WorldWideScience

Sample records for ambulatory care practitioners

  1. Evaluation of Ambulatory Care Information Systems

    OpenAIRE

    Simborg, Donald W.; Whiting-O'Keefe, Quinn E.

    1980-01-01

    The central purpose of an ambulatory care information system is to communicate information to the practitioner to facilitate clinical decision making. The clinical decision can be considered the dependent output variable in a process having the information system, the patient, clinician characteristics, and the environment as the independent input variables. Evaluation approaches using patient outcomes are problematic because of the indirect relationship between the information system and pat...

  2. National Hospital Ambulatory Medical Care Survey

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect data on the utilization and provision of ambulatory care services in hospital...

  3. Ambulatory Care Database

    OpenAIRE

    Misener, Terry R.

    1983-01-01

    A six month project was undertaken to collect outpatient encounter data (demographic, workload, and diagnoses) at a community medical treatment facility. To capture data, the 13,000 patients seen each month, the clerical staff and primary care providers all completed portions of a “mark sense” form. Study results, lessons learned, and a conceptual plan for a future outpatient information system are reviewed.

  4. National Ambulatory Medical Care Survey (NAMCS)

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Ambulatory Medical Care Survey (NAMCS) is a national survey designed to meet the need for objective, reliable information about the provision and use...

  5. Ambulatory Medical Care Utilization Estimates for 2007

    Science.gov (United States)

    ... the caveats discussed in the ‘‘Methods’’ section. The relationship between characteristics of the patient’s ZIP Code and the choice of ambulatory care setting is shown in Table 5. For persons ...

  6. Planning an ambulatory care joint venture.

    Science.gov (United States)

    Harpster, L M

    1988-01-01

    This article discusses ambulatory care joint ventures by hospitals and selected members of their medical staffs and emphasizes the resolution of problems in the early planning stages. Failure to follow an orderly and thoughtful planning process not only risks valuable resources of the venture partners, but also jeopardizes the working relationship between the hospital and its medical staff.

  7. Ambulatory Care Skills: Do Residents Feel Prepared?

    Directory of Open Access Journals (Sweden)

    Denise Bonds

    2002-10-01

    Full Text Available Objective: To determine resident comfort and skill in performing ambulatory care skills. Methods: Descriptive survey of common ambulatory care skills administered to internal medicine faculty and residents at one academic medical center. Respondents were asked to rate their ability to perform 12 physical exam skills and 6 procedures, and their comfort in performing 7 types of counseling, and obtaining 6 types of patient history (4 point Likert scale for each. Self-rated ability or comfort was compared by gender, status (year of residency, faculty, and future predicted frequency of use of the skill. Results: Residents reported high ability levels for physical exam skills common to both the ambulatory and hospital setting. Fewer felt able to perform musculoskeletal, neurologic or eye exams easily alone. Procedures generally received low ability ratings. Similarly, residents’ comfort in performing common outpatient counseling was also low. More residents reported feeling very comfortable in obtaining history from patients. We found little variation by gender, year of training, or predicted frequency of use. Conclusion: Self-reported ability and comfort for many common ambulatory care skills is low. Further evaluation of this finding in other training programs is warranted.

  8. Big Data and Ambulatory Care

    OpenAIRE

    Thorpe, Jane Hyatt; Gray, Elizabeth Alexandra

    2014-01-01

    Big data is heralded as having the potential to revolutionize health care by making large amounts of data available to support care delivery, population health, and patient engagement. Critics argue that big data's transformative potential is inhibited by privacy requirements that restrict health information exchange. However, there are a variety of permissible activities involving use and disclosure of patient information that support care delivery and management. This article presents an ov...

  9. [Ambulatory care nursing sites in Italy: results of a pilot study].

    Science.gov (United States)

    Alvaro, Rosaria; Venturini, Giulia; Tartaglini, Daniela; Vellone, Ercole; De Marinis, Maria Grazia

    2009-01-01

    The aim of this study was to map existing ambulatory care nursing sites in Italy, compare operational and organizational methodologies used, and evaluate visibility of the sites in health institutions and the community. Nurses' level of satisfaction with this work experience was also evaluated. The American Academy of Ambulatory Care Nursing and American Nurses Association definition of ambulatory care nursing (1997) was used to select sites for the study. Two hundred fifty ambulatory care sites meeting this definition were listed, most of which provide clinical and educational services to oncology and cardiology patients. Surgical sites provide treatment of surgical wounds and stomas. Results of the study show that ambulatory care nursing sites are not uniformly distributed across Italy and a greater concentration of sites can be found in northern Italy with respect to central and southern Italy. Nurses report having greater professional autonomy and an excellent level of satisfaction. All interviewed nurses attend specific training and continuing education courses. Ambulatory care sites are managed by nurses; medical consultations are requested when necessary and home assistance is assured through coordination with general practitioners. PMID:19629150

  10. Redesigning ambulatory care business processes supporting clinical care delivery.

    Science.gov (United States)

    Patterson, C; Sinkewich, M; Short, J; Callas, E

    1997-04-01

    The first step in redesigning the health care delivery process for ambulatory care begins with the patient and the business processes that support the patient. Patient-related business processes include patient access, service documentation, billing, follow-up, collection, and payment. Access is the portal to the clinical delivery and care management process. Service documentation, charge capture, and payment and collection are supporting processes to care delivery. Realigned provider networks now demand realigned patient business services to provide their members/customers/patients with improved service delivery at less cost. Purchaser mandates for cost containment, health maintenance, and enhanced quality of care have created an environment where every aspect of the delivery system, especially ambulatory care, is being judged. Business processes supporting the outpatient are therefore being reexamined for better efficiency and customer satisfaction. Many health care systems have made major investments in their ambulatory care environment, but have pursued traditional supporting business practices--such as multiple access points, lack of integrated patient appointment scheduling and registration, and multiple patient bills. These are areas that are appropriate for redesign efforts--all with the customer's needs and convenience in mind. Similarly, setting unrealistic expectations, underestimating the effort required, and ignoring the human elements of a patient-focused business service redesign effort can sabotage the very sound reasons for executing such an endeavor. Pitfalls can be avoided if a structured methodology, coupled with a change management process, are employed. Deloitte & Touche Consulting Group has been involved in several major efforts, all with ambulatory care settings to assist with the redesign of their business practices to consider the patient as the driver, instead of the institution providing the care. PMID:10181605

  11. Growing ambulatory care nurse leaders in a multigenerational workforce.

    Science.gov (United States)

    Moye, Janet P; Swan, Beth Ann

    2009-01-01

    Ambulatory care faces challenges in sustaining a nursing workforce in the future as newly licensed nurses are heavily recruited to inpatient settings and retirements will impact ambulatory care sooner than other areas. Building a diverse team by recruiting nurses of different ages (generations) and skills may result in a more successful and robust organization. Knowledge about generational characteristics and preferences will aid nurse leaders and recruiters in attracting high-quality, talented nurses. Nurses of Generations X and Y can increase their likelihood of success in ambulatory care by better understanding intergenerational issues. PMID:20050492

  12. Predictors of antibiotic prescription in respiratory tract infections by ambulatory care practitioners Predictores de la prescripción de antibióticos en infecciones del tracto respiratorio por médicos de atención ambulatoria

    Directory of Open Access Journals (Sweden)

    Mireya Aznar

    2005-12-01

    Full Text Available The use of antibiotics in viral respiratory infections (common cold, acute rhinosinusitis and acute bronchitis promotes the emergence and spread of resistant bacteria. Studies have found that antibiotics are prescribed for 50-70% of respiratory tract infections, despite the fact that most of them have a viral etiology. The objective of the study was to determine predictors of antibiotic use in acute respiratory infections. It was conducted as a cross-sectional study on physicians' practices for antibiotic use. The subjects were internists and otolaryngologists of adult patients in an ambulatory setting in Buenos Aires. The instrument was a questionnaire with 20 clinical vignettes that included relevant variables for making decisions regarding antibiotic use in acute respiratory infections. The vignettes were constructed with a fractional factorial design with nine clinical variables. The absolute and relative weight of each clinical variable that predicted antibiotic use were calculated for each individual practitioner using multiple linear regression. The predictors with the greatest absolute weight in the decision to prescribe antibiotics were nasal discharge and cough (24% and 21% of total weight. The correlation between predictors and individual physician answers was high (r² = 0.73. The mean probability and the rate of antibiotic prescription were both about 50%. Predictors of antibiotic use for acute respiratory infections among ambulatory physicians in this sample differ from internationally accepted guidelines. The likelihood of prescribing antibiotics for these illnesses is high. Wider implementation of management guidelines for acute respiratory infections could improve cost effective antibiotic use and decrease the development of antibiotic resistance.El uso excesivo de antibióticos promueve la aparición y diseminación de bacterias resistentes. Se ha encontrado una tasa de prescripción de antibióticos en infecciones

  13. [Interprofessional pill box management in an ambulatory care setting].

    Science.gov (United States)

    Abrecht, Loïc; Anchisi, Annick; Widmer, Daniel; Bugnon, Olivier; Du Pasquier, Sophie; Jotterand, Sébastien; Karlen, Martine; Herzig, Lilli

    2014-11-26

    Complex multimorbid patients are now more common in ambulatory care and the management of their medication more frequently needs interprofessional collaboration. This qualitative study explored health professional's main challenges when introducing, preparing and sharing the use of a pill box for a patient. Another objective of this study was to explore options for improving care in these situations.

  14. Transitioning the RN to Ambulatory Care: An Investment in Orientation.

    Science.gov (United States)

    Allen, Juliet Walshe

    2016-01-01

    Registered nurses (RNs) struggle when transitioning from the inpatient setting to the outpatient clinical environment because it results in a diverse skill-set shift. The RN, considered an outpatient revenue source, experiences a decrease in peer-to-peer relationships, changes in leadership responsibilities, and changes in workgroup dynamics (supervision of unlicensed clinical personnel who function under the direction of the physician, not the RN). Ambulatory organizations find themselves implementing clinical orientation programs that may not delineate the attributes of the RN. This diminishes their value while emphasizing the unlicensed technical skill set. Creating a core RN orientation program template is paramount for the transition of the RN to the ambulatory setting. The literature reveals several areas where improving the value of the RN will ultimately enhance recruitment and retention, patient care outcomes, and leverage the RN role within any organization. Eleven 30-minute in-depth telephone interviews were conducted in addition to 4 nurse observations to explore the lived experience of the RN in ambulatory care. The findings disclosed an overarching theme of nurse isolation and offered insightful underpinnings for the nurse leader as ambulatory growth continues and nurse leaders further endorse the RN presence in the ambulatory setting. PMID:26938183

  15. An overview of anesthetic procedures, tools, and techniques in ambulatory care

    Directory of Open Access Journals (Sweden)

    Messieha Z

    2015-01-01

    Full Text Available Zakaria Messieha Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL, USA Abstract: Ambulatory surgical and anesthesia care (ASAC, also known as Same Day Surgery or Day Care in some countries, is the fastest growing segment of ambulatory surgical and anesthesia care. Over 50 million ambulatory surgical procedures are conducted annually comprising over 60% of all anesthesia care with an impressive track record of safety and efficiency. Advances in ambulatory anesthesia care have been due to newer generation of inhalation and intravenous anesthetics as well as airway management technology and techniques. Successful ambulatory anesthesia care relies on patient selection, adequate facilities, highly trained personnel and quality improvement policies and procedures. Favoring one anesthetic technique over the other should be patient and procedure-specific. Effective management of post-operative pain as well as nausea and vomiting are the final pieces in assuring success in ambulatory anesthesia care. Keywords: ambulatory anesthesia, out-patient anesthesia, Day-Care anesthesia

  16. Interdisciplinary Shared Governance in Ambulatory Care: One Health System's Journey.

    Science.gov (United States)

    Powers, Sharon; Bacon, Cynthia Thornton

    2016-01-01

    The implementation of shared governance structures in acute care has illustrated the positive relationship between shared decision making and nurse empowerment and positive nurse and patient outcomes. Little is known, however, about interdisciplinary shared governance, and even less is known about shared governance in ambulatory care. This article details one health system's experience with the implementation of an interdisciplinary shared governance structure in ambulatory care over a 4-year period. The authors report lessons learned, positive health system outcomes that resulted including improved communication, better preparedness for accreditation visits, improved assessment of fall risk, and a streamlined documentation system. Also discussed are mechanisms to enhance sustainability of the structure and discussion of future opportunities and challenges. PMID:27259130

  17. General practitioner's reported use of clinical guidelines for hypertension and ambulatory blood pressure.

    LENUS (Irish Health Repository)

    Flynn, E

    2012-03-01

    ABPM is an invaluable clinical tool, as it has been shown to improve blood pressure control in primary care. Many clinical guidelines for hypertension advocate ambulatory blood pressure monitoring. This study aims to quantify the use of clinical guidelines for hypertension and to explore the role of ABPM in Primary Care. A questionnaire survey was sent to GPs working in the West of Ireland. 88% (n=139) of GPs use clinical guidelines that recommend the use of ABPM. 82% (n=130) of GPs find use of clinic blood pressure monitoring insufficient for the diagnosis and monitoring of hypertension. Despite good access to ABPM, GPs report lack of remuneration, 72% (n=116), cost 68% (n=108), and lack of time, 51% (n=83) as the main limiting factors to use of ABPM. GPs recognise the clinical value of ABPM, but this study identifies definite barriers to the use of ABPM in Primary Care.

  18. Primary Care, Ambulatory Care, and Family Medicine: Overlapping But Not Synonymous

    Science.gov (United States)

    Reynolds, Robert E.

    1975-01-01

    Defines and depicts graphically the relationships between primary, secondary, and tertiary care functions (from least to most intensified phases of medical care); ambulatory care (care of sick or well people not confined to bed); and family medicine (an emerging medical discipline focusing on complete and longterm care of the family). (JT)

  19. Quality assurance in the ambulatory care setting.

    Science.gov (United States)

    Tyler, R D

    1989-01-01

    One of the most utilitarian developments in the field of quality assurance in health care has been the introduction of industrial concepts of quality management. These concepts, coupled with buyer demand for accountability, are bringing new perspectives to health care quality assurance. These perspectives provide a new view of quality assurance as a major responsibility and strategic opportunity for management; a competitive and marketable commodity; and a method of improving safety, effectiveness, and satisfaction with medical care.

  20. Use of extramural ambulatory care curricula in postgraduate medical training

    OpenAIRE

    Talwalkar, Jaideep S.; Satcher, D’Juanna; Turner, Teri L.; Sisson, Stephen D.; Fenick, Ada M.

    2015-01-01

    Introduction Extramural curricula developed for the purpose of sharing with other institutions have been designed to improve education on important topics in ambulatory care. We sought to assess the usage rates of these curricula among paediatric, internal medicine, and combined medicine-paediatrics residency programmes in the United States. Methods Surveys on aspects of trainee continuity clinic were sent to paediatric and medicine-paediatrics programme directors in 2012. Surveys contained a...

  1. Speak Up: Help Prevent Errors in Your Care: Ambulatory Care

    Science.gov (United States)

    ... role in making health care safe. That includes doctors, nurses and other health care professionals. Health care organizations ... embarrassed if you don't understand what your doctor, nurse or other health care professional tells you. • Don’ ...

  2. AMBULATORY CARE SENSITIVE CONDITIONS: DIAGNOSTIC RELIABILITY IN SOUTHERN BRAZIL

    Directory of Open Access Journals (Sweden)

    Rafael Antoniazzi Abaid

    2014-12-01

    Full Text Available Introduction: Ambulatory Care Sensitive Conditions (ACSC are illnesses that could be prevented with adjusted ambulatorial care. ACSC have been used as indicator in effectiveness of the primary healthcare attention, through the evaluation of hospital admissions. However, we do not have studies to certify the reliability of diagnosis of ACSC in our country. Objective: To determine if the classification of ACSC from the main diagnostic field of the authorization of hospital internment (AHI is reliable. Methods: Transversal study carried through February of 2010 to January of 2011, in the city of Santa Cruz of Sul (RS. A random sample of 389 medical records was selected and evaluated by two medical appraisers. The main diagnosis in the AHI was compared with the classification in ACSC or not ACSC given for the appraisers after the study of each medical record. Kappa ratio agreement was used to calculate the reliability of the ACSC diagnostic. Results: The ratio of agreement between diagnosis from the AIH and CSAP assessment contained in the records was 92%, with a kappa coefficient of 0,784. Conclusions: The diagnostic of ACSC found in main diagnostic field of AHI showed agreement ratios over expected by chance, with kappa value equal to 0.784 and the correlation rated between substantial and almost perfect.

  3. Terminal care: the role of the general practitioner hospital

    OpenAIRE

    Lyon, A; Love, D R

    1984-01-01

    A survey of all deaths occurring over a two-year period in a group practice population was carried out to assess the contribution of the local general practitioner hospital to terminal care overall. With the availability of the hospital, the general practitioners were able to provide a higher proportion of terminal care for their patients than in areas where general practitioners did not have access to hospital beds. This was particularly so in terminal care for patients dying of cancer.

  4. Health care practitioners and dying patients

    Directory of Open Access Journals (Sweden)

    Panagiotis Pentaris

    2013-06-01

    Full Text Available A full understanding of and a competent approach to dying patients may lead to a more qualitative service delivery, an enhanced quality of life paradigms, and the patients’ wellbeing, all of which remain the ultimate goal of health care practice. The modern world has developed in parallel with secularism and religious diversity. This paper aims to illustrate the secularization process in Britain (with indications of generalized meanings and juxtaposes it with a description of the needs of dying patients regarding the meanings of religion and nonreligion. Although this paper draws on and provides a review of selected theoretical literature, it also addresses a significant challenge: the lack of scientifi c research on the subject. Hence, this paper aims to give an overview of the issues, but not synthesise them. The arguments that are elaborated in the paper are also supported by the author’s current research project in the city of London. The approach here is client oriented, and concerns social and health care. Practitioners ought to become competent, and maintain their competence throughout their professional career. Religious competence seems to have not been at the centre of discussions, regardless of the historical pathway that religious discourse has drawn since the beginnings of humanity. The paper concludes with certain suggestions for future research and inclusive approaches regarding religious matters.

  5. What Ambulatory Care Managers Need to Know About Examination Room Utilization Measurement and Analysis.

    Science.gov (United States)

    Klarich, Mark J; Rea, Ronald W; Lal, Tarun Mohan; Garcia, Angel L; Steffens, Fay L

    2016-01-01

    Demand for ambulatory care visits is projected to increase 22% between 2008 and 2025. Given this growth, ambulatory care managers need to proactively plan for efficient use of scarce resources (ie, space, equipment, and staff). One important component of ambulatory care space (the number of examination rooms) is dependent on multiple factors, including variation in demand, hours of operation, scheduling, and staff. The authors (1) outline common data collection methods, (2) highlight analysis and reporting considerations for examination room utilization, and (3) provide a strategic framework for short- and long-term decision making for facility design or renovation. PMID:27232683

  6. Translating caring theory across the continuum from inpatient to ambulatory care.

    Science.gov (United States)

    Tonges, Mary; McCann, Meghan; Strickler, Jeff

    2014-06-01

    While theory-based practice is a Magnet® characteristic, translating theories to practice remains challenging. As a result, theory-guided practice remains an ideal rather than a realized goal in many organizations. This article provides an overview of a research-derived caring theory, a translational model for theory-driven practice, implementation of a delivery model designed to translate theory across the acute and ambulatory care continuum, and resulting outcomes in oncology clinics and the emergency department.

  7. Adopting Ambulatory Breast Cancer Surgery as the Standard of Care in an Asian Population

    Directory of Open Access Journals (Sweden)

    Yvonne Ying Ru Ng

    2014-01-01

    Full Text Available Introduction. Ambulatory surgery is not commonly practiced in Asia. A 23-hour ambulatory (AS23 service was implemented at our institute in March 2004 to allow more surgeries to be performed as ambulatory procedures. In this study, we reviewed the impact of the AS23 service on breast cancer surgeries and reviewed surgical outcomes, including postoperative complications, length of stay, and 30-day readmission. Methods. Retrospective review was performed of 1742 patients who underwent definitive breast cancer surgery from 1 March 2004 to 31 December 2010. Results. By 2010, more than 70% of surgeries were being performed as ambulatory procedures. Younger women (P<0.01, those undergoing wide local excision (P<0.01 and those with ductal carcinoma-in situ or early stage breast cancer (P<0.01, were more likely to undergo ambulatory surgery. Six percent of patients initially scheduled for ambulatory surgery were eventually managed as inpatients; a third of these were because of perioperative complications. Wound complications, 30-day readmission and reoperation rates were not more frequent with ambulatory surgery. Conclusion. Ambulatory breast cancer surgery is now the standard of care at our institute. An integrated workflow facilitating proper patient selection and structured postoperativee outpatient care have ensured minimal complications and high patient acceptance.

  8. Does general practitioner gatekeeping curb health care expenditure?

    NARCIS (Netherlands)

    Delnoij, D.; Merode, G. van; Paulus, A.; Groenewegen, P.

    2000-01-01

    Objectives: It is generally assumed that health care systems in which specialist and hospital care is only accessible after referral by a general practitioner (GP) have lower total health care costs. In this study, the following questions were addressed: do health care systems with GPs acting as gat

  9. Ambulatory care training during core internal medicine residency training: the Canadian experience.

    OpenAIRE

    McLeod, P. J.; Meagher, T W

    1993-01-01

    OBJECTIVE: To determine the status of ambulatory care training of core internal medicine residents in Canada. DESIGN: Mail survey. PARTICIPANTS: All 16 program directors of internal medicine residency training programs in Canada. OUTCOME MEASURES: The nature and amount of ambulatory care training experienced by residents, information about the faculty tutors, and the sources and types of patients seen by the residents. As well, the program directors were asked for their opinions on the ideal ...

  10. Health care innovation: Working with General Practitioners

    Directory of Open Access Journals (Sweden)

    Moyez Jiwa

    2013-01-01

    Full Text Available The development of innovations for clinical practice warrants active engagement of clinicians in the research process. This requires attention to factors that serve as incentive to participate. The explanation for the success of factors that encourage practitioners to participate in research can be found in sources of satisfaction and dissatisfaction with clinical practice. It is also important to consider intrinsic incentives such as common and troublesome clinical presentations that are related to workload or unsatisfactory clinical encounters. This review will consider each of these factors and suggest ways in which clinicians, especially general practitioners, may be invited to assist on research projects.

  11. Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions

    NARCIS (Netherlands)

    Freund, T.; Campbell, S.M.; Geissler, S.; Kunz, C.U.; Mahler, C.; Peters-Klimm, F.; Szecsenyi, J.

    2013-01-01

    PURPOSE: Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are seen as potentially avoidable with optimal primary care. Little is known, however, about how primary care physicians rate these hospitalizations and whether and how they could be avoided. This study explores the complex c

  12. Maximizing nurse practitioners' contributions to primary care through organizational changes.

    Science.gov (United States)

    Poghosyan, Lusine; Aiken, Linda H

    2015-01-01

    The nurse practitioner (NP) workforce represents a considerable supply of primary care providers able to contribute to meeting a growing demand for care. However, organizational barriers hinder their optimal use. This article presents reports from 592 NPs on their roles, organizational support available to them, relationships between NPs and administration, their job satisfaction, and intentions of leaving their jobs. Nurse practitioners reported deficits in organizational context of care, problematic deployment of resources, and unfavorable working relationships with administrators. Addressing these challenges and creating work environments conducive to NP practice are necessary to fully exploit the capacity of the NP workforce. PMID:25748259

  13. General practitioners and their role in maternity care.

    NARCIS (Netherlands)

    Wiegers, T.A.

    2003-01-01

    During the last century the perception of pregnancy and childbirth has changed from a normal, physiological life-event to a potentially dangerous condition. Maternity care has become more and more obstetrical care, focussed on pathology and complications. The involvement of general practitioners (GP

  14. A cluster randomized trial evaluating electronic prescribing in an ambulatory care setting

    Directory of Open Access Journals (Sweden)

    Quan Sherman

    2007-10-01

    Full Text Available Abstract Background Medication errors, adverse drug events and potential adverse drug events are common and serious in terms of the harms and costs that they impose on the health system and those who use it. Errors resulting in preventable adverse drug events have been shown to occur most often at the stages of ordering and administration. This paper describes the protocol for a pragmatic trial of electronic prescribing to reduce prescription error. The trial was designed to overcome the limitations associated with traditional study design. Design This study was designed as a 65-week, cluster randomized, parallel study. Methods The trial was conducted within ambulatory outpatient clinics in an academic tertiary care centre in Ontario, Canada. The electronic prescribing software for the study is a Canadian electronic prescribing software package which provides physician prescription entry with decision support at the point of care. Using a handheld computer (PDA the physician selects medications using an error minimising menu-based pick list from a comprehensive drug database, create specific prescription instructions and then transmit the prescription directly and electronically to a participating pharmacy via facsimile or to the physician's printer using local area wireless technology. The unit of allocation and randomization is by 'week', i.e. the system is "on" or "off" according to the randomization scheme and the unit of analysis is the prescription, with adjustment for clustering of patients within practitioners. Discussion This paper describes the protocol for a pragmatic cluster randomized trial of point-of-care electronic prescribing, which was specifically designed to overcome the limitations associated with traditional study design. Trial Registration This trial has been registered with clinicaltrials.gov (ID: NCT00252395

  15. Impact of an Elective Course in Community and Ambulatory Care Pharmacy Practices on Student Perception of Patient Care.

    Science.gov (United States)

    Barnes, Kelli D; Maguire, Michelle; Bennett, Marialice S

    2015-09-25

    Objective. To determine the impact of an elective course on students' perception of opportunities and of their preparedness for patient care in community and ambulatory pharmacy settings. Design. Each course meeting included a lecture and discussion to introduce concepts and active-learning activities to apply concepts to patient care or practice development in a community or ambulatory pharmacy setting. Assessment. A survey was administered to students before and after the course. Descriptive statistics were used to assess student responses to survey questions, and Wilcoxon signed rank tests were used to analyze the improvement in student responses with an alpha level set at 0.05. Students felt more prepared to provide patient care, develop or improve a clinical service, and effectively communicate recommendations to other health care providers after course completion. Conclusion. This elective course equipped students with the skills necessary to increase their confidence in providing patient care services in community and ambulatory settings. PMID:27168617

  16. Exploring the link between ambulatory care and avoidable hospitalizations at the Veteran Health Administration.

    Science.gov (United States)

    Pracht, Etienne E; Bass, Elizabeth

    2011-01-01

    This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason. A bivariate probit model with instrumental variables was used to estimate the probability of rehospitalization. Veterans who had at least 1 ambulatory care visit per month experienced a significant reduction in the probability of rehospitalization for the same avoidable hospitalization condition. The findings suggest that ambulatory care can serve as an important substitute for more expensive hospitalization for the conditions characterized as avoidable.

  17. General practitioners and their role in maternity care.

    OpenAIRE

    Wiegers, T.A.

    2003-01-01

    During the last century the perception of pregnancy and childbirth has changed from a normal, physiological life-event to a potentially dangerous condition. Maternity care has become more and more obstetrical care, focussed on pathology and complications. The involvement of general practitioners (GPs) in maternity care is strongly reduced and almost everywhere the same reasons are found: interference with lifestyle and interruption of office routine, fear of litigation and costs of malpractic...

  18. Oncology Advanced Practitioners Bring Advanced Community Oncology Care.

    Science.gov (United States)

    Vogel, Wendy H

    2016-01-01

    Oncology care is becoming increasingly complex. The interprofessional team concept of care is necessary to meet projected oncology professional shortages, as well as to provide superior oncology care. The oncology advanced practitioner (AP) is a licensed health care professional who has completed advanced training in nursing or pharmacy or has completed training as a physician assistant. Oncology APs increase practice productivity and efficiency. Proven to be cost effective, APs may perform varied roles in an oncology practice. Integrating an AP into an oncology practice requires forethought given to the type of collaborative model desired, role expectations, scheduling, training, and mentoring. PMID:27249776

  19. Role Model Ambulatory Care Clinical Training Site in a Community-Based Pharmacy.

    Science.gov (United States)

    Magarian, Edward O.; And Others

    1993-01-01

    An interdisciplinary project provided ambulatory care clinical training for pharmacy and nursing students in community-based pharmacies, promoting early detection and medical follow-up of common health problems within the community. Students learned new clinical skills in patient health assessment, new diagnostic technologies, patient education…

  20. Integrated Clinical Geriatric Pharmacy Clerkship in Long Term, Acute and Ambulatory Care.

    Science.gov (United States)

    Polo, Isabel; And Others

    1994-01-01

    A clinical geriatric pharmacy clerkship containing three separate practice areas (long-term, acute, and ambulatory care) is described. The program follows the medical education clerkship protocol, with a clinical pharmacy specialist, pharmacy practice resident, and student. Participation in medical rounds, interdisciplinary conferences, and…

  1. Big data and ambulatory care: breaking down legal barriers to support effective use.

    Science.gov (United States)

    Thorpe, Jane Hyatt; Gray, Elizabeth Alexandra

    2015-01-01

    Big data is heralded as having the potential to revolutionize health care by making large amounts of data available to support care delivery, population health, and patient engagement. Critics argue that big data's transformative potential is inhibited by privacy requirements that restrict health information exchange. However, there are a variety of permissible activities involving use and disclosure of patient information that support care delivery and management. This article presents an overview of the legal framework governing health information, dispels misconceptions about privacy regulations, and highlights how ambulatory care providers in particular can maximize the utility of big data to improve care. PMID:25401945

  2. Provider practice models in ambulatory oncology practice: analysis of productivity, revenue, and provider and patient satisfaction.

    Science.gov (United States)

    Buswell, Lori A; Ponte, Patricia Reid; Shulman, Lawrence N

    2009-07-01

    Physicians, nurse practitioners, and physician assistants often work in teams to deliver cancer care in ambulatory oncology practices. This is likely to become more prevalent as the demand for oncology services rises, and the number of providers increases only slightly.

  3. Quality of Ambulatory Care in Medicare Advantage HMOs and Traditional Medicare

    OpenAIRE

    Ayanian, John Z.; Landon, Bruce E.; Robert C. Saunders; Pawlson, L. Greg; Newhouse, Joseph P.

    2013-01-01

    To compare quality of care nationally between Medicare Advantage health maintenance organizations (HMOs) and traditional Medicare and determine how various types of Medicare HMOs differed in quality from traditional Medicare, we assessed performance measures of the quality of ambulatory care from the among beneficiaries matched by demographic characteristics within local areas during 2003-2009. HMO enrollees were consistently more likely than traditional Medicare beneficiaries to receive appr...

  4. Hospitalization for ambulatory care sensitive conditions and the role of primary care in Italian regions.

    Directory of Open Access Journals (Sweden)

    Aldo Rosano

    2011-03-01

    Full Text Available Abstract
    Background: Hospitalization may often be prevented by timely and effective outpatient care either by preventing the onset of an illness, controlling an acute illness or managing a chronic disease with an appropriate follow-up. The objective of the study is to examine the variability of hospital admissions within Italian regions for Ambulatory Care Sensitive Conditions (ACSCs, and their relationship with primary care supply.
    Methods: Hospital discharge data aggregated at a regional level collected in 2005 were analysed by type of ACS conditions. Main outcome measures were regional hospital admission rates for ACSCs. Negative binomial models were used to analyse the association with individual risk factors (age and gender and regional risk factors (propensity to hospitalisation and prevalence of specific conditions.
    Non-parametric correlation indexes between standardised hospital admission rates and quantitative measures of primary care services were calculated.
    Results: ACSC admissions accounted for 6.6% of total admissions, 35.7% were classified as acute conditions and 64.3% as chronic conditions. Admission rates for ACSCs varied widely across Italian regions with different patterns for chronic and acute conditions. Southern regions showed significantly higher rates for chronic conditions and North-eastern regions for acute conditions. We found a significant negative association between the provision of ambulatory specialist services and standardised hospitalization rates
    (SHR for ACS chronic conditions (r=-0.50; p=0.02 and an inverse correlation among SHR for ACS acute conditions and the rate of GPs per 1,000 residents, although the latter was not statistically significant.
    Conclusions: In Italy, about 480,000 inpatient hospital admissions in 2005 were attributable to ACSCs. Even
    adjusting for potential confounders

  5. General practitioners and their role in maternity care.

    Science.gov (United States)

    Wiegers, T A

    2003-10-01

    During the last century the perception of pregnancy and childbirth has changed from a normal, physiological life-event to a potentially dangerous condition. Maternity care has become more and more obstetrical care, focussed on pathology and complications. The involvement of general practitioners (GPs) in maternity care is strongly reduced and almost everywhere the same reasons are found: interference with lifestyle and interruption of office routine, fear of litigation and costs of malpractice insurance, insufficient training and insufficient numbers of cases to retain competency. In Canada, the USA, and to a lesser extent in Australia and New Zealand, GPs still providing intrapartum care are GP-obstetricians rather than maternity care providers. They provide low-risk as well as high-risk obstetrical care, especially in rural areas with few specialist obstetricians. In Europe, GPs do not provide high-risk obstetrical care. Instead they emphasize their role as generalist, and compete with midwives for a central role in maternity care for women with an uncomplicated pregnancy. The ongoing medicalisation of childbirth and the changing attitudes towards the demands of maternity care practice have diminished the role of GPs or family physicians. If they want to stay involved in maternity care in the future they need to cooperate with midwives, preferably in shared care programs. PMID:14499165

  6. Anesthesiologists' practice patterns for treatment of postoperative nausea and vomiting in the ambulatory Post Anesthesia Care Unit

    Directory of Open Access Journals (Sweden)

    Claybon Louis

    2006-06-01

    Full Text Available Abstract Background When patients are asked what they find most anxiety provoking about having surgery, the top concerns almost always include postoperative nausea and vomiting (PONV. Only until recently have there been any published recommendations, mostly derived from expert opinion, as to which regimens to use once a patient develops PONV. The goal of this study was to assess the responses to a written survey to address the following questions: 1 If no prophylaxis is administered to an ambulatory patient, what agent do anesthesiologists use for treatment of PONV in the ambulatory Post-Anesthesia Care Unit (PACU?; 2 Do anesthesiologists use non-pharmacologic interventions for PONV treatment?; and 3 If a PONV prophylaxis agent is administered during the anesthetic, do anesthesiologists choose an antiemetic in a different class for treatment? Methods A questionnaire with five short hypothetical clinical vignettes was mailed to 300 randomly selected USA anesthesiologists. The types of pharmacological and nonpharmacological interventions for PONV treatment were analyzed. Results The questionnaire was completed by 106 anesthesiologists (38% response rate, who reported that on average 52% of their practice was ambulatory. If a patient develops PONV and received no prophylaxis, 67% (95% CI, 62% – 79% of anesthesiologists reported they would administer a 5-HT3-antagonist as first choice for treatment, with metoclopramide and dexamethasone being the next two most common choices. 65% (95% CI, 55% – 74% of anesthesiologists reported they would also use non-pharmacologic interventions to treat PONV in the PACU, with an IV fluid bolus or nasal cannula oxygen being the most common. When PONV prophylaxis was given during the anesthetic, the preferred PONV treatment choice changed. Whereas 3%–7% of anesthesiologists would repeat dose metoclopramide, dexamethasone, or droperidol, 26% (95% confidence intervals, 18% – 36% of practitioners would re

  7. Marketing ambulatory care to women: a segmentation approach.

    Science.gov (United States)

    Harrell, G D; Fors, M F

    1985-01-01

    Although significant changes are occurring in health care delivery, in many instances the new offerings are not based on a clear understanding of market segments being served. This exploratory study suggests that important differences may exist among women with regard to health care selection. Five major women's segments are identified for consideration by health care executives in developing marketing strategies. Additional research is suggested to confirm this segmentation hypothesis, validate segmental differences and quantify the findings.

  8. Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings

    Directory of Open Access Journals (Sweden)

    Sen S

    2014-06-01

    Full Text Available Objective: To introduce pharmacists to the process, challenges, and opportunities of creating transitions of care (TOC models in the inpatient, ambulatory, and community practice settings. Methods: TOC literature and resources were obtained through searching PubMed, Ovid, and GoogleScholar. The pharmacist clinicians, who are the authors in this manuscript are reporting their experiences in the development, implementation of, and practice within the TOC models. Results: Pharmacists are an essential part of the multidisciplinary team and play a key role in providing care to patients as they move between health care settings or from a health care setting to home. Pharmacists can participate in many aspects of the inpatient, ambulatory care, and community pharmacy practice settings to implement and ensure optimal TOC processes. This article describes establishing the pharmacist’s TOC role and practicing within multiple health care settings. In these models, pharmacists focus on medication reconciliation, discharge counseling, and optimization of medications. Additionally, a checklist has been created to assist other pharmacists in developing the pharmacist’s TOC roles in a practice environment or incorporating more TOC elements in their practice setting. Conclusion: Optimizing the TOC process, reducing medication errors, and preventing adverse events are important focus areas in the current health care system, as emphasized by The Joint Commission and other health care organizations. Pharmacists have the unique opportunity and skillset to develop and participate in TOC processes that will enhance medication safety and improve patient care.

  9. Experiences of the advanced nurse practitioner role in acute care.

    Science.gov (United States)

    Cowley, Alison; Cooper, Joanne; Goldberg, Sarah

    2016-05-01

    The aim of the service evaluation presented in this article was to explore the multidisciplinary team's (MDT) experiences and perception of the advanced nurse practitioner (ANP) role on an acute health care of the older person ward. A qualitative case study was carried out comprising semi-structured interviews with members of the MDT, exploring their experiences of the ANP role. An overarching theme of 'Is it a nurse? Is it a doctor? No, it's an ANP' emerged from the data, with three subthemes: the missing link; facilitating and leading holistic care; and safe, high quality care. The ANP role is valued by the MDT working with them and provides a unique skill set that has the potential to enhance care of older patients living with frailty. While there are challenges to its introduction, it is a role worth introducing to older people's wards. PMID:27125941

  10. Manager's leadership is the main skill for ambulatory health care plan success.

    Science.gov (United States)

    Marin, Gustavo Horacio; Silberman, Martin; Colombo, Maria Virginia; Ozaeta, Belen; Henen, Jaime

    2015-01-01

    To demonstrate effectiveness of ambulatory health care plan implementation among institutions and variables associated with the differences observed. Randomized selection of primary health care (PHC) centers was done. Leadership ability of the plan manager was explored. Univariate/bivariate analyses were performed to observe correlation between variables. Two groups of PHC centers were established according to the efficacy of plan implementation: high and low performance. Differences between groups were observed (592%-1023% more efficacy in controls and practices; P < .001). Leadership was responsible for the main differences observed. Leadership of manager for implementation of the health care plan was the major important variable to reach the best efficacy standards.

  11. Pharmacists implementing transitions of care in inpatient, ambulatory and community practice settings

    OpenAIRE

    Sen S.; Bowen JF; Ganetsky VS; Hadley D; Melody K; Otsuka S; Vanmali R; Thomas T

    2014-01-01

    Objective: To introduce pharmacists to the process, challenges, and opportunities of creating transitions of care (TOC) models in the inpatient, ambulatory, and community practice settings. Methods: TOC literature and resources were obtained through searching PubMed, Ovid, and GoogleScholar. The pharmacist clinicians, who are the authors in this manuscript are reporting their experiences in the development, implementation of, and practice within the TOC models. Results: Pharmacists are...

  12. Preconception care by family physicians and general practitioners in Japan

    Directory of Open Access Journals (Sweden)

    Fetters Michael D

    2005-07-01

    Full Text Available Abstract Background Preconception care provided by family physicians/general practitioners (FP/GPs can provide predictable benefits to mothers and infants. The objective of this study was to elucidate knowledge of, attitudes about, and practices of preconception care by FP/GPs in Japan. Methods A survey was distributed to physician members of the Japanese Academy of Family Medicine. The questionnaire addressed experiences of preconception education in medical school and residency, frequency of preconception care in clinical practice, attitudes about providing preconception care, and perceived need for preconception education to medical students and residents. Results Two hundred and sixty-eight of 347 (77% eligible physicians responded. The most common education they reported receiving was about smoking cessation (71%, and the least was about folic acid supplementation (12%. Many participants reported providing smoking cessation in their practice (60%, though only about one third of respondents advise restricting alcohol intake. Few reported advising calcium supplementation (10% or folic acid supplementation (4%. About 70% reported their willingness to provide preconception care. Almost all participants believe medical students and residents should have education about preconception care. Conclusion FP/GPs in Japan report little training in preconception care and few currently provide it. With training, most participants are willing to provide preconception care themselves and think medical students and residents should receive this education.

  13. Primary care nurse practitioners' integrity when faced with moral conflict.

    Science.gov (United States)

    Laabs, Carolyn Ann

    2007-11-01

    Primary care presents distressful moral problems for nurse practitioners (NPs) who report frustration, powerlessness, changing jobs and leaving advanced practice. The purpose of this grounded theory study was to describe the process NPs use to manage moral problems common to primary care. Twenty-three NPs were interviewed, commenting on hypothetical situations depicting ethical issues common to primary care. Coding was conducted using a constant comparative method. A theory of maintaining moral integrity emerged consisting of the phases of encountering conflict, drawing a line, finding a way without crossing the line, and evaluating actions. The NPs varied in their awareness and the discord encountered in conflict, and in clarity, flexibility and justification of the line drawn. A critical juncture occurred when NPs evaluated how well integrity had been maintained. Some experienced no distress while others experienced self-doubt, regret, outrage and frustration at external constraints, and attempted to reconcile through avoiding, convincing themselves, and compensating.

  14. [Management and organization of ambulatory medical care in a district].

    Science.gov (United States)

    Schneider, K; Keune, H G; Miethe, D; Ringel, M; Szkibik, B

    1990-01-01

    An analysis is given of the management and organization of out-patient medical care in 15 districts and of the District Physician's responsibilities as well as the profile of a District Health Department. Compared to the situation of a decade ago, substantial changes in the territorial health organization have occurred (decentralization, formation of care areas, affiliation of small health facilities to bigger ones). The District Physician's scope of responsibility is increasingly determined by activities within the framework of the District Council, the proportion of organizational work has increased. In order to be able to fulfill his tasks the District Physician needs the support of a special Health Department. Skeleton regulations for out-patient medical care are necessary.

  15. AMBULATORY CARE - SENSITIVE CONDITIONS IN CHILDREN UNDER FIVE YEARS

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Araújo Figueiredo

    2013-05-01

    Full Text Available Objective:analyzethe extent to which the incidence rate of primary care sensitivehospitalizations in children under five years is influenced by the percentage of coverage of theprimary care.Methods:This was a cross-sectional ecological study that combines coverage ofprimary careand theambulatorycare-sensitiveconditionsin 2000 and 2010. We used data from theHospital Information System (HIS and the Information System of Primary Care (SIAB.Results:The data revealed that the increased coverage providedprimary carereductionrateofhospitalization diseases studied. In 2000 the reduction was greater for gastroenteritis (51% inchildren under 01 years and 30% in children 01-04 years in 2010 for respiratory diseases (51% inchildren under 01years and 33% in children aged 01-04 years.Conclusion:we found an association between the coverage ofprimary careand admission rates, however seem to affect othervariables, suggesting the need for further studies.

  16. Developing Staffing Models to Support Population Health Management And Quality Oucomes in Ambulatory Care Settings.

    Science.gov (United States)

    Haas, Sheila A; Vlasses, Frances; Havey, Julia

    2016-01-01

    There are multiple demands and challenges inherent in establishing staffing models in ambulatory heath care settings today. If health care administrators establish a supportive physical and interpersonal health care environment, and develop high-performing interprofessional teams and staffing models and electronic documentation systems that track performance, patients will have more opportunities to receive safe, high-quality evidence-based care that encourages patient participation in decision making, as well as provision of their care. The health care organization must be aligned and responsive to the community within which it resides, fully invested in population health management, and continuously scanning the environment for competitive, regulatory, and external environmental risks. All of these challenges require highly competent providers willing to change attitudes and culture such as movement toward collaborative practice among the interprofessional team including the patient.

  17. Is Health Practitioner Regulation Keeping Pace with the Changing Practitioner and Health-Care Landscape? An Australian Perspective.

    Science.gov (United States)

    Wardle, Jonathan Lee; Sibbritt, David; Broom, Alex; Steel, Amie; Adams, Jon

    2016-01-01

    Health-care delivery is undergoing significant evolution and change. Task substitution has resulted in some practitioner groups expanding their scope of practice by assuming more complex clinical roles, new practitioner groups have emerged, and consumer-driven demand has changed the way the public engage with health practitioners and the way many health-care services are delivered. Using Australia as a case study, this paper explores the issue of the hesitancy to include new professions in health professions regulation schemes. Despite the significant changes in the health-care delivery landscape, policy development in this area has remained relatively static, with active resistance to extending formal registration to new practitioner groups. Ignoring the issue of new practitioner groups in regulatory schemes is unacceptable from a public health perspective and runs against the key public protection objectives of health practitioner regulation. Development of pathways for the entry of new health practitioner groups into regulatory schemes must be developed as a matter of priority. PMID:27379222

  18. The Role of Rural Health Clinics in Hospitalization Due to Ambulatory Care Sensitive Conditions: A Study in Nebraska

    Science.gov (United States)

    Zhang, Wanqing; Mueller, Keith J.; Chen, Li-Wu; Conway, Kevin

    2006-01-01

    Context: Hospitalization due to ambulatory care sensitive conditions (ACSCs) is often used as an indicator for measuring access to primary care. Rural health clinics (RHCs) provide basic primary care services for rural residents in health professional shortage areas (HPSAs). The relationship between RHCs and ACSCs is unclear. Purpose: The purpose…

  19. Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system

    Directory of Open Access Journals (Sweden)

    Tania Cristina Morais Santa Barbara Rehem

    2013-09-01

    Full Text Available OBJECTIVE: to estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. METHOD: the hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. RESULT: the sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. CONCLUSION: there are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

  20. [The social hygienic assessment of significance of diseases under organization of ambulatory polyclinic care].

    Science.gov (United States)

    Babenko, A I; Murakhovskiy, A G; Tomtchuk, A A; Bravve, Yu I

    2013-01-01

    The article presents the results of analysis of appealability of adult population of Omsk to municipal polyclinic on the subject of diseases. The coefficients of relative importance of different classes of diseases to determine the groups af their significance were calculated on the basis of integrated evaluation of common and primary morbidity and diseases of patients under dispensarization monitoring. The established character of formation of flows of appealabiliy of population on the subject of diseases is a basic one to determine demand in medical technologies and planning of activities of ambulatory polyclinic section of health care.

  1. How acceptable are primary health care nurse practitioners to Australian consumers?

    Science.gov (United States)

    Parker, Rhian; Forrest, Laura; Ward, Nathaniel; McCracken, James; Cox, Darlene; Derrett, Julie

    2013-01-01

    International evidence indicates that nurses working in primary care can provide effective care and achieve positive health outcomes for patients similar to that provided by doctors. Nurse practitioners employed in primary health care perform some tasks previously exclusive to the GP role due to their advanced skills, knowledge and training. In November 2010 Medicare provider rights and Pharmaceutical Benefits Scheme rights were provided for nurse practitioners working in private practice, and in collaboration with a medical practitioner. However, there is limited evidence about how acceptable nurse practitioners are to Australian consumers and what knowledge consumers have of the nurse practitioner role in the delivery of primary health care. The aim of this study was to examine Australian health care consumers' perceptions of nurse practitioners working in primary health care. This paper reports on the results of seven focus groups (n = 77 participants) conducted around Australia. Focus groups participants were asked how acceptable nurse practitioners are as provides of primary health care. Although there was some confusion about the role of nurse practitioners and how this role differed from other primary health care nurses, participants in the focus groups were very positive about nurse practitioners and would find them acceptable in providing primary health care.

  2. Identifying consumer segments in health services markets: an application of conjoint and cluster analyses to the ambulatory care pharmacy market.

    Science.gov (United States)

    Carrol, N V; Gagon, J P

    1983-01-01

    Because of increasing competition, it is becoming more important that health care providers pursue consumer-based market segmentation strategies. This paper presents a methodology for identifying and describing consumer segments in health service markets, and demonstrates the use of the methodology by presenting a study of consumer segments in the ambulatory care pharmacy market.

  3. Attitudes of general practitioners to caring for people with learning disability.

    OpenAIRE

    Kerr, M.; Dunstan, F.; Thapar, A.

    1996-01-01

    BACKGROUND: The views of general practitioners on their increasing role in caring for people with learning disability in the community are not known. AIM: A study was carried out to assess the views of general practitioners with regard to providing routine care, organizing health promotion and specific health checks for people with learning disability and the role of specialists. METHOD: A postal questionnaire was sent to all 242 general practitioners in Gwent, south Wales. Participants had t...

  4. Research on the effects of pharmacist-patient communication in institutions and ambulatory care sites, 1969-1994.

    Science.gov (United States)

    De Young, M

    1996-06-01

    Research on the effects of pharmacist-patient communication that appeared in the pharmacy literature between 1969 and 1994 is reviewed. The terms patients education and patient counseling were used in identifying relevant research. Many authors used these terms interchangeably; also, the terms counseling and consultation often were not clearly defined. Studies of pharmacists' history-taking in institutional settings and of other communication with patients in ambulatory care settings were examined by decade. The research questions, theories, methods, results, and limitations were analyzed. More than 30 studies examined the effect of pharmacists' communication on patient outcomes, primarily knowledge and medication compliance; generally, the results suggested that pharmacists' communication led to increased knowledge and compliance. A few researchers raised concerns about patients' knowledge as an indicator of effective communication by pharmacists, and in the 1980s a few suggested that better medication compliance could be associated with the time and attention given to patients rather than the informational content of the interaction. Little was reported about the communication theories or models on which the studies were based, and there was little indication in most studies that patients' ideas about their therapy were considered. Often, the numbers of patients and pharmacists were small, and the pharmacists may have had training or motivation exceeding that of the average practitioner. In studies of pharmacists' versus physicians' history-taking, the physicians were not well described; their involvement and their approach may not have been comparable to those of the pharmacists. Before 1990, a few researchers had examined outcomes such as pulmonary function and control of diabetes. In the 1990s, more researchers looked at outcomes such as medication-related problems and use of health care resources. The research indicated that pharmacists can increase patients

  5. Marketing strategy adjustments in the ambulatory care center industry: implications for community pharmacy.

    Science.gov (United States)

    Phillips, J H

    1989-01-01

    Each stage of a product's life cycle requires marketing strategy modifications in response to changing demand levels. The purpose of this study was to investigate changes in ambulatory care center (ACC) operational characteristics indicative of product, market, and distribution channel adjustments that could have a competitive impact upon community pharmacy practice. A questionnaire was mailed to a national sample of 325 ACC managers. Evidence of new product feature additions includes increased emphasis on continued care and increased prevalence of prescription drug dispensing. Expansion into new market segments and distribution channels was demonstrated by increased participation in HMO and employer relationships. The observed adjustments in ACC marketing strategies present obvious challenges as well as less obvious opportunities for community pharmacy practice. PMID:10295634

  6. Evaluation of a career ladder program in an ambulatory care environment.

    Science.gov (United States)

    Nelson, Joan M; Cook, Paul F

    2008-01-01

    Clinical ladders, or career advancement systems, were designed to enhance professional development, provide a reward system for quality clinical performance, promote quality nursing practice, and improve job satisfaction among nurses. Most of the literature on RN clinical ladder programs is related to the acute care setting, where these programs originated; not much is known about their effectiveness in the ambulatory care environment. The RN Career Ladder at Kaiser Permanente of Colorado was begun by a Labor Management Partnership Committee in 2003, and awards financial incentives to RNs who demonstrate a commitment to continuing education, leadership activities, and program development on a local and regional level. In this study significantly more involvement in leadership, interdisciplinary, and quality improvement activities were found among career ladder nurses than non-career ladder nurses, regardless of their job role. It is not clear whether nursing leaders gravitate toward a career ladder or whether career ladder participation encourages increased participation in leadership activities. PMID:19330969

  7. Marketing strategy adjustments in the ambulatory care center industry: implications for community pharmacy.

    Science.gov (United States)

    Phillips, J H

    1989-01-01

    Each stage of a product's life cycle requires marketing strategy modifications in response to changing demand levels. The purpose of this study was to investigate changes in ambulatory care center (ACC) operational characteristics indicative of product, market, and distribution channel adjustments that could have a competitive impact upon community pharmacy practice. A questionnaire was mailed to a national sample of 325 ACC managers. Evidence of new product feature additions includes increased emphasis on continued care and increased prevalence of prescription drug dispensing. Expansion into new market segments and distribution channels was demonstrated by increased participation in HMO and employer relationships. The observed adjustments in ACC marketing strategies present obvious challenges as well as less obvious opportunities for community pharmacy practice.

  8. Health problems presented in general practice by survivors before and after a fireworks disaster: associations with mental health care.

    NARCIS (Netherlands)

    Ouden, D.J. den; Dirkzwager, A.J.E.; IJzermans, C.J.

    2005-01-01

    Objective: To study the health problems presented to general practitioners by disaster survivors who received specialized ambulatory mental health care. Design: (Longitudinal) case-control study based on general practitioners' electronic medical records. Setting: General practice and a mental health

  9. Health care professionals' perceptions towards lifelong learning in palliative care for general practitioners: a focus group study

    OpenAIRE

    Pype, Peter; Symons, Linda; Wens, Johan; Van den Eynden, Bart; Stes, Ann; Deveugele, Myriam

    2014-01-01

    Background: There is a growing need for palliative care. The majority of palliative patients prefer their general practitioner (GP) to organize their palliative home care. General practitioners need a range of competences to perform this task. However, there has been no general description so far of how GPs keep these competences up-to-date. The present study explores current experiences, views and preferences towards training and education in palliative care among GPs, palliative home-care p...

  10. Hepatitis B Vaccination and Screening Awareness in Primary Care Practitioners

    Directory of Open Access Journals (Sweden)

    Adnan Said

    2014-01-01

    Full Text Available Introduction. The goals of Healthy People US 2020 have called for increased screening and vaccination of high-risk groups for Hepatitis B (HBV. Methods. We performed a survey of 400 randomly chosen primary care practitioners (PCPs in Wisconsin to assess their knowledge, attitudes, and practices regarding screening and vaccination for HBV. Results. Screening rates of patients at risk of sexual transmission were low, with 61% of respondents stating that they screen patients who had more than 1 sex partner in 6 months and 86% screening patients with a history of sex with prostitutes. Screening rate for persons with a history of intravenous drug use was 94%. Children of immigrants were screened by 65%, persons on hemodialysis by 73%, and prison inmates by 69%. Screening increased with provider experience with HBV. Deficiencies in vaccination rates mirrored screening practices. Major barriers to screening were cost, someone else’s responsibility, time constraints, or lack of knowledge. Conclusions. Without improved education and practices of PCPs about HBV screening and vaccination, the goals of healthy people 2020 regarding HBV will not be met. Barriers to screening and vaccination need to be addressed. Cost-effectiveness of alternative strategies such as universal vaccination under the age of 50 should be explored.

  11. Hepatitis B vaccination and screening awareness in primary care practitioners.

    Science.gov (United States)

    Said, Adnan; Jou, Janice H

    2014-01-01

    Introduction. The goals of Healthy People US 2020 have called for increased screening and vaccination of high-risk groups for Hepatitis B (HBV). Methods. We performed a survey of 400 randomly chosen primary care practitioners (PCPs) in Wisconsin to assess their knowledge, attitudes, and practices regarding screening and vaccination for HBV. Results. Screening rates of patients at risk of sexual transmission were low, with 61% of respondents stating that they screen patients who had more than 1 sex partner in 6 months and 86% screening patients with a history of sex with prostitutes. Screening rate for persons with a history of intravenous drug use was 94%. Children of immigrants were screened by 65%, persons on hemodialysis by 73%, and prison inmates by 69%. Screening increased with provider experience with HBV. Deficiencies in vaccination rates mirrored screening practices. Major barriers to screening were cost, someone else's responsibility, time constraints, or lack of knowledge. Conclusions. Without improved education and practices of PCPs about HBV screening and vaccination, the goals of healthy people 2020 regarding HBV will not be met. Barriers to screening and vaccination need to be addressed. Cost-effectiveness of alternative strategies such as universal vaccination under the age of 50 should be explored. PMID:24729872

  12. Perceived Stress, Multimorbidity, and Risk for Hospitalizations for Ambulatory Care-sensitive Conditions

    DEFF Research Database (Denmark)

    Prior, Anders; Vestergaard, Mogens; Davydow, Dimitry S;

    2016-01-01

    BACKGROUND: Psychiatric disorders are associated with an increased risk for ambulatory care-sensitive condition (ACSC)-related hospitalizations, but it remains unknown whether this holds for individuals with nonsyndromic stress that is more prevalent in the general population. OBJECTIVES......: To determine whether perceived stress is associated with ACSC-related hospitalizations and rehospitalizations, and posthospitalization 30-day mortality. RESEARCH DESIGN AND MEASURES: Population-based cohort study with 118,410 participants from the Danish National Health Survey 2010, which included data...... on Cohen's Perceived Stress Scale, followed from 2010 to 2014, combined with individual-level national register data on hospitalizations and mortality. Multimorbidity was assessed using health register information on diagnoses and drug prescriptions within 39 condition categories. RESULTS: Being...

  13. The Role of Ambulatory Care Pharmacists in an HIV Multidisciplinary Team within a Free and Bilingual Clinic

    OpenAIRE

    Ann M. Fugit, Pharm.D., BCPS; Sallie D. Mayer, Pharm.D., MBA, BCPS, CDE; Radha S. Vanmali, Pharm.D., BCACP

    2013-01-01

    Objective: Describe the role and integration of ambulatory care pharmacists in a Human Immunodeficiency Virus (HIV) clinic within a free and bilingual clinic with regards to types of interventions made during the patient-pharmacist visit. Design: Retrospective, single-centered, chart review. Setting: Free, bilingual clinic in Richmond, VA. Participants: Thirty-two adult patients with diagnosed HIV receiving care in the clinic between June 30, 2010 and January 26, 2011. Main Outcome Measure: T...

  14. The emerging primary care workforce: preliminary observations from the primary care team: learning from effective ambulatory practices project.

    Science.gov (United States)

    Ladden, Maryjoan D; Bodenheimer, Thomas; Fishman, Nancy W; Flinter, Margaret; Hsu, Clarissa; Parchman, Michael; Wagner, Edward H

    2013-12-01

    Many primary care practices are changing the roles played by the members of their health care teams. The purpose of this article is to describe some of these new roles, using the authors' preliminary observations from 25 site visits to high-performing primary care practices across the United States in 2012-2013. These sites visits, to practices using their workforce creatively, were part of the Robert Wood Johnson Foundation-funded initiative, The Primary Care Team: Learning From Effective Ambulatory Practices.Examples of these new roles that the authors observed on their site visits include medical assistants reviewing patient records before visits to identify care gaps, ordering and administering immunizations using protocols, making outreach calls to patients, leading team huddles, and coaching patients to set self-management goals. The registered nurse role has evolved from an emphasis on triage to a focus on uncomplicated acute care, chronic care management, and hospital-to-home transitions. Behavioral health providers (licensed clinical social workers, psychologists, or licensed counselors) were colocated and integrated within practices and were readily available for immediate consults and brief interventions. Physicians have shifted from lone to shared responsibility for patient panels, with other team members empowered to provide significant portions of chronic and preventive care.An innovative team-based primary care workforce is emerging. Spreading and sustaining these changes will require training both health professionals and nonprofessionals in new ways. Without clinical experiences that model this new team-based care and role models who practice it, trainees will not be prepared to practice as a team. PMID:24128622

  15. Columbia University's Competency and Evidence-based Acute Care Nurse Practitioner Program.

    Science.gov (United States)

    Curran, Christine R.; Roberts, W. Dan

    2002-01-01

    Columbia University's acute care nurse practitioner curriculum incorporates evaluation strategies and standards to assess clinical competence and foster evidence-based practice. The curriculum consists of four core courses, supporting sciences, and specialty courses. (Contains 17 references.) (SK)

  16. Brief Cognitive Behavioural Therapy Compared to Optimised General Practitioners? Care for Depression: A Randomised Trial

    NARCIS (Netherlands)

    Schene, A. H.; Baas, Kim D.; Koeter, Maarten; Lucassen, Peter; Bockting, Claudi; Wittkampf, K.F.; van Weert, H.C.; Huyser, J.

    2014-01-01

    Background: How to treat Major Depressive Disorder (MDD) in primary care? Studies that compared (brief) Cognitive Behavioural Therapy (CBT) with care as usual by the General Practitioner (GP) found the first to be more effective. However, to make a fair comparison GP care should be optimised and pro

  17. General practitioners (GPs) and palliative care: perceived tasks and barriers in daily practice.

    NARCIS (Netherlands)

    Groot, C.M.; Vernooy-Dassen, M.J.F.J.; Crul, B.J.P.; Grol, R.P.T.M.

    2005-01-01

    BACKGROUND: General practitioners (GPs) play a crucial part in palliative care. The quality of care can be improved by investigating and addressing barriers perceived by GPs in daily practice. The aim of this study was to investigate GPs' task perception and barriers involved in palliative care. MET

  18. What do practitioners think? A qualitative study of a shared care mental health and nutrition primary care program

    Directory of Open Access Journals (Sweden)

    Jann Paquette-Warren

    2006-10-01

    Full Text Available Objective: To develop an in-depth understanding of a shared care model from primary mental health and nutrition care practitioners with a focus on program goals, strengths, challenges and target population benefits. Design: Qualitative method of focus groups. Setting/Participants: The study involved fifty-three practitioners from the Hamilton Health Service Organization Mental Health and Nutrition Program located in Hamilton, Ontario, Canada. Method: Six focus groups were conducted to obtain the perspective of practitioners belonging to various disciplines or health care teams. A qualitative approach using both an editing and template organization styles was taken followed by a basic content analysis. Main findings: Themes revealed accessibility, interdisciplinary care, and complex care as the main goals of the program. Major program strengths included flexibility, communication/collaboration, educational opportunities, access to patient information, continuity of care, and maintenance of practitioner and patient satisfaction. Shared care was described as highly dependent on communication style, skill and expertise, availability, and attitudes toward shared care. Time constraint with respect to collaboration was noted as the main challenge. Conclusion: Despite some challenges and variability among practices, the program was perceived as providing better patient care by the most appropriate practitioner in an accessible and comfortable setting.

  19. Nurse Practitioner Mental Health Care in the Primary Context: A Californian Case Study

    Directory of Open Access Journals (Sweden)

    Theane Theophilos

    2015-03-01

    Full Text Available In America, mental health needs surpass the availability of specialized providers. This vulnerable population also has other obstacles for comprehensive care including gaps in medical coverage, stigma, economic barriers, and a geographical mal‑distribution of qualified mental health professionals. A wide availability of primary care providers, including primary care and family nurse practitioners, are well-positioned to deliver integrated mental and physical health care. A case study from a Southern California Coachella Valley primary care clinic with integrated services is used to demonstrate the much-needed approach of care to address health disparities that face low‑income immigrants, migrant workers, and others without access to specialized care centers and providers. It is argued that mental health care should be part of all holistic treatment provided by primary care and family nurse practitioners. This has implications for curricula and practice development.

  20. Application of Porter's generic strategies in ambulatory health care: a comparison of managerial perceptions in two Israeli sick funds.

