuntos
Atenção Primária à Saúde , Serviços de Saúde , Acesso aos Serviços de Saúde , Implementação de Plano de Saúde
14.
Metas enferm ; 22(7): 65-71, sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184101

RESUMO

La función cardiaca y la función renal están íntimamente asociadas, ya que el corazón y los riñones llevan a cabo la regulación hemodinámica del organismo. Cuando se producen alteraciones de forma bidireccional en ambos órganos se activa una serie de mecanismos compensadores que provocan un efecto nocivo de uno de ellos sobre el otro. Es lo que se conoce como síndrome cardiorrenal. Actualmente se dispone de protocolos de Enfermería estandarizados para el manejo de la insuficiencia cardiaca y para la insuficiencia renal; no obstante, es necesario ampliar la información para entender de forma óptima la relación cardiorrenal y aplicar la mejor evidencia científica a los cuidados. Por ello se expone un caso clínico abordado desde Atención Primaria, con el desarrollo de un plan de cuidados elaborado una vez identificados los diagnósticos de Enfermería que se han derivado de la valoración enfermera siguiendo el modelo de las 14 necesidades básicas de Virginia Henderson


Cardiac function and renal function are closely related, because the heart and the kidneys carry out the hemodynamic regulation of the body. When there are bidirectional alterations in both organs, a series of compensating mechanisms are activated, which cause harmful effects of one over the other. This is known as Cardiorenal Syndrome. There are current standard Nursing protocols available for the management of heart failure and renal impairment; however, it is necessary to increase information for an optimal understanding of the cardiorenal interaction, and to apply the best scientific evidence into care. To this aim, we present a case record addressed at Primary Care, with the development of a plan of care prepared after the Nursing diagnoses were identified, derived from nursing assessment following the model of the 14 Basic Needs of Virginia Henderson


Assuntos
Humanos , Feminino , Idoso , Cuidados de Enfermagem , Atenção Primária à Saúde/métodos , Síndrome Cardiorrenal/complicações , Síndrome Cardiorrenal/enfermagem , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/enfermagem , Padrão de Cuidado/normas , Nível de Saúde , Atenção Primária à Saúde , Nefropatias/complicações , Cardiopatias/complicações , Implementação de Plano de Saúde/normas , Insuficiência Cardíaca/enfermagem
15.
Am J Health Syst Pharm ; 76(7): 470-477, 2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-31415682

RESUMO

PURPOSE: The development and implementation of a team-based pharmacy practice model is described. METHODS: In January 2016 a transition from a staff-specialist to a team-based pharmacy practice model was implemented. The overall goal of the model change was to enhance the pharmacist's clinical roles and further integrate pharmacists into the healthcare team. Before implementation of the new staffing model, a formalized metric evaluation process was created. The aim of this metric evaluation was to gauge model success, determine areas of model revision, and objectively communicate pharmacist impact. Objective metrics were evaluated before implementation and 1 year after implementation. In addition, surveys were distributed to pharmacists, physicians, nursing and hospital administration before and after model implementation. RESULTS: At 1-year postimplementation, the pharmacist:patient bed ratio decreased from 1:87 to 1:47, the number of rounds/huddles with pharmacist attendance increased by 63% to 80 per week, and the number of clinical interventions and new clinical consultations increased from 57 to 62 and from 12 to 16 per day, respectively. Nonformulary medication use also decreased from 1.77 to 0.623 per 1000 patient days, and compliance with therapeutic initiatives increased from 77%to 91%. Overall, 72% of pharmacist survey responses indicated satisfaction with the model change. CONCLUSION: A team-based pharmacy practice model was designed and successfully implemented over a 3-year period. Data analysis revealed improvements in clinical and operational endpoints and enhanced pharmacist, physician, and nursing satisfaction.


Assuntos
Modelos Organizacionais , Equipe de Assistência ao Paciente/organização & administração , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Papel Profissional , Centros Médicos Acadêmicos/organização & administração , Atitude do Pessoal de Saúde , Implementação de Plano de Saúde , Humanos , Satisfação no Emprego , Enfermeiras e Enfermeiros/psicologia , Farmacêuticos/psicologia , Farmacêuticos/estatística & dados numéricos , Médicos/psicologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Visitas com Preceptor/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos
16.
Am J Health Syst Pharm ; 76(6): 387-397, 2019 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-31415684

