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2.
Rev Bras Enferm ; 72(suppl 1): 143-150, 2019 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30942356

RESUMO

OBJECTIVE: To describe the facilities and difficulties of the counter-referral of an Emergency Care Unit in Santa Catarina State. METHOD: Descriptive, qualitative study, with the participation of three nurses and 17 physicians. The data were collected through a semi-structured interview and analyzed using the Discourse of the Collective Subject technique. For the theoretical basis, the Política Nacional de Atenção às Urgências (National Policy of Emergency Care) and the Rede de Atenção às Urgências (Network of Care to the Emergencies) was used. RESULTS: The facilities of the counter-referral correspond to the strategies of communication with the Primary Care: embracement; good interpersonal relationships; and electronic medical record network. The difficulties are related to the deficiencies of Primary Care and specialized services, such as the insufficient number of physicians and the delay in scheduling consultations and more complex exams. FINAL CONSIDERATIONS: The difficulties highlighted indicate significant challenges of the local health system in the search for integration between emergency care points.


Assuntos
Serviços Médicos de Emergência/métodos , Pessoal de Saúde/psicologia , Encaminhamento e Consulta/normas , Adulto , Serviços Médicos de Emergência/normas , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/tendências , Feminino , Pessoal de Saúde/tendências , Humanos , Entrevistas como Assunto/métodos , Masculino , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/tendências , Médicos/psicologia , Médicos/tendências , Pesquisa Qualitativa
5.
Psychiatry Res ; 272: 425-430, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30611959

RESUMO

BACKGROUND: Physicians are at risk of burnout, anxiety and depression. Prevention is needed from the beginning of the medical studies to detect early poor mental health outcomes. OBJECTIVE: To determine the prevalence and associated of psychiatric or psychological follow-up in a national sample of undergraduate and postgraduate medical students (UPMS). METHODS: UPMS of the 35 French Medicine faculties were recruited through mailing lists and social networks between December 2016 and May 2017 and fulfilled Internet anonymised questionnaires. RESULTS: Overall, 10,985 UPMS were included in the present study (2165 (19.7%) postgraduate, 31.6% males, mean aged 21.8 years). Overall, 1345 (12.2%) were followed-up by a psychiatrist and/or a psychologist, 20.5% of them were regular anxiolytic consumers and 17.2% of them were regular antidepressant consumers. In multivariate analyses, being followed-up by a psychiatrist and/or psychologist was associated with older age (aOR = 1.2[1.2-1.2], p < 0.0001), female gender (aOR = 0.5[0.5-0.7], p < 0.0001), current alcohol use disorder (aOR = 1.3[1.3-1.5], p < 0.0001), higher anxiolytic (aOR = 3.1[2.5-3.7],p < 0.0001) and antidepressant (aOR = 11.7[7.6-18.0],p < 0.0001) consumption, and with lower self-reported general health, social functioning and mental health quality of life (all aORs = 0.9, all p < 0.05). The UPMS followed-up by psychiatrist and/or psychologist reported to have been more frequently exposed to sexual assault (5.1% vs. 0.9%, aOR = 2.5[1.3-4.7], p < 0.0001), domestic violence (3.3% vs. 0.8% aOR = 2.1[1.2-4.0], p = 0.01) and parents divorce (11% vs. 6.4%, aOR = 1.5[1.2-1.9], p = 0.001). Students followed-up by a psychiatrist and/or psychologist reported more frequently to seek alleviating anxiety (aOR 1.9[1.6-2.3], p < 0.0001), depression (aOR 1.7[1.3-2.1],p < 0.0001), coping with studies difficulties (aOR 1.5[1.2-1.8],p < 0.0001), experiencing more stress at hospital (aOR = 2.3[1.6-3.5],p < 0.001) and more burnout syndrome (aOR = 1.4[1.1-1.8], p = 0.03). CONCLUSIONS: Around 12% of UPMS are followed-up by a psychiatrist and/or a psychologist. These students reported higher antidepressant and anxiolytic consumption, psychic suffering and altered quality of life, associated with professional pressure and personal issues. Public health programs should be developed to help these students through their studies to prevent later mental /addictive issues and professional suffering. Improving UPMS mental health may also improve the later quality of care of their patients and global stress at hospital.


