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1.
BMC Infect Dis ; 19(1): 943, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703669

RESUMO

BACKGROUND: A large proportion of people who inject drugs (PWID) living with hepatitis C virus (HCV) infection have not been treated. It is unknown whether inclusion of HCV diagnostics and treatment into integrated substance use disorder treatment and care clinics will improve uptake and outcome of HCV treatment in PWID. The aim is to assess the efficacy of integrating HCV treatment to PWID and this paper will present the protocol for an ongoing trial. METHODS: INTRO-HCV is a multicentre, randomised controlled clinical trial that will compare the efficacy of integrated treatment of HCV in PWID with the current standard treatment. Integrated treatment includes testing for HCV, assessing liver fibrosis with transient elastography, counselling, treatment delivery, follow-up and evaluation provided by integrated substance use disorder treatment and care clinics. Most of these clinics for PWID provide opioid agonist therapy while some clinics provide low-threshold care without opioid agonist therapy. Standard care involves referral to further diagnostics, treatment and treatment follow-up given in a hospital outpatient clinic with equivalent medications. The differences between the delivery platforms in the two trial arms involve use of a drop-in approach rather than specific appointment times, no need for additional travelling, less blood samples taken during treatment, and treatment given from already known clinicians. The trial will recruit approximately 200 HCV infected individuals in Bergen and Stavanger, Norway. The primary outcomes are time to treatment initiation and sustained virologic response, defined as undetectable HCV RNA 12 weeks after end of treatment. Secondary outcomes are cost-effectiveness, treatment adherence, changes in quality of life, fatigue and psychological well-being, changes in drug use, infection related risk behaviour, and risk of reinfection. The target group is PWID with HCV diagnosed receiving treatment and care within clinics for PWID. DISCUSSION: This study will inform on the effects of an integrated treatment program for HCV in clinics for PWID compared to standard care aiming to increase access to treatment and improving treatment adherence. If the integrated treatment model is found to be safe and efficacious, it can be considered for further scale-up. TRIAL REGISTRATION: ClinicalTrials.gov.no. NCT03155906.


Assuntos
Antivirais/uso terapêutico , Prestação Integrada de Cuidados de Saúde/métodos , Hepacivirus/genética , Hepatite C/tratamento farmacológico , Tratamento de Substituição de Opiáceos , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Assistência ao Convalescente , Análise Custo-Benefício , Aconselhamento , Feminino , Hepatite C/etiologia , Humanos , Masculino , Noruega , Reação em Cadeia da Polimerase , Qualidade de Vida , Recidiva , Abuso de Substâncias por Via Intravenosa/complicações , Resposta Viral Sustentada , Cooperação e Adesão ao Tratamento
2.
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-31702984

RESUMO

INTRODUCTION: Despite guidelines for prevention of recurrent renal calculi, routine dietary modification and metabolic evaluation are often not performed. OBJECTIVE: To determine feasibility of a multicenter, pharmacist-staffed program to enroll patients at high risk of recurrent kidney stones and provide dietary instruction, metabolic evaluation, and medical therapy via telemedicine. METHODS: A total of 536 consecutive adult patients were referred from 3 Northern California Kaiser Permanente facilities. We determined the proportion of patients who enrolled, received dietary counseling, and completed metabolic evaluation at 12 months. The program was staffed by a clinical pharmacist and supervised by urologists following a protocol based on the American Urological Association guidelines. Patients were contacted entirely via telemedicine. Cystine or struvite kidney stones, renal tubular acidosis, and primary hyperoxaluria were exclusion criteria. RESULTS: Of the 536 patients, 500 agreed to enrollment. Among patients enrolled for 3 months, 99% self-reported compliance with at least 3 of 5 aspects of dietary advice. A complete metabolic evaluation including 24-hour urine collection was performed in 80% of patients by 12 months. A significant improvement in all urinary parameters occurred in 52 patients with calcium stones who repeated 24-hour urine testing. The 12-month dropout rate was 12.4%. CONCLUSION: A telemedicine-administered, pharmacist-staffed, protocol-driven program can provide dietary advice and obtain compliance with metabolic testing for patients at high risk of recurrent kidney stones. Rates of metabolic testing and dropout compare favorably with previously reported rates. This report represents, to our knowledge, the first telemedicine-administered, pharmacist-staffed, kidney stone prevention program published in the literature.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Cálculos Renais/prevenção & controle , Farmacêuticos , Telemedicina/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Prestação Integrada de Cuidados de Saúde/organização & administração , Dieta , Estudos de Viabilidade , Feminino , Humanos , Cálculos Renais/epidemiologia , Masculino , Pessoa de Meia-Idade , Farmacêuticos/organização & administração , Projetos Piloto , Telemedicina/organização & administração , Adulto Jovem
3.
Med Care ; 57(11): 882-889, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31567863