RESUMO

PURPOSE: As a preliminary evaluation of the outcomes of implementing pharmacogenetic testing within a large rural healthcare system, patients who received pre-emptive pharmacogenetic testing and warfarin dosing were monitored until June 2017. SUMMARY: Over a 20-month period, 749 patients were genotyped for VKORC1 and CYP2C9 as part of the electronic Medical Records and Genomics Pharmacogenetics (eMERGE PGx) study. Of these, 27 were prescribed warfarin and received an alert for pharmacogenetic testing pertinent to warfarin; 20 patients achieved their target international normalized ratio (INR) of 2.0-3.0, and 65% of these patients achieved target dosing within the recommended pharmacogenetic alert dose (± 0.5 mg/day). Of these, 10 patients had never been on warfarin prior to the alert and were further evaluated with regard to time to first stable target INR, bleeds and thromboembolic events, hospitalizations, and mortality. There was a general trend of faster time to first stable target INR when the patient was initiated at a warfarin dose within the alert recommendation versus a dose outside of the alert recommendation with a mean (± SD) of 34 (± 28) days versus 129 (± 117) days, respectively. No trends regarding bleeds, thromboembolic events, hospitalization, or mortality were identified with respect to the pharmacogenetic alert. The pharmacogenetic alert provided pharmacogenetic dosing information to prescribing clinicians and appeared to deploy appropriately with the correct recommendation based upon patient genotype. CONCLUSION: Implementing pharmacogenetic testing as a standard of care service in anticoagulation monitoring programs may improve dosage regimens for patients on anticoagulation therapy.


Assuntos
Anticoagulantes/administração & dosagem , Monitoramento de Medicamentos/métodos , Testes Farmacogenômicos , Serviços de Saúde Rural/organização & administração , Varfarina/administração & dosagem , Idoso , Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Relação Dose-Resposta a Droga , Feminino , Genótipo , Implementação de Plano de Saúde , Hemorragia/sangue , Hemorragia/induzido quimicamente , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Variantes Farmacogenômicos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Padrão de Cuidado , Tromboembolia/sangue , Tromboembolia/prevenção & controle , Varfarina/efeitos adversos
17.
Am J Health Syst Pharm ; 76(13): 992-997, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31415686

RESUMO

PURPOSE: To describe the methods used in the development of an intravenous chemotherapy workload and productivity dashboard and its impact on symptoms of burnout and technician turnover. SUMMARY: In February 2017, chemotherapy sterile preparation pharmacy technicians reported symptoms of burnout as a result of perceived increase in workload. In response, an i.v. chemotherapy workload and productivity dashboard was developed at an academic medical center to validate workload in comparison to the reported job stress of pharmacy technicians. The dashboard provided pharmacy leadership objective data to validate staff concerns and leveraged lean principles to level-load the work prior to requesting additional full-time equivalents (FTEs) to senior leadership. The rate of turnover of i.v. chemotherapy technicians was assessed before (December 2016-June 2017) and after (July 2017-January 2018) dashboard implementation and approval of an additional i.v. chemotherapy technician FTE. The addition of the new FTE resulted in a decrease in productivity from an average of 106% (range 67%-151%) to 84% (range 65%-110%). The interventions allowed for the ability to leverage a staffing-to-demand model, resulting in the observed improvement in technician symptoms of burnout and a notable decrease in the overall turnover rate of i.v. chemotherapy technicians. CONCLUSION: The i.v. chemotherapy workload and productivity dashboard confirmed frontline staff perception and provided data to support the addition of labor resource and an opportunity to leverage a staffing-to-demand model to decrease symptoms of burnout and technician turnover.


Assuntos
Eficiência Organizacional , Reorganização de Recursos Humanos/estatística & dados numéricos , Serviço de Farmácia Hospitalar/organização & administração , Técnicos em Farmácia/estatística & dados numéricos , Carga de Trabalho/estatística & dados numéricos , Administração Intravenosa , Antineoplásicos/administração & dosagem , Atitude do Pessoal de Saúde , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , Implementação de Plano de Saúde , Humanos , Neoplasias/tratamento farmacológico , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Técnicos em Farmácia/psicologia , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Carga de Trabalho/psicologia
18.
Am J Health Syst Pharm ; 76(11): 829-834, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31415689