Assuntos
Esgotamento Profissional/psicologia , Transtornos Mentais/psicologia , Médicos/psicologia , Qualidade de Vida/psicologia , Estudantes de Medicina/psicologia , Adulto , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Esgotamento Profissional/diagnóstico , Esgotamento Profissional/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Saúde Mental/tendências , Pessoa de Meia-Idade , Médicos/tendências , Prevalência , Inquéritos e Questionários , Adulto Jovem
6.
J Cardiothorac Vasc Anesth ; 33(5): 1430-1439, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30600204

RESUMO

The authors aimed to identify interventions documented by randomized controlled trials (RCTs) that reduce mortality in adult critically ill and perioperative patients, followed by a survey of clinicians' opinions and routine practices to understand the clinicians' response to such evidence. The authors performed a comprehensive literature review to identify all topics reported to reduce mortality in perioperative and critical care settings according to at least 2 RCTs or to a multicenter RCT or to a single-center RCT plus guidelines. The authors generated position statements that were voted on online by physicians worldwide for agreement, use, and willingness to include in international guidelines. From 262 RCT manuscripts reporting mortality differences in the perioperative and critically ill settings, the authors selected 27 drugs, techniques, and strategies (66 RCTs, most frequently published by the New England Journal of Medicine [13 papers], Lancet [7], and Journal of the American Medical Association [5]) with an agreement ≥67% from over 250 physicians (46 countries). Noninvasive ventilation was the intervention supported by the largest number of RCTs (n = 13). The concordance between agreement and use (a positive answer both to "do you agree" and "do you use") showed differences between Western and other countries and between anesthesiologists and intensive care unit physicians. The authors identified 27 clinical interventions with randomized evidence of survival benefit and strong clinician support in support of their potential life-saving properties in perioperative and critically ill patients with noninvasive ventilation having the highest level of support. However, clinician views appear affected by specialty and geographical location.


Assuntos
Cuidados Críticos/métodos , Estado Terminal/mortalidade , Internet , Médicos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Inquéritos e Questionários , Cuidados Críticos/tendências , Estado Terminal/terapia , Humanos , Unidades de Terapia Intensiva/tendências , Internet/tendências , Mortalidade/tendências , Médicos/tendências
7.
Evid. actual. práct. ambul ; 21(3): 70-72, oct. 2018.
Artigo em Espanhol | LILACS | ID: biblio-1016174

RESUMO

En este artículo, el autor reflexiona sobre sobre el presente y el futuro de la educación médica en el contexto de las tecnologías de la información y de la convivencia de nuestro trabajo con los dispositivos de inteligencia artificial, de los nuevos contenidos de genética y neurociencias, del trabajo en equipo y de la necesaria resignifificación de los términos "cura" y "cuidado". Se pregunta además si estamos en condiciones de encarar dicho desafío y de estar a la altura de las necesidades educativas de las próximas (y la actual) generación/es de médicos. (AU)


In this article, the author reflects on the present and the future of medical education in the context of information technologies and the coexistence of our work with artificial intelligence devices, the new contents of genetics and neurosciences, about team work and the necessary resignification of the terms "cure" and "care". He also wonders if we are able to face this challenge and to deal with the educational needs of the next (and the current) generation/s of doctors. (AU)


Assuntos
Humanos , Inteligência Artificial/tendências , Educação/tendências , Educação Médica/tendências , Tecnologia da Informação/tendências , Docentes de Medicina/tendências , Médicos/psicologia , Médicos/tendências , Neurociências/educação , Cura em Homeopatia/tendências , Educação Médica/estatística & dados numéricos , Avaliação Educacional , Empatia , Docentes de Medicina/educação , Genética/educação
11.
SEMERGEN, Soc. Esp. Med. Rural Gen. (Ed. Impr.) ; 44(3): 211-215, abr. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-173473

RESUMO

Este artículo trata de explicar cómo, desde el punto de vista antropológico, el colectivo médico se comporta como una tribu similar a las que pueblan el Amazonas o la sabana africana. La familia como unidad fundamental de la banda de cazadores define a su vez el centro de salud y a los médicos que lo habitan, como grupo igualitario en el que los miembros trabajan por el bien de la tribu. Los líderes de la tribu, también llamados directores de centro, también son similares a los grandes hombres de la Polinesia o a los aborígenes que lideran la partida de caza. Incluso los enfrentamientos entre médicos, en torno a sus competencias respecto a los pacientes, han sido descritas a lo largo de la historia por los antropólogos y repiten los patrones de los grupos segmentarios. Se concluye con que esta visión de tribus enfrentadas se ha de superar para avanzar hacia la mejora de la salud de la población


