Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.240
Filtrar
2.
Int J Gynaecol Obstet ; 149(3): 377-378, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32267531

RESUMO

From February 24, 2020, a COVID-19 obstetric task force was structured to deliver management recommendations for obstetric care. From March 1, 2020, six COVID-19 hubs and their spokes were designated. An interim analysis of cases occurring in or transferred to these hubs was performed on March 20, 2020 and recommendations were released on March 24, 2020. The vision of this strict organization was to centralize patients in high-risk maternity centers in order to concentrate human resources and personal protective equipment (PPE), dedicate protected areas of these major hospitals, and centralize clinical multidisciplinary experience with this disease. All maternity hospitals were informed to provide a protected labor and delivery room for nontransferable patients in advanced labor. A pre-triage based on temperature and 14 other items was developed in order to screen suspected patients in all hospitals to be tested with nasopharyngeal swabs. Obstetric outpatient facilities were instructed to maintain scheduled pregnancy screening as per Italian guidelines, and to provide pre-triage screening and surgical masks for personnel and patients for pre-triage-negative patients. Forty-two cases were recorded in the first 20 days of hub and spoke organization. The clinical presentation was interstitial pneumonia in 20 women. Of these, seven required respiratory support and eventually recovered. Two premature labors occurred.


Assuntos
Instituições de Assistência Ambulatorial/normas , Infecções por Coronavirus , Alocação de Recursos para a Atenção à Saúde , Maternidades/normas , Obstetrícia/normas , Pandemias , Assistência ao Paciente/normas , Pneumonia Viral , Instituições de Assistência Ambulatorial/organização & administração , Feminino , Alocação de Recursos para a Atenção à Saúde/organização & administração , Alocação de Recursos para a Atenção à Saúde/normas , Maternidades/organização & administração , Hospitais Especializados/organização & administração , Hospitais Especializados/normas , Humanos , Itália , Equipamento de Proteção Individual/provisão & distribução , Gravidez
3.
J Nephrol ; 33(2): 193-196, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32207068

RESUMO

Confronting the SARS-CoV-2 outbreak has allowed us to appreciate how efficiently highly-resourced settings can respond to crises. However even such settings are not prepared to deal with the situation, and lessons are only slowly being learnt. There is still an urgent need to accelerate protocols that lead to the implementation of rapid point-of-care diagnostic testing and effective antiviral therapies. In some high-risk populations, such as dialysis patients, where several individuals are treated at the same time in a limited space and overcrowded areas, our objective must be to ensure protection to patients, the healthcare team and the dialysis ward. The difficult Italian experience may help other countries to face the challenges. The experience of the Lombardy underlines the need for gathering and sharing our data to increase our knowledge and support common, initially experience-based, and as soon as possible evidence-based position to face this overwhelming crisis.


Assuntos
Instituições de Assistência Ambulatorial/normas , Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Diálise Renal , Instituições de Assistência Ambulatorial/organização & administração , Infecções por Coronavirus/transmissão , Humanos , Itália/epidemiologia , Pneumonia Viral/transmissão
4.
Bone Joint J ; 102-B(2): 148-154, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32009438

RESUMO

Cell therapies hold significant promise for the treatment of injured or diseased musculoskeletal tissues. However, despite advances in research, there is growing concern about the increasing number of clinical centres around the world that are making unwarranted claims or are performing risky biological procedures. Such providers have been known to recommend, prescribe, or deliver so called 'stem cell' preparations without sufficient data to support their true content and efficacy. In this annotation, we outline the current environment of stem cell-based treatments and the strategies of marketing directly to consumers. We also outline the difficulties in the regulation of these clinics and make recommendations for best practice and the identification and reporting of illegitimate providers. Cite this article: Bone Joint J 2020;102-B(2):148-154.


