WorldWideScience

Sample records for preventive care continues

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

    Science.gov (United States)

    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.

  2. Key role in the prevention of child neglect and abuse in Germany: continuous care by qualified family midwives.

    Science.gov (United States)

    Ayerle, Gertrud M; Makowsky, Katja; Schücking, Beate A

    2012-08-01

    the aim of two related studies was an in-depth knowledge of psychosocially and health-related vulnerable families and the 'portfolio' of care that family midwives (FM) provide. Besides factors which influence acceptance and access from the mothers' perspective, the effectiveness of FM with regard to care, infant nutrition, and parent-child relationship as well as multidisciplinary collaboration were of interest, especially against the backdrop of Germany's national aim to strengthen prevention of neglect and abuse of infants. In addition, the reasons why families did not want FM care were explored. two FM model projects in Saxony-Anhalt (SA) and Lower Saxony (LS), Germany, were evaluated. Quantitative data were prospectively collected on 93% of vulnerable families being cared for by FM (SA) and regarding vulnerable families that declined FM care (LS). These data were complemented by problem-focused interviews with 14 mothers and six social workers (LS). the 33 FM in SA and 11 FM in LS are community-based and visit vulnerable families from pregnancy up to the first birthday of the child, maximally. They provide health promotion, maternal and infant care, and multidisciplinary support geared towards early prevention of child neglect and abuse. from May 2006 until 2008 (SA) and from January 2008 until December 2009 (LS) 814 and 235 vulnerable families, respectively, were cared for by FM. Complete data on 734 families were analysed (SA) as were 30 questionnaires on 'non-compliant' families (LS). Problem-focused interviews were conducted with 14 mothers and 6 social workers (LS). many families exhibited a high vulnerability score of complex risk factors. Four vulnerability patterns were statistically extracted explaining 40% of the total variance. The highest frequencies of care activities related to infant care and nutrition, giving advice on the Mother-Child relationship, and psychosocial support. The Youth Welfare Services (YWS) were significant collaboration

  3. Continuity of Care to Prevent Readmissions for Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Yang, Fen; Xiong, Zhen-Fang; Yang, Chongming; Li, Lin; Qiao, Guiyuan; Wang, Yuncui; Zheng, Taoyun; He, Huijuan; Hu, Hui

    2017-04-01

    Readmissions of patients with chronic obstructive pulmonary disease (COPD) to hospitals cast a heavy burden to health care systems. This meta-analysis was aimed to assess the efficacy of continuity of care as interventions, which reduced readmission and mortality rates of such patients. PubMed, Cochrane Library and Embase were searched for articles published before July 2015. A total of 31 reports with randomized controlled trials (RCTs) were finally included in this meta-analysis. The results showed that health education reduced all-cause readmission at 3 months. In addition, health education, comprehensive nursing intervention (CNI) and telemonitoring reduced all-cause readmissions over 6-12 months, and the effect of CNI was best because CNI also reduced COPD-specific readmissions. Home visits also reduced COPD-specific readmissions (the quality more than moderate), but it did not reduce the risk for all-cause readmissions (risk ratios (RRs), 0.92 [95% CI, 0.82-1.04]; moderate quality). There was no statistically significant difference in reducing mortality and quality of life (QOL) among various continued cares. In conclusion, CNI, telemonitoring, health education and home visits should receive more consideration than other interventions by caregivers seeking to implement continued care interventions for patients with COPD.

  4. Prevention IS Care

    Centers for Disease Control (CDC) Podcasts

    2009-03-26

    This podcast provides an overview of the Prevention IS Care campaign, which provides HIV prevention tools for medical care providers to use on a daily basis with patients who are living with HIV.  Created: 3/26/2009 by National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP).   Date Released: 3/26/2009.

  5. Wound Care: Preventing Infection

    Science.gov (United States)

    ... or wearing your Immediate Post-op or preliminary prosthesis; keep it elevated whenever possible. The limb should be raised above the level of your heart to prevent swelling. Take care of your whole self – body, mind, and spirit. Eat well and drink plenty ...

  6. 42 CFR 441.60 - Continuing care.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Continuing care. 441.60 Section 441.60 Public... Periodic Screening, Diagnosis, and Treatment (EPSDT) of Individuals Under Age 21 § 441.60 Continuing care. (a) Continuing care provider. For purposes of this subpart, a continuing care provider means a...

  7. [Continuity of care from the acute care hospital: Results].

    Science.gov (United States)

    Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Alsina-Ribas, Anna; Puigoriol-Juvanteny, Emma; Oriol-Ruscalleda, Margarita; Subirana-Casacuberta, Mireia

    2015-01-01

    To describe the profile of patients treated by a Continuity of Care Manager in an acute-care center during the first six months of its activity, as well as the profile of patients treated and the resource allocation. A prospective cross-sectional study was conducted on patients with complex care needs requiring continuity of care liaison, and who were attended by the Continuity of Care Nurse during the period from October 2013 to March 2014. Patient characteristics, their social environment and healthcare resource allocation were registered and analyzed. A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age 80.57±10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multivariate model, it was observed that the variables associated with readmission were polypharmacy (OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88). Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidities, geriatric syndromes, complex care, and of life needs, to whom an alternative solution to hospitalization is provided, thus preventing readmissions. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  8. Understanding and Teaching Continuity of Care.

    Science.gov (United States)

    Ruane, Thomas J.; Brody, Howard

    1987-01-01

    The continuity of health care includes three elements: cognitive, management, and relationship. Exploration of each expands the understanding of continuity in medical practice. Continuity of care can be evaluated in both undergraduate and residency programs by the application of the criteria offered. (Author/MLW)

  9. Measuring continuity of elders' posthospital care.

    Science.gov (United States)

    Bull, M J; Luo, D; Maruyama, G M

    2000-01-01

    Continuity of care is a critical component of quality patient care, yet the paucity of reliable and valid measures of continuity of care make it difficult to ascertain the extent to which continuity has been achieved. The purpose of this article is to describe the development of an instrument to measure continuity of care that incorporates the perspectives of elders hospitalized for a chronic illness and their family caregivers. The instrument was used, and its reliability and validity examined, in a series of studies related to elders' posthospital transition. Elders in the studies ranged in age from 55 to 94 years. The findings supported content and construct validity, internal consistency reliability, and ability to detect changes in the same subjects at different points in time for the care management and services subscales. With further refinement, the continuity of provider and conflicting information subscales might also facilitate assessment of care continuity.

  10. Continuity of Care in Infancy and Early Childhood Health Outcomes.

    Science.gov (United States)

    Enlow, Elizabeth; Passarella, Molly; Lorch, Scott A

    2017-07-01

    Continuity of care is a key aspect of the patient-centered medical home and improves pediatric outcomes. Health care reform requires high-quality data to demonstrate its continued value. We hypothesized that increased provider continuity in infancy will reduce urgent health care use and increase receipt of preventive services in early childhood. Continuity, using the Usual Provider of Care measure, was calculated across all primary care encounters during the first year of life in a prospectively-constructed cohort of 17 773 infants receiving primary care from birth through 3 years at 30 clinics. Health care utilization and preventive care outcomes were measured from ages 1 to 3 years. Confounders, including chronic conditions, number of sick visits in the first year, socioeconomic status, and site, were addressed by using multivariable regression models incorporating a propensity score. Demographics associated with the lowest continuity quartile included white race (adjusted odds ratio [aOR] 1.43; 95% confidence interval [CI] 1.25-1.64), Medicaid insurance (aOR 1.41; 95% CI 1.23-1.61), and asthma (aOR 1.59; 95% CI 1.30-1.93). Lower continuity was associated with more ambulatory care-sensitive hospitalizations (adjusted incidence rate ratio 2.74; 95% CI 1.49-5.03), ambulatory sick visits (adjusted incidence rate ratio 1.08; 95% CI 1.05-1.11), and lower odds of lead screening (aOR 0.61; 95% CI 0.46-0.79). These associations were stronger for children with chronic conditions. Continuity measured during well visits was not associated with outcomes. Continuity may improve care quality and prevent high-cost health encounters, especially for children with chronic conditions. Novel solutions are needed to improve continuity in the medical home. Copyright © 2017 by the American Academy of Pediatrics.

  11. Continuity of care: differing conceptions and values.

    Science.gov (United States)

    Delva, Dianne; Kerr, Jonathan; Schultz, Karen

    2011-08-01

    To understand how the conception of continuity of care can influence family physician trainees by exploring the perspectives of established family physicians, physicians working in episodic care who had been trained in family medicine, and family medicine trainees. Qualitative analysis of focus group data. Southeastern Ontario. Seven focus groups consisting of members from 3 groups: established family physicians, physicians working in episodic care who had been trained in family medicine, or family medicine trainees. Semistructured focus group interviews were taped and transcribed. Using constant comparison, the transcripts were analyzed for themes related to continuity of care and how these were valued among the 3 groups of physicians. The 3 groups differed on how they valued continuity of the relationship, how they valued informational continuity, and how these concepts affected their perceptions of difficult clinician-patient relationships. Experienced family physicians described long-term relationships as a core value in their practices. In contrast, episodic care physicians valued informational continuity. Family medicine trainees learned about continuity of care through role models and theoretical teaching. They valued the efficiency gained by knowing patients and the reward of being recognized by patients. Family medicine trainees expressed greater distress with difficult clinician-patient interactions than experienced family physicians expressed. It was unclear whether the challenges of difficult relationships were offset by the trainees' appreciation of continuity of care. Different perceptions, settings, and skills can influence how continuity of care is valued, which might affect career and practice decisions among trainees.

  12. Models of maternity care: evidence for midwifery continuity of care.

    Science.gov (United States)

    Homer, Caroline Se

    2016-10-17

    There has been substantial reform in the past decade in the provision of maternal and child health services, and specifically regarding models of maternity care. Increasingly, midwives are working together in small groups to provide midwife-led continuity of care. This article reviews the current evidence for models of maternity care that provide midwifery continuity of care, in terms of their impact on clinical outcomes, the views of midwives and childbearing women, and health service costs. A systematic review of midwife-led continuity of care models identified benefits for women and babies, with no adverse effects. Non-randomised studies have shown benefits of midwifery continuity of care for specific groups, such as Aboriginal and Torres Strait Islander women. There are also benefits for midwives, including high levels of job satisfaction and less occupational burnout. Implementing midwifery continuity of care in public and private settings in Australia has been challenging, despite the evidence in its favour and government policy documents that support it. A reorganisation of the way maternity services are provided in Australia is required to ensure that women across the country can access this model of care. Critical to such reform is collaboration with obstetricians, general practitioners, paediatricians and other medical professionals involved in the care of pregnant women, as well as professional respect for the central role of midwives in the provision of maternity care. More research is needed into ways to ensure that all childbearing women can access midwifery continuity of care.

  13. Continuity of care in day surgical care - perspective of patients.

    Science.gov (United States)

    Suominen, Tarja; Turtiainen, Ann-Marie; Puukka, Pauli; Leino-Kilpi, Helena

    2014-12-01

    The realisation of continuity in day surgical care is analysed in this study. The term 'continuity of care' is used to refer to healthcare processes that take place in time (time flow) and require coordination (coordination flow), rapport (caring relationship flow) and information (information flow). Patients undergoing laparoscopic cholecystectomy or inguinal hernia day surgery are ideal candidates for studying the continuity of care, as the diseases are very common and the treatment protocol is mainly the same in different institutions, in addition to which the procedure is elective and most patients have a predictable clinical course. The aim of the study was to describe, from the day surgery patients' own perspective, how continuity of care was realised at different phases of the treatment, prior to the day of surgery, on the day of surgery and after it. The study population consisted of 203 day surgical patients 10/2009-12/2010 (N = 350, response rate 58%). A questionnaire was developed for this study. Based on the results, the continuity of care was well realised as a rule. Continuity is improved by the fact that patients know the nurse who will look after them in the hospital before the day of surgery and have a chance to meet the nurse even after the operation. Meeting the surgeon who performed the operation afterwards also improves patients' perception of continuation of care. Continuity of care may be improved by ensuring that the patient meets caring staff prior to the day of operation and after the procedure. An important topic for further research would be how continuation of care is realised in the case of other patient groups (e.g. in internal medicine). On the other hand, realisation of continuation of care should also be studied from the viewpoint of those taking part in patient care in order to find similarities/differences between patients' perceptions and professionals' views. Studying interventions aimed to promote continuity of care, for

  14. Can the use of urgent care clinics improve access to care without undermining continuity in primary care?

    Science.gov (United States)

    Villaseñor, Sally; Krouse, Helene J

    2016-06-01

    There is a niche for urgent care clinics as an alternate source of health care in the United States. This systematic review examines whether the use of urgent care clinics can improve access to care or if these facilities undermine continuity of primary care. Databases used were Cumulative Index for Nursing and Allied Health (CINAHL) and Medical Literature Analysis and Retrieval System Online (MEDLINE). Articles from 2004 to 2014 were searched using keywords-access, barriers, continuity of care, nurse practitioner (NP), urgent care, retail clinic, emergency, and primary care. Urgent care clinics can improve access to care, but may also negatively impact continuity of care, preventative services, and ongoing management of chronic conditions. Barriers to primary care and benefits of urgent care are inversely related. Insufficient knowledge regarding navigation of the healthcare system, perceived urgency of medical need, and deflection of care contribute to use of urgent care over primary care. NPs are frontline healthcare providers essential to developing and maintaining successful communication and collaboration among providers across healthcare settings. In both primary care and urgent care facilities, NPs can ensure continuity of care, decreased healthcare costs, and optimized health outcomes for patients. ©2015 American Association of Nurse Practitioners.

  15. Pain control in the continuity of care

    Directory of Open Access Journals (Sweden)

    Boaz Gedaliahu Samolsky Dekel

    2014-09-01

    Full Text Available As cancer is earlier diagnosed and its treatments improve, palliative care is increasingly playinga vital role in the oncology population. The concept and the timing of application of palliativecare have evolved in the last decades. The WHO pain ladder and the greater understanding ofappropriate multimodal pain control treatments have dramatically improved the managementof cancer pain. Integration of palliative care, which appears crucial for a proper management ofpatients, can be defined as the provision of palliative care both during curative cancer treatmentand after curative treatment has ceased. Clinical assistance should be delivered by specialisedphysicians in different fields, psychologists and nurses, and should include all aspects of advancedcancercare, from diagnosis to the treatment of symptoms. A further aspect of integration ofpalliative care concerns the role of the continuity of care in acute or emergency contexts bothfor out- and inpatients. Further improvements in the management of cancer pain are needed.First, the WHO ladder should be modified with further steps, like those of interventional paincontrol procedures and techniques, with the aim of being effective also for the small proportion ofnonresponsive patients. Second, more research is needed to find out which interventions aimingto improve continuity of care of cancer patients are beneficial to improve patient, providerand process of care outcomes and to identify which outcomes are the most sensitive to change.Of crucial importance would be the development of a standardised instrument to measure thecontinuity of care in cancer patients.This article is a brief overview on the management of cancer pain, from the pharmacologicaltreatments reported by WHO ladder, to the need for integration and continuity of care.http://dx.doi.org/10.7175/cmi.v8i3.930

  16. Health care process and workflow in continuity of care.

    Science.gov (United States)

    Mennerat, François; Lundell, Karl-Henrik; Fogelberg, Magnus; Hofdijk, Jacob; Braga, Silviu

    2009-01-01

    Basically, the workshop aims to raise and collect input to Part 2 ("Health care process and workflow"), currently under development, of the European standard EN 13940 "Health informatics - System of concepts to support continuity of care", the general objective of which is to enable communication at the semantic level between information systems in health care in the perspective of continuity of care. Its scope encompasses identifying the various processes and process objects involved, taking into consideration resource management aspects, responsibilities of health care providers, and means for patients' participation. While the process description and concept system model is meant as a tool for the development of information systems, it may also be used for enterprise analysis and form the basis for organizational decisions and more widely organizational developments that are not inherently tied to the use of ICT.

  17. Preventive Care Benefits (Affordable Care Act)

    Science.gov (United States)

    ... For children Footer Resources About the Affordable Care Act Regulatory and Policy Information For Navigators, Assisters & Partners ... gov USA.gov Resources About the Affordable Care Act Regulatory and Policy Information For Navigators, Assisters & Partners ...

  18. Continuing Education Credits | Division of Cancer Prevention

    Science.gov (United States)

    We are pleased to be able to offer continuing education credits to Registered Dietitians. Registered Dietitians This event is pending for approval by the Commission on Dietetic Registration for 2 CPEUs.  Procedure  Immediately after the event, a link to a short questionnaire will be sent to you by email. Please complete the questionnaire online and print out your certificate of completion.  |

  19. Preventive kidney stones: Continue medical education

    Directory of Open Access Journals (Sweden)

    Farahnak Assadi

    2017-01-01

    Full Text Available Nephrolithiasis is a common health problem across the globe with a prevalence of 15%–20%. Idiopathic hypercalciuria is the most common cause of nephrolithiasis, and calcium oxalate stones are the most common type of stones in idiopathic hypercalciuric patients. Calcium phosphate stones are frequently associated with other diseases such as renal tubular acidosis type 1, urinary tract infections, and hyperparathyroidism. Compared with flat abdominal film and renal sonography, a noncontrast helical computed tomography scan of the abdomen is the diagnostic procedure of choice for detection of small and radiolucent kidney stones with sensitivity and specificity of nearly 100%. Stones smaller than 5 mm in diameter often pass the urinary tract system and rarely require surgical interventions. The main risk factors for stone formation are low urine output, high urinary concentrations of calcium, oxalate, phosphate, and uric acid compounded by a lower excretion of magnesium and citrate. A complete metabolic workup to identify the risk factors is highly recommended in patients who have passed multiple kidney stones or those with recurrent disease. Calcium oxalate and calcium phosphate stones are treated by the use of thiazide diuretics, allopurinol, and potassium citrate. Strategies to prevent kidney stone recurrence should include the elimination of the identified risk factors and a dietary regimen low in salt and protein, rich in calcium and magnesium which is coupled with adequate fluid intake.

  20. Teacher Perspectives on the Practice of Continuity of Care

    Science.gov (United States)

    Longstreth, Sascha; Garrity, Sarah; Ritblatt, Shulamit N.; Olson, Kelsey; Virgilio, Ashley; Dinh, Hilary; Padamada, Shane

    2016-01-01

    This study aims to address gaps in the literature on continuity of care through focus group interviews with teachers at public early care and education programs in San Diego County, California, USA. To better understand various perspectives on continuity of care, focus groups were conducted at programs that currently practice continuity of care,…

  1. 'Falling through gaps': primary care patients' accounts of breakdowns in experienced continuity of care.

    Science.gov (United States)

    Tarrant, Carolyn; Windridge, Kate; Baker, Richard; Freeman, George; Boulton, Mary

    2015-02-01

    Experienced continuity is important for good quality primary care but may be challenging to achieve. Little is known about how discontinuities or gaps in care may arise, how they impact on patients' experiences and how best to understand them so that they can be avoided or managed. Using the theoretical framework of candidacy, we aim to explore patients' experiences of discontinuities in care and to gain insight into how gaps come to be bridged and why they might remain unresolved. A secondary analysis was undertaken of interview data from a large study into continuity in primary care, involving a diverse sample of 50 patients, recruited from 15 general practices, one walk-in centre and community settings in Leicestershire, UK. Analysis was conducted using a constant comparative approach. Experiences of gaps in care were common, arising from failures in communication and coordination of care. Although some gaps were easily bridged, many patients described 'falling through gaps' because of difficulties establishing their candidacy for ongoing care when gaps occurred. These patients commonly had complex, chronic conditions and multi-morbidity. Bridging gaps required resources; relationship continuity was a valuable resource for preventing and repairing gaps in care. When gaps were not bridged, distress and dysfunctional use of health services followed. This study demonstrates that some patients with complex chronic conditions and multi-morbidity may be unable to get the continuity they need and highlights the potential for relationship continuity to help prevent vulnerable patients falling through gaps in care. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Preventive Dental Care in Older Adults with Diabetes

    Science.gov (United States)

    Shen, Chan; Sambamoorthi, Nethra; Sambamoorthi, Usha

    2016-01-01

    Background The association between poor oral health and diabetes is well documented. Therefore, preventive oral health is strongly indicated for individuals with diabetes. The purposes of this study were 1) to determine if there were a difference in preventive dental care utilization among older adults with diabetes from 2002 and 2011, and 2) to compare preventive dental care utilization of older adults with and without diabetes from 2002 and 2011. Methods The data were from the Medicare Current Beneficiary Survey. The sample included older, fee-for-service Medicare beneficiaries (ages 65 years and above). The key outcome was self-reported preventive dental care. In 2002, there were 8,725 participants; in 2011, there were 7,425 participants. Chi square and logistic regressions were conducted. Results In 2002, 28.8 % of participants with diabetes had preventive dental care. In 2011, this percentage increased to 36.0%. Similar results were seen among individuals without diabetes (42.9% in 2002 and 45.5% in 2011). The increase in preventive dental care was statistically significant for individuals with and without diabetes. The participants with diabetes, as compared with participants without diabetes, remained statistically less likely to have preventive dental care in adjusted logistic regression analysis with and without considering the interaction between observation year and diabetes (adjusted odds ratios= 0.73, and 0.86, respectively). Conclusion While the increase in preventive dental care is welcoming, older adults with diabetes continue to have significant preventive dental care need. Practical Implication Additional efforts are needed to encourage individuals with diabetes to obtain preventive dental care. PMID:27189741

  3. Measuring continuity of care: psychometric properties of the Nijmegen Continuity Questionnaire.

    NARCIS (Netherlands)

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

    2012-01-01

    BACKGROUND: Recently, the Nijmegen Continuity Questionnaire (NCQ) was developed. It aims to measure continuity of care from the patient perspective across primary and secondary care settings. Initial pilot testing proved promising. AIM: To further examine the validity, discriminative ability, and

  4. Measuring continuity of care: psychometric properties of the Nijmegen Continuity Questionnaire.

    NARCIS (Netherlands)

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

    2012-01-01

    Background: Recently, the Nijmegen Continuity Questionnaire (NCQ) was developed. It aims to measure continuity of care from the patient perspective across primary and secondary care settings. Initial pilot testing proved promising. Aim: To further examine the validity, discriminative ability, and

  5. Measuring continuity of care: psychometric properties of the Nijmegen Continuity Questionnaire

    NARCIS (Netherlands)

    Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; Mokkink, H.G.; van Weel, C.; van den Bosch, W.J.

    2012-01-01

    Background: Recently, the Nijmegen Continuity Questionnaire (NCQ) was developed. It aims to measure continuity of care from the patient perspective across primary and secondary care settings. Initial pilot testing proved promising. Aim: To further examine the validity, discriminative ability, and

  6. 42 CFR 438.208 - Coordination and continuity of care.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Coordination and continuity of care. 438.208... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Access Standards § 438.208 Coordination and continuity of care. (a) Basic requirement—(1) General...

  7. Continuity of Care and Outcomes in Residential Care: A Comparison of Two Care Giving Models

    Science.gov (United States)

    Jones, Loring

    2006-01-01

    This study examined differences in two residential care giving models (houseparent vs. child care worker) in providing continuity of care for youth in residential placement, and the effect that a care giving model had on selected program outcomes. Data for this research were collected in a residential facility that used both models. Youth with…

  8. Prevention of health care-associated infections.

    Science.gov (United States)

    Hsu, Vincent

    2014-09-15

    Health care-associated infections cause approximately 75,000 deaths annually, in addition to increasing morbidity and costs. Over the past decade, a downward trend in health care-associated infections has occurred nationwide. Basic prevention measures include administrative support, educating health care personnel, and hand hygiene and isolation precautions. Prevention of central line- or catheter-associated infections begins with avoidance of unnecessary insertion, adherence to aseptic technique when inserting, and device removal when no longer necessary. Specific recommendations for preventing central line-associated bloodstream infections include use of chlorhexidine for skin preparation, as a component of dressings, and for daily bathing of patients in intensive care units. Catheter-associated urinary tract infections are the most common device-related health care-associated infection. Maintaining a closed drainage system below the patient reduces the risk of infection. To prevent ventilator-associated pneumonia, which is associated with high mortality, mechanically ventilated patients should be placed in the semirecumbent position and receive antiseptic oral care. Prevention of surgical site infections includes hair removal using clippers, glucose control, and preoperative antibiotic prophylaxis. Reducing transmission of Clostridium difficile and multidrug-resistant organisms in the hospital setting begins with hand hygiene and contact precautions. Institutional efforts to reduce unnecessary antibiotic prescribing are also strongly recommended. Reducing rates of methicillin-resistant Staphylococcus aureus infection can be achieved through active surveillance cultures and decolonization therapy with mupirocin.

  9. Opportunity Knocks: HIV Prevention in Primary Care.

    Science.gov (United States)

    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.

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

    OpenAIRE

    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 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, pa...

  11. Molding to the Children: Primary Caregiving and Continuity of Care

    Science.gov (United States)

    Theilheimer, Rachel

    2006-01-01

    The author describes the practices of primary caregiving and continuity of care as necessary components of a high quality child care setting. Yet recent evidence suggests that continuity of care is rare for infants and toddlers because young children are often moved from room to room as they grow. The author describes the benefits of primary…

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

    Science.gov (United States)

    ... informed member of your health care team. The “Speak Up” program is sponsored by The Joint Commission. ... prevent health care mistakes, patients are urged to “Speak Up.” S peak up if you have questions or ...

  13. Continuity of Care in a University-Based Practice

    Science.gov (United States)

    Breslau, Naomi; Reeb, Kenneth G.

    1975-01-01

    Effects of changes in a pediatric practice--expansion of the number of pediatricians and incorporation into a university hospital setting--on continuity of care and utilization were examined, results showing a marked decline in the continuity of sick visits. Discussion emphasizes the need for a deliberate plan of continuity in primary care.…

  14. Preventing re-entry to foster care.

    Science.gov (United States)

    Carnochan, Sarah; Rizik-Baer, Daniel; Austin, Michael J

    2013-01-01

    Re-entry to foster care generally refers to circumstances in which children who have been discharged from foster care to be reunified with their family of origin, adopted, or provided kinship guardianship are returned to foster care. In the context of the federal performance measurement system, re-entry refers specifically to a return to foster care following an unsuccessful reunification. The federal Children and Family Services Review measures re-entry to foster care with a single indicator, called the permanency of reunification indicator, one of four indicators comprising the reunification composite measure. This review focuses on research related to the re-entry indicator, including the characteristics of children, caregivers and families, as well as case and child welfare services that are associated with a higher or lower risk of re-entry to foster care. Promising post-reunification services designed to prevent re-entry to foster care are described.

  15. Continuity of medication management and continuity of care: Conceptual and operational considerations.

    Science.gov (United States)

    Beadles, Christopher A; Voils, Corrine I; Crowley, Matthew J; Farley, Joel F; Maciejewski, Matthew L

    2014-01-01

    Continuity of care is considered foundational to high-quality care. Traditional continuity of care constructs may adequately characterize care quality in general populations, but may merit reconceptualization for patients with multiple chronic conditions. Specifically, interactions between multiple chronic condition patients and providers involve complex medication management; therefore care continuity measurement may be more relevant if focused on the provider subset who prescribes essential medications for chronic conditions-a construct we call continuity of medication management. Our objective was to explore conceptual distinctions between continuity of medication management and continuity of care, survey existing evidence in this area, and discuss implications of our findings for future research and intervention development. In this topical review, we discuss conceptual distinctions between continuity of medication management and continuity of care, review the limited continuity of medication management-related empirical evidence, and discuss implications for future research and interventions. Continuity of medication management represents a potential conceptual and measurement advance by reflecting interpersonal continuity and management continuity, and may provide a means of identifying patients at high-risk of adverse events. Empirical evidence also establishes support for continuity of medication management as a meaningful measure of care continuity. Finally, continuity of medication management may also be a potential target for future intervention to improve care delivery among multiple chronic condition patients. If continuity of medication management is validated in diverse populations, correlated with patient outcomes, and responsive to change, then it may be an important target for improving the health and health care of multiple chronic condition patients.

  16. Effect of Health Care Professionals' Continuing Education ...

    African Journals Online (AJOL)

    Purpose: To evaluate the impact of educational intervention by health care providers on clinical outcomes in type 2 diabetes patients in a Yemeni health facility. Methods: A prospective, one-group and pre- and post-test design to assess the effects of health care providers' education on clinical patient outcomes was ...

  17. Measuring Care Continuity: A Comparison of Claims-based Methods.

    Science.gov (United States)

    Pollack, Craig E; Hussey, Peter S; Rudin, Robert S; Fox, D Steven; Lai, Julie; Schneider, Eric C

    2016-05-01

    Assessing care continuity is important in evaluating the impact of health care reform and changes to health care delivery. Multiple measures of care continuity have been developed for use with claims data. This study examined whether alternative continuity measures provide distinct assessments of coordination within predefined episodes of care. This was a retrospective cohort study using 2008-2009 claims files for a national 5% sample of beneficiaries with congestive heart failure, chronic obstructive pulmonary disease, and diabetes mellitus. Correlations among 4 measures of care continuity-the Bice-Boxerman Continuity of Care Index, Herfindahl Index, usual provider of care, and Sequential Continuity of Care Index-were derived at the provider- and practice-levels. Across the 3 conditions, results on 4 claims-based care coordination measures were highly correlated at the provider-level (Pearson correlation coefficient r=0.87-0.98) and practice-level (r=0.75-0.98). Correlation of the results was also high for the same measures between the provider- and practice-levels (r=0.65-0.92). Claims-based care continuity measures are all highly correlated with one another within episodes of care.