RESUMO

OBJECTIVE: The objective of this study was to assess the potential health and budgetary impacts of implementing a pharmacist-involved team-based hypertension management model in the United States. RESEARCH DESIGN: In 2017, we evaluated a pharmacist-involved team-based care intervention among 3 targeted groups using a microsimulation model designed to estimate cardiovascular event incidence and associated health care spending in a cross-section of individuals representative of the US population: implementing it among patients with: (1) newly diagnosed hypertension; (2) persistently (≥1 year) uncontrolled blood pressure (BP); or (3) treated, yet persistently uncontrolled BP-and report outcomes over 5 and 20 years. We describe the spending thresholds for each intervention strategy to achieve budget neutrality in 5 years from a payer's perspective. RESULTS: Offering this intervention could prevent 22.9-36.8 million person-years of uncontrolled BP and 77,200-230,900 heart attacks and strokes in 5 years (83.8-174.8 million and 393,200-922,900 in 20 years, respectively). Health and economic benefits strongly favored groups 2 and 3. Assuming an intervention cost of $525 per enrollee, the intervention generates 5-year budgetary cost-savings only for Medicare among groups 2 and 3. To achieve budget neutrality in 5 years across all groups, intervention costs per person need to be around $35 for Medicaid, $180 for private insurance, and $335 for Medicare enrollees. CONCLUSIONS: Adopting a pharmacist-involved team-based hypertension model could substantially improve BP control and cardiovascular outcomes in the United States. Net cost-savings among groups 2 and 3 make a compelling case for Medicare, but favorable economics may also be possible for private insurers, particularly if innovations could moderately lower the cost of delivering an effective intervention.


Assuntos
Orçamentos , Prestação Integrada de Cuidados de Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Hipertensão/economia , Equipe de Assistência ao Paciente/economia , Simulação por Computador , Redução de Custos , Análise Custo-Benefício , Estudos Transversais , Prestação Integrada de Cuidados de Saúde/métodos , Humanos , Farmacêuticos/economia , Estados Unidos
4.
BMC Health Serv Res ; 19(1): 682, 2019 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-31581947

RESUMO

BACKGROUND: Person-centred care (PCC) focusing on personalised goals and care plans derived from "What matters to you?" has an impact on single disease outcomes, but studies on multi-morbid elderly are lacking. Furthermore, the combination of PCC, Integrated Care (IC) and Pro-active care are widely recognised as desirable for multi-morbid elderly, yet previous studies focus on single components only, leaving synergies unexplored. The effect of a synergistic intervention, which implements 1) Person-centred goal-oriented care driven by "What matters to you?" with 2) IC and 3) pro-active care is unknown. METHODS: Inspired by theoretical foundations, complexity science, previous health service research and a patient-driven evaluation of care quality, we designed the Patient-Centred Team (PACT) intervention across primary and secondary care. The PACT team collaborate with the patient to make and deliver a person-centred, integrated and proactive multi-morbidity care-plan. The control group receives conventional care. The study design is a pragmatic six months prospective, controlled clinical trial based on hospital electronic health record data of 439 multi-morbid frail elderly at risk for emergency (re) admissions referred to PACT and 779 propensity score matched controls in Norway, 2014-2016. Outcomes are emergency admissions, the sum of emergency inpatient bed days, 30-day readmissions, planned and emergency outpatient visits and mortality at three and six months follow-up. RESULTS: The Rate Ratios (RR) for emergency admissions was 0,9 (95%CI: 0,82-0,99), for sum of emergency bed days 0,68 (95%CI:0,52-0,79) and for 30-days emergency readmissions 0,72 (95%CI: 0,41-1,24). RRs were 2,3 (95%CI: 2,02-2,55) and 0,9 (95%CI: 0,68-1,20) for planned and emergency outpatient visits respectively. The RR for death at 3 months was 0,39 (95% CI: 0,22-0,70) and 0,57 (95% CI: 0,34-0,94) at 6 months. CONCLUSION: Compared with propensity score matched controls, the care process of frail multi-morbid elderly who received the PACT intervention had a reduced risk of high-level emergency care, increased use of low-level planned care, and substantially reduced mortality risk. Further study of process differences between groups is warranted to understand the genesis of these results better. TRIAL REGISTRATION: ClinicalTrials.gov (identifier: NCT02541474 ), registered Sept 2015.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Múltiplas Afecções Crônicas/terapia , Assistência Centrada no Paciente/métodos , Idoso , Serviço Hospitalar de Emergência , Feminino , Idoso Fragilizado/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Morbidade , Noruega , Planejamento de Assistência ao Paciente , Readmissão do Paciente/estatística & dados numéricos , Pontuação de Propensão , Estudos Prospectivos , Autocuidado
5.
Clín. investig. arterioscler. (Ed. impr.) ; 31(5): 222-227, sept.-oct. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-184165