    Science.gov (United States)

    Torgovicky, Refael; Goldberg, Avishay; Shvarts, Shifra; Bar Dayan, Yosefa; Onn, Erez; Levi, Yehezkel; BarDayan, Yaron

    2005-01-01

    A number of typologies have been developed in the strategic management literature to categorize strategies that an organization can pursue at the business level. Extensive research has established Porter's generic strategies of (1) cost leadership, (2) differentiation, (3) differentiation focus, (4) cost focus, and (5) stuck-in-the-middle as the dominant paradigm in the literature. The purpose of the current study was to research competitive strategies in the Israeli ambulatory health care system, by comparing managerial perceptions of present and ideal business strategies in two Israeli sick funds. We developed a unique research tool, which reliably examines the gap between the present and ideal status managerial views. We found a relation between the business strategy and performance measures, thus strengthening Porter's original theory about the nonviability of the stuck-in-the-middle strategy, and suggesting the applicability Porter's generic strategies to not-for-profit institutes in an ambulatory health care system.

  1. Application of Porter's generic strategies in ambulatory health care: a comparison of managerial perceptions in two Israeli sick funds.

    Science.gov (United States)

    Torgovicky, Refael; Goldberg, Avishay; Shvarts, Shifra; Bar Dayan, Yosefa; Onn, Erez; Levi, Yehezkel; BarDayan, Yaron

    2005-01-01

    A number of typologies have been developed in the strategic management literature to categorize strategies that an organization can pursue at the business level. Extensive research has established Porter's generic strategies of (1) cost leadership, (2) differentiation, (3) differentiation focus, (4) cost focus, and (5) stuck-in-the-middle as the dominant paradigm in the literature. The purpose of the current study was to research competitive strategies in the Israeli ambulatory health care system, by comparing managerial perceptions of present and ideal business strategies in two Israeli sick funds. We developed a unique research tool, which reliably examines the gap between the present and ideal status managerial views. We found a relation between the business strategy and performance measures, thus strengthening Porter's original theory about the nonviability of the stuck-in-the-middle strategy, and suggesting the applicability Porter's generic strategies to not-for-profit institutes in an ambulatory health care system. PMID:15773250

  2. Application of three different sets of explicit criteria for assessing inappropriate prescribing in older patients: a nationwide prevalence study of ambulatory care visits in Taiwan

    OpenAIRE

    Chang, Chirn-Bin; Yang, Shu-yu; Lai, Hsiu-Yun; Wu, Ru-Shu; Liu, Hsing-Cheng; Hsu, Hsiu-Ying; Hwang, Shinn-Jang; Chan, Ding-Cheng (Derrick)

    2015-01-01

    Objective To investigate the national prevalence of potentially inappropriate medications (PIMs) prescribed in ambulatory care clinics in Taiwan according to three different sets of regional criteria and the correlates of PIM use. Design Cross-sectional study. Setting This analysis included older patients who visited ambulatory care clinics in 2009 and represented half of the older population included on the Taiwanese National Health Insurance Research Database. Participants We identified 1 1...

  3. Cost-effectiveness analysis of computerized ECG interpretation system in an ambulatory health care organization.

    Science.gov (United States)

    Carel, R S

    1982-04-01

    The cost-effectiveness of a computerized ECG interpretation system in an ambulatory health care organization has been evaluated in comparison with a conventional (manual) system. The automated system was shown to be more cost-effective at a minimum load of 2,500 patients/month. At larger monthly loads an even greater cost-effectiveness was found, the average cost/ECG being about $2. In the manual system the cost/unit is practically independent of patient load. This is primarily due to the fact that 87% of the cost/ECG is attributable to wages and fees of highly trained personnel. In the automated system, on the other hand, the cost/ECG is heavily dependent on examinee load. This is due to the relatively large impact of equipment depreciation on fixed (and total) cost. Utilization of a computer-assisted system leads to marked reduction in cardiologists' interpretation time, substantially shorter turnaround time (of unconfirmed reports), and potential provision of simultaneous service at several remotely located "heart stations."

  4. Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center

    OpenAIRE

    Rosińczuk,Joanna; Manulik,Stanisław; Karniej,Piotr

    2016-01-01

    Stanisław Manulik,1 Joanna Rosińczuk,2 Piotr Karniej3 1Non-Public Health Care Institution, “Ambulatory of Cosmonauts” Ltd. Liability Company, 2Department of Nervous System Diseases, Faculty of Health Science, 3Department of Organization and Management, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland Introduction: Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUA...

  5. Caring for dementia carers: the role of general practitioners in Ireland.

    LENUS (Irish Health Repository)

    O'Connor, C

    2012-02-01

    BACKGROUND: Dementia patients in Ireland live 8 years on average after diagnosis and health policy aims to ensure patients are cared for in the home for as long as possible. AIM: To assess the role of general practitioners in Ireland caring for dementia carers. METHODS: A PubMed search (1980-2010) was performed using MeSH terms "caregivers or carers", "Dementia or Alzheimer\\'s disease", "family physician or general practitioner". An English language restriction was imposed and the search continued to June 24th 2010. RESULTS: Psychosocial multidisciplinary interventions that unite education, skills training, management of psychological problems and family support in the community are effective in managing the problems of carers and should be facilitated by general practitioners. CONCLUSIONS: Dementia carers form an important yet understated patient group who present unique challenges for general practitioners in Ireland.

  6. Caring for dementia carers: the role of general practitioners in Ireland.

    LENUS (Irish Health Repository)

    O'Connor, C

    2011-01-29

    BACKGROUND: Dementia patients in Ireland live 8 years on average after diagnosis and health policy aims to ensure patients are cared for in the home for as long as possible. AIM: To assess the role of general practitioners in Ireland caring for dementia carers. METHODS: A PubMed search (1980-2010) was performed using MeSH terms "caregivers or carers", "Dementia or Alzheimer\\'s disease", "family physician or general practitioner". An English language restriction was imposed and the search continued to June 24th 2010. RESULTS: Psychosocial multidisciplinary interventions that unite education, skills training, management of psychological problems and family support in the community are effective in managing the problems of carers and should be facilitated by general practitioners. CONCLUSIONS: Dementia carers form an important yet understated patient group who present unique challenges for general practitioners in Ireland.

  7. Hospitalisations and costs relating to ambulatory care sensitive conditions in Ireland.

    LENUS (Irish Health Repository)

    Sheridan, A

    2012-03-08

    BACKGROUND: Ambulatory care sensitive conditions (ACSCs) are conditions for which the provision of timely and effective outpatient care can reduce the risks of hospitalisation by preventing, controlling or managing a chronic disease or condition. AIMS: The aims of this study were to report on ACSCs in Ireland, and to provide a baseline for future reference. METHODS: Using HIPE, via Health Atlas Ireland, inpatient discharges classified as ACSCs using definitions from the Victorian ACSC study were extracted for the years 2005-2008. Direct methods of standardisation allowed comparison of rates using the EU standard population as a comparison for national data, and national population as comparison for county data. Costs were estimated using diagnosis-related groups. RESULTS: The directly age-standardised discharge rate for ACSC-related discharges increased slightly, but non-significantly, from 15.40 per 1,000 population in 2005 to 15.75 per 1,000 population in 2008. The number of discharges increased (9.5%) from 63,619 in 2005 to 69,664 in 2008, with the estimated associated hospital costs increasing (31.5%) from 267.8 million in 2005 to 352.2 million in 2008. Across the country, there was considerable variation in the discharge rates for the Top-10 ACSCs for the years 2005-2008. Significantly lower rates of hospitalisation were observed in more urban areas including Cork, Dublin and Galway. The most common ACSC in 2008 was diabetes with complications (29.8%). CONCLUSIONS: The variation in rates observed indicates the scope of reducing hospitalisations and associated costs for ACSCs, across both adult\\'s and children\\'s services and particularly in relation to diabetes complications.

  8. Low back pain research priorities: a survey of primary care practitioners

    Directory of Open Access Journals (Sweden)

    Das Anurina

    2007-07-01

    Full Text Available Abstract Background Despite the large amount of time and money which has been devoted to low back pain research, successful management remains an elusive goal and low back pain continues to place a large burden on the primary care setting. One reason for this may be that the priorities for research are often developed by researchers and funding bodies, with little consideration of the needs of primary care practitioners. This study aimed to determine the research priorities of primary care practitioners who manage low back pain on a day-to-day basis. Methods A modified-Delphi survey of primary care practitioners was conducted, consisting of three rounds of questionnaires. In the first round, 70 practitioners who treat low back pain were each asked to provide up to five questions which they would like answered with respect to low back pain in primary care. The results were collated into a second round questionnaire consisting of 39 priorities, which were rated for importance by each practitioner on a likert-scale. The third round consisted of asking the practitioners to rank the top ten priorities in order of importance. Results Response rates for the modified-Delphi remained above 70% throughout the three rounds. The ten highest ranked priorities included the identification of sub-groups of patients that respond optimally to different treatments, evaluation of different exercise approaches in the management of low back pain, self-management of low back pain, and comparison of different treatment approaches by primary care professions treating low back pain. Conclusion Practitioners identified a need for more information on a variety of topics, including diagnosis, the effectiveness of treatments, and identification of patient characteristics which affect treatment and recovery.

  9. General practitioners' attitudes towards research in primary care: qualitative results of a cross sectional study

    OpenAIRE

    Szecsenyi Joachim; Rosemann Thomas

    2004-01-01

    Abstract Background Research in General Practice requires the participation of General practitioners (GPs). In Germany there is little tradition of research in this field, and GPs are not used to be participants in research. Little is known about German GPs attitudes towards research. Therefore the aim of our study was to assess the willingness of German General Practitioners to participate in primary care research and their attitude towards research in general practice. The results should en...

  10. National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners: reporting on adverse and negative actions. Final rule.

    Science.gov (United States)

    2010-01-28

    This final rule revises existing regulations under sections 401 through 432 of the Health Care Quality Improvement Act of 1986, governing the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners, to incorporate statutory requirements under section 1921 of the Social Security Act, as amended by section 5(b) of the Medicare and Medicaid Patient and Program Protection Act of 1987 (MMPPPA), and as amended by the Omnibus Budget Reconciliation Act of 1990 (OBRA). The MMPPPA, along with certain additional provisions in the OBRA, was designed to protect program beneficiaries from unfit health care practitioners, and otherwise improve the anti-fraud provisions of Medicare and State health care programs. Section 1921, the statutory authority upon which this regulatory action is based, requires each State to adopt a system of reporting to the Secretary of Health and Human Services (the Secretary) certain adverse licensure actions taken against health care practitioners and health care entities licensed or otherwise authorized by a State (or a political subdivision thereof) to provide health care services. It also requires each State to report any negative actions or findings that a State licensing authority, peer review organization, or private accreditation entity has concluded against a health care practitioner or health care entity.

  11. Patient care and the general practitioner. Joint Working Party of the Welsh Council of the Royal College of General Practitioners and the Welsh General Medical Services Committee.

    OpenAIRE

    1994-01-01

    The role of general practitioners is being redefined in the light of the emphasis on more care in the community, economic factors, and patients' expectations. The strength of general practice lies in the doctor-patient relationship; this strength must not be lost sight of. Specific tasks of the general practitioner include the responsibility for the care of individuals; the role of gatekeeper; broad knowledge of curative, preventive; and rehabilitative medicine; teamwork; management; and deve...

  12. How do primary health-care practitioners identify and manage communication impairments in preschool children?

    Science.gov (United States)

    Woolfenden, Sue; Short, Kate; Blackmore, Roger; Pennock, Rene; Moore, Michael

    2015-01-01

    Communication impairments (CIs) in preschool children are common and can have long-term adverse consequences if not detected and treated early. This study investigated the knowledge, training and practice of primary health-care practitioners in the identification and management of CIs in preschool-aged children. A cross-sectional survey of 277 primary health-care practitioners in the Inner West and South West Sydney was undertaken. The majority of practitioners surveyed understood the importance of early identification of CIs. Eight per cent ofpractitioners correctly identified all of the 'red flags' for verbal and non-verbal communication. The majority (80%) correctly described the management of a typical case presentation. Two-thirds of practitioners reported using a tool in their practice for developmental surveillance, but the quality of surveillance tools was variable. One-third felt their training in this area was poor and 90% indicated they would like further training. Barriers to referral included waiting times, availability and cost of services. We concluded that primary health-care practitioners are aware that CIs are significant and they need to be identified early. There are opportunities for further training and promoting high-quality developmental surveillance in primary care. In addition, there are broader health system issues that include promotion of an integrated response to the detection and management of CIs.

  13. Physician Assistants and Nurse Practitioners Perform Effective Roles on Teams Caring for Medicare Patients with Diabetes

    OpenAIRE

    Everett, Christine M.; Thorpe, Carolyn T; Palta, Mari; Carayon, Pascale; Bartels, Christie; Smith, Maureen A.

    2013-01-01

    Redesigning healthcare systems to deliver team-based care is considered important to improving care for chronically ill patients. Including physician assistants and/or nurse practitioners on primary care teams is one approach to the patient-centered medical home. However, understanding of the impact of team structure on outcomes is limited. Using Medicare claims and electronic health record data from a large physician group, we compared multiple patient outcomes for older patients with diabet...

  14. Ambulatory Surgical Measures - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  15. Ambulatory Surgical Measures - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  16. Ambulatory Surgical Measures - Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  17. The establishment of a primary spine care practitioner and its benefits to health care reform in the United States

    Directory of Open Access Journals (Sweden)

    Donald Murphy R

    2011-07-01

    Full Text Available Abstract It is widely recognized that the dramatic increase in health care costs in the United States has not led to a corresponding improvement in the health care experience of patients or the clinical outcomes of medical care. In no area of medicine is this more true than in the area of spine related disorders (SRDs. Costs of medical care for SRDs have skyrocketed in recent years. Despite this, there is no evidence of improvement in the quality of this care. In fact, disability related to SRDs is on the rise. We argue that one of the key solutions to this is for the health care system to have a group of practitioners who are trained to function as primary care practitioners for the spine. We explain the reasons we think a primary spine care practitioner would be beneficial to patients, the health care system and society, some of the obstacles that will need to be overcome in establishing a primary spine care specialty and the ways in which these obstacles can be overcome.

  18. Nurse Practitioners: Knowledge, Skills, and Leadership for the End-of-Life Conversation in Intensive Care.

    Science.gov (United States)

    McRee, Laura; Reed, Pamela G

    2016-01-01

    An impending policy change in Medicare will provide reimbursement for the end-of-life conversation. The rise in numbers of older adults who face serious illness coupled with advances in healthcare technology are increasing the need for providers to address end of life issues in the acute care setting. Doctoral-level nurse practitioners who specialize in acute care of older adults are poised to be leaders and facilitators of this conversation in a particularly challenging context-the intensive care unit. The focus of this article is the new end-of-life policy in relation to the particular contributions that adult gerontology acute care nurse practitioners offer in the acute care setting. PMID:26660780

  19. Model of learning for practitioners in dementia care with music therapy as the joint focal point

    DEFF Research Database (Denmark)

    Ottesen, Aase Marie

    of tangible tools from the musical activities? And further: What impact does the emphasis on development of the care provider’s musical and interpersonal competencies have on quality of life and well-being among persons suffering from dementia? The model of learning includes using the Dementia Care Mapping...... results indicate that the care providers are able to develop and transfer new knowledge and acquired skills to the daily nursing and care through the application of tangible tools from the musical activities, which has an effect on quality of life and wellbeing for persons suffering from dementia.......Abstract to the 21st Nordic Congress of Gerontology in June 10th - 13th, 2012 Title Model of learning for practitioners in dementia care with music therapy as the joint focal point The project is a PhD research in progress, which aims to develop a model of learning for practitioners in dementia...

  20. Treatment goals for ambulatory blood pressure and plasma lipids after stroke are often not reached

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Kofoed, Klaus

    2013-01-01

    In Danish health care, secondary prevention after stroke is currently handled mainly by general practitioners using office blood pressure (OBP) assessment of hypertension. The aim of this study was to compare the OBP approach to 24-hour assessment by ambulatory blood pressure (ABP) monitoring....... Furthermore, we aimed to record the degree of adherence to recommended therapy goals for blood pressure and plasma lipids....

  1. Treatment goals for ambulatory blood pressure and plasma lipids after stroke are often not reached

    DEFF Research Database (Denmark)

    Engberg, Aase Worså; Kofoed, Klaus

    2013-01-01

    In Danish health care, secondary prevention after stroke is currently handled mainly by general practitioners using office blood pressure (OBP) assessment of hypertension. The aim of this study was to compare the OBP approach to 24-hour assessment by ambulatory blood pressure (ABP) monitoring. Fu....... Furthermore, we aimed to record the degree of adherence to recommended therapy goals for blood pressure and plasma lipids....

  2. Integrated Modular Teaching of Human Biology for Primary Care Practitioners

    Science.gov (United States)

    Glasgow, Michael S.

    1977-01-01

    Describes the use of integrated modular teaching of the human biology component of the Health Associate Program at Johns Hopkins University, where the goal is to develop an understanding of the sciences as applied to primary care. Discussion covers the module sequence, the human biology faculty, goals of the human biology faculty, laboratory…

  3. Evaluation of the Medical Care of Patients with Hypertension in an Emergency Department and in Ambulatory Hypertension Unit

    Directory of Open Access Journals (Sweden)

    Fernando Nobre

    2002-02-01

    Full Text Available OBJECTIVE: To evaluate the characteristics of the patients receiving medical care in the Ambulatory of Hypertension of the Emergency Department, Division of Cardiology, and in the Emergency Unit of the Clinical Hospital of the Ribeirão Preto Medical School. METHODS: Using a protocol, we compared the care of the same hypertensive patients in on different occasions in the 2 different places. The characteristics of 62 patients, 29 men with a mean age of 57 years, were analyzed between January 1996 and December 1997. RESULTS: The care of these patients resulted in different medical treatment regardless of their clinical features and blood pressure levels. Thus, in the Emergency Unit, 97% presented with symptoms, and 64.5% received medication to rapidly reduce blood pressure. In 50% of the cases, nifedipine SL was the elected medication. Patients who applied to the Ambulatory of Hypertension presenting with similar features, or, in some cases, presenting with similar clinically higher levels of blood pressure, were not prescribed medication for a rapid reduction of blood pressure at any of the appointments. CONCLUSION: The therapeutic approach to patients with high blood pressure levels, symptomatic or asymptomatic, was dependent on the place of treatment. In the Emergency Unit, the conduct was, in the majority of cases, to decrease blood pressure immediately, whereas in the Ambulatory of Hypertension, the same levels of blood pressure, in the same individuals, resulted in therapeutic adjustment with nonpharmacological management. These results show the need to reconsider the concept of hypertensive crises and their therapeutical implications.

  4. Managing Patients With Psoriasis in the Busy Clinic: Practical Tips for Health Care Practitioners.

    Science.gov (United States)

    Armstrong, April W; Aldredge, Lakshi; Yamauchi, Paul S

    2016-05-01

    Psoriasis is a common inflammatory disease with significant comorbidities, whose management can be challenging given the variety of treatment options. It is critical for nurse practitioners, physician assistants, general practitioners, and dermatology trainees to have useful information about the treatment and monitoring of patients with psoriasis. Although certain aspects of care apply to all patients, each therapeutic agent has its own nuances in terms of assessments, dosing, and monitoring. The most appropriate treatment is based not only on disease severity but also on comorbid conditions and concomitant medications. These practitioners are vital in facilitating patient care by thorough understanding of systemic agents, selection criteria, dosing, and recommended monitoring. This article provides high-yield practical pearls on managing patients with moderate to severe psoriasis. It includes case-based discussions illustrating considerations for special populations, such as pregnant women, children, and patients with comorbidities (eg, human immunodeficiency virus infection, hepatitis C, hepatitis B, and history of malignancy).

  5. Managing Patients With Psoriasis in the Busy Clinic: Practical Tips for Health Care Practitioners.

    Science.gov (United States)

    Armstrong, April W; Aldredge, Lakshi; Yamauchi, Paul S

    2016-05-01

    Psoriasis is a common inflammatory disease with significant comorbidities, whose management can be challenging given the variety of treatment options. It is critical for nurse practitioners, physician assistants, general practitioners, and dermatology trainees to have useful information about the treatment and monitoring of patients with psoriasis. Although certain aspects of care apply to all patients, each therapeutic agent has its own nuances in terms of assessments, dosing, and monitoring. The most appropriate treatment is based not only on disease severity but also on comorbid conditions and concomitant medications. These practitioners are vital in facilitating patient care by thorough understanding of systemic agents, selection criteria, dosing, and recommended monitoring. This article provides high-yield practical pearls on managing patients with moderate to severe psoriasis. It includes case-based discussions illustrating considerations for special populations, such as pregnant women, children, and patients with comorbidities (eg, human immunodeficiency virus infection, hepatitis C, hepatitis B, and history of malignancy). PMID:26712930

  6. Brief cognitive behavioral therapy compared to general practitioners care for depression in primary care: a randomized trial

    Directory of Open Access Journals (Sweden)

    Bockting Claudi LH

    2010-10-01

    Full Text Available Abstract Background Depressive disorders are highly prevalent in primary care (PC and are associated with considerable functional impairment and increased health care use. Research has shown that many patients prefer psychological treatments to pharmacotherapy, however, it remains unclear which treatment is most optimal for depressive patients in primary care. Methods/Design A randomized, multi-centre trial involving two intervention groups: one receiving brief cognitive behavioral therapy and the other receiving general practitioner care. General practitioners from 109 General Practices in Nijmegen and Amsterdam (The Netherlands will be asked to include patients aged between 18-70 years presenting with depressive symptomatology, who do not receive an active treatment for their depressive complaints. Patients will be telephonically assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I to ascertain study eligibility. Eligible patients will be randomized to one of two treatment conditions: either 8 sessions of cognitive behavioral therapy by a first line psychologist or general practitioner's care according to The Dutch College of General Practitioners Practice Guideline (NHG- standaard. Baseline and follow-up assessments are scheduled at 0, 6, 12 and 52 weeks following the start of the intervention. Primary outcome will be measured with the Hamilton Depression Rating Scale-17 (HDRS-17 and the Patient Health Questionnaire-9 (PHQ-9. Outcomes will be analyzed on an intention to treat basis. Trial Registration ISRCTN65811640

  7. Barriers to the implementation of preconception care guidelines as perceived by general practitioners: a qualitative study

    Directory of Open Access Journals (Sweden)

    Mazza Danielle

    2013-01-01

    Full Text Available Abstract Background Despite strong evidence of the benefits of preconception interventions for improving pregnancy outcomes, the delivery and uptake of preconception care and periconceptional folate supplementation remain low. General practitioners play a central role in the delivery of preconception care. Understanding general practitioners’ perceptions of the barriers and enablers to implementing preconception care allows for more appropriate targeting of quality improvement interventions. Consequently, the aim of this study was to examine the barriers and enablers to the delivery and uptake of preconception care guidelines from general practitioners’ perspective using theoretical domains related to behaviour change. Methods We conducted a qualitative study using focus groups consisting of 22 general practitioners who were recruited from three regional general practice support organisations. Questions were based on the theoretical domain framework, which describes 12 domains related to behaviour change. General practitioners’ responses were classified into predefined themes using a deductive process of thematic analysis. Results Beliefs about capabilities, motivations and goals, environmental context and resources, and memory, attention and decision making were the key domains identified in the barrier analysis. Some of the perceived barriers identified by general practitioners were time constraints, the lack of women presenting at the preconception stage, the numerous competing preventive priorities within the general practice setting, issues relating to the cost of and access to preconception care, and the lack of resources for assisting in the delivery of preconception care guidelines. Perceived enablers identified by general practitioners included the availability of preconception care checklists and patient brochures, handouts, and waiting room posters outlining the benefits and availability of preconception care consultations

  8. Pharmaceutical care and its relationship to prescribing behaviour of general practitioners.

    NARCIS (Netherlands)

    Muijrers, P.E.; Grol, R.P.T.M.; Sijbrandij, J.; Janknegt, R.; Knottnerus, J.A.

    2006-01-01

    OBJECTIVE: To study the correlation between pharmaceutical care and prescribing routines of general practitioners (GPs). METHODS: Cross-sectional study; 201 pharmacies, 408 general practices, The Netherlands, 2000/2001. The variation in prescribing behaviour was characterised using 20 validated pres

  9. Alternative Health Care Practitioners in a Chinese American Community: A Preliminary Report of Findings.

    Science.gov (United States)

    Kao, Jessica Ching-Yi

    This paper provides a brief review of the literature on traditional Chinese medicine in both China and the United States and presents observations from a preliminary study of Chinese practitioners in the Chinatown section of Los Angeles, California. The dualistic health care system in Chinese culture is described as comprising both scholarly and…

  10. Practitioner perspectives from seven health professional groups on core competencies in the context of chronic care.

    Science.gov (United States)

    Fouche, Christa; Kenealy, Timothy; Mace, Jennifer; Shaw, John

    2014-11-01

    The prevalence of chronic illness is growing worldwide and management is increasingly undertaken by interprofessional teams, yet education is still generally provided in separate professions. The aim of this study was to explore the perspectives of New Zealand healthcare practitioners from seven professional groups involved in chronic care (general practice medicine, nursing, occupational therapy, pharmacy, physiotherapy, social work, and speech language therapy) on the core competencies required of those working in this area. The study was set in the context of the chronic care and shared decision-making (SDM) models. The core competencies for chronic care practitioners proposed by the World Health Organisation were used to shape the research questions. Focus groups with expert clinicians (n = 20) and semi-structured interviews with practitioners (n = 32) were undertaken. Findings indicated a high level of agreement that the core competencies were appropriate and relevant for chronic care practitioners but that many educational and practice gaps existed and interprofessional education in New Zealand was not currently addressing these gaps. Among the key issues highlighted for attention by educators and policy-makers were the following: teams and teamwork, professional roles and responsibilities, interprofessional communication, cultural competence, better engagement with patients, families, and carers, and common systems, information sharing and confidentiality.

  11. Managing the marketing function for advanced nurse practitioners in a managed care environment.

    Science.gov (United States)

    Pakis, S

    1997-09-01

    Delivering quality, cost-efficient health care is a desired service in the health care market today. Advanced nurse practitioners are positioned to deliver this product. The key in today's market is clearly defining the product, identifying the customers of the product, and crafting the message for each customer. The development of marketing strategies to address each of the above points will assist an organization in targeting resources and evaluating the effectiveness of the message being delivered.

  12. Supply sensitive services in Swiss ambulatory care: An analysis of basic health insurance records for 2003-2007

    Directory of Open Access Journals (Sweden)

    Künzi Beat

    2010-11-01

    Full Text Available Abstract Background Swiss ambulatory care is characterized by independent, and primarily practice-based, physicians, receiving fee for service reimbursement. This study analyses supply sensitive services using ambulatory care claims data from mandatory health insurance. A first research question was aimed at the hypothesis that physicians with large patient lists decrease their intensity of services and bill less per patient to health insurance, and vice versa: physicians with smaller patient lists compensate for the lack of patients with additional visits and services. A second research question relates to the fact that several cantons are allowing physicians to directly dispense drugs to patients ('self-dispensation' whereas other cantons restrict such direct sales to emergencies only. This second question was based on the assumption that patterns of rescheduling patients for consultations may differ across channels of dispensing prescription drugs and therefore the hypothesis of different consultation costs in this context was investigated. Methods Complete claims data paid for by mandatory health insurance of all Swiss physicians in own practices were analyzed for the years 2003-2007. Medical specialties were pooled into six main provider types in ambulatory care: primary care, pediatrics, gynecology & obstetrics, psychiatrists, invasive and non-invasive specialists. For each provider type, regression models at the physician level were used to analyze the relationship between the number of patients treated and the total sum of treatment cost reimbursed by mandatory health insurance. Results The results show non-proportional relationships between patient numbers and total sum of treatment cost for all provider types involved implying that treatment costs per patient increase with higher practice size. The related additional costs to the health system are substantial. Regions with self-dispensation had lowest treatment cost for primary care

  13. Shared care between specialised psychiatric services and primary care: The experiences and expectations of General Practitioners in Ireland.

    LENUS (Irish Health Repository)

    Agyapong, Vincent Israel Opoku

    2012-04-17

    Objective. The study aims to explore the views of General Practitioners in Ireland on shared care between specialised psychiatric services and primary care. Method. A self-administered questionnaire was designed and posted to 400 randomly selected General Practitioners working in Ireland. Results. Of the respondents, 189 (94%) reported that they would support a general policy on shared care between primary care and specialised psychiatric services for patients who are stable on their treatment. However, 124 (61.4%) reported that they foresaw difficulties for patients in implementing such a policy including: a concern that primary care is not adequately resourced with allied health professionals to support provision of psychiatric care (113, 53.2%); a concern this would result in increased financial burden on some patients (89, 48.8%); a lack of adequate cooperation between primary care and specialised mental health services (84, 41.8%); a concern that some patients may lack confidence in GP care (55, 27.4%); and that primary care providers are not adequately trained to provide psychiatric care (29, 14.4% ). Conclusion. The majority of GPs in Ireland would support a policy of shared care of psychiatric patients; however they raise significant concerns regarding practical implications of such a policy in Ireland.

  14. A qualitative study of nurse practitioner promotion of interprofessional care across institutional settings: Perspectives from different healthcare professionals

    Directory of Open Access Journals (Sweden)

    Christina Hurlock-Chorostecki

    2016-03-01

    Conclusions: Nurse practitioners in acute care hospital and long-term care settings have valued attributes that can promote interprofessional care. Effective strategies to promote interprofessional care emerge from these role attributes. However, the interprofessional relationship type perceived could enhance or impede the contribution of the strategies to interprofessional care promotion.

  15. General dental practitioners' opinions on orthodontics in primary and secondary care.

    Science.gov (United States)

    McMichael, J A

    1997-01-01

    A survey of 232 general dental practitioners was undertaken by the purchasing authorities in Hereford and Worcester, England, in 1993, to establish local practitioners' views on primary and secondary care orthodontics. The response rate was 90.1%. The dentists overestimated their orthodontic case-load: 66.6% of contract holders submitted no claims for upper removable appliances (URA) treatment, but 70.8% claimed they undertook removable appliance therapy. Dentists believed orthodontics should be a feature of the General Dental Services (GDS) but did not seem inclined to commit themselves to providing it. A majority of GDPs (54.9%) felt orthodontics was uneconomic under the GDS. There was support for the treatment planning role of hospitals, but although this was available locally it did not appear to have stimulated primary care provision. Consultant outreach clinics were not generally supported but there was a desire for more opportunities for hospital clinical attachments in orthodontics. The implications for the policies of National Health Service (NHS) purchasers are considered: purchasing health authorities need to carry out systematic assessment of the views of their general dental practitioners and take account of their desired patterns of specialist provision. Policies encouraging the shift of orthodontics into primary care are called into question by this study. If demand for orthodontics is to be met, policy should concentrate on the development of hospital services and specialist practitioners.

  16. Clinical hypertension in Native American/span>s: a comparison of 1987 and 1992 rates from ambulatory care data.

    Science.gov (United States)

    Acton, K J; Preston, S; Rith-Najarian, S

    1996-01-01

    THE AUTHORS EXAMINED THE PREVALENCE of clinically diagnosed hypertension among all American Indian and Alaska Native outpatients served in Indian Health Service (IHS) facilities in fiscal year 1992, and compared these rates with a similar analysis done in 1987. In this report they provided data on that analysis as well as on the association between hypertension and diabetes. The 1992 overall estimated age-adjusted prevalence of clinically diagnosed hypertension in adults older than age 15 was 10.4%, compared with 10.9% in 1987, a small but significant decrease. Considerable variation exists in hypertension prevalence rates in American Indian communities as analyzed by IHS service area. This report represents an attempt to use ambulatory patient care data to demonstrate a means for ongoing surveillance of a chronic disease for the entire service population of the IHS. This comprehensive data set represents approximately 60% of the entire U.S. American Indian and Alaska Native population. Based on the ongoing nature of this ambulatory patient care data system, this model for hypertension surveillance permits a unique opportunity for longitudinal evaluation of quality improvement efforts for the American Indian and Alaska Native populations served by the IHS. PMID:8898769

  17. Nurse practitioners--where do they belong within the organizational structure of the acute care setting?

    Science.gov (United States)

    el-Sherif, C

    1995-01-01

    Nurse practitioners are expanding their scope of practice and moving into acute care settings. Striving to be part of the nursing organizational structure in the acute care setting will keep NP's practice firmly rooted in nursing theory. Remaining within the nursing realm will enable them to receive support and guidance from their nursing colleagues while advancing the profession through their knowledge and expertise. Within the nursing organizational structure, NPs can become leaders as clinicians and role models. Without the formal support of the nursing organizational structure, the unique skills and contributions nurse practitioners furnish to the profession will be lost, as others will then dictate the NP role and scope of practice within the acute care setting.

  18. Patient care and the general practitioner. Joint Working Party of the Welsh Council of the Royal College of General Practitioners and the Welsh General Medical Services Committee.

    Science.gov (United States)

    1994-10-29

    The role of general practitioners is being redefined in the light of the emphasis on more care in the community, economic factors, and patients' expectations. The strength of general practice lies in the doctor-patient relationship; this strength must not be lost sight of. Specific tasks of the general practitioner include the responsibility for the care of individuals; the role of gatekeeper; broad knowledge of curative, preventive; and rehabilitative medicine; teamwork; management; and development of population based strategies. Future work patterns include the general practitioner first and foremost as a clinician and an integrator of health services, but they also involve audit, education and training, research, management, and relations with organisations in the public, private, and voluntary sectors. It is important to make changes only when they benefit patients and to maintain the principle of equity of access to care. PMID:7987112

  19. Parents' Perception of Satisfaction With Pediatric Nurse Practitioners' Care And Parental Intent to Adhere To Recommended Health Care Regimen.

    Science.gov (United States)

    Kinder, Frances DiAnna

    2016-01-01

    The purposes of this study were to explore parents' perceptions of satisfaction with care from primary care pediatric nurse practitioners (PNPs) and to explore the relationships of the four components of parental satisfaction with parents' intent to adhere to recommended health care regimen. The study used a descriptive correlational research design. A convenience sample of 91 participants was recruited from practices in southeastern Pennsylvania. The 28-item, Parents' Perceptions of Satisfaction with Care from Pediatric Nurse Practitioners (PPSC-PNP) tool was developed to measure four components of satisfaction and overall satisfaction of parents with PNP care after the health visit. A 100 mm visual analog (VAS) scale measured parental intent to adhere to the care regimen recommended by the PNP. Parents' perceptions of overall satisfaction with care from PNPs and satisfaction with each of the four components (communication, clinical competence, caring behavior, and decisional control) were high as measured by the PPSC-PNP. Multiple regression analysis revealed that clinical competence had the strongest positive relationship with parental intent to adhere to PNP recommended health regimen and was the only variable to enter the regression equation. The findings of this study have implications for nursing practice. The PPSC-PNP instrument may be used with a variety of pediatric populations and settings as a benchmark for quality care. Clinical competence is important for the role of the PNP. Other variables of parental intent to adhere to the health regimen should be explored in future studies. PMID:27468517

  20. The Role of Ambulatory Care Pharmacists in an HIV Multidisciplinary Team within a Free and Bilingual Clinic

    Directory of Open Access Journals (Sweden)

    Ann M. Fugit, Pharm.D., BCPS

    2013-01-01

    Full Text Available Objective: Describe the role and integration of ambulatory care pharmacists in a Human Immunodeficiency Virus (HIV clinic within a free and bilingual clinic with regards to types of interventions made during the patient-pharmacist visit. Design: Retrospective, single-centered, chart review. Setting: Free, bilingual clinic in Richmond, VA. Participants: Thirty-two adult patients with diagnosed HIV receiving care in the clinic between June 30, 2010 and January 26, 2011. Main Outcome Measure: Types of interventions documented during the patient-pharmacist visit, categorized as medication review, patient education, or adherence monitoring. Results: Total of 32 patients accounted for 55 patient-pharmacist visits and 296 interventions. The most common interventions were medication review (66.9%, patient education (23.3%, and adherence monitoring (9.8%. Post-hoc analysis suggests Hispanic patients are more likely to be diagnosed with Acquired Immune Deficiency Syndrome (AIDS (P = 0.01, have current or history of opportunistic infection (OI (P=0.01, and have current or history of OI prophylaxis (P = 0.03. Adherence monitoring was less common amongst the non-Hispanics (7.1% compared to the Hispanic sub-population (16.5%, (P = 0.04. Conclusion: The role of ambulatory care pharmacists in a free and bilingual clinic goes beyond adherence monitoring. Pharmacists can be a valuable part of the patient care team by providing medication review and patient education for HIV and other co-morbidities within free clinics. Further research is warranted to assess outcomes and to further explore the underlying barriers to early HIV diagnosis and adherence within the Hispanic population.

  1. Care for patients with severe mental illness: the general practitioner's role perspective

    Directory of Open Access Journals (Sweden)

    Groenier Klaas H

    2009-05-01

    Full Text Available Abstract Background Patients with severe mental illness (SMI experience distress and disabilities in several aspects of life, and they have a higher risk of somatic co-morbidity. Both patients and their family members need the support of an easily accessible primary care system. The willingness of general practitioners and the impeding factors for them to participate in providing care for patients with severe mental illness in the acute and the chronic or residual phase were explored. Methods A questionnaire survey of a sample of Dutch general practitioners spread over the Netherlands was carried out. This comprised 20 questions on the GP's 'Opinion and Task Perspective', 19 questions on 'Treatment and Experiences', and 27 questions on 'Characteristics of the General Practitioner and the Practice Organisation'. Results 186 general practitioners distributed over urban areas (49%, urbanised rural areas (38% and rural areas (15% of the Netherlands participated. The findings were as follows: GPs currently considered themselves as the first contact in the acute psychotic phase. In the chronic or residual phase GPs saw their core task as to diagnose and treat somatic co-morbidity. A majority would be willing to monitor the general health of these patients as well. It appeared that GP trainers and GPs with a smaller practice setting made follow-up appointments and were willing to monitor the self-care of patients with SMI more often than GPs with larger practices. GPs also saw their role as giving support and information to the patient's family. However, they felt a need for recognition of their competencies when working with mental health care specialists. Conclusion GPs were willing to participate in providing care for patients with SMI. They considered themselves responsible for psychotic emergency cases, for monitoring physical health in the chronic phase, and for supporting the relatives of psychotic patients.

  2. Self-care and Professional Quality of Life: Predictive Factors among MSW Practitioners

    Directory of Open Access Journals (Sweden)

    Kori R Bloomquist

    2016-02-01

    Full Text Available This study explored the effects of self-care practices and perceptions on positive and negative indicators of professional quality of life, including burnout, secondary traumatic stress, and compassion satisfaction among MSW practitioners. Results reveal that while social workers value and believe self-care is effective in alleviating job-related stress, they engage in self-care on a limited basis. Findings indicate that MSW programs and employers do not teach social workers how to effectively engage in self-care practice. Various domains of self-care practice contribute differently to indicators of professional quality of life. This study sheds light on the under-studied relationship between social worker self-care and professional quality of life, provides insights into the types of activities practiced and not practiced by MSW practitioners, and identifies gaps between perceived value and effective teaching of self-care. Implications exist for social work educators and employers and the potential to support a healthier, sustainable workforce.

  3. Factors Related to Successful Transition to Practice for Acute Care Nurse Practitioners.

    Science.gov (United States)

    Dillon, Deborah L; Dolansky, Mary A; Casey, Kathy; Kelley, Carol

    2016-01-01

    The transition from student to acute care nurse practitioner (ACNP) has been recognized as a time of stress. The purpose of this descriptive, correlational-comparative design pilot study was to examine: (1) the relationships among personal resources, community resources, successful transition, and job retention; (2) the difference between ACNPs with 0 to 4 years and ACNPs with more than 4 years of prior experience as a registered nurse in an intensive care unit or emergency department; and (3) the skills/procedures that ACNPs found difficult to perform independently. Thirty-four participants were recruited from a social media site for nurse practitioners. Organizational support, communication, and leadership were the most important elements of successful transition into the ACNP role. This information can help ACNP faculty and hospital orientation/fellowship program educators to help ACNPs transition into their first position after graduation. PMID:27153306

  4. Improving year-end transfers of care in academic ambulatory clinics: a survey of pediatric resident physician perceptions

    Directory of Open Access Journals (Sweden)

    Carlos F. Lerner

    2012-05-01

    Full Text Available Background: In resident primary care continuity clinics, at the end of each academic year, continuity of care is disrupted when patients cared for by the graduating class are redistributed to other residents. Yet, despite the recent focus on the transfers of care between resident physicians in inpatient settings, there has been minimal attention given to patient care transfers in academic ambulatory clinics. We sought to elicit the views of pediatric residents regarding year-end patient handoffs in a pediatric resident continuity clinic.Methods: Residents assigned to a continuity clinic of a large pediatric residency program completed a questionnaire regarding year-end transfers of care.Results: Thirty-one questionnaires were completed out of a total 45 eligible residents (69% response. Eighty seven percent of residents strongly or somewhat agreed that it would be useful to receive a written sign-out for patients with complex medical or social issues, but only 35% felt it would be useful for patients with no significant issues. Residents more frequently reported having access to adequate information regarding their new patients’ medical summary (53% and care plan (47% than patients’ functional abilities (30%, social history (17%, or use of community resources (17%. When rating the importance of receiving adequate sign-out in each those domains, residents gave most importance to the medical summary (87% of residents indicating very or somewhat important and plan of care (84%. Residents gave less importance to receiving sign-out regarding their patients’ functional abilities (71% social history (58%, and community resources (58%. Residents indicated that lack of access to adequate patient information resulted in additional work (80%, delays or omissions in needed care (56%, and disruptions in continuity of care (58%.Conclusions: In a single-site study, residents perceive that they lack adequate information during year-end patient transfers

  5. National Practitioner Data Bank for Adverse Information on Physicians and other Health Care Practitioners: charge for self-queries. Health Resources and Services Administration, HHS. Final rule.

    Science.gov (United States)

    1999-03-01

    This final rule amends the existing regulations implementing the Health Care Quality Improvement Act of 1986 (the Act), which established the National Practitioner Data Bank for Adverse Information on Physicians and Other Health Care Practitioners (the Data Bank). The final rule amends the existing fee structure so that the Data Bank can fully recover its costs, as required by law. This rule removes the prohibition against charging for self-queries and, therefore, allows the Data Bank to assess costs in an equitable manner. This is consistent with both the Freedom of Information Act and the Privacy Act which allow the Government to charge fees for the reproduction of records. The Data Bank will continue its current practice of sending to the practitioner in whose name it was submitted--automatically, without a request, and free of charge--a copy of every report received by the Data Bank for purposes of verification and dispute resolution.

  6. An exploration of food intolerance in the primary care setting: The general practitioner's experience

    OpenAIRE

    Nelson, M; Ogden, J

    2008-01-01

    Food intolerance is one of medicine's modern enigmas. Its etiology and mechanism are unclear and the subject of constant debate, while estimates of its prevalence vary widely from 2% to over 20% of the population. Using interpretive phenomenonological analysis, this study explored the phenomenon of food intolerance in primary care from the general practitioner's (GP) perspective. Semi-structured interviews were carried out with 17 GPs from around the UK. Food intolerance was primarily concept...

  7. Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey

    Directory of Open Access Journals (Sweden)

    Mansfield Richard J

    2005-02-01

    Full Text Available Abstract Background Although shoulder pain is a commonly encountered problem in primary care, there are few studies examining its presenting characteristics and clinical management in this setting. Methods We performed secondary data analysis of 692 office visits for shoulder pain collected through the National Ambulatory Medical Care Survey (Survey years 1993–2000. Information on demographic characteristics, history and place of injury, and clinical management (physician order of imaging, physiotherapy, and steroid intraarticular injection were examined. Results Shoulder pain was associated with an injury in one third (33.2% (230/692 of office visits in this population of US primary care physicians. Males, and younger adults (age ≤ 52 more often associated their shoulder pain with previous injury, but there were no racial differences in injury status. Injury-related shoulder pain was related to work in over one-fifth (21.3% (43/202 of visits. An x-ray was performed in 29.0% (164/566 of office visits, a finding that did not differ by gender, race, or by age status. Other imaging (CT scan, MRI, or ultrasound was infrequently performed (6.5%, 37/566. Physiotherapy was ordered in 23.9% (135/566 of visits for shoulder pain. Younger adults and patients with a history of injury more often had physiotherapy ordered, but there was no significant difference in the ordering of physiotherapy by gender or race. Examination of the use of intraarticular injection was not possible with this data set. Conclusion These data from the largest sample of patients with shoulder pain presenting to primary care settings offer insights into the presenting characteristics and clinical management of shoulder pain at the primary care level. The National Ambulatory Medical Care Survey is a useful resource for examining the clinical management of specific symptoms in U.S. primary care offices.

  8. Repeat prescribing: scale, problems and quality management in ambulatory care patients.

    NARCIS (Netherlands)

    Smet, P.A.G.M. de; Dautzenberg, M.

    2004-01-01

    The reported scale of repeat prescriptions ranges from 29% to 75% of all items prescribed, depending on the definition of repeat prescribing and other variables. It is likely that a substantial part of repeat prescribing by general practitioners (GPs) occurs without direct doctor-patient contact. Wh

  9. A co-design process developing heuristics for practitioners providing end of life care for people with dementia

    OpenAIRE

    Davies, N; R. Mathew; Wilcock, J.; Manthorpe, J; Sampson, E. L.; Lamahewa, K.; Iliffe, S.

    2016-01-01

    Background: The end of life for someone with dementia can present many challenges for practitioners; such as, providing care if there are swallowing difficulties. This study aimed to develop a toolkit of heuristics (rules-of-thumb) to aid practitioners making end-of-life care decisions for people with dementia. / Methods: An iterative co-design approach was adopted using a literature review and qualitative methods, including; 1) qualitative interviews and focus groups with family carers and 2...

  10. [Acute head injuries in primary health care--internet survey conducted with general practitioners].

    Science.gov (United States)

    Luoto, Teemu M; Artsola, Minna; Helminen, Mika; Liimatainen, Suvi; Kosunen, Elise; Ohman, Juha

    2013-01-01

    Patients with head injury constitute a large population treated in primary health care. It is essential to recognize patients with traumatic brain injury among this notable population to determine the need for more specific evaluation. General practitioners (n=331) in Pirkanmaa hospital district in Finland received an email link to answer the survey. The response rate was 54.1% (n=179). Mean survey score was 20.5 points (max. 25). Only acquaintance with the national traumatic brain injury practice guidelines was associated with greater survey scores. The general practitioners' level of knowledge in managing head injuries was good. Deficiencies were found in the questions dealt with post-traumatic amnesia and the definition of traumatic brain injury. PMID:23786110

  11. The Character Strengths of Special Forces Personnel: Insights for Civilian Health Care Practitioners.

    Science.gov (United States)

    Gayton, Scott D; Kehoe, E James

    2016-09-01

    Civilian employees, contractors, and private community clinicians are increasingly providing health treatment to currently serving and former military personnel. This study addresses recent calls for evidence-based information to assist civilian practitioners in understanding the perspectives of their military clients. To this end, the self-reported character strengths of military personnel were elicited as an operationalized expression of their underlying personal values that shape their perspectives and conduct as soldiers. Specifically, Australian Army Special Forces operators and support personnel (N = 337) were asked to rank themselves on 24 character strengths. The three character strengths of integrity, teamworker, and good judgment were ranked significantly above random assignment. Nearly all the respondents (84%) gave a top rank to at least one of these character strengths. Differences between the operators and support personnel were modest. Results are discussed with respect to establishing an effective relationship between military clients and civilian health care practitioners. PMID:27612343

  12. Enhancing youth health in primary care: lessons learned from general practitioners.

    Science.gov (United States)

    Dadich, Ann; Jarrett, Carmen; Robards, Fiona; Bennett, David

    2014-01-01

    Primary care represents a fundamental component of the health system, particularly for young people. However, youth access to primary care is less than ideal. To optimize clinician capacity to promote youth health, an interactive training module was developed and tailored to the needs of general practitioners. As part of an exploratory study, 11 participants were interviewed to determine the perceived capacity of the module to promote youth-friendly primary care. Findings suggest the module can enhance clinician skills, knowledge, and confidence to promote youth health; however, it has a limited ability to inform how organizational capacity might be bolstered-this includes the development of interagency networks. In this epoch of primary care reform, these findings are important for two key reasons. First, they reveal the need to bolster clinicians' perceived ability to use youth healthcare skills; second, they highlight the complementary importance of organizational support to ensure and sustain youth-friendly practices. The article concludes with a discussion of key implications for policymakers, practitioners, and researchers.

  13. Nurse practitioner organizational climate in primary care settings: implications for professional practice.

    Science.gov (United States)

    Poghosyan, Lusine; Nannini, Angela; Stone, Patricia W; Smaldone, Arlene

    2013-01-01

    The expansion of the nurse practitioner (NP) workforce in primary care is key to meeting the increased demand for care. Organizational climates in primary care settings affect NP professional practice and the quality of care. This study investigated organizational climate and its domains affecting NP professional practice in primary care settings. A qualitative descriptive design, with purposive sampling, was used to recruit 16 NPs practicing in primary care settings in Massachusetts. An interview guide was developed and pretested with two NPs and in 1 group interview with 7 NPs. Data collection took place in spring of 2011. Individual interviews lasted from 30-70 minutes, were audio recorded, and transcribed. Data were analyzed using Atlas.ti 6.0 software by 3 researchers. Content analysis was applied. Three previously identified themes, NP-physician relations, independent practice and autonomy, and professional visibility, as well as two new themes, organizational support and resources and NP-administration relations emerged from the analyses. NPs reported collegial relations with physicians, challenges in establishing independent practice, suboptimal relationships with administration, and lack of support. NP contributions to patient care were invisible. Favorable organizational climates should be promoted to support the expanding of NP workforce in primary care and to optimize recruitment and retention efforts.

  14. General practitioners' and district nurses' conceptions of the encounter with obese patients in primary health care

    Directory of Open Access Journals (Sweden)

    Rasmussen Finn

    2011-02-01

    Full Text Available Abstract Background Primary health care specialists have a key role in the management of obesity. Through understanding how they conceive the encounter with patients with obesity, treatment may be improved. The aim of this study was thus to explore general practitioners' and district nurses' conceptions of encountering patients with obesity in primary health care. Method Data were collected through semi-structured interviews, and analysed using a phenomenographic approach. The participants were 10 general practitioners (6 women, 4 men and 10 district nurses (7 women, 3 men from 19 primary health care centres within a well-defined area of Sweden. Results Five descriptive categories were identified: Adequate primary health care, Promoting lifestyle change, Need for competency, Adherence to new habits and Understanding patient attitudes. All participants, independent of gender and profession, were represented in the descriptive categories. Some profession and gender differences were, however, found in the underlying conceptions. The general staff view was that obesity had to be prioritised. However, there was also the contradictory view that obesity is not a disease and therefore not the responsibility of primary health care. Despite this, staff conceived it as important that patients were met with respect and that individual solutions were provided which could be adhered to step-by-step by the patient. Patient attitudes, such as motivation to change, evasive behaviour, too much trust in care and lack of self-confidence, were, however, conceived as major barriers to a fruitful encounter. Conclusions Findings from this study indicate that there is a need for development and organisation of weight management in primary health care. Raising awareness of staff's negative views of patient attitudes is important since it is likely that it affects the patient-staff relationship and staff's treatment efforts. More research is also needed on gender and

  15. Psychometric properties of the Persian version of the Ambulatory Care Learning Educational Environment Measure (ACLEEM questionnaire, Shiraz, Iran

    Directory of Open Access Journals (Sweden)

    Parvizi MM

    2016-09-01

    Full Text Available Mohammad Mahdi Parvizi,1,2 Mitra Amini,2 Mohammad Reza Dehghani,2 Peyman Jafari,3 Zahra Parvizi,1 1Health Policy Research Center, 2Quality Improvement in Clinical Education Research Center, 3Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Fars, Iran Purpose: Evaluation is the main component in design and implementation of educational activities and rapid growth of educational institution programs. Outpatient medical education and clinical training environment is one of the most important parts of training of medical residents. This study aimed to determine the validity and reliability of the Persian version of Ambulatory Care Learning Educational Environment Measure (ACLEEM questionnaire, as an instrument for assessment of educational environments in residency medical clinics. Materials and methods: This study was performed on 180 residents in Shiraz University of Medical Sciences, Shiraz, Iran, in 2014–2015. The questionnaire designers’ electronic permission (by email and the residents’ verbal consent were obtained before distributing the questionnaires. The study data were gathered using ACLEEM questionnaire developed by Arnoldo Riquelme in 2013. The data were analyzed using the SPSS statistical software, version 14, and MedCalc® software. Then, the construct validity, including convergent and discriminant validities, of the Persian version of ACLEEM questionnaire was assessed. Its internal consistency was also checked by Cronbach’s alpha coefficient. Results: Five team members who were experts in medical education were consulted to test the cultural adaptation, linguistic equivalency, and content validity of the Persian version of the questionnaire. Content validity indexes were >0.9 in all items. In factor analysis of the instrument, the ­Kaiser–Meyer–Olkin index was 0.928 and Barlett’s sphericity test yielded the following results: X 2=6,717.551, df =1,225, and P ≤0.001. Besides, Cronbach

  16. Older adults' pain communication during ambulatory medical visits: an exploration of communication accommodation theory.

    Science.gov (United States)

    Hehl, Jennifer; McDonald, Deborah Dillon

    2014-06-01

    The purpose of this descriptive secondary analysis was to explore the use of Communication Accommodation Theory as a framework to examine pain communication strategies used by older adults and their primary care practitioners during medical ambulatory care visits. Ambulatory medical visits for 22 older adults with moderate or greater osteoarthritis pain were audiotaped, transcribed verbatim, and coded by two independent raters for six a priori communication strategies derived from the attuning strategies of Communication Accommodation Theory: (1) patient selecting the pain topic; (2) patient taking a turn; (3) patient maintaining focus on the pain topic; (4) practitioner using an open-ended question without social desirability to start the pain discussion; (5) practitioner encouraging the patient to take a turn by asking open-ended questions; and (6) practitioner interruptions. The majority of practitioners did not start the pain discussion with an open-ended question, but did not interrupt the older adults as they discussed their pain. Five (22.7%) of the older adults did not discuss their osteoarthritis pain during the ambulatory medical visit. The majority of patients took their turn during the pain discussion, but did not maintain focus while describing important osteoarthritis pain information to their practitioner. Practitioners might assist older adults to communicate more information about their pain by initiating the pain discussion with an open-ended pain question. Older adults might provide more pain information to their practitioner by staying on the pain topic until they have completed all of the pain information they wish to discuss with the practitioner.

  17. Older adults' pain communication during ambulatory medical visits: an exploration of communication accommodation theory.

    Science.gov (United States)

    Hehl, Jennifer; McDonald, Deborah Dillon

    2014-06-01

    The purpose of this descriptive secondary analysis was to explore the use of Communication Accommodation Theory as a framework to examine pain communication strategies used by older adults and their primary care practitioners during medical ambulatory care visits. Ambulatory medical visits for 22 older adults with moderate or greater osteoarthritis pain were audiotaped, transcribed verbatim, and coded by two independent raters for six a priori communication strategies derived from the attuning strategies of Communication Accommodation Theory: (1) patient selecting the pain topic; (2) patient taking a turn; (3) patient maintaining focus on the pain topic; (4) practitioner using an open-ended question without social desirability to start the pain discussion; (5) practitioner encouraging the patient to take a turn by asking open-ended questions; and (6) practitioner interruptions. The majority of practitioners did not start the pain discussion with an open-ended question, but did not interrupt the older adults as they discussed their pain. Five (22.7%) of the older adults did not discuss their osteoarthritis pain during the ambulatory medical visit. The majority of patients took their turn during the pain discussion, but did not maintain focus while describing important osteoarthritis pain information to their practitioner. Practitioners might assist older adults to communicate more information about their pain by initiating the pain discussion with an open-ended pain question. Older adults might provide more pain information to their practitioner by staying on the pain topic until they have completed all of the pain information they wish to discuss with the practitioner. PMID:24882026

  18. Psychometric properties of the Persian version of the Ambulatory Care Learning Educational Environment Measure (ACLEEM) questionnaire, Shiraz, Iran

    Science.gov (United States)

    Parvizi, Mohammad Mahdi; Amini, Mitra; Dehghani, Mohammad Reza; Jafari, Peyman; Parvizi, Zahra

    2016-01-01

    Purpose Evaluation is the main component in design and implementation of educational activities and rapid growth of educational institution programs. Outpatient medical education and clinical training environment is one of the most important parts of training of medical residents. This study aimed to determine the validity and reliability of the Persian version of Ambulatory Care Learning Educational Environment Measure (ACLEEM) questionnaire, as an instrument for assessment of educational environments in residency medical clinics. Materials and methods This study was performed on 180 residents in Shiraz University of Medical Sciences, Shiraz, Iran, in 2014–2015. The questionnaire designers’ electronic permission (by email) and the residents’ verbal consent were obtained before distributing the questionnaires. The study data were gathered using ACLEEM questionnaire developed by Arnoldo Riquelme in 2013. The data were analyzed using the SPSS statistical software, version 14, and MedCalc® software. Then, the construct validity, including convergent and discriminant validities, of the Persian version of ACLEEM questionnaire was assessed. Its internal consistency was also checked by Cronbach’s alpha coefficient. Results Five team members who were experts in medical education were consulted to test the cultural adaptation, linguistic equivalency, and content validity of the Persian version of the questionnaire. Content validity indexes were >0.9 in all items. In factor analysis of the instrument, the Kaiser–Meyer–Olkin index was 0.928 and Barlett’s sphericity test yielded the following results: X2=6,717.551, df =1,225, and P≤0.001. Besides, Cronbach’s alpha coefficient of ACLEEM questionnaire was 0.964. Cronbach’s alpha coefficients were also >0.80 in all the three domains of the questionnaire. Overall, the Persian version of ACLEEM showed excellent convergent validity and acceptable discriminant validity, except for the clinical training domain

  19. An analysis of risk factors and adverse events in ambulatory surgery

    Directory of Open Access Journals (Sweden)

    Kent C

    2014-06-01

    Full Text Available Christopher Kent, Julia Metzner, Laurent BollagDepartment of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA, USAAbstract: Care for patients undergoing ambulatory procedures is a broad and expanding area of anesthetic and surgical practice. There were over 35 million ambulatory surgical procedures performed in the US in 2006. Ambulatory procedures are diverse in both type and setting, as they span the range from biopsies performed under local anesthesia to intra-abdominal laparoscopic procedures, and are performed in offices, freestanding ambulatory surgery centers, and ambulatory units of hospitals. The information on adverse events from these varied settings comes largely from retrospective reviews of sources, such as quality-assurance databases and closed malpractice claims. Very few if any ambulatory procedures are emergent, and in comparison to the inpatient population, ambulatory surgical patients are generally healthier. They are still however subject to most of the same types of adverse events as patients undergoing inpatient surgery, albeit at a lower frequency. The only adverse events that could be considered to be unique to ambulatory surgery are those that arise out of the circumstance of discharging a postoperative patient to an environment lacking skilled nursing care. There is limited information on these types of discharge-related adverse events, but the data that are available are reviewed in an attempt to assist the practitioner in patient selection and discharge decision making. Among ambulatory surgical patients, particularly those undergoing screening or cosmetic procedures, expectations from all parties involved are high, and a definition of adverse events can be expanded to include any occurrence that interrupts the rapid throughput of patients or interferes with early discharge and optimal patient satisfaction. This review covers all types of adverse events, but focuses on the more

  20. Systematic review of the incidence and characteristics of preventable adverse drug events in ambulatory care

    DEFF Research Database (Denmark)

    Thomsen, Linda Aagaard; Winterstein, Almut G; Søndergaard, Birthe;

    2007-01-01

    -months, and the pADE incidence was 5.6 per 1000 person-months (1.1-10.1). The median ADE preventability rate was 21% (11-38%). The median incidence of ADEs requiring hospital admission was 0.45 (0.10-13.1) per 1000 person-months, and the median incidence of pADEs requiring hospital admission was 4.5 per 1000 person....../pADE incidence, (2) clinical outcomes, (3) associated drug groups, and/or (4) underlying medication errors were included. Study country, year and design, sample size, follow-up time, ADE/pADE identification method, proportion of ADEs/pADEs and ADEs/pADEs requiring hospital admission, and frequency distribution...... of adverse outcome, associated drug groups, or medication errors were extracted. DATA SYNTHESIS: Twenty-nine studies met inclusion criteria: 14 were ambulatory-based and 15 were hospital-based. Seven studies enrolled only elderly patients. The median ADE incidence was 14.9 (range 4.0-91.3) per 1000 person...

  1. The Role of General Practitioners in Cancer Care: A Mixed Method Design.

    Science.gov (United States)

    Suija, Kadri; Kordemets, Tanel; Annuk, Kadi; Kalda, Ruth

    2016-03-01

    The aims of this study were to identify the current role of general practitioners (GP) and the unmet needs of cancer patients in primary care. First, we conducted individual interviews with 10 cancer patients. Next, we developed a questionnaire, which was distributed among cancer patients across Estonia. Altogether, 113 questionnaires were returned. We observed that while the patients were satisfied with their GP's work, they mostly preferred to discuss cancer-related problems with oncologists. The role of GPs in regard to other diseases was perceived as very important, also patients found it relevant to consult all investigations with their primary health care physician. The main problems experienced by the patients were a lack of proper accessible information about their disease and its inadequate presentation by doctors, as well as problems with coordination between primary and secondary health care providers. In conclusion, we can say that even treatment of cancer is centralised to oncology clinics, patients also contact their GPs during cancer care. Therefore, GPs should be aware of patients' general health and comorbid medical problems. Better communication between primary and secondary health care doctors as well as more integration of GPs in cancer care is needed. PMID:25876172

  2. Quality of private and public ambulatory health care in low and middle income countries: systematic review of comparative studies.

    Directory of Open Access Journals (Sweden)

    Sima Berendes

    2011-04-01

    Full Text Available BACKGROUND: In developing countries, the private sector provides a substantial proportion of primary health care to low income groups for communicable and non-communicable diseases. These providers are therefore central to improving health outcomes. We need to know how their services compare to those of the public sector to inform policy options. METHODS AND FINDINGS: We summarised reliable research comparing the quality of formal private versus public ambulatory health care in low and middle income countries. We selected studies against inclusion criteria following a comprehensive search, yielding 80 studies. We compared quality under standard categories, converted values to a linear 100% scale, calculated differences between providers within studies, and summarised median values of the differences across studies. As the results for for-profit and not-for-profit providers were similar, we combined them. Overall, median values indicated that many services, irrespective of whether public or private, scored low on infrastructure, clinical competence, and practice. Overall, the private sector performed better in relation to drug supply, responsiveness, and effort. No difference between provider groups was detected for patient satisfaction or competence. Synthesis of qualitative components indicates the private sector is more client centred. CONCLUSIONS: Although data are limited, quality in both provider groups seems poor, with the private sector performing better in drug availability and aspects of delivery of care, including responsiveness and effort, and possibly being more client orientated. Strategies seeking to influence quality in both groups are needed to improve care delivery and outcomes for the poor, including managing the increasing burden of non-communicable diseases.