  18. Does Continuous Hospice Care Help Patients Remain at Home?

    Science.gov (United States)

    Casarett, David; Harrold, Joan; Harris, Pamela S; Bender, Laura; Farrington, Sue; Smither, Eugenia; Ache, Kevin; Teno, Joan

    2015-09-01

    In the U. S., hospices sometimes provide high-intensity "continuous care" in patients' homes. However, little is known about the way that continuous care is used or what impact continuous care has on patient outcomes. To describe patients who receive continuous care and determine whether continuous care reduces the likelihood that patients will die in an inpatient unit or hospital. Data from 147,137 patients admitted to 11 U.S. hospices between 2008 and 2012 were extracted from the electronic medical records. The hospices are part of a research-focused collaboration. The study used a propensity score-matched cohort design. A total of 99,687 (67.8%) patients were in a private home or nursing home on the day before death, and of these, 10,140 (10.2%) received continuous care on the day before death. A propensity score-matched sample (n = 24,658) included 8524 patients who received continuous care and 16,134 patients who received routine care on the day before death. Using the two matched groups, patients who received continuous care on the day before death were significantly less likely to die in an inpatient hospice setting (350/8524 vs. 2030/16,134; 4.1% vs. 12.6%) (odds ratio [OR] 0.29; 95% CI 0.27-0.34; P cared for by a spouse, the use of continuous care was associated with a larger decrease in inpatient deaths (OR 0.12; 95% CI 0.09-0.16; P cared for by other family members (OR 0.37; 95% CI 0.32-0.42; P care on the day before death is associated with a significant reduction in the use of inpatient care on the last day of life, particularly when patients are cared for by a spouse. Copyright © 2015. Published by Elsevier Inc.

  19. [Perceptions about continuous training of Chilean health care teachers].

    Science.gov (United States)

    Pérez V, Cristhian; Fasce H, Eduardo; Coloma N, Katherine; Vaccarezza G, Giulietta; Ortega B, Javiera

    2013-06-01

    Continuous training of teachers, in discipline and pedagogical topics, is a key step to improve the quality of educational processes. To report the perception of Chilean teachers of undergraduate health care programs, about continuous training activities. Twenty teachers working at different undergraduate health care programs in Chile were interviewed. Maximum variation and theoretical sampling methods were used to select the sample. Data was analyzed by open coding, according to the Grounded Theory guidelines. Nine categories emerged from data analysis: Access to continuous training, meaning of training in discipline, activities of continuous training in discipline, meaning of continuous training in pedagogy, kinds of continuous training in pedagogy, quality of continuous training in pedagogy, ideal of continuous training in pedagogy, outcomes of continuous training in pedagogy and needs for continuous training in pedagogy. Teachers of health care programs prefer to participate in contextualized training activities. Also, they emphasize their need of training in evaluation and teaching strategies.

  20. Nijmegen Continuity Questionnaire: development and testing of a questionnaire that measures continuity of care.

    OpenAIRE

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

    2011-01-01

    Abstract: To develop and pilot test a generic questionnaire to measure continuity of care from the patient's perspective across primary and secondary care settings. We developed the Nijmegen Continuity Questionnaire (NCQ) based on a systematic literature review and analysis of 30 patient interviews. The questionnaire consisted of 16 items about the patient-provider relationship to be answered for five different care providers and 14 items each on the collaboration between four groups of care ...

  1. Measuring continuity of care: psychometric properties of the Nijmegen Continuity Questionnaire

    Science.gov (United States)

    Uijen, Annemarie A; Schers, Henk J; Schellevis, François G; Mokkink, Henk GA; van Weel, Chris; van den Bosch, Wil JHM

    2012-01-01

    Background Recently, the Nijmegen Continuity Questionnaire (NCQ) was developed. It aims to measure continuity of care from the patient perspective across primary and secondary care settings. Initial pilot testing proved promising. Aim To further examine the validity, discriminative ability, and reliability of the NCQ. Design A prospective psychometric instrument validation study in primary and secondary care in the Netherlands. Method The NCQ was administered to patients with a chronic disease recruited from general practice (n = 145) and hospital outpatient departments (n = 123) (response rate 76%). A principal component analysis was performed to confirm three subscales that had been found previously. Construct validity was tested by correlating the NCQ score to scores of other scales measuring quality of care, continuity, trust, and satisfaction. Discriminative ability was tested by investigating differences in continuity subscores of different subgroups. Test–retest reliability was analysed in 172 patients. Results Principal factor analysis confirmed the previously found three continuity subscales — personal continuity, care provider knows me; personal continuity, care provider shows commitment; and team/cross-boundary continuity. Construct validity was demonstrated through expected correlations with other variables and discriminative ability through expected differences in continuity subscores of different subgroups. Test–retest reliability was high (the intraclass correlation coefficient varied between 0.71 and 0.82). Conclusion This study provides evidence for the validity, discriminative ability, and reliability of the NCQ. The NCQ can be of value to identify problems in continuity of care. PMID:22782001

  2. Measuring continuity of care: psychometric properties of the Nijmegen Continuity Questionnaire.

    Science.gov (United States)

    Uijen, Annemarie A; Schers, Henk J; Schellevis, François G; Mokkink, Henk G A; van Weel, Chris; van den Bosch, Wil Jhm

    2012-07-01

    Recently, the Nijmegen Continuity Questionnaire (NCQ) was developed. It aims to measure continuity of care from the patient perspective across primary and secondary care settings. Initial pilot testing proved promising. To further examine the validity, discriminative ability, and reliability of the NCQ. A prospective psychometric instrument validation study in primary and secondary care in the Netherlands. The NCQ was administered to patients with a chronic disease recruited from general practice (n = 145) and hospital outpatient departments (n = 123) (response rate 76%). A principal component analysis was performed to confirm three subscales that had been found previously. Construct validity was tested by correlating the NCQ score to scores of other scales measuring quality of care, continuity, trust, and satisfaction. Discriminative ability was tested by investigating differences in continuity subscores of different subgroups. Test-retest reliability was analysed in 172 patients. Principal factor analysis confirmed the previously found three continuity subscales - personal continuity, care provider knows me; personal continuity, care provider shows commitment; and team/cross-boundary continuity. Construct validity was demonstrated through expected correlations with other variables and discriminative ability through expected differences in continuity subscores of different subgroups. Test-retest reliability was high (the intraclass correlation coefficient varied between 0.71 and 0.82). This study provides evidence for the validity, discriminative ability, and reliability of the NCQ. The NCQ can be of value to identify problems in continuity of care.

  3. Nurses' Perceptions of Patient Care Continuity in Day Surgery.

    Science.gov (United States)

    Renholm, Marja; Suominen, Tarja; Puukka, Pauli; Leino-Kilpi, Helena

    2017-12-01

    The increase in day surgery has brought about a significant change in patient care and care continuity. The purpose of this study was to analyze nurses' perceptions of the realization of continuity of care in day surgery. Continuity of care is examined from the perspectives of time, flow, co-ordination flow, caring relationship flow, and information flow. Descriptive study. A questionnaire including demographics and questions about continuity of care was completed by 83 of the 120 eligible nurses (response rate, 69%) in one hospital district in Finland. According to the nurses, continuity of patient care is mostly well realized. On the day of surgery, information flow was the domain that was best realized. In the opinion of the nurses, continuity of care was least realized at home before surgery and at home during the period after surgery. Based on nurses' perceptions, continuity of care was relatively well realized. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  4. Continuity of pharmaceutical care for psychiatric patients

    NARCIS (Netherlands)

    Abdullah-Koolmees, Heshu

    2015-01-01

    Psychiatric diseases are common. The effective treatment of a psychiatric disease, its (somatic) side effects and any concurrent somatic diseases is important for the patient’s overall health and wellbeing. The studies conducted in psychiatric patients generally focus on the continuation of

  5. Continuity of care from the perspective of users.

    Science.gov (United States)

    Mendes, Felismina Rosa P; Gemito, Maria Laurência G Parreirinha; Caldeira, Ermelinda do Carmo; Serra, Isaura da Conceição; Casas-Novas, Maria Vitória

    2017-03-01

    Continuity of care, in addition to ensuring improvement of the quality of care, contributes to the reduction of health costs. The objective of this study was to analyse the continuity of care in health units in the municipality of Évora (south of Portugal), from the perspective of users. This is across-sectional, exploratory and descriptive study with a quantitative approach, with a sample consisting of 342 users of health units. The instrument was a questionnaire adapted from English and Spanish studies. The results show that elements of continuity were identified in the different dimensions of the continuity of care - relational, management, information and some items of flexible continuity. Longitudinal continuity has the lowest values in nursing care. In conclusion, what stands out positively, and in its different dimensions, is relational continuity, in which most users recommend their family doctor and nurse to family and friends, and flexible continuity, which translates into reduced waiting times to be attended by a doctor or nurse and access to care. What stands out negatively is the weak involvement of the user in care by health professionals, in the dimensions of relational continuity.

  6. Nijmegen Continuity Questionnaire: Development and testing of a questionnaire that measures continuity of care

    NARCIS (Netherlands)

    Uijen, A.A.; Schellevis, F.G.; Bosch, W.J. van den; Mokkink, H.G.A.; Weel, C. van; Schers, H.J.

    2011-01-01

    OBJECTIVE: To develop and pilot test a generic questionnaire to measure continuity of care from the patient's perspective across primary and secondary care settings. STUDY DESIGN AND SETTING: We developed the Nijmegen Continuity Questionnaire (NCQ) based on a systematic literature review and

  7. Nijmegen Continuity Questionnaire: development and testing of a questionnaire that measures continuity of care.

    NARCIS (Netherlands)

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

    2011-01-01

    Abstract: To develop and pilot test a generic questionnaire to measure continuity of care from the patient's perspective across primary and secondary care settings. We developed the Nijmegen Continuity Questionnaire (NCQ) based on a systematic literature review and analysis of 30 patient interviews.

  8. Continuity of care in home health-care practice: two management paradoxes.

    Science.gov (United States)

    Gjevjon, Edith R; Romøren, Tor I; Kjøs, Bente Ø; Hellesø, Ragnhild

    2013-01-01

      To explore continuity of care from a manager's perspective: How do managers understand the concept of continuity of care and how do they assess continuity of care in home health-care? How do managers work to ensure continuity of care when managing care provision for patients in their homes?   Continuity of care is considered a prerequisite for service quality. Managers can influence continuity of care through managing day-to-day work.   Semi-structured interviews of a purposive sample of 16 managers from 12 municipal units. Theory-driven and data-driven analysis was applied.   Ideally, to promote continuity of care, the number of carers should be limited. Yet, in practice, discontinuity of care was accepted as a working compromise. The managers faced two paradoxes: the continuity ideal vs. the practicalities of home health-care, and caring for patients vs. caring for staff.   The managers were forced to prioritize, in conflict with ideals or professional standards, patients' wellbeing or the wellbeing of the staff. Ensuring continuity of care for all patients did not seem feasible.   The study highlights management paradoxes: possible unintended consequences of prioritizing needs for continuity of care should be objects of reflection in care management. © 2012 Blackwell Publishing Ltd.

  9. Continuity of care: important, but only the first step

    Directory of Open Access Journals (Sweden)

    Corrigan Janet M

    2012-05-01

    Full Text Available Abstract Continuity of care is critical to achieving the best outcomes, especially for patients with chronic conditions. Israel’s strong commitment to primary care as a central organizing concept of the health system, accompanied by investments in health information technology and training primary care physicians, has contributed to its impressive levels of continuity of care. Taking the next steps toward a comprehensive system of patient- and population-centered care for proactive management of patients with chronic conditions has much potential to further enhance outcomes and reduce costs.

  10. Measuring continuity of care: psychometric properties of the Nijmegen Continuity Questionnaire.

    OpenAIRE

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

    2012-01-01

    Background: Recently, the Nijmegen Continuity Questionnaire (NCQ) was developed. It aims to measure continuity of care from the patient perspective across primary and secondary care settings. Initial pilot testing proved promising. Aim: To further examine the validity, discriminative ability, and reliability of the NCQ. Design: A prospective psychometric instrument validation study in primary and secondary care in the Netherlands. Method: The NCQ was administered to patients with a chronic di...

  11. 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

  12. 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

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

    Directory of Open Access Journals (Sweden)

    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.

  14. Schizophrenia in the Netherlands: Continuity of Care with Better Quality of Care for Less Medical Costs.

    Directory of Open Access Journals (Sweden)

    Arnold van der Lee

    Full Text Available Patients with schizophrenia need continuous elective medical care which includes psychiatric treatment, antipsychotic medication and somatic health care. The objective of this study is to assess whether continuous elective psychiatric is associated with less health care costs due to less inpatient treatment.Data concerning antipsychotic medication and psychiatric and somatic health care of patients with schizophrenia in the claims data of Agis Health Insurance were collected over 2008-2011 in the Netherlands. Included were 7,392 patients under 70 years of age with schizophrenia in 2008, insured during the whole period. We assessed the relationship between continuous elective psychiatric care and the outcome measures: acute treatment events, psychiatric hospitalization, somatic care and health care costs.Continuous elective psychiatric care was accessed by 73% of the patients during the entire three year follow-up period. These patients received mostly outpatient care and accessed more somatic care, at a total cost of €36,485 in three years, than those without continuous care. In the groups accessing fewer or no years of elective care 34%-68% had inpatient care and acute treatment events, while accessing less somatic care at average total costs of medical care from €33,284 to €64,509.Continuous elective mental and somatic care for 73% of the patients with schizophrenia showed better quality of care at lower costs. Providing continuous elective care to the remaining patients may improve health while reducing acute illness episodes.

  15. Continuity of care: betrayed values or misplaced nostalgia.

    Science.gov (United States)

    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.

  16. RFID Continuance Usage Intention in Health Care Industry.

    Science.gov (United States)

    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.

  17. Measuring parents’ perspective on continuity of care in children with special health care needs

    OpenAIRE

    Paola Rucci; Jos Latour; Elisa Zanello; Simona Calugi; Silvia Vandini; Giacomo Faldella; Maria Pia Fantini

    2015-01-01

    Introduction: Children with special health care needs are an exponentially growing population needing integrated health care programmes that involve primary, community, hospital and tertiary care services. The aims of the study are (1) to develop and validate the Special Needs Kids Questionnaire (SpeNK-Q) designed to measure parents’ perspective on continuity of care for children with special health care needs and (2) to evaluate the continuity of care based on parental experiences in this po...

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

    Science.gov (United States)

    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.

  19. 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.)

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

    Science.gov (United States)

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

    2014-09-01

    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 for depression with chronic heart failure patients. Continuity of care was measured using a patient questionnaire and defined as ( 1 ) number of care providers contacted (personal continuity); ( 2 ) collaboration between care providers in general practice (team continuity) (six items, score 1-5); and ( 3 ) collaboration between GPs and care providers outside general practice (cross-boundary continuity) (four items, score 1-5). Most patients at risk for depression contacted several care providers throughout the care spectrum in the past year. They experienced high team continuity and low cross-boundary continuity. In their general practice, they contacted more different care providers for their illness than heart failure patients did (P care providers in their practice: a mean score of 4.3 per item compared to 4.0 for heart failure patients (P = 0.03). The perceived cross-boundary continuity, however, was reversed: a mean score of 3.5 per item for patients at risk for depression, compared to 4.0 for heart failure patients (P = 0.01). The explorative comparison between patients at risk for depression and heart failure patients shows small differences in experienced continuity of care. This should be analysed further in a more robust study.

  1. 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.

  2. Technology Solutions to Support Care Continuity in Home Care: A Focus Group Study.

    Science.gov (United States)

    Dowding, Dawn W; Russell, David; Onorato, Nicole; Merrill, Jacqueline A

    2017-09-01

    Elevated hospital readmission rates from home care are an indicator of poor care quality, and rates are particularly high for patients with heart failure. Readmissions may be avoided by optimizing continuity of care. To explore perceptions among home care clinicians of the barriers they face and the information they need to improve care continuity for patients with heart failure. Focus groups were conducted with teams of home care clinicians at a large certified home healthcare agency in the Northeastern United states. In total, there were 61 participants across 6 focus groups. Three overarching themes emerged: continuity of care and communication on care transitions, maintaining continuity of care during a home care episode (with subthemes tracking signs and symptoms and patient teaching), and health information technology (HIT) characteristics to support communication and care continuity. Our study highlights areas of improvement for HIT solutions that could support care delivery for patients with heart failure in a home care setting. Home care agencies planning to introduce technology can use these findings to assess if and how potential systems can support nurses to provide continuity of care across healthcare organizations and home care visits.

  3. Interpersonal continuity of care and type two diabetes.

    Science.gov (United States)

    Lustman, Alex; Comaneshter, Doron; Vinker, Shlomo

    2016-06-01

    Continuity of care is one of the core principles of primary care. The importance of interpersonal continuity in treating diabetic patients is unclear. To examine the association of interpersonal continuity of care, by the primary care physician, on the process of diabetic care and on health end points including diabetes control, hospital admissions and mortality. We conducted a population based cohort study, 23,294 eligible participants were identified in Clalit Health Services Central Region at January 1, 2011 and followed through to December 31, 2012. Multivariate logistic regression models were applied to the data to study simultaneously the independent relationship between low interpersonal continuity, adjusted for background characteristics, and outcomes of care, including hospitalization and mortality. Achieving clinical targets was more likely in the high interpersonal continuity group HBA1 C OR 1.11 (CI 1.04-1.19), blood pressure OR 1.12 (1.04-1.20), LDL OR 1.14 (1.06-1.22). Patients with high interpersonal continuity had lower odds for mortality OR 0.59 (0.50-0.70). Admissions to hospital were lower in the high interpersonal continuity group, OR 0.82 (0.75-0.90), however when adjusting for background characteristics the difference in OR for hospital admissions became non-significant 0.92 (0.84-1.01). High interpersonal continuity was associated with improved outcomes of process, and both primary and secondary clinical targets amongst adult patients with diabetes. This study is the first to find an association between interpersonal continuity and mortality amongst adults with diabetes. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  4. 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 ...

  5. Impact of diabetes continuing education on health care ...

    African Journals Online (AJOL)

    The short-term impact of a continuing medical education program on providers. Diabetes Care. 1999; 22: 1929. 25. Gagliardino JJ, González C, Caporale JE. Diabetes. Education Study Group of Argentina. The diabetes- related attitudes of health care professionals and persons with diabetes in Argentina. Rev Panam Salud.

  6. The Relationship between Same-Day Access and Continuity in Primary Care and Emergency Department Visits.

    Directory of Open Access Journals (Sweden)

    Jean Yoon

    Full Text Available We examined how emergency department (ED visits for potentially preventable, mental health, and other diagnoses were related to same-day access and provider continuity in primary care using administrative data from 71,296 patients in 22 VHA clinics over a three-year period. ED visits were categorized as non-emergent; primary care treatable; preventable; not preventable; or mental health-related. We conducted multi-level regression models adjusted for patient and clinic factors. More same-day access significantly predicted fewer non-emergent and primary care treatable ED visits while continuity was not significantly related to any type of ED visit. Neither measure was related to ED visits for mental health problems.

  7. 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

  8. Lapse in Institutional Animal Care and Use Committee Continuing Reviews.

    Directory of Open Access Journals (Sweden)

    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.

  9. Health Care Improvement and Continuing Interprofessional Education: Continuing Interprofessional Development to Improve Patient Outcomes

    Science.gov (United States)

    Wilcock, Peter M.; Janes, Gillian; Chambers, Alison

    2009-01-01

    Health care improvement and continuing professional education must be better understood if we are to promote continuous service improvement through interprofessional learning in the workplace. We propose that situating interprofessional working, interprofessional learning, work-based learning, and service improvement within a framework of social…

  10. 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

  11. 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.L.; Bosch, W.J.H.M. van den

    2014-01-01

    Abstract 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:

  12. 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.; van den Bosch, W.J.H.M.

    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

  13. Barriers to the Implementation of Continuity-of-Care Practices in Child Care Centers

    Science.gov (United States)

    Aguillard, Amber E.; Pierce, Sarah H.; Benedict, Joan H.; Burts, Diane C.

    2005-01-01

    This study examined barriers to the implementation of continuity-of-care practices in child care centers. We collected qualitative and quantitative data for 52 children at four centers that advertise their programs as continuity programs. Of the 52 children, only 7 of the children had been cared for in a single child-caregiver dyad between the…

  14. 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

  15. 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

    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......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......, 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...

  16. Nijmegen Continuity Questionnaire: development and testing of a questionnaire that measures continuity of care.

    Science.gov (United States)

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

    2011-12-01

    To develop and pilot test a generic questionnaire to measure continuity of care from the patient's perspective across primary and secondary care settings. We developed the Nijmegen Continuity Questionnaire (NCQ) based on a systematic literature review and analysis of 30 patient interviews. The questionnaire consisted of 16 items about the patient-provider relationship to be answered for five different care providers and 14 items each on the collaboration between four groups of care providers. The questionnaire was distributed among patients with a chronic disease recruited from general practice. We used principal component analysis (PCA) to identify subscales. We refined the factors by excluding several items, for example, items with a high missing rate. In total, 288 patients filled out the questionnaire (response rate, 72%). PCA yielded three subscales: "personal continuity: care provider knows me," "personal continuity: care provider shows commitment," and "team/cross-boundary continuity." Internal consistency of the subscales ranged from 0.82 to 0.89. Interscale correlations varied between 0.42 and 0.61. The NCQ shows to be a comprehensive, reliable, and valid instrument. Further testing of reliability, construct validity, and responsiveness is needed before the NCQ can be more widely implemented. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. continuity of care and avoidable hospitalizations for chronic obstructive pulmonary disease (COPD).

    Science.gov (United States)

    Lin, I-Po; Wu, Shiao-Chi; Huang, Shu-Tzu

    2015-01-01

    Numerous studied suggest that better continuity of care could result in better health outcomes. However, few studies have examined the relationship between continuity of care and avoidable hospitalizations. A retrospective cohort study design was adopted. We used secondary data analysis based on claim data regarding health care utilization under a universal coverage health insurance scheme in Taiwan. The study population included 3,015 subjects who were newly diagnosed with chronic obstructive pulmonary disease (COPD) in 2006. The main outcome was COPD-related avoidable hospitalization, and the continuity of care index (COCI) was used to measure continuity of care. A logistic regression model was used to control for sex, age, low-income status, and health status. With regard to the effects of continuity of care on avoidable hospitalizations, dose-response trends were observed. The logistic regression model showed that after controlling for covariables, subjects in the low COCI group were 129% (adjusted odds ratio, 2.29; 95% confidence interval, 1.26-4.15) more likely to undergo COPD-related avoidable hospitalizations than those in the high COCI group. Patients with COPD with higher continuity of care had a significantly lower likelihood of avoidable hospitalization. To prevent future hospitalizations, health policy stakeholders should encourage physicians and patients to develop long-term relationships to further improve their health outcomes. © Copyright 2015 by the American Board of Family Medicine.

  18. Translating evidence into practice: Hong Kong Reference Framework for Preventive Care for Children in Primary Care Settings.

    Science.gov (United States)

    Siu, Natalie P Y; Too, L C; Tsang, Caroline S H; Young, Betty W Y

    2015-06-01

    There is increasing evidence that supports the close relationship between childhood and adult health. Fostering healthy growth and development of children deserves attention and effort. The Reference Framework for Preventive Care for Children in Primary Care Settings has been published by the Task Force on Conceptual Model and Preventive Protocols under the direction of the Working Group on Primary Care. It aims to promote health and prevent disease in children and is based on the latest research, and contributions of the Clinical Advisory Group that comprises primary care physicians, paediatricians, allied health professionals, and patient groups. This article highlights the comprehensive, continuing, and patient-centred preventive care for children and discusses how primary care physicians can incorporate the evidence-based recommendations into clinical practice. It is anticipated that the adoption of this framework will contribute to improved health and wellbeing of children.

  19. Improving preventive health care in Aboriginal and Torres Strait Islander primary care settings.

    Science.gov (United States)

    Bailie, Jodie; Matthews, Veronica; Laycock, Alison; Schultz, Rosalie; Burgess, Christopher P; Peiris, David; Larkins, Sarah; Bailie, Ross

    2017-07-14

    Like other colonised populations, Indigenous Australians experience poorer health outcomes than non-Indigenous Australians. Preventable chronic disease is the largest contributor to the health differential between Indigenous and non-Indigenous Australians, but recommended best-practice preventive care is not consistently provided to Indigenous Australians. Significant improvement in health care delivery could be achieved through identifying and minimising evidence-practice gaps. Our objective was to use clinical audit data to create a framework of the priority evidence-practice gaps, strategies to address them, and drivers to support these strategies in the delivery of recommended preventive care. De-identified preventive health clinical audit data from 137 primary health care (PHC) centres in five jurisdictions were analysed (n = 17,108 audited records of well adults with no documented major chronic disease; 367 system assessments; 2005-2014), together with stakeholder survey data relating to interpretation of these data, using a mixed-methods approach (n = 152 responses collated in 2015-16). Stakeholders surveyed included clinicians, managers, policy officers, continuous quality improvement (CQI) facilitators and academics. Priority evidence-practice gaps and associated barriers, enablers and strategies to address the gaps were identified and reported back through two-stages of consultation. Further analysis and interpretation of these data were used to develop a framework of strategies and drivers for health service improvement. Stakeholder identified priorities were: following-up abnormal test results; completing cardiovascular risk assessments; timely recording of results; recording enquiries about living conditions, family relationships and substance use; providing support for clients identified with emotional wellbeing risk; enhancing systems to enable team function and continuity of care. Drivers identified for improving care in these areas included

  20. Opportunities for Prevention: Assessing Where Low-Income Patients Seek Care for Preventable Coronary Artery Disease.

    Science.gov (United States)

    Klaiman, Tamar A; Valdmanis, Vivian G; Bernet, Patrick; Moises, James

    2015-10-01

    The Affordable Care Act has many aspects that are aimed at improving health care for all Americans, including mandated insurance coverage for individuals, as well as required community health needs assessments (CHNAs), and reporting of investments in community benefit by nonprofit hospitals in order to maintain tax exemptions. Although millions of Americans have gained access to health insurance, many--often the most vulnerable--remain uninsured, and will continue to depend on hospital community benefits for care. Understanding where patients go for care can assist hospitals and communities to develop their CHNA and implementation plans in order to focus resources where the need for prevention is greatest. This study evaluated patient care-seeking behavior among patients with coronary artery disease (CAD) in Florida in 2008--analyzed in 2013--to assess whether low-income patients accessed specific safety net hospitals for treatment or received care from hospitals that were geographically closer to their residence. This study found evidence that low-income patients went to hospitals that treated more low-income patients, regardless of where they lived. The findings demonstrate that hospitals-especially public safety net hospitals with a tradition of treating low-income patients suffering from CAD-should focus prevention activities where low-income patients reside.

  1. Colorectal cancer in Jordan: prevention and care.

    Science.gov (United States)

    Ahmad, Muayyad M; Dardas, Latefa; Dardas, Lubna; Ahmad, Huthaifa

    2015-12-01

    The aim of this study was to describe the knowledge, attitudes, and practices toward colorectal cancer prevention and care in Jordan. A survey was designed to produce reliable estimates for the population's knowledge, attitudes, and practices in all 12 governorates of Jordan by using stratified random sampling. A representative sample of the adult population in Jordan completed a comprehensive tool which explored participants' knowledge about the risk factors associated with colorectal cancer, cancer prevention through lifestyle changes, and early cancer diagnosis and screening. According to the participants (n = 3196), colorectal cancer had the second highest percentage of screening recommendation (12.6%) after breast cancer (57.3%). Only 340 individuals (11%) reported ever screening for cancer. About 20% of the participants had heard of one of the screening tests for colorectal cancer. In fact, only 290 (9.1%) participants had performed the colorectal cancer screening tests. This study provides data that will help colorectal cancer prevention and treatment programs and may enhance the efficiency of colorectal cancer-controlling programs. The findings confirm the necessity of starting colorectal screening intervention that targets the most vulnerable individuals. © The Author(s) 2014.

  2. 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.

  3. Continuity of care: a nursing needs assessment instrument.

    Science.gov (United States)

    Holland, D E; Hansen, D C; Matt-Hensrud, N N; Severson, M A; Wenninger, C R

    1998-01-01

    Based on testing of the Uniform Needs Assessment Instrument (UNAI), a nursing needs assessment tool for adult hospitalized patients was integrated into nursing practice. Some content and format changes to the UNAI occurred as a result of the research process. The revised assessment form is called the Nursing Needs Assessment Instrument (NNAI). Community providers, including nursing home and home health care personnel, use the NNAI to derive necessary admission data for assessing patients, planning care, and communicating with other staff regarding patient needs. Instituting an evidence-based practice change in hospital discharge forms enables the next care provider to consistently meet the patient's continuing needs.

  4. Enhancing Continuity of Care Using an Emergency Medical Card and a Continuity of Care Report

    Science.gov (United States)

    Olola, Christopher Hillary Opiyo

    2010-01-01

    Discontinuity of care due to poor communication of patient health information among healthcare providers (HCPs) is a major efficiency and patient safety concern. Patients often see multiple HCPs and during each visit, the patient's core health information is required for appropriate decision making. Patients with access to their electronic medical…

  5. Workplace continuing education for nurses caring for hospitalised older people.

    Science.gov (United States)

    Baumbusch, Jennifer; Shaw, Maureen; Leblanc, Marie-Eve; Kjorven, Mary; Kwon, Jae-Yung; Blackburn, Lorraine; Lawrie, Barb; Shamatutu, Marilyn; Wolff, Angela C

    2017-12-01

    To develop, implement and evaluate a workplace continuing education programme about nursing care of hospitalised older people. The healthcare system cannot rely solely upon nurses' prelicensure education to prepare them to meet the evolving needs of hospitalised older patients. Over the past decade, there has been a dramatic rise in the proportion of older people in hospitals, yet many nurses do not have specialised knowledge about the unique care needs of this population. A multimethod pre-to post-design was employed. Between September 2013 and April 2014, data were collected via surveys, focus groups and interviews. Thirty-two Registered Nurses initially enrolled in the programme of which 22 completed all data points. Three managers also participated in interviews. One-way repeated-measures ANOVAs were conducted to evaluate the effect of the programme and change over time. Qualitative data were analysed using thematic analysis. Survey results indicated improvements in perceptions about nursing care of older people but no changes in knowledge. Themes generated from the qualitative data focused on participants' experiences of taking part in the programme and included: (i) relevance of content and delivery mode, (ii) value of participating in the programme and (iii) continuing education in the context of acute care. This study illustrated the potential role of workplace continuing education in improving care for hospitalised older people, particularly the potential to change nurses' perceptions about this population. Nurses prefer learning opportunities that are varied in delivery of educational elder-focused content and accessible at work. Organisational leaders need to consider strategies that minimise potential barriers to workplace continuing education. Workplace continuing education can play a key role in improving quality of care for hospitalized older adults and ought to be a priority for employers planning education for nurses. © 2017 John Wiley & Sons Ltd.

