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1.
Epidemiol Psychiatr Sci ; 29: e105, 2020 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-32100662

RESUMO

There is growing interest in digital mental health as well as accumulating evidence of the potential for technology-based tools to augment traditional mental health services and to potentially overcome barriers to access and use of mental health services. Our research group has examined how people with mental illnesses think about and make use of technology in their everyday lives as a means to provide insight into the emerging paradigm of digital mental health. This research has been guided by anthropological approaches that emphasise lived experience and underscore the complexity of psychiatric recovery. In this commentary I describe how an anthropological approach has motivated us to ask how digital technology can be leveraged to promote meaningful recovery for people with mental illnesses and to develop a new approach to the integration of technology-based tools for people with mental illnesses.


Assuntos
Serviços Comunitários de Saúde Mental/organização & administração , Transtornos Mentais/reabilitação , Telemedicina/organização & administração , Humanos , Transtornos Mentais/psicologia , Saúde Mental
2.
JAMA Netw Open ; 3(1): e1919954, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995214

RESUMO

Importance: The number of patients presenting to emergency departments (EDs) for psychiatric care continues to increase. Psychiatrists often make a conservative recommendation to admit patients because robust outpatient services for close follow-up are lacking. Objective: To assess whether the availability of a 45-day behavioral health-virtual patient navigation program decreases hospitalization among patients presenting to the ED with a behavioral health crisis or need. Design, Setting, and Participants: This randomized clinical trial enrolled 637 patients who presented to 6 EDs spanning urban and suburban locations within a large integrated health care system in North Carolina from June 12, 2017, through February 14, 2018; patients were followed up for up to 45 days. Eligible patients were aged 18 years or older, with a behavioral health crisis and a completed telepsychiatric ED consultation. The availability of the behavioral health-virtual patient navigation intervention was randomly allocated to specific days (Monday through Friday from 7 am to 7 pm) so that, in a 2-week block, there were 5 intervention days and 5 usual care days; 323 patients presented on days when the program was offered, and 314 presented on usual care days. Data analysis was performed from March 7 through June 13, 2018, using an intention-to-treat approach. Interventions: The behavioral health-virtual patient navigation program included video contact with a patient while in the ED and telephonic outreach 24 to 72 hours after discharge and then at least weekly for up to 45 days. Main Outcomes and Measures: The primary outcome was the conversion of an ED encounter to hospital admission. Secondary outcomes included 45-day follow-up encounters with a self-harm diagnosis and postdischarge acute care use. Results: Among 637 participants, 358 (56.2%) were men, and the mean (SD) age was 39.7 (16.6) years. The conversion rates were 55.1% (178 of 323) in the intervention group vs 63.1% (198 of 314) in the usual care group (odds ratio, 0.74; 95% CI, 0.54-1.02; P = .06). The percentage of patient encounters with follow-up encounters having a self-harm diagnosis was significantly lower in the intervention group compared with the usual care group (36.8% [119 of 323] vs 45.5% [143 of 314]; P = .03). Conclusions and Relevance: Although the primary result did not reach statistical significance, there is a strong signal of potential positive benefit in an area that lacks evidence, suggesting that there should be additional investment and inquiry into virtual behavioral health programs. Trial Registration: ClinicalTrials.gov identifier: NCT03204643.


Assuntos
Terapia Comportamental/métodos , Serviço Hospitalar de Emergência , Transtornos Mentais/terapia , Admissão do Paciente/estatística & dados numéricos , Telemedicina/organização & administração , Adulto , Medicina do Comportamento/métodos , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , North Carolina , Autogestão/educação , Resultado do Tratamento , Adulto Jovem
3.
J Stroke Cerebrovasc Dis ; 29(2): 104480, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31780246