RESUMO

La existencia de una buena coordinación entre los distintos niveles asistenciales constituye un factor fundamental en el desarrollo de una asistencia sanitaria de calidad y eficiente. El médico de atención primaria es fundamental en la prevención secundaria de la enfermedad cardiovascular, y la estrecha colaboración entre atención primaria y cardiología constituye un factor clave en el control de la enfermedad cardiovascular. El proyecto CAPaCERES (Colaboración AP-Cardiología en Cáceres) pretende mejorar la coordinación entre atención primaria y cardiología desde la perspectiva del conocimiento mutuo y la mejora de la comunicación entre los profesionales que la desarrollan, y con ello a mejorar la calidad de la asistencia al paciente crónico con enfermedad cardiovascular


The existence of good coordination between the different levels of care is an essential factor in the development of quality and efficient healthcare. The primary care physician is fundamental in the secondary prevention of cardiovascular disease and the close collaboration between primary care and cardiology is a key factor in the control of cardiovascular disease. The CAPaCERES project (AP-Cardiology Collaboration in Cáceres) aims to improve the coordination between primary care and cardiology from the perspective of mutual knowledge and the improvement of communication between the professionals who develop it, and with that to improve the quality of care chronic patient with cardiovascular disease


Assuntos
Humanos , Assistência à Saúde , Atenção Primária à Saúde , Doenças Cardiovasculares/prevenção & controle , Comunicação , Projetos Piloto , Educação Continuada , Prevenção Secundária , Prestação Integrada de Cuidados de Saúde/métodos
6.
Afr J Prim Health Care Fam Med ; 11(1): e1-e11, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31478738

RESUMO

BACKGROUND:  Medical male circumcision (MMC) and traditional male circumcision (TMC) are reportedly having negative and positive outcomes in the Eastern Cape province. Researchers show contradictory remedies; some advocate for abolishment of TMC and others call for the integration of both methods. AIM:  This study aimed to explore factors influencing the integration of TMC and MMC at different socio-ecological levels. SETTING:  The study was conducted at Ingquza Hill Local Municipality in the Eastern Cape province. METHODS:  An explorative qualitative study design, using in-depth interviews (IDIs) and focus group discussions (FGDs), was employed in this study. Purposive sampling was used to select the participants. A framework analysis approach was used to analyse the data, and the themes were developed in line with the socio-ecological model. RESULTS:  Four main themes emerged from the data as important in influencing the integration of TMC and MMC methods. These included: (1) individual factors, related to circumcision age eligibility and post-circumcision behaviour; (2) microsystem factors, related to alcohol and drug abuse, peer pressure, abuse of initiates, and family influence; (3) exosystem factors, related to financial gains associated with circumcision and the role of community forums; and (4) macrosystem factors, related to stigma and discrimination, and male youth dominance in circumcision practices. CONCLUSION:  Male circumcision in this area is influenced by complex factors at multiple social levels. Interventions directed at all of these levels are urgently needed to facilitate integration of the TMC and MMC methods.


Assuntos
Atitude do Pessoal de Saúde , Circuncisão Masculina/psicologia , Prestação Integrada de Cuidados de Saúde/métodos , Medicina Tradicional Africana/psicologia , Adulto , Idoso , Circuncisão Masculina/métodos , Fenômenos Ecológicos e Ambientais , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Infuência dos Pares , Pesquisa Qualitativa , Estigma Social , Fatores Socioeconômicos , África do Sul
7.
World J Gastroenterol ; 25(27): 3546-3562, 2019 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-31367156