  6. Preconception care: preventing and treating infections.

    Science.gov (United States)

    Lassi, Zohra S; Imam, Ayesha M; Dean, Sohni V; Bhutta, Zulfiqar A

    2014-09-26

    Infections can impact the reproductive health of women and hence may influence pregnancy related outcomes for both the mother and the child. These infections range from sexually transmitted infections (STIs) to TORCHS infections to periodontal disease to systemic infections and may be transmitted to the fetus during pregnancy, labor, delivery or breastfeeding. A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on MNCH outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. Preconception behavioral interventions significantly declines re-infection or new STI rates by 35% (95% CI: 20-47%). Further, condom use has been shown to be the most effective way to prevent HIV infection (85% protection in prospective studies) through sexual intercourse. Intervention trials showed that preconception vaccination against tetanus averted a significant number of neonatal deaths (including those specifically due to tetanus) when compared to placebo in women receiving more than 1 dose of the vaccine (OR 0.28; 95% CI: 0.15-0.52); (OR 0.02; 95% CI: 0.00-0.28) respectively. Preconception counseling should be offered to women of reproductive age as soon as they test HIV-positive, and conversely women of reproductive age should be screened with their partners before pregnancy. Risk assessment, screening, and treatment for specific infections should be a component of preconception care because there is convincing evidence that treatment of these infections before pregnancy prevents neonatal infections.

  7. Continuing education in geriatrics for rural health care providers in ...

    African Journals Online (AJOL)

    Population trends in developing countries show an increasing population of older adults (OAs), especially in rural areas. The purpose of this study was to explore the geriatrics continuing education needs of health care providers (HCPs) working in rural Uganda. The study employed a descriptive design to collect data from ...

  8. Transition from Long Day Care to Kindergarten: Continuity or Not?

    Science.gov (United States)

    Barblett, Lennie; Barratt-Pugh, Caroline; Kilgallon, Pam; Maloney, Carmel

    2011-01-01

    Transition practices that ensure continuity between early childhood settings have been shown to be important in assisting children's short-term and long-term growth and development (Vogler, Cravello & Woodhead, 2008). In Western Australia many young children move from and between long day care (LDC) settings to kindergarten. In that state,…

  9. Student Continuity with Patients: A System Delivery Innovation to Benefit Patient Care and Learning (Continuity Patient Benefit).

    Science.gov (United States)

    Poncelet, Ann N; Hudson, J Nicky

    2015-07-22

    Medical education is continuing to evolve to meet the healthcare needs of the future. The longitudinal integrated clerkship (LIC) model is an important innovation in medical education. It has in its vision and structure "patient- and learner-centered education", using longitudinal relationships between patients and students as a foundational element in its design. LIC students have shown more patient-centered attitudes and behaviors that persist after medical school. They remain connected with the patient experience of care, which supports empathy and student moral development. The time that LIC students spend acting independently with patients also supports the development of higher order clinical and cognitive skills and professional identity formation. Student participation in a more meaningful way in the care of their patients promotes patient wellbeing, and helps patients with transitions of care, communication and preventative care. Patients report feeling empowered to be more active agents in their own care and feel an accountability and pleasure in the training of new physicians. Focusing on the patient/student relationship as a foundational element of clinical education has meaningful benefits to the patient and student with the potential to improve patient care directly and in the future, as these students become physicians.

  10. Student Continuity with Patients: A System Delivery Innovation to Benefit Patient Care and Learning (Continuity Patient Benefit

    Directory of Open Access Journals (Sweden)

    Ann N. Poncelet

    2015-07-01

    Full Text Available Medical education is continuing to evolve to meet the healthcare needs of the future. The longitudinal integrated clerkship (LIC model is an important innovation in medical education. It has in its vision and structure “patient- and learner-centered education”, using longitudinal relationships between patients and students as a foundational element in its design. LIC students have shown more patient-centered attitudes and behaviors that persist after medical school. They remain connected with the patient experience of care, which supports empathy and student moral development. The time that LIC students spend acting independently with patients also supports the development of higher order clinical and cognitive skills and professional identity formation. Student participation in a more meaningful way in the care of their patients promotes patient wellbeing, and helps patients with transitions of care, communication and preventative care. Patients report feeling empowered to be more active agents in their own care and feel an accountability and pleasure in the training of new physicians. Focusing on the patient/student relationship as a foundational element of clinical education has meaningful benefits to the patient and student with the potential to improve patient care directly and in the future, as these students become physicians.

  11. Moderators of Response to Telephone Continuing Care for Alcoholism

    Science.gov (United States)

    Lynch, Kevin G.; Van Horn, Deborah; Drapkin, Michelle; Ivey, Megan; Coviello, Donna; McKay, James R.

    2011-01-01

    Objectives To evaluate potential moderators of the effect of adding extended telephone monitoring (TM) and telephone monitoring and counseling (TMC) continuing care to treatment as usual (TAU) for alcoholism. Continuing care was predicted to be more effective for patients with severe substance-use histories, poor initial response to treatment, and other risk factors for relapse. Methods Randomized study with 18-month follow-up. Outcomes were frequency of drinking and any drinking. Results Main effects favored TMC over TAU on alcohol outcomes. However, none of the 11 variables examined moderated these effects. Conversely, main effect and moderator analyses indicated TM was more beneficial than TAU only for women and for participants with lower readiness to change. Conclusions TMC improves drinking outcomes when added to standard care, regardless of alcohol use history, early response to treatment, or other risk factors for relapse. TM is recommended for women and less motivated patients. PMID:20604702

  12. 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

  13. 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

  14. Parents' experiences of midwifery students providing continuity of care.

    Science.gov (United States)

    Aune, Ingvild; Dahlberg Msc, Unn; Ingebrigtsen, Oddbjørn

    2012-08-01

    the aim of this study was to gain knowledge and a deeper understanding of the value attached by parents to relational continuity provided by midwifery students to the woman and her partner during the childbearing process. The focus of the study was on the childbirth and the postnatal home visit. in this pilot project by researchers at Sør-Trøndelag University College, Norway, six midwifery students provided continuity of care to 58 women throughout their pregnancy, birth and the postnatal period. One group interview of eight women and two group interviews of five men, based on the focus group technique, were conducted at the end of the project. Qualitative data were analysed through systematic text condensation. the findings included two main themes: 'trusting relationship' and 'being empowered'. The sub-themes of a 'trusting relationship' were 'relational continuity' and 'presence'. For the women, relational continuity was important throughout the childbearing process, but the men valued the continuous presence during birth most highly. 'Being empowered' had two sub-themes: 'individual care' and 'coping'. For the women, individual care and coping with birth were important factors for being empowered. The fathers highlighted the individual care as necessary to feel empowered for early parenting. The home visit of the student was highly appreciated. The relationship with the midwifery student could be concluded, and they had the opportunity to review the progression of the birth with the student who had been present during the birth. During the home visit, the focus was more on the experiences of pregnancy and birth than on what lay ahead. when midwifery students provided continuous care during pregnancy, birth and the postnatal period, both women and men experienced a trusting relationship. Relational continuity was important for women in the entire process, but for the men this was mostly important during childbirth. Individual care and coping with birth and

  15. Measuring parents’ perspective on continuity of care in children with special health care needs

    Directory of Open Access Journals (Sweden)

    Paola Rucci

    2015-12-01

    Full Text Available Introduction: Children with special health care needs are an exponentially growing population needing integrated health care programmes that involve primary, community, hospital and tertiary care services. The aims of the study are (1 to develop and validate the Special Needs Kids Questionnaire (SpeNK-Q designed to measure parents’ perspective on continuity of care for children with special health care needs and (2 to evaluate the continuity of care based on parental experiences in this population.Methods: SpeNK-Q was derived from a previous qualitative study and was based on Haggerty’s constructs of informational, management and relational continuity. Parents of preterm birth children completed the 20-item SpeNK-Q at the second or subsequent planned follow-up visit after the child’s hospital discharge. Principal component analysis was used to examine the structure of the instrument.Results: Principal component analysis of 101 questionnaires administered allowed us to identify five factors explaining 60.2% of item variance: informational continuity; coordination of care; continuity of family–paediatrician relationship; family support; information on care plan.Conclusions and discussion: SpeNK-Q proved to be a psychometrically promising instrument. Its utilisation could improve the identification of areas for service development, the delivery of coordinated care and support policy makers in redesigning integrated services.

  16. Measuring parents' perspective on continuity of care in children with special health care needs.

    Science.gov (United States)

    Rucci, Paola; Latour, Jos; Zanello, Elisa; Calugi, Simona; Vandini, Silvia; Faldella, Giacomo; Fantini, Maria Pia

    2015-01-01

    Children with special health care needs are an exponentially growing population needing integrated health care programmes that involve primary, community, hospital and tertiary care services. The aims of the study are (1) to develop and validate the Special Needs Kids Questionnaire (SpeNK-Q) designed to measure parents' perspective on continuity of care for children with special health care needs and (2) to evaluate the continuity of care based on parental experiences in this population. SpeNK-Q was derived from a previous qualitative study and was based on Haggerty's constructs of informational, management and relational continuity. Parents of preterm birth children completed the 20-item SpeNK-Q at the second or subsequent planned follow-up visit after the child's hospital discharge. Principal component analysis was used to examine the structure of the instrument. Principal component analysis of 101 questionnaires administered allowed us to identify five factors explaining 60.2% of item variance: informational continuity; coordination of care; continuity of family-paediatrician relationship; family support; information on care plan. SpeNK-Q proved to be a psychometrically promising instrument. Its utilisation could improve the identification of areas for service development, the delivery of coordinated care and support policy makers in redesigning integrated services.

  17. Measuring parents’ perspective on continuity of care in children with special health care needs

    Directory of Open Access Journals (Sweden)

    Paola Rucci

    2015-12-01

    Full Text Available Introduction: Children with special health care needs are an exponentially growing population needing integrated health care programmes that involve primary, community, hospital and tertiary care services. The aims of the study are (1 to develop and validate the Special Needs Kids Questionnaire (SpeNK-Q designed to measure parents’ perspective on continuity of care for children with special health care needs and (2 to evaluate the continuity of care based on parental experiences in this population. Methods: SpeNK-Q was derived from a previous qualitative study and was based on Haggerty’s constructs of informational, management and relational continuity. Parents of preterm birth children completed the 20-item SpeNK-Q at the second or subsequent planned follow-up visit after the child’s hospital discharge. Principal component analysis was used to examine the structure of the instrument. Results: Principal component analysis of 101 questionnaires administered allowed us to identify five factors explaining 60.2% of item variance: informational continuity; coordination of care; continuity of family–paediatrician relationship; family support; information on care plan. Conclusions and discussion: SpeNK-Q proved to be a psychometrically promising instrument. Its utilisation could improve the identification of areas for service development, the delivery of coordinated care and support policy makers in redesigning integrated services.

  18. Measuring parents’ perspective on continuity of care in children with special health care needs

    Science.gov (United States)

    Rucci, Paola; Latour, Jos; Zanello, Elisa; Calugi, Simona; Vandini, Silvia; Faldella, Giacomo

    2015-01-01

    Introduction Children with special health care needs are an exponentially growing population needing integrated health care programmes that involve primary, community, hospital and tertiary care services. The aims of the study are (1) to develop and validate the Special Needs Kids Questionnaire (SpeNK-Q) designed to measure parents’ perspective on continuity of care for children with special health care needs and (2) to evaluate the continuity of care based on parental experiences in this population. Methods SpeNK-Q was derived from a previous qualitative study and was based on Haggerty’s constructs of informational, management and relational continuity. Parents of preterm birth children completed the 20-item SpeNK-Q at the second or subsequent planned follow-up visit after the child’s hospital discharge. Principal component analysis was used to examine the structure of the instrument. Results Principal component analysis of 101 questionnaires administered allowed us to identify five factors explaining 60.2% of item variance: informational continuity; coordination of care; continuity of family–paediatrician relationship; family support; information on care plan. Conclusions and discussion SpeNK-Q proved to be a psychometrically promising instrument. Its utilisation could improve the identification of areas for service development, the delivery of coordinated care and support policy makers in redesigning integrated services. PMID:27118963

  19. Do You Know My Child? Continuity of Nursing Care in the Pediatric Intensive Care Unit.

    Science.gov (United States)

    Baird, Jennifer; Rehm, Roberta S; Hinds, Pamela S; Baggott, Christina; Davies, Betty

    2016-01-01

    Parents of children with complex, chronic conditions report a desire for continuity of care, but relatively little is known about the ways in which nursing continuity of care occurs and the extent to which it is delivered in the inpatient setting. The objective of this analysis, which arose from a study on best practices in parent/nurse interactions in the pediatric intensive care unit (PICU), was to explore the delivery of continuity of nursing care in the PICU from the perspective of both parents and nurses. A qualitative, grounded theory study using situational analysis was conducted with seven parents and 12 nurse participants from a single PICU. Data sources included in-depth interviews, observation, and organizational written materials. Data were coded and analyzed using memoing and situational and positional maps to highlight emerging themes, context, and positions within the data. Parents repeatedly endorsed a desire for continuity of nursing care, wanting to ensure that the bedside nurse valued their child as an individual and understood the complexities of the child's care regimen. Nurses understood this need but faced both contextual and personal challenges to achieving continuity, including fluctuations in staffing needs, training demands, fear of emotional entanglement, and concern for missed learning opportunities. Continuity of nursing care is highly valued by parents of children with complex chronic condition in the PICU, but significant barriers to optimal delivery exist within the current critical care environment. Mechanisms for supporting nurses to deliver continuity of care are needed, as are alternative ways to help parents feel that all nurses caring for their child have the knowledge necessary to deliver safe and compassionate care.

  20. Factors associated with preventive care practice among adults with diabetes.

    Science.gov (United States)

    Yuen, Hon K

    2012-04-01

    Adherence to annual preventive care (foot, eye, and dental examinations) in this group of study participants with diabetes (n=253) was suboptimal. Participants were 2.6-5.8 times more likely to have a specific preventive care in the past 12 months if they were told to do so by a health care professional. Copyright © 2011 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  1. Chronic disease in childhood and adolescence: continuity of care in the Health Care Network

    Directory of Open Access Journals (Sweden)

    Vanessa Medeiros da Nóbrega

    Full Text Available abstract OBJECTIVE To evaluate the continuity of care for children and adolescents with chronic diseases in the health care network. METHODS This qualitative study was conducted between February and October 2013 with 12 families, six health managers, and 14 health professionals from different health care services in a municipality of the state of Paraíba, Brazil, using focal groups, semi-structured interviews, and medical record consultation. The data were analyzed by triangulation and thematic analysis. RESULTS Two categories were created: “health care management” and “(discontinuity of care.” We found gaps in the system, including poor data recording aimed to facilitate follow-up and guide the planning actions as well as sporadic and discoordinate services with a limited flow of information, which hinders follow-up over time. CONCLUSION Continuity of care in the health care network is limited and creates the need to develop strategies to improve these services.

  2. Continuity of care with HL7 v3 care record for oncology nursing.

    Science.gov (United States)

    Duim, Mitchell; Boterenbrood, Frank; Goossen, William T F

    2014-01-01

    The Clinical Data Ware House needs to meet three functions: reporting quality indicators, clinical research, and continuity of care. This paper reports on one function, namely the development and testing of data exchange for continuity of nursing care for oncology patients. The proof of principle was carried out using system analysis, requirements setting, system design, system development and experiment with the application of Health Level 7 version 3 Care Record electronic message. A successful testing of the Care Record message was conducted, using a case based data-subset for oncology nursing care including personal data, pain, weight and vital signs, among others. The development illustrated that the system components facilitate electronic data exchange from hospital to home care, allowing home care nurses to use received clinical data in their local system. In an incremental approach this data exchange can be enhanced to meet all data and all systems requirements.

  3. Speak Up: Help Prevent Errors in Your Care: Behavioral Health Care

    Science.gov (United States)

    ... TM Help Prevent Errors in Your Care Behavioral Health Care To prevent health care errors, patients are urged to... SpeakUP TM Service ... individuals should be involved in their own behavioral health care. These efforts to increase consumer awareness and involvement ...

  4. Multimorbidity and quality of preventive care in Swiss university primary care cohorts.

    Directory of Open Access Journals (Sweden)

    Sven Streit

    Full Text Available Caring for patients with multimorbidity is common for generalists, although such patients are often excluded from clinical trials, and thus such trials lack of generalizability. Data on the association between multimorbidity and preventive care are limited. We aimed to assess whether comorbidity number, severity and type were associated with preventive care among patients receiving care in Swiss University primary care settings.We examined a retrospective cohort composed of a random sample of 1,002 patients aged 50-80 years attending four Swiss university primary care settings. Multimorbidity was defined according to the literature and the Charlson index. We assessed the quality of preventive care and cardiovascular preventive care with RAND's Quality Assessment Tool indicators. Aggregate scores of quality of provided care were calculated by taking into account the number of eligible patients for each indicator.Participants (mean age 63.5 years, 44% women had a mean of 2.6 (SD 1.9 comorbidities and 67.5% had 2 or more comorbidities. The mean Charlson index was 1.8 (SD 1.9. Overall, participants received 69% of recommended preventive care and 84% of cardiovascular preventive care. Quality of care was not associated with higher numbers of comorbidities, both for preventive care and for cardiovascular preventive care. Results were similar in analyses using the Charlson index and after adjusting for age, gender, occupation, center and number of visits. Some patients may receive less preventive care including those with dementia (47% and those with schizophrenia (35%.In Swiss university primary care settings, two thirds of patients had 2 or more comorbidities. The receipt of preventive and cardiovascular preventive care was not affected by comorbidity count or severity, although patients with certain comorbidities may receive lower levels of preventive care.

  5. The Social Work in the Continuous Care Unit

    Directory of Open Access Journals (Sweden)

    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.

  6. 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.

  7. 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.

  8. Innovation or rebranding, acute care surgery diffusion will continue.

    Science.gov (United States)

    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.

  9. 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.

  10. Electronic Nursing Documentation: Patient Care Continuity Using the Clinical Care Classification System (CCC).

    Science.gov (United States)

    Whittenburg, Luann; Meetim, Aunchisa

    2016-01-01

    An innovative nursing documentation project conducted at Bumrungrad International Hospital in Bangkok, Thailand demonstrated patient care continuity between nursing patient assessments and nursing Plans of Care using the Clinical Care Classification System (CCC). The project developed a new generation of interactive nursing Plans of Care using the six steps of the American Nurses Association (ANA) Nursing process and the MEDCIN® clinical knowledgebase to present CCC coded concepts as a natural by-product of a nurse's documentation process. The MEDCIN® clinical knowledgebase is a standardized point-of-care terminology intended for use in electronic health record systems. The CCC is an ANA recognized nursing terminology.

  11. Continuity of care after percutaneous coronary intervention: The patient's perspective across secondary and primary care settings.

    Science.gov (United States)

    Valaker, Irene; Norekvål, Tone M; Råholm, Maj-Britt; Nordrehaug, Jan Erik; Rotevatn, Svein; Fridlund, Bengt

    2017-06-01

    Although patients may experience a quick recovery followed by rapid discharge after percutaneous coronary interventions (PCIs), continuity of care from hospital to home can be particularly challenging. Despite this fact, little is known about the experiences of care across the interface between secondary and primary healthcare systems in patients undergoing PCI. To explore how patients undergoing PCI experience continuity of care between secondary and primary care settings after early discharge. The study used an inductive exploratory design by performing in-depth interviews of 22 patients at 6-8 weeks after PCI. Nine were women and 13 were men; 13 were older than 67 years of age. Eight lived remotely from the PCI centre. Patients were purposively recruited from the Norwegian Registry for Invasive Cardiology. Interviews were analysed by qualitative content analysis. Patients undergoing PCI were satisfied with the technical treatment. However, patients experienced an unplanned patient journey across care boundaries. They were not receiving adequate instruction and information on how to integrate health information. Patients also needed help to facilitate connections to community-based resources and to schedule clear follow-up appointments. As high-technology treatment dramatically expands, healthcare organisations need to be concerned about all dimensions of continuity. Patients are witnessing their own processes of healthcare delivery and therefore their voices should be taken into greater account when discussing continuity of care. Nurse-led initiatives to improve continuity of care involve a range of interventions at different levels of the healthcare system.

  12. Improving Continuity of Care Reduces Emergency Department Visits by Long-Term Care Residents.

    Science.gov (United States)

    Marshall, Emily Gard; Clarke, Barry; Burge, Frederick; Varatharasan, Nirupa; Archibald, Greg; Andrew, Melissa K

    2016-01-01

    Care by Design™ (CBD) (Canada), a model of coordinated team-based primary care, was implemented in long-term care facilities (LTCFs) in Halifax, Nova Scotia, Canada, to improve access to and continuity of primary care and to reduce high rates of transfers to emergency departments (EDs). This was an observational time series before and after the implementation of CBD (Canada). Participants are LTCF residents with 911 Emergency Health Services calls from 10 LTCFs, representing 1424 beds. Data were abstracted from LTCF charts and Emergency Health Services databases. The primary outcome was ambulance transports from LTCFs to EDs. Secondary outcomes included access (primary care physician notes in charts) and continuity (physician numbers and contacts). After implementation of CBD (Canada), transports from LTCFs to EDs were reduced by 36%, from 68 to 44 per month (P = .01). Relational and informational continuity of care improved with resident charts with ≥10 physician notes, increasing 38% before CBD to 55% after CBD (P = .003), and the median number of chart notes increased from 7 to 10 (P = .0026). Physicians contacted before 911 calls and onsite assessment increased from 38% to 54% (P = .01) and 3.7% to 9.2% (P = .03), respectively, before CBD to after CBD. A 34% reduction in overall transports from LTCFs to EDs is likely attributable to improved onsite primary care, with consistent physician and team engagement and improvements in continuity of care. © Copyright 2016 by the American Board of Family Medicine.

  13. 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.

  14. Association of Continuity of Primary Care and Statin Adherence.

    Directory of Open Access Journals (Sweden)

    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.

  15. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  17. Differentiating clinical care from disease prevention: a prerequisite for practicing quaternary prevention

    Directory of Open Access Journals (Sweden)

    Charles Dalcanale Tesser

    Full Text Available Abstract: This article contends that the distinction between clinical care (illness and prevention of future disease is essential to the practice of quaternary prevention. The authors argue that the ongoing entanglement of clinical care and prevention transforms healthy into "sick" people through changes in disease classification criteria and/or cut-off points for defining high-risk states. This diverts health care resources away from those in need of care and increases the risk of iatrogenic harm in healthy people. The distinction in focus is based on: (a management of uncertainty (more flexible when caring for ill persons; (b guarantee of benefit (required only in prevention; (c harm tolerance (nil or minimal in prevention. This implies attitudinal differences in the decision-making process: greater skepticism, scientism and resistance towards preventive action. These should be based on high-quality scientific evidence of end-outcomes that displays a net positive harm/benefit ratio.

  18. [The importance of longitudinality, comprehensiveness, coordination and continuity of nursing home care].

    Science.gov (United States)

    Corrales-Nevado, Dolores; Palomo-Cobos, Luis

    2014-01-01

    Home care is essential for dependent persons, in order to support the high levels of morbidity, for the elderly as well as their caregivers, as it enables patients to remain in their familiar environment as long as possible, fulfilling the wish expressed by most of the population. Home care is the activity that best represents the essential attributes (longitudinality, comprehensiveness, continuity, coordination) of the primary, and that suffers most when these attributes are not included in the activities undertaken by primary care teams, or due to cuts in health-care. Home care requires highly skilled, versatile and committed nursing staff, with whom the population identifies as a source of care, and where they are assessed for their relevance and effectiveness. Nurses with wide clinical care skills, with a balanced content of treatment and prevention, and the freedom to develop their work, are needed in order to continuously monitor the health problems of their acute and chronic patients, in the family and community. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  19. The association between continuity of care in the community and health outcomes: a population-based study

    Science.gov (United States)

    2012-01-01

    Background The study goal was to assess indices of continuity of care in the primary care setting and their association with health outcomes and healthcare services utilization, given the reported importance of continuity regarding quality of care and healthcare utilization. Methods The study included a random sample of enrollees from Clalit Health Services 19 years-of-age or older who visited their primary care clinic at least three times in 2009. Indices of continuity of care were computed, including the Usual Provider Index (UPC), Modified Modified Continuity Index (MMCI), Continuity of Care Index (COC), and Sequential Continuity (SECON). Quality measures of preventive medicine and healthcare services utilization and their costs were assessed as outcomes. Results 1,713 randomly sampled patients were included in the study (mean age: 48.9 ± 19.2, 42% males). Continuity of care indices were: UPC: 0.75; MMCI: 0.81; COC: 0.67; SECON: 0.70. After controlling for patient characteristics in a multivariate analysis, a statistically significant association was found between higher values of UPC, COC, and SECON and a decrease in the number and cost of ED visits. Higher MMCI values were associated with a greater number and higher costs of medical consultation visits. Continuity of care indices were associated with BMI measurements, and inversely associated with blood pressure measurements. No association was found with other quality indicators, e.g., screening tests for cancer. Conclusions Several continuity of care indices were associated with decreased number and costs of ED visits. There were both positive and negative associations of continuity of care indices with different aspects of healthcare utilization. The relatively small effects of continuity might be due to the consistently high levels of continuity in Clalit Health Services. PMID:22913949

  20. Ambient-aware continuous care through semantic context dissemination.

    Science.gov (United States)

    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

  1. Indicators for continuous quality improvement for otitis media in primary health care for Aboriginal and Torres Strait Islander children.

    Science.gov (United States)

    Sibthorpe, Beverly; Agostino, Jason; Coates, Harvey; Weeks, Sharon; Lehmann, Deborah; Wood, Marianne; Lannigan, Francis; McAullay, Daniel

    2017-04-01

    Otitis media is a common, generally self-limiting childhood illness that can progress to severe disease and have lifelong sequelae, including hearing loss and developmental delays. Severe disease is disproportionately prevalent among Aboriginal and Torres Strait Islander children. Primary health care is at the frontline of appropriate prevention and treatment. Continuous quality improvement in the prevention and management of important causes of morbidity in client populations is accepted best practice in primary health care and now a requirement of Australian Government funding to services providing care for Aboriginal and Torres Strait Islander children. To date, there have been no indicators for continuous quality improvement in the prevention and management of otitis media and its sequelae in primary health care. Through an expert group consensus process, seven evidence-based indicators, potentially extractable from electronic health records, have been developed. The development process and indicators are described.

  2. [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.

  3. The effect of continuity in nursing care on patient outcomes in the pediatric intensive care unit.

    Science.gov (United States)

    Siow, Elaine; Wypij, David; Berry, Patricia; Hickey, Patricia; Curley, Martha A Q

    2013-01-01

    Previous studies have examined the links between continuity of care and patient outcomes, but little is known about this relationship in acute care pediatric settings. The aim of this study was to examine the associations between continuity in nursing care (CINC), defined as fewer nurses caring for a patient, and patient outcomes in a pediatric intensive care unit (ICU). A secondary analysis of prospectively collected data was carried out. A total of 332 patients admitted to the medical/surgical ICU at Children's Hospital Boston from March 2004 to December 2012 were included in the study. The mean (SD) Continuity of Care Index score was 0.4 (0.1). Multivariable analyses demonstrated that CINC was associated with a longer ICU stay (P nurse expertise and mortality risk was included as interaction term, CINC was significantly associated with fewer nurse-sensitive adverse events (P = .05). In this study, sicker patients were more likely to receive more CINC. Continuity in providers may have the potential to affect patient outcomes. More studies are needed to explore this relationship.

  4. Disparities in the use of preventive health care among children with disabilities in Taiwan.

    Science.gov (United States)

    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 nationwide databases from the Ministry of the Interior, Bureau of Health Promotion, and National Health Research Institutes were linked to gather related information between 2006 and 2008. A total of 8572 children with disabilities aged 1-7 years were included in this study. Multivariate logistic regression analysis was conducted to adjust for covariates. Nationally, only 37.58% of children with disabilities received preventive health care in 2008. Children with severe and very severe disabilities were less likely to use preventive care than those with mild severity. Children with disabilities from the lowest income family were less likely to have preventive care than other income groups. Urbanization was strongly associated with the receipt of preventive health care. However, surprisingly, urban children with disabilities were less likely to receive preventive care than all others. Under universal health insurance coverage, the overall usage of preventive health care is still low among children with disabilities. The study also identified several disparities in their usage. Potential factors affecting the lack of use deserve additional research. Policymakers should target low socioeconomic brackets and foster education about the importance of preventive care. Mobile health services should be continually provided in those areas in need. Capitation reimbursement and other incentives should be considered in improving the utilization among children with disabilities. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Continuing Care for Mentally Stable Psychiatric Patients in Primary Care: Patients' Preferences and Views

    Directory of Open Access Journals (Sweden)

    Vincent I. O. Agyapong

    2012-01-01

    Full Text Available Objective. To investigate the preferences of psychiatric patients regarding attendance for their continuing mental health care once stable from a primary care setting as opposed to a specialized psychiatric service setting. Methods. 150 consecutive psychiatric patients attending outpatient review in a community mental health centre in Dublin were approached and asked to complete a semistructured questionnaire designed to assess the objectives of the study. Results. 145 patients completed the questionnaire giving a response rate of 97%. Ninety-eight patients (68% preferred attending a specialized psychiatry service even when stabilised on their treatment. The common reason given by patients in this category was fear of substandard quality of psychiatric care from their general practitioners (GPs (67 patients, 68.4%. Twenty-nine patients (20% preferred to attend their GP for continuing mental health care. The reasons given by these patients included confidence in GPs, providing same level of care as psychiatrist for mental illness (18 patients or 62%, and the advantage of managing both mental and physical health by GPs (13 patients, 45%. Conclusion. Most patients who attend specialised psychiatric services preferred to continue attending specialized psychiatric services even if they become mentally stable than primary care, with most reasons revolving around fears of inadequate psychiatric care from GPs.