RESUMO

OBJECTIVES: Acute ischemic stroke is one of the leading causes of death. Patient outcomes, such as in-patient mortality, may be impacted by the time of arrival to the hospital. Telestroke networks have been found to be effective and safe at treating acute ischemic strokes. This paper investigated the association between mortality and time of arrival and hospital's participation in a telestroke network. METHODS: Data were collected on ischemic stroke patients who arrived at 15 nonteaching hospitals in Georgia's Paul Coverdell Acute stroke registry from 2009 to 2016. After controlling for patient and hospital characteristics, multivariate logistic regression was conducted to assess whether time of arrival and telestroke participation was associated with in-hospital mortality. Subgroup analysis was conducted based on hospital bed size. RESULTS: Overall, a total of 19,759 admissions for acute ischemic stroke were included in this analysis. The odds of dying in the hospital when arriving during the nighttime are 1.22 times the odds of dying when arriving during the day (95% CI: 1.04-1.45) and the odds of dying at a telestroke hospital are 53% lower than at a nontelestroke hospital (OR .47, 95% CI .31-.71). The associations were more prominent in large hospitals. CONCLUSIONS: Our study found that the hour of arrival for acute ischemic stroke is linked with in-hospital mortality in large hospitals, with patients more likely to die if they arrive during the nighttime hours as compared to the daytime hours. Telestroke participation is linked with lower odds of hospital mortality in all hospitals.


Assuntos
Plantão Médico , Isquemia Encefálica/mortalidade , Isquemia Encefálica/terapia , Mortalidade Hospitalar , Admissão do Paciente , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/terapia , Telemedicina/organização & administração , Adolescente , Adulto , Idoso , Isquemia Encefálica/diagnóstico , Prestação Integrada de Cuidados de Saúde/organização & administração , Feminino , Georgia/epidemiologia , Número de Leitos em Hospital , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/organização & administração , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
4.
Clin Nurse Spec ; 34(1): 17-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31789959

RESUMO

PURPOSE/AIMS: Development and implementation of a predictive analytic scoring system in a system of 21 hospitals required 24-hour surveillance to ensure alerts were responded and acted upon. Identification of gaps in patient care created an opportunity to innovate and develop a team to integrate both workflows. DESCRIPTION OF PROJECT/PROGRAM: A Virtual Nurse team of master's degree-prepared nurses with backgrounds in intensive care and management led by a clinical nurse specialist work remotely from their homes. Each nurse is assigned to either of 2 workflows: Advance Alert Monitor-predictive analytic scores or e-Hospital involving capturing of care gaps. The Virtual Nurse team covers 24 hours a day/7 days a week. OUTCOMES: The program has resulted in 169 lives saved and an observed-to-expected mortality of 0.8. Improvements in standard workflows across the system have enabled Rapid Response Teams to be implemented in each hospital. CONCLUSIONS: The success of the Virtual Nurse team has resulted in developments to spread the program into other Kaiser Permanente regions. The Virtual Nurse team has grown to 40 nurses and will expand as the program spreads.


Assuntos
Enfermeiras Clínicas , Equipe de Enfermagem/organização & administração , Assistência ao Paciente/normas , Telemedicina/organização & administração , Humanos , Pesquisa em Avaliação de Enfermagem
5.
Mayo Clin Proc ; 94(12): 2510-2523, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31806104

RESUMO

Telepsychiatry is effective and has generated hope and promise for improved access and enhanced quality of care with reasonable cost containment. Clinicians and organizations are informed about clinical, technological, and administrative telepsychiatric barriers via guidelines, but there are many practical patient and clinician factors that have slowed implementation and undermined sustainability. Literature describing barriers to use of telepsychiatry was reviewed. PubMed search terms with date limits from January 1, 1959, to April 25, 2019, included telepsychiatry, telemedicine, telemental health, videoconferencing, video based, Internet, synchronous, real-time, two-way, limitations, restrictions, barriers, obstacles, challenges, issues, implementation, utilization, adoption, perspectives, perceptions, attitudes, beliefs, willingness, acceptability, feasibility, culture/cultural, outcomes, satisfaction, quality, effectiveness, and efficacy. Articles were selected for inclusion on the basis of relevance. Barriers are described from both patient and clinicians' perspectives. Patients and clinicians are largely satisfied with telepsychiatry, but concerns about establishing rapport, privacy, safety, and technology limitations have slowed acceptance of telepsychiatry. Clinicians are also concerned about reimbursement/financial, legal/regulatory, licensure/credentialing, and education/learning issues. These issues point to system and policy concerns, which, in combination with other administrative concerns, raise questions about system design/workflow, efficiency of clinical care, and changing organizational culture. Although telepsychiatry service is convenient for patients, the many barriers from clinicians' perspectives are concerning, because they serve as gatekeepers for implementation and sustainability of telepsychiatry services. This suggests that solutions to overcome barriers must start by addressing the concerns of clinicians and enhancing clinical workflow.