In this paper we try to explain, using an anthropological point of view, how the medical community behaves like a tribe like those who inhabit the Amazon forests or the African Savanna. The Family as fundamental unit of a band of hunter-gatherers also defines the Primary Care Centre and the professionals who work there, as an egalitarian group in which every member works for the good of the tribe. The leaders of the tribe, also called "Health Centre Managers", are also comparable to the "big men" of Polynesia or the aborigines, who leads hunting parties. Even the clashes between physicians about the responsibilities as regards patients have been described throughout history in the anthropological literature, and they repeat the patterns of the segmental groups. We finish by concluding that this vision of warring tribes has to be overcome in order to advance towards the improvement of our community's health


Assuntos
Humanos , Médicos/classificação , Médicos/organização & administração , População , Antropologia/organização & administração , Relações Interprofissionais , Papel Profissional , Médicos/tendências , Antropologia/tendências , Grupos Étnicos , Relações Hospital-Médico
12.
Midwifery ; 61: 29-35, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29524773

RESUMO

BACKGROUND AND OBJECTIVES: prescription rates of antidepressants during pregnancy range from 2-3% in The Netherlands to 6.2% in the USA. Inconclusive evidence about harms and benefits of antidepressants during pregnancy leads to variation in advice given by gynaecologists and midwives. The objective was to investigate familiarity with, and adherence to the Dutch multidisciplinary guideline on Selective Serotonin Reuptake Inhibitor (SSRI) use during pregnancy by gynaecologists and midwives in the Netherlands. METHODS: an online survey was developed and send to Dutch gynaecologists and midwives. The survey consisted mainly of multiple-choice questions addressing guideline familiarity and current practice of the respondent. Also, caregiver characteristics associated with guideline adherence were investigated. FINDINGS: a total of 178 gynaecologists and 139 midwives responded. Overall familiarity with the Dutch guideline was 92.7%. However, current practice and advice given to patients by caregivers differed substantially, both between gynaecologists and midwives as well as within both professions. Overall guideline adherence was 13.9%. Multivariable logistic regression showed that solely caregiver profession was associated with guideline adherence, with gynaecologists having a higher adherence rate (OR 2.10, 95%CI 1.02-4.33) than midwives. KEY CONCLUSION: although reported familiarity with the guideline is high, adherence to the guideline is low, possibly resulting in advice to patients that is inconsistent with guidelines and unwanted variation in current practice. IMPLICATIONS FOR PRACTICE: further implementation of the recommendations as given in the guideline should be stimulated. Additional research is needed to examine how gynaecologists and midwives can be facilitated to follow the recommendations of the clinical guideline on SSRI use during pregnancy.


Assuntos
Antidepressivos/uso terapêutico , Enfermeiras Obstétricas/normas , Médicos/normas , Padrões de Prática Médica/normas , Adulto , Estudos Transversais , Feminino , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/tendências , Ginecologia/métodos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Países Baixos , Enfermeiras Obstétricas/tendências , Médicos/tendências , Gravidez , Cuidado Pré-Natal/métodos , Inquéritos e Questionários , Recursos Humanos
13.
Int J Clin Pharm ; 40(2): 474-479, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29468527

RESUMO

Background Given the complexity of solid organ transplant recipients, a multidisciplinary approach is required. To promote medication safety and enable providers to focus on the medical and surgical needs of these patients, our department of pharmacy created a collaborative practice agreement between physicians and pharmacists. Through this agreement, credentialed pharmacists are empowered to provide inpatient services including initiation and adjustment of medications through independent review of laboratory results after multidisciplinary rounds. Objective To evaluate the effect of our collaborative practice agreement on clinical care and institutional finances. Setting An inpatient setting at a large academic medical center. Methods Three transplant pharmacists entered all clinical interventions made on abdominal transplant recipients between September and October 2013 into Quantifi®, a software application that categorizes and assigns a cost savings value based on impact and type of intervention. Main outcome measure The main outcome measures in this study were number and categorization of interventions, as well as estimated cost savings to the institution. Results There were 1060 interventions recorded, an average of 20 interventions per pharmacist per day. The most common interventions were pharmacokinetic evaluations (36%) and dose adjustments (19%). Over the time period, these interventions translated into an estimated savings of $107,634.00, or an annual cost savings of $373,131.20 per pharmacist, or a cost-benefit ratio of 2.65 to the institution. Conclusions Based on our study, implementation of a collaborative practice agreement enables credentialed pharmacists to make clinically and financially meaningful interventions in a complex patient population.