  6. 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

  7. Preventive dental health care experiences of preschool-age children with special health care needs.

    Science.gov (United States)

    Huebner, Colleen E; Chi, Donald L; Masterson, Erin; Milgrom, Peter

    2015-01-01

    This study examined the preventive dental health care experiences of young children with special needs and determined the feasibility of conducting clinical dental examinations at a community-based early intervention services center. Study methods included 90 parent interviews and dental examinations of their preschool-age children. Thirteen percent of the children received optimal preventive care, defined as twice daily tooth brushing with fluoridated toothpaste and two preventive dental visits in the prior 12 months; 37% experienced care that fell short in both areas. Optimal care was more common among children of parents who reported tooth brushing was not a struggle and those with a personal dentist. Parents' opinion of the study experience was generally positive. Few children with special needs receive effective preventive care early, when primary prevention could be achieved. Barriers to optimal care could be readily addressed by the dental community in coordination with early intervention providers. © 2014 Special Care Dentistry Association and Wiley Periodicals, Inc.

  8. A critical care network pressure ulcer prevention quality improvement project.

    Science.gov (United States)

    McBride, Joanna; Richardson, Annette

    2015-03-30

    Pressure ulcer prevention is an important safety issue, often underrated and an extremely painful event harming patients. Critically ill patients are one of the highest risk groups in hospital. The impact of pressure ulcers are wide ranging, and they can result in increased critical care and the hospital length of stay, significant interference with functional recovery and rehabilitation and increase cost. This quality improvement project had four aims: (1) to establish a critical care network pressure ulcer prevention group; (2) to establish baseline pressure ulcer prevention practices; (3) to measure, compare and monitor pressure ulcers prevalence; (4) to develop network pressure ulcer prevention standards. The approach used to improve quality included strong critical care nursing leadership to develop a cross-organisational pressure ulcer prevention group and a benchmarking exercise of current practices across a well-established critical care Network in the North of England. The National Safety Thermometer tool was used to measure pressure ulcer prevalence in 23 critical care units, and best available evidence, local consensus and another Critical Care Networks' bundle of interventions were used to develop a local pressure ulcer prevention standards document. The aims of the quality improvement project were achieved. This project was driven by successful leadership and had an agreed common goal. The National Safety Thermometer tool was an innovative approach to measure and compare pressure ulcer prevalence rates at a regional level. A limitation was the exclusion of moisture lesions. The project showed excellent engagement and collaborate working in the quest to prevent pressure ulcers from many critical care nurses with the North of England Critical Care Network. A concise set of Network standards was developed for use in conjunction with local guidelines to enhance pressure ulcer prevention. © 2015 British Association of Critical Care Nurses.

  9. Mobilizing Lithuanian Health Professionals as Community Peer Leaders for AIDS Prevention: An International Primary Health Care Collaboration.

    Science.gov (United States)

    Norr, Kathleen F.; McElmurry, Beverly J.; Slutas, Frances M.; Christiansen, Carol D.; Misner, Susan J.; Marks, Beth A.

    2001-01-01

    Using primary health care and peer leadership models, U.S. nurses trained Lithuanian health professionals as community peer leaders in AIDS prevention. A national continuing education program is in place to sustain the initiative in Lithuania. (SK)

  10. 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.

  11. Cultural factors in preventive care: Latinos.

    Science.gov (United States)

    Diaz, Victor Alejandro

    2002-09-01

    For many, the term "Hispanic" places undue emphasis on the European influence of Spanish colonialism and may even have negative connotations for some. "Latino" is a more encompassing term that gives recognition to the influences of the indigenous and African cultures on modern day Latin Americans. Nevertheless, recognition of typical Latino attitudes and beliefs may assist health care providers. Poverty, unemployment, and low level of education usually account for adverse health in this population. Anti-immigrant sentiment and discrimination in health care and education add adversity to the immigrant's experience. Lack of health insurance and access to quality health care typically plague the adult immigrant. For many, the nearest emergency department is their only source of medical care.

  12. A comprehensive analysis of patients' perceptions of continuity of care and their associated factors.

    Science.gov (United States)

    Aller, Marta-Beatriz; Vargas, Ingrid; Waibel, Sina; Coderch, Jordi; Sánchez-Pérez, Inma; Colomés, Lluís; Llopart, Josep Ramon; Ferran, Manel; Vázquez, M Luisa

    2013-07-01

    To determine the patients' perceived degree of continuity of care between primary and secondary care and to identify contextual and individual factors that influence patients' perceptions of continuity of care. Cross-sectional study by means of a survey of patients attended to in primary and secondary care. Three health-care areas of the Catalonian public health-care system. A random sample of 1500 patients. Relational, informational and managerial continuity of care measured by means of Likert scales, using the CCAENA questionnaire. Overall, 93.8 and 83.8% of patients perceived an ongoing relationship with primary and secondary care physicians, respectively (relational continuity), 71.2% perceived high levels of information transfer (informational continuity) and 90.7% perceived high levels of consistency of care (managerial continuity). Patients from health-care areas where primary and secondary care were managed by a single organization and the elderly tended to perceive higher levels of all three types of continuity. Foreign-born patients were less likely to perceive relational continuity with primary care physicians; those with higher educational levels were less likely to perceive high levels of informational continuity and patients with worse health status were less likely to report high levels of managerial and relational continuity with secondary care physicians. Study results suggest high levels of perceived continuity of care, especially for relational and managerial continuity. The adopted comprehensive approach proves to be useful to properly understand the phenomenon because perceptions and associated factors vary according to the type of continuity.

  13. 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.

  14. Uptake of preventive health care among Mediterranean migrants in Belgium.

    Science.gov (United States)

    Van der Stuyft, P; Woodward, M; Amstrong, J; De Muynck, A

    1993-02-01

    The aim was to investigate the influence of ethnicity on the demand for preventive care by Mediterranean migrants in Belgium. This was a survey of patient contacts with general practitioners. 33 general practitioners working in Belgian localities with the highest migrant density collaborated in the study. During two months they recorded information on consultations with an estimated 72,600 clients. Participation was obtained from all subjects attending for preventive care or for a new episode of illness (n = 6256). An average of 30% of the patients sought preventive care, but multivariate analysis showed ethnicity to be a strong independent predictor of this type of demand. The higher primary preventive uptake by female Moroccans and Turks and the higher secondary preventive uptake by males from the same ethnic groups, as compared with the Belgian reference population, contrasted with a lower demand for tertiary prevention in migrants of either gender. The relative demand for preventive care by the more acculturated migrants was, however, quite similar to the demand of the Belgian population. The differential uptake of primary preventive care could be partly explained by the higher fertility rates of immigrant women, and the differential secondary uptake by a lower incidence of tuberculosis in the indigenous population. The meagre demand for tertiary prevention by Moroccan and Turkish migrants could be due to weaker compliance with treatments for chronic disorders, which is related to the perceptions of illness in these ethnic groups. The establishment of cross cultural mechanisms of dialogue should enhance compliance and improve the access of immigrants to the benefits of tertiary preventive care.

  15. Contributions of Physical Therapists to Primary Preventive Health Care.

    Science.gov (United States)

    Nomura, Takuo

    2016-01-01

    The limitations of what physical therapists can differ from country to country. In Japan, physical therapists are national licensed health care professionals who can help patients improve or restore their mobility. Most Japanese physical therapists provide care for people in health care facilities, medical-welfare transitional facilities, and welfare facilities for the elderly. Currently, physical therapists are unable to sufficiently contribute to primary preventive health care in Japan. However, there are many health problems that physical therapists could help alleviate. For example, low back pain (LBP) more likely than any other condition prevents people from working; thus, making the establishment of effective measures to prevent and reduce LBP vital. An estimated 20,500,000 Japanese individuals have diabetes mellitus (DM) or are at a high risk of developing the disease. DM commonly accompanies stroke and/or heart disease, and is characterized by complications that result from chronic hyperglycemia. Evidence-based physical therapy is effective for the prevention and treatment of LBP and DM. The Japanese Physical Therapy Association established the Japanese Society of Physical Therapy (JSPT) in June 2013. The JSPT has 12 departmental societies and 10 sections. We believe that the JSPT will advance the study of the potential role of physical therapists in primary preventive health care. In the future, it is expected that Japanese physical therapists will contribute to primary preventive health care.

  16. Oncology-critical care nursing collaboration: recommendations for optimizing continuity of care of critically ill patients with cancer.

    Science.gov (United States)

    Hull, Christine S; O'Rourke, Maureen E

    2007-12-01

    Highly specialized care is required for critically ill patients with cancer, but continuity of care equally is important to their survival when they are admitted to the critical care setting. The use of oncology nurses as liaisons to critical care nurses may help ensure the continuity of care and reduce rates of morbidity and mortality. This article provides a framework for collaborative consultation between oncology and critical care nurses.

  17. Adapting pressure ulcer prevention for use in home health care.

    Science.gov (United States)

    Bergquist-Beringer, Sandra; Daley, Christine Makosky

    2011-01-01

    Clinical practice guidelines on pressure ulcer (PU)prevention have been written primarily for inpatient settings,but we currently lack data as to how these guidelines have been adapted for use in home health care. The purpose of this study was to delineate interventions and activities used to prevent PU in home health care. Focus group study using text analysis. A focus group was conducted with 9 certified wound care nurses who practiced in home health care at least 50% of the time. Most of the participants had 10 or more years of home health experience and 5 or more years of wound care experience. The single 75-minute focus group was convened by teleconference and audiotaped. A semistructured moderator's guide was used to lead the discussion. Transcribed data were analyzed using standard text analysis. Preliminary results were distributed to focus group participants for review, comment, or clarification, and refined as needed. Certified wound care nurse participants used an array of interventions, including those recommended by clinical practice guidelines, to prevent PU in home health patients.However, specific activities differed from those performed in hospitals and nursing homes. Interventions unique to homehealth care included (1) assessment of patients' economic and insured status to determine implementation options, (2) assessment of caregiving resources and caregivers' ability to manage PU prevention, and (3) collaboration with community resources and health care vendors to obtain needed prevention materials and supplies. Findings provide insight into guideline adaptation in home health care and suggest that PU prevention in the homehealth care setting is more complex than that in hospitals and nursing homes and requires significant skills in communication and collaboration.

  18. Continuity of care of cancer patients. Analysis of theoretical models and survey tools of continuity of care in people with a cancer diagnosis.

    Science.gov (United States)

    Marcon, A; Bravi, F; Foglino, S; Angelastro, A; Carretta, E; Altini, M P; Fantini, M P; Carradori, T

    2014-01-01

    The Italian Ministry of Health declared oncology a priority and stressed the importance of ensuring continuity and integration in cancer care pathways. In order to monitor the quality of cancer care pathways, we need to explore patients' experience of the continuity of care, identifying the dimensions that define continuity. We found 886 relevant articles in the Pubmed database from 1987 to 5 November 2013. The search strategy for the electronic database was defined using the Population, Intervention, Comparison and Outcome(s) framework (PICO) to identify keywords. Two researchers independently reviewed records identified through the search strategy, analyzing continuity dimensions, specificity and/or transversal domains. We selected 20 articles that measure the patients' experience of continuity of care: 7 articles including 5 questionnaires [Questionnaire by King et al. 2008; Cancer care coordination Questionnaire (Cccq); Patient Continuity of Care Questionnaire (Pccq); Medical Care Questionnaire (Mcq); Continuity and Coordination of Care Questionnaire (CCCQ)]; 6 articles evaluating the relationship between patient and his/her physician (the same across the care pathway) in terms of frequency and/or dispersion; 6 articles considering one subscale of larger scales designed to evaluate the generic cancer care service patient experience; 1 revealing four organizational indicators of care pathway continuity / discontinuity. We traced 3 transversal dimensions across the individual analyses: informational, organizational, relational continuity. It follows that in order to cater to the needs of cancer patients, we need to simultaneously focus on these three dimensions along the cancer care pathway. In line with these results, we promoted the "R.In.Cu.ORAM.i" study (Networks for Integrated Treatment of colorectal and breast cancer), in Area Vasta Romagna Area (Italy), and developed a continuity of care patient-experience continuity tool.

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

    Science.gov (United States)

    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.

  20. 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

    OpenAIRE

    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 region in the Netherlands in 2014 among 790 women after they gave birth. To measure experienced continuity of care, the Nijmegen Continuity Questionnaire was used. Quality of care during labor was me...

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

    Science.gov (United States)

    ... Make sure your home care professional checks your identity. Make sure they do this before giving you ... for written information about it. Find out its brand and generic names. Ask about the side effects ...

  2. Relationship preferences and experience of primary care patients in continuity of care: a case study in Beijing, China.

    Science.gov (United States)

    Liu, Chaojie; Wu, Yeqing; Chi, Xueyang

    2017-08-22

    Continuity of care can bring a wide range of benefits to consumers, providers and health care systems. This study aimed to understand the relationship preferences of primary care patients and their associations with patient experience of continuity of care. A questionnaire survey was conducted on 700 patients who sought medical care from a community health organisation in Beijing. The survey contained four items examining the relationship preferences of the respondents, and a modified Questionnaire of Continuity between Care Levels (CCAENA) measuring patient experience of continuity of care based on a three dimensional (relational, informational and managerial) model. The associations between the relationship preferences and the experience of respondents in continuity of care was tested using a linear regression model controlling for age, sex, education, medical insurance, personal income and servicing facilities. The respondents experienced relatively lower levels of informational and managerial continuity compared with relational continuity of care. More than 80% of respondents preferred free choice and a continuing relationship with doctors, compared with 59% who endorsed community facility control over hospital appointments. A preference for a continuing relationship with doctors was associated with all aspects of continuity of care. A preference in favour of community facility control over hospital appointments was a strong predictor of managerial continuity (β = 0.333, p continuity (β = 0.256, p continuity with specialists (p care providers (p > 0.08). Perceived importance of information exchange was associated with relational and managerial continuity (p continuity (p = 0.34). Patients prefer a high level of freedom of choice and sustained individual relationship with doctors. Relationship preferences of patients are associated with their experience of continuity of care. But patient strong preference for free choice of doctors is not

  3. Storytelling: a care technology in continuing education for active ageing.

    Science.gov (United States)

    Costa, Nadia Pinheiro da; Polaro, Sandra Helena Isse; Vahl, Eloá Aparecida Caliari; Gonçalves, Lucia Hisako Takase

    2016-01-01

    assessing relevance and effectiveness of care/educational technology in the form of "storytelling" as a strategy in the cultivation of active ageing (AA) for elderly users of a Basic Health Unit (BHU), from the Amazon region. convergent care research (CCR) held in a BHU in Belém, state of Pará, with eight elderly ladies for testing this technology. An active ageing assessment questionnaire and WHOQOL-BREF - quality of life assessment were applied. After training with a view to continuing education, elderly ladies told stories for an audience that addressed the question: "What did you learn from it for your life?" tThe popular stories elicited reactions from which the following categories emerged: solidarity; respect for the other; imagination, dreams, hopes and culture of the Amazonian. This practice had a positive result, producing changes in the quality of life of the elderly, particularly in the psychological domain. "storytelling" proved to be an innovative technology, a relevant and effective resource in health education, especially for active ageing.

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

    Science.gov (United States)

    ... informed member of your health care team. The “Speak Up” program is sponsored by The Joint Commission. ... prevent health care mistakes, patients are urged to “Speak Up.” S peak up if you have questions or ...

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

    Science.gov (United States)

    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

  6. Safe care spaces and places: exploring urban Aboriginal families' access to preventive care.

    Science.gov (United States)

    Van Herk, Kimberley A; Smith, Dawn; Tedford Gold, Sara

    2012-05-01

    Many Aboriginal children living in Canadian cities experience high levels of perinatal and infant health challenges. Despite efforts to reduce inequities in early childhood development, numerous urban Aboriginal families have poor access to preventive care. In this paper, we challenge conventional notions of access and use a postcolonial population health perspective to explain how access to preventive care for Aboriginal families is influenced by safety and responsiveness within care experiences. We explore an approach to care that addresses the safety of care spaces and care places. The potential of this approach for improving access to preventive services for Aboriginal families may be of considerable interest to urban preventive health policy or health system managers. Copyright © 2012. Published by Elsevier Ltd.

  7. Concordance between continuity of care reported by patients and measured from administrative data.

    Science.gov (United States)

    Nyweide, David J

    2014-04-01

    Continuity of care can be measured using patient survey or administrative data, though the degree of concordance between continuity of care reported by patients and measured from their actual utilization is not well understood. A cross-sectional analysis of the 2010 Medicare Current Beneficiary Survey and linked 2009-2010 Medicare Carrier and outpatient claims data measured the concentration of ambulatory care visit patterns according to two commonly used metrics of continuity of care. Continuity of care measured from claims data did not align with patient reports of having a usual care provider. However, high levels of continuity for patients with a usual care provider were associated with a longer patient-provider relationship, greater patient-perceived provider knowledge of the patient's medical condition and history, and more confidence in the provider. Inferences about a patient's continuity of care must be placed in the context of the data source with which continuity is measured.

  8. Effect of facemasks on empathy and relational continuity: a randomised controlled trial in primary care.

    Science.gov (United States)

    Wong, Carmen Ka Man; Yip, Benjamin Hon Kei; Mercer, Stewart; Griffiths, Sian; Kung, Kenny; Wong, Martin Chi-Sang; Chor, Josette; Wong, Samuel Yeung-shan

    2013-12-24

    There is limited evidence to support the use of facemasks in preventing infection for primary care professionals. Negative effects on communication has been suggested when the physician wears a facemask. As communication skills and doctor patient relationship are essential to primary care consultations, the effects of doctor's facemask wearing were explored. A randomised controlled study was conducted in primary care to explore the effects of doctors wearing facemasks on patients' perception of doctors' empathy, patient enablement and patient satisfaction. Primary care doctors were randomized to mask wearing and non mask wearing clinical consultations in public primary care clinics in Hong Kong. Patients' views were gathered using the Consultation and Relational Empathy (CARE) Measure, Patient Enablement Instrument (PEI) and an overall satisfaction rating scale. The effects of face mask wearing were investigated using multilevel (hierarchical) modelling. 1,030 patients were randomised to doctor-mask wearing consultations (n = 514) and non mask wearing consultations (n = 516). A significant and negative effect was found in the patients' perception of the doctors' empathy (CARE score reduction -0.98, p-value = 0.04). In the more established doctor-patient relationship, the effect of doctors' mask wearing was more pronounced (CARE score reduction -5.67, p-value = 0.03). This study demonstrates that when doctors wearing a facemask during consultations, this has a significant negative impact on the patient's perceived empathy and diminish the positive effects of relational continuity. Consideration should be taken in planning appropriate use of facemasks in infectious disease policy for primary care and other healthcare professionals at a national, local or practice level. This trial was registered on Chinese Clinical Trial Register (ChiCTR). Registration no.: ChiCTR-TTRCC-12002519. URL: http://www.chictr.org/en/proj/show.aspx?proj=3486. Due to administrative error

  9. Nurse-led outpatient clinics in oncology care - Patient satisfaction, information and continuity of care.

    Science.gov (United States)

    Berglund, Catharina Bau; Gustafsson, Eva; Johansson, Hemming; Bergenmar, Mia

    2015-12-01

    The aims of the present study were to investigate patients' satisfaction with nurse-led clinics, patients' perception of received information and associations between continuity of care and satisfaction with information. Questionnaires on patient satisfaction were sent to consecutive samples of patients after they attended a nurse-led clinic at the Department of Oncology, Karolinska University Hospital in 2007, 2009, 2011 and 2013. Patients' perceptions of received information were evaluated in 2011 and 2013, by the EORTC QLQ-INFO25. Data on registered continuity of care were retrieved from the patients' medical record. A total of 962 patients responded (79%) to one of the four surveys. Patients' satisfaction with nurse-led clinics was stable over time. More than 90% rated nurses' interpersonal manners and the care at the clinic as "good", the waiting time as "acceptable", and the length of appointments as "sufficient". Over 90% responded that it was important to meet the same nurse and 62% reported they actually did so and 52% stated they were assigned a named nurse navigator. More than 75% rated the information at their latest visit at a nurse-led clinic as "completely" sufficient. However, 48% expressed wish for more information "during the current disease". No statistical significant associations were found between "satisfaction with information" and continuity of care. Patients' satisfaction with nurse-led clinics was stable over time with generally high figures with the exception for continuity of care and information, areas in which improvements are needed. The wide variety in information needs might require a person-centred approach. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. How Well Is CHIP Addressing Primary and Preventive Care Needs and Access for Children?

    Science.gov (United States)

    Smith, Kimberly V; Dye, Claire

    2015-01-01

    To examine differences in primary care outcomes under the Children's Health Insurance Program (CHIP) compared to private coverage and being uninsured in 10 states. We used data from a survey of parents of recent and established CHIP enrollees conducted from January 2012 through March 2013. We compared the primary care experiences of established CHIP enrollees to the preenrollment experiences of previously uninsured and privately insured recent CHIP enrollees to estimate differences in care outcomes. Parents of 4142 recent enrollees and 5518 established enrollees responded to the survey (response rates were 46% for recent enrollees and 51% for established enrollees). Compared to being uninsured, CHIP enrollees were more likely to have a well-child visit, receive a range of preventive care services, and have patient-centered care experiences. They were also more likely than uninsured children to have a regular source of care or provider, an easy time making appointments, and shorter wait times for those appointments. Relative to privately insured children, CHIP enrollees received preventive care services at similar rates and to be more likely to receive effective care coordination services. However, CHIP enrollees were less likely than privately insured children to have a regular source of care or provider and nighttime and weekend access to a usual source of care. CHIP continues to provide high levels of access to primary care, especially compared to uninsured children, and to provide benefits comparable to private insurance. Copyright © 2015 Academic Pediatric Association. All rights reserved.

  11. Women's views about maternity care: how do women conceptualise the process of continuity?

    Science.gov (United States)

    Jenkins, Mary G; Ford, Jane B; Todd, Angela L; Forsyth, Rowena; Morris, Jonathan M; Roberts, Christine L

    2015-01-01

    to gain an understanding of how women conceptualise continuity of maternity care. a qualitative study involving in-depth semi-structured interviews and thematic analysis. a range of urban and rural public hospitals in New South Wales, Australia. 53 women aged 18-44 years (median age 27 years) receiving maternity care in 2011-2012. responses from women suggested five concepts of continuity: continuity of staff, continuity of relationship, continuity of information, continuity across pregnancies and continuity across locations. These concepts of continuity differed by parity and location. continuity of maternity care has a variety of meanings to women. If health care providers are to commit to providing woman-centred maternity care it is important to recognise the diversity of women's experiences, and ensure that systems of care are flexible and appropriate to women's circumstances and needs. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Improving care transitions through meaningful use stage 2: continuity of care document.

    Science.gov (United States)

    Murphy, Lyn Stankiewicz; Wilson, Marisa L; Newhouse, Robin P

    2013-02-01

    In this department, Drs Murphy, Wilson, and Newhouse highlight hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demon strate innovative approaches to organizational problems. In this article, the authors describe the elements of continuity of care documentation, how sharing information can improve the quality and safety of care transitions and the implications for nurse executives.

  13. 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.

  14. 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.

  15. 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.

  16. 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…

  17. Pediatric dentist density and preventive care utilization for Medicaid children

    Science.gov (United States)

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

    2014-01-01

    Purpose This study evaluates the relationship between county-level pediatric dentist density and dental care utilization for Medicaid-enrolled children in Washington State. Methods This is a cross-sectional analysis of 604,885 children ages 0-17 enrolled in the Washington State Medicaid Program for ≥11 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. Results 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 in Washington utilizing preventive dental services. After adjusting for confounders, county-level density was significantly associated with county-level dental care utilization (β=1.67, 95 percent CI=0.02, 3.32, p=0.047). Conclusions There is a significant relationship between pediatric dentist density and the proportion of Medicaid-enrolled children 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. PMID:26314606

  18. Pressure ulcer prevention in intensive care patients: guidelines and practice.

    Science.gov (United States)

    Shahin, Eman S M; Dassen, Theo; Halfens, Ruud J G

    2009-04-01

    Pressure ulcers are a potential problem in intensive care patients, and their prevention is a major issue in nursing care. This study aims to assess the allocation of preventive measures for patients at risk for pressure ulcers in intensive care and the evidence of applied pressure ulcer preventive measures in intensive care settings in respect to the European Pressure Ulcer Advisory Panel (EPUAP) and Agency for Health Care Policy and Research (AHCPR) guidelines for pressure ulcer prevention. The design of this study was a cross-sectional study (point prevalence). Setting The study setting was intensive care units. The sample consisted of 169 patients - 60 patients from surgical wards, 59 from interdisciplinary wards and 50 from medical intensive care wards. The study results revealed that pressure reducing devices like mattresses (alternating pressure air, low air loss and foam) are applied for 58 (36.5%) patients, and all of these patients are at risk for pressure ulcer development. Most patients receive more than one nursing intervention, especially patients at risk. Nursing interventions applied are skin inspection, massage with moisture cream, nutrition and mobility (81.8%, 80.5%, 68.6% and 56.6%) respectively. Moreover, all applied pressure ulcer preventive measures in this study are in line with the guidelines of the EPUAP and AHCPR except massage which is applied to 8.8% of all patients. The use of pressure reducing devices and nursing interventions in intensive care patients are in line with international pressure ulcer guidelines. Only massage, which is also being used, should be avoided according to the recommendation of national and international guidelines.

  19. Practice of preventive dentistry for nursing staff in primary care.

    Science.gov (United States)

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

    2014-01-01

    Determine the domain of preventive dentistry in nursing personnel assigned to a primary care unit. 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. 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). 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.

  20. Measurement properties of questionnaires measuring continuity of care: a systematic review.

    Science.gov (United States)

    Uijen, Annemarie A; Heinst, Claire W; Schellevis, Francois G; van den Bosch, Wil J H M; van de Laar, Floris A; Terwee, Caroline B; Schers, Henk J

    2012-01-01

    Continuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties. We did a systematic review using the PubMed, Embase and PsycINFO databases, with an extensive search strategy including 'continuity of care', 'coordination of care', 'integration of care', 'patient centered care', 'case management' and its linguistic variations. We searched from 1995 to October 2011 and included articles describing the development and/or evaluation of the measurement properties of instruments measuring one or more dimensions of continuity of care (1) care from the same provider who knows and follows the patient (personal continuity), (2) communication and cooperation between care providers in one care setting (team continuity), and (3) communication and cooperation between care providers in different care settings (cross-boundary continuity). We assessed the methodological quality of the measurement properties of each instrument using the COSMIN checklist. We included 24 articles describing the development and/or evaluation of 21 instruments. Ten instruments measured all three dimensions of continuity of care. Instruments were developed for different groups of patients or providers. For most instruments, three or four of the six measurement properties were assessed (mostly internal consistency, content validity, structural validity and construct validity). Six instruments scored positive on the quality of at least three of six measurement properties. Most included instruments have problems with either the number or quality of its assessed measurement properties or the ability to measure all three dimensions of continuity of care. Based on the results of this review, we recommend the use of one of the four most promising instruments, depending on the target population Diabetes Continuity of Care Questionnaire, Alberta

  1. Measurement properties of questionnaires measuring continuity of care: a systematic review.

    Directory of Open Access Journals (Sweden)

    Annemarie A Uijen

    Full Text Available BACKGROUND: Continuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties. METHODS: We did a systematic review using the PubMed, Embase and PsycINFO databases, with an extensive search strategy including 'continuity of care', 'coordination of care', 'integration of care', 'patient centered care', 'case management' and its linguistic variations. We searched from 1995 to October 2011 and included articles describing the development and/or evaluation of the measurement properties of instruments measuring one or more dimensions of continuity of care (1 care from the same provider who knows and follows the patient (personal continuity, (2 communication and cooperation between care providers in one care setting (team continuity, and (3 communication and cooperation between care providers in different care settings (cross-boundary continuity. We assessed the methodological quality of the measurement properties of each instrument using the COSMIN checklist. RESULTS: We included 24 articles describing the development and/or evaluation of 21 instruments. Ten instruments measured all three dimensions of continuity of care. Instruments were developed for different groups of patients or providers. For most instruments, three or four of the six measurement properties were assessed (mostly internal consistency, content validity, structural validity and construct validity. Six instruments scored positive on the quality of at least three of six measurement properties. CONCLUSIONS: Most included instruments have problems with either the number or quality of its assessed measurement properties or the ability to measure all three dimensions of continuity of care. Based on the results of this review, we recommend the use of one of the four most promising instruments, depending on the target population

  2. Provider connectedness and communication patterns: extending continuity of care in the context of the circle of care

    Science.gov (United States)

    2013-01-01

    Background Continuity is an important aspect of quality of care, especially for complex patients in the community. We explored provider perceptions of continuity through a system’s lens. The circle of care was used as the system. Methods Soft systems methodology was used to understand and improve continuity for end of life patients in two communities. Participants: Physicians, nurses, pharmacists in two communities in British Columbia, involved in end of life care. Two debates/discussion groups were completed after the interviews and initial analysis to confirm findings. Interview recordings were qualitatively analyzed to extract components and enablers of continuity. Results 32 provider interviews were completed. Findings from this study support the three types of continuity described by Haggerty and Reid (information, management, and relationship continuity). This work extends their model by adding features of the circle of care that influence and enable continuity: Provider Connectedness the sense of knowing and trust between providers who share care of a patient; a set of ten communication patterns that are used to support continuity across the circle of care; and environmental factors outside the circle that can indirectly influence continuity. Conclusions We present an extended model of continuity of care. The components in the model can support health planners consider how health care is organized to promote continuity and by researchers when considering future continuity research. PMID:23941179

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

    OpenAIRE

    Faria, Lina; Gonçalves, Maria do Céu Pereira; Silva, Elirez Bezerra da

    2016-01-01

    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...