Assuntos
Serviços de Saúde Mental/organização & administração , Telemedicina/organização & administração , Humanos , Videoconferência
6.
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
7.
J Glob Health ; 9(2): 020428, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31673341

RESUMO

Background: Health Alliance International (HAI) with the Ministry of Health (MoH) of Timor-Leste and Catalpa International implemented a mobile phone-based mHealth program in 2013 known as Liga Inan ("Connecting Mothers"). Liga Inan was designed as a sustainable and scalable effort that would support MoH efforts to improve maternal and newborn health care-seeking and home practices. Key aims were to use mobile phone technology to improve communication between pregnant women and their MoH health providers and to increase optimal maternal health behaviors. MoH health staff registered pregnant women into Liga Inan at their first antenatal care (ANC) visit and followed them through pregnancy, delivery and six months postpartum. A web-based platform sent text messages twice weekly to promote safe pregnancy/delivery and facilitated phone communication between pregnant women and their MoH care providers. Methods: For the program's final evaluation, baseline (2012) and final (2015) surveys interviewed women in one intervention district and one adjacent control district who had given birth in the preceding two years. Primary outcomes were receiving four or more ANC visits, using skilled birth attendants, delivery in health facilities, and timely postnatal care. Results: Multivariate analysis compared endline maternal health behaviors for women in the intervention district compared to baseline and to women in the control district. Controlling for other factors, women in the intervention district had nearly twice the odds of having a skilled birth attendant and a facility delivery, nearly five times the odds of receiving a postpartum care visit within two days of delivery, and over five times the odds of having their newborn's health checked within two days of birth. There was no significant association between Liga Inan exposure and receipt of four or more ANC visits. Conclusions: Liga Inan was associated with substantial increases in MoH health provider-assisted and facility-based births and timely postnatal care in Timor-Leste. These positive results led the MoH to incorporate Liga Inan into the national maternal and child health program. To date the program has expanded to cover all 13 districts in the country, with gradual assumption of management and financial responsibility by the MoH under way.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Telemedicina/organização & administração , Adolescente , Adulto , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Avaliação de Programas e Projetos de Saúde , Timor-Leste , Adulto Jovem
8.
BMC Health Serv Res ; 19(1): 800, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690287

RESUMO

BACKGROUND: The growing field of participation in healthcare has the potential to provide a number of benefits for children, patients, healthcare professionals and also the healthcare systems. According to the Convention on the Rights of the Child (UNCRC), children have the right to participate in their own healthcare and make their voice heard. Children's opportunities for understanding their conditions, sharing their views and participating in decisions regarding their care depend on healthcare professionals but also on parents' ability to communicate and include children. E-health solutions can remove barriers to children's communication with healthcare professionals. The aim of this study was to explore parents' perspectives on the outcomes of an e-health solution, Sisom, used by children during healthcare appointments. METHODS: The empirical data is based on interviews with 16 parents. In the present study constructivist, grounded theory was chosen as the method. RESULTS: The theory of enhancing participation, by orientating communication about healthcare towards the voice of the child instead of the parents, summarizes the process of how the outcome of Sisom for children lead to enhanced participation, by making the child the main actor and an agent in his/her own healthcare. The facilitators for achieving participation in Sisom were four interrelated outcomes; engaging, voice-guarding, raising awareness and integrity preserving. In addition to generating increased participation, it emerged that the use of Sisom also initiated a process, which was evident in all four subcategories that facilitated the child in coping with the experience of having an illness. CONCLUSIONS: We conclude, that Sisom orientated communication about healthcare towards the voice of the child instead of the parents as well as including the child in the dialogue with the healthcare professional and thus increasing the child's participation and human rights.