RESUMO

Current evidence shows that individuals with gastric dysplasia, severe and extensive gastric atrophy, extensive gastric intestinal metaplasia and the incomplete subtype of intestinal metaplasia are at high risk for gastric cancer (GC) development. There are several approaches to identifying these subjects, including noninvasive methods, esophagogastroduodenoscopy and histology. The main approach in Western countries is histology-based while that in Eastern countries with a high prevalence of GC is endoscopy-based. Regarding asymptomatic individuals, the key issues in selecting applicable approaches are the ability to reduce GC mortality and the cost-effectiveness of the approach. At present, population-based screening programs have only been applied in a few Asian countries with a high risk of GC. Pre-endoscopic risk assessment based on demographic and clinical features, such as ethnicity, age, gender, smoking and Helicobacter pylori status, is helpful for identifying subjects with high pre-test probability for a possibly cost-effective approach, especially in intermediate- and low-risk countries. Regarding symptomatic patients with indications for esophagogastroduodenoscopy, the importance of opportunistic screening should be emphasized. The combination of endoscopic and histological approaches should always be considered as endoscopy provides a real-time assessment of the patient's risk level. In addition, imaging enhanced endoscopy (IEE) has been shown to facilitate targeted biopsies resulting in better correlation between endoscopic and histological findings. Currently, the use of IEE is recommended for endoscopic examinations, and the Operative Link for Gastric Intestinal Metaplasia or Operative Link on Gastritis Assessment grading systems are recommended for histological examinations whenever available. However, resource limitations are an important barrier in many regions worldwide. Thus, for an approach to be applicable in real-life practice, it should be not only evidence-based but also resource-sensitive. In this review, we discuss the current understanding and approaches to identifying high-risk individuals from western and eastern perspectives, as well as the possibility of an integrated, resource-sensitive approach.


Assuntos
Detecção Precoce de Câncer/métodos , Endoscopia do Sistema Digestório/métodos , Programas de Rastreamento/métodos , Lesões Pré-Cancerosas/diagnóstico , Neoplasias Gástricas/diagnóstico , Biópsia , Comparação Transcultural , Prestação Integrada de Cuidados de Saúde/métodos , Progressão da Doença , Medicina Baseada em Evidências/métodos , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/patologia , Carga Global da Doença , Humanos , Incidência , Imagem Multimodal/métodos , Lesões Pré-Cancerosas/epidemiologia , Lesões Pré-Cancerosas/patologia , Medição de Risco/métodos , Fatores de Risco , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/patologia
9.
Biosci Trends ; 13(3): 279-281, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31327797

RESUMO

Japan is experiencing unprecedented aging of its population. People age 65 years or older accounted for 28.1% of the total population in 2018, and that proportion is expected to reach 33.3% in 2036 and 38.4% in 2065. In 2017, the average life expectancy in Japan was 81.09 years for men and 87.26 years for women. By 2065, it is expected to reach 84.95 years for men and 91.35 years for women. Population aging affects health and long-term care systems. The government proposed the establishment of "a community-based integrated care system" by 2025 with the purpose of comprehensively ensuring the provision of health care, nursing care, preventive care, housing, and livelihood support. This will require health care and nursing care professionals who are capable of fully understanding the physical and mental characteristics of elderly people and the fostering of organic collaboration with others professionals in the community-based integrated care system. A department of gerontology or geriatric medicine is desired to be established in each medical school to teach students medicine and efficient medical care, to conduct research, and to develop personnel to facilitate this paradigm shift. In 2018, there were 263 colleges of nursing with an admissions capacity of 23,667. In Japan, Certified Nurse Specialists can specialize in 13 areas as of December 2016. The number of Certified Nurse Specialists increased to 2,279 as of December 2018. One hundred and forty-four of those specialists specialized in Gerontological Nursing while 53 specialized in Home Care Nursing. The number of nurses specializing in Gerontological Nursing and Home Care Nursing is desired to be increased in order to implement and improve community-based comprehensive care.


Assuntos
Enfermagem Geriátrica/métodos , Geriatria/métodos , Assistência à Saúde/métodos , Prestação Integrada de Cuidados de Saúde/métodos , Feminino , Serviços de Assistência Domiciliar , Humanos , Japão , Masculino
10.
J Holist Nurs ; 37(3): 260-272, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31257971