Assuntos
Custos Hospitalares/tendências , Colaboração Intersetorial , Transplante de Órgãos/tendências , Farmacêuticos/tendências , Médicos/tendências , Papel Profissional , Redução de Custos/economia , Redução de Custos/tendências , Humanos , Transplante de Órgãos/economia , Farmacêuticos/economia , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/tendências , Médicos/economia , Estudos Prospectivos
14.
Int J Clin Pharm ; 40(2): 464-473, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29372492

RESUMO

Background Effective communication between health professionals contributes to safe and efficient patient care, whereas communication breakdown can lead to adverse patient outcomes and increased healthcare expenditure. Information on how pharmacists and doctors communicate with each other in hospitals is limited. Objective To explore usage and perceptions of communication methods by doctors and pharmacists in hospital settings. Setting Four public hospitals in Australia. Method A mixed method study utilising a pilot questionnaire, semi-structured interviews, and electronic survey was designed. Frequentist statistics and logistic regression were used to analyse survey data. Thematic analysis was conducted to evaluate semi-structured interview data and free-text survey comments. MAIN OUTCOME MEASURES: Frequency of use of communication methods, perceptions of the convenience, time taken to use, accuracy and effectiveness of each method. Results More than 95% of doctors and pharmacists combined used face-to-face and phone calls to communicate with each other, 70% used a medication management plan, and 62% used progress notes. A preference for oral communication was confirmed with the expressed need for building professional rapport and receiving responses. Perceptions regarding effectiveness of oral communication methods were related to perceptions of their convenience and accuracy. Professional groups described differences in perceived ownership of various modes of communication. Conclusions Preferences for oral communication create potential issues with recall and comprehension. Integrating oral communication features into written communication methods, e.g. creating responses, conversations, building rapport, may change doctors' and pharmacists' perceptions of effectiveness. Communication receipt and response functionality in electronic medication and record management systems may improve communication.


Assuntos
Comunicação , Hospitais Públicos , Colaboração Intersetorial , Percepção , Farmacêuticos/psicologia , Médicos/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Hospitais Públicos/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Farmacêuticos/tendências , Médicos/tendências , Inquéritos e Questionários
15.
BMJ Open ; 8(1): e018538, 2018 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-29317415

RESUMO

OBJECTIVES: In this longitudinal study, we examined changes in the geographical distribution of physicians in Japan from 2000 to 2014 by clinical specialty with adjustments for healthcare demand based on population structure. METHODS: The Japanese population was adjusted for healthcare demand using health expenditure per capita stratified by age and sex. The numbers of physicians per 100 000 demand-adjusted population (DAP) in 2000 and 2014 were calculated for subprefectural regions known as secondary medical areas. Disparities in the geographical distribution of physicians for each specialty were assessed using Gini coefficients. A subgroup analysis was conducted by dividing the regions into four groups according to urban-rural classification and initial physician supply. RESULTS: Over the study period, the number of physicians per 100 000 DAP decreased in all specialties assessed (internal medicine: -6.9%, surgery: -26.0%, orthopaedics: -2.1%, obstetrics/gynaecology (per female population): -17.5%) except paediatrics (+33.3%) and anaesthesiology (+21.1%). No reductions in geographical disparity were observed in any of the specialties assessed. Geographical disparity increased substantially in internal medicine, surgery and obstetrics and gynaecology(OB/GYN). Rural areas with lower initial physician supply experienced the highest decreases in physicians per 100 000 DAP for all specialties assessed except paediatrics and anaesthesiology. In contrast, urban areas with lower initial physician supply experienced the lowest decreases in physicians per 100 000 DAP in internal medicine, surgery, orthopaedics and OB/GYN, but the highest increase in anaesthesiology. CONCLUSION: Between 2000 and 2014, the number of physicians per 100 000 DAP in Japan decreased in all specialties assessed except paediatrics and anaesthesiology. There is also a growing urban-rural disparity in physician supply in all specialties assessed except paediatrics. Additional measures may be needed to resolve these issues and improve physician distribution in Japan.