  4. Care Coordination and Continuity of Care in Oral Anticancer Treatment: The Patients' Perspective

    OpenAIRE

    Cohen Castel, Orit; Shadmi, Efrat; Granot, Tal; Keinan-Boker, Lital; Karkabi, Khaled; Dagan, Efrat

    2017-01-01

    Introduction: Patients receiving oral anticancer medications (OAMs) are at increased risk for fragmentation and lack of continuity which can potentially significantly hinder their ability for self-management.  Factors such as the complexity of the regimen, the need for special safety precautions, occurrence of side effects, and drug-drug interactions require close collaboration between the oncology and primary care providers and the alignment of treatment and follow-up plans (1-3). The multip...

  5. Workplace managed care: collaboration for substance abuse prevention.

    Science.gov (United States)

    Galvin, D M

    2000-05-01

    This article describes the history, purpose, and overall methodology of the Workplace Managed Care (WMC) study sponsored by the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention (CSAP). This study was initiated to discern best practices for workplaces and managed care organizations integrating their substance abuse prevention and early intervention programs, strategies, and activities for employees and their families. CSAP funded nine WMC grants to study their retrospective and prospective data. Results of the WMC study suggested the addition of substance abuse prevention material to existing workplace health promotion offerings that resulted in improved substance abuse attitudes without jeopardizing existing health promotion programs. Stress management programming was successful at improving substance abuse attitudes indirectly. This study provides a platform for multidisciplinary research in workplace and managed care settings.

  6. [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.

  7. Informing comprehensive HIV prevention: a situational analysis of the HIV prevention and care context, North West Province South Africa.

    Directory of Open Access Journals (Sweden)

    Sheri A Lippman

    Full Text Available Building a successful combination prevention program requires understanding the community's local epidemiological profile, the social community norms that shape vulnerability to HIV and access to care, and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa.The situational analysis was conducted in two sub-districts in 2012 and guided by an adaptation of WHO's Strategic Approach, a predominantly qualitative method, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. Analysis began during fieldwork with nightly discussions of findings and continued with coding original textual data from the fieldwork notebooks and a select number of recorded interviews.We conducted over 200 individual and group interviews and gleaned four principal social barriers to HIV prevention and care, including: HIV fatalism, traditional gender norms, HIV-related stigma, and challenges with communication around HIV, all of which fuel the HIV epidemic. At the different levels of response needed to stem the epidemic, we found evidence of national policies and programs that are mitigating the social risk factors but little community-based responses that address social risk factors to HIV.Understanding social and structural barriers to care helped shape our comprehensive HIV prevention program, which address the four 'themes' identified into each component of the program. Activities are underway to engage communities, offer community-based testing in high transmission areas, community stigma reduction, and a positive health, dignity and prevention program for stigma reduction and improve communication skills. The situational analysis

  8. The association of longitudinal and interpersonal continuity of care with emergency department use, hospitalization, and mortality among Medicare beneficiaries.

    Directory of Open Access Journals (Sweden)

    Suzanne E Bentler

    Full Text Available BACKGROUND: Continuity of medical care is widely believed to lead to better health outcomes and service utilization patterns for patients. Most continuity studies, however, have only used administrative claims to assess longitudinal continuity with a provider. As a result, little is known about how interpersonal continuity (the patient's experience at the visit relates to improved health outcomes and service use. METHODS: We linked claims-based longitudinal continuity and survey-based self-reported interpersonal continuity indicators for 1,219 Medicare beneficiaries who completed the National Health and Health Services Use Questionnaire. With these linked data, we prospectively evaluated the effect of both types of continuity of care indicators on emergency department use, hospitalization, and mortality over a five-year period. RESULTS: Patient-reported continuity was associated with reduced emergency department use, preventable hospitalization, and mortality. Most of the claims-based measures, including those most frequently used to assess continuity, were not associated with reduced utilization or mortality. CONCLUSION: Our results indicate that the patient- and claims-based indicators of continuity have very different effects on these important health outcomes, suggesting that reform efforts must include the patient-provider experience when evaluating health care quality.

  9. The Association of Longitudinal and Interpersonal Continuity of Care with Emergency Department Use, Hospitalization, and Mortality among Medicare Beneficiaries

    Science.gov (United States)

    Bentler, Suzanne E.; Morgan, Robert O.; Virnig, Beth A.; Wolinsky, Fredric D.

    2014-01-01

    Background Continuity of medical care is widely believed to lead to better health outcomes and service utilization patterns for patients. Most continuity studies, however, have only used administrative claims to assess longitudinal continuity with a provider. As a result, little is known about how interpersonal continuity (the patient's experience at the visit) relates to improved health outcomes and service use. Methods We linked claims-based longitudinal continuity and survey-based self-reported interpersonal continuity indicators for 1,219 Medicare beneficiaries who completed the National Health and Health Services Use Questionnaire. With these linked data, we prospectively evaluated the effect of both types of continuity of care indicators on emergency department use, hospitalization, and mortality over a five-year period. Results Patient-reported continuity was associated with reduced emergency department use, preventable hospitalization, and mortality. Most of the claims-based measures, including those most frequently used to assess continuity, were not associated with reduced utilization or mortality. Conclusion Our results indicate that the patient- and claims-based indicators of continuity have very different effects on these important health outcomes, suggesting that reform efforts must include the patient-provider experience when evaluating health care quality. PMID:25531108

  10. 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...

  11. 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 continuity of care provided (0.108% per FTE, p care (-0.033 days per FTE, p continuity of care provided was a significant mediator (0.016% per FTE, p continuity and access, but they may provide a better patient experience. Physician workforce planning should consider these care attributes when considering the role of part-time PCPs in practice redesign efforts and initiatives to meet the demand for primary care services.

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

    Science.gov (United States)

    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.

  13. Patients' experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care.

    Science.gov (United States)

    Chung, Vincent Ch; Yip, Benjamin Hk; Griffiths, Sian M; Yu, Ellen Lm; Liu, Siya; Ho, Robin St; Wu, Xinyin; Leung, Albert Wn; Sit, Regina Ws; Wu, Justin Cy; Wong, Samuel Ys

    2015-12-21

    Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients' experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients' perspective; and (ii) to investigate how quality varies with patients' demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of "coordination of patient information", "continuity of care", and "range of service provided". Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services.

  14. 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.

  15. Continuity of Care to Optimize Chronic Disease Management in the Community Setting

    Science.gov (United States)

    2013-01-01

    Background This evidence-based analysis reviews relational and management continuity of care. Relational continuity refers to the duration and quality of the relationship between the care provider and the patient. Management continuity ensures that patients receive coherent, complementary, and timely care. There are 4 components of continuity of care: duration, density, dispersion, and sequence. Objective The objective of this evidence-based analysis was to determine if continuity of care is associated with decreased health resource utilization, improved patient outcomes, and patient satisfaction. Data Sources MEDLINE, EMBASE, CINAHL, the Cochrane Library, and the Centre for Reviews and Dissemination database were searched for studies on continuity of care and chronic disease published from January 2002 until December 2011. Review Methods Systematic reviews, randomized controlled trials, and observational studies were eligible if they assessed continuity of care in adults and reported health resource utilization, patient outcomes, or patient satisfaction. Results Eight systematic reviews and 13 observational studies were identified. The reviews concluded that there is an association between continuity of care and outcomes; however, the literature base is weak. The observational studies found that higher continuity of care was frequently associated with fewer hospitalizations and emergency department visits. Three systematic reviews reported that higher continuity of care is associated with improved patient satisfaction, especially among patients with chronic conditions. Limitations Most of the studies were retrospective cross-sectional studies of large administrative databases. The databases do not capture information on trust and confidence in the provider, which is a critical component of relational continuity of care. The definitions for the selection of patients from the databases varied across studies. Conclusions There is low quality evidence that: Higher

  16. Promoting Prevention Through the Affordable Care Act: Workplace Wellness

    Science.gov (United States)

    Roffenbender, Jason S.; Goetzel, Ron Z.; Millard, Francois; Wildenhaus, Kevin; DeSantis, Charles; Novelli, William

    2012-01-01

    Public health in the United States can be improved by building workplace “cultures of health” that support healthy lifestyles. The Affordable Care Act (ACA), which includes the Prevention and Public Health Fund, will support a new focus on prevention and wellness, offering opportunities to strengthen the public’s health through workplace wellness initiatives. This article describes the opportunity the ACA provides to improve worker wellness. PMID:23237245

  17. Improving Obesity Prevention and Management in Primary Care in Canada.

    Science.gov (United States)

    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.

  18. Extending "Continuity of Care" to include the Contribution of Family Carers.

    Science.gov (United States)

    Wong-Cornall, Cecilia; Parsons, John; Sheridan, Nicolette; Kenealy, Timothy; Peckham, Allie

    2017-06-27

    Family carers, as a "shadow workforce", are foundational to the day-to-day integration of health service delivery for older family members living with complex health needs. This paper utilises Haggerty's model of continuity of care to explore the contribution of family carers' to the provision of care and support for an older family member's chronic condition within the context of health service delivery. We analysed data from interviews of 13 family carers in a case study of primary health care in New Zealand - a Maori Provider Organisation - to determine the alignment of family caregiving with the three levels of continuity of care (relational continuity, informational continuity, and management continuity). We found alignment of family caregiving tasks, responsibilities, and relationships with the three levels of continuity of care. Family carers 1) partnered with providers to extend chronic care to the home; 2) transferred and contributed information from one provider/service to another; 3) supported consistent and flexible management of care. The Maori Provider Organisation supported family carer-provider partnership enabled by shared Maori cultural values and social mandate of building family-centred wellbeing. Relational continuity was the most important level of continuity of care; it sets precedence for family carers and providers to establish the other levels - informational and management - continuity of care for their family member cared for. Family carers need to be considered as active partners working alongside responsive primary health care providers and organisation in the implementation of chronic care.

  19. Effect of continuity of care on hospital utilization for seniors with multiple medical conditions in an integrated health care system.

    Science.gov (United States)

    Bayliss, Elizabeth A; Ellis, Jennifer L; Shoup, Jo Ann; Zeng, Chan; McQuillan, Deanna B; Steiner, John F

    2015-03-01

    Lower continuity of care has been associated with higher rates of adverse outcomes for persons with multiple chronic medical conditions. It is unclear, however, whether this relationship also exists within integrated systems that offer high levels of informational continuity through shared electronic health records. We conducted a retrospective cohort study of 12,200 seniors with 3 or more chronic conditions within an integrated delivery system. Continuity of care was calculated using the Continuity of Care Index, which reflects visit concentration with individual clinicians. Using Cox proportional hazards regression permitting continuity to vary monthly until the outcome or censoring event, we separately assessed inpatient admissions and emergency department visits as a function of primary care continuity and specialty care continuity. After adjusting for covariates (demographics; baseline, primary, and specialty care visits; baseline outcomes; and morbidity burden), greater primary care continuity and greater specialty care continuity were each associated with a lower risk of inpatient admission (respective hazard ratios (95% CIs) = 0.97 (0.96, 0.99) and 0.95 (0.93, 0.98)) and a lower risk of emergency department visits (respective hazard ratios = 0.97 (0.96, 0.98) and 0.98 (0.96, 1.00)). For the subgroup with 3 or more primary care and 3 or more specialty care visits, specialty care continuity (but not primary care continuity) was independently associated with a decreased risk of inpatient admissions (hazard ratio = 0.94 (0.92, 0.97)), and primary care continuity (but not specialty care continuity) was associated with a decreased risk of emergency department visits (hazard ratio = 0.98 (0.96, 1.00)). In an integrated delivery system with high informational continuity, greater continuity of care is independently associated with lower hospital utilization for seniors with multiple chronic medical conditions. Different subgroups of patients will benefit from

  20. Chronic disease in childhood and adolescence: continuity of care in the Health Care Network.

    Science.gov (United States)

    Nóbrega, Vanessa Medeiros da; Silva, Maria Elizabete de Amorim; Fernandes, Leiliane Teixeira Bento; Viera, Claudia Silveira; Reichert, Altamira Pereira da Silva; Collet, Neusa

    2017-06-12

    To evaluate the continuity of care for children and adolescents with chronic diseases in the health care network. This qualitative study was conducted between February and October 2013 with 12 families, six health managers, and 14 health professionals from different health care services in a municipality of the state of Paraíba, Brazil, using focal groups, semi-structured interviews, and medical record consultation. The data were analyzed by triangulation and thematic analysis. Two categories were created: "health care management" and "(dis)continuity of care." We found gaps in the system, including poor data recording aimed to facilitate follow-up and guide the planning actions as well as sporadic and discoordinate services with a limited flow of information, which hinders follow-up over time. Continuity of care in the health care network is limited and creates the need to develop strategies to improve these services. Analisar a continuidade do cuidado à criança/adolescente com doença crônica na rede de atenção à saúde. Pesquisa qualitativa realizada entre fevereiro e outubro de 2013 com 12 familiares, seis gestores e 14 profissionais de saúde de diferentes serviços da rede de saúde de um município da Paraíba através das técnicas de grupo focal, entrevista semiestruturada e consulta a prontuários. A triangulação dos dados e a análise temática subsidiaram a interpretação dos dados. Foram construídas duas categorias: "Gestão da atenção à saúde" e "(Des)continuidade do cuidado". Constataram-se lacunas como a ausência de cadastro para favorecer o acompanhamento e nortear o planejamento de ações; atendimento pontual e desarticulado entre os serviços com fragilidade no fluxo de informações, que obstaculizam o seguimento ao longo do tempo. A continuidade do cuidado na rede de atenção à saúde está fragilizada e há necessidade do desenvolvimento de estratégias que a favoreçam.

  1. Poor continuity of care for TB diagnosis and treatment in Zambian Prisons: a situation analysis.

    Science.gov (United States)

    Hatwiinda, S; Topp, S M; Siyambango, M; Harris, J B; Maggard, K R; Chileshe, C; Kapata, N; Reid, S E; Henostroza, G

    2018-02-01

    Prisons act as infectious disease reservoirs. We aimed to explore the challenges of TB control and continuity of care in prisons in Zambia. We evaluated treatment outcomes for a cohort of inmates diagnosed with TB during a TB REACH funded screening programme initiated by the Zambia Prisons Service and the Centre for Infectious Disease Research in Zambia. Between October 2010 and September 2011, 6282 inmates from six prisons were screened for TB, of whom 374 (6.0%) were diagnosed. TB treatment was initiated in 345 of 374 (92%) inmates. Of those, 66% were cured or completed treatment, 5% died and 29% were lost to follow-up. Among those lost to follow-up, 11% were released into the community and 13% were transferred to other prisons. Weak health systems within the Zambian prison service currently undermines continuity of care, despite intensive TB screening and case-finding interventions. To prevent TB transmission and the development of drug resistance, we need sufficient numbers of competent staff for health care, reliable health information systems including electronic record keeping for prison facilities, and standard operating procedures to guide surveillance, case-finding and timely treatment initiation and completion. © 2017 John Wiley & Sons Ltd.

  2. 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.

  3. Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway

    Science.gov (United States)

    Myklebust, Lars Henrik; Olstad, Reidun; Bjorbekkmo, Svein; Eisemann, Martin; Wynn, Rolf; Sørgaard, Knut

    2011-01-01

    Background The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention. Aims To study whether inpatients’ utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model. Method The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization. Results Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients’ utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care. Conclusion Inpatients’ utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore represent a favourable alternative

  4. Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway

    Directory of Open Access Journals (Sweden)

    Lars Henrik Myklebust

    2011-12-01

    Full Text Available Background: The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention.Aims: To study whether inpatients' utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model.  Method: The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization. Results: Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients' utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care. Conclusion: Inpatients' utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore represent a

  5. Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway

    Directory of Open Access Journals (Sweden)

    Lars Henrik Myklebust

    2011-12-01

    Full Text Available Background: The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention. Aims: To study whether inpatients' utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model.   Method: The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization.  Results: Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients' utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care.  Conclusion: Inpatients' utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore

  6. Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway.

    Science.gov (United States)

    Myklebust, Lars Henrik; Olstad, Reidun; Bjorbekkmo, Svein; Eisemann, Martin; Wynn, Rolf; Sørgaard, Knut

    2011-10-01

    The issue of continuity of care is central in contemporary psychiatric services research. In Norway, inpatient admissions are mainly to take place locally, in a system of small bed-units that represent an alternative to traditional central psychiatric hospitals. This type of organization may be advantageous for accessibility and cooperation, but has been given little scientific attention. To study whether inpatients' utilization of outpatient services differ between an area with a decentralized care model in comparison to an adjacent area with a partly centralized model. The study was based on data from a one-year registered prevalence sample, drawing on routinely sampled data supplemented with data from medical records. Service-utilization for 247 inpatients was analyzed. The results were controlled for diagnosis, demographic variables, type of service system, localization of inpatient admissions, and length of hospitalization. Most inpatients in the area with the decentralized care model also utilized outpatient consultations, whereas a considerable number of inpatients in the area with a partly centralized model did not enter outpatient care at all. Type of service system, localization of inpatient admission, and length of hospitalization predicted inpatients' utilization of outpatient consultations. The results are discussed in the light of systems integration, particularly management-arrangements and clinical bridging over the transitional phase from inpatient to outpatient care. Inpatients' utilization of outpatient services differed between an area with a decentralized care model in comparison to an adjacent area with a partly centralized care model. In the areas studied, extensive decentralization of the psychiatric services positively affected coordination of inpatient and outpatient services for people with severe psychiatric disorders. Small, local-bed units may therefore represent a favourable alternative to traditional central psychiatric hospitals.

  7. 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.

    Science.gov (United States)

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

    2018-01-08

    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. We conducted a questionnaire survey in a region in the Netherlands in 2014 among 790 women after they gave birth. To measure experienced continuity of care, the Nijmegen Continuity Questionnaire was used. Quality of care during labor was measured with the Pregnancy and Childbirth Questionnaire, and to measure perception of labor we used the Childbirth Perception Scale. Three hundred twenty five women consented to participate (41%). Of these, 187 women completed the relevant questions in the online questionnaire. 136 (73%) women were in midwife-led care at the onset of labor, 15 (8%) were in obstetrician-led care throughout pregnancy and 36 (19%) were referred to obstetrician-led care during pregnancy. Experienced personal and team continuity of care during pregnancy were higher for women in midwife-led care compared to those in obstetrician-led care at the onset of labor. Experienced continuity of care was moderately correlated with experienced quality of care although not significantly so in all subgroups. A weak negative correlation was found between experienced personal continuity of care by the midwife and perception of labor. This study suggests that experienced continuity of care depends on the care context and is significantly higher for women who are in midwife-led compared to obstetrician-led care during labor. It will be a challenge to maintain the high level of experienced continuity of care in an integrated maternity care system. Experienced continuity of care seems to be a distinctive concept that should not be confused with experienced quality of care or perception of labor and should be considered as a complementary aspect of quality of care.

  8. Continuity of Care, Caregiver-Child Interactions, and Toddler Social Competence and Problem Behaviors

    Science.gov (United States)

    Ruprecht, Karen; Elicker, James; Choi, Ji Young

    2016-01-01

    Research Findings: Continuity of care is a recommended practice in child care intended to promote secure and supportive relationships between infants and toddlers and their caregivers. Toddlers (N = 115) between 12 and 24 months were observed in 30 continuity and 29 noncontinuity classrooms. The average duration of care for toddlers with…

  9. Patients' experiences with continuity of cancer care in Canada: Results from the CanIMPACT study.

    Science.gov (United States)

    Easley, Julie; Miedema, Baukje; Carroll, June C; O'Brien, Mary Ann; Manca, Donna P; Grunfeld, Eva

    2016-10-01

    To explore patient perspectives on and experiences with the coordination and continuity of cancer care. Qualitative study using semistructured telephone interviews. Canada. Thirty-eight breast and colorectal cancer survivors 1 to 4 years after diagnosis. Using a constructivist grounded theory approach, semistructured telephone interviews were conducted with the participants. The interviews were digitally recorded, transcribed verbatim, and proofread. Transcripts were reviewed to create a focused coding scheme that was used to develop categories for participants' experiences. Although this study focused on the continuity of cancer care, patients described their experiences with cancer care in general, concentrating predominantly on their relationships with individual health care providers (HCPs). Based on patients' experiences, several themes were identified as the core components of providing good continuity and well coordinated care. The most important overarching theme was communication, which overlapped with 4 other themes: patient-HCP relationships, the role of HCPs, lack of access to care, and timely and tailored information. Patients believed that good communication between HCPs and patients was key to improving the overall continuity of cancer care. Continuity of care is an important theoretical concept in cancer care, but it is not easily recognized by patients. They perceive the cancer care continuum and continuity of care as cancer care in general, which is typically framed by the individual relationships with their HCPs. Future research and interventions need to focus on finding and testing ways to improve communication to enhance continuity of cancer care. Copyright© the College of Family Physicians of Canada.

  10. Patients’ experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care

    Science.gov (United States)

    Chung, Vincent CH; Yip, Benjamin HK; Griffiths, Sian M; Yu, Ellen LM; Liu, Siya; Ho, Robin ST; Wu, Xinyin; Leung, Albert WN; Sit, Regina WS; Wu, Justin CY; Wong, Samuel YS

    2015-01-01

    Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients’ experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients’ perspective; and (ii) to investigate how quality varies with patients’ demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of “coordination of patient information”, “continuity of care”, and “range of service provided”. Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services. PMID:26686267

  11. The Durham Family Initiative: A Preventive System of Care

    Science.gov (United States)

    Dodge, Kenneth A.; Berlin, Lisa J.; Epstein, Matthew; Spitz-Roth, Adele; O'Donnell, Karen; Kaufman, Martha; Amaya-Jackson, Lisa; Rosch, Joel; Christopoulos, Christina

    2004-01-01

    This article describes the Durham Family Initiative (DFI), an innovative effort to bring together child welfare and juvenile justice systems to reach DFI's goal of reducing the child abuse rate in Durham, North Carolina, by 50% within the next 10 years. DFI will follow principles of a preventive system of care (PSoC), which focuses on nurturing…

  12. 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

  13. Compliance With Infection Prevention Guidelines By Health Care ...

    African Journals Online (AJOL)

    Objective: To determine the level of health-care workers' compliance with Infection Prevention Guidelines and identify factors that influence compliance at Ronald Ross General Hospital, Mufulira District. Methods: A quantitative study was carried out in 2007. Convenient sampling method was used. Data was obtained using ...

  14. Improving access to and utilization of adolescent preventive health care: the perspectives of adolescents and parents.

    Science.gov (United States)

    Coker, Tumaini R; Sareen, Harvinder G; Chung, Paul J; Kennedy, David P; Weidmer, Beverly A; Schuster, Mark A

    2010-08-01

    To examine the perspectives of publicly insured adolescents and their parents on ways to encourage adolescent utilization of preventive health services. We conducted eight focus groups with 77 adolescents enrolled in a large Medicaid managed care plan in Los Angeles County, California, and two focus groups with 21 of their parents. Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. Adolescents and parents reported that the most effective way to encourage preventive care utilization among teens was to directly address provider-level barriers related to the timeliness, privacy, confidentiality, comprehensiveness, and continuity of their preventive care. They reported that incentives (e.g., cash, movie tickets, gift cards) might also be an effective way to increase preventive care utilization. To improve adolescent receipt of surveillance and guidance on sensitive health-related topics, most adolescents suggested that the best way to encourage clinician-adolescent discussion was to increase private face-to-face discussions with a clinician with whom they had a continuous and confidential relationship. Adolescents reported that the use of text messaging, e-mail, and Internet for providing information and counseling on various sensitive health-related topics would also encourage adolescent utilization of preventive health services. Parents, however, more often preferred that their teen receive these services through in-office discussions and clinician-provided brochures. State agencies, health plans, clinics, and individual providers may consider focusing their efforts to improve adolescents' utilization of preventive services on basic structural and quality of care issues related to the clinician-patient relationship, access to services, and confidentiality. (c) 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  15. Undocumented migrants lack access to pregnancy care and prevention

    Directory of Open Access Journals (Sweden)

    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.

  16. 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

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

    Science.gov (United States)

    2013-01-01

    Background 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. Methods 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. Results 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. Conclusions 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

  18. Measurement Properties of Questionnaires Measuring Continuity of Care: A Systematic Review

    Science.gov (United States)

    Uijen, Annemarie A.; Heinst, Claire W.; Schellevis, Francois G.; van den Bosch, Wil J.H.M.; van de Laar, Floris A.; Terwee, Caroline B.; Schers, Henk J.

    2012-01-01

    Background Continuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties. Methods We did a systematic review using the PubMed, Embase and PsycINFO databases, with an extensive search strategy including ‘continuity of care’, ‘coordination of care’, ‘integration of care’, ‘patient centered care’, ‘case management’ and its linguistic variations. We searched from 1995 to October 2011 and included articles describing the development and/or evaluation of the measurement properties of instruments measuring one or more dimensions of continuity of care (1) care from the same provider who knows and follows the patient (personal continuity), (2) communication and cooperation between care providers in one care setting (team continuity), and (3) communication and cooperation between care providers in different care settings (cross-boundary continuity). We assessed the methodological quality of the measurement properties of each instrument using the COSMIN checklist. Results We included 24 articles describing the development and/or evaluation of 21 instruments. Ten instruments measured all three dimensions of continuity of care. Instruments were developed for different groups of patients or providers. For most instruments, three or four of the six measurement properties were assessed (mostly internal consistency, content validity, structural validity and construct validity). Six instruments scored positive on the quality of at least three of six measurement properties. Conclusions Most included instruments have problems with either the number or quality of its assessed measurement properties or the ability to measure all three dimensions of continuity of care. Based on the results of this review, we recommend the use of one of the four most promising instruments, depending on the target

  19. [Continuity, coordination and integration of care: from theory to practice].

    Science.gov (United States)

    Schaller, Philippe; Gaspoz, Jean-Michel

    2008-09-24

    If the Swiss health care system has reached several important objectives, fragmentation of its organization alter its efficacy, its effectiveness and its quality. Numerous experts put forward the necessity of coordinating care and services, particularly for complex and, most often, chronic diseases. Physicians have a key role to play in that coordination, but the exponential growth of medical knowledge, together with a more and more sophisticated technology, requires this role to be based on interdisciplinarity and network organization. This article proposes a model to implement, around the primary care physician, a first level organization of care to ensure this organization. Such a model may better meet future challenges of the Swiss health care system.

  20. Advancing educational continuity in primary care residencies: an opportunity for patient-centered medical homes.

    Science.gov (United States)

    Bowen, Judith L; Hirsh, David; Aagaard, Eva; Kaminetzky, Catherine P; Smith, Marie; Hardman, Joseph; Chheda, Shobhina G

    2015-05-01

    Continuity of care is a core value of patients and primary care physicians, yet in graduate medical education (GME), creating effective clinical teaching environments that emphasize continuity poses challenges. In this Perspective, the authors review three dimensions of continuity for patient care-informational, longitudinal, and interpersonal-and propose analogous dimensions describing continuity for learning that address both residents learning from patient care and supervisors and interprofessional team members supporting residents' competency development. The authors review primary care GME reform efforts through the lens of continuity, including the growing body of evidence that highlights the importance of longitudinal continuity between learners and supervisors for making competency judgments. The authors consider the challenges that primary care residency programs face in the wake of practice transformation to patient-centered medical home models and make recommendations to maximize the opportunity that these practice models provide. First, educators, researchers, and policy makers must be more precise with terms describing various dimensions of continuity. Second, research should prioritize developing assessments that enable the study of the impact of interpersonal continuity on clinical outcomes for patients and learning outcomes for residents. Third, residency programs should establish program structures that provide informational and longitudinal continuity to enable the development of interpersonal continuity for care and learning. Fourth, these educational models and continuity assessments should extend to the level of the interprofessional team. Fifth, policy leaders should develop a meaningful recognition process that rewards academic practices for training the primary care workforce.