RESUMO

Background: Nurses and others have used various terms to describe our caring/healing approach to practice. Because terms used can influence our image of ourselves and the image others have of us, we sought to clarify their meanings. Questions: How are the terms holistic nursing, integrative health care, and integrative nursing defined or described? Do we identify with these definitions/descriptions? Are the various terms the same or are they distinct? Method: We conducted an integrated review of peer-reviewed literature following the process described by Whittemore and Knafl. Using standard search methods, we reviewed full texts of 94 published papers and extracted data from 58 articles. Findings: Holistic describes "whole person care" often acknowledging body-mind-spirit. Holistic nursing defines a disciplinary practice specialty. The term integrative refers to practice that includes two or more disciplines or distinct approaches to care. Both terms, integrative and holistic, are associated with alternative/complementary modalities and have similar philosophical and/or theoretical underpinnings. Conclusions: There is considerable overlap between holistic nursing and integrative nursing. The relationship of integrative nursing to integrative health care is unclear based solely on definitions. Consideration of terms used provides opportunities for reflection, collaboration, and growth.


Assuntos
Prestação Integrada de Cuidados de Saúde/classificação , Enfermagem Holística/classificação , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/tendências , Enfermagem Holística/métodos , Enfermagem Holística/tendências , Humanos
11.
Fam Syst Health ; 37(2): 173-175, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31180709

RESUMO

In addition to providing critical behavioral health services for those with mental health issues and substance use disorders, some Community Mental Health Centers (CMHCs) in the United States have begun integrating primary care services, referred to as "reverse integration". Representing the interests of CMHCs across the United States, the National Council for Behavioral Health (NCBH) represents over 3,000 member organizations delivering mental health and/or addictions treatment and services to roughly 10 million patients and families. This article reflects a recent wide-ranging conversation with Linda Rosenberg, the president and CEO of NCBH. Trained as a social worker, Rosenberg was senior deputy commissioner of the New York State Office of Mental Health prior to joining the NCBH and is a dynamic and high-energy strategist and thought leader in the field of community mental health and integrated care. We discussed issues impacting payment for integrated care, including private equity investment, capitated payment, and the role of risk, and how these market dynamics impact vulnerable populations. For the sake of brevity, we summarize our conversation with Ms. Rosenberg and offer her perspective to integrated care practitioners and researchers who largely operate outside of this world of business built on calculated risks and rewards. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Gestão de Mudança , Centros Comunitários de Saúde Mental/tendências , Prestação Integrada de Cuidados de Saúde/tendências , Centros Comunitários de Saúde Mental/organização & administração , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/organização & administração , Feminino , Humanos , Liderança , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , New York , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Estados Unidos
12.
AIDS Behav ; 23(11): 3175-3183, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31154559

RESUMO

Social media can potentially serve as a platform to coordinate medical care among fragmented health sectors. This paper describes procedures of using social media to enhance antiretroviral therapy (ART) and methadone maintenance treatment (MMT) providers' virtual network for integrated service for HIV-positive people who inject drugs (PWID) in Vietnam. A total of 88 ART and MMT treatment providers participated in person group sessions followed by online virtual support to improve service integration. In-person reunions were held to reinforce Facebook participation and network activities. Content analysis was used to identify keywords and topic categories of the online information exchange. Both MMT and ART providers were actively engaged in online communications. Referral and treatment adherence were the two most frequently discussed topic areas by both the MMT and ART providers. Frequent cross-agency connections were observed. Online provider networks and communities could be built and useful to support treatment providers to improve service integration.


Assuntos
Antirretrovirais/uso terapêutico , Prestação Integrada de Cuidados de Saúde/métodos , Infecções por HIV/psicologia , Redução do Dano , Acesso aos Serviços de Saúde , Metadona/uso terapêutico , Mídias Sociais , Centros de Tratamento de Abuso de Substâncias/organização & administração , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Atitude do Pessoal de Saúde , Infecções por HIV/tratamento farmacológico , Humanos , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/psicologia , Vietnã
13.
Afr J Prim Health Care Fam Med ; 11(1): e1-e7, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31170790