Assuntos
Instituições de Assistência Ambulatorial/normas , Publicidade Direta ao Consumidor/normas , Marketing de Serviços de Saúde/normas , Doenças Musculoesqueléticas/cirurgia , Segurança do Paciente/normas , Transplante de Células-Tronco/normas , Instituições de Assistência Ambulatorial/legislação & jurisprudência , Qualidade de Produtos para o Consumidor/legislação & jurisprudência , Qualidade de Produtos para o Consumidor/normas , Publicidade Direta ao Consumidor/legislação & jurisprudência , Publicidade Direta ao Consumidor/tendências , Humanos , Marketing de Serviços de Saúde/legislação & jurisprudência , Marketing de Serviços de Saúde/tendências , Segurança do Paciente/legislação & jurisprudência , Guias de Prática Clínica como Assunto/normas , Transplante de Células-Tronco/legislação & jurisprudência , Transplante de Células-Tronco/tendências , Reino Unido , Estados Unidos
5.
Curr Opin Ophthalmol ; 31(1): 28-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31770164

RESUMO

PURPOSE OF REVIEW: This article reviews the various challenges in infection control in eye clinics and successful measures taken to prevent nosocomial infections. RECENT FINDINGS: The Center for Disease Control recommends hand-washing when hands are visibly soiled, and after direct contact with patients, and inanimate objects such as medical equipment. Published studies have identified poor hygiene in clinical settings as a major cause of nosocomial outbreaks, particularly in cases of epidemic keratoconjunctivitis (EKC). Some studies of EKC outbreaks are able to support direct observation of hygiene lapses with molecular analysis that can match viral strains on particular instruments to those found in infected patients. Although most studies are about adenoviral infection and tonometer use, researchers have found viral and bacterial loads on other common surfaces, indicating a need for further research. SUMMARY: Proper hygiene in eye clinics requires special attention because of the potential to examine many patients at a time and because multiple instruments are often used during a single exam. Studies reinforce the link between hygiene and outbreak prevention, and more research can be done to determine the specific links between certain instruments and nosocomial infections.


Assuntos
Infecção Hospitalar/prevenção & controle , Desinfecção/métodos , Higiene das Mãos , Controle de Infecções/métodos , Oftalmologia/instrumentação , Esterilização/métodos , Instituições de Assistência Ambulatorial/normas , Humanos , Oftalmologia/normas
6.
Artigo em Inglês | MEDLINE | ID: mdl-31861326

RESUMO

Osteoarthritis (OA) is one of the most common causes of rehabilitation benefits and senior disability. It generates high costs of treatment and increasing demand for medical staff and care of geriatric profile. The aim of the study was to determine the relationship between health evaluation and satisfaction with medical services among individuals with OA in rehabilitation outpatient clinics. The survey was carried out from June 2017 to May 2018, among patients being provided with services of five outpatient rehabilitation clinics in Lublin. The surveyed group comprised 328 respondents. The following tools were utilized: the List of Health Criteria (LHC), the Multidimensional Health Locus of Control Scale (version B) (MHLC), the authors' own questionnaire compiled for the study, and the Servperf Method. According to the respondents, the most important health criterion is "not to experience any ailments" (M = 1.56). In an assessment of a clinic, the respondents rated neatness (cleanliness) of the staff highest (M = 4.38) and the appearance of a building where a clinic is located lowest (M = 3.42). The better the evaluation of medical services in an outpatient rehabilitation clinic in comparison to other settings, the better the evaluation of the quality of service (rho S = 0.593; p < 0.000). The study conducted in outpatient rehabilitation clinics showed great demand for outpatient specialist care of geriatric profile. Undoubtedly, there is need for continuation and expansion of studies on patients with OA in other rehabilitation settings.


Assuntos
Instituições de Assistência Ambulatorial/normas , Assistência Ambulatorial/normas , Osteoartrite/reabilitação , Satisfação do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/psicologia , Polônia , Garantia da Qualidade dos Cuidados de Saúde , Indicadores de Qualidade em Assistência à Saúde
7.
Environ Monit Assess ; 191(12): 770, 2019 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-31768655

RESUMO

Appropriate clinical waste management is a critical concern in today's era. Resource-constrained countries agonize greatly over this issue in order to mitigate inappropriate clinical waste management practices. The goal of this study is to assess factors behind inappropriate waste management of small clinics in resource-constrained countries. We tested the hypothesis that negligence of government, knowledge and awareness, and financial burden are three key factors behind inappropriate solid waste management of small clinics. A two-phase survey including a pilot study and a main study was conducted for exploratory factor analysis and confirmatory factor analysis, respectively, in the fourth largest city of Pakistan, i.e., Hyderabad. One sample t test was used to validate the hypothesis, the correlation between the three key factors, and the location of the clinics were established. These factors were found to have a contribution to inappropriate waste management of small clinics. The hypothesis was then validated, and all three factors were found to have no significant variation in responses with the contrast of three types of clinic locations, namely, low-, medium-, and high-income areas. Responses were almost identical and bear equal significance from all locations, the financial burden factor is at the highest, the second factor is the negligence of government, and the third factor is that of knowledge and awareness. This study highlights the factors that are usually neglected and can help to improve solid waste management of small clinics in resource-constrained countries.