  1. A performance measure for continuity of care after detoxification: relationship with outcomes.

    Science.gov (United States)

    Lee, Margaret T; Horgan, Constance M; Garnick, Deborah W; Acevedo, Andrea; Panas, Lee; Ritter, Grant A; Dunigan, Robert; Babakhanlou-Chase, Hermik; Bidorini, Alfred; Campbell, Kevin; Haberlin, Karin; Huber, Alice; Lambert-Wacey, Dawn; Leeper, Tracy; Reynolds, Mark

    2014-08-01

    Administrative data from five states were used to examine whether continuity of specialty substance abuse treatment after detoxification predicts outcomes. We examined the influence of a 14-day continuity of care process measure on readmissions. Across multiple states, there was support that clients who received treatment for substance use disorders within 14-days after discharge from detoxification were less likely to be readmitted to detoxification. This was particularly true for reducing readmissions to another detoxification that was not followed with treatment and when continuity of care was in residential treatment. Continuity of care in outpatient treatment was related to a reduction in readmissions in some states, but not as often as when continuity of care occurred in residential treatment. A performance measure for continuity of care after detoxification is a useful tool to help providers monitor quality of care delivered and to alert them when improvement is needed. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. A Performance Measure for Continuity of Care After Detoxification: Relationship With Outcomes

    Science.gov (United States)

    Lee, Margaret T.; Horgan, Constance M.; Garnick, Deborah W.; Acevedo, Andrea; Panas, Lee; Ritter, Grant A.; Dunigan, Robert; Babakhanlou-Chase, Hermik; Bidorini, Alfred; Campbell, Kevin; Haberlin, Karin; Huber, Alice; Lambert-Wacey, Dawn; Leeper, Tracy; Reynolds, Mark

    2014-01-01

    Administrative data from five states were used to examine whether continuity of specialty substance abuse treatment after detoxification predicts outcomes. We examined the influence of a 14-day continuity of care process measure on readmissions. Across multiple states, there was support that clients who received treatment for substance use disorders within 14-days after discharge from detoxification were less likely to be readmitted to detoxification. This was particularly true for reducing readmissions to another detoxification that was not followed with treatment and when continuity of care was in residential treatment. Continuity of care in outpatient treatment was related to a reduction in readmissions in some states, but not as often as when continuity of care occurred in residential treatment. A performance measure for continuity of care after detoxification is a useful tool to help providers monitor quality of care delivered and to alert them when improvement is needed. PMID:24912862

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

    Science.gov (United States)

    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…

  4. Informal Caregiver Disability and Access to Preventive Care in Care Recipients.

    Science.gov (United States)

    Thorpe, Joshua M; Thorpe, Carolyn T; Schulz, Richard; Van Houtven, Courtney H; Schleiden, Loren

    2015-09-01

    Many informal caregivers of dependent midlife and older adults suffer from their own functional limitations. The impact of caregiver functional limitations on care recipient receipt of preventive services is unknown. The purpose of this study is to examine the association between caregiver functional limitations and decreased access to recommended preventive services in dependent care recipients. Dependent adults (those receiving assistance with activities of daily living or instrumental activities of daily living) and their primary informal caregiver were identified from pooled alternate years (2000-2008) of the nationally representative Medical Expenditure Panel Survey (data analyzed February-October 2014). The impact of caregiver limitations (cognitive, mobility, sensory, emotional health) on care recipient's receipt of up to seven different preventive services was assessed via survey-weighted linear and logistic regression. Of the 5-year weighted estimate of 14.2 million caregiver-care recipient dyads, 38.0% of caregivers reported at least one functional limitation. The percentage of recommended preventive services received by care recipients was significantly lower if the caregiver had cognitive, mobility, or emotional health limitations. Each type of caregiver functional limitation was negatively associated with at least four different preventive services. Informal caregivers burdened by their own functional impairments may face challenges in facilitating access to preventive care in dependent midlife and older adults. Policies and interventions designed to prevent or mitigate the impact of caregiver functional impairments are critical to the success of community-based models of care for dependent adults. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    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.

  6. Impact of continuity of care on mortality and health care costs: a nationwide cohort study in Korea.

    Science.gov (United States)

    Shin, Dong Wook; Cho, Juhee; Yang, Hyung Kook; Park, Jae Hyun; Lee, Hyejin; Kim, Hyunsu; Oh, Juhwan; Hwang, Soohee; Cho, BeLong; Guallar, Eliseo

    2014-01-01

    Continuity of care is considered a core element of high-quality primary care, but its impact on mortality and health care costs is unclear. We aimed to determine the impact of continuity of care on mortality, costs, and health outcomes in patients with newly diagnosed cardiovascular risk factors. We conducted a cohort study of a 3% nationwide random sample of Korean National Health Insurance enrollees. A total of 47,433 patients who had received new diagnoses of hypertension, diabetes, hypercholesterolemia, or their complications in 2003 or 2004 were included. We determined standard indices of continuity of care-most frequent provider continuity (MFPC), modified, modified continuity index (MMCI), and continuity of care index (COC)-and evaluated their association with study outcomes over 5 years of follow-up. Outcome measures included overall mortality, cardiovascular mortality, incident cardiovascular events, and health care costs. The multivariable-adjusted hazard ratios (HRs) for all-cause mortality, cardiovascular mortality, incident myocardial infarction, and incident ischemic stroke comparing participants with COC index below the median to those above the median were HR = 1.12 (95% CI, 1.04-1.21), 1.30 (1.13-1.50), 1.57 (1.28-1.95), and 1.44 (1.27-1.63), respectively. Similar findings were obtained for other indices of continuity of care. Lower continuity of care was also associated with increased inpatient and outpatient days and costs. Lower indices of continuity of care in patients with newly diagnosed hypertension, diabetes, and hypercholesterolemia were associated with higher all-cause and cardiovascular mortality, cardiovascular events, and health care costs. Health care systems should be designed to support long-term trusting relationships between patients and physicians. © 2014 Annals of Family Medicine, Inc.

  7. The effect of continuous care on the lifestyle of patients with multiple sclerosis: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Masoud Khodaveisi

    2017-01-01

    Full Text Available Background: Multiple sclerosis is a common debilitating chronic disease of the central nervous system with a progressive and prolonged nature. Patients need an adjusted lifestyle and continuous care in order to prevent its recurrence and progressive disabilities. This study aimed to assess the effect of continuous care on lifestyle in patients suffering from multiple sclerosis. Materials and Methods: A randomized clinical trial was conducted among 72 patients with multiple sclerosis who referred to the Farshchian Educational Hospital in Hamadan, Iran in 2013. The patients were allocated to intervention and control groups using balanced block randomization with blocks of four. The steps of continuous care (orientation, sensitization, control, and evaluation were implemented in the case group for 2 months. The patients' lifestyle was assessed before and 1 and 2 months after continuous care using the researcher-developed Lifestyle Questionnaire. The data were analyzed using the Chi-square test, t-test, and repeated-measures analysis of variance. Results: The mean score of lifestyle and its dimensions were significantly higher in the intervention group 1 and 2 months after the intervention compared to the baseline (P = 0.001. In contrast, the mean score of lifestyle and its dimensions had no significant difference in the control group 1 and 2 months after routine care compared to the baseline.Conclusions: Continuous care improved the patients' lifestyle. It could be designed as an appropriate care system into the hospitals or other health care centers. This care system could be used widely in order to improve adherence to suitable lifestyle in patients with chronic diseases.

  8. [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.

  9. Attributions and emotions regarding health care mistreatment impact continuity of care among Latino and Anglo American women.

    Science.gov (United States)

    Flynn, Patricia M; Betancourt, Hector; Garberoglio, Carlos; Regts, Gregory J; Kinworthy, Kayla M; Northington, Daniel J

    2015-10-01

    Ethnic minority and lower socioeconomic status (SES) populations report less positive health care encounters and lower continuity of health care compared with higher SES and non-Latino White (Anglo) Americans. This study examined similarities and differences concerning the influence of patients' causal attributions for health care mistreatment and related emotions on continuity of health care among 335 Latin American (Latinas) and Anglo American women in Southern California. A mixed methods research approach was implemented to identify and assess perceptions of health care mistreatment, causal attributions for mistreatment, negative emotions, and continuity of cancer screening care. Multigroup structural equation modeling revealed that causal attributions for health care mistreatment and related emotions explained continuity of care above and beyond what was explained by patients' exposure to health care mistreatment alone, for both ethnic groups. Still, the improvement in variance accounted for by including attributions and emotions was considerably more for Latinas (194%) than Anglo women (109%). Compared with attributions having to do with the health care environment (e.g., time constraints), attributions to the health care professional (e.g., uncompassionate) were related to higher levels of negative emotions for both Latinas and Anglo women and lower continuity of care, particularly for Anglo women. Results also suggest that for Latinas continuity of care was more a function of the attribution-emotion process, particularly the negative emotions associated with attributions concerning mistreatment, whereas for Anglo women it was more a function of mistreatment and the attribution itself. Interventions designed to improve professionals' communication and interpersonal skills may help enhance continuity of health care and reduce health disparities. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  10. 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.

  11. 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.

  12. 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.

  13. Continuity of home-based care for persons with dementia from formal and family caregivers' perspective.

    Science.gov (United States)

    Larsen, Lill Sverresdatter; Normann, Hans Ketil; Hamran, Torunn

    2016-12-06

    Western health care policy emphasizes continuity of care for people with dementia. This paper presents formal and family caregivers' descriptions of collaboration in home-based dementia care and explores whether this collaboration inhibits or enables continuity of care and the use of the statutory individual plan. Empirical data were derived from 18 in-depth interviews with formal and family caregivers and brief fieldwork. The results reveal dynamic positions in collaborative practice and, from these positions, discrepancies in descriptions of practices and the needs of the person with dementia. Such micro-level discrepancies may serve as barriers for macro-level continuity of care objectives. To ensure continuity of care, formal and family caregivers must be aware of their positions and discuss specific expectations for information flow, involvement and care responsibilities. Individual plan can serve as a starting point for such discussions. © The Author(s) 2016.

  14. Measuring continuity of care for cardiac patients: development of a patient self-report questionnaire.

    Science.gov (United States)

    Kowalyk, Kristine M; Hadjistavropoulos, Heather D; Biem, H Jay

    2004-02-01

    Continuity of care can be a challenge for cardiac patients, many of whom require chronic and complex management from a variety of health care personnel in multiple settings. For health services research, measures are needed that encompass the multifaceted nature of continuity of care for cardiac patients. To assess continuity of care from the patient's perspective, a comprehensive self-report instrument of continuity of care for patients with congestive heart failure and atrial fibrillation was developed and validated. Based on published work, patient interviews and provider input, the Heart Continuity of Care Questionnaire (HCCQ) was developed to assess various aspects of care in the transition from hospital to home. The HCCQ covered a variety of content areas relevant to cardiac care. The HCCQ and either the Continuity of Care Index (CCI) or the Minnesota Living with Heart Failure Questionnaire (MLHFQ) were completed by 83 patients who had been discharged for at least six months. Most items had good response rates. The subscales, defined a priori, had good reliability (subscales alpha ranged from 0.80 to 0.93). The HCCQ and its subscales had strong correlations with the CCI but not the MLHFQ. The HCCQ subscales demonstrated better known group validity than the CCI. In this preliminary study, the HCCQ appears to be a comprehensive, reliable and valid measure of continuity of care from the patient perspective. Further studies of the validity, generalizability and use are needed.

  15. 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...

  16. Continuity of care in hospital rehabilitation services: a qualitative insight from inpatients' experience.

    Science.gov (United States)

    Medina-Mirapeix, Francesc; Oliveira-Sousa, Silvana L; Escolar-Reina, Pilar; Sobral-Ferreira, Marta; Lillo-Navarro, M Carmen; Collins, Sean M

    Few empirical studies have been conducted on the continuity of rehabilitation services, despite the fact that it may affect clinical outcomes, patient satisfaction, the perception of quality, and safety. The aim of this study was to explore experiences and perceptions of inpatients receiving physical rehabilitation in an acute care hospital and how these experiences may have led to perceived gaps in the continuity of rehabilitation care. Using qualitative research methods, fifteen semi-structured interviews were conducted with patients who received physical rehabilitation during hospital stay in an acute care hospital in Murcia, Spain. Interviews were transcribed verbatim, analyzed, and grouped into predetermined and emergent codes. Patients described three main themes in continuity of care: informational, management, and relational continuity. Several factors were described as influencing the perceived gaps in these three types of continuity. Informational continuity was influenced by the transfer of information among care providers. Relational continuity was influenced by patient-therapist relations and consistency on the part of the provider. Management continuity was influenced by consistency of care between providers and the involvement of patients in their own care. The participants in this study identified several gaps in three types of continuity of care (informational, management, and relational). Inpatients often perceive their experiences of rehabilitation as being disconnected or incoherent over time. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. 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

    2015-01-01

    BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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. PMID:25388597

  19. [Improving the continuous care process in primary care during weekends and holidays: redesigning and FMEA].

    Science.gov (United States)

    Cañada Dorado, A; Cárdenas Valladolid, J; Espejo Matorrales, F; García Ferradal, I; Sastre Páez, S; Vicente Martín, I

    2010-01-01

    To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.

  20. Ethical decisions in endof- life care | Norval | Continuing Medical ...

    African Journals Online (AJOL)

    Ethical decisions in endof- life care. D Norval, E Gwyther. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...

  1. Direct Care Workers' Recommendations for Training and Continuing Education

    Science.gov (United States)

    Menne, Heather L.; Ejaz, Farida K.; Noelker, Linda S.; Jones, James A.

    2007-01-01

    Training of direct care workers (DCWs) varies depending upon the setting in which they work and the state in which they are trained. Evidence points to the importance of adequate training as critical to DCW job satisfaction and reduction in turnover. Several approaches have been taken to enhance the training of DCWs with the objective that as job…

  2. 76 FR 57637 - TRICARE; Continued Health Care Benefit Program Expansion

    Science.gov (United States)

    2011-09-16

    ... having trouble transitioning to ``civilian'' life would have more time to obtain medical and dental care...(a). (D) In the case of a former spouse of a retiree whose marriage was dissolved after the member... former spouse: (1) Has not remarried before the age of 55 after the marriage to the former member was...

  3. Issues in treating depression in primary care | Horn | Continuing ...

    African Journals Online (AJOL)

    Issues in treating depression in primary care. NR Horn. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL ...

  4. Preventive care and recall intervals. Targeting of services in child dental care in Norway.

    Science.gov (United States)

    Wang, N J; Aspelund, G Ø

    2010-03-01

    Skewed caries distribution has made interesting the use of a high risk strategy in child dental services. The purpose of this study was to describe the preventive dental care given and the recall intervals used for children and adolescents in a low caries risk population, and to study how the time spent for preventive care and the length of intervals were associated with characteristics of the children and factors related to care delivery. Time spent for and type of preventive care, recall intervals, oral health and health behaviour of children and adolescents three to 18 years of age (n = 576) and the preventive services delivered were registered at routine dental examinations in the public dental services. The time used for preventive dental care was on average 22% of the total time used in a course of treatment (7.3 of 33.4 minutes). Less than 15% of the variation in time spent for prevention was explained by oral health, oral health behaviours and other characteristics of the children and the service delivery. The mean (SD) recall intervals were 15.4 (4.6) months and 55% of the children were given intervals equal to or longer than 18 months. Approximately 30% of the variation in the length of the recall intervals was explained by characteristics of the child and the service delivery. The time used for preventive dental care of children in a low risk population was standardized, while the recall intervals to a certain extent were individualized according to dental health and dental health behaviour.

  5. 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

  6. Prevention of mental handicaps in children in primary health care.

    Science.gov (United States)

    Shah, P M

    1991-01-01

    Some 5-15% of children aged 3 to 15 years in both developing and developed countries suffer from mental handicaps. There may be as many as 10-30 million severely and about 60-80 million mildly or moderately mentally retarded children in the world. The conditions causing mental handicaps are largely preventable through primary health care measures in developing countries. Birth asphyxia and birth trauma are the leading causes of mental handicaps in developing countries where over 1.2 million newborns die each year from moderate or severe asphyxia and an equal number survive with severe morbidity due to brain damage. The other preventable or manageable conditions are: infections such as tuberculous and pyogenic meningitides and encephalopathies associated with measles and whooping cough; severe malnutrition in infancy; hyperbilirubinaemia in the newborn; iodine deficiency; and iron deficiency anaemia in infancy and early childhood. In addition, recent demographic and socioeconomic changes and an increase in the number of working mothers tend to deprive both infants and young children of stimulation for normal development. To improve this situation, the primary health care approach involving families and communities and instilling the spirit of self-care and self-help is indispensable. Mothers and other family members, traditional birth attendants, community health workers, as well as nurse midwives and physicians should be involved in prevention and intervention activities, for which they should be trained and given knowledge and skills about appropriate technologies such as the risk approach, home-based maternal record, partograph, mobilogram (kick count), home-risk card, icterometer, and mouth-to-mask or bag and mask resuscitation of the newborn. Most of these have been field-tested by WHO and can be used in the home, the health centre or day care centres to detect and prevent the above-mentioned conditions which can cause mental handicap.

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

    Science.gov (United States)

    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.

  8. Knowledge of Critical Care Provider on Prevention of Ventilator Associated Pneumonia

    Directory of Open Access Journals (Sweden)

    Passang Chiki Sherpa

    2014-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP continues to be an important cause of morbidity and mortality in ventilated patient. Prevention of VAP in critically ill patient is significant concern for health care team in intensive care units (ICUs. Knowledge on prevention of VAP would have a significant impact on patient outcome. Aims and Objectives: To assess knowledge on prevention of VAP in critical care providers and to find the association between knowledge on prevention of VAP and educational qualification and years of experience in ICUs. Settings and Design: The study was conducted in 5 different ICUs of Kasturba Hospital, Manipal, and using descriptive study design. Material and Methods: The study involved a purposive sample of 138 critical care providers. Critical care providers who were willing to participate in the study were included. Tools on demographic proforma and self-administered structured knowledge questionnaire on prevention of VAP were developed and content validity was established. The reliability of the tools was established.The data was categorized and analyzed by using descriptive and inferential statistics. The SPSS 16.0 version was used for the analysis of the study. Result: Majority 89.1% of the participant were 20-29 years, 63% unmarried 51.4% had completed diploma course and majority 81.2% were from nursing discipline. The study revealed that only 55.80% of subjects were having adequate knowledge on prevention of VAP based on median score. There was no significant association between knowledge score and educational qualification (÷²=0, p=0.833, years of experience in ICU (÷²= 2.221, p=0.329.

  9. Continuous Positive Airway Pressure (CPAP for prevention of recurrent pneumonia in the Neuromyelitis Optica patient

    Directory of Open Access Journals (Sweden)

    James A. Welker

    2014-01-01

    Conclusions: Patients with Neuromyelitis Optica differ from those with traumatic spinal cord injury as they have a chronic progressive systemic illness that causes continued deterioration of their nervous system resulting in the need for routine monitoring that ensures the timely addition of CPAP for the prevention of pneumonia and its associated medical expenses.

  10. Preventive dental care among Medicaid-enrolled senior adults: from community to nursing facility residence.

    Science.gov (United States)

    Kelly, Mary C; Caplan, Daniel J; Bern-Klug, Mercedes; Cowen, Howard J; Cunningham-Ford, Marsha A; Marchini, Leonardo; Momany, Elizabeth T

    2018-12-01

    The primary objective of this study was to determine whether the utilization rate of preventive oral health care services while senior adults were community-dwelling differed from the rate after those same senior adults were admitted to nursing facilities. A secondary objective was to evaluate other significant predictors of receipt of preventive oral health procedures after nursing facility entry. Iowa Medicaid claims from 2007-2014 were accessed for adults who were 68+ years upon entry to a nursing facility and continuously enrolled in Medicaid for at least three years before and at least two years after admission (n = 874). Univariate, bivariate and multivariable analyses were conducted. During the five years that subjects were followed, 52.8% never received a dental exam and 75.9% never received a dental hygiene procedure. More Medicaid-enrolled senior adults received ≥1 preventive dental procedure in the two years while residing in a nursing facility compared to the three years before entry. In multivariable analyses, the strongest predictor of preventive oral health care utilization after entry was the receipt of preventive oral health services before entry (p senior adult establishing a source of dental care while community-dwelling. © 2017 American Association of Public Health Dentistry.

  11. Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare.

    Science.gov (United States)

    Amjad, Halima; Carmichael, Donald; Austin, Andrea M; Chang, Chiang-Hua; Bynum, Julie P W

    2016-09-01

    Poor continuity of care may contribute to high health care spending and adverse patient outcomes in dementia. To examine the association between medical clinician continuity and health care utilization, testing, and spending in older adults with dementia. This was a study of an observational retrospective cohort from the 2012 national sample in fee-for-service Medicare, conducted from July to December 2015, using inverse probability weighted analysis. A total of 1 416 369 continuously enrolled, community-dwelling, fee-for-service Medicare beneficiaries 65 years or older with a claims-based dementia diagnosis and at least 4 ambulatory visits in 2012 were included. Continuity of care score measured on patient visits across physicians over 12 months. A higher continuity score is assigned to visit patterns in which a larger share of the patient's total visits are with fewer clinicians. Score range from 0 to 1 was examined in low-, medium-, and high-continuity tertiles. Outcomes include all-cause hospitalization, ambulatory care sensitive condition hospitalization, emergency department visit, imaging, and laboratory testing (computed tomographic [CT] scan of the head, chest radiography, urinalysis, and urine culture), and health care spending (overall, hospital and skilled nursing facility, and physician). Beneficiaries with dementia who had lower levels of continuity of care were younger, had a higher income, and had more comorbid medical conditions. Almost 50% of patients had at least 1 hospitalization and emergency department visit during the year. Utilization was lower with increasing level of continuity. Specifically comparing the highest- vs lowest-continuity groups, annual rates per beneficiary of hospitalization (0.83 vs 0.88), emergency department visits (0.84 vs 0.99), CT scan of the head (0.71 vs 0.83), urinalysis (0.72 vs 1.09), and health care spending (total spending, $22 004 vs $24 371) were higher with lower continuity even after accounting for

  12. Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study.

    Science.gov (United States)

    Maarsingh, Otto R; Henry, Ykeda; van de Ven, Peter M; Deeg, Dorly Jh

    2016-08-01

    Although continuity of care is a widely accepted core principle of primary care, the evidence about its benefits is still weak. To investigate whether continuity of care in general practice is associated with better survival in older people. Data were derived from the Longitudinal Aging Study Amsterdam, an ongoing cohort study in older people in the Netherlands. The study sample consisted of 1712 older adults aged ≥60 years, with 3-year follow-up cycles up to 17 years (1992-2009), and mortality follow-up until 2013. Continuity of care was defined as the duration of the ongoing therapeutic relationship between patient and GP. The Herfindahl-Hirschman Index was used to calculate the continuity of care (COC). A COC index value of 1 represented maximum continuity. COC index values 0-0.500) showed significantly greater mortality than those in the maximum COC category (hazard ratio (HR) = 1.20, 95% CI = 1.01 to 1.42). There were no confounders that affected this HR. This study demonstrates that low continuity of care in general practice is associated with a higher risk of mortality, strengthening the case for encouragement of continuity of care. © British Journal of General Practice 2016.

  13. Improving continuity of care for frequent users of emergency departments: service user and provider perspectives.

    Science.gov (United States)

    Poremski, Daniel; Harris, Deborah Wise; Kahan, Deborah; Pauly, Daniel; Leszcz, Molyn; O'Campo, Patricia; Wasylenki, Donald; Stergiopoulos, Vicky

    2016-01-01

    This study explored service user and provider perspectives on barriers and facilitators of continuity of care for frequent users of emergency departments (ED) participating in a brief intensive case management intervention. We conducted semistructured interviews with 20 frequent ED users with mental health and addiction challenges participating in a brief intensive case management intervention, eliciting experiences of care and care continuity. We interviewed 13 service providers working with this population. We used thematic analysis to determine shared and unique barriers and facilitators to continuity of care, and we gave priority to themes reported by both service users and providers. Within fragmented systems of care, strong working relationships between service users and providers, timely access to coordinated services and seamless transitions to needed supports increased perceived care continuity. Barriers to continuity of care included difficulties engaging this population, short intervention duration and the lack of a single accountable service provider to address health and social needs. Although brief intensive case management interventions have the potential to improve continuity of care for frequent ED users, continuity of care, especially for people with complex health and social needs, may be compromised by program and personal characteristics as well as lack of broader system integration. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Measurement properties of questionnaires measuring continuity of care: a systematic review.

    NARCIS (Netherlands)

    Uijen, A.A.; Heinst, C.W.; Schellevis, F.G.; Bosch, W.J.H.M. van den; Laar, F.A. van de; Terwee, C.B.; Schers, H.J.

    2012-01-01

    Background: Continuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties. Methods: We did a systematic review using the PubMed,

  15. Measurement Properties of Questionnaires Measuring Continuity of Care: A Systematic Review

    NARCIS (Netherlands)

    Uijen, A.A.; Heinst, C.W.; Schellevis, F.G.; van den Bosch, W.J.H.M.; van de Laar, F.A.; Terwee, C.B.; Schers, H.J.

    2012-01-01

    Background: Continuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties. Methods: We did a systematic review using the PubMed,

  16. Mediators of Telephone-Based Continuing Care for Alcohol and Cocaine Dependence

    Science.gov (United States)

    Mensinger, Janell Lynn; Lynch, Kevin G.; Tenhave, Thomas R.; McKay, James R.

    2007-01-01

    A previous randomized trial with 224 alcohol and/or cocaine addicts who had completed an initial phase of treatment indicated that 12 weeks of telephone-based continuing care yielded higher abstinence rates over 24 months than did group counseling continuing care. The current study examined mediators of this treatment effect. Results suggested…

  17. Caregiver-Child Relationships as a Context for Continuity in Child Care

    Science.gov (United States)

    Recchia, Susan L.

    2012-01-01

    This paper focuses on one aspect of continuity--the caregiver-child relationship--within a larger global study of continuity in child care based at a university-affiliated child care center. Case studies are presented of two toddler boys, followed as they transitioned from their infant classroom to the preschool classroom at the age of…

  18. Medical Trainee Continuity of Care Following Emergency Department Consultations in a Pediatric Hospital.

    Science.gov (United States)

    Bjorklund, Kim; Eismann, Emily A; Cornwall, Roger

    2016-02-01

    The importance of continuity of care in training is widely recognized; however, a broad-spectrum assessment across all specialties has not been performed. We assessed the continuity of care provided by trainees, following patient consultations in the emergency department (ED) across all specialties at a large pediatric tertiary care center. Medical records were reviewed to identify patients seen in consultation by a resident or fellow trainee in the ED over a 1-year period, and to determine if the patient followed up with the same trainee for the same condition during the next 6 months. Resident and fellow trainees from 33 specialties participated in 3400 ED consultations. Approximately 50% (1718 of 3400) of the patients seen in consultation by a trainee in the ED followed up with the same specialty within 6 months, but only 4.1% (70 of 1718) followed up with the same trainee for the same condition. Trainee continuity of care ranged from 0% to 21% among specialties, where specialties with resident clinics (14.4%) have a greater continuity of care than specialties without resident clinics (2.7%, P Continuity of care did not differ between fellows (4.2%) and residents (4.0%, P = .87), but did differ between postgraduate years for residents (P continuity of care for ED consultations was low across all specialties and levels of training. If continuity of care is important for patient well-being and trainee education, efforts to improve continuity for trainees must be undertaken.

  19. [COMMUNITY, HOSPITAL AND IN-BETWEEN: QUALITY MEASURES FOR THE CONTINUITY OF CARE].

    Science.gov (United States)

    Weinstein, Orly; Cohen, Arnon D; Comaneshter, Doron; Limon, Yehuda; Hazanov, Ilia; Dery, Michael Mishori; Bitterman, Haim; Codish, Shlomi; Davidson, Ehud

    2016-05-01

    The southern district of Clalit Health Services and Soroka University Medical Center are combined in an organizational configuration: the Southern Region. The Region has developed joint programs in order to advance the quality of medical care whilst optimizing the utilization of available resources. An objective continuous method of assessment was needed to evaluate the continuity of care between the community and the hospital. To produce objective tools for quantification based on pre-existing data systems, which enable ongoing assessment of the quality of continuity of care between the community and hospital, and the impact of the introduction of novel means of improvement. We defined a set of measurements that exemplify continuity of care in different areas of transition between community and hospital, all directly retrievable from existing computerized data sources. About forty different measurements have been defined, in different clinical areas. Of these, a dozen have already been implemented by mapping the process and the main obstacles that the patient goes through, followed by implementation of appropriate solutions. The application of an objective system of assessment of the results of continuity of care, utilizing pre-existing data sources, is essential for advancing the initiative, and is a breakthrough in the quantification of continuity of care. Continuity of care between community and hospital has been applied in the Southern Region to dozens of quality measurements. This is a novel project developing an objective system of measurement, directly assessing the quality of continuity of care for the individual patient.

  20. 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

  1. Measurement properties of questionnaires measuring continuity of care: a systematic review.

    NARCIS (Netherlands)

    Uijen, A.A.; Heinst, C.W.; Schellevis, F.G.; Bosch, W.J.H.M. van den; Laar, F.A. van de; Terwee, C.B.; Schers, H.J.

    2012-01-01

    BACKGROUND: Continuity of care is widely acknowledged as a core value in family medicine. In this systematic review, we aimed to identify the instruments measuring continuity of care and to assess the quality of their measurement properties. METHODS: We did a systematic review using the PubMed,

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

    Science.gov (United States)

    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

  3. Continuity of nursing care and its link to cesarean birth rate.

    Science.gov (United States)

    Gagnon, Anita J; Meier, Katharine M; Waghorn, Kathy

    2007-03-01

    High cesarean birth rates are an international concern. The role of patterns of nursing care responsibility in preventing or contributing to cesarean births has been understudied. Our study sought to identify and describe indicators of continuity of nursing care responsibility during labor and to explore whether any association between these indicators and risk of cesarean birth could be identified empirically using an existing data set. We obtained a representative sample of low-risk women giving birth in an intrapartum unit at a university hospital in Quebec, Canada, with approximately 3,700 births per year. To be considered for inclusion, women needed to have been primiparous, carrying singletons in vertex position, and at 37 weeks' gestation or more. All women giving birth over a 13-month period were assessed for eligibility using the hospital's birth log. Data were extracted from the medical records of every second eligible birth, including information related to patterns of nursing care responsibility, maternal and infant characteristics, obstetric procedures, non-health-related risk factors, and type of birth. Data on all variables of interest were available for 467 women. These women were cared for by 1-17 nurses, care responsibility changed hands for them from 1 to 28 times, and the mean length of labor for which the same nurse was responsible for a woman ranged from 10 to 1,045 minutes. After controlling for length of labor, maternal age, maternal height, infant weight, gestational age, induction, type of rupture, and epidural analgesia, the odds ratio for cesarean birth due to number of nurses was 1.17 (95% CI 1.04, 1.32); 1 or more nurses switch per 2 hours (i.e., number of times care responsibilities changed hands), 1.04 (95% CI 0.62, 1.74); and 33 percent or more of the labor attended by the same nurse, 0.74 (95% CI 0.42, 1.30). An association was observed between number of nurses caring for a laboring woman and risk of cesarean delivery. Estimates of

  4. Individual and Contextual-Level Factors Associated with Continuity of Care for Adults with Schizophrenia

    Science.gov (United States)

    Guada, Joseph; Phillips, Gary; Ranbom, Lorin; Fortney, John C.