RESUMO

PURPOSE: Describe patient-, clinician-, system-, and community-level interventions for pain management developed and employed by 9 healthcare systems across the United States and report on lessons learned from the implementation of these interventions. SUMMARY: The high cost associated with pain coupled with the frequent use of opioid analgesics as primary treatment options has made novel pain management strategies a necessity. Interventions that target multiple levels within healthcare are needed to help combat the opioid epidemic and improve strategies to manage chronic pain. Patient-level interventions implemented ranged from traditional paper-based educational tools to videos, digital applications, and peer networks. Clinician-level interventions focused on providing education, ensuring proper follow-up care, and establishing multidisciplinary teams that included prescribers, pharmacists, nurses, and other healthcare professionals. System- and community-level interventions included metric tracking and analytics, electronic health record tools, lockbox distribution for safe storage, medication return bins for removal of opioids, risk assessment tool utilization, and improved access to reversal agents. CONCLUSION: Strategies to better manage pain can be implemented within health systems at multiple levels and on many fronts; however, these changes are most effective when accepted and widely used by the population for which they are targeted.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica/tratamento farmacológico , Prestação Integrada de Cuidados de Saúde/organização & administração , Manejo da Dor/métodos , Assistência Farmacêutica/organização & administração , Implementação de Plano de Saúde , Humanos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Manejo da Dor/efeitos adversos , Farmacêuticos/organização & administração , Estados Unidos/epidemiologia
19.
Transplant Proc ; 51(6): 1661-1666, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399157

RESUMO

BACKGROUND: For many cornea disorders, transplantation can be the treatment of first choice. In Brazil, there is a disparity in the number of transplants between regions due to the lack of an oriented system for cornea procurement.The aim of this study was to analyze the implementation of a system exclusively oriented toward the improvement of cornea recovery in the Rio de Janeiro State Organ Procurement Organization (OPO) area. With this system, all cornea donation activities were coordinated by the OPO after telephone referrals following asystolic death. From the perspective of health care innovation, we will discuss the role of the main participants and their interactions following the implementation phase. METHODS: One hospital was chosen to host the project following the first 2 years of the implementation of the State Cornea Donation System. We retrospectively analyzed all deaths between January 1 and December 31, 2016, using the hospital death records and the OPO referrals record. The strategic plan, documents, and interviews were carried out for the analysis of the implementation of this innovation in our region. RESULTS: Of 1720 deaths in 2016, 1093 (63.5%) were referred to the OPO following asystolic death for assessment and screening, but 819 of these potential tissue donors (PTDs) were not eligible for donation due to medical contraindications. The remaining 274 (25.1%) fulfilled the PTD criteria. Less than half of the families (n = 128) of these PTDs could be contacted requesting donation, but 50% consented. Finally, corneas were procured from 58 patients. The interactions between in-house coordinators and top managers were mandatory for the success of program implementation. CONCLUSION: For the first time in our country, cornea recovery took place following asystolic death with OPO coordination at a central level. The PTD rate could be estimated, and an analysis of the role of stakeholders could be made for the implementation phase of this innovation in our system.


Assuntos
Transplante de Córnea , Implementação de Plano de Saúde/organização & administração , Inovação Organizacional , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/organização & administração , Brasil , Hospitais , Humanos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Obtenção de Tecidos e Órgãos/métodos
20.
Am J Health Syst Pharm ; 76(Supplement_3): S74-S78, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418772

RESUMO

PURPOSE: The development and implementation of centralized mail-order pharmacy services in an academic healthcare system are described. SUMMARY: The use of mail-order pharmacy services continues to increase, as mail-order services offer patient benefits such as reduced copayments and improved clinical outcomes. Prior to undertaking an initiative to improve its mail-order pharmacy services, the University of Utah Health system's pharmacy department offered decentralized mail-order pharmacy services at all of its retail pharmacies, but there was no standardized process for processing mail-order prescriptions or providing phone support to mail-order patients. Centralized mail-order pharmacy services were developed and implemented by creating (1) a standard process for mail-order pharmacy services, (2) a centralized mail-order prescription filling center, and (3) a call center to support mail-order pharmacy services. Implementation of centralized mail-order pharmacy services resulted in an almost 50% reduction in time spent by pharmacy team members on mail-order prescription filling and packaging tasks. Use of a central call center resulted in a decreased call abandonment rate and contributed to a decreased pharmacy workload resulting from an overall reduction in call volume due to an increased rate of first-call issue resolution. CONCLUSION: Establishment of a centralized mail-order pharmacy service along with operational and infrastructure improvements resulted in improved quality and regulatory compliance and enhanced labor efficiency and patient communication.


Assuntos
Implementação de Plano de Saúde , Farmácias/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Serviços Postais , Call Centers/organização & administração , Hospitais Universitários/organização & administração , Hospitais Universitários/estatística & dados numéricos , Humanos , Farmácias/estatística & dados numéricos , Farmacêuticos/organização & administração , Farmacêuticos/estatística & dados numéricos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Carga de Trabalho/estatística & dados numéricos
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