RESUMO

BACKGROUND: Tuberculosis (TB) is the most common presenting illness among people living with human immunodeficiency virus (HIV), with co-infection occurring in up to 60% of cases in South Africa. In line with international guidelines, South Africa has adopted an integrated model at primary healthcare level to provide HIV and TB services by the same healthcare provider at the same visit. AIM: The aim of the study was to conduct a rapid appraisal of integration of HIV and TB services at primary healthcare level in eThekwini District in 2015. SETTING: The study was conducted in 10 provincial primary healthcare clinics in the eThekwini Metropolitan Health District in KwaZulu-Natal Province. METHODS: An observational, cross-sectional study was conducted. Key informant interviews with operational managers and community health workers were conducted, as well as a review of registers and electronic databases for the period of January to March 2015. RESULTS: Two clinics complied with the mandated integrated model. Three clinics were partially integrated; while five clinics maintained the stand-alone model. Possible constraints included reorganisation of on-site location of services, drug provision, TB infection control and inadequate capacity building, while potential enablers comprised structural infrastructure, staffing ratios and stakeholder engagement. CONCLUSION: HIV and TB integration is suboptimal and will need to be improved by addressing the systemic challenges affecting health service delivery, including strengthening supervision, training and the implementation of a change management programme.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Infecções por HIV/terapia , Atenção Primária à Saúde/métodos , Tuberculose/terapia , Estudos Transversais , Prestação Integrada de Cuidados de Saúde/organização & administração , Humanos , Atenção Primária à Saúde/organização & administração , Estudos Retrospectivos , África do Sul
14.
BMC Public Health ; 19(1): 708, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174501

RESUMO

BACKGROUND: A population-based approach to healthcare goes beyond the traditional biomedical model and addresses the importance of cross-sectoral collaboration in promoting health of communities. By establishing partnerships across primary care (PC) and public health (PH) sectors in particular, healthcare organizations can address local health needs of populations and improve health outcomes. The purpose of this study was to map a series of interventions from the empirical literature that facilitate PC-PH collaboration and develop a resource for healthcare organizations to self-evaluate their clinical practices and identify opportunities for collaboration with PH. METHODS: A scoping review was designed and studies from relevant peer-reviewed literature and reports between 1990 and 2017 were included if they met the following criteria: empirical study methodology (quantitative, qualitative, or mixed methods), based in US, Canada, Western Europe, Australia or New Zealand, describing an intervention involving PC-PH collaboration, and reporting on structures, processes, outcomes or markers of a PC-PH collaboration intervention. RESULTS: Out of 2962 reviewed articles, 45 studies with interventions leading to collaboration were classified into the following four synergy groups developed by Lasker's Committee on Medicine and Public Health: Coordinating healthcare services (n = 13); Applying a population perspective to clinical practice (n = 21); Identifying and addressing community health problems (n = 19), and Strengthening health promotion and health protection (n = 21). Furthermore, select empirical examples of interventions and their key features were highlighted to illustrate various approaches to implementing collaboration interventions in the field. CONCLUSIONS: The findings of our review can be utilized by a range of organizations in healthcare settings across the included countries. Furthermore, we developed a self-evaluation tool that can serve as a resource for clinical practices to identify opportunities for cross-sectoral collaboration and develop a range of interventions to address unmet health needs in communities; however, the generalizability of the findings depends on the evaluations conducted in individual studies in our review. From a health equity perspective, our findings also highlight interventions from the empirical literature that address inequities in care by targeting underserved, high-risk populations groups. Further research is needed to develop outcome measures for successful collaboration and determine which interventions are sustainable in the long term.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Promoção da Saúde/métodos , Colaboração Intersetorial , Atenção Primária à Saúde/métodos , Saúde Pública/métodos , Austrália , Canadá , Europa (Continente) , Humanos , Nova Zelândia , Estados Unidos
15.
AIDS Behav ; 23(10): 2840-2848, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31236748

RESUMO

A mixed design approach was performed to assess the CD4 count levels over time and their associated factors among 362 HIV patients on ART from clinics with HIV testing and counseling (ART-HTC) services and those with general healthcare (ART-GH) services. Longitudinal CD4 count data were retrospectively collected from medical records. Sociodemographic, clinical, alcohol use and smoking characteristics were obtained via face-to-face interviews. Multivariate mixed effect linear regression was utilized to determine the association. We found that HIV patients at ART-GH clinics were more likely to achieve higher CD4 counts over time compared to patients at ART-HTC clinics. Additionally, having an increase in CD4 counts was found to be associated with having longer duration of ART and higher baseline CD4 levels. Cigarette smoking and hazardous alcohol use, however, were not associated with CD4 count improvement. Our findings suggest that combining HTC and GH services might provide a synergistic benefit in ART treatment outcomes through an improved access to comprehensive HIV healthcare services for HIV patients on therapy.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Prestação Integrada de Cuidados de Saúde/métodos , Infecções por HIV/tratamento farmacológico , Atenção Primária à Saúde/organização & administração , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Contagem de Linfócito CD4 , Aconselhamento , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fumar/epidemiologia , Resultado do Tratamento , Vietnã/epidemiologia
16.
Fam Syst Health ; 37(2): 120-130, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31058530