Assuntos
Mão de Obra em Saúde/estatística & dados numéricos , Mão de Obra em Saúde/tendências , Medicina/estatística & dados numéricos , Médicos/provisão & distribução , Médicos/tendências , Feminino , Humanos , Japão , Estudos Longitudinais , Masculino , Serviços de Saúde Rural , População Rural , População Urbana
16.
Acad Psychiatry ; 42(3): 346-353, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29302928

RESUMO

OBJECTIVE: The goal of this study was to identify trends in MD/PhD graduates entering psychiatry, to compare these trends with other specialties, and to review strategies for enhancing the physician-scientist pipeline. METHODS: Data on 226,588 medical students graduating from Liaison Committee on Medical Education accredited programs between 1999 and 2012 (6626 MD/PhDs) were used to evaluate the number, percentage, and proportion of MD/PhDs entering psychiatry in comparison with other specialties (neurology, neurosurgery, internal medicine, family medicine, and radiation oncology). Linear regression and multiple linear regression determined whether these values increased over time and varied by sex. RESULTS: Over 14 years, an average of 18 MD/PhDs (range 13-29) enrolled in psychiatry each year. The number of MD/PhDs going into psychiatry significantly increased, although these gains were modest (less than one additional MD/PhD per year). The proportion of students entering psychiatry who were MD/PhDs varied between 2.9 and 5.9 per 100 residents, with no significant change over time. There was also no change in the percentage of MD/PhDs entering psychiatry from among all MD/PhD graduates. The rate of increase in the number of MD/PhDs going into psychiatry did not differ significantly from other specialties except for family medicine, which is decreasing. The rate of MD/PhDs going into psychiatry was higher for women, suggesting closure of the sex gap in 17 years. CONCLUSIONS: Despite the increase in the number of MD/PhDs entering psychiatry, these numbers remain low. Expanding the cohort of physician-scientists dedicated to translational research in psychiatry will require a multipronged approach.


Assuntos
Pesquisa Biomédica , Escolha da Profissão , Internato e Residência , Médicos/tendências , Psiquiatria/educação , Pesquisa Biomédica/educação , Pesquisa Biomédica/tendências , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Masculino , Médicos/estatística & dados numéricos , Médicas/estatística & dados numéricos , Médicas/tendências , Apoio à Pesquisa como Assunto , Estados Unidos , Recursos Humanos
17.
J Pharm Pract ; 31(3): 272-278, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28539104

RESUMO

Collaborative drug therapy management (CDTM) is a written agreement that allows a pharmacist to initiate, modify, or continue pharmacotherapies under a physician's scope of practice. While available literature pertaining to cardiometabolic and respiratory CDTM services is growing, publications are sparse in psychiatry, particularly outside Veterans Health Administration medical centers. A descriptive study was undertaken to demonstrate how a board-certified psychiatric pharmacist would begin organizing a protocol for clinical pharmacy services at an outpatient, community treatment center for mental health and substance abuse disorders. The primary CDTM service proposed was metabolic monitoring for atypical antipsychotics, though profile reviews for medication reconciliation, drug level monitoring, and insurance coverage were also considered. Potential obstacles identified and worked through during the project included pharmacist-prescriber relationships, federal and state law requirements, pharmacy informatics development, and pharmacy services billing. Discussions with both administrative and medical stakeholders across the health system were essential in helping a pharmacist detail professional qualifications, justify positive impacts on patient outcomes, and navigate these legal and financial issues. The systematic approach arrived at through the study addresses current literature gaps concerning how pharmacists can evolve their practices from ancillary to collaborative design by nature within psychiatric settings.


Assuntos
Serviços Comunitários de Farmácia/tendências , Serviços de Emergência Psiquiátrica/tendências , Colaboração Intersetorial , Conduta do Tratamento Medicamentoso/tendências , Farmacêuticos/tendências , Médicos/tendências , Instituições de Assistência Ambulatorial/tendências , Serviços de Saúde Comunitária/tendências , Humanos , Transtornos Mentais/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico
18.
Int J Cardiol ; 251: 1-7, 2018 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-29092757