Assuntos
Instituições de Assistência Ambulatorial , Resíduos Sólidos , Gerenciamento de Resíduos , Instituições de Assistência Ambulatorial/economia , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/normas , Monitoramento Ambiental , Análise Fatorial , Humanos , Paquistão , Projetos Piloto , Gerenciamento de Resíduos/economia , Gerenciamento de Resíduos/normas
8.
Rev Esc Enferm USP ; 53: e03471, 2019 Aug 19.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31433013

RESUMO

OBJECTIVE: To identify the prevalence of nursing process documentation in hospitals and outpatient clinics administered by the São Paulo State Department of Health. METHOD: A descriptive study conducted through interviews with nurses responsible for 416 sectors of 40 institutions on the documentation of four phases of the Nursing Process (data collection, diagnosis, prescription and evaluation) and nursing annotations. RESULTS: Of the 416 sectors studied, 89.9% documented at least one phase; 56.0% documented the four phases; 4.3% only documented nursing annotations; 5.8% did not document any phase, nor did the nursing notes. The types of sectors which were less documented were: ambulatory, diagnostic support, surgical center and obstetric center; while the ones which were most documented included: intensive care units, emergency rooms and hospitalization units. The data collection and diagnosis were the least documented phases, both in 78.8% of the sectors. CONCLUSION: Most of the studied sectors document the Nursing Process and do nursing annotations, but there are sectors where documentation does not meet formal requirements. The viability of documentation of all the Nursing Process phases in certain types of sectors needs to be better studied.


Assuntos
Documentação/estatística & dados numéricos , Processo de Enfermagem/normas , Registros de Enfermagem/normas , Instituições de Assistência Ambulatorial/normas , Brasil , Estudos Transversais , Serviço Hospitalar de Emergência/normas , Hospitais/normas , Humanos , Unidades de Terapia Intensiva/normas , Entrevistas como Assunto , Saúde Pública
9.
Rev Esc Enferm USP ; 53: e03436, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31314862

RESUMO

OBJECTIVE: To evaluate the degree of satisfaction and the socioeconomic profile of patients attending Gastroenterology Outpatient Clinics at a University institution linked to the Brazilian Unified Health System. METHOD: A researcher-administered questionnaire was applied during a structured interview in outpatient clinics. RESULTS: Two hundred and forty (240) patients were included in the study (mean age of 53 years, 55% women). About 30% of the patients had incomplete elementary education, 25% had complete secondary education, and 53% were active workers. Approximately 87% attending the outpatient clinics were from the B2, C1 and C2 socioeconomic classes with an estimated family income of USD$275.00 to USD$825.00/month. Ninety-two percent (92%) of patients were satisfied with the care received; the items associated with a lower degree of satisfaction were facilities/comfort, cleanliness, and waiting time for consultation. No relationship was observed between socioeconomic profile and degree of satisfaction. CONCLUSION: Satisfaction surveys are important to identify opportunities for improving healthcare services, and it is incumbent upon managers, health professionals and even users to promote compliance with laws and decrees that seek to improve healthcare.


Assuntos
Assistência Ambulatorial/normas , Gastroenterologia/normas , Programas Nacionais de Saúde/organização & administração , Satisfação do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial/normas , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
10.
Med Care ; 57(9): 734-741, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31274781