  3. Direct observation of the nutrition care practices of Australian general practitioners

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    Ball LE

    2014-06-01

    Full Text Available INTRODUCTION: Nutrition care refers to nutrition-related advice or counselling provided by health professionals in an attempt to improve the nutrition behaviour of patients. AIM: The aim of this study was to describe the practices of a sample of Australian general practitioners (GPs when providing nutrition care to adult patients. METHODS: Eighteen GPs (13 male, 5 female were observed by fourth-year medical students during their general practice rotation. Each GP was observed for five consultations that included nutrition care, totalling 90 observed consultations. In each consultation, students completed a 31-item nutrition care checklist of nutrition care practices that could feasibly occur in a standard consultation. Each practice was marked with either a ‘yes’ (completed, ‘no’ (did not complete or ‘completed by practice nurse prior to or after the consultation’. RESULTS: Twenty-eight nutrition care practices were observed at least once. The most frequently observed practices were measuring and discussing blood pressure (76.7%; n=69, followed by general questions about current diet (74.4%; n=67. Approximately half of the consultations included a statement of a nutrition-related problem (52.2%; n=47, and the provision of nutrition advice that focused on a nutrient (45.6%; n=41 or food group (52.2%; n=47. Consultations with male GPs, as well as GPs with more than 25 years of experience, were associated with an increased number of nutrition care practices per consultation. DISCUSSION: The GPs performed nutrition care practices in varying frequencies. Further research is required to identify the most effective GP nutrition care practices to improve the nutrition behaviour of patients.

  4. The influence of distance on ambulatory care use, death, and readmission following a myocardial infarction.

    OpenAIRE

    Piette, J. D.; Moos, R.H.

    1996-01-01

    OBJECTIVE: To examine whether patients admitted for treatment of a myocardial infarction (MI) who live farther from their source of care are less likely to be followed in an outpatient clinic, and whether patients who receive follow-up care are less likely to die or to have a subsequent acute care admission. DATA SOURCE: Department of Veterans Affairs (VA) databases to identify a national sample of 4,637 MI patients discharged in 1992, their use of care, and vital status within the subsequent...

  5. The successful implementation of nurse practitioner model of care for threatened or inevitable miscarriage.

    Science.gov (United States)

    Webster-Bain, Debora

    2011-03-01

    The NP project has been successful in a variety of ways. Feedback through a patient satisfaction survey was very positive and showed that patients appreciated and responded well to the NP model of care (Scully 2006). According to the hospital patient advocate, Ruth Reid (March 2006), this has led to not only a reduction in waiting and treatment times for this cohort of patients, but also to complete elimination in complaints when the NP service is running. Medical staff support the service and find it a sensible use of nursing and medical resources. This mirrors the overseas experience of NPs who offer primary health care in EDs. Finally, through successful collaboration between the nurse practitioner, supportive emergency physicians and the O&G team, this service is now a permanent part of Sunshine Hospital. PMID:21661480

  6. Integrating physiotherapists within primary health care teams: perspectives of family physicians and nurse practitioners.

    Science.gov (United States)

    Dufour, Sinéad Patricia; Brown, Judith; Deborah Lucy, S

    2014-09-01

    The international literature suggests a number of benefits related to integrating physiotherapists into primary health care (PHC) teams. Considering the mandate of PHC teams in Canada, emphasizing healthy living and chronic disease management, a broad range of providers, inclusive of physiotherapists is required. However, physiotherapists are only sparsely integrated into these teams. This study explores the perspectives of "core" PHC team members, family physicians and nurse practitioners, regarding the integration of physiotherapists within Ontario (Canada) PHC teams. Twenty individual semi-structured in-depth interviews were conducted, transcribed verbatim, and then analyzed following an iterative process drawing from an interpretive phenomenological approach. Five key themes emerged which highlighted "how physiotherapists could and do contribute as team members within PHC teams particularly related to musculoskeletal health and chronic disease management". The perceived value of physiotherapists within Ontario, Canada PHC teams was a unanimous sentiment particularly in terms of musculoskeletal health, chronic disease management and maximizing health human resources efficiency to ensure the right care, is delivered by the right practitioner, at the right time.

  7. Caring for patients with chronic kidney disease: a joint opinion of the ambulatory care and the nephrology practice and research networks of the American College of Clinical Pharmacy.

    Science.gov (United States)

    Zillich, Alan J; Saseen, Joseph J; Dehart, Renee M; Dumo, Peter; Grabe, Darren W; Gilmartin, Cheryl; Hachey, David M; Hudson, Joanna Q; Pruchnicki, Maria C; Joy, Melanie S

    2005-01-01

    An increasing number of patients are developing chronic kidney disease (CKD). Appropriate care for patients with CKD must occur in the earliest stages, preferably before CKD progresses to more severe stages. Therefore, recognition and treatment of CKD and its associated complications must occur in primary care settings. Patients with CKD often have comorbid conditions such as diabetes mellitus, hypertension, and dyslipidemia, creating specific considerations when treating these diseases. Also, these patients have CKD-related conditions, including anemia and renal osteodystrophy, that are not traditionally evaluated and monitored by the primary care practitioner. Collectively, many opportunities exist for pharmacists who practice in the primary care setting to improve the care of patients with CKD. PMID:15767229

  8. Finding falls in ambulatory care clinical documents using statistical text mining

    Science.gov (United States)

    McCart, James A; Berndt, Donald J; Jarman, Jay; Finch, Dezon K; Luther, Stephen L

    2013-01-01

    Objective To determine how well statistical text mining (STM) models can identify falls within clinical text associated with an ambulatory encounter. Materials and Methods 2241 patients were selected with a fall-related ICD-9-CM E-code or matched injury diagnosis code while being treated as an outpatient at one of four sites within the Veterans Health Administration. All clinical documents within a 48-h window of the recorded E-code or injury diagnosis code for each patient were obtained (n=26 010; 611 distinct document titles) and annotated for falls. Logistic regression, support vector machine, and cost-sensitive support vector machine (SVM-cost) models were trained on a stratified sample of 70% of documents from one location (dataset Atrain) and then applied to the remaining unseen documents (datasets Atest–D). Results All three STM models obtained area under the receiver operating characteristic curve (AUC) scores above 0.950 on the four test datasets (Atest–D). The SVM-cost model obtained the highest AUC scores, ranging from 0.953 to 0.978. The SVM-cost model also achieved F-measure values ranging from 0.745 to 0.853, sensitivity from 0.890 to 0.931, and specificity from 0.877 to 0.944. Discussion The STM models performed well across a large heterogeneous collection of document titles. In addition, the models also generalized across other sites, including a traditionally bilingual site that had distinctly different grammatical patterns. Conclusions The results of this study suggest STM-based models have the potential to improve surveillance of falls. Furthermore, the encouraging evidence shown here that STM is a robust technique for mining clinical documents bodes well for other surveillance-related topics. PMID:23242765

  9. Problems and needs for improving primary care of osteoarthritis patients : the views of patients, general practitioners and practice nurses

    NARCIS (Netherlands)

    Rosemann, T.J.; Wensing, M.J.P.; Joest, K.; Backenstrass, M.; Mahler, C.; Szecsenyi, J.

    2006-01-01

    BACKGROUND: Osteoarthritis (OA) is highly prevalent and has substantial impact on quality of life as well as on healthcare costs. The general practitioner (GP) often is the first care provider for patients with this chronic disease. The aim of this study was to identify health care needs of patients

  10. Open Mouth, Open Mind: Expanding the Role of Primary Care Nurse Practitioners.

    Science.gov (United States)

    Clark, Carol A; Kent, Kathleen A; Jackson, Richard D

    2016-01-01

    Oral health is essential to overall health at any age, although in children it is particularly important because poor oral health can have a deleterious effect on deciduous and permanent dentition. For decades, oral health providers have urged primary care providers to incorporate oral health assessment, risk factor identification, parent education, and preventive therapy into routine well-child visits. Despite recommendations from various professional associations and governmental organizations, the incidence of dental disease in young children remains relatively unchanged. Although the literature has clearly demonstrated that preventive care treatments, such as the application of fluoride varnish performed in the primary care setting, improve oral health in children, very few primary care providers include oral health services in their well-child visits. The purpose of this article is to reduce the barriers and knowledge gaps identified in recent pediatric oral health research and educate primary care nurse practitioners on the application of fluoride varnish to reduce the risk of the development of dental caries in young children. PMID:27554397

  11. Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center

    Directory of Open Access Journals (Sweden)

    Manulik S

    2016-08-01

    Full Text Available Stanisław Manulik,1 Joanna Rosińczuk,2 Piotr Karniej3 1Non-Public Health Care Institution, “Ambulatory of Cosmonauts” Ltd. Liability Company, 2Department of Nervous System Diseases, Faculty of Health Science, 3Department of Organization and Management, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland Introduction: Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services.Objectives: The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services.Materials and methods: The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected.Results: All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel.Conclusion: Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility. Keywords: health care service quality, patients’ expectations, qualitative priorities, outpatient health care facilities

  12. Impact of Instruction and Feedback on Reflective Responses during an Ambulatory Care Advanced Pharmacy Practice Experience.

    Science.gov (United States)

    Teply, Robyn; Spangler, Mikayla; Klug, Laura; Tilleman, Jennifer; Coover, Kelli

    2016-06-25

    Objective. To investigate whether instruction and feedback on reflective responses are beneficial in developing pharmacy students to become more reflective practitioners. Methods. Students on an advanced pharmacy practice experience answered weekly reflection questions and were randomly assigned to either an intervention (received instruction and feedback on reflection) or control group. The final week's responses were de-identified and two blinded faculty members independently categorized them as reflective or nonreflective. The primary outcome measure was comparing the number of "reflective" responses in each group. Results. The responses were classified as reflective in 83.3% of students in the intervention group (n=18) compared to 37.5% of the control group (n=16). The odds that the response was categorized as reflective were 8.3 times higher in the intervention group. Conclusion. Providing instruction and feedback to students improved the likelihood that their work was reflective. PMID:27402984

  13. Are managed care organizations in the United States impeding the delivery of primary care by nurse practitioners? A 2012 update on managed care organization credentialing and reimbursement practices.

    Science.gov (United States)

    Hansen-Turton, Tine; Ware, Jamie; Bond, Lisa; Doria, Natalie; Cunningham, Patrick

    2013-10-01

    In 2014, the Affordable Care Act will create an estimated 16 million newly insured people. Coupled with an estimated shortage of over 60,000 primary care physicians, the country's public health care system will be at a challenging crossroads, as there will be more patients waiting to see fewer doctors. Nurse practitioners (NPs) can help to ease this crisis. NPs are health care professionals with the capability to provide important and critical access to primary care, particularly for vulnerable populations. However, despite convincing data about the quality of care provided by NPs, many managed care organizations (MCOs) across the country do not credential NPs as primary care providers, limiting the ability of NPs to be reimbursed by private insurers. To assess current credentialing practices of health plans across the United States, a brief telephone survey was administered to 258 of the largest health maintenance organizations (HMOs) in the United States, operated by 98 different MCOs. Results indicated that 74% of these HMOs currently credential NPs as primary care providers. Although this represents progress over prior assessments, findings suggest that just over one fourth of major HMOs still do not recognize NPs as primary care providers. Given the documented shortage of primary care physicians in low-income communities in the United States, these credentialing policies continue to diminish the ability of NPs to deliver primary care to vulnerable populations. Furthermore, these policies could negatively impact access to care for thousands of newly insured Americans who will be seeking a primary care provider in 2014.

  14. Quality and correlates of medical record documentation in the ambulatory care setting

    OpenAIRE

    Simon Steven R; Kleinman Kenneth P; Soto Carlos M

    2002-01-01

    Abstract Background Documentation in the medical record facilitates the diagnosis and treatment of patients. Few studies have assessed the quality of outpatient medical record documentation, and to the authors' knowledge, none has conclusively determined the correlates of chart documentation. We therefore undertook the present study to measure the rates of documentation of quality of care measures in an outpatient primary care practice setting that utilizes an electronic medical record. Metho...

  15. Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy

    Directory of Open Access Journals (Sweden)

    Forastiere Francesco

    2009-12-01

    Full Text Available Abstract Background A relationship between quality of primary health care and preventable hospitalizations has been described in the US, especially among the elderly. In Europe, there has been a recent increase in the evaluation of Ambulatory Care Sensitive Conditions (ACSC as an indicator of health care quality, but evidence is still limited. The aim of this study was to determine whether income level is associated with higher hospitalization rates for ACSC in adults in a country with universal health care coverage. Methods From the hospital registries in four Italian cities (Turin, Milan, Bologna, Rome, we identified 9384 hospital admissions for six chronic conditions (diabetes, hypertension, congestive heart failure, angina pectoris, chronic obstructive pulmonary disease, and asthma among 20-64 year-olds in 2000. Case definition was based on the ICD-9-CM coding algorithm suggested by the Agency for Health Research and Quality - Prevention Quality Indicators. An area-based (census block income index was used for each individual. All hospitalization rates were directly standardised for gender and age using the Italian population. Poisson regression analysis was performed to assess the relationship between income level (quintiles and hospitalization rates (RR, 95% CI separately for the selected conditions controlling for age, gender and city of residence. Results Overall, the ACSC age-standardized rate was 26.1 per 10.000 inhabitants. All conditions showed a statistically significant socioeconomic gradient, with low income people being more likely to be hospitalized than their well off counterparts. The association was particularly strong for chronic obstructive pulmonary disease (level V low income vs. level I high income RR = 4.23 95%CI 3.37-5.31 and for congestive heart failure (RR = 3.78, 95% CI = 3.09-4.62. With the exception of asthma, males were more vulnerable to ACSC hospitalizations than females. The risks were higher among 45-64 year

  16. Hotel-based ambulatory care for complex cancer patients: a review of the University College London Hospital experience.

    Science.gov (United States)

    Sive, Jonathan; Ardeshna, Kirit M; Cheesman, Simon; le Grange, Franel; Morris, Stephen; Nicholas, Claire; Peggs, Karl; Statham, Paula; Goldstone, Anthony H

    2012-12-01

    Since 2005, University College London Hospital (UCLH) has operated a hotel-based Ambulatory Care Unit (ACU) for hematology and oncology patients requiring intensive chemotherapy regimens and hematopoietic stem cell transplants. Between January 2005 and 2011 there were 1443 patient episodes, totaling 9126 patient days, with increasing use over the 6-year period. These were predominantly for hematological malignancy (82%) and sarcoma (17%). Median length of stay was 5 days (range 1-42), varying according to treatment. Clinical review and treatment was provided in the ACU, with patients staying in a local hotel at the hospital's expense. Admission to the inpatient ward was arranged as required, and there was close liaison with the inpatient team to preempt emergency admissions. Of the 523 unscheduled admissions, 87% occurred during working hours. An ACU/hotel-based treatment model can be safely used for a wide variety of cancers and treatments, expanding hospital treatment capacity, and freeing up inpatient beds for those patients requiring them. PMID:22591143

  17. Rural general practitioners' experience of the provision of out-of-hours care: a qualitative study.

    Science.gov (United States)

    Cuddy, N J; Keane, A M; Murphy, A W

    2001-01-01

    BACKGROUND: Published research into the provision and utilisation of out-of-hours services shows long-term trends towards decreasing personal commitment among general practitioners (GPs). However, the on-call commitments of rural GPs remain especially onerous. There has been little research relating to either rural out-of-hours services or the implications of such services for the families of the providers. AIM: To explore and describe how rural GPs in Ireland perceive and experience out-of-hours care provision. DESIGN OF STUDY: A qualitative study was conducted with 10 rural GPs and their spouses in their homes or practices using one-to-one in-depth interviews. SETTING: Ten general practices in rural Ireland. METHOD: The interviews were guided by an interview schedule that was based on pertinent themes that had emerged from previous relevant literature. The interviews were audiotaped, transcribed, and analysed for themes and issues. RESULTS: Results indicated that rural GPs experience a wide variety of satisfactions from work related to the provision of out-of-hours care. However, the large proportion of time committed to out-of-hours care greatly infringes on their social and family life. The key stressors identified related to organisational system difficulties, especially with regard to locum cover, and unrealistic patient expectations. The stressors were mainly expressed as lack of time off, restrictions on family life, and interruptions. CONCLUSION: System difficulties, such as difficulty with obtaining locums and rota extension, need to be addressed at an organisational level. Patient expectations of the role of the rural GP have significant implications for practitioners and their families. PMID:11458481

  18. Challenges in the care for consanguineous couples: an exploratory interview study among general practitioners and midwives

    Directory of Open Access Journals (Sweden)

    Teeuw Marieke E

    2012-10-01

    Full Text Available Abstract Background It is often suggested that an effort must be made to increase awareness among consanguineous couples of their reproductive risk, and to refer them for genetic counseling if needed. Primary care professionals are considered most appropriate for addressing the subject and identifying couples at risk during consultations in their practice. This Dutch study aims to explore the experiences, attitudes and beliefs of such professionals regarding their care for consanguineous couples. Methods Sixteen semi-structured interviews were conducted with midwives and general practitioners. Results Although most primary care professionals considered it their task to inform couples about the risks of consanguinity, during consultations the topic was generally only briefly touched upon and quickly abandoned. Important reasons for this were professionals’ beliefs about religious and social values of couples, their low perception of the couples’ reproductive risk and expected limited feasibility of referral. Feelings of embarrassment regarding addressing consanguinity did not seem to play a significant role. Conclusions Primary care professional beliefs about their clients’ religious and social values, their attitudes toward the risk, and perceived limited options for referral seem to conflict with the professional norm to address the topic of consanguinity.

  19. General practitioners' use and experiences of palliative care services: a survey in south east England

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    Higginson Irene J

    2008-11-01

    Full Text Available Abstract Background The role of the General Practitioner (GP is central to community palliative care. Good liaison between the different professionals involved in a patient's care is extremely important in palliative care patients. In cases where GPs have previously been dissatisfied with palliative services, this may be seen as a barrier to referral when caring for other patients. The aim of this survey is to investigate the use and previous experiences of GPs of two palliative care services, with particular emphasis on barriers to referral and to explore issues surrounding the GP's role in caring for palliative patients. Methods Design: Descriptive postal survey of use and experience of palliative care services with particular emphasis on barriers to referral. Setting: One Primary Care Trust (PCT, south London, England, population 298,500. Subjects: 180 GPs in the PCT, which is served by two hospice services (A&B. Results An overall questionnaire response rate of 77% (138 was obtained, with 69% (124 used in analysis. Over 90% of GPs were satisfied with the palliative care services over the preceding two years. Two areas of possible improvement emerged; communication and prescribing practices. GPs identified some patients that they had not referred, most commonly when patients or carers were reluctant to accept help, or when other support was deemed sufficient. Over half of the GPs felt there were areas where improvement could be made; with clarification of the rules and responsibilities of the multi disciplinary team being the most common. The majority of GPs were working, and want to work with, the specialist services as part of an extended team. However, a greater number of GPs want to hand over care to the specialist services than are currently doing so. Conclusion A large number of GPs were happy with the service provision of the palliative care services in this area. They suggested that 3 out of 4 terminally ill patients needed specialist

  20. Ambulatory Diagnosis and Management of Obstructive Sleep Apnea: Screening Questionnaires, Diagnostic Tests, and the Care Team.

    Science.gov (United States)

    McEvoy, R Doug; Chai-Coetzer, Ching Li; Antic, Nick A

    2016-09-01

    Obstructive sleep apnea has increased in prevalence in recent years and despite the expansion in sleep medicine services there is a significant unmet burden of disease. This burden presents a challenge to specialists and requires a reappraisal of service delivery, including a move toward lower-cost, simplified methods of diagnosis and treatment, an expansion of the sleep apnea workforce to include suitably trained and equipped primary care physicians and nurses, and the incorporation of chronic disease management principles that link patients to relevant community resources and empower them through new technologies to engage more fully in their own care. PMID:27542873

  1. Development and Implementation of an Ambulatory Integrated Care Pathway for Major Depressive Disorder and Alcohol Dependence.

    Science.gov (United States)

    Awan, Saima; Samokhvalov, Andriy V; Aleem, Nadia; Hendershot, Christian S; Irving, Julie Anne; Kalvik, Anne; Lefebvre, Lisa; Le Foll, Bernard; Quilty, Lena; Voore, Peter

    2015-12-01

    Integrated care pathways (ICPs) provide an approach for delivering evidence-based treatment in a hospital setting. This column describes the development and pilot implementation in a clinical setting of an ICP for patients with concurrent major depressive disorder and alcohol dependence at the Centre for Addiction and Mental Health (CAMH), an academic tertiary care hospital, in Toronto, Canada. The ICP methodology includes evidence reviews, knowledge translation, process reengineering, and change management. Pilot results indicate high patient satisfaction, evidence of symptom improvement, and excellent retention. PMID:26278235

  2. Improving the quality of palliative care for ambulatory patients with lung cancer

    DEFF Research Database (Denmark)

    von Plessen, Christian; Aslaksen, Aslak

    2005-01-01

    and energy in organisational aspects of care that could be better used in direct interaction with patients. DESIGN: Quality improvement study using direct observation and run and flow charts, and focus group meetings with patients and families regarding perceptions of the clinic and with staff regarding...... satisfaction with working conditions. SETTING: Thoracic oncology outpatient clinic at a Norwegian university hospital where patients receive chemotherapy and complementary palliative care. KEY MEASURES FOR IMPROVEMENT: Waiting time and time wasted during consultations; calmer working situation at the clinic...

  3. The importance of Resilience to Primary Care Practitioners: an Interactive Psycho-Social Model

    Directory of Open Access Journals (Sweden)

    Dr Robert Muller

    2009-01-01

    Full Text Available In this paper, it is argued that an understanding of the factors that make up resilience canenhance communication and concordance between practitioner and patient. A model ispresented demonstrating that resilience is an interaction between factors in the internaldomain, comprising psychological characteristics and resources, and the external domain,comprising the social environment surrounding the individual. As resilience manifests itselfin different ways across the life-cycle, and according to individual circumstances, time is alsoan important part of the model presented in this paper. Understanding this model of resiliencecan lead to an insight that there are factors that can be influenced whereby the primary carepractitioner can treat the patient, or refer them after a process of concordance through adeeper understanding of the factors that surround a patient’s current health status. Underlyingthe model is the view that resilience is linked to the assets model of health, seeking topromote and maintain health and prevent illness. Therefore, primary care practitioners,through a deeper understanding of the circumstances of the patient, and throughunderstanding the factors that promote resilience, may be better able to take action in healthpromotion and maintenance.

  4. Clinical Preventive Services for Patients at Risk for Cardiovascular Disease, National Ambulatory Medical Care Survey, 2005-2006

    Directory of Open Access Journals (Sweden)

    Paula W. Yoon, ScD, MPH

    2011-03-01

    Full Text Available IntroductionClinical preventive services can detect diseases early, when they are most treatable, but these services may not be provided as recommended. Assessing the provision of services to patients at risk for cardiovascular disease (CVD could help identify disparities and areas for improvement.MethodsWe used data on patient visits (n = 21,261 from the National Ambulatory Medical Care Survey, 2005-2006, and classified patients with hypertension, hyperlipidemia, obesity, or diabetes as being at risk for CVD. We assessed differences in the provision of preventive services offered to patients who were and who were not at risk for CVD. Further, for those at risk, we compared the demographic characteristics of those who had and who had not been offered services.ResultsPatients at risk for CVD received significantly more preventive services compared with those not at risk. For patients at risk for CVD, aspirin therapy was more likely to be recommended to those aged 65 years or older than those aged 45 to 64 years and to men than women. Cholesterol screening was more likely for men and was less likely for patients with Medicare/Medicaid or no insurance than for patients who were insured. Rates of counseling for diet and nutrition, weight reduction, and exercise were low overall, but younger patients received these services more than older patients did.ConclusionPatients at risk for CVD are not all receiving the same level of preventive care, suggesting the need to clarify clinical practice guidelines and provide clinicians with education and support for more effective lifestyle counseling.

  5. A Break-Even Analysis of Optimum Faculty Assignment for Ambulatory Primary Care Training.

    Science.gov (United States)

    Xakellis, George C.; And Others

    1996-01-01

    A computer simulation was developed to estimate the number of medical residents one or two faculty teachers could supervise in a university-based primary medical care teaching clinic. With no non-teaching tasks, it was shown that two teachers could supervise 11 residents, while one teacher was able to supervise only three residents under similar…

  6. How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark

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    Jensen Natasja Koitzsch

    2013-01-01

    Full Text Available Abstract Background Refugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients’ refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems. Methods The study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE. Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis. Results One of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms. Conclusion General practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy

  7. Extending nurse practitioner care using the virtual reality world of second life.

    Science.gov (United States)

    Weiner, Elizabeth E; Elasy, Tom; Lorenzi, Nancy M; McNew, Ryan; Shackleford, Laura; Wolff, Kathleen; Martin, Stephanie; Benson, Christy

    2012-01-01

    The growth of Internet applications has substantially broadened the potential for its use in global telehealth. This pilot project used the virtual reality world of Second Life for diabetic patients to meet with their nurse practitioners for their maintenance visits. Using avatars and the online patient portal, these scheduled visits were designed to meet the needs of the patients as determined by the results from a questionnaire completed by patients prior to the visit. The virtual visits took place in the replicated building where patients typically receive their care, the Eskind Diabetes Clinic. Orientation sessions to Second Life were made available prior to the actual visit, and additional online resources were made available after the visit was over. Although only seven pilot patients have currently completed visits, data illustrate the positive potential use of this treatment modality for future study.

  8. Knowledge and beliefs concerning evidence-based practice amongst complementary and alternative medicine health care practitioners and allied health care professionals: A questionnaire survey

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    Khan Khalid S

    2008-07-01

    Full Text Available Abstract Background Evidence-based practice (EBP has become an important competency in many allied and complementary and alternative medicine (CAM health care practitioners' professional standards of proficiency. Methods To compliment an EBP course for allied health care professionals and CAM practitioners, we undertook a questionnaire survey to assess learning needs. We developed a questionnaire to measure allied health care professionals and CAM practitioners' basic knowledge, skills and beliefs concerning the main principles of EBP. The questionnaires were administered to all attendees of one-day EBP workshops. Results During 2004–5 we surveyed 193 allied health care professionals and CAM practitioners who attended one-day EBP courses prior to commencement of teaching. Of the respondents 121 (62.7% were allied health care professionals and 65 (33.7% practitioners stated that they work in the CAM field Our survey found that the majority of the respondents had not previously attended a literature appraisal skills workshop (87.3% or received formal training in research methods (69.9%, epidemiology (91.2% or statistics (80.8%. Furthermore, 67.1% of practitioners specified that they felt that they had not had adequate training in EBM and they identified that they needed more training and education in the principles of EBM (86.7%. Differences in knowledge and beliefs concerning EBP amongst allied and CAM practitioners were found and length of time since qualification was also found to be an important factor in practitioner's beliefs. More CAM practitioners compared to allied health professionals accessed educational literature via the Internet (95.3% v 68.1%, p = 0.008. Whilst, practitioners with more than 11 years experience felt that original research papers were far more confusing (p = 0.02 than their less experienced colleagues. Conclusion The results demonstrate that practitioner's learning needs do vary according to the type of profession

  9. Asking questions of a palliative care nurse practitioner on a pancreatic cancer website

    Science.gov (United States)

    GRANT, MARIAN S.; WIEGAND, DEBRA L.; DY, SYDNEY M.

    2015-01-01

    Objective Increasing evidence demonstrates the benefits of online cancer interventions but very little about the needs of those with pancreatic cancer or interaction with online providers. Our study was done to (1) see how many people would visit a webpage where they could interact with a palliative care nurse practitioner (PCNP), (2) see how many would ask the PCNP questions, (3) determine the type of questions, and (4) obtain feedback regarding the usefulness of the webpage. Method Mixed-methods descriptive design. Results There were 2174 visits to the webpage, and a total of 84 participants sent 110 questions/comments. Some 28 (33%) were people worried that they might have pancreatic cancer. Most questions (59, 53%) had to do with palliative care issues, with the largest subgroup (26, 23%) involving psychological concerns. A total of 39 completed an online survey and were relatives (20, 52%), or patients (17, 44%). They rated the webpage at 3.3/4 as being helpful at learning about the physical symptoms/treatments of pancreatic cancer, at 3.1/4 for learning about emotional issues, at 3/4 for learning about palliative care, at 2.8/4 for learning about hospice, and at 3.3/4 for reading other people’s questions. Significance of results The PCNP webpage was a helpful resource. Most asking questions were worried about having or getting pancreatic cancer. More research is needed into online providers, interventions, and conducting research online. PMID:24909893

  10. A force field evaluation tool for telephone service in ambulatory health care.

    Science.gov (United States)

    da Silva, V L; Steinberg, B

    1991-10-01

    The tool presented here is useful in analyzing the constraints and capabilities of a health care telephone service. It also provides a systematic method for assessing systems problems. As part of our analysis, we recommended that the manager implement the following steps. First, the manager determines whether the driving force on the unit is continuity of care by an individual provider or consistency of response. This focus directly affects how the unit's telephone service can be best organized (i.e., decentralized or centralized) and clarifies the factors most needed for success. For example, to function effectively and efficiently, a centralized phone service needs strong provider-endorsed protocols. Second, the manager should carefully examine neutral constraint factors to determine methods to transform these constraints into capabilities, such as planning for extra staff or office hours (or both) during influenza season. Planning for extra hours or staff depends largely on whether budget and resource planning is done in advance and whether value is placed on customer access and satisfaction during peak demand periods. The manager must next determine whether the service delivery format (centralized or decentralized) is consistent with the force field analysis findings. If the findings are not consistent, can the analysis present a compelling argument for using the opposite approach? Finally, the manager must create a plan of action for minimizing the constraints revealed and maximizing existing capabilities to achieve the overall goal of excellent phone service. The process of analysis and creating a plan of action is an excellent opportunity to involve staff, providers, and administrators in efforts to achieve better health care telephone service for all customers. PMID:10112997

  11. Teamwork in primary care: perspectives of general practitioners and community nurses in Lithuania

    Science.gov (United States)

    2013-01-01

    Background A team approach in primary care has proven benefits in achieving better outcomes, reducing health care costs, satisfying patient needs, ensuring continuity of care, increasing job satisfaction among health providers and using human health care resources more efficiently. However, some research indicates constraints in collaboration within primary health care (PHC) teams in Lithuania. The aim of this study was to gain a better understanding of the phenomenon of teamwork in Lithuania by exploring the experiences of teamwork by general practitioners (GPs) and community nurses (CNs) involved in PHC. Methods Six focus groups were formed with 29 GPs and 27 CNs from the Kaunas Region of Lithuania. Discussions were recorded and transcribed verbatim. A thematic analysis of these data was then performed. Results The analysis of focus group data identified six thematic categories related to teamwork in PHC: the structure of a PHC team, synergy among PHC team members, descriptions of roles and responsibilities of team members, competencies of PHC team members, communications between PHC team members and the organisational background for teamwork. These findings provide the basis for a discussion of a thematic model of teamwork that embraces formal, individual and organisational factors. Conclusions The need for effective teamwork in PHC is an issue receiving broad consensus; however, the process of teambuilding is often taken for granted in the PHC sector in Lithuania. This study suggests that both formal and individual behavioural factors should be targeted when aiming to strengthen PHC teams. Furthermore, this study underscores the need to provide explicit formal descriptions of the roles and responsibilities of PHC team members in Lithuania, which would include establishing clear professional boundaries. The training of team members is an essential component of the teambuilding process, but not sufficient by itself. PMID:23945286

  12. Measuring factors that influence the utilisation of preventive care services provided by general practitioners in Australia

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    Oldenburg Brian

    2009-12-01

    Full Text Available Abstract Background Relatively little research attention has been given to the development of standardised and psychometrically sound scales for measuring influences relevant to the utilisation of health services. This study aims to describe the development, validation and internal reliability of some existing and new scales to measure factors that are likely to influence utilisation of preventive care services provided by general practitioners in Australia. Methods Relevant domains of influence were first identified from a literature review and formative research. Items were then generated by using and adapting previously developed scales and published findings from these. The new items and scales were pre-tested and qualitative feedback was obtained from a convenience sample of citizens from the community and a panel of experts. Principal Components Analyses (PCA and internal reliability testing (Cronbach's alpha were then conducted for all of the newly adapted or developed scales utilising data collected from a self-administered mailed survey sent to a randomly selected population-based sample of 381 individuals (response rate 65.6 per cent. Results The PCA identified five scales with acceptable levels of internal consistency were: (1 social support (ten items, alpha 0.86; (2 perceived interpersonal care (five items, alpha 0.87, (3 concerns about availability of health care and accessibility to health care (eight items, alpha 0.80, (4 value of good health (five items, alpha 0.79, and (5 attitudes towards health care (three items, alpha 0.75. Conclusion The five scales are suitable for further development and more widespread use in research aimed at understanding the determinants of preventive health services utilisation among adults in the general population.

  13. Repeat prescribing: scale, problems and quality management in ambulatory care patients.

    Science.gov (United States)

    De Smet, Peter A G M; Dautzenberg, Maaike

    2004-01-01

    The reported scale of repeat prescriptions ranges from 29% to 75% of all items prescribed, depending on the definition of repeat prescribing and other variables. It is likely that a substantial part of repeat prescribing by general practitioners (GPs) occurs without direct doctor-patient contact. While this reduces the workload for the GP and is convenient for the patient, it does not provide the adequate control that is needed to ensure that every repeat prescription is still appropriate, effective and well tolerated, and that it is still being viewed upon and taken by the patient as intended. Infrequent therapy reviews may lead to failure to prevent, identify and solve drug-related problems and drug wastage, and may, thereby, have a negative impact on the effectiveness, safety or cost of the medications prescribed. Studies evaluating the repeat prescribing process have shown that GPs and medical practices vary widely in their degree of administrative and clinical control of repeat prescriptions. Contrary to the opinion that GPs cannot change prescribing behaviour when the prescription is initiated by a medical specialist, GPs have their own responsibility for controlling the repeats of such prescriptions. Intervention studies suggest that a medication review by a pharmacist can help to reduce drug-related problems with repeat prescriptions, and the effectiveness of the intervention may be increased by combining the medication review with a consultation of the patient's medical records and a patient interview. In several studies, such an intervention was relatively inexpensive and, therefore, feasible. However, these conclusions should be viewed with appropriate caution because a number of caveats pertain. There is still no evidence that these types of intervention improve health-related quality of life or reduce healthcare cost, and so far only a few trials have produced any evidence of clinical improvement. As implicit and explicit screening criteria have their

  14. Uses of ambulatory health/mental health utilization data in organized health care settings.

    Science.gov (United States)

    Burns, B J; Goldberg, I D; Hankin, J; Hoeper, E W; Jacobson, A M; Regier, D A

    1982-01-01

    A follow-up assessing uses of findings from NIMH-supported research on health and mental health services utilization in organized health care settings revealed a range of applications across the study sites. The research, conducted primarily for national policy purposes, had an impact on study sites in the following areas: clinician perceptions and attitudes about mental health services provided; program directions; fiscal policy; and further related research. Research team composition and dissemination of study findings are discussed in relation to the applications made. PMID:10260970

  15. Care provided by general practitioners to patients with psychotic disorders: a cohort study

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    Slooff Cees J

    2010-11-01

    Full Text Available Abstract Background Patients suffering from psychotic disorders have an increased risk of comorbid somatic diseases such as cardiovascular disorders and diabetes mellitus. Doctor-related factors, such as unfamiliarity with these patients, as well as patient-related factors, such as cognitive disturbance and negative symptoms, contribute to suboptimal health care for these patients. General practitioners (GPs could play a key role in diagnosing and treating this somatic comorbidity as in the Netherlands, almost all residents are registered at a general practice. This study aims to find out whether there are any differences between the levels of health care provided by GPs to patients with psychotic disorders, compared to other types of patients. Methods A cohort of patients with an ICPC code of psychosis and two matched control groups, one consisting of patients with other mental problems and the other one of patients without any mental problems, were followed over a period of 5 years. Results Patients with psychotic disorders (N = 734 contacted the GP practice more often than patients in the control groups. These patients, both adults (p = 0.051 and the elderly (p 65 years old (p = 0.007. With regard to chronic illnesses, elderly psychosis patients had fewer contacts related to cardiovascular diseases or chronic lung diseases. Conclusion Patients with psychotic disorders contact the GP practice more frequently than other types of patients. Adult psychosis patients with diabetes mellitus, cardiovascular diseases or chronic lung diseases receive the same amount of health care for these diseases as other primary care patients. The finding that older patients with psychotic disorders are diagnosed with cardiovascular diseases and obstructive lung diseases less frequently than other types of elderly patients requires further study.

  16. General practitioners are bearing an increasing burden of the care of common mental disorders in France

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    Joanna Norton

    2007-03-01

    Full Text Available Introduction: In France, general practice is playing an increasing role in the management of common mental disorders. This is due to a variety of factors, among which the way general practice and specialised mental health services have evolved over time. Methods: A description of the status quo in France, with a comparison between France, the UK and the Netherlands. A review of reasons for the present position. Results: The general practitioner (GP is often the only medical carer to be contacted in cases of psychological distress and over 80% of psychotropic medications are prescribed in this setting. Although most common forms of mental disorder can be managed at the primary care level, GPs need to be able to refer patients rapidly to specialised mental health services. Yet there are delays for consultations with both private and public psychiatrists along with difficulties in finding beds for full-time hospitalisation. The situation is predicted to get worse with the reduction in the number of psychiatrists and GPs forecasted for the coming years. 'Psychiatric sectorisation' has led to a substantial development of community mental health care services, yet this has not compensated fully for the reduction in full-time hospital beds. Furthermore, community mental health care services remain relatively isolated from other community health services with very limited exchanges with general practice. Conclusion: GPs report an urgent need for training in mental health. Along with improving their ability to accurately detect and treat mental disorders, it is crucial also to improve communication between GPs and psychiatrists and increase shared case-management. Structural changes are also necessary to ensure a quicker and easier access to specialised mental health care services.

  17. Influenza-like-illness and clinically diagnosed flu: disease burden, costs and quality of life for patients seeking ambulatory care or no professional care at all.

    Directory of Open Access Journals (Sweden)

    Joke Bilcke

    Full Text Available This is one of the first studies to (1 describe the out-of-hospital burden of influenza-like-illness (ILI and clinically diagnosed flu, also for patients not seeking professional medical care, (2 assess influential background characteristics, and (3 formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011-2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever, a longer duration of illness, more use of medication (especially antibiotics and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5-6 symptoms over a 6-day period; required 1.6 physician visits and 86-91% took medication. An average episode amounted to €51-€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries.

  18. Influenza-like-illness and clinically diagnosed flu: disease burden, costs and quality of life for patients seeking ambulatory care or no professional care at all.

    Science.gov (United States)

    Bilcke, Joke; Coenen, Samuel; Beutels, Philippe

    2014-01-01

    This is one of the first studies to (1) describe the out-of-hospital burden of influenza-like-illness (ILI) and clinically diagnosed flu, also for patients not seeking professional medical care, (2) assess influential background characteristics, and (3) formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011-2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever), a longer duration of illness, more use of medication (especially antibiotics) and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5-6 symptoms over a 6-day period; required 1.6 physician visits and 86-91% took medication. An average episode amounted to €51-€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries. PMID:25032688

  19. Influenza-Like-Illness and Clinically Diagnosed Flu: Disease Burden, Costs and Quality of Life for Patients Seeking Ambulatory Care or No Professional Care at All

    Science.gov (United States)

    Bilcke, Joke; Coenen, Samuel; Beutels, Philippe

    2014-01-01

    This is one of the first studies to (1) describe the out-of-hospital burden of influenza-like-illness (ILI) and clinically diagnosed flu, also for patients not seeking professional medical care, (2) assess influential background characteristics, and (3) formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011–2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever), a longer duration of illness, more use of medication (especially antibiotics) and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5–6 symptoms over a 6-day period; required 1.6 physician visits and 86–91% took medication. An average episode amounted to €51–€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries. PMID:25032688

  20. Overview of hospitalizations by ambulatory care sensitive conditions in the municipality of Cotia, Brazil

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    Renata Laszlo Torres

    2014-08-01

    Full Text Available Objective To describe the profile of Hospitalizations by Amulatory Care Sensitive Conditions (HACSC, in the Municipality of Cotia, from 2008 to 2012. Method ecological, exploratory, longitudinal study with a quantitative approach. Data on HACSC, by age group and sex, were obtained from the Department of the Unified Health System. For data analysis descriptive statistics were used. Results During the period, there were 46,676 admissions, excluding deliveries, 7,753 (16.61% by HACSC. The main causes were cerebrovascular diseases, 16.96%, heart failure, 15.50%, hypertension, 10.80% and infection of the kidney and urinary tract, 10.51%. Regarding gender, HACSC occurred predominantly in males. There was a greater number of HACSC at extreme age ranges, especially in the elderly. Conclusion Chronic diseases predominate among the leading causes of HACSC and there was no significant difference between sex.

  1. Computerized extraction of information on the quality of diabetes care from free text in electronic patient records of general practitioners

    NARCIS (Netherlands)

    Voorham, Jaco; Denig, Petra

    2007-01-01

    Objective: This study evaluated a computerized method for extracting numeric clinical measurements related to diabetes care from free text in electronic patient records (EPR) of general practitioners. Design and Measurements: Accuracy of this number-oriented approach was compared to manual chart abs

  2. Management of orthodontic emergencies in primary care - self-reported confidence of general dental practitioners.

    Science.gov (United States)

    Popat, H; Thomas, K; Farnell, D J J

    2016-07-01

    Objective To determine general dental practitioners' (GDPs) confidence in managing orthodontic emergencies.Design Cross-sectional study.Setting Primary dental care.Subjects and methods An online survey was distributed to dentists practicing in Wales. The survey collected basic demographic information and included descriptions of ten common orthodontic emergency scenarios.Main outcome measure Respondents' self-reported confidence in managing the orthodontic emergency scenarios on a 5-point Likert scale. Differences between the Likert responses and the demographic variables were investigated using chi-squared tests.Results The median number of orthodontic emergencies encountered by respondents over the previous six months was 1. Overall, the self-reported confidence of respondents was high with 7 of the 10 scenarios presented scoring a median of 4 indicating that GDPs were 'confident' in their management. Statistical analysis revealed that GDPs who saw more orthodontic emergencies in the previous six months were more confident when managing the presented scenarios. Other variables such as age, gender, geographic location of practice and number of years practising dentistry were not associated with self-reported confidence.Conclusions Despite GDPs encountering very few orthodontic emergencies in primary care, they appear to be confident in dealing with commonly arising orthodontic emergency situations. PMID:27388086

  3. Priority Setting and Influential Factors on Acceptance of Pharmaceutical Recommendations in Collaborative Medication Reviews in an Ambulatory Care Setting – Analysis of a Cluster Randomized Controlled Trial (WestGem-Study)

    Science.gov (United States)

    Rose, Olaf; Mennemann, Hugo; John, Carina; Lautenschläger, Marcus; Mertens-Keller, Damaris; Richling, Katharina; Waltering, Isabel; Hamacher, Stefanie; Felsch, Moritz; Herich, Lena; Czarnecki, Kathrin; Schaffert, Corinna; Jaehde, Ulrich; Köberlein-Neu, Juliane

    2016-01-01

    Background Medication reviews are recognized services to increase quality of therapy and reduce medication risks. The selection of eligible patients with potential to receive a major benefit is based on assumptions rather than on factual data. Acceptance of interprofessional collaboration is crucial to increase the quality of medication therapy. Objective The research question was to identify and prioritize eligible patients for a medication review and to provide evidence-based criteria for patient selection. Acceptance of the prescribing general practitioner to implement pharmaceutical recommendations was measured and factors influencing physicians’ acceptance were explored to obtain an impression on the extent of collaboration in medication review in an ambulatory care setting. Methods Based on data of a cluster-randomized controlled study (WestGem-study), the correlation between patient parameters and the individual performance in a medication review was calculated in a multiple logistic regression model. Physician’s acceptance of the suggested intervention was assessed using feedback forms. Influential factors were analyzed. Results The number of drugs in use (p = 0.001), discrepancies between prescribed and used medicines (p = 0.014), the baseline Medication Appropriateness Index score (p0.05) and a low kidney function (p>0.05) do not predetermine the outcome. Longitudinal patient care with repeated reviews showed higher interprofessional acceptance and superior patient benefit. A total of 54.9% of the recommendations in a medication review on drug therapy were accepted for implementation. Conclusions The number of drugs in use and medication reconciliation could be a first rational step in patient selection for a medication review. Most elderly, multimorbid patients with polymedication experience a similar chance of receiving a benefit from a medication review. Longitudinal patient care should be preferred over confined medication reviews. The acceptance

  4. The impact of general practitioner morale on patient satisfaction with care: a cross-sectional study

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    McKinstry Brian

    2007-09-01

    Full Text Available Abstract Background The association between stress and morale among general practitioners (GP is well documented. However, the impact of GP stress or low morale on patient care is less clear. GPs in the UK now routinely survey patients about the quality of their care including organizational issues and consultation skills and the General Practice Assessment Questionnaire (GPAQ is widely used for this purpose. We aimed to see if there was a relationship between doctor morale as measured by a validated instrument, the Morale Assessment in General Practice Index (MAGPI and scores in the GPAQ. Methods All GPs in Lothian, Scotland who were collecting GPAQ data were approached and asked to complete the MAGPI. Using an anonymised linkage system, individual scores on the MAGPI were linked to the doctors' GPAQ scores. Levels of association between the scores were determined by calculating rank correlations at the level of the individual doctor. Hypothesised associations between individual MAGPI and GPAQ items were also assessed. Results 276 of 475 GPs who were approached agreed to complete a MAGPI questionnaire and successfully collected anonymous GPAQ data from an average of 49.6 patients. There was no significant correlation between the total MAGPI score and the GPAQ communication or enablement scale. There were weak correlations between "control of work" in the MAGPI scale and GPAQ items on waiting times to see doctors (r = 0.24 p Conclusion This study showed no relationship between overall GP morale and patient perception of performance. There was a weak relationship between patients' perceptions ofquality and doctors' beliefs about their workload and whether patients value them. Further research is required to elucidate the complex relationship between workload, morale and patients' perception of care.

  5. Ambulatory electrocardiology.

    Science.gov (United States)

    Romero, Iñaki

    2013-01-01

    About 50 years ago, Norman Jefferis Holter invented a device that opened the possibility of recording heart activity over long periods of time. This invention, together with the rapid developments in electronics, has enabled a revolutionary change in the diagnosis and management of cardiac diseases. Ambulatory cardiac monitors have decreased in size to the point of becoming wearable or implantable and are able to monitor heart activity for months or even years. In addition, new telecommunication systems allow clinicians to remotely access cardiac events and to respond within a short period of time. Novel advances in computing and algorithm development are expanding the clinical applications of ambulatory devices with more complex automatic interpretation of the electrocardiographic signal. This article reviews the state of the art of these techniques from both clinical and technical approaches, covering a historic perspective up to today, and discusses current applications, challenges, and future directions. PMID:23422020

  6. Patient Complaint Cases in Primary Health Care: What Are the Characteristics of General Practitioners Involved?

    OpenAIRE

    Søren Birkeland; Rene dePont Christensen; Niels Damsbo; Jakob Kragstrup

    2013-01-01

    Background. Limited knowledge exists about factors increasing the risk of general practitioners becoming involved in a complaint case or getting disciplined in connection with a complaint case. Aim. The present study aimed to identify the general practitioner and practice characteristics associated with complaint cases and discipline. Methods. Information on general practitioners involved in complaint case decisions during one year (2007) was linked to Danish National register data on all gen...

  7. Medical care of asylum seekers: a descriptive study of the appropriateness of nurse practitioners' care compared to traditional physician-based care in a gatekeeping system

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    Pécoud Alain

    2007-10-01

    Full Text Available Abstract Background Medical care for asylum seekers is a complex and critical issue worldwide. It is influenced by social, political, and economic pressures, as well as premigration conditions, the process of migration, and postmigration conditions in the host country. Increasing needs and healthcare costs have led public health authorities to put nurse practitioners in charge of the management of a gatekeeping system for asylum seekers. The quality of this system has never been evaluated. We assessed the competencies of nurses and physicians in identifying the medical needs of asylum seekers and providing them with appropriate treatment that reflects good clinical practice. Methods This cross-sectional descriptive study evaluated the appropriateness of care provided to asylum seekers by trained nurse practitioners in nursing healthcare centers and by physicians in private practices, an academic medical outpatient clinic, and the emergency unit of the university hospital in Lausanne, Switzerland. From 1687 asylum seeking patients who had consulted each setting between June and December 2003, 450 were randomly selected to participate. A panel of experts reviewed their medical records and assessed the appropriateness of medical care received according to three parameters: 1 use of appropriate procedures to identify medical needs (medical history, clinical examination, complementary investigations, and referral, 2 provision of access to treatment meeting medical needs, and 3 absence of unnecessary medical procedures. Results In the nurse practitioner group, the procedures used to identify medical needs were less often appropriate (79% of reports vs. 92.4% of reports; p Conclusion Although the nursing gatekeeping system provides appropriate treatment to asylum seekers, it might be improved with further training in recording medical history and performing targeted clinical examination.

  8. The decline in 'free' general practitioner care in Australia: reasons and repercussions.

    Science.gov (United States)

    Hopkins, Sandra; Speed, Nathan

    2005-09-01

    The Australian public insurer, Medicare, allows general practitioners (GPs) to bulk bill patients, or accept the government rebate as full payment for their services. The percentage of GP consultations bulk billed, however has declined from 78.6% in June 2000 to 65.7% in December 2003. The immediate impact of a declining level of bulk billing is a decrease in the availability of free GP health care for patients. This has implications for copayments and access to GPs for low income groups in particular. In this paper, we explore the reasons for and repercussions of the decline in bulk billing. We analyse two main reasons for the decline. The first is a failure of the rebate to maintain a level consistent with increases in medical practice costs. The second is a decline in GPs in some regional and rural areas resulting in a decrease in price competition. The government has recently made changes to deal with the decline in bulk billing and based on three quarters of data, there has been a modest improvement in bulk billing.

  9. The decline in 'free' general practitioner care in Australia: reasons and repercussions.

    Science.gov (United States)

    Hopkins, Sandra; Speed, Nathan

    2005-09-01

    The Australian public insurer, Medicare, allows general practitioners (GPs) to bulk bill patients, or accept the government rebate as full payment for their services. The percentage of GP consultations bulk billed, however has declined from 78.6% in June 2000 to 65.7% in December 2003. The immediate impact of a declining level of bulk billing is a decrease in the availability of free GP health care for patients. This has implications for copayments and access to GPs for low income groups in particular. In this paper, we explore the reasons for and repercussions of the decline in bulk billing. We analyse two main reasons for the decline. The first is a failure of the rebate to maintain a level consistent with increases in medical practice costs. The second is a decline in GPs in some regional and rural areas resulting in a decrease in price competition. The government has recently made changes to deal with the decline in bulk billing and based on three quarters of data, there has been a modest improvement in bulk billing. PMID:16039350

  10. Is chronic pelvic pain a comfortable diagnosis for primary care practitioners: a qualitative study

    Directory of Open Access Journals (Sweden)

    Creed Francis

    2010-01-01

    Full Text Available Abstract Background Chronic pelvic pain (CPP has a prevalence similar to asthma and chronic back pain, but little is known about how general practitioners (GPs and practice nurses manage women with this problem. A clearer understanding of current management is necessary to develop appropriate strategies, in keeping with current health care policy, for the supported self-management of patients with long term conditions. The aim of this study was to explore GPs' and practice nurses' understanding and perspectives on the management of chronic pelvic pain. Methods Data were collected using semi-structured interviews with a purposive sample of 21 GPs and 20 practice nurses, in three primary care trusts in the North West of England. Data were analysed using the principles of Framework analysis. Results Analysis suggests that women who present with CPP pose a challenge to GPs and practice nurses. CPP is not necessarily recognized as a diagnostic label and making the diagnosis was achieved only by exclusion. This contrasts with the relative acceptability of labels such as irritable bowel syndrome (IBS. GPs expressed elements of therapeutic nihilism about the condition. Despite practice nurses taking on increasing responsibilities for the management of patients with long term conditions, respondents did not feel that CPP was an area that they were comfortable in managing. Conclusions The study demonstrates an educational/training need for both GPs and practice nurses. GPs described a number of skills and clinical competencies which could be harnessed to develop a more targeted management strategy. There is potential to develop facilitated self- management for use in this patient group, given that this approach has been successful in patients with similar conditions such as IBS.

  11. Experiences of Parents and General Practitioners with End-of-Life Care in Adolescents and Young Adults with Cancer.

    Science.gov (United States)

    Kaal, Suzanne E J; Kuijken, Noortje M J; Verhagen, Constant A H H V M; Jansen, Rosemarie; Servaes, Petra; van der Graaf, Winette T A

    2016-03-01

    This study aims to analyze the experiences of Dutch bereaved parents and general practitioners (GPs) with palliative care of AYAs (18-35 years) in the terminal stage. Fifteen parents and nine GPs involved with nine deceased AYAs filled out questionnaires and were interviewed by telephone, respectively. In general, the parents were satisfied with the emotional care they themselves received and the medical care that their child received. The GPs were very satisfied with the cooperation with the palliative team. Gaps are present in the areas of symptom control, communication between hospital professionals and parents, aftercare, and transition between hospital and GP. PMID:26812457

  12. Brand Name and Generic Proton Pump Inhibitor Prescriptions in the United States: Insights from the National Ambulatory Medical Care Survey (2006–2010

    Directory of Open Access Journals (Sweden)

    Andrew J. Gawron

    2015-01-01

    Full Text Available Introduction. Proton pump inhibitors (PPI are one of the most commonly prescribed medication classes with similar efficacy between brand name and generic PPI formulations. Aims. We determined demographic, clinical, and practice characteristics associated with brand name PPI prescriptions at ambulatory care visits in the United States. Methods. Observational cross sectional analysis using the National Ambulatory Medical Care Survey (NAMCS of all adult (≥18 yrs of age ambulatory care visits from 2006 to 2010. PPI prescriptions were identified by using the drug entry code as brand name only or generic available formulations. Descriptive statistics were reported in terms of unweighted patient visits and proportions of encounters with brand name PPI prescriptions. Global chi-square tests were used to compare visits with brand name PPI prescriptions versus generic PPI prescriptions for each measure. Poisson regression was used to determine the incidence rate ratio (IRR for generic versus brand PPI prescribing. Results. A PPI was prescribed at 269.7 million adult ambulatory visits, based on 9,677 unweighted visits, of which 53% were brand name only prescriptions. In 2006, 76.0% of all PPI prescriptions had a brand name only formulation compared to 31.6% of PPI prescriptions in 2010. Visits by patients aged 25–44 years had the greatest proportion of brand name PPI formulations (57.9%. Academic medical centers and physician-owned practices had the greatest proportion of visits with brand name PPI prescriptions (58.9% and 55.6% of visits with a PPI prescription, resp.. There were no significant differences in terms of median income, patient insurance type, or metropolitan status when comparing the proportion of visits with brand name versus generic PPI prescriptions. Poisson regression results showed that practice ownership type was most strongly associated with the likelihood of receiving a brand name PPI over the entire study period. Compared to

  13. Employment of Nurse Practitioners and Physician Assistants in Breast Cancer Care

    OpenAIRE

    Friese, Christopher R.; Hawley, Sarah T.; Griggs, Jennifer J.; Jagsi, Reshma; Graff, John; Hamilton, Ann S.; Janz, Nancy K.; Katz, Steven J.

    2010-01-01

    This study found that nurse practitioner and physician assistant employment is higher with newer physicians and in more heavily resourced practices. Employment of nurse practitioners and physician assistants is relatively modest, which suggests an opportunity for physicians to employ these providers to alleviate workloads.

  14. Society for Ambulatory Anesthesia

    Science.gov (United States)

    ... Webinars Publications & Resources Clinical Practice Guidelines SAMBA Link Digital ... We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, encourages research ...

  15. Physician - nurse practitioner teams in chronic disease management: the impact on costs, clinical effectiveness, and patients' perception of care.

    Science.gov (United States)

    Litaker, David; Mion, Lorraine; Planavsky, Loretta; Kippes, Christopher; Mehta, Neil; Frolkis, Joseph

    2003-08-01

    Increasing demand to deliver and document therapeutic and preventive care sharpens the need for disease management strategies that accomplish these goals efficiently while preserving quality of care. The purpose of this study was to compare selected outcomes for a new chronic disease management program involving a nurse practitioner - physician team with those of an existing model of care. One hundred fifty-seven patients with hypertension and diabetes mellitus were randomly assigned to their primary care physician and a nurse practitioner or their primary care physician alone. Costs for personnel directly involved in patient management, calculated from hourly rates and encounter time with patients, and pre- and post-study glycosylated hemoglobin (HbA(1c)), high-density lipoprotein cholesterol (HDL-c), satisfaction with care and health-related quality of life (HRQoL) were assessed. Although 1-year costs for personnel were higher in the team-treated group, participants experienced significant improvements in mean HbA(1c) ( - 0.7%, p = 0.02) and HDL-c ( + 2.6 mg dL( - 1), p = 0.02). Additionally, satisfaction with care improved significantly for team-treated subjects in several sub-scales whereas the mean change over time in HRQoL did not differ significantly between groups. This study demonstrates the value of a complementary team approach to chronic disease management in improving patient-derived and clinical outcomes at modest incremental costs.

  16. "My Favourite Day Is Sunday": Community Perceptions of (Drug-Resistant Tuberculosis and Ambulatory Tuberculosis Care in Kara Suu District, Osh Province, Kyrgyzstan.

    Directory of Open Access Journals (Sweden)

    Doris Burtscher

    Full Text Available Kyrgyzstan is one of the 27 high multidrug-resistant tuberculosis (MDR-TB burden countries listed by the WHO. In 2012, Médecins Sans Frontières (MSF started a drug-resistant tuberculosis (DR-TB project in Kara Suu District. A qualitative study was undertaken to understand the perception of TB and DR-TB in order to improve the effectiveness and acceptance of the MSF intervention and to support advocacy strategies for an ambulatory model of care.This paper reports findings from 63 interviews with patients, caregivers, health care providers and members of communities. Data was analysed using a qualitative content analysis. Validation was ensured by triangulation and a 'thick' description of the research context, and by presenting deviant cases.Findings show that the general population interprets TB as the 'lungs having a cold' or as a 'family disease' rather than as an infectious illness. From their perspective, individuals facing poor living conditions are more likely to get TB than wealthier people. Vulnerable groups such as drug and alcohol users, homeless persons, ethnic minorities and young women face barriers in accessing health care. As also reported in other publications, TB is highly stigmatised and possible side effects of the long treatment course are seen as unbearable; therefore, people only turn to public health care quite late. Most patients prefer ambulatory treatment because of the much needed emotional support from their social environment, which positively impacts treatment concordance. Health care providers favour inpatient treatment only for a better monitoring of side effects. Health staff increasingly acknowledges the central role they play in supporting DR-TB patients, and the importance of assuming a more empathic attitude.Health promotion activities should aim at improving knowledge on TB and DR-TB, reducing stigma, and fostering the inclusion of vulnerable populations. Health seeking delays and adherence problems will

  17. Optimizing anesthesia techniques in the ambulatory setting

    NARCIS (Netherlands)

    E. Galvin

    2007-01-01

    textabstractAmbulatory surgery refers to the process of admitting patients, administering anesthesia and surgical care, and discharging patients home following an appropriate level of recovery on the same day. The word ambulatory is derived from the latin word ambulare, which means ''to walk''. This

  18. Transforming youth care through online simulation gaming. Aligning the positions of practitioners and observers

    Directory of Open Access Journals (Sweden)

    Kees JM van Haaster

    2014-09-01

    Full Text Available Transforming youth care through online simulation gaming. Aligning the positions of practitioners and observersThe youth care service in the Netherlands is currently undergoing a major transition from national and regional finance and control to localized regulation and responsibility. The aim is to initiate a transformation towards greater intervention value and to support greater self-reliance in social networks. Effective youth care depends largely on the quality of the network exchange. If efficiency is our concern, we should look into the methods and techniques of network exchange. When it comes to solving hard problems, the significance of situational knowledge construction and network coordination must not be underrated. Professional deliberation is directed toward understanding, acting and analysis. We need smart and flexible ways to direct systems information from practice to network reflection, and to guide results from network consultation to practice.This article presents a proposal for a case study, as a follow-up to a recent dissertation about online simulation gaming for youth care network exchange (Van Haaster, 2014. The results of that research show that it is a valuable exercise to model intricate issues from practice using simulation game design and that youth care professionals appreciate the relevance, usability and usefulness of this new tool. The question in this paper is how to develop a practicable approach using online simulation gaming to improve patterns of action and reflection on dilemmas and hard-to-solve problems in youth care practice. Child-rearing conditions and family behaviour are usually enhanced through sequences of exploration, experimentation and evaluation. Step-by-step progressions are characterized by balancing acting and thinking. The author elaborates this observation through a model that alternates acting in practice with retrospect and prospect reflection in online game sessions

  19. Effectiveness of the palliative care ‘Availability, Current issues and Anticipation’ (ACA) communication training programme for general practitioners on patient outcomes: A controlled trial

    Science.gov (United States)

    Blankenstein, Annette H; Schweitzer, Bart PM; Knol, Dirk L; van der Horst, Henriëtte E; Aaronson, Neil K; Deliens, Luc

    2014-01-01

    Background: Although communicating effectively with patients receiving palliative care can be difficult, it may contribute to maintaining or enhancing patients’ quality of life. Little is known about the effect of training general practitioners in palliative care–specific communication. We hypothesized that palliative care patients of general practitioners exposed to the ‘Availability, Current issues and Anticipation’ communication training programme would report better outcomes than patients of control general practitioners. Aim: To evaluate the effectiveness of the Availability, Current issues and Anticipation training programme for general practitioners on patient-reported outcomes. Design: In a controlled trial, general practitioners followed the Availability, Current issues and Anticipation programme or were part of the control group. Patients receiving palliative care of participating general practitioners completed the Palliative Care Outcome Scale, the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative, the Rest & Peace Scale, the Patient Satisfaction Questionnaire–III and the Availability, Current issues and Anticipation Scale, at baseline and 12 months follow-up. We analysed differences between groups using linear mixed models. Trial registration: ISRCTN56722368. Setting/participants: General practitioners who attended a 2-year Palliative Care Training Course in the Netherlands. Results: Questionnaire data were available for 145 patients (89 in intervention and 56 in control group). We found no significant differences over time between the intervention and control groups in any of the five outcome measures. Ceiling effects were observed for the Rest & Peace Scale, Patient Satisfaction Questionnaire–III and Availability, Current issues and Anticipation Scale. Conclusion: General practitioner participation in the Availability, Current issues and Anticipation training programme did not have

  20. Resource utilisation and cost of ambulatory HIV care in a regional HIV centre in Ireland: a micro-costing study

    OpenAIRE

    Brennan, Aline; Jackson, Arthur; Horgan, Mary; Bergin, Colm J; Browne, John P

    2015-01-01

    BACKGROUND: It is anticipated that demands on ambulatory HIV services will increase in coming years as a consequence of the increased life expectancy of HIV patients on highly active anti-retroviral therapy (HAART). Accurate cost data are needed to enable evidence based policy decisions be made about new models of service delivery, new technologies and new medications. METHODS: A micro-costing study was carried out in an HIV outpatient clinic in a single regional centre in the south of Irelan...

  1. Awareness of the Food and Drug Administration's Bad Ad Program and Education Regarding Pharmaceutical Advertising: A National Survey of Prescribers in Ambulatory Care Settings.