RESUMO

INTRODUCTION: Although behavioral health treatment can improve distress and pain functioning for patients with chronic pain, few who are referred by their primary care physician will see a behavioral health specialist. Given the benefits of integrating behavioral health into primary care, this may be an avenue for delivering a psychological intervention for chronic pain. The purpose of this study was to optimize a psychological intervention for patients with chronic pain to be delivered in primary care, utilizing the perspectives of providers and patients. METHOD: Psychologists (n = 9), primary care providers (n = 9), and patients with chronic pain (n = 9) participated in separate focus groups. Participants reviewed the proposed 4-session intervention, provided feedback prompted by a set of open-ended questions, and completed a survey. RESULTS: Statements from focus groups were transcribed and coded into 2 thematic categories: (a) content of the intervention and (b) logistics and design. Participants believed that offering a brief, behavioral intervention for chronic pain in a primary care clinic was feasible and useful. All providers (100%) agreed or strongly agreed that they would refer a patient to this intervention, and 100% of patients agreed or strongly agreed that they would participate. DISCUSSION: Feedback solicited from the focus groups led to alterations to the treatment manual, such as adding a fifth session, using different psychological strategies, and logistical changes in delivery (i.e., meeting biweekly and intervisit contacts). The modified version of this intervention will be evaluated with a pilot randomized controlled clinical trial. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Pessoal de Saúde/psicologia , Manejo da Dor/métodos , Pacientes/psicologia , Atenção Primária à Saúde/normas , Adulto , Dor Crônica/terapia , Prestação Integrada de Cuidados de Saúde/métodos , Feminino , Grupos Focais/métodos , Humanos , Masculino , Manejo da Dor/tendências , Atenção Primária à Saúde/métodos , Psicologia , Pesquisa Qualitativa , Melhoria de Qualidade , Qualidade da Assistência à Saúde/normas
17.
J Surg Res ; 241: 285-293, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31048219

RESUMO

BACKGROUND: Palliative care can improve end-of-life care and reduce health care expenditures, but the optimal timing for initiation remains unclear. We sought to characterize the association between timing of palliative care, in-hospital deaths, and health care costs. METHODS: This is a retrospective cohort study including all patients who were diagnosed and died of colorectal cancer between 2004 and 2012 in Manitoba, Canada. The primary exposure was timing of palliative care, defined as no involvement, late involvement (less than 14 d before death), early involvement (14 to 60 d before death), and very early involvement (>60 d before death). The primary outcome was in-hospital deaths and end-of-life health care costs. RESULTS: A total of 1607 patients were included; 315 (20%) received palliative care and 162 (10%) died in hospital. Compared to those who did not receive palliative care, patients with early and very early involvement experienced significantly decreased odds of dying in hospital (OR 0.21 95% CI 0.06-0.69 P = 0.01 and OR 0.11 95% CI 0.01-0.78 P = 0.03, respectively) and significantly lower health care costs. There were no significant differences in in-hospital deaths and health care costs between patients without palliative care and those who received late palliative care. CONCLUSIONS: Early palliative care involvement is associated with decreased odds of dying in hospital and lower health care utilization and costs in patients with colorectal cancer. These findings provide real-world evidence supporting early integration of palliative care, although the optimal timing (early versus very early) remains a matter of debate.


Assuntos
Neoplasias Colorretais/terapia , Prestação Integrada de Cuidados de Saúde/métodos , Cuidados Paliativos/métodos , Assistência Terminal/métodos , Idoso , Idoso de 80 Anos ou mais , Canadá/epidemiologia , Neoplasias Colorretais/economia , Neoplasias Colorretais/mortalidade , Análise Custo-Benefício/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Medicina Baseada em Evidências/economia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Feminino , Gastos em Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Masculino , Oncologia/economia , Oncologia/métodos , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Cuidados Paliativos/economia , Cuidados Paliativos/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Assistência Terminal/economia , Assistência Terminal/estatística & dados numéricos , Fatores de Tempo
18.
Afr J Prim Health Care Fam Med ; 11(1): e1-e8, 2019 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-31038335