    2013-01-01

    This retrospective cohort study examined rates of conformance to continuity of care treatment guidelines and factors associated with conformance for persons with schizophrenia. Subjects were 8,621 adult Ohio Medicaid recipients, aged 18–64, treated for schizophrenia in 2004. Information on individual-level (demographic and clinical characteristics) and contextual-level variables (county socio-demographic, economic, and health care resources) were abstracted from Medicaid claim files and the Area Resource File. Outcome measures captured four dimensions of continuity of care: (1) regularity of care; (2) transitions; (3) care coordination, and (4) treatment engagement. Multilevel modeling was used to assess the association between individual and contextual-level variables and the four continuity of care measures. The results indicated that conformance rates for continuity of care for adults with schizophrenia are below recommended guidelines and that variations in continuity of care are associated with both individual and contextual-level factors. Efforts to improve continuity of care should target high risk patient groups (racial/ethnic minorities, the dually diagnosed, and younger adults with early onset psychosis), as well as community-level risk factors (provider supply and geographic barriers of rural counties) that impede access to care. PMID:23689992

  5. Advancing Public Health through Continuing Education of Health Care Professionals

    Science.gov (United States)

    Hudmon, Karen Suchanek; Addleton, Robert L.; Vitale, Frank M.; Christiansen, Bruce A.; Mejicano, George C.

    2011-01-01

    This article describes how the CS2day (Cease Smoking Today) initiative positioned continuing education (CE) in the intersection between medicine and public health. The authors suggest that most CE activities address the medical challenges that clinicians confront, often to the neglect of the public health issues that are key risk factors for the…

  6. Continuity of Care in Resident Outpatient Clinics: A Scoping Review of the Literature.

    Science.gov (United States)

    Walker, Jeremey; Payne, Brittany; Clemans-Taylor, B Lee; Snyder, Erin Dunn

    2018-02-01

    Continuity between patients and physicians is a core principle of primary care and an accreditation requirement. Resident continuity clinics face challenges in nurturing continuity for their patients and trainees. We undertook a scoping review of the literature to better understand published benchmarks for resident continuity; the effectiveness of interventions to improve continuity; and the impact of continuity on resident and patient satisfaction, patient outcomes, and resident career choice. We developed a MEDLINE search strategy to identify articles that defined continuity in residency programs in internal medicine, family medicine, and pediatrics published prior to December 31, 2015, and used a quality evaluation tool to assess included studies. The review includes 34 articles describing 12 different measures of continuity. The usual provider of care and continuity for physician formulas were most commonly utilized, and mean baseline continuity was 56 and 55, respectively (out of a total possible score of 100). Clinic and residency program redesign innovations (eg, advanced access scheduling, team-based care, and block scheduling) were studied and had mixed impact on continuity. Continuity in resident clinics is lower than published continuity rates for independently practicing physicians. Interventions to enhance continuity in resident clinics have mixed effects. More research is needed to understand how changes in continuity affect resident and patient satisfaction, patient outcomes, and resident career choice. A major challenge to research in this area is the lack of empanelment of residents' patients, creating difficulties in scheduling and measuring continuity visits.

  7. Health care providers' missed opportunities for preventing femicide.

    Science.gov (United States)

    Sharps, P W; Koziol-McLain, J; Campbell, J; McFarlane, J; Sachs, C; Xu, X

    2001-11-01

    Homicide of women (femicide) by intimate partners is the most serious form of violence against women. The purpose of this analysis of a larger multisite study was to describe health care use in the year prior to murder of women by their intimate partner in order to identify opportunities for intervention to prevent femicide. A sample of femicide cases was identified from police or medical examiner records. Participants (n = 311) were proxy informants (most often female family members) of victims of intimate partner femicide from 11 U.S. cities. Information about prior domestic abuse and use of health care and other helping agencies for victims and perpetrators was obtained during structured telephone interviews. Most victims had been abused by their partners (66%) and had used health care agencies for either injury or physical or mental health problems (41%). Among women who had been pregnant during the relationship, 23% were beaten by partners during pregnancy. Among perpetrators with fair or poor physical health, 53% had contact with physicians and 15% with fair or poor mental health had seen a doctor about their mental health problem. Among perpetrators with substance problems, 5.4% had used alcohol treatment programs and 5.7% had used drug treatment programs. Frequent contacts with helping agencies by victims and perpetrators represent opportunities for the prevention of femicide by health care providers. Copyright 2001 American Health Foundation and Academic Press.

  8. Electronic Health Record in Continuous Shared Health Care

    Czech Academy of Sciences Publication Activity Database

    Hanzlíček, Petr; Zvárová, Jana; Zvára, K.; Bureš, V.; Špidlen, Josef

    2005-01-01

    Roč. 11, - (2005), s. 1-6 ISSN 1727-1983. [EMBEC'05. European Medical and Biomedical Conference /3./. Prague, 20.11.2005-25.11.2005] R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : electronic health record * shared health care * information technology Subject RIV: BD - Theory of Information

  9. Electronic Health Record for Continuous Shared Health Care

    Czech Academy of Sciences Publication Activity Database

    Hanzlíček, Petr; Zvárová, Jana

    2005-01-01

    Roč. 9, - (2005), s. 275-280 ISSN 1335-2393. [YBERC 2005. Young Biomedical Engineers and Researchers Conference. Stará Lesná, 13.07.2005-15.07.2005] R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : information society * telemedicine * electronic health record * digital signature * personal data protection * biomedical informatics Subject RIV: FQ - Public Health Care, Social Medicine

  10. Continuity in different care modes and its relationship to quality of life: a randomised controlled trial in patients with COPD

    NARCIS (Netherlands)

    Uijen, A.A.; Bischoff, E.W.; Schellevis, F.G.; Bor, H.H.; van den Bosch, W.J.; Schers, H.J.

    2012-01-01

    Background: New care modes in primary caremay affect patients' experienced continuity of care. Aim: To analyse whether experienced continuity for patients with chronic obstructive pulmonary disease (COPD) changes after different care modes are introduced, and to analyse the relationship between

  11. Continuity of Care in Dual Diagnosis Treatment: Definitions, Applications, and Implications.

    Science.gov (United States)

    McCallum, Stacey; Mikocka-Walus, Antonina; Turnbull, Deborah; Andrews, Jane M

    2015-01-01

    The goal of this work is to review the current literature on continuity of care in the treatment of people with dual diagnosis. In particular, this review set out to clarify how continuity of care has been defined, applied, and assessed in treatment and to enhance its application in both research and clinical practice. To identify articles for review, the term "continuity" and combinations of "substance" and "treatment" were searched in electronic databases. The search was restricted to quantitative articles published in English after 1980. Papers were required to discuss "continuity" in treatment samples that included a proportion of patients with a dual diagnosis. A total of 18 non-randomized studies met the inclusion criteria. Analysis revealed six core types of continuity in this treatment context: continuity of relationship with provider(s), continuity across services, continuity through transfer, continuity as regularity and intensity of care, continuity as responsive to changing patient need, and successful linkage of the patient. Patient age, ethnicity, medical status, living status, and the type of mental health and/or substance use disorder influenced the continuity of care experienced in treatment. Some evidence suggested that achieving continuity of care was associated with positive patient and treatment-related outcomes. This review summarizes how continuity of care has been understood, applied, and assessed in the literature to date. Findings provide a platform for future researchers and service providers to implement and evaluate continuity of care in a consistent manner and to determine its significance in the treatment of people with a dual diagnosis.

  12. 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

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

    Science.gov (United States)

    Waibel, Sina; Vargas, Ingrid; Aller, Marta-Beatriz; Gusmão, Renata; Henao, Diana; Vázquez, M Luisa

    2015-01-01

    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. 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. 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 physicians highlighted numerous problems of the

  14. Perceived factors affecting distress among women taking part in surgical continuity of care for breast cancer

    DEFF Research Database (Denmark)

    Jørgensen, Lone; Laursen, Birgitte Schantz

    2016-01-01

    REVIEW QUESTION/OBJECTIVE: The objective of this systematic review is to identify, appraise and synthesize the evidence on perceived factors affecting distress among women taking part in surgical continuity of care for breast cancer to provide evidence for improving support and care.The specific...... review question is: What are the perceived factors that contribute to an increase or a reduction in distress among women taking part in surgical continuity of care for breast cancer?...

  15. Lack of access and continuity of adult health care: a national population-based survey

    OpenAIRE

    Dilélio,Alitéia Santiago; Tomasi,Elaine; Thumé,Elaine; Silveira,Denise Silva da; Siqueira,Fernando Carlos Vinholes; Piccini,Roberto Xavier; Silva,Suele Manjourany; Nunes,Bruno Pereira; Facchini,Luiz Augusto

    2015-01-01

    OBJECTIVE To describe the lack of access and continuity of health care in adults. METHODS A cross-sectional population-based study was performed on a sample of 12,402 adults aged 20 to 59 years in urban areas of 100 municipalities of 23 states in the five Brazilian geopolitical regions. Barriers to the access and continuity of health care and were investigated based on receiving, needing and seeking health care (hospitalization and accident/emergency care in the last 12 months; care provided ...

  16. Lack of access and continuity of adult health care: a national population-based survey

    OpenAIRE

    Dilélio, Alitéia Santiago; Tomasi, Elaine; Thumé, Elaine; Silveira, Denise Silva da; Siqueira, Fernando Carlos Vinholes; Piccini, Roberto Xavier; Silva, Suele Manjourany; Nunes, Bruno Pereira; Facchini, Luiz Augusto

    2015-01-01

    OBJECTIVE To describe the lack of access and continuity of health care in adults.METHODS A cross-sectional population-based study was performed on a sample of 12,402 adults aged 20 to 59 years in urban areas of 100 municipalities of 23 states in the five Brazilian geopolitical regions. Barriers to the access and continuity of health care and were investigated based on receiving, needing and seeking health care (hospitalization and accident/emergency care in the last 12 months; care provided b...

  17. A longitudinal approach for measuring integration and continuity of nursing care.

    Science.gov (United States)

    Shukla, R K

    1985-01-01

    Munson and Clinton developed an instrument to measure cross-sectional variation in integration and continuity of nursing care in team, modular, and primary nursing units in a hospital. In this study I show that when the instrument is adapted for longitudinal studies of nursing care, it provides more reliable and sensitive measurements. My results also indicate that the primary nursing care structure provides higher integration and continuity of care and care management than the team and the modular structures, and that the modular structure scores higher than the team structure.

  18. Access to Interprofessional Continuing Education in Integrated Care through Digital Instructional Technology

    Science.gov (United States)

    Lapidos, Adrienne; Ruffolo, Mary

    2017-01-01

    In preparing the workforce for integrated care, continuing professional education serves a critical role. Within a rapidly changing health care landscape, matriculated students now benefit from pedagogical innovations supporting integrated care, particularly interprofessional education, and working professionals must not be excluded from this…

  19. 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.

    2001-01-01

    Variations in amounts of nonparental care across infancy, preschool, early elementary school, and early adolescence were examined. Correlations among overall amounts of care provided little evidence of cross-time continuity; grade 1 self-care and grade 6 unsupervised peer contact incrementally predicted grade 6 problems; and most predictive…

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

    Directory of Open Access Journals (Sweden)

    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.

  1. Validation of a generic measure of continuity of care: when patients encounter several clinicians.

    Science.gov (United States)

    Haggerty, Jeannie L; Roberge, Danièle; Freeman, George K; Beaulieu, Christine; Bréton, Mylaine

    2012-01-01

    Patients who regularly see more than one clinician for health problems risk discontinuity and fragmented care. Our objective was to develop and validate a generic measure of management continuity from the patient perspective. Themes from 33 qualitative studies of patient experience with care from various clinicians were matched to existing instruments to identify potential measures and measurement gaps. Adapted and new items were tested cognitively, and the instrument was administered to 376 adult patients consulting in primary care for a variety of health conditions but seeing clinicians in a variety of settings. After initial psychometric analysis, the instrument was modified slightly and readministered after 6 months. The analysis identified reliable subscales and their association with indicators of continuity. Observed factors correspond to 8 intended constructs, with good reliability. Three subscales (12 items) relate to the principal clinician and cover management and relational continuity. Four subscales (13 items) are related to multiple clinicians and address team relational continuity and problems with coordination and gaps in information transfer. Two (11 items) pertain to the patient's partnership in care. Subscales correlate well and in expected directions with indicators of discontinuity (wanting to change clinicians, suffering, and sense of being abandoned, medical errors) and degree of care organization. The instrument reliably assesses both positive and negative dimensions of continuity of care across the entire system, and the subscales correlate with continuity effects. It supports patient-centered and relationship-based care and can be used as a whole or in part to assess coordination and continuity in primary care.

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

    Science.gov (United States)

    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.

  3. [Survey on the needs expressed by primary care doctors for continuing education in drug therapy].

    Science.gov (United States)

    Rodríguez, D; Llop, R; Barceló, M E; Cucurull, E; Vallés, J A; Diogène, E; García, N; Fernández, E; Sabaté, N; Simó, E; Casadevall, J

    2002-12-01

    To describe the aspects of continuing education in pharmacological therapeutics considered as most relevant by the primary health care physicians. Observational study.Setting. Physicians filled-up the questionnaires during 45 minutes at their primary health care centres. Primary health care physicians involved in the Fundation Institut Català de Farmacologia continuing education activities since 1997 were selected. A specific questionnaire was designed to collect the physicians' opinion on different topics regarding continuing education in pharmacological therapeutics. 180 physicians from 21 primary health care centres answered the questionnaire. 68% of the responding physicians considered that continuing education has to be useful to improve routine clinical practice. Regular seminars and methods stimulating active participation administered by primary health care professionels are preferred. Continuing education in pharmacological therapeutics should be focused to health problems rather than being drug-oriented. They referred being more interested in drug selection issues and in the role of new drug in comparison with the existing alternatives rather than in regulation and drug consumption issues. 66,3% of the responding physicians considered that continuing education in pharmacological therapeutics should be compulsory. Public health authorities and primary health care physicians should share the responsibility in setting-up continuing education in pharmacological therapeutics programs, according to the opinion of almost 70% of the physicians. Primary health care physicians are interested in continuing education in pharmacological therapeutics as far as it is practical and useful to solve problems of their routine clinical practice.

  4. Focus on Dementia Care: Continuing Education Preferences, Challenges, and Catalysts among Rural Home Care Providers

    Science.gov (United States)

    Kosteniuk, Julie G.; Morgan, Debra G.; O'Connell, Megan E.; Dal Bello-Haas, Vanina; Stewart, Norma J.

    2016-01-01

    Home care staff who provide housekeeping and personal care to individuals with dementia generally have lower levels of dementia care training compared with other health care providers. The study's purposes were to determine whether the professional role of home care staff in a predominantly rural region was associated with preferences for delivery…

  5. Technologies for HIV prevention and care: challenges for health services.

    Science.gov (United States)

    Maksud, Ivia; Fernandes, Nilo Martinez; Filgueiras, Sandra Lucia

    2015-09-01

    This article aims to consider some relevant challenges to the provision of "new prevention technologies" in health services in a scenario where the "advances" in the global response to AIDS control are visible. We take as material for analysis the information currently available on the HIV post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), treatment as prevention (TASP) and over the counter. The methodology consisted of the survey and analysis of the Biblioteca Virtual em Saúde (BVS: MEDLINE, LILACS, WHOLIS, PAHO, SciELO) articles that addressed the issue of HIV prevention and care in the context of so-called new prevention technologies. The results of the studies show that there is assistance on the ground of clinics for the treatment of disease responses, but there are several challenges related to the sphere of prevention. The articles list some challenges regarding to management, organization of services and the attention given by health professionals to users. The current context shows evidence of the effectiveness of antiretroviral therapy in reducing the risk of HIV transmission, but the challenges for the provision of preventive technologies in health services permeate health professionals and users in their individual dimensions and health services in organizational and structural dimension. Interventions should be made available in a context of community mobilization; there should be no pressure on people to make HIV testing, antiretroviral treatment or for prevention. In the management is responsible for the training of health professionals to inform, clarify and make available to users, partners and family information about the new antiretroviral use strategies.

  6. 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...

  7. Providing continuity of care to a specific population: Attracting new family physicians.

    Science.gov (United States)

    Roy, Andréanne; Breton, Mylaine; Loslier, Julie

    2016-05-01

    To analyze the factors that influence newly licensed family physicians in their decision to provide continuity of care to a specific primary care population. Mixed-methods study that included a self-administered online questionnaire for family physicians followed by individual interviews. Monteregie, the second-most populated region of Quebec, with rural and urban areas. All family physicians with 10 or fewer years of work experience who were practising in Monteregie were contacted (366 physicians). Of this group, 118 completed the online questionnaire (response rate of 32.2%). Of the respondents, 10 physicians with varied continuity of care profiles were selected for individual interviews. The percentage of work time spent on continuity of care analyzed in conjunction with factors that support or present barriers to continuity of care at the contextual and organizational levels and for family physicians and patients. The main factors that facilitate continuity of care are the physician-patient relationship, interest in clinical continuity of care activities, positive role models, working alongside a nurse, and adequate access to resources, specifically mental health resources. The main barriers are the scope of administrative duties, interest in a comprehensive practice, a negative experience of continuity of care during training, a sense of inadequacy with respect to continuity of care, a heavy case load, and a lack of support in the first years of practice. Possible ways to encourage newly licensed family physicians to provide continuity of care to a specific population are offered. Areas for improvement include medical training, administrative support, and human resources. Copyright© the College of Family Physicians of Canada.

  8. 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

  9. Falls prevention in community care: 10 years on

    Directory of Open Access Journals (Sweden)

    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

  10. Purpose in life and use of preventive health care services.

    Science.gov (United States)

    Kim, Eric S; Strecher, Victor J; Ryff, Carol D

    2014-11-18

    Purpose in life has been linked with better health (mental and physical) and health behaviors, but its link with patterns of health care use are understudied. We hypothesized that people with higher purpose would be more proactive in taking care of their health, as indicated by a higher likelihood of using preventive health care services. We also hypothesized that people with higher purpose would spend fewer nights in the hospital. Participants (n = 7,168) were drawn from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, and tracked for 6 y. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a higher likelihood that people would obtain a cholesterol test [odds ratio (OR) = 1.18, 95% confidence interval (CI) = 1.08-1.29] or colonoscopy (OR = 1.06, 95% CI = 0.99-1.14). Furthermore, females were more likely to receive a mammogram/X-ray (OR = 1.27, 95% CI = 1.16-1.39) or pap smear (OR = 1.16, 95% CI = 1.06-1.28), and males were more likely to receive a prostate examination (OR = 1.31, 95% CI = 1.18-1.45). Each unit increase in purpose was also associated with 17% fewer nights spent in the hospital (rate ratio = 0.83, 95% CI = 0.77-0.89). An increasing number of randomized controlled trials show that purpose in life can be raised. Therefore, with additional research, findings from this study may inform the development of new strategies that increase the use of preventive health care services, offset the burden of rising health care costs, and enhance the quality of life among people moving into the ranks of our aging society.

  11. Purpose in life and use of preventive health care services

    Science.gov (United States)

    Kim, Eric S.; Strecher, Victor J.; Ryff, Carol D.

    2014-01-01

    Purpose in life has been linked with better health (mental and physical) and health behaviors, but its link with patterns of health care use are understudied. We hypothesized that people with higher purpose would be more proactive in taking care of their health, as indicated by a higher likelihood of using preventive health care services. We also hypothesized that people with higher purpose would spend fewer nights in the hospital. Participants (n = 7,168) were drawn from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, and tracked for 6 y. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a higher likelihood that people would obtain a cholesterol test [odds ratio (OR) = 1.18, 95% confidence interval (CI) = 1.08–1.29] or colonoscopy (OR = 1.06, 95% CI = 0.99–1.14). Furthermore, females were more likely to receive a mammogram/X-ray (OR = 1.27, 95% CI = 1.16–1.39) or pap smear (OR = 1.16, 95% CI = 1.06–1.28), and males were more likely to receive a prostate examination (OR = 1.31, 95% CI = 1.18–1.45). Each unit increase in purpose was also associated with 17% fewer nights spent in the hospital (rate ratio = 0.83, 95% CI = 0.77–0.89). An increasing number of randomized controlled trials show that purpose in life can be raised. Therefore, with additional research, findings from this study may inform the development of new strategies that increase the use of preventive health care services, offset the burden of rising health care costs, and enhance the quality of life among people moving into the ranks of our aging society. PMID:25368165

  12. How continuity of care is experienced within the context of integrated palliative care: A qualitative study with patients and family caregivers in five European countries.

    Science.gov (United States)

    den Herder-van der Eerden, Marlieke; Hasselaar, Jeroen; Payne, Sheila; Varey, Sandra; Schwabe, Sven; Radbruch, Lukas; Van Beek, Karen; Menten, Johan; Busa, Csilla; Csikos, Agnes; Vissers, Kris; Groot, Marieke

    2017-12-01

    Patients with advanced diseases often experience deficient continuity of care. Although integrated palliative care promotes continuity of care, it is not clear how it can be optimized to improve continuity of care experiences. To examine how relational, informational and management continuity of care are experienced by patients with advanced diseases and their family caregivers receiving care from several integrated palliative care initiatives in five European countries. We adopted a longitudinal qualitative study design including two interviews (interval 3 months) with patients and family caregivers focusing on how health care professionals responded to their needs. Interviews were audio-recorded and transcribed verbatim. Analysis involved a two-step qualitative content approach. A total of 22 integrated palliative care initiatives (established local palliative care collaborations) were selected in Belgium, Germany, Hungary, the Netherlands and the United Kingdom. We recruited 152 patients (63% cancer, 24% chronic obstructive pulmonary disease, 13% heart failure; life expectancy care professionals to receive tailored care and easily access help were essential. Relational continuity was often deficient, especially with general practitioners. Although informational and management continuity was often lacking in care provision, collaborative integrated palliative care initiatives were related to consistent and coherent care. Patients and family caregivers most likely experience continuity of care by having a small number of trusted health care professionals who are available, provide multidisciplinary care and regularly transfer information to all health care professionals involved. Optimizing continuity of care requires further integration of integrated palliative care initiatives with other health care professionals involved in the patients' care networks.

  13. The role of health centers in preventive care provision

    Directory of Open Access Journals (Sweden)

    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.

  14. Continuous primary nursing care increases satisfaction with nursing care and reduces postpartum problems for hospitalized pregnant women.

    Science.gov (United States)

    Wan, Hongwei; Hu, Senqi; Thobaben, Marshelle; Hou, Yanwen; Yin, Tao

    2011-02-01

    To compare the differences in practicing continuous primary nursing care (CPNC) versus task-centered nursing care (TCNC) with regard to patient satisfaction with nursing care and early postpartum health problems for hospitalized pregnant women. All participants filled out the satisfaction with nursing care questionnaire, breastfeeding knowledge questionnaire, and early postpartum problem questionnaire. Participants in the CPNC group received continuous individualized primary nursing care and participants in the TCNC group received task-centered nursing care during their perinatal period. Using a randomized controlled trial, 470 hospitalized pregnant women participated in the study with 230 pregnant women in the CPNC group and 240 in TCNC group. Questionnaire data were collected, calculated, and statistically analyzed using independent t-tests or Χ(2) tests along with power analysis. Participants in the CPNC group reported significantly higher overall satisfaction with nursing care (t(468) = 5.936, p continuous primary nursing care was more effective than practicing traditional task-centered nursing care for hospitalized pregnant women in increasing satisfaction with nursing care, enhancing breastfeeding, and reducing early postpartum problems.

  15. 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.

  16. Eye movement desensitization and reprocessing in addiction continuing care: a phenomenological study of women in recovery.

    Science.gov (United States)

    Marich, Jamie

    2010-09-01

    Traditional models of addiction treatment and relapse prevention fail to consider the role that unresolved trauma plays in an addicted woman's recovery experience. Implementing Eye Movement Desensitization and Reprocessing (EMDR) into the treatment process offers a potential solution to this problem. Ten women (alumnae of an extended-care treatment facility) participated in a semistandardized interview to share their experiences with active addiction, treatment, EMDR therapy, and recovery. With the use of A. P. Giorgi's descriptive phenomenological psychological method for analysis, four major thematic areas emerged from the interview data: the existence of safety as an essential crucible of the EMDR experience, the importance of accessing the emotional core as vital to the recovery experience, the role of perspective shift in lifestyle change, and the use of a combination of factors for successful treatment. All 10 women, to some degree, credited EMDR treatment as a crucial component of their addiction continuing-care processes, especially in helping with emotional core access and perspective shift. Implications emerge from the data on how to best implement EMDR into a comprehensive addiction treatment program.

  17. Measuring patient-perceived continuity of care for patients with long-term conditions in primary care.

    Science.gov (United States)

    Hill, Kate M; Twiddy, Maureen; Hewison, Jenny; House, Allan O

    2014-12-05

    Continuity of care is widely acknowledged as important for patients with multi-morbidity but simple, service-orientated indices cannot capture the full impact of continuity in complex care delivery systems. The patient's perspective is important to assess outcomes fully and this is challenging because generic measures of patient-perceived continuity are lacking. We investigate the Chao Perception of Continuity (Chao PC) scale to determine its suitability as a measure of continuity of care for patients with a long-term condition (stroke), and co-morbidity, in a primary care setting. A questionnaire study embedded in a prospective observational cohort study of outcomes for patients following acute stroke. 168 community dwelling patients (58% male) mean age 68 years a minimum one year post-stroke. Functional status: Barthel Index mean =16. A 23-item questionnaire, the Chao Perception of Continuity (Chao PC) scale, sent by post to their place of residence or administered face to face as part of the final cohort study assessment. 310 patients were invited to participate; 168 (54%) completed a questionnaire. All 23 questionnaire items were entered into a Principal Component Analysis. Emergent factors from the exploratory analysis were (1) inter-personal trust (relational continuity); (2) interpersonal knowledge and information (informational and relational continuity) and (3) the process of care (managerial continuity). The strongest of these was inter-personal trust. The context-specific items in the Chao PC scale are difficult for respondents to interpret in a United Kingdom Primary Care setting resulting in missing data and low response rates. The Chao-PC therefore cannot be recommended for wider application as a general measure of continuity of care without significant modification. Our findings reflect the acknowledged dimensions of continuity and support the concept of continuity of care as a multi-dimensional construct. We demonstrate the overlapping boundaries

  18. Continuity across inpatient and outpatient mental health care or specialisation of teams? A systematic review.

    Science.gov (United States)

    Omer, S; Priebe, S; Giacco, D

    2015-02-01

    A central question for the organisation of mental health care is whether the same clinicians should be responsible for a patient's care across inpatient and outpatient settings (continuity of care) or if there should be separate teams (specialisation). Current reforms in Europe are inconsistent on which to favour, and are based on little research evidence. This review is the first systematic appraisal of the existing evidence comparing continuity of care and specialisation across inpatient and outpatient mental health care. A systematic search for studies of any design comparing mental health care systems based on continuity or specialisation of care was performed. Differences in clinical, social and cost-effective outcomes, and the views and experiences of patients and staff were assessed using narrative synthesis. Seventeen studies met the inclusion criteria. All studies had methodological shortcomings, but findings point towards reduced length and number of hospitalisations, and faster or more flexible transitions between services in continuity systems. Survey and qualitative findings suggest advantages of both systems, whilst patients and staff appear to prefer a continuity system. The evidence base suggests better outcomes and stakeholder preferences for continuity of care systems, but the quality of existing studies is insufficient to draw definitive conclusions. Higher quality comparative studies across various settings and population groups are urgently needed. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Relational continuity of care in integrated maternity and child health clinics improve parents' service experiences.

    Science.gov (United States)

    Tuominen, Miia; Kaljonen, Anne; Ahonen, Pia; Rautava, Päivi

    2014-10-01

    In the Finnish primary health care, relational continuity of care is implemented in integrated maternity and child health clinics where the same nurse takes care of the family from the pregnancy until the child reaches school age. The aim of this study was to clarify the association between this relational continuity of care and the availability, utilisation and selected features of the maternity and child health clinic services, as evaluated by the parents. A comparative, cross-sectional service evaluation survey was used. Eighteen months after their baby's delivery, mothers (N = 987) and fathers (N = 835) from Southwest Finland evaluated specific maternity and child health clinic services. Comparisons were made between the parents who had relational continuity of care in the integrated maternity and child health clinics and those who did not. Home visits were more frequently provided when relational continuity of care in integrated maternity and child health clinics existed. Parents who had this relational continuity of care, evaluated several features of the service, especially provided support, more positively than parents who did not. Relational continuity of care in integrated maternity and child health clinics seems to increase parents' satisfaction with the services and might increase the provision of home visits.

  20. Relational continuity of care in integrated maternity and child health clinics improve parents’ service experiences

    Science.gov (United States)

    Tuominen, Miia; Kaljonen, Anne; Ahonen, Pia; Rautava, Päivi

    2014-01-01

    Introduction In the Finnish primary health care, relational continuity of care is implemented in integrated maternity and child health clinics where the same nurse takes care of the family from the pregnancy until the child reaches school age. The aim of this study was to clarify the association between this relational continuity of care and the availability, utilisation and selected features of the maternity and child health clinic services, as evaluated by the parents. Methods A comparative, cross-sectional service evaluation survey was used. Eighteen months after their baby's delivery, mothers (N = 987) and fathers (N = 835) from Southwest Finland evaluated specific maternity and child health clinic services. Comparisons were made between the parents who had relational continuity of care in the integrated maternity and child health clinics and those who did not. Results Home visits were more frequently provided when relational continuity of care in integrated maternity and child health clinics existed. Parents who had this relational continuity of care, evaluated several features of the service, especially provided support, more positively than parents who did not. Conclusions Relational continuity of care in integrated maternity and child health clinics seems to increase parents’ satisfaction with the services and might increase the provision of home visits. PMID:25411571

  1. [Design and validation of a questionnaire to measure continuity between care levels from the user's perspective].