    Science.gov (United States)

    O'Donoghue, Amie C; Boudewyns, Vanessa; Aikin, Kathryn J; Geisen, Emily; Betts, Kevin R; Southwell, Brian G

    2015-01-01

    The U.S. Food and Drug Administration's Bad Ad program educates health care professionals about false or misleading advertising and marketing and provides a pathway to report suspect materials. To assess familiarity with this program and the extent of training about pharmaceutical marketing, a sample of 2,008 health care professionals, weighted to be nationally representative, responded to an online survey. Approximately equal numbers of primary care physicians, specialists, physician assistants, and nurse practitioners answered questions concerning Bad Ad program awareness and its usefulness, as well as their likelihood of reporting false or misleading advertising, confidence in identifying such advertising, and training about pharmaceutical marketing. Results showed that fewer than a quarter reported any awareness of the Bad Ad program. Nonetheless, a substantial percentage (43%) thought it seemed useful and 50% reported being at least somewhat likely to report false or misleading advertising in the future. Nurse practitioners and physician assistants expressed more openness to the program and reported receiving more training about pharmaceutical marketing. Bad Ad program awareness is low, but opportunity exists to solicit assistance from health care professionals and to help health care professionals recognize false and misleading advertising. Nurse practitioners and physician assistants are perhaps the most likely contributors to the program. PMID:26176326

  2. Breastfeeding: Mothers and health practitioners in the context of private medical care in Gauteng

    Directory of Open Access Journals (Sweden)

    Diana du Plessis

    2009-04-01

    Full Text Available Despite the well-documented health benefits of breastfeeding and recommendations by the Department of Health for women to exclusively breastfeed for approximately the first six months of life and continuation beyond one year, a large percentage of South African women do not breastfeed their infants, or only do so for a short period of time. No national South African statistics are available but figures emerging from the attendance of mothers at a baby clinic on the West Rand in Gauteng indicated the following: 64% of the mothers breastfeed up to six weeks, after which the figure rapidly declines to less than 20% at three months (Truter 2007. Several studies have assessed the attitudes of health care personnel towards breastfeeding, but little is known of the type of information given to breastfeeding mothers by private medical practitioners who are the frontline of contact with clients and who may convey information that either promotes or discourages breastfeeding. The following question was thus formulated: With regard to breastfeeding, what are the constraints to breastfeeding in private practice?

    Therefore, in order to understand the constraints to breastfeeding, the purpose of this study was to assess the breastfeeding information given to pregnant women by health professionals in private practice. The specific objectives of the study were to determine the breastfeeding recommendations made by private health professionals during pregnancy, to describe the management of breastfeeding in the consulting rooms of private medical practitioners, and to describe women’s experiences of breastfeeding in private hospitals. In Phase 1 of the study the population comprised all mothers who attended a support group for new mothers at a private post-natal clinic In Phase 2 the population comprised all mothers who attended a community baby clinic or support group. The sample consisted of all primigravidae who breastfed or attempted to breastfeed in the

  3. Practitioner research to promote practice development: the continued development by means of practitioner research of a multidisciplinary learning environment within neurorehabilitation care for older persons

    Directory of Open Access Journals (Sweden)

    Cyrilla van der Donk

    2015-11-01

    Full Text Available Background: Continuous innovation is required to help clinical practice adapt to healthcare demand and there is a pressing need for sufficient numbers of professionals trained to work in this ever-changing context. New environments for learning are needed to enhance the development of these skills for existing and future care professionals. This article gives an account of how practitioner research was used to further develop a multidisciplinary learning environment for students of the Institute of Health Studies and the Institute of Nursing Studies of HAN University of Applied Sciences in a department specialising in neurorehabilitation for older persons from ZZG Herstelhotel, a public hospital offering long-term residential care in the Netherlands. Aim: The aim of the study was to pursue the development of the learning environment by exploring stakeholders’ visions of their ideal multidisciplinary learning environment. Method: Practitioner research was chosen as a methodology as it deliberately seeks to generate local knowledge and theories through exploring different perspectives, and to encourage learning and reflection. A research group was formed consisting of the first author and three practice supervisors. A mixed-methods approach was used by the research group. First, a selection of relevant publications was reviewed by the group. This was followed by learning sessions in which students, supervisors and managers were invited to dream and design on the basis of their own experiences, thereby linking up with the constructionist-based change approach of Appreciative Inquiry. Results: A collective view of the characteristics of a workbased learning environment was developed by students, supervisors and managers. These characteristics were placed in one of four ideal perspectives: the core professional competencies to be acquired; the resources available; the learning culture; and the supervision. Not all students valued multidisciplinary

  4. The Relative Impacts of Design Effects and Multiple Imputation on Variance Estimates: A Case Study with the 2008 National Ambulatory Medical Care Survey

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    Lewis Taylor

    2014-03-01

    Full Text Available The National Ambulatory Medical Care Survey collects data on office-based physician care from a nationally representative, multistage sampling scheme where the ultimate unit of analysis is a patient-doctor encounter. Patient race, a commonly analyzed demographic, has been subject to a steadily increasing item nonresponse rate. In 1999, race was missing for 17 percent of cases; by 2008, that figure had risen to 33 percent. Over this entire period, single imputation has been the compensation method employed. Recent research at the National Center for Health Statistics evaluated multiply imputing race to better represent the missing-data uncertainty. Given item nonresponse rates of 30 percent or greater, we were surprised to find many estimates’ ratios of multiple-imputation to single-imputation estimated standard errors close to 1. A likely explanation is that the design effects attributable to the complex sample design largely outweigh any increase in variance attributable to missing-data uncertainty.

  5. Patient Complaint Cases in Primary Health Care: What Are the Characteristics of General Practitioners Involved?

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    Søren Birkeland

    2013-01-01

    Full Text Available Background. Limited knowledge exists about factors increasing the risk of general practitioners becoming involved in a complaint case or getting disciplined in connection with a complaint case. Aim. The present study aimed to identify the general practitioner and practice characteristics associated with complaint cases and discipline. Methods. Information on general practitioners involved in complaint case decisions during one year (2007 was linked to Danish National register data on all general practitioners (. Logistic regression was used for statistical analysis. Results. With regard to complaints concerning daytime services (, the professional seniority of the general practitioner was positively associated with the odds of receiving a complaint decision (OR = 1.44 per 20 years of seniority; CI 95%, 1.04–1.98. Likewise, having more consultations per day was associated with increased odds (OR = 1.29 per 10 extra consultations per day; CI 95%, 1.07–1.54. No statistically significant association could be demonstrated between being disciplined and general practitioner or practice characteristics. Conclusion. The possible relationship between professional seniority, rate of consultations, and complaint cases merits further studies to clarify the impact of professional seniority and workload on professional performance and to furthermore consider the role of factors such as job content and communication styles.

  6. Nonurgent Use of the Emergency Department by Pediatric Patients: A Theory-Guided Approach for Primary and Acute Care Pediatric Nurse Practitioners.

    Science.gov (United States)

    Ohns, Mary Jean; Oliver-McNeil, Sandra; Nantais-Smith, Leanne M; George, Nancy M

    2016-01-01

    Providing quality, cost-effective care to children and their families in the appropriate setting is the goal of nurse practitioners in primary and acute care. However, increased utilization of the emergency department (ED) for nonurgent care threatens cost-effective quality care, interrupts continuity of care, and contributes to ED overcrowding. To date, descriptive research has identified demographics of those using the ED for nonurgent care, the chief complaints of children seeking nonurgent care, the cost to the health care system of pediatric nonurgent care, and characteristics of associated primary care settings. Using Donabedian's Model of Quality of Healthcare and a Theory of Dependent Care by Taylor and colleagues, acute and primary care pediatric nurse practitioners can incorporate interventions that will channel care to the appropriate setting and educate caregivers regarding common childhood illnesses and the value of continuity of care. By using a theoretical framework as a guide, this article will help both acute and primary care pediatric nurse practitioners understand why parents seek nonurgent care for their children in the ED and actions they can take to ensure that care is provided in an optimal setting.

  7. Nonurgent Use of the Emergency Department by Pediatric Patients: A Theory-Guided Approach for Primary and Acute Care Pediatric Nurse Practitioners.

    Science.gov (United States)

    Ohns, Mary Jean; Oliver-McNeil, Sandra; Nantais-Smith, Leanne M; George, Nancy M

    2016-01-01

    Providing quality, cost-effective care to children and their families in the appropriate setting is the goal of nurse practitioners in primary and acute care. However, increased utilization of the emergency department (ED) for nonurgent care threatens cost-effective quality care, interrupts continuity of care, and contributes to ED overcrowding. To date, descriptive research has identified demographics of those using the ED for nonurgent care, the chief complaints of children seeking nonurgent care, the cost to the health care system of pediatric nonurgent care, and characteristics of associated primary care settings. Using Donabedian's Model of Quality of Healthcare and a Theory of Dependent Care by Taylor and colleagues, acute and primary care pediatric nurse practitioners can incorporate interventions that will channel care to the appropriate setting and educate caregivers regarding common childhood illnesses and the value of continuity of care. By using a theoretical framework as a guide, this article will help both acute and primary care pediatric nurse practitioners understand why parents seek nonurgent care for their children in the ED and actions they can take to ensure that care is provided in an optimal setting. PMID:26489793

  8. General practitioner attitudes to the care of people with epilepsy: an examination of clustering within practices and prediction of patient-rated quality of care

    Directory of Open Access Journals (Sweden)

    Thapar Ajay K

    2005-03-01

    Full Text Available Abstract Background There is wide variation in the quality of care provided by primary care practices to individuals with chronic illnesses. Individual doctor attitudes and interest have been demonstrated to influence patient outcomes in some instances. Given the trend towards larger practices and part-time working, continuity of care is likely to fall and thus practice-based rather than individual general practitioner attributes and attitudes are likely to become increasingly important. The aim in this paper was to examine the extent to which individual general practitioner (G.P. attitudes to the care of people with epilepsy cluster within practices and predict patient-rated quality of care. Methods The sample consisted of 1255 people with active epilepsy (a recent seizure or on anti-convulsant medication for epilepsy and 199 GPs from 82 general practices. Measures of GP attitudes (a 17-item GP attitudes questionnaire and patient-rated quality of epilepsy care were obtained. 1210 individuals completed initial questionnaires and 975 patients filled in final questionnaires one year later. Responses were achieved from 64 practices (83% of total and 115 GPs (60% of total. Results 2 main factors were found to underlie GP attitudes to the care of people with epilepsy and these demonstrated clustering within practices "epilepsy viewed as a primary care responsibility" (Eigenvalue 3.98, intra-class correlation coefficient (ICC 0.40, and "medication skills"(Eigenvalue 2.74, ICC 0.35. GP-rated scores on "epilepsy care being a primary care responsibility" were a significant predictor of patient-rated quality of GP care (p = 0.031. Other contributory factors were seizure frequency (p = 0.044, and patient-rated "shared decision making" (p = 0.022. Conclusion Specific general practitioner attitudes to the care of people with epilepsy cluster within practices and are significantly associated with patient-rated quality of epilepsy care. It is important to take

  9. Current experiences and educational preferences of general practitioners and staff caring for people with dementia living in residential facilities

    Directory of Open Access Journals (Sweden)

    Scherer Samuel

    2009-08-01

    Full Text Available Abstract Background Residential care is important for older adults, particularly for those with advanced dementia and their families. Education interventions that achieve sustainable improvement in the care of older adults are critical to quality care. There are few systematic data available regarding the educational needs of Residential Care Facility (RCF staff and General Practitioners (GPs relating to dementia, or the sustainability of educational interventions. We sought to determine participation in dementia education, perceived levels of current knowledge regarding dementia, perceived unmet educational needs, current barriers, facilitators and preferences for dementia education. Methods A mixed methods study design was utilised. A survey was distributed to a convenience sample of general practitioners, and staff in 223 consecutive residential care facilities in Perth, Western Australia. Responses were received from 102 RCF staff working in 10 facilities (out of 33 facilities who agreed to distribute the survey and 202 GPs (19% of metropolitan GPs. Quantitative survey data were summarised descriptively and chi squared statistics were used to analyse the distribution of categorical variables. Qualitative data were collected from general practitioners, staff in residential care facilities and family carers of people with dementia utilizing individual interviews, surveys and focus groups. Qualitative data were analysed thematically. Results Among RCF staff and GPs attending RCF, participation in dementia education was high, and knowledge levels generally perceived as good. The individual experiences and needs of people with dementia and their families were emphasised. Participants identified the need for a person centred philosophy to underpin educational interventions. Limited time was a frequently mentioned barrier, especially in relation to attending dementia care education. Perceived educational needs relating to behaviours of concern

  10. Contextualising professional ethics: the impact of the prison context on the practices and norms of health care practitioners.

    Science.gov (United States)

    White, Karolyn L A; Jordens, Christopher F C; Kerridge, Ian

    2014-09-01

    Health care is provided in many contexts-not just hospitals, clinics, and community health settings. Different institutional settings may significantly influence the design and delivery of health care and the ethical obligations and practices of health care practitioners working within them. This is particularly true in institutions that are established to constrain freedom, ensure security and authority, and restrict movement and choice. We describe the results of a qualitative study of the experiences of doctors and nurses working within two women's prisons in the state of New South Wales (NSW), Australia. Their accounts make clear how the provision and ethics of health care may be compromised by the physical design of the prison, the institutional policies and practices restricting movement of prisoners and practitioners, the focus on maintaining control and security, and the very purpose of the prison and prison system itself. The results of this study make clear the impact that context has on professional practice and illustrate the importance of sociology and anthropology to bioethics and to the development of a more nuanced account of professional ethics.

  11. Recruitment difficulties in a primary care cluster randomised trial: investigating factors contributing to general practitioners' recruitment of patients

    Directory of Open Access Journals (Sweden)

    McKenzie Joanne E

    2011-03-01

    Full Text Available Abstract Background Recruitment of patients by health professionals is reported as one of the most challenging steps when undertaking studies in primary care settings. Numerous investigations of the barriers to patient recruitment in trials which recruit patients to receive an intervention have been published. However, we are not aware of any studies that have reported on the recruitment barriers as perceived by health professionals to recruiting patients into cluster randomised trials where patients do not directly receive an intervention. This particular subtype of cluster trial is commonly termed a professional-cluster trial. The aim of this study was to investigate factors that contributed to general practitioners recruitment of patients in a professional-cluster trial which evaluated the effectiveness of an intervention to increase general practitioners adherence to a clinical practice guideline for acute low-back pain. Method General practitioners enrolled in the study were posted a questionnaire, consisting of quantitative items and an open-ended question, to assess possible reasons for poor patient recruitment. Descriptive statistics were used to summarise quantitative items and responses to the open-ended question were coded into categories. Results Seventy-nine general practitioners completed at least one item (79/94 = 84%, representing 68 practices (85% practice response rate, and 44 provided a response to the open-ended question. General practitioners recalled inviting a median of two patients with acute low-back pain to participate in the trial over a seven-month period; they reported that they intended to recruit patients, but forgot to approach patients to participate; and they did not perceive that patients had a strong interest or disinterest in participating. Additional open-ended comments were generally consistent with the quantitative data. Conclusion A number of barriers to the recruitment of patients with acute low

  12. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    OpenAIRE

    Plas, A.G.M. van der; Onwuteaka-Philipsen, B.D.; Vissers, K.C.; Deliens, L.; Jansen, W.J.J.; Francke, A.L.

    2016-01-01

    Aims: To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. Background: For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for co...

  13. Ambulatory and Community-Based Services

    OpenAIRE

    Thomas, Fred

    1999-01-01

    The shift in the site of service delivery from inpatient and institutional to ambulatory and community settings has been prompted by concerns over cost and the prospect for improving the quality of life. In response to these concerns, Medicare has implemented several demonstrations that emphasize ambulatory and community-based services. In this issue, articles are presented on four demonstrations, which focus on the extent to which coordinated care models reduce health care costs, and the cos...

  14. [A guide to good practice for information security in the handling of personal health data by health personnel in ambulatory care facilities].

    Science.gov (United States)

    Sánchez-Henarejos, Ana; Fernández-Alemán, José Luis; Toval, Ambrosio; Hernández-Hernández, Isabel; Sánchez-García, Ana Belén; Carrillo de Gea, Juan Manuel

    2014-04-01

    The appearance of electronic health records has led to the need to strengthen the security of personal health data in order to ensure privacy. Despite the large number of technical security measures and recommendations that exist to protect the security of health data, there is an increase in violations of the privacy of patients' personal data in healthcare organizations, which is in many cases caused by the mistakes or oversights of healthcare professionals. In this paper, we present a guide to good practice for information security in the handling of personal health data by health personnel, drawn from recommendations, regulations and national and international standards. The material presented in this paper can be used in the security audit of health professionals, or as a part of continuing education programs in ambulatory care facilities.

  15. Mind-Mindedness in Infant Child-Care: Associations with Early Childhood Practitioner Sensitivity and Stimulation

    Science.gov (United States)

    Degotardi, Sheila; Sweller, Naomi

    2012-01-01

    The significance of mind-mindedness, or the tendency of adults to ascribe mental states and processes when describing and interpreting children's behavior, is well established in home contexts. The purpose of this study was to explore the prevalence and pedagogical implications of the mind-mindedness of 24 early childhood practitioners working…

  16. Diagnosis of prostate cancer in patients with persistently elevated PSA and tumor-negative biopsy in ambulatory care. Performance of MR imaging in a multi-reader environment

    International Nuclear Information System (INIS)

    Purpose: False-negative results are obtained in approx. 20 % of prostate cancer (PCa) patients (pts) at initial systematic transrectal biopsy (Bx), in particular when digital rectal examination (DRE) or transrectal ultrasound (TRUS) is negative. The aim of this study was to assess whether MR endorectal imaging of the prostate in a multi-reader ambulatory care setting may assist in patient selection for re-biopsy. Materials and Methods: 115 consecutive pts with persistent PSA elevation, negative Bx, DRE and TRUS were examined using T2w axial and coronal and T1w axial sequences for tumor diagnosis. MR images were prospectively read as tumor-suspicious or tumor-negative by the MR radiologist on duty. Additionally, a retrospective readout of a prostate MR expert and an abdominal imaging fellowship-trained radiologist was performed to evaluate the effect of the reader's experience on tumor detection. Imaging findings were compared to the results of the repeat Bx (61 pts) or the clinical course of at least two years. Results: For the prospective reading, the sensitivity of MRI was 83 %, the specificity was 69 %, the PPV was 33 % and the NPV was 96 %. ROC analysis revealed a significantly better performance of the prostate MR imaging expert compared to the abdominal imaging radiologist (area under ROC 0.88 vs. 0.66, p < 0.001). Based on the prospective reading, a pre-test probability for PCa of 17.4 % as in our study can be reduced to 5 % when obtaining a tumor-negative result in MRI. Conclusion: MR imaging in a multi-reader ambulatory care setting assists in patient selection for re-biopsy. Reducing the post-test probability for PCa to 5 % allows for further follow-up instead of re-biopsy in MR tumor-negative patients. Specific training and experience improve tumor detection in prostate MR imaging. (orig.)

  17. Diagnosis of prostate cancer in patients with persistently elevated PSA and tumor-negative biopsy in ambulatory care. Performance of MR imaging in a multi-reader environment

    Energy Technology Data Exchange (ETDEWEB)

    Scheidler, J. [Radiologisches Zentrum Muenchen-Pasing, Muenchen (Germany); Weoeres, I.; Scharf, M.; Siebels, M. [Urologische Gemeinschaftspraxis Pasing (Germany); Brinkschmidt, C. [Gemeinschaftspraxis Pathologie, Starnberg (Germany); Zeitler, H.; Heuck, A. [Radiologisches Zentrum Muenchen (Germany); Panzer, S. [Unfallklinik Murnau (Germany). Radiologie

    2012-02-15

    Purpose: False-negative results are obtained in approx. 20 % of prostate cancer (PCa) patients (pts) at initial systematic transrectal biopsy (Bx), in particular when digital rectal examination (DRE) or transrectal ultrasound (TRUS) is negative. The aim of this study was to assess whether MR endorectal imaging of the prostate in a multi-reader ambulatory care setting may assist in patient selection for re-biopsy. Materials and Methods: 115 consecutive pts with persistent PSA elevation, negative Bx, DRE and TRUS were examined using T2w axial and coronal and T1w axial sequences for tumor diagnosis. MR images were prospectively read as tumor-suspicious or tumor-negative by the MR radiologist on duty. Additionally, a retrospective readout of a prostate MR expert and an abdominal imaging fellowship-trained radiologist was performed to evaluate the effect of the reader's experience on tumor detection. Imaging findings were compared to the results of the repeat Bx (61 pts) or the clinical course of at least two years. Results: For the prospective reading, the sensitivity of MRI was 83 %, the specificity was 69 %, the PPV was 33 % and the NPV was 96 %. ROC analysis revealed a significantly better performance of the prostate MR imaging expert compared to the abdominal imaging radiologist (area under ROC 0.88 vs. 0.66, p < 0.001). Based on the prospective reading, a pre-test probability for PCa of 17.4 % as in our study can be reduced to 5 % when obtaining a tumor-negative result in MRI. Conclusion: MR imaging in a multi-reader ambulatory care setting assists in patient selection for re-biopsy. Reducing the post-test probability for PCa to 5 % allows for further follow-up instead of re-biopsy in MR tumor-negative patients. Specific training and experience improve tumor detection in prostate MR imaging. (orig.)

  18. General practitioners believe that hypnotherapy could be a useful treatment for irritable bowel syndrome in primary care

    Directory of Open Access Journals (Sweden)

    de Lusignan Simon

    2004-10-01

    Full Text Available Abstract Background Irritable bowel syndrome is a common condition in general practice. It occurs in 10 to 20% of the population, but less than half seek medical assistance with the complaint. Methods A questionnaire was sent to the 406 GPs listed on the West Sussex Health Authority Medical List to investigate their views of this condition and whether they felt hypnotherapy had a place in its management Results 38% of general practitioners responded. The achieved sample shared the characteristics of target sample. Nearly half thought that irritable bowel syndrome (IBS was a "nervous complaint" and used a combination of "the placebo effect of personal care," therapeutic, and dietary advice. There is considerable divergence in the perceived effectiveness of current approaches. Over 70% thought that hypnotherapy may have a role in the management of patients with IBS; though the majority (68% felt that this should not be offered by general practitioners. 84% felt that this should be offered by qualified hypnotherapist, with 40% feeling that this should be offered outside the health service. Conclusions General practitioners vary in their perceptions of what constitutes effective therapy in IBS. They are willing to consider referral to a qualified hypnotherapist.

  19. Referral patterns between the child health care, general practitioners and secondary health care: a prospective descriptive study in the Netherlands

    NARCIS (Netherlands)

    Einhorn, R.; Eekhof, J.A.H. van; Engelberts, A.C.; Groeneveld, Y.; Verkerk, P.H.; Wit, J.M.

    2007-01-01

    Background: In the Netherlands, preventive child health service (CHS) screening plays an important role in the early detection of congenital, developmental, physical, and mental disorders. Objective: To obtain insight into the referral patterns of children from CHS to general practitioners and from

  20. Teamwork in primary care: perspectives of general practitioners and community nurses in Lithuania

    OpenAIRE

    Jaruseviciene, Lina; Liseckiene, Ida; Valius, Leonas; Kontrimiene, Ausrine; Jarusevicius, Gediminas; Lapão, Luís Velez

    2013-01-01

    Background A team approach in primary care has proven benefits in achieving better outcomes, reducing health care costs, satisfying patient needs, ensuring continuity of care, increasing job satisfaction among health providers and using human health care resources more efficiently. However, some research indicates constraints in collaboration within primary health care (PHC) teams in Lithuania. The aim of this study was to gain a better understanding of the phenomenon of teamwork in Lithuania...

  1. Processo de cuidar do idoso em Diálise Peritoneal Ambulatorial Contínua no domicílio Proceso de cuidar del anciano, que hace Diálisis Peritoneal Ambulatorial Contínua en el domicilio Home care for the elderly undergoing Continuous Ambulatory Peritoneal Dialysis

    Directory of Open Access Journals (Sweden)

    Daniele Favaro Ribeiro

    2009-12-01

    DPAC.Objectives: To describe the elders with end stage renal disease (ESRD undergoing continuous ambulatory peritoneal dialysis (CAPD, their caregivers, and the care the caregivers provide to the elders. Methods: This was a qualitative study with 9 caregivers. Data were collected through oral history. Data analysis consisted of thematic content analysis. Results: The sample consisted of 5 male and 4 female elders and all them were dependent on caregivers to change the dialysis collection bag. The mean age of the participants was 70 years. Among the caregivers, 8 of them were female with a mean age of 41.5 years and they provided 8 hours of care to the elders daily. The main theme emerging from the content analysis was "home care for the elderly undergoing continuous ambulatory peritoneal dialysis." Conclusion: Caregivers need support for the development of knowledge and skills to deal with the elders' demand of care, particularly in regard to the management of CAPD.

  2. Ambulatory spine surgery: a survey study.

    Science.gov (United States)

    Baird, Evan O; Brietzke, Sasha C; Weinberg, Alan D; McAnany, Steven J; Qureshi, Sheeraz A; Cho, Samuel K; Hecht, Andrew C

    2014-08-01

    Study Design Cross-sectional study. Objective To assess the current practices of spine surgeons performing ambulatory surgery in the United States. Methods An electronic survey was distributed to members of the International Society for the Advancement of Spine Surgery. Data were initially examined in a univariate manner; variables with a p value ambulatory spine surgery, and 49.1% were investors in an ambulatory surgery center. Surgeon investors in ambulatory surgery centers were more likely to perform procedures of increased complexity than noninvestors, though limited data precluded a statistical correlation. Surgeons in private practice were more likely to perform ambulatory surgery (94.3%; p = 0.0176), and nonacademic surgeons were both more likely to invest in ambulatory surgery centers (p = 0.0024) and perform surgery at least part of the time in a surgery center (p = 0.0039). Conclusions Though the numbers were too few to calculate statistical significance, there was a trend toward the performance of high-risk procedures on an ambulatory basis being undertaken by those with investment status in an ambulatory center. It is possible that this plays a role in the decision to perform these procedures in this setting versus that of a hospital, where a patient may have better access to care should a complication arise requiring emergent assessment and treatment by a physician. This decision should divest itself of financial incentives and focus entirely on patient safety.

  3. Drivers for change in primary care of diabetes following a protected learning time educational event: interview study of practitioners

    Directory of Open Access Journals (Sweden)

    Ward Kate

    2008-01-01

    Full Text Available Abstract Background A number of protected learning time schemes have been set up in primary care across the United Kingdom but there has been little published evidence of their impact on processes of care. We undertook a qualitative study to investigate the perceptions of practitioners involved in a specific educational intervention in diabetes as part of a protected learning time scheme for primary health care teams, relating to changing processes of diabetes care in general practice. Methods We undertook semistructured interviews of key informants from a sample of practices stratified according to the extent they had changed behaviour in prescribing of ramipril and diabetes care more generally, following a specific educational intervention in Lincolnshire, United Kingdom. Interviews sought information on facilitators and barriers to change in organisational behaviour for the care of diabetes. Results An interprofessional protected learning time scheme event was perceived by some but not all participants as bringing about changes in processes for diabetes care. Participants cited examples of change introduced partly as a result of the educational session. This included using ACE inhibitors as first line for patients with diabetes who developed hypertension, increased use of aspirin, switching patients to glitazones, and conversion to insulin either directly or by referral to secondary care. Other reported factors for change, unrelated to the educational intervention, included financially driven performance targets, research evidence and national guidance. Facilitators for change linked to the educational session were peer support and teamworking supported by audit and comparative feedback. Conclusion This study has shown how a protected learning time scheme, using interprofessional learning, local opinion leaders and early implementers as change agents may have influenced changes in systems of diabetes care in selected practices but also how

  4. Patient safety in primary care: A survey of general practitioners in the Netherlands

    NARCIS (Netherlands)

    Gaal, S.; Verstappen, W.H.J.M.; Wensing, M.J.P.

    2010-01-01

    BACKGROUND: Primary care encompasses many different clinical domains and patient groups, which means that patient safety in primary care may be equally broad. Previous research on safety in primary care has focused on medication safety and incident reporting. In this study, the views of general prac

  5. Educational Implications of Nurse Practitioner Students and Medical Residents' Attitudes toward Managed Care.

    Science.gov (United States)

    Breer, M. Lynn; Pohl, Joanne M.; Stommel, Manfred; Barkauskas, Violet H.; Schillo, Barbara; Oakley, Deborah

    2002-01-01

    Attitudes toward managed care of 431 medical residents and 153 advanced practice nursing students were compared. Medical students were more likely to agree that managed care emphasizes cost over quality and threatens autonomy. Nursing students were more likely to agree that it encourages preventive care. Medical students were less enthusiastic…

  6. Practitioner Perceptions of the A3 Method for Process Improvement in Health Care

    Science.gov (United States)

    Visich, John K.; Wicks, Angela M.; Zalila, Faiza

    2010-01-01

    The focus of this article is to present students' perceptions of the recently developed A3 method, a structured problem-solving approach based on lean concepts and tools that have been adapted to the health care environment. The students were all employees of a large health care provider and were enrolled in a customized health care executive MBA…

  7. Health care consumers’ perspectives on pharmacist integration into private general practitioner clinics in Malaysia: a qualitative study

    Directory of Open Access Journals (Sweden)

    Saw PS

    2015-03-01

    Full Text Available Pui San Saw,1 Lisa M Nissen,2,3 Christopher Freeman,2,4 Pei Se Wong,3 Vivienne Mak5 1School of Postgraduate Studies and Research, International Medical University, Kuala Lumpur, Malaysia; 2School of Clinical Sciences, Queensland University Technology, Brisbane, QLD, Australia; 3School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia; 4School of Pharmacy, University of Queensland, St Lucia, QLD, Australia; 5School of Pharmacy, Monash University Malaysia, Selangor, Malaysia Background: Pharmacists are considered medication experts but are underutilized and exist mainly at the periphery of the Malaysian primary health care team. Private general practitioners (GPs in Malaysia are granted rights under the Poison Act 1952 to prescribe and dispense medications at their primary care clinics. As most consumers obtain their medications from their GPs, community pharmacists’ involvement in ensuring safe use of medicines is limited. The integration of a pharmacist into private GP clinics has the potential to contribute to quality use of medicines. This study aims to explore health care consumers’ views on the integration of pharmacists within private GP clinics in Malaysia.Methods: A purposive sample of health care consumers in Selangor and Kuala Lumpur, Malaysia, were invited to participate in focus groups and semi-structured interviews. Sessions were audio recorded and transcribed verbatim and thematically analyzed using NVivo 10. Results: A total of 24 health care consumers participated in two focus groups and six semi-structured interviews. Four major themes were identified: 1 pharmacists’ role viewed mainly as supplying medications, 2 readiness to accept pharmacists in private GP clinics, 3 willingness to pay for pharmacy services, and 4 concerns about GPs’ resistance to pharmacist integration. Consumers felt that a pharmacist integrated into a private GP clinic could offer potential benefits such as to provide trustworthy

  8. What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care

    Directory of Open Access Journals (Sweden)

    Geudens Leo

    2010-07-01

    Full Text Available Abstract Background Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC. GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice. Methods We used a prospective before/after interventional study design. The intervention was the implementation of a GPC. Results One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880, while there were no significant changes in patient contacts at the Emergency Department (ED or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908. At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960 and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836. Conclusions One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.

  9. Continuity of care : is the personal doctor still important? : A survey of general practitioners and family physicians in England and Wales, the United States, and The Netherlands

    NARCIS (Netherlands)

    Stokes, T.; Tarrant, C.; Mainous, A.G.; Schers, H.J.; Freeman, G.; Baker, R.

    2005-01-01

    PURPOSE: We determined the reported value general practitioners/family physicians in 3 different health care systems place on the various types of continuity of care. METHODS: We conducted a postal questionnaire survey in England and Wales, the United States, and The Netherlands. The participants we

  10. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    NARCIS (Netherlands)

    Plas, A.G.M. van der; Onwuteaka-Philipsen, B.D.; Vissers, K.C.; Deliens, L.; Jansen, W.J.J.; Francke, A.L.

    2016-01-01

    Aims: To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case managemen

  11. Beginning to explore the experience of managing a direct payment for someone with dementia: The perspectives of suitable people and adult social care practitioners.

    Science.gov (United States)

    Laybourne, Anne H; Jepson, Marcus J; Williamson, Toby; Robotham, Dan; Cyhlarova, Eva; Williams, Val

    2016-01-01

    Following legal improvements made around mental capacity together with the Health and Social Care Act, it is now possible for a direct payment to be paid to a 'Suitable Person' to manage on someone's behalf to purchase directly care and support services. People with dementia are a key group affected by this change in England of adult social care. We interviewed nine social care practitioners and seven Suitable People for people with dementia across five English local authorities to begin to examine their experiences of this new method of social care provision. Findings from thematic analyses suggest positive outcomes and multiple beneficiaries, but some challenges: potentially inappropriate processes, support planning, divergence in attitudes towards care and support outcomes. Implications for practice include obfuscation of recipients' and Suitable People's best interests and supporting practitioners to explore fully clients' aspirations for care and support.

  12. 'Making every contact count': Evaluation of the impact of an intervention to train health and social care practitioners in skills to support health behaviour change.

    Science.gov (United States)

    Lawrence, Wendy; Black, Christina; Tinati, Tannaze; Cradock, Sue; Begum, Rufia; Jarman, Megan; Pease, Anna; Margetts, Barrie; Davies, Jenny; Inskip, Hazel; Cooper, Cyrus; Baird, Janis; Barker, Mary

    2016-02-01

    A total of 148 health and social care practitioners were trained in skills to support behaviour change: creating opportunities to discuss health behaviours, using open discovery questions, listening, reflecting and goal-setting. At three time points post-training, use of the skills was evaluated and compared with use of skills by untrained practitioners. Trained practitioners demonstrated significantly greater use of these client-centred skills to support behaviour change compared to their untrained peers up to 1 year post-training. Because it uses existing services to deliver support for behaviour change, this training intervention has the potential to improve public health at relatively low cost.

  13. Brief cognitive behavioral therapy compared to general practitioners care for depression in primary care: a randomized trial

    NARCIS (Netherlands)

    K.D. Baas; M.W.J. Koeter; H.C. van Weert; P. Lucassen; C.L.H. Bockting; K.A. Wittkampf; A.H. Schene

    2010-01-01

    ABSTRACT: BACKGROUND: Depressive disorders are highly prevalent in primary care (PC) and are associated with considerable functional impairment and increased health care use. Research has shown that many patients prefer psychological treatments to pharmacotherapy, however, it remains unclear which t

  14. The 5As team intervention: bridging the knowledge gap in obesity management among primary care practitioners

    OpenAIRE

    Ogunleye, Ayodele; Osunlana, Adedayo; Asselin, Jodie; Cave, Andrew; Sharma, Arya Mitra; Campbell-Scherer, Denise Lynn

    2015-01-01

    Background Despite opportunities for didactic education on obesity management, we still observe low rates of weight management visits in our primary care setting. This paper describes the co-creation by front-line interdisciplinary health care providers and researchers of the 5As Team intervention to improve obesity prevention and management in primary care. Methods We describe the theoretical foundations, design, and core elements of the 5AsT intervention, and the process of eliciting practi...

  15. At the Bedside: Traditional Navajo practitioners in a patient-centered health care model.

    Science.gov (United States)

    Joe, Jennie R; Young, Robert S; Moses, Jill; Knoki-Wilson, Ursula; Dennison, Johnson

    2016-01-01

    The growing national racial and ethnic diversity has created a greater need for health care delivery systems and health care providers to be more responsive to unique patient needs, that goes beyond meeting the immediate health problems to include attention to other critical component of patient care that take into account cultural competency such as health literacy, health beliefs and behaviors, cultural practices, etc. PMID:27115131

  16. PRESCRIBING PRACTICES OF NON TEACHING GENERAL PRACTITIONERS OF PRIVATE CLINICS AND PHYSICIANS OF A TERTIARY CARE TEACHING HOSPITAL: A COMPARATIVE CROSS SECTIONAL STUDY

    Directory of Open Access Journals (Sweden)

    Sudar Codi R, Samiya Khan, Manimekalai K

    2015-01-01

    Full Text Available Background: Doctor’s prescription provides vivid information and instruction to the patient. In spite of the WHO programs, irrational prescribing is still a common practice. Aim: To evaluate and compare the prescribing pattern of private practitioners and physicians of a tertiary care teaching hospital in a semi urban area and detect their rationality. Materials & methods: 150 prescriptions, each prescribed by private practitioners and physicians of a tertiary care hospital were collected over a period of two months and evaluated. Information regarding the drugs used, drugs from the essential drug list, the use of injections, fixed dose combinations, drug prescribed by generic names were observed. Results: The average number of drugs per prescription prescribed by the private practitioners was 2.47 compared to 1.58 by the physicians of a tertiary care hospital. 82% of prescriptions of private practitioners had one injection prescribed in the prescription compared to 12% by physicians of a tertiary care hospital. 30 unnecessary drugs, 46 unnecessary injections and 8 irrational fixed dose combinations were prescribed by the private practitioners, whereas only 6 unnecessary drugs and 2 unnecessary injections were prescribed by the physicians of a tertiary care hospital respectively. There was no irrational fixed dose combination prescribed by them. The private practitioners prescribed 12 (3.2% drugs by generic names, whereas the physicians of a tertiary care hospital prescribed 72 (30.3% drugs by generic names. (P<0.000. 36 (9.7% drugs prescribed by the private practitioners were not included in the essential drug list and only 2 (0.8% drugs prescribed by the physicians of a tertiary care hospital were not included in the essential drug list. Conclusion: Private practitioners prescribe more irrational prescriptions on comparison with the physicians of a tertiary care teaching hospital. This may be due to the promotional pharmaceutical incentives

  17. Preparing general practitioners to receive cancer patients following treatment in secondary care

    DEFF Research Database (Denmark)

    Guassora, Ann Dorrit Kristiane; Jarlbæk, Lene; Thorsen, Thorkil

    2015-01-01

    Background: Many patients consider the interface between secondary and primary care difficult, and in particular, the transition of care between these different parts of the healthcare system presents problems. This interface has long been recognized as a critical point for quality of care. The p...... too complex to be coordinated by administrative standards alone. We recommend that healthcare professionals are more engaged and present in the coordination of care across organizational boundaries.......Background: Many patients consider the interface between secondary and primary care difficult, and in particular, the transition of care between these different parts of the healthcare system presents problems. This interface has long been recognized as a critical point for quality of care...... departments to GPs; 3) To provide plans and future affiliations for patients when they leave a department, and 4) To arrange a return visit to general practice dedicated to discussion of the patients’ cancer disease and the treatment experience. Conclusions: The transition of care of cancer patients appears...

  18. How do General Practitioners experience providing care for their psychotic patients?

    NARCIS (Netherlands)

    Oud, Marian J. T.; Schuling, Jan; Slooff, Cees J.; Meyboom-de Jong, Betty

    2007-01-01

    Background: In primary care, GPs usually provide care for patients with chronic diseases according to professional guidelines. However, such guidelines are not available in the Netherlands for patients with recurring psychoses. It seems that the specific difficulties that GPs experience in providing

  19. The Ryan Report (2009. A Practitioner's Perspective on Implications for Residential Child Care

    Directory of Open Access Journals (Sweden)

    Noel Howard

    2012-01-01

    Full Text Available This article suggests that recent abuse reports and the Ryan Report in particular are now warning signs etched in the consciousness of social care workers. Quite rightly, this consciousness will determine how social care workers approach their work with children in the care system. In many care units the incessant, ostensibly plausible, demands of bureaucracy mean that children exist in an artificial, sanitised care bubble where they are bereft of structure, empathy, spontaneity and real relationships – the very things they crave. Written in a personal capacity and based on the author’s background practice experience, some of this article represents points of view rather than evidential conclusions. The article’s purpose is to contribute to debate, so necessary if lessons of the Ryan Report are really to be learned.

  20. A study evaluating knowledge, attitude and practices of practitioners in the medicine department of tertiary care teaching rural hospital with respect to antihypertensives

    Directory of Open Access Journals (Sweden)

    Jatin Patel

    2015-06-01

    Full Text Available Background: The aim of this study was to evaluate knowledge, attitude and practices of practitioners in the medicine department of tertiary care teaching rural hospital with respect to antihypertensives and find out the disparity between the recommended and actual practices for pharmacological management. Methods: It was survey type of study, carried out using feedback questionnaire related to use of antihypertensives. Total 25 consultants were included in the study. Results: It was found that in mild hypertension single drug and two drugs in combination were preferred by 15 and 10 practitioners respectively. In moderate hypertension single drug, two drugs in combination, and greater than two drugs were preferred by 3, 13, and 7 practitioners respectively. In severe hypertension two drugs in combination and greater than two drugs were preferred by 16 and 9 practitioners respectively; none preferred single drug. Angiotensin converting enzyme inhibitors /angiotensin receptor blockers, beta blockers, Calcium channel blockers, diuretics were preferred as first line drug by 7, 4, 8, and 16 practitioners respectively. Most commonly preferred combination was Losartan and amlodipine by 16 practitioners. In pregnancy nifedipine was preferred as the first line drug while in elderly diuretics were preferred. In hypertensive patients with age less than 40 years all practitioners preferred ACEIs/ARBs. In diabetics ACEIs/ARBs was preferred by all practitioners. Each practitioner claimed to follow Joint National Committee (JNC 7 criteria. Cost of drug was an important consideration in all their prescribing patterns. Conclusion: The knowledge, attitudes and practices followed by the practitioners of Dhiraj hospital were satisfactory and guidelines oriented. [Int J Res Med Sci 2015; 3(3.000: 715-717

  1. Nutritional counselling in primary health care: a randomized comparison of an intervention by general practitioner or dietician

    DEFF Research Database (Denmark)

    Willaing, Ingrid; Ladelund, Steen; Jørgensen, Torben;

    2004-01-01

    AIMS: To compare health effects and risk reduction in two different strategies of nutritional counselling in primary health care for patients at high risk of ischaemic heart disease. METHODS: In a cluster-randomized trial 60 general practitioners (GPs) in the Copenhagen County were randomized...... to give nutritional counselling or to refer patients to a dietician. Patients were included after opportunistically screening (n=503 patients), and received nutritional counselling by GP or dietician over 12 months. Health effects were measured by changes in weight, waist circumference and blood lipids...... of cardiovascular disease and addressed these when counselling. The guidance from a GP was of significant importance for risk reduction in relation to IHD. However, a long-term lifestyle intervention by GP was difficult to implement. In the case of obesity it was effective to refer to long-term nutritional...

  2. Nutritional counselling in primary health care: a randomized comparison of an intervention by general practitioner or dietician

    DEFF Research Database (Denmark)

    Willaing, Ingrid; Ladelund, Steen; Jørgensen, Torben;

    2004-01-01

    AIMS: To compare health effects and risk reduction in two different strategies of nutritional counselling in primary health care for patients at high risk of ischaemic heart disease. METHODS: In a cluster-randomized trial 60 general practitioners (GPs) in the Copenhagen County were randomized to...... give nutritional counselling or to refer patients to a dietician. Patients were included after opportunistically screening (n=503 patients), and received nutritional counselling by GP or dietician over 12 months. Health effects were measured by changes in weight, waist circumference and blood lipids...... cardiovascular disease and addressed these when counselling. The guidance from a GP was of significant importance for risk reduction in relation to IHD. However, a long-term lifestyle intervention by GP was difficult to implement. In the case of obesity it was effective to refer to long-term nutritional...

  3. The burden of care: a focus group study of healthcare practitioners in Scotland talking about parental drug misuse.

    Science.gov (United States)

    Whittaker, Anne; Williams, Nigel; Chandler, Amy; Cunningham-Burley, Sarah; McGorm, Kelly; Mathews, Gillian

    2016-09-01

    Parenting and family support are key prevention and intervention strategies for improving outcomes for children and families affected by parental drug misuse. However, little is known about the delivery of parenting support for drug-dependent parents, particularly within universal healthcare services. This study aimed to explore the way healthcare practitioners engage with this challenging agenda. Four multidisciplinary focus groups involving a purposive sample of 18 experienced healthcare professionals were conducted in Scotland. Participants included general practitioners, midwives, public health nurses and addiction staff who work together to provide care for vulnerable families. A focus group topic guide was developed to explore the views and experiences of these healthcare professionals in relation to providing parenting support for drug-using parents, predominantly those receiving opioid substitution therapy. Data were analysed using a constant comparison method and thematic approach. The overarching narrative which united the focus group discussions was about the 'burden of care' that these families pose for frontline healthcare professionals. Recurring themes centred on three key issues: the problematic nature of drug-using parents themselves; clinical challenges in living up to the ideals of professional practice; and the wider context in which current practice is governed. Professionals expressed ambivalence over their parenting support role; anxiety over responsibility for intervening with this 'hard-to-engage' population; and concern over 'dwindling' resources and lack of organisational support. Nevertheless, strategies and opportunities for providing parenting support were acknowledged and there was consensus about the need for further skills training. Despite a proliferation of policy and good practice guidance on the delivery of parenting support for drug-dependent parents, the findings of this study suggest that significant challenges remain

  4. Prescribing pattern of general practitioners for osteoarthritis in primary care settings in Bolu, Turkey

    International Nuclear Information System (INIS)

    Objective was to assess the drug preferences of primary care physicians for osteoarthritis (OA) in comparison with the current guidelines and their reflections in the cost of prescriptions. Data were collected from all primary health care centers in Bolu, Turkey during from November 2002 from patient polyclinic logbooks. Drugs prescribed were classified according to the Anatomical Therapeutical Chemical Classification system for comparison purposes. Gender, age and health insurance of patients were analyzed for drug preferences and costs. Forty-eight primary care physicians prescribed 1047 drugs for 507 OA patients with total cost of $10,254. Anti-inflammatory and antirheumatic products were the leading group accounting for 59.6% of the prescribed drugs, and 84.1% of the total expenditure. Paracetamol, the most commonly recommended in the guidelines, constituted 6.9% of all prescribed drugs and 0.9% of the total cost. Drug preferences showed a statistical difference among the health insurance types while drugs cost showed statistical significance among the gender and health insurance types. Cyclooygenase-2-specific inhibitors were the most commonly prescribed subgroup, constituting 23.2% of prescribed drugs and 62.6% of the total expenditure. Paracetamol in practice was not the first-line drug preferred by primary care physicians. Drug prescription data showed that the preference of drugs was affected by health insurance types and the gender of patients in favor of expensive new drugs. There is a need for improvement of drug prescriptions to reflect current recommendations and guidelines. (author)

  5. White coat hypertension: improving the patient–health care practitioner relationship

    Directory of Open Access Journals (Sweden)

    Cobos B

    2015-05-01

    Full Text Available Briana Cobos, Kelly Haskard-Zolnierek, Krista Howard Department of Psychology, Texas State University, San Marcos, TX, USA Abstract: White coat hypertension is characterized by the variability of a patient's blood pressure measurements between the physician’s office and the patient’s home environment. A patient with white coat hypertension has high blood pressure levels in the physician's office and normal blood pressure levels in their typical environment. This condition is likely caused by the patient’s anxiety within the physician’s office and in the presence of the physician. Research has shown that improving the relationship between a patient and their health care provider can decrease the patient’s anxiety, with the implication of decreasing the patient’s likelihood of demonstrating white coat hypertension. This review provides an overview of the previous literature regarding white coat hypertension, its prevalence, and the consequences for those who develop persistent hypertension. Furthermore, this review discusses the implications of improving patient and health care provider interactions through effective communication, empathy, and trust, as well as the implications for future research studies in improving the patient and health care provider’s relationship. Keywords: white coat hypertension, anxiety, health care professional–patient relationship, physician–patient communication 

  6. Graduate Leaders in Early Childhood Education and Care Settings, the Practitioner Perspective

    Science.gov (United States)

    Davis, Geraldine

    2014-01-01

    Since 2006, UK policy has identified a professionalisation agenda for staff working in early childhood education and care settings. This has included the development of graduate leaders with a specific purpose to lead improvements in these settings by leading change, and hence improving outcomes for children. This article reports on findings from…

  7. Acute Gastroenteritis and Campylobacteriosis in Swiss Primary Care: The Viewpoint of General Practitioners

    Science.gov (United States)

    Bless, Philipp J.; Muela Ribera, Joan; Schmutz, Claudia; Zeller, Andreas; Mäusezahl, Daniel

    2016-01-01

    Acute gastroenteritis (AG) is frequently caused by infectious intestinal diseases (IID) including food- and waterborne pathogens of public health importance. Among these pathogens, Campylobacter spp. plays a major role. Many European countries monitor selected IIDs within disease surveillance systems. In Switzerland, the information on IIDs is restricted to limited surveillance data, while no data is available for AG. We conducted a qualitative study among Swiss general practitioners (GPs) to investigate the case management of AG and campylobacteriosis patients, the associated disease burden and the determinants leading to registration in the National Notification System for Infectious Diseases (NNSID). Interviews were conducted with a semi-structured questionnaire and underwent inductive content analysis based on Grounded Theory. The questionnaire was repeatedly adapted to capture emerging themes until the point of theoretical saturation. GPs perceived AG and campylobacteriosis of little relevance to their daily work and public health in general. According to GP self-estimates each consults about two cases of AG per week and diagnoses a median of five campylobacteriosis cases per year. A large proportion of AG cases receives telephone consultations only and gets medical advice from the practice nurse. Antibiotic therapy is considered useful and stool diagnostics are performed for about a fifth of consulting AG patients. Stool diagnostics (“test”) and antibiotic therapy (“treat”) are interrelated and follow four strategies: “Wait & See”, “Treat & See”, “Treat & Test”, and “Test & See”. AG case management is diverse and includes different triage steps. A small proportion of AG patients have stool diagnostics performed and only positive tested patients are reported to the NNSID. As a result severe cases and cases with a history of travel abroad are overrepresented in the NNSID. The use of multiplex PCR panels in routine diagnostics likely

  8. Acute Gastroenteritis and Campylobacteriosis in Swiss Primary Care: The Viewpoint of General Practitioners.

    Science.gov (United States)

    Bless, Philipp J; Muela Ribera, Joan; Schmutz, Claudia; Zeller, Andreas; Mäusezahl, Daniel

    2016-01-01

    Acute gastroenteritis (AG) is frequently caused by infectious intestinal diseases (IID) including food- and waterborne pathogens of public health importance. Among these pathogens, Campylobacter spp. plays a major role. Many European countries monitor selected IIDs within disease surveillance systems. In Switzerland, the information on IIDs is restricted to limited surveillance data, while no data is available for AG. We conducted a qualitative study among Swiss general practitioners (GPs) to investigate the case management of AG and campylobacteriosis patients, the associated disease burden and the determinants leading to registration in the National Notification System for Infectious Diseases (NNSID). Interviews were conducted with a semi-structured questionnaire and underwent inductive content analysis based on Grounded Theory. The questionnaire was repeatedly adapted to capture emerging themes until the point of theoretical saturation. GPs perceived AG and campylobacteriosis of little relevance to their daily work and public health in general. According to GP self-estimates each consults about two cases of AG per week and diagnoses a median of five campylobacteriosis cases per year. A large proportion of AG cases receives telephone consultations only and gets medical advice from the practice nurse. Antibiotic therapy is considered useful and stool diagnostics are performed for about a fifth of consulting AG patients. Stool diagnostics ("test") and antibiotic therapy ("treat") are interrelated and follow four strategies: "Wait & See", "Treat & See", "Treat & Test", and "Test & See". AG case management is diverse and includes different triage steps. A small proportion of AG patients have stool diagnostics performed and only positive tested patients are reported to the NNSID. As a result severe cases and cases with a history of travel abroad are overrepresented in the NNSID. The use of multiplex PCR panels in routine diagnostics likely leads to improved case

  9. Research Priorities for Fertility and Conception Research as Identified by Multidisciplinary Health Care Practitioners and Researchers

    Directory of Open Access Journals (Sweden)

    Lisa J. Moran

    2016-01-01

    Full Text Available The Robinson Research Institute of the University of Adelaide convened a multidisciplinary group of n = 33 clinicians, researchers and representatives of government organisations on the 2 October 2014 for a workshop entitled “Promoting fertility and healthy conception. How do we generate greater reproductive health awareness?” The key aim of the workshop was to assess the body of knowledge that informs clinical practice and government policy, and to identify questions and additional information needed by health practitioners and government representatives working in the field of reproductive health and to frame future research and policy. The workshop identified topics that fell mostly into three categories: lifestyle-related, societal and biological factors. The lifestyle topics included nutrition and diet, exercise, obesity, shift work and other factors deemed to be modifiable at the level of the individual. The societal topics included discussions of matters that are structural, and resistant to change by individuals, including specific ethical issues, social disadvantage, government and educational policies. The biological factors are intrinsic physical states of the individual, and included many factors where there is a dense body of scientific knowledge which may not be readily accessible in less academic language. This workshop thus provided an opportunity to identify further actions that could be undertaken to meet the needs of diverse organisations and groups of professionals with an interest in human fertility. Since so many factors in our social and biological environment can impact fertility and preconception health, it is imperative to involve many disciplines or levels of government or societal organisations that have not traditionally been involved in this area.

  10. Research Priorities for Fertility and Conception Research as Identified by Multidisciplinary Health Care Practitioners and Researchers.

    Science.gov (United States)

    Moran, Lisa J; Spencer, Laura; Russell, Darryl L; Hull, Mary Louise; Robertson, Sarah A; Varcoe, Tamara J; Davies, Michael J; Brown, Hannah M; Rodgers, Raymond J

    2016-01-13

    The Robinson Research Institute of the University of Adelaide convened a multidisciplinary group of n = 33 clinicians, researchers and representatives of government organisations on the 2 October 2014 for a workshop entitled "Promoting fertility and healthy conception. How do we generate greater reproductive health awareness?" The key aim of the workshop was to assess the body of knowledge that informs clinical practice and government policy, and to identify questions and additional information needed by health practitioners and government representatives working in the field of reproductive health and to frame future research and policy. The workshop identified topics that fell mostly into three categories: lifestyle-related, societal and biological factors. The lifestyle topics included nutrition and diet, exercise, obesity, shift work and other factors deemed to be modifiable at the level of the individual. The societal topics included discussions of matters that are structural, and resistant to change by individuals, including specific ethical issues, social disadvantage, government and educational policies. The biological factors are intrinsic physical states of the individual, and included many factors where there is a dense body of scientific knowledge which may not be readily accessible in less academic language. This workshop thus provided an opportunity to identify further actions that could be undertaken to meet the needs of diverse organisations and groups of professionals with an interest in human fertility. Since so many factors in our social and biological environment can impact fertility and preconception health, it is imperative to involve many disciplines or levels of government or societal organisations that have not traditionally been involved in this area.

  11. Research Priorities for Fertility and Conception Research as Identified by Multidisciplinary Health Care Practitioners and Researchers.

    Science.gov (United States)

    Moran, Lisa J; Spencer, Laura; Russell, Darryl L; Hull, Mary Louise; Robertson, Sarah A; Varcoe, Tamara J; Davies, Michael J; Brown, Hannah M; Rodgers, Raymond J

    2016-01-01

    The Robinson Research Institute of the University of Adelaide convened a multidisciplinary group of n = 33 clinicians, researchers and representatives of government organisations on the 2 October 2014 for a workshop entitled "Promoting fertility and healthy conception. How do we generate greater reproductive health awareness?" The key aim of the workshop was to assess the body of knowledge that informs clinical practice and government policy, and to identify questions and additional information needed by health practitioners and government representatives working in the field of reproductive health and to frame future research and policy. The workshop identified topics that fell mostly into three categories: lifestyle-related, societal and biological factors. The lifestyle topics included nutrition and diet, exercise, obesity, shift work and other factors deemed to be modifiable at the level of the individual. The societal topics included discussions of matters that are structural, and resistant to change by individuals, including specific ethical issues, social disadvantage, government and educational policies. The biological factors are intrinsic physical states of the individual, and included many factors where there is a dense body of scientific knowledge which may not be readily accessible in less academic language. This workshop thus provided an opportunity to identify further actions that could be undertaken to meet the needs of diverse organisations and groups of professionals with an interest in human fertility. Since so many factors in our social and biological environment can impact fertility and preconception health, it is imperative to involve many disciplines or levels of government or societal organisations that have not traditionally been involved in this area. PMID:26771633

  12. The 'wise list'- a comprehensive concept to select, communicate and achieve adherence to recommendations of essential drugs in ambulatory care in Stockholm.

    Science.gov (United States)

    Gustafsson, Lars L; Wettermark, Björn; Godman, Brian; Andersén-Karlsson, Eva; Bergman, Ulf; Hasselström, Jan; Hensjö, Lars-Olof; Hjemdahl, Paul; Jägre, Ingrid; Julander, Margaretha; Ringertz, Bo; Schmidt, Daniel; Sjöberg, Susan; Sjöqvist, Folke; Stiller, Carl-Olav; Törnqvist, Elisabeth; Tryselius, Rolf; Vitols, Sigurd; von Bahr, Christer

    2011-04-01

    The aim was to present and evaluate the impact of a comprehensive strategy over 10 years to select, communicate and achieve adherence to essential drug recommendations (EDR) in ambulatory care in a metropolitan healthcare region. EDRs were issued and launched as a 'Wise List' by the regional Drug and Therapeutics Committee in Stockholm. This study presents the concept by: (i) documenting the process for selecting, communicating and monitoring the impact of the 'Wise List'; (ii) analysing the variation in the number of drug substances recommended between 2000 and 2010; (iii) assessing the attitudes to the 'Wise List' among prescribers and the public; (iv) evaluating the adherence to recommendations between 2003 and 2009. The 'Wise List' consistently contained 200 drug substances for treating common diseases. The drugs were selected based on their efficacy, safety, suitability and cost-effectiveness. The 'Wise List' was known among one-third of a surveyed sample of the public in 2002 after initial marketing campaigns. All surveyed prescribers knew about the concept and 81% found the recommendations trustworthy in 2005. Adherence to recommendations increased from 69% in 1999 to 77% in 2009. In primary care, adherence increased from 83% to 87% from 2003 to 2009. The coefficient of variation (CV%) decreased from 6.1% to 3.8% for 156 healthcare centres between these years. The acceptance of the 'Wise List' in terms of trust among physicians and among the public and increased adherence may be explained by clear criteria for drug recommendations, a comprehensive communication strategy, electronic access to recommendations, continuous medical education and involvement of professional networks and patients.

  13. Problems and needs for improving primary care of osteoarthritis patients: the views of patients, general practitioners and practice nurses

    Directory of Open Access Journals (Sweden)

    Backenstrass Matthias

    2006-06-01

    Full Text Available Abstract Background Osteoarthritis (OA is highly prevalent and has substantial impact on quality of life as well as on healthcare costs. The general practitioner (GP often is the first care provider for patients with this chronic disease. The aim of this study was to identify health care needs of patients with OA and to reveal possible obstacles for improvements in primary care management of OA patients. Methods We performed semi-structured interviews with a stratified sample of 20 patients, 20 GPs and 20 practice nurses. Results Diagnosing OA posed no major problem, but during the course of OA, GPs found it difficult to distinguish between complaints resulting from the affection of the joints and complaints related to a concomitant depression. Patients felt to be well informed about the degenerative nature of the disease and possible side effects of medications, but they lacked information on individual consequences of the disease. Therefore, the most important concerns of many patients were pain and fear of disability which they felt to be addressed by GPs only marginally. Regarding pain treatment, physicians and patients had an ambivalent attitude towards NSAIDs and opiates. Therefore, pain treatment was not performed according to prevailing guidelines. GPs felt frustrated about the impact of counselling regarding life style changes but on the other hand admitted to have no systematic approach to it. Patients stated to be aware of the impact of life style on OA but lacked detailed information e.g. on how to exercise. Several suggestions were made concerning improvement. Conclusion GPs should focus more on disability and pain and on giving information about treatment since these topics are inadequately addressed. Advanced approaches are needed to increase GPs impact on patients' life style. Being aware of the problem of labelling patients as chronically ill, a more proactive, patient-centred care is needed.

  14. Consultations with general practitioners on patient safety measures based on routinely collected data in primary care

    OpenAIRE

    Tsang, C; Majeed, A; Aylin, P

    2012-01-01

    OBJECTIVES To gauge the opinions of doctors working, or interested, in general practice on monitoring patient safety using administrative data. The findings will inform the development of routinely collected data-based patient safety indicators in general practice and elsewhere in primary care. DESIGN Non-systematic participant recruitment, using personal contacts and colleagues' recommendations. SETTING Face-to-face consultations at participants' places of work, between June 2010 a...

  15. White coat hypertension: improving the patient–health care practitioner relationship

    Science.gov (United States)

    Cobos, Briana; Haskard-Zolnierek, Kelly; Howard, Krista

    2015-01-01

    White coat hypertension is characterized by the variability of a patient’s blood pressure measurements between the physician’s office and the patient’s home environment. A patient with white coat hypertension has high blood pressure levels in the physician’s office and normal blood pressure levels in their typical environment. This condition is likely caused by the patient’s anxiety within the physician’s office and in the presence of the physician. Research has shown that improving the relationship between a patient and their health care provider can decrease the patient’s anxiety, with the implication of decreasing the patient’s likelihood of demonstrating white coat hypertension. This review provides an overview of the previous literature regarding white coat hypertension, its prevalence, and the consequences for those who develop persistent hypertension. Furthermore, this review discusses the implications of improving patient and health care provider interactions through effective communication, empathy, and trust, as well as the implications for future research studies in improving the patient and health care provider’s relationship. PMID:25999772

  16. White coat hypertension: improving the patient-health care practitioner relationship.

    Science.gov (United States)

    Cobos, Briana; Haskard-Zolnierek, Kelly; Howard, Krista

    2015-01-01

    White coat hypertension is characterized by the variability of a patient's blood pressure measurements between the physician's office and the patient's home environment. A patient with white coat hypertension has high blood pressure levels in the physician's office and normal blood pressure levels in their typical environment. This condition is likely caused by the patient's anxiety within the physician's office and in the presence of the physician. Research has shown that improving the relationship between a patient and their health care provider can decrease the patient's anxiety, with the implication of decreasing the patient's likelihood of demonstrating white coat hypertension. This review provides an overview of the previous literature regarding white coat hypertension, its prevalence, and the consequences for those who develop persistent hypertension. Furthermore, this review discusses the implications of improving patient and health care provider interactions through effective communication, empathy, and trust, as well as the implications for future research studies in improving the patient and health care provider's relationship. PMID:25999772

  17. Barriers and facilitators to evidence based care of type 2 diabetes patients : experiences of general practitioners participating to a quality improvement program

    NARCIS (Netherlands)

    Goderis, G.; Borgermans, L.D.A.; Mathieu, C.; Broeke, C. Van Den; Hannes, K.; Heyrman, J.; Grol, R.P.T.M.

    2009-01-01

    ABSTRACT: OBJECTIVE: To evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs) who participated in an 18-month quality improvement program (QIP). This QIP was implemented to promote compliance with international guidelines. METHODS: Twenty

  18. Atención médica ambulatoria en México: el costo para los usuarios Ambulatory medical care in Mexico: the cost for users

    Directory of Open Access Journals (Sweden)

    Armando Arredondo

    1999-01-01

    Full Text Available Objetivo. Analizar los resultados de la Encuesta Nacional de Salud II (ENSA-II, en lo relativo a los costos del proceso de búsqueda y obtención de la atención médica ambulatoria en diferentes instituciones del sector público y privado. Material y métodos. La informacion se obtuvo a partir de los indicadores de costos de la atención médica que notificó la población de estudio de la ENSA-II. Los costos para el bolsillo del consumidor fueron la variable dependiente, y las independientes, la condición de aseguramiento y el ingreso económico. La significancia de los niveles de variación se identificó aplicando la prueba de Duncan. Resultados. Los costos en todo el país, en dólares estadunidenses, fueron: transporte, $ 2.20; consulta general, $ 7.90; medicamentos, $ 9.60, y estudios de diagnóstico, $13.6. El costo promedio total de la atención ambulatoria fue de $ 22.70. Los hallazgos empíricos permiten sugerir una nueva propuesta de análisis de los costos en salud, tanto directos como indirectos, en que incurren los consumidores de servicios de salud; dichos costos representan una carga importante en relación con el ingreso familiar, situación que se agudiza en el caso de la población no asegurada. Conclusiones. La incorporación de la perspectiva económica en el análisis de los problemas de los sistemas de salud, no debe limitarse a los costos de producción de servicios en que incurren los proveedores, sobre todo si lo que se busca es resolver los problemas de equidad y accesibilidad que actualmente caracterizan a la oferta de servicios médicos en México.Objective. To analyze the results of the National Health Survey (ENSA-II as to the costs generated by the search and obtainment of ambulatory medical attention in various intitutions of the private and public health sector. Material and methods. Information was raised from the health care cost indicators reported by the study population of the ENSA-II. The dependent

  19. A Study to Take Account of Scientific Management of Waste Generated During Patient Care by General Practitioners in Mumbai City, India

    Directory of Open Access Journals (Sweden)

    Shishir Basarkar

    2015-08-01

    Full Text Available It has been mentioned that scientific management of waste generated during patient care is essential as well as a legal liability of the generator. Unfortunately, complacency and inadequate knowledge followed by practice for waste disposal leads to various kinds of community and individual health and environment issues which are detrimental to the human life. The present study is aimed to take an account of scientific knowledge and it’s practical applicability of BMW among the general practitioners of Mumbai city in India. In the present study general practitioners in Mumbai city were visited and interviewed personally and also administered questionnaire in order to analyse biomedical waste management by general practitioners. 37 (30.8% belongs to age group 14-50 years followed by 30-40 years (30%. The percentage of male (64.1% is more than female (35.8% practitioners. The qualification ranged from BHMS, BAMS, MBBS to MD of which majority ware medical graduates (40.8%. 66.6% practitioners had average while only 23.3% has good knowledge about proper waste management. Maximum concern was shown towards the safety where it scored 80% followed by waste generation (62%, definition (51%, transportation (46%, Colour coding (34%. The study brought out the facts that the deficiency of knowledge and practices of waste management were the main reason for non scientific management of waste generated by general practitioners thus exposing self as well as community at large to health and environment hazards.

  20. In a unique position or squeezed out? The professional roles of general practitioners in cancer care in general and of young adult cancer patients in particular

    DEFF Research Database (Denmark)

    Hølge-Hazelton, B.; Christensen, I.

    2009-01-01

    BACKGROUND: Exploring experiences of general practitioners (GPs), regarding roles in cancer care of young adults (YAs). METHODS: Ten qualitative interviews with GPs were theoretically analyzed against professional characteristics. FINDINGS: The GPs tended to make general statements, using everyday...... language, they experience that their patients disappear, they are seldom involved, and they lack knowledge. CONCLUSIONS: GPs have few experiences with YA cancer patients, but they have a potentially unique role in general primary cancer care if they develop their vocational vocabulary, relate more to...

  1. Association between community health center and rural health clinic presence and county-level hospitalization rates for ambulatory care sensitive conditions: an analysis across eight US states

    Directory of Open Access Journals (Sweden)

    Laditka Sarah B

    2009-07-01

    Full Text Available Abstract Background Federally qualified community health centers (CHCs and rural health clinics (RHCs are intended to provide access to care for vulnerable populations. While some research has explored the effects of CHCs on population health, little information exists regarding RHC effects. We sought to clarify the contribution that CHCs and RHCs may make to the accessibility of primary health care, as measured by county-level rates of hospitalization for ambulatory care sensitive (ACS conditions. Methods We conducted an ecologic analysis of the relationship between facility presence and county-level hospitalization rates, using 2002 discharge data from eight states within the US (579 counties. Counties were categorized by facility availability: CHC(s only, RHC(s only, both (CHC and RHC, and neither. US Agency for Healthcare Research and Quality definitions were used to identify ACS diagnoses. Discharge rates were based on the individual's county of residence and were obtained by dividing ACS hospitalizations by the relevant county population. We calculated ACS rates separately for children, working age adults, and older individuals, and for uninsured children and working age adults. To ensure stable rates, we excluded counties having fewer than 1,000 residents in the child or working age adult categories, or 500 residents among those 65 and older. Multivariate Poisson analysis was used to calculate adjusted rate ratios. Results Among working age adults, rate ratio (RR comparing ACS hospitalization rates for CHC-only counties to those of counties with neither facility was 0.86 (95% Confidence Interval, CI, 0.78–0.95. Among older adults, the rate ratio for CHC-only counties compared to counties with neither facility was 0.84 (CI 0.81–0.87; for counties with both CHC and RHC present, the RR was 0.88 (CI 0.84–0.92. No CHC/RHC effects were found for children. No effects were found on estimated hospitalization rates among uninsured populations

  2. From bed to bench: Which attitude towards the laboratory liver tests should health care practitioners strike?

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    There is a general consensus in re-interpreting the so-called liver function tests in the light of novel discoveries. At the same time, recent evidence favours the use of different laboratory data to assess liver damage, fibrosis or regenerative process, but this point is not always shared. Actually, balancing the need for diagnosis, prognostic evaluation and therapy response of liver disease with a good cost/benefit ratio is very difficult. New tests are probably not needed but the aim should be for better utilization of existing tests to contain the increasing cost of health care.

  3. The perceived meaning of a (wholistic view among general practitioners and district nurses in Swedish primary care: a qualitative study

    Directory of Open Access Journals (Sweden)

    Borgquist Lars

    2007-03-01

    Full Text Available Abstract Background The definition of primary care varies between countries. Swedish primary care has developed from a philosophic viewpoint based on quality, accessibility, continuity, co-operation and a holistic view. The meaning of holism in international literature differs between medicine and nursing. The question is, if the difference is due to different educational traditions. Due to the uncertainties in defining holism and a holistic view we wished to study, in depth, how holism is perceived by doctors and nurses in their clinical work. Thus, the aim was to explore the perceived meaning of a holistic view among general practitioners (GPs and district nurses (DNs. Methods Seven focus group interviews with a purposive sample of 22 GPs and 20 nurses working in primary care in two Swedish county councils were conducted. The interviews were transcribed verbatim and analysed using qualitative content analysis. Results The analysis resulted in three categories, attitude, knowledge, and circumstances, with two, two and four subcategories respectively. A professional attitude involves recognising the whole person; not only fragments of a person with a disease. Factual knowledge is acquired through special training and long professional experience. Tacit knowledge is about feelings and social competence. Circumstances can either be barriers or facilitators. A holistic view is a strong motivator and as such it is a facilitator. The way primary care is organised can be either a barrier or a facilitator and could influence the use of a holistic approach. Defined geographical districts and care teams facilitate a holistic view with house calls being essential, particularly for nurses. In preventive work and palliative care, a holistic view was stated to be specifically important. Consultations and communication with the patient were seen as important tools. Conclusion 'Holistic view' is multidimensional, well implemented and very much alive among both

  4. Degree of Ambulatory Disability: Effects on Rural Siblings' Social Development.

    Science.gov (United States)

    Chamberlain, Theresa Nowak; Ross-Reynolds, Jane

    1993-01-01

    Interviews with 22 mothers of children with ambulatory disability and 33 nondisabled siblings showed no differences in sibling's child care responsibilities, general home responsibilities, or independence related to severity of the ambulatory disability. A difference in the amount of social activity, reported by mothers, was not confirmed by…

  5. Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries

    Directory of Open Access Journals (Sweden)

    Harris MF

    2016-01-01

    Full Text Available Mark F Harris,1 Jenny Advocat,2 Benjamin F Crabtree,3 Jean-Frederic Levesque,1,4 William L Miller,5 Jane M Gunn,6 William Hogg,7 Cathie M Scott,8 Sabrina M Chase,9 Lisa Halma,10 Grant M Russell11 1Center for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, VIC, Australia; 3Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA; 4Bureau of Health Information, NSW Government, Sydney, NSW, Australia; 5Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA, USA; 6Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia; 7The CT Lamont Primary Care Research Center, The University of Ottawa, Ottawa, ON, 8Alberta Centre for Child, Family, and Community Research, University of Calgary, AB, Canada; 9Rutgers University, Rutgers School of Nursing, Rutgers, NJ, USA; 10Alberta Health Services, Lethbridge, AB, Canada; 11School of Primary Health Care, Monash University, Notting Hill, VIC, Australia Context: A key aim of reforms to primary health care (PHC in many countries has been to enhance interprofessional teamwork. However, the impact of these changes on practitioners has not been well understood.Objective: To assess the impact of reform policies and interventions that have aimed to create or enhance teamwork on professional communication relationships, roles, and work satisfaction in PHC practices.Design: Collaborative synthesis of 12 mixed methods studies.Setting: Primary care practices undergoing transformational change in three countries: Australia, Canada, and the USA, including three Canadian provinces (Alberta, Ontario, and Quebec.Methods: We conducted a synthesis and secondary analysis of 12 qualitative and quantitative studies conducted by the authors in order to understand the impacts and how they

  6. Why are some evidence-based care recommendations in chronic obstructive pulmonary disease better implemented than others? Perspectives of medical practitioners

    Directory of Open Access Journals (Sweden)

    Johnston KN

    2011-12-01

    Full Text Available Kylie N Johnston1, Mary Young2, Karen A Grimmer-Somers1, Ral Antic3, Peter A Frith41International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia, Australia; 2Transitional and Community Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia; 3Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia; 4Respiratory, Allergy and Sleep Services, Repatriation General Hospital and Flinders University Adelaide, South Australia, AustraliaBackground: Clinical guidelines for management of patients with chronic obstructive pulmonary disease (COPD include recommendations based on high levels of evidence, but gaps exist in their implementation. The aim of this study was to examine the perspectives of medical practitioners regarding implementation of six high-evidence recommendations for the management of people with COPD.Methods: Semi-structured interviews were conducted with medical practitioners involved with care of COPD patients in hospital and general practice. Interviews sought medical practitioners' experience regarding implementation of smoking cessation, influenza vaccination, pulmonary rehabilitation, guideline-based medications, long-term oxygen therapy for hypoxemia and plan and advice for future exacerbations. Interviews were audiotaped, transcribed verbatim and analyzed using content analysis.Results: Nine hospital-based medical practitioners and seven general practitioners participated. Four major categories were identified which impacted on implementation of the target recommendations in the care of patients with COPD: (1 role clarity of the medical practitioner; (2 persuasive communication with the patient; (3 complexity of behavioral change required; (4 awareness and support available at multiple levels. For some recommendations, strength in all four categories provided significant enablers supporting implementation. However, with regard to

  7. Effect of Comorbid Depression on Outcomes in Diabetes and Its Relationship to Quality of Care and Patient Adherence: A Statewide Primary Care Ambulatory Research and Resources Consortium Study

    OpenAIRE

    Katerndahl, David; Calmbach, Walter L.; Becho, Johanna

    2012-01-01

    Objective: To determine whether current depression was associated with poorer quality of care and poorer patient adherence to treatment regimens and whether current depression was associated with patient diabetes outcomes independent of its relationships to quality of care and patient adherence among patients with diabetes.

  8. Awareness and use of Benzodiazepines in healthy volunteers and ambulatory patients visiting a tertiary care hospital: a cross sectional survey.

    Directory of Open Access Journals (Sweden)

    Mustafa Raoof

    Full Text Available BACKGROUND: Indiscriminate prescription of Benzodiazepines in Pakistan and subsequent availability over-the-counter without prescription is a major public health problem, requiring systematic inquiry through research. Additionally, there is limited data on the awareness and use of Benzodiazepines from developing countries making it impossible to devise meaningful health policies. METHODOLOGY/PRINCIPAL FINDINGS: This was an Observational, Cross-Sectional study. conducted at Aga Khan University. A total of 475 (58.5% males, 41.5% females people visiting a tertiary care hospital were interviewed by means of a structured questionnaire. The results showed that majority of population was aware of one or more Benzodiazepines (80.4% and 30.4% had used them at some point in life. 42.4% of the users had been using it for more than a year. Commonest reason for use was sleep disturbance. Frequency of usage was higher for females, married individuals, educated (>Grade12, high socioeconomic status and housewives. More (59% were prescribed than not and of them most by GP (58.5%. Only 36.5% of them were particularly told about the long-term addiction potential by the use of these drugs. CONCLUSION: Easy availability, access to re-fills without prescription and self prescription compounded with the lack of understanding of abuse potential of benzodiazepines constitutes a significant problem demanding serious consideration from health policy makers.

  9. Systematic care for caregivers of people with dementia in the ambulatory mental health service: designing a multicentre, cluster, randomized, controlled trial

    Directory of Open Access Journals (Sweden)

    Adang Eddy

    2009-06-01

    Full Text Available Abstract Background Care for people with dementia and their informal caregivers is a challenging aim in healthcare. There is an urgent need for cost-effective support programs that prevent informal caregivers of people with dementia from becoming overburdened, which might result in a delay or decrease of patient institutionalization. For this reason, we have developed the Systematic Care Program for Dementia (SCPD. The SCPD consists of an assessment of caregiver's sense of competence and suggestions on how to deal with competence deficiencies. The efficiency of the SCPD will be evaluated in our study. Methods and design In our ongoing, cluster, randomized, single-blind, controlled trial, the participants in six mental health services in four regions of the Netherlands have been randomized per service. Professionals of the ambulatory mental health services (psychologists and social psychiatric nurses have been randomly allocated to either the intervention group or the control group. The study population consists of community-dwelling people with dementia and their informal caregivers (patient-caregiver dyads coming into the health service. The dyads have been clustered to the professionals. The primary outcome measure is the patient's admission to a nursing home or home for the elderly at 12 months of follow-up. This measure is the most important variable for estimating cost differences between the intervention group and the control group. The secondary outcome measure is the quality of the patient's and caregiver's lives. Discussion A novelty in the SCPD is the pro-active and systematic approach. The focus on the caregiver's sense of competence is relevant to economical healthcare, since this sense of competence is an important determinant of delay of institutionalization of people with dementia. The SCPD might be able to facilitate this with a relatively small cost investment for caregivers' support, which could result in a major decrease in

  10. Nontraumatic dental condition-related visits to emergency departments on weekdays, weekends and night hours: findings from the National Hospital Ambulatory Medical Care Survey

    Directory of Open Access Journals (Sweden)

    Okunseri C

    2013-09-01

    Full Text Available Christopher Okunseri,1 Elaye Okunseri,1 Melissa Christine Fischer,1 Saba Noori Sadeghi,1 Qun Xiang,2 Aniko Szabo21Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA; 2Division of Biostatistics, Institute of Health and Society, Medical College of Wisconsin, Milwaukee, WI, USAObjective: To determine whether the rates of nontraumatic dental condition (NTDC-related emergency department (ED visits are higher during the typical working hours of dental offices and lower during night hours, as well as the associated factors.Methods: We analyzed data from the National Hospital Ambulatory Medical Care Survey for 1997 through 2007 using multivariate binary and polytomous logistic regression adjusted for survey design to determine the effect of predictors on specified outcome variables.Results: Overall, 4,726 observations representing 16.4 million NTDC-related ED visits were identified. Significant differences in rates of NTDC-related ED visits were observed with 40%–50% higher rates during non-working hours and 20% higher rates on weekends than the overall average rate of 170 visits per hour. Compared with 19–33 year olds, subjects <18 years old had significantly higher relative rates of NTDC-related ED visits during nonworking hours [relative rate ratio (RRR = 1.6 to 1.8], whereas those aged 73 and older had lower relative rates during nonworking hours (RRR = 0.4; overall P = 0.0005. Compared with those having private insurance, Medicaid and self-pay patients had significantly lower relative rates of NTDC visits during nonworking and night hours (RRR = 0.6 to 0.7, overall P < 0.0003. Patients with a dental reason for visit were overrepresented during the night hours (RRR = 1.3; overall P = 0.04.Conclusion: NTDC-related visits to ED occurred at a higher rate during non-working hours and on weekends and were significantly associated with age, patient-stated reason for visit and payer type.Keywords: dental

  11. Ambulatory patient classifications and the regressive nature of medicare reform: is the reduction in outpatient health care reimbursement worth the price?

    International Nuclear Information System (INIS)

    Purpose: To evaluate the impact of the proposed Ambulatory Patient Classification (APC) system on reimbursement for hospital outpatient Medicare procedures at the Massachusetts General Hospital (MGH) Department of Radiation Oncology. Methods and Materials: Treatment and cost data for the MGH Department of Radiation Oncology for the fiscal year 1997 were analyzed. This represented 66,981 technical procedures and 41 CPT-4 codes. The cost of each procedure was calculated by allocating departmental costs to the relative value units (RVUs) for each procedure according to accepted accounting principles. Net reimbursement for each CPT-4 procedure was then calculated by subtracting its cost from the allowed 1998 Boston area Medicare reimbursement or from the proposed Boston area APC reimbursement. The impact of the proposed APC reimbursement system on changes in reimbursement per procedure and on volume-adjusted changes in overall net reimbursements per procedure was determined. Results: Although the overall effect of APCs on volume-adjusted net reimbursements for Medicare patients was projected to be budget-neutral, treatment planning revenues would have decreased by 514% and treatment delivery revenues would have increased by 151%. Net reimbursements for less complicated courses of treatment would have increased while those for treatment courses requiring more complicated or more frequent treatment planning would have decreased. Net reimbursements for a typical prostate interstitial implant and a three-treatment high-dose-rate intracavitary application would have decreased by 481% and 632%, respectively. Conclusion: The financial incentives designed into the proposed APC reimbursement structure could lead to compromises in currently accepted standards of care, and may make it increasingly difficult for academic institutions to continue to fulfill their missions of research and service to their communities. The ability of many smaller, low patient volume, high Medicare

  12. Nurse practitioner and physician roles: delineation and complementarity of practice.

    Science.gov (United States)

    Davidson, R A; Lauver, D

    1984-03-01

    Because of differences in education and role preparation, nurse practitioners (NPs) and physicians (MDs) may assume either complementary or substitutive roles in patient care. To describe role complementarity and similarity, the role perceptions of 15 NPs and 15MDs in joint practice were assessed. Ten NP and MD respondent pairs were selected from a variety of ambulatory primary care settings (urban, rural, public, private, and health maintenance organizations), and five NP-MD pairs were chosen at random. A questionnaire of nine patient vignettes was created; respondents rated the appropriateness of their role in managing the clients described in each vignette using an 8-point scale. Significant differences existed between NP and MD perceived roles for six vignettes, p less than .05. NPs identified as highly role appropriate those vignettes necessitating psychosocial support and health education; MDs identified as highly role appropriate vignettes representing high risk physical conditions. The differences in NP and MD role perception were complementary. PMID:6565298

  13. Don’t let up: implementing and sustaining change in a new post-licensure education model for developing extended role practitioners involved in arthritis care

    Directory of Open Access Journals (Sweden)

    Lundon K

    2015-08-01

    Full Text Available Katie Lundon,1,3 Rachel Shupak,1–3 Sonya Canzian,4 Ed Ziesmann,5 Rayfel Schneider,6,71Office of Continuing Professional Development, Faculty of Medicine, University of Toronto, 2Division of Rheumatology, St Michael's Hospital, 3Department of Medicine, University of Toronto, 4Trauma/Neurosurgery and Mobility Programs, St Michael's Hospital, 5Programs and Services, The Arthritis Society, 6Division of Rheumatology, The Hospital for Sick Children, 7Department of Paediatrics, University of Toronto, Toronto, ON, CanadaKey message: Across a 9-year period, the Advanced Clinician Practitioner in Arthritis Care program has achieved a set of short-term “wins” giving direction and momentum to the development of new roles for health care practitioners providing arthritis care.Implications: This is a viable model for post-licensure training offered to multiple allied health professionals to support the development of competent extended role practitioners (extended scope practice. Challenges at this critical juncture include: retain focus, drive, and commitment; develop academic and financial partnerships transferring short-term success to long-term sustainability; advanced, context-driven, system-level evaluation including fiscal outcome; health care policy adaptation to new human health resource development.Supporting evidence: Success includes: completed 2-year health services research evaluating 37 graduates; leadership, innovation, educational excellence, and human health resource benefit awards; influential publications/presentations addressing post-licensure education/outcome, interprofessional collaboration, and improved patient care. Keywords: human health resource development, post-licensure education, arthritis, extended role practitioners, allied health professionals

  14. Improving patient satisfaction with ambulatory surgical care through quality control circle activities%开展品管圈活动提升门诊手术患者满意度

    Institute of Scientific and Technical Information of China (English)

    张健; 白晓霞

    2013-01-01

    Objective To explore the effect of quality control circle (QCC) activities on patient satisfaction with ambulatory surgical care.Methods The operating room nursing staff formed a QCC,delved into problems affecting patient satisfaction with ambulatory surgical care,and formulated solutions to the problems through brainstorming.They put forward improvement schemes and put them into practice.Results Patient overall satisfaction with ambulatory surgical care increased from (6.80 ± 0.57) points before QCC activities to (7.41±0.44) points after the activities,with significant difference found in the scores (P<0.01).Nurses' consciousness in participating nursing management,and job satisfaction were enhanced,and staff's enthusiasm,creativity,and initiative were fully exercised.Conclusion QCC activities help improve quality of ambulatory surgical care and patient satisfaction.%目的 探讨品管圈活动用于提升门诊手术患者满意度的效果.方法 由手术室一线护理人员组成品管圈小组,通过脑力激荡,讨论分析门诊手术患者满意度不高的原因,制订相应的整改措施并组织实施.结果 门诊手术患者总体满意度由活动前(6.80±0.57)分提高到活动后的(7.41±0.44)分,效果显著(P<0.01);护理人员参与护理管理的意识和工作满足感增强,护理人员的积极性、创造性、主动性得到充分发挥.结论 品管圈活动的开展,有利于提高门诊手术服务质量、提升门诊手术患者满意度.

  15. Evaluation of health care service quality in Poland with the use of SERVQUAL method at the specialist ambulatory health care center

    Science.gov (United States)

    Manulik, Stanisław; Rosińczuk, Joanna; Karniej, Piotr

    2016-01-01

    Introduction Service quality and customer satisfaction are very important components of competitive advantage in the health care sector. The SERVQUAL method is widely used for assessing the quality expected by patients and the quality of actually provided services. Objectives The main purpose of this study was to determine if patients from state and private health care facilities differed in terms of their qualitative priorities and assessments of received services. Materials and methods The study included a total of 412 patients: 211 treated at a state facility and 201 treated at a private facility. Each of the respondents completed a 5-domain, 22-item SERVQUAL questionnaire. The actual quality of health care services in both types of facilities proved significantly lower than expected. Results All the patients gave the highest scores to the domains constituting the core aspects of health care services. The private facility respondents had the highest expectations with regard to equipment, and the state facility ones regarding contacts with the medical personnel. Conclusion Health care quality management should be oriented toward comprehensive optimization in all domains, rather than only within the domain identified as the qualitative priority for patients of a given facility.

  16. Evaluation of a general practitioner-led urgent care centre in an urban setting: description of service model and plan of analysis

    OpenAIRE

    Gnani, Shamini; Ramzan, Farzan; Ladbrooke, Tim; Millington, Hugh; Islam, Saiful; Car, Josip; Majeed, Azeem

    2013-01-01

    Estimates of patients attending with conditions deemed non-urgent or inappropriate for accident and emergency services vary widely, from 6 to 80%. Previous research suggests that general practitioners (GPs) working in emergency departments can reduce referral rates, diagnostic testing, the proportion of patients who become emergency hospital admissions, and inappropriate attendances. However, little of this previous research is recent and new models of care for GPs working in emergency depart...

  17. Science Translational Medicine - improving human health care worldwide by providing an interdisciplinary forum for idea exchange between basic scientists and clinical research practitioners

    OpenAIRE

    Forsythe, K

    2010-01-01

    Science Translational Medicine 's mission is to improve human health care worldwide by providing a forum for communication and interdisciplinary idea exchange between basic scientists and clinical research practitioners from all relevant established and emerging disciplines. The weekly journal debuted in October 2009 and is published by the American Association for the Advancement of Science (AAAS), the publisher of Science and Science Signaling . The journal features peer-reviewed researc...

  18. Science Translational Medicine – improving human health care worldwide by providing an interdisciplinary forum for idea exchange between basic scientists and clinical research practitioners

    OpenAIRE

    Forsythe, Katherine

    2010-01-01

    Science Translational Medicine’s mission is to improve human health care worldwide by providing a forum for communication and interdisciplinary idea exchange between basic scientists and clinical research practitioners from all relevant established and emerging disciplines. The weekly journal debuted in October 2009 and is published by the American Association for the Advancement of Science (AAAS), the publisher of Science and Science Signaling. The journal features peer-reviewed research art...

  19. Practices used for recommending sickness certification by general practitioners: a conversation analytic study of UK primary care consultations.

    Science.gov (United States)

    Wheat, Hannah C; Barnes, Rebecca K; Byng, Richard

    2015-02-01

    Existing research indicates that many patients and doctors find the process of negotiating sickness certification for time off work to be a difficult one. This study examined how patients and general practitioners (GPs) managed these negotiations in a sample of UK primary care consultations. The study made use of an existing dataset of audio-recorded consultations between 13 GPs and 506 unselected adult patients in five general practices in London. Forty-nine consultations included discussions for both initial and repeat sickness certification across a wide range of conditions. Here we report our findings on doctor practices for recommending, as opposed to patient practices for advocating for, sickness certification (n = 26 cases). All cases were transcribed in detail and analysed using conversation analytic methods. Four main communication practices were observed: (1) declarative statements of need for sickness certification; (2) 'do you need' offers for sickness certification; (3) 'do you want' offers for sickness certification; and (4) conditional 'If X, Y' offers for sickness certification. These different communication practices indexed doctor agency, doctor endorsement and patient entitlement to varying degrees. In the main, recommendations to patients presenting with biomedical problems or a repeat occurrence of a psychosocial problem displayed stronger doctor endorsement and patient entitlement. Contrastingly, recommendations to patients presenting with new psychosocial and biopsychosocial problems, displayed weaker endorsement and patient entitlement. This study offers new evidence to support the Parsonian argument that becoming sick involves entering a social role with special rights and obligations. Through documenting doctors' orientations to their gatekeeping role as well as patients' orientations to differential rights vis à vis legitimacy, we demonstrate the contrasting stances of doctors in situ when giving sick notes for biomedical problems as

  20. Out of hours care: a profile analysis of patients attending the emergency department and the general practitioner on call

    Directory of Open Access Journals (Sweden)

    Buylaert Walter

    2010-11-01

    Full Text Available Abstract Background Overuse of emergency departments (ED is of concern in Western society and it is often referred to as 'inappropriate' use. This phenomenon may compromise efficient use of health care personnel, infrastructure and financial resources of the ED. To redirect patients, an extensive knowledge of the experiences and attitudes of patients and their choice behaviour is necessary. The aim of this study is to quantify the patients and socio-economical determinants for choosing the general practitioner (GP on call or the ED. Methods Data collection was conducted simultaneously in 4 large cities in Belgium. All patients who visited EDs or used the services of the GP on call during two weekends in January 2005 were enrolled in the study in a prospective manner. We used semi-structured questionnaires to interview patients from both services. Results 1611 patient contacts were suitable for further analysis. 640 patients visited the GP and 971 went to the ED. Determinants that associated with the choice of the ED are: being male, having visited the ED during the past 12 months at least once, speaking another language than Dutch or French, being of African (sub-Saharan as well as North African nationality and no medical insurance. We also found that young men are more likely to seek help at the ED for minor trauma, compared to women. Conclusions Patients tend to seek help at the service they are acquainted with. Two populations that distinctively seek help at the ED for minor medical problems are people of foreign origin and men suffering minor trauma. Aiming at a redirection of patients, special attention should go to these patients. Informing them about the health services' specific tasks and the needlessness of technical examinations for minor trauma, might be a useful intervention.

  1. Diabetes and hypertension guidelines and the primary health care practitioner in Barbados: knowledge, attitudes, practices and barriers-a focus group study

    Directory of Open Access Journals (Sweden)

    Carter Anne O

    2010-12-01

    Full Text Available Abstract Background Audits have shown numerous deficiencies in the quality of hypertension and diabetes primary care in Barbados, despite distribution of regional guidelines. This study aimed to evaluate the knowledge, attitudes and practices, and the barriers faced by primary care practitioners in Barbados concerning the recommendations of available diabetes and hypertension guidelines. Methods Focus groups using a moderator's manual were conducted at all 8 public sector polyclinics, and 5 sessions were held for private practitioners. Results Polyclinic sessions were attended by 63 persons (17 physicians, 34 nurses, 3 dieticians, 3 podiatrists, 5 pharmacists, and 1 other, and private sector sessions by 20 persons (12 physicians, 1 nurse, 3 dieticians, 2 podiatrists and 2 pharmacists. Practitioners generally thought they gave a good quality of care. Commonwealth Caribbean Medical Research Council 1995 diabetes and 1998 hypertension guidelines, and the Ministry of Health 2001 diabetes protocol had been seen by 38%, 32% and 78% respectively of polyclinic practitioners, 67%, 83%, and 33% of private physicians, and 25%, 0% and 38% of non-physician private practitioners. Current guidelines were considered by some to be outdated, unavailable, difficult to remember and lacking in advice to tackle barriers. Practitioners thought that guidelines should be circulated widely, promoted with repeated educational sessions, and kept short. Patient oriented versions of the guidelines were welcomed. Patient factors causing barriers to ideal outcome included denial and fear of stigma; financial resources to access an appropriate diet, exercise and monitoring equipment; confusion over medication regimens, not valuing free medication, belief in alternative medicines, and being unable to change habits. System barriers included lack of access to blood investigations, clinic equipment and medication; the lack of human resources in polyclinics; and an uncoordinated

  2. Escuta psicanalítica de gestantes no contexto ambulatorial: uma experiência em grupos de fala = Psychoanalytic care of pregnant women in the context of an ambulatory: the experience of words group

    Directory of Open Access Journals (Sweden)

    Vilas Boas, Laís Macêdo

    2013-01-01

    Full Text Available A gestação é um momento de mudanças significativas na vida da mulher, permeado por afetos, fantasias e expectativas em relação ao parto e ao bebê. A existência de um espaço de fala, no qual a futura mãe possa de algum modo elaborar tais conteúdos psíquicos, pode auxiliar tanto no processo de construção do lugar materno, como na preparação para o parto e para a interação com o bebê. O presente trabalho é uma proposta de reflexão a partir da experiência que se desenvolve no chamado Grupo de Palavras – espaço de fala e partilha de experiências de gestantes sobre questões relativas à gravidez, criado na sala de espera de um ambulatório – com objetivo de discutir nuances do processo psíquico envolvido na construção do ser mãe e a possibilidade de elaboração de tal processo por meio da fala, bem como os desafios do trabalho de escuta psicanalítica no contexto ambulatorial

  3. Videos of communication in primary care: a study exploring nurse practitioner and patient consultations in a Walk-in centre

    OpenAIRE

    Bickerton, Jane E.

    2015-01-01

    The researcher (an experienced advanced nurse practitioner) examined and interpreted twenty videos of consultations between six nurse practitioners and patients aged between 18 and 65 years. A qualitative visual research method (VS) was used drawing on phenomenology, video elicitation, reflexivity, and narrative hermeneutics. The findings demonstrated shared verbal and visual aspects of conversations. The majority of the videos elicited knowledge-based, rather than predominately emotion or mo...

  4. [Interdisciplinary care for a patient suffering from Diogenes syndrome].

    Science.gov (United States)

    Beggah-Alioua, Sabah; Berger, Jérôme; Cheseaux, Michel

    2014-06-25

    Interdisciplinarity is the combined care of a patient by two or more healthcare professionals. Taking into account the contribution of the different healthcare partners improves patient follow-up, quality of the care and use of resources. General practitioner (GP) becomes the pivot of a combined interdisciplinary ambulatory care allowing a prolonged staying at home and avoiding the multiplication of care offers. This paper, by the clinical description of a patient suffering from Diogenes Syndrome, allows a cross of the care between the GP, home nurse and pharmacist. It deals with follow-up questions, acceptance, objectives of treatment, communication between healthcare partners and "false notes" in the follow-up. PMID:25055477

  5. [Care networks, mobile palliative and supportive teams. What benefits are there for patients, natural caregivers and general practitioners in patient homes?].

    Science.gov (United States)

    Hubault, Philippe; Chataigner, Bernard; Diquero, Vincent; Cesbron, Jean-Yves; Pommateau, Romuald; Cotinat, Jean-Paul; Guitard, Véronique; Mathien, Laurence; Thetas, Elisabeth

    2009-06-20

    Civil society at large and all caregivers, whether at home or within institutions, are involved in palliative care However, procedures may vary considerably, excluding a single approach. So as to best adapt their responses, the authors recorded everyone's expectations. Such a participatory methodology is, sine 1990, behind the establishment of local networks providing assistance, support and training to physicians non-specialized in palliative care (general practitioners, specialists, students or residents facing specific aspects of this medical management, as well as other health and social workers).

  6. Primary care practitioner and patient understanding of the concepts of multimorbidity and self-management: A qualitative study

    Directory of Open Access Journals (Sweden)

    Cassandra Kenning

    2013-10-01

    Full Text Available Objectives: The aim of this article is to offer insight into how professionals and patients understand and experience multimorbidity and how these accounts differ, and how they affect attitudes and engagement with self-management. Methods: Semi-structured interviews with 20 primary healthcare practitioners and 20 patients with at least 2 long-term conditions (including coronary heart disease, diabetes, osteoarthritis, chronic obstructive pulmonary disease and depression. Thematic analysis was used, and themes were identified using an open-coding method. Results: Practitioners associated multimorbidity with complexity and uncertainty in the clinic, leading to emotional strain and ‘heart sink’. Patient accounts differed. Some described multimorbidity as problematic when it exacerbated their symptoms and caused emotional and psychological strain. Others did not perceive multimorbidity as problematic. Self-management was seen by practitioners and patients to be a key element of managing multiple conditions, but drivers for prompting and engaging in self-management differed between patients and practitioners. Conclusion: This study suggests that recommendations for clinical practice for multimorbid patients should take into account the gap in perceptions between practitioner and patients about experiences of multimorbidity. Not least, practice would need to reflect the tension between practitioners’ and patients’ accounts about the role and benefits of self-management in the presence of multimorbidity.

  7. Effectiveness of in-office blood pressure measurement by eye care practitioners in early detection and management of hypertension

    Institute of Scientific and Technical Information of China (English)

    Saud; A.Al; Anazi; Uchechukwu; L.Osuagwu; Turki; M.Al; Mubrad; Hany; K.Ahmed; Kelechi; C.Ogbuehi

    2015-01-01

    AIM: To investigate the number of hypertensive patients, the optometrist is able to identify by routinely taking blood pressure(BP) measurements for patients in "at-risk" groups, and to sample patients’ opinions regarding in-office BP measurement. Many of the optometrists in Saudi Arabia practice in optical stores.These stores are wide spread, easily accessible and seldom need appointments. The expanding role of the optometrist as a primary health care provider(PHCP) and the increasing global prevalence of hypertension,highlight the need for an integrated approach towards detecting and monitoring hypertension.METHODS: Automated BP measurements were made twice(during the same session) at five selected optometry practices using a validated BP monitor(Omron M6) to assess the number of patients with high BP(HBP)- in at-risk groups-visiting the eye clinic routinely. Prior to data collection, practitioners underwent a two-day training workshop by a cardiologist on hypertension and how to obtain accurate BP readings. A protocol for BP measurement was distributed and retained in all participating clinics. The general,,.,attitude towards cardiovascular health of 480 patients aged 37.2(±12.4)y and their opinion towards in-office BP measurement was assessed using a self-administered questionnaire.RESULTS: A response rate of 83.6% was obtained for the survey. Ninety-three of the 443 patients(21.0%)tested for BP in this study had HBP. Of these,(62subjects) 67.7% were unaware of their HBP status. Thirty of the 105 subjects(28.6%) who had previously been diagnosed with HBP, still had HBP at the time of this study, and only 22(73.3%) of these patients were on medication. Also, only 25% of the diagnosed hypertensive patients owned a BP monitor.CONCLUSION: Taking BP measurements in optometry practices, we were able to identify one previously undiagnosed patient with HBP for every 8 adults tested.We also identified 30 of 105 previously diagnosed patients whose BP was poorly

  8. Use of Self-Care and Practitioner-Based Forms of Complementary and Alternative Medicine before and after a Diagnosis of Breast Cancer

    Directory of Open Access Journals (Sweden)

    Alissa R. Link

    2013-01-01

    Full Text Available Purpose. We examine factors associated with self-care, use of practitioner-based complementary and alternative medicine (CAM, and their timing in a cohort of women with breast cancer. Methods. Study participants were women with breast cancer who participated in the Long Island Breast Cancer Study Project. Self-care is defined as the use of multivitamins, single vitamins, botanicals, other dietary supplements, mind-body practices, special diets, support groups, and prayer. Within each modality, study participants were categorized as continuous users (before and after diagnosis, starters (only after diagnosis, quitters (only before diagnosis, or never users. Multivariable logistic regression was used for the main analyses. Results. Of 764 women who provided complete data, 513 (67.2% initiated a new form of self-care following breast cancer diagnosis. The most popular modalities were those that are ingestible, and they were commonly used in combination. The strongest predictor of continuous use of one type of self-care was continuous use of other types of self-care. Healthy behaviors, including high fruit/vegetable intake and exercise, were more strongly associated with continuously using self-care than starting self-care after diagnosis. Conclusions. Breast cancer diagnosis was associated with subsequent behavioral changes, and the majority of women undertook new forms of self-care after diagnosis. Few women discontinued use of modalities they used prior to diagnosis.

  9. Assessment of activities performed by clinical nurse practitioners and implications for staffing and patient care at primary health care level in South Africa

    Directory of Open Access Journals (Sweden)

    Jude Igumbor

    2016-02-01

    Full Text Available Background: The shortage of nurses in public healthcare facilities in South Africa is well documented; finding creative solutions to this problem remains a priority.Objective: This study sought to establish the amount of time that clinical nurse practitioners (CNPs in one district of the Western Cape spend on clinical services and the implications for staffing and skills mix in order to deliver quality patient care.Methods: A descriptive cross-sectional study was conducted across 15 purposively selected clinics providing primary health services in 5 sub-districts. The frequency of activities and time CNPs spent on each activity in fixed and mobile clinics were recorded. Time spent on activities and health facility staff profiles were correlated and predictors of the total time spent by CNPs with patients were identified.Results: The time spent on clinical activities was associated with the number of CNPs in the facilities. CNPs in fixed clinics spent a median time of about 13 minutes with each patient whereas CNPs in mobile clinics spent 3 minutes. Fixed-clinic CNPs also spent more time on their non-core functions than their core functions, more time with patients, and saw fewer patients compared to mobile-clinic CNPs.Conclusions: The findings give insight into the time CNPs in rural fixed and mobile clinics spend with their patients, and how patient caseload may affect consultation times. Two promising strategies were identified – task shifting and adjustments in health workerd eployment – as ways to address staffing and skills mix, which skills mix creates the potential for using healthcare workers fully whilst enhancing the long-term health of these rural communities.

  10. Helping You Choose Quality Hospice Care

    Science.gov (United States)

    ... Accreditation Accreditation Ambulatory Health Care Behavioral Health Care Critical Access Hospitals Home Care (+ Pharmacy) Hospital Laboratory Nursing Care Center International Accreditation Accreditation Top Spots What ...

  11. How to coordinate the care for patients with chronic diseases when general practitioners have no gatekeeping function?

    NARCIS (Netherlands)

    Basak, O.; Boerma, W.; Guldal, D.; Schellevis, F.

    2014-01-01

    Justification and interest of the workshop Coordination of care is a core function of primary care and its goal is to support patients, especially those with chronic diseases and their families to receive effective health care within an increasingly complex healthcare system. Coordinated care is cha

  12. Training general practitioners in the treatment of functional somatic symptoms: effects on patient health in a cluster-randomised controlled trial (the Functional Illness in Primary Care study)

    DEFF Research Database (Denmark)

    Toft, Tomas; Rosendal, Marianne; Ørnbøl, Eva;

    2010-01-01

    BACKGROUND: Patients with medically unexplained or functional somatic symptoms (FSS) are prevalent in primary care. In this pragmatic cluster-randomised controlled trial we aimed to test the effect of a training programme (The Extended Reattribution and Management model) for general practitioners...... (GPs) in the treatment of FSS. METHODS: 38 participating GPs were randomised to the control group or the training group. The GPs included consecutive 18- to 65-year-old patients presenting during a 3-week period for new health complaints. We assessed a stratified subsample with the psychiatric...

  13. General practitioners believe that hypnotherapy could be a useful treatment for irritable bowel syndrome in primary care

    OpenAIRE

    de Lusignan Simon; Cox Stephen; Chan Tom

    2004-01-01

    Abstract Background Irritable bowel syndrome is a common condition in general practice. It occurs in 10 to 20% of the population, but less than half seek medical assistance with the complaint. Methods A questionnaire was sent to the 406 GPs listed on the West Sussex Health Authority Medical List to investigate their views of this condition and whether they felt hypnotherapy had a place in its management Results 38% of general practitioners responded. The achieved sample shared the characteris...

  14. Regional anesthesia techniques for ambulatory orthopedic surgery.

    LENUS (Irish Health Repository)

    O'Donnell, Brian D

    2012-02-03

    PURPOSE OF REVIEW: The purpose of this review is to present advances in the use of regional anesthetic techniques in ambulatory orthopedic surgery. New findings regarding the use of both neuraxial anesthesia and peripheral nerve block are discussed. RECENT FINDINGS: Neuraxial anesthesia: The use of short-acting local anesthetic agents such as mepivacaine, 2-chloroprocaine, and articaine permits rapid onset intrathecal anesthesia with early recovery profiles. Advantages and limitations of these agents are discussed.Peripheral nerve block: Peripheral nerve blocks in limb surgery have the potential to transform this patient cohort into a truly ambulatory, self-caring group. Recent trends and evidence regarding the benefits of regional anesthesia techniques are presented.Continuous perineural catheters permit extension of improved perioperative analgesia into the ambulatory home setting. The role and reported safety of continuous catheters are discussed. SUMMARY: In summary, shorter acting, neuraxial, local anesthetic agents, specific to the expected duration of surgery, may provide superior recovery profiles in the ambulatory setting. A trend towards more peripheral and selective nerve blocks exists. The infrapatellar block is a promising technique to provide analgesia following knee arthroscopy. Improved analgesia seen in the perioperative period can be safely and effectively extended to the postoperative period with the use of perineural catheters.

  15. Does depression screening have an effect on the diagnosis and treatment of mood disorders in general medical settings?: an instrumental variable analysis of the national ambulatory medical care survey.

    Science.gov (United States)

    Mojtabai, Ramin

    2011-08-01

    This study examined the association of depression screening with the diagnoses of mood disorders and prescription of antidepressants in 73,712 visits to nonpsychiatrist physician offices drawn from the 2005-2007 U.S. National Ambulatory Medical Care Survey. Physicians used depression screening selectively for patients whom they perceived as more likely to have a mood disorder. In bivariate probit analyses with instrumental variables, depression screening did not increase the prevalence of either mood disorder diagnoses or prescription of antidepressants. However, screening was associated with lower rates of antidepressants prescription without a diagnosis of a mood disorder. In visits in which antidepressants were prescribed, 47.4% of the screened visits compared with 16.3% of nonscreened visits had a mood disorder diagnosis. As currently practiced in medical settings, depression screening may help improve targeting and appropriate use of antidepressant medications. Wider use of depression screening may help curb the growing trend of off-label antidepressant prescriptions. PMID:21454246

  16. Can biomedical and traditional health care providers work together? Zambian practitioners' experiences and attitudes towards collaboration in relation to STIs and HIV/AIDS care: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Höjer Bengt

    2006-07-01

    Full Text Available Abstract Background The World Health Organization's World health report 2006: Working together for health underscores the importance of human resources for health. The shortage of trained health professionals is among the main obstacles to strengthening low-income countries' health systems and to scaling up HIV/AIDS control efforts. Traditional health practitioners are increasingly depicted as key resources to HIV/AIDS prevention and care. An appropriate and effective response to the HIV/AIDS crisis requires reconsideration of the collaboration between traditional and biomedical health providers (THPs and BHPs. The aim of this paper is to explore biomedical and traditional health practitioners' experiences of and attitudes towards collaboration and to identify obstacles and potential opportunities for them to collaborate regarding care for patients with sexually transmitted infections (STIs and HIV/AIDS. Methods We conducted a cross-sectional study in two Zambian urban sites, using structured questionnaires. We interviewed 152 biomedical health practitioners (BHPs and 144 traditional health practitioners (THPs who reported attending to patients with STIs and HIV/AIDS. Results The study showed a very low level of experience of collaboration, predominated by BHPs training THPs (mostly traditional birth attendants on issues of safe delivery. Intersectoral contacts addressing STIs and HIV/AIDS care issues were less common. However, both groups of providers overwhelmingly acknowledged the potential role of THPs in the fight against HIV/AIDS. Obstacles to collaboration were identified at the policy level in terms of legislation and logistics. Lack of trust in THPs by individual BHPs was also found to inhibit collaboration. Nevertheless, as many as 40% of BHPs expressed an interest in working more closely with THPs. Conclusion There is indication that practitioners from both sectors seem willing to strengthen collaboration with each other. However

  17. Putting prevention into practice: qualitative study of factors that inhibit and promote preventive care by general practitioners, with a focus on elderly patients

    Directory of Open Access Journals (Sweden)

    Hussein Rugzan J

    2010-09-01

    Full Text Available Abstract Background General practitioners (GPs have a key role in providing preventive care, particularly for elderly patients. However, various factors can inhibit or promote the implementation of preventive care. In the present study, we identified and examined factors that inhibit and promote preventive care by German GPs, particularly for elderly patients, and assessed changes in physicians' attitudes toward preventive care throughout their careers. Methods A qualitative, explorative design was used to identify inhibitors and promoters of preventive care in German general medical practice. A total of 32 GPs in Berlin and Hannover were surveyed. Questions about factors that promote or inhibit implementation of preventive care and changes in physicians' perceptions of promoting and inhibiting factors throughout their careers were identified. Episodic interviews, which encouraged the reporting of anecdotes regarding daily knowledge and experiences, were analyzed using ATLAS/ti. Socio-demographic data of GPs and structural information about their offices were collected using short questionnaires. The factors identified as inhibitory or promoting were classified as being related to patients, physicians, or the healthcare system. The changes in GP attitudes toward preventive care throughout their careers were classified as personal transitions or as social and health policy transitions. Results Most of the identified barriers to preventive care were related to patients, such as a lack of motivation for making lifestyle changes and a lack of willingness to pay for preventive interventions. In addition, the healthcare system seemed to inadequately promote preventive care, mainly due to poor reimbursement for preventive care and fragmentation of care. GPs own attitudes and health habits seemed to influence the implementation of preventive care. GPs recognized their own lack of awareness of effective preventive interventions, particularly for elderly

  18. Barriers and facilitators to evidence based care of type 2 diabetes patients: experiences of general practitioners participating to a quality improvement program

    Directory of Open Access Journals (Sweden)

    Hannes Karen

    2009-07-01

    Full Text Available Abstract Objective To evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs who participated in an 18-month quality improvement program (QIP. This QIP was implemented to promote compliance with international guidelines. Methods Twenty out of the 120 participating GPs in the QIP underwent semi-structured interviews that focused on three questions: 'Which changes did you implement or did you observe in the quality of diabetes care during your participation in the QIP?' 'According to your experience, what induced these changes?' and 'What difficulties did you experience in making the changes?' Results Most GPs reported that enhanced knowledge, improved motivation, and a greater sense of responsibility were the key factors that led to greater compliance with diabetes care guidelines and consequent improvements in diabetes care. Other factors were improved communication with patients and consulting specialists and reliance on diabetes nurse educators. Some GPs were reluctant to collaborate with specialists, and especially with diabetes educators and dieticians. Others blamed poor compliance with the guidelines on lack of time. Most interviewees reported that a considerable minority of patients were unwilling to change their lifestyles. Conclusion Qualitative research nested in an experimental trial may clarify the improvements that a QIP may bring about in a general practice, provide insight into GPs' approach to diabetes care and reveal the program's limits. Implementation of a QIP encounters an array of cognitive, motivational, and relational obstacles that are embedded in a patient-healthcare provider relationship.

  19. 24 Hours chronomics of ambulatory blood pressure and its relation with circadian rhythm of 6-sulfatoxy melatonin in night shift health care workers

    Directory of Open Access Journals (Sweden)

    B. Anjum

    2015-08-01

    Results: Ambulatory BP and HR were recorded at every 30 min intervals in day time and each hour in night time synchronically with circadian pattern of 6 sulfatoxy melatonin during shift duties. Highly Significant difference was found in double amplitude (2DA of blood pressure between night and day shift (p<0.001. In night shift, hyperbaric index (HBI of mean systolic blood pressure was found to be increased at 00-03 am (midnight while during day shift, peak was found at 06-09 am. Peak melatonin was to be found in early morning as compared to mid night in both the shift. Conclusions: The present study concluded that the desynchronization was appeared during night shift and entrainment of circadian rhythm in the day shift. [Int J Res Med Sci 2015; 3(8.000: 1922-1931

  20. Comprehensive ambulatory medicine training for categorical internal medicine residents.

    Science.gov (United States)

    Bharel, Monica; Jain, Sharad; Hollander, Harry

    2003-04-01

    It is challenging to create an educational and satisfying experience in the outpatient setting. We developed a 3-year ambulatory curriculum that addresses the special needs of our categorical medicine residents with distinct learning objectives for each year of training and clinical experiences and didactic sessions to meet these goals. All PGY1 residents spend 1 month on a general medicine ambulatory care rotation. PGY2 residents spend 3 months on an ambulatory block focusing on 8 core medicine subspecialties. Third-year residents spend 2 months on an advanced ambulatory rotation. The curriculum was started in July 2000 and has been highly regarded by the house staff, with statistically significant improvements in the PGY2 and PGY3 evaluation scores. By enhancing outpatient clinical teaching and didactics with an emphasis on the specific needs of our residents, we have been able to reframe the thinking and attitudes of a group of inpatient-oriented residents. PMID:12709096

  1. 45 CFR 60.1 - The National Practitioner Data Bank.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false The National Practitioner Data Bank. 60.1 Section... PRACTITIONER DATA BANK FOR ADVERSE INFORMATION ON PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS General Provisions § 60.1 The National Practitioner Data Bank. The Health Care Quality Improvement Act of 1986,...

  2. Consumer satisfaction among patients and their general practitioners about involving nurse specialists in primary care for patients with urinary incontinence

    NARCIS (Netherlands)

    C.P. Albers-Heitner (C. P.); R.A.G. Winkens (R. A G); B. Berghmans; M.A. Joore (Manuela); F.H. Nieman (Fred); J.L. Severens (Hans); T. Lagro-Janssen (Toine)

    2013-01-01

    textabstractUrinary incontinence (UI) is a very common problem, but existing guidelines on UI are not followed. To bring care in line with guidelines, we planned an intervention to involve nurse specialists on UI in primary care and assessed this in a randomised controlled trial. Alongside this inte

  3. The perspectives of clients and unqualified allopathic practitioners on the management of delivery care in urban slums, Dhaka, Bangladesh - a mixed method study

    Directory of Open Access Journals (Sweden)

    Wahed Tasnuva

    2010-09-01

    Full Text Available Abstract Background BRAC is implementing a program to improve maternal and newborn health among the urban poor in the slums of Bangladesh (Mansohi, funded by the Bill & Melinda Gates Foundation. Formative research has demonstrated that unqualified allopathic practitioners (UAPs are commonly assisting home-delivery. The objective of this study was to explore the role of unqualified allopathic practitioners during home delivery in urban slums of Dhaka. Methods This cross-sectional study was conducted between September 2008 and June 2009 in Kamrangirchar slum in Dhaka, Bangladesh, using both qualitative and quantitative research methods. Through a door-to-door household survey, quantitative data were collected from 463 women with a home birth and/or trial of labor at home. We also conducted seven in-depth interviews with the UAPs to explore their practices. Results About one-third (32% of the 463 women interviewed sought delivery care from a UAP. We did not find an association between socio-demographic characteristics and care-seeking from a UAP, except for education of women. Compared to women with three or more pregnancies, the highest odds ratio was found in the primi-gravidity group [odds ratio (OR: 3.46; 95% confidence interval (CI: 1.65-7.25], followed by women with two pregnancies (OR: 2.54; 95% CI: 1.36-4.77 to use a UAP. Of women who reported at least one delivery-related complication, 45.2% received care from the UAPs. Of 149 cases where the UAP was involved with delivery care, 133 (89.3% received medicine to start or increase labor with only 6% (9 of 149 referred by a UAP to any health facility. The qualitative findings showed that UAPs provided a variety of medicines to manage excessive bleeding immediately after childbirth. Conclusion There is demand among slum women for delivery-related care from UAPs during home births in Bangladesh. Some UAPs' practices are contrary to current World Health Organization recommendations and could be

  4. Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries

    OpenAIRE

    Harris MF; Advocat J; Crabtree BF; Levesque JF; Miller WL; Gunn JM; Hogg W; Scott CM; Chase SM; Halma L; Russell GM

    2016-01-01

    Mark F Harris,1 Jenny Advocat,2 Benjamin F Crabtree,3 Jean-Frederic Levesque,1,4 William L Miller,5 Jane M Gunn,6 William Hogg,7 Cathie M Scott,8 Sabrina M Chase,9 Lisa Halma,10 Grant M Russell11 1Center for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, VIC, Australia; 3Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medic...

  5. Report a Complaint (about a Health Care Organization)

    Science.gov (United States)

    ... Accreditation Accreditation Ambulatory Health Care Behavioral Health Care Critical Access Hospitals Home Care (+ Pharmacy) Hospital Laboratory Nursing Care Center International Accreditation Accreditation Top Spots What ...

  6. Enfermagem em cirurgia ambulatorial de um hospital escola: clientela, procedimentos e necessidades biológicas e psicossociais Enfermería en cirugía ambulatoria en hospital escuela: clientela, procedimientos y necesidades biológicas y psicosociales Nursing care in ambulatory surgery at a teaching hospital: patients, procedures and biological and psychosocial needs

    Directory of Open Access Journals (Sweden)

    Tatiane Vegette Pinto

    2005-04-01

    local con o sin sedación. Como necesidades biológicas fueron identificadas: alteraciones en la tensión arterial, alteraciones electrocardiográficas, uso de medicamentos y alergias a los mismos, ayuno prolongado, náusea, vómito y dolor; como necesidades psicosociales: preocupación, miedo, ansiedad, incomodo por la espera para realizarse el procedimiento y dudas o desconocimiento respecto a los cuidados perioperatorios.This descriptive study aimed to characterize the profile of 167 subjects who were treated at the Ambulatory Surgical Center of a University Hospital in São Paulo State and procedures realized at the Ambulatory Surgical Center, as well as to identify the biological and psychosocial needs of these patients. Data were obtained through a semistructured interview and patients' files and were subject to descriptive analysis. The group was characterized by an equal number of individuals from both genders; average age was 51 years and socioeconomic levels were poor. The most common surgical and anesthetic procedures were ophthalmologic procedures and use of local anesthesia with or without sedation. The biological needs were: altered arterial pressure, electrocardiographic alterations, use of medication, allergy to medication, prolonged fasting, nausea, vomits and pain. The psychosocial needs were: worry, fear, anxiety, discomfort caused by waiting for the realization of procedures and doubts or lack of information concerning perioperative care.

  7. The influence of patients' immigration background and residence permit status on treatment decisions in health care. Results of a factorial survey among general practitioners in Switzerland.

    Science.gov (United States)

    Drewniak, Daniel; Krones, Tanja; Sauer, Carsten; Wild, Verina

    2016-07-01

    This study examines the influence of patients' immigration background and residence permit status on physicians' willingness to treat patients in due time. A factorial survey was conducted among 352 general practitioners with a background in internal medicine in a German-speaking region in Switzerland. Participants expressed their self-rating (SR) as well as the expected colleague-rating (CR) to provide immediate treatment to 12 fictive vignette patients. The effects of the vignette variables were analysed using random-effects models. The results show that SR as well as CR was not only influenced by the medical condition or the physicians' time pressure, but also by social factors such as the ethnicity and migration history, the residence permit status, and the economic condition of the patients. Our findings can be useful for the development of adequate, practically relevant teaching and training materials with the ultimate aim to reduce unjustified discrimination or social rationing in health care. PMID:27258017

  8. 78 FR 56711 - Health Insurance Exchanges; Application by the Accreditation Association for Ambulatory Health...

    Science.gov (United States)

    2013-09-13

    ... accreditation program to conduct surveys for ambulatory surgery centers that wish to participate in the Medicare... HUMAN SERVICES Centers for Medicare & Medicaid Services Health Insurance Exchanges; Application by the Accreditation Association for Ambulatory Health Care To Be a Recognized Accrediting Entity for the...

  9. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Shah U

    2015-04-01

    Full Text Available Ushma Shah, David T Wong, Jean Wong Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada Abstract: Most surgeries in North America are performed on an ambulatory basis, reducing health care costs and increasing patient comfort. Patient satisfaction is an important outcome indicator of the quality of health care services incorporated by the American Society of Anesthesiologists (ASA. Patient satisfaction is a complex concept that is influenced by multiple factors. A patient's viewpoint and knowledge plays an influential role in patient satisfaction with ambulatory surgery. Medical optimization and psychological preparation of the patient plays a pivotal role in the success of ambulatory surgery. Postoperative pain, nausea, and vomiting are the most important symptoms for the patient and can be addressed by multimodal drug regimens. Shared decision making, patient–provider relationship, communication, and continuity of care form the main pillars of patient satisfaction. Various psychometrically developed instruments are available to measure patient satisfaction, such as the Iowa Satisfaction with Anesthesia Scale and Evaluation du Vecu de I'Anesthesie Generale, but none have been developed specifically for ambulatory surgery. The ASA has made recommendations for data collection for patient satisfaction surveys and emphasized the importance of reporting the data to the Anesthesia Quality Institute. Future research is warranted to develop a validated tool to measure patient satisfaction in ambulatory surgery. Keywords: patient, satisfaction, anesthesia, outcomes, questionnaire, perspectives

  10. The development of leadership outcome-indicators evaluating the contribution of clinical specialists and advanced practitioners to health care: a secondary analysis.

    LENUS (Irish Health Repository)

    Elliott, Naomi

    2014-05-01

    To report a secondary analysis of data collected from the case study phase of a national study of advanced practitioners and to develop leadership outcome-indicators appropriate for advanced practitioners.

  11. The Impact of Maternal Health Literacy on Structures, Interpersonal Processes and Outcomes of Ambulatory Care for Low-Income Latino Children

    OpenAIRE

    Fry-Bowers, Eileen Katherine

    2012-01-01

    Objective: Child health outcomes depend on a parent's ability to read, communicate, analyze, and use health information to participate in their child's care. Low maternal health literacy (HL) may disrupt access to pediatric health care, impede informed parent decision-making, and exacerbate pediatric health disparities. This dissertation explores relationships between maternal (HL), maternal self-efficacy (SE) in communication, interpersonal interactions with health care providers (HCPs), a...

  12. The "Assistant Practitioner" as "Associate Professional"? Professional Development of Intermediate Roles in Health and Social Care and Education

    Science.gov (United States)

    Edmond, Nadia; Aranda, Kay; Gaudoin, Rosemary; Law, Kate

    2012-01-01

    Recent years have seen the health and social care and education sectors subject to a range of policy initiatives which have been characterised by a concern for "modernisation" and restructuring of the workforce which has resulted in a reappraisal and so-called "professionalisation" of many existing previously lowskill roles. This has resulted in…

  13. The evolution of ambulatory ECG monitoring.

    Science.gov (United States)

    Kennedy, Harold L

    2013-01-01

    Ambulatory Holter electrocardiographic (ECG) monitoring has undergone continuous technological evolution since its invention and development in the 1950s era. With commercial introduction in 1963, there has been an evolution of Holter recorders from 1 channel to 12 channel recorders with increasingly smaller storage media, and there has evolved Holter analysis systems employing increasingly technologically advanced electronics providing a myriad of data displays. This evolution of smaller physical instruments with increasing technological capacity has characterized the development of electronics over the past 50 years. Currently the technology has been focused upon the conventional continuous 24 to 48 hour ambulatory ECG examination, and conventional extended ambulatory monitoring strategies for infrequent to rare arrhythmic events. However, the emergence of the Internet, Wi-Fi, cellular networks, and broad-band transmission has positioned these modalities at the doorway of the digital world. This has led to an adoption of more cost-effective strategies to these conventional methods of performing the examination. As a result, the emergence of the mobile smartphone coupled with this digital capacity is leading to the recent development of Holter smartphone applications. The potential of point-of-care applications utilizing the Holter smartphone and a vast array of new non-invasive sensors is evident in the not too distant future. The Holter smartphone is anticipated to contribute significantly in the future to the field of global health.

  14. Use of marketing to disseminate brief alcohol intervention to general practitioners: promoting health care interventions to health promoters.

    Science.gov (United States)

    Lock, C A; Kaner, E F

    2000-11-01

    Health research findings are of little benefit to patients or society if they do not reach the audience they are intended to influence. Thus, a dissemination strategy is needed to target new findings at its user group and encourage a process of consideration and adoption or rejection. Social marketing techniques can be utilized to aid successful dissemination of research findings and to speed the process by which new information reaches practice. Principles of social marketing include manipulating the marketing mix of product, price, place and promotion. This paper describes the development of a marketing approach and the outcomes from a trial evaluating the effectiveness and cost-effectiveness of manipulating promotional strategies to disseminate actively a screening and brief alcohol intervention (SBI) programme to general practitioners (GPs). The promotional strategies consisted of postal marketing, telemarketing and personal marketing. The study took place in general practices across the Northern and Yorkshire Regional Health Authority. Of the 614 GPs eligible for the study, one per practice, 321 (52%) took the programme and of those available to use it for 3 months (315), 128 (41%) actively considered doing so, 73 (23%) actually went on to use it. Analysis of the specific impact of the three different promotional strategies revealed that while personal marketing was the most effective overall dissemination and implementation strategy, telemarketing was more cost-effective. The findings of our work show that using a marketing approach is promising for conveying research findings to GPs and in particular a focus on promotional strategies can facilitate high levels of uptake and consideration in this target group. PMID:11133118

  15. Occupational closure in nursing work reconsidered: UK health care support workers and assistant practitioners: A focus group study.

    Science.gov (United States)

    Traynor, Michael; Nissen, Nina; Lincoln, Carol; Buus, Niels

    2015-07-01

    In healthcare, occupational groups have adopted tactics to maintain autonomy and control over their areas of work. Witz described a credentialist approach to occupational closure adopted by nursing in the United Kingdom during the 19th and early 20th centuries. However, the recent advancement of assistant, 'non-qualified' workers by governments and managers forms part of a reconfiguration of traditional professional work. This research used focus groups with three cohorts of healthcare support workers undertaking assistant practitioner training at a London university from 2011 to 13 (6 groups, n = 59). The aim was to examine how these workers positioned themselves as professionals and accounted for professional boundaries. A thematic analysis revealed a complex situation in which participants were divided between articulating an acceptance of a subordinate role within traditional occupational boundaries and a usurpatory stance towards these boundaries. Participants had usually been handpicked by managers and some were ambitious and confident in their abilities. Many aspired to train to be nurses claiming that they will gain recognition that they do not currently get but which they deserve. Their scope of practice is based upon their managers' or supervisors' perception of their individual aptitude rather than on a credentialist claim. They 'usurp' nurses claim to be the healthcare worker with privileged access to patients, saying they have taken over what nursing has considered its core work, while nurses abandon it for largely administrative roles. We conclude that the participants are the not unwilling agents of a managerially led project to reshape the workforce that cuts across existing occupational boundaries.

  16. Occupational closure in nursing work reconsidered: UK health care support workers and assistant practitioners: A focus group study.

    Science.gov (United States)

    Traynor, Michael; Nissen, Nina; Lincoln, Carol; Buus, Niels

    2015-07-01

    In healthcare, occupational groups have adopted tactics to maintain autonomy and control over their areas of work. Witz described a credentialist approach to occupational closure adopted by nursing in the United Kingdom during the 19th and early 20th centuries. However, the recent advancement of assistant, 'non-qualified' workers by governments and managers forms part of a reconfiguration of traditional professional work. This research used focus groups with three cohorts of healthcare support workers undertaking assistant practitioner training at a London university from 2011 to 13 (6 groups, n = 59). The aim was to examine how these workers positioned themselves as professionals and accounted for professional boundaries. A thematic analysis revealed a complex situation in which participants were divided between articulating an acceptance of a subordinate role within traditional occupational boundaries and a usurpatory stance towards these boundaries. Participants had usually been handpicked by managers and some were ambitious and confident in their abilities. Many aspired to train to be nurses claiming that they will gain recognition that they do not currently get but which they deserve. Their scope of practice is based upon their managers' or supervisors' perception of their individual aptitude rather than on a credentialist claim. They 'usurp' nurses claim to be the healthcare worker with privileged access to patients, saying they have taken over what nursing has considered its core work, while nurses abandon it for largely administrative roles. We conclude that the participants are the not unwilling agents of a managerially led project to reshape the workforce that cuts across existing occupational boundaries. PMID:25989001

  17. Moving general practitioner training into primary care with cluster-based learning: a qualitative study in the West Midlands.

    Science.gov (United States)

    Doug, Manjo; Johnson, Neil; Wilkinson, Martin

    2010-03-01

    This study sought to explore the early implementation of cluster-based learning (CBL) pilots in one part of the UK. A qualitative study using semi-structured one-to-one interviews was conducted with 10 key informants responsible for managing and delivering local training programmes across 14 general practice specialty training schemes. Data were analysed using thematic content analysis using the constant comparative method. Wide variation existed in the running of CBL pilots between different schemes. The principal reasons for trialling CBL were the high numbers of general practitioner trainees, resulting in extra pressure placed on postgraduate education facilities. Training programme directors (TPDs) managed and facilitated the current pilots. Effective facilitation of the groups was considered essential, along with good organisation and planning, and enthusiastic facilitators. Having a mixture of specialist trainees from different stages of training promoted shared learning in the group. The cluster-based approach was also judged to enable the targeting of training to meet the needs of learners and to address specific local needs. Responders considered that CBL should ultimately comprise learner-led sessions facilitated by educational supervisors, with TPDs being responsible for leading the improvement of the quality of educational and clinical supervision. The main reasons why CBL was not implemented were anxieties about the risks of losing the perceived benefits of the current training format in the absence of evidence of the added value of CBL. The reluctance of trainers to get involved was a major barrier - this resulted mainly from a lack of confidence with facilitating small groups and funding for their time. PMID:20359387

  18. Use of marketing to disseminate brief alcohol intervention to general practitioners: promoting health care interventions to health promoters.

    Science.gov (United States)

    Lock, C A; Kaner, E F

    2000-11-01

    Health research findings are of little benefit to patients or society if they do not reach the audience they are intended to influence. Thus, a dissemination strategy is needed to target new findings at its user group and encourage a process of consideration and adoption or rejection. Social marketing techniques can be utilized to aid successful dissemination of research findings and to speed the process by which new information reaches practice. Principles of social marketing include manipulating the marketing mix of product, price, place and promotion. This paper describes the development of a marketing approach and the outcomes from a trial evaluating the effectiveness and cost-effectiveness of manipulating promotional strategies to disseminate actively a screening and brief alcohol intervention (SBI) programme to general practitioners (GPs). The promotional strategies consisted of postal marketing, telemarketing and personal marketing. The study took place in general practices across the Northern and Yorkshire Regional Health Authority. Of the 614 GPs eligible for the study, one per practice, 321 (52%) took the programme and of those available to use it for 3 months (315), 128 (41%) actively considered doing so, 73 (23%) actually went on to use it. Analysis of the specific impact of the three different promotional strategies revealed that while personal marketing was the most effective overall dissemination and implementation strategy, telemarketing was more cost-effective. The findings of our work show that using a marketing approach is promising for conveying research findings to GPs and in particular a focus on promotional strategies can facilitate high levels of uptake and consideration in this target group.

  19. General practitioner management of shoulder pain in comparison with rheumatologist expectation of care and best evidence: an Australian national survey.

    Directory of Open Access Journals (Sweden)

    Rachelle Buchbinder

    Full Text Available OBJECTIVES: To determine whether current care for common shoulder problems in Australian general practice is in keeping with rheumatologist expectations and the best available evidence. METHODS: We performed a mailed survey of a random sample of 3500 Australian GPs and an online survey of all 270 rheumatologists in Australia in June 2009. Each survey included four vignettes (first presentation of shoulder pain due to rotator cuff tendinopathy, acute rotator cuff tear in a 45 year-old labourer and early and later presentation of adhesive capsulitis. For each vignette, GPs were asked to indicate their management, rheumatologists were asked to indicate appropriate primary care, and we determined best available evidence from relevant Cochrane and other systematic reviews and published guidelines. RESULTS: Data were available for at least one vignette for 614/3500 (17.5% GPs and 64 (23.8% rheumatologists. For first presentation of rotator cuff tendinopathy, 69% and 82% of GPs and 50% and 56% rheumatologists would order a shoulder X-ray and ultrasound respectively (between group comparisons P = 0.004 and P<0001. Only 66% GPs and 60% rheumatologists would refer to an orthopaedic surgeon for the acute rotator cuff tear. For adhesive capsulitis, significantly more rheumatologists recommended treatments of known benefit (e.g. glucocorticoid injection (56% versus 14%, P<0.0001, short course of oral glucocorticoids (36% versus 6%, p<0.0001 and arthrographic distension of the glenohumeral joint (41% versus 19%, P<0.0001. CONCLUSIONS: There is a mismatch between the stated management of common shoulder problems encountered in primary care by GPs, rheumatologist expectations of GP care and the available evidence.

  20. Becoming an interprofessional practitioner: factors promoting the application of pre-qualification learning to professional practice in maternity care.

    Science.gov (United States)

    Murray-Davis, Beth; Marshall, Michelle; Gordon, Frances

    2014-01-01

    Teamwork and collaboration have been recognized as essential competencies for health care providers in the field of maternity care. Health care policy and regulatory bodies have stressed the importance of Interprofessional Education (IPE) for learners in this field; however, there is little evidence of sustained application of pre-qualifying IPE to the realm of interprofessional collaboration (IPC) in practice following qualification. The aim of this research was to understand how newly qualified midwives applied their IPE training to professional practice. A purposive sample of midwifery students, educators, new midwives and Heads of Midwifery from four universities in the United Kingdom participated in semi-structured interviews, questionnaires and focus groups. Qualitative, grounded theory methodology was used to develop the emerging theory. Newly qualified midwives appeared better able to integrate their IPE training into practice when IPE occurred in a favourable learning environment that facilitated acquisition and application of IPE skills and that recognized the importance of shared partnership between the university and the clinical workplace. PMID:23914937

  1. Cost-effectiveness of exercise therapy versus general practitioner care for osteoarthritis of the hip: design of a randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Verhaar Jan AN

    2011-10-01

    Full Text Available Abstract Background Osteoarthritis (OA is the most common joint disease, causing pain and functional impairments. According to international guidelines, exercise therapy has a short-term effect in reducing pain/functional impairments in knee OA and is therefore also generally recommended for hip OA. Because of its high prevalence and clinical implications, OA is associated with considerable (healthcare costs. However, studies evaluating cost-effectiveness of common exercise therapy in hip OA are lacking. Therefore, this randomised controlled trial is designed to investigate the cost-effectiveness of exercise therapy in conjunction with the general practitioner's (GP care, compared to GP care alone, for patients with hip OA. Methods/Design Patients aged ≥ 45 years with OA of the hip, who consulted the GP during the past year for hip complaints and who comply with the American College of Rheumatology criteria, are included. Patients are randomly assigned to either exercise therapy in addition to GP care, or to GP care alone. Exercise therapy consists of (maximally 12 treatment sessions with a physiotherapist, and home exercises. These are followed by three additional treatment sessions in the 5th, 7th and 9th month after the first treatment session. GP care consists of usual care for hip OA, such as general advice or prescribing pain medication. Primary outcomes are hip pain and hip-related activity limitations (measured with the Hip disability Osteoarthritis Outcome Score [HOOS], direct costs, and productivity costs (measured with the PROductivity and DISease Questionnaire. These parameters are measured at baseline, at 6 weeks, and at 3, 6, 9 and 12 months follow-up. To detect a 25% clinical difference in the HOOS pain score, with a power of 80% and an alpha 5%, 210 patients are required. Data are analysed according to the intention-to-treat principle. Effectiveness is evaluated using linear regression models with repeated measurements. An

  2. Does participation in preventive child health care at the general practitioner minimise social differences in the use of specialist care outside the hospital system?

    DEFF Research Database (Denmark)

    Mårtensson, Solvej; Hansen, Kristine Halling; Olsen, Kim Rose;

    2012-01-01

    INTRODUCTION: The primary purposes of preventive child health care in Denmark are to help ensure a healthy childhood and to create preconditions for a healthy adult life. The aim of this study is to examine whether participation in age-appropriate preventative child health care affects...... with a specialist than children from more affluent families. CONCLUSIONS: Ensuring participation in preventive child health care at the GP may reduce the social gap in utilisation of specialised health care that exists between children from families of different income levels....... the association between the socioeconomic position of the family and subsequent use of specialised health care outside the hospital system. METHODS: The study population was children born in 1999 and living in Denmark between 1 January 2002 and 31 December 2006 (n=68,366). The study investigated whether...

  3. Advances in the use of intravenous techniques in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Eng MR

    2015-07-01

    Full Text Available Matthew R Eng,1 Paul F White1,2 1Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 2White Mountain Institute, The Sea Ranch, CA, USA Summary statement: Advances in the use of intravenous techniques in ambulatory anesthesia has become important for the anesthesiologist as the key perioperative physician in outpatient surgery. Key techniques and choices of anesthetics are important in accomplishing fast track goals of ambulatory surgery. Purpose of review: The anesthesiologist in the outpatient environment must focus on improving perioperative efficiency and reducing recovery times while accounting for patients' well-being and safety. This review article focuses on recent intravenous anesthetic techniques to accomplish these goals. Recent findings: This review is an overview of techniques in intravenous anesthesia for ambulatory anesthesia. Intravenous techniques may be tailored to accomplish outpatient surgery goals for the type of surgical procedure and individual patient needs. Careful anesthetic planning and the application of the plans are critical to an anesthesiologist's success with fast-track ambulatory surgery. Conclusion: Careful planning and application of intravenous techniques are critical to an anesthesiologist's success with fast-track ambulatory surgery. Keywords: intravenous anesthesia, outpatient anesthesia, fast-track surgery

  4. [The role of a day care center for sick children in the convalescent stage to enable female medical practitioners to successfully continue their careers].

    Science.gov (United States)

    Kizuki, Noyuri

    2013-11-01

    From my experience of child rearing difficulties, when I decided to start a private practice, I planned to have a day care center for sick children in the convalescent stage in the same building to help working mothers, especially those employed in the provision of critical medical services to the community. Financial support was obtained from the city where the clinic exists, and the facility was built that satisfied the requirements of this purpose. I believe that the female surgeons are an especially important personnel resource of Japan's medical services, because surgeons are decreasing in number these days. However, sometimes, qualified medical practitioners, such as surgeons, have to give up their careers because of the difficulty of raising children and working at the same time, especially when their children become ill. The number of these types of day care centers should be increasing, along with necessary support systems to be established immediately, so that female professionals, most particularly in medical facilities, can continue successful careers. PMID:24358733

  5. Time, Cost, Information Seeking Skills and Format of Resources Present Barriers to Information Seeking by Primary Care Practitioners in a Research Environment. A review of: Andrews James E., Kevin A. Pearce, Carol Ireson, and Margaret M. Love. “Information‐Seeking Behaviors of Practitioners in a Primary Care Practice‐Based Research Network (PBRN.” Journal of the Medical Library Association 93.2 (Apr. 2005: 206‐12.

    Directory of Open Access Journals (Sweden)

    Martha Ingrid Preddie

    2007-09-01

    Full Text Available Objective – To determine the information seeking behaviors of primary care practitioners in order to inform future efforts towards the design of information services that would support quality inprimary care.Design – A cross‐sectional survey.Setting – A primary care practice based research network (PBRN of caregivers who serve a broad population while simultaneously studying and disseminating innovations aimed at improvements in quality, efficiency and/or safety of primaryhealth care in the United States.Subjects – All primary care practitioners in the PBRN including family practitioners, general practitioners, nurse practitioners and physician assistants.Methods – A questionnaire comprising twenty‐six questions was distributed to 116 practitioners. Practitioners attached to academic centres (who were also members of the PBRN were excluded in order “to achieve a sample of practices more representative of the primary care practising population” (208. Descriptive data were collected and analyzed. SPSS v11.5 was used for statistical analyses.Main results – There was a response rate of 51% (59 of 116. Fifty‐eight percent of the respondents stated that they sought information (excluding drug dosing or drug interactions information to support patient care several times a week. Sixty‐eight per cent sought this information while the patient waited. Almost half of therespondents had access to a small medical library (48% or a hospital library (46%, while 21% used a university medical library.Approximately 14% had no immediate access to a medical library. Almost 60% of practitioners stated that they had an e‐mail account. Thirty‐four percent agreed that the use of e‐mail to communicate with patients enhanced medical practice, while 24% disagreed. There was frequent prescribing of Internet‐based consumer health information to patients by only 16% of the practitioners, while Internet support groups were frequently recommended

  6. The ACA training programme to improve communication between general practitioners and their palliative care patients: development and applicability

    Directory of Open Access Journals (Sweden)

    Slort Willemjan

    2012-06-01

    Full Text Available Abstract We describe the development of a new training programme on GP-patient communication in palliative care, and the applicability to GPs and GP Trainees. This ‘ACA training programme’ focuses on  A vailability of the GP for the patient,  C urrent issues that should be raised by the GP, and  A nticipating various scenarios. Evaluation results indicate the ACA training programme to be applicable to GPs and GP Trainees. The ACA checklist was appreciated by GPs as useful both in practice and as a learning tool, whereas GP Trainees mainly appreciated the list for use in practice.

  7. [How can the patient's home be changed into a work place for the nurse? Interaction theoretical note on the role of the professional nurse in ambulatory care].

    Science.gov (United States)

    Wiese, M

    1995-09-01

    In home-care-situations nurses are confronted with the special problem of changing the house of the patients into a nurse's place of work and to play at this "stage" the role of professional nurses. The role-theory of Goffman is the background to outline some structural barriers for the performance of this role. In such and other care-giving-situations the nurse must be able to keep a necessary amount of role-distance, to regain professional autonomy.

  8. Cost of ambulatory care by mobile health clinic run by a Medical College in India for the year 2008-09

    Directory of Open Access Journals (Sweden)

    Aslesh Prabhakaran

    2014-01-01

    Full Text Available Background: The feasibility of using mobile health clinics (MHCs to deliver health services in urban poor areas has to be explored as the health needs of the residents are not sufficiently addressed by the existing primary health care delivery system in India. Objective: To estimate the cost of providing primary health care services and the out of pocket expenditure (OOPE incurred, while utilizing these services provided through the MHC based Urban Health Program of a Medical College in North India for the year 2008-2009. Materials and Methods: A cross-sectional study to estimate OOPE was conducted among 330 subjects selected from patients attending the mobile health care facility. For estimation of provider cost, 5 steps process involving identification of cost centres, measurement of inputs, valuing of inputs, assigning of inputs to cost centers, and estimation of unit cost were carried out. Results: Total annual cost of providing services under Urban Health Program in the year 2008-2009 was Rs. 7,691,943 Unit cost of providing outpatient curative care, antenatal care, and immunization were Rs. 107.74/visit, Rs. 388/visit and Rs. 66.14 per immunization, respectively. The mean OOPE incurred was Rs. 29.50/visit, while utilizing outpatient curative services and Rs. 88.70/visit for antenatal services. Conclusion: The MHC can be considered as a viable option to provide services to urban poor.

  9. Ambulatory anaesthesia and cognitive dysfunction

    DEFF Research Database (Denmark)

    Rasmussen, Lars S; Steinmetz, Jacob

    2015-01-01

    anaesthesia in the outpatient setting. Cognitive complications such as delirium and postoperative cognitive dysfunction are less frequent in ambulatory surgery than with hospitalization. SUMMARY: The elderly are especially susceptible to adverse effects of the hospital environment such as immobilisation...

  10. Surgical Site Infections Following Pediatric Ambulatory Surgery: An Epidemiologic Analysis.

    Science.gov (United States)

    Rinke, Michael L; Jan, Dominique; Nassim, Janelle; Choi, Jaeun; Choi, Steven J

    2016-08-01

    OBJECTIVE To identify surgical site infection (SSI) rates following pediatric ambulatory surgery, SSI outcomes and risk factors, and sensitivity and specificity of SSI administrative billing codes. DESIGN Retrospective chart review of pediatric ambulatory surgeries with International Classification of Disease, Ninth Revision (ICD-9) codes for SSI, and a systematic random sampling of 5% of surgeries without SSI ICD-9 codes, all adjudicated for SSI on the basis of an ambulatory-adapted National Healthcare Safety Network definition. SETTING Urban pediatric tertiary care center April 1, 2009-March 31, 2014. METHODS SSI rates and sensitivity and specificity of ICD-9 codes were estimated using sampling design, and risk factors were analyzed in case-rest of cohort, and case-control, designs. RESULTS In 15,448 pediatric ambulatory surgeries, 34 patients had ICD-9 codes for SSI and 25 met the adapted National Healthcare Safety Network criteria. One additional SSI was identified with systematic random sampling. The SSI rate following pediatric ambulatory surgery was 2.9 per 1,000 surgeries (95% CI, 1.2-6.9). Otolaryngology surgeries demonstrated significantly lower SSI rates compared with endocrine (P=.001), integumentary (P=.001), male genital (Psurgeries. Almost half of patients with an SSI were admitted, 88% received antibiotics, and 15% returned to the operating room. No risk factors were associated with SSI. The sensitivity of ICD-9 codes for SSI following ambulatory surgery was 55.31% (95% CI, 12.69%-91.33%) and specificity was 99.94% (99.89%-99.97%). CONCLUSIONS SSI following pediatric ambulatory surgery occurs at an appreciable rate and conveys morbidity on children. Infect Control Hosp Epidemiol 2016;37:931-938.

  11. Surgical Site Infections Following Pediatric Ambulatory Surgery: An Epidemiologic Analysis.

    Science.gov (United States)

    Rinke, Michael L; Jan, Dominique; Nassim, Janelle; Choi, Jaeun; Choi, Steven J

    2016-08-01

    OBJECTIVE To identify surgical site infection (SSI) rates following pediatric ambulatory surgery, SSI outcomes and risk factors, and sensitivity and specificity of SSI administrative billing codes. DESIGN Retrospective chart review of pediatric ambulatory surgeries with International Classification of Disease, Ninth Revision (ICD-9) codes for SSI, and a systematic random sampling of 5% of surgeries without SSI ICD-9 codes, all adjudicated for SSI on the basis of an ambulatory-adapted National Healthcare Safety Network definition. SETTING Urban pediatric tertiary care center April 1, 2009-March 31, 2014. METHODS SSI rates and sensitivity and specificity of ICD-9 codes were estimated using sampling design, and risk factors were analyzed in case-rest of cohort, and case-control, designs. RESULTS In 15,448 pediatric ambulatory surgeries, 34 patients had ICD-9 codes for SSI and 25 met the adapted National Healthcare Safety Network criteria. One additional SSI was identified with systematic random sampling. The SSI rate following pediatric ambulatory surgery was 2.9 per 1,000 surgeries (95% CI, 1.2-6.9). Otolaryngology surgeries demonstrated significantly lower SSI rates compared with endocrine (P=.001), integumentary (P=.001), male genital (PSSI were admitted, 88% received antibiotics, and 15% returned to the operating room. No risk factors were associated with SSI. The sensitivity of ICD-9 codes for SSI following ambulatory surgery was 55.31% (95% CI, 12.69%-91.33%) and specificity was 99.94% (99.89%-99.97%). CONCLUSIONS SSI following pediatric ambulatory surgery occurs at an appreciable rate and conveys morbidity on children. Infect Control Hosp Epidemiol 2016;37:931-938. PMID:27121727

  12. Acupuncture in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Norheim AJ

    2015-09-01

    Full Text Available Arne Johan Norheim,1 Ingrid Liodden,1 Terje Alræk1,2 1National Research Center in Complementary and Alternative Medicine (NAFKAM, Department of Community Medicine, Faculty of Health Sciences, University of Tromsø – The Arctic University of Norway, Tromsø, 2The Norwegian School of Health Sciences, Institute of Acupuncture, Kristiania University College, Oslo, NorwayBackground: Post-anesthetic morbidities remain challenging in our daily practice of anesthesia. Meta-analyses and reviews of acupuncture and related techniques for postoperative nausea and vomiting (POVN and postoperative vomiting (POV show promising results while many clinicians remain skeptical of the value of acupuncture. Given the interest in finding safe non-pharmacological approaches toward postoperative care, this body of knowledge needs to be considered. This review critically appraises and summarizes the research on acupuncture and acupressure in ambulatory anesthesia during the last 15 years.Methods: Articles were identified through searches of Medline, PubMed, and Embase using the search terms “acupuncture” or “acupuncture therapy” in combination with “ambulatory anesthesia” or “ambulatory surgery” or “day surgery” or “postoperative”. A corresponding search was done using “acupressure” and “wristbands”. The searches generated a total of 104, 118, and 122 references, respectively.Results: Sixteen studies were included; eight studies reported on acupuncture and eight on acupressure. Nine studies found acupuncture or acupressure effective on primary endpoints including postoperative nausea and vomiting, postoperative pain, sore throat, and emergence agitation. Four studies found acupuncture had a similar effect to antiemetic medication.Conclusion: Overall, the studies were of fairly good quality. A large proportion of the reviewed papers highlights an effect of acupuncture or acupressure on postoperative morbidities in an ambulatory setting

  13. Systematic care for caregivers of people with dementia in the ambulatory mental health service: designing a multicentre, cluster, randomized, controlled trial.

    NARCIS (Netherlands)

    Spijker, A.; Verhey, F.; Graff, M.J.L.; Grol, R.P.T.M.; Adang, E.M.M.; Wollersheim, H.C.H.; Vernooy-Dassen, M.J.F.J.

    2009-01-01

    BACKGROUND: Care for people with dementia and their informal caregivers is a challenging aim in healthcare. There is an urgent need for cost-effective support programs that prevent informal caregivers of people with dementia from becoming overburdened, which might result in a delay or decrease of pa

  14. Patient satisfaction and acceptability: a journey through an ambulatory gynaecology clinic in the West of Ireland

    LENUS (Irish Health Repository)

    Uzochukwu, I

    2016-06-01

    Ambulatory Gynaecology allows a “see-and-treat” approach to managing gynaecological conditions, providing a more streamlined, integrated care pathway than the traditional gynaecology clinic and inpatient care model. This study was designed to assess patient satisfaction and acceptability of Ambulatory Gynaecology services in Mayo University Hospital, Castlebar, Ireland. It also provided for feedback from patients as to how the service might be improved. \\r\

  15. Cuidando de idosos com Demência: um estudo a partir da prática ambulatorial de enfermagem Cuidando de ancianos con Demencia: pratica de enfermería en el ambulatorio Caring the elderly with Dementia: a study of the ambulatorial nursing practice

    Directory of Open Access Journals (Sweden)

    Rosimeire Ferreira Santana

    2005-02-01

    characteristics of sixteen elderly and their caregivers in attendence at the neurogeriatrical ambulatory of Rio de Janeiro during 2004; to identify nursing and care diagnosis used by caregivers, through EDG, MEEM, AIVDs and AVDs applied in nursing assessments. The quantitative descriptive method was employed, as a study of each case, obtaining the results: in the client- Disorientation, aggressiveness, skin drought, urinary incontinence, disturbance in the family relationship; In the caregivers- inefficient caregiver/ elderly communication, physical fatigue, lack of knowledge about care; accomplished types of care - feeding, medication and hygiene. In conclusion, educational nursing actions are necessary to improve the care quality to the elderly and their family.

  16. Ambulatory laparoscopic cholecystectomy: Is it safe and cost effective?

    Directory of Open Access Journals (Sweden)

    Ali Athar

    2009-01-01

    Full Text Available Background : Laparoscopic cholecystectomy (LC is the most commonly performed minimal invasive surgery. However, practice of its use as an ambulatory surgery in our hospital settings is uncommon. Objective : To evaluate safety and cost effectiveness of LC as an ambulatory day care surgery. Study Design : Quasiexperimental. Setting : Department of surgery, Aga Khan University Hospital, Karachi, Pakistan. Materials and Methods : Patients with uncomplicated symptomatic gallstones were selected for Ambulatory LC. They were admitted electively on the same day and operated on in the morning hours and discharged after a check by the surgeon 6-8 hrs later. Results : Of fifty (n = 50 patients selected for ambulatory LC, 92% were discharged successfully after 6-8 hrs observation. No significant perioperative complications were noted. Unplanned admission and readmission rate was 8 and 2%, respectively. Cost saving for the daycare surgery was Rs. 6,200, Rs. 13,300, and Rs.22,800 per patient as compared to in patient general, semiprivate, and private ward package, respectively. Conclusion : Practice ambulatory LC is safe and cost-effective in selected patients with uncomplicated symptomatic gallstones.

  17. Common mental health disorders in children and adolescents in primary care: A survey of knowledge, skills and attitudes among general practitioners in a newly developed European country

    Directory of Open Access Journals (Sweden)

    Kurt Buhagiar

    2012-09-01

    Full Text Available Background and Objectives: General Practitioners (GPs are generally the first point of contact for children and adolescents with mental health problems. This study investigates the confidence, beliefs, and knowledge of GPs regarding common mental health problems in youngsters. Methods: A self-designed questionnaire was distributed to nearly all registered GPs in a middle-income European country in order to address the aims of the study. Results: Response rate was 58%. Many GPs reported relatively low confidence on a number of issues, including diagnosis (70.0%, initiating management (86.6%, assessing the child-caregiver relationship (72.0% and the ability to distinguish between normal and pathological behavioural problems (75.1%. However, GPs showed greater inclination to conduct follow-up care after assessment by specialist services (53.5%. Few GPs considered psychosocial interventions to play a role in the treatment of anxiety disorders (18.5%, hyperkinetic disorders (24.2%, depression (22.9% and disruptive behaviour disorders (18.5% and this largely came from younger GPs (p < 0.001. Conclusions: Confidence of GPs in the management of youngsters with mental health problems is generally low. They may require significant back-up from specialist services in the form of both training and clinical collaboration.

  18. Child and adolescent psychiatry: which knowledge and skills do primary care physicians need to have? A survey in general practitioners and paediatricians.

    Science.gov (United States)

    Lempp, Thomas; Heinzel-Gutenbrunner, Monika; Bachmann, Christian

    2016-04-01

    Primary care physicians (PCPs) play a key role in the initial assessment and management of children and adolescents with mental health problems. However, it is unclear whether current medical education curricula sufficiently equip PCPs for this task. The aim of this study was to investigate, which child and adolescent psychiatry (CAP)-related skills and knowledge PCPs say they require in their daily practice. A questionnaire was generated, employing a modified two-step Delphi approach. Besides socio-demographic items, the questionnaire contained 17 CAP-related knowledge items and 13 CAP-related skills items, which had to be rated by importance in daily practice. The questionnaire was distributed to 348 office-based paediatricians and 500 general practitioners (GPs) in Germany. The overall return rate was 51.3 % (435/848). Regarding CAP-related knowledge, both paediatricians and GPs rated somatoform disorders and obesity as highly important for daily practice. Moreover, paediatricians also deemed regulatory disorders during infancy (e.g. crying, sleep disorders) as important, while GPs assessed knowledge on paediatric depression as relevant. For paediatricians and GPs, the most relevant CAP-related skills were communicating with children and adolescents and their parents. Additionally, paediatricians rated differentiating between non-pathologic and clinically relevant behaviour problems very relevant, while GPs considered basic psychotherapeutic skills essential. The CAP-related knowledge and skills perceived relevant for doctors in primary care differ from the majority of current medical school CAP curricula, which cover mainly typical, epitomic CAP disorders and are predominantly knowledge-oriented. Therefore, medical education in CAP should be amended to reflect the needs of PCPs to improve healthcare for children and adolescents with mental health problems. PMID:26250895

  19. Child and adolescent psychiatry: which knowledge and skills do primary care physicians need to have? A survey in general practitioners and paediatricians.

    Science.gov (United States)

    Lempp, Thomas; Heinzel-Gutenbrunner, Monika; Bachmann, Christian

    2016-04-01

    Primary care physicians (PCPs) play a key role in the initial assessment and management of children and adolescents with mental health problems. However, it is unclear whether current medical education curricula sufficiently equip PCPs for this task. The aim of this study was to investigate, which child and adolescent psychiatry (CAP)-related skills and knowledge PCPs say they require in their daily practice. A questionnaire was generated, employing a modified two-step Delphi approach. Besides socio-demographic items, the questionnaire contained 17 CAP-related knowledge items and 13 CAP-related skills items, which had to be rated by importance in daily practice. The questionnaire was distributed to 348 office-based paediatricians and 500 general practitioners (GPs) in Germany. The overall return rate was 51.3% (435/848). Regarding CAP-related knowledge, both paediatricians and GPs rated somatoform disorders and obesity as highly important for daily practice. Moreover, paediatricians also deemed regulatory disorders during infancy (e.g. crying, sleep disorders) as important, while GPs assessed knowledge on paediatric depression as relevant. For paediatricians and GPs, the most relevant CAP-related skills were communicating with children and adolescents and their parents. Additionally, paediatricians rated differentiating between non-pathologic and clinically relevant behaviour problems very relevant, while GPs considered basic psychotherapeutic skills essential. The CAP-related knowledge and skills perceived relevant for doctors in primary care differ from the majority of current medical school CAP curricula, which cover mainly typical, epitomic CAP disorders and are predominantly knowledge-oriented. Therefore, medical education in CAP should be amended to reflect the needs of PCPs to improve healthcare for children and adolescents with mental health problems.

  20. The use and effectiveness of electronic clinical decision support tools in the ambulatory/primary care setting: a systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Cathy Bryan

    2008-07-01

    Conclusion Although there is validation that CDSS has the potential to produce statistically significant improvement in outcomes, there is much variability among the types and methods of CDSS implementation and resulting effectiveness. As CDSS will likely continue to be at the forefront of the march toward effective standards-based care, more work needs to be done to determine effective implementation strategies for the use of CDSS across multiple settings and patient populations.

  1. Ambulatory surgery for the patient with breast cancer: current perspectives

    OpenAIRE

    Tan, Ern Yu; Pek, Chong Han; Tey,Boon Lim, John

    2016-01-01

    Chong Han Pek,1 John Tey,2 Ern Yu Tan1 1Department of General Surgery, 2Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore Abstract: Ambulatory breast cancer surgery is well accepted and is the standard of care at many tertiary centers. Rather than being hospitalized after surgery, patients are discharged on the day of surgery or within 23 hours. Such early discharge does not adversely affect patient outcomes and has the added benefit...

  2. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    OpenAIRE

    Wong, Jean; Shah, Ushma; Wong, David

    2015-01-01

    Ushma Shah, David T Wong, Jean Wong Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada Abstract: Most surgeries in North America are performed on an ambulatory basis, reducing health care costs and increasing patient comfort. Patient satisfaction is an important outcome indicator of the quality of health care services incorporated by the American Society of Anesthesiologists (ASA). Patient satisfaction is a complex concep...

  3. A Librarian Consultation Service Improves Decision-Making and Saves Time for Primary Care Practitioners. A Review of: McGowan, Jessie, William Hogg, Craig Campbell, and Margo Rowan. “Just-in-Time Information Improved Decision-Making in Primary Care: A Randomized Controlled Trial.” PLoS ONE 3.11 (2008): e3785. 10 Mar 2009

    OpenAIRE

    Heather Ganshorn

    2009-01-01

    Objectives – To determine whether a point-of-care librarian consultation service for primary care practitioners (PCPs) improves the quality of PCPs’ decision-making; saves PCPs time; reduces the number of point-of-care questions that go unanswered due to time constraints; and is cost-effective. Overall PCP satisfaction with the service was also assessed.Design – Randomized controlled trial.Setting – Four Family Health Networks (FHNs) and 14 Family Health Groups (FHGs) in Ontario, Canada. Thes...

  4. Biomedical Wireless Ambulatory Crew Monitor

    Science.gov (United States)

    Chmiel, Alan; Humphreys, Brad

    2009-01-01

    A compact, ambulatory biometric data acquisition system has been developed for space and commercial terrestrial use. BioWATCH (Bio medical Wireless and Ambulatory Telemetry for Crew Health) acquires signals from biomedical sensors using acquisition modules attached to a common data and power bus. Several slots allow the user to configure the unit by inserting sensor-specific modules. The data are then sent real-time from the unit over any commercially implemented wireless network including 802.11b/g, WCDMA, 3G. This system has a distributed computing hierarchy and has a common data controller on each sensor module. This allows for the modularity of the device along with the tailored ability to control the cards using a relatively small master processor. The distributed nature of this system affords the modularity, size, and power consumption that betters the current state of the art in medical ambulatory data acquisition. A new company was created to market this technology.

  5. Diagnosis and treatment of headache in the ambulatory care setting: a review of classic presentations and new considerations in diagnosis and management.

    Science.gov (United States)

    Hale, Natalie; Paauw, Douglas S

    2014-05-01

    Headaches represent the most common constellation of neurologic disorders and are a very common cause of morbidity, lost work time, and decreased quality of life among sufferers. In this article, the diagnostic features, workup, and treatment of common, nuanced, and difficult-to-diagnose headache conditions were addressed. The future will hold a number of changes, with respect to both the diagnosis and treatment of headache disorders. As the aging population continues to grow, primary care providers will need to become increasingly familiar with differentiating between benign primary and more serious secondary headache disorders and will need to be able to treat the headache disorders unique to the elderly. With respect to therapeutic options, the future for treatment of the various headache disorders is promising. With the rise in popularity of complementary medical practices, there is likely to be more research on the roles of acupuncture, herbal and alternative remedies, massage therapy, and mind-body techniques. Further, new research is suggesting that neurostimulation may be useful in certain chronic, intractable headache conditions. Finally, the pathophysiology of headache disorders is still poorly understood and there is great hope that better understanding of the underlying mechanics of headache might contribute to improved treatment modalities and better quality of life for patients. PMID:24758958

  6. Indicadores da qualidade dos registros e da assistência ambulatorial em Maringá, (estado do Paraná, Brasil, 1991: um exercício de avaliação Indicators of quality for medical records and ambulatory care in Maringá (state of Paraná, Brazil, 1991: an exercise in evaluation

    Directory of Open Access Journals (Sweden)

    Maria José Scochi

    1994-09-01

    Full Text Available Buscou-se indicadores de qualidade da assistência passíveis de análise a partir de registros rotineiros na rede ambulatorial de serviços de saúde da Secretaria Municipal de Saúde de Maringá, Paraná (Brasil. Foram avaliados os atendimentos realizados em três Núcleos Integrados de Saúde (NIS com o objetivo de verificar se o que foi registrado permite a formulação de indicadores de qualidade. Pesquisou-se todos os prontuários dos 7.813 pacientes atendidos durante o mês de outubro de 1991. Foram formulados indicadores de qualidade de registro, procedência da clientela, demanda, cobertura e resolutividade por unidade de saúde. Em 49,7% dos prontuários, as hipóteses diagnósticas (HD estavam ausentes e em 14,8% haviam HD ilegíveis; 78% dos atendimentos foram destinados a moradores que residiam na área de abrangência das unidades; a cobertura de gestantes foi baixa 37%; 70% das crianças menores de um ano da comunidade foram atendidas no mês, e as pessoas atendidas tiveram em média três consultas médicas no ano precedente, 4,3% dos prontuários dos usuários atendidos apresentava registro de encaminhamentos para outros serviços. Os prontuários nestes três núcleos funcionam precariamente como fonte de informação, tanto para uso interno como para avaliação. Apesar destas insuficiências foi possível extrair alguns indicadores de qualidade, sendo necessário, melhoras significativas na qualidade do preenchimento, para sustentar avaliações mais aprofundadas.This study sought to establish health-care quality indicators based on data from routine clinical records produced by the Municipal Health Department in Maringá, Paraná State. Records for 7813 patients seen in the month of October 1991 at three Integrated Health Centers (IHC were assessed to determine whether the recorded information allowed for the formulation of quality indicators. Indicators of data quality, demand, coverage, resolubility, and geographic

  7. Science Translational Medicine – improving human health care worldwide by providing an interdisciplinary forum for idea exchange between basic scientists and clinical research practitioners

    Directory of Open Access Journals (Sweden)

    Forsythe, Katherine

    2010-09-01

    Full Text Available Science Translational Medicine’s mission is to improve human health care worldwide by providing a forum for communication and interdisciplinary idea exchange between basic scientists and clinical research practitioners from all relevant established and emerging disciplines. The weekly journal debuted in October 2009 and is published by the American Association for the Advancement of Science (AAAS, the publisher of Science and Science Signaling. The journal features peer-reviewed research articles, perspectives and commentary, and is guided by an international Advisory Board, led by Chief Scientific Adviser, Elias A. Zerhouni, M.D., former Director of the National Institutes of Health, and Senior Scientific Adviser, Elazer R. Edelman, M.D., Ph.D., Thomas D. and Virginia W. Cabot Professor of Health Sciences and Technology, Massachusetts Institute of Technology. The Science Translational Medicine editorial team is led by Katrina L. Kelner, Ph.D., AAAS. A profound transition is required for the science of translational medicine. Despite 50 years of advances in our fundamental understanding of human biology and the emergence of powerful new technologies, the rapid transformation of this knowledge into effective health measures is not keeping pace with the challenges of global health care. Creative experimental approaches, novel technologies, and new ways of conducting scientific explorations at the interface of established and emerging disciplines are now required to an unprecedented degree if real progress is to be made. To aid in this reinvention, Science and AAAS have created a new interdisciplinary journal, Science Translational Medicine. The following interview exemplefies the pioneering content found in Science Translational Medicine. It is an excerpt from a Podcast interview with Dr. Samuel Broder, former director of the National Cancer Institute and current Chief Medical Officer at Celera. The Podcast was produced in tangent with Dr

  8. Wound care in horses.

    Science.gov (United States)

    Caston, Stephanie S

    2012-04-01

    Care of equine wounds in the field can be a challenging endeavor. Many times, wound care is complicated by chronicity or by prior inappropriate care in addition to the great degree of tissue trauma that occurred when the horse was wounded. Recognizing involvement of synovial structures, loss of skin, and damage to bone are critical in the initial examination of wounds and will guide future care. Education of clients is also important in that preparing them for possible outcomes during healing may help improve compliance and proper treatment of wound. Owners and trainers often perform much of the daily care and monitoring of equine wounds and thus can greatly assist or impede the progress. Bandaging is important to management of equine wounds-especially on the limbs-and is sometimes overlooked because of its labor-intensive nature and the desire for a spray, ointment, or salve that will heal the wound. The practitioner that improves and utilizes his or her understanding of the wound-healing process in concert with his or her knowledge of local anatomy will be the one who is best equipped to care for wounds in ambulatory practice.

  9. Management of comorbidities in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Dabu-Bondoc S

    2015-06-01

    Full Text Available Susan Dabu-Bondoc, Kirk Shelley Department of Anesthesiology, School of Medicine, Yale University, New Haven, CT, USAAbstract: Advances in medical science now allow people with significant medical issues to live at home. As the outpatient population ages and surgical techniques advance, the ambulatory anesthesiologist has to be prepared to handle these “walking wounded”. The days of restricting ambulatory surgery procedures to American Society of Anesthesiologists class 1 and 2 patients are rapidly fading into the past. To remain competitive and economically viable, the modern ambulatory surgery center needs to expand its practice to include patients with medical comorbidities. In an environment where production and economic pressures exist, maintaining safety and good outcomes in high-risk patients for ambulatory surgery can be arduous. Adding to the complexity of this challenge is the rapid evolution of the therapeutic approaches to a variety of medical issues. For example, there has been a significant increase in the number and types of insulin a diabetic patient might be prescribed in recent years. In the case of the patient with coronary artery disease, the variety of both drug and nondrug eluding stents or new antithrombotic agents has also increased the complexity of perioperative management. Complex patients need careful, timely, and team-based preoperative evaluation by an anesthesia provider who is knowledgeable of outpatient care. Optimizing comorbidities preoperatively is a crucial initial step in minimizing risk. This paper will examine a number of common medical issues and explore their impact on managing outpatient surgical procedures.Keywords: ambulatory surgery, medical comorbidities, diabetes, coronary artery disease, respiratory disease, obesity

  10. Health system support and health system strengthening: two key facilitators to the implementation of ambulatory tuberculosis treatment in Uzbekistan.

    Science.gov (United States)

    Kohler, Stefan; Asadov, Damin Abdurakhimovich; Bründer, Andreas; Healy, Sean; Khamraev, Atadjan Karimovich; Sergeeva, Natalia; Tinnemann, Peter

    2015-12-01

    Uzbekistan inherited a hospital-based health system from the Soviet Union. We explore the health system-related challenges faced during the scale-up of ambulatory (outpatient) treatment for drug-susceptible and drug-resistant tuberculosis (TB) in Karakalpakstan in Uzbekistan. Semi-structured interviews were conducted with key informants of the TB services, the ministries of health and finance, and their TB control partners. Structural challenges and resource needs were both discussed as obstacles to the expansion of ambulatory TB treatment. Respondents stated need for revising the financing mechanisms of the TB services to incentivize referral to ambulatory TB treatment. An increased workload and need for transportation in ambulatory TB care were also pointed out by respondents, given the quickly rising outpatient numbers but per capita financing of outpatient care. Policy makers showed strong interest in good practice examples for financing ambulatory-based management of TB in comparable contexts and in guidance for revising the financing of the TB services in a way that strengthens ambulatory TB treatment. To facilitate changing the model of care, TB control strategies emphasizing ambulatory care in hospital-oriented health systems should anticipate health system support and strengthening needs, and provide a plan of action to resolve both. Addressing both types of needs may require not only involving TB control and health financing actors, but also increasing knowledge about viable and tested financing mechanisms that incentivize the adoption of new models of care for TB. PMID:27406392

  11. Characteristics of ambulatory anticoagulant adverse drug events: a descriptive study

    Directory of Open Access Journals (Sweden)

    Eckstrand Julie

    2010-02-01

    Full Text Available Abstract Background Despite the high frequency with which adverse drug events (ADEs occur in outpatient settings, detailed information regarding these events remains limited. Anticoagulant drugs are associated with increased safety concerns and are commonly involved in outpatient ADEs. We therefore sought to evaluate ambulatory anticoagulation ADEs and the patient population in which they occurred within the Duke University Health System (Durham, NC, USA. Methods A retrospective chart review of ambulatory warfarin-related ADEs was conducted. An automated trigger surveillance system identified eligible events in ambulatory patients admitted with an International Normalized Ratio (INR >3 and administration of vitamin K. Event and patient characteristics were evaluated, and quality/process improvement strategies for ambulatory anticoagulation management are described. Results A total of 169 events in 167 patients were identified from December 1, 2006-June 30, 2008 and included in the study. A median supratherapeutic INR of 6.1 was noted, and roughly half of all events (52.1% were associated with a bleed. Nearly 74% of events resulted in a need for fresh frozen plasma; 64.8% of bleeds were classified as major. A total of 59.2% of events were at least partially responsible for hospital admission. Median patient age was 68 y (range 36-95 y with 24.9% initiating therapy within 3 months prior to the event. Of events with a prior documented patient visit (n = 157, 73.2% were seen at a Duke clinic or hospital within the previous month. Almost 80% of these patients had anticoagulation therapy addressed, but only 60.0% had a follow-up plan documented in the electronic note. Conclusions Ambulatory warfarin-related ADEs have significant patient and healthcare utilization consequences in the form of bleeding events and associated hospital admissions. Recommendations for improvement in anticoagulation management include use of information technology to assist

  12. Replacing Ambulatory Surgical Follow-Up Visits With Mobile App Home Monitoring: Modeling Cost-Effective Scenarios

    OpenAIRE

    Armstrong, Kathleen A; Semple, John L; Coyte, Peter C.

    2014-01-01

    Background Women’s College Hospital (WCH) offers specialized surgical procedures, including ambulatory breast reconstruction in post-mastectomy breast cancer patients. Most patients receiving ambulatory surgery have low rates of postoperative events necessitating clinic visits. Increasingly, mobile monitoring and follow-up care is used to overcome the distance patients must travel to receive specialized care at a reduced cost to society. WCH has completed a feasibility study using a mobile ap...

  13. Forecasting the nursing workforce in a dynamic health care market.

    Science.gov (United States)

    Dumpe, M L; Herman, J; Young, S W

    1998-01-01

    The ability to discern the interacting factors that affect supply and demand for nurses could help nurse educators and nurse leaders allocate resources to meet these needs. Forecasting models must take into account the interactions of three crucial groups of health care providers--physicians, nurse practitioners, and physician's assistants. Buerhaus has noted that market size, wages, preferences for nursing services, and availability of substitutes influence the demand for nursing services. Changes in nurse supply resulting from Medicare reimbursement for nursing services have not been studied, though it could safely be projected that such reimbursement will increase nurse supply. Nurses with baccalaureate degrees and advanced practice preparation will be in the greatest demand in ambulatory care, managed care, public health, and home care settings, raising concerns again that the educational mix is in need of adjustment upwards. PMID:9748982

  14. Towards ambulatory mental stress measurement from physiological parameters

    NARCIS (Netherlands)

    Wijsman, Jacqueline; Vullers, Ruud; Polito, Salvatore; Agell, Carlos; Penders, Julien; Hermens, Hermie

    2013-01-01

    Ambulatory mental stress monitoring requires longterm physiological measurements. This paper presents a data collection protocol for ambulatory recording of physiological parameters for stress measurement purposes. We present a wearable sensor system for ambulatory recording of ECG, EMG, respiration

  15. Characteristics of primary care office visits to nurse practitioners, physician assistants and physicians in United States Veterans Health Administration facilities, 2005 to 2010: a retrospective cross-sectional analysis

    Directory of Open Access Journals (Sweden)

    Morgan Perri A

    2012-11-01

    Full Text Available Abstract Background Primary care, an essential determinant of health system equity, efficiency, and effectiveness, is threatened by inadequate supply and distribution of the provider workforce. The Veterans Health Administration (VHA has been a frontrunner in the use of nurse practitioners (NPs and physician assistants (PAs. Evaluation of the roles and impact of NPs and PAs in the VHA is critical to ensuring optimal care for veterans and may inform best practices for use of PAs and NPs in other settings around the world. The purpose of this study was to characterize the use of NPs and PAs in VHA primary care and to examine whether their patients and patient care activities were, on average, less medically complex than those of physicians. Methods This is a retrospective cross-sectional analysis of administrative data from VHA primary care encounters between 2005 and 2010. Patient and patient encounter characteristics were compared across provider types (PA, NP, and physician. Results NPs and PAs attend about 30% of all VHA primary care encounters. NPs, PAs, and physicians fill similar roles in VHA primary care, but patients of PAs and NPs are slightly less complex than those of physicians, and PAs attend a higher proportion of visits for the purpose of determining eligibility for benefits. Conclusions This study demonstrates that a highly successful nationwide primary care system relies on NPs and PAs to provide over one quarter of primary care visits, and that these visits are similar to those of physicians with regard to patient and encounter characteristics. These findings can inform health workforce solutions to physician shortages in the USA and around the world. Future research should compare the quality and costs associated with various combinations of providers and allocations of patient care work, and should elucidate the approaches that maximize quality and efficiency.

  16. Common mental health disorders in children and adolescents in primary care: A survey of knowledge, skills and attitudes among general practitioners in a newly developed European country

    OpenAIRE

    Kurt Buhagiar; Cassar, Joseph R.

    2012-01-01

    Background and Objectives: General Practitioners (GPs) are generally the first point of contact for children and adolescents with mental health problems. This study investigates the confidence, beliefs, and knowledge of GPs regarding common mental health problems in youngsters. Methods: A self-designed questionnaire was distributed to nearly all registered GPs in a middle-income European country in order to address the aims of the study. Results: Response rate was 58%. Many GPs reported relat...

  17. Accuracy of general practitioner unassisted detection of depression

    OpenAIRE

    Carey, Mariko; Jones, Kim; Meadows, Graham; Sanson-Fisher, Rob; D’Este, Catherine; Inder, Kerry; Yoong, Sze Lin; Russell, Grant

    2014-01-01

    Objective: Primary care is an important setting for the treatment of depression. The aim of the study was to describe the accuracy of unassisted general practitioner judgements of patients’ depression compared to a standardised depression-screening tool delivered via touch-screen computer. Method: English-speaking patients, aged 18 or older, completed the Patient Health Questionnaire-9 (PHQ-9) when presenting for care to one of 51 general practitioners in Australia. General practitioners were...

  18. 预警干预护理在预防脑卒中卧床患者褥疮发病中的应用%Warning intervention in the prevention of stroke care in ambulatory patients bedsore incidence Application

    Institute of Scientific and Technical Information of China (English)

    白洁琼

    2013-01-01

    目的:对脑卒中卧床患者实施预警干预护理,探讨和分析其预防患者发生褥疮的效果。方法:对我院此次收治的100例脑卒中卧床患者,根据Braden评分法来对患者发生褥疮的危险度进行预测。同时按照分值来进行分组,分为试验组和对照组,各为50例。对照组:对患者采用传统型的分级护理;试验组:对患者采用预警干预护理。结果:试验组:发生褥疮的患者为2例,占4.0%;其中I期1例,II期1例。对照组:发生褥疮的患者为7例,占14.0%;其中I期5例, II期2例。试验组患者发生褥疮的几率明显低于对照组,差异显著,具有统计学意义(P<0.05)。结论:在临床上,对脑卒中卧床患者采用Braden评分法进行预警干预护理,降低患者发生褥疮的几率,促进患者的康复,提高患者的生活质量。%Objective:Implementation of stroke warning intervention nursing bedridden patients to explore and analyze their preventive effect in patients with bedsores. Method:The admit ed in our hospital 100 cases of stroke bedridden patients, according to Braden score for patients to predict the risk of bedsores. Grouped according to both scores were divided into experimental and control groups, each of 50 cases. Control group: patients using traditional type of grading nursing; experimental group: nursing interventions for patients with early warning. Results:The experimental group:patients with pressure ulcers occur in 2 cases, accounting for 4.0%;including one case of stage I, II stage 1 case. Control group:patients with bedsores 7 cases, accounting for 14.0%;including five cases of stage I, II Phase 2 cases. Experimental group were significantly lower than the probability of occurrence of bedsores control group, the difference was significant, with statistical significance (P<0.05). Conclusions: In clinical practice, ambulatory patients with stroke using the Braden score early warning

  19. Infection prevention and control practitioners: improving engagement.

    Science.gov (United States)

    Aziz, Ann-Marie

    Every healthcare worker plays a vital part in minimising the risk of cross infection. Infection prevention and control (IPC) practitioners have the skills and competencies to assist organisations in improving engagement among staff and play a vital part in achieving this. IPC practitioners have skills in clinical practice, education, research and leadership, and these skills ensure high-quality care for patients and support strategies for engaging staff. This article highlights how IPC practitioners' skills and competencies are required for preventing infection and improving staff engagement. Engaged staff generate positive outcomes for both patients and staff, which is a welcome result for all healthcare organisations.

  20. Prevalência de dislipidemias na demanda laboratorial de três diferentes prestadores de assistência Prevalence of dyslipidemias in adult ambulatory laboratory tests from different health care providers

    Directory of Open Access Journals (Sweden)

    Ines Lessa

    1998-05-01

    Full Text Available OBJETIVO: Detectar diferenças nas prevalências das dislipidemias em adultos da demanda laboratorial de três diferentes prestadores de assistência médica, em Salvador, 1995. MÉTODOS: Estudo seccional, clínico epidemiológico, baseado em resultados das dosagens de lípides séricos de uma amostra probabilística de 25% dos 104 laboratórios que usavam o mesmo método de dosagem e o mesmo padrão para controle de qualidade. O critério de dislipidemia foi o do II Consenso Brasileiro de Dislipidemias para adultos. Os resultados foram agrupados conforme procedência: Sistema Único de Saúde (SUS, convênios (C e seguros privados + particulares (SP. Análise: prevalência com intervalos de confiança (IC a 95%, e teste do chi². RESULTADOS: Dos 5.464 adultos com menção da procedência, 14,8% foram do SUS, 31,6% dos C e 53,6% dos S+P. As mais elevadas prevalências de hipercolesterolemia - 28,0% (IC 24,0; 32,0 e de LDL-c elevado - 30,4% (IC 27,6; 33,2 foram detectadas no grupo C. No grupo S+P concentraram-se as maiores prevalências de HDL-c anormal - 12,3% (IC 10,0; 13,8 e hipertrigliceridemia - 17,8% (IC 16,3; 19,3. Quase todas as diferenças entre as prevalências foram estatisticamente significantes, favoráveis às taxas mais baixas do SUS. CONCLUSÃO: O melhor perfil lipídico do grupo SUS sugere diferenças sociais nas prevalências das dislipidemias. Para os três prestadores de assistência, a prevalência do HDL-c OBJECTIVE: To detect differences in the prevalence of dyslipidemia in adult ambulatory laboratory tests from three different health care providers, in Salvador-Brazil, 1995. METHODS: The study was carried out using a probabilistic sample of 24 out of 104 laboratories (@25% which performed the same enzymatic method for lipid tests with the same quality control. Laboratory tests results were separated into three groups, according to health care provider: Sistema Único de Saúde (SUS, governamental, Health Maintenance

  1. Surgical Site Infection Surveillance Following Ambulatory Surgery

    OpenAIRE

    Rhee, Chanu; Huang, Susan S.; Berríos-Torres, Sandra I.; Kaganov, Rebecca; Bruce, Christina; Lankiewicz, Julie; Platt, Richard; Yokoe, Deborah S.

    2015-01-01

    We assessed 4045 ambulatory surgery patients for surgical site infection (SSI) using claims-based triggers for medical chart review. Of 98 patients flagged by codes suggestive of SSI, 35 had confirmed SSIs. SSI rates ranged from 0 to 3.2% for common procedures. Claims may be useful for SSI surveillance following ambulatory surgery.

  2. Costs of coordinated versus uncoordinated care in Germany: results of a routine data analysis in Bavaria

    Science.gov (United States)

    Schneider, Antonius; Donnachie, Ewan; Tauscher, Martin; Gerlach, Roman; Maier, Werner; Mielck, Andreas; Linde, Klaus; Mehring, Michael

    2016-01-01

    Objectives The efficiency of a gatekeeping system for a health system, as in Germany, remains unclear particularly as access to specialist ambulatory care is not restricted. The aim was to compare the costs of coordinated versus uncoordinated patients (UP) in ambulatory care; with additional subgroup analysis of patients with mental disorders. Design Retrospective routine data analysis of patients with statutory health insurance, using claims data held by the Bavarian Association of Statutory Health Insurance Physicians. A patient was defined as uncoordinated if he or she visited at least 1 specialist without a referral from a general practitioner within a quarter. Outcomes were compared with propensity score matching analysis. Participants The study encompassed all statutorily insured patients in Bavaria contacting at least 1 ambulatory specialist in the first quarter of 2011 (n=3 616 510). Primary and secondary outcome measures Primary outcome was total costs of ambulatory care; secondary outcomes were financial claims of general physicians, specialists and for medication. Results The average age was 55.3 years for coordinated patients (CP, n=1 629 302), 48.3 years for UP (n=1 825 840). CP more frequently had chronic diseases (85.4%) as compared with UP (67.5%). The total unadjusted financial claim per patient was higher for UP (€234.52) than for CP (€224.41); the total adjusted difference was −€9.65 (95% CI −11.64 to −7.67), indicating lower costs for CP. The cost differences increased with increasing age. Total adjusted difference per patient with mental diseases as documented with an International Classification of Diseases (ICD)-10 F-diagnosis, was −€20.31 (95% CI −26.43 to −14.46). Conclusions Coordination of care is associated with lower ambulatory healthcare expenditures and is of particular importance for patients who are more vulnerable to medical interventions, especially for elderly and patients with mental disorders

  3. Advance directives: role of nurse practitioners.

    Science.gov (United States)

    Schlenk, J S

    1997-07-01

    Advance directives are documents that guide end of life decisions. Although advance directives are a fairly recent phenomenon in health care, they are grounded in both legal and ethical principles. Studies show few people have completed advance directives. Persons do not tend to complete advance directives for various reasons. Lack of knowledge has been identified, as well as belief that physicians should initiate the discussion and that the topic is appropriate only for the elderly or those in poor health. Many nurse practitioners practice in primary care settings, which are ideal for discussions about advance directives. Nurse practitioners possess the opportunities and skills to discuss advance directives with their patients.

  4. A Review of System-Level and Practitioner Relevant Factors That Improve Access to Primary Dental Care for Children Living in Vulnerable Contexts

    OpenAIRE

    Serrato Solis, Kayla M.

    2015-01-01

    The distribution of childhood caries and dental surgery in BC and Canada is inequitable and is a potential indicator of limited access to prevention and treatment through primary dental care. This paper focuses on different ways to improve access to primary dental care, specifically with an interest in better meeting the needs of children 0-18 years of age living in vulnerable contexts. Findings from this research indicate that policies and investment strategies that reduce the cost of primar...

  5. Guidance for Practitioners on the Use of Antiviral Drugs to Control Influenza Outbreaks in Long-Term Care Facilities in Canada, 2014-2015 Season

    OpenAIRE

    Fred Y Aoki; Allen, Upton D.; H Grant Stiver; Michel Laverdière; Danuta Skowronski; Evans, Gerald A

    2015-01-01

    The AMMI Canada Guidelines document ‘The use of antiviral drugs for influenza: A foundation document for practitioners’, published in the Autumn 2013 issue of the Journal, outlines the recommendations for the use of antiviral drugs to treat influenza. This article, which represents the first of two updates to these guidelines published in the current issue of the Journal, aims to inform health care professionals of the increased risk for influenza in long-term care facilities due to a documen...

  6. 75 FR 14606 - Medicare Program; Request for Nominations to the Advisory Panel on Ambulatory Payment...

    Science.gov (United States)

    2010-03-26

    ...; Center for Medicare Management, Hospital & Ambulatory Policy Group, Division of Outpatient Care; 7500... components of the Medicare hospital Outpatient Prospective Payment System (OPPS). The Charter requires that... consist of a chair and up to 15 members who are full- time employees of hospitals, hospital systems,...

  7. A systematic review of professional supervision experiences and effects for allied health practitioners working in non-metropolitan health care settings

    Directory of Open Access Journals (Sweden)

    Ducat WH

    2015-08-01

    Full Text Available Wendy H Ducat,1,3 Saravana Kumar2 1Cunningham Centre, Darling Downs Hospital and Health Service, Australia; 2School of Health Sciences, International Centre for Allied Health Evidence, Sansom Institute, University of South Australia, Adelaide, SA, Australia; 3Rural Clinical School, School of Medicine, University of Queensland, Brisbane, QLD, Australia Introduction: In regional, rural, and remote settings, allied health professional supervision is one organizational mechanism designed to support and retain the workforce, provide clinical governance, and enhance service delivery. A systematic approach to evaluating the evidence of the experience and effects of professional supervision for non-metropolitan allied health practitioners and their service delivery is needed. Methods: Studies investigating the experience and effects of professional supervision across 17 allied health disciplines in non-metropolitan health services were systematically searched for using standardized keywords across seven databases. The initial search identified 1,574 references. Of these studies, five met inclusion criteria and were subject to full methodological appraisal by both reviewers. Two studies were primarily qualitative with three studies primarily quantitative in their approach. Studies were appraised using McMaster critical appraisal tools and data were extracted and synthesized. Results: Studies reported the context specific benefits and challenges of supervision in non-metropolitan areas and the importance of supervision in enhancing satisfaction and support in these areas. Comparison of findings between metropolitan and non-metropolitan settings within one study suggested that allied health in non-metropolitan settings were more satisfied with supervision though less likely to access it and preferred supervision with other non-metropolitan practitioners over access to more experienced supervisors. One study in a regional health service identified the lack

  8. Outcomes associated with nurse practitioners in collaborative practice with general practitioners in rural settings in Canada: a mixed methods study

    OpenAIRE

    Roots, Alison; MacDonald, Marjorie

    2014-01-01

    Background The formalized nurse practitioner (NP) role in British Columbia is relatively new with most roles implemented in primary care. The majority of primary care is delivered by physicians using the fee-for-service model. There is a shortage of general practitioners associated with the difficulties of recruitment and retention, particularly in rural and remote locations. The uptake of the primary care NP role has been slow due to challenges in understanding the extent of its contribution...

  9. Setting up of ambulatory hysteroscopy service.

    Science.gov (United States)

    Kolhe, Shilpa

    2015-10-01

    There is an obvious trend towards developing ambulatory procedures in gynaecology with ambulatory hysteroscopy as its mainstay. In the recent years, the fast pace of modern technological advances in gynaecologic endoscopy, and particularly in the field of hysteroscopy, have been both thrilling and spectacular. Despite this, the uptake of operative hysteroscopy in ambulatory settings has been relatively slow. There is some apprehension amongst gynaecologists to embark on therapeutic outpatient hysteroscopy, and an organisational change is required to alter the mindset. Although there are best practice guidelines for outpatient hysteroscopy, there are unresolved issues around adequate training and accreditation of future hysteroscopists. Virtual-reality simulation training for operative hysteroscopy has shown promising preliminary results, and it is being aggressively evaluated and validated. This review article is an attempt to provide a useful practical guide to all those who wish to implement ambulatory hysteroscopy services in their outpatient departments. PMID:25979350

  10. Consultations between Immigrant Patients, Their Interpreters, and Their General Practitioners: Are They Real Meetings or Just Encounters? A Qualitative Study in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Eivor Wiking

    2013-01-01

    Full Text Available Objective. In Sweden, about 19% of residents have a foreign background. Previous studies reported immigrant patients experience communication difficulties despite the presence of interpreters during consultations. The objective of this study was to gain insights into the participants’ perceptions and reflections of the triangular meeting by means of in-depth interviews with immigrant patients, interpreters, and general practitioners (GPs. Method. A total of 29 participants—10 patients, 9 interpreters, and 10 GPs—participated in face-to-face interviews. Content analysis was used to process the interview material. Results. Six themes were generated and arranged under two subject areas: the interpretation process (the means of interpreting and means of informing and the meeting itself (individual tailored approaches, consultation time, the patient’s feelings, and the role of family members. Conclusion. This paper highlights feelings including frustration and insecurity when interpretation and relationships are suboptimal. Strategies for immigrant patients, interpreters, and GPs for getting a successful consultation may be needed. To transform the triangular meeting from an encounter to a real meeting, our results indicate a need for professional interpreters, for GPs to use a patient-tailored approach, and sufficient consultation time. Practice Implications. Use of professional interpreters is recommended, as is developing cultural competence.

  11. Searching for more comprehensive health care records: development, application and assessment of a new tool to register outpatient consultations Buscando um registro mais integral do cuidado à saúde: desenvolvimento, aplicação e avaliação de um novo instrumento de registro da consulta ambulatorial

    Directory of Open Access Journals (Sweden)

    Fabiana Braunstein Bassan

    2010-11-01

    Full Text Available

    The medical record is important for health care since it allows, through the analysis of data collected in several contacts between patients and health units, to appreciate and understand the disease and health care processes. This comprehension will be the more complete, the more the medical record accounts for the patient’s way of living, health-disease processes, investigations and therapeutic procedures, clinical evolution and possible difficulties to follow medical advice – that is, the way health care was/is delivered by different professionals in several sectors. In this sense, the service – and its record as well – must focus on the individual, the person as a whole, living and becoming ill, and not only on his diseases and morbidities. Based on this premise, this study aimed to develop, apply and assess a new tool for outpatient records at the Integral Ambulatory Care (AMI at Pedro Ernesto University.

    O prontuário médico constitui-se em um importante elemento no cuidado à saúde, na medida em que possibilita, por meio do levantamento das informações registradas nos diversos contatos dos indivíduos com as unidades de saúde, uma apreciação e compreensão de seu processo de adoecimento e de cuidado. Tal compreensão será tão mais completa quanto melhor o prontuário tiver registrado os elementos referentes ao seu modo de viver, ao seu processo de saúde-adoecimento, às investigações e condutas terapêuticas tomadas, à evolução clínica, bem como às eventuais dificuldades no atendimento, às orientações recebidas, o modo, enfim, como o cuidado foi ou está sendo prestado pelos diferentes profissionais responsáveis nos diversos setores de uma dada instituição. Para tal, o atendimento . e também o seu registro . deve ter como foco o indivíduo, a pessoa na sua totalidade do viver e adoecer, e não apenas as suas doenças ou o evoluir de suas morbidades. Tendo por foco o eixo acima, o objetivo deste

  12. The multicompetent practitioner: a needs analysis in an urban area.

    Science.gov (United States)

    Low, G; Weisbord, A

    1987-02-01

    This study examined the concept of the multicompetent practitioner - the health care worker trained in more than one specialty - as one way of meeting the changing needs of the health care system. Seventy-four hospital administrators, 74 directors of nursing, 14 directors of community health organizations, and 12 private physicians from the Philadelphia metropolitan area were surveyed to explore the feasibility of developing and using multicompetent practitioners at their participating institutions. The results indicated that multicompetent practitioners are already working in some institutions and that there is a willingness to hire this new type of health care worker. How the multicompetent practitioner fits into the institution, the level of education required beyond the original area of skill, and the question of salary were included in the survey. Findings also indicate positive support for the development of multicompetent practitioner training within allied health educational programs.

  13. Nurse Practitioner Residency Programs: An Educational Journey

    Science.gov (United States)

    Rys, Gregory P.

    2016-01-01

    Primary care is in a state of crisis due to the lack of clinicians and increasing numbers of insured patients. Encouraging more students to go directly through school for their doctor of nursing practice degree and nurse practitioner (NP) certifications is one proposal to alleviate this crisis. However, this approach would deliver graduates with…

  14. Nurse Practitioners' attitude to nutritional challenges dealing with the patients' nutritional needs and ability to care for themselves in a fast track program

    DEFF Research Database (Denmark)

    Graarup, Jytte; Pedersen, Preben Ulrich; Bjerrum, Merete

    2014-01-01

    Background: Nutrition plays an important role to the success of fast track programs, but under nutrition are still reported. Nutritional care seems to be a low priority among nurses even though it is well-known that insufficient nutrition has severe consequences for the patients. The aim is to re...

  15. Ambulatory oral surgery: 1-year experience with 11 680 patients from Zagreb district, Croatia

    Science.gov (United States)

    Jokić, Dražen; Macan, Darko; Perić, Berislav; Tadić, Marinka; Biočić, Josip; Đanić, Petar; Brajdić, Davor

    2013-01-01

    Aim To examine the types and frequencies of oral surgery diagnoses and ambulatory oral surgical treatments during one year period at the Department of Oral Surgery, University Hospital Dubrava in Zagreb, Croatia. Methods Sociodemographic and clinical data on 11 680 ambulatory patients, treated between January 1 and of December 31, 2011 were retrieved from the hospital database using a specific protocol. The obtained data were subsequently analyzed in order to assess the frequency of diagnoses and differences in sex and age. Results The most common ambulatory procedure was tooth extraction (37.67%) and the most common procedure in ambulatory operating room was alveolectomy (57.25%). The test of proportions showed that significantly more extractions (P apicoectomies were performed among female patients (P < 0.001). A greater prevalence of periodontal disease was found in patients residing in Zagreb than in patients residing in rural areas. Conclusion The data from this study may be useful for planning of ambulatory oral surgery services, budgeting, and sustaining quality improvement, enhancing oral surgical curricula, training and education of primary health care doctors and oral surgery specialists, and promoting patients’ awareness of the importance of oral health. PMID:23444246

  16. The organizational and performance effects of nurse practitioner roles

    NARCIS (Netherlands)

    van Offenbeek, MAG; Knip, M

    2004-01-01

    Background. Most studies evaluating the roles of Nurse Practitioners have compared the care delivered by individual Nurse Practitioners with that provided by other professionals. These studies should be complemented by research focusing on a higher unit of analysis, namely the organization of the ca

  17. Collaboration of general practitioners and exercise providers in promotion of physical activity a written survey among general practitioners

    NARCIS (Netherlands)

    Leemrijse, C J; de Bakker, D H; Ooms, L; Veenhof, C

    2015-01-01

    BACKGROUND: General practitioners have an ideal position to motivate inactive patients to increase their physical activity. Most patients are able to exercise in regular local facilities outside the health care setting. The purpose of this study was to get insight into general practitioners percepti

  18. Collaboration of general practitioners and exercise providers in promotion of physical activity a written survey among general practitioners.

    NARCIS (Netherlands)

    Leemrijse, C.J.; Bakker, D.H. de; Ooms, L.; Veenhof, C.

    2015-01-01

    Background: General practitioners have an ideal position to motivate inactive patients to increase their physical activity. Most patients are able to exercise in regular local facilities outside the health care setting. The purpose of this study was to get insight into general practitioners percepti

  19. Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Lucassen PL

    2008-04-01

    Full Text Available Abstract Background Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff. However, none of these interventions focussed on collaboration between GPs and nurses in dementia care. We developed an EASYcare-based Dementia Training Program (DTP aimed at stimulating collaboration in dementia primary care. We expect this program to increase the number of cognitive assessments and dementia diagnoses and to improve attitudes and knowledge of GPs and nurses. Methods The DTP is a complex educational intervention that consists of two workshops, a coaching program, access to an internet forum, and a Computerized Clinical Decision Support System on dementia diagnostics. One hundred duos of GPs and nurses will be recruited, from which 2/3 will be allocated to the intervention group and 1/3 to the control group. The effects of implementation of the DTP will be studied in a cluster-randomised controlled trial. Primary outcomes will be the number of cognitive assessments and dementia diagnoses in a period of 9 months following workshop participation. Secondary outcomes are measured on GP and nurse level: adherence to national guidelines for dementia, attitude, confidence and knowledge regarding dementia diagnosis and management; on patient level: number of emergency calls, visits and consultations and patient satisfaction; and on caregiver level: informal caregiver burden and satisfaction. Data will be collected from GPs' electronic medical records, self-registration forms and questionnaires. Statistical analysis will be performed using the MANOVA-method. Also, exploratory analyses will be performed, in order to gain insight into barriers and facilitators for implementation and

  20. [MODERN EDUCATIONAL TECHNOLOGY MASTERING PRACTICAL SKILLS OF GENERAL PRACTITIONERS].

    Science.gov (United States)

    Kovalchuk, L I; Prokopchuk, Y V; Naydyonova, O V

    2015-01-01

    The article presents the experience of postgraduate training of general practitioners--family medicine. Identified current trends, forms and methods of pedagogical innovations that enhance the quality of learning and mastering the practical skills of primary professionals providing care.

  1. Optimising postoperative pain management in the ambulatory patient.

    Science.gov (United States)

    Shang, Allan B; Gan, Tong J

    2003-01-01

    Over 60% of surgery is now performed in an ambulatory setting. Despite improved analgesics and sophisticated drug delivery systems, surveys indicate that over 80% of patients experience moderate to severe pain postoperatively. Inadequate postoperative pain relief can prolong recovery, precipitate or increase the duration of hospital stay, increase healthcare costs, and reduce patient satisfaction. Effective postoperative pain management involves a multimodal approach and the use of various drugs with different mechanisms of action. Local anaesthetics are widely administered in the ambulatory setting using techniques such as local injection, field block, regional nerve block or neuraxial block. Continuous wound infusion pumps may have great potential in an ambulatory setting. Regional anaesthesia (involving anaesthetising regional areas of the body, including single extremities, multiple extremities, the torso, and the face or jaw) allows surgery to be performed in a specific location, usually an extremity, without the use of general anaesthesia, and potentially with little or no sedation. Opioids remain an important component of any analgesic regimen in treating moderate to severe acute postoperative pain. However, the incorporation of non-opioids, local anaesthetics and regional techniques will enhance current postoperative analgesic regimens. The development of new modalities of treatment, such as patient controlled analgesia, and newer drugs, such as cyclo-oxygenase-2 inhibitors, provide additional choices for the practitioner. While there are different routes of administration for analgesics (e.g. oral, parenteral, intramuscular, transmucosal, transdermal and sublingual), oral delivery of medications has remained the mainstay for postoperative pain control. The oral route is effective, the simplest to use and typically the least expensive. The intravenous route has the advantages of a rapid onset of action and easier titratibility, and so is recommended for the

  2. [Approach to the patient in the ambulatory surgery unit].

    Science.gov (United States)

    Cordero-Ponce, Montserrat; Romero-Sánchez, Isabel María; López-Barea, José; Martínez-Ramos, Pablo

    2008-01-01

    Ambulatory surgery aims to improve the quality of care, provide services in an environment closer to users' normal surroundings, reduce the risk of nosocomial infection and release hospital beds for other uses demanded by the population, thus reducing health costs. Nursing activity in these units should aim to restore health and aid the rapid recovery of patients in their homes. To achieve this, an effective health education program is required. Such programs should be simple and, at the same time, cover the care that these patients will require during the recovery period at home. The unit covers patients in the Virgen de Rocío University Hospital, The Fleming Peripheral Center for Specialties and the Virgen de los Reyes Peripheral Center for Specialties in Seville, Spain and the the specialties included are plastic surgery, otorhinolaryngology, orthopedic surgery, urology, and general surgery. The duration of the education program will be at most 14-17 h.

  3. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Ghisi D

    2015-11-01

    Full Text Available Daniela Ghisi, Stefano Bonarelli Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy Abstract: Spinal anesthesia is a reliable and safe technique for procedures of the lower extremities. Nevertheless, some of its characteristics may limit its use for ambulatory surgery, including delayed ambulation, risk of urinary retention, and pain after block regression. The current availability of short-acting local anesthetics has renewed interest for this technique also in the context of short- and ultra-short procedures. Chloroprocaine (CP is an amino-ester local anesthetic with a very short half-life. It was introduced and has been successfully used for spinal anesthesia since 1952. Sodium bisulfite was then added as a preservative after 1956. The drug was then abandoned in the 1980s for several reports of neurological deficits in patients receiving accidentally high doses of intrathecal CP during epidural labor analgesia. Animal studies have proven the safety of the preservative-free formulation, which has been extensively evaluated in volunteer studies as well as in clinical practice with a favorable profile in terms of both safety and efficacy. In comparison with bupivacaine, 2-chloroprocaine (2-CP showed faster offset times to end of anesthesia, unassisted ambulation, and discharge from hospital. These findings suggests that 2-CP may be a suitable alternative to low doses of long-acting local anesthetics in ambulatory surgery. Its safety profile also suggests that 2-CP could be a valid substitute for intrathecal short- and intermediate-acting local anesthetics, such as lidocaine and mepivacaine – often causes of transient neurological symptoms. In this context, literature suggests a dose ranging between 30 and 60 mg of 2-CP for procedures lasting 60 minutes or less, while 10 mg is considered the no-effect dose. The present review describes recent evidence about 2-CP as an anesthetic agent for

  4. HCUP State Ambulatory Surgery Databases (SASD) - Restricted Access Files

    Data.gov (United States)

    U.S. Department of Health & Human Services — The State Ambulatory Surgery Databases (SASD) contain the universe of hospital-based ambulatory surgery encounters in participating States. Some States include...

  5. Redes integradas, programas de gestão clínica e generalista coordenador: análise das reformas recentes do setor ambulatorial na Alemanha Networks, disease management programs, GP coordinator: analysis of recent ambulatory reforms in Germany

    Directory of Open Access Journals (Sweden)

    Ligia Giovanella

    2011-01-01

    Full Text Available O fortalecimento do papel do generalista na condução e coordenação de cuidados especializados, hospitalares e sociais para garantir a continuidade é tendência observada em reformas de saúde recentes em países europeus. Na Alemanha, a partir da segunda metade da década de noventa, impulsionadas por pressões econômicas, legislação específica e iniciativas dos próprios prestadores, foram desenvolvidas novas estruturas organizacionais e modelos assistenciais com o propósito de integração do sistema de saúde e a coordenação da atenção, na forma de redes de consultórios médicos, modelo generalista coordenador, programas de gestão clínica para agravos específicos e assistência integrada. A partir de revisão bibliográfica, análise documental, visitas a serviços e entrevistas com informantes-chave, o artigo analisa a dinâmica destas mudanças organizacionais no setor ambulatorial alemão. Examinam-se os mecanismos de integração e coordenação propostos, discutem-se os impactos potenciais das novas modalidades organizacionais sobre a eficiência e a qualidade e analisam-se motivos e interesses envolvidos, apontando obstáculos para a implementação. Observa-se processo de reforma incremental com tendência à diversificação do panorama assistencial na Alemanha, com presença de modelos integrados de atenção e fortalecimento do papel do médico generalista na função de coordenação dos cuidados aos pacientes.Strengthening the role of the general practitioner in the conduction and coordination of specialized, inpatient and social care to ensure the continuity is a trend observed in recent health reforms in European countries. In Germany, from the second half of the 1990s, driven by economic pressures, a specific legislation and initiatives of the providers themselves have developed new organizational structures and care models for the purpose of the integration of the health care system and the coordination of

  6. A Practitioner's Commentary

    Science.gov (United States)

    McVey, Richard

    2010-01-01

    I have been delivering the flexible family work approaches outlined in this supplement at Aquarius for the past 8 years. Aquarius is an English Midlands-based addictions charity working with people who have problems with alcohol, drugs, or gambling and supporting their family members/concerned others. I have been a practitioner participating in…

  7. Reflective Practitioner Account

    Institute of Scientific and Technical Information of China (English)

    干青

    2009-01-01

    This article focus on the reflective account of an English teacher learning and teaching in higher education with the British post-graduate certificate program of the Yunnan Agdculture University.As n practitioner for smny years in English learning and teaching for many years,it reflects in four fields.

  8. Orientation of Medical Residents to the Psychosocial Aspects of Primary Care: Influence of Training Program.

    Science.gov (United States)

    Eisenthal, Sherman; And Others

    1994-01-01

    A survey of 63 general medical residents found most accepted the psychosocial role of the primary care physician, found it most appropriate in ambulatory care settings, felt ambivalent about their ability to perform it, and assigned it secondary priority in patient care. More attention by training programs to ambulatory care and psychosocial…

  9. Study of written communication between general practitioners and a community physiotherapist.

    OpenAIRE

    Scaffardi, R A

    1989-01-01

    Previous studies have shown that written communication between hospitals and general practitioners could be improved. This study investigated whether communication problems exist between general practitioners and a community physiotherapist in primary care. Deficiencies were evident in the written referral information received by the physiotherapist. The general practitioners felt they would like to receive feedback information from the physiotherapist after treatment. The information needs o...

  10. Ambulatory Measurement of Ground Reaction Forces

    NARCIS (Netherlands)

    Veltink, Peter H.; Liedtke, Christian; Droog, Ed

    2004-01-01

    The measurement of ground reaction forces is important in the biomechanical analysis of gait and other motor activities. It is the purpose of this study to show the feasibility of ambulatory measurement of ground reaction forces using two six degrees of freedom sensors mounted under the shoe. One se

  11. The Effect of Mobile App Home Monitoring on Number of In-Person Visits Following Ambulatory Surgery: Protocol for a Randomized Controlled Trial

    OpenAIRE

    Armstrong, Kathleen A; Coyte, Peter C.; Bhatia, R Sacha; Semple, John L

    2015-01-01

    Background Women’s College Hospital, Toronto, Canada, offers specialized ambulatory surgical procedures. Patients often travel great distances to undergo surgery. Most patients receiving ambulatory surgery have a low rate of postoperative events necessitating clinic visits. However, regular follow-up is still considered important in the early postoperative phase. Increasingly, telemedicine is used to overcome the distance patients must travel to receive specialized care. Telemedicine data sug...

  12. Predicting recovery at home after Ambulatory Surgery

    Directory of Open Access Journals (Sweden)

    Ayala Guillermo

    2011-10-01

    Full Text Available Abstract The correct implementation of Ambulatory Surgery must be accompanied by an accurate monitoring of the patient post-discharge state. We fit different statistical models to predict the first hours postoperative status of a discharged patient. We will also be able to predict, for any discharged patient, the probability of needing a closer follow-up, or of having a normal progress at home. Background The status of a discharged patient is predicted during the first 48 hours after discharge by using variables routinely used in Ambulatory Surgery. The models fitted will provide the physician with an insight into the post-discharge progress. These models will provide valuable information to assist in educating the patient and their carers about what to expect after discharge as well as to improve their overall level of satisfaction. Methods A total of 922 patients from the Ambulatory Surgery Unit of the Dr. Peset University Hospital (Valencia, Spain were selected for this study. Their post-discharge status was evaluated through a phone questionnaire. We pretend to predict four variables which were self-reported via phone interviews with the discharged patient: sleep, pain, oral tolerance of fluid/food and bleeding status. A fifth variable called phone score will be built as the sum of these four ordinal variables. The number of phone interviews varies between patients, depending on the evolution. The proportional odds model was used. The predictors were age, sex, ASA status, surgical time, discharge time, type of anaesthesia, surgical specialty and ambulatory surgical incapacity (ASI. This last variable reflects, before the operation, the state of incapacity and severity of symptoms in the discharged patient. Results Age, ambulatory surgical incapacity and the surgical specialty are significant to explain the level of pain at the first call. For the first two phone calls, ambulatory surgical incapacity is significant as a predictor for all

  13. Brote por Pseudomonas aeruginosa, en el área de atención ambulatoria de heridas quirúrgicas, en pacientes posmastectomizadas Outbreak of postmastectomy wound infections caused by Pseudomonas aeruginosa in an ambulatory surgical care setting

    Directory of Open Access Journals (Sweden)

    Diana Vilar-Compte

    2003-10-01

    by a ciprofloxacin and gentamycin-resistant P. aeruginosa. The causative Pseudomonas was isolated from a nurse's nostrils and non-sterile gauzes left by her on the Mayo table at the Breast Tumor ambulatory clinic. None of the closed packages was positive to Pseudomonas. On April 14, 2000, the nurse was transferred to another ward and strict infection control practices were established. After this date, 4 additional cases were diagnosed. Radiation therapy was the only risk factor for infection (Or=5.1, 95% cI 1.1-28.4. CONCLUSIONS: This outbreak was probably caused by a common source initially, and later disseminated by cross-infection among patients. The poor compliance with infection control practices during wound cleaning and drainage led to implementing a series of specific preventive interventions.

  14. A Librarian Consultation Service Improves Decision-Making and Saves Time for Primary Care Practitioners. A Review of: McGowan, Jessie, William Hogg, Craig Campbell, and Margo Rowan. “Just-in-Time Information Improved Decision-Making in Primary Care: A Randomized Controlled Trial.” PLoS ONE 3.11 (2008: e3785. 10 Mar 2009

    Directory of Open Access Journals (Sweden)

    Heather Ganshorn

    2009-06-01

    Full Text Available Objectives – To determine whether a point-of-care librarian consultation service for primary care practitioners (PCPs improves the quality of PCPs’ decision-making; saves PCPs time; reduces the number of point-of-care questions that go unanswered due to time constraints; and is cost-effective. Overall PCP satisfaction with the service was also assessed.Design – Randomized controlled trial.Setting – Four Family Health Networks (FHNs and 14 Family Health Groups (FHGs in Ontario, Canada. These represent new models for primary care service delivery in Ontario.Subjects – PCPs working within the selected FHNs and FHGs. The majority of these were physicians, but the sample also contained one resident, one nurse, and four nurse-practitioners.Methods – Subjects were trained in the use of a Web-based query form or mobile device to submit their point-of-care questions electronically. They were also trained in query formulation using PICO (patient, intervention, comparison, and outcome. Allocation was concealed by an independent company hired to manage data for the project. Participants were not randomized; rather the questions were randomized using a random-number generator. To ensure blinding of the librarians, all questions submitted were answered by a librarian. Answers to questions in the intervention group were relayed by a third party to the practitioner within minutes. Answers to the questions in the control group were not communicated to the physician. Blinding of the PCP subjects was not possible, as they either received or did not receive an answer. Subjects were asked to respond to a questionnaire 24 hours after submitting their question. If the question was in the control group, subjects were asked to indicate whether they had let the question remain unanswered or pursued an answer on their own. In order to assess cognitive impact of both librarian-provided information and self-sought information, respondents were asked to rate

  15. Ambulatory surgery center market share and rates of outpatient surgery in the elderly.

    Science.gov (United States)

    Hollenbeck, Brent K; Hollingsworth, John M; Dunn, Rodney L; Zaojun Ye; Birkmeyer, John D

    2010-12-01

    Relative to outpatient surgery in hospital settings, ambulatory surgery centers (ASCs) are more efficient and associated with a lower cost per case. However, these facilities may also spur higher overall procedure utilization and thus lead to greater overall health care costs. The authors used the State Ambulatory Surgery Database from the State of Florida to identify Medicare-aged patients undergoing 4 common ambulatory procedures in 2006, including knee arthroscopy, cystoscopy, cataract removal, and colonoscopy. Hospital service areas (HSAs) were characterized according to ASC market share, that is, the proportion of residents undergoing outpatient surgery in these facilities. The authors then examined relationships between ASC market share and rates of each procedure. Age-adjusted rates of ambulatory surgery ranged from 190.5 cases per 1000 to 320.8 cases per 1000 in HSAs with low and high ASC market shares, respectively (P < .01). For all 4 procedures, adjusted rates of procedures were significantly higher in HSAs with the highest ASC market share. The greatest difference, both in relative and absolute terms, was observed for patients undergoing cystoscopy. In areas of high ASC market share, the age-adjusted rate of cystoscopy was nearly 3-fold higher than in areas with low ASC market share (34.5 vs 11.9 per 1000 population; P < .01). The presence of an ASC is associated with higher utilization of common outpatient procedures in the elderly. Whether ASCs are meeting unmet clinical demand or spurring overutilization is not clear.

  16. Brief Bedside Refresher Training to Practice Cardiopulmonary Resuscitation Skills in the Ambulatory Surgery Center Setting.

    Science.gov (United States)

    Kemery, Stephanie; Kelly, Kelley; Wilson, Connie; Wheeler, Corrine A

    2015-08-01

    Cardiac arrest can occur in any health care setting at any time, requiring nursing staff to be prepared to quickly and adequately perform basic cardiopulmonary resuscitation (CPR). Currently, the American Heart Association certifies health care providers in Basic Life Support (BLS) for a 2-year period, but evidence indicates that psychomotor skills decline well before the end of the certification time frame. Nurses in the ambulatory surgery setting expressed concern regarding their ability to implement CPR successfully, given the infrequent occurrence of cardiac and respiratory arrests. Using a study by Niles et al. as a model, the authors piloted the implementation of brief CPR refresher training at the bedside of an ambulatory surgery center to assess and increase nurse confidence in BLS skills. PMID:26247660

  17. Local Anesthesia Combined With Sedation Compared With General Anesthesia for Ambulatory Operative Hysteroscopy

    DEFF Research Database (Denmark)

    Brix, Lone Dragnes; Thillemann, Theis Muncholm; Nikolajsen, Lone

    2016-01-01

    anesthesia combined with sedation (group LA + S; n = 76) or general anesthesia (group GA; n = 77). Primary outcome was the worst pain intensity score in the postanesthesia care unit (PACU) rated by the patients on a numerical rating scale. FINDING: Data from 144 patients were available for analysis (LA + S...... was shorter (P anesthesia with sedation can be recommended as a first choice anesthetic technique for operative ambulatory hysteroscopy....

  18. Medicare beneficiaries more likely to receive appropriate ambulatory services in HMOs than in traditional medicare.

    Science.gov (United States)

    Ayanian, John Z; Landon, Bruce E; Zaslavsky, Alan M; Saunders, Robert C; Pawlson, L Gregory; Newhouse, Joseph P

    2013-07-01

    With quality-of-care bonus payments now available for Medicare Advantage health maintenance organizations (HMOs) and for accountable care organizations in traditional Medicare, the need to understand the relative quality of care delivered to Medicare enrollees has increased. We compared the quality of ambulatory care from 2003 through 2009 between beneficiaries enrolled in Medicare Advantage HMOs and those enrolled in traditional Medicare, and we assessed how the performance of various types of Medicare HMOs differed from that of traditional Medicare for these same measures. We found that beneficiaries in Medicare HMOs were consistently more likely than those in traditional Medicare to receive appropriate breast cancer screening, diabetes care, and cholesterol testing for cardiovascular disease. We also found that Medicare HMO physicians were rated less favorably by their patients than were physicians in traditional Medicare in 2003; however, by 2009 the opposite was true. Not-for-profit, larger, and older Medicare HMOs performed consistently more favorably on clinical measures and ratings of care than for-profit, smaller, and newer HMOs. Our results suggest that the positive effects of more-integrated delivery systems on the quality of ambulatory care in Medicare HMOs may outweigh the potential incentives to restrict care under capitated payments.

  19. Today's students, tomorrow's practitioners

    DEFF Research Database (Denmark)

    Heape, Chris

    2015-01-01

    There is an inherent dilemma that some research indicates ways and means of doing design practice, in particular how practitioners bring what this paper identifies as informal resources into play, that are seldom reflected in how and what design students are taught or learn. The question is posed...... draw up an alternative understanding of collaborative design practice as participatory inquiry. The paper suggests that participatory inquiry, as it more fully takes into account the learning driven and relational nature of design practice, could help inform alternative design educational strategies....

  20. Ambulatory Healthcare Utilization in the United States: A System Dynamics Approach

    Science.gov (United States)

    Diaz, Rafael; Behr, Joshua G.; Tulpule, Mandar

    2011-01-01

    Ambulatory health care needs within the United States are served by a wide range of hospitals, clinics, and private practices. The Emergency Department (ED) functions as an important point of supply for ambulatory healthcare services. Growth in our aging populations as well as changes stemming from broader healthcare reform are expected to continue trend in congestion and increasing demand for ED services. While congestion is, in part, a manifestation of unmatched demand, the state of the alignment between the demand for, and supply of, emergency department services affects quality of care and profitability. The central focus of this research is to provide an explanation of the salient factors at play within the dynamic demand-supply tensions within which ambulatory care is provided within an Emergency Department. A System Dynamics (SO) simulation model is used to capture the complexities among the intricate balance and conditional effects at play within the demand-supply emergency department environment. Conceptual clarification of the forces driving the elements within the system , quantifying these elements, and empirically capturing the interaction among these elements provides actionable knowledge for operational and strategic decision-making.

  1. Avaliação da qualidade de atendimento ambulatorial em pediatria em um hospital universitário Quality-of-care assessment in a university hospital pediatric clinic

    Directory of Open Access Journals (Sweden)

    Selma Cristina Franco

    1998-01-01

    Full Text Available Estudou-se o ambulatório de Pediatria do Hospital das Clínicas da Unicamp, um serviço didático-assistencial que, inserido no Sistema Único de Saúde, presta assistência secundária e terciária para crianças de 0 a 18 anos. Foram aplicados 221 questionários entre clientes do ambulatório geral de pediatria e de uma de suas especialidades, permitindo comparar diversos indicadores de qualidade da assistência médica prestada. Evidenciou-se um bom nível de conhecimento dos responsáveis pelos usuários sobre seus problemas de saúde. Encontrou-se alto grau de satisfação dos mesmos, embora houvesse baixíssima vinculação entre médico e paciente. Com relação ao atendimento, 43,4% relataram problemas, mas apenas 17,6% propuseram sugestões para melhorá-lo. O tempo de espera nas consultas foi bastante longo. A clientela da especialidade se diferenciou da do ambulatório geral com relação a diversos indicadores.This study focuses on the Pediatric Clinic of the UNICAMP University Hospital, teaching and care facility belonging to the Brazilian National Health System, providing secondary and tertiary health care for children aged 0 to 18 years. A total of 221 questionnaires were applied with users of the general pediatric out-patient services and one of the specialties, allowing for comparison of various medical care indicators. Users were found to be quite knowledgeable about their health conditions and satisfied with the care received, despite a weak link in the physician-patient relationship. 43.4% reported problems related to the services, while only 17.6% made suggestions to improve them. Waiting time was found to be quite long. Users of specialized services differed from general care patients with regard to several indicators.

  2. The informed Practitioner: Communication between social scientists and practitioners

    OpenAIRE

    Hessler, Gudrun; Unzicker, Kai

    2006-01-01

    This paper examines interaction processes and knowledge exchange between social scientists and practitioners. We conducted semi-structured interviews with practitioners working in specified fields of practice who have been involved in sociological research projects - as subjects of investigation or as experts. These research projects focused on social integration and disintegration in different sectors of German society. The interviewed practitioners were working in sectors under scrutiny by ...

  3. Technology and the ambulatory equine practitioner: implementing and affording the 21st century.

    Science.gov (United States)

    Baus, Mark R; Magnus, Robert P

    2012-04-01

    Purchasing new or used capital assets involves both emotional and financial components in the decision making process. In addition, there are intangible factors such as client perceptions and expectations that fit into the equation. Identify the facts from a business perspective and then define whether this investment (expense) is good for the practice and fits with the short- and long-term growth strategies. Ask the tough questions, analyze the numbers, understand the clients’ needs, and tie this together with the practice brand and strategic objectives. The informed and prepared buyer is usually successful in making the right decision.

  4. Technology and the ambulatory equine practitioner: implementing and affording the 21st century.

    Science.gov (United States)

    Baus, Mark R; Magnus, Robert P

    2012-04-01

    Purchasing new or used capital assets involves both emotional and financial components in the decision making process. In addition, there are intangible factors such as client perceptions and expectations that fit into the equation. Identify the facts from a business perspective and then define whether this investment (expense) is good for the practice and fits with the short- and long-term growth strategies. Ask the tough questions, analyze the numbers, understand the clients’ needs, and tie this together with the practice brand and strategic objectives. The informed and prepared buyer is usually successful in making the right decision. PMID:22640577

  5. Advances in ambulatory monitoring: regulatory considerations.

    Science.gov (United States)

    Buckles, David; Aguel, Felipe; Brockman, Randall; Cheng, James; Demian, Cindy; Ho, Charles; Jensen, Donald; Mallis, Elias

    2004-01-01

    Conventional ambulatory electrocardiogram (ECG) (Holter) monitoring involves 2 or 3 surface leads recorded with electrode positions and signal characteristics that are different from diagnostic quality 12-lead ECGs due to the limitations imposed by technology on the ambulatory recorders. The rapid pace of technological development for medical devices, particularly electrocardiography, has now enabled the recording of diagnostic quality 12-lead ECG waveforms for extended time periods. This capability allows Holter recording to become another source for diagnostic 12-lead ECG records on a par with other modalities such as resting ECG and exercise stress testing. Additionally, other diagnostic techniques such as S-T segment analysis and Q-T interval analysis that rely on diagnostic quality waveforms can now be applied. All of these enhancements to the traditional Holter modality have altered the regulatory perspective of these devices, since the enhancements may represent a new intended use for the device. PMID:15534803

  6. Cochlear implant in an ambulatory surgery center.

    Science.gov (United States)

    Joseph, Aimee M; Lassen, L Frederick

    2013-02-01

    Presbycusis, or sensorineural hearing loss in the elderly population, affects approximately 40% to 50% of people over the age of 75. A variety of devices are available to those with hearing loss. Cochlear implants, for example, are especially useful for those with severe-to-profound hearing loss. The population is aging, so the demand for cochlear implantation in ambulatory surgery centers will likely increase. Ambulatory surgery centers (ASC) can provide a more convenient and less expensive location for cochlear implant surgery than hospital-based operating facilities. Patient selection using standard ASC criteria, coupled with an understanding of the unique surgical and anesthetic needs of cochlear implant patients, are key to bringing this once exotic inpatient procedure into the ASC.

  7. Advances in ambulatory monitoring: regulatory considerations.

    Science.gov (United States)

    Buckles, David; Aguel, Felipe; Brockman, Randall; Cheng, James; Demian, Cindy; Ho, Charles; Jensen, Donald; Mallis, Elias

    2004-01-01

    Conventional ambulatory electrocardiogram (ECG) (Holter) monitoring involves 2 or 3 surface leads recorded with electrode positions and signal characteristics that are different from diagnostic quality 12-lead ECGs due to the limitations imposed by technology on the ambulatory recorders. The rapid pace of technological development for medical devices, particularly electrocardiography, has now enabled the recording of diagnostic quality 12-lead ECG waveforms for extended time periods. This capability allows Holter recording to become another source for diagnostic 12-lead ECG records on a par with other modalities such as resting ECG and exercise stress testing. Additionally, other diagnostic techniques such as S-T segment analysis and Q-T interval analysis that rely on diagnostic quality waveforms can now be applied. All of these enhancements to the traditional Holter modality have altered the regulatory perspective of these devices, since the enhancements may represent a new intended use for the device.

  8. Ambulatory Medical Assistance - After Cancer (AMA-AC): A model for an early trajectory survivorship survey of lymphoma patients treated with anthracycline-based chemotherapy

    OpenAIRE

    Compaci, Gisèle; Rueter, Manuela; Lamy, Sébastien; Oberic, Lucie; Recher, Christian; Lapeyre-Mestre, Maryse; LAURENT, GUY; Despas, Fabien

    2015-01-01

    Background Cancer survivorship has emerged as an important aspect of oncology due to the possibility of physical and psychosocial complications. The purpose of this study was to assess the feasibility of the Ambulatory Medical Assistance for After Cancer (AMA-AC) procedure for monitoring lymphoma survivorship during the first year after chemotherapy. Methods AMA-AC is based on systematic general practitioner (GP) consultations and telephone interventions conducted by a nurse coordinator (NC) ...

  9. Collaboration of general practitioners and exercise providers in promotion of physical activity a written survey among general practitioners

    OpenAIRE

    Leemrijse, C. J.; de Bakker, D. H.; Ooms, L; Veenhof, C.

    2015-01-01

    Background: General practitioners have an ideal position to motivate inactive patients to increase their physical activity. Most patients are able to exercise in regular local facilities outside the health care setting. The purpose of this study was to get insight into general practitioners perceptions and current practices regarding referral of patients to local exercise facilities. Furthermore, collaboration with exercise providers in the community was investigated, and motivators and barri...

  10. Avaliação da estrutura organizacional da assistência ambulatorial em HIV/Aids no Brasil Evaluation of the organizational structure of HIV/AIDS outpatient care in Brazil

    Directory of Open Access Journals (Sweden)

    Regina Melchior

    2006-02-01

    Full Text Available OBJETIVO: No contexto de acesso universal à terapia antiretroviral, os resultados do Programa de Aids dependem da qualidade do cuidado prestado. O objetivo do estudo foi avaliar a qualidade do cuidado dos serviços ambulatoriais que assistem pacientes de Aids. MÉTODOS: Estudo realizado em sete Estados brasileiros, em 2001 e 2002. Foi avaliada a qualidade do atendimento a pacientes com Aids quanto à disponibilidade de recursos e a organização do trabalho de assistência. Um questionário com 112 questões estruturadas abordando esses aspectos, foi enviado a 336 serviços. RESULTADOS: A taxa de resposta foi de 95,8% (322. Os indicadores de disponibilidade de recursos mostram uma adequação maior do que os indicadores de organização do trabalho. Não faltam antiretrovirais em 95,5% dos serviços, os exames de CD4 e Carga Viral estão disponíveis em quantidade adequada em 59 e 41% dos serviços, respectivamente. Em 90,4% dos serviços há pelo menos um profissional não médico (psicólogo, enfermeiro ou assistente social. Quanto à organização, 80% não agendavam consulta médica com hora marcada; 40,4% agendavam mais que 10 consultas médicas por período; 17% não possuíam gerentes exclusivos na assistência e 68,6% não realizavam reuniões sistemáticas de trabalho com a equipe. CONCLUSÕES: Os resultados apontam que além de garantir a distribuição mais homogênea de recursos, o programa precisa investir no treinamento e disseminação do manejo do cuidado, conforme evidenciado nos resultados da organização de trabalho.OBJECTIVE: In the context of universal access to antiretroviral treatment, the results of the Brazilian AIDS Program will depend on the quality of the care provided. The aim of the present study was to evaluate the healthcare provided by outpatient services for the treatment of AIDS patients. METHODS: The present study was carried out in seven Brazilian States between 2001 and 2002. We evaluated the quality of

  11. Development of the nurse practitioner.

    Science.gov (United States)

    Howie, P

    1992-03-25

    In the first of two articles on the development of the emergency nurse practitioner, Peter Howie reports on a new scheme in Lincoln where all first-level nurses have been trained as nurse practitioners. The initiative was introduced following a study in the theoretical management of patients by experienced accident and emergency sisters. The author outlines the training course provided and the protocols within which nurse practitioners work. PMID:27236949

  12. Library service to dental practitioners.

    OpenAIRE

    Ashin, E R

    1983-01-01

    Dental school libraries offer resources of value to dental practitioners, but do not always consider practitioners to be primary clientele. A survey was conducted among the sixty U.S. dental school libraries to examine policies and attitudes toward service to practitioners. Although library use by dentists is estimated to be low, most libraries are willing to serve them as long as it does not reduce the libraries' ability to assist students and faculty. Of the respondents, 57% replied that th...

  13. Recognizing intimate partner violence in primary care: Western Cape, South Africa.

    Directory of Open Access Journals (Sweden)

    Kate Joyner

    Full Text Available INTRODUCTION: Interpersonal violence in South Africa is the second highest contributor to the burden of disease after HIV/AIDS and 62% is estimated to be from intimate partner violence (IPV. This study aimed to evaluate how women experiencing IPV present in primary care, how often IPV is recognized by health care practitioners and what other diagnoses are made. METHODS: At two urban and three rural community health centres, health practitioners were trained to screen all women for IPV over a period of up to 8 weeks. Medical records of 114 thus identified women were then examined and their reasons for encounter (RFE and diagnoses over the previous 2-years were coded using the International Classification of Primary Care. Three focus group interviews were held with the practitioners and interviews with the facility managers to explore their experience of screening. RESULTS: IPV was previously recognized in 11 women (9.6%. Women presented with a variety of RFE that should raise the index of suspicion for IPV- headache, request for psychiatric medication, sleep disturbance, tiredness, assault, feeling anxious and depressed. Depression was the commonest diagnosis. Interviews identified key issues that prevented health practitioners from screening. CONCLUSION: This study demonstrated that recognition of women with IPV is very low in South African primary care and adds useful new information on how women present to ambulatory health services. These findings offer key cues that can be used to improve selective case finding for IPV in resource-poor settings. Universal screening was not supported by this study.

  14. Volume of Cataract Surgery and Surgeon Gender: The Florida Ambulatory Surgery Center Experience 2005 Through 2012.

    Science.gov (United States)

    French, Dustin D; Margo, Curtis E; Campbell, Robert R; Greenberg, Paul B

    2016-01-01

    Cataract is the most common surgically reversible cause of vision loss and the most common major surgical procedure performed in the United States. To understand how gender composition might affect differences in health services, we examined the surgeon gender-specific rates of routine cataract surgery performed in ambulatory surgical centers in Florida. Routine cataract surgeries were identified through the Florida Agency for Health Care Administration (AHCA) ambulatory surgery center dataset. The background of individual surgeons was determined by linking license numbers in the dataset to physician profiles publicly available from AHCA. From 2005 through 2012, women ophthalmologists in Florida performed roughly half the annual rate of cataract surgery as their male counterparts. This difference is not explained by greater time in clinical practice for men. Further investigation into the causes of this gender-volume disparity is warranted to determine what roles choice and barriers may play.

  15. The effectiveness of Nurse Practitioners working at a GP cooperative: a study protocol

    Directory of Open Access Journals (Sweden)

    Wijers Nancy

    2012-08-01

    Full Text Available Abstract Background In many countries out-of-hours care faces serious challenges, including shortage of general practitioners, a high workload, reduced motivation to work out of hours, and increased demand for out-of-hours care. One response to these challenges is the introduction of nurse practitioner as doctor substitutes, in order to maintain the (high accessibility and safety of out of hours care. Although nurse practitioners have proven to provide equally safe and efficient care during daytime primary care, it is unclear whether substitution is effective and efficient in the more complex out of hours primary care. This study aims to assess the effects of substitution of care from general practitioners to nurse practitioners in an out of hours primary care setting. Design A quasi experimental study is undertaken at one “general practitioner cooperative” to offer out-of-hours care for 304.000 people in the South East of the Netherlands. In the experimental condition patient care is provided by a team of one nurse practitioner and four general practitioners; where the nurse practitioner replaces one general practitioner during one day of the weekend from 10 am to 5 pm. In the control condition patient care is provided by a team of five general practitioners during the other day of the weekend, also from 10 am to 5 pm. The study period last 15 months, from April 2011 till July 2012. Methods Data will be collected on number of different outcomes using a range of methods. Our primary outcome is substitution of care. This is calculated using the number and characteristics of patients that have a consultation at the GP cooperative. We compare the number of patients seen by both professionals, type of complaints, resource utilization (e.g. prescription, tests, investigations, referrals and waiting times in the experimental condition and control condition. This data is derived from patient electronic medical records. Secondary outcomes

  16. Assisted or hastened death: the healthcare practitioner's dilemma.

    Science.gov (United States)

    Macleod, Rod Duncan; Wilson, Donna M; Malpas, Phillipa

    2012-11-01

    Assisting or hastening death is a dilemma with many ethical as well as practical issues facing healthcare practitioners in many countries worldwide now. Various arguments for and against assisted dying have been made over time but the call from the public for legalisation of euthanasia or assisted suicide has never been stronger. While many studies have documented the reluctance of medical and other health professionals to be involved in the practice of assisted dying or euthanasia, there is still much open debate in the public domain. Those who have the most experience of palliative care are strongest in their opposition to assisted death or euthanasia. This paper explores salient practical and ethical considerations for healthcare practitioners associated with assisted death, with a focus on examining the concepts of autonomy for patients and healthcare practitioners. The role of the healthcare practitioner has clearly and undoubtedly changed over time with advances in healthcare practices but the duty of care has not changed. The dilemmas for healthcare practitioners thus who have competent patients requesting hastened death extends far beyond acting within a country's laws as they go to the very heart of the relationship between the practitioner and patient. PMID:23121745

  17. Conceptual and methodological aspects in the study of hospitalizations for ambulatory care sensitive conditions Aspectos conceituais e metodológicos no estudo das hospitalizações por condições sensíveis à atenção primária

    Directory of Open Access Journals (Sweden)

    Fúlvio Borges Nedel

    2011-01-01

    Full Text Available Hospitalization rates for Ambulatory Care Sensitive Conditions have been used to assess effectiveness of the first level of health care. From a critical analysis of related concepts, we discuss principles for selecting a list of codes and, taking the example of the Brazilian Family Health Program, propose a methodological pathway for identifying variables in order to inform statistical models of analysis. We argue that for the indicator to be comparable between regions, disease codes should be selected based on sensitivity and specificity principles, not on observed disease frequency. Rates of hospitalization will be determined, at a distal level, by the socio-economic environment and their effect on the social and demographic structure. Timely and effective care depends on the organization of health services, their availability and access barriers, which depend on the ways health and related technology are conceptualised and on their adherence to the biomedical model or to the Primary Health Care (PHC principles; performance indicators of the health system will be the proximal determinants. This indicator is potentially useful for primary care evaluation. The historical reconstruction of PHC improves the analysis of the indicator variability.As taxas de hospitalização por condições sensíveis à atenção primária são um indicador da efetividade do primeiro nível de atenção à saúde. Partindo de breve revisão crítica, este artigo discute princípios para a seleção de códigos de internação por essas causas e, com o exemplo do Programa Saúde da Família, propõe um modelo teórico para a seleção de variáveis para análise estatística. A comparabilidade inter-regional do indicador depende da seleção de códigos de doenças baseada em princípios de sensibilidade e especificidade, não na frequência da doença. As taxas de hospitalização serão distalmente determinadas pela situação socioeconômica e seu efeito sobre a

  18. Maternal care

    OpenAIRE

    2001-01-01

    In June 2000 a distinguished group of obstetricians, midwives, general practitioners, and medical statisticians came together to discuss maternal care. Chaired by Professor James Drife from Leeds, discussion ranged over many topics, including: the changing role of the obstetrician, general practitioners, and the increasing status and responsibility of midwives. Other subjects include the induction of labour, obstetric analgesia and anaesthesia, and debates about the place and kind of delivery...

  19. An Ambulatory Program for Surgical Residents and Medical Students.

    Science.gov (United States)

    Levy, Margaret

    1988-01-01

    A pilot program based in a freestanding ambulatory surgery center at the Chicago Medical School Department of Surgery is described, its curriculum outlined, and the daily activities of the residents and medical students are detailed. A brief history of ambulatory surgery is given. (Author/MLW)

  20. Preparing Culturally Competent Practitioners.

    Science.gov (United States)

    St. Clair, Anita; McKenry, Leda

    1999-01-01

    Compared to 120 controls, 80 nursing students participating in international clinical-immersion experiences showed a significant increase in cultural self-efficacy and awareness, ability to overcome ethnocentrism, and ability to integrate patients' cultural beliefs into health-care practices. (SK)

  1. Managing hypertension with ambulatory blood pressure monitoring.

    Science.gov (United States)

    White, William B; Gulati, Vinay

    2015-02-01

    There has been a dramatic shift in the manner in which blood pressure (BP) is measured to provide far more comprehensive clinical information than that provided by a single set of office BP readings. Extensive clinical and epidemiological research shows an important role of ambulatory BP monitoring (ABPM) in the management of hypertensive patients. A 24-h BP profile helps to determine the absence of nocturnal dipping status and evaluate BP control in patients on antihypertensive therapy. The ability to detect white-coat or masked hypertension is enhanced by ambulatory BP monitoring. In 2001, the Center for Medicare and Medicaid Services approved ABPM for reimbursement for the identification of patients with white-coat hypertension. In 2011, the National Institute for Health and Clinical Excellence (NICE) in the UK published guidelines that recommended the routine use of ABPM in all patients suspected of having hypertension. The European Society of Hypertension (ESH) 2013 guidelines also support greater use of ABPM in clinical practice. While the advantages of ABPM are apparent from a clinical perspective, its use should be considered in relation to its cost, the complexity of data evaluation, as well as patient inconvenience. In this review, we evaluate the clinical importance of ABPM, highlighting its role in the current management of hypertension.

  2. Nursing: What's a Nurse Practitioner?

    Science.gov (United States)

    ... nurses, or APNs) have a master's degree in nursing (MS or MSN) and board certification in their ... Nurse Practitioners (NAPNAP) and through local hospitals or nursing schools. In addition, many doctors share office space ...

  3. Preparedness of Lithuanian general practitioners to provide mental healthcare services

    DEFF Research Database (Denmark)

    Jaruseviciene, Lina; Sauliune, Skirmante; Jarusevicius, Gediminas;

    2014-01-01

    BACKGROUND: A large unmet need for mental healthcare in Lithuania is partially attributable to a lack of primary care providers with skills in this area. The aim of this study was to assess general practitioners' (GPs) experience in mental healthcare and their perceptions about how to increase th...

  4. Universe of Goals. Pediatric Nurse Practitioner/Associate Programs.

    Science.gov (United States)

    Taunton, Roma Lee; Soptick, John M.

    Goals for the Pediatric Nurse Practitioner Associate Programs (PNP/A) are provided for the following areas: health care delivery systems; role responsibility; legal base for PNP/A role; growth and development; family-cultural factors; common childhood problems/illnesses/accidents; communication; assessment; recording; evaluation/interpretation;…

  5. Quality assessment of private practitioners in rural Wardha, Maharashtra

    Directory of Open Access Journals (Sweden)

    Ganguly Enakshi

    2008-01-01

    Full Text Available Objective: To assess the quality of care provided by private practitioners in rural areas of Wardha district. Methodology: The study was carried out in three primary health centres of Wardha district. 20% of the 44 registered private practitioners were selected randomly for the study. The data was collected using checklist through direct observation for the infrastructure. Assessment of quality of services delivered, 10 consecutive patients were observed and also the medical practitioner was interviewed. Supplies and logistics were assessed through observation. Results: All the facilities were sheltered from weather conditions and 90% had adequate waiting space. But, drinking water and adequate IEC material was available in only 20% facilities. Complete history taking and relevant physical examination was done in only 20% cases. Only 20% practitioners recorded blood pressure and 30% recorded temperature in cases with fever. Provisional diagnosis was not written in any of the case and only 20% explained prescription to the patients. Conclusion: There is considerable scope to improve the quality of services of private practitioners. To achieve this quality assurance programs may be initiated along with the training of private medical practitioners.

  6. Cooperative m-learning with nurse practitioner students.

    Science.gov (United States)

    Wyatt, Tami H; Krauskopf, Patricia B; Gaylord, Nan M; Ward, Andrew; Huffstutler-Hawkins, Shelley; Goodwin, Linda

    2010-01-01

    New technologies give nurse academicians the opportunity to incorporate innovative teaching-learning strategies into the nursing curricula. Mobile technology for learning, or m-learning, has considerable potential for the nursing classroom but lacks sufficient empirical evidence to support its use. Based on Mayer's multimedia learning theory, the effect of using cooperative and interactive m-learning techniques in enhancing classroom and clinical learning was explored. The relationship between m-learning and students' learning styles was determined through a multimethod educational research study involving nurse practitioner students at two mid-Atlantic universities. During the 16-month period, nurse practitioner students and their faculty used personal digital assistants (PDAs) to participate in various m-learning activities. Findings from focus group and survey responses concluded that PDAs, specifically the Pocket PC, are useful reference tools in the clinical setting and that all students, regardless of learning style, benefited from using PDAs. It was also demonstrated that connecting students with classmates and other nurse practitioner students at distant universities created a cooperative learning community providing additional support and knowledge acquisition. The authors concluded that in order to successfully prepare nurse practitioner graduates with the skills necessary to function in the present and future health care system, nurse practitioner faculty must be creative and innovative, incorporating various revolutionary technologies into their nurse practitioner curricula.

  7. Roles of the general practitioner in different contexts.

    Science.gov (United States)

    Van Dormael, M

    1995-01-01

    The word ¿general practice¿ denotes different contents of work as we look at different contexts. General practitioners may provide first line care, function as secondary care providers at hospital level, take responsibility for the management of health care systems. These different roles can be seen as results from historical processes of division of work in the field of health care, which gave general practice its present shapes. During the first half of the 20th century, western general practitioners were gradually excluded from hospitals as well as from public health activities. When they started to react in order to increase their legitimacy they strived--with variable success--to gain recognition as curative first line care providers, as this had become the only place in the health care system they could claim for. They gradually defined their specificity in terms of polyvalence enabling them to deal with unselected problems, and in terms of global view allowing for adequate priority setting. In developing countries, the organisation of medical care was and remains influenced by western models. As in western countries, emphasis has been put on specialisation and hospital technology. General practice was not exported to developing countries: general practitioners appear rather as cheap substitutes for specialists. The most typical workplace for general practitioners in developing countries remains the rural hospital. But their role model refers to the hospital based specialist: they tend to focus on patient care for hospital users rather than on dynamising health care delivery to the whole community in the district. In urban areas, the recent expansion of (mostly private) first line medical care is also not specific to general practice and tends to be in favour of specialists. What is the common denominator to these different roles, if any? A possible answer lies in the primary health care approach. It allows to define the specificity of general practitioners

  8. CAM practitioners in the Australian health workforce: an underutilized resource

    Directory of Open Access Journals (Sweden)

    Grace Sandra

    2012-11-01

    Full Text Available Abstract Background CAM practitioners are a valuable but underutilizes resource in Australian health care. Despite increasing public support for complementary and alternative medicine (CAM little is known about the CAM workforce. Apart from the registered professions of chiropractic, osteopathy and Chinese medicine, accurate information about the number of CAM practitioners in the workforce has been difficult to obtain. It appears that many non-registered CAM practitioners, although highly qualified, are not working to their full capacity. Discussion Increasing public endorsement of CAM stands in contrast to the negative attitude toward the CAM workforce by some members of the medical and other health professions and by government policy makers. The marginalisation of the CAM workforce is evident in prejudicial attitudes held by some members of the medical and other health professions and its exclusion from government policy making. Inconsistent educational standards has meant that non-registered CAM practitioners, including highly qualified and competent ones, are frequently overlooked. Legitimising their contribution to the health workforce could alleviate workforce shortages and provide opportunities for redesigned job roles and new multidisciplinary teams. Priorities for better utilisation of the CAM workforce include establishing a guaranteed minimum education standard for more CAM occupation groups through national registration, providing interprofessional education that includes CAM practitioners, developing courses to upgrade CAM practitioners' professional skills in areas of indentified need, and increasing support for CAM research. Summary Marginalisation of the CAM workforce has disadvantaged those qualified and competent CAM practitioners who practise evidence-informed medicine on the basis of many years of university training. Legitimising and expanding the important contribution of CAM practitioners could alleviate projected health

  9. Computer database of ambulatory EEG signals.

    Science.gov (United States)

    Jayakar, P B; Brusse, E; Patrick, J P; Shwedyk, E; Seshia, S S

    1987-01-01

    The paper describes an ambulatory EEG database. The database contains segments of AEEGs done on 45 subjects. Each epoch (1/8th second or more) of AEEG data has been annotated into 1 of 40 classes. The classes represent background activity, paroxysmal patterns and artifacts. The majority of classes have over 200 discrete epochs. The structure is flexible enough to allow additional epochs to be readily added. The database is stored on transportable media such as digital magnetic tape or hard disk and is thus available to other researchers in the field. The database can be used to design, evaluate and compare EEG signal processing algorithms and pattern recognition systems. It can also serve as an educational medium in EEG laboratories.

  10. Ambulatory ST segment monitoring after myocardial infarction

    DEFF Research Database (Denmark)

    Mickley, H

    1994-01-01

    The prevalence of transient myocardial ischaemia after myocardial infarction seems to be lower than in other subgroups with coronary artery disease. In postinfarction patients, however, a greater proportion of ischaemic episodes are silent. At present there is substantial evidence that transient...... ischaemia provides prognostic information in different subsets of patients with previous myocardial infarction, but there is considerable disagreement about how this is expressed in terms of cardiac events. Small patient numbers, patient selection, and different timing of ambulatory monitoring are proposed...... be that it can be performed early after infarction at the time of maximum risk. Secondly, it can be performed in most patients after infarction, including those recognised as being at high risk who are unable to perform an exercise stress test....

  11. Ectodermal Dysplasia: A Clinical Overview for the Dental Practitioner.

    Science.gov (United States)

    Halai, Tina; Stevens, Claire

    2015-10-01

    The term ectodermal dysplasia (ED) is used to describe a group of rare congenital disorders characterized by abnormalities of two or more ectodermal structures such as the skin, hair, nails, teeth and sweat glands. This paper will give an overview of the aetiology of ED and describe the manifestations and dental management of this condition. In particular, the important role of the dental practitioner in the identification and management of patients with ED will be highlighted. CPD/Clinical Relevance: Dental practitioners should be aware of the oral features of ectodermal dysplasia and be able to make timely referrals and provide appropriate continuing care for these patients. PMID:26685476

  12. Respiratory functions in Kalaripayattu practitioners.

    Science.gov (United States)

    Chandran, C Kesava; Nair, R Harikumaran; Shashidhar, S

    2004-04-01

    Kalaripayattu, an ancient traditional martial art form of Kerala, is considered as the basis for all martial arts viz. Karate, Kungfu, etc. physiological studies are more concentrated on Karate, Kungfu and other martial arts due to their global acceptance. Considering the limited knowledge available regarding the physiological profiles of Kalaripayattu practitioners, the present study was taken up for filling the lacunae in the field. Lung function tests were carried out in ten Kalari practitioners. Residual volume was measured by indirect method. Higher lung volumes and flow rates were achieved in Kalari practitioners compared to age and height-matched controls. Better mechanical factors and lower airway resistance influenced during Kalari practice might have benefited in improving hung volumes and flow rates.

  13. Ambulatory Pessary Trial Unmasks Occult Stress Urinary Incontinence

    Directory of Open Access Journals (Sweden)

    Bilal Chughtai

    2012-01-01

    Conclusion. An ambulatory pessary trial is an effective, easy, and inexpensive method to approximate anatomic results achieved by surgery under real-life conditions. In our series, 20% of patients with occult SUI were identified by pessary trial alone.

  14. Assessment of antibiotic prescribing in Latvian general practitioners

    Directory of Open Access Journals (Sweden)

    Dumpis Uga

    2013-01-01

    Full Text Available Abstract Background Though general antibiotic consumption data is available, information on the actual patterns of prescribing antibiotics locally is difficult to obtain. An easy to use methodology was designed to assess ambulatory management of infections by Latvian general practitioners (GPs. Methods GPs were asked to record data in a patient data collection form for every patient that received antibiotics. Study period – (7 days one week in November, 2008. Data recorded included the following details: an antibiotic, the prescribed dose, dosing interval, route of administration combined with the demographic factors of the patient and clinical diagnosis based on a pre-defined list. Results Two hundred forty eight forms out of the 600 (41% were returned by post. Antibiotics were prescribed in 6.4% (1711/26803 of outpatient consultations. In total, 1763 antibiotics were prescribed during the study period. Ninety seven percent of the patients received monotherapy and only 47 (2.7% patients were prescribed two antibiotics. The most commonly prescribed antibiotics were amoxicillin (33.9% of prescribed, amoxicillin/clavulanate (18,7% and clarithromycin (7.6%. The most commonly treated indications were pharyngitis (29.8%, acute bronchitis (25.3% and rhinosinusitis (10.2%. Pneumonia was mostly treated with amoxicillin/clavulanate (25,7%, amoxicillin (15.7% and clarithromycin (19.3%. Conclusions Methodology employed provided useful additional information on ambulatory practice of prescribing antibiotics and could be used in further assessment studies. Educational interventions should be focused on treatment of acute pharyngitis and bronchitis in children and unnecessary use of quinolones in adults for uncomplicated urinary tract infection.

  15. Computerized adaptive testing--ready for ambulatory monitoring?

    DEFF Research Database (Denmark)

    Rose, Matthias; Bjørner, Jakob; Fischer, Felix;

    2012-01-01

    Computerized adaptive tests (CATs) have abundant theoretical advantages over established static instruments, which could improve ambulatory monitoring of patient-reported outcomes (PROs). However, an empirical demonstration of their practical benefits is warranted.......Computerized adaptive tests (CATs) have abundant theoretical advantages over established static instruments, which could improve ambulatory monitoring of patient-reported outcomes (PROs). However, an empirical demonstration of their practical benefits is warranted....

  16. Pros and cons of the ambulatory surgery center joint venture.

    Science.gov (United States)

    Giannini, Deborah

    2008-01-01

    If a physician group has determined that it has a realistic patient base to establish an ambulatory surgery center, it may be beneficial to consider a partner to share the costs and risks of this new joint venture. Joint ventures can be a benefit or liability in the establishment of an ambulatory surgery center. This article discusses the advantages and disadvantages of a hospital physician-group joint venture. PMID:18061764

  17. Comparing Ambulatory Preceptors’ and Students’ Perceptions of Educational Planning

    OpenAIRE

    Qualters, Donna M.; Regan, Mary Beth; O’Brien, Mary Callery; Stone, Sarah L

    1999-01-01

    To compare ambulatory preceptors’ and students’ perceptions of the use of educational planning (setting goals, assessing needs, formulating objectives, choosing methods, and providing feedback and evaluation) in the office setting, we mailed a survey, which was returned by 127 longitudinal ambulatory preceptors and 168 first-year and second-year medical students. Faculty perceptions did not match student perceptions of what occurred in the longitudinal preceptor program teaching sessions in e...

  18. Pros and cons of the ambulatory surgery center joint venture.

    Science.gov (United States)

    Giannini, Deborah

    2008-01-01

    If a physician group has determined that it has a realistic patient base to establish an ambulatory surgery center, it may be beneficial to consider a partner to share the costs and risks of this new joint venture. Joint ventures can be a benefit or liability in the establishment of an ambulatory surgery center. This article discusses the advantages and disadvantages of a hospital physician-group joint venture.

  19. Effects of creatine supplementation in taekwondo practitioners

    Directory of Open Access Journals (Sweden)

    Rafael Manjarrez-Montes de Oca

    2013-04-01

    Full Text Available Introduction: Taekwondo (TKD is a combat sport, which has also been proposed as a fitness program, with a strong anaerobic component. Creatine (Cr supplementation is used to improve both anaerobic exercise performance and body composition. Therefore, Cr supplementation could be beneficial in TKD. Aims: To determine the effect of Cr supplementation (50 mg/kg body wt on body composition, anaerobic power and blood chemistry in young male TKD practitioners. Methods: Ten male TKD practitioners (age [20 ± 2 yr], height [1.69 ± 0.06 m], and mass [67 ± 9.8 kg] participated in a placebo-controlled, double blind, crossover study. Body composition (DEXA, anaerobic power (Wingate Test, blood lactate and blood chemistry were measured before and after supplementation. Differences between data before and after supplementation were calculated for each treatment (Cr and Placebo and were compared using the Wilcoxon signed-rank test. Results: Fat mass (kg decreased after placebo (Mdn [IqR] = -0.75 [-1.44 to 0.03] and increased following Cr intake (0.17 [-0.77 to 1.13] kg (Z = 2.191, p < 0.028, r = 0.49. Serum triglyceride concentration (mg/mL increased after Cr (45.00 [-7.50 to 75.00] and decrease with placebo (-7.00 [-10.75 to 12.00] (Z = 2.090, p < 0.037, r = 0.47. No changes were found in others parameters. Conclusion: Cr supplementation may increase fat mass and serum triglycerides concentration in young male TKD practitioners without improvement in anaerobic power. Cr supplementation appears to be safe, but athletes should be careful when they want to loss fat.

  20. Biofilm models for the practitioner

    DEFF Research Database (Denmark)

    Morgenroth, Eberhard Friedrich; van Loosdrecht, M. C. M.; Wanner, O.

    2000-01-01

    Even though mathematical biofilm models are extensively used in biofilm research, there has been very little application of these models in the engineering practice so far. However, practitioners would be interested in models that can be used as tools to control plant operation under dynamic...... conditions or to help them handle complex interactions between particle removal, carbon oxidation, nitrification, denitrification and biological phosphorus removal. But even though there is a whole range of biofilm models available, it is difficult for the practitioner to select the appropriate modeling...

  1. The Effect of Physician Delegation to Other Health Care Providers on the Quality of Care for Geriatric Conditions

    Science.gov (United States)

    Lichtenstein, Brian J.; Reuben, David B.; Karlamangla, Arun S.; Han, Weijuan; Roth, Carol P.; Wenger, Neil S.

    2016-01-01

    OBJECTIVES to examine the effects of delegation on quality of care that patients receive for three common geriatric conditions: dementia, falls, and incontinence. DESIGN pooled analysis of 8 the Assessing Care of Vulnerable Elders (ACOVE) projects from 1998 to 2010. SETTING 15 ambulatory practice sites across the United States PARTICIPANTS 4,776 patients age ≥ 65 years, of mixed demographic backgrounds who participated in ACOVE studies. INTERVENTION multivariate analysis of prior ACOVE observation and intervention studies was conducted, with in addition to two retrospectively defined variables: “intent to delegate” and “maximum delegation” for each ACOVE quality indicator (QI). MEASUREMENTS The primary outcome for the study was QI pass probability, by level of delegation, for 47 ACOVE quality indicators. RESULTS A total of 4,776 patients were evaluated, with 16,204 QIs included for analysis. Across all studies, QI pass probabilities were 0.36 for physician-performed tasks; 0.55 for nurse practitioner (NP), physician assistant (PA), and registered nurse (RN)-performed tasks; and 0.61 for medical assistant (MA), or licensed vocational nurse (LVN)-performed tasks. In multiply adjusted models, the independent pass-probability effect of delegation to NPs, PAs, or RNs was 1.37 (p = 0.055) CONCLUSIONS Delegation to non-physician providers is associated with higher quality of care for geriatric conditions in community practices and supports the value of interdisciplinary team management for common outpatient conditions among older adults. PMID:26480977

  2. CHALLENGES FACING THE ESP PRACTITIONER

    Directory of Open Access Journals (Sweden)

    SIMION MINODORA OTILIA

    2015-12-01

    Full Text Available The ESP teacher has to face certain challenges in his profession: One of the biggest challenges of the ESP teacher is the fact that he/she lacks the necessary knowledge of the subject to teach Business English, for instance, some researchers believing that such courses should be taught by subject teachers. The task of teaching ESP by ESL teachers is not an easy one. Dudley- Evans and St. John pointed out its complexity, identifying five key roles of the ESP practitioner: teacher, course designer and materials provider, collaborator, researcher and evaluator and this is probably the biggest challenge of the profession. The ESP practitioner has also to be aware of the fact that using a foreign language for workplace or study purposes requires not only linguistic proficiency and knowledge but also knowledge of work –related and disciplinary concepts.Last but not least, another challenge for the ESP practitioner is the use of technology in class, a valuable tool for helping with traditional forms of teaching and for creating new forms of communicating.Thus, the ESP practitioner has many things in common with the teacher of general English: he has to be familiar with linguistic development and teaching theories ,he has to be aware of contemporary ideas related to his position and role and he has to become familiar with the new technologies which can be used to improve his methodology.However,his role is more complex than that of a General English teacher.

  3. The National Practitioner Data Bank: the first 4 years.

    Science.gov (United States)

    Oshel, R E; Croft, T; Rodak, J

    1995-01-01

    The National Practitioner Data Bank became operational September 1, 1990, as a flagging system to identify health care practitioners who may have been involved in incidents of medical incompetence. Query volumes have grown substantially over the Data Bank's first 4 years of operation. The greatest increase has come in the number of voluntary queries. By the end of 1994, the Data Bank had processed more than 4.5 million requests for information on practitioners, more than 1.5 million of which were received in 1994 alone. The proportion of queries for which the Data Bank contains information on the practitioner in question has grown as the Data Bank has come to contain more reports. During 1994, 7.9 percent of queries were matched. The Data Bank contained more than 97,500 reports at the end of 1994. More than 82 percent of the reports concerned malpractice payments. Licensure reports made up the bulk of the rest. Physicians predominate in reports, accounting for slightly more than 76 percent of the total. The remainder are related to dentists (16 percent) and all other types of practitioners (8 percent). Since reporting of adverse actions is mandatory only for physicians and dentists, the proportion of reports attributable to these types of practitioners is higher than it would be if adverse action reporting requirements were uniform for all practitioners. State malpractice payment rates and adverse action rates vary widely, but a State's rate in any given year is highly correlated with its rate in any other year. State malpractice rates are not strongly correlated with adverse action rates, neither are the rates for physicians strongly correlated with those for dentists. There is a weak tendency for States with smaller physician populations to have higher levels of licensure and privileging actions.

  4. American Society of Regional Anesthesia and Pain Medicine 2010 Gaston Labat Lecture: Perineural catheter analgesia as a routine method after ambulatory surgery--effective but unrealistic.

    Science.gov (United States)

    Rawal, Narinder

    2012-01-01

    Adequate postoperative analgesia is a prerequisite for successful ambulatory surgery and remains a challenge. The problem of pain at home may be increasing because previously inpatient surgical procedures are becoming ambulatory and it is expected that the number and complexity of ambulatory surgical procedures will continue to increase. In 1998, we described the use of surgical-site and perineural catheter techniques that allowed patients to self-administer local anesthetics through disposable, elastomeric pumps for pain management at home. In recent years, availability of improved elastometric and other lightweight pump devices, the general trend of avoiding strong opioids and the preference for non-opioid analgesic techniques has led to increasing use of this technique after a variety of ambulatory surgical procedures. The two most common techniques are perineural and wound catheter infusions (WCI). Current evidence suggests that both are effective, although comparative studies are lacking. Perineural techniques are highly effective but are technically challenging and require labor-intensive and expensive home care that can be provided only in specialized centers. Disappointing past experience with implementation of perineural catheter techniques in inpatients suggests that it is unrealistic to expect their routine use in most ambulatory centers. Surgical-site catheter technique is a simpler, safer, and less expensive alternative and therefore more likely to gain widespread use. Only controlled comparisons can show whether the current belief about the superiority of ambulatory perineural techniques over WCI is justified. Such studies should address technical failures, side effects, home care of the medically unsupervised or undersupervised patient, and cost-effectiveness to demonstrate which of the 2 techniques is most appropriate for a particular procedure. PMID:22157738

  5. Market conditions and general practitioners' referrals.

    Science.gov (United States)

    Iversen, Tor; Ma, Ching-to Albert

    2011-12-01

    We study how market conditions influence referrals of patients by general practitioners (GPs). We set up a model of GP referral for the Norwegian health care system, where a GP receives capitation payment based on the number of patients in his practice, as well as fee-for-service reimbursements. A GP may accept new patients or close the practice to new patients. We model GPs as partially altruistic, and compete for patients. We show that a GP operating in a more competitive market has a higher referral rate. To compete for patients and to retain them, a GP satisfies patients' requests for referrals. Furthermore, a GP who faces a patient shortage will refer more often than a GP who does not. Tests with Norwegian GP radiology referral data support our theory. PMID:22009482

  6. Teamwork in obstetric critical care

    OpenAIRE

    Guise, Jeanne-Marie; Segel, Sally

    2008-01-01

    Whether seeing a patient in the ambulatory clinic environment, performing a delivery or managing a critically ill patient, obstetric care is a team activity. Failures in teamwork and communication are among the leading causes of adverse obstetric events, accounting for over 70% of sentinel events according to the Joint Commission. Effective, efficient and safe care requires good teamwork. Although nurses, doctors and healthcare staff who work in critical care environments are extremely well t...

  7. The efficacy of ginger added to ondansetron for preventing postoperative nausea and vomiting in ambulatory surgery

    Directory of Open Access Journals (Sweden)

    Pragnadyuti Mandal

    2014-01-01

    Full Text Available Background: Post-operative nausea and vomiting (PONV frequently hampers implementation of ambulatory surgery in spite of so many costly antiemetic drugs and regimens. Objective: The study was carried out to compare the efficacy of ginger (Zingiber officinale added to Ondansetron in preventing PONV after ambulatory surgery. Materials and Methods: It was a prospective, double blinded, and randomized controlled study. From March 2008 to July 2010, 100 adult patients of either sex, aged 20-45, of ASA physical status I and II, scheduled for day care surgery, were randomly allocated into Group A[(n = 50 receiving (IV Ondansetron (4 mg and two capsules of placebo] and Group B[(n = 50 receiving IV Ondansetron (4 mg and two capsules of ginger] simultaneously one hour prior to induction of general anaesthesia (GA in a double-blind manner. One ginger capsule contains 0.5 gm of ginger powder. Episodes of PONV were noted at 0.5h, 1h, 2h, 4h, 6h, 12h and 18h post- operatively. Statistical Analysis and Results: Statistically significant difference between groups A and B (P < 0.05, was found showing that ginger ondansetron combination was superior to plain Ondansetron as antiemetic regimen for both regarding frequency and severity. Conclusion: Prophylactic administration of ginger and ondansetron significantly reduced the incidence of postoperative nausea and vomiting compared to ondansetron alone in patients undergoing day care surgery under general anaesthesia.

  8. The efficacy of ginger added to ondansetron for preventing postoperative nausea and vomiting in ambulatory surgery

    Science.gov (United States)

    Mandal, Pragnadyuti; Das, Anjan; Majumdar, Saikat; Bhattacharyya, Tapas; Mitra, Tapobrata; Kundu, Ratul

    2014-01-01

    Background: Post-operative nausea and vomiting (PONV) frequently hampers implementation of ambulatory surgery in spite of so many costly antiemetic drugs and regimens. Objective: The study was carried out to compare the efficacy of ginger (Zingiber officinale) added to Ondansetron in preventing PONV after ambulatory surgery. Materials and Methods: It was a prospective, double blinded, and randomized controlled study. From March 2008 to July 2010, 100 adult patients of either sex, aged 20-45, of ASA physical status I and II, scheduled for day care surgery, were randomly allocated into Group A[(n = 50) receiving (IV) Ondansetron (4 mg) and two capsules of placebo] and Group B[(n = 50) receiving IV Ondansetron (4 mg) and two capsules of ginger] simultaneously one hour prior to induction of general anaesthesia (GA) in a double-blind manner. One ginger capsule contains 0.5 gm of ginger powder. Episodes of PONV were noted at 0.5h, 1h, 2h, 4h, 6h, 12h and 18h post- operatively. Statistical Analysis and Results: Statistically significant difference between groups A and B (P < 0.05), was found showing that ginger ondansetron combination was superior to plain Ondansetron as antiemetic regimen for both regarding frequency and severity. Conclusion: Prophylactic administration of ginger and ondansetron significantly reduced the incidence of postoperative nausea and vomiting compared to ondansetron alone in patients undergoing day care surgery under general anaesthesia. PMID:24497743

  9. Facilitating Ambulatory Electronic Health Record System Implementation: Evidence from a Qualitative Study

    Directory of Open Access Journals (Sweden)

    Ann Scheck McAlearney

    2013-01-01

    Full Text Available Background. Ambulatory care practices have increasing interest in leveraging the capabilities of electronic health record (EHR systems, but little information is available documenting how organizations have successfully implemented these systems. Objective. To characterize elements of successful electronic health record (EHR system implementation and to synthesize the key informants' perspectives about successful implementation practices. Methods. Key informant interviews and focus groups were conducted with a purposive sample of individuals from US healthcare organizations identified for their success with ambulatory EHR implementation. Rigorous qualitative data analyses used both deductive and inductive methods. Results. Participants identified personal and system-related barriers, at both the individual and organization levels, including poor computer skills, productivity losses, resistance to change, and EHR system failure. Implementation success was reportedly facilitated by careful planning and consistent communication throughout distinct stages of the implementation process. A significant element of successful implementation was an emphasis on optimization, both during “go-live” and, subsequently, when users had more experience with the system. Conclusion. Successful EHR implementation requires both detailed planning and clear mechanisms to deal with unforeseen or unintended consequences. Focusing on user buy-in early and including plans for optimization can facilitate greater success.

  10. Peritonitis during continuous ambulatory peritoneal dialysis.

    Science.gov (United States)

    Rubin, J; Rogers, W A; Taylor, H M; Everett, E D; Prowant, B F; Fruto, L V; Nolph, K D

    1980-01-01

    We initiated a therapeutic program of continuous ambulatory peritoneal dialysis for patients with chronic renal failure. Our program resulted in many episodes of peritonitis arising from contamination due to the technical aspects of the procedure. Microbiologic evaluation showed that 73% of 97 episodes were culture positive, with gram-positive organisms causing most of the cases, especially early in dialysis. Gram-negative rods tended to occur later. Gram stains of dialysate effluent resulted in a disappointingly low yield of only 9% positivity. Cell counts were a dependable indicator of the presence of peritoneal inflammation and also of therapeutic success. Most patients responded well to intraperitoneal cephalothin, 125 mg/L for 10 to 14 d. The occurrence of peritonitis resulted in 0.93 years of hospitalization during the total of 15.45 patient-years on dialysis, which essentially negated the financial advantages of this method of treatment of chronic renal failure. For this to be a successful mode of therapy, advances in the prevention of peritonitis must be made. PMID:6985785

  11. Cuff inflation during ambulatory blood pressure monitoring and heart rate

    Directory of Open Access Journals (Sweden)

    Mia Skov-Madsen

    2008-11-01

    Full Text Available Mia Skov-Madsen, My Svensson, Jeppe Hagstrup ChristensenDepartment of Nephrology, Aarhus University Hospital, Aalborg, DenmarkIntroduction: Twenty four-hour ambulatory blood pressure monitoring is a clinically validated procedure in evaluation of blood pressure (BP. We hypothesised that the discomfort during cuff inflation would increase the heart rate (HR measured with 24-h ambulatory BP monitoring compared to a following HR measurement with a 24-h Holter monitor.Methods: The study population (n = 56 were recruited from the outpatient’s clinic at the Department of Nephrology, Aalborg Hospital, Aarhus University Hospital at Aalborg, Denmark. All the patients had chronic kidney disease (CKD. We compared HR measured with a 24-h Holter monitor with a following HR measured by a 24-h ambulatory BP monitoring.Results: We found a highly significant correlation between the HR measured with the Holter monitor and HR measured with 24-h ambulatory blood pressure monitoring (r = 0.77, p < 0.001. Using the Bland-Altman plot, the mean difference in HR was only 0.5 beat/min during 24 hours with acceptable limits of agreement for both high and low HR levels. Dividing the patients into groups according to betablocker treatment, body mass index, age, sex, angiotensin-converting enzyme inhibitor treatment, statins treatment, diuretic treatment, or calcium channel blocker treatment revealed similar results as described above.Conclusion: The results indicate that the discomfort induced by cuff inflation during 24-h ambulatory BP monitoring does not increase HR. Thus, 24-h ambulatory BP monitoring may be a reliable measurement of the BP among people with CKD.Keywords: ambulatory blood pressure monitoring, Holter monitoring, heart rate, chronic kidney disease, hypertension

  12. Determinants of general practitioner use among women in Australia.

    Science.gov (United States)

    Young, A F; Dobson, A J; Byles, J E

    2001-12-01

    This study investigates the use of general practitioner services by women in Australia. Although there is a universal health insurance system (Medicare) in Australia, there are variations in access to services and out of pocket costs for services. Survey data from 2350 mid-age (45-50 years) and 2102 older (70-75 years) women participating in the Australian Longitudinal Study on Women's Health were linked with Medicare data to provide a range of individual and contextual variables hypothesised to explain general practitioner use. Structural equation modelling showed that physical health was the most powerful explanatory factor of general practitioner use. However, after adjusting for self-reported health, out of pocket cost per consultation was inversely associated with use of services. The out of pocket cost was generally lower for women with low socioeconomic status but cost was also directly related to geographical remoteness. Women living in more remote areas had higher out of pocket costs and poorer access to services. Women who reported better access to care were more likely to be satisfied with their most recent general practice consultation and less likely to be sceptical of the value of medical care. These results show the need for health policies that improve the equitable use of general practitioner services in Australia. PMID:11762890

  13. The Paediatric Ambulatory Consulting Service (PACS) program: a role for family pediatricians in the hospital emergency rooms.

    Science.gov (United States)

    Nigri, Luigi; Piazzolla, Ruggiero; Pettoello-Mantovani, Massimo; Giardino, Ida; Abbinante, Micaela; Gorgoni, Giovanni

    2016-02-25

    This paper describes the Paediatric Ambulatory Consulting Service (PACS) project, developed by ASL-BT (Azienda Sanitaria Locale, Barletta-Andria-Trani), an Italian regional Public Health Centers network, in response to the current global situation of economic distress.PACS consist in integrating existing public health care services that are independently provided by hospitals and the Primary Care Paediatrics network. It has been developed with the aim to establish innovative yet efficient managerial solutions able to rationalize the resources not weakening the quality of services provided to the population.

  14. Nurse practitioner prescribing: an international perspective

    Directory of Open Access Journals (Sweden)

    Fong J

    2015-10-01

    Full Text Available Jacqueline Fong,1,2 Thomas Buckley,2 Andrew Cashin3 1St George Hospital, Kogarah, 2Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia; 3School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia Background: Internationally, the delivery of care provided by nurses and midwives has undergone a significant change due to a variety of interrelated factors, including economic circumstances, a diminishing number of medical providers, the unavailability of adequate health care services in underserved and rural areas, and growing specialization among the professions. One solution to the challenges of care delivery has been the introduction of nurse practitioners (NPs and the authorization of NPs to prescribe medicines. Aim: The aim of this paper was to review the current international literature related to NP prescribing and compare the findings to the Australian context. The review focuses on literature from the United States, Canada, Europe, Australia, and New Zealand. Methods: Databases were searched from January 2000 to January 2015. The following keywords: “nurse practitioner”, “advanced nurse”, “advanced practice nurse”, “prescri*”, “Australia”, “United States America”, “UK”, “New Zealand”, “Canada”, “Europe”, “drug prescri*”, “prescri* authority”, and “prescri* legislation” were used. Findings: NPs tend to prescribe in differing contexts of practice to provide care in underserved populations and require good systems literacy to practice across complex systems. The key themes identified internationally related to NP prescribing relate to barriers to prescribing, confidence in prescribing, and the unique role of NPs in prescribing medicines, eg, the high prevalence of prescribing pain medicines in several countries, including Australia. Conclusion: Across all countries reviewed, there appears a need for further research into the organizational and

  15. Complementary medicine and the general practitioner

    OpenAIRE

    Wharton, R; Lewith, G.

    1986-01-01

    The attitudes to complementary medicine of a random sample of general practitioners in Avon were assessed. A questionnaire was sent to 200 general practitioners, of whom 145 responded. The treatments studied were acupuncture, homoeopathy, herbal medicine, spinal manipulation, faith healing, and hypnosis. Of the 145 general practitioners, 55 (38%) had received some training in complementary medicine and 22 (15%) wished to arrange training. Overall, general practitioners knew little about the t...

  16. Statistical literacy for clinical practitioners

    CERN Document Server

    Holmes, William H

    2014-01-01

    This textbook on statistics is written for students in medicine, epidemiology, and public health. It builds on the important role evidence-based medicine now plays in the clinical practice of physicians, physician assistants and allied health practitioners. By bringing research design and statistics to the fore, this book can integrate these skills into the curricula of professional programs. Students, particularly practitioners-in-training, will learn statistical skills that are required of today’s clinicians. Practice problems at the end of each chapter and downloadable data sets provided by the authors ensure readers get practical experience that they can then apply to their own work.  Topics covered include:   Functions of Statistics in Clinical Research Common Study Designs Describing Distributions of Categorical and Quantitative Variables Confidence Intervals and Hypothesis Testing Documenting Relationships in Categorical and Quantitative Data Assessing Screening and Diagnostic Tests Comparing Mean...

  17. Nurse practitioner succession planning: forward thinking or just an after-thought?

    Science.gov (United States)

    Raftery, Chris

    2013-11-01

    This paper examines the concept of backfill and succession planning for an elite speciality nursing group, nurse practitioners. Nurse practitioners work in many public, private, inpatient and outpatient settings across the country. This discussion is relevant to all practicing nurse practitioners, but especially those with their own specific patient group. A nurse practitioner is an elite nursing specialist with specific speciality skills. While present, nurse practitioners can be most effective at holistically managing their patient group. However, if an endorsed nurse practitioner is no longer present, for a short or long interval, their specific skills and abilities cannot be easily substituted or replaced in the short term. This potential compromise in patient care can be detrimental to the developing reputation of the role of the nurse practitioner. In order to address the shortage of specifically skilled nurse practitioners across the country in all specialties, there is a need to forward plan and consider contingencies for succession in the event of short- or long-term absences from the clinical environment. Succession planning is the key to patient safety and the successful implementation of the role of the nurse practitioner.

  18. Ambulatory anesthesia in plastic surgery: opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Facque AR

    2015-10-01

    Full Text Available Alexander R Facque, Peter J Taub Division of Plastic and Reconstructive Surgery, Department of Surgery, Mount Sinai Medical Center, New York, NY, USA Abstract: In 2013, there were 17 million procedures performed by plastic and reconstructive surgeons in the United States in the private office or ambulatory “surgicenter” setting, as well as additional operations performed in hospitals on an outpatient basis. As interest in performing increasingly complex surgical procedures on an outpatient basis continues to grow, the surgeon and anesthesiologist alike must be prepared to offer safe and reliable anesthesia and analgesia in the ambulatory setting. Surgeons must be aware of the possible techniques that will be employed in their surgeries in order to anticipate and prepare patients for possible postoperative side effects, and anesthesiologists must be prepared to offer such techniques in order to ensure a relatively rapid return to normal activity despite potentially having undergone major surgery. The following is a review of the specific considerations that should be given to ambulatory plastic surgery patients with comments on recent developments in the techniques used to safely administer agreeable and effective anesthesia. Keywords: ambulatory surgery, cosmetic anesthesia, outpatient, ambulatory anesthesia

  19. Burnout contagion among general practitioners.

    OpenAIRE

    Bakker, A. B.; Schaufeli, W.B.; Sixma, H.J.; Bosveld, W.

    2001-01-01

    This study used a representative sample of 507 general practitioners (GPs) to test the hypothesis that burnout is contagious. Following a two-dimensional conceptualization of burnout, it is assumed that burnout is comprised of emotional exhaustion and negative attitudes (i.e., depersonalization and reduced personal accomplishment). We hypothesized that perceived burnout complaints among colleagues and susceptibility to emotional contagion would make an independent contribution to explaining v...

  20. Software engineering a practitioner's approach

    CERN Document Server

    Pressman, Roger S

    1997-01-01

    This indispensable guide to software engineering exploration enables practitioners to navigate the ins and outs of this rapidly changing field. Pressman's fully revised and updated Fourth Edition provides in-depth coverage of every important management and technical topic in software engineering. Moreover, readers will find the inclusion of the hottest developments in the field such as: formal methods and cleanroom software engineering, business process reengineering, and software reengineering.

  1. Women's health care: from whom and why?

    NARCIS (Netherlands)

    Brink-Muinen, A. van den

    1997-01-01

    Differences are investigated between female practice populations of female general practitioners providing women's health care and of women and men general practitioners providing regular health care. Women's health care in the Netherlands is provided in the general practice "Aletta" and is based o

  2. Ambulatory laparoscopic cholecystectomy: A single center experience

    Directory of Open Access Journals (Sweden)

    Cagri Tiryaki

    2016-01-01

    Full Text Available Aim: To evaluate the demographic and clinical parameters affecting the outcomes of ambulatory laparoscopic cholecystectomy (ALC in terms of pain, nausea, anxiety level, and satisfaction of patients in a tertiary health center. Materials and Methods: ALC was offered to 60 patients who met the inclusion criteria. Follow-up (questioning for postoperative pain or discomfort, nausea or vomiting, overall satisfaction was done by telephone contact on the same day at 22:00 p.m. and the first day after surgery at 8: 00 a.m. and by clinical examination one week after operation. STAI I and II data were used for proceeding to the level of anxiety of patients before and/or after the operation. Results: Sixty consecutive patients, with a mean age of 40.6 ± 8.1 years underwent ALC. Fifty-five (92% patients could be sent to their homes on the same day but five patients could not be sent due to anxiety, pain, or social indications. Nausea was reported in four (6.7% cases and not associated with any demographic or clinical features of patients. On the other hand, pain has been reported in 28 (46.7% cases, and obesity and shorter duration of gallbladder disease were associated with the increased pain perception (P = 0.009 and 0.004, respectively. Preopereative anxiety level was significantly higher among patients who could not complete the ALC procedure (P = 0.018. Conclusion: Correct management of these possible adverse effects results in the increased satisfaction of patients and may encourage this more cost-effective and safe method of laparoscopic cholecystectomy.

  3. Introduction to health economics for the medical practitioner

    OpenAIRE

    Kernick, D

    2003-01-01

    Against a background of increasing demands on limited resources, health economics is exerting an influence on decision making at all levels of health care. Health economics seeks to facilitate decision making by offering an explicit decision making framework based on the principle of efficiency. It is not the only consideration but it is an important one and practitioners will need to have an understanding of its basic principles and how it can impact on clinical decision making. This article...

  4. Drawing on International Experiences to Build General Practitioner System

    Institute of Scientific and Technical Information of China (English)

    Liu; Chang

    2015-01-01

    stablished in 1849,the Royal Dutch Medical Association seeks to promote the academic research and development in medical care to provide high-quality service.At the invitation of the CPAFFC,a 25-member RDMA delegation visited Beijing from March 15 to 20 for in-depth discussions on the general practitioner system with China’s National Health and Family Planning Commission,Beijing Municipal Health and Family Planning Commission,Peking University Health E

  5. Survey of general practitioners' knowledge about Helicobacter pylori infection

    OpenAIRE

    Peksen Yildiz; Sunter Ahmet; Canbaz Sevgi; Leblebicioglu Hakan

    2005-01-01

    Abstract Background Helicobacter pylori, occurring throughout the world and causing gastroduodenal diseases, is one of the most common chronic bacterial agents in humans. The purpose of this study was to measure the general practitioners' (GPs) knowledge and practices pertaining to H. pylori infection. Methods A cross-sectional type questionnaire survey was conducted in all of 19 primary health care centres (PHCC) in Samsun, Turkey, between November 1 and December 31, 2003. The questionnaire ...

  6. Canine aggression toward people: a guide for practitioners.

    Science.gov (United States)

    Sueda, Karen Lynn C; Malamed, Rachel

    2014-05-01

    This article reviews the various causes of human-directed aggression in dogs and provides a step-by-step plan guiding the general practitioner through history taking, behavior observations, diagnosis, consultation, treatment, and follow-up care. Charts summarizing how to obtain behavioral information, the client's management options, treatment recommendations, diagnosis and treatment of human-directed aggression, and the clinician's role in preventing human-directed aggression are included. A graphic illustration of canine body language is also provided. PMID:24766702

  7. Assessment of Communication Skills Level among Healthcare Practitioners

    OpenAIRE

    Barati, M; A. Afsar; M. Ahmadpanah

    2012-01-01

    Introduction & Objective: Communication skills are the most important characteristics for healthcare providers. The aim of this study was to assess communication skills level and its related factors among healthcare practitioners in Bahar-Hamadan.Materials & Methods: This descriptive-analytical study was carried out on 309 employees in Bahar health care system. Data-gathering tools consisted of a 3-part questionnaire: communication skills level measuring feedback, listening, and verbal commun...

  8. Canine aggression toward people: a guide for practitioners.

    Science.gov (United States)

    Sueda, Karen Lynn C; Malamed, Rachel

    2014-05-01

    This article reviews the various causes of human-directed aggression in dogs and provides a step-by-step plan guiding the general practitioner through history taking, behavior observations, diagnosis, consultation, treatment, and follow-up care. Charts summarizing how to obtain behavioral information, the client's management options, treatment recommendations, diagnosis and treatment of human-directed aggression, and the clinician's role in preventing human-directed aggression are included. A graphic illustration of canine body language is also provided.

  9. Análise situacional do atendimento ambulatorial prestado a recém-nascidos egressos das unidades de terapia intensiva neonatais no Estado do Rio de Janeiro Situational analysis of outpatient care for newborns discharged from neonatal intensive care units in the State of Rio de Janeiro

    Directory of Open Access Journals (Sweden)

    Maria Dalva Barbosa Baker Méio

    2005-04-01

    Full Text Available A diminuição da mortalidade neonatal contribui para o aumento de crianças que necessitam de maior atenção em relação a morbidades clínicas e à evolução do desenvolvimento neuropsicomotor. O objetivo deste estudo foi discutir a situação da assistência às crianças egressas das Unidades de Terapia Intensiva Neonatais (UTIN em cinco unidades em diferentes regiões do Estado do Rio de Janeiro; em nenhuma havia informações sobre o perfil dos egressos da UTIN. Evidenciou-se restrição ao acesso e baixa estruturação da rede em relação à assistência prestada a esses bebês. Não há uniformidade no atendimento prestado, e ambulatórios específicos para essa população concentram-se na cidade do Rio de Janeiro. Constatou-se deficiência de profissionais nas áreas de reabilitação - fisioterapia motora, terapia ocupacional, fonoaudiologia e psicologia -, e de especialistas para atendimento oftalmológico adequado e para a criança portadora de deficiência auditiva. Os autores discutem possíveis explicações para essa situação, propondo a organização de um sistema de atendimento em graus de complexidade para poder viabilizar o acesso das crianças de risco a um atendimento diferenciado, importante para detecção precoce de anormalidades do desenvolvimento.The decrease in neonatal mortality contributes for the increase of children needing more attention to clinical morbidities and to neuro-psycho-motor development outcome. The objective of this study was to discuss the situation of care of children discharged from the Neonatal Intensive Care Units (NICU in five units from differents regions of the state of Rio de Janeiro. In none of them were found informations regarding the description of those discharged from the NICU. This study revealed restricted access and scarcy organization of the health network for the care of these babies. The care provided is not uniform, with a concentration of specific outpatient clinics for

  10. [Certification of an ambulatory gastroenterologic service fulfilling ISO Law 9001--criteria and national guidelines of the Gastroenterologic Association].

    Science.gov (United States)

    Birkner, B

    2000-09-01

    The objectives of certification and accreditation are the deployment and examination of quality improvement measures in health care services. The quality management system of the ISO 9001 is created to install measures and tools leading to assured and improved quality in health care. Only some experiences with certification fulfilling ISO 9001 criteria exist in the German health care system. Evidence-based clinical guidelines can serve as references for the development of standards in quality measurement. Only little data exists on the implementation strategy of guidelines and evaluation, respectively. A pilot quality management system in consistence with ISO 9001 criteria was developed for ambulatory, gastroenterological services. National guidelines of the German Society of Gastroenterology and Metabolism and the recommendations of the German Association of Physicians for quality assurance of gastrointestinal endoscopy were included in the documentation and internal auditing. This pilot quality management system is suitable for the first steps in the introduction of quality management in ambulatory health care. This system shows validity for accreditation and certification of gastrointestinal health care units as well.

  11. [Certification of an ambulatory gastroenterologic service fulfilling ISO Law 9001--criteria and national guidelines of the Gastroenterologic Association].

    Science.gov (United States)

    Birkner, B

    2000-09-01

    The objectives of certification and accreditation are the deployment and examination of quality improvement measures in health care services. The quality management system of the ISO 9001 is created to install measures and tools leading to assured and improved quality in health care. Only some experiences with certification fulfilling ISO 9001 criteria exist in the German health care system. Evidence-based clinical guidelines can serve as references for the development of standards in quality measurement. Only little data exists on the implementation strategy of guidelines and evaluation, respectively. A pilot quality management system in consistence with ISO 9001 criteria was developed for ambulatory, gastroenterological services. National guidelines of the German Society of Gastroenterology and Metabolism and the recommendations of the German Association of Physicians for quality assurance of gastrointestinal endoscopy were included in the documentation and internal auditing. This pilot quality management system is suitable for the first steps in the introduction of quality management in ambulatory health care. This system shows validity for accreditation and certification of gastrointestinal health care units as well. PMID:11084717

  12. Programa Saúde da Família e condições sensíveis à atenção primária, Bagé (RS Programa Salud de la Familia y condiciones sensibles a la atención primaria, Sur de Brasil Family Health Program and ambulatory care-sensitive conditions in Southern Brazil

    Directory of Open Access Journals (Sweden)

    Fúlvio Borges Nedel

    2008-12-01

    familia, ser usuaria del Programa Salud de la Familia, consulta médica en la emergencia en el mes anterior a la investigación y hospital de internación; b hombres: rango de edad, haber sufrido otra internación en el año anterior a la entrevista y el hospital de internación. CONCLUSIONES: Las condiciones sensibles a la atención primaria permiten identificar grupos carentes de atención a la salud adecuada. A pesar de que el estudio no permita hacer inferencias sobre el riesgo de internación, los análisis por sexo y modelo de atención sugieren que el programa Salud de la Familia es más equitativo que la atención básica tradicional.OBJECTIVE: Ambulatory care-sensitive conditions (ACSC are health problems managed by actions at the first level of care. The need for hospitalization by these causes is avoidable through an effective and proper primary health care. The objective of the study was to estimate ACSC among patients hospitalized by the Sistema Único de Saúde (Brazilian Health System. METHODS: Hospital-based cross-sectional study involving 1,200 inhabitants of Bagé (Southern Brazil who were inpatients between September/2006 and January/2007. The patients answered a questionnaire applied by interviewers and were classified according to the model of attention utilized prior to hospitalization. ACSC were defined in a workshop promoted by the Ministry of Health. The variables analyzed included demographic and socioeconomic characteristics, health and health services utilized. Multivariate analysis was conducted by the Poisson model, according to a hierarchical conceptual framework, stratified by sex and model of care. RESULTS: ACSC accounted for 42.6% of the hospitalizations. The probability that the main diagnosis for hospitalization is considered an ACSC is greater among women, children under five years of age, individuals with less then five years of schooling, hospitalization in the year prior to the interview, emergency room consultation, and being an

  13. Abordagem ambulatorial do nutricionista em anemia hemolítica Nutritional ambulatory approach in hemolytic anemia

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Vieira

    1999-04-01

    Full Text Available Descreve a atuação do nutricionista em ambulatório de Hematologia Pediátrica em um hospital escola e relata as condutas dietéticas necessárias na abordagem de crianças com anemia hemolítica com e sem sobrecarga de ferro, e também as atitudes mais freqüentes dos familiares em relação à alimentação desses pacientes.The Authors describe the performance of the Dietitian in a Pediatric Hematology Ambulatory. They emphasize the necessary dietetic procedures for adequate management of children with hemolytic anemia, with and without iron overload. Furthermore, they approach the family's attitude towards the patient's nutrition.

  14. How to successfully select and implement electronic health records (EHR in small ambulatory practice settings

    Directory of Open Access Journals (Sweden)

    Detmer Don E

    2009-02-01

    Full Text Available Abstract Background Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation. Discussion The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff

  15. Ambulatory monitoring in the diagnosis and management of obstructive sleep apnoea syndrome

    Directory of Open Access Journals (Sweden)

    Jaime Corral-Peñafiel

    2013-09-01

    Full Text Available Obstructive sleep apnoea (OSA is a highly prevalent disorder associated with complications such as arterial hypertension, cardiovascular diseases and traffic accidents. The resources allocated for OSA are insufficient and OSA is a significant public health problem. Portable recording devices have been developed for the detection of OSA syndrome and have proved capable of providing an equivalent diagnosis to in-laboratory polysomnography (PSG, at least in patients with a high pre-test probability of OSA syndrome. PSG becomes important in patients who have symptoms and certain comorbidities such as chronic obstructive pulmonary disease or stroke, as well as in patients with a clinical history suggesting a different sleep disorder. Continuous positive airway pressure is the most effective treatment in OSA. Ambulatory monitoring of the therapeutic modalities has been evaluated to enhance the care process and reduce costs compared to the conventional approach, without sacrificing efficiency. This review evaluates the role of portable monitoring devices in the diagnostic process of OSA and the search for alternative strategies based on ambulatory management protocols.

  16. Accuracy of patient's turnover time prediction using RFID technology in an academic ambulatory surgery center.

    Science.gov (United States)

    Marchand-Maillet, Florence; Debes, Claire; Garnier, Fanny; Dufeu, Nicolas; Sciard, Didier; Beaussier, Marc

    2015-02-01

    Patients flow in outpatient surgical unit is a major issue with regards to resource utilization, overall case load and patient satisfaction. An electronic Radio Frequency Identification Device (RFID) was used to document the overall time spent by the patients between their admission and discharge from the unit. The objective of this study was to evaluate how a RFID-based data collection system could provide an accurate prediction of the actual time for the patient to be discharged from the ambulatory surgical unit after surgery. This is an observational prospective evaluation carried out in an academic ambulatory surgery center (ASC). Data on length of stay at each step of the patient care, from admission to discharge, were recorded by a RFID device and analyzed according to the type of surgical procedure, the surgeon and the anesthetic technique. Based on these initial data (n = 1520), patients were scheduled in a sequential manner according to the expected duration of the previous case. The primary endpoint was the difference between actual and predicted time of discharge from the unit. A total of 414 consecutive patients were prospectively evaluated. One hundred seventy four patients (42%) were discharged at the predicted time ± 30 min. Only 24% were discharged behind predicted schedule. Using an automatic record of patient's length of stay would allow an accurate prediction of the discharge time according to the type of surgery, the surgeon and the anesthetic procedure.

  17. Determinants of Diabetes and Hypertension Control in Ambulatory Healthcare in Al Ain, United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Latifa M. Baynouna

    2014-05-01

    Full Text Available bjectives: This study aims to study determinants for the control of diabetes and hypertension in Al Ain Ambulatory Healthcare patients. Method: This is a cross sectional observational study of patients attending ambulatory healthcare centers in Al Ain, United Arab Emirates in 2009. From a yearly audit evaluating the care of patients with diabetes and hypertension, the determinants for improved diabetes and hypertension outcomes were identified from a total of 512 patients and its association with glycemic and blood pressure control were studied. Results: From all variables studied, only the clinic where the patient was treated helped predict both improved blood sugar and blood pressure control. For patients with diabetes, poor control the year before (p<0.001, the number of chronic disease clinic visits (p=0.042 and triglyceride levels (p=0.007 predicted worse control of diabetes. A predictor of poor control of blood pressure (p<0.001 for patients with hypertension was poor control of blood pressure in the year before. Conclusion: In this population, the healthcare system and the team played major roles as determinants in the control of patient’s diabetes and blood pressure more than any of the other factors examined.

  18. Disparities in the use of ambulatory surgical centers: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Wei John T

    2009-07-01

    Full Text Available Abstract Background Ambulatory surgical centers (ASCs provide outpatient surgical services more efficiently than hospital outpatient departments, benefiting patients through lower co-payments and other expenses. We studied the influence of socioeconomic status and race on use of ASCs. Methods From the 2005 State Ambulatory Surgery Database for Florida, a cohort of discharges for urologic, ophthalmologic, gastrointestinal, and orthopedic procedures was created. Socioeconomic status was established at the zip code level. Logistic regression models were fit to assess associations between socioeconomic status and ASC use. Results Compared to the lowest group, patients of higher socioeconomic status were more likely to have procedures performed in ASCs (OR 1.07 CI 1.05, 1.09. Overall, the middle socioeconomic status group was the most likely group to use the ASC (OR 1.23, CI 1.21 to 1.25. For whites and blacks, higher status is associated with increased ASC use, but for Hispanics this relationship was reversed (OR 0.84 CI 0.78, 0.91. Conclusion Patients of lower socioeconomic status treated with outpatient surgery are significantly less likely to have their procedures in ASCs, suggesting that less resourced patients are encountering higher cost burdens for care. Thus, the most economically vulnerable group is unnecessarily subject to higher charges for surgery.

  19. Validating competence: a new credential for clinical documentation improvement practitioners.

    Science.gov (United States)

    Ryan, Jessica; Patena, Karen; Judd, Wallace; Niederpruem, Mike

    2013-01-01

    As the health information management (HIM) profession continues to expand and become more specialized, there is an ever-increasing need to identify emerging HIM workforce roles that require a codified level of proficiency and professional standards. The Commission on Certification for Health Informatics and Information Management (CCHIIM) explored one such role-clinical documentation improvement (CDI) practitioner-to define the tasks and responsibilities of the job as well as the knowledge required to perform them effectively. Subject-matter experts (SMEs) defined the CDI specialty by following best practices for job analysis methodology. A random sample of 4,923 CDI-related professionals was surveyed regarding the tasks and knowledge required for the job. The survey data were used to create a weighted blueprint of the six major domains that make up the CDI practitioner role, which later formed the foundation for the clinical documentation improvement practitioner (CDIP) credential. As a result, healthcare organizations can be assured that their certified documentation improvement practitioners have demonstrated excellence in clinical care, treatment, coding guidelines, and reimbursement methodologies. PMID:23843769

  20. Description of the role of nonphysician practitioners in radiation oncology

    International Nuclear Information System (INIS)

    Purpose: With changes in reimbursement and a decrease in the number of residents, there is a need to explore new ways of achieving high-quality patient care in radiation oncology. One mechanism is the implementation of nonphysician practitioner roles. The purpose of this paper is to describe the roles and responsibilities of clinical nurse specialists (CNSs), nurse practitioners (NPs), and physician assistants (PAs) currently working in the field of radiation oncology in the United States. Methods and Materials: A nationwide mailing was sent to elicit responses to an 8-page self-report questionnaire. Results: The final sample of 86 included 45 (52%) CNSs, 31 (36%) NPs, and 10 (12%) PAs. Two-thirds worked in private practice settings. Most of the nonphysician practitioners frequently obtained histories (57-90%) and ordered laboratory studies (52-68%). However, NPs and PAs were more likely than CNSs to frequently perform 'medical' services such as perform physical exams (42-80% vs. 19-36%), order radiologic studies (50% vs. 17%), and prescribe medication (60-84% vs. 26%). CNSs were more likely to provide 'supportive' services such as develop educational materials, participate in quality improvement initiatives, and develop policies and procedures. Conclusions: Nonphysician practitioners are not substituting for physicians, but rather are working in collaboration with them, performing designated tasks

  1. Adesão medicamentosa em idosos em seguimento ambulatorial Medicine adeshion in eldery people in an ambulatorial attendance

    OpenAIRE

    Fernanda Aparecida Cintra; Maria Elena Guariento; Lilian Akemi Miyasaki

    2010-01-01

    Este estudo objetivou avaliar a adesão ao tratamento medicamentoso em idosos em seguimento ambulatorial e identificar os fatores relacionados a esta adesão. Foram entrevistados 165 idosos em seguimento ambulatorial no Hospital das Clínicas da Universidade Estadual de Campinas (Unicamp), São Paulo. Utilizou-se instrumento próprio, com informações relativas à identificação dos sujeitos, dados de saúde autorreferidos e relativos à terapêutica medicamentosa. Os dados foram submetidos às análises ...

  2. Health Care of the Elderly in Medically Disadvantaged Populations.

    Science.gov (United States)

    German, Pearl S.; And Others

    1978-01-01

    This study of three disadvantaged urban areas reports on the relationship between available resources and ambulatory health care. Findings indicate a high proportion of elderly receiving care for serious conditions but a sharp drop in care for less serious but potentially disabling conditions. (Author)

  3. Is it economically viable to employ the nurse practitioner in general practice?

    NARCIS (Netherlands)

    Dierick-van Daele, Angelique; Steuten, Lotte M.G.; Romeijn, Aria; Derckx, Emmy W.C.C.; Vrijhoef, Hubertus J.M.

    2011-01-01

    Background:  General practitioners face the challenging task of finding the most efficient and effective mix of professionals in general practice to accommodate future care demands within scarce health care budgets. To enable informed decision-making about skill mix issues, economic information is n

  4. Parent perceptions of pediatric ambulatory surgery: using family feedback for program evaluation.

    Science.gov (United States)

    Voepel-Lewis, T; Andrea, C M; Magee, S S

    1992-04-01

    Pediatric ambulatory surgery programs have grown tremendously during the past decade. However, limited nursing time places severe constraints on the care and education of surgical outpatients. Preoperative teaching, patient support, and postoperative instruction, previously conducted over days, is now completed in several hours. The ambulatory surgical program at Mott Children's Hospital was designed to provide thorough patient and family education, comprehensive patient care, and short-term follow-up. A formal evaluation of the program was conducted to ensure quality care for outpatients. This study evaluated preoperative and discharge preparation, postoperative problems and follow-up, preoperative waiting, stress, and privacy. The sample was composed of 332 families. Of the respondents, 289 (87%) felt very prepared overall for outpatient surgery; 33 families (10%) attended the preoperative tour, and felt significantly better prepared for surgery than families who did not attend; 322 families (97%) felt adequately prepared to very prepared for discharge; 245 families (76%) felt that the recovery time was just right; 40 parents (12%) felt that their children experienced more pain and 34 (10.4%) more nausea and vomiting than expected postoperatively; 54 families called a PACU nurse postoperatively with questions, and 92% rated the call as very helpful; 31 families called the surgical service with concerns, and 61% rated the surgeon as helpful; 83 families (25%) perceived the outpatient experience as being very stressful. Stress correlated significantly with preoperative preparation, preoperative wait, previous outpatient experience, and perceived postoperative pain. Privacy in the environment was rated as fair to poor by 192 families (59%).(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Gender and communication style in general practice: differences between women's health care and regular health care.

    NARCIS (Netherlands)

    Brink-Muinen, A. van den; Bensing, J.M.; Kerssens, J.J.

    1998-01-01

    Objectives: differences were investigated between general practitioners providing women's health care (4 women) and general practitioners providing regular health care (8 women and 8 men). Expectations were formulated on the basis of the principles of women's health care and literature about gender

  6. Preoperative testing and risk assessment: perspectives on patient selection in ambulatory anesthetic procedures

    Directory of Open Access Journals (Sweden)

    Stierer TL

    2015-08-01

    Full Text Available Tracey L Stierer,1,2 Nancy A Collop3,41Department of Anesthesiology, 2Department of Critical Care Medicine, Otolaryngology Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, MD, USA; 3Department of Medicine, 4Department of Neurology, Emory University, Emory Sleep Center, Wesley Woods Center, Atlanta, GA, USAAbstract: With recent advances in surgical and anesthetic technique, there has been a growing emphasis on the delivery of care to patients undergoing ambulatory procedures of increasing complexity. Appropriate patient selection and meticulous preparation are vital to the provision of a safe, quality perioperative experience. It is not unusual for patients with complex medical histories and substantial systemic disease to be scheduled for discharge on the same day as their surgical procedure. The trend to “push the envelope” by triaging progressively sicker patients to ambulatory surgical facilities has resulted in a number of challenges for the anesthesia provider who will assume their care. It is well known that certain patient diseases are associated with increased perioperative risk. It is therefore important to define clinical factors that warrant more extensive testing of the patient and medical conditions that present a prohibitive risk for an adverse outcome. The preoperative assessment is an opportunity for the anesthesia provider to determine the status and stability of the patient’s health, provide preoperative education and instructions, and offer support and reassurance to the patient and the patient’s family members. Communication between the surgeon/proceduralist and the anesthesia provider is critical in achieving optimal outcome. A multifaceted approach is required when considering whether a specific patient will be best served having their procedure on an outpatient basis. Not only should the patient's comorbidities be stable and optimized, but details regarding the planned procedure and the resources available

  7. Current Usage of Traditional Chinese Medicine in the Management of Breast Cancer: A Practitioner's Perspective.

    Science.gov (United States)

    McPherson, Luke; Cochrane, Suzanne; Zhu, Xiaoshu

    2016-09-01

    Introduction This qualitative study seeks to explore the role within the context of Australian breast cancer oncology treatments that traditional Chinese medicine (TCM) practitioners play in the treatment of breast cancer. Methods Semistructured interviews were used on 2 groups: the first group was TCM practitioners who were recognized experts in breast cancer, and the second group consisted of TCM practitioners who treated breast cancer as part of their practice but were not recognized experts. Data analysis was achieved through grounded theory with open coding. Results The main themes reported on here are the following: the role of TCM in the biomedical management of breast cancer, TCM strategies for the management of breast cancer, and the perceived holistic approach of the TCM practitioner and the importance of a TCM diagnosis in the role of breast cancer care. Discussion The role of TCM in biomedical breast cancer management is a supportive one; however, this role is difficult as there is a lack of understanding of TCM by biomedical practitioners. The viewpoints of practitioners differed on key strategies of TCM: diagnosis, and treatment protocols. Patients sought the holistic approach of TCM practitioners as they felt it addressed all aspects of their health and not just the symptoms relating to breast cancer. Conclusion The lack of an integrated medicine approach in relation to TCM makes it difficult to demonstrate the value of the contribution TCM can make to biomedicine in the field of breast care oncology. Effectiveness studies are needed that can accurately represent TCM in this field. PMID:26420777

  8. Determinants of patient satisfaction in ambulatory oncology: a cross sectional study based on the OUT-PATSAT35 questionnaire

    Directory of Open Access Journals (Sweden)

    Nguyen Thanh Vân France

    2011-12-01

    Full Text Available Abstract Background The aim of this study was to identify factors associated with satisfaction with care in cancer patients undergoing ambulatory treatment. We investigated associations between patients' baseline clinical and socio-demographic characteristics, as well as self-reported quality of life, and satisfaction with care. Methods Patients undergoing ambulatory chemotherapy or radiotherapy in 2 centres in France were invited, at the beginning of their treatment, to complete the OUT-PATSAT35, a 35 item and 13 scale questionnaire evaluating perception of doctors, nurses and aspects of care organisation. Additionally, for each patient, socio-demographic variables, clinical characteristics and self-reported quality of life using the EORTC QLQ-C30 questionnaire were recorded. Results Among 692 patients included between January 2005 and December 2006, only 6 were non-responders. By multivariate analysis, poor perceived global health strongly predicted dissatisfaction with care (p Conclusions A number of clinical of socio-demographic factors were significantly associated with different scales of the satisfaction questionnaire. However, the main determinant was the patient's global health status, underlining the importance of measuring and adjusting for self-perceived health status when evaluating satisfaction. Further analyses are currently ongoing to determine the responsiveness of the OUT-PATSAT35 questionnaire to changes over time.

  9. Quality indicators and performance measures in diabetes care.

    Science.gov (United States)

    Aron, David C

    2014-03-01

    The operations of any portion of the healthcare delivery system, eg, ambulatory care, the consultation and referral process, or hospital care, are critically dependent upon their control systems. The quality of health care produced by the system and its components is also subject to "control." One of the regulatory mechanisms involves performance measures. The development of good measures of quality is a complex and dynamic process. Within endocrinology, most measures have addressed diabetes care and most quality measurement in diabetes has focused on the ambulatory setting and mainly includes measures of process and intermediate outcomes. This review addresses quality and performance measures for diabetes, their development, characteristics, use, misuse, and future prospects.

  10. Mercury and Other Biomedical Waste Management Practices among Dental Practitioners in India

    OpenAIRE

    Raghuwar D Singh; Jurel, Sunit K.; Shuchi Tripathi; Agrawal, Kaushal K.; Reema Kumari

    2014-01-01

    Objectives. The objective of the study was to assess the awareness and performance towards dental waste including mercury management policy and practices among the dental practitioners in North India. Materials and Methods. An epidemiologic survey was conducted among 200 private dental practitioners. The survey form was composed of 29 self-administered questions frame based on knowledge, attitude, and those regarding the practices of dentists in relation to dental health-care waste management...

  11. Attempt at deriving a formula for setting general practitioner fundholding budgets.

    OpenAIRE

    Sheldon, T. A.; SMITH, P.; Borowitz, M.; Martin, S.; Hill, R. C.

    1994-01-01

    OBJECTIVE--To explore the possibility of using routine Hospital Episode Statistics, census data, and vital statistics to derive weights for an equitable capitation formula for setting general practitioner fundholding budgets for buying acute hospital services. DESIGN--Analysis of a routine dataset of 9 million hospital episodes in 1991-2, extracting elective general practitioner fundholding procedures, combined with 1991 census variables, vital statistics, and data on supply of health care at...

  12. Does the Maslach Burnout Inventory correlate with cognitive performance in anesthesia practitioners? A pilot study

    OpenAIRE

    Eleonora Francesca Orena; Dario Caldiroli; Paolo Cortellazzi

    2013-01-01

    Background: Chronic stress is a common condition among health-care operators, anesthetists in particular. It is known to cause cognitive weakening and pathological outcomes, as the Burnout syndrome. Nevertheless, the impact of clinicians′ health on their performance has received limited attention thus far. Our pilot study, aims at evaluating the influence of burnout on the cognitive performance in a population of anesthesia practitioners. Methods: In 18 practitioners we assessed attention by ...

  13. Screening for Pediatric Obstructive Sleep Apnea before Ambulatory Surgery

    Science.gov (United States)

    Ishman, Stacey L.; Tawfik, Kareem O.; Smith, David F.; Cheung, Kristin; Pringle, Lauren M.; Stephen, Matthew J.; Everett, Tiffany L.; Stierer, Tracey L.

    2015-01-01

    Purpose: The American Society of Anesthesia practice guidelines recommend that pediatric and adult patients who undergo ambulatory surgery be screened for obstructive sleep apnea (OSA). With this in mind, our objective was to assess the frequency of screening by anesthesia providers for the signs and symptoms of OSA in children undergoing surgery in an ambulatory setting. Methods: Prospective single-blinded observational study of anesthesia providers' preoperative interview of caregivers of consecutive patients younger than age 18 who were scheduled for ambulatory surgery. Results: One hundred one children (30 females) were identified, with a mean age of 6.9 ± 5.0 years; 54 were classified as white, 33 as black, and 14 as other. Total OSA-18 scores ranged from 18 to 97, with a mean of 33.1 ± 14.8. The mean score for adenotonsillectomy patients was higher than that for children who underwent procedures other than adenotonsillectomy. Thirty-one percent of children were screened for OSA, and snoring was the most common symptom recorded (28%). Patients who were screened for OSA were more likely to have snoring (p Tawfik KO, Smith DF, Cheung K, Pringle LM, Stephen MJ, Everett TL, Stierer TL. Screening for pediatric obstructive sleep apnea before ambulatory surgery. J Clin Sleep Med 2015;11(7):751–755. PMID:25902820

  14. T-wave Alternans Analysis In Ambulatory ECG Monitoring

    OpenAIRE

    Ch?apinski, Jakub; Kaminski, Marek; Sakowicz, Bartosz; Kotas, Rafa?

    2010-01-01

    The aim of the research presented in this paper was to test and evaluate the possibility of T-wave alternans (TWA) detection with the use of standard ambulatory ECG monitors. In development work there is proposal of author's advanced method allowing to remove from signal any distortion and disturbances making impossible further analysis.

  15. Utilizing ambulatory blood pressure recordings to evaluate antihypertensive drug therapy.

    Science.gov (United States)

    White, W B

    1992-04-30

    Until recently, the efficacy and pharmacodynamics of antihypertensive agents were assessed by resting blood pressure measurements in the doctor's office or a research clinic. The limitations of the office or clinic blood pressure measurement include the lack of representation (from recording only 1 point of time in the dosing schedule), the effects of the doctor's office on the patient's blood pressure, and, perhaps more relevant, observer bias. Ambulatory monitoring of the blood pressure has gained worldwide acceptance as an alternative method to assess antihypertensive drug efficacy and the time-effect relation of a drug. The ambulatory monitoring devices have been refined and are smaller, more precise, and more reliable than earlier recording models. Although there are no reference standards for analysis of ambulatory blood pressure data, international consensus groups are presently addressing this problem. Key roles for ambulatory blood pressure recordings in clinical trials of antihypertensive agents now include determination of the entry criteria for patients, improving the assessment of peak/trough pharmacodynamics in the patient's own environment (including nocturnal/sleep readings), and evaluating efficacy through calculation of the hypertensive burden, or blood pressure load. PMID:1575177

  16. Efficacy of a training intervention on the quality of practitioners' decision support for patients deciding about place of care at the end of life: A randomized control trial: Study protocol

    Directory of Open Access Journals (Sweden)

    Murray Mary Ann

    2008-04-01

    Full Text Available Abstract Background Most people prefer home palliation but die in an institution. Some experience decisional conflict when weighing options regarding place of care. Clinicians can identify patients' decisional needs and provide decision support, yet generally lack skills and confidence in doing so. This study aims to determine whether the quality of clinicians' decision support can be improved with a brief, theory-based, skills-building intervention. Theory The Ottawa Decision Support Framework (ODSF guides an evidence based, practical approach to assist clinicians in providing high-quality decision support. The ODSF proposes that decisional needs [personal uncertainty, knowledge, values clarity, support, personal characteristics] strongly influence the quality of decisions patients make. Clinicians can improve decision quality by providing decision support to address decisional needs [clarify decisional needs, provide facts and probabilities, clarify values, support/guide deliberation, monitor/facilitate progress]. Methods/Design The efficacy of a brief education intervention will be assessed in a two-phase study. In phase one a focused needs assessment will be conducted with key informants. Phase two is a randomized control trial where clinicians will be randomly allocated to an intervention or control group. The intervention, informed by the needs assessment, knowledge transfer best practices and the ODSF, comprises an online tutorial; an interactive skills building workshop; a decision support protocol; performance feedback, and educational outreach. Participants will be assessed: a at baseline (quality of decision support; b after the tutorial (knowledge; and c four weeks after the other interventions (quality of decision support, intention to incorporate decision support into practice and perceived usefulness of intervention components. Between group differences in the primary outcome (quality of decision support scores will be analyzed

  17. Pharmacological treatment of ambulatory schizophrenic patients in Belgium

    Directory of Open Access Journals (Sweden)

    Reginster J-Y

    2006-05-01

    Full Text Available Abstract Background the objective of this study was twofold: 1 Describe the use of antipsychotic treatments in ambulatory patients suffering from schizophrenia in Belgium. 2 Evaluate to which extend antipsychotic treatment prescribing patterns are in accordance with published treatment guidelines. Method A cross-sectional survey was carried out in 16 Belgian hospitals selected from a sample of 67 hospitals. The hospitals were equally distributed between the north and south part of the country and were representative of Belgian practice. During 2 months, participating psychiatrists were asked to record the medication use as well as demographic parameters of all consecutive ambulatory patients seen at their consultation or attending a day-hospital. Data concerning 1000 ambulatory patients with schizophrenia or schizoaffective disorder were collected. Results In Belgium, the use of atypical antipsychotics is frequent (69% in ambulatory patients with schizophrenia. In the overall sample, 73% receive only one antipsychotic drug. The majority of patients are treated with drugs of only one antipsychotic drug group, either first- typical (29.8% or second-generation, atypical antipsychotics (53.2%. 15.8% of patients combine different types of antipsychotics. Antipsychotic dosing is adequate for the majority of patients but about one fifth receives a higher than recommended dose as per package inserts. Polypharmacy remains within reasonable limits. The use of concomitant medication varies according the antipsychotic treatment: patients who take second-generation antipsychotics only, receive the least additional drugs. Conclusion Atypical antipsychotics appear to be the first line treatment for schizophrenic psychosis. Psychiatrists working with ambulatory patients are well aware of treatment guidelines and follow them quite adequately.

  18. Ambulatory pressure monitoring in the assessment of antihypertensive therapy.

    Science.gov (United States)

    Coats, A J; Conway, J; Somers, V K; Isea, J E; Sleight, P

    1989-06-01

    A low-cost, ambulatory blood-pressure monitor has been calibrated and validated against a random zero sphygmomanometer. The repeatability of ambulatory pressure recordings after a placebo month in 44 mild to moderate untreated hypertensives was assessed. Systolic blood pressure showed a mean difference over 1 month of 2.0 mmHg, with a standard deviation of differences of 9.3 mmHg. The diastolic blood pressure mean difference was 0.1 mmHg (SD = 6.3 mmHg). This variability was much less than for clinic readings (SD = 17.3 mmHg) or for single home pressure readings (SD = 19.7 mmHg). Using ambulatory monitoring to detect a drop in pressure of 8/5 mmHg with a power of 0.9, the number of subjects needed in a parallel group trial is reduced from 360 to 68, and in a crossover study from 88 to 16 subjects. The usefulness of ambulatory pressure monitoring is demonstrated in a placebo-controlled comparison of atenolol, nifedipine retard, or their combination in random order. Eleven subjects, 21-60 years, with initial average blood pressures of 166.5/104.7 mmHg, showed a reduction in pressure with atenolol 50 mg a day of 15.1/10.0 mmHg, with nifedipine retard 20 mg b.i.d. of 21.0/11.6 mmHg, and with atenolol 50 mg and nifedipine retard 20 mg once a day of 26.2/16.8 mmHg. Ambulatory monitoring of pressure improved the accuracy of the trial and demonstrated a reduction in the alerting response with atenolol. PMID:2487802

  19. Electrophysiological correlates of higher states of consciousness during sleep in long-term practitioners of the Transcendental Meditation program.

    Science.gov (United States)

    Mason, L I; Alexander, C N; Travis, F T; Marsh, G; Orme-Johnson, D W; Gackenbach, J; Mason, D C; Rainforth, M; Walton, K G

    1997-02-01

    Standard ambulatory night sleep electroencephalograph (EEG) of 11 long-term practitioners of the Transcendental Meditation (TM) program reporting "higher states of consciousness" during sleep (the experimental group) was compared to that of nine short-term practitioners and 11 non-practitioners. EEG tracings during stages 3 and 4 sleep showed the experimental group to have: 1) theta-alpha activity simultaneously with delta activity and 2) decreased chin electromyograph (EMG) during deep sleep (p = 0.002) compared to short-term practitioners. Spectral analysis fast Fourier transform (FFT) data of the first three cycles showed that: 3) the experimental subjects had significantly greater theta 2 (6-8 Hz)-alpha 1 (8-10 Hz) relative power during stages 3 and 4 than the combined control groups [t(30) = 5.5, p = 0.0000008] with no difference in time in delta; 4) there was a graded difference across groups during stages 3 and 4 in theta 2-alpha 1 power, with experimentals having greater power than short-term practitioners, who in turn had greater power than non-practitioners [t(30) = 5.08, p = 0.00002]; and 5) experimentals also had increased rapid eye movement (REM) density during REM periods compared to short-term practitioners (p = 0.04). Previous studies have found increased theta-alpha EEG activity during reported periods of "transcendental consciousness" during the TM technique. In the Vedic tradition, as described by Maharishi Mahesh Yogi, transcendental consciousness is the first of a sequence of higher states. The maintenance of transcendental consciousness along with deep sleep is said to be a distinctive criterion of further, stabilized higher states of consciousness. The findings of this study are interpreted as physiological support for this model.

  20. General practitioners and occupational health services.

    OpenAIRE

    Parker, G.

    1996-01-01

    BACKGROUND: Occupational physicians and general practitioners often appear to differ in their attitudes to the provision of health screening, health promotion and vaccination in the workplace. AIM: This study aimed to explore the attitudes of occupational physicians and general practitioners to particular aspects of workplace health services. METHOD: Anonymous piloted postal questionnaires were sent to 400 UK general practitioners and 300 occupational physicians. RESULTS: Questionnaires were ...