Assuntos
Pais/psicologia , Pediatria/organização & administração , Telemedicina/organização & administração , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
9.
Artigo em Inglês | MEDLINE | ID: mdl-31635373

RESUMO

This study explored the effects of information technology (IT) resources-in conjunction with IT infrastructure and organizational resources-on organizational capabilities and performance. The study further analyzed the mediating effect of organizational capabilities on the relationship between IT resources and organizational performance. A cross-sectional research design was adopted, and questionnaire copies were administered to senior care supervisors of Taiwanese day care centers, care institutions, and hospitals. In total, 328 valid questionnaire responses were obtained. The study results are summarized as follows: (1) A direct effect analysis revealed that IT infrastructure significantly affected service performance and financial performance; organizational resources significantly affected service performance but did not significantly affect financial performance. (2) A mediation model analysis indicated that organizational capabilities exerted a mediating effect on the relationship between IT resources and organizational performance. These results can serve as a reference for medical care organizations in developing strategies for reviewing internal IT resources, integrating internal and external capabilities, creating a competitive advantage, and boosting their performance.


Assuntos
Administração de Instituições de Saúde , Recursos em Saúde , Administração Hospitalar , Telemedicina/organização & administração , Estudos Transversais , Eficiência Organizacional , Humanos , Tecnologia da Informação , Inquéritos e Questionários , Taiwan
10.
Nurse Pract ; 44(11): 30-35, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31567701

RESUMO

Consumers of healthcare services are demanding more convenient and accessible options to care. Technologic advancements can support this demand, but telehealth knowledge is lacking. This article will describe the current state of telehealth and examine the role that NPs can play in furthering its adoption.


Assuntos
Profissionais de Enfermagem , Telemedicina/organização & administração , Humanos , Papel do Profissional de Enfermagem
11.
BMC Public Health ; 19(1): 1311, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623589

RESUMO

BACKGROUND: The mortality of coronary heart disease can be largely reduced by modifying unhealthy lifestyles. However, the long-term effectiveness of interventions for modifying unhealthy diet and physical inactivity of patients with coronary heart disease remain unsatisfactory worldwide. This study aims to systematically design a set of theory-based and evidence-based, individualized, and intelligent interventions for promoting the adoption and maintenance of a healthy diet and physical activity level in patients with coronary heart disease. METHODS: The interventions will be delivered by a mobile health care system called Individualized, Intelligent and Integrated Cardiovascular Application for Risk Elimination. Three steps of the intervention mapping framework were used to systematically develop the interventions. Step 1: needs assessment, which was carried out by a literature review, in-depth interviews and focus group discussions. Step 2: development of objective matrix for diet and physical activity changes, based on the intersection of objectives and determinants from the Contemplation-Action-Maintenance behavior change model. Step 3: formulation of evidence-based methods and strategies, and practical applications, through a systematic review of existing literature, research team discussions, and consultation with multidisciplinary expert panels. RESULTS: Three needs relevant to content of the intervention, one need relevant to presentation modes of the intervention, and four needs relevant to functional features of the application were identified. The objective matrix includes three performance objectives, and 24 proximal performance objectives. The evidence-based and theory-based interventions include 31 strategies, 61 evidence-based methods, and 393 practical applications. CONCLUSIONS: This article describes the development of theory-based and evidence-based interventions of the mobile health care system for promoting the adoption and maintenance of a healthy diet and physical activity level in a structured format. The results will provide a theoretical and methodological basis to explore the application of intervention mapping in developing effective behavioral mobile health interventions for patients with coronary heart disease. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR-INR-16010242. Registered 24 December 2016. http://www.chictr.org.cn/index.aspx.


Assuntos
Doença das Coronárias/prevenção & controle , Exercício , Promoção da Saúde/organização & administração , Telemedicina/organização & administração , Adulto , Feminino , Promoção da Saúde/métodos , Humanos , Inteligência , Masculino , Pessoa de Meia-Idade , Medicina de Precisão , Telemedicina/métodos
12.
BMC Health Serv Res ; 19(1): 681, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31547824

RESUMO

BACKGROUND: Telemedicine services are promoting more access to healthcare. Portugal was an early adopter of telemedicine to overcome both its geological barriers and the shortage of healthcare professionals. The Pediatric Cardiology Service (PCS) at Coimbra University Hospital Centre (CHUC) has been using telemedicine to increase access and coverage since 1998. Their Pediatric Telecardiology Service has been daily connecting CHUC with 13 other Portuguese national hospitals, and regularly connecting with Portuguese-speaking African countries, through a teleconsultation platform. METHODS: This study aims at exploring the Pediatric Telecardiology Service's evolution, through a comprehensive assessment of the PCS's development, evolution and impact in public health, to better understand the critical factors for implementation and sustainability of telemedicine, in the context of healthcare services digitalization. A case study was performed, with cost-benefit, critical factors and organizational culture assessment. Finally, the Kingdon's framework helped to understand the implementation and scale-up process and the role of policy-making. RESULTS: With the total of 32,685 out-patient teleconsultations, growing steadily from 1998 to 2016, the Pediatric Telecardiology Service has reached national and international recognition, being a pioneer and an active promotor of telemedicine. This telemedicine service has saved significant resources, about 1.1 million euros for the health system (e.g. in administrative and logistic costs) and approximately 419 euros per patient (considering an average of 1777 patients per year). PCS presents a dominant "Clan" culture. The Momentum's critical factors for telemedicine service implementation enabled us to understand how barriers were overcome (e.g. political forces). Willingness, perseverance and teamwork, allied with partnership with key stakeholders, were the foundation for professionals' engagement and service networking development. Its positive results, new regulations and the increasing support from the hospital board, set up a window of opportunity to establish a sustainable telemedicine service. CONCLUSION: The Pediatric Telecardiology Service enables real-time communication and the sharing of clinical information, overcoming many barriers (from geographical ones to shortage of healthcare professionals), improving access to specialized care both in Portugal and Africa. Motivation and teamwork, and perseverance, were key for the Pediatric Telecardiology Service to tackle the window of opportunity which created conditions for sustainability.


Assuntos
Cardiologia/métodos , Pediatria/métodos , Consulta Remota/organização & administração , Telemedicina/organização & administração , África , Criança , Comunicação , Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Portugal , Consulta Remota/estatística & dados numéricos , Consulta Remota/tendências , Telemedicina/estatística & dados numéricos , Telemedicina/tendências
13.
Z Gerontol Geriatr ; 52(6): 529-536, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31492973

RESUMO

BACKGROUND: The support of relatives living far away in terms of distance caregiving between children and their parents has gained in importance in Europe. At the same time, little is known about these care arrangements based on representative European survey data. OBJECTIVE: This article is concerned with the following questions: which statements are possible in Europe about the prevalence of persons caring for at least one parent from a geographical distance? Which forms of support are provided and which other specific socioeconomic and health-related aspects characterize these care situations? In this respect special attention is paid to differences to relatives who provide help close to their parents who are in need of care. MATERIAL AND METHODS: Data from the Survey of Health, Ageing and Retirement in Europe (SHARE) from the sixth wave of the survey in 2015 were used to perform a descriptive analysis and multivariate logistic regression. RESULTS AND CONCLUSION: The analysis showed that distance caregiving is more than a marginal phenomenon in Europe with a prevalence of 11% for a relatively close terminology (over 100 km distance between locations) and 23% for a broader terminology (over 25 km); however, the various countries are very different in terms of prevalence. The findings also point to some significant differences in terms of resources, care tasks and quality of life compared to caregivers in the same household. In light of these dynamically developing distance caregiving arrangements, this article can provide further discussion, critical reflection, and advancement to the operationalization of informal care.


Assuntos
Envelhecimento , Cuidadores , Família , Aposentadoria , Telemedicina , Criança , Europa (Continente) , Humanos , Qualidade de Vida , Inquéritos e Questionários , Telemedicina/organização & administração
15.
J Clin Nurs ; 28(21-22): 3935-3948, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31410925

RESUMO

AIMS AND OBJECTIVES: To develop an understanding of how Indigenous mothers experience selecting and using health services for their infants can assist nurses in improving their access to care. This understanding may ultimately lead to improved health outcomes for Indigenous infants and their families. BACKGROUND: Access to acute care services is important to minimise morbidity and mortality from urgent health issues; however, Indigenous people describe difficulties accessing care. Indigenous infants are known to use the emergency department frequently, yet little is known about the facilitators and barriers their mothers experience when accessing these services. DESIGN: This study undertook a qualitative, interpretive description design. METHODS: This article adheres to the reporting guidelines of COREQ. Data collection methods included interviews and a discussion group with Indigenous mothers (n = 19). Data analysis was collaborative and incorporated both Indigenous and Western ways of knowing, through the application of Two-Eyed Seeing. RESULTS: A thematic summary resulted in six themes: (a) problematic wait times; (b) the hidden costs of acute care; (c) paediatric care; (d) trusting relationships; (e) racism and discrimination; and (f) holistic care. CONCLUSIONS: The experiences of Indigenous mothers using acute care services for their infants suggest a role for culturally safe and trauma and violence-informed care by health providers in the acute care context. RELEVANCE TO CLINICAL PRACTICE: Nurses can improve access to acute care services for Indigenous mothers and infants through the provision of culturally safe and trauma and violence-informed approaches care, by building rapport with families, providing care that is respectful and nonjudgemental, eliminating fees associated with using acute care services and linking families with cultural resources both in hospital and within the community.


Assuntos
Acesso aos Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde , Índios Norte-Americanos/estatística & dados numéricos , Mães/psicologia , Adulto , Instituições de Assistência Ambulatorial/organização & administração , Canadá , Serviços Médicos de Emergência/organização & administração , Feminino , Humanos , Índios Norte-Americanos/psicologia , Lactente , Pesquisa Qualitativa , Telemedicina/organização & administração
16.
Int J Health Care Qual Assur ; 32(7): 1072-1080, 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31411096

RESUMO

PURPOSE: The capacity available to deliver outpatient surgical services is outweighed by the demand. Although additional investment is sometimes needed, better aligning resources, increasing operational efficiency and considering new processes all have a role in improving delivering these services. The purpose of this paper is to evaluate the safety of a physician associate (PA) delivered virtual outpatient department (VOPD) consultation service that was established in a General and Colorectal Surgery Department at an Irish teaching hospital. DESIGN/METHODOLOGY/APPROACH: A series of low-risk surgical patients were referred by senior surgeons to a PA delivered virtual clinic (VOPD). Medical records belonging to half the included patients were randomly selected for review by two doctors three months following discharge back to primary care to confirm appropriate standards of care and documentation and to audit any recorded adverse incidents or outcomes. FINDINGS: In total, 191 patients had been reviewed by the PA in the VOPD with 159 discharged directly back to primary care. Among the 95 medical records that were reviewed by the NCHDs, there were no recorded adverse incidents after discharge. Medical record keeping was deficient in 1 out of 95 reviewed cases. PRACTICAL IMPLICATIONS: Using a PA delivered VOPD consultation appears to have a role in following up patients who have undergone low-risk procedures irrespective of age or co-morbidity when selected appropriately. This may assist in reducing the demand on outpatient services by reducing unnecessary return visits, thereby increasing the capacity for new referrals. ORIGINALITY/VALUE: While there are reported examples to date of virtual clinics, these relate to services delivered by registered medical practitioners. Here, the authors demonstrate the acceptability of this model of care in an Irish population as delivered by a PA.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Assistentes Médicos/organização & administração , Atenção Primária à Saúde/organização & administração , Telemedicina/organização & administração , Adulto , Fatores Etários , Idoso , Colonoscopia/efeitos adversos , Colonoscopia/métodos , Comorbidade , Eficiência Organizacional , Feminino , Hospitais de Ensino , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Fatores de Risco , Escleroterapia/efeitos adversos , Escleroterapia/métodos
17.
Trials ; 20(1): 502, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412937

RESUMO

BACKGROUND: Globally, eye care provision is currently insufficient to meet the requirement for eye care services. Lack of access and awareness are key barriers to specialist services; in addition, specialist services are over-utilised by people with conditions that could be managed in the community or primary care. In combination, these lead to a large unmet need for eye health provision. We have developed a validated smartphone-based screening algorithm (Peek Community Screening App). The application (App) is part of the Peek Community Eye Health system (Peek CEH) that enables Community Volunteers (CV) to make referral decisions about patients with eye problems. It generates referrals, automated short messages service (SMS) notifications to patients or guardians and has a program dashboard for visualising service delivery. We hypothesise that a greater proportion of people with eye problems will be identified using the Peek CEH system and that there will be increased uptake of referrals, compared to those identified and referred using the current community screening approaches. STUDY DESIGN: A single masked, cluster randomised controlled trial design will be used. The unit of randomisation will be the 'community unit', defined as a dispensary or health centre with its catchment population. The community units will be allocated to receive either the intervention (Peek CEH system) or the current care (periodic health centre-based outreach clinics with onward referral for further treatment). In both arms, a triage clinic will be held at the link health facility four weeks from sensitisation, where attendance will be ascertained. During triage, participants will be assessed and treated and, if necessary, referred onwards to Kitale Eye Unit. DISCUSSION: We aim to evaluate a M-health system (Peek CEH) geared towards reducing avoidable blindness through early identification and improved adherence to referral for those with eye problems and reducing demand at secondary care for conditions that can be managed effectively at primary care level. TRIAL REGISTRATION: The Pan African Clinical Trials Registry (PACTR), 201807329096632 . Registered on 8 June 2018.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Técnicas de Diagnóstico Oftalmológico , Oftalmopatias/terapia , Aplicativos Móveis , Oftalmologia/organização & administração , Telemedicina/organização & administração , Oftalmopatias/diagnóstico , Feminino , Humanos , Quênia , Masculino , Valor Preditivo dos Testes , Ensaios Clínicos Controlados Aleatórios como Assunto , Encaminhamento e Consulta/organização & administração , Mensagem de Texto
18.
World J Gastroenterol ; 25(29): 3849-3856, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31413523

RESUMO

Decompensated cirrhosis is a condition associated with significant morbidity and mortality. While there have been significant efforts to develop quality metrics that ensure high-value care of these patients, wide variations in clinical practice exist. In this opinion review, we discuss the quality gap in the care of patients with cirrhosis, including low levels of compliance with recommended cancer screening and other clinical outcome and patient-reported outcome measures. We posit that innovations in telemedicine and mobile health (mHealth) should play a key role in closing the quality gaps in liver disease management. We highlight interventions that have been performed to date in liver disease and heart failure-from successful teleconsultation interventions in the care of veterans with cirrhosis to the use of telemonitoring to reduce hospital readmissions and decrease mortality rates in heart failure. Telemedicine and mHealth can effectively address unmet needs in the care of patients with cirrhosis by increasing preventative care, expanding outreach to rural communities, and increasing high-value care. We aim to highlight the benefits of investing in innovative solutions in telemedicine and mHealth to improve care for patients with cirrhosis and create downstream cost savings.


Assuntos
Gastroenterologia/organização & administração , Cirrose Hepática/terapia , Aplicativos Móveis , Melhoria de Qualidade , Telemedicina/organização & administração , Telefone Celular , Computadores de Mão , Gastroenterologia/métodos , Implementação de Plano de Saúde , Humanos , Medidas de Resultados Relatados pelo Paciente , Lacunas da Prática Profissional , Telemedicina/instrumentação , Telemedicina/métodos
19.
Medicine (Baltimore) ; 98(34): e16636, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441838

RESUMO

Electrocardiography (ECG) is essential to detect and diagnose life threatening cardiac conditions and to determine further treatment. Correct interpretation of an ECG can be challenging, especially in the out-of-hospital setting and by less experienced emergency team members.The aim of this study was to compare the rate of ECG transmission from an out-of-hospital emergency scene to an in-hospital cardiologist on call in EMS-B and EMS-S providers and its impact on direct transportation to a cardiac catheterization laboratory and hospital admission.The study was designed as an observational study. Data from 3 separate emergency medical service teams were collected. Two teams are staffed by paramedics only (EMT-B), while another specialized team is staffed with an emergency physician (EMT-S). 5864 out-of-hospital emergencies were performed during a 12-month period and were analyzed for this study.In 124 out of 5864 (2.1%) out-of-hospital emergencies, an ECG transmission from the out-of-hospital scene to an in-hospital cardiologist on call was performed. Rate of transmission was similar between both teams (EMT-B n = 70, 2.2% vs EMT-S n = 54, 2.0%, P = .054). After coordinating with the cardiologist on call, 11 patients (15.7%) of the EMT-B (15.7%) and 24 patients (44.4%) of the EMT-S were directly transported from the scene of emergency to a cardiac catheterization laboratory (P < .001). Overall, 80% of patients treated by EMT-S, compared to 52.5% treated by the EMT-B required subsequent hospital admission (P < .05).Transmission of ECG from the out-of-hospital emergency scene to the in-hospital cardiologist is infrequently performed. The rate of STEMI in transmitted ECG's by emergency teams staffed with an emergency physician was higher compared to emergency teams staffed with paramedics only.


Assuntos
Cardiologistas/organização & administração , Eletrocardiografia/métodos , Serviços Médicos de Emergência/organização & administração , Parada Cardíaca Extra-Hospitalar/diagnóstico , Telemedicina/organização & administração , Institutos de Cardiologia/organização & administração , Humanos , Admissão do Paciente , Estudos Retrospectivos
20.
Z Gerontol Geriatr ; 52(6): 521-528, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31444551

RESUMO

BACKGROUND: Demographic change, increasing work mobility as well as changed family patterns lead to social relationships over long distances; however, support from relatives from a distance is hardly debated in the German-speaking region. The project "DiCa" (2016-2019) studies various dimensions of long-distance caregiving. OBJECTIVE: This article presents the state of the art in research on specific characteristics of care arrangements from a distance. In addition, it presents the underlying challenges, strategies, and supportive as well as hindering conditions. MATERIAL AND METHODS: Systematic literature review. RESULTS: These studies, conducted largely in the Anglo-American region, draw a clear picture of who distance caregivers are (in general well-educated daughters or daughters-in-law) and that they make a substantial contribution to care in terms of organization, coordination, and emotional support in addition to visits. Distance impedes the flow of information about the health condition of the person in need of care and limits the possibilities to react to the needs at short notice or in crisis situations. Distance caregivers are often faced by financial as well as emotional burdens due to the care situation and lack of control even if there are some support strategies and compatibility between care and occupation, e.g. emergency management, local support networks, flexible working arrangements. CONCLUSION: In the German-speaking region, pertinent studies on long-distance caregiving are missing. Internationally, the numbers of cases are not always clear and there is a lack of sound knowledge on the assessment of the care arrangements on the part of the distance caregiver, the actual role of the distance, specific barriers, conflicts, effective strategies and solution options. This applies to people in family homecare as well primary care facilities and employers.


Assuntos
Cuidadores , Família , Telemedicina/organização & administração , Humanos , Telecomunicações
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