RESUMO

BACKGROUND:  Mental health care at primary health care (PHC) still remains a challenge despite the Policy on Integration of Mental Health Care into PHC which was developed in 1997 at the time when the White Paper for the Transformation of the Health System in South Africa was published. The White Paper made provision for a new health care system based on the principles of the PHC approach to care. This was followed by the promulgation of the Mental Health Care Act No. 17 of 2002 which is based on the principle that mental health care should be integrated into PHC; however, there have been challenges with regard to the implementation of this policy. AIM:  This study aimed to analyse the implementation of Policy on Integration of Mental Health Care into PHC with the ultimate aim of developing a practice framework for PHC nurses to enhance such implementation in KwaZulu-Natal (KZN). SETTING:  The study took place in selected health districts in KZN, namely, Ugu, eThekwini, iLembe and uMgungundlovu. METHODS:  A qualitative approach using grounded theory design was used to develop a practice framework to enhance the implementation of Policy on Integration of Mental Health Care into PHC. A theoretical sampling method was used to select the sample from PHC managers, operational managers and professional nurses for the collection of data. The sample consisted of 42 participants. Data were collected by means of one-on-one interviews and focus group interviews. Strauss and Corbin's approach of data analysis was used for analysing data. The paradigm model was used as a guide to develop a practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into PHC in KZN. RESULTS:  This study found that integration of mental health care into PHC is understood as a provision of comprehensive care to mental health care users using either a supermarket approach or a one-stop-shop approach at PHC clinics. Strategies that are used at PHC clinics in KZN ensure that the integration of mental health care into PHC is implemented, includes the screening of all patients that come to the PHC clinic for mental illness, fast tracking of mental health care users once they have been assessed, and found to be mentally ill and management of all mental health care users as patients with chronic diseases. CONCLUSION:  The practice framework developed identifies comprehensive mental health care being offered to mental health care users using either a supermarket approach or a one-stop-shop approach, depending on the availability of staff with a qualification in psychiatric nursing science.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Implementação de Plano de Saúde/métodos , Política de Saúde/legislação & jurisprudência , Serviços de Saúde Mental/legislação & jurisprudência , Atenção Primária à Saúde/métodos , Prestação Integrada de Cuidados de Saúde/legislação & jurisprudência , Grupos Focais , Reforma dos Serviços de Saúde/legislação & jurisprudência , Humanos , Programas de Rastreamento/métodos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Atenção Primária à Saúde/legislação & jurisprudência , Pesquisa Qualitativa , África do Sul
19.
J Manag Care Spec Pharm ; 25(5): 526-531, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039067

RESUMO

Health care payment models that reward value over volume have the potential to improve patient care and control rising costs. These payment models are increasingly being implemented by a range of care delivery providers in the United States. Integrated delivery networks (IDNs)-systems of providers and sites (e.g., group practices and hospitals) that care for and provide health care services and health insurance plans to patients in a specific region or market-present special opportunities and challenges for value-based care and represent an important sector for the advancement of value-based models. Successful implementation of value-based agreements in IDNs requires a range of complex capabilities, including advanced data analytics, population health management solutions, comprehensive care management, and successful patient engagement. To address these and other operational issues, the Academy of Managed Care Pharmacy convened a stakeholder forum on November 13-14, 2018, in Baltimore, MD. Forum attendees addressed topics including (a) the current delivery of value-based care in IDNs; (b) opportunities and barriers to implementing pharmaceutical value-based agreements; (c) recommendations for IDNs to reach the full potential of value-based agreements; and (d) opportunities for collaborations among managed care organizations, accountable care organizations, and IDNs to improve health care outcomes. Thought leaders with a wide range of backgrounds attended the forum, including those representing patients, payers, providers, government, and biopharmaceutical companies. The forum was sponsored by Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Genentech, Lilly, MedImpact, Merck, National Pharmaceutical Council, Novo Nordisk, Pharmaceutical Research and Manufacturers of America, Takeda, and Xcenda. This proceedings document presents common themes and comments from individual participants at the forum, which are not necessarily endorsed by all attendees, nor should they be construed to reflect group consensus. DISCLOSURES: This AMCP Partnership Forum and the development of this proceedings document were supported by Amgen, Boehringer Ingelheim, Bristol-Myers Squibb, Genentech, Lilly, MedImpact, Merck, National Pharmaceutical Council, Novo Nordisk, Pharmaceutical Research and Manufacturers of America, Takeda, and Xcenda.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Assistência Farmacêutica/organização & administração , Seguro de Saúde Baseado em Valor/organização & administração , Prestação Integrada de Cuidados de Saúde/métodos , Custos de Cuidados de Saúde , Humanos , Assistência Farmacêutica/economia , Estados Unidos , Seguro de Saúde Baseado em Valor/economia
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