RESUMO

BACKGROUND: Retail clinics, also referred to as walk-in or convenient care clinics, share common features such as a limited menu of primary care services, on-demand patient appointments, greater use of nonphysician providers such as nurse practitioners, and more convenient hours and access points for patients. OBJECTIVES: Given their rising popularity as an alternative primary care delivery site, it is important to examine retail clinics' impact on patient outcomes. This study's aim was to systematically review the extant literature on retail clinics in the United States with respect to 3 outcomes of interest: quality, cost, and patient satisfaction. RESEARCH DESIGN: A systematic search of 4 databases was done using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies needed to be empirical, measure care in retail, walk-in, or convenient care clinic, and present quality, cost, and/or satisfaction findings. MEASURES: The majority of studies used commercial, administrative claims databases to procure patient outcome data (n=9). Nine of the 15 studies examined costs, 6 examined quality, and only 1 examined patient satisfaction. RESULTS: Overall, retail clinic care compares favorably with similar care in other settings in terms of lower costs, although the evidence on quality and patient satisfaction is minimal and less conclusive. CONCLUSIONS: Future research on retail clinic care requires more rigorous study designs, richer quality measures, inclusion of the patient experience in outcomes, less reliance on administrative claims data, and greater independence from industry stakeholders with interest in seeing the retail clinic model grow.


Assuntos
Instituições de Assistência Ambulatorial , Custos de Cuidados de Saúde , Satisfação do Paciente , Atenção Primária à Saúde/métodos , Qualidade da Assistência à Saúde , Plantão Médico/estatística & dados numéricos , Instituições de Assistência Ambulatorial/economia , Instituições de Assistência Ambulatorial/normas , Agendamento de Consultas , Feminino , Humanos , Masculino , Estados Unidos
11.
Work ; 63(3): 369-374, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256106

RESUMO

BACKGROUND: Musculoskeletal disorders are not properly managed in office workers because of their busy work life. In-house physical therapy is a good way to manage the musculoskeletal disorders in office workers. Despite the numerous advantages of in-house physical therapy, the establishment and research of in-house physical therapy were insufficient. OBJECTIVE: The purpose this study was to determine the characteristics of musculoskeletal disorders in office workers and to investigate their satisfaction with in-house physical therapy clinics and the associated factors. METHODS: In this study, 664 office workers who used in-house physical therapy clinics were surveyed for characteristics of musculoskeletal disorders and satisfaction with in-house physical therapy clinics. RESULTS: Of these office workers, the most common causes of damage were nontraumatic (36.8%) and the most common lesion sites were the neck (30.3%) and lower back (25.6%). In the empirical characteristics of in-house physical therapy clinics, basic thermoelectric treatments were the most common (46.8%). The satisfaction with in-house physical therapy clinic was generally high. In addition, the cause of damage and treatment contents affected treatment-related and functional return-related satisfaction. CONCLUSION: In-house physical therapy, including therapeutic exercises and self-management education, is a good system to manage musculoskeletal disorders in office workers.


Assuntos
Pessoal Administrativo/psicologia , Instituições de Assistência Ambulatorial/normas , Doenças Musculoesqueléticas/classificação , Satisfação do Paciente , Modalidades de Fisioterapia/normas , Pessoal Administrativo/estatística & dados numéricos , Adulto , Instituições de Assistência Ambulatorial/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/complicações , Doenças Musculoesqueléticas/psicologia , República da Coreia , Inquéritos e Questionários
12.
Ir J Psychol Med ; 36(2): 145-151, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31187724

RESUMO

AimTo investigate whether a small regional memory clinic would benefit from engaging with a structured external audit process such as the Royal College of Psychiatrists' Memory Service National Accreditation Program (MSNAP). BACKGROUND: The Psychiatry of Old Age service in Navan operates a public cognitive clinic. Despite the publication of the 2014 National Dementia Strategy, there are currently no national standards for memory clinics in Ireland. It may be beneficial to link in with an external quality control system as part of routine clinical governance. METHODS: Published data from the MSNAP group was reviewed and a set of audit materials extrapolated to replicate the MSNAP self-review process. The audit cycle involved (1) retrospective case review, (2) institution of a range of interventions and (3) a prospective audit, which included service user feedback. RESULTS: Overall the results demonstrated a high standard of service, especially in the areas of accessibility, assessment and communication of diagnosis. The clinic performed well against MSNAP key performance indicators. Patient and carer satisfaction with the service was very high. Clinic policies needed further development, particularly in the areas of referral, consent and data protection. CONCLUSIONS: The process was useful, providing clear pointers for action. It highlighted the need to formalise organisational and practice policies, patient support and education, audit and outreach. Although accreditation is a laborious process requiring financial investment, it provides a strong scaffold to maintain and improve standards and is likely to be a valuable learning experience, where national guidelines are lacking.


Assuntos
Acreditação/normas , Instituições de Assistência Ambulatorial/normas , Transtornos da Memória/diagnóstico , Garantia da Qualidade dos Cuidados de Saúde/normas , Demência/diagnóstico , Humanos , Irlanda , Auditoria Médica/normas , Estudos Prospectivos , Estudos Retrospectivos , Reino Unido
13.
JAMA Netw Open ; 2(6): e196201, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-31225894

RESUMO

Importance: There is new emphasis on clinician trust in health care organizations but little empirical data about the association of trust with clinician satisfaction and retention. Objective: To examine organizational characteristics associated with trust. Design, Setting, and Participants: This prospective cohort study uses data collected from 2012 to 2014 from 34 primary care practices employing physicians (family medicine and general internal medicine) and advanced practice clinicians (nurse practitioners and physician assistants) in the upper Midwest and East Coast of the United States as part of the Healthy Work Place randomized clinical trial. Analyses were performed from 2015 to 2016. Main Outcomes and Measures: Clinician trust was measured using a 5-item scale, including belonging, loyalty, safety focus, sense of trust, and responsibility to clinicians in need (range, 1-4, with 1 indicating low and 4 indicating high; Cronbach α = 0.77). Other metrics included work control, work atmosphere (calm to chaotic), organizational culture (cohesiveness, emphases on quality and communication, and values alignment; range, 1-4, with 1 indicating low and 4 indicating high), and clinician stress (range, 1-5, with 1 indicating low and 5 indicating high), satisfaction (range, 1-5, with 1 indicating low and 4 indicating high), burnout (range, 1-5, with 1 indicating no burnout and 5 indicating very high feeling of burnout), and intention to leave (range, 1-5, with 1 indicating no intention to leave and 5 indicating definite intention to leave). Analyses included 2-level hierarchical modeling controlling for age, sex, specialty, and clinician type. Cohen d effect sizes (ESs) were considered small at 0.20, moderate at 0.50, and large at 0.80 or more. Results: The study included 165 clinicians (mean [SD] age, 47.3 [9.2] years; 86 [52.1%] women). Of these, 143 (87.7%) were physicians and 22 (13.3%) were advanced practice clinicians; 105 clinicians (63.6%) worked in family medicine, and 60 clinicians (36.4%) worked in internal medicine. Compared with clinicians with low levels of trust, clinicians who reported high levels of trust had higher mean (SD) scores for work control (2.49 [0.52] vs 2.18 [0.45]; P < .001), cohesiveness (3.11 [0.46] vs 2.51 [0.51]; P < .001), emphasis on quality vs productivity (3.12 [0.48] vs 2.58 [0.41]; P < .001), emphasis on communication (3.39 [0.41] vs 3.01 [0.44]; P < .001), and values alignment (2.61 [0.59] vs 2.12 [0.52]; P < .001). Men were more likely than women to express loyalty (ES, 0.35; 95% CI, 0.05-0.66; P = .02) and high trust (ES, 0.31; 95% CI, 0.01-0.62; P = .04). Compared with clinicians with low trust at baseline, clinicians with high trust at baseline had a higher mean (SD) satisfaction score (3.99 [0.08] vs 3.51 [0.07]; P < .001; ES, 0.70; 95% CI, 0.39-1.02). Compared with clinicians in whom trust declined or remained low, clinicians with improved or stable high trust reported higher mean (SD) satisfaction (4.01 [0.07] vs 3.43 [0.06]; P < .001; ES, 0.98; 95% CI, 0.66-1.31) and lower stress (3.21 [0.09] vs 3.53 [0.09]; P = .02; ES, -0.39; 95% CI, -0.70 to -0.08) scores and had approximately half the odds of intending to leave (odds ratio, 0.481; 95% CI, 0.241-0.957; P = .04). Conclusions and Relevance: Addressing low levels of trust by improving work control and emphasizing quality, cohesion, communication, and values may improve clinician satisfaction, stress, and retention.


Assuntos
Pessoal de Saúde/psicologia , Organizações/normas , Atenção Primária à Saúde/normas , Confiança , Local de Trabalho/normas , Instituições de Assistência Ambulatorial/normas , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Comunicação , Eficiência Organizacional/estatística & dados numéricos , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Medicina Interna/estatística & dados numéricos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/estatística & dados numéricos , Saúde do Trabalhador/normas , Saúde do Trabalhador/estatística & dados numéricos , Estresse Ocupacional/etiologia , Cultura Organizacional , Organizações/estatística & dados numéricos , Lealdade ao Trabalho , Assistentes Médicos/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional , Estudos Prospectivos , Responsabilidade Social , Estados Unidos , Carga de Trabalho/estatística & dados numéricos
14.
J Laryngol Otol ; 133(5): 441-444, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31038097

RESUMO

BACKGROUND: In November 2017, a working feasibility analysis commenced of a local anaesthetic endonasal procedures out-patient clinic service at Freeman Hospital, Newcastle upon Tyne. Fundamental to introducing an innovative ambulatory out-patient practice is the development of a novel local safety standard for invasive procedures to support this service. OBJECTIVE: This paper presents the new safety standard developed for this purpose and implemented in our institution. CONCLUSION: Increasingly, there is a shift toward ambulatory services, directed by patient choice, technological advances and the opportunity for cost savings. It is hoped that this local safety standard for invasive procedures will provide a useful template for those considering implementing ambulatory endonasal services, or other novel procedures, within the specialty of ENT.


Assuntos
Instituições de Assistência Ambulatorial/normas , Procedimentos Cirúrgicos Ambulatórios/normas , Endoscopia/normas , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Gestão da Segurança/métodos , Procedimentos Cirúrgicos Ambulatórios/métodos , Anestesia Local/normas , Anestésicos Locais/uso terapêutico , Endoscopia/métodos , Inglaterra , Humanos , Nariz/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos
15.
Curationis ; 42(1): e1-e8, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31038329

RESUMO

BACKGROUND:  The Republic of South Africa (RSA) is shifting towards universal health coverage and a unified health system. This milestone can be achieved through the implementation of National Health Insurance (NHI). To employ NHI, health establishments in the country are compelled to comply with quality standards. The non-compliance with quality standards at primary health care (PHC) clinics within a district in Gauteng, which was verified by quality standards' audit reports, prompted an intervention. No prior research aimed at facilitating managers' compliance with quality standards has been conducted within the context under study. This research gap necessitated an exploration on how managers' compliance to quality standards at PHC clinics within a district in Gauteng could best be facilitated. OBJECTIVES:  To describe recommendations to facilitate managers' compliance with quality standards at PHC clinics within a district in Gauteng. METHOD:  A qualitative, exploratory, descriptive and contextual research design was used in this study. Semi-structured, individual interviews were conducted. RESULTS:  The recommendations to facilitate managers' compliance with quality standards at PHC clinics within a district in Gauteng were described. However, for the purpose of this article, only the recommendations seeking to address challenges with management practices as a reason for non-compliance with quality standards at PHC clinics will be discussed. These recommendations include involvement of PHC clinic managers in decision-making, adequate support from senior management and improvement of internal communication practices. CONCLUSION:  The researcher concludes that the senior management team in the district under study should strive to embrace the described recommendations as a strategy to facilitate managers' compliance to quality standards at PHC clinics.


Assuntos
Instituições de Assistência Ambulatorial/normas , Enfermeiras Administradoras/psicologia , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde/normas , Instituições de Assistência Ambulatorial/organização & administração , Humanos , Entrevistas como Assunto/métodos , Enfermeiras Administradoras/normas , Atenção Primária à Saúde/métodos , Pesquisa Qualitativa , África do Sul , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência , Cobertura Universal do Seguro de Saúde/tendências
16.
Pediatrics ; 143(5)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30962253

RESUMO

BACKGROUND AND OBJECTIVES: Use of commercial direct-to-consumer (DTC) telemedicine outside of the pediatric medical home is increasing among children, and acute respiratory infections (ARIs) are the most commonly diagnosed condition at DTC telemedicine visits. Our objective was to compare the quality of antibiotic prescribing for ARIs among children across 3 settings: DTC telemedicine, urgent care, and the primary care provider (PCP) office. METHODS: In a retrospective cohort study using 2015-2016 claims data from a large national commercial health plan, we identified ARI visits by children (0-17 years old), excluding visits with comorbidities that could affect antibiotic decisions. Visits were matched on age, sex, chronic medical complexity, state, rurality, health plan type, and ARI diagnosis category. Within the matched sample, we compared the percentage of ARI visits with any antibiotic prescribing and the percentage of ARI visits with guideline-concordant antibiotic management. RESULTS: There were 4604 DTC telemedicine, 38 408 urgent care, and 485 201 PCP visits for ARIs in the matched sample. Antibiotic prescribing was higher for DTC telemedicine visits than for other settings (52% of DTC telemedicine visits versus 42% urgent care and 31% PCP visits; P < .001 for both comparisons). Guideline-concordant antibiotic management was lower at DTC telemedicine visits than at other settings (59% of DTC telemedicine visits versus 67% urgent care and 78% PCP visits; P < .001 for both comparisons). CONCLUSIONS: At DTC telemedicine visits, children with ARIs were more likely to receive antibiotics and less likely to receive guideline-concordant antibiotic management compared to children at PCP visits and urgent care visits.


Assuntos
Assistência Ambulatorial/tendências , Antibacterianos/uso terapêutico , Publicidade Direta ao Consumidor/tendências , Prescrições de Medicamentos , Pediatria/tendências , Telemedicina/tendências , Adolescente , Assistência Ambulatorial/normas , Instituições de Assistência Ambulatorial/normas , Instituições de Assistência Ambulatorial/tendências , Criança , Pré-Escolar , Estudos de Coortes , Publicidade Direta ao Consumidor/normas , Prescrições de Medicamentos/normas , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Telemedicina/normas
17.
J Laryngol Otol ; 133(5): 386-389, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30967160

RESUMO

OBJECTIVE: Acute tonsillitis represents a significant proportion of admissions to ENT departments nationally. Given current hospital pressures, it is vital to look for safe alternatives to admission. This study explores the safe management of patients in an ambulatory medical unit, without the need for admission. METHODS: A retrospective review of 48 patients' notes was carried out. Following the development and implementation of a guideline for acute tonsillitis, a prospective re-audit of 41 patients was carried out, measuring length of stay, overnight admissions and re-admissions. RESULTS: The rate of overnight admission following implementation of the guideline fell from 0.75 to 0.29, and average length of stay dropped from 19.2 to 9.5 hours. There were two re-admissions in each cycle of the audit, which represents a non-significant increase. CONCLUSION: The tonsillitis guideline has significantly reduced admissions and length of stay. Re-admissions remain low, demonstrating that this is a safe and cost-effective intervention.


Assuntos
Instituições de Assistência Ambulatorial/normas , Assistência Ambulatorial/normas , Implementação de Plano de Saúde/métodos , Guias de Prática Clínica como Assunto , Tonsilite/terapia , Doença Aguda , Adulto , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Auditoria Médica , Admissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , Estudos Retrospectivos
18.
J Pediatr Endocrinol Metab ; 32(5): 505-511, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31028713

RESUMO

Background A structured transition process for young adults with chronic medical conditions from pediatric to adult clinics is strongly promoted. However, the most appropriate transition model has not yet been determined. This study evaluated the effect of a "combined team" Endocrinology Transition Clinic model, including a joint meeting with the patient and pediatric and adult endocrinologists, regarding medical treatment, adherence to follow-up and patient satisfaction with the process. Methods Clinical and demographic data of patients admitted to the Endocrinology Transition Clinic were collected. The clinical impact of the transition meeting was evaluated based on treatment modifications and patient adherence to follow-up. Patient satisfaction was evaluated using a questionnaire. Results From September 2014 through November 2018, 107 patients attended the Endocrinology Transition Clinic, 85.0% were females, mean age 19.7 ± 2.2 years (range 16-29), 97.2% were unmarried. The most common endocrine disorders were obesity (41.1%), Hashimoto's thyroiditis (41.1%) and ovarian hyperandrogenism (38.3%). The Transition Clinic visit modified treatment and/or evaluation for 48 (44.8%) patients. Adherence to follow-up in the adult clinic was 82.9% and was not associated with gender (p = 0.366), ethnicity (p = 0.725), age at transition (p = 0.479) or obesity (p = 0.375). Overall satisfaction reported by 65/85 patients was high (86.8%), although higher among patients who were adherent to follow-up (89.4% vs. 65.6%, p = 0.006). Conclusions The "combined team" transition model in endocrinology requires relatively few resources and has considerable clinical impact, high adherence to follow-up and high patient satisfaction rate. Implementing this model at the interface of pediatric and adult endocrinology units, and possibly in other medical fields, is feasible and efficient.


Assuntos
Instituições de Assistência Ambulatorial/normas , Doenças do Sistema Endócrino/terapia , Endocrinologia/normas , Cooperação do Paciente/estatística & dados numéricos , Satisfação do Paciente , Transição para Assistência do Adulto/normas , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Cooperação do Paciente/psicologia , Prognóstico , Inquéritos e Questionários , Adulto Jovem
19.
Diabetes Care ; 42(5): 705-712, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31010940

RESUMO

Group clinics are becoming popular as a new care model in diabetes care. This evidence synthesis, using realist review methodology, examined the role of group clinics in meeting the complex needs of young people living with diabetes. Following Realist And Meta-narrative Evidence Synthesis-Evolving Standards (RAMESES) quality standards, we conducted a systematic search across 10 databases. A total of 131 articles met inclusion criteria and were analyzed to develop theoretically informed explanations of how and why group clinics could work (or not) for young people with diabetes. Models of group-based care in the literature varied significantly and incorporated different degrees of clinical and educational content. Our analysis identified four overarching principles that can be applied in different contexts to drive sustained engagement of young people in group clinics: 1) emphasizing self-management as practical knowledge; 2) developing a sense of affinity between patients; 3) providing safe, developmentally appropriate care; and 4) balancing group and individual needs. Implementation of group clinics was not always straightforward; numerous adjustments to operational and clinical processes were required to establish and deliver high-quality care. Group clinics for young people with diabetes offer the potential to complement individualized care but are not a panacea and may generate as well as solve problems.


Assuntos
Instituições de Assistência Ambulatorial , Diabetes Mellitus/terapia , Acesso aos Serviços de Saúde , Adolescente , Fatores Etários , Idade de Início , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/normas , Diabetes Mellitus/epidemiologia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas , Humanos , Autogestão , Adulto Jovem
20.
Qual Manag Health Care ; 28(2): 70-77, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30921280

RESUMO

BACKGROUND: Although organizational context can affect the implementation of quality initiatives, we know less about the influence of contextual conditions on quality outcomes. We examined organizational features of primary care clinics that achieved greatest performance improvements after implementing Lean redesigns. METHODS: We used operational data and baseline (ie, pre-Lean implementation) surveys of 1333 physicians and staff in 43 primary care clinics located across a large ambulatory care system. Segmented regression with interrupted time series analysis was used to identify clinics with highest improvements in workflow efficiency, physician productivity, and patient satisfaction following Lean redesign. We conducted independent-samples t tests to identify contextual features of clinics that showed greatest improvements in performance outcomes. RESULTS: Clinics with highest increases in efficiency had most prior experience with quality improvement, compared with all other clinics. Efficiency gains were also found in clinics reporting highest levels of burnout and work stress prior to redesign. Highest improvements in physician productivity were associated with a history of change, staff participation, and leadership support for redesigns. Greatest improvements in patient satisfaction occurred in least stressful environments with highest levels of teamwork, staff engagement/efficacy, and leadership support. CONCLUSIONS: Our findings encourage careful evaluation of clinic characteristics and capacity to effectively implement redesigns. Such evaluations may help leaders select interventions most appropriate for certain clinics, while identifying others that may need extra support with implementing change.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Eficiência Organizacional , Atenção Primária à Saúde/organização & administração , Melhoria de Qualidade/organização & administração , Gestão da Qualidade Total/organização & administração , Instituições de Assistência Ambulatorial/normas , Atitude do Pessoal de Saúde , Esgotamento Profissional/epidemiologia , Processos Grupais , Humanos , Análise de Séries Temporais Interrompida , Liderança , Participação do Paciente , Satisfação do Paciente , Atenção Primária à Saúde/normas , Melhoria de Qualidade/normas , Gestão da Qualidade Total/normas , Engajamento no Trabalho , Fluxo de Trabalho
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA