Prevention of anxiety disorders in primary care: A feasibility study

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Batelaan Neeltje M

2012-11-01

Full Text Available Abstract Background Anxiety disorders are highly prevalent in primary care and cause a substantial burden of disease. Screening on risk status, followed by preventive interventions in those at risk may prevent the onset of anxiety disorders, and thereby reduce the disease burden. The willingness to participate in screening and interventions is crucial for the scope of preventive strategies, but unknown. This feasibility study, therefore, investigated participation rates of screening and preventive services for anxiety disorders in primary care, and explored reasons to refrain from screening. Methods In three general practices, screening was offered to individuals visiting their general practitioner (total n = 2454. To assess risk status, a 10-item questionnaire was followed by a telephone interview (including the CIDI when scoring above a predefined threshold. Preventive services were offered to those at risk. Participation rates for screening and preventive services for anxiety disorders were assessed. Those not willing to be screened were asked for their main reason to refrain from screening. Results Of all individuals, 17.3% participated in initial screening, and of those with a possible risk status, 56.0% continued screening. In 30.1% of those assessed, a risk status to develop an anxiety disorder was verified. Of these, 22.6% already received some form of mental health treatment and 38.7% of them agreed to participate in a preventive intervention and were referred. The most frequently mentioned reasons to refrain from screening were the emotional burden associated with elevated risk status, the assumption not to be at risk, and a lack of motivation to act upon an elevated risk status by using preventive services. Conclusions Screening in general practice, followed by offering services to prevent anxiety disorders in those at risk did not appear to be a feasible strategy due to low participation rates. To enable the development of

A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates.

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Yokoe, Deborah S; Anderson, Deverick J; Berenholtz, Sean M; Calfee, David P; Dubberke, Erik R; Ellingson, Katherine D; Gerding, Dale N; Haas, Janet P; Kaye, Keith S; Klompas, Michael; Lo, Evelyn; Marschall, Jonas; Mermel, Leonard A; Nicolle, Lindsay E; Salgado, Cassandra D; Bryant, Kristina; Classen, David; Crist, Katrina; Deloney, Valerie M; Fishman, Neil O; Foster, Nancy; Goldmann, Donald A; Humphreys, Eve; Jernigan, John A; Padberg, Jennifer; Perl, Trish M; Podgorny, Kelly; Septimus, Edward J; VanAmringe, Margaret; Weaver, Tom; Weinstein, Robert A; Wise, Robert; Maragakis, Lisa L

2014-08-01

Since the publication of "A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals" in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts. They are the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS).

Breaks in continuity of care and the rural senior transferred for medical care under regionalisation

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H. Jay Biem

2003-09-01

Full Text Available Continuity of care, defined as the patient experiencing coherent care over time and place, is challenged when a rural senior with multiple medical problems is transferred to a regional hospital for acute care. From an illustrative case of an older patient with pneumonia and atrial fibrillation, we catalogue potential breaks in continuity of care. Optimal continuity of care is characterised not only by regular contact with the providers who establish collaboration with patients and their caregivers, but also by communication, co-ordination, contingency, convenience, and consistency. Because it is not possible to have the same providers continuously available (relational continuity, for continuity of care, there is a need for integrative system approaches, such as: (1 policy and standards, disease management programs, integrated clinical pathways (management continuity, (2 electronic health information systems and telecommunications technology (communication continuity. The evaluation of these approaches requires measures that account for the multi-faceted nature of continuity of care.

Opportunity Knocks: HIV Prevention in Primary Care.

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Thrun, Mark W

2014-06-01

Expansions in health care coverage, a comprehensive framework for HIV prevention and care, electronic medical records, and novel HIV prevention modalities create a current opportunity to change the trajectory of the HIV epidemic in the United States. HIV is increasingly disproportionately found in populations historically at higher risk, including gay men and other men who have sex with men, transgender women, injection drug users, and persons of color. This underscores the need for providers to identify persons at higher risk for HIV and assure the provision of screening and prevention services. In turn, universal screening for HIV-testing every adolescent and adult at least once in their lifetime-will increasingly be necessary to find the infrequent cases of HIV in lower risk populations. In both these domains, primary care providers will play a unique role in complementing traditional providers of HIV prevention and care services by increasing the proportion of their patients who have been screened for HIV, opening dialogues around sexual health, including asking about sexual orientation and gender identity, and prescribing antivirals as pre- and postexposure prophylaxis for their non-HIV-infected patients. Primary care providers must understand and embrace their importance along the HIV prevention and care continuum.

[Continuous medical education of general practitioners/family doctors in chronic wound care].

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Sinozić, Tamara; Kovacević, Jadranka

2014-10-01

A number of healthcare professionals, specialists in different fields and with different levels of education, as well as non-healthcare professionals, are involved in the care of chronic wound patients, thus forming a multidisciplinary team that is not only responsible for the course and outcome of treatment, but also for the patient quality of life. Family doctor is also member of the team the task of which is to prevent, diagnose, monitor and anticipate complications and relapses, as well as complete recovery of chronic wound patients, with the overall care continuing even after the wound has healed, or is involved in palliative care. A family medicine practitioner with specialized education and their team of associates in the primary health care, along with material conditions and equipment improvement, can provide quality care for patients with peripheral cardiovascular diseases and chronic wounds, organized according to the holistic approach. It is essential that all professional associations of family medicine as well as professional associations of other specialties - fields that are involved in wound prevention and treatment - be included in developing the continuous medical education program. The benefits of modern information technology should be used to good advantage. The education should be adapted to the needs of family practitioners in terms of the form, place, time, volume, financial affordability and choice of topic. The interest shown in team education should be transformed into specialized programs in the creation of which it is essential to include both physicians and nurses and their respective professional associations. Special attention should be paid to education and training of young doctors/nurses, those with less work experience, those that have not yet been part of such education, those that lack experience in working with wound patients, those whose teams deal mostly with elderly patients, and also residents in family medicine and

Impact of Provider Participation in ACO Programs on Preventive Care Services, Patient Experiences, and Health Care Expenditures in US Adults Aged 18-64.

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Hong, Young-Rock; Sonawane, Kalyani; Larson, Samantha; Mainous, Arch G; Marlow, Nicole M

2018-05-15

Little is known about the impact of accountable care organization (ACO) on US adults aged 18-64. To examine whether having a usual source of care (USC) provider participating in an ACO affects receipt of preventive care services, patient experiences, and health care expenditures among nonelderly Americans. A cross-sectional analysis of the 2015 Medical Organizations Survey linked with the Medical Expenditure Panel Survey. Survey respondents aged 18-64 with an identified USC and continuous health insurance coverage during 2015. Preventative care services (routine checkup, flu vaccination, and cancer screening), patient experiences with health care (access to care, interaction quality with providers, and global satisfaction), and health care expenditures (total and out-of-pocket expenditures) for respondents with USC by ACO and non-ACO provider groups. Among 1563, nonelderly Americans having a USC, we found that nearly 62.7% [95% confidence interval (CI), 58.6%-66.7%; representing 15,722,208 Americans] were cared for by ACO providers. Our analysis showed no significant differences in preventive care services or patient experiences between ACO and non-ACO groups. Adjusted mean total health expenditures were slightly higher for the ACO than non-ACO group [$7016 (95% CI, $4949-$9914) vs. $6796 (95% CI, $4724-$9892)]; however, this difference was not statistically significant (P=0.250). Our findings suggest that having a USC provider participating in an ACO is not associated with preventive care services use, patient experiences, or health care expenditures among a nonelderly population.

Speak Up: Help Prevent Errors in Your Care: Home Care

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... Your Care Home Care To prevent health care errors, patients are urged to... SpeakUP TM Everyone has a ... you think they have confused you with another patient. P ay attention to the care you ... for their identification (ID) badges. • Make sure you or family members ...

Successful prevention of ventilator-associated pneumonia in an intensive care setting.

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Marra, Alexandre R; Cal, Ruy Guilherme Rodrigues; Silva, Cláudia Vallone; Caserta, Raquel Afonso; Paes, Angela Tavares; Moura, Denis Faria; dos Santos, Oscar Fernando Pavão; Edmond, Michael B; Durão, Marcelino Souza

2009-10-01

Ventilator-associated pneumonia (VAP) is one of the most common health care-associated infections (HAIs) in critical care settings. Our objective was to examine the effect of a series of interventions, implemented in 3 different periods to reduce the incidence of VAP in an intensive care unit (ICU). A quasiexperimental study was conducted in a medical-surgical ICU. Multiple interventions to optimize VAP prevention were performed during different phases. From March 2001 to December 2002 (phase 1: P1), some Centers for Disease Control and Prevention (CDC) evidence-based practices were implemented. From January 2003 to December 2006 (P2), we intervened in these processes at the same time that performance monitoring was occurring at the bedside, and, from January 2007 to September 2008 (P3), we continued P2 interventions and implemented the Institute for Healthcare Improvement's ventilator bundle plus oral decontamination with chlorhexidine and continuous aspiration of subglottic secretions. The incidence density of VAP in the ICU per 1000 patient-days was 16.4 in phase 1, 15.0 in phase 2, and 10.4 in phase 3, P=.05. Getting to zero VAP was possible only in P3 when compliance with all interventions exceeded 95%. These results suggest that reducing VAP rates to zero is a complex process that involves multiple performance measures and interventions.

Experienced continuity of care in patients at risk for depression in primary care.

NARCIS (Netherlands)

Uijen, A.A.; Schers, H.J.; Schene, A.H.; Schellevis, F.G.; Lucassen, P.; Bosch, W.J.H.M. van den

2014-01-01

Background: Existing studies about continuity of care focus on patients with a severe mental illness. Objectives: Explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure. Methods: Explorative

Experienced continuity of care in patients at risk for depression in primary care

NARCIS (Netherlands)

Uijen, Annemarie A.; Schers, Henk J.; Schene, Aart H.; Schellevis, Francois G.; Lucassen, Peter; van den Bosch, Wil J. H. M.

2014-01-01

Existing studies about continuity of care focus on patients with a severe mental illness. Explore the level of experienced continuity of care of patients at risk for depression in primary care, and compare these to those of patients with heart failure. Explorative study comparing patients at risk

RFID Continuance Usage Intention in Health Care Industry.

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Iranmanesh, Mohammad; Zailani, Suhaiza; Nikbin, Davoud

Radio-frequency identification (RFID) has been proved to be an effective tool both for improving operational efficiency and for gaining competitive advantage in the health care industry despite its relatively low-usage rate in hospitals. The sustained use of RFID by health care professionals will promote its development in the long term. This study evaluates the acceptance continuance of RFID among health care professionals through technology continuance theory (TCT). Data were collected from 178 medical professionals in Malaysia and were then analyzed using the partial least squares technique. The analysis showed that the TCT model provided not only a thorough understanding of the continuance behavior of health care professionals toward RFID but also the attitudes, satisfaction, and perceived usefulness of professionals toward it. The results of this study are expected to assist policy makers and managers in the health care industry in implementing the RFID technology in hospitals by understanding the determinants of continuance of RFID usage intention.

Continuity of care: betrayed values or misplaced nostalgia.

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Roland, Martin

2012-10-01

Care is better coordinated when doctors have personal responsibility for their patients. Continuity and a sense of personal responsibility are becoming more difficult to provide in hospitals, in part because of the European Working Time Directive. However, in many countries general practitioners are self-employed and able to organise their practices as they wish. In the UK, they increasingly do so in ways that make it difficult for patients to get continuity of care. This is despite most patients being clear that they want to see a regular doctor, and professional bodies in primary care consistently promoting continuity as a core value. General practitioners need to decide whether continuity of care matters. If it does, then they need to take a lead in ensuring that care is organised so that patients who want to see a regular doctor are able to do so. Suggestions are included for how contemporary practice can be organised to promote this traditional but still highly relevant value.

Continuity of care: betrayed values or misplaced nostalgia?

Directory of Open Access Journals (Sweden)

Martin Roland

2012-10-01

Full Text Available Care is better coordinated when doctors have personal responsibility for their patients. Continuity and a sense of personal responsibility are becoming more difficult to provide in hospitals, in part because of the European Working Time Directive. However, in many countries general practitioners are self-employed and able to organise their practices as they wish. In the UK, they increasingly do so in ways that make it difficult for patients to get continuity of care. This is despite most patients being clear that they want to see a regular doctor, and professional bodies in primary care consistently promoting continuity as a core value. General practitioners need to decide whether continuity of care matters. If it does, then they need to take a lead in ensuring that care is organised so that patients who want to see a regular doctor are able to do so. Suggestions are included for how contemporary practice can be organised to promote this traditional but still highly relevant value.

System care improves trauma outcome: patient care errors dominate reduced preventable death rate.

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Thoburn, E; Norris, P; Flores, R; Goode, S; Rodriguez, E; Adams, V; Campbell, S; Albrink, M; Rosemurgy, A

1993-01-01

A review of 452 trauma deaths in Hillsborough County, Florida, in 1984 documented that 23% of non-CNS trauma deaths were preventable and occurred because of inadequate resuscitation or delay in proper surgical care. In late 1988 Hillsborough County organized a County Trauma Agency (HCTA) to coordinate trauma care among prehospital providers and state-designated trauma centers. The purpose of this study was to review county trauma deaths after the inception of the HCTA to determine the frequency of preventable deaths. 504 trauma deaths occurring between October 1989 and April 1991 were reviewed. Through committee review, 10 deaths were deemed preventable; 2 occurred outside the trauma system. Of the 10 deaths, 5 preventable deaths occurred late in severely injured patients. The preventable death rate has decreased to 7.0% with system care. The causes of preventable deaths have changed from delayed or inadequate intervention to postoperative care errors.

Visitation in the intensive care unit: impact on infection prevention and control.

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Adams, Sheila; Herrera, Amando; Miller, Laura; Soto, Rhonda

2011-01-01

Evidence-based practice has shown that open visitation in the intensive care setting positively impacts patient outcomes. However, many intensive care units continue to strictly limit visitation hours. One concern for nurses is that open visitation will expose their vulnerable patients to an increased risk of infection. This fear is unfounded in professional literature as well as in the experience of a busy intensive care unit in San Antonio, Texas. Keeping our patients safe from hospital-acquired infections requires vigilant attention to infection prevention procedures. Meanwhile, what may actually be bugging our patients is a health care culture that is based on tradition and is blind to the many benefits provided by a more liberal visitation policy rooted in patient-centered care.

How unique is continuity of care? A review of continuity and related concepts.

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Uijen, Annemarie A; Schers, Henk J; Schellevis, François G; van den Bosch, Wil J H M

2012-06-01

The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. In order to clarify the confusion of tongues and to identify core values of these patient-centred concepts, we provide a historical overview of continuity of care and four related concepts: coordination of care, integration of care, patient-centred care and case management. We identified and reviewed articles including a definition of one of these concepts by performing an extensive literature search in PubMed. In addition, we checked the definition of these concepts in the Oxford English Dictionary. Definitions of continuity, coordination, integration, patient-centred care and case management vary over time. These concepts show both great entanglement and also demonstrate differences. Three major common themes could be identified within these concepts: personal relationship between patient and care provider, communication between providers and cooperation between providers. Most definitions of the concepts are formulated from the patient's perspective. The identified themes appear to be core elements of care to patients. Thus, it may be valuable to develop an instrument to measure these three common themes universally. In the patient-centred medical home, such an instrument might turn out to be an important quality measure, which will enable researchers and policy makers to compare care settings and practices and to evaluate new care interventions from the patient perspective.

Study of relation of continuing medical education to quality of family physicians' care.

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Dunn, E V; Bass, M J; Williams, J I; Borgiel, A E; MacDonald, P; Spasoff, R A

1988-10-01

A random sample of 120 physicians in Ontario was studied to assess quality of care in primary care and test an hypothesis that quality of care was related to continuing medical education (CME) activities. The quality-of-care scores were obtained by an in-office audit of a random selection of charts. The scores were global scores for charting, prevention, the use of 13 classes of drugs, and care of a two-year period for 182 different diagnoses. There were no relationships between global quality-of-care scores based on these randomly chosen charts and either the type or quantity of the physicians' CME activities. These activities were reading journals, attending rounds, attending scientific conferences, having informal consultations, using audio and video cassettes, and engaging in self-assessment. The implications of these findings are significant for future research in CME and for planners of present CME programs.

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

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... Your Care Ambulatory Care To prevent health care errors, patients are urged to... SpeakUP TM Everyone has a ... he or she has confused you with another patient. P ay attention to the ... for their identification (ID) badges. • Notice whether your caregivers have washed ...

How do dentists and their teams incorporate evidence about preventive care? An empirical study.

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Sbaraini, Alexandra; Carter, Stacy Marie; Evans, Robin Wendell; Blinkhorn, Anthony

2013-10-01

To identify how dentists and their teams adopt evidence-based preventive care. A qualitative study using grounded theory methodology was conducted. We interviewed 23 participants working in eight dental practices about their experience and work processes, while adopting evidence-based preventive care. During the study, Charmaz's grounded theory methodology was employed to examine the social process of adopting preventive dental care in dental practices. Charmaz's iteration of the constant comparative method was used during the data analysis. This involved coding of interview transcripts, detailed memo-writing and drawing diagrams. The transcripts were analyzed as soon as possible after each round of interviews in each dental practice. Coding was conducted primarily by AS, supported by team meetings and discussions when researchers compared their interpretations. Participants engaged in a slow process of adapting evidence-based protocols and guidelines to the existing logistics of the practices. This process was influenced by practical, philosophical, and historical aspects of dental care, and a range of barriers and facilitators. In particular, dentists spoke spontaneously about two deeply held 'rules' underpinning continued restorative treatment, which acted as barriers to provide preventive care: (i) dentists believed that some patients were too 'unreliable' to benefit from prevention; and (ii) dentists believed that patients thought that only tangible restorative treatment offered 'value for money'. During the adaptation process, some dentists and teams transitioned from their initial state - selling restorative care - through an intermediary stage - learning by doing and educating patients about the importance of preventive care - and finally to a stage where they were offering patients more than just restorative care. Resources were needed for the adaptation process to occur, including: the ability to maintain the financial viability of the practice

[Perception of Primary Care physicians on the integration with cardiology through continuity of healthcare programs in secondary prevention].

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Cosin-Sales, J; Orozco Beltrán, D; Ledesma Rodríguez, R; Barbon Ortiz Casado, A; Fernández, G

2018-02-17

To determine the perception of Primary Care (PC) physicians on the integration with cardiology (CA) through continuity of healthcare programs. A cross-sectional and multicentre study was conducted, in which a total of 200 PC physicians from all over Spain completed a qualitative survey that evaluated the level of integration with CA in secondary prevention. Physicians were grouped according to the level of PC-CA integration. The integration between CA and PC was good, but it was better in those centres with a higher integration (74.0% vs. 60.0%; p=.02) and in general, physicians considered that integration had improved (92.0% vs. 73.0%; pintegration. In 55.8%, 63.6%, and 51.3% of hospital discharge reports, indications were given on when to perform the follow-up blood analysis, as well as information about returning to working life and sexual activity, respectively. The most common communication method was the paper-based report (75 vs. 84%; p=NS). The communication between healthcare levels was greater in those Primary Care centres with a higher level of integration, as well as periodicity of the communication and the satisfaction of physicians (80.0% vs. 63.0%; p=.005). The level of integration between PC and CA is, in general, satisfactory, but those centres with a higher level of integration benefit more from a greater communication and satisfaction. Copyright © 2018 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

Pressure ulcer prevention in care home settings.

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Ellis, Michael

2017-03-31

Pressure ulcer prevention in the care home setting can be challenging and is often compromised by a lack of access to education and resources. There are measures that have been shown to consistently improve outcomes in pressure ulcer prevention including assessment of the patient and their individual risks, delivery of a consistent plan of care that meets patients' needs, and regular evaluation to identify shortfalls. In addition, there should be a robust approach to investigating events that lead to a person developing a pressure ulcer and that information should be used to improve future practice. Pressure ulcer prevention in care homes is achievable and nurses should all be aware of the necessary measures detailed in this article.

Speak Up: Help Prevent Errors in Your Care: Laboratory Services

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SpeakUP TM Help Prevent Errors in Your Care Laboratory Services To prevent health care errors, patients are urged to... SpeakUP TM ... are more likely to get better faster. To help prevent health care mistakes, patients are urged to “ ...

Knowledge and practice for pressure injury prevention among care managers in a home care setting: a cross-sectional study

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Kohta M

2017-08-01

new risk assessment scale as a bridge between both medical professionals and social welfare professionals. Practically, the authors recommend care managers should receive continuous education and practical training for pressure injury prevention in a home care setting. Keywords: long term care, Braden scale, questionnaire, risk assessment, pressure ulcer

Continuity of care is an important and distinct aspect of childbirth experience : Findings of a survey evaluating experienced continuity of care, experienced quality of care and women's perception of labor

NARCIS (Netherlands)

Perdok, Hilde; Verhoeven, Corine J.; van Dillen, Jeroen; Schuitmaker, Tjerk Jan; Hoogendoorn, Karla; Colli, Jolanda; Schellevis, François G.; de Jonge, Ank

2018-01-01

Background: To compare experienced continuity of care among women who received midwife-led versus obstetrician-led care. Secondly, to compare experienced continuity of care with a. experienced quality of care during labor and b. perception of labor. Methods: We conducted a questionnaire survey in a

Continuity of midwifery care and gestational weight gain in obese women: a randomised controlled trial

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Patterson Denise

2011-03-01

Full Text Available Abstract Background The increased prevalence of obesity in pregnant women in Australia and other developed countries is a significant public health concern. Obese women are at increased risk of serious perinatal complications and guidelines recommend weight gain restriction and additional care. There is limited evidence to support the effectiveness of dietary and physical activity lifestyle interventions in preventing adverse perinatal outcomes and new strategies need to be evaluated. The primary aim of this project is to evaluate the effect of continuity of midwifery care on restricting gestational weight gain in obese women to the recommended range. The secondary aims of the study are to assess the impact of continuity of midwifery care on: women's experience of pregnancy care; women's satisfaction with care and a range of psychological factors. Methods/Design A two arm randomised controlled trial (RCT will be conducted with primigravid women recruited from maternity services in Victoria, Australia. Participants will be primigravid women, with a BMI≥30 who are less than 17 weeks gestation. Women allocated to the intervention arm will be cared for in a midwifery continuity of care model and receive an informational leaflet on managing weight gain in pregnancy. Women allocated to the control group will receive routine care in addition to the same informational leaflet. Weight gain during pregnancy, standards of care, medical and obstetric information will be extracted from medical records. Data collected at recruitment (self administered survey and at 36 weeks by postal survey will include socio-demographic information and the use of validated scales to measure secondary outcomes. Discussion Continuity of midwifery care models are well aligned with current Victorian, Australian and many international government policies on maternity care. Increasingly, midwifery continuity models of care are being introduced in low risk maternity care, and

Knowledge and attitude towards preventive dental care among dental faculties in Bangalore city

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Nikhil Ahuja

2014-01-01

Full Text Available Background and Objectives: Preventive approach in dental practice has been cited as a reason for the decline in oral diseases and as a predominant part of the service-mix of dental practices in the future. Dental faculty′s knowledge and attitude toward prevention are important, since they have exceptionally important direct and indirect roles in shaping student′s preventive orientation and also potentially influencing their patient′s ability to take care of their teeth. Thus, this study was conducted to assess knowledge and attitudes toward preventive dental care among dental faculties and their relation to demographic and professional characteristics. Materials and Methods: A cross-sectional study was conducted among dental faculties in Bangalore city. Of 17 dental colleges, 4 were selected by simple random sampling. A total of 218 dental faculties was individually asked to complete a pretested questionnaire. The questionnaire requested information on dental faculty′s demographic and professional characteristics and their knowledge and attitudes toward preventive dental care. Descriptive, Chi-square tests, and ANOVA were used to analyze the data. Results: The highest knowledge was seen among dental faculties regarding prevention of malocclusion (3.51 ± 1.02 followed by oral cancer (2.95 ± 1.09 and periodontal diseases (2.86 ± 1.02. The least knowledge was seen for the prevention of caries (2.63 ± 1.35. The most positive attitudes regarding preventive dentistry was characterized as being essential (6.34 ± 1.05, useful (6.32 ± 1.07 and valuable (6.27 ± 1.00. Statistically significant differences were found in relation to knowledge and attitudes for all demographic and professional characteristics except for gender and Department of Teaching. Conclusion: Dental faculty seems to have differing levels of knowledge regarding oral diseases with positive attitudes seen regarding preventive dentistry. Continuing education activities and

Preventive Care Quality of Medicare Accountable Care Organizations: Associations of Organizational Characteristics With Performance.

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Albright, Benjamin B; Lewis, Valerie A; Ross, Joseph S; Colla, Carrie H

2016-03-01

Accountable Care Organizations (ACOs) are a delivery and payment model aiming to coordinate care, control costs, and improve quality. Medicare ACOs are responsible for 8 measures of preventive care quality. To create composite measures of preventive care quality and examine associations of ACO characteristics with performance. This is a cross-sectional study of Medicare Shared Savings Program and Pioneer participants. We linked quality performance to descriptive data from the National Survey of ACOs. We created composite measures using exploratory factor analysis, and used regression to assess associations with organizational characteristics. Of 252 eligible ACOs, 246 reported on preventive care quality, 177 of which completed the survey (response rate=72%). In their first year, ACOs lagged behind PPO performance on the majority of comparable measures. We identified 2 underlying factors among 8 measures and created composites for each: disease prevention, driven by vaccines and cancer screenings, and wellness screening, driven by annual health screenings. Participation in the Advanced Payment Model, having fewer specialists, and having more Medicare ACO beneficiaries per primary care provider were associated with significantly better performance on both composites. Better performance on disease prevention was also associated with inclusion of a hospital, greater electronic health record capabilities, a larger primary care workforce, and fewer minority beneficiaries. ACO preventive care quality performance is related to provider composition and benefitted by upfront investment. Vaccine and cancer screening quality performance is more dependent on organizational structure and characteristics than performance on annual wellness screenings, likely due to greater complexity in eligibility determination and service administration.

How unique is continuity of care? A review of continuity and related concepts.

NARCIS (Netherlands)

Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; Bosch, W.J.H.M. van den

2012-01-01

BACKGROUND: The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. OBJECTIVE: In order to clarify the confusion of

How unique is continuity of care? A review of continuity and related concepts

NARCIS (Netherlands)

Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; van den Bosch, W.J.H.M.

2012-01-01

Background: The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. Objective: In order to clarify the confusion of

A Role for Health Communication in the Continuum of HIV Care, Treatment, and Prevention

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Tomori, Cecilia; Risher, Kathryn; Limaye, Rupali J.; Lith, Lynn Van; Gibbs, Susannah; Smelyanskaya, Marina; Celentano, David D.

2015-01-01

Health communication has played a pivotal role in HIV prevention efforts since the beginning of the epidemic. The recent paradigm of combination prevention, which integrates behavioral, biomedical, and structural interventions, offers new opportunities for employing health communication approaches across the entire continuum of care. We describe key areas where health communication can significantly enhance HIV treatment, care, and prevention, presenting evidence from interventions that include health communication components. These interventions rely primarily on interpersonal communication, especially individual and group counseling, both within and beyond clinical settings to enhance the uptake of and continued engagement in care. Many successful interventions mobilize a network of trained community supporters or accompagnateurs, who provide education, counseling, psychosocial support, treatment supervision and other pragmatic assistance across the care continuum. Community treatment supporters reduce the burden on overworked medical providers, engage a wider segment of the community, and offer a more sustainable model for supporting people living with HIV. Additionally, mobile technologies are increasingly seen as promising avenues for ongoing cost-effective communication throughout the treatment cascade. A broader range of communication approaches, traditionally employed in HIV prevention efforts, that address community and sociopolitical levels through mass media, school- or workplace-based education, and entertainment modalities may be useful to interventions seeking to address the full care continuum. Future interventions would benefit from development of a framework that maps appropriate communication theories and approaches onto each step of the care continuum in order to evaluate the efficacy of communication components on treatment outcomes. PMID:25007201

Urban-rural disparity in utilization of preventive care services in China.

Science.gov (United States)

Liu, Xiang; Li, Ningxiu; Liu, Chaojie; Ren, Xiaohui; Liu, Danping; Gao, Bo; Liu, Yuanyuan

2016-09-01

Preventive care service is considered pivotal on the background of demographic ageing and a rise in chronic diseases in China. The disparity in utilization of preventive care services between urban and rural in China is a serious issue. In this paper, we explored factors associated with urban-rural disparity in utilization of preventive care services in China, and determined how much of the urban-rural disparity was attributable to each determinant of utilization in preventive care services. Using representative sample data from China Health and Nutrition Survey in 2011 (N = 12,976), the present study performed multilevel logistic model to examine the factors that affected utilization of preventive care services in last 4 weeks. Blinder-Oaxaca decomposition method was applied to divide the utilization of preventive care disparity between urban and rural residents into a part that can be explained by differences in observed covariates and unobserved part. The percentage of rural residents utilizing preventive care service in last 4 weeks was lower than that of urban residents (5.1% vs 9.3%). Female, the aged, residents with higher education level and household income, residents reporting self-perceived illness in last 4 weeks and physician-diagnosed chronic disease had higher likelihood of utilizing preventive care services. Household income was the most important factor accounting for 26.6% of urban-rural disparities in utilization of preventive care services, followed by education (21.5%), self-perceived illness in last 4 weeks (7.8%), hypertension (4.4%), diabetes (3.3%), other chronic diseases (0.8%), and health insurance (-1.0%). Efforts to reduce financial barriers for low-income individuals who cannot afford preventive services, increasing awareness of the importance of obtaining preventive health services and providing more preventive health services covered by health insurance, may help to reduce the gap of preventive care services utilization between

Patients report better satisfaction with part-time primary care physicians, despite less continuity of care and access.

Science.gov (United States)

Panattoni, Laura; Stone, Ashley; Chung, Sukyung; Tai-Seale, Ming

2015-03-01

The growing number of primary care physicians (PCPs) reducing their clinical work hours has raised concerns about meeting the future demand for services and fulfilling the continuity and access mandates for patient-centered care. However, the patient's experience of care with part-time physicians is relatively unknown, and may be mediated by continuity and access to care outcomes. We aimed to examine the relationships between a physicians' clinical full-time equivalent (FTE), continuity of care, access to care, and patient satisfaction with the physician. We used a multi-level structural equation estimation, with continuity and access modeled as mediators, for a cross-section in 2010. The study included family medicine (n = 104) and internal medicine (n = 101) physicians in a multi-specialty group practice, along with their patient satisfaction survey responses (n = 12,688). Physician level FTE, continuity of care received by patients, continuity of care provided by physician, and a Press Ganey patient satisfaction with the physician score, on a 0-100 % scale, were measured. Access to care was measured as days to the third next-available appointment. Physician FTE was directly associated with better continuity of care received (0.172% per FTE, p part-time PCPs in practice redesign efforts and initiatives to meet the demand for primary care services.

[Recognition, care and prevention of suicidal behaviour in adults].

Science.gov (United States)

Rihmer, Zoltán; Németh, Attila; Kurimay, Tamás; Perczel-Forintos, Dóra; Purebl, György; Döme, Péter

2017-01-01

majority of suicidal patients have problems with relationships, work, school and lack functioning social networks. 4. A secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks. 5. Education of treatment team: Training of general practitioners is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals. Multidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality. 6. Public aspects: Not only the health care workers are responsible for suicide prevention. All members of our society (including community/political leaders as well as religious and civil organizations) have their own task with more or less competence and responsibility.

Infection control in intensive care units and prevention of ventilator-associated pneumonia.

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Bonten, M J; Weinstein, R A

2000-12-01

Ventilator-associated pneumonia (VAP) is considered the most frequent infection in the intensive care unit (ICU), although incidence rates depend on the diagnostic methods. Because VAP has been associated with increased mortality and greater costs for medical care, prevention remains an important goal for intensive care medicine. Selective digestive decontamination (SDD), the most frequently studied method of infection prevention, is still controversial despite more than 30 prospective randomized trials and 6 metaanalyses. SDD reduces the incidence of VAP diagnoses, but beneficial effects on duration of ventilation or ICU stay, antibiotic use, and patient survival have not been shown unequivocally. Although recent metaanalyses suggest a 20% to 40% decrease in ICU mortality for SDD used with systemic prophylaxis, this benefit should be confirmed in a large, prospective, randomized study, preferably with a cost-benefit analysis. Selection of pathogens resistant to the antibiotics used in SDD remains the most important drawback of SDD, rendering SDD contraindicated in wards with endemic resistant problems. Other methods of infection prevention that do not create a selective growth advantage for resistant microorganisms may be more useful. Among these are the use of endotracheal tubes with the possibility of continuous aspiration of subglottic secretions, oropharyngeal decontamination with antiseptics, or the semirecumbent treatment position of patients. Although these methods were successful in single studies, more data are needed. Notwithstanding the potential benefits of these interventions, such classic infection control measures as handwashing remain the cornerstone of infection prevention.

Care provision to prevent chronic disease by community mental health clinicians.

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Bartlem, Kate M; Bowman, Jennifer A; Freund, Megan; Wye, Paula M; McElwaine, Kathleen M; Wolfenden, Luke; Campbell, Elizabeth M; Gillham, Karen E; Wiggers, John H

2014-12-01

People with a mental illness have higher prevalence of behavioral risks for chronic disease than the general population. Despite recommendations regarding the provision of preventive care by mental health services, limited research has examined the extent to which such care is provided. To examine mental health clinician provision of care for preventable chronic disease risks, and whether such care was associated with the availability of practice support strategies. A cross-sectional survey was undertaken of 151 community mental health clinicians in New South Wales, Australia regarding the provision of three elements of preventive care (i.e., assessment, brief advice, and referral/follow-up) for four health risk behaviors (i.e., tobacco smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption, and inadequate physical activity). Clinicians reported the availability of 16 strategies to support such care delivery. Data were collected in 2010 and analyzed in 2012-2013. Preventive care provision varied by both care element and risk behavior. Optimal care (each care element provided to at least 80% of clients for all health behaviors) was provided by few clinicians: assessment (8.6%), brief advice (24.5%), and referral/follow-up (9.9%). Less than half of clinicians reported more than four support strategies were available (44.4%). The availability of five or more strategies was associated with increased optimal preventive care. The provision of preventive care focused on chronic disease prevention in community mental health services is suboptimal. Interventions to increase the routine provision of such care should involve increasing the availability of evidence-based strategies to support care provision. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Receipt of preventive oral health care by U.S. children: a population-based study of the 2005-2008 medical expenditure panel surveys.

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Huebner, Colleen E; Bell, Janice F; Reed, Sarah C

2013-11-01

This study provides estimates of the annual use of preventive oral health care by U.S. children ages 6 months-17 years. We estimated the annual use of preventive oral health care with data from the Medical Expenditure Panel Survey for the years 2005 through 2008 (n = 18,218). Additionally, we tested associations between use of preventive oral health care and predisposing factors, enabling factors and health need within three age groups: young children, school-age children and youth. Overall, 21 % of the sample was reported to have received preventive oral health care in the prior year. More school-age children received preventive care than did young children or youth regardless of gender, race/ethnicity, health status, residence, or family size. Among the youngest children, low parental education and lack of health insurance were associated with lower odds of receiving preventive care. School-age children of racial and ethnic minority groups had a higher odds of receiving preventive care than did non-Hispanic Whites. Youth with special health care needs were less likely to receive care than their peers. Within each age group, use of preventive care increased significantly from 2005 to 2008. In the U.S. there has been an increase in use of pediatric preventive dental care. Continued effort is needed to achieve primary prevention. Outreach and education should include all parents and especially parents with low levels of education, parents of children with special health care needs and those without health insurance.

Suicide Prevention: An Emerging Priority For Health Care.

Science.gov (United States)

Hogan, Michael F; Grumet, Julie Goldstein

2016-06-01

Suicide is a significant public health problem. It is the tenth leading cause of death in the United States, and the rate has risen in recent years. Many suicide deaths are among people recently seen or currently under care in clinical settings, but suicide prevention has not been a core priority in health care. In recent years, new treatment and management strategies have been developed, tested, and implemented in some organizations, but they are not yet widely used. This article examines the feasibility of improving suicide prevention in health care settings. In particular, we consider Zero Suicide, a model for better identification and treatment of patients at risk for suicide. The approach incorporates new tools for screening, treatment, and support; it has been deployed with promising results in behavioral health programs and primary care settings. Broader adoption of improved suicide prevention care may be an effective strategy for reducing deaths by suicide. Project HOPE—The People-to-People Health Foundation, Inc.

[Continuity of nutritional care at discharge in the era of ICT].

Science.gov (United States)

Martínez Olmos, Miguel Ángel

2015-05-07

Telemedicine represents the union of information technology and telecommunication services in health. This allows the improvement of health care, especially in underserved areas, bringing professionals working in continuing education and improving patient care at home. The application of telemedicine in various hospital complexes, clinics and health centers, has helped to provide a better service, within the parameters of efficiency, effectiveness, cost-benefit, with increasing satisfaction of medical staff and patients. The development and application of various types of telemedicine, the technological development of audio, text, video and data, and constant improvement of infrastructure in telecommunications, have favored the expansion and development of telemedicine in various medical specialties. The use of electronic health records by different health professionals can have a positive impact on the care provided to patients. This should also be supported by the development of better health policies, legal security and greater awareness in health professionals and patients regarding the potential benefits. Regarding the clinical activity in Nutrition, new technologies also provide an opportunity to improve in various educational, preventive, diagnostic and treatment aspects, including shared track between Nutrition Units and Primary Care Teams, for patients who need home nutritional care at, with shared protocols, providing teleconsultation in required cases and avoiding unnecessary travel to hospital.

[Using eHealth in the Continuity Care of Chronic Kidney Disease: Opportunities and Considerations].

Science.gov (United States)

Chen, Yu-Chi; Chang, Polun

2016-04-01

Kidney disease is a common complication of chronic diseases among adult and elderly populations. As early-stage chronic kidney disease (CKD) is asymptomatic, CKD patients are frequently unaware of their condition and fail to implement requisite self-care in a timely fashion. Furthermore, the shortage of case-management manpower and difficulties in follow-up have led to high incidence rates for CKD worldwide. Integrative and continuous care is key to preventing CKD. How to implement this care effectively is a challenge. However, innovative technologies, online information, and cloud technology are increasingly providing access to good-quality healthcare beyond the traditional limitations of time and location. This environment is not only increasing the participation of patients in their care and collaboration among healthcare team members but is also improving the continuity, accessibility, and promptness of care service in order to promote the effectiveness of disease management. While the primary aim of innovative technologies is to make healthcare more cost-effective, it is also causing disparities in healthcare. Within the high-tech e-healthcare system, the ability of patients to utilize these new services relates directly to their health behaviors and quality of care. Thus, emergent e-healthcare system services should be made as patient-centered as possible in order to maximize the benefits in terms of both cost and patient care. Furthermore, improving the eHealth literacy of patients is crucial to promoting innovative technology within healthcare services.

GPs' perspectives on preventive care for older people: a focus group study.

Science.gov (United States)

Drewes, Yvonne M; Koenen, Julia M; de Ruijter, Wouter; van Dijk-van Dijk, D J Annemarie; van der Weele, Gerda M; Middelkoop, Barend J C; Reis, Ria; Assendelft, Willem J J; Gussekloo, Jacobijn

2012-11-01

Preventive care traditionally aims to prevent diseases or injuries. For older people, different aims of prevention, such as maintenance of independence and wellbeing, are increasingly important. To explore GPs' perspectives on preventive care for older people. Qualitative study comprising six focus groups with GPs in the Netherlands. The focus-group discussions with 37 GPs were analysed using the framework analysis method. Whether or not to implement preventive care for older people depends on the patient's individual level of vitality, as perceived by the GP. For older people with a high level of vitality, GPs confine their role to standardised disease-oriented prevention on a patient's request; when the vitality levels in older people fall, the scope of preventive care shifts from prevention of disease to prevention of functional decline. For older, vulnerable people, GPs expect most benefit from a proactive, individualised approach, enabling them to live as independently as possible. Based on these perspectives, a conceptual model for preventive care was developed, which describes GPs' different perspectives toward older people who are vulnerable and those with high levels of vitality. It focuses on five main dimensions: aim of care (prevention of disease versus prevention of functional decline), concept of care (disease model versus functional model), initiator (older persons themselves versus GP), target groups (people with requests versus specified risk groups), and content of preventive care (mainly cardiovascular risk management versus functional decline). GPs' perspectives on preventive care are determined by their perception of the level of vitality of their older patients. Preventive care for older people with high levels of vitality may consist of a standardised disease-oriented approach; those who are vulnerable will need an individualised approach to prevent functional decline.

Predictors of relational continuity in primary care: patient, provider and practice factors.

Science.gov (United States)

Kristjansson, Elizabeth; Hogg, William; Dahrouge, Simone; Tuna, Meltem; Mayo-Bruinsma, Liesha; Gebremichael, Goshu

2013-05-31

Continuity is a fundamental tenet of primary care, and highly valued by patients; it may also improve patient outcomes and lower cost of health care. It is thus important to investigate factors that predict higher continuity. However, to date, little is known about the factors that contribute to continuity. The purpose of this study was to analyse practice, provider and patient predictors of continuity of care in a large sample of primary care practices in Ontario, Canada. Another goal was to assess whether there was a difference in the continuity of care provided by different models of primary care. This study is part of the larger a cross-sectional study of 137 primary care practices, their providers and patients. Several performance measures were evaluated; this paper focuses on relational continuity. Four items from the Primary Care Assessment Tool were used to assess relational continuity from the patient's perspective. Multilevel modeling revealed several patient factors that predicted continuity. Older patients and those with chronic disease reported higher continuity, while those who lived in rural areas, had higher education, poorer mental health status, no regular provider, and who were employed reported lower continuity. Providers with more years since graduation had higher patient-reported continuity. Several practice factors predicted lower continuity: number of MDs, nurses, opening on weekends, and having 24 hours a week or less on-call. Analyses that compared continuity across models showed that, in general, Health Service Organizations had better continuity than other models, even when adjusting for patient demographics. Some patients with greater health needs experience greater continuity of care. However, the lower continuity reported by those with mental health issues and those who live in rural areas is concerning. Furthermore, our finding that smaller practices have higher continuity suggests that physicians and policy makers need to consider

Preventive Care Recommendations for Adults with MS

Science.gov (United States)

... risk factors including prolonged use of steroids or anticonvulsants, a family history of osteoporosis, and a sedentary ... care provider. Yearly. Monthly. The American Academy of Pediatrics recommends starting at age eighteen. Preventive Care Recommendations | ...

Preventive and Community Medicine in Primary Care. Teaching of Preventive Medicine Vol. 5.

Science.gov (United States)

Barker, William H., Ed.

This monograph is the result of a conference on the role of preventive and community medicine in primary medical care and education. The following six papers were presented at the conference: (1) Roles of Departments of Preventive Medicine; (2) Competency-Based Objectives in Preventive Medicine for the Family Physician; (3) Preventive Medicine…

Effect of the Japanese preventive-care version of the Minimum Data Set--Home Care on the health-related behaviors of community-dwelling, frail older adults and skills of preventive-care managers: a quasi-experimental study conducted in Japan

DEFF Research Database (Denmark)

Igarashi, Ayumi; Ikegami, Naoki; Yamada, Yukari

2009-01-01

. The skills of the preventive-care managers were assessed by considering the number of and variations in the needs of the clients, as reflected in the care plans formulated by the managers. RESULTS: The clients' self-care levels were higher in the intervention group than in the control group (P ...AIM: To determine whether the Japanese preventive-care version of the Minimum Data Set-Home Care improves the health-related behaviors of older adults and the skills of preventive-care managers. METHODS: Municipal preventive-care managers were instructed on the use of the Japanese preventive...... Data Set--Home Care may improve the skills of preventive-care managers, and consequently, the health-related behaviors of frail older clients....

Prevention of nosocomial infections in intensive care unit and nursing practices

Directory of Open Access Journals (Sweden)

Sevilay Yüceer

2009-01-01

Full Text Available Nosocomial infections which are considered as the primary indicator of the quality of care in hospitals, cause to prolong hospitalization at intensive care unit and hospital, increase morbidity, mortality, and the cost of treatment. Although only 5-10% of the patients are treated in the intensive care units, 20-25% of all nosocomial infections are seen in these units. Preventing nosocomial infections in intensive care units is a process started at the patient acceptance to unit that requires an interdisciplinary team approach of intensive care staffs’ and Infection Control Committee members.Intensive care nurses who are in constant contact with patients have important responsibilities in preventing nosocomial infections. Intensive care nurses should be aware that the nosocomial infections can be prevented. They should have current knowledge about universal precautions related to prevention and control of infections, which are accepted by the entire world and they reinforce this knowledge by practice and should provide the most effective care to patients.In this article, nursing practices for prevention of nosocomial infections in intensive care units are discussed based on universal precautions.

Assessment of the management factors that influence the development of preventive care in the New South Wales public dental service.

Science.gov (United States)

Masoe, Angela V; Blinkhorn, Anthony S; Taylor, Jane; Blinkhorn, Fiona A

2015-01-01

Oral diseases, particularly dental caries, remain one of the most common chronic health problems for adolescents, and are a major public health concern. Public dental services in New South Wales, Australia offer free clinical care and preventive advice to all adolescents under 18 years of age, particularly those from disadvantaged backgrounds. This care is provided by dental therapists and oral health therapists (therapists). It is incumbent upon clinical directors (CDs) and health service managers (HSMs) to ensure that the appropriate clinical preventive care is offered by clinicians to all their patients. The aims of this study were to 1) explore CDs' and HSMs' perceptions of the factors that could support the delivery of preventive care to adolescents, and to 2) record the strategies they have utilized to help therapists provide preventive care to adolescents. In-depth, semistructured interviews were undertaken with 19 CDs and HSMs from across NSW local health districts. A framework matrix was used to systematically code data and enable key themes to be identified for analysis. The 19 CDs and HSMs reported that fiscal accountability and meeting performance targets impacted on the levels and types of preventive care provided by therapists. Participants suggested that professional clinical structures for continuous quality improvement should be implemented and monitored, and that an adequate workforce mix and more resources for preventive dental care activities would enhance therapists' ability to provide appropriate levels of preventive care. CDs and HSMs stated that capitalizing on the strengths of visiting pediatric dental specialists and working with local health district clinical leaders would be a practical way to improve models of preventive oral health care for adolescents. The main issue raised in this study is that preventive dentistry per se lacks strong support from the central funding agency, and that increasing prevention activities is not a simple

Preventive-care practices among adults with diabetes--Puerto Rico, 2000-2002.

Science.gov (United States)

2004-11-12

Preventive-care practices among persons with diabetes can prevent or delay complications such as eye disease, kidney disease, or nerve damage that is a precursor to disabling foot disease. However, the level of diabetes-related preventive care is inadequate in the United States, and little has been reported about preventive care in Puerto Rico, where an estimated 10% of adults have diagnosed diabetes. CDC analyzed data from 2000, 2001, and 2002 Behavioral Risk Factor Surveillance System (BRFSS) surveys to assess the percentage of adults with diabetes in Puerto Rico who engaged in five selected preventive-care practices. This report summarizes the results of that analysis, which indicated that, with the exception of hemoglobin A1c testing, the percentages of adults engaging in preventive-care practices were lower than the target percentages set by U.S. national health objectives for 2010.

Managed care, consumerism, preventive medicine: does a causal connection exist?

Science.gov (United States)

Rizzo, John A; Xie, Yang

2006-07-01

Managed care plans, and HMOs in particular, have long touted that their emphasis is on preventive care, to avoid expensive illness later in life. However, few articles in the contemporary literature adequately address this claim. The available evidence seems to support that HMOs do, in fact, provide greater access to preventive services, but the limitations of this research are substantial. This article discusses the scientific evidence on the relationships between managed care arrangements and the implications for preventive care in the current era, emphasizing consumer choices and less-restrictive plan structures.

Improvement of pressure ulcer prevention care in private for-profit residential care homes: an action research study.

Science.gov (United States)

Kwong, Enid Wy; Hung, Maria Sy; Woo, Kevin

2016-11-25

A need exits to develop a protocol for preventing pressure ulcers (PUs) in private for-profit nursing homes in Hong Kong, where the incidence of PUs is relatively high and which have high proportion of non-professional care staff. The implementation of such protocol would involve changes in the practice of care, likely evoking feelings of fear and uncertainty that may become a barrier to staff adherence. We thus adopted the Systems Model of Action Research in this study to manage the process of change for improving PU prevention care and to develop a pressure ulcer prevention protocol for private for-profit nursing homes. A total of 474 residents and care staff who were health workers, personal care workers, and/or nurses from four private, for-profit nursing homes in Hong Kong participated in this study. Three cyclic stages and steps, namely, unfreezing (planning), changing (action), and refreezing (results) were carried out. During each cycle, focus group interviews, field observations of the care staff's practices and inspections of the skin of the residents for pressure ulcers were conducted to evaluate the implementation of the protocol. Qualitative content analysis was adopted to analyse the data. The data and methodological triangulation used in this study increased the credibility and validity of the results. The following nine themes emerged from this study: prevention practices after the occurrence of PUs, the improper use of pressure ulcer prevention materials, non-compliance with several prevention practices, improper prevention practices, the perception that the preventive care was being performed correctly, inadequate readiness to use the risk assessment tool, an undesirable environment, the supplying of unfavorable resources, and various management styles in the homes with or without nurses. At the end of the third cycle, the changes that were identified included improved compliance with the revised risk assessment method, the timely and appropriate

Intervention to Prevent Mental Ill-Health Among Health Care Workers

Directory of Open Access Journals (Sweden)

Hans Michélsen

2014-05-01

Full Text Available Psychological strain in working life is gaining ever more attention. Health care workers are often under extreme emotional stress, which can become so overwhelming that they show signs of mental ill-health. This project aimed to develop a model for sustainable psychological support within a hospital clinic to prevent mental ill-health among employees. Mental strains at work and mental ill-health among clinic employees were mapped out, after which interventions for psychological support were designed in collaboration with employees. The interventions were conducted over one year and evaluated. Throughout the process the clinic received continuous feedback. Both questionnaires and interviews were used. The results of identifying mental strains and conducting interventions showed that employees experienced mental strain at work and perceived a need for support. Intervention evaluations showed that the project provided support, new insights, and an increased acceptance for long-term prevention of mental strain. Quantitative and qualitative methodologies supported the results. The conclusion was that increased legitimacy for mental strain at work and continuous feedback between clinic management and employees, as well as organizational circumstances are important factors when developing long-term intervention programs with various forms of psychological support.

Preventing Rehospitalization through effective home health nursing care.

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Vasquez, Monica S

2009-01-01

To identify strategies to improve patient outcomes and prevent rehospitalizations in home healthcare. PRIMARY PRACTICE SETTINGS(S): Primarily for home healthcare but can also be a tool for all other fields in nursing. Through team collaboration and the proper resources, patient outcomes can improve and be cost-effective for home healthcare agencies despite the changes implemented after the Medicare change in payment for services, the prospective payment system. The main goal for home healthcare is to improve patient outcomes. Nurses experienced in case management can devise creative strategies to ensure patient outcomes are met in a cost-effective manner. With continuous changes in reimbursement and payment incentives, case managers in every level of care must know about, and be responsible for, fiscal initiatives.

How unique is continuity of care? A review of continuity and related concepts.

NARCIS (Netherlands)

Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; Bosch, W.J.H.M. van den

2012-01-01

Background: The concept of ‘continuity of care’ has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. Objective: In order to clarify the confusion of

A fall prevention guideline for older adults living in long-term care facilities.

Science.gov (United States)

Jung, D; Shin, S; Kim, H

2014-12-01

Falls are among the most frequent critical health problems for older adults over 65 years of age and often result in consequential injuries. This study developed a guideline covering risk factors and interventions for falls in order to prevent them from occurring in long-term care facilities. This study was grounded in the methodological approach of the Scottish Intercollegiate Guideline Network for establishing evidence-based guidelines: (1) establishment of the target population and scope of the guideline, (2) systematic literature review and critical analysis, (3) determination of the recommendation grade, (4) development of a draft nursing intervention guideline and algorithm, (5) expert evaluation of the draft nursing intervention guideline, and (6) confirmation of the final intervention guideline and completion of the algorithm. The resulting evidence-based fall prevention guideline consists of a three-step factor assessment and a three-step intervention approach. The resulting guideline was based on the literature and clinical experts. Further research is required to test the guideline's feasibility in across long term care facilities. This guideline can be used by nurses to screen patients who are at a high risk of falling to provide patient interventions to help prevent falls. Considering the high rate of falls at long-term care facilities and the absence of evidence-based guidelines to prevent them, additional studies on falls at long-term care facilities are necessary. Meanwhile, given prior research that indicates the importance of human resources in the application of such guidelines, continuous investigations are needed as to whether the research outcomes are actually conveyed to nurses. © 2014 International Council of Nurses.

Preventive intervention in diabetes: a new model for continuing medical education.

Science.gov (United States)

Beaser, Richard S; Brown, Julie A

2013-04-01

Competence and skills in overcoming clinical inertia for diabetes treatment, and actually supporting and assisting the patient through adherence and compliance (as opposed to just reiterating what they "should" be doing and then assigning them the blame if they fail) is a key component to success in addressing diabetes, and to date it is a component that has received little formal attention. To improve and systematize diabetes care, it is critical to move beyond the "traditional" continuing medical education (CME) model of imparting knowledge as the entirety of the educational effort, and move toward a focus on Performance Improvement CME. This new approach does not just teach new information but also provides support for improvements where needed most within practice systems based on targeted data-based on self-assessments for the entire system of care. Joslin data conclude that this new approach will benefit support, clinical, and office teams as well as the specialist. In short, the Performance Improvement CME structure reflects the needed components of the successful practice today, particularly for chronic conditions such as diabetes, including the focus on interdisciplinary team care and on quality improvement, which is becoming more and more aligned with reimbursement schemes, public and private, in the U.S. Copyright © 2013 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Improvement of pressure ulcer prevention care in private for-profit residential care homes: an action research study

Directory of Open Access Journals (Sweden)

Enid WY Kwong

2016-11-01

Full Text Available Abstract Background A need exits to develop a protocol for preventing pressure ulcers (PUs in private for-profit nursing homes in Hong Kong, where the incidence of PUs is relatively high and which have high proportion of non-professional care staff. The implementation of such protocol would involve changes in the practice of care, likely evoking feelings of fear and uncertainty that may become a barrier to staff adherence. We thus adopted the Systems Model of Action Research in this study to manage the process of change for improving PU prevention care and to develop a pressure ulcer prevention protocol for private for-profit nursing homes. Methods A total of 474 residents and care staff who were health workers, personal care workers, and/or nurses from four private, for-profit nursing homes in Hong Kong participated in this study. Three cyclic stages and steps, namely, unfreezing (planning, changing (action, and refreezing (results were carried out. During each cycle, focus group interviews, field observations of the care staff’s practices and inspections of the skin of the residents for pressure ulcers were conducted to evaluate the implementation of the protocol. Qualitative content analysis was adopted to analyse the data. The data and methodological triangulation used in this study increased the credibility and validity of the results. Results The following nine themes emerged from this study: prevention practices after the occurrence of PUs, the improper use of pressure ulcer prevention materials, non-compliance with several prevention practices, improper prevention practices, the perception that the preventive care was being performed correctly, inadequate readiness to use the risk assessment tool, an undesirable environment, the supplying of unfavorable resources, and various management styles in the homes with or without nurses. At the end of the third cycle, the changes that were identified included improved compliance with the

Youth suicide prevention: does access to care matter?

Science.gov (United States)

Campo, John V

2009-10-01

Recent increases in adolescent suicide rates after a decade of decline highlight the relevance of pediatric suicide prevention. Existing strategies to intervene with youth at risk for suicide are largely based on the premise that access to effective services is of critical importance. This review aims to examine the relationship between youth suicide and access to care. Promising reductions in suicidal thinking and behavior have been associated with the application of manualized psychotherapies, collaborative interventions in primary care, lithium for mood-disordered adults, and clozapine in schizophrenia. Suicide rates correlate inversely with indices of care access across the lifespan, including antidepressant prescription rates. Suicide is a preventable cause of death, and any public health relevant effort to prevent youth suicide must include improving access to effective care for at-risk youth as a strategy. Education and training of professionals and consumers, the integration of mental health services in primary care, and the use of novel technologies to track and maintain contact with at-risk youth are worthy of study. Additional research on the relationship between specific treatments, especially antidepressants, and youth suicide risk reduction is desperately needed.

Wound Care Center of Excellence: A Process for Continuous Monitoring and Improvement of Wound Care Quality.

Science.gov (United States)

Howell, Raelina S; Kohan, Lauren S; Woods, Jon S; Criscitelli, Theresa; Gillette, Brian M; Donovan, Virginia; Gorenstein, Scott

2018-05-01

To provide information about a study using a new process for continuous monitoring to improve chronic wound care quality.This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After completing this continuing education activity, you should be better able to:1. Recognize problems associated with chronic wound care.2. Identify methods used in this project to improve care.3. Illustrate the findings from this and similar projects and implications for providing improved wound care.Patients with chronic wounds require complex care because of comorbidities that can affect healing. Therefore, the goal of this project was to develop a system of reviewing all hospitalized patients seen by the study authors' wound care service on a weekly basis to decrease readmissions, morbidity, and mortality. Weekly multidisciplinary conferences were conducted to evaluate patient data and systematically assess for adherence to wound care protocols, as well as to create and modify patient care plans. This review of pathology and the performance of root-cause analyses often led to improved patient care.

Continuity of care in the Health Care Network: negotiation between users and professionals

Directory of Open Access Journals (Sweden)

Maria Denise Schimith

2014-12-01

Full Text Available This study aimed to identify the negotiation and shared decision-making between professionals and users in a Family Health Unit and its influence on the continuity of care in the Health Care Network. Qualitative research created from a case study. One conducted 19 interviews, observation and document research. It was developed in a city in the countryside of Rio Grande do Sul, Brazil, in 2012. The results show that decisions used to happen unilaterally and that users and professionals looked for alternative ways to the continuity of care. It was not possible to identify the negotiation between professional and users and it was noticed that the user was alone looking for access. It is understood that primary care in the city researched needs to take responsibility for users and their access.

Service Users' and Caregivers' Perspectives on Continuity of Care in Out-of-Hours Primary Care.

LENUS (Irish Health Repository)

Gallagher, Niamh

2012-12-20

Modernization policies in primary care, such as the introduction of out-of-hours general practice cooperatives, signify a marked departure from many service users\\' traditional experiences of continuity of care. We report on a case study of accounts of service users with chronic conditions and their caregivers of continuity of care in an out-of-hours general practice cooperative in Ireland. Using Strauss and colleagues\\' Chronic Illness Trajectory Framework, we explored users\\' and caregivers\\' experiences of continuity in this context. Whereas those dealing with "routine trajectories" were largely satisfied with their experiences, those dealing with "problematic trajectories" (characterized by the presence of, for example, multimorbidity and complex care regimes) had considerable concerns about continuity of experiences in this service. Results highlight that modernization policies that have given rise to out-of-hours cooperatives have had a differential impact on service users with chronic conditions and their caregivers, with serious consequences for those who have "problematic" trajectories.

Developing a diabetes prevention education programme for community health-care workers in Thailand: formative findings.

Science.gov (United States)

Sranacharoenpong, Kitti; Hanning, Rhona M

2011-10-01

The aim of this study was to investigate barriers to and supports for implementing a diabetes prevention education programme for community health-care workers (CHCWs) in Chiang Mai province, Thailand. The study also aimed to get preliminary input into the design of a tailored diabetes prevention education programme for CHCWs. Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. As access to diabetes prevention programme is limited in Thailand, especially in rural and semi-urban areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective, and sustainable. Health-care professionals (n = 12) selected from health centres within one district participated in in-depth interviews. In addition, screened people at risk for diabetes participated in interviews (n = 8) and focus groups (n = 4 groups, 23 participants). Coded transcripts from audio-taped interviews or focus groups were analysed by hand and using NVivo software. Concept mapping illustrated the findings. Health-care professionals identified potential barriers to programme success as a motivation for regular participation, and lack of health policy support for programme sustainability. Health-care professionals identified opportunities to integrate health promotion and disease prevention into CHCWs' duties. Health-care professionals recommended small-group workshops, hands-on learning activities, case studies, and video presentations that bring knowledge to practice within their cultural context. CHCWs should receive a credit for continuing study. People at risk for diabetes lacked knowledge of nutrition, diabetes risk factors, and resources to access health information. They desired two-way communication with CHCWs. Formative research supports the need for an effective, sustainable programme to support knowledge translation to CHCWs and at-risk populations in the

A Health Care Project Management Office's Strategies for Continual Change and Continuous Improvement.

Science.gov (United States)

Lavoie-Tremblay, Mélanie; Aubry, Monique; Richer, Marie-Claire; Cyr, Guylaine

Health care organizations need project and change management support in order to achieve successful transformations. A project management office (PMO) helps support the organizations through their transformations along with increasing their capabilities in project and change management. The aim of the present study was to extend understanding of the continuous improvement mechanisms used by PMOs and to describe PMO's strategies for continual change and continuous improvement in the context of major transformation in health care. This study is a descriptive case study design with interviews conducted from October to December 2015 with PMO's members (3 managers and 1 director) and 3 clients working with the PMO after a major redevelopment project ended (transition to the new facility). Participants suggested a number of elements including carefully selecting the members of the PMO, having a clear mandate for the PMO, having a method and a discipline at the same time as allowing openness and flexibility, clearly prioritizing projects, optimizing collaboration, planning for everything the PMO will need, not overlooking organizational culture, and retaining the existing support model. This study presents a number of factors ensuring the sustainability of changes.

42 CFR 438.208 - Coordination and continuity of care.

Science.gov (United States)

2010-10-01

... Improvement Access Standards § 438.208 Coordination and continuity of care. (a) Basic requirement—(1) General... MCO must meet the primary care coordination, identification, assessment, and treatment planning... those activities. (4) Ensure that in the process of coordinating care, each enrollee's privacy is...

Perceptions of oral health, preventive care, and care-seeking behaviors among rural adolescents.

Science.gov (United States)

Dodd, Virginia J; Logan, Henrietta; Brown, Cameron D; Calderon, Angela; Catalanotto, Frank

2014-12-01

An asymmetrical oral disease burden is endured by certain population subgroups, particularly children and adolescents. Reducing oral health disparities requires understanding multiple oral health perspectives, including those of adolescents. This qualitative study explores oral health perceptions and dental care behaviors among rural adolescents. Semistructured individual interviews with 100 rural, minority, low socioeconomic status adolescents revealed their current perceptions of oral health and dental care access. Respondents age ranged from 12 to 18 years. The sample was 80% black and 52% male. Perceived threat from dental disease was low. Adolescents perceived regular brushing and flossing as superseding the need for preventive care. Esthetic reasons were most often cited as reasons to seek dental care. Difficulties accessing dental care include finances, transportation, fear, issues with Medicaid coverage and parental responsibility. In general, adolescents and their parents are in need of information regarding the importance of preventive dental care. Findings illuminate barriers to dental care faced by low-income rural adolescents and counter public perceptions of government-sponsored dental care programs as being "free" or without cost. The importance of improved oral health knowledge, better access to care, and school-based dental care is discussed. © 2014, American School Health Association.

Critical Care Nurses' Reasons for Poor Attendance at a Continuous Professional Development Program.

Science.gov (United States)

Viljoen, Myra; Coetzee, Isabel; Heyns, Tanya

2016-12-01

Society demands competent and safe health care, which obligates professionals to deliver quality patient care using current knowledge and skills. Participation in continuous professional development programs is a way to ensure quality nursing care. Despite the importance of continuous professional development, however, critical care nurse practitioners' attendance rates at these programs is low. To explore critical care nurses' reasons for their unsatisfactory attendance at a continuous professional development program. A nominal group technique was used as a consensus method to involve the critical care nurses and provide them the opportunity to reflect on their experiences and challenges related to the current continuous professional development program for the critical care units. Participants were 14 critical care nurses from 3 critical care units in 1 private hospital. The consensus was that the central theme relating to the unsatisfactory attendance at the continuous professional development program was attitude. In order of importance, the 4 contributing priorities influencing attitude were communication, continuous professional development, time constraints, and financial implications. Attitude relating to attending a continuous professional development program can be changed if critical care nurses are aware of the program's importance and are involved in the planning and implementation of a program that focuses on the nurses' individual learning needs. ©2016 American Association of Critical-Care Nurses.

Continuity of care in mental health: understanding and measuring a complex phenomenon.

Science.gov (United States)

Burns, T; Catty, J; White, S; Clement, S; Ellis, G; Jones, I R; Lissouba, P; McLaren, S; Rose, D; Wykes, T

2009-02-01

Continuity of care is considered by patients and clinicians an essential feature of good quality care in long-term disorders, yet there is general agreement that it is a complex concept. Most policies emphasize it and encourage systems to promote it. Despite this, there is no accepted definition or measure against which to test policies or interventions designed to improve continuity. We aimed to operationalize a multi-axial model of continuity of care and to use factor analysis to determine its validity for severe mental illness. A multi-axial model of continuity of care comprising eight facets was operationalized for quantitative data collection from mental health service users using 32 variables. Of these variables, 22 were subsequently entered into a factor analysis as independent components, using data from a clinical population considered to require long-term consistent care. Factor analysis produced seven independent continuity factors accounting for 62.5% of the total variance. These factors, Experience and Relationship, Regularity, Meeting Needs, Consolidation, Managed Transitions, Care Coordination and Supported Living, were close but not identical to the original theoretical model. We confirmed that continuity of care is multi-factorial. Our seven factors are intuitively meaningful and appear to work in mental health. These factors should be used as a starting-point in research into the determinants and outcomes of continuity of care in long-term disorders.

Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study.

Science.gov (United States)

Fairbrother, Peter; Pinnock, Hilary; Hanley, Janet; McCloughan, Lucy; Sheikh, Aziz; Pagliari, Claudia; McKinstry, Brian

2012-09-01

Continuity of care is widely regarded as an important marker of quality in the management of patients with long-term conditions. New services that integrate telemonitoring into care pathways have potential to change aspects of continuity in both positive and negative ways. A telemonitoring service for patients with chronic obstructive pulmonary disease (COPD) was introduced in Lothian, Scotland, in 2009. A qualitative study, nested within the TELESCOT COPD randomised control trial, was undertaken to explore the views of patients and professionals on telemonitoring. The perceived impact of telemonitoring on continuity of care was investigated as part of the research. Semi-structured interviews were undertaken with 38 patients (47% male, mean age 67.5 years). A maximum variation sample in relation to age, sex, socio-economic background, disease severity, and compliance with telemonitoring was recruited. Thirty-two stakeholders (healthcare professionals and managers) were interviewed. Transcribed coded data were analysed thematically using the framework approach. Interpretation was supported by multidisciplinary discussion. Patients and healthcare professionals considered that relationship-based continuity of care was important in the delivery of telemonitoring services. Managers placed emphasis on improved continuity of clinical management as a means of reducing healthcare costs. However, professionals described many operational challenges arising from the 'bolting-on' of telemonitoring provision to existing usual care provision which, they considered, resulted in the proliferation of additional managerial discontinuities. Managers and healthcare professionals face major challenges in meeting demands for both relationship continuity and continuity of clinical management in the development of telemonitoring services.

Patient Experienced Continuity of Care in the Psychiatric Healthcare System

DEFF Research Database (Denmark)

Jensen, Natasja Koitzsch; Johansen, Katrine Schepelern; Kastrup, Marianne

2014-01-01

Aim: The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. Method: The study is based on 19 narrative interviews conducted with 15 patients with diverse...... migration backgrounds (immigrants, descendents, refugees, and ethnic Danes). Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry......, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Results: Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups...

Pediatric primary care to help prevent child maltreatment: the Safe Environment for Every Kid (SEEK) Model.

Science.gov (United States)

Dubowitz, Howard; Feigelman, Susan; Lane, Wendy; Kim, Jeongeun

2009-03-01

Effective strategies for preventing child maltreatment are needed. Few primary care-based programs have been developed, and most have not been well evaluated. Our goal was to evaluate the efficacy of the Safe Environment for Every Kid model of pediatric primary care in reducing the occurrence of child maltreatment. A randomized trial was conducted from June 2002 to November 2005 in a university-based resident continuity clinic in Baltimore, Maryland. The study population consisted of English-speaking parents of children (0-5 years) brought in for child health supervision. Of the 1118 participants approached, 729 agreed to participate, and 558 of them completed the study protocol. Resident continuity clinics were cluster randomized by day of the week to the model (intervention) or standard care (control) groups. Model care consisted of (1) residents who received special training, (2) the Parent Screening Questionnaire, and (3) a social worker. Risk factors for child maltreatment were identified and addressed by the resident physician and/or social worker. Standard care involved routine pediatric primary care. A subset of the clinic population was sampled for the evaluation. Child maltreatment was measured in 3 ways: (1) child protective services reports using state agency data; (2) medical chart documentation of possible abuse or neglect; and (3) parental report of harsh punishment via the Parent-Child Conflict Tactics scale. Model care resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer child protective services reports, fewer instances of possible medical neglect documented as treatment nonadherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. One-tailed testing was conducted in accordance with the study hypothesis. The Safe Environment for Every Kid (SEEK) model of pediatric primary care seems promising as a practical strategy for helping prevent child maltreatment

The Value Proposition of Prevention: The Impacts of Pure North S’Energy Foundation’s Preventive Care Program on Acute Care Utilization in Alberta

Directory of Open Access Journals (Sweden)

J.C. Herbert Emery

2016-04-01

Full Text Available This analysis of Pure North S’Energy Foundation’s preventive health services shows that the acute health care cost savings of being pro-active, rather than reactive, and averting chronic disease, are significant, immediate and worth pursuing further. Chronic disease, such as cardiovascular maladies, diabetes, cancer and other long-term illnesses, represents the leading cause of disability and death in Canada. An estimated 25 per cent of expenditures in the public health system go towards treating these frequently avoidable diseases. This health-care cost curve, which sees more money expended on fighting the increase of chronic disease, can be bent, so to speak, through prevention services that offer long-term benefits to people’s health. Preventing disease is not just good for individuals, but for the health system in general, as prevention frees up acute care beds for more timely access by those who need them. The concern for health care decision makers struggling to find dollars to meet current health care needs is that investment in prevention is risky compared spending on medical treatment. It is often expressed that the health cost savings of prevention are too far off in the future and there is a lack of convincing evidence that preventive services and interventions will achieve the health gains expected. Pure North offers participants in its eight-year-old program access to a variety of healthcare practitioners, including doctors, naturopaths, nurses, nurse practitioners and dentists. Participants receive lifestyle counselling and dietary supplements aimed at combating vitamin D insufficiency, obesity, insulin resistance and other problems that can lead to chronic disease. Our study found that participants who stay with the program for two years demonstrate significant reductions in their number of visits to emergency rooms and hospitals. Indeed, after just one year in the program, the number of hospital visits was down 27 per cent

Personal Continuity of Care in a University-Based Primary Care Practice: Impact on Blood Pressure Control.

Directory of Open Access Journals (Sweden)

Nik Sherina Hanafi

Full Text Available Continuity of care is an important quality outcome of patient care. This study aimed to investigate the relationship between personal continuity and blood pressure (BP control among the patients with hypertension in an academic primary care centre. Between January and May 2012, we conducted a retrospective review of medical records of patients with hypertension who had been followed up for at least 1 year in the Primary Care Clinic, University of Malaya Medical Centre, Malaysia. In this setting, doctors who provided care for hypertension included postgraduate family medicine trainees, non-trainee doctors and academic staff. Systematic random sampling (1:4 was used for patient selection. BP control was defined as less than 130/80 mm Hg for patients with diabetes mellitus, proteinuria and chronic kidney disease and less than 140/90 mm Hg for all other patients. Continuity of care was assessed using the usual provider continuity index (UPCI, which is the ratio of patient visits to the usual provider to the total number of visits to all providers in 1 year. A UPC index of zero denotes no continuity while an index of one reflects perfect continuity with only the usual provider. We reviewed a total of 1060 medical records. The patients' mean age was 62.0 years (SD 10.4. The majority was women (59.2% and married (85.7%. The mean number of visits in a year was 3.85 (SD 1.36. A total of 72 doctors had provided consultations (55 postgraduate family medicine trainees, 8 non-trainee doctors and 9 academic staff. The mean UPCI was 0.43 (SD 0.34. Target BP was achieved in 42% of the patients. There was no significant relationship between BP control and personal continuity after adjustment for total number of visits. Continuity of care was not associated with BP control in our centre. Further studies are needed to explore the reasons for this.

Treating alcoholism as a chronic disease: approaches to long-term continuing care.

Science.gov (United States)

McKay, James R; Hiller-Sturmhofel, Susanne

2011-01-01

For many patients, alcohol and other drug (AOD) use disorders are chronic, recurring conditions involving multiple cycles of treatment, abstinence, and relapse. To disrupt this cycle, treatment can include continuing care to reduce the risk of relapse. The most commonly used treatment approach is initial intensive inpatient or outpatient care based on 12-step principles, followed by continuing care involving self-help groups, 12-step group counseling, or individual therapy. Although these programs can be effective, many patients drop out of initial treatment or do not complete continuing care. Thus, researchers and clinicians have begun to develop alternative approaches to enhance treatment retention in both initial and continuing care. One focus of these efforts has been the design of extended treatment models. These approaches increasingly blur the distinction between initial and continuing care and aim to prolong treatment participation by providing a continuum of care. Other researchers have focused on developing alternative treatment strategies (e.g., telephone-based interventions) that go beyond traditional settings and adaptive treatment algorithms that may improve outcomes for clients who do not respond well to traditional approaches.

Preventive care utilization: Association with individual- and workgroup-level policy and practice perceptions.

Science.gov (United States)

Sabbath, Erika L; Sparer, Emily H; Boden, Leslie I; Wagner, Gregory R; Hashimoto, Dean M; Hopcia, Karen; Sorensen, Glorian

2018-06-01

Preventive medical care may reduce downstream medical costs and reduce population burden of disease. However, although social, demographic, and geographic determinants of preventive care have been studied, there is little information about how the workplace affects preventive care utilization. This study examines how four types of organizational policies and practices (OPPs) are associated with individual workers' preventive care utilization. We used data collected in 2012 from 838 hospital patient care workers, grouped in 84 patient care units at two hospitals in Boston. Via survey, we assessed individuals' perceptions of four types of OPPs on their work units. We linked the survey data to a database containing detailed information on medical expenditures. Using multilevel models, we tested whether individual-level perceptions, workgroup-average perceptions, and their combination were associated with individual workers' preventive care utilization (measured by number of preventive care encounters over a two-year period). Adjusting for worker characteristics, higher individual-level perceptions of workplace flexibility were associated with greater preventive care utilization. Higher average unit-level perceptions of people-oriented culture, ergonomic practices, and flexibility were associated with greater preventive care utilization. Overall, we find that workplace policies and practices supporting flexibility, ergonomics, and people-oriented culture are associated with positive preventive care-seeking behavior among workers, with some policies and practices operating at the individual level and some at the group level. Improving the work environment could impact employers' health-related expenditures and improve workers' health-related quality of life. Copyright © 2018 Elsevier Inc. All rights reserved.

Impact of diabetes continuing education on health care ...

African Journals Online (AJOL)

Purpose: To evaluate the impact of a continuing education (CE) program on the attitudes of health care professionals (HCPs) towards diabetes care in Yemen. Methods: A pre- and post-intervention study was carried out in Mukalla City, Hadramout, Yemen and was offered to all physicians, pharmacists, and nurses ...

Primary prevention of chronic obstructive pulmonary disease in primary care.

Science.gov (United States)

van der Molen, Thys; Schokker, Siebrig

2009-12-01

Chronic obstructive pulmonary disease (COPD) is a prevalent disease, with cigarette smoking being the main risk factor. Prevention is crucial in the fight against COPD. Whereas primary prevention is targeted on whole populations, patient populations are the focus of primary care; therefore, prevention in this setting is mainly aimed at preventing further deterioration of the disease in patients who present with the first signs of disease (secondary prevention). Prevention of COPD in primary care requires detection of COPD at an early stage. An accurate definition of COPD is crucial in this identification process. The benefits of detecting new patients with COPD should be determined before recommending screening and case-finding programs in primary care. No evidence is available that screening by spirometry results in significant health gains. Effective treatment options in patients with mild disease are lacking. Smoking cessation is the cornerstone of COPD prevention. Because cigarette smoking is not only a major cause of COPD but is also a major cause of many other diseases, a decline in tobacco smoking would result in substantial health benefits.

Prescribing tamoxifen in primary care for the prevention of breast cancer: a national online survey of GPs' attitudes.

Science.gov (United States)

Smith, Samuel G; Foy, Robbie; McGowan, Jennifer A; Kobayashi, Lindsay C; DeCensi, Andrea; Brown, Karen; Side, Lucy; Cuzick, Jack

2017-06-01

The cancer strategy for England (2015-2020) recommends GPs prescribe tamoxifen for breast cancer primary prevention among women at increased risk. To investigate GPs' attitudes towards prescribing tamoxifen. In an online survey, GPs in England, Northern Ireland, and Wales ( n = 928) were randomised using a 2 × 2 between-subjects design to read one of four vignettes describing a healthy patient seeking a tamoxifen prescription. In the vignette, the hypothetical patient's breast cancer risk (moderate versus high) and the clinician initiating the prescription (GP prescriber versus secondary care clinician [SCC] prescriber) were manipulated in a 1:1:1:1 ratio. Outcomes were willingness to prescribe, comfort discussing harms and benefits, comfort managing the patient, factors affecting the prescribing decision, and awareness of tamoxifen and the National Institute for Health and Care Excellence (NICE) guideline CG164. Half (51.7%) of the GPs knew tamoxifen can reduce breast cancer risk, and one-quarter (24.1%) were aware of NICE guideline CG164. Responders asked to initiate prescribing (GP prescriber) were less willing to prescribe tamoxifen than those continuing a prescription initiated in secondary care (SCC prescriber) (68.9% versus 84.6%, P preventive therapy in secondary care before asking GPs to continue the patient's care may overcome some prescribing barriers. © British Journal of General Practice 2017.

[Skin care and prevention of bed sores in bedridden patients].

Science.gov (United States)

Martínez Cuervo, Fernando; Soldevilla Agreda, J Javier; Verdú Soriano, José; Segovia Gómez, Teresa; García Fernández, Francisco Pedro; Pancorbo Hidalgo, Pedro Luís

2007-12-01

The aging process and environmental aggressions will leave their imprints on the state of a person's skin, possibly compromising some of its functions. Age is a risk factor for the development of bed sores, but not the only factor nor the most important one; therefore, we need to develop prevention programs directed to all patients who spend long periods of time sedentary or bedridden. Prevention programs for bed sores must be based on the best evidence available and include a risk evaluation on these factors: suffering a lesion due to pressure, specific skin treatment, incontinence control, excessive humidity posture changes and the use of special surfaces to manage pressure during an increase in mobility or activity by the patient, local pressure reducing devices as well as paying attention to special situations. All of these care measures have to be developed based on a continuity of treatment among the institutions and caretakers involved with treating each patient.

Study of Continuance Rate and Related Causes of Discontinuance of Pregnancy Prevention Methods among Women in Yazd

Directory of Open Access Journals (Sweden)

H Fallahzadeh

2008-04-01

Full Text Available Introduction: From maturity to menopause, women are worried about pregnancy. Abstinence from sex or use of pregnancy prevention methods are choices for them. As abstinence is impossible, the only remaining choice is use of pregnancy prevention methods. Effective control of pregnancy is really essential for the health of mother and infant and also control of unplanned increase in population. Regarding the importance of continuance rate of pregnancy prevention methods (OCP, IUD, Condom &DMPA & the reasons for their disruption, this study was carried out with the aim of determining the continuance rate and reasons for discontinuance of pregnancy prevention methods in Yazd women. Methods: This was a cross-sectional study. Six urban health care centers of Yazd were selected as study clusters and information of 15-49 year old women using the pregnancy prevention methods (OCP, IUD, Condom& injection was collected via a questionnaire. The data collected was analyzed by Coplan- Mayer statistic method and variance analysis test. Results: Pregnancy prevention methods were most prevalent in the 25-34 years old age group (57%. Mean duration of pregnancy prevention method usage was 27.98 months using Caplan-mayer method with a median of 24 months. 86.3% for 6 months, 72.8% for 12 months, 62.5% for 18 months, 47.9% for 24 months, 39.9% for 30 months and 37% for 37 months had used four certain methods of pregnancy prevention (OCP, IUD, Condom and Injection. The reasons of discontinuance were disease (15.6% for OCPS, bleeding (27% for IUD, unwanted pregnancy (21% for Condoms and also disease (75% for Injection method. Discussion: According to the results, not only education programs regarding family planning before starting each pregnancy prevention method to women is recommended, but a complete incentive consultation about these methods is essential. This educational & consultation programs should be implemented initially for women using OCP method.

Incidence and preventability of adverse events requiring intensive care admission: a systematic review.

Science.gov (United States)

Vlayen, Annemie; Verelst, Sandra; Bekkering, Geertruida E; Schrooten, Ward; Hellings, Johan; Claes, Neree

2012-04-01

Adverse events are unintended patient injuries or complications that arise from health care management resulting in death, disability or prolonged hospital stay. Adverse events that require critical care are a considerable financial burden to the health care system, but also their global impact on patients and society is probably underestimated. The objectives of this systematic review were to synthesize the best available evidence regarding the estimates of the incidence and preventability of adverse events that necessitate intensive care admission, to determine the type and consequences [mortality, length of intensive care unit (ICU) stay and costs] of these adverse events. MEDLINE (from 1966 to present), EMBASE (from 1974 to present) and CENTRAL (version 1-2010) were searched for studies reporting on unplanned admissions on ICUs. Several other sources were searched for additional studies. Only quantitative studies that used chart review for the detection of adverse events requiring intensive care admission were considered for eligibility. For the purposes of this systematic review, ICUs were defined as specialized hospital facilities which provide continuous monitoring and intensive care for acutely ill patients. Studies that were published in the English, Dutch, German, French or Spanish language were eligible for inclusion. Two reviewers independently extracted data and assessed the methodological quality of the included studies. A total of 27 studies were reviewed. Meta-analysis of the data was not appropriate because of methodological and statistical heterogeneity between studies; therefore, results are presented in a descriptive way. The percentage of surgical and medical adverse events that required ICU admission ranged from 1.1% to 37.2%. ICU readmissions varied from 0% to 18.3%. Preventability of the adverse events varied from 17% to 76.5%. Preventable adverse events are further synthesized by type of event. Consequences of the adverse events included a

Design of a continuous quality improvement program to prevent falls among community-dwelling older adults in an integrated healthcare system

Directory of Open Access Journals (Sweden)

Yano Elizabeth M

2009-11-01

Full Text Available Abstract Background Implementing quality improvement programs that require behavior change on the part of health care professionals and patients has proven difficult in routine care. Significant randomized trial evidence supports creating fall prevention programs for community-dwelling older adults, but adoption in routine care has been limited. Nationally-collected data indicated that our local facility could improve its performance on fall prevention in community-dwelling older people. We sought to develop a sustainable local fall prevention program, using theory to guide program development. Methods We planned program development to include important stakeholders within our organization. The theory-derived plan consisted of 1 an initial leadership meeting to agree on whether creating a fall prevention program was a priority for the organization, 2 focus groups with patients and health care professionals to develop ideas for the program, 3 monthly workgroup meetings with representatives from key departments to develop a blueprint for the program, 4 a second leadership meeting to confirm that the blueprint developed by the workgroup was satisfactory, and also to solicit feedback on ideas for program refinement. Results The leadership and workgroup meetings occurred as planned and led to the development of a functional program. The focus groups did not occur as planned, mainly due to the complexity of obtaining research approval for focus groups. The fall prevention program uses an existing telephonic nurse advice line to 1 place outgoing calls to patients at high fall risk, 2 assess these patients' risk factors for falls, and 3 triage these patients to the appropriate services. The workgroup continues to meet monthly to monitor the progress of the program and improve it. Conclusion A theory-driven program development process has resulted in the successful initial implementation of a fall prevention program.

Continuity of care for patients on a waiting list for institutional long-term care.

NARCIS (Netherlands)

Caris-Verhallen, W.M.C.M.; Kerkstra, A.

2001-01-01

The aim of this study was to examine patients' satisfaction with continuity of care while on a waiting list for residential care or nursing home care. Two hundred and seventy-eight patients participated in the study, all living in the community setting of two cities in the Netherlands. These

Personnel decontamination and preventive skin care

International Nuclear Information System (INIS)

Henning, Klaus; Gojowczyk, Peter

2010-01-01

Skin contamination arises from contact with contaminated aqueous solutions and from transmission of radioactively contaminated dirt particles. As long as the surface of the skin is neither inflamed nor showing any lesions, normally only a limited part of the top layer (epidermis), i.e. the upper layers of the stratum corneum, is contaminated. The intact horny layer has a barrier function protecting against the penetration of chemicals and dirt particles. The horny layer can be damaged by water, solvents, alkaline substances, and acids. In general, it is safe to say that the horny layer acts as a natural barrier to the penetration of liquid and particulate impurities into lower layers of the skin. As long as the horny layer is intact and free from lesions, the risk of incorporation can be considered low. When decontaminating and cleansing the skin, also in daily skin cleansing, care must be taken to prevent the acid protective layer and the horny layer from being compromised. Daily cleansing and cleansing for decontamination must be carried out with a mild, weakly acidic detergent. In addition, prevention should be achieved daily by applying a non-greasy skin lotion to protect the skin. Following a systematic regular regimen in skin cleansing and preventive skin care as well as a specific approach in skin decontamination and cleansing will avoid damage to the skin and remove any contamination incurred. This approach comprises a three-pronged concept, namely skin protection, cleansing and care. (orig.)

Estimated time spent on preventive services by primary care physicians

Directory of Open Access Journals (Sweden)

Gradison Margaret

2008-12-01

Full Text Available Abstract Background Delivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services. Methods We analyzed a large dataset of primary care (family and internal medicine visits using the National Ambulatory Medical Care Survey (2001–4; analyses were conducted 2007–8. Multiple linear regression was used to estimate the amount of time spent delivering each preventive service, controlling for demographic covariates. Results Preventive visits were longer than chronic care visits (M = 22.4, SD = 11.8, M = 18.9, SD = 9.2, respectively. New patients required more time from physicians. Services on which physicians spent relatively more time were prostate specific antigen (PSA, cholesterol, Papanicolaou (Pap smear, mammography, exercise counseling, and blood pressure. Physicians spent less time than recommended on two "A" rated ("good evidence" services, tobacco cessation and Pap smear (in preventive visits, and one "B" rated ("at least fair evidence" service, nutrition counseling. Physicians spent substantial time on two services that have an "I" rating ("inconclusive evidence of effectiveness", PSA and exercise counseling. Conclusion Even with limited time, physicians address many of the "A" rated services adequately. However, they may be spending less time than recommended for important services, especially smoking cessation, Pap smear, and nutrition counseling. Future research is needed to understand how physicians decide how to allocate their time to address preventive health.

How is continuity of care experienced by people living with chronic kidney disease?

Science.gov (United States)

Brand, Sarah; Pollock, Kristian

2018-01-01

To explore patients' perceptions of continuity of care within a hospital-based specialist service. Patient journeys through health care are becoming increasingly complex. For patients with chronic conditions, the longevity of their illness and common multiple co-morbidities make this complexity more pronounced. Continuity of care is most challenging to provide for these patients. A multifaceted model of continuity is widely accepted, but despite this, much literature focuses exclusively on relational aspects. In addition, the majority of the literature has focused on primary and family care settings whilst continuity within specialist and hospital care has not been widely researched. A qualitative descriptive design was used. Thirteen semi-structured interviews with patients accessing services as at a Renal and Transplant Unit at a UK hospital were conducted in 2014. Data were analysed thematically to identify commonality as well as diversity amongst participants. Five themes of time, being known, knowledge, knowing the system and responsibility were identified within patient experiences of continuity. The multidisciplinary team was more important in relational continuity than literature has previously suggested. Patients' expectations in relation to continuity were notably different in their interactions with hospital-based services in comparison with community and family-based care. Patients accessing specialist care services may perceive continuity differently to those receiving care in the community. Generic guidance concerned with patient experience outcomes may be difficult to implement in practice. Nurses and the wider healthcare team play a fundamental role within the provision of continuity, even in predominantly medically led specialist services. The differences between primary and secondary care in terms of patient expectation and experience should be recognised to ensure effective models of care are implemented which both meet patient expectations and

Continuing education for primary health care nurse practitioners in Ontario, Canada.

Science.gov (United States)

Baxter, Pamela; DiCenso, Alba; Donald, Faith; Martin-Misener, Ruth; Opsteen, Joanne; Chambers, Tracey

2013-04-01

The Council of Ontario University Programs in Nursing offers a nine-university, consortium-based primary health care nurse practitioner education program and on-line continuing education courses for primary health care nurse practitioners. Our study sought to determine the continuing education needs of primary health care nurse practitioners across Ontario, how best to meet these needs, and the barriers they face in completing continuing education. Surveys were completed by 83 (40%) of 209 learners who had participated in continuing education offered by the Council of Ontario University Programs in Nursing between 2004 and 2007. While 83% (n=50) of nurse practitioners surveyed indicated that continuing education was extremely important to them, they also identified barriers to engaging in continuing education offerings including; time intensity of the courses, difficulty taking time off work, family obligations, finances and fatigue. The most common reason for withdrawal from a continuing education offering was the difficulty of balancing work and study demands. Continuing education opportunities are important to Ontario primary health care nurse practitioners, and on-line continuing education offerings have been well received, but in order to be taken up by their target audience they must be relevant, readily accessible, flexible, affordable and offered over brief, intense periods of time using technology that is easy to use and Internet sites that are easily navigated. Copyright © 2012 Elsevier Ltd. All rights reserved.

Falls prevention in community care: 10 years on

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Burton E

2018-02-01

Full Text Available Elissa Burton,1 Gill Lewin,2 Hilary O’Connell,3 Keith D Hill1 1School of Physiotherapy and Exercise Science, Curtin University, 2School of Nursing, Midwifery and Paramedicine, Curtin University, 3Independent Living Centre WA, Perth, WA, Australia Background: A million older people living in Australia receive community care services each year due to experiencing functional or mental health difficulties. This group may be at greater risk of falling than similar-aged people not receiving services. However, there is limited falls prevention research for this population.Purpose: The aim of this study was to identify the falls prevalence rates of older people from 10 Australian community care organizations and compare current falls prevention data to a study 10 years prior that utilized the same 10 organizations. This study also identified factors associated with falling for this population.Patients and methods: This is a cross-sectional descriptive study, in which 5,338 questionnaires were mailed to a random sample of community care recipients aged ≥65 years. Results: A total of 1,991 questionnaires were returned (37.3%, with 47.7% of respondents having fallen in the previous year, and 32.7% in the month prior to completing the questionnaire, similar to 10 years prior. Community care clients had a 50% higher falls rate than that reported for similar-aged people not receiving services, and this remained unchanged over the last 10 years. Eighty-six per cent of fallers had fallen once or twice, and 60% reported being injured. Thirty-six per cent of respondents reported not being able to get up independently, and only 27.4% of fallers were referred to a falls prevention program (significantly fewer than 10 years ago; 95% CI: 0.821–6.366, p=0.01. Balance issues (odds ratio [OR]: 2.06, 95% CI: 1.288–3.290, p=0.003 and perceived risk of falling in the future being “definite” (OR: 6.42, 95% CI: 1.890–21.808, p=0.003 or “unsure” (OR: 3

Pediatric Dentist Density and Preventive Care Utilization for Medicaid Children.

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Heidenreich, James F; Kim, Amy S; Scott, JoAnna M; Chi, Donald L

2015-01-01

The purpose of this study was to evaluate county-level pediatric dentist density and dental care utilization for Medicaid-enrolled children. This was a cross-sectional analysis of 604,885 zero- to 17-year-olds enrolled in the Washington State Medicaid Program for 11-12 months in 2012. The relationship between county-level pediatric dentist density, defined as the number of pediatric dentists per 10,000 Medicaid-enrolled children, and preventive dental care utilization was evaluated using linear regression models. In 2012, 179 pediatric dentists practiced in 16 of the 39 counties in Washington. County-level pediatric dentist density varied from zero to 5.98 pediatric dentists per 10,000 Medicaid-enrolled children. County-level preventive dental care utilization ranged from 32 percent to 81 percent, with 62 percent of Medicaid-enrolled children utilizing preventive dental services. County-level density was significantly associated with county-level dental care utilization (Slope equals 1.67, 95 percent confidence interval equals 0.02, 3.32, Pchildren who utilize preventive dental care services. Policies aimed at improving pediatric oral health disparities should include strategies to increase the number of oral health care providers, including pediatric dentists, in geographic areas with large proportions of Medicaid-enrolled children.

Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial.

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Parshuram, Christopher S; Amaral, Andre C K B; Ferguson, Niall D; Baker, G Ross; Etchells, Edward E; Flintoft, Virginia; Granton, John; Lingard, Lorelei; Kirpalani, Haresh; Mehta, Sangeeta; Moldofsky, Harvey; Scales, Damon C; Stewart, Thomas E; Willan, Andrew R; Friedrich, Jan O

2015-03-17

Shorter resident duty periods are increasingly mandated to improve patient safety and physician well-being. However, increases in continuity-related errors may counteract the purported benefits of reducing fatigue. We evaluated the effects of 3 resident schedules in the intensive care unit (ICU) on patient safety, resident well-being and continuity of care. Residents in 2 university-affiliated ICUs were randomly assigned (in 2-month rotation-blocks from January to June 2009) to in-house overnight schedules of 24, 16 or 12 hours. The primary patient outcome was adverse events. The primary resident outcome was sleepiness, measured by the 7-point Stanford Sleepiness Scale. Secondary outcomes were patient deaths, preventable adverse events, and residents' physical symptoms and burnout. Continuity of care and perceptions of ICU staff were also assessed. We evaluated 47 (96%) of 49 residents, all 971 admissions, 5894 patient-days and 452 staff surveys. We found no effect of schedule (24-, 16- or 12-h shifts) on adverse events (81.3, 76.3 and 78.2 events per 1000 patient-days, respectively; p = 0.7) or on residents' sleepiness in the daytime (mean rating 2.33, 2.61 and 2.30, respectively; p = 0.3) or at night (mean rating 3.06, 2.73 and 2.42, respectively; p = 0.2). Seven of 8 preventable adverse events occurred with the 12-hour schedule (p = 0.1). Mortality rates were similar for the 3 schedules. Residents' somatic symptoms were more severe and more frequent with the 24-hour schedule (p = 0.04); however, burnout was similar across the groups. ICU staff rated residents' knowledge and decision-making worst with the 16-hour schedule. Our findings do not support the purported advantages of shorter duty schedules. They also highlight the trade-offs between residents' symptoms and multiple secondary measures of patient safety. Further delineation of this emerging signal is required before widespread system change. ClinicalTrials.gov, no. NCT00679809. © 2015 Canadian Medical

i Engaging as an innovative approach to engage patients in their own fall prevention care

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Tzeng HM

2014-05-01

Full Text Available Huey-Ming Tzeng,1 Chang-Yi Yin21College of Nursing, Washington State University, Spokane, WA, USA; 2Department of History, Chinese Culture University, Taipei, TaiwanAbstract: Decreasing patient fall injuries during hospitalization continues to be a ­challenge at the bedside. Empowering patients to become active participants in their own fall ­prevention care could be a solution. In a previous study, elderly patients recently discharged from a United States hospital expressed a need for nurses to give and repeat directives about fall prevention; when the nurse left a brochure on the topic, but did not provide any (or limited verbal explanations about the content or the importance of the information, the patient felt that the information was insufficient. To address patients’ needs, we developed “i ­Engaging”, a Web-based software application for use at the bedside. i Engaging is an innovative approach that is used to engage patients in their own fall prevention care during hospital stays. The application was designed based on the assumption that patients are the best and most critical sources of information about their health status. i Engaging has not yet been tested in clinical trials.Keywords: patient, safety, hospital, nursing care, fall, consumer involvement

Improving quality in Medicaid: the use of care management processes for chronic illness and preventive care.

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Rittenhouse, Diane R; Robinson, James C

2006-01-01

Care management processes (CMPs), tools to improve the efficiency and quality of primary care delivery, are particularly important for low-income patients facing substantial barriers to care. To measure the adoption of CMPs by medical groups, Independent Practice Associations, community clinics, and hospital-based clinics in California's Medicaid program and the factors associated with CMP adoption. Telephone survey of every provider organization with at least 6 primary care physicians and at least 1 Medi-Cal HMO contract, Spring 2003. One hundred twenty-three organizations participated, accounting for 64% of provider organizations serving Medicaid managed care in California. We surveyed 30 measures of CMP use for asthma and diabetes, and for child and adolescent preventive services. The mean number of CMPs used by each organization was 4.5 for asthma and 4.9 for diabetes (of a possible 8). The mean number of CMPs for preventive services was 4.0 for children and 3.5 for adolescents (of a possible 7). Organizations with more extensive involvement in Medi-Cal managed care used more CMPs for chronic illness and preventive service. Community clinics and hospital-based clinics used more CMPs for asthma and diabetes than did Independent Practice Associations (IPAs), and profitable organizations used more CMPs for child and adolescent preventive services than did entities facing severe financial constraints. The use of CMPs by Medicaid HMOs and the presence of external (financial and nonfinancial) incentives for clinical performance were strongly associated with use of care management by provider organizations. Physician and provider organizations heavily involved in California's Medicaid program are extensively engaged in preventive and chronic care management programs.

Development of STEADI: a fall prevention resource for health care providers.

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Stevens, Judy A; Phelan, Elizabeth A

2013-09-01

Falls among people aged ≥65 years are the leading cause of both injury deaths and emergency department visits for trauma. Research shows that many falls are preventable. In the clinical setting, an effective fall intervention involves assessing and addressing an individual's fall risk factors. This individualized approach is recommended in the American and British Geriatrics Societies' (AGS/BGS) practice guideline. This article describes the development of STEADI (Stopping Elderly Accidents, Deaths, and Injuries), a fall prevention tool kit that contains an array of health care provider resources for assessing and addressing fall risk in clinical settings. As researchers at the Centers for Disease Control and Prevention's Injury Center, we reviewed relevant literature and conducted in-depth interviews with health care providers to determine current knowledge and practices related to older adult fall prevention. We developed draft resources based on the AGS/BGS guideline, incorporated provider input, and addressed identified knowledge and practice gaps. Draft resources were reviewed by six focus groups of health care providers and revised. The completed STEADI tool kit, Preventing Falls in Older Patients-A Provider Tool Kit, is designed to help health care providers incorporate fall risk assessment and individualized fall interventions into routine clinical practice and to link clinical care with community-based fall prevention programs.

Continuing Vocational Training for Teachers in Beauty and Hair Care : Teachers Act as Active Developers of their Work and Engage in Transferring Good Practices to their Students

OpenAIRE

Aalto-Korte, Kristiina; Kurimo, Ritva; Laitinen, Jaana; Pesonen, Maria; Takala, Esa-Pekka; Poutanen, Marjo

2016-01-01

This paper describes the experiences of students and organizers of the Hair and beauty care, the prevention of health hazards (HIKAT) project which offered nationwide continuing vocational training (CVT) for teachers in beauty and hair care to be further disseminated in vocational secondary education. The development of occupational skin diseases is one of the most important health risks related to the exposure to chemical and physical risks in hairdressing. The prevention of occupational...

Partnership for fragility bone fracture care provision and prevention program (P4Bones: study protocol for a secondary fracture prevention pragmatic controlled trial

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Gaboury Isabelle

2013-01-01

Full Text Available Abstract Background Fractures associated with bone fragility in older adults signal the potential for secondary fracture. Fragility fractures often precipitate further decline in health and loss of mobility, with high associated costs for patients, families, society and the healthcare system. Promptly initiating a coordinated, comprehensive pharmacological bone health and falls prevention program post-fracture may improve osteoporosis treatment compliance; and reduce rates of falls and secondary fractures, and associated morbidity, mortality and costs. Methods/design This pragmatic, controlled trial at 11 hospital sites in eight regions in Quebec, Canada, will recruit community-dwelling patients over age 50 who have sustained a fragility fracture to an intervention coordinated program or to standard care, according to the site. Site study coordinators will identify and recruit 1,596 participants for each study arm. Coordinators at intervention sites will facilitate continuity of care for bone health, and arrange fall prevention programs including physical exercise. The intervention teams include medical bone specialists, primary care physicians, pharmacists, nurses, rehabilitation clinicians, and community program organizers. The primary outcome of this study is the incidence of secondary fragility fractures within an 18-month follow-up period. Secondary outcomes include initiation and compliance with bone health medication; time to first fall and number of clinically significant falls; fall-related hospitalization and mortality; physical activity; quality of life; fragility fracture-related costs; admission to a long term care facility; participants’ perceptions of care integration, expectations and satisfaction with the program; and participants’ compliance with the fall prevention program. Finally, professionals at intervention sites will participate in focus groups to identify barriers and facilitating factors for the integrated

Air bubbles induce a critical continuous stress to prevent marine biofouling accumulation

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Belden, Jesse; Menesses, Mark; Dickenson, Natasha; Bird, James

2017-11-01

Significant shear stresses are needed to remove established hard fouling organisms from a ship hull. Given that there is a link between the amount of time that fouling accumulates and the stress required to remove it, it is not surprising that more frequent grooming requires less shear stress. One approach to mitigate marine biofouling is to continuously introduce a curtain of air bubbles under a submerged surface; it is believed that this aeration exploits the small stresses induced by rising bubbles to continuously prevent accumulation. Although curtains of rising bubbles have successfully prevented biofouling accumulation, it is unclear if a single stream of bubbles could maintain a clean surface. In this talk, we show that single bubble stream aeration can prevent biofouling accumulation in regions for which the average wall stress exceeds approximately 0.01 Pa. This value is arrived at by comparing observations of biofouling growth and prevention from field studies with laboratory measurements that probe the associated flow fields. We also relate the spatial and temporal characteristics of the flow to the size and frequency of the rising bubbles, which informs the basic operating conditions required for aeration to continuously prevent biofouling accumulation.

Veterans Affairs methicillin-resistant Staphylococcus aureus prevention initiative associated with a sustained reduction in transmissions and health care-associated infections.

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Evans, Martin E; Kralovic, Stephen M; Simbartl, Loretta A; Freyberg, Ron W; Obrosky, D Scott; Roselle, Gary A; Jain, Rajiv

2013-11-01

Implementation of a methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative was associated with significant declines in MRSA transmission and MRSA health care-associated infection rates in Veterans Affairs acute care facilities nationwide in the 33-month period from October 2007 through June 2010. Here, we show continuing declines in MRSA transmissions (P = .004 for trend, Poisson regression) and MRSA health care-associated infections (P < .001) from July 2010 through June 2012. The Veterans Affairs Initiative was associated with these effects, sustained over 57 months, in a large national health care system. Published by Mosby, Inc.

The performance of integrated health care networks in continuity of care: a qualitative multiple case study of COPD patients

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Sina Waibel

2015-07-01

Full Text Available Background: Integrated health care networks (IHN are promoted in numerous countries as a response to fragmented care delivery by providing a coordinated continuum of services to a defined population. However, evidence on their effectiveness and outcome is scarce, particularly considering continuity across levels of care; that is the patient's experience of connected and coherent care received from professionals of the different care levels over time. The objective was to analyse the chronic obstructive pulmonary disease (COPD patients’ perceptions of continuity of clinical management and information across care levels and continuity of relation in IHN of the public health care system of Catalonia.Methods: A qualitative multiple case study was conducted, where the cases are COPD patients. A theoretical sample was selected in two stages: (1 study contexts: IHN and (2 study cases consisting of COPD patients. Data were collected by means of individual, semi-structured interviews to the patients, their general practitioners and pulmonologists and review of records. A thematic content analysis segmented by IHN and cases with a triangulation of sources and analysists was carried out.Results: COPD patients of all networks perceived that continuity of clinical management was existent due to clear distribution of roles for COPD care across levels, rapid access to care during exacerbations and referrals to secondary care when needed; nevertheless, patients of some networks highlighted too long waiting times to non-urgent secondary care. Physicians generally agreed with patients, however, also indicated unclear distribution of roles, some inadequate referrals and long waiting times to primary care in some networks. Concerning continuity of information, patients across networks considered that their clinical information was transferred across levels via computer and that physicians also used informal communication mechanisms (e-mail, telephone; whereas

Fall Prevention in a Primary Care Setting.

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Siegrist, Monika; Freiberger, Ellen; Geilhof, Barbara; Salb, Johannes; Hentschke, Christian; Landendoerfer, Peter; Linde, Klause; Halle, Martin; Blank, Wolfgang A

2016-05-27

Falls and fall-related injuries are common in community-dwelling elderly people. Effective multifactorial fall prevention programs in the primary care setting may be a promising approach to reduce the incidence rate of falls. In a cluster randomized trial in 33 general practices 378 people living independently and at high risk of falling (65 to 94 years old; 285 women) were allocated to either a 16 week exercise-based fall prevention program including muscle strengthening and challenging balance training exercises, combined with a 12 week home-based exercise program (222 participants), or to usual care (156 participants). The main outcome was number of falls over a period of 12 months. Secondary outcomes were the number of fall-related injuries, physical function (Timed-Up-and-Go-Test, TUG, Chair-Stand-Test, CST, modified Romberg Test), and fear of falling. In the intervention group (n=222 patients in 17 general practices) 291 falls occurred, compared to 367 falls in the usual care group (n=156 patients in 16 general practices). We observed a lower incidence rate for falls in the intervention group (incidence rate ratio/IRR: 0.54; 95% confidence interval (CI): [0.35; 0.84], p=0.007) and for fall-related injuries (IRR: 0.66; [0.42; 0.94], p=0.033). Additionally, patients in the intervention group showed significant improvements in secondary endpoints (TUG: -2.39 s, [-3.91; -0.87], p=0.014; mRomberg: 1.70 s, [0.35; 3.04], p=0.037; fear of falling: -2.28 points, [-3.87; -0.69], p=0.022) compared to usual care. A complex falls prevention program in a primary care setting was effective in reducing falls and fall-related injuries in community dwelling older adults at risk.

Estimating Demand for and Supply of Pediatric Preventive Dental Care for Children and Identifying Dental Care Shortage Areas, Georgia, 2015.

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Cao, Shanshan; Gentili, Monica; Griffin, Paul M; Griffin, Susan O; Harati, Pravara; Johnson, Ben; Serban, Nicoleta; Tomar, Scott

Demand for dental care is expected to outpace supply through 2025. The objectives of this study were to determine the extent of pediatric dental care shortages in Georgia and to develop a general method for estimation that can be applied to other states. We estimated supply and demand for pediatric preventive dental care for the 159 counties in Georgia in 2015. We compared pediatric preventive dental care shortage areas (where demand exceeded twice the supply) designated by our methods with dental health professional shortage areas designated by the Health Resources & Services Administration. We estimated caries risk from a multivariate analysis of National Health and Nutrition Examination Survey data and national census data. We estimated county-level demand based on the time needed to perform preventive dental care services and the proportion of time that dentists spend on pediatric preventive dental care services from the Medical Expenditure Panel Survey. Pediatric preventive dental care supply exceeded demand in Georgia in 75 counties: the average annual county-level pediatric preventive dental care demand was 16 866 hours, and the supply was 32 969 hours. We identified 41 counties as pediatric dental care shortage areas, 14 of which had not been designated by the Health Resources & Services Administration. Age- and service-specific information on dental care shortage areas could result in more efficient provider staffing and geographic targeting.

Lapse in Institutional Animal Care and Use Committee Continuing Reviews.

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Min-Fu Tsan

Full Text Available The United States federal animal welfare regulations and the Public Health Service Policy on Humane Care and Use of Laboratory Animals require that institutional animal care and use committees (IACUCs conduct continuing reviews of all animal research activities. However, little is known about the lapse rate of IACUC continuing reviews, and how frequently investigators continue research activities during the lapse. It is also not clear what factors may contribute to an institution's lapse in IACUC continuing reviews. As part of the quality assurance program, the Department of Veterans Affairs (VA has collected performance metric data for animal care and use programs since 2011. We analyzed IACUC continuing review performance data at 74-75 VA research facilities from 2011 through 2015. The IACUC continuing review lapse rates improved from 5.6% in 2011 to 2.7% in 2015. The rate of investigators continuing research activities during the lapse also decreased from 47.2% in 2012 to 7.4% in 2015. The type of IACUCs used and the size of animal research programs appeared to have no effect in facility's rates of lapse in IACUC continuing reviews. While approximately 80% of facilities reported no lapse in IACUC continuing reviews, approximately 14% of facilities had lapse rates of >10% each year. Some facilities appeared to be repeat offenders. Four facilities had IACUC lapse rates of >10% in at least 3 out of 5 years, suggesting a system problem in these facilities requiring remedial actions to improve their IACUC continuing review processes.

Business continuity and pandemic preparedness: US health care versus non-health care agencies.

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Rebmann, Terri; Wang, Jing; Swick, Zachary; Reddick, David; delRosario, John Leon

2013-04-01

Only limited data are available on US business continuity activities related to biologic events. A questionnaire was administered to human resource professionals during May-July 2011 to assess business continuity related to biologic events, incentives businesses are providing to maximize worker surge capacity, and seasonal influenza vaccination policy. Linear regressions were used to describe factors associated with higher business continuity and pandemic preparedness scores. The χ(2) and Fisher exact tests compared health care versus non-health care businesses on preparedness indicators. Possible business continuity and pandemic preparedness scores ranged from 0.5 to 27 and 0 to 15, with average resulting scores among participants at 13.2 and 7.3, respectively. Determinants of business continuity and pandemic preparedness were (1) business size (larger businesses were more prepared), (2) type of business (health care more prepared), (3) having human resource professional as company disaster planning committee member, and (4) risk perception of a pandemic in the next year. Most businesses (63.3%, n = 298) encourage staff influenza vaccination; 2.1% (n = 10) mandate it. Only 10% of businesses (11.0%, n = 52) provide employee incentives, and fewer than half (41.0%, n = 193) stockpile personal protective equipment. Despite the recent H1N1 pandemic, many US businesses lack adequate pandemic plans. It is critical that businesses of all sizes and types become better prepared for a biologic event. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Prevention of violence in prison - The role of health care professionals.

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Pont, Jörg; Stöver, Heino; Gétaz, Laurent; Casillas, Alejandra; Wolff, Hans

2015-08-01

The World Health Organization (WHO) classifies violence prevention as a public health priority. In custodial settings, where violence is problematic, administrators and custodial officials are usually tasked with the duty of addressing this complicated issue-leaving health care professionals largely out of a discussion and problem-solving process that should ideally be multidisciplinary in approach. Health care professionals who care for prisoners are in a unique position to help identify and prevent violence, given their knowledge about health and violence, and because of the impartial position they must sustain in the prison environment in upholding professional ethics. Thus, health care professionals working in prisons should be charged with leading violence prevention efforts in custodial settings. In addition to screening for violence and detecting violent events upon prison admission, health care professionals in prison must work towards uniform in-house procedures for longitudinal and systemized medical recording/documentation of violence. These efforts will benefit the future planning, implementation, and evaluation of focused strategies for violence prevention in prisoner populations. Copyright © 2015. Published by Elsevier Ltd.

Assessment of the management factors that influence the development of preventive care in the New South Wales public dental service

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Masoe AV

2015-03-01

Full Text Available Angela V Masoe,1 Anthony S Blinkhorn,2 Jane Taylor,1 Fiona A Blinkhorn1 1Faculty of Health and Medicine, School of Health Sciences, Oral Health, University of Newcastle, Ourimbah, 2Department of Population Oral Health, Faculty of Dentistry, University of Sydney, Sydney, NSW, Australia Background: Oral diseases, particularly dental caries, remain one of the most common chronic health problems for adolescents, and are a major public health concern. Public dental services in New South Wales, Australia offer free clinical care and preventive advice to all adolescents under 18 years of age, particularly those from disadvantaged backgrounds. This care is provided by dental therapists and oral health therapists (therapists. It is incumbent upon clinical directors (CDs and health service managers (HSMs to ensure that the appropriate clinical preventive care is offered by clinicians to all their patients. The aims of this study were to 1 explore CDs’ and HSMs’ perceptions of the factors that could support the delivery of preventive care to adolescents, and to 2 record the strategies they have utilized to help therapists provide preventive care to adolescents. Subjects and methods: In-depth, semistructured interviews were undertaken with 19 CDs and HSMs from across NSW local health districts. A framework matrix was used to systematically code data and enable key themes to be identified for analysis. Results: The 19 CDs and HSMs reported that fiscal accountability and meeting performance targets impacted on the levels and types of preventive care provided by therapists. Participants suggested that professional clinical structures for continuous quality improvement should be implemented and monitored, and that an adequate workforce mix and more resources for preventive dental care activities would enhance therapists’ ability to provide appropriate levels of preventive care. CDs and HSMs stated that capitalizing on the strengths of visiting pediatric

The Social Work in the Continuous Care Unit

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Ana Rita dos Santos de Pina Duarte

2014-06-01

Full Text Available The Social Worker is a qualified professional who, by proper training intervention and by research and analysis of social reality, is ready to act, execute and evaluate services, programs and social policies aiming to preserve, protect and expand human rights and social justice. The Portuguese National Network of Integrated Continuous Care (RNCCI emerged in 2006 considering the health care needs with the recognition that the system could not cope with the rehabilitation needs of the different groups of patients. Thus, this health structure was created to establish an intermediary between health and social care and as a way to connect hospitalization and clinical discharge, as well as re-integration into the community. The primary goal was to clearly assess the importance of the social service in one Continuous Care Unit by using, as methodology, questioner applications for different professionals (social service team and other health team members. The results were helpful and positive, allowing us to conclude that the social service area is valued by the team members at different levels with a fundamental goal of supporting patients, families / caregivers and the other health professionals in their interventions.

Perspectives on Providing And Receiving Preventive Health Care From Primary Care Providers and Their Patients With Mental Illnesses.

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Stumbo, Scott P; Yarborough, Bobbi Jo H; Yarborough, Micah T; Green, Carla A

2018-01-01

Individuals with mental illnesses have higher morbidity rates and reduced life expectancy compared to the general population. Understanding how patients and providers perceive the need for prevention, as well as the barriers and beliefs that may contribute to insufficient care, are important for improving service delivery tailored to this population. Cross-sectional; mixed methods. An integrated health system and a network of federally qualified health centers and safety net clinics. Interviews (n = 30) and surveys (n = 249) with primary care providers. Interviews (n = 158) and surveys (n = 160) with patients diagnosed with schizophrenia, bipolar, anxiety, or major depressive disorders. Semi-structured interviews and surveys. Thematic analysis for qualitative data; frequencies for quantitative data. More than half (n = 131, 53%) of clinicians believed patients with mental illnesses care less about preventive care than the general population, yet 88% (n = 139) of patients reported interest in improving health. Most providers (n = 216, 88%) lacked confidence that patients with mental illnesses would follow preventive recommendations; 82% (n = 129) of patients reported they would try to change lifestyles if their doctor recommended. Clinicians explained that their perception of patients' chaotic lives and lack of interest in preventive care contributed to their fatalistic attitudes on care delivery to this population. Clinicians and patients agreed on substantial need for additional support for behavior changes. Clinicians reported providing informational support by keeping messages simple; patients reported a desire for more detailed information on reasons to complete preventive care. Patients also detailed the need for assistive and tangible support to manage behavioral health changes. Our results suggest a few clinical changes could help patients complete preventive care recommendations and improve health behaviors: improving clinician-patient collaboration on

[Multicenter survey on ventilator-associated pneumonia prevention in intensive care].

Science.gov (United States)

Fischer, M-O; Garreau, N; Jarno, P; Villers, D; Dufour Trivini, M; Gérard, J-L; Fellahi, J-L; Hanouz, J-L; Parienti, J-J

2013-12-01

Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in intensive care unit (ICU). The aim of the study was to evaluate the follow-up of the guidelines for VAP prevention. Retrospective, observational and multicenter study. During one year, all patients with mechanical ventilation over 48 hours were included in the CCLIN-Ouest Network. The demographic characteristics of the patients, the use of specific protocol for VAP prevention and the density of incidence of VAP were recorded. The use of a protocol for preventing VAP (absence, incomplete, complete and care bundle (i.e. complete prevention of VAP with weaning mechanical protocol and sedation protocol)) was collected. 26 ICU with 5742 patients were included. Ten ICU (38%; 2595 patients) had no protocol for VAP prevention, eight ICU (31%; 1821 patients) had an incomplete protocol, five ICU (19%; 561 patients) had a complete protocol and three ICU (12%; 765 patients) had a care bundle. The density of incidence of VAP was 14.8‰ (Interquartile range [IQR]: 10.2-0.1) for no protocol group, 15.6‰ [IQR: 12.6-6.2] for incomplete protocol group, 11.0‰ [IQR: 9.1-14.0] for complete protocol group and 12.9‰ [5-7,7-9,9-12] for care bundle group (P=0.742). The compliance to prevention of VAP was poor. Proposals for improving practice are discussed. Copyright © 2013. Published by Elsevier SAS.

The emotional and professional wellbeing of Australian midwives: A comparison between those providing continuity of midwifery care and those not providing continuity.

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Fenwick, Jennifer; Sidebotham, Mary; Gamble, Jenny; Creedy, Debra K

2018-02-01

Continuity of midwifery care contributes to significant positive outcomes for women and babies. There is a perception that providing continuity of care may negatively impact on the wellbeing and professional lives of midwives. To compare the emotional and professional wellbeing as well as satisfaction with time off and work-life balance of midwives providing continuity of care with midwives not providing continuity. Online survey. Measures included; Copenhagen Burnout Inventory (CBI); Depression, Anxiety and Stress Scale-21; and Perceptions of Empowerment in Midwifery Scale (PEMS-Revised). The sample (n=862) was divided into two groups; midwives working in continuity (n=214) and those not working in continuity (n=648). Mann Whitney U tests were used to compare the groups. The continuity group had significantly lower scores on each of the burnout subscales (CBI Personal p=.002; CBI Work pwork-life balance. Our results indicate that providing continuity of midwifery care is also beneficial for midwives. Conversely, midwives working in shift-based models providing fragmented care are at greater risk of psychological distress. Maternity service managers should feel confident that re-orientating care to align with the evidence is likely to improve workforce wellbeing and is a sustainable way forward. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients.

Science.gov (United States)

Gupta, A; Gupta, A; Singh, T K; Saxsena, A

2016-01-01

Ventilator associated pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients

OpenAIRE

A Gupta; A Gupta; T K Singh; A Saxsena

2016-01-01

Ventilator associated pneumonia (VAP) is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

Breast cancer prevention across the cancer care continuum.

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Klemp, Jennifer R

2015-05-01

To review the current state of breast cancer prevention from primary prevention through survivorship, highlight cross-cutting issues, and discuss strategies for clinical integration and future research. Published articles between 1985 and 2015 and original research. Cancer risk persists across the lifespan. Interprofessional strategies to reduce morbidity and mortality from cancer include primary, secondary, and tertiary prevention (survivorship). Prevention strategies across the cancer care continuum are cross-cutting and focus on measures to: prevent the onset of disease, identify and treat asymptomatic persons who have already developed risk factors or preclinical disease, and restore function, minimize the negative effects of disease, and prevent disease-related complications. Oncology nurses and advanced practice nurses are vital in the delivery of breast cancer prevention strategies. Published by Elsevier Inc.

Outlining a preventive oral health care system for China.

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Saekel, Rüdiger

2015-01-01

The most recent Chinese health care reform, scheduled to run until 2020, has been underway for a number of years. Oral health care has not been explicitly mentioned in the context of this reform. However, oral health is an integral part of general health and the under-servicing of the Chinese population in the area of dental care is particularly high. The article describes how this problem could be addressed. Based on present scientific knowledge,specifically on evidence-based strategies and long-term empirical experience from Western industrialised countries, as well as findings from Chinese pilot studies, the author outlines a preventive oral health care system tailored specifically to the conditions prevailing in China. He describes the background and rationale for a clearly structured, preventive system and summarises the scientific cornerstones on which this concept is founded. The single steps of this model, that are adapted specifically to China, are presented so as to facilitate a critical discussion on the pros and cons of the approach. The author concludes that, by implementing preventive oral care, China could gradually reduce the under-servicing of great parts of the population with dental care that largely avoids dental disease and preserves teeth at a price that is affordable to both public health and patients. This approach would minimise the danger of starting a cycle of re-restorations, owing to outdated treatment methods. The proposal would both fit in well with and add to the current blueprint for Chinese health care reform.

Role of oral care to prevent VAP in mechanically ventilated Intensive Care Unit patients

Directory of Open Access Journals (Sweden)

A Gupta

2016-01-01

Full Text Available Ventilator associated pneumonia (VAP is the most common nosocomial infection in Intensive Care Unit. One major factor causing VAP is the aspiration of oral colonization because of poor oral care practices. We feel the role of simple measure like oral care is neglected, despite the ample evidence of it being instrumental in preventing VAP.

Integration and Continuity of Primary Care: Polyclinics and Alternatives, a Patient-Centred Analysis of How Organisation Constrains Care Coordination

OpenAIRE

Sheaff, WR; Halliday, J; Øvretveit, J; Byng, R; Exworthy, M; Peckham, S; Asthana, S

2015-01-01

Background\\ud An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by pa...

Understanding, Treating, and Preventing STDs / Questions to Ask your Health Care Professional

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... Preventing STDs / Questions to Ask your Health Care Professional Past Issues / Fall 2008 Table of Contents For ... sexual partner Questions to Ask Your Health Care Professional How can I prevent getting an STD? If ...

Practice of preventive dentistry for nursing staff in primary care

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Acuña-Reyes, Raquel; Cigarroa-Martínez, Didier; Ureña-Bogarín, Enrique; Orgaz-Fernández, Jose David

2014-01-01

Objectives: Determine the domain of preventive dentistry in nursing personnel assigned to a primary care unit. Methods: Prospective descriptive study, questionnaire validation, and prevalence study. In the first stage, the questionnaire for the practice of preventive dentistry (CPEP, for the term in Spanish) was validated; consistency and reliability were measured by Cronbach's alpha, Pearson's correlation, factor analysis with intra-class correlation coefficient (ICC). In the second stage, the domain in preventive dental nurses was explored. Results: The overall internal consistency of CPEP is α= 0.66, ICC= 0.64, CI95%: 0.29-0.87 (p >0.01). Twenty-one subjects in the study, average age 43, 81.0% female, average seniority of 12.5 were included. A total of 71.5% showed weak domain, 28.5% regular domain, and there was no questionnaire with good domain result. The older the subjects were, the smaller the domain; female nurses showed greater mastery of preventive dentistry (29%, CI95%: 0.1-15.1) than male nurses. Public health nurses showed greater mastery with respect to other categories (50%, CI95%: 0.56-2.8). Conclusions: The CDEP has enough consistency to explore the domain of preventive dentistry in health-care staff. The domain of preventive dentistry in primary care nursing is poor, required to strengthen to provide education in preventive dentistry to the insured population. PMID:25386037

Cardiovascular preventive care for patients with serious mental illness.

Science.gov (United States)

Ritchie, Sarah; Muldoon, Laura

2017-11-01

To determine whether patients with serious mental illness (SMI) are receiving preventive care for cardiovascular disease at the same rate as those without SMI in an interprofessional practice with a mandate to care for persons with barriers to access to the health care system. Quality improvement exercise using a case-matched retrospective chart review. Somerset West Community Health Centre in downtown Ottawa, Ont. All patients with SMI were adult, current primary care patients from the Somerset West Community Health Centre with a recorded diagnosis of SMI (bipolar affective disorder, schizophrenia, or other psychosis) during the 2-year period from June 1, 2013, to May 31, 2015. Two control patients (current primary care patients without SMI and matched for age and sex) were randomly chosen for each patient with SMI. They had at least 1 record in their electronic chart during the 2-year study period of measurement of blood pressure, weight, body mass index, smoking status, lipid screening results, or diabetes screening results. Prevention score was calculated as the number of preventive tests documented out of the possible 6. Secondary measures included age, sex, comorbidities (diabetes, hypertension, or hyperlipidemia), mental illness diagnosis, involvement of a psychiatrist, and involvement of a mental health case worker. Patients with SMI had higher rates of diabetes, hypertension, and dyslipidemia. Screening rates for the 6 outcome measures were very similar between patients with and without SMI. Patients with SMI who were under the care of a psychiatrist or who had a case worker had more complete screening results than those who had neither provider. As expected, patients with SMI had higher rates of metabolic comorbidities than control patients had. Screening rates for cardiovascular risk factors were similar in the 2 groups. Involvement of mental health case workers and psychiatrists in the patients' care might be linked to more complete preventive screening

Preventative foot care in people with diabetes: Quality patient ...

African Journals Online (AJOL)

Keywords: preventative foot care; diabetes; risk stratification: self care. Introduction ... diabetes is considered to be a key indicator of the quality of foot ... loss of protective sensation, the importance of foot monitoring on a daily basis, the proper ...

Continuity of care for children with complex chronic health conditions: parents' perspectives

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Shaw Nicola

2009-12-01

Full Text Available Abstract Background Continuity of care has been explored largely from academic and service provider perspectives, and in relation to adult patient/client groups. We interviewed parents of children with complex chronic health conditions to examine how their experiences and perceptions of continuity of care fit with these perspectives; and to identify the salient factors in the experience of, and factors contributing to, continuity in this population. Methods Parents of 47 elementary school-aged children with spina bifida, Down syndrome, attention-deficit/hyperactivity disorder, Duchenne muscular dystrophy or cystic fibrosis participated in semi-structured interviews. Parents described and mapped the pattern of their interactions with service providers over time in all domains relevant to their child's health, well-being, and development (medical, rehabilitational, educational, and social supportive services, with particular attention paid to their perceptions of connectedness or coherency in these interactions. Verbatim transcripts were analyzed thematically using a framework approach to impose structure regarding parents' perspectives on continuity of care. Results Existing academic concepts of relational, informational and management continuity were all discernable in parents' narratives. A thorough knowledge of the child on the part of service providers emerged as extremely important to parents; such knowledge was underpinned by continuity of personal relationships, principally, and also by written information. For this population, notions of continuity extend to the full range of service providers these children and families need to achieve optimal health status, and are not limited to physicians and nurses. Communication among providers was seen as integral to perceived continuity. Compartmentalization of services and information led to parents assuming a necessary, though at times, uncomfortable, coordinating role. Geographic factors

"Macho men" and preventive health care: implications for older men in different social classes.

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Springer, Kristen W; Mouzon, Dawne M

2011-06-01

The gender paradox in mortality--where men die earlier than women despite having more socioeconomic resources--may be partly explained by men's lower levels of preventive health care. Stereotypical notions of masculinity reduce preventive health care; however, the relationship between masculinity, socioeconomic status (SES), and preventive health care is unknown. Using the Wisconsin Longitudinal Study, the authors conduct a population-based assessment of masculinity beliefs and preventive health care, including whether these relationships vary by SES. The results show that men with strong masculinity beliefs are half as likely as men with more moderate masculinity beliefs to receive preventive care. Furthermore, in contrast to the well-established SES gradient in health, men with strong masculinity beliefs do not benefit from higher education and their probability of obtaining preventive health care decreases as their occupational status, wealth, and/or income increases. Masculinity may be a partial explanation for the paradox of men's lower life expectancy, despite their higher SES.

Understanding nurses' views on a pressure ulcer prevention care bundle: a first step towards successful implementation.

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Chaboyer, Wendy; Gillespie, Brigid M

2014-12-01

To explore nurses' views of the barriers and facilitators to the use of a newly devised patient-centred pressure ulcer prevention care bundle. Given pressure ulcer prevention strategies are not implemented consistently, the use of a pressure ulcer care bundle may improve implementation given bundles generally assist in standardising care. A quality improvement project was undertaken after a pressure ulcer prevention care bundle was developed and pilot-tested. Short, conversational interviews with nurse explored their views of a patient-centred pressure ulcer care bundle. Interviews were audio-taped and transcribed. Inductive content analysis was used to analyse the transcripts. A total of 20 nurses were interviewed. Five categories with corresponding subcategories emerged from the analysis. They were increasing awareness of pressure ulcer prevention, prompting pressure ulcer prevention activities, promoting active patient participation, barriers to using a pressure ulcer prevention care bundle and enabling integration of the pressure ulcer prevention care bundle into routine practice. Benefits of using a patient-centred pressure ulcer prevention care bundle may include prompting patients and staff to implement prevention strategies and promote active patient participation in care. The success of the care bundle relied on both patients' willingness to participate and nurses' willingness to incorporate it into their routine work. A patient-centred pressure ulcer prevention care bundle may facilitate more consistent implementation of pressure ulcer prevention strategies and active patient participation in care. © 2014 John Wiley & Sons Ltd.

Observations of infection prevention and control practices in primary health care, Kenya.

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Bedoya, Guadalupe; Dolinger, Amy; Rogo, Khama; Mwaura, Njeri; Wafula, Francis; Coarasa, Jorge; Goicoechea, Ana; Das, Jishnu

2017-07-01

To assess compliance with infection prevention and control practices in primary health care in Kenya. We used an observational, patient-tracking tool to assess compliance with infection prevention and control practices by 1680 health-care workers during outpatient interactions with 14 328 patients at 935 health-care facilities in 2015. Compliance was assessed in five domains: hand hygiene; protective glove use; injections and blood sampling; disinfection of reusable equipment; and waste segregation. We calculated compliance by dividing the number of correct actions performed by the number of indications and evaluated associations between compliance and the health-care worker's and facility's characteristics. Across 106 464 observed indications for an infection prevention and control practice, the mean compliance was 0.318 (95% confidence interval, CI: 0.315 to 0.321). The compliance ranged from 0.023 (95% CI: 0.021 to 0.024) for hand hygiene to 0.871 (95% CI: 0.866 to 0.876) for injection and blood sampling safety. Compliance was weakly associated with the facility's characteristics (e.g. public or private, or level of specialization) and the health-care worker's knowledge of, and training in, infection prevention and control practices. The observational tool was effective for assessing compliance with infection prevention and control practices across multiple domains in primary health care in a low-income country. Compliance varied widely across infection prevention and control domains. The weak associations observed between compliance and the characteristics of health-care workers and facilities, such as knowledge and the availability of supplies, suggest that a broader focus on behavioural change is required.

Determinants of and opportunities for continuing education among health care professionals in public health care institutions in Jimma township, Southwest Ethiopia

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Fentahun N

2012-09-01

Full Text Available Netsanet Fentahun,1 Ashagre Molla21Department of Health Education and Behavioral Sciences, 2Department of Nursing, Jimma University, Jimma, EthiopiaBackground: An effectively prepared and continually updated workforce of health professionals is essential to maintenance and improvement in patient care. The major goal of continuing education is to improve and promote quality care. Continuing education is also important to an organization's strategic plan because of its positive influence on the quality of care provided. The purpose of this study was to identify the determinants of and opportunities for continuing education among health care professionals at public health facilities in Jimma township.Methods: A cross-sectional study of 319 health care professionals working in the public health facilities of Jimma township was conducted from January 10, 2012 to February 28, 2012. A self-administered questionnaire was used to collect the data. First, descriptive analysis was done to describe the characteristics of the study participants. Finally logistic regression was then used to determine the independent predictors of continuing education.Results: Only 70 (25% of the study participants were participating in continuing education. As working experience increased, participation in continuing education did not steadily increase. The working hours per week were higher for diploma holders than for those with any other qualification. One hundred and fifty-three (71.8% participants mentioned lack of support from their current employer as the reason for not participating in continuing education. Health care professionals with a lack of support from management were 2.4 times more likely not to participate in advanced education. Health care professionals with lack of funding were 0.3 times less likely to participate in advanced education. Health care professionals with lack of resources other than financial were 2.2 times more likely not to participate in

Undocumented migrants lack access to pregnancy care and prevention

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Andreoli Nicole

2008-03-01

Full Text Available Abstract Background Illegal migration is an increasing problem worldwide and the so-called undocumented migrants encounter major problems in access to prevention and health care. The objective of the study was to compare the use of preventive measures and pregnancy care of undocumented pregnant migrants with those of women from the general population of Geneva, Switzerland. Methods Prospective cohort study including pregnant undocumented migrants presenting to the University hospital from February 2005 to October 2006. The control group consisted of a systematic sample of pregnant women with legal residency permit wishing to deliver at the same public hospital during the same time period. Results 161 undocumented and 233 control women were included in the study. Mean ages were 29.4 y (SD 5.8 and 31.1 y (SD 4.8 (p Conclusion Compared to women who are legal residents of Geneva, undocumented migrants have more unintended pregnancies and delayed prenatal care, use fewer preventive measures and are exposed to more violence during pregnancy. Not having a legal residency permit therefore suggests a particular vulnerability for pregnant women. This study underscores the need for better access to prenatal care and routine screening for violence exposure during pregnancy for undocumented migrants. Furthermore, health care systems should provide language- and culturally-appropriate education on contraception, family planning and cervical cancer screening.

Participation in preventive care programs: individual determinants, social interactions and program design.

OpenAIRE

Bouckaert, Nicolas

2014-01-01

This doctoral research focuses on existing medical preventive care programs. Because of externalities (e.g. in the prevention of communicable diseases) or the program cost-benefit ratio, preventive care programs require high participation rates. In the United States, the Centers for Disease Control and Prevention have set clear participation objectives – next to quality targets – which are measured and evaluated over time (National Center for Health Statistics, 2012). For example, the 2010 pa...

Reconstructing continuity of care in mental health services : a multilevel conceptual framework

NARCIS (Netherlands)

Wierdsma, Andre; Mulder, Cornelis; de Vries, Sanne; Sytema, Sjoerd

Continuity of mental health care is a key issue in the organization and evaluation of services for patients with disabling chronic conditions. Over many years, health services researchers have been exploring the conceptual boundaries between continuity of care and other service characteristics. On

Breaking Boundaries: Complementary and Alternative Medicine Provider Framing of Preventive Care.

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Agarwal, Vinita

2017-11-01

This textual examination extends understandings of how complementary and alternative medicine (CAM) providers constitute preventive care in their discourse by identifying the frame of breaking boundaries referencing relational, structural, and philosophical orientations in their practice with their clients. Analysis of semistructured, in-depth interviews with CAM providers ( n = 17) reveals that the frame of breaking boundaries was comprised of three themes: finding one's own strength; I don't prescribe, so I'm exploring; and ground yourself, and have an escape route. The themes describe preventive care by identifying how CAM providers negotiate their relational positionality in connecting with clients, structural positionality within the field of health care, and philosophical positionality within the ontological understandings that guide how health is defined and conceptualized. The study contributes toward enhancing diverse understandings of constituting preventive care in practice and suggests pragmatic implications for addressing biomedical provider communication with their patients seeking CAM care alongside conventional treatments.

[Innovations in continuing/permanent education methods for the intensive care nurses].

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Vázquez Guillamet, B; Guillamet Lloveras, A; Martínez Estalella, G; Pérez Ramírez, F

2014-01-01

Intensive care nursing is carried out in a dynamic environment characterized by the continuous incorporation of new technologies, approaches to care and a request for safety, participation and transparency by the public. Continuing/permanent intensive care nursing training in the acquisition of new competencies is key in this setting. In order to achieve this goal, simulation and problem based learning should be incorporated as essential methodologies to teach these skills. At the same time research should be done on which attitudes, competences, and knowledge are necessary to increase their intellectual knowledge. The core characteristics of ICU and its nursing should allow a deep change in their approach to continuing/permanent nursing education. Copyright © 2013 Elsevier España, S.L. y SEEIUC. All rights reserved.

Policy choices in dementia care-An exploratory analysis of the Alberta continuing care system (ACCS) using system dynamics.

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Cepoiu-Martin, Monica; Bischak, Diane P

2018-02-01

The increase in the incidence of dementia in the aging population and the decrease in the availability of informal caregivers put pressure on continuing care systems to care for a growing number of people with disabilities. Policy changes in the continuing care system need to address this shift in the population structure. One of the most effective tools for assessing policies in complex systems is system dynamics. Nevertheless, this method is underused in continuing care capacity planning. A system dynamics model of the Alberta Continuing Care System was developed using stylized data. Sensitivity analyses and policy evaluations were conducted to demonstrate the use of system dynamics modelling in this area of public health planning. We focused our policy exploration on introducing staff/resident benchmarks in both supportive living and long-term care (LTC). The sensitivity analyses presented in this paper help identify leverage points in the system that need to be acknowledged when policy decisions are made. Our policy explorations showed that the deficits of staff increase dramatically when benchmarks are introduced, as expected, but at the end of the simulation period, the difference in deficits of both nurses and health care aids are similar between the 2 scenarios tested. Modifying the benchmarks in LTC only versus in both supportive living and LTC has similar effects on staff deficits in long term, under the assumptions of this particular model. The continuing care system dynamics model can be used to test various policy scenarios, allowing decision makers to visualize the effect of a certain policy choice on different system variables and to compare different policy options. Our exploration illustrates the use of system dynamics models for policy making in complex health care systems. © 2017 John Wiley & Sons, Ltd.

Pressure Ulcer in Norway—A Snapshot of Pressure Ulcer Occurrence across Various Care Sites and Recommendations for Improved Preventive Care

Science.gov (United States)

Johansen, Edda; Bakken, Linda N.; Moore, Zena

2015-01-01

Pressure ulcers (PU) are common in all care settings, although most ulcers are preventable. Much evidence exists on Hospital Acquired Pressure Ulcers (HAPU), however, few studies describe PU in community care. From a Norwegian perspective, little is known about pressure ulcer prevalence and prevention strategies across the variety of healthcare sectors. Therefore, this study explored PU prevalence and preventive care in home care, nursing homes and hospitals. Seventeen postgraduate wound care students collected data. A data collection instrument by Jordan O’Brien and Cowman was used together with an online forum in which students described how to improve practice to reduce PU incidence. This study showed that pressure ulcers are a problem across all care settings in Norway; however, nursing homes had the highest proportion of at risk patients and the highest prevalence. By implementing the care bundle provided by the Patient Safety Programme across all care settings, increasing staff competency and make sure that access to appropriate equipment for beds and chairs is readily available, a structured and evidence based approach to prevention could be ensured. PMID:27417771

Pressure Ulcer in Norway—A Snapshot of Pressure Ulcer Occurrence across Various Care Sites and Recommendations for Improved Preventive Care

Directory of Open Access Journals (Sweden)

Edda Johansen

2015-06-01

Full Text Available Pressure ulcers (PU are common in all care settings, although most ulcers are preventable. Much evidence exists on Hospital Acquired Pressure Ulcers (HAPU, however, few studies describe PU in community care. From a Norwegian perspective, little is known about pressure ulcer prevalence and prevention strategies across the variety of healthcare sectors. Therefore, this study explored PU prevalence and preventive care in home care, nursing homes and hospitals. Seventeen postgraduate wound care students collected data. A data collection instrument by Jordan O’Brien and Cowman was used together with an online forum in which students described how to improve practice to reduce PU incidence. This study showed that pressure ulcers are a problem across all care settings in Norway; however, nursing homes had the highest proportion of at risk patients and the highest prevalence. By implementing the care bundle provided by the Patient Safety Programme across all care settings, increasing staff competency and make sure that access to appropriate equipment for beds and chairs is readily available, a structured and evidence based approach to prevention could be ensured.

Wellness Programs: Preventive Medicine to Reduce Health Care Costs.

Science.gov (United States)

Martini, Gilbert R., Jr.

1991-01-01

A wellness program is a formalized approach to preventive health care that can positively affect employee lifestyle and reduce future health-care costs. Describes programs for health education, smoking cessation, early detection, employee assistance, and fitness, citing industry success figures. (eight references) (MLF)

Factors that influence the preventive care offered to adolescents accessing Public Oral Health Services, NSW, Australia

Directory of Open Access Journals (Sweden)

Masoe AV

2015-06-01

Full Text Available Angela V Masoe,1 Anthony S Blinkhorn,2 Jane Taylor,1 Fiona A Blinkhorn1 1School of Health Sciences, Faculty of Health and Medicine, Oral Health, University of Newcastle, Ourimbah, NSW, Australia; 2Department of Population Oral Health, Faculty of Dentistry, University of Sydney, Westmead, NSW, Australia Background: Many adolescents are at risk of dental caries and periodontal disease, which may be controlled through health education and clinical preventive interventions provided by oral health and dental therapists (therapists. Senior clinicians (SCs can influence the focus of dental care in the New South Wales (NSW Public Oral Health Services as their role is to provide clinical support and advice to therapists, advocate for their communities, and inform Local Health District (LHD managers of areas for clinical quality improvement. The objective of this study was to record facilitating factors and strategies that are used by SCs to encourage therapists to provide preventive care and advice to adolescent patients. Methods: In-depth, semistructured interviews were undertaken with 16 SCs from all of the 15 NSW LHDs (nine rural and six metropolitan. A framework matrix was used to systematically code data and enable key themes to be identified for analysis. Results: All SCs from the 15 NSW Health LHDs participated in the study. Factors influencing SCs' ability to integrate preventive care into clinical practice were: 1 clinical leadership and administrative support, 2 professional support network, 3 clinical and educational resources, 4 the clinician's patient management aptitude, and 5 clinical governance processes. Clinical quality improvement and continuing professional development strategies equipped clinicians to manage and enhance adolescents' confidence toward self-care. Conclusion: This study shows that SCs have a clear understanding of strategies to enhance the therapist's offer of scientific-based preventive care to adolescents. The problem

Wound-care teams for preventing and treating pressure ulcers.

Science.gov (United States)

Moore, Zena E H; Webster, Joan; Samuriwo, Ray

2015-09-16

Pressure ulcers, which are localised injury to the skin or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful and impact negatively on the individual's quality of life. The cost implications of pressure ulcer treatment are considerable, compounding the challenges in providing cost effective, efficient health service delivery. International guidelines suggest that to prevent and manage pressure ulcers successfully a team approach is required. Therefore, this review has been conducted to clarify the role of wound-care teams in the prevention and management of pressure ulcers. To assess the impact of wound-care teams in preventing and treating pressure ulcers in people of any age, nursed in any healthcare setting. In April 2015 we searched: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. We considered RCTs that evaluated the effect of any configuration of wound-care teams in the treatment or prevention of pressure ulcers. Two review authors independently assessed titles and, where available, abstracts of the studies identified by the search strategy for their eligibility. We obtained full versions of potentially relevant studies and two review authors independently screened these against the inclusion criteria. We identified no studies that met the inclusion criteria. We set out to evaluate the RCT evidence pertaining to the impact of wound-care teams on the prevention and management of pressure ulcers. However, no studies met the inclusion criteria. There is a lack of evidence concerning whether wound-care teams make a difference to the incidence or healing of pressure

What factors influence the provision of preventive care by general dental practitioners?

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Sbaraini, A

2012-06-08

What factors influence a general dental practitioner to offer preventive care to patients? A potential answer to this question is presented based on the findings of a qualitative study recently undertaken in general dental practice in Australia. A model of how practices come to be oriented towards preventive or restorative care is described, condensing all of the findings of the study into a single framework. Eight practices were studied and highlighted the interaction between two factors: leadership in practice and prioritisation of cultural, social and economic resources. In this model, dentists' leadership to reorient the prioritisation of resources towards preventive care was crucial. Ideally a whole practice changed to preventive philosophy, but change was also possible in a single dentist within a practice. Prioritisation of resources was also key and interacted with dentist leadership. Prioritisation could be seen in the reorganisation of space, routines and fee schedules. During this process, one key support factor for dentists was their external networks of trusted peers and respected practicing dentists. These peers were crucial for transferring preventive knowledge within small networks of dentists who trusted one another; their influence was reportedly more important than centrally produced guidelines or academic advice. In order to help dentists change their practices towards preventive care, the findings from our study suggest that it is important to intervene in these local networks by identifying local dental opinion leaders. During this study, the key conditions needed for practices to reorient to preventive care included the presence of a committed leader with a prevention-supportive peer network, and the reorientation of space, routines and fee schedules to support preventive practice.

Continuity of care by a midwife team versus routine care during pregnancy and birth: a randomised trial.

Science.gov (United States)

Rowley, M J; Hensley, M J; Brinsmead, M W; Wlodarczyk, J H

1995-09-18

To compare continuity of care from a midwife team with routine care from a variety of doctors and midwives. A stratified, randomised controlled trial. 814 women attending the antenatal clinic of a tertiary referral, university hospital. Women were randomly allocated to team care from a team of six midwives, or routine care from a variety of doctors and midwives. Antenatal, intrapartum and neonatal events; maternal satisfaction; and cost of treatment. 405 women were randomly allocated to team care and 409 to routine care; they delivered 385 and 386 babies, respectively. Team care women were more likely to attend antenatal classes (OR, 1.73; 95% CI, 1.23-2.42); less likely to use pethidine during labour (OR, 0.32; 95% CI, 0.22-0.46); and more likely to labour and deliver without intervention (OR, 1.73; 95% CI, 1.28-2.34). Babies of team care mothers received less neonatal resuscitation (OR, 0.59; 95% CI, 0.41-0.86), although there was no difference in Apgar scores at five minutes (OR, 0.86; 95% CI, 0.29-2.57). The stillbirth and neonatal death rate was the same for both groups of mothers with a singleton pregnancy (three deaths), but there were three deaths (birthweights of 600 g, 660 g, 1340 g) in twin pregnancies in the group receiving team care. Team care was rated better than routine care for all measures of maternal satisfaction. Team care meant a cost reduction of 4.5%. Continuity of care provided by a small team of midwives resulted in a more satisfying birth experience at less cost than routine care and fewer adverse maternal and neonatal outcomes. Although a much larger study would be required to provide adequate power to detect rare outcomes, our study found that continuity of care by a midwife team was as safe as routine care.

[The prevention of pressure sores in paediatric intensive care].

Science.gov (United States)

Thueux, Emilie

2014-01-01

In paediatric intensive care, children develop pressure sores as a result of various mechanical and clinical factors. The prevention and assessment of the risk of pressure sores constitute a key concern for the nursing teams which establish prevention strategies adapted to the young patients.

Nursing care for patients carrying indwelling catheter in target vessel for continuous chemotherapy

International Nuclear Information System (INIS)

Wen Lihong

2009-01-01

Objective: To reduce the occurrence of undesirable catheter-related events in patients with indwelling catheter during the course of continuous chemotherapy. Methods: (1)To enhance the propaganda,education and guidance to patients. (2) To standardize the nursing care operations. (3) To establish the reasonable care rules and procedures. (4) The nurses should take the daily nursing care,observations and recording work seriously. Results: Through the analysis of a variety of problems occurred in patients with indwelling catheter during the course of continuous chemotherapy the nursing care experience was summed up. Conclusion: Proper and effective care can reduce the occurrence of undesirable catheter-related events in patients with indwelling catheter during the course of continuous chemotherapy. (authors)

Working conditions and parents' ability to care for children's preventive health needs.

Science.gov (United States)

Earle, Alison; Heymann, Jody

2014-04-01

To determine whether workplace flexibility policies influence parents' ability to meet their children's preventive primary health care needs. Study sample included 917 employed adults with at least 1 child younger than 18 years in their household from a nationally representative survey of US adults. Multivariate logistic regression analyses of factors influencing parental ability to meet their children's preventive primary health care needs were conducted. Analyses assessed the effect of having access to schedule flexibility, a supervisor who is accommodating about work adjustments when family issues arise, and the ability to make personal calls without consequences on the odds of a parents' being unable to meet their child's preventive health care needs. Being able to make a personal phone call at work was associated with a 56% (P flexibility at work could make a substantial difference in parents' ability to obtain preventive care for their children.

Attitudes About and Practices of Health Promotion and Prevention Among Primary Care Providers.

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Luquis, Raffy R; Paz, Harold L

2015-09-01

The Patient Protection and Affordable Care Act's emphasis on health promotion and prevention activities required an examination of the current practices of primary care providers in these areas. A total of 196 primary care providers completed a survey to assess current health promotion and prevention attitudes, practices, and barriers. Results of this study showed that family physicians in Pennsylvania recognize the importance of and their role in providing health promotion and prevention and offer advice in key behavioral and disease prevention areas. Results from the study suggest that their ability to provide these services is hindered by a lack of time and the heavy workload. Although most family physicians provided advice to patients in several health promotion and prevention areas, few participants reported that they referred patients to other health professionals. Finally, when it comes to preventive services, participants ranked blood pressure screening, tobacco use screening, and tobacco use cessation interventions as the most important services. Effective implementation of the Patient Protection and Affordable Care Act will require necessary resources and support of primary care providers to help patients achieve healthier lives. © 2014 Society for Public Health Education.

Determinants and gaps in preventive care for Indigenous Australians: a cross sectional analysis

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Ross Stewart Bailie

2016-03-01

Full Text Available BackgroundPotentially preventable chronic diseases are the greatest contributor to the health gap between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians. Preventive care is important for earlier detection and control of chronic disease, and a number of recent policy initiatives have aimed to enhance delivery of preventive care. We examined documented delivery of recommended preventive services for Indigenous peoples across Australia, and investigated the influence of health center and client level factors on adherence to best practice guidelines. MethodsClinical audit data from 2012-2014 for 3623 well adult clients (aged 15-54 of 101 health centers from four Australian states and territories were analyzed to determine adherence to delivery of 26 recommended preventive services classified into five different modes of care on the basis of the way in which they are delivered (eg. basic measurement; laboratory tests and imaging; assessment and brief interventions, eye, ear and oral checks; follow-up of abnormal findings. Summary statistics were used to describe the delivery of each service item across jurisdictions. Multilevel regression models were used to quantify the variation in service delivery attributable to health center and client level factors and to identify factors associated with higher quality care.ResultsDelivery of recommended preventive care varied widely between service items, with good delivery of most basic measurements but poor follow-up of abnormal findings. Health center characteristics were associated with most variation. Higher quality care was associated with Northern Territory location, urban services and smaller service population size. Client factors associated with higher quality care included age between 25-34 years, female sex and more regular attendance. ConclusionsWide variation in documented preventive care delivery, poor follow-up of abnormal findings, and system factors that

Outcome of alcohol dependence: The role of continued care

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Murthy Pratima

2009-01-01

Full Text Available Aims: This study attempted to determine the effects of continued care on subjects with alcohol dependence. Materials and Methods: Study patients were recruited from a slum in Bangalore. The control group comprised individuals from a lower socio-economic status. Both groups received identical treatment from a specialised de-addiction facility. The study group also received weekly continued care in the community, either at a clinic located within the slum or through home visits. Those patients without stable jobs were referred for employment. The control group was given routine hospital follow-up visits. Both groups were evaluated on the Alcohol Problem Questionnaire and quantity/frequency of drinking at baseline and every 3 month interval for one year after discharge. Results: Both groups showed improvement in terms of reduction of drinking at 3 months, with the study group showing a 64% improvement with respect to the number of non drinking days and the control group showed a 50% improvement. However, at 6 months, 9 months, and 12 months, the study group continued to maintain these gains while the control group showed a downward slide (differences significant at P < 0.05. At the end of 12 months, the study group maintained a 53% improvement with respect to the number of non drinking days as compared with baseline, while the control group had an improvement of only 28%. Conclusions: Follow-up support and continued care appear to significantly improve longer-term recovery in alcohol dependents.

Measuring a critical stress for continuous prevention of marine biofouling accumulation with aeration.

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Menesses, Mark; Belden, Jesse; Dickenson, Natasha; Bird, James

2017-10-01

When cleaning the hull of a ship, significant shear stresses are needed to remove established biofouling organisms. Given that there exists a link between the amount of time that fouling accumulates and the stress required to remove it, it is not surprising that more frequent grooming requires less shear stress. Yet, it is unclear if there is a minimum stress needed to prevent the growth of macrofouling in the limit of continuous grooming. This manuscript shows that single bubble stream aeration provides continuous grooming and prevents biofouling accumulation in regions where the average wall stress exceeds ~0.01 Pa. This value was found by comparing observations of biofouling growth from field studies with complementary laboratory measurements that probe the associated flow fields. These results suggest that aeration and other continuous grooming systems must exceed a wall stress of 0.01 Pa to prevent macrofouling accumulation.

Knowledge, perceptions, and practices of methicillin-resistant Staphylococcus aureus transmission prevention among health care workers in acute-care settings.

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Seibert, Dorothy J; Speroni, Karen Gabel; Oh, Kyeung Mi; DeVoe, Mary C; Jacobsen, Kathryn H

2014-03-01

Health care workers (HCWs) play a critical role in prevention of health care-associated infections such as methicillin-resistant Staphylococcus aureus (MRSA), but glove and gown contact precautions and hand hygiene may not be consistently used with vulnerable patients. A cross-sectional survey of MRSA knowledge, attitudes/perceptions, and practices among 276 medical, nursing, allied health, and support services staff at an acute-care hospital in the eastern United States was completed in 2012. Additionally, blinded observations of hand hygiene behaviors of 104 HCWs were conducted. HCWs strongly agreed that preventive behaviors reduce the spread of MRSA. The vast majority reported that they almost always engage in preventive practices, but observations of hand hygiene found lower rates of adherence among nearly all HCW groups. HCWs who reported greater comfort with telling others to take action to prevent MRSA transmission were significantly more likely to self-report adherence to recommended practices. It is important to reduce barriers to adherence with preventive behaviors and to help all HCWs, including support staff who do not have direct patient care responsibilities, to translate knowledge about MRSA transmission prevention methods into consistent adherence of themselves and their coworkers to prevention guidelines. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Delinquency and Crime Prevention: Overview of Research Comparing Treatment Foster Care and Group Care

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Osei, Gershon K.; Gorey, Kevin M.; Jozefowicz, Debra M. Hernandez

2016-01-01

Background: Evidence of treatment foster care (TFC) and group care's (GC) potential to prevent delinquency and crime has been developing. Objectives: We clarified the state of comparative knowledge with a historical overview. Then we explored the hypothesis that smaller, probably better resourced group homes with smaller staff/resident ratios have…

The effectiveness of an intervention in increasing community health clinician provision of preventive care: a study protocol of a non-randomised, multiple-baseline trial

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McElwaine Kathleen M

2011-12-01

Full Text Available Abstract Background The primary behavioural risks for the most common causes of mortality and morbidity in developed countries are tobacco smoking, poor nutrition, risky alcohol use, and physical inactivity. Evidence, guidelines and policies support routine clinician delivery of care to prevent these risks within primary care settings. Despite the potential afforded by community health services for the delivery of such preventive care, the limited evidence available suggests it is provided at suboptimal levels. This study aims to assess the effectiveness of a multi-strategic practice change intervention in increasing clinician's routine provision of preventive care across a network of community health services. Methods/Design A multiple baseline study will be conducted involving all 56 community health facilities in a single health district in New South Wales, Australia. The facilities will be allocated to one of three administratively-defined groups. A 12 month practice change intervention will be implemented in all facilities in each group to facilitate clinician risk assessment of eligible clients, and clinician provision of brief advice and referral to those identified as being 'at risk'. The intervention will be implemented in a non-random sequence across the three facility groups. Repeated, cross-sectional measurement of clinician provision of preventive care for four individual risks (smoking, poor nutrition, risky alcohol use, and physical inactivity will occur continuously for all three facility groups for 54 months via telephone interviews. The interviews will be conducted with randomly selected clients who have visited a community health facility in the last two weeks. Data collection will commence 12 months prior to the implementation of the intervention in the first group, and continue for six months following the completion of the intervention in the last group. As a secondary source of data, telephone interviews will be undertaken

Continuity of care of emergency surgical admissions: impact on SpR training.

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Ledwidge, S F C; Bryden, E; Halestrap, P; Galland, R B

2008-06-01

Continuity of patient care is an important component of surgical education. This study assesses continuity of care in the current working climate. Data were collected prospectively on consecutive emergency general surgical admissions during one month. Our SpR rota is a partial shift 24 hour on call with the SpR's own consultant. The SpR is free of commitments the next day following post-take work. The on call general surgery SpR was designated the 'assessor'. Data were analysed according to involvement of the 'assessor' at subsequent stages of the admission--consent, operation, review during admission and review on discharge. Data were also collected defining whether the 'assessor' and operator followed-up the patient. There were 200 admissions; 108 female and 92 male. Overall 23% admissions had the same 'assessor' for all stages of patient care. The 'assessor' dealt with an aspect of patient care in 11% of admissions who underwent an operation and 29% of admissions who were conservatively managed. SpR follow-up of admissions on whom they operated was 70% but only 41% of admissions who were conservatively managed were followed-up by the assessing SpR. Complete in-hospital continuity of care was poor, although SpR follow-up of patients on whom they had operated was better. Introduction of shift patterns has reduced continuity of patient care. This will have a negative impact on both surgical training and patient care.

Facilitators and Barriers for Successful Implementation of Interconception Care in Preventive Child Health Care Services in the Netherlands

NARCIS (Netherlands)

Sijpkens, M.K. (Meertien K.); E.A.P. Steegers (Eric); Rosman, A.N. (Ageeth N.)

2016-01-01

textabstractObjectives Successful implementation of preconception and interconception care contributes to optimizing pregnancy outcomes. While interconception care to new mothers could potentially be provided by Preventive Child Health Care services, this care is currently not routinely available in

Effectiveness of locomotion training in a home visit preventive care project: one-group pre-intervention versus post-intervention design study.

Science.gov (United States)

Ito, Shinya; Hashimoto, Mari; Aduma, Saori; Yasumura, Seiji

2015-11-01

Locomotion training in a home visit-type preventive-care program has been reported elsewhere. However, continuation of appropriate exercises in a home setting is difficult, and few reports are available on locomotion training in a home setting. The objective of this study was to evaluate the effectiveness of locomotion training over 3 months in a home visit-type preventive-care program for improvement of motor function among elderly people. Nine hundred and fifty-eight elderly people in Tendo City in Japan who were not currently attending any preventive-care program were invited to participate in the study, and 87 were enrolled. In the pre-intervention and post-intervention assessments, we administered an interview survey (the Kihon Checklist), the timed one-leg standing test with eyes open and the sit-to-stand test, at the participants' homes. The intervention involved one set of training exercises with the participants standing on each leg for 1 min and squatting five or six times. The participants were asked to repeat one set of the exercises three times a day at home. In addition, the participants were regularly asked over the telephone about their performance of the exercises. Physical strength, cognitive function, and total scores of the Kihon Checklist were significantly lower after the intervention than before. In addition, the one-leg standing test time was significantly longer after the intervention (mean ± SD, 23.9 ± 35.4) than before (15.7 ± 20.5), and the sit-to-stand test time was significantly shorter after the intervention (13.0 ± 6.2) than before (14.8 ± 8.3). Locomotion training in a home-visit preventive-care program with telephone support effectively improved the motor function of elderly people who were not currently attending any preventive-care program organized by the long-term care insurance system.

Continuing Need for Sexually Transmitted Disease Clinics After the Affordable Care Act.

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Hoover, Karen W; Parsell, Bradley W; Leichliter, Jami S; Habel, Melissa A; Tao, Guoyu; Pearson, William S; Gift, Thomas L

2015-11-01

We assessed the characteristics of sexually transmitted disease (STD) clinic patients, their reasons for seeking health services in STD clinics, and their access to health care in other venues. In 2013, we surveyed persons who used publicly funded STD clinics in 21 US cities with the highest STD morbidity. Of the 4364 STD clinic patients we surveyed, 58.5% were younger than 30 years, 72.5% were non-White, and 49.9% were uninsured. They visited the clinic for STD symptoms (18.9%), STD screening (33.8%), and HIV testing (13.6%). Patients chose STD clinics because of walk-in, same-day appointments (49.5%), low cost (23.9%), and expert care (8.3%). Among STD clinic patients, 60.4% had access to another type of venue for sick care, and 58.5% had access to another type of venue for preventive care. Most insured patients (51.6%) were willing to use insurance to pay for care at the STD clinic. Despite access to other health care settings, patients chose STD clinics for sexual health care because of convenient, low-cost, and expert care. Policy Implication. STD clinics play an important role in STD prevention by offering walk-in care to uninsured patients.

Up-to-Date on Preventive Care Services Under Affordable Care Act: A Trend Analysis From MEPS 2007-2014.

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Hong, Young-Rock; Jo, Ara; Mainous, Arch G

2017-08-01

The utilization of preventive care services has been less than optimal. As part of an effort to address this, the Affordable Care Act (ACA) mandated that private health insurance plans cover evidence-based preventive services. To evaluate whether the provisions of ACA have increased being up-to-date on recommended preventive care services among privately insured individuals aged 18-64. Multivariate linear regression models were used to examine trends in prevalence of being up-to-date on selected preventive services, diagnosis of health conditions, and health expenditures between pre-ACA (2007-2010) and post-ACA (2011-2014). Adjusted difference-in-difference analyses were used to estimate changes in those outcomes in the privately insured that differed from changes in the uninsured (control group). After the passage of ACA, up-to-date rates of routine checkup (2.7%; 95% confidence interval, 0.8%-4.7%; P=0.007) and flu vaccination (5.9%; 95% confidence interval, 4.2%-7.6%; Ppreventive care services. Additional efforts may be required to take full advantage of the elimination of cost-sharing under the ACA.

[Participation as Target of Social Medicine and Nursing Care: - Legal Definition of Long-Term Care Dependency - Strategies to Prevent Long-Term Care Dependency].

Science.gov (United States)

Nüchtern, Elisabeth; Gansweid, Barbara; Gerber, Hans; von Mittelstaedt, Gert

2017-01-01

Objective: By the "Second Bill to Strengthen Long-Term Care", a new concept of long-term care dependency will be introduced, valid from 2017. Long-term care dependency according to Social Code XI will be defined covering more aspects than today. Therefore, the working group "Nursing Care" of the division "Social Medicine in Practice and Rehabilitation" in the German Society for Social Medicine and Prevention presents their results after working on the social medicine perspective of the definition and prevention of long-term care dependency. Methods: Both the definition and strategies to prevent long-term care dependency are systematically taken into consideration from the point of view of social medicine on the basis of the International Classification of Functioning, Disability and Health (ICF), as long-term care dependency means a defined condition of disability. Results: Both the current and the new concept of long-term care dependency focus activity limitations. The perspective of social medicine considers the interactions of health condition, its effects on daily activities and personal as well as environmental factors. From this point of view approaches for social benefits concerning prevention and rehabilitation can be identified systematically so as to work against the development and progression of long-term care dependency. The reference to the ICF can facilitate the communication between different professions. The new "graduation" of long-term care dependency would allow an international "translation" referring to the ICF. Conclusion: Experts from the field of social medicine as well as those of nursing care, care-givers and nursing researchers have in common the objective that persons in need of nursing care can participate in as many aspects of life of importance to them in an autonomous and self-determined way. The point of view of social medicine on long-term care dependency is fundamental for all occupational groups that are involved and for their

Continuing Professional Development: Pedagogical Practices of Interprofessional Simulation in Health Care

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Nyström, Sofia; Dahlberg, Johanna; Edelbring, Samuel; Hult, Håkan; Abrandt Dahlgren, Madeleine

2017-01-01

The increasing complexity of health care practice makes continuing professional development (CPD) essential for health care professionals. Simulation-based training is a CPD activity that is often applied to improve interprofessional collaboration and the quality of care. The aim of this study is to explore simulation as a pedagogical practice for…

Continuity of care as experienced by mental health service users - a qualitative study

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Eva Biringer

2017-11-01

Full Text Available Abstract Background People who struggle with mental health problems can provide valuable insight into understanding and improving the coordination of mental health and welfare services. The aims of the study were to explore service users’ experiences and perceptions of continuity of care within and across services relevant to personal recovery, to elicit which dimensions of continuity of care are most essential to service users, and to generate ideas for improving service users’ experiences of continuity of care. Methods In the context of a hermeneutic-phenomenological approach, ten service users at a community mental health centre were interviewed about their experiences of continuity of care in and across services. Eight of these were re-interviewed two years later. A collaborative research approach was adopted. Data were analysed by means of a data-driven stepwise approach in line with thematic analysis. Results Following the analysis five themes representing experiences of continuity of care were developed. Each theme ranged from poor to good experiences of continuity of care: Relationship – from experiencing frequent setbacks and anxiety due to breaks in relationships, to feeling safe in an ongoing personal relationship; Timeliness – from experiencing frustrating waiting times with worsening of problems, to getting help when needed; Mutuality – from having a one-sided struggle, to a situation in which both professionals and service users take initiatives; Choice – from not having the opportunity to make practical arrangements within the context of one’s everyday life, to having an array of support options to choose from; Knowledge – from feeling confused and insecure because one does not know what is happening, to feeling safe because one is informed about what is going to happen. Participants provided a range of suggestions for improving experiences of continuity of care. Conclusions A discrepancy between aspects of

Development and pilot testing of a patient-participatory pressure ulcer prevention care bundle.

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Gillespie, Brigid M; Chaboyer, Wendy; Sykes, Mark; O'Brien, Jennifer; Brandis, Susan

2014-01-01

This study developed and piloted a patient-centered pressure ulcer prevention care bundle for adult hospitalized patients to promote patient participation in prevention. The care bundle had 3 core messages: (1) keep moving, (2) care for your skin, and (3) ensure a good diet. A brief video, combined brochure/checklist, and poster were developed as training resources. Patient evaluation identified benefits of the care bundle; however, the combined checklist/brochure was rarely used.

Stakeholder views of ethical guidance regarding prevention and care in HIV vaccine trials.

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Moorhouse, Rika; Slack, Catherine; Quayle, Michael; Essack, Zaynab; Lindegger, Graham

2014-06-30

South Africa is a major hub of HIV prevention trials, with plans for a licensure trial to start in 2015. The appropriate standards of care and of prevention in HIV vaccine trials are complex and debated issues and ethical guidelines offer some direction. However, there has been limited empirical exploration of South African stakeholders' perspectives on ethical guidance related to prevention and care in HIV vaccine trials. Site staff, Community Advisory Board members and Research Ethics Committee members involved with current HIV vaccine trials in South Africa were invited to participate in an exploration of their views. A questionnaire listed 10 care and 10 prevention recommendations drawn from two widely available sets of ethical guidelines for biomedical HIV prevention trials. Respondents (n = 98) rated each recommendation on five dimensions: "Familiarity with", "Ease of Understanding", "Ease of Implementing", "Perceived Protection", and "Agreement with" each ethical recommendation. The ratings were used to describe stakeholder perspectives on dimensions for each recommendation. Dimension ratings were averaged across the five dimensions and used as an indication of overall merit for each recommendation. Differences were explored across dimensions, between care-oriented and prevention-oriented recommendations, and between stakeholder groups. Both care and prevention recommendations were rated highly overall, with median ratings well above the scale midpoint. In general, informed consent recommendations were most positively rated. Care-related recommendations were rated significantly more positively than prevention-related recommendations, with the five lowest-rated recommendations being prevention-related. The most problematic dimension across all recommendations was "Ease of Implementing," and the least problematic was "Agreement with," suggesting the most pressing stakeholder concerns are practical rather than theoretical; that is, respondents agree with

The Patient Protection and Affordable Care Act and Utilization of Preventive Health Care Services

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Victor Eno

2016-02-01

Full Text Available We examined how (a health insurance coverage, and (b familiarity with the Patient Protection and Affordable Care Act (ACA’s or ObamaCare mandate of cost-free access to preventive health services, affect the use of preventive services by residents of a minority community. It was based on primary data collected from a survey conducted during March to April 2012 among a sample of self-identified African American adults in Tallahassee-Leon County area of northwest Florida. The Statistical Package for the Social Sciences (SPSS Version 22 was used for running frequency analysis on the data set and multivariable regression modeling. The results showed that of 524 respondents, 382 (73% had health insurance while 142 (27% lacked insurance. Majority of insured respondents, 332 (87%, used preventive health services. However, the remaining 13% of respondents did not use preventive services because they were unfamiliar with the ACA provision of free access to preventive services for insured people. Regression analysis showed a high (91.04% probability that, among the insured, the use of preventive health services depended on the person’s age, income, and education. For uninsured residents, the lack of health insurance was the key reason for non-use of preventive health services, while among the insured, lack of knowledge about the ACA benefit of free access contributed to non-use of preventive services. Expansion of Medicaid eligibility can increase insurance coverage rates among African Americans and other minority populations. Health promotion and awareness campaigns about the law’s benefits by local and state health departments can enhance the use of preventive services.

Communities Putting Prevention to Work: Results of an Obesity Prevention Initiative in Child Care Facilities

Science.gov (United States)

Natale, Ruby; Camejo, Stephanie; Sanders, Lee M.

2016-01-01

Obesity is a significant public health issue affecting even our youngest children. Given that a significant amount of young children are enrolled in child care, the goal of this project was to evaluate the effectiveness of a child care facility-based obesity prevention program. Over 1,000 facilities participated in the study. The intervention…

Obstacles to preventive care for individuals with disability: Implications for nurse practitioners.

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Marrocco, Anna; Krouse, Helene J

2017-05-01

Individuals with disabilities have been identified as a population with a significantly lower usage of preventive services. Nurse practitioners (NPs) provide a key access point in the healthcare delivery system for preventive services for vulnerable populations such as those with disabilities. It is essential to understand existing barriers that prohibit access to effective preventive care for this vulnerable population. Systematic search and review of Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PubMed, Google Scholar, and government reports and World Health Organizations reports. Twenty-six articles were included in the review. This literature review confirmed previous notions that people with disabilities are receiving much fewer preventive services than the general population. The studies reviewed identified four major barriers that contributed to the lack of preventive care. These barriers included physical environment and system, transportation, provider knowledge and attitude, and financial. Recognition of the obstacles that this subpopulation faces in accessing preventive care services is the first step to effectively remedying this problem. Preventive services have been identified as one of the cornerstones to improving health and quality of life. By understanding the circumstances that restrict those with disabilities from accessing preventive services, NPs can provide meaningful and effective solutions. ©2017 American Association of Nurse Practitioners.

Innovation or rebranding, acute care surgery diffusion will continue.

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Collins, Courtney E; Pringle, Patricia L; Santry, Heena P

2015-08-01

Patterns of adoption of acute care surgery (ACS) as a strategy for emergency general surgery (EGS) care are unknown. We conducted a qualitative study comprising face-to-face interviews with senior surgeons responsible for ACS at 18 teaching hospitals chosen to ensure diversity of opinions and practice environment (three practice types [community, public or charity, and university] in each of six geographic regions [Mid-Atlantic, Midwest, New England, Northeast, South, and West]). Interviews were recorded, transcribed, and analyzed using NVivo (QSR International, Melbourne, Australia). We applied the methods of investigator triangulation using an inductive approach to develop a final taxonomy of codes organized by themes related to respondents' views on the future of ACS as a strategy for EGS. We applied our findings to a conceptual model on diffusion of innovation. We found a paradox between ACS viewed as a health care delivery innovation versus a rebranding of comprehensive general surgery. Optimism for the future of ACS because of increased desirability for trauma and critical care careers as well as improved EGS outcomes was tempered by fear over lack of continuity, poor institutional resources, and uncertainty regarding financial viability. Our analysis suggests that the implementation of ACS, whether a true health care delivery innovation or an innovative rebranding, fits into the Rogers' diffusion of innovation theory. Despite concerns over resource allocation and the definition of the specialty, from the perspective of senior surgeons deeply entrenched in executing this care delivery model, ACS represents the new face of general surgery that will likely continue to diffuse from these early adopters. Published by Elsevier Inc.

The continuous glucose monitoring sensor in neonatal intensive care

OpenAIRE

Beardsall, K; Ogilvy-Stuart, A; Ahluwalia, J; Thompson, M; Dunger, D

2005-01-01

Objective: To determine the feasibility of continuous glucose monitoring in the very low birthweight baby requiring intensive care, as these infants are known to be at high risk of abnormalities of glucose control.

Improving Obesity Prevention and Management in Primary Care in Canada.

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Campbell-Scherer, Denise; Sharma, Arya Mitra

2016-09-01

Obesity is a major risk factor for chronic diseases with significant morbidity, mortality and health care cost. There is concern due to the dramatic increase in overweight and obesity in Canada in the last 20 years. The causes of obesity are multifactorial, with underestimation by patients and healthcare providers of the long-term nature of the condition, and its complexity. Solutions related to prevention and management will require multifaceted strategies involving education, health policy, public health and health systems across the care continuum. We believe that to support such strategies we need to have a strong primary care workforce equipped with appropriate knowledge, skills and attitudes to support persons at risk for, or with, obesity. To achieve this end, significant skills building is required to improve primary care obesity prevention and management efforts. This review will first examine the current state, and then will outline how we can improve.

Medicaid Primary Care Physician Fees and the Use of Preventive Services among Medicaid Enrollees

Science.gov (United States)

Atherly, Adam; Mortensen, Karoline

2014-01-01

Objective The Patient Protection and Affordable Care Act (ACA) increases Medicaid physician fees for preventive care up to Medicare rates for 2013 and 2014. The purpose of this paper was to model the relationship between Medicaid preventive care payment rates and the use of U.S. Preventive Services Task Force (USPSTF)–recommended preventive care use among Medicaid enrollees. Data Sources/Study Session We used data from the 2003 and 2008 Medical Expenditure Panel Survey (MEPS), a national probability sample of the U.S. civilian, noninstitutionalized population, linked to Kaiser state Medicaid benefits data, including the state Medicaid-to-Medicare physician fee ratio in 2003 and 2008. Study Design Probit models were used to estimate the probability that eligible individuals received one of five USPSF-recommended preventive services. A difference-in-difference model was used to separate out the effect of changes in the Medicaid payment rate and other factors. Data Collection/Extraction Methods Data were linked using state identifiers. Principal Findings Although Medicaid enrollees had a lower rate of use of the five preventive services in univariate analysis, neither Medicaid enrollment nor changes in Medicaid payment rates had statistically significant effects on meeting screening recommendations for the five screenings. The results were robust to a number of different sensitivity tests. Individual and state characteristics were significant. Conclusions Our results suggest that although temporary changes in primary care provider payments for preventive services for Medicaid enrollees may have other desirable effects, they are unlikely to substantially increase the use of these selected USPSTF-recommended preventive care services among Medicaid enrollees. PMID:24628495

Knowledge levels of intensive care nurses on prevention of ventilator-associated pneumonia.

Science.gov (United States)

Akın Korhan, Esra; Hakverdioğlu Yönt, Gülendam; Parlar Kılıç, Serap; Uzelli, Derya

2014-01-01

Ventilator-associated pneumonia constitutes a significant concern for ventilated patients in the intensive care unit. This study was planned to evaluate the knowledge of nurses working in general intensive care units concerning evidence-based measures for the prevention of ventilator-associated pneumonia. This study design is cross-sectional. It was carried out on nurses working in the general intensive care units of anesthiology and re-animation clinics. Collection of research data was performed by means of a Nurse Identification Form and a Form of Evidence-Based Knowledge concerning the Prevention of Ventilator-Associated Pneumonia. Characterization statistics were shown by percentage, median and interquartile range. Chi-square and Wilcoxon tests and Kruskal-Wallis tests were used as appropriate. The median value of total points scored by nurses on the questionnaire was 4.00 ± 2.00. The difference between the nurses' education levels, duration of work experience and participation in in-service training programmes on ventilator-associated pneumonia prevention and the median value of their total scores on the questionnaire was found to be statistically significant (p < 0.05). The conclusion of the study was that critical care nurses' knowledge about ventilator-associated pneumonia prevention is poor. © 2013 British Association of Critical Care Nurses.

Comparing Dental and Pharmacy Students’ Perceptions on Public Health and Preventive Health Care Course

Science.gov (United States)

Mandiracioglu, Aliye; Dogan, Fethi

2012-01-01

Objectives: A Public health course has an important role in the undergraduate education of pharmacy and dentistry in terms of emphasizing preventive care. The purpose of this study is to evaluate the views of pharmacy and dentistry students on a public health course and preventive health care. Methods: 173 students enrolled at Ege University, Faculties of Pharmacy and Dentistry completed a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis and replied to 18 Likert type question to determine their perceptions on a public health course and preventive health care. The comments of the students were reviewed and categorized into key themes. Results: SWOT analysis and the results of quantitative Likert type questions supported each other. According to the quantitative results, there was no significant difference between the scores of students from both schools in terms of their statements about the public health course and preventive care. Both groups of students mentioned the contribution of the public health course to their professions in the future. They also appreciated the importance of preventive care in the health services. PMID:22347604

Basic nursing care to prevent nonventilator hospital-acquired pneumonia.

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Quinn, Barbara; Baker, Dian L; Cohen, Shannon; Stewart, Jennifer L; Lima, Christine A; Parise, Carol

2014-01-01

Nonventilator hospital-acquired pneumonia (NV-HAP) is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life. The purpose of our study was to (a) identify the incidence of NV-HAP in a convenience sample of U.S. hospitals and (b) determine the effectiveness of reliably delivered basic oral nursing care in reducing NV-HAP. A descriptive, quasi-experimental study using retrospective comparative outcomes to determine (a) the incidence of NV-HAP and (b) the effectiveness of enhanced basic oral nursing care versus usual care to prevent NV-HAP after introduction of a basic oral nursing care initiative. We used the International Statistical Classification of Diseases and Related Problems (ICD-9) codes for pneumonia not present on admission and verified NV-HAP diagnosis using the U.S. Centers for Disease Control and Prevention diagnostic criteria. We completed an evidence-based gap analysis and designed a site-specific oral care initiative designed to reduce NV-HAP. The intervention process was guided by the Influencer Model (see Figure) and participatory action research. We found a substantial amount of unreported NV-HAP. After we initiated our oral care protocols, the rate of NV-HAP per 100 patient days decreased from 0.49 to 0.3 (38.8%). The overall number of cases of NV-HAP was reduced by 37% during the 12-month intervention period. The avoidance of NV-HAP cases resulted in an estimated 8 lives saved, $1.72 million cost avoided, and 500 extra hospital days averted. The extra cost for therapeutic oral care equipment was $117,600 during the 12-month intervention period. Cost savings resulting from avoided NV-HAP was $1.72 million. Return on investment for the organization was $1.6 million in avoided costs. NV-HAP should be elevated to the same level of concern, attention, and effort as prevention of ventilator-associated pneumonia in hospitals. Nursing needs to lead the way in the design and

Stakeholder views of ethical guidance regarding prevention and care in HIV vaccine trials

Science.gov (United States)

2014-01-01

Background South Africa is a major hub of HIV prevention trials, with plans for a licensure trial to start in 2015. The appropriate standards of care and of prevention in HIV vaccine trials are complex and debated issues and ethical guidelines offer some direction. However, there has been limited empirical exploration of South African stakeholders’ perspectives on ethical guidance related to prevention and care in HIV vaccine trials. Methods Site staff, Community Advisory Board members and Research Ethics Committee members involved with current HIV vaccine trials in South Africa were invited to participate in an exploration of their views. A questionnaire listed 10 care and 10 prevention recommendations drawn from two widely available sets of ethical guidelines for biomedical HIV prevention trials. Respondents (n = 98) rated each recommendation on five dimensions: “Familiarity with”, “Ease of Understanding”, “Ease of Implementing”, “Perceived Protection”, and “Agreement with” each ethical recommendation. The ratings were used to describe stakeholder perspectives on dimensions for each recommendation. Dimension ratings were averaged across the five dimensions and used as an indication of overall merit for each recommendation. Differences were explored across dimensions, between care-oriented and prevention-oriented recommendations, and between stakeholder groups. Results Both care and prevention recommendations were rated highly overall, with median ratings well above the scale midpoint. In general, informed consent recommendations were most positively rated. Care-related recommendations were rated significantly more positively than prevention-related recommendations, with the five lowest-rated recommendations being prevention-related. The most problematic dimension across all recommendations was “Ease of Implementing,” and the least problematic was “Agreement with,” suggesting the most pressing stakeholder concerns are practical

Preventing compulsory admission to psychiatric inpatient care through psycho-education and crisis focused monitoring.

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Lay, Barbara; Salize, Hans Joachim; Dressing, Harald; Rüsch, Nicolas; Schönenberger, Thekla; Bühlmann, Monika; Bleiker, Marco; Lengler, Silke; Korinth, Lena; Rössler, Wulf

2012-09-05

The high number of involuntary placements of people with mental disorders in Switzerland and other European countries constitutes a major public health issue. In view of the ethical and personal relevance of compulsory admission for the patients concerned and given the far-reaching effects in terms of health care costs, innovative interventions to improve the current situation are much needed. A number of promising approaches to prevent involuntary placements have been proposed that target continuity of care by increasing self-management skills of patients. However, the effectiveness of such interventions in terms of more robust criteria (e.g., admission rates) has not been sufficiently analysed in larger study samples. The current study aims to evaluate an intervention programme for patients at high risk of compulsory admission to psychiatric hospitals. Effectiveness will be assessed in terms of a reduced number of psychiatric hospitalisations and days of inpatient care in connection with involuntary psychiatric admissions as well as in terms of cost-containment in inpatient mental health care. The intervention furthermore intends to reduce the degree of patients' perceived coercion and to increase patient satisfaction, their quality of life and empowerment. This paper describes the design of a randomised controlled intervention study conducted currently at four psychiatric hospitals in the Canton of Zurich. The intervention programme consists of individualised psycho-education focusing on behaviours prior to and during illness-related crisis, the distribution of a crisis card and, after inpatient admission, a 24-month preventive monitoring of individual risk factors for compulsory re-admission to hospital. All measures are provided by a mental health care worker who maintains permanent contact to the patient over the course of the study. In order to prove its effectiveness the intervention programme will be compared with standard care procedures (control group

Preventing compulsory admission to psychiatric inpatient care through psycho-education and crisis focused monitoring

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Lay Barbara

2012-09-01

Full Text Available Abstract Background The high number of involuntary placements of people with mental disorders in Switzerland and other European countries constitutes a major public health issue. In view of the ethical and personal relevance of compulsory admission for the patients concerned and given the far-reaching effects in terms of health care costs, innovative interventions to improve the current situation are much needed. A number of promising approaches to prevent involuntary placements have been proposed that target continuity of care by increasing self-management skills of patients. However, the effectiveness of such interventions in terms of more robust criteria (e.g., admission rates has not been sufficiently analysed in larger study samples. The current study aims to evaluate an intervention programme for patients at high risk of compulsory admission to psychiatric hospitals. Effectiveness will be assessed in terms of a reduced number of psychiatric hospitalisations and days of inpatient care in connection with involuntary psychiatric admissions as well as in terms of cost-containment in inpatient mental health care. The intervention furthermore intends to reduce the degree of patients’ perceived coercion and to increase patient satisfaction, their quality of life and empowerment. Methods/Design This paper describes the design of a randomised controlled intervention study conducted currently at four psychiatric hospitals in the Canton of Zurich. The intervention programme consists of individualised psycho-education focusing on behaviours prior to and during illness-related crisis, the distribution of a crisis card and, after inpatient admission, a 24-month preventive monitoring of individual risk factors for compulsory re-admission to hospital. All measures are provided by a mental health care worker who maintains permanent contact to the patient over the course of the study. In order to prove its effectiveness the intervention programme will be

A guide for identification and continuing care of adult congenital heart disease patients in primary care.

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Ellison, S; Lamb, J; Haines, A; O'Dell, S; Thomas, G; Sethi, S; Ratcliffe, J; Chisholm, S; Vaughan, J; Mahadevan, V S

2013-03-10

Surgical and other advances in the treatment and care of congenital heart disease have resulted in a significant increase in the number of adults with congenital heart disease (ACHD), many of whom have no regular cardiology follow-up. Optimised care for ACHD patients requires continuity of specialist and shared care and education of practitioners and patients. The challenges for managing ACHD were identified by a Health Needs Assessment in the North West and are addressed within the UK Department of Health's ACHD Commissioning Guide. An ACHD model of care was recommended in the North West of England and developed by the three North West Cardiac & Stroke Networks. Within this, a Task Group focused on the role of primary care in the identification and continuing care of ACHD patients. A feasibility study demonstrated that existing diagnostic Read Codes can identify ACHD patients on general practice registers. An ACHD Toolkit was developed to provide algorithms to guide the appropriate management of ACHD patients through primary, secondary and/or specialist ACHD care and to improve education/knowledge amongst primary care staff about ACHD and its wider implications. Early findings during the development of this Toolkit illustrate a wide disparity of provision between current and optimal management strategies. Patients lost to follow-up have already been identified and their management modified. By focusing on identifying ACHD patients in primary care and organising/delivering ACHD services, the ACHD Toolkit could help to improve quality, timeliness of care, patient experience and wellbeing. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Optimizing the Primary Prevention of Type-2 Diabetes in Primary Health Care

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2017-08-18

Interprofessional Relations; Primary Health Care/Organization & Administration; Diabetes Mellitus, Type 2/Prevention & Control; Primary Prevention/Methods; Risk Reduction Behavior; Randomized Controlled Trial; Life Style

Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care.

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Miller, Margaret; Hearn, Lydia; van der Pligt, Paige; Wilcox, Jane; Campbell, Karen J

2014-01-01

Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.

Preventive physical therapy and care humanization in the treatment of a bedridden, home care, neurologic patient

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Lina Faria

Full Text Available Abstract Introduction: This case study investigated the impact of preventive physical therapy on shoulder problems and the prevention of pressure ulcers (PU in a bedridden, home care, post-neurological surgery patient. Objective: To highlight the importance of physical therapy in the prevention of comorbidities, chronic neurological sequelae, and PU. Materials and Methods: In the immediate post-surgical phase, the patient was treated with preventive measures against PU, according to the Pressure Ulcer Prevention Protocol of the University of São Paulo, the National Pressure Ulcer Advisory Panel, and the Braden Scale. In addition, we used the modified Ashworth scale to assess spasticity. A kinesiotherapy program based on the Bobath's concept was used to prevent subluxation of the plegic arm and help in the recovery of functional movements. Results: The use of preventive measures and delivery of humanized care during a six-month period helped prevent the development of stage 3 and 4 PU and physical, functional, and respiratory complications. By the end of six months, the patient was found to be at low risk of developing PU. Conclusion: Notwithstanding the difficulties experienced during treatment, especially for the positioning of the arm and performance of transferring and positioning techniques, the results of this study are in agreement with aspects considered important for treatment outcomes.

Ambient-aware continuous care through semantic context dissemination.

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Ongenae, Femke; Famaey, Jeroen; Verstichel, Stijn; De Zutter, Saar; Latré, Steven; Ackaert, Ann; Verhoeve, Piet; De Turck, Filip

2014-12-04

The ultimate ambient-intelligent care room contains numerous sensors and devices to monitor the patient, sense and adjust the environment and support the staff. This sensor-based approach results in a large amount of data, which can be processed by current and future applications, e.g., task management and alerting systems. Today, nurses are responsible for coordinating all these applications and supplied information, which reduces the added value and slows down the adoption rate.The aim of the presented research is the design of a pervasive and scalable framework that is able to optimize continuous care processes by intelligently reasoning on the large amount of heterogeneous care data. The developed Ontology-based Care Platform (OCarePlatform) consists of modular components that perform a specific reasoning task. Consequently, they can easily be replicated and distributed. Complex reasoning is achieved by combining the results of different components. To ensure that the components only receive information, which is of interest to them at that time, they are able to dynamically generate and register filter rules with a Semantic Communication Bus (SCB). This SCB semantically filters all the heterogeneous care data according to the registered rules by using a continuous care ontology. The SCB can be distributed and a cache can be employed to ensure scalability. A prototype implementation is presented consisting of a new-generation nurse call system supported by a localization and a home automation component. The amount of data that is filtered and the performance of the SCB are evaluated by testing the prototype in a living lab. The delay introduced by processing the filter rules is negligible when 10 or fewer rules are registered. The OCarePlatform allows disseminating relevant care data for the different applications and additionally supports composing complex applications from a set of smaller independent components. This way, the platform significantly reduces

Achieving continuity of care: facilitators and barriers in community mental health teams.

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Belling, Ruth; Whittock, Margaret; McLaren, Susan; Burns, Tom; Catty, Jocelyn; Jones, Ian Rees; Rose, Diana; Wykes, Til

2011-03-18

The integration of mental health and social services for people diagnosed with severe mental illness (SMI) has been a key aspect of attempts to reform mental health services in the UK and aims to minimise user and carer distress and confusion arising from service discontinuities. Community mental health teams (CMHTs) are a key component of UK policy for integrated service delivery, but implementing this policy has raised considerable organisational challenges. The aim of this study was to identify and explore facilitators and barriers perceived to influence continuity of care by health and social care professionals working in and closely associated with CMHTs. This study employed a survey design utilising in-depth, semi-structured interviews with a proportionate, random sample of 113 health and social care professionals and representatives of voluntary organisations. Participants worked in two NHS Mental Health Trusts in greater London within eight adult CMHTs and their associated acute in-patient wards, six local general practices, and two voluntary organisations. Team leadership, decision making, and experiences of teamwork support were facilitators for cross boundary and team continuity; face-to-face communication between teams, managers, general practitioners, and the voluntary sector were facilitators for information continuity. Relational, personal, and longitudinal continuity were facilitated in some local areas by workforce stability. Barriers for cross boundary and team continuity were specific leadership styles and models of decision making, blurred professional role boundaries, generic working, and lack of training for role development. Barriers for relational, personal, and longitudinal continuity were created by inadequate staffing levels, high caseloads, and administrative duties that could limit time spent with users. Incompatibility of information technology systems hindered information continuity. Flexible continuity was challenged by the

Association of Continuity of Primary Care and Statin Adherence.

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James R Warren

Full Text Available Deficiencies in medication adherence are a major barrier to effectiveness of chronic condition management. Continuity of primary care may promote adherence. We assessed the association of continuity of primary care with adherence to long-term medication as exemplified by statins.We linked data from a prospective study of 267,091 Australians aged 45 years and over to national data sets on prescription reimbursements, general practice claims, hospitalisations and deaths. For participants having a statin dispense within 90 days of study entry, we computed medication possession ratio (MPR and usual provider continuity index (UPI for the subsequent two years. We used multivariate Poisson regression to calculate the relative risk (RR and 95% confidence interval (CI for the association between tertiles of UPI and MPR adjusted for socio-demographic and health-related patient factors, including age, gender, remoteness of residence, smoking, alcohol intake, fruit and vegetable intake, physical activity, prior heart disease and speaking a language other than English at home. We performed a comparison approach using propensity score matching on a subset of the sample.36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04-1.06 for highest versus lowest tertile. Dichotomised analysis using a cut-off of UPI at 75% showed a similar effect size. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. Stratification analyses further showed a stronger association among those who were new to statins (RR 1.33, 95% CI 1.15-1.54.Greater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors.

Association of Continuity of Primary Care and Statin Adherence.

Science.gov (United States)

Warren, James R; Falster, Michael O; Tran, Bich; Jorm, Louisa

2015-01-01

Deficiencies in medication adherence are a major barrier to effectiveness of chronic condition management. Continuity of primary care may promote adherence. We assessed the association of continuity of primary care with adherence to long-term medication as exemplified by statins. We linked data from a prospective study of 267,091 Australians aged 45 years and over to national data sets on prescription reimbursements, general practice claims, hospitalisations and deaths. For participants having a statin dispense within 90 days of study entry, we computed medication possession ratio (MPR) and usual provider continuity index (UPI) for the subsequent two years. We used multivariate Poisson regression to calculate the relative risk (RR) and 95% confidence interval (CI) for the association between tertiles of UPI and MPR adjusted for socio-demographic and health-related patient factors, including age, gender, remoteness of residence, smoking, alcohol intake, fruit and vegetable intake, physical activity, prior heart disease and speaking a language other than English at home. We performed a comparison approach using propensity score matching on a subset of the sample. 36,144 participants were eligible and included in the analysis among whom 58% had UPI greater than 75%. UPI was significantly associated with 5% increased MPR for statin adherence (95% CI 1.04-1.06) for highest versus lowest tertile. Dichotomised analysis using a cut-off of UPI at 75% showed a similar effect size. The association between UPI and statin adherence was independent of socio-demographic and health-related factors. Stratification analyses further showed a stronger association among those who were new to statins (RR 1.33, 95% CI 1.15-1.54). Greater continuity of care has a positive association with medication adherence for statins which is independent of socio-demographic and health-related factors.

Translating Pressure Ulcer Prevention Into Intensive Care Nursing Practice: Overlaying a Care Bundle Approach With a Model for Research Implementation.

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Tayyib, Nahla; Coyer, Fiona

This article reports on the development and implementation process used to integrate a care bundle approach (a pressure ulcer [PU] prevention bundle to improve patients' skin integrity in intensive care) and the Ottawa Model of Research Use (OMRU). The PU prevention care bundle demonstrated significant reduction in PU incidence, with the OMRU model providing a consolidated framework for the implementation of bundled evidence in an effective and consistent manner into daily clinical nursing practice.

Spillover Effects of Drug Safety Warnings on Preventive Health Care Use

DEFF Research Database (Denmark)

Daysal, N. Meltem; Orsini, Chiara

2015-01-01

We examine how new medical information on drug safety impacts preventive health care use. We exploit the release of the findings of the Women’s Health Initiative Study (WHIS) – the largest randomized controlled trial of women’s health – which demonstrated in 2002 the health risks associated...... with the long-term use of hormone replacement therapy (HRT). We first show that, after the release of the WHIS findings, HRT use dropped sharply among post-menopausal women. We then estimate the spillover effects of the WHIS findings on preventive care by means of a difference-in-differences methodology...... comparing changes in preventive care use among 60 to 69 year-old women (who have high rates of HRT use) with the change among women aged 75 and above (who have much lower rates of HRT use). Using data from the Behavioral Risk Factor Surveillance System for the period 1998–2007, we find that women aged 60...

Patients' assessments of the continuity of primary care in Finland: a 15-year follow-up questionnaire survey.

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Raivio, Risto; Holmberg-Marttila, Doris; Mattila, Kari J

2014-10-01

Continuity of care is an essential aspect of quality in general practice. This study is the first systematic follow-up of Finnish primary care patients' assessments with regard to personal continuity of care. To ascertain whether patient-reported longitudinal personal continuity of care is related to patient characteristics and their consultation experiences, and how this had changed over the study period. A 15-year follow-up questionnaire survey that took place at Tampere University Hospital catchment area, Finland. The survey was conducted among patients attending health centres in the Tampere University Hospital catchment area from 1998 until 2013. From a sample of 363 464 patients, a total of 157 549 responded. The responses of patients who had visited a doctor during the survey weeks (n = 97 468) were analysed. Continuity of care was assessed by asking the question: 'When visiting the health centre, do you usually see the same doctor?'; patients could answer 'yes' or 'no'. Approximately half of the responders had met the same doctor when visiting the healthcare centre. Personal continuity of care decreased by 15 percentage points (from 66% to 51%) during the study years. The sense of continuity was linked to several patients' experiences of the consultation. The most prominent factor contributing to the sense of continuity of care was having a doctor who was specifically appointed (odds ratio 7.28, 95% confidence interval = 6.65 to 7.96). Continuity of care was proven to enhance the experienced quality of primary care. Patients felt that continuity of care was best realised when they could consult a doctor who had been specifically appointed to them. Despite efforts of the authorities, over the past 15 years patient-reported continuity of care has declined in Finland. © British Journal of General Practice 2014.

Patient perspectives on continuity of care: adaption and preliminary psychometric assessment of a Norwegian version of the Nijmegen Continuity Questionnaire (NCQ-N

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Øystein Hetlevik

2017-11-01

Full Text Available Abstract Background Continuity of care is regarded as a core quality element in healthcare. Continuity can be related to one or more specific caregivers but also applies to collaboration within a team or across boundaries of healthcare. Measuring continuity is important to identify problems and evaluate quality improvement of interventions. This study aimed to assess the feasibility and psychometric properties of a Norwegian version of the Nijmegen Continuity Questionnaire (NCQ. Methods The NCQ was developed in The Netherlands. It measures patients’ experienced continuity of care across multiple care settings and as a multidimensional concept regardless of morbidity. The NCQ comprises 28 items categorised into three subscales; two personal continuity scales, “care giver knows me” and “shows commitment”, asked regarding the patient’s general practitioner (GP and the most important specialist; and one “team/cross boundary continuity” scale, asked regarding primary care, specialised care and cooperation between GP and specialist, with a total of seven factors. The NCQ was translated and adapted to Norwegian (NCQ-N and distributed among patients referred to somatic rehabilitation (N = 984, response rate 34.5%. Confirmatory factor analyses (CFA, Cronbach’s alpha, intra-class correlation (ICC and Bland–Altman plots were used to assess psychometric properties. Results All patients (N = 375 who had responded to all parts of the NCQ-N were included in CFA. The CFA fit indices (CFI 0.941, RMSEA 0.064 (95% CI 0.059–0.070, SRMR 0.041 support a seven-factor structure in the NCQ-N based on the three subscales of the original NCQ. Cronbach’s alpha showed internal consistency (0.84–0.97, and was highest for the team/cross-boundary subscales. The NCQ-N showed overall high reliability with ICC 0.84–91 for personal continuity factors and 0.67–0.91 for team factors, with the lowest score for team continuity within primary care

Efficacy of continuous versus intermittent subglottic secretion drainage in preventing ventilator-associated pneumonia in patients requiring mechanical ventilation: A single-center randomized controlled trial.

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Fujimoto, Hiroko; Yamaguchi, Osamu; Hayami, Hajime; Shimosaka, Mika; Tsuboi, Sayaka; Sato, Mitsunori; Takebayashi, Shigeo; Morita, Satoshi; Saito, Mari; Goto, Takahisa; Kurahashi, Kiyoyasu

2018-03-23

Aspiration of subglottic secretion is a widely used intervention to prevent ventilator-associated pneumonia (VAP). This study aimed to compare the efficacy of continuous and intermittent subglottic secretion drainage (SSD) in preventing VAP. A single-center randomized controlled trial was conducted on adult postoperative patients who were expected to undergo mechanical ventilation for more than 48 hours. Primary outcome measure was incidence of VAP and secondary outcome measures were length of mechanical ventilation and intensive-care unit (ICU) stay. Fifty-nine patients received continuous SSD, while 60 patients received intermittent SSD. Of these 119 patients, 88 (74%) were excluded and 15 and 16 patients were allocated to receive continuous and intermittent SSD, respectively. VAP was detected in 4 (26.7%) and 7 (43.8%) patients in the continuous and intermittent groups, respectively, (p=0.320). The length of mechanical ventilation was significantly shorter (p=0.034) in the continuous group (99.5±47.1 h) than in the intermittent group (159.9±94.5 h). The length of ICU stay was also shorter (p=0.0097) in the continuous group (6.3±2.1 days) than the intermittent group (9.8±4.8 days). Although continuous SSD did not reduce the incidence of VAP, it reduced the length of mechanical ventilation and ICU stay when compared to intermittent SSD.

Exploring family physicians' reasons to continue or discontinue providing intrapartum care: Qualitative descriptive study.

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Dove, Marion; Dogba, Maman Joyce; Rodríguez, Charo

2017-08-01

To examine the reasons why family physicians continue or discontinue providing intrapartum care in their clinical practice. Qualitative descriptive study. Two hospitals located in a multicultural area of Montreal, Que, in November 2011 to June 2012. Sixteen family physicians who were current or former providers of obstetric care. Data were collected using semistructured qualitative interviews. Thematic analysis was used to analyze the interview transcripts. Three overarching themes that help create understanding of why family doctors continue to provide obstetric care were identified: their attraction, often initiated by role models early in their careers, to practising complete continuity of care and accompanying patients in a special moment in their lives; the personal, family, and organizational pressures experienced while pursuing a family medicine career that includes obstetrics; and their ongoing reflection about continuing to practise obstetrics. The practice of obstetrics was very attractive to family physician participants whether they provided intrapartum care or decided to stop. More professional support and incentives might help keep family doctors practising obstetrics. Copyright© the College of Family Physicians of Canada.

A tool for assessing continuity of care across care levels: an extended psychometric validation of the CCAENA questionnaire

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Marta Beatriz Aller

2013-12-01

Full Text Available Background: The CCAENA questionnaire was developed to assess care continuity across levels from the patients’ perspective. The aim is to provide additional evidence on the psychometric properties of the scales of this questionnaire. Methods: Cross-sectional study by means of a survey of a random sample of 1500 patients attended in primary and secondary care in three healthcare areas of the Catalan healthcare system. Data were collected in 2010 using the CCAENA questionnaire. To assess psychometric properties, an exploratory factor analysis was performed (construct validity and the item-rest correlations and Cronbach’s alpha were calculated (internal consistency. Spearman correlation coefficients were calculated (multidimensionality and the ability to discriminate between groups was tested. Results: The factor analysis resulted in 21 items grouped into three factors: patient-primary care provider relationship, patient-secondary care provider relationship and continuity across care levels. Cronbach’s alpha indicated good internal consistency (0.97, 0.93, 0.80 and the correlation coefficients indicated that dimensions can be interpreted as separated scales. Scales discriminated patients according to healthcare area, age and educational level. Conclusion: The CCAENA questionnaire has proved to be a valid and reliable tool for measuring patients’ perceptions of continuity. Providers and researchers could apply the questionnaire to identify areas for healthcare improvement.

Fall prevention in acute care hospitals: a randomized trial.

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Dykes, Patricia C; Carroll, Diane L; Hurley, Ann; Lipsitz, Stuart; Benoit, Angela; Chang, Frank; Meltzer, Seth; Tsurikova, Ruslana; Zuyov, Lyubov; Middleton, Blackford

2010-11-03

Falls cause injury and death for persons of all ages, but risk of falls increases markedly with age. Hospitalization further increases risk, yet no evidence exists to support short-stay hospital-based fall prevention strategies to reduce patient falls. To investigate whether a fall prevention tool kit (FPTK) using health information technology (HIT) decreases patient falls in hospitals. Cluster randomized study conducted January 1, 2009, through June 30, 2009, comparing patient fall rates in 4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients). The FPTK integrated existing communication and workflow patterns into the HIT application. Based on a valid fall risk assessment scale completed by a nurse, the FPTK software tailored fall prevention interventions to address patients' specific determinants of fall risk. The FPTK produced bed posters composed of brief text with an accompanying icon, patient education handouts, and plans of care, all communicating patient-specific alerts to key stakeholders. The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit. A secondary outcome was fall-related injuries. During the 6-month intervention period, the number of patients with falls differed between control (n = 87) and intervention (n = 67) units (P=.02). Site-adjusted fall rates were significantly higher in control units (4.18 [95% confidence interval {CI}, 3.45-5.06] per 1000 patient-days) than in intervention units (3.15 [95% CI, 2.54-3.90] per 1000 patient-days; P = .04). The FPTK was found to be particularly effective with patients aged 65 years or older (adjusted rate difference, 2.08 [95% CI, 0.61-3.56] per 1000 patient-days; P = .003). No significant effect was noted in fall-related injuries. The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls. clinicaltrials.gov Identifier: NCT

Rural-Urban Differences in Access to Preventive Health Care Among Publicly Insured Minnesotans.

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Loftus, John; Allen, Elizabeth M; Call, Kathleen Thiede; Everson-Rose, Susan A

2018-02-01

Reduced access to care and barriers have been shown in rural populations and in publicly insured populations. Barriers limiting health care access in publicly insured populations living in rural areas are not understood. This study investigates rural-urban differences in system-, provider-, and individual-level barriers and access to preventive care among adults and children enrolled in a public insurance program in Minnesota. This was a secondary analysis of a 2008 statewide, cross-sectional survey of publicly insured adults and children (n = 4,388) investigating barriers associated with low utilization of preventive care. Sampling was stratified with oversampling of racial/ethnic minorities. Rural enrollees were more likely to report no past year preventive care compared to urban enrollees. However, this difference was no longer statistically significant after controlling for demographic and socioeconomic factors (OR: 1.37, 95% CI: 1.00-1.88). Provider- and system-level barriers associated with low use of preventive care among rural enrollees included discrimination based on public insurance status (OR: 2.26, 95% CI: 1.34-2.38), cost of care concerns (OR: 1.72, 95% CI: 1.03-2.89) and uncertainty about care being covered by insurance (OR: 1.70, 95% CI: 1.01-2.85). These and additional provider-level barriers were also identified among urban enrollees. Discrimination, cost of care, and uncertainty about insurance coverage inhibit access in both the rural and urban samples. These barriers are worthy targets of interventions for publicly insured populations regardless of residence. Future studies should investigate additional factors associated with access disparities based on rural-urban residence. © 2017 National Rural Health Association.

Migraine-preventive prescription patterns by physician specialty in ambulatory care settings in the United States.

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Takaki, Hiroko; Onozuka, Daisuke; Hagihara, Akihito

2018-03-01

Many adults with migraine who require preventive therapy are often not prescribed the proper medications. The most likely reason is that primary care physicians are unacquainted with preventive medications for migraine. The present study assessed the migraine-preventive prescription patterns in office visits using data from the National Ambulatory Medical Care Survey from 2006 to 2009 in the United States. Patients who were 18 years or older and diagnosed with migraine were included in the analysis. In accordance with the recommendations of the headache guidelines, we included beta-blockers, antidepressants, triptans for short-term prevention of menstrual migraine, and other triptans for acute treatment. Weighted visits of adults with migraine prescribed with preventive medication ranged from 32.8% in 2006 to 38.6% in 2009. Visits to primary care physicians accounted for 72.6% of the analyzed adult migraine visits. Anticonvulsants (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.14-0.57, p  < 0.001) and triptans for menstrual migraine (OR 0.50, 95% CI 0.28-0.91, p  = 0.025) were less frequently prescribed by primary care physicians compared with specialty care physicians, such as neurologists and psychiatrists. There were no significant differences in the prescription patterns of antidepressants and beta-blockers between primary and specialty care physicians. Beta-blockers were prescribed to patients with comorbidity of hypertension, and antidepressants were used by patients with comorbidity of depression. There are differences in the prescription patterns of certain type of preventive medications between primary care physicians and specialty care physicians.

Migraine-preventive prescription patterns by physician specialty in ambulatory care settings in the United States

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Hiroko Takaki

2018-03-01

Full Text Available Many adults with migraine who require preventive therapy are often not prescribed the proper medications. The most likely reason is that primary care physicians are unacquainted with preventive medications for migraine. The present study assessed the migraine-preventive prescription patterns in office visits using data from the National Ambulatory Medical Care Survey from 2006 to 2009 in the United States. Patients who were 18 years or older and diagnosed with migraine were included in the analysis. In accordance with the recommendations of the headache guidelines, we included beta-blockers, antidepressants, triptans for short-term prevention of menstrual migraine, and other triptans for acute treatment. Weighted visits of adults with migraine prescribed with preventive medication ranged from 32.8% in 2006 to 38.6% in 2009. Visits to primary care physicians accounted for 72.6% of the analyzed adult migraine visits. Anticonvulsants (odds ratio [OR] 0.29, 95% confidence interval [CI] 0.14–0.57, p < 0.001 and triptans for menstrual migraine (OR 0.50, 95% CI 0.28–0.91, p = 0.025 were less frequently prescribed by primary care physicians compared with specialty care physicians, such as neurologists and psychiatrists. There were no significant differences in the prescription patterns of antidepressants and beta-blockers between primary and specialty care physicians. Beta-blockers were prescribed to patients with comorbidity of hypertension, and antidepressants were used by patients with comorbidity of depression. There are differences in the prescription patterns of certain type of preventive medications between primary care physicians and specialty care physicians.

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, KH; Olsen, KR

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...... the number of contacts with a specialist in 2006 was related to participation in preventive child health care between 2002 and 2005. To control for the potential effect of difference in GP behaviour the data were analysed using a multilevel Poisson model linking each child to the GP with whom he or she...... was listed. RESULTS: If the children attended any preventive child health care visits, they had the same probability of contact with a specialist regardless of the parents' income. However, children from low-income families not participating in any preventive care had a lower probability of contact...

Designing a patient-centered personal health record to promote preventive care

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Krist Alex H

2011-11-01

Full Text Available Abstract Background Evidence-based preventive services offer profound health benefits, yet Americans receive only half of indicated care. A variety of government and specialty society policy initiatives are promoting the adoption of information technologies to engage patients in their care, such as personal health records, but current systems may not utilize the technology's full potential. Methods Using a previously described model to make information technology more patient-centered, we developed an interactive preventive health record (IPHR designed to more deeply engage patients in preventive care and health promotion. We recruited 14 primary care practices to promote the IPHR to all adult patients and sought practice and patient input in designing the IPHR to ensure its usability, salience, and generalizability. The input involved patient usability tests, practice workflow observations, learning collaboratives, and patient feedback. Use of the IPHR was measured using practice appointment and IPHR databases. Results The IPHR that emerged from this process generates tailored patient recommendations based on guidelines from the U.S. Preventive Services Task Force and other organizations. It extracts clinical data from the practices' electronic medical record and obtains health risk assessment information from patients. Clinical content is translated and explained in lay language. Recommendations review the benefits and uncertainties of services and possible actions for patients and clinicians. Embedded in recommendations are self management tools, risk calculators, decision aids, and community resources - selected to match patient's clinical circumstances. Within six months, practices had encouraged 14.4% of patients to use the IPHR (ranging from 1.5% to 28.3% across the 14 practices. Practices successfully incorporated the IPHR into workflow, using it to prepare patients for visits, augment health behavior counseling, explain test results

Role of the primary health care team in preventing accidents to children.

OpenAIRE

Kendrick, D

1994-01-01

Accidents are the most common cause of mortality in children and account for considerable childhood morbidity. The identification of risk factors for childhood accidents suggests that many are predictable and therefore preventable. Numerous interventions have been found to be effective in reducing the morbidity and mortality from childhood accidents. The scope for accident prevention within the primary care setting and the roles of the members of the primary health care team are discussed. Fi...

Parents-CARE: a suicide prevention program for parents of at-risk youth.

Science.gov (United States)

Hooven, Carole

2013-02-01

Families play an important role in youth suicide prevention, as both a source of protection and a source of risk, and thus are an important target for adolescent suicide prevention programs. This article describes in detail Parents-CARE, a brief youth suicide prevention program for parents, for which effectiveness has been demonstrated. Engaging parents in preventive intervention can be challenging; therefore, the feasibility, acceptability, and relevance of the program to parents are examined. A total of 289 households participated in Parents-CARE. Parent attendance data and parent and interventionist process data are utilized to demonstrate the positive response by parents to the program. The Parents-CARE program was highly attended, and ratings demonstrate that parents were engaged in the program. Ratings show parents found the program both acceptable and relevant. Hence, the program described is promising for clinicians working with at-risk youth as they seek brief, accessible, and effective interventions that include parents in order to amplify the effects of an individual intervention approach. © 2013 Wiley Periodicals, Inc.

Experiences of security and continuity of care: Patients' and families' narratives about the work of specialized palliative home care teams.

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Klarare, Anna; Rasmussen, Birgit H; Fossum, Bjöörn; Fürst, Carl Johan; Hansson, Johan; Hagelin, Carina Lundh

2017-04-01

Those who are seriously ill and facing death are often living with physical, emotional, social, and spiritual suffering. Teamwork is considered to be necessary to holistically meet the diverse needs of patients in palliative care. Reviews of studies regarding palliative care team outcomes have concluded that teams provide benefits, especially regarding pain and symptom management. Much of the research concerning palliative care teams has been performed from the perspective of the service providers and has less often focused on patients' and families' experiences of care. Our aim was to investigate how the team's work is manifested in care episodes narrated by patients and families in specialized palliative home care (SPHC). A total of 13 interviews were conducted with patients and families receiving specialized home care. Six patients and seven family members were recruited through SPHC team leaders. Interviews were transcribed verbatim and the transcripts qualitatively analyzed into themes. Two themes were constructed through thematic analysis: (1) security ("They are always available," "I get the help I need quickly"); and (2) continuity of care ("They know me/us, our whole situation and they really care"). Of the 74 care episodes, 50 were descriptions of regularly scheduled visits, while 24 related to acute care visits and/or interventions. Patients' and family members' descriptions of the work of SPHC teams are conceptualized through experiences of security and continuity of care. Experiences of security are fostered through the 24/7 availability of the team, sensitivity and flexibility in meeting patients' and families' needs, and practical adjustments to enable care at home. Experiences of continuity of care are fostered through the team's collective approach, where the individual team member knows the patients and family members, including their whole situation, and cares about the little things in life as well as caring for the family unit.

Achieving Continuity of Care: Facilitators and Barriers in Community Mental Health Teams

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Jones Ian Rees

2011-03-01

Full Text Available Abstract Background The integration of mental health and social services for people diagnosed with severe mental illness (SMI has been a key aspect of attempts to reform mental health services in the UK and aims to minimise user and carer distress and confusion arising from service discontinuities. Community mental health teams (CMHTs are a key component of UK policy for integrated service delivery, but implementing this policy has raised considerable organisational challenges. The aim of this study was to identify and explore facilitators and barriers perceived to influence continuity of care by health and social care professionals working in and closely associated with CMHTs. Methods This study employed a survey design utilising in-depth, semi-structured interviews with a proportionate, random sample of 113 health and social care professionals and representatives of voluntary organisations. Participants worked in two NHS Mental Health Trusts in greater London within eight adult CMHTs and their associated acute in-patient wards, six local general practices, and two voluntary organisations. Results Team leadership, decision making, and experiences of teamwork support were facilitators for cross boundary and team continuity; face-to-face communication between teams, managers, general practitioners, and the voluntary sector were facilitators for information continuity. Relational, personal, and longitudinal continuity were facilitated in some local areas by workforce stability. Barriers for cross boundary and team continuity were specific leadership styles and models of decision making, blurred professional role boundaries, generic working, and lack of training for role development. Barriers for relational, personal, and longitudinal continuity were created by inadequate staffing levels, high caseloads, and administrative duties that could limit time spent with users. Incompatibility of information technology systems hindered information

Reform, change, and continuity in Finnish health care.

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Häkkinen, Unto; Lehto, Juhani

2005-01-01

This article describes some essential aspects of the Finnish political and governmental system and the evolution of the basic institutional elements of the health care system. We examine the developments that gave rise to a series of health care reforms and reform proposals in the late 1980s and early 1990s and relate them to changes in health care expenditure, structure, and performance. Finally, we discuss the relationship between policy changes, reforms, and health system changes and the strength of neo-institutional theory in explaining both continuity and change. Much of the change in Finnish health care can be explained by institutional path dependency. The tradition of strong but small local authorities and the lack of legitimate democratic regional authorities as well as the coexistence of a dominant Beveridge-style health system with a marginal Bismarckian element explain the specific path of Finnish health care reform. Public responsibility for health care has been decentralized to smaller local authorities (known as municipalities) more than in any other country. Even an exceptionally deep economic recession in the early 1990s did not lead to systems change; rather, the economic imperative was met by the traditional centralized policy pattern. Some of the developments of the 1990s are, however, difficult to explain by institutional theory. Thus, there is a need for testing alternative theories as well.

Effectiveness of a citywide patient immunization navigator program on improving adolescent immunizations and preventive care visit rates.

Science.gov (United States)

Szilagyi, Peter G; Humiston, Sharon G; Gallivan, Sarah; Albertin, Christina; Sandler, Martha; Blumkin, Aaron

2011-06-01

To assess the impact of a tiered patient immunization navigator intervention (immunization tracking, reminder/recall, and outreach) on improving immunization and preventive care visit rates in urban adolescents. Randomized clinical trial allocating adolescents (aged 11-15 years) to intervention vs standard of care control. Eight primary care practices. Population-based sample of adolescents (N = 7546). Immunization navigators at each practice implemented a tiered protocol: immunization tracking, telephone or mail reminder/recall, and home visits if participants remained unimmunized or behind on preventive care visits. Immunization rates at study end. Secondary outcomes were preventive care visit rates during the previous 12 months and costs. The intervention and control groups were similar at baseline for demographics (mean age, 13.5 years; 63% black, 14% white, and 23% Hispanic adolescents; and 74% receiving Medicaid), immunization rates, and preventive care visit rates. Immunization rates at the end of the study were 44.7% for the intervention group and 32.4% for the control group (adjusted risk ratio, 1.4; 95% confidence interval, 1.3-1.5); preventive care visit rates were 68.0% for the intervention group and 55.2% for the control group (1.2; 1.2-1.3). Findings were similar across practices, sexes, ages, and insurance providers. The number needed to treat for immunizations and preventive care visits was 9. The intervention cost was $3.81 per adolescent per month; the cost per additional adolescent fully vaccinated was $465, and the cost per additional adolescent receiving a preventive care visit was $417. A tiered tracking, reminder/recall, and outreach intervention improved immunization and preventive care visit rates in urban adolescents. clinicaltrials.gov Identifier: NCT00581347.

Prevention Service System Transformation Using "Communities That Care"

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Brown, Eric C.; Hawkins, J. David; Arthur, Michael W.; Briney, John S.; Fagan, Abigail A.

2011-01-01

This study examines prevention system transformation as part of a community-randomized controlled trial of Communities That Care (CTC). Using data from surveys of community leaders, we examine differences between CTC and control communities 4.5 years after CTC implementation. Significantly higher levels of adopting a science-based approach to…

Estimated hospital costs associated with preventable health care-associated infections if health care antiseptic products were unavailable

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Schmier JK

2016-05-01

Full Text Available Jordana K Schmier,1 Carolyn K Hulme-Lowe,1 Svetlana Semenova,2 Juergen A Klenk,3 Paul C DeLeo,4 Richard Sedlak,5 Pete A Carlson6 1Health Sciences, Exponent, Inc., Alexandria, VA, 2EcoSciences, Exponent, Inc., Maynard, MA, 3Health Sciences, Exponent, Inc., Alexandria, VA, 4Environmental Safety, 5Technical and International Affairs, American Cleaning Institute, Washington, DC, 6Regulatory Affairs, Ecolab, Saint Paul, MN, USA Objectives: Health care-associated infections (HAIs pose a significant health care and cost burden. This study estimates annual HAI hospital costs in the US avoided through use of health care antiseptics (health care personnel hand washes and rubs; surgical hand scrubs and rubs; patient preoperative and preinjection skin preparations. Methods: A spreadsheet model was developed with base case inputs derived from the published literature, supplemented with assumptions when data were insufficient. Five HAIs of interest were identified: catheter-associated urinary tract infections, central line-associated bloodstream infections, gastrointestinal infections caused by Clostridium difficile, hospital- or ventilator-associated pneumonia, and surgical site infections. A national estimate of the annual potential lost benefits from elimination of these products is calculated based on the number of HAIs, the proportion of HAIs that are preventable, the proportion of preventable HAIs associated with health care antiseptics, and HAI hospital costs. The model is designed to be user friendly and to allow assumptions about prevention across all infections to vary or stay the same. Sensitivity analyses provide low- and high-end estimates of costs avoided. Results: Low- and high-end estimates of national, annual HAIs in hospitals avoided through use of health care antiseptics are 12,100 and 223,000, respectively, with associated hospital costs avoided of US$142 million and US$4.25 billion, respectively. Conclusion: The model presents a novel

Preventing pressure ulcers in long-term care: a cost-effectiveness analysis.

Science.gov (United States)

Pham, Ba'; Stern, Anita; Chen, Wendong; Sander, Beate; John-Baptiste, Ava; Thein, Hla-Hla; Gomes, Tara; Wodchis, Walter P; Bayoumi, Ahmed; Machado, Márcio; Carcone, Steven; Krahn, Murray

2011-11-14

Pressure ulcers are common in many care settings, with adverse health outcomes and high treatment costs. We evaluated the cost-effectiveness of evidence-based strategies to improve current prevention practice in long-term care facilities. We used a validated Markov model to compare current prevention practice with the following 4 quality improvement strategies: (1) pressure redistribution mattresses for all residents, (2) oral nutritional supplements for high-risk residents with recent weight loss, (3) skin emollients for high-risk residents with dry skin, and (4) foam cleansing for high-risk residents requiring incontinence care. Primary outcomes included lifetime risk of stage 2 to 4 pressure ulcers, quality-adjusted life-years (QALYs), and lifetime costs, calculated according to a single health care payer's perspective and expressed in 2009 Canadian dollars (Can$1 = US$0.84). Strategies cost on average $11.66 per resident per week. They reduced lifetime risk; the associated number needed to treat was 45 (strategy 1), 63 (strategy 4), 158 (strategy 3), and 333 (strategy 2). Strategy 1 and 4 minimally improved QALYs and reduced the mean lifetime cost by $115 and $179 per resident, respectively. The cost per QALY gained was approximately $78 000 for strategy 3 and $7.8 million for strategy 2. If decision makers are willing to pay up to $50 000 for 1 QALY gained, the probability that improving prevention is cost-effective is 94% (strategy 4), 82% (strategy 1), 43% (strategy 3), and 1% (strategy 2). The clinical and economic evidence supports pressure redistribution mattresses for all long-term care residents. Improving prevention with perineal foam cleansers and dry skin emollients appears to be cost-effective, but firm conclusions are limited by the available clinical evidence.

The Importance of and the Complexities Associated With Measuring Continuity of Care During Resident Training: Possible Solutions Do Exist.

Science.gov (United States)

Carney, Patricia A; Conry, Colleen M; Mitchell, Karen B; Ericson, Annie; Dickinson, W Perry; Martin, James C; Carek, Peter J; Douglass, Alan B; Eiff, M Patrice

2016-04-01

Evolutions in care delivery toward the patient-centered medical home have influenced important aspects of care continuity. Primary responsibility for a panel of continuity patients is a foundational requirement in family medicine residencies. In this paper we characterize challenges in measuring continuity of care in residency training in this new era of primary care. We synthesized the literature and analyzed information from key informant interviews and group discussions with residency faculty and staff to identify the challenges and possible solutions for measuring continuity of care during family medicine training. We specifically focused on measuring interpersonal continuity at the patient level, resident level, and health care team level. Challenges identified in accurately measuring interpersonal continuity of care during residency training include: (1) variability in empanelment approaches for all patients, (2) scheduling complexity in different types of visits, (3) variability in ability to attain continuity counts at the level of the resident, and (4) shifting make-up of health care teams, especially in residency training. Possible solutions for each challenge are presented. Philosophical issues related to continuity are discussed, including whether true continuity can be achieved during residency training and whether qualitative rather than quantitative measures of continuity are better suited to residencies. Measuring continuity of care in residency training is challenging but possible, though improvements in precision and assessment of the comprehensive nature of the relationships are needed. Definitions of continuity during training and the role continuity measurement plays in residency need further study.

Phenomenological perspectives of self-care in healthcare professionals' continuing education

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Daniele Bruzzone

2014-12-01

Full Text Available Healthcare professionals, daily confronted with existential failty, feel themselves emotionally vulnerable too. For this reason, they need knowledge and tools in order to take care for themselves. Phenomenology provides an epistemological model that includes subjective and affective dimensions and legitimates lived experience as a source of cognition. In the undergraduate and continuing education of healthcare professionals, the phenomenological approach can represent a way of promoting self-care through personal narrative and reflection.

National infection prevention and control programmes: Endorsing quality of care.

Science.gov (United States)

Stempliuk, Valeska; Ramon-Pardo, Pilar; Holder, Reynaldo

2014-01-01

Core components Health care-associated infections (HAIs) are a major cause of morbidity and mortality. In addition to pain and suffering, HAIs increase the cost of health care and generates indirect costs from loss of productivity for patients and society as a whole. Since 2005, the Pan American Health Organization has provided support to countries for the assessment of their capacities in infection prevention and control (IPC). More than 130 hospitals in 18 countries were found to have poor IPC programmes. However, in the midst of many competing health priorities, IPC programmes are not high on the agenda of ministries of health, and the sustainability of national programmes is not viewed as a key point in making health care systems more consistent and trustworthy. Comprehensive IPC programmes will enable countries to reduce the mobility, mortality and cost of HAIs and improve quality of care. This paper addresses the relevance of national infection prevention and control (NIPC) programmes in promoting, supporting and reinforcing IPC interventions at the level of hospitals. A strong commitment from national health authorities in support of national IPC programmes is crucial to obtaining a steady decrease of HAIs, lowering health costs due to HAIs and ensuring safer care.

Disparities in the Use of Preventive Health Care among Children with Disabilities in Taiwan

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Tsai, Wen-Chen; Kung, Pei-Tseng; Wang, Jong-Yi

2012-01-01

Children with disabilities face more barriers accessing preventive health services. Prior research has documented disparities in the receipt of these services. However, most are limited to specific types of disability or care. This study investigates disparities in the use of preventive health care among children with disabilities in Taiwan. Three…

Cumulative Risk and Continuity in Nonparental Care from Infancy to Early Adolescence.

Science.gov (United States)

Colwell, Malinda J; Pettit, Gregory S; Meece, Darrell; Bates, John E; Dodge, Kenneth A

2001-04-01

Variations in amounts of nonparental care across infancy, preschool, early elementary school, and early adolescence were examined in a longitudinal sample (N = 438). Of interest was (a) continuity in use of the different arrangements, (b) whether the arrangements were additively and cumulatively associated with children's externalizing behavior problems, and (c) whether predictive relations were accounted for by social-ecological (socioeconomic status, mothers' employment status, marital status) and social-experiential (parenting quality, exposure to aggressive peers) factors. Correlations among overall amounts of care provided little evidence of cross-time continuity. Consistent with the cumulative risk perspective, Grade 1 self-care and Grade 6 unsupervised peer contact incrementally predicted Grade 6 externalizing problems. Most of the predictive associations were accounted for by family background and social relationship factors.

Can community care workers deliver a falls prevention exercise program? A feasibility study

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Burton E

2018-03-01

Full Text Available Elissa Burton,1 Gill Lewin,2 Hilary O’Connell,3 Mark Petrich,4,5 Eileen Boyle,1 Keith D Hill1 1School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; 2School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia; 3Independent Living Centre Western Australia, Perth, Western Australia, Australia; 4Western Australian Department of Health, Perth, Western Australia, Australia; 5School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia Background: Almost half of older people receiving community care fall each year and this rate has not improved in the last decade. Falls prevention programs targeted at this group are uncommon, and expensively delivered by university trained allied health professionals. Purpose: To investigate the feasibility of community care workers delivering a falls prevention exercise program to older clients, at low or medium risk of falling, as part of an existing service provision. Patients and methods: Community care workers from 10 community care organizations participated in the training for, and delivery to their clients of, an 8-week evidence-based falls prevention exercise program. Community care workers included assessment staff (responsible for identifying the need for community care services through completing an assessment and support workers (responsible for providing support in the home. Clients were surveyed anonymously at the completion of the intervention and workers participated in a semi-structured interview. Results: Twenty-five community care workers participated in the study. The falls prevention program was delivered to 29 clients, with an average age of 82.7 (SD: 8.72 years and consisting of 65.5% female. The intervention was delivered safely with no adverse events recorded, and the eligibility and assessment tools

Opioid use in palliative care | Hosking | Continuing Medical Education

African Journals Online (AJOL)

Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 21, No 5 (2003) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Opioid use in palliative care. M Hosking. Abstract.

Using communities that care for community child maltreatment prevention.

Science.gov (United States)

Salazar, Amy M; Haggerty, Kevin P; de Haan, Benjamin; Catalano, Richard F; Vann, Terri; Vinson, Jean; Lansing, Michaele

2016-03-01

The prevention of mental, emotional, and behavioral (MEB) disorders among children and adolescents is a national priority. One mode of implementing community-wide MEB prevention efforts is through evidence-based community mobilization approaches such as Communities That Care (CTC). This article provides an overview of the CTC framework and discusses the adaptation process of CTC to prevent development of MEBs through preventing child abuse and neglect and bolstering child well-being in children aged 0 to 10. Adaptations include those to the intervention itself as well as those to the evaluation approach. Preliminary findings from the Keeping Families Together pilot study of this evolving approach suggest that the implementation was manageable for sites, and community board functioning and community adoption of a science-based approach to prevention in pilot sites looks promising. Implications and next steps are outlined. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Incorporating Multifaceted Mental Health Prevention Services in Community Sectors-of-Care

Science.gov (United States)

Gewirtz, Abigail H.; August, Gerald J.

2008-01-01

This article proposes a framework for embedding prevention services into community sectors-of-care. Community sectors-of-care include both formal and grassroot organizations distributed throughout a community that provide various resources and services to at-risk children and their families. Though the child population served by these…

[Knowledge about AIDS prevention among professionals and students in health care].

Science.gov (United States)

de Oliveira, A D; Viegas, C R; Sabka, E; Guerra, M; Baltazar, R

1996-07-01

This work is a exploratory research based on the analysis of the answers to the questionnaires of 52 students and health care professionals knowledge about AIDS sexual prevention, biosecurity, diagnosis tests, patients and workers rights and the modifications of nursing and medical care to this kind of disease.

Continuous Care Units: a response to aging and dependency in Portugal

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Maria Carolina Monteiro

2013-12-01

Full Text Available The Portuguese population is undergoing an irreversible aging process and must deal with this demographic issue. Many influencing factors have been identified, including biological, psychological and social changes which have led to this new social stratification. The increasing prevalence of chronic and debilitating illnesses as a direct result of human aging has increased the demand for answers on both a health and social level. Life expectancy at birth in Portugal is almost 81 years, one year above the OECD mean. Life expectancy for women is 84 years, compared to 78 years for men. The National Network for Continuous Care (REDE was formed in response to this new issue. The implementation of Continuous Care Units (UCCI provide an alternative to hospitalization for dependent people needing special care but who do not require the specific care of an acute unit. The UCCI present a model of multidisciplinary intervention that covers all aspects of a health, social and economic nature and, consists of multidisciplinary teams. Due to the characteristics of the elderly and / or their situation of dependency, the intervention from specialized professionals of UCCI must be carefully prepared. Focused training and team expertise are key factors of the REDE’s success.

Explaining the de-prioritization of primary prevention: Physicians' perceptions of their role in the delivery of primary care

Directory of Open Access Journals (Sweden)

Kuo Christina L

2003-05-01

Full Text Available Abstract Background While physicians are key to primary preventive care, their delivery rate is sub-optimal. Assessment of physician beliefs is integral to understanding current behavior and the conceptualization of strategies to increase delivery. Methods A focus group with regional primary care physician (PCP Opinion Leaders was conducted as a formative step towards regional assessment of attitudes and barriers regarding preventive care delivery in primary care. Following the PRECEDE-PROCEED model, the focus group aim was to identify conceptual themes that characterize PCP beliefs and practices regarding preventive care. Seven male and five female PCPs (family medicine, internal medicine participated in the audiotaped discussion of their perceptions and behaviors in delivery of primary preventive care. The transcribed audiotape was qualitatively analyzed using grounded theory methodology. Results The PCPs' own perceived role in daily practice was a significant barrier to primary preventive care. The prevailing PCP model was the "one-stop-shop" physician who could provide anything from primary to tertiary care, but whose provision was dominated by the delivery of immediate diagnoses and treatments, namely secondary care. Conclusions The secondary-tertiary prevention PCP model sustained the expectation of immediacy of corrective action, cure, and satisfaction sought by patients and physicians alike, and, thereby, de-prioritized primary prevention in practice. Multiple barriers beyond the immediate control of PCP must be surmounted for the full integration of primary prevention in primary care practice. However, independent of other barriers, physician cognitive value of primary prevention in practice, a base mediator of physician behavior, will need to be increased to frame the likelihood of such integration.

[Infection prevention and control in neonatal intensive care unit].

Science.gov (United States)

Lorenzini, Elisiane; Lorenzini, Elisiane; da Costa, Tatiane Costa; da Silva, Eveline Franco

2013-12-01

This study was aimed to identify the knowledge of the nursing team of a Neonatal Intensive Care Unit (NICU) on infection control, identijfying the factors that facilitate or hinder the prevention and control of Healthcare Associated Infections (HICAI). A descriptive study using a qualitative research method conducted with three nurses and 15 nurse technicians, who work in a NICU of a charitable organization, in southern Brazil. It became evident that the nursing staff had great knowledge about the factors that facilitate the prevention and control of HCAI in NICU, the most important factor being proper hand hygiene. Among the factors that hinder infection prevention and control are to overcrowding and excessive workload. The efficient performance of the nursing staff is an important part of the strategy for prevention and control of HCAI.

[Equivalent continuous noise level in neonatal intensive care unit associated to burnout syndrome].

Science.gov (United States)

Garrido Galindo, A P; Camargo Caicedo, Y; Vélez-Pereira, A M

2015-01-01

Noise levels in neonatal intensive care units allow the appearance of symptoms associated with burnout such as stress, irritability, fatigue and emotional instability on health care personnel. The aim of this study was to evaluate the equivalent continuous noise levels in the neonatal intensive care unit and compare the results with noise levels associated with the occurrence of burnout syndrome on the care team. Continuous sampling was conducted for 20 days using a type I sound level meter on the unit. The maximum, the ninetieth percentile and the equivalent continuous noise level (Leq) values were recorded. Noise level is reported in the range of 51.4-77.6 decibels A (dBA) with an average of 64 dBA, 100.6 dBA maximum, and average background noise from 57.9 dBA. Noise levels exceed the standards suggested for neonatal intensive care units, are close to maximum values referred for noise exposure in the occupational standards and to noise levels associated with the onset of burnout; thus allowing to infer the probability of occurrence of high levels of noise present in the unit on the development of burnout in caregivers. Copyright © 2013 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

Eight years of decreased methicillin-resistant Staphylococcus aureus health care-associated infections associated with a Veterans Affairs prevention initiative.

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Evans, Martin E; Kralovic, Stephen M; Simbartl, Loretta A; Jain, Rajiv; Roselle, Gary A

2017-01-01

Declines in methicillin-resistant Staphylococcus aureus (MRSA) health care associated infections (HAIs) were previously reported in Veterans Affairs acute care (2012), spinal cord injury (SCIU) (2011), and long-term-care facilities (LTCFs) (2012). Here we report continuing declines in infection rates in these settings through September 2015. Monthly data entered into a national database from 127 acute care facilities, 22 SCIUs, and 133 LTCFs were evaluated for trends using negative binomial regression. There were 23,153,240 intensive care unit (ICU) and non-ICU, and 1,794,234 SCIU patient-days from October 2007-September 2015, and 22,262,605 LTCF resident-days from July 2009-September 2015. Admission nasal swabbing remained >92% in all 3 venues. Admission prevalence changed from 13.2%-13.5% in acute care, from 35.1%-32.0% in SCIUs, and from 23.1%-25.0% in LTCFs during the analysis periods. Monthly HAI rates fell 87.0% in ICUs, 80.1% in non-ICUs, 80.9% in SCIUs, and 49.4% in LTCFs (all P values Prevention Initiative. Published by Elsevier Inc.

Responses of Aboriginal and Torres Strait Islander Primary Health-Care Services to Continuous Quality Improvement Initiatives.

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Larkins, Sarah; Woods, Cindy E; Matthews, Veronica; Thompson, Sandra C; Schierhout, Gill; Mitropoulos, Maxwell; Patrao, Tania; Panzera, Annette; Bailie, Ross Stewart

2015-01-01

Indigenous primary health-care (PHC) services participating in continuous quality improvement (CQI) cycles show varying patterns of performance over time. Understanding this variation is essential to scaling up and sustaining quality improvement initiatives. The aim of this study is to examine trends in quality of care for services participating in the ABCD National Research Partnership and describe patterns of change over time and examine health service characteristics associated with positive and negative trends in quality of care. PHC services providing care for Indigenous people in urban, rural, and remote northern Australia that had completed at least three annual audits of service delivery for at least one aspect of care (n = 73). Longitudinal clinical audit data from use of four clinical audit tools (maternal health, child health, preventive health, Type 2 diabetes) between 2005 and 2013 were analyzed. Health center performance was classified into six patterns of change over time: consistent high improvement (positive), sustained high performance (positive), decline (negative), marked variability (negative), consistent low performance (negative), and no specific increase or decrease (neutral). Backwards stepwise multiple logistic regression analyses were used to examine the associations between health service characteristics and positive or negative trends in quality of care. Trends in quality of care varied widely between health services across the four audit tools. Regression analyses of health service characteristics revealed no consistent statistically significant associations of population size, remoteness, governance model, or accreditation status with positive or negative trends in quality of care. The variable trends in quality of care as reflected by CQI audit tools do not appear to be related to easily measurable health service characteristics. This points to the need for a deeper or more nuanced understanding of factors that moderate the

Faith-Based HIV Care and Prevention in Chinese Immigrant Communities: Rhetoric or Reality?

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Kang, Ezer; Chin, John J.; Behar, Elana

2012-01-01

Ethnic churches attended by first generation Chinese immigrants are uniquely positioned to address emerging HIV prevention and care needs within the Chinese community at-large. Efforts to develop faith-based HIV programs necessitate identifying how HIV intersects with the sinicization of Christianity within Chinese churches. This paper will review the process of contextualizing HIV within theological and cultural frameworks that are meaningful for ethnic Chinese church leaders and members. The authors specifically propose two points of integration between public health and ecclesial functions: (1) HIV stigma-mitigation initiatives as informed by Christo-centric teachings of compassion and justice, and (2) HIV prevention and care reframed as social responsibility and informed by the Christian tradition of evangelism. Systems and practices that hinder and promote the involvement of Chinese churches in HIV prevention, care, and stigma-reduction will be discussed. PMID:23483037

Optimal Preventive Bank Supervision: Combining Random Audits and Continuous Intervention

OpenAIRE

Mohamed Belhaj; Nataliya Klimenko

2012-01-01

Early regulator interventions into problem banks are one of the key suggestions of Basel II. However, no guidance is given on their design. To fill this gap, we outline an incentive-based preventive supervision strategy that eliminates bad asset management in banks. Two supervision techniques are combined: continuous regulator intervention and random audits. Random audit technologies differ as to quality and cost. Our design ensures good management without excessive supervision costs, through...

Factors predicting the development of pressure ulcers in an at-risk population who receive standardized preventive care: secondary analyses of a multicentre randomised controlled trial.

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Demarre, Liesbet; Verhaeghe, Sofie; Van Hecke, Ann; Clays, Els; Grypdonck, Maria; Beeckman, Dimitri

2015-02-01

To identify predictive factors associated with the development of pressure ulcers in patients at risk who receive standardized preventive care. Numerous studies have examined factors that predict risk for pressure ulcer development. Only a few studies identified risk factors associated with pressure ulcer development in hospitalized patients receiving standardized preventive care. Secondary analyses of data collected in a multicentre randomized controlled trial. The sample consisted of 610 consecutive patients at risk for pressure ulcer development (Braden Score Pressure ulcers in category II-IV were significantly associated with non-blanchable erythema, urogenital disorders and higher body temperature. Predictive factors significantly associated with superficial pressure ulcers were admission to an internal medicine ward, incontinence-associated dermatitis, non-blanchable erythema and a lower Braden score. Superficial sacral pressure ulcers were significantly associated with incontinence-associated dermatitis. Despite the standardized preventive measures they received, hospitalized patients with non-blanchable erythema, urogenital disorders and a higher body temperature were at increased risk for developing pressure ulcers. Improved identification of at-risk patients can be achieved by taking into account specific predictive factors. Even if preventive measures are in place, continuous assessment and tailoring of interventions is necessary in all patients at risk. Daily skin observation can be used to continuously monitor the effectiveness of the intervention. © 2014 John Wiley & Sons Ltd.

Implementing a pressure ulcer prevention bundle in an adult intensive care.

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Tayyib, Nahla; Coyer, Fiona; Lewis, Peter A

2016-12-01

The incidence of pressure ulcers (PUs) in intensive care units (ICUs) is high and numerous strategies have been implemented to address this issue. One approach is the use of a PU prevention bundle. However, to ensure success care bundle implementation requires monitoring to evaluate the care bundle compliance rate, and to evaluate the effectiveness of implementation strategies in facilitating practice change. The aims of this study were to appraise the implementation of a series of high impact intervention care bundle components directed at preventing the development of PUs, within ICU, and to evaluate the effectiveness of strategies used to enhance the implementation compliance. An observational prospective study design was used. Implementation strategies included regular education, training, audit and feed-back and the presence of a champion in the ICU. Implementation compliance was measured along four time points using a compliance checklist. Of the 60 registered nurses (RNs) working in the critical care setting, 11 participated in this study. Study participants demonstrated a high level of compliance towards the PU prevention bundle implementation (78.1%), with 100% participant acceptance. No significant differences were found between participants' demographic characteristics and the compliance score. There was a significant effect for time in the implementation compliance (Wilks Lambda=0.29, F (3, 8)=6.35, p<0.016), indicating that RNs needed time to become familiar with the bundle and routinely implement it into their practice. PU incidence was not influenced by the compliance level of participants. The implementation strategies used showed a positive impact on compliance. Assessing and evaluating implementation compliance is critical to achieve a desired outcome (reduction in PU incidence). This study's findings also highlighted that while RNs needed time to familiarise themselves with the care bundle elements, their clinical practice was congruent with the

Preventive care in general practice among healthy older New South Wales residents.

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Harris, Mark F; Islam, Fakhrul Md; Jalaludin, Bin; Chen, Jack; Bauman, Adrian E; Comino, Elizabeth J

2013-06-16

Despite being at high risk, disadvantaged patients may be less likely to receive preventive care in general practice. This study aimed to explore self-reported preventive care received from general practitioners and the factors associated with this by healthy New South Wales (NSW) residents aged 45-74 years. A self-completed questionnaire was sent to 100,000 NSW residents in the 45 and Up cohort study. There was a 60% response rate. After exclusions there were 39,964 participants aged 45-74 years who did not report cardiovascular disease or diabetes. Dichotomised outcome variables were participant report of having had a clinical assessment of their blood pressure (BP), blood cholesterol (BC) or blood glucose (BG), or received advice to eat less high fat food, eat more fruit and vegetables or be more physically active from their GP in the last 12 months. Independent variables included socio-demographic, lifestyle risk factors, health status, access to health care and confidence in self-management. Most respondents reported having had their BP (90.6%), BC (73.9%) or BG (69.4%) assessed. Fewer reported being given health advice to (a)eat less high fat food (26.6%), (b) eat more fruit and vegetables (15.5%) or (c) do more physical activity (19.9%). The patterns of association were consistent with recognised need: participants who were older, less well educated or overweight were more likely to report clinical assessments; participants who were overseas born, of lower educational attainment, less confident in their own self-management, reported insufficient physical activity or were overweight were more likely to report receiving advice. However current smokers were less likely to report clinical assessments; and rural and older participants were less likely to receive diet or physical activity advice. This study demonstrated a gap between reported clinical assessments and preventive advice. There was evidence for inverse care for rural participants and smokers, who

Continuing Care

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... Can’t Grandma Remember My Name? Artwork for Purchase Support Articles Ten Signs of Caregiver Stress Therapeutic ... loved one with Alzheimer’s may be a difficult decision. It is best to make decisions about care ...

Initiating and continuing behaviour change within a weight gain prevention trial: a qualitative investigation.

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Kozica, Samantha; Lombard, Catherine; Teede, Helena; Ilic, Dragan; Murphy, Kerry; Harrison, Cheryce

2015-01-01

Preventing obesity is an international health priority. In Australia, young women who live in rural communities are at high risk of unhealthy weight gain. Interventions which engage young women and support sustainable behaviour change are needed and comprehensive evaluation of such interventions generates knowledge for population scale-up. This qualitative sub-study aims to identify enablers and barriers to behaviour change initiation and continuation within a community weight gain prevention program. In-depth semi-structured interviews were conducted with program participants 6 months after baseline. All interviews were audio-taped and transcribed verbatim. Transcripts were analysed independently by two investigators via thematic analysis. A total of 28 women with a mean age of 39.9±6.2years and a BMI of 28.6±5.2kg/m2 were purposively recruited from the larger cohort (n = 649) that participated in the prevention trial. Four behaviour change groups emerged were identified from participant interviews: (i) no change, (ii) relapse, (iii) intermittent and (iv) continued change. Factors influencing behaviour change initiation and continuation included realistic program expectations and the participant's ability to apply the core program elements including: setting small, achievable behaviour change goals, problem solving and using self-management techniques. Personal knowledge, skills, motivation, self-efficacy, accountability and perceived social and environmental barriers also affected behaviour change. Satisfaction with personal program progress and the perceived amount of program supports required to achieve ongoing behaviour change varied amongst participants. Women who relapsed expressed a desire for more intensive and regular support from health professionals, identified more barriers unrelated to the program, anticipated significant weight loss and had lower satisfaction with their progress. Initiating and continuing behaviour change is a complex process. Our

Adopting new models for continuity of care: what are the needs?

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May, P R

1975-09-01

There are glaring, almost universal deficiencies in the organization of community resources for treating and rehabilitating the mentally ill, particularly psychotic patients, the author says. The deficiencies could be partly remedied by reorganizing psychiatric hospitals to play a key role in outpatient service delivery, and by paying more attention to the principles of continuity of care for psychotic patients. One way of doing both is through the model of a mini-mental-health-center adopted at a Veterans Administration hospital: the same terms provide active, continual care for patients regardless of whether they are in or out of the hospital. The program developed on one ward is described further in the next paper, written by ward staff members and others.

Surrogate decision makers' perspectives on preventable breakdowns in care among critically ill patients: A qualitative study.

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Fisher, Kimberly A; Ahmad, Sumera; Jackson, Madeline; Mazor, Kathleen M

2016-10-01

To describe surrogate decision makers' (SDMs) perspectives on preventable breakdowns in care among critically ill patients. We screened 70 SDMs of critically ill patients for those who identified a preventable breakdown in care, defined as an event where the SDM believes something "went wrong", that could have been prevented, and resulted in harm. In-depth interviews were conducted with SDMs who identified an eligible event. 32 of 70 participants (46%) identified at least one preventable breakdown in care, with a total of 75 discrete events. Types of breakdowns involved medical care (n=52), communication (n=59), and both (n=40). Four additional breakdowns were related to problems with SDM bedside access to the patient. Adverse consequences of breakdowns included physical harm, need for additional medical care, emotional distress, pain, suffering, loss of trust, life disruption, impaired decision making, and financial expense. 28 of 32 SDMs raised their concerns with clinicians, yet only 25% were satisfactorily addressed. SDMs of critically ill patients frequently identify preventable breakdowns in care which result in harm. An in-depth understanding of the types of events SDMs find problematic and the associated harms is an important step towards improving the safety and patient-centeredness of healthcare. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service

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O'Dea Kerin

2011-01-01

Full Text Available Abstract Background Cardiovascular disease (CVD is the single greatest contributor to the gap in life expectancy between Indigenous and non-Indigenous Australians. Our objective is to determine if holistic CVD risk assessment, introduced as part of the new Aboriginal and Torres Strait Islander Adult Health Check (AHC, results in better identification of elevated CVD risk, improved delivery of preventive care for CVD and improvements in the CVD risk profile for Aboriginal adults in a remote community. Methods Interrupted time series study over six years in a remote primary health care (PHC service involving Aboriginal adults identified with elevated CVD risk (N = 64. Several process and outcome measures were audited at 6 monthly intervals for three years prior to the AHC (the intervention and three years following: (i the proportion of guideline scheduled CVD preventive care services delivered, (ii mean CVD medications prescribed and dispensed, (iii mean PHC consultations, (iv changes in participants' CVD risk factors and estimated absolute CVD risk and (v mean number of CVD events and iatrogenic events. Results Twenty-five percent of AHC participants were identified as having elevated CVD risk. Of these, 84% had not been previously identified during routine care. Following the intervention, there were significant improvements in the recorded delivery of preventive care services for CVD (30% to 53%, and prescription of CVD related medications (28% to 89% (P P = 0.004 following the intervention. However, there were no significant changes in the mean number of PHC consultations or mean number of CVD events or iatrogenic events. Conclusions Holistic CVD risk assessment during an AHC can lead to better and earlier identification of elevated CVD risk, improvement in the recorded delivery of preventive care services for CVD, intensification of treatment for CVD, and improvements in participants' CVD risk profile. Further research is required on

The role of health centers in preventive care provision

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Shemetova G.N.

2017-12-01

Full Text Available Aim: to assess the importance of the Centers of Health in the organization and provision of preventive care to the population, in the early detection of risk factors for the development of chronic non-communicable diseases and the development of a healthy lifestyle. Material and Methods. On the basis of the Health Center of Engels Center for Medical Prevention in the Saratov Region, the detection of risk factors for 2011-2015 was analyzed according to statistical reporting (form No. 68 and health cards (form025-CZ/y of 207 patients. To assess the satisfaction of visitors with the work of the Center, a specially developed questionnaire was conducted, which included 22 questions that characterize the patient profile, his attitude to the organization and the results of the survey, and the motivation to modify the way of life. Results. The study confirmed the important role of the Centers of Health in the organization and provision of preventive care to the population, the formation of a healthy lifestyle and the early detection of diseases and risk factors for their development. Conclusion. Only joint efforts of medical institutions, authorities, educational organizations, mass media can lead to the formation of the population's responsibility for their health and readiness to modify the way of life.

Mobile health applications for HIV prevention and care in Africa.

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Forrest, Jamie I; Wiens, Matthew; Kanters, Steve; Nsanzimana, Sabin; Lester, Richard T; Mills, Edward J

2015-11-01

More people have mobile phones in Africa than at any point in history. Mobile health (m-health), the use of mobile phones to support the delivery of health services, has expanded in recent years. Several models have been proposed for conceptualizing m-health in the fields of maternal-child health and chronic diseases. We conducted a literature review of m-health interventions for HIV prevention and care in African countries and present the findings in the context of a simplified framework. Our review identified applications of m-health for HIV prevention and care categorized by the following three themes: patient-care focused applications, such as health behavior change, health system-focused applications, such as reporting and data collection, and population health-focused applications, including HIV awareness and testing campaigns. The potential for m-health in Africa is numerous and should not be limited only to direct patient-care focused applications. Although the use of smart phone technology is on the rise in Africa, text messaging remains the primary mode of delivering m-health interventions. The rate at which mobile phone technologies are being adopted may outpace the rate of evaluation. Other methods of evaluation should be considered beyond only randomized-controlled trials.

Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices.

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Dahrouge, Simone; Hogg, William E; Russell, Grant; Tuna, Meltem; Geneau, Robert; Muldoon, Laura K; Kristjansson, Elizabeth; Fletcher, John

2012-02-07

Several jurisdictions attempting to reform primary care have focused on changes in physician remuneration. The goals of this study were to compare the delivery of preventive services by practices in four primary care funding models and to identify organizational factors associated with superior preventive care. In a cross-sectional study, we included 137 primary care practices in the province of Ontario (35 fee-for-service practices, 35 with salaried physicians [community health centres], 35 practices in the new capitation model [family health networks] and 32 practices in the established capitation model [health services organizations]). We surveyed 288 family physicians. We reviewed 4108 randomly selected patient charts and assigned prevention scores based on the proportion of eligible preventive manoeuvres delivered for each patient. A total of 3284 patients were eligible for at least one of six preventive manoeuvres. After adjusting for patient profile and contextual factors, we found that, compared with prevention scores in practices in the new capitation model, scores were significantly lower in fee-for-service practices (β estimate for effect on prevention score = -6.3, 95% confidence interval [CI] -11.9 to -0.6) and practices in the established capitation model (β = -9.1, 95% CI -14.9 to -3.3) but not for those with salaried remuneration (β = -0.8, 95% CI -6.5 to 4.8). After accounting for physician characteristics and organizational structure, the type of funding model was no longer a statistically significant factor. Compared with reference practices, those with at least one female family physician (β = 8.0, 95% CI 4.2 to 11.8), a panel size of fewer than 1600 patients per full-time equivalent family physician (β = 6.8, 95% CI 3.1 to 10.6) and an electronic reminder system (β = 4.6, 95% CI 0.4 to 8.7) had superior prevention scores. The effect of these three factors was largely but not always consistent across the funding models; it was largely

Preventing dehydration-related hospitalizations: a mixed-methods study of parents, inpatient attendings, and primary care physicians.

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Shanley, Leticia; Mittal, Vineeta; Flores, Glenn

2013-07-01

The goal of this study was to identify the proportion of dehydration-related ambulatory care-sensitive condition hospitalizations, the reasons why these hospitalizations were preventable, and factors associated with preventability. A cross-sectional survey of primary care providers (PCPs), inpatient attending physicians, and parents was conducted in a consecutive series of children with ambulatory care-sensitive conditions admitted to an urban hospital over 14 months. Eighty-five children were diagnosed with dehydration. Their mean age was 1.6 years; most had public (74%) or no (17%) insurance, and were nonwhite (91%). The proportion of hospitalizations assessed as preventable varied from 12% for agreement among all 3 sources to 45% for any source. Parents identified inadequate prevention (50%), poor self-education (34%), and poor quality of care (38%) as key factors. PCPs identified parents providing insufficient home rehydration (33%), not visiting the clinic (25%), and not calling earlier (16%) as reasons. Inpatient attending physicians cited home rehydration (40%), delays in seeking care (40%), and lacking a PCP (20%) as contributors. Physicians (PCPs and inpatient attending physicians) were more likely than parents to describe the admission as inappropriate (75% vs 67% vs 0%; P dehydration-related hospitalizations may be preventable. Inadequate parental education by physicians, insufficient home rehydration, deferring clinic visits, insurance and cost barriers, inappropriate admissions, poor quality of care, and parental dissatisfaction with PCPs are the reasons that these hospitalizations might have been prevented.

How Peru introduced a plan for comprehensive HIV prevention and care for transwomen.

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Salazar, Ximena; Núnez-Curto, Arón; Villayzán, Jana; Castillo, Regina; Benites, Carlos; Caballero, Patricia; Cáceres, Carlos F

2016-01-01

As a group, transwomen in Peru have the highest prevalence of HIV (>20%) in the country, but they have little access to HIV prevention, testing and care services. Until recently, Peru's national HIV programme did not recognize transwomen and had remained essentially static for decades. This changed in December 2014, when the Ministry of Health expressed its commitment to improve programming for transwomen and to involve transwomen organizations by prioritizing the development of a "Targeted Strategy Plan of STIs/HIV/AIDS Prevention and Comprehensive Care for Transwomen." A policy dialogue between key stakeholders - Peru's Ministry of Health, academic scientists, civil society, transgender leaders and international agencies - created the conditions for a change in Peru's national HIV policy for transwomen. Supported by the effective engagement of all sectors, the Ministry of Health launched a plan to provide comprehensive HIV prevention and care for transwomen. The five-year plan includes new national guidelines for HIV prevention, care and support, and country-level investments in infrastructure and equipment. In addition to new biomedical strategies, the plan also incorporates several strategies to address structural factors that contribute to the vulnerability of transwomen. We identified three key factors that created the right conditions for this change in Peru's HIV policy. These factors include (1) the availability of solid evidence, based on scientific research; (2) ongoing efforts within the transwomen community to become better advocates of their own rights; and (3) a dialogue involving honest discussions between stakeholders about possibilities of changing the nation's HIV policy. The creation of Peru's national plan for HIV prevention and care for transwomen shows that long-term processes, focused on human rights for transwomen in Peru, can lead to organizational and public-policy change.

Rural Indonesian health care workers' constructs of infection prevention and control knowledge.

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Marjadi, Brahmaputra; McLaws, Mary-Louise

2010-06-01

Understanding the constructs of knowledge behind clinical practices in low-resource rural health care settings with limited laboratory facilities and surveillance programs may help in designing resource-appropriate infection prevention and control education. Multiple qualitative methods of direct observations, individual and group focus discussions, and document analysis were used to examine health care workers' knowledge of infection prevention and control practices in intravenous therapy, antibiotic therapy, instrument reprocessing, and hand hygiene in 10 rural Indonesian health care facilities. Awareness of health care-associated infections was low. Protocols were in the main based on verbal instructions handed down through the ranks of health care workers. The evidence-based knowledge gained across professional training was overridden by empiricism, nonscientific modifications, and organizational and societal cultures when resources were restricted or patients demanded inappropriate therapies. This phenomenon remained undetected by accreditation systems and clinical educators. Rural Indonesian health care workers would benefit from a formal introduction to evidence-based practice that would deconstruct individual protocols that include nonscientific knowledge. To achieve levels of acceptable patient safety, protocols would have to be both evidence-based and resource-appropriate. Copyright 2010 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

Policy environment for prevention, control and management of cardiovascular diseases in primary health care in Kenya.

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Asiki, Gershim; Shao, Shuai; Wainana, Carol; Khayeka-Wandabwa, Christopher; Haregu, Tilahun N; Juma, Pamela A; Mohammed, Shukri; Wambui, David; Gong, Enying; Yan, Lijing L; Kyobutungi, Catherine

2018-05-09

In Kenya, cardiovascular diseases (CVDs) accounted for more than 10% of total deaths and 4% of total Disability-Adjusted Life Years (DALYs) in 2015 with a steady increase over the past decade. The main objective of this paper was to review the existing policies and their content in relation to prevention, control and management of CVDs at primary health care (PHC) level in Kenya. A targeted document search in Google engine using keywords "Kenya national policy on cardiovascular diseases" and "Kenya national policy on non-communicable diseases (NCDs)" was conducted in addition to key informant interviews with Kenyan policy makers. Relevant regional and international policy documents were also included. The contents of documents identified were reviewed to assess how well they aligned with global health policies on CVD prevention, control and management. Thematic content analysis of the key informant interviews was also conducted to supplement the document reviews. A total of 17 documents were reviewed and three key informants interviewed. Besides the Tobacco Control Act (2007), all policy documents for CVD prevention, control and management were developed after 2013. The national policies were preceded by global initiatives and guidelines and were similar in content with the global policies. The Kenya health policy (2014-2030), The Kenya Health Sector Strategic and Investment Plan (2014-2018) and the Kenya National Strategy for the Prevention and Control of Non-communicable diseases (2015-2020) had strategies on NCDs including CVDs. Other policy documents for behavioral risk factors (The Tobacco Control Act 2007, Alcoholic Drinks Control (Licensing) Regulations (2010)) were available. The National Nutrition Action Plan (2012-2017) was available as a draft. Although Kenya has a tiered health care system comprising primary healthcare, integration of CVD prevention and control at PHC level was not explicitly mentioned in the policy documents. This review revealed

Continuous versus intermittent endotracheal cuff pressure control for the prevention of ventilator-associated respiratory infections in Vietnam: study protocol for a randomised controlled trial.

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Dat, Vu Quoc; Geskus, Ronald B; Wolbers, Marcel; Loan, Huynh Thi; Yen, Lam Minh; Binh, Nguyen Thien; Chien, Le Thanh; Mai, Nguyen Thi Hoang; Phu, Nguyen Hoan; Lan, Nguyen Phu Huong; Hao, Nguyen Van; Long, Hoang Bao; Thuy, Tran Phuong; Kinh, Nguyen Van; Trung, Nguyen Vu; Phu, Vu Dinh; Cap, Nguyen Trung; Trinh, Dao Tuyet; Campbell, James; Kestelyn, Evelyne; Wertheim, Heiman F L; Wyncoll, Duncan; Thwaites, Guy Edward; van Doorn, H Rogier; Thwaites, C Louise; Nadjm, Behzad

2018-04-04

Ventilator-associated respiratory infection (VARI) comprises ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT). Although their diagnostic criteria vary, together these are the most common hospital-acquired infections in intensive care units (ICUs) worldwide, responsible for a large proportion of antibiotic use within ICUs. Evidence-based strategies for the prevention of VARI in resource-limited settings are lacking. Preventing the leakage of oropharyngeal secretions into the lung using continuous endotracheal cuff pressure control is a promising strategy. The aim of this study is to investigate the efficacy of automated, continuous endotracheal cuff pressure control in preventing the development of VARI and reducing antibiotic use in ICUs in Vietnam. This is an open-label randomised controlled multicentre trial. We will enrol 600 adult patients intubated for ≤ 24 h at the time of enrolment. Eligible patients will be stratified according to admission diagnosis (180 tetanus, 420 non-tetanus) and site and will be randomised in a 1:1 ratio to receive either (1) automated, continuous control of endotracheal cuff pressure or (2) intermittent measurement and control of endotracheal cuff pressure using a manual cuff pressure meter. The primary outcome is the occurrence of VARI, defined as either VAP or VAT during the ICU admission up to a maximum of 90 days after randomisation. Patients in both groups who are at risk for VARI will receive a standardised battery of investigations if their treating physician feels a new infection has occurred, the results of which will be used by an endpoint review committee, blinded to the allocated arm and independent of patient care, to determine the primary outcome. All enrolled patients will be followed for mortality and endotracheal tube cuff-related complications at 28 days and 90 days after randomisation. Other secondary outcomes include antibiotic use; days ventilated, in ICU and in hospital

Secondary prevention after minor stroke and TIA - usual care and development of a support program.

Directory of Open Access Journals (Sweden)

Stefanie Leistner

Full Text Available Effective methods of secondary prevention after stroke or TIA are available but adherence to recommended evidence-based treatments is often poor. The study aimed to determine the quality of secondary prevention in usual care and to develop a stepwise modeled support program.Two consecutive cohorts of patients with acute minor stroke or TIA undergoing usual outpatient care versus a secondary prevention program were compared. Risk factor control and medication adherence were assessed in 6-month follow-ups (6M-FU. Usual care consisted of detailed information concerning vascular risk factor targets given at discharge and regular outpatient care by primary care physicians. The stepwise modeled support program additionally employed up to four outpatient appointments. A combination of educational and behavioral strategies was employed.168 patients in the observational cohort who stated their openness to participate in a prevention program (mean age 64.7 y, admission blood pressure (BP: 155/84 mmHg and 173 patients participating in the support program (mean age 67.6 y, BP: 161/84 mmHg were assessed at 6 months. Proportions of patients with BP according to guidelines were 50% in usual-care and 77% in the support program (p<0.01. LDL<100 mg/dl was measured in 62 versus 71% (p = 0.12. Proportions of patients who stopped smoking were 50 versus 79% (p<0.01. 72 versus 89% of patients with atrial fibrillation were on oral anticoagulation (p = 0.09.Risk factor control remains unsatisfactory in usual care. Targets of secondary prevention were met more often within the supported cohort. Effects on (cerebro-vascular recurrence rates are going to be assessed in a multicenter randomized trial.

Information management for aged care provision in Australia: development of an aged care minimum dataset and strategies to improve quality and continuity of care.

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Davis, Jenny; Morgans, Amee; Burgess, Stephen

2016-04-01

Efficient information systems support the provision of multi-disciplinary aged care and a variety of organisational purposes, including quality, funding, communication and continuity of care. Agreed minimum data sets enable accurate communication across multiple care settings. However, in aged care multiple and poorly integrated data collection frameworks are commonly used for client assessment, government reporting and funding purposes. To determine key information needs in aged care settings to improve information quality, information transfer, safety, quality and continuity of care to meet the complex needs of aged care clients. Modified Delphi methods involving five stages were employed by one aged care provider in Victoria, Australia, to establish stakeholder consensus for a derived minimum data set and address barriers to data quality. Eleven different aged care programs were identified; with five related data dictionaries, three minimum data sets, five program standards or quality frameworks. The remaining data collection frameworks related to diseases classification, funding, service activity reporting, and statistical standards and classifications. A total of 170 different data items collected across seven internal information systems were consolidated to a derived set of 60 core data items and aligned with nationally consistent data collection frameworks. Barriers to data quality related to inconsistencies in data items, staff knowledge, workflow, system access and configuration. The development an internal aged care minimum data set highlighted the critical role of primary data quality in the upstream and downstream use of client information; and presents a platform to build national consistency across the sector.

Preventive aspects in children's caries treatments preceding dental care under general anaesthesia.

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Savanheimo, Nora; Vehkalahti, Miira M

2008-03-01

In Helsinki Public Dental Service (PDS) the Special Oral Health Care Unit (SOHCU) provides comprehensive dental treatments under general anaesthesia (GA). For the present study, all dental treatment given under GA for generally healthy children (n = 102) below 16 years of age (range 2.3-15.8) during a 1-year period and dental treatment and visits of these children in the preceding 2 years in Helsinki PDS was recorded in detail. These children were referred to the SOHCU because of serious difficulties in dental care due to large treatment needs or failures in psychological and chemical management, including sedation. To describe treatments given to generally healthy children under GA and to evaluate preventive aspects of their dental care in the preceding 2 years. The study was cross-sectional and retrospective. Data came from the patients' individual records. Treatments under GA included an average of 6.0 restorations (SD = 2.7, range 0-12) and 1.7 extractions (SD = 2.1, range 0-10). In the 2 preceding years, these children had visited dentist an average of 5.1 times (SD = 2.7, range 1-14) with an average of 2.4 restorations (SD = 1.9, range 0-12) and 0.5 extractions (SD = 1.4, range 0-10). Of the restorations made, 36% were temporary. Of all visits, those with an operative approach accounted for 35%, preventive for 37%, operative and preventive for 5%, and visits with total uncooperation for 23%. Of the children, 90% had at least one preventive visit. Children treated under conscious sedation in the preceding 2 years received less prevention (P = 0.02). Remaining without preventive measures was most likely for those children exhibiting visits with total uncooperation (odds ratio = 4.6; P = 0.004) and for those receiving numerous temporary fillings (odds ratio = 4.1; P = 0.0005). The uncooperative high-caries children pose a demanding challenge to PDS. The early identification of high-caries risk and efforts of intensive preventive care are in key position to

Racial/Ethnic and social class differences in preventive care practices among persons with diabetes

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Barnett Elizabeth

2006-10-01

Full Text Available Abstract Background Diabetes is the sixth leading cause of death in the United States. Persons with diabetes are at increased risk for serious complications including CVD, stroke, retinopathy, amputation, and nephropathy. Minorities have the highest incidence and prevalence of diabetes and related complications compared to other racial groups. Preventive care practices such as smoking cessation, eye examinations, feet examinations, and yearly checkups can prevent or delay the incidence and progression of diabetes related complications. The purpose of this study was to examine racial/ethnic differences in diabetes preventive care practices by several socio-demographic characteristics including social class. Methods Data from the Behavioral Risk Factor Surveillance Survey for 1998–2001 were used for analyses. The study population consisted of persons who indicated having diabetes on the BRFSS, 35 yrs and older, and Non-Hispanic Black, non-Hispanic White, or Hispanic persons. Logistic regression was used in analyses. Results Contrary to our hypotheses, Blacks and Hispanics engaged in preventive care more frequently than Whites. Whites were less likely to have seen a doctor in the previous year, less likely to have had a foot exam, more likely to smoke, and less likely to have attempted smoking cessation. Persons of lower social class were at greatest risk for not receiving preventive care regardless of race/ethnicity. Persons with no health care coverage were twice as likely to have not visited the doctor in the previous year and twice as likely to have not had an eye exam, 1.5 times more likely to have not had a foot exam or attempted smoking cessation. Conclusion This study showed that persons of lower social class and persons with no health insurance are at greatest risk for not receiving preventive services.

Nursing Care Model Based on Knowledge Management in Preventing Nosocomial Infection After Caesarean Section in Hospital

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Ahsan Ahsan

2016-09-01

Full Text Available Introduction: Nosocomial infection is one indicator of the quality of health services in the community, which also determines the image of health care institutions becauseit was a major cause of morbidityand death rate (mortality in hospital. Nursing care based on knowledge management is established from identification knowledge which is required, prevention performance of nosocomial infections post section caesarea. Nosocomial infections component consists of wound culture result. Method: This study was an observational study with a quasi experimental design. The population was all of nursing staff who working in obstetrics installation in hospitals A and B as much as 46 people. Sample was the total population. Data was collected through questionnaire, observation sheets and examination of the wound culture. Data was analyzed using t test B 1.274 dan p=0.028 Result: The result showed that 1 there was difference in knowledge management implementation before and after training; 2 there was difference in nurse’s performance in preventing nosocomial infection before and after training; 3 there is significant relationship between nurse’s performance in preventing nosocomial infection and infection incidence; 4 there is no significant difference of nursing care impementation on nosocomial incidence. Discussion: In conclusion, the development of nursing care based on knowledge management as a synthesis or induction of findings directed at 1 nurses’ knowledge does not affect the performance of the prevention of nosocomial infections; 2 knowledge management has a positive effect on the performance of the prevention of nosocomial infections; 3 implementation of infection prevention is integrated capabilities between knowledge, skills and attitudes of nurses in implementing performance in care. Keywords: model prevention, nosocomial infections, nursing care, knowledge management, sectio Caesarea

Suicide Prevention Training: Policies for Health Care Professionals Across the United States as of October 2017.

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Graves, Janessa M; Mackelprang, Jessica L; Van Natta, Sara E; Holliday, Carrie

2018-06-01

To identify and compare state policies for suicide prevention training among health care professionals across the United States and benchmark state plan updates against national recommendations set by the surgeon general and the National Action Alliance for Suicide Prevention in 2012. We searched state legislation databases to identify policies, which we described and characterized by date of adoption, target audience, and duration and frequency of the training. We used descriptive statistics to summarize state-by-state variation in suicide education policies. In the United States, as of October 9, 2017, 10 (20%) states had passed legislation mandating health care professionals complete suicide prevention training, and 7 (14%) had policies encouraging training. The content and scope of policies varied substantially. Most states (n = 43) had a state suicide prevention plan that had been revised since 2012, but 7 lacked an updated plan. Considerable variation in suicide prevention training for health care professionals exists across the United States. There is a need for consistent polices in suicide prevention training across the nation to better equip health care providers to address the needs of patients who may be at risk for suicide.

Diabetes Preventive Care Practices in North Carolina, 2000-2015.

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Luo, Huabin; Bell, Ronny A; Cummings, Doyle M; Chen, Zhuo Adam

2018-03-22

This analysis assessed trends in measures of diabetes preventive care overall and by race/ethnicity and socioeconomic status in the North Carolina Behavioral Risk Factor Surveillance System (2000-2015). We found increasing trends in 5 measures: diabetes self-management education (DSME), daily blood glucose self-monitoring, hemoglobin A 1c tests, foot examinations, and flu shots. Non-Hispanic black and non-Hispanic white respondents showed increases in blood glucose self-monitoring, and a significant time-by-race interaction was observed for annual flu shots. Predisposing, enabling, and need factors were significantly associated with most measures. DSME was positively associated with 7 measures. Expanding access to health insurance and health care providers is key to improving diabetes management, with DSME being the gateway to optimal care.

Primary Prevention of Cardiovascular Disease

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Danny J. Eapen, MD

2016-09-01

Full Text Available Cardiovascular disease (CVD is the leading cause of death worldwide. This article focuses on current guidelines for the primary prevention of CVD and addresses management of key risk factors. Dietary modification, weight loss, exercise, and tobacco use cessation are specific areas where focused efforts can successfully reduce CVD risk on both an individual and a societal level. Specific areas requiring management include dyslipidemia, hypertension, physical activity, diabetes, aspirin use, and alcohol intake. These preventive efforts have major public health implications. As the global population continues to grow, health care expenditures will also rise, with the potential to eventually overwhelm the health care system. Therefore it is imperative to apply our collective efforts on CVD prevention to improve the cardiovascular health of individuals, communities, and nations.

The influence of care interventions on the continuity of sleep of intensive care unit patients.

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Hamze, Fernanda Luiza; de Souza, Cristiane Chaves; Chianca, Tânia Couto Machado

2015-01-01

to identify care interventions, performed by the health team, and their influence on the continuity of sleep of patients hospitalized in the Intensive Care Unit. descriptive study with a sample of 12 patients. A filming technique was used for the data collection. The awakenings from sleep were measured using the actigraphy method. The analysis of the data was descriptive, processed using the Statistical Package for the Social Sciences software. 529 care interventions were identified, grouped into 28 different types, of which 12 (42.8%) caused awakening from sleep for the patients. A mean of 44.1 interventions/patient/day was observed, with 1.8 interventions/patient/hour. The administration of oral medicine and food were the interventions that caused higher frequencies of awakenings in the patients. it was identified that the health care interventions can harm the sleep of ICU patients. It is recommended that health professionals rethink the planning of interventions according to the individual demand of the patients, with the diversification of schedules and introduction of new practices to improve the quality of sleep of Intensive Care Unit patients.

Review and analysis of existing mobile phone applications for health care-associated infection prevention.

Science.gov (United States)

Schnall, Rebecca; Iribarren, Sarah J

2015-06-01

The expanding number of mobile health applications (apps) holds potential to reduce and eliminate health care-associated infections (HAIs) in clinical practice. The purpose of this review was to identify and provide an overview of the apps available to support prevention of HAIs and to assess their functionality and potential uses in clinical care. We searched 3 online mobile app stores using the following terms: infection prevention, prevention, hand hygiene, hand washing, and specific HAI terms (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infections, surgical site infection, and ventilator associated pneumonia [VAP]). Search queries yielded a total of 2,646 potentially relevant apps, of which 17 met our final inclusion criteria. The areas of focus were CAUTI (n = 1, 5.9%), VAP (n = 1, 5.9%), environmental monitoring (n = 2, 11.8%), and hand hygiene (n = 2, 11.8%); the remainder (n = 11, 64.7%) were focused on >1 area (eg, multiple infection prevention bundles, infection prevention guidelines). Almost all of the apps (70.6%) had a maximum of two functions. Mobile apps may help reduce HAI by providing easy access to guidelines, hand hygiene monitoring support, or step-by-step procedures aimed at reducing infections at the point of clinical care. Given the dearth of available apps and the lack of functionality with those that are available, there is a need for further development of mobile apps for HAI prevention at the point of care. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Association Between Parental Barriers to Accessing a Usual Source of Care and Children's Receipt of Preventive Services.

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Bellettiere, John; Chuang, Emmeline; Hughes, Suzanne C; Quintanilla, Isaac; Hofstetter, C Richard; Hovell, Melbourne F

Preventive health services are important for child development, and parents play a key role in facilitating access to services. This study examined how parents' reasons for not having a usual source of care were associated with their children's receipt of preventive services. We used pooled data from the 2011-2014 National Health Interview Survey (n = 34 843 participants). Parents' reasons for not having a usual source of care were framed within the Penchansky and Thomas model of access and measured through 3 dichotomous indicators: financial barriers (affordability), attitudes and beliefs about health care (acceptability), and all other nonfinancial barriers (accessibility, accommodation, and availability). We used multivariable logistic regression models to test associations between parental barriers and children's receipt of past-year well-child care visits and influenza vaccinations, controlling for other child, family, and contextual factors. In 2014, 14.3% (weighted percentage) of children had at least 1 parent without a usual source of care. Children of parents without a usual source of care because they "don't need a doctor and/or haven't had any problems" or they "don't like, trust, or believe in doctors" had 35% lower odds of receiving well-child care (adjusted odds ratio = 0.65; 95% CI, 0.56-0.74) and 23% lower odds of receiving influenza vaccination (adjusted odds ratio = 0.77; 95% CI, 0.69-0.86) than children of parents without those attitudes and beliefs about health care. Financial and other nonfinancial parental barriers were not associated with children's receipt of preventive services. Results were independent of several factors relevant to children's access to preventive health care, including whether the child had a usual source of care. Parents' attitudes and beliefs about having a usual source of care were strongly associated with their children's receipt of recommended preventive health services. Rates of receipt of child preventive

Relationship Between Attention-Deficit/Hyperactivity Disorder Care and Medication Continuity.

Science.gov (United States)

Brinkman, William B; Baum, Rebecca; Kelleher, Kelly J; Peugh, James; Gardner, William; Lichtenstein, Phil; Langberg, Joshua; Epstein, Jeffery N

2016-04-01

To describe the relationships between attention-deficit/hyperactivity disorder (ADHD) care practices and subsequent medication use. A retrospective cohort from a random sample of medical records in 50 pediatric practices with 188 providers, including 1,352 children who started ADHD medication, was studied. Independent variables included physician behaviors related to medication titration and monitoring of treatment response. Primary outcomes were number of days covered with ADHD medication during the first year of treatment and time from starting medicine to the first 30-day gap in medication supply. Multilevel modeling and Cox proportional hazards regression models were conducted. Children had an average medication supply of 217 days in the first year. Half experienced a 30-day gap in medication supply in the first 3 months. Nearly three-fourths had a medication adjustment in the first year with the first adjustment usually being a dosage change. The average time to the first medication adjustment was over 3 months. Physician's first contact with parents occurred in the first month of treatment for less than half, with the average time being over 2 months. Little variation related to ADHD care quality was accounted for at the physician level. Early titration and early contact were related to greater medication supply and continuity of treatment. Earlier physician-delivered ADHD care (e.g., contact with parent after starting medication and medication adjustment) is related to greater medication supply and continuity. It remains to be determined whether interventions that improve the quality of titration and monitoring practices for children with ADHD would also improve medication continuity. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Child/Youth Homelessness: housing affordability, early intervention, and preventive care in Australia

OpenAIRE

Shiga, Fumiya

2009-01-01

The purpose of this paper is to explore the child/youth homelessness including its preventive care.This paper explores the housing support program implemented across Australia in brief at first, and then profile child/youth homelessness and housing policy. Based on that, it discusses early intervention and preventive methods followed by the conclusion.

The effectiveness of a skin care program for the prevention of contact dermatitis in health care workers (the Healthy Hands Project): study protocol for a cluster randomized controlled trial.

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Soltanipoor, Maryam; Kezic, Sanja; Sluiter, Judith K; Rustemeyer, Thomas

2017-02-28

Health care workers (HCW) are at high risk for developing occupational hand dermatitis (HD) due to frequent exposure to 'wet work'. Amongst HCWs, nurses are at highest risk, with an estimated point prevalence of HD ranging between 12 and 30%. The burden of disease is high with chronicity, sick leave, risk of unemployment and impaired quality of life. Despite evidence from the medical literature on the risk factors and the importance of skin care in the prevention of HD, in practice, compliance to skin care protocols are below 30%. New preventive strategies are obviously needed. This is a cluster randomized controlled trial, focusing on nurses performing wet work. In total, 20 wards are recruited to include 504 participating nurses in the study at baseline. The wards will be randomized to an intervention or a control group and followed up for 18 months. The intervention consists of the facilitation of creams being available at the wards combined with the continuous electronic monitoring of their consumption with regular feedback on skin care performance in teams of HCWs. Both the intervention and the control group receive basic education on skin protection (as 'care as usual'). Every 6 months, participants of both groups will fill in the questionnaires regarding exposure to wet work and skin protective behavior. Furthermore, skin condition will be assessed and samples of the stratum corneum collected. The effect of the intervention will be measured by comparing the change in Hand Eczema Severity Index (HECSI score) from baseline to 12 months. The Natural Moisturizing Factor (NMF) levels, measured in the stratum corneum as an early biomarker of skin barrier damage, and the total consumption of creams per ward will be assessed as a secondary outcome. This trial will assess the clinical effectiveness of an intervention program to prevent hand dermatitis among health care workers TRIAL REGISTRATION: Netherlands Trial Register (NTR), identification number NTR5564

Translation of clinical practice guidelines for childhood obesity prevention in primary care mobilizes a rural Midwest community.

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Gibson, S Jo

2016-03-01

The purpose of this project was to implement clinic system changes that support evidence-based guidelines for childhood obesity prevention. Adherence rates for prevention and screening of children in a rural Midwest primary care setting were used to measure the success of the program. Retrospective chart reviews reflected gaps in current practice and documentation. An evidence-based toolkit for childhood obesity prevention was used to implement clinic system changes for the identified gaps. The quality improvement approach proved to be effective in translating knowledge of obesity prevention guidelines into rural clinic practices with significant improvements in documentation of prevention measures that may positively impact the childhood obesity epidemic. Primary care providers, including nurse practitioners (NPs), are at the forefront of diagnosing, educating, and counseling children and families on obesity prevention and need appropriate resources and tools to deliver premier care. The program successfully demonstrated how barriers to practice, even with the unique challenges in a rural setting, can be overcome. NPs fulfill a pivotal primary care role and can provide leadership that may positively impact obesity prevention in their communities. ©2015 American Association of Nurse Practitioners.

The future of digital games for HIV prevention and care.

Science.gov (United States)

Hightow-Weidman, Lisa B; Muessig, Kathryn E; Bauermeister, José A; LeGrand, Sara; Fiellin, Lynn E

2017-09-01

Although there has been a significant increase in mHealth interventions addressing the HIV prevention and care continuum, interventions using game mechanics have been less explored. Digital games are rapidly becoming an important tool for improving health behaviors and supporting the delivery of care and education. The purpose of this review is to provide a historical context for the use of gamification and videogames (including those using virtual reality) used in technology-based HIV interventions and to review new research in the field. A review of recently published (1 January 2016-31 March 2017) or presented abstracts (2016) identified a paucity of technology-based interventions that included gamification elements or any terms associated with videogames or gameplay. A larger portfolio of digital gaming interventions is in the pipeline. Use of digital games that include elements of gamification or consist of standalone videogames or virtual-reality-based games, represent a promising intervention strategy to address the HIV prevention and care continuum, especially among youth. Our review demonstrates that there is significant room for growth in this area in designing, developing, testing and most importantly, implementation and dissemination these novel interventions.

Mobile phone messaging for preventive health care.

Science.gov (United States)

Vodopivec-Jamsek, Vlasta; de Jongh, Thyra; Gurol-Urganci, Ipek; Atun, Rifat; Car, Josip

2012-12-12

Preventive health care promotes health and prevents disease or injuries by addressing factors that lead to the onset of a disease, and by detecting latent conditions to reduce or halt their progression. Many risk factors for costly and disabling conditions (such as cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases) can be prevented, yet healthcare systems do not make the best use of their available resources to support this process. Mobile phone messaging applications, such as Short Message Service (SMS) and Multimedia Message Service (MMS), could offer a convenient and cost-effective way to support desirable health behaviours for preventive health care. To assess the effects of mobile phone messaging interventions as a mode of delivery for preventive health care, on health status and health behaviour outcomes. We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2009, Issue 2), MEDLINE (OvidSP) (January 1993 to June 2009), EMBASE (OvidSP) (January 1993 to June 2009), PsycINFO (OvidSP) (January 1993 to June 2009), CINAHL (EbscoHOST) (January 1993 to June 2009), LILACS (January 1993 to June 2009) and African Health Anthology (January 1993 to June 2009).We also reviewed grey literature (including trial registers) and reference lists of articles. We included randomised controlled trials (RCTs), quasi-randomised controlled trials (QRCTs), controlled before-after (CBA) studies, and interrupted time series (ITS) studies with at least three time points before and after the intervention. We included studies using SMS or MMS as a mode of delivery for any type of preventive health care. We only included studies in which it was possible to assess the effects of mobile phone messaging independent of other technologies or interventions. Two review authors independently assessed all studies against the inclusion criteria, with any disagreements resolved by a third review author. Study design features

Strategic prevention of musculoskeletal disorders in elderly care

DEFF Research Database (Denmark)

Seim, Rikke; Edwards, Kasper; Poulsen, Signe

2015-01-01

and the Institute of Medicine 2001). The first three risk factors are prevalent in the health care sector and employees are prone to develop MSDs due to the high level of manual labor e.g. physical handling of patients. The sector work environment council for the social and health care sector (BAR SOSU) has joint...... is a serious and comprehensive work environment problem. It is also recognized as such in the Danish National Work Environment Strategy 2020, where MSD is ranked as one of three main focus areas with the aim of reducing the number of MSD incidents with 20% by the year 2020 (WEA 2020). It is estimated...... forces with researchers at the Department of Management Engineering with the aim of developing a set of tools to strategically prevent MSDs in municipalities. The 98 municipalities in Denmark are the primary provider of elderly care in home and nursing home and we expect to find varied but systematic...

Initiating and continuing behaviour change within a weight gain prevention trial: a qualitative investigation.

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Samantha Kozica

Full Text Available Preventing obesity is an international health priority. In Australia, young women who live in rural communities are at high risk of unhealthy weight gain. Interventions which engage young women and support sustainable behaviour change are needed and comprehensive evaluation of such interventions generates knowledge for population scale-up. This qualitative sub-study aims to identify enablers and barriers to behaviour change initiation and continuation within a community weight gain prevention program.In-depth semi-structured interviews were conducted with program participants 6 months after baseline. All interviews were audio-taped and transcribed verbatim. Transcripts were analysed independently by two investigators via thematic analysis.A total of 28 women with a mean age of 39.9±6.2years and a BMI of 28.6±5.2kg/m2 were purposively recruited from the larger cohort (n = 649 that participated in the prevention trial.Four behaviour change groups emerged were identified from participant interviews: (i no change, (ii relapse, (iii intermittent and (iv continued change. Factors influencing behaviour change initiation and continuation included realistic program expectations and the participant's ability to apply the core program elements including: setting small, achievable behaviour change goals, problem solving and using self-management techniques. Personal knowledge, skills, motivation, self-efficacy, accountability and perceived social and environmental barriers also affected behaviour change. Satisfaction with personal program progress and the perceived amount of program supports required to achieve ongoing behaviour change varied amongst participants. Women who relapsed expressed a desire for more intensive and regular support from health professionals, identified more barriers unrelated to the program, anticipated significant weight loss and had lower satisfaction with their progress.Initiating and continuing behaviour change is a complex

Enhancing the role of private practitioners in tuberculosis prevention and care activities in India

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Tanu Anand

2017-01-01

Full Text Available India accounts for the highest number of incident tuberculosis (TB cases globally. Hence, to impact the TB incidence world over, there is an urgent need to address and accelerate TB control activities in the country. Nearly, half of the TB patients first seek TB care in private sector. However, the participation of private practitioners (PPs has been patchy in TB prevention and care and distrust exists between public and private sector. PPs usually have varied diagnostic and treatment practices that are inadequate and amplify the risk of drug resistance. Hence, their regulation and involvement as key stakeholders are important in TB prevention and care in India if we are to achieve TB control at global level. However, there remain certain barriers and gaps, which are preventing their upscaling. The current paper aims to discuss the status of private sector involvement in TB prevention and care in India. The paper also discusses the strategies and initiatives taken by the government in this regard as evidence shows that the involvement of private sector in co-opting directly observed treatment short-course (DOTS helps to enhance case finding and treatment outcomes; it improves the accessibility of quality TB care with greater geographic coverage. Besides public-private mix, DOTS has been found more cost-effective and reduces financial burden of patients. The paper also offers to present some more solutions both at policy and program level for upscaling the engagement of PPs in the national TB control program.

Effect of continuous versus intermittent turning on nursing and non-nursing care time for acute spinal cord injuries.

Science.gov (United States)

Bugaresti, J M; Tator, C H; Szalai, J P

1991-06-01

The present study was conducted to determine whether automated, continuous turning beds would reduce the nursing care time for spinal cord injured (SCI) patients by freeing hospital staff from manual turning of patients every 2 hours. Seventeen patients were randomly assigned to continuous or intermittent turning and were observed during the 8 hour shift for 1 to 18 days following injury. Trained observers recorded the time taken for patient contact activities performed by the nursing staff (direct nursing care) and other hospital staff. The mean direct nursing care time per dayshift per patient was 130 +/- 22 (mean +/- SD) minutes for 9 patients managed with continuous turning and 115 +/- 41 (mean +/- SD) minutes for 8 patients managed with intermittent turning. The observed difference in care time between the two treatment groups was not significant (p greater than 0.05). Numerous factors including neurological level, time following injury, and medical complications appeared to affect the direct nursing care time. Although continuous turning did not reduce nursing care time it offered major advantages for the treatment of selected cases of acute SCI. Some major advantages of continuous turning treatment were observed. Spinal alignment was easier to maintain during continuous turning in patients with injuries of the cervical spine. Continuous turning allowed radiological procedures on the spine, chest and abdomen to be more easily performed without having to alter the patients' position in bed. Therapy and nursing staff indicated that the continuous turning bed facilitated patient positioning for such activities as chest physiotherapy. With continuous turning, one nurse was sufficient to provide care for an individual SCI patient without having to rely on the assistance of other nurses on the ward for patient turning every 2 hours.

Preventable hospitalization and the role of primary care: a comparison between Italy and Germany.

NARCIS (Netherlands)

Rosano, A.; Peschel, P.; Kugler, J.; Zee, J. van der; Ricciardi, W.; Guasticchi, G.

2010-01-01

Background: Hospitalization may often be prevented by timely and effective outpatient care. For Italy we found that the type and density of primary-care facilities, among other factors, influence admission rates. However, results from Italy may not be valid for other types of health-care systems,

Where do youth in foster care receive information about preventing unplanned pregnancy and sexually transmitted infections?

Science.gov (United States)

Hudson, Angela L

2012-10-01

Adolescents in foster care are at risk for unplanned pregnancy and sexually transmitted infections, including HIV infection. A study using a qualitative method was conducted to describe how and where foster youth receive reproductive health and risk reduction information to prevent pregnancy and sexually transmitted infections. Participants also were asked to describe their relationship with their primary health care provider while they were in foster care. Nineteen young adults, recently emancipated from foster care, participated in individual interviews. Using grounded theory as the method of analysis, three thematic categories were generated: discomfort visiting and disclosing, receiving and not receiving the bare essentials, and learning prevention from community others. Recommendations include primary health care providers providing a confidential space for foster youth to disclose sexual activity and more opportunities for foster youth to receive reproductive and risk prevention information in the school setting. Copyright © 2012 Elsevier Inc. All rights reserved.

Midwifery students׳ experiences of an innovative clinical placement model embedded within midwifery continuity of care in Australia.

Science.gov (United States)

Carter, Amanda G; Wilkes, Elizabeth; Gamble, Jenny; Sidebotham, Mary; Creedy, Debra K

2015-08-01

midwifery continuity of care experiences can provide high quality clinical learning for students but can be challenging to implement. The Rural and Private Midwifery Education Project (RPMEP) is a strategic government funded initiative to (1) grow the midwifery workforce within private midwifery practice and rural midwifery, by (2) better preparing new graduates to work in private midwifery and rural continuity of care models. this study evaluated midwifery students׳ experience of an innovative continuity of care clinical placement model in partnership with private midwifery practice and rural midwifery group practices. a descriptive cohort design was used. All students in the RPMEP were invited to complete an online survey about their experiences of clinical placement within midwifery continuity models of care. Responses were analysed using descriptive statistics. Correlations between total scale scores were examined. Open-ended responses were analysed using content analysis. Internal reliability of the scales was assessed using Cronbach׳s alpha. sixteen out of 17 completed surveys were received (94% response rate). Scales included in the survey demonstrated good internal reliability. The majority of students felt inspired by caseload approaches to care, expressed overall satisfaction with the mentoring received and reported a positive learning environment at their placement site. Some students reported stress related to course expectations and demands in the clinical environment (e.g. skill acquisition and hours required for continuity of care). There were significant correlations between scales on perceptions of caseload care and learning culture (r=.87 pflexible academic programme enabled students to access learning at any time and prioritise continuity of care experiences. Strategies are needed to better support students achieve a satisfactory work-life balance. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Falls prevention among older people and care providers: protocol for an integrative review

OpenAIRE

Cuesta Benjumea, Carmen de la; Henriques, Maria Adriana; Abad Corpa, Eva; Roe, Brenda; Orts-Cortés, María Isabel; Lidón-Cerezuela, Beatriz; Avendaño-Céspedes, Almudena; Oliver-Carbonell, José Luis; Sánchez Ardila, Carmen

2017-01-01

Aim. To review the evidence about the role of care providers in fall prevention in older adults aged ≥ 65 years, this includes their views, strategies, and approaches on falls prevention and effectiveness of nursing interventions. Background. Some fall prevention programmes are successfully implemented and led by nurses and it is acknowledged the vital role they play in developing plans for fall prevention. Nevertheless, there has not been a systematic review of the literature that describes ...

Building laboratory infrastructure to support scale-up of HIV/AIDS treatment, care, and prevention: in-country experience.

Science.gov (United States)

Abimiku, Alash'le G

2009-06-01

An unprecedented influx of funds and support through large programs such as the Global Fund for AIDS, Malaria and Tuberculosis and the World Health Organization's and President's Emergency Plan for AIDS Relief (PEPFAR) has made it possible for more than 1 million persons in resource-limited settings to access AIDS treatment and several million more to be in care and prevention programs. Nevertheless, there remain major challenges that prevent AIDS drugs and care from reaching many more in need, especially in rural settings. The roll-out of a high-quality treatment, care, and prevention program depends on an effective and reliable laboratory infrastructure. This article presents a strategy used by the Institute of Human Virology (IHV)-University of Maryland and its affiliate IHV-Nigeria to establish a multifaceted, integrated tier laboratory program to support a PEPFAR-funded scale-up of its AIDS Care Treatment in Nigeria program, in collaboration with the Centers for Disease Control and Prevention and the Nigerian government, as a possible model for overcoming a key challenge that faces several resource-limited countries trying to roll out and scale-up their HIV/AIDS treatment, care, and prevention program.

Essential competencies in nursing education for prevention and care related to unintended pregnancy.

Science.gov (United States)

Hewitt, Caroline; Cappiello, Joyce

2015-01-01

To identify the essential competencies for prevention and care related to unintended pregnancy to develop program outcomes for nursing curricula. Modified Delphi study. National. Eighty-five nurse experts, including academic faculty and advanced practice nurses providing sexual and reproductive health care in primary or specialty care settings. Expert panelists completed a three-round Delphi study using an electronic survey. Eighty-five panelists completed the first round survey, and 72 panelists completed all three rounds. Twenty-seven items achieved consensus of at least 75% of the experts by the third round to comprise the educational competencies. Through an iterative process, experts in prevention and care related to unintended pregnancy reached consensus on 27 core educational competencies for nursing education. The competencies provide a framework for curricular development in an important area of nursing education. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

The influence of care interventions on the continuity of sleep of intensive care unit patients

Directory of Open Access Journals (Sweden)

Fernanda Luiza Hamze

2015-10-01

Full Text Available Objective: to identify care interventions, performed by the health team, and their influence on the continuity of sleep of patients hospitalized in the Intensive Care Unit.Method: descriptive study with a sample of 12 patients. A filming technique was used for the data collection. The awakenings from sleep were measured using the actigraphy method. The analysis of the data was descriptive, processed using the Statistical Package for the Social Sciences software.Results: 529 care interventions were identified, grouped into 28 different types, of which 12 (42.8% caused awakening from sleep for the patients. A mean of 44.1 interventions/patient/day was observed, with 1.8 interventions/patient/hour. The administration of oral medicine and food were the interventions that caused higher frequencies of awakenings in the patients.Conclusion: it was identified that the health care interventions can harm the sleep of ICU patients. It is recommended that health professionals rethink the planning of interventions according to the individual demand of the patients, with the diversification of schedules and introduction of new practices to improve the quality of sleep of Intensive Care Unit patients.

OECD Health Care Quality Indicator Project. The expert panel on primary care prevention and health promotion

NARCIS (Netherlands)

Marshall, Martin; Klazinga, Niek; Leatherman, Sheila; Hardy, Charlie; Bergmann, Eckhard; Pisco, Luis; Mattke, Soeren; Mainz, Jan

2006-01-01

PURPOSE: This article describes a project undertaken as part of the Organization for Economic Co-operation and Development (OECD)'s Healthcare Quality Indicator (HCQI) Project, which aimed to develop a set of quality indicators representing the domains of primary care, prevention and health

A survey of primary care resident attitudes toward continuity clinic patient handover

Directory of Open Access Journals (Sweden)

Victor O. Kolade

2014-11-01

Full Text Available Background: Transfer of clinic patients from graduating residents to interns or junior residents occurs every year, affecting large numbers of patients. Breaches in care continuity may occur, with potential for risk to patient safety. Several guidelines have been developed for implementing standardized inpatient sign-outs, but no specific guidelines exist for outpatient handover. Methods: Residents in primary care programs – internal medicine, family medicine, and pediatrics – at a US academic medical center were invited to participate in an online survey. The invitation was extended approximately 2 years after electronic medical record (EMR rollout began at the institution. Results: Of 71 eligible residents, 22 (31% responded to the survey. Of these, 18 felt that handover of ambulatory patients was at least moderately important – but only one affirmed the existence of a system for handover. IM residents perceived that they had the highest proportion of high-risk patients (p=0.042; transition-of-care letters were more important to IM residents than other respondents (p=0.041. Conclusion: There is room for improvement in resident acknowledgement of handover processes in continuity clinics. In this study, IM residents attached greater importance to a specific handover tool than other primary care residents. Thus, the different primary care specialties may need to have different handover tools available to them within a shared EMR system.

What are the roles involved in establishing and maintaining informational continuity of care within family practice? A systematic review

Directory of Open Access Journals (Sweden)

Agarwal Gina

2008-12-01

Full Text Available Abstract Background Central to establishing continuity of care is the development of a relationship between doctor and patient/caregiver. Transfer of information between these parties facilitates the development of continuity in general; and specifically informational continuity of care. We conducted a systematic review of published literature to gain a better understanding of the roles that different parties – specifically doctors, patients, family caregivers, and technology – play in establishing and maintaining informational continuity of care within family practice. Methods Relevant published articles were sought from five databases. Accepted articles were reviewed and appraised in a consistent way. Fifty-six articles were retained following title and abstract reviews. Of these, 28 were accepted for this review. Results No articles focused explicitly on the roles involved in establishing or maintaining informational continuity of care within family practice. Most informational continuity of care literature focused on the transfer of information between settings and not at the first point of contact. Numerous roles were, however, were interpreted using the data extracted from reviewed articles. Doctors are responsible for record keeping, knowing patients' histories, recalling accumulated knowledge, and maintaining confidentiality. Patients are responsible for disclosing personal and health details, transferring information to other practitioners (including new family doctors, and establishing trust. Both are responsible for developing a relationship of trust. Technology is an important tool of informational continuity of care through holding important information, providing search functions, and providing a space for recorded information. There is a significant gap in our knowledge about the roles that family caregivers play. Conclusion The number of roles identified and the interrelationships between them indicates that establishing and

The National Expert Standard Pressure Ulcer Prevention in Nursing and pressure ulcer prevalence in German health care facilities: a multilevel analysis.

Science.gov (United States)

Wilborn, Doris; Grittner, Ulrike; Dassen, Theo; Kottner, Jan

2010-12-01

The objective of this study was to describe the relationship between the German National Expert Standard Pressure Ulcer Prevention and the pressure ulcer prevalence in German nursing homes and hospitals. The patient outcome pressure ulcer does not only depend on individual characteristics of patients, but also on institutional factors. In Germany, National Expert Standards are evidence-based instruments that build the basis of continuing improvement in health care quality. It is expected that after having implemented the National Expert Standard Pressure Ulcer Prevention, the number of pressure ulcers should decrease in health care institutions. The analysed data were obtained from two cross-sectional studies from 2004-2005. A multilevel analysis was performed to show the impact of the National Expert Standard Pressure Ulcer Prevention on pressure ulcer prevalence. A total of 41.5% of hospitals and 38.8% of the nursing homes claimed to use the National Expert Standard in the process of developing their local protocols. The overall pressure ulcer prevalence grade 2-4 was 4.7%. Adjusted for hospital departments, survey year and individual characteristics, there was no significant difference in the prevalence of pressure ulcers between institutions that refer to the National Expert Standard or those referring to other sources in developing their local protocols (OR=1.14, 95% CI=0.90-1.44). There was no empirical evidence demonstrating that local protocols of pressure ulcer prevention based on the National Expert Standard were superior to local protocols which refer other sources of knowledge with regard to the pressure ulcer prevalence. The use of the National Expert Standard Pressure Ulcer Prevention can neither be recommended nor be refused. The recent definition of implementation of Expert Standards should be mandatory for all health care institutions which introduce Expert Standards. © 2010 Blackwell Publishing Ltd.

Continued care of uranium mill sites: some economic considerations

International Nuclear Information System (INIS)

Harrington, W.; Sawyer, J.W. Jr.

1978-01-01

A critique of recently enacted legislation authorizing the New Mexico Environmental Improvement Agency to regulate uranium mills in the state is presented. Under this new legislation, the Agency is authorized to require payment of up to 10 cents per pound of yellowcake from each licensed mill in the state until a total of $1 million has been deposited by that mill. The continued care fund thus created will provide for maintenance in perpetuity of mill sites after being decommissioned. Arguments are presented, based on calculations for a typical 5,000 ton per day mill, that even the maximum amount is not likely to generate sufficient income to support an adequate maintenance program. The matter is further aggravated by the rate of inflation which will increase costs beyond the coverage provided by a fixed funding system. To correct this situation, it is proposed that (1) the fund should generate an income stream sufficient to meet all maintenance costs based on currently available information on costs, interest, and inflation rates, and (2) the terms of the continued care contribution should be readily alterable as new information becomes available. The latter condition should be coupled with removal of the upper statutory limit now established for the fund

Development of a Patient Charting System to Teach Family Practice Residents Disease Management and Preventive Care

National Research Council Canada - National Science Library

Dickerman, Joel

1997-01-01

.... Designing notes which 'prompt' residents to gather patient information vital to optimal care can teach residents the concepts of longitudinal care, particularly chronic disease management and preventive care...

Access to Employee Wellness Programs and Use of Preventive Care Services Among U.S. Adults.

Science.gov (United States)

Isehunwa, Oluwaseyi O; Carlton, Erik L; Wang, Yang; Jiang, Yu; Kedia, Satish; Chang, Cyril F; Fijabi, Daniel; Bhuyan, Soumitra S

2017-12-01

There is little research at the national level on access to employee wellness programs and the use of preventive care services. This study examined the use of seven preventive care services among U.S working adults with access to employee wellness programs. The study population comprised 17,699 working adults aged ≥18 years, obtained from the 2015 National Health Interview Survey. Multivariate logistic regression models examined the relationship between access to employee wellness programs and use of seven preventive care services: influenza vaccination, blood pressure check, diabetes check, cholesterol check, Pap smear test, mammogram, and colon cancer screening. Data analysis began in Fall 2016. Overall, 46.6% of working adults reported having access to employee wellness programs in 2015. Working adults with access to employee wellness programs had higher odds of receiving influenza vaccination (OR=1.57, 95% CI=1.43, 1.72, pemployee wellness programs and the use of Pap smear test and colon cancer screening services. Using a nationally representative sample of individuals, this study found a positive association between access to employee wellness programs and the use of preventive care services. The results support favorable policies to encourage implementing wellness programs in all worksites, especially those with employees. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Preventing crime in cooperation with the mental health care profession

NARCIS (Netherlands)

Harte, J.M.

2015-01-01

Although major mental disorders do not have a central position in many criminological theories, there seems to be an evident relationship between these disorders and criminal behavior. In daily practice police officers and mental health care workers work jointly to prevent nuisance and crime and to

The (cost-)effectiveness of preventive, integrated care for community-dwelling frail older people: A systematic review.

Science.gov (United States)

Looman, Wilhelmina Mijntje; Huijsman, Robbert; Fabbricotti, Isabelle Natalina

2018-04-17

Integrated care is increasingly promoted as an effective and cost-effective way to organise care for community-dwelling frail older people with complex problems but the question remains whether high expectations are justified. Our study aims to systematically review the empirical evidence for the effectiveness and cost-effectiveness of preventive, integrated care for community-dwelling frail older people and close attention is paid to the elements and levels of integration of the interventions. We searched nine databases for eligible studies until May 2016 with a comparison group and reporting at least one outcome regarding effectiveness or cost-effectiveness. We identified 2,998 unique records and, after exclusions, selected 46 studies on 29 interventions. We assessed the quality of the included studies with the Effective Practice and Organization of Care risk-of-bias tool. The interventions were described following Rainbow Model of Integrated Care framework by Valentijn. Our systematic review reveals that the majority of the reported outcomes in the studies on preventive, integrated care show no effects. In terms of health outcomes, effectiveness is demonstrated most often for seldom-reported outcomes such as well-being. Outcomes regarding informal caregivers and professionals are rarely considered and negligible. Most promising are the care process outcomes that did improve for preventive, integrated care interventions as compared to usual care. Healthcare utilisation was the most reported outcome but we found mixed results. Evidence for cost-effectiveness is limited. High expectations should be tempered given this limited and fragmented evidence for the effectiveness and cost-effectiveness of preventive, integrated care for frail older people. Future research should focus on unravelling the heterogeneity of frailty and on exploring what outcomes among frail older people may realistically be expected. © 2018 The Authors. Health and Social Care in the Community

The cost-effectiveness of a patient centred pressure ulcer prevention care bundle: Findings from the INTACT cluster randomised trial.

Science.gov (United States)

Whitty, Jennifer A; McInnes, Elizabeth; Bucknall, Tracey; Webster, Joan; Gillespie, Brigid M; Banks, Merrilyn; Thalib, Lukman; Wallis, Marianne; Cumsille, Jose; Roberts, Shelley; Chaboyer, Wendy

2017-10-01

Pressure ulcers are serious, avoidable, costly and common adverse outcomes of healthcare. To evaluate the cost-effectiveness of a patient-centred pressure ulcer prevention care bundle compared to standard care. Cost-effectiveness and cost-benefit analyses of pressure ulcer prevention performed from the health system perspective using data collected alongside a cluster-randomised trial. Eight tertiary hospitals in Australia. Adult patients receiving either a patient-centred pressure ulcer prevention care bundle (n=799) or standard care (n=799). Direct costs related to the intervention and preventative strategies were collected from trial data and supplemented by micro-costing data on patient turning and skin care from a 4-week substudy (n=317). The time horizon for the economic evaluation matched the trial duration, with the endpoint being diagnosis of a new pressure ulcer, hospital discharge/transfer or 28days; whichever occurred first. For the cost-effectiveness analysis, the primary outcome was the incremental costs of prevention per additional hospital acquired pressure ulcer case avoided, estimated using a two-stage cluster-adjusted non-parametric bootstrap method. The cost-benefit analysis estimated net monetary benefit, which considered both the costs of prevention and any difference in length of stay. All costs are reported in AU$(2015). The care bundle cost AU$144.91 (95%CI: $74.96 to $246.08) more per patient than standard care. The largest contributors to cost were clinical nurse time for repositioning and skin inspection. In the cost-effectiveness analysis, the care bundle was estimated to cost an additional $3296 (95%CI: dominant to $144,525) per pressure ulcer avoided. This estimate is highly uncertain. Length of stay was unexpectedly higher in the care bundle group. In a cost-benefit analysis which considered length of stay, the net monetary benefit for the care bundle was estimated to be -$2320 (95%CI -$3900, -$1175) per patient, suggesting the care

Geriatrics and the triple aim: defining preventable hospitalizations in the long-term care population.

Science.gov (United States)

Ouslander, Joseph G; Maslow, Katie

2012-12-01

Reducing preventable hospitalizations is fundamental to the "triple aim" of improving care, improving health, and reducing costs. New federal government initiatives that create strong pressure to reduce such hospitalizations are being or will soon be implemented. These initiatives use quality measures to define which hospitalizations are preventable. Reducing hospitalizations could greatly benefit frail and chronically ill adults and older people who receive long-term care (LTC) because they often experience negative effects of hospitalization, including hospital-acquired conditions, morbidity, and loss of functional abilities. Conversely, reducing hospitalizations could mean that some people will not receive hospital care they need, especially if the selected measures do not adequately define hospitalizations that can be prevented without jeopardizing the person's health and safety. An extensive literature search identified 250 measures of preventable hospitalizations, but the measures have not been validated in the LTC population and generally do not account for comorbidity or the capacity of various LTC settings to provide the required care without hospitalization. Additional efforts are needed to develop measures that accurately differentiate preventable from necessary hospitalizations for the LTC population, are transparent and fair to providers, and minimize the potential for gaming and unintended consequences. As the new initiatives take effect, it is critical to monitor their effect and to develop and disseminate training and resources to support the many community- and institution-based healthcare professionals and emergency department staff involved in decisions about hospitalization for this population. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Changing disease profile and preventive health care in India: Issues of economy, equity and effectiveness

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Salma Kaneez

2015-01-01

Full Text Available The importance of preventive health care practices has increasingly been recognized in the wake of changing disease profile in India. The disease burden has been shifting from communicable to non-communicable diseases as a result of greater focus on achieving competitiveness in a fast globalizing economy. The rapid pace of social and technological changes has led to adverse life style choices resulting in higher incidence of heart diseases, diabetes, obesity, cancer, and deteriorating inter-personal relations and psychological well-being among individuals. Most of these health risks can considerably be reduced through disseminating science-based information on health promotion and disease prevention including exercise, nutrition, smoking and tobacco cessation, immunization, counseling, fostering good habits of health and hygiene, disease screening and preventive medicine. Prior evidences indicate that preventive health interventions can improve health outcomes in a great deal. In a regressive health delivery system of India where major health expenses on curative health is met by out-of-pocket money, preventive health services hold promise to be cost efficient, clinically effective and equity promoting. This article, therefore, examines in depth the issues and prospects of preventive and promotive health care services in realizing optimum health care needs of the people.

The surgical care improvement project and prevention of post-operative infection, including surgical site infection.

Science.gov (United States)

Rosenberger, Laura H; Politano, Amani D; Sawyer, Robert G

2011-06-01

In response to inconsistent compliance with infection prevention measures, the Centers for Medicare & Medicaid Services collaborated with the U.S. Centers for Disease Control and Prevention on the Surgical Infection Prevention (SIP) project, introduced in 2002. Quality improvement measures were developed to standardize processes to increase compliance. In 2006, the Surgical Care Improvement Project (SCIP) developed out of the SIP project and its process measures. These initiatives, published in the Specifications Manual for National Inpatient Quality Measures, outline process and outcome measures. This continually evolving manual is intended to provide standard quality measures to unify documentation and track standards of care. Seven of the SCIP initiatives apply to the peri-operative period: Prophylactic antibiotics should be received within 1 h prior to surgical incision (1), be selected for activity against the most probable antimicrobial contaminants (2), and be discontinued within 24 h after the surgery end-time (3); (4) euglycemia should be maintained, with well-controlled morning blood glucose concentrations on the first two post-operative days, especially in cardiac surgery patients; (6) hair at the surgical site should be removed with clippers or by depilatory methods, not with a blade; (9) urinary catheters are to be removed within the first two post-operative days; and (10) normothermia should be maintained peri-operatively. There is strong evidence that implementation of protocols that standardize practices reduce the risk of surgical infection. The SCIP initiative targets complications that account for a significant portion of preventable morbidity as well as cost. One of the goals of the SCIP guidelines was a 25% reduction in the incidence of surgical site infections from implementation through 2010. Process measures are becoming routine, and as we practice more evidence-based medicine, it falls to us, the surgeons and scientists, to be active

Predictors of change and continuity in home care for dementia patients

NARCIS (Netherlands)

Vernooy-Dassen, M.J.F.J.; Felling, A.J.A.; Persoon, J.M.G.

1997-01-01

Objective. To investigate predictors of change in the sense of competence of primary caregivers and continuity in home care for dementia patients. Design. A prospective longitudinal study with a follow-up period of 10 months. Setting. Dementia patients living in the community selected by Dutch

Continuous glucose and exhaled breath analysis in the Intensive Care Unit

NARCIS (Netherlands)

Leopold, J.H.

2017-01-01

This thesis covers several topics including studies on the accuracy of continuous glucose measurement (CGM) devices in the Intensive Care Unit (ICU). In addition, it is investigated whether an electronic nose (eNose) can be used to predict blood glucose levels in mechanically ventilated ICU

Pediatric Primary Care-Based Obesity Prevention for Parents of Preschool Children: A Pilot Study.

Science.gov (United States)

Sherwood, Nancy E; JaKa, Meghan M; Crain, A Lauren; Martinson, Brian C; Hayes, Marcia G; Anderson, Julie D

2015-12-01

The Healthy Homes/Healthy Kids Preschool (HHHK-Preschool) pilot program is an obesity prevention intervention integrating pediatric care provider counseling and a phone-based program to prevent unhealthy weight gain among 2- to 4-year-old children at risk for obesity (BMI percentile between the 50th and 85th percentile and at least one overweight parent) or currently overweight (85th percentile ≤ BMI pediatric primary care clinics were randomized to: (1) the Busy Bodies/Better Bites Obesity Prevention Arm or the (2) Healthy Tots/Safe Spots safety/injury prevention Contact Control Arm. Baseline and 6-month data were collected, including measured height and weight, accelerometry, previous day dietary recalls, and parent surveys. Intervention process data (e.g., call completion) were also collected. High intervention completion and satisfaction rates were observed. Although a statistically significant time by treatment interaction was not observed for BMI percentile or BMI z-score, post-hoc examination of baseline weight status as a moderator of treatment outcome showed that the Busy Bodies/Better Bites obesity prevention intervention appeared to be effective among children who were in the overweight category at baseline relative to those who were categorized as at risk for obesity (p = 0.04). HHHK-Preschool pilot study results support the feasibility, acceptability, and potential efficacy in already overweight children of a pediatric primary care-based obesity prevention intervention integrating brief provider counseling and parent-targeted phone coaching. What's New: Implementing pediatric primary care-based obesity interventions is challenging. Previous interventions have primarily involved in-person sessions, a barrier to sustained parent involvement. HHHK-preschool pilot study results suggest that integrating brief provider counseling and parent-targeted phone coaching is a promising approach.

Public Health Investment in Team Care: Increasing Access to Clinical Preventive Services in Los Angeles County

Directory of Open Access Journals (Sweden)

Tony Kuo

2018-02-01

Full Text Available As part of federal and local efforts to increase access to high quality, clinical preventive services (CPS in underserved populations, the Los Angeles County Department of Public Health (DPH partnered with six local health system and community organization partners to promote the use of team care for CPS delivery. Although these partners were at different stages of organizational capacity, post-program review suggests that each organization advanced team care in their clinical or community environments, potentially affecting >250,000 client visits per year. Despite existing infrastructure and DPH’s funding support of CPS integration, partner efforts faced several challenges. They included lack of sustainable funding for prevention services; limited access to community resources that support disease prevention; and difficulties in changing health-care provider behavior. Although team care can serve as a catalyst or vehicle for delivering CPS, downstream sustainability of this model of practice requires further state and national policy changes that prioritize prevention. Public health is well positioned to facilitate these policy discussions and to assist health system and community organizations in strengthening CPS integration.

Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers

National Research Council Canada - National Science Library

1998-01-01

.... OSHA s new violence prevention guidelines provide the agency s recommendations for reducing workplace violence developed following a careful review of workplace violence studies, public and private...

The Preventable Admissions Care Team (PACT): A Social Work-Led Model of Transitional Care.

Science.gov (United States)

Basso Lipani, Maria; Holster, Kathleen; Bussey, Sarah

2015-10-01

In 2010, the Preventable Admissions Care Team (PACT), a social work-led transitional care model, was developed at Mount Sinai to reduce 30-day readmissions among high-risk patients. PACT begins with a comprehensive bedside assessment to identify the psychosocial drivers of readmission. In partnership with the patient and family, a patient-centered action plan is developed and carried out through phone calls, accompaniments, navigations and home visits, as needed, in the first 30 days following discharge. 620 patients were enrolled during the pilot from September 2010-August 2012. Outcomes demonstrated a 43% reduction in inpatient utilization and a 54% reduction in emergency department visits among enrollees. In addition, 93% of patients had a follow-up appointment within 7-10 days of discharge and 90% of patients attended the appointment. The success of PACT has led to additional funding from the Centers for Medicare and Medicaid Services under the Community-based Care Transitions Program and several managed care companies seeking population health management interventions for high risk members.

Social network approaches to recruitment, HIV prevention, medical care, and medication adherence.

Science.gov (United States)

Latkin, Carl A; Davey-Rothwell, Melissa A; Knowlton, Amy R; Alexander, Kamila A; Williams, Chyvette T; Boodram, Basmattee

2013-06-01

This article reviews the current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates, treatment access, and outcomes. Social network analysis is a valuable tool to link social structural factors to individual behaviors. Social networks provide an avenue for low-cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, optimizing HIV medical care, and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics.

Gender Differentials in Preventive Health Care: Incidences and Determinants among Pakistani Children

Directory of Open Access Journals (Sweden)

Faham Masud

2012-12-01

Full Text Available In this study, an attempt has been made to estimate gender health differential with a focus on preventive health care. Using the Pakistan Demographic Health Survey (PDHS of 2006-07, the study has targeted the children of age 12-23 months and found substantialsex differences in the immunization status of children where boys are more immunized than girls, reflecting gender biasness over preventive health provision. Through bi-variate and multi-variate analysis, the study found that a variety of factors, including individual,socio-demographic and economic factors are causing this dilemma. Mother’s characteristics including age, literacy and headship of the household significantly affect the immunization status of the children. Similarly, the socio-economic status of thehousehold including income, household size, structure and gender of the head of the households are also the key determinants of preventive health care differentials. Across the provinces, the variation of coverage and discrimination is also evident with morecoverage in Punjab and least in Baluchistan.

Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update

Science.gov (United States)

Anderson, Deverick J.; Podgorny, Kelly; Berríos-Torres, Sandra I.; Bratzler, Dale W.; Dellinger, E. Patchen; Greene, Linda; Nyquist, Ann-Christine; Saiman, Lisa; Yokoe, Deborah S.; Maragakis, Lisa L.; Kaye, Keith S.

2014-01-01

PURPOSE Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their surgical site infection (SSI) prevention efforts. This document updates “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals,”1 published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.2 PMID:24799638

Cost assessment of a new oral care program in the intensive care unit to prevent ventilator-associated pneumonia.

Science.gov (United States)

Ory, Jérôme; Mourgues, Charline; Raybaud, Evelyne; Chabanne, Russell; Jourdy, Jean Christophe; Belard, Fabien; Guérin, Renaud; Cosserant, Bernard; Faure, Jean Sébastien; Calvet, Laure; Pereira, Bruno; Guelon, Dominique; Traore, Ousmane; Gerbaud, Laurent

2018-06-01

Ventilator-associated pneumonia (VAP) is the most frequent hospital-acquired infections in intensive care units (ICU). In the bundle of care to prevent the VAP, the oral care is very important strategies, to decrease the oropharyngeal bacterial colonization and presence of causative bacteria of VAP. In view of the paucity of medical economics studies, our objective was to determine the cost of implementing this oral care program for preventing VAP. In five ICUs, during period 1, caregivers used a foam stick for oral care and, during period 2, a stick and tooth brushing with aspiration. Budgetary effect of the new program from the hospital's point of view was analyzed for both periods. The costs avoided were calculated from the incidence density of VAP (cases per 1000 days of intubation). The cost study included device cost, benefit lost, and ICU cost (medication, employer and employee contributions, blood sample analysis…). A total of 2030 intubated patients admitted to the ICUs benefited from oral care. The cost of implementing the study protocol was estimated to be €11,500 per year. VAP rates decreased significantly between the two periods (p1 = 12.8% and p2 = 8.5%, p = 0.002). The VAP revenue was ranged from €28,000 to €45,000 and the average cost from €39,906 to €42,332. The total cost assessment calculated was thus around €1.9 million in favor of the new oral care program. Our study showed that the implementation of a simple strategy improved the quality of patient care is economically viable. NCT02400294.

Continuity in care of older people chronically ill patients in a battlefield of competing rationales

DEFF Research Database (Denmark)

Kjerholt, Mette; Wagner, Lis; Delmar, Charlotte

2014-01-01

professionals' communication concerning older patients, leading to lack of continuity and integration of the patient perspective in care and treatment. In spite of these problems being well investigated, they continue to prevail. OBJECTIVES: To examine conditions for continuity and integration of the patient...... perspective in older, chronically ill patients' care as reflected in nursing staff's communication about the patients. DESIGN: Explorative Participatory Action Research (PAR). SETTING: An acute, general medical ward at a Danish university hospital. PARTICIPANTS: Hospital and municipality nurses (n = 29......). Nursing records (n = 12). METHOD: Field studies: observations, interviews, nursing records audits and logs. Data were subject to manifest and latent content analysis. RESULTS: Participants were aware of the importance of ensuring continuity, a comprehensive approach and integration of the patient...

Continuing professional development for volunteers working in palliative care in a tertiary care cancer institute in India: A cross-sectional observational study of educational needs

Directory of Open Access Journals (Sweden)

Jayita Kedar Deodhar

2015-01-01

Full Text Available Context: Training programs for volunteers prior to their working in palliative care are well-established in India. However, few studies report on continuing professional development programs for this group. Aims: To conduct a preliminary assessment of educational needs of volunteers working in palliative care for developing a structured formal continuing professional development program for this group. Settings and Design: Cross-sectional observational study conducted in the Department of Palliative Medicine of a tertiary care cancer institute in India. Materials and Methods: Participant volunteers completed a questionnaire, noting previous training, years of experience, and a comprehensive list of topics for inclusion in this program, rated in order of importance according to them. Statistical Analysis Used: Descriptive statistics for overall data and Chi-square tests for categorical variables for group comparisons were applied using Statistical Package for Social Sciences version 18. Results: Fourteen out of 17 volunteers completed the questionnaire, seven having 5-10-years experience in working in palliative care. A need for continuing professional development program was felt by all participants. Communication skills, more for children and elderly specific issues were given highest priority. Spiritual-existential aspects and self-care were rated lower in importance than psychological, physical, and social aspects in palliative care. More experienced volunteers (>5 years of experience felt the need for self-care as a topic in the program than those with less (<5-years experience ( P < 0.05. Conclusions: Understanding palliative care volunteers′ educational needs is essential for developing a structured formal continuing professional development program and should include self-care as a significant component.

Behavioral counseling to prevent childhood obesity – study protocol of a pragmatic trial in maternity and child health care

Directory of Open Access Journals (Sweden)

Mustila Taina

2012-07-01

Full Text Available Abstract Background Prevention is considered effective in combating the obesity epidemic. Prenatal environment may increase offspring's risk for obesity. A child starts to adopt food preferences and other behavioral habits affecting weight gain during preschool years. We report the study protocol of a pragmatic lifestyle intervention aiming at primary prevention of childhood obesity. Methods/Design A non-randomized controlled pragmatic trial in maternity and child health care clinics. The control group was recruited among families who visited the same clinics one year earlier. Eligibility criteria was mother at risk for gestational diabetes: body mass index ≥ 25 kg/m2, macrosomic newborn in any previous pregnancy, immediate family history of diabetes and/or age ≥ 40 years. All maternity clinics in town involved in recruitment. The gestational intervention consisted of individual counseling on diet and physical activity by a public health nurse, and of two group counseling sessions. Intervention continues until offspring’s age of five years. An option to participate a group counseling at child’s age 1 to 2 years was offered. The intervention includes advice on healthy diet, physical activity, sedentary behavior and sleeping pattern. The main outcome measure is offspring BMI z-score and its changes by the age of six years. Discussion Early childhood is a critical time period for prevention of obesity. Pragmatic trials targeting this period are necessary in order to find effective obesity prevention programs feasible in normal health care practice. Trial registration Clinical Trials gov NCT00970710

Continuity of care: what matters to women when they are referred from primary to secondary care during labour? a qualitative interview study in the Netherlands.

Science.gov (United States)

de Jonge, Ank; Stuijt, Rosan; Eijke, Iva; Westerman, Marjan J

2014-03-17

Continuity of care during labour is important for women. Women with an intrapartum referral from primary to secondary care look back more negatively on their birh experience compared to those who are not referred. It is not clear which aspects of care contribute to this negative birth experience. This study aimed to explore in-depth the experiences of women who were referred during labour from primary to secondary care with regard to the different aspects of continuity of care. A qualitative interview study was conducted in the Netherlands among women who were in primary care at the onset of labour and were referred to secondary care before the baby was born. Through purposive sampling 27 women were selected. Of these, nine women planned their birth at home, two in an alongside midwifery unit and 16 in hospital. Thematic analysis was used. Continuity of care was a very important issue for women because it contributed to their feeling of safety during labour. Important details were sometimes not handed over between professionals within and between primary and secondary care, in particular about women's personal preferences. In case of referral of care from primary to secondary care, it was important for women that midwives handed over the care in person and stayed until they felt safe with the hospital team. Personal continuity of care, in which case the midwife stayed until the end of labour, was highly appreciated but not always expected.Fear of transportion during or after labour was a reason for women to choose hospital birth but also to opt for home birth. Choice of place of birth emerged as a fluid concept; most women planned their place of birth during pregnancy and were aware that they would spend some time at home and possibly some time in hospital. In case of referral from primary to secondary care during labour, midwives should hand over their care in person and preferrably stay with women throughout labour. Planned place of birth should be regarded as a

Medicare annual preventive care visits: use increased among fee-for-service patients, but many do not participate.

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Chung, Sukyung; Lesser, Lenard I; Lauderdale, Diane S; Johns, Nicole E; Palaniappan, Latha P; Luft, Harold S

2015-01-01

Under the Affordable Care Act (ACA), Medicare coverage expanded in 2011 to fully cover annual preventive care visits. We assessed the impact of coverage expansion, using 2007-13 data from primary care patients of Medicare-eligible age at the Palo Alto Medical Foundation (204,388 patient-years), which serves people in four counties near San Francisco, California. We compared trends in preventive visits and recommended preventive services among Medicare fee-for-service and Medicare health maintenance organization (HMO) patients as well as non-Medicare patients ages 65-75 who were covered by private fee-for-service and private HMO plans. Among Medicare fee-for-service patients, the annual use of preventive visits rose from 1.4 percent before the implementation of the ACA to 27.5 percent afterward. This increase was significantly larger than was seen for patients in the other insurance groups. Nevertheless, rates of annual preventive care visit use among Medicare fee-for-service patients remained 10-20 percentage points lower than was the case for people with private coverage (43-44 percent) or those in a Medicare HMO (53 percent). ACA policy changes led to increased preventive service use by Medicare fee-for-service beneficiaries, which suggests that Medicare coverage expansion is an effective way to increase seniors' use of preventive services. Project HOPE—The People-to-People Health Foundation, Inc.

Preventive youth health care in 11 European countries: An exploratory analysis

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Wieske, R.C.N.; Nijnuis, M.G.; Carmiggelt, B.C.; Wagenaar-Fischer, M.M.; Boere-Boonekamp, M.M.

2012-01-01

Objective To systematically identify similarities and differences in the way preventive youth health care (YHC) is organized in 11 European countries. Method Questionnaire survey to EUSUHM (European Union for School and University Health and Medicine) representatives. Results The greatest

The Zero Suicide Model: Applying Evidence-Based Suicide Prevention Practices to Clinical Care

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Beth S. Brodsky

2018-02-01

Full Text Available Suicide is reaching epidemic proportions, with over 44,000 deaths by suicide in the US, and 800,000 worldwide in 2015. This, despite research and development of evidence-based interventions that target suicidal behavior directly. Suicide prevention efforts need a comprehensive approach, and research must lead to effective implementation across public and mental health systems. A 10-year systematic review of evidence-based findings in suicide prevention summarized the areas necessary for translating research into practice. These include risk assessment, means restriction, evidence-based treatments, population screening combined with chain of care, monitoring, and follow-up. In this article, we review how suicide prevention research informs implementation in clinical settings where those most at risk present for care. Evidence-based and best practices address the fluctuating nature of suicide risk, which requires ongoing risk assessment, direct intervention and monitoring. In the US, the National Action Alliance for Suicide Prevention has put forth the Zero Suicide (ZS Model, a framework to coordinate a multilevel approach to implementing evidence-based practices. We present the Assess, Intervene and Monitor for Suicide Prevention model (AIM-SP as a guide for implementation of ZS evidence-based and best practices in clinical settings. Ten basic steps for clinical management model will be described and illustrated through case vignette. These steps are designed to be easily incorporated into standard clinical practice to enhance suicide risk assessment, brief interventions to increase safety and teach coping strategies and to improve ongoing contact and monitoring of high-risk individuals during transitions in care and high risk periods.

A cross-sectional survey of the prevalence of environmental tobacco smoke preventive care provision by child health services in Australia

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Daly Justine B

2011-05-01

Full Text Available Abstract Background Despite the need for a reduction in levels of childhood exposure to environmental tobacco smoke (ETS being a recognised public health goal, the delivery of ETS preventive care in child health service settings remains a largely unstudied area. The purpose of this study was to determine the prevalence of ETS preventive care in child health services; differences in the provision of care by type of service; the prevalence of strategies to support such care; and the association between care support strategies and care provision. Method One-hundred and fifty-one (83% child health service managers within New South Wales, Australia completed a questionnaire in 2002 regarding the: assessment of parental smoking and child ETS exposure; the provision of parental smoking cessation and ETS-exposure reduction advice; and strategies used to support the provision of such care. Child health services were categorised based on their size and case-mix, and a chi-square analysis was performed to compare the prevalence of ETS risk assessment and ETS prevention advice between service types. Logistic regression analysis was used to examine associations between the existence of care support strategies and the provision of ETS risk assessment and ETS exposure prevention advice. Results A significant proportion of services reported that they did not assess parental smoking status (26%, and reported that they did not assess the ETS exposure (78% of any child. Forty four percent of services reported that they did not provide smoking cessation advice and 20% reported they did not provide ETS exposure prevention advice. Community based child and family health services reported a greater prevalence of ETS preventive care compared to other hospital based units. Less than half of the services reported having strategies to support the provision of ETS preventive care. The existence of such support strategies was associated with greater odds of care provision

The mentoring experiences of new graduate midwives working in midwifery continuity of care models in Australia.

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Cummins, Allison M; Denney-Wilson, E; Homer, C S E

2017-05-01

The aim of this paper was to explore the mentoring experiences of new graduate midwives working in midwifery continuity of care models in Australia. Most new graduates find employment in hospitals and undertake a new graduate program rotating through different wards. A limited number of new graduate midwives were found to be working in midwifery continuity of care. The new graduate midwives in this study were mentored by more experienced midwives. Mentoring in midwifery has been described as being concerned with confidence building based through a personal relationship. A qualitative descriptive study was undertaken and the data were analysed using continuity of care as a framework. We found having a mentor was important, knowing the mentor made it easier for the new graduate to call their mentor at any time. The new graduate midwives had respect for their mentors and the support helped build their confidence in transitioning from student to midwife. With the expansion of midwifery continuity of care models in Australia mentoring should be provided for transition midwives working in this way. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

Risks for depression onset in primary care elderly patients: potential targets for preventive interventions.

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Lyness, Jeffrey M; Yu, Qin; Tang, Wan; Tu, Xin; Conwell, Yeates

2009-12-01

Prevention of late-life depression, a common, disabling condition with often poor outcomes in primary care, requires identification of seniors at highest risk of incident episodes. The authors examined a broad range of clinical, functional, and psychosocial predictors of incident depressive episodes in a well-characterized cohort of older primary care patients. In this observational cohort study, patients age >/=65 years without current major depression, recruited from practices in general internal medicine, geriatrics, and family medicine, received annual follow-up assessments over a period of 1 to 4 years. Of 617 enrolled subjects, 405 completed the 1-year follow-up evaluation. The Structured Clinical Interview for DSM-IV (SCID) determined incident major depressive episodes. Each risk indicator's predictive utility was examined by calculating the risk exposure rate, incident risk ratio, and population attributable fraction, leading to determination of the number needed to treat in order to prevent incident depression. A combination of risks, including minor or subsyndromal depression, impaired functional status, and history of major or minor depression, identified a group in which fully effective treatment of five individuals would prevent one new case of incident depression. Indicators routinely assessed in primary care identified a group at very high risk for onset of major depressive episodes. Such markers may inform current clinical care by fostering the early detection and intervention critical to improving patient outcomes and may serve as the basis for future studies refining the recommendations for screening and determining the effectiveness of preventive interventions.

Evidence of effectiveness of preventive dental care in reducing dental treatment use and related expenditures.

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Pourat, Nadereh; Choi, Moonkyung Kate; Chen, Xiao

2018-02-06

Preventive dental health services are intended to reduce the likelihood of development of tooth decay and the need for more intensive treatment overtime. The evidence on the effectiveness of preventive dental care in reducing treatment services and expenditures is lagging for adults, particularly those with lower incomes and chronic conditions. We assessed the impact of preventive dental services on dental treatment service use and expenditures overall and by category of service. We calculated the annual numbers of preventive (periodic diagnostic and prophylactic procedures) and treatment (restorative, surgery, prosthodontic, endodontic, and periodontic) services per beneficiary using Medicaid enrollment and claims data for beneficiaries with three categories of conditions (diabetes, heart disease, and respiratory disease) from 10 largest California counties. We used Cragg hurdle exponential regression models controlling for past service use, demographics, length of enrollment, and county. We found that using preventive services in 2005-2007 was associated with higher likelihood and number of treatment dental services used, but associated with lower treatment expenditures in 2008. The reduction in expenditures was noted only in restorative, prosthodontics, and periodontic services. The findings provide much needed evidence of the contribution of preventive dental care in maintaining oral health of low-income adults with chronic conditions and potential for savings to the Medicaid program. Providing lower cost preventive dental care to the individuals with chronic conditions would achieve better oral health and lower treatment expenditures. © 2018 American Association of Public Health Dentistry.

Effectiveness of an intervention in increasing the provision of preventive care by community mental health services: a non-randomized, multiple baseline implementation trial.

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Bartlem, Kate M; Bowman, Jenny; Freund, Megan; Wye, Paula M; Barker, Daniel; McElwaine, Kathleen M; Wolfenden, Luke; Campbell, Elizabeth M; McElduff, Patrick; Gillham, Karen; Wiggers, John

2016-04-02

Relative to the general population, people with a mental illness are more likely to have modifiable chronic disease health risk behaviours. Care to reduce such risks is not routinely provided by community mental health clinicians. This study aimed to determine the effectiveness of an intervention in increasing the provision of preventive care by such clinicians addressing four chronic disease risk behaviours. A multiple baseline trial was undertaken in two groups of community mental health services in New South Wales, Australia (2011-2014). A 12-month practice change intervention was sequentially implemented in each group. Outcome data were collected continuously via telephone interviews with a random sample of clients over a 3-year period, from 6 months pre-intervention in the first group, to 6 months post intervention in the second group. Outcomes were client-reported receipt of assessment, advice and referral for tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption and inadequate physical activity and for the four behaviours combined. Logistic regression analyses examined change in client-reported receipt of care. There was an increase in assessment for all risks combined following the intervention (18 to 29 %; OR 3.55, p = 0.002: n = 805 at baseline, 982 at follow-up). No significant change in assessment, advice or referral for each individual risk was found. The intervention had a limited effect on increasing the provision of preventive care. Further research is required to determine how to increase the provision of preventive care in community mental health services. Australian and New Zealand Clinical Trials Registry ACTRN12613000693729.

Long-Term Outcomes for the Promoting CARE Suicide Prevention Program

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Hooven, Carole; Herting, Jerald R.; Snedker, Karen A.

2010-01-01

Objectives: To provide a long-term look at suicide risk from adolescence to young adulthood for former participants in Promoting CARE, an indicated suicide prevention program. Methods: Five hundred ninety-three suicide-vulnerable high school youth were involved in a long-term follow-up study. Latent class growth models identify patterns of change…

Electronic Immunization Alerts and Spillover Effects on Other Preventive Care.

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Kim, Julia M; Rivera, Maria; Persing, Nichole; Bundy, David G; Psoter, Kevin J; Ghazarian, Sharon R; Miller, Marlene R; Solomon, Barry S

2017-08-01

The impact of electronic health record (EHR) immunization clinical alert systems on the delivery of other preventive services remains unknown. We assessed for spillover effects of an EHR immunization alert on delivery of 6 other preventive services, in children 18 to 30 months of age needing immunizations. We conducted a secondary data analysis, with additional primary data collection, of a randomized, historically controlled trial to improve immunization rates with EHR alerts, in an urban, primary care clinic. No significant differences were found in screening for anemia, lead, development, nutrition, and injury prevention counseling in children prompting EHR immunization alerts (n = 129), compared with controls (n = 135). Significant increases in oral health screening in patients prompting EHR alerts (odds ratio = 4.8, 95% CI = 1.8-13.0) were likely due to practice changes over time. An EHR clinical alert system targeting immunizations did not have a spillover effect on the delivery of other preventive services.

[A population-targeted approach to connect prevention, care and welfare: visualising the trend].

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Lemmens, L C; Drewes, H W; Lette, M; Baan, C A

2017-01-01

To map initiatives in the Netherlands using a population-targeted approach to link prevention, care and welfare. Descriptive investigation, based on conversations and structured interviews. We searched for initiatives in which providers in the areas of prevention, care and welfare together with health insurers and/or local authorities attempted to provide the 'triple aim': improving the health of the population and the quality of care, and managing costs. We found potential initiatives on the basis of interviews with key figures, project databases and congress programmes. We looked for additional information on websites and via contact persons to gather additional information to determine whether the initiative met the inclusion criteria. An initiative should link prevention, care and welfare with a minimum of three players actively pursuing a population-targeted goal through multiple interventions for a non-disease specific and district-transcending population. We described the goal, organisational structure, parties involved, activities and funding on the basis of interviews conducted in the period August-December 2015 with the managers of the initiatives included. We found 19 initiatives which met the criteria where there was experimentation with organisational forms, levels of participation, interventions and funding. It was noticeable that the interventions mostly concerned medical care. There was a lack of insight into the 'triple aim', mostly because data exchange between parties is generally difficult. There is an increasing number of initiatives that follow a population-targeted approach. Although the different parties strive to connect the three domains, they are still searching for an optimal collaboration, organisational form, data exchange and financing.

Pathways to Preventing Substance Use Among Youth in Foster Care.

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Kim, Hyoun K; Buchanan, Rohanna; Price, Joseph M

2017-07-01

Substance use problems are highly prevalent among youth in foster care. Such problems in adolescence have long-lasting implications for subsequent adjustment throughout adulthood and even across generations. Although several programs have demonstrated positive results in reducing substance use in at-risk youth, few studies have systemically examined how such programs work for foster youth and whether they are effective for both genders. This study examined the efficacy of KEEP SAFE, a family-based and skill-focused program designed to prevent substance use and other related health risking behaviors among youth in foster care. We hypothesized that improving the caregiver-youth relationship would lead to later reductions in youths' involvement with deviant peers, which subsequently would lead to less substance use, and that this mechanism would work comparably for both genders. A sample of 259 youth (154 girls, ages 11-17 years) in foster care and their caregivers participated in a randomized controlled trial and was followed for 18 months post-baseline. Results indicated that the intervention significantly reduced substance use in foster youth at 18 months post-baseline and that the intervention influenced substance use through two processes: youths' improved quality of relationships with caregivers at 6 months post-baseline and fewer associations with deviant peers at 12 months post-baseline. This suggests that these two processes may be fruitful immediate targets in substance use prevention programs for foster youth. We also found little gender differences in direct and mediating effects of the intervention, suggesting KEEP SAFE may be effective for both genders in foster care.

Strategies for the prevention of hospital-acquired infections in the neonatal intensive care unit.

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Borghesi, A; Stronati, M

2008-04-01

Nosocomial infections are among the leading causes of mortality and morbidity in neonatal intensive care units. Prevention of healthcare-associated infections is based on strategies that aim to limit susceptibility to infections by enhancing host defences, interrupting transmission of organisms by healthcare workers and by promoting the judicious use of antimicrobials. Several strategies are available and include: hand hygiene practices; prevention of central venous catheter-related bloodstream infections; judicious use of antimicrobials for therapy and prophylaxis; enhancement of host defences; skin care; and early enteral feeding with human milk.

Guidelines for the preventive health care of hairdressing apprentices

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Aleksandra Golińska-Zach

2017-10-01

Full Text Available Hairdressing is one of the most developing branch of the service industry in Poland. Providing representatives of this occupational group with preventive health care services it should be remembered that they are at risk of skin and respiratory diseases, which occur due to a quite frequent exposure to harmful agents in the work environment of hairdressers and hairdressing apprentices. Interestingly, a much lower number of researches concentrate on respiratory symptoms than on skin disorders in hairdressers. The authors of this article have carried out the first Polish follow-up study focused not only on skin disorders but also on respiratory tract symptoms in hairdressing apprentices. The results of the study have been reported in other publications while this paper presents a literature review based on EBSCO and PubMed databases, Elsevier and contained articles (on the subject discussed in this paper. On the basis of information obtained from the authors’ own research evidence and from the literature review, the guidelines for the preventive health care of hairdressing apprentices were developed. It was confirmed that neither determination of allergen-specific immunoglobulin E (IgE nor performance of skin prick tests (SPTs and patch tests for hairdressing factors are necessary. They should be performed as a part of preventive medical examination only in those apprentice candidates and trainees in this profession who report work-related symptoms and it is suspected that they result from exposure to particular factor in the work environment. Med Pr 2017;68(5:677–687

Implementation of pressure ulcer prevention best practice recommendations in acute care: an observational study.

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Barker, Anna Lucia; Kamar, Jeannette; Tyndall, Tamara Jane; White, Lyn; Hutchinson, Anastasia; Klopfer, Nicole; Weller, Carolina

2013-06-01

Pressure ulcers are a common but preventable problem in hospitals. Implementation of best practice guideline recommendations can prevent ulcers from occurring. This 9-year cohort study reports prevalence data from point prevalence surveys during the observation period, and three practice metrics to assess implementation of best practice guideline recommendations: (i) nurse compliance with use of a validated pressure ulcer risk assessment and intervention checklist; (ii) accuracy of risk assessment scoring in usual-care nurses and experienced injury prevention nurses; and (iii) use of pressure ulcer prevention strategies. The prevalence of hospital-acquired pressure ulcers decreased following implementation of an evidence-based prevention programme from 12·6% (2 years preprogramme implementation) to 2·6% (6 years postprogramme implementation) (P pressure ulcer prevention documentation according to best practice guidelines was high (>84%). A sample of 270 patients formed the sample for the study of risk assessment scoring accuracy and use of prevention strategies. It was found usual-care nurses under-estimated patients' risk of pressure ulcer development and under-utilised prevention strategies compared with experienced injury prevention nurses. Despite a significant reduction in prevalence of hospital-acquired pressure ulcers and high documentation compliance, use of prevention strategies could further be improved to achieve better patient outcomes. Barriers to the use of prevention strategies by nurses in the acute hospital setting require further examination. This study provides important insights into the knowledge translation of pressure ulcer prevention best practice guideline recommendations at The Northern Hospital. © 2012 The Authors. International Wound Journal © 2012 John Wiley & Sons Ltd and Medicalhelplines.com Inc.

Takotsubo Cardiomyopathy in Intensive Care Unit: Prevention, Diagnosis and Management

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Hannah Masoud

2016-01-01

Full Text Available Accurate diagnosis of Takotsubo Cardiomyopathy has substantial prognostic implications in an intensive care unit, given its increased mortality risk and association with life-threatening complications. This report seeks to discuss diagnostic modalities that can be useful in accurately differentiating Takotsubo Cardiomyopathy from Acute Coronary Syndrome, and also briefly discuss prevention and management of this cardiomyopathy in an intensive care unit. For critically ill Takotsubo patients, intensive clinicians can consider establishment of diagnosis by specific electrocardiograph changes, distinctive marked release of cardiac enzymes, characteristic echocardiograph findings, as well as invasive coronary angiography or noninvasive cardiac magnetic imaging.

Compliance with the standards for prevention of ventilator-associated pneumonia by nurses in the intensive care units

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Saiede Masomeh Tabaeian

2017-01-01

Full Text Available Introduction: Ventilator-associated pneumonia (VAP is the most common infection in the intensive care unit, and has many side effects such as increased mortality, increased length of hospital stay, and increased health costs. This study aimed to evaluate the compliance with the standards for prevention of VAP by nurses in the intensive care units. Materials and Methods: In this descriptive cross-sectional study, 120 nurses in 11 intensive care units of hospitals affiliated to Isfahan university of Medical Sciences, Iran, were assessed for 4 months from July to October 2014. The implementation of all measures for the prevention of VAP was investigated through observation and using a checklist. Results: The mean compliance with the standards for the prevention of VAP in the intensive care unit by the nurses was 56.32%; analysis of variance test showed significant difference between the hospitals (P < 0.001. Disposable ventilator circuit was performed for all patients; however, reviewing the patient readiness for separation from the ventilator was not conducted on a daily basis. Conclusions: Compliance with the standards for the prevention of VAP in the intensive care units was relatively acceptable; however, it still requires serious attention by the officials with training and sensitization of nurses in implementing preventive measures, especially through the provision of clinical guidelines and related protocols.

Business model innovation for value and technology based preventive health care

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Linner, T.; Solcanu, G.; van den Boom, C.B.; Lingegard, H.; Istamto, T.; Proctor, G.M.; Lu, Y.; Steenbakkers, J.J.H.

2017-01-01

In this paper, a structured approach for the development of an initial business strategy blueprint for a complicated, multi-partner, multidisciplinary, early-stage research project focusing on valuebased and preventive health care technology, is presented. Based on an in-depth analysis of the

Current prevention and control of health care-associated infections in long-term care facilities for the elderly in Japan.

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Kariya, Naoko; Sakon, Naomi; Komano, Jun; Tomono, Kazunori; Iso, Hiroyasu

2018-05-01

Residents of long-term care facilities for the elderly are vulnerable to health care-associated infections. However, compared to medical institutions, long-term care facilities for the elderly lag behind in health care-associated infection control and prevention. We conducted a epidemiologic study to clarify the current status of infection control in long-term care facilities for the elderly in Japan. A questionnaire survey on the aspects of infection prevention and control was developed according to SHEA/APIC guidelines and was distributed to 617 long-term care facilities for the elderly in the province of Osaka during November 2016 and January 2017. The response rate was 16.9%. The incidence rates of health care-associated infection outbreaks and residents with health care-associated infections were 23.4 per 100 facility-years and 0.18 per 1,000 resident-days, respectively. Influenza and acute gastroenteritis were reported most frequently. Active surveillance to identify the carrier of multiple drug-resistant organisms was not common. The overall compliance with 21 items selected from the SHEA/APIC guidelines was approximately 79.2%. All facilities had infection control manuals and an assigned infection control professional. The economic burdens of infection control were approximately US$ 182.6 per resident-year during fiscal year 2015. Importantly, these data implied that physicians and nurses were actively contributed to higher SHEA/APIC guideline compliance rates and the advancement of infection control measures in long-term care facilities for the elderly. Key factors are discussed to further improve the infection control in long-term care facilities for the elderly, particularly from economic and social structural standpoints. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Acceptability and Receipt of Preventive Care for Chronic-Disease Health Risk Behaviors Reported by Clients of Community Mental Health Services.

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Bartlem, Kate; Bowman, Jenny; Freund, Megan; Wye, Paula; Lecathelinais, Christophe; McElwaine, Kathleen; Wolfenden, Luke; Gillham, Karen; Wiggers, John

2015-08-01

Compared with the general population, people with a mental illness have a greater prevalence of behaviors that contribute to higher chronic disease rates. Mental health clinical guidelines recommend preventive care to address such behaviors; however, little information is available about whether clients consider preventive care acceptable or about the prevalence of such care in mental health services. This article describes acceptability and receipt of assessment, advice, and referral for smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption, and physical inactivity, as reported by community mental health service clients. The association between preventive care, diagnosis, and number of clinical appointments was examined. A cross-sectional telephone interview was conducted with clients (N=558) of community mental health services in Australia. Although preventive care was highly acceptable to clients (86%-97%), receipt of preventive care was low. Client receipt of risk assessment ranged from 26% (assessment of fruit or vegetable intake) to 76% (assessment of alcohol consumption). The proportion of clients at risk of and assessed for unhealthy behavior who then received brief advice ranged from 69% (fruit or vegetable intake) to 85% (physical activity), whereas only 38% (alcohol consumption) to 49% (smoking) received any referral. A greater number of mental health appointments were associated with higher prevalence of preventive care, as were diagnoses of diabetes or respiratory conditions and not having a schizophrenia diagnosis. Practice change strategies are required to increase the delivery of routine preventive care within mental health services if clients are to benefit from clinical guidelines.

Implementation of preventive strength training in residential geriatric care: a multi-centre study protocol with one year of interventions on multiple levels.

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Brach, Michael; Nieder, Frank; Nieder, Ulrike; Mechling, Heinz

2009-11-24

There is scientific evidence that preventive physical exercise is effective even in high age. In contrast, there are few opportunities of preventive exercise for highly aged people endangered by or actually in need of care. For example, they would not be able to easily go to training facilities; standard exercises may be too intensive and therefore be harmful to them; orientation disorders like dementia would exacerbate individuals and groups in following instructions and keeping exercises going. In order to develop appropriate interventions, these and other issues were assigned to different levels: the individual-social level (ISL), the organisational-institutional level (OIL) and the political-cultural level (PCL). Consequently, this conceptional framework was utilised for development, implementation and evaluation of a new strength and balance exercise programme for old people endangered by or actually in need of daily care. The present paper contains the development of this programme labeled "fit for 100", and a study protocol of an interventional single-arm multi-centre trial. The intervention consisted of (a) two group training sessions every week over one year, mainly resistance exercises, accompanied by sensorimotor and communicative group exercises and games (ISL), (b) a sustainable implementation concept, starting new groups by instructors belonging to the project, followed by training and supervision of local staff, who stepwise take over the group (OIL), (c) informing and convincing activities in professional, administrative and governmental contexts, public relation activities, and establishing an advisory council with renowned experts and public figures (PCL). Participating institutions of geriatric care were selected through several steps of quality criteria assessment. Primary outcome measures were continuous documentation of individual participation (ISL), number of groups continued without external financial support (at the end of the project, and

Implementation of preventive strength training in residential geriatric care: a multi-centre study protocol with one year of interventions on multiple levels

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Nieder Ulrike

2009-11-01

Full Text Available Abstract Background There is scientific evidence that preventive physical exercise is effective even in high age. In contrast, there are few opportunities of preventive exercise for highly aged people endangered by or actually in need of care. For example, they would not be able to easily go to training facilities; standard exercises may be too intensive and therefore be harmful to them; orientation disorders like dementia would exacerbate individuals and groups in following instructions and keeping exercises going. In order to develop appropriate interventions, these and other issues were assigned to different levels: the individual-social level (ISL, the organisational-institutional level (OIL and the political-cultural level (PCL. Consequently, this conceptional framework was utilised for development, implementation and evaluation of a new strength and balance exercise programme for old people endangered by or actually in need of daily care. The present paper contains the development of this programme labeled "fit for 100", and a study protocol of an interventional single-arm multi-centre trial. Methods The intervention consisted of (a two group training sessions every week over one year, mainly resistance exercises, accompanied by sensorimotor and communicative group exercises and games (ISL, (b a sustainable implementation concept, starting new groups by instructors belonging to the project, followed by training and supervision of local staff, who stepwise take over the group (OIL, (c informing and convincing activities in professional, administrative and governmental contexts, public relation activities, and establishing an advisory council with renowned experts and public figures (PCL. Participating institutions of geriatric care were selected through several steps of quality criteria assessment. Primary outcome measures were continuous documentation of individual participation (ISL, number of groups continued without external financial

The failure of suicide prevention in primary care: family and GP perspectives - a qualitative study.

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Leavey, Gerard; Mallon, Sharon; Rondon-Sulbaran, Janeet; Galway, Karen; Rosato, Michael; Hughes, Lynette

2017-11-21

Although Primary care is crucial for suicide prevention, clinicians tend to report completed suicides in their care as non-preventable. We aimed to examine systemic inadequacies in suicide prevention from the perspectives of bereaved family members and GPs. Qualitative study of 72 relatives or close friends bereaved by suicide and 19 General Practitioners who have experienced the suicide of patients. Relatives highlight failures in detecting symptoms and behavioral changes and the inability of GPs to understand the needs of patients and their social contexts. A perceived overreliance on anti-depressant treatment is a major source of criticism by family members. GPs tend to lack confidence in the recognition and management of suicidal patients, and report structural inadequacies in service provision. Mental health and primary care services must find innovative and ethical ways to involve families in the decision-making process for patients at risk of suicide.

Prehospital emergency care and injury prevention in Sudan

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Khalid Elbashir

2014-12-01

Conclusion: Due to an absence of published literature in Sudan, much of the data have been recorded from paper records and empirical observations. Prehospital care and injury prevention in the Sudan is a recent initiative, but it is developing into a promising model with many opportunities for improvement. This momentum should be nurtured and requires a purposive, collective collaboration to draw a blueprint for a locally relevant, effective and efficient prehospital system in Sudan. It is hoped that this article will highlight and encourage further progress.

Patient experienced continuity of care in the psychiatric healthcare system-a study including immigrants, refugees and ethnic danes.

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Jensen, Natasja Koitzsch; Johansen, Katrine Schepelern; Kastrup, Marianne; Krasnik, Allan; Norredam, Marie

2014-09-17

The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. The study is based on 19 narrative interviews conducted with 15 patients with diverse migration backgrounds (immigrants, descendents, refugees, and ethnic Danes). Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups. For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of individualised care, trauma, additional vulnerability, and taboo concerning mental illness were of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field are complex and diverse and the patient perspective of continuity of care provides important insight into the delivery of care. The study highlights the importance of person-centred care irrespective of migration background though it may be beneficial to have an awareness of areas that may be of more specific concern to immigrants and refugees. The study sheds light on concerns specific to immigrants and refugees in a framework of continuity of care, but also commonalities across the patient groups.

Increasing retention in care of HIV-positive women in PMTCT services through continuous quality improvement-breakthrough (CQI-BTS) series in primary and secondary health care facilities in Nigeria: a cluster randomized controlled trial. The Lafiyan Jikin Mata Study.

Science.gov (United States)

Oyeledun, Bolanle; Oronsaye, Frank; Oyelade, Taiwo; Becquet, Renaud; Odoh, Deborah; Anyaike, Chukwuma; Ogirima, Francis; Ameh, Bernice; Ajibola, Abiola; Osibo, Bamidele; Imarhiagbe, Collins; Abutu, Inedu

2014-11-01

Rates of retention in care of HIV-positive pregnant women in care programs in Nigeria remain generally poor with rates around 40% reported for specific programs. Poor quality of services in health facilities and long waiting times are among the critical factors militating against retention of these women in care. The aim of the interventions in this study is to assess whether a continuous quality improvement intervention using a Breakthrough Series approach in local district hospitals and primary health care clinics will lead to improved retention of HIV-positive women and mothers. A cluster randomized controlled trial with 32 health facilities randomized to receive a continuous quality improvement/Breakthrough Series intervention or not. The care protocol for HIV-infected pregnant women and mothers is the same in all sites. The quality improvement intervention started 4 months before enrollment of individual HIV-infected pregnant women and initially focused on reducing waiting times for women and also ensuring that antiretroviral drugs are dispensed on the same day as clinic attendance. The primary outcome measure is retention of HIV-positive mothers in care at 6 months postpartum. Results of this trial will inform whether quality improvement interventions are an effective means of improving retention in prevention of mother-to-child transmission of HIV programs and will also guide where health system interventions should focus to improve the quality of care for HIV-positive women. This will benefit policymakers and program managers as they seek to improve retention rates in HIV care programs.

Control beliefs are related to smoking prevention in prenatal care.

Science.gov (United States)

Lemola, Sakari; Meyer-Leu, Yvonne; Samochowiec, Jakub; Grob, Alexander

2013-10-01

Smoking during pregnancy is one of the most important avoidable health risks for the unborn child. Gynaecologists and midwives play a fundamental role in the prevention of smoking during pregnancy. However, a large number of health care practitioners still do not address smoking in pregnant patients. We examined whether gynaecologists and midwives engage in screening and counselling of pregnant women and conducting interventions to prevent smoking during pregnancy. Further, we examined the role of gynaecologists' and midwives' control beliefs. Control beliefs involve efficacy expectations--the practitioner's confidence in his capacity to conduct prevention efforts adequately--and outcome expectations--the practitioner's expectation that such prevention efforts are successful in general. A total of 486 gynaecologists and 366 midwives completed a questionnaire on screening of smoking, counselling and other interventions they conduct to prevent smoking during pregnancy. Moreover, gynaecologists and midwives rated their control beliefs regarding their influence on pregnant patients' smoking habits. The majority of gynaecologists and midwives reported screening all pregnant patients regarding smoking, explaining the risks and recommending smoking cessation. By contrast, only a minority engages in more extensive prevention efforts. Strong control beliefs were predictive of a higher likelihood of screening and counselling, as well as of engaging in more extensive interventions. The findings point to the importance of strengthening gynaecologists' and midwives' control beliefs by professional education and training on smoking prevention. © 2012 John Wiley & Sons Ltd.

[Continuous subcutaneous infusion in palliative care, an undervalued method].

Science.gov (United States)

van Marum, R J; de Vogel, E M; Zylicz, Z

2002-11-23

Three patients, 2 men aged 55 and 54 years and a woman aged 86 years, were admitted to hospital for treatment of symptoms resulting from terminal disease (pain, agitation, nausea etc.). In all three patients, continuous subcutaneous infusion (CSI) of medication was successfully used to control the symptoms. Compared with intravenous infusion, the technique of CSI is easy to learn and is associated with fewer complications. Its reliability and ease-of-use make it a technique that can be used not only in a hospital setting, but also in general practice and nursing homes. Medication used in palliative care (e.g. morphine, haloperidol, metoclopramide, levomepromazine, midazolam) can often be administered safely by CSI. In palliative care, where goals should be accomplished with minimal burden to the patient, CSI must be considered the technique of choice in patients who are unable to swallow their medication.

Preventative Therapeutics: A Study of Risk and Prevention in Australian Mental Health

Directory of Open Access Journals (Sweden)

Andrew McLachlan

2014-10-01

Full Text Available his study investigates the preventative therapeutics of two major Australian mental health organisations - beyondblue and The Black Dog Institute. The aim of this study is to examine how the resilience-based programs of both organisations reconfigure clinical and preventative expertise into new forms of ‘anticipatory action' (Anderson 2010. First, this article situates beyondblue and the Black Dog Institute within their historical contexts to consider how issues of risk and protection have become essential to mental health care today. Second, it examines the institutional practices of beyondblue and the Black Dog Institute and the role of clinical and preventative expertise as enacted forms of authority. Finally, this study investigates the intellectual and biokeeping technologies promoted through both organisations“ resilience-based pedagogies. The view taken in this study is that such technologies actively participate in the making of new therapeutic cultures and practices. Moreover, as biomarkers continue to act as indicators of future states of ‘unhealth' (Dumit 2012: 112, biokeeping technologies will continue to act as essential elements in the governmentality of mental health and wellbeing.

The new health-care quality: value, outcomes, and continuous improvement.

Science.gov (United States)

O'Connor, S J; Lanning, J A

1991-01-01

No longer convinced that their viewpoint on quality is the only one, different stakeholders in the health-care arena are sharing perspectives to piece together the quality picture. Although still preoccupied with the cost of health care, purchasers are concerned about value--efficiency, appropriateness, and effectiveness--as well as price. Faced with evidence of medically unnecessary procedures and unexamined medical theory, practitioners are searching for appropriateness guidelines, useful outcome measures, and methods to elicit informed patient preferences about elective surgeries. Underlying this search for reliable indicators of quality--now expanded to include patient satisfaction--is a new interest in the Japanese notion of "Kaizen" or continuous quality improvement. The end product of this ferment may determine whether good medicine drives out the bad--or vice versa.

Social network approaches to recruitment, HIV prevention, medical care, and medication adherence

OpenAIRE

Latkin, Carl A.; Davey-Rothwell, Melissa A.; Knowlton, Amy R.; Alexander, Kamila A.; Williams, Chyvette T.; Boodram, Basmattee

2013-01-01

This article reviews current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates and treatment access and outcomes. Social network analysis is a value tool to link social structural factors to individual behaviors. Social networks provide an avenue for low cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social ne...

Addressing the Concerns Surrounding Continuous Deep Sedation in Singapore and Southeast Asia: A Palliative Care Approach.

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Krishna, Lalit Kumar Radha

2015-09-01

The application of continuous deep sedation (CDS) in the treatment of intractable suffering at the end of life continues to be tied to a number of concerns that have negated its use in palliative care. Part of the resistance towards use of this treatment option of last resort has been the continued association of CDS with physician-associated suicide and/or euthanasia (PAS/E), which is compounded by a lack clinical guidelines and a failure to cite this treatment under the aegis of a palliative care approach. I argue that reinstituting a palliative care-inspired approach that includes a holistic review of the patient's situation and the engagement of a multidisciplinary team (MDT) guided by clearly defined practice requirements that have been lacking amongst many prevailing guidelines will overcome prevailing objections to this practice and allow for the legitimization of this process.

Interdisciplinary Collaboration in Medication-Related Falls Prevention in Older Adults.

Science.gov (United States)

Huang, Lisa; Turner, Jazmin; Brandt, Nicole J

2018-04-01

The older adult population continues to steadily increase. Largely attributed to longer life spans and aging of the Baby Boomer generation, continued growth of this population is expected to affect a multitude of challenging public health concerns. Specifically, falls in older adults are prevalent but overlooked concerns. Health care providers are well-positioned to provide valuable interventions in this aspect. An interdisciplinary, team-based approach of health care providers is required to maximize falls prevention through patient-centered and collaborative care. The current article highlights the implications of inappropriate medication use and the need to improve care coordination to tackle this public health issue affecting older adults. [Journal of Gerontological Nursing, 44(4), 11-15.]. Copyright 2018, SLACK Incorporated.

Continuity and Change : Comparative Case Study of Hospital and Home Care Governance in The Netherlands

NARCIS (Netherlands)

Oomkens, Rosanne|info:eu-repo/dai/nl/314569286; Hoogenboom, Marcel|info:eu-repo/dai/nl/14667863X; Knijn, Trudie|info:eu-repo/dai/nl/072101032

2015-01-01

This article aims to understand the evolution of health care governance in the Dutch hospital and home care sector. We pay particular attention to how institutionalized governance structures shape policy reform. Professionally-dominated governance structures are likely to continue to exist to some

Preventive care delivered within Public Dental Service after caries risk assessment of young adults

DEFF Research Database (Denmark)

Hänsel Petersson, G; Ericson, E; Twetman, S

2016-01-01

OBJECTIVES: To study preventive care provided to young adults in relation to their estimated risk category over a 3-year period. METHODS: The amount and type of preventive treatment during 3 years was extracted from the digital dental records of 982 patients attending eight public dental clinics...... adults attending public dental service. Further research is needed how to reach those with the greatest need of primary and secondary prevention....

Computerized clinical decision support systems for primary preventive care: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes.

Science.gov (United States)

Souza, Nathan M; Sebaldt, Rolf J; Mackay, Jean A; Prorok, Jeanette C; Weise-Kelly, Lorraine; Navarro, Tamara; Wilczynski, Nancy L; Haynes, R Brian

2011-08-03

Computerized clinical decision support systems (CCDSSs) are claimed to improve processes and outcomes of primary preventive care (PPC), but their effects, safety, and acceptance must be confirmed. We updated our previous systematic reviews of CCDSSs and integrated a knowledge translation approach in the process. The objective was to review randomized controlled trials (RCTs) assessing the effects of CCDSSs for PPC on process of care, patient outcomes, harms, and costs. We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews Database, Inspec, and other databases, as well as reference lists through January 2010. We contacted authors to confirm data or provide additional information. We included RCTs that assessed the effect of a CCDSS for PPC on process of care and patient outcomes compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive. We added 17 new RCTs to our 2005 review for a total of 41 studies. RCT quality improved over time. CCDSSs improved process of care in 25 of 40 (63%) RCTs. Cumulative scientifically strong evidence supports the effectiveness of CCDSSs for screening and management of dyslipidaemia in primary care. There is mixed evidence for effectiveness in screening for cancer and mental health conditions, multiple preventive care activities, vaccination, and other preventive care interventions. Fourteen (34%) trials assessed patient outcomes, and four (29%) reported improvements with the CCDSS. Most trials were not powered to evaluate patient-important outcomes. CCDSS costs and adverse events were reported in only six (15%) and two (5%) trials, respectively. Information on study duration was often missing, limiting our ability to assess sustainability of CCDSS effects. Evidence supports the effectiveness of CCDSSs for screening and

Primary care in the prevention, treatment and control of cardiovascular disease in sub-Saharan Africa

Science.gov (United States)

Ojji, Dike B; Ojji, Dike B Ojji; Lamont, Kim; Sliwa, Karen; Ojji, Olubunmi I; Egenti, Bibiana Nonye; Sliwa, Karen

2017-01-01

Summary Cardiovascular disease (CVD) is the frontrunner in the disease spectrum of sub-Saharan Africa, with stroke and ischaemic heart disease ranked seventh and 14th as leading causes of death, respectively, on this sub-continent. Unfortunately, this region is also grappling with many communicable, maternal, neonatal and nutritional disorders. Limited resources and the high cost of CVD treatment necessitate that primary prevention should have a high priority for CVD control in sub- Saharan Africa. One major challenge of such an approach is how to equip primary care to respond promptly and effectively to this burden. We present a practical approach on how primary care in sub-Saharan Africa could effectively address the prevention, treatment and control of CVD on the subcontinent. For effective prevention, control and treatment of CVD in sub-Saharan Africa, there should be strategic plans to equip primary care clinics with well-trained allied healthcare workers who are supervised by physicians. PMID:28752890

Preventive home care of frail older people: a review of recent case management studies.

Science.gov (United States)

Hallberg, Ingalill Rahm; Kristensson, Jimmie

2004-09-01

Preventive actions targeting community-dwelling frail older people will be increasingly important with the growing number of very old and thereby also frail older people. This study aimed to explore and summarize the empirical literature on recent studies of case/care management interventions for community-dwelling frail older people and especially with regard to the content of the interventions and the nurse's role and outcome of it. Very few of the interventions took either a preventive or a rehabilitative approach using psycho-educative interventions focusing, for instance, on self-care activities, risk prevention, health complaints management or how to preserve or strengthen social activities, community involvement and functional ability. Moreover, it was striking that very few included a family-oriented approach also including support and education for informal caregivers. Thus it seems that the content of case/care management needs to be expanded and more influenced by a salutogenic health care perspective. Targeting frail older people seemed to benefit from a standardized two-stage strategy for inclusion and for planning the interventions. A comprehensive geriatric assessment seemed useful as a base. Nurses, preferably trained in gerontological practice, have a key role in case/care management for frail older people. This approach calls for developing the content of case/care management so that it involves a more salutogenic, rehabilitative and family-oriented approach. To this end it may be useful for nurses to strengthen their psychosocial skills or develop close collaboration with social workers. The outcome measures examined in this study represented one of three perspectives: the consumer's perspective, the perspective of health care consumption or the recipient's health and functional ability. Perhaps effects would be expected in all three areas and thus these should be included in evaluative studies in addition to measures for family and/or informal

[Guidelines for the preventive health care of hairdressing apprentices].

Science.gov (United States)

Golińska-Zach, Aleksandra; Wiszniewska, Marta; Walusiak-Skorupa, Jolanta

2017-07-26

Hairdressing is one of the most developing branch of the service industry in Poland. Providing representatives of this occupational group with preventive health care services it should be remembered that they are at risk of skin and respiratory diseases, which occur due to a quite frequent exposure to harmful agents in the work environment of hairdressers and hairdressing apprentices. Interestingly, a much lower number of researches concentrate on respiratory symptoms than on skin disorders in hairdressers. The authors of this article have carried out the first Polish follow-up study focused not only on skin disorders but also on respiratory tract symptoms in hairdressing apprentices. The results of the study have been reported in other publications while this paper presents a literature review based on EBSCO and PubMed databases, Elsevier and contained articles (on the subject discussed in this paper). On the basis of information obtained from the authors' own research evidence and from the literature review, the guidelines for the preventive health care of hairdressing apprentices were developed. It was confirmed that neither determination of allergen-specific immunoglobulin E (IgE) nor performance of skin prick tests (SPTs) and patch tests for hairdressing factors are necessary. They should be performed as a part of preventive medical examination only in those apprentice candidates and trainees in this profession who report work-related symptoms and it is suspected that they result from exposure to particular factor in the work environment. Med Pr 2017;68(5):677-687. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

The continuing care retirement community executive: a manager for all seasons.

Science.gov (United States)

Hurley, R E; Brewer, K P

1991-01-01

The continuing care retirement community industry is a growing source of residential and health care services for the elderly population. It is also a relatively new and expanding career path for both health care and hospitality managers. Using in-depth interviews with executives in a sample of 26 communities, this study provides one of the most complete portraits to date of the nature of managing these communities. The findings indicate that these organizations are complex and multifaceted, demanding versatile skills and abilities. Most critical are those skills that enable a manager to interact effectively with residents and staff to build and maintain a hospitable, accommodating community environment. As competition in the industry intensifies, community viability may become synonymous with customer satisfaction. Management training and development will need to be highly attentive to the distinctive features of these intriguing organizations.

Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes

Directory of Open Access Journals (Sweden)

Eva H. DuGoff

2016-06-01

Full Text Available Follow us on Twitter Co-Editors-in-Chief Martin Fortin Jane Gunn Stewart W. Mercer Susan Smith Marjan van den Akker Society for Academic Primary Care Journal Help USER You are logged in as... avalster My Profile Log Out JOURNAL CONTENT Search Search Scope Search Browse By Issue By Author By Title By Sections By Identify Types OPEN JOURNAL SYSTEMS FONT SIZE Make font size smallerMake font size defaultMake font size larger INFORMATION For Readers For Authors For Librarians ARTICLE TOOLS Print this article Indexing metadata How to cite item Supplementary files Finding References Email this article Email the author Post a Comment NOTIFICATIONS View (378 new Manage IRCMO NEWS ‘Addressing the global challenge of... Publications on multimorbidity... The CARE Plus study Prevalence of multimorbidity in the... Multimorbidity in adults from a... CURRENT ISSUE Atom logo RSS2 logo RSS1 logo HOSTED BY Part of the PKP Publishing Services Network HOME ABOUT USER HOME SEARCH CURRENT ARCHIVES ANNOUNCEMENTS PUBLISHER AUTHOR GUIDELINES SUBMISSIONS WHY PUBLISH WITH US? Home > Vol 6, No 2 (2016 >\tDuGoff Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes Eva H. DuGoff, Karen Bandeen-Roche, Gerard F. Anderson Abstract Background: Continuity of care is a basic tenant of primary care practice. However, the evidence on the importance of continuity of care for older adults with complex conditions is mixed. Objective: To assess the relationship between measurement of continuity of care, number of chronic conditions, and health outcomes. Design: We analyzed data from a cohort of 1,600 US older adults with diabetes and ≥1 other chronic condition in a private Medicare health plan from July 2010 to December 2011. Multivariate regression models were used to examine the association of baseline continuity (the first 6 months and the composite outcome of any emergency room use or inpatient

Mobile Health to Maintain Continuity of Patient-Centered Care for Chronic Kidney Disease: Content Analysis of Apps.

Science.gov (United States)

Lee, Ying-Li; Cui, Yan-Yan; Tu, Ming-Hsiang; Chen, Yu-Chi; Chang, Polun

2018-04-20

Chronic kidney disease (CKD) is a global health problem with a high economic burden, which is particularly prevalent in Taiwan. Mobile health apps have been widely used to maintain continuity of patient care for various chronic diseases. To slow the progression of CKD, continuity of care is vital for patients' self-management and cooperation with health care professionals. However, the literature provides a limited understanding of the use of mobile health apps to maintain continuity of patient-centered care for CKD. This study identified apps related to the continuity of patient-centered care for CKD on the App Store, Google Play, and 360 Mobile Assistant, and explored the information and frequency of changes in these apps available to the public on different platforms. App functionalities, like patient self-management and patient management support for health care professionals, were also examined. We used the CKD-related keywords "kidney," "renal," "nephro," "chronic kidney disease," "CKD," and "kidney disease" in traditional Chinese, simplified Chinese, and English to search 3 app platforms: App Store, Google Play, and 360 Mobile Assistant. A total of 2 reviewers reached consensus on coding guidelines and coded the contents and functionalities of the apps through content analysis. After coding, Microsoft Office Excel 2016 was used to calculate Cohen kappa coefficients and analyze the contents and functionalities of the apps. A total of 177 apps related to patient-centered care for CKD in any language were included. On the basis of their functionality and content, 67 apps were recommended for patients. Among them, the most common functionalities were CKD information and CKD self-management (38/67, 57%), e-consultation (17/67, 25%), CKD nutrition education (16/67, 24%), and estimated glomerular filtration rate (eGFR) calculators (13/67, 19%). In addition, 67 apps were recommended for health care professionals. The most common functionalities of these apps were

Gender Differentials in Preventive Health Care: Incidences and Determinants among Pakistani Children

OpenAIRE

Faham Masud; Shujaat Farooq

2012-01-01

In this study, an attempt has been made to estimate gender health differential with a focus on preventive health care. Using the Pakistan Demographic Health Survey (PDHS) of 2006-07, the study has targeted the children of age 12-23 months and found substantialsex differences in the immunization status of children where boys are more immunized than girls, reflecting gender biasness over preventive health provision. Through bi-variate and multi-variate analysis, the study found that a variety o...

Impact of Fall Prevention on Nurses and Care of Fall Risk Patients.

Science.gov (United States)

King, Barbara; Pecanac, Kristen; Krupp, Anna; Liebzeit, Daniel; Mahoney, Jane

2018-03-19

Falls are common events for hospitalized older adults, resulting in negative outcomes both for patients and hospitals. The Center for Medicare and Medicaid (CMS) has placed pressure on hospital administrators by identifying falls as a "never event", resulting in a zero falls goal for many hospitals. Staff nurses are responsible for providing direct care to patients and for meeting the hospital no falls goal. Little is known about the impact of "zero falls" on nurses, patients and the organization. A qualitative study, using Grounded Dimensional Analysis (GDA) was conducted to explore nurses' experiences with fall prevention in hospital settings and the impact of those experiences on how nurses provide care to fall risk patients. Twenty-seven registered nurses and certified nursing assistants participated in in-depth interviews. Open, axial and selective coding was used to analyze data. A conceptual model which illustrates the impact of intense messaging from nursing administration to prevent patient falls on nurses, actions nurses take to address the message and the consequences to nurses, older adult patients and to the organization was developed. Intense messaging from hospital administration to achieve zero falls resulted in nurses developing a fear of falls, protecting self and unit, and restricting fall risk patients as a way to stop messages and meet the hospital goal. Results of this study identify unintended consequences of fall prevention message on nurses and older adult patients. Further research is needed understand how nurse care for fall risk patients.

Receipt of preventive dental care among special-needs children enrolled in Medicaid: a crisis in need of attention.

Science.gov (United States)

Mitchell, Jean M; Gaskin, Darrell J

2008-10-01

Although not widely recognized, tooth decay is the most common childhood chronic disease among children ages five to seventeen. Despite higher rates of dental caries and greater needs, low-income minority children enrolled in Medicaid are more likely to go untreated relative to their higher income counterparts. No research has examined this issue for children with special needs. We analyzed Medicaid enrollment and claims data for special-needs children enrolled in the District of Columbia Medicaid program to evaluate receipt of recommended preventive dental care. Use of preventive dental care is abysmally low and has declined over time. Enrollment in managed care rather than fee for service improves the likelihood that special-needs children receive recommended preventive dental services, whereas residing farther from the Metro is an impediment to receipt of dental care.

Decolonization in Prevention of Health Care-Associated Infections

Science.gov (United States)

Schweizer, Marin L.

2016-01-01

SUMMARY Colonization with health care-associated pathogens such as Staphylococcus aureus, enterococci, Gram-negative organisms, and Clostridium difficile is associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused on S. aureus decolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent for S. aureus nasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well as Candida. Conversely, triclosan use is discouraged, and

National survey of practices to prevent health care-associated infections in Thailand: The role of prevention bundles.

Science.gov (United States)

Apisarnthanarak, Anucha; Ratz, David; Greene, M Todd; Khawcharoenporn, Thana; Weber, David J; Saint, Sanjay

2017-07-01

We evaluated the practices used in Thai hospitals to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP). From January 1, 2014-November 30, 2014, we surveyed all Thai hospitals with an intensive care unit and at least 250 beds. The use of prevention practices for CAUTI, CLABSI, and VAP was assessed. High compliance (≥75%) with all components of the CLABSI and VAP prevention bundles were determined. CAUTI, CLABSI, and VAP infection rates before and after implementing infection control practices are reported. Multivariable regression was used to examine associations between infection prevention bundle compliance and infection rate changes. Out of 245 eligible hospitals, 212 (86.5%) responded. A total of 120 (56.6%) and 115 hospitals (54.2%) reported ≥75% compliance for all components of the CLABSI and VAP prevention bundles, respectively, and 91 hospitals (42.9%) reported using ≥ 4 recommended CAUTI-prevention practices. High compliance with all of the CLABSI and VAP bundle components was associated with significant infection rate reductions (CLABSI, 38.3%; P Hospitals regularly using ≥ 4 CAUTI-prevention practices did not have greater reductions in CAUTI (0.02%; P = .99). Compliance with practices to prevent hospital infections was suboptimal. Policies and interventions promoting bundled approaches may help reduce hospital infections for Thai hospitals. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

The Benefits of Continuous Leisure Participation in Relocation Adjustment Among Residents of Long-Term Care Facilities.

Science.gov (United States)

Lin, Li-Jung; Yen, Hsin-Yen

2018-03-19

The rising population of older adults is transforming Taiwan society. Although many long-term care facilities now operate for older adults, the transition from the home environment to long-term facilities may cause multiple issues, including relocation stress syndrome, for new residents. Autonomy is a critical element of the human experience. Leisure, as an expression of autonomy, has been shown to enhance self-image and promote feelings of competence and mastery. The aim of this study was to assess the relationship between participation in leisure activities and adjustment to residential care using the continuity theory. One hundred sixty-three qualified individuals from 11 long-term care institutions were recruited and completed the questionnaire. The sampling criteria for the study were age (55+ years), appropriate cognitive skills, and residency (less than 5 years). Interviews conducted by trained interviewers were used to collect data. Measured outcomes included leisure participation; physical, psychological, and social adjustments; and background information. Cluster analysis, descriptive analysis, multivariate analysis of variance, and least significant difference test were used in analysis. Type of admission (voluntary/mandated) and type of leisure participation significantly affected the level of relocation adjustment success. Four leisure behavior categories were identified, including reduced participation, expanded participation, active participation, and continuing participation. The participants in the active and continuing participation categories had significantly higher psychological adjustment than their peers in the reduced participation category. Moreover, the continuing participation category had a significantly better level of social adjustment than their expanded participation category peers. Continuous and active participation categories had a beneficial outcome in relocation adjustment. The findings support that, in general, residents of

Structure for Success: 30 Preventive Discipline Techniques. Caring for the Little Ones.

Science.gov (United States)

Miller, Karen

2000-01-01

Presents 30 suggestions for preventing behavior problems among infants and toddlers in child care settings. The suggestions are in four areas: (1) environment; (2) caregiver style; (3) organization and routines; and (4) child to child: as situations happen. (KB)

Adult Learners' Preferred Methods of Learning Preventative Heart Disease Care

Science.gov (United States)

Alavi, Nasim

2016-01-01

The purpose of this study was to investigate the preferred method of learning about heart disease by adult learners. This research study also investigated if there was a statistically significant difference between race/ethnicity, age, and gender of adult learners and their preferred method of learning preventative heart disease care. This…

Home and community care services: a major opportunity for preventive health care

Directory of Open Access Journals (Sweden)

Lujic Sanja

2010-05-01

Full Text Available Abstract Background In Australia, the Home and Community Care (HACC program provides services in the community to frail elderly living at home and their carers. Surprisingly little is known about the health of people who use these services. In this study we sought to describe health-related factors associated with use of HACC services, and to identify potential opportunities for targeting preventive services to those at high risk. Methods We obtained questionnaire data from the 45 and Up Study for 103,041 men and women aged 45 years and over, sampled from the general population of New South Wales, Australia in 2006-2007, and linked this with administrative data about HACC service use. We compared the characteristics of HACC clients and non-clients according to a range of variables from the 45 and Up Study questionnaire, and estimated crude and adjusted relative risks for HACC use with generalized linear models. Results 4,978 (4.8% participants used HACC services in the year prior to completing the questionnaire. Increasing age, female sex, lower pre-tax household income, not having a partner, not being in paid work, Indigenous background and living in a regional or remote location were strongly associated with HACC use. Overseas-born people and those speaking languages other than English at home were significantly less likely to use HACC services. People who were underweight, obese, sedentary, who reported falling in the past year, who were current smokers, or who ate little fruit or vegetables were significantly more likely to use HACC services. HACC service use increased with decreasing levels of physical functioning, higher levels of psychological distress, and poorer self-ratings of health, eyesight and memory. HACC clients were more likely to report chronic health conditions, in particular diabetes, stroke, Parkinson's disease, anxiety and depression, cancer, heart attack or angina, blood clotting problems, asthma and osteoarthritis

Sustaining Transfers through Affordable Research Translation (START): study protocol to assess knowledge translation interventions in continuing care settings.

Science.gov (United States)

Slaughter, Susan E; Estabrooks, Carole A; Jones, C Allyson; Wagg, Adrian S; Eliasziw, Misha

2013-10-26

Bridging the research-practice gap is an important research focus in continuing care facilities, because the population of older adults (aged 65 years and over) requiring continuing care services is the fastest growing demographic among countries in the Organisation for Economic Co-operation and Development (OECD). Unlicensed practitioners, known as health care aides, provide the majority of care for residents living in continuing care facilities. However, little research examines how to sustain health care aide behavior change following initial adoption of current research evidence. We will conduct a phase III, multicentre, cluster randomized controlled trial (RCT) using a stratified 2 × 2 additive factorial design, including an embedded process evaluation, in 24 supportive living facilities within the health zone of Edmonton, AB, Canada. We will determine which combination of frequency and intensity of reminders most effectively sustains the completion of the sit-to-stand activity by health care aides with residents. Frequency refers to how often a reminder is implemented; intensity refers to whether a reminder is social or paper-based. We will compare monthly reminders with reminders implemented every 3 months, and we will compare low intensity, paper-based reminders and high intensity reminders provided by a health care aide peer.Using interviews, questionnaires, and observations, Sustaining Transfers through Affordable Research Translation (START) will evaluate the processes that inhibit or promote the mobility innovation's sustainability among health care aides in daily practice. We will examine how the reminders are implemented and perceived by health care aides and licensed practical nurses, as well as how health care aides providing peer reminders are identified, received by their peers, and supported by their supervisors. START will connect up-to-date innovation research with the practice of health care aides providing direct care to a growing population

PREVENTION OF ONCOLOGICAL DISEASES AS THE BASIS OF INTERACTION OF ONCOLOGICAL SERVICE WITH PRIMARY LINK OF HEALTH CARE

Directory of Open Access Journals (Sweden)

L. M. Aleksandrova

2017-01-01

Full Text Available Malignant neoplasms (MN are the second cause of death for the population of Russia, resulted in 15.5% of all deaths in 2015. Their share in the structure of the male population mortality rate was 16.4%, female — 14.4%. Among both sexes, deaths of working age, the proportion of deaths from MN was 16.0%, among women of reproductive age — 16.3%. More than half of the working age population of deaths in Russia falls on the disease from the group of preventable death, and a third — to preventable causes, depending on the primary and secondary prevention, quality of care, along with a high prevalence of behavioral risk factors (RF, demographic characteristics, marked medical and social reasons for the high mortality rate of the MN: late uptake of the population for health care, lack of alertness in oncology healthcare professionals, patients defects in routing.The leading factor in increasing life expectancy is prevention. Today, prevention is regarded as active method of strengthening and preservation of health, and the currently existing approaches in promoting healthy life mostly only directed at the prevention of behavioral risk factors: tobacco use, poor diet, physical inactivity and harmful use of alcohol. Experts estimate the impact on them will prevent, at least 40% of the cases of MN.In Russia we have a 3-step system of health care. In general preventive health orientation is implemented on the 1st level: in the provision of primary health care. In this regard, particular attention should be paid to the implementation of measures for specific clinical examination of the adult population, which plays an important role in the early detection of both the disease and the risk factors for their development. Properly organized conduct of the clinical examination can provide a substantial, up to 30%, the contribution to the reduction of total mortality, including mortality from MN. The necessity of increasing the role of the oncology service

The facilitators’ point of view regarding the primary health care planning as a continuing education program