    Science.gov (United States)

    Letelier, María José; Aller, Marta Beatriz; Henao, Diana; Sánchez-Pérez, Inma; Vargas Lorenzo, Ingrid; Coderch de Lassaletta, Jordi; Ramon Llopart, Josep; Ferran, Manel; Colomés, Lluís; Vázquez Navarrete, María Luisa

    2010-01-01

    To design and validate an instrument that measures continuity between levels of care from the user's perspective to be applied in any healthcare system providing a continuum of care. 1) A questionnaire for the measurement of continuity of care was designed, based on a literature review, and 2) the questionnaire was validated using an expert group, two pretests and a pilot test to a sample of 200 healthcare users. We assessed the questionnaire's comprehensibility, content validity and interviewer burden, as well as the reliability and construct validity of the scale. The instrument encompasses three types of continuity (management, information and relational) and is divided in two complementary parts. The first part addresses the patients' care pathways and the continuity of care for a particular episode that occurred in the last 3 months. The second part measures patients' perception of the continuity between levels of care. The experts agreed that all dimensions of continuity were represented and the interviewees found the questionnaire easy to understand. The mean time required to apply the instrument was 33.9 min. Cronbach's alpha was acceptable (>0.7) in all subscales except one, which was then removed. The multiple correspondence analyses showed associations among theoretically related items. The questionnaire (CCAENA) seems to be an useful, valid and reliable instrument to assess comprehensively continuity between levels of care from the user's perspective. Further information about the questionnaire's psychometric properties will be obtained by applying it to a larger population. Copyright © 2009 SESPAS. Published by Elsevier Espana. All rights reserved.

  2. Experienced Continuity of Care When Patients See Multiple Clinicians: A Qualitative Metasummary

    Science.gov (United States)

    Haggerty, Jeannie L.; Roberge, Danièle; Freeman, George K.; Beaulieu, Christine

    2013-01-01

    PURPOSE Continuity of care among different clinicians refers to consistent and coherent care management and good measures are needed. We conducted a metasummary of qualitative studies of patients’ experience with care to identify measurable elements that recur over a variety of contexts and health conditions as the basis for a generic measure of management continuity. METHODS From an initial list of 514 potential studies (1997–2007), 33 met our criteria of using qualitative methods and exploring patients’ experiences of health care from various clinicians over time. They were coded independently. Consensus meetings minimized conceptual overlap between codes. RESULTS For patients, continuity of care is experienced as security and confidence rather than seamlessness. Coordination and information transfer between professionals are assumed until proven otherwise. Care plans help clinician coordination but are rarely discerned as such by patients. Knowing what to expect and having contingency plans provides security. Information transfer includes information given to the patient, especially to support an active role in giving and receiving information, monitoring, and self-management. Having a single trusted clinician who helps navigate the system and sees the patient as a partner undergirds the experience of continuity between clinicians. CONCLUSION Some dimensions of continuity, such as coordination and communication among clinicians, are perceived and best assessed indirectly by patients through failures and gaps (discontinuity). Patients experience continuity directly through receiving information, having confidence and security on the care pathway, and having a relationship with a trusted clinician who anchors continuity. PMID:23690327

  3. Preventive Dental Care: An Educational Program to Integrate Oral Care Into Pediatric Oncology
.

    Science.gov (United States)

    Hartnett, Erin; Krainovich-Miller, Barbara

    2017-10-01

    Early childhood dental caries (dental cavities) is an infectious process. The development of oral problems during cancer care results in pain, fever, and delay in treatment. 
. The objective of this project was to integrate preventive oral care into pediatric oncology care. 
. This project consisted of an educational program for pediatric oncology providers who completed pre- and postprogram surveys assessing oral health knowledge, attitudes, and practice; attended an oral health education session; and performed oral assessment and fluoride varnish application on children during cancer treatment. 
. Three major outcomes resulted from this project.

  4. Using the Alberta Continuity of Services Observer-Rated Scale to Measure Continuity of Care in a Psychiatric Population.

    Science.gov (United States)

    Vandyk, Amanda Digel; VanDenkerkhof, Elizabeth G; Graham, Ian D; Harrison, Margaret B

    2016-01-01

    Continuity of care (CoC) is an important component in the delivery of quality mental health care. Yet, its measurement is inconsistent. We explored the use of the Alberta Continuity of Services Scale for Mental Health (ACSS-MH) observer-rated scale and compared CoC scores in 2 groups (N = 140) of individuals with mental health complaints (5+ and 1 emergency department [ED] visits/year). Secondary analysis of health record data. The application of the ACSS-MH observer-rated scale in our population is discussed, as well as differences in CoC scores by group. The ACSS-MH observer-rated scale may be useful for obtaining CoC scores in several mental health populations. Minor modifications (e.g., to response options) are suggested that may improve scoring accuracy. Research is needed to further explore the relationship between CoC and ED use.

  5. Measuring Continuity of Care in Diabetes Mellitus: An Experience-Based Measure

    Science.gov (United States)

    Gulliford, Martin C.; Naithani, Smriti; Morgan, Myfanwy

    2006-01-01

    PURPOSE Continuity is an important attribute of health care, but appropriate measures are not currently available. We developed an experience-based measure of continuity of care in type 2 diabetes. METHODS A 19-item measure of experienced continuity of care for diabetes mellitus (ECC-DM) was developed from qualitative patient interview data with 4 continuity subdomains: longitudinal, flexible, relational, and team and cross-boundary continuity. The measure was implemented in a survey of 193 patients with type 2 diabetes from 19 family practices. Associations of ECC-DM scores with clinician organizational characteristics were estimated. RESULTS Potential ECC-DM scores ranged from 0 to 100 with an observed mean of 62.1 (SD 16.0). The average inter-item correlation was 0.343 and Cronbach’s α was 0.908. Factor analysis found 4 factors that were generally consistent with the proposed subdomains. Patients’ mean scores varied significantly between practices (P = .001), ranging from 46 to 78 at different family practices. Experienced continuity was lower for patients receiving only hospital clinic care than for those receiving some diabetes care from their family practice (difference 13.7; 95% confidence interval [CI], 8.2–19.2; P <.001). Patients had higher ECC-DM scores if their family practice had a designated lead doctor for diabetes (difference 8.2; 95% CI, 2.7–13.6; P = .003). CONCLUSIONS The results provide evidence for the reliability, construct validity, and criterion validity of the experienced continuity-of-care measure. The measure may be used in research and monitoring to evaluate patient-centered outcomes of diabetes care. Patients’ experiences of continuity of care vary between health care organizations and are influenced by the organizational arrangements for care. PMID:17148634

  6. 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

  7. Fall prevention in acute care hospitals: a randomized trial.

    Science.gov (United States)

    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

  8. The Diabetes Continuity of Care Scale: the development and initial evaluation of a questionnaire that measures continuity of care from the patient perspective.

    Science.gov (United States)

    Dolovich, Lisa R; Nair, Kalpana M; Ciliska, Donna K; Lee, Hui N; Birch, Stephen; Gafni, Amiram; Hunt, Dereck L

    2004-11-01

    The purpose of the present study was to develop and pilot test a questionnaire to assess continuity of care from the perspective of patients with diabetes. Seven patient and two healthcare-provider focus groups were conducted. These focus groups generated 777 potential items. This number was reduced to 56 items after item reduction, face validity testing and readability analysis, and to 47 items after a preliminary factor analysis. Readability was assessed as requiring 7-8 years of schooling. Sixty adult patients with diabetes completed the draft Diabetes Continuity of Care Scale (DCCS) at a single point in time to assess the validity of the instrument. Patients completed the draft DCCS again 2 weeks later to assess test-retest reliability. A provisional factor analysis and grouping according to clinical sense yielded five domains: access and getting care, care by doctor, care by other healthcare professionals, communication between healthcare professionals, and self-care. The internal consistency (Cronbach's alpha) for the whole scale was 0.89. The test-retest reliability was r = 0.73. The DCCS total score was moderately correlated with some of the measures used to establish construct validity. The DCCS could differentiate between patients who did and did not achieve specific process and clinical indicators of good diabetes care (e.g. Hba1c tested within 6 months). The development of the DCCS was centred on the patient's perspective and revealed that the patient perspective regarding continuity of care extends beyond the concept of seeing one doctor. Initial testing of this instrument demonstrates that it has promise as a reliable and valid measure in this area.

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

    Science.gov (United States)

    Hanafi, Nik Sherina; Abdullah, Adina; Lee, Ping Yein; Liew, Su May; Chia, Yook Chin; Khoo, Ee Ming

    2015-01-01

    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.

  10. 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.

  11. Continuity of care in general practice vocational training: prevalence, associations and implications for training.

    Science.gov (United States)

    Pearlman, James; Morgan, Simon; van Driel, Mieke; Henderson, Kim; Tapley, Amanda; McElduff, Patrick; Scott, John; Spike, Neil; Thomson, Allison; Magin, Parker

    2016-01-01

    Continuity of care is a defining characteristic of general practice. Practice structures may limit continuity of care experience for general practice registrars (trainees). This study sought to establish prevalence and associations of registrars' continuity of care. We performed an analysis of an ongoing cohort study of Australian registrars' clinical consultations. Primary outcome factors were 'Upstream' continuity (having seen the patient prior to the index consultation) and 'Downstream' continuity (follow-up organised post-index consultation). Independent variables were registrar, practice, patient, consultation and educational factors. 400 registrars recorded 48,114 consultations. 43% of patients had seen the registrar pre-index consultation, and 49% had follow-up organised. 'Upstream' continuity associations included registrar seniority, Australian medical qualification, practice billing policy, smaller practice size, registrar's previous training in the practice, chronic disease and older, female patients (but not registrar full-time/part-time status). Associations of 'Downstream' continuity included non-Australian qualification, billing, chronic disease and the patient having seen the registrar previously. Consultations prompting follow-up were more complex: longer duration, involving more problems and generating more learning goals. There was, however, evidence for limited educational utility of this 'continuity'. In our study, continuity of care in Australian registrars' training experience is modest. Associations are complex, but may inform initiatives to increase in-training continuity.

  12. Association of weekend continuity of care with hospital length of stay.

    Science.gov (United States)

    Blecker, Saul; Shine, Daniel; Park, Naeun; Goldfeld, Keith; Scott Braithwaite, R; Radford, Martha J; Gourevitch, Marc N

    2014-10-01

    The purpose of this study was to evaluate the association of physician continuity of care with length of stay, likelihood of weekend discharge, in-hospital mortality and 30-day readmission. A cohort study of hospitalized medical patients. The primary exposure was the weekend usual provider continuity (UPC) over the initial weekend of care. This metric was adapted from an outpatient continuity of care index. Regression models were developed to determine the association between UPC and outcomes. An academic medical center. Length of stay which was calculated as the number of days from the first Saturday of the hospitalization to the day of discharge. Of the 3391 patients included in this study, the prevalence of low, moderate and high UPC for the initial weekend of hospitalization was 58.7, 22.3 and 19.1%, respectively. When compared with low continuity of care, both moderate and high continuity of care were associated with reduced length of stay, with adjusted rate ratios of 0.92 (95% CI 0.86-1.00) and 0.64 (95% CI 0.53-0.76), respectively. High continuity of care was associated with likelihood of weekend discharge (adjusted odds ratio 2.84, 95% CI 2.11-3.83) but was not significantly associated with mortality (adjusted odds ratio 0.72, 95% CI 0.29-1.80) or readmission (adjusted odds ratio 0.88, 95% CI 0.68-1.14) when compared with low continuity of care. Increased weekend continuity of care is associated with reduced length of stay. Improvement in weekend cross-coverage and patient handoffs may be useful to improve clinical outcomes. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  13. Continuity of Care for Older Adults with Chronic Illness in China: An Exploratory Study.

    Science.gov (United States)

    Cheng, Shu-Ling; Zhao, Jin-Zhi; Bai, Jinbing; Zang, Xiao-Ying

    2015-01-01

    To explore nurses' understanding of continuity of care and existing problems in implementation of continuity of care for Chinese elders with chronic illnesses. Cross-sectional survey and semi-structured interview were performed on 15 nurses and older patients and 1,902 older patients between July 2010 and February 2011. Semi-structured interview guideline and four-section scale were used. The interviews showed nurses lacked knowledge of continuity of care, and nurses from small towns or rural areas had less understanding of continuity of care and discharge planning than nurses from central cities. Significant differences were found among patients located in referred areas in selection of medical institutions for treatment, suggesting older adults were more likely to choose general hospitals for treatment. Self-reported surveys demonstrated more than 70% of hospitalized elders chose community hospitals for further recovery after discharge from general hospitals. Chinese nurses lack knowledge of continuity of care, and significant discontinuity exists between health care provided by general hospitals, community hospitals and other institutions for elders. A further model for the development of continuity of care should be established that addresses older patients' demands and current barriers in China. © 2014 Wiley Periodicals, Inc.

  14. Longitudinal continuity of care is associated with high patient satisfaction with physical therapy.

    Science.gov (United States)

    Beattie, Paul; Dowda, Marsha; Turner, Christine; Michener, Lori; Nelson, Roger

    2005-10-01

    Recent literature has suggested that longitudinal continuity (ie, the patient is seen by the same practitioner for the entire course of treatment) may be linked to high degrees of patient satisfaction with medical care. The purpose of this study was to provide preliminary information regarding the association between longitudinal continuity and reports of patient satisfaction with physical therapy outpatient care. A sample of 1,502 adult subjects completed the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care at the time of discharge from outpatient physical therapy. Relationships between satisfaction measures and the presence or absence of longitudinal continuity were assessed by use of binary logistic regression. Overall, 36.8% of the subjects reported complete satisfaction on the internal subscale (patient-therapist), and 47.9% of the subjects reported complete satisfaction on the external subscale (patient-support staff). Higher percentages of women (40.2% and 51.1% for internal and external subscales, respectively) than of men (31.9% and 43.3% for internal and external subscales, respectively) were completely satisfied with care. Of subjects who reported complete satisfaction on the internal subscale, 71.2% had longitudinal continuity of care, and 28.8% did not. A similar trend was noted for the external subscale (patient-support staff); 66.8% of subjects who reported complete satisfaction had longitudinal continuity, and 33.2% did not. Odds ratios describing the probability of complete satisfaction with care for subjects who had longitudinal continuity and for those who did not were significant and ranged from 2.7 to 3.5. Subjects who received their entire course of outpatient physical therapy from only 1 provider were approximately 3 times more likely to report complete satisfaction with care than those who received care from more than 1 provider. These findings suggest that clinicians and managers should make efforts to

  15. Vaccine-Preventable Admissions to an Irish Paediatric Intensive Care

    LENUS (Irish Health Repository)

    Doyle, Y

    2017-05-01

    In the Republic of Ireland, the schedule of state-funded immunisation for children is comprehensive and includes diphtheria, pertussis, tetanus, pneumococcus, hepatitis B, meningococcus C, haemophilus B, polio, measles, rubella and mumps. Varicella and meningococcal B vaccines are commercially available but are not currently funded by the government. Each of the illnesses preventable by these vaccines can cause substantial morbidity, and rarely mortality, in infants and children. Our PICU continues to see serious illness due to avoidable infection. There were 39 admissions in a 4 year period, with 34 children surviving to discharge. Nine children were infected with pneumococcus, with 4 deaths. There was one case of pertussis, causing death. Most infections occurred in previously healthy children. These preventable conditions represent a significant burden on children, families, and on social and healthcare resources

  16. Using standardized patient encounters to teach longitudinal continuity of care in a family medicine clerkship.

    Science.gov (United States)

    Vest, Bonnie M; Lynch, Abigail; McGuigan, Denise; Servoss, Timothy; Zinnerstrom, Karen; Symons, Andrew B

    2016-08-17

    Despite demonstrated benefits of continuity of care, longitudinal care experiences are difficult to provide to medical students. A series of standardized patient encounters was developed as an innovative curricular element to address this gap in training for medical students in a family medicine clerkship. The objective of this paper is to describe the development and implementation of the curriculum, evaluate the effectiveness of the curriculum for increasing student confidence around continuity of care and chronic disease management, and explore student opinions of the value of the experience. The encounters simulate continuity of care in typical family medicine practice over four standardized patient visits, providing students with experience in longitudinal relationships, ongoing management of chronic and acute conditions, lifestyle counseling, and the use of an electronic medical record. Perceptions of the curriculum were obtained using a pre-post survey asking students to self-rate experience and confidence in continuity relationships, chronic disease management, and lifestyle counseling. Students were also asked about the overall effectiveness of the encounters for simulating family practice and continuity of care. Open-ended comments were gathered through weekly reflection papers submitted by the students. Of 138 third-year medical students, 137 completed the pre-survey, 126 completed the post-survey, and 125 (91%) completed both the pre- and the post-survey. Evaluation results demonstrated that students highly valued the experience. Complete confidence data for 116 students demonstrated increased confidence pre-post (t(115) = 14.92, p continuity of care. This curriculum offers a promising approach to providing students with continuity of care experience. The model addresses a general lack of training in continuity of care in medical schools and provides a standardized method for teaching chronic disease management and continuity relationships.

  17. Access to Continuing Education for Critical Care Nurses in Rural or Remote Settings.

    Science.gov (United States)

    Hendrickx, Lori; Winters, Charlene

    2017-04-01

    Caring for the critically ill does not occur solely in large medical centers or urban areas. Nurses practicing in rural or remote settings practice as nurse generalists, caring for a wide range of patients, including those needing critical care. As a nurse generalist, the need for a wide variety of skill sets challenges nurses in rural areas to maintain current practice through continuing education across many content areas. They also may not come in contact with critically ill patients or emergent situations as often as their urban counterparts, which can make remaining comfortable with more advanced skills difficult. Because nurses working in rural or remote areas may care for critically ill patients less often, the need to remain vigilant in pursuit of continuing education is increased; however, access to continuing education can be problematic because of geographic isolation, difficulty getting time off from work, limited financial resources, and perceived lack of applicable topics. With advances in technology, critical care nurses working in rural areas have more options for continuing education, which is crucial for maintaining a skilled nursing workforce in rural health care facilities. This article addresses challenges critical care nurses working in remote or rural areas face in pursuing continuing education and provides information about available educational opportunities. ©2017 American Association of Critical-Care Nurses.

  18. Resident continuity of care experience in a Canadian general surgery training program

    Science.gov (United States)

    Sidhu, Ravindar S.; Walker, G. Ross

    Objectives To provide baseline data on resident continuity of care experience, to describe the effect of ambulatory centre surgery on continuity of care, to analyse continuity of care by level of resident training and to assess a resident-run preadmission clinic’s effect on continuity of care. Design Data were prospectively collected for 4 weeks. All patients who underwent a general surgical procedure were included if a resident was present at operation. Setting The Division of General Surgery, Queen’s University, Kingston, Ont. Outcome measures Preoperative, operative and inhospital postoperative involvement of each resident with each case was recorded. Results Residents assessed preoperatively (before entering the operating room) 52% of patients overall, 20% of patients at the ambulatory centre and 83% of patients who required emergency surgery. Of patients assessed by the chief resident, 94% were assessed preoperatively compared with 32% of patients assessed by other residents ( p 0.1). Conclusions This study serves as a reference for the continuity of care experience in Canadian surgical programs. Residents assessed only 52% of patients preoperatively, and only 40% of patients had complete continuity of care. Factors such as ambulatory surgery and junior level of training negatively affected continuity experience. Such factors must be taken into account in planning surgical education. PMID:10526519

  19. EFFICIENT MEASURES FOR BURNOUT PREVENTION IN PALLIATIVE CARE

    Directory of Open Access Journals (Sweden)

    Cristina DOBRE

    2017-06-01

    Full Text Available The term burnout, meaning ”professional exhaustion”, was introduced by Herbert Freudenberger in 1974. On May 21, 2014 , the World Health Assembly, the decisional organ of the World Health Organization, voted the resolution for the integration and development of the capacity of palliative care services as a constituent part of the health systems. The resolution represents a major pace in the development of palliative care at world level, once the ministers responsible for the field took upon themselves - by means of information and training programs - the task of services’ development, mainly at community level, the support from the part of the next of kins, the elaboration of educational programs, of guides and clinical protocols for specialists, of instruments for the monitorization of the quality of services provided, an easier access of patients to medication, as well as partnerships with the civil society. Burnout is a state of emotional, mental and physical overfatigue caused by excessive and prolongued stress. It is installed mainly when the person affected with it feels care-worn and uncapable of fulfilling his/her usual duties. As the stress continues, he/she will come to lose the interest or motivation which made him/her assume a certain position in the organizational hierarchy. The burnout phenomenon includes three components: emotional exhaustion, depersonalization and lack of professional accomplishment. The main observations on the phenomenon indicate that, apparently, the burnout level in palliative care is not higher than in other services, such as intensive therapy or surgery. Nevertheless, mention should be made of a characteristic of the palliative care services which influences the burnout level, namely the emotional relation created between the patient and the medical team, as a result of the prolongued duration of the care services

  20. Practice-Education Synergy: A Research Focus on Continuity of Care.

    Science.gov (United States)

    Lee, Jan L.; Dean, Hannah

    1995-01-01

    Describes one focus of an ongoing partnership between a Veterans Health Administration medical center and a university-based school of nursing: to improve patient outcomes through patient-centered continuity of care. (Author)

  1. Evaluating Continuity and Comprehensiveness of Care in an Elective Family Practice Clerkship.

    Science.gov (United States)

    Beasley, John W.; And Others

    1985-01-01

    A computerized, sampling instrument is described that measures continuity and comprehensiveness of care learned by medical students at the University of Wisconsin Medical School and the clinical content of the students' experience. (Author/MLW)

  2. 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

  3. 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

  4. 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)

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

    Science.gov (United States)

    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.

  6. Validation of the OPportunity for Treatment In ONcology (OPTION) questionnaire measuring continuity of care.

    Science.gov (United States)

    Rucci, Paola; Foglino, Silvia; Bravi, Francesca; D'Avenia, Rossella; Altini, Mattia; Carradori, Tiziano; Angelastro, Angela; Fantini, Maria Pia

    2018-01-01

    Increasing efforts are ongoing to deliver effective cancer care through integrated networks of services. Measuring patients' experience of care is essential to identify problematic areas that require organisational adjustments. The aim of the present study was to examine the validity of OPTION questionnaire, designed to measure patient's perceived continuity of care across different phases of their care pathway. The study was carried at the Institute for Cancer Treatment and Research, Meldola and the oncology departments of the Local Health Authority of Romagna, Italy. Principal component analysis (PCA) was performed to identify factors underlying patients' perception of continuity of care. Factor scores were compared between patients with or without a care coordinator using Mann-Whitney test. The study sample consisted of 214 patients with breast or colorectal cancer, with a mean age of 62.3 years. Most patients identified the oncologist as their care coordinator. Five factors were extracted using PCA: (1) "trustful relationship with health care staff," (2) "information on care pathway," (3) "information on changes related to the illness," (4) "feelings of abandonment" and (5) "collaboration among health care professionals." The scores of factors 2 and 3 were significantly higher among those with a care coordinator. The OPTION questionnaire is a reliable instrument that can help clinicians and administrative stakeholder target efforts and resources in the pursuit of quality of care. © 2017 John Wiley & Sons Ltd.

  7. CASALUD: an innovative health-care system to control and prevent non-communicable diseases in Mexico.

    Science.gov (United States)

    Tapia-Conyer, Roberto; Gallardo-Rincón, Héctor; Saucedo-Martinez, Rodrigo

    2015-07-01

    Mexico and other Latin American countries are currently facing a dramatic increase in the number of adults suffering from non-communicable diseases (NCDs) such as diabetes, cardiovascular disease (CVD) and chronic kidney disease (CKD), which require prolonged, continuous care. This epidemiological shift has created new challenges for health-care systems. Both the World Health Organization (WHO) and the United Nations (UN) have recognised the growing human and economic costs of NCDs and outlined an action plan, recognising that NCDs are preventable, often with common preventable risk factors linked to risky health behaviours. In line with international best practices, Mexico has applied a number of approaches to tackle these diseases. However, challenges remain for the Mexican health-care system, and in planning a strategy for combating and preventing NCDs, it must consider how best to integrate these strategies with existing health-care infrastructure. Shifting the paradigm of care in Mexico from a curative, passive approach to a preventive, proactive model will require an innovative and replicable system that guarantees availability of medicines and services, strengthens human capital through ongoing professional education, expands early and continuous access to care through proactive prevention strategies and incorporates technological innovations in order to do so. Here, we describe CASALUD: an innovative model in health-care that leverages international best practices and uses innovative technology to deliver NCD care, control and prevention. In addition, we describe the lessons learned from the initial implementation of the model for its effective use in Mexico, as well as the plans for wider implementation throughout the country, in partnership with the Mexican Ministry of Health. © Royal Society for Public Health 2013.

  8. 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.

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

    Science.gov (United States)

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

    2015-04-01

    midwifery continuity of care has been shown to be beneficial to women through reducing interventions and other maternal and neonatal morbidity. In Australia, numerous government reports recognise the importance of midwifery models of care that provide continuity. Given the benefits, midwives, including new graduate midwives, should have the opportunity to work in these models of care. Historically, new graduates have been required to have a number of years׳ experience before they are able to work in these models of care although a small number have been able to move into these models as new graduates. to explore the experiences of the new graduate midwives who have worked in midwifery continuity of care, in particular, the support they received; and, to establish the facilitators and barriers to the expansion of new graduate positions in midwifery continuity of care models. a qualitative descriptive study was undertaken framed by the concept of continuity of care. the new graduate midwives valued the relationship with the women and with the group of midwives they worked alongside. The ability to develop trusting relationships, consolidate skills and knowledge, be supported by the group and finally feeling prepared to work in midwifery continuity of care from their degree were all sub-themes. All of these factors led to the participants feeling as though they were 'becoming a real midwife'. this is the first study to demonstrate that new graduate midwives value working in midwifery continuity of care - they felt well prepared to work in this way from their degree and were supported by midwives they worked alongside. The participants reported having more confidence to practice when they have a relationship with the woman, as occurs in these models. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. [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.

  11. Measuring quality of dental care: Caries prevention services for children.

    Science.gov (United States)

    Herndon, Jill Boylston; Tomar, Scott L; Catalanotto, Frank A; Rudner, Nancy; Huang, I-Chan; Aravamudhan, Krishna; Shenkman, Elizabeth A; Crall, James J

    2015-08-01

    The authors conducted a study to validate the following 3 evidence-based, process-of-care quality measures focused on dental caries prevention for children with an elevated risk of experiencing caries: sealants for 6- to 9-year-olds, sealants for 10- to 14-year-olds, and topical fluoride. Using evidence-based guidelines, the Dental Quality Alliance developed measures for implementation with administrative data at the plan and program levels. To validate the measures, the authors used data from the Florida and Texas Medicaid programs and Children's Health Insurance Programs and from national commercial dental benefit plans. Data were extracted from 414 randomly selected dental office records to validate the use of administrative data to accurately calculate the measures. The authors also assessed statistically significant variations in overall measure performance. Agreement between administrative data and dental records was 95% for sealants (κ = 0.82) and 90% for topical fluoride (κ = 0.78). Sensitivity and specificity were 90.7% and 88.5% for topical fluoride and 77.8% and 98.8% for sealants, respectively. Variation in overall measure performance was greatest for topical fluoride (χ(2) = 5,887.1; P caries received at least 2 topical fluoride applications during the reporting year. Although there was greater variation in performance for sealants for 6- to 9-year-olds (range, 21.0-31.3%; χ(2) = 548.6; P caries prevention process-of-care quality measures can be implemented feasibly and validly using administrative claims data. The measures can be used to assess, monitor, and improve the proportion of children with an elevated risk of experiencing dental caries who receive evidence-based caries prevention services. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

  12. Guidelines for the preventive health care of hairdressing apprentices

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

    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.

  14. Promoting continuity of care for homeless adults with unmet health needs: The role of brief interventions.

    Science.gov (United States)

    Lamanna, Denise; Stergiopoulos, Vicky; Durbin, Janet; O'Campo, Patricia; Poremski, Daniel; Tepper, Joshua

    2018-01-01

    Promoting timely and continuous care for people experiencing homelessness has been a challenge in many jurisdictions, plagued by access barriers and service fragmentation. As part of a larger programme evaluation, this study used qualitative methods to examine the role of a brief interdisciplinary intervention in supporting continuity of care for this population in a large Canadian urban centre. The intervention provides time-limited case management, primary and psychiatric care, and peer accompaniment to homeless adults with unmet health needs discharged from hospital. Data were collected from 52 study participants between July 2013 and December 2014. Three focus groups were conducted with service providers and people with lived experience of homelessness, and 29 individual, semi-structured interviews were conducted with service users and other key informants. Transcripts were analysed using thematic analysis. Analysis was informed by existing frameworks for continuity of care, while remaining open to additional or unexpected findings. Findings suggest that brief interdisciplinary interventions can promote continuity of care by offering low-barrier access, timely and responsive service provision, including timely connection to long-term services and supports, appropriate individualised services and effective co-ordination of services. Although brief interdisciplinary interventions were perceived to promote access, timeliness and co-ordination of care for this population with complex health and social needs, gaps in the local service delivery context can present persisting barriers to care comprehensiveness and continuity. © 2017 John Wiley & Sons Ltd.

  15. Population-based Cancer Screening: Measurement of Coordination and Continuity of Care.

    Science.gov (United States)

    Benito, Llucia; Espinosa, Jose; Binefa, Gemma; Vidal, Carmen; Lluch, María Teresa; Puig, Montse; Fernandez, Maria; Padrol, Isabel; García, Montse

    2017-06-15

    European guidelines for the quality of screening programs for breast and colorectal cancer describe process, structure, and outcome indicators. However, none of them specifically evaluate coordination and continuity of care during the