RESUMO

BACKGROUND: With a mortality rate above European average, myocardial infarction (MI) is the second most common cause of death in Germany. Data about post-MI ambulatory care and mortality is scarce. We examined the association between ambulatory treating physicians' specialty and the mortality of post-MI patients. METHODS: Medical claims data of all 17 German regional Associations of Statutory Health Insurance physicians were analyzed, which cover approximately 90% of the German population. Patients with a new diagnosis of a MI in 2011 were divided into treatment groups with and without ambulant cardiology care within the first year after MI diagnosis. Propensity-score matching based on socio-demographic and clinical variables was performed to achieve comparability between groups. The 18-month mortality rate was derived employing a validated method. RESULTS: 158,494 patients with a new diagnosis of MI had received post-MI ambulatory care in 2011. Half of them (51%) had at least one ambulatory contact with a cardiologist within the first year. During a follow-up of 18months, the mortality rate before and after propensity-score matching was 19% and 14% in patients without cardiology care and 6%, respectively, in patients with cardiology care (χ2=666.7; P<0.000 after propensity adjustment). Patients who only saw a cardiologist and had no additional contact to an ambulant general practitioner (GP)/internist within the first year did not have increased survival rates. CONCLUSIONS: Outpatient follow-up care by a cardiologist in combination with consultations of GP/internists within the first year may be of importance for the prognosis of MI patients.


Assuntos
Assistência Ambulatorial/tendências , Cardiologistas/tendências , Seguro Saúde/tendências , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/métodos , Feminino , Seguimentos , Alemanha/epidemiologia , Humanos , Masculino , Medicina/métodos , Medicina/tendências , Pessoa de Meia-Idade , Médicos/tendências , Pontuação de Propensão , Taxa de Sobrevida/tendências
19.
J Pharm Pract ; 31(3): 268-271, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28532224

RESUMO

BACKGROUND: This study analyzed the impact of a pharmacist-managed diabetes clinic on clinical outcomes compared to usual care received from primary care providers (PCPs). This comparison may more definitively demonstrate the value of pharmacist management of chronic disease states. METHODS: Retrospective observational cohort study conducted in patients referred to a pharmacist-managed pharmacotherapy (PT) clinic from July 2009 to October 2014. RESULTS: For the primary outcome, the absolute change in A1c during the usual care phase was +1.53% (95% confidence interval [CI]: 1.10-1.96, P < .0001) versus an absolute change of -1.63% (95% CI: -1.28 to -1.97, P < .0001) in the intervention phase. For secondary outcomes, diabetes-related hospitalizations (10 vs 6, P = .104) and emergency room (ER) visits (27 vs 8, P = .049) decreased in the intervention phase compared to the usual care phase. The rate of diabetes-related interventions made per patient per year in the usual care phase was 2.7 versus 11.1 in the intervention phase ( P < .0001). CONCLUSION: Patients referred to the PT clinic had worsening blood glucose control prior to referral, and their control improved after referral to the clinic. Furthermore, there was an improvement in all diabetes-related outcomes in the intervention phase compared to the usual care phase.


Assuntos
Instituições de Assistência Ambulatorial/normas , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/terapia , Assistência ao Paciente/normas , Farmacêuticos/normas , Médicos/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial/tendências , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/métodos , Assistência ao Paciente/tendências , Farmacêuticos/tendências , Médicos/tendências , Papel Profissional , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/tendências , Estudos Retrospectivos , Resultado do Tratamento
20.
Med Leg J ; 86(1): 32-35, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29206080

RESUMO

In 2000, the Institute of Medicine stunned many professionals with their published report that noted the vast number of deaths that occur each year in hospitals across the United States which reach as many as 98,000. Therefore, it comes as no surprise that the healthcare arena faces litigious issues regularly, with some specialties budgets being significantly impacted by the cost of maintaining liability insurance. Legal Nurse Consultants and forensic physicians working in tandem but who work independently from treating clinicians can carry out forensic independent medical examinations (IME). This can help to assess the validity of malpractice claims, including issues of causation and degree of injuries claimed due to the incident(s) and recommend treatment strategies where appropriate. Reviews can cover a wide range of issues such as a person's past or current testamentary capacity, a prisoner or an accused person's mental health and/or mental impairment where necessary sending them for more assessment or treatment outside prison. This article argues that independent medical reviews are a useful tool that can assist the civil and criminal courts processes.


Assuntos
Consultores/legislação & jurisprudência , Psiquiatria Legal/legislação & jurisprudência , Responsabilidade Legal , Humanos , Papel do Profissional de Enfermagem , Enfermeiras e Enfermeiros/legislação & jurisprudência , Enfermeiras e Enfermeiros/organização & administração , Enfermeiras e Enfermeiros/tendências , Médicos/legislação & jurisprudência , Médicos/tendências , Estados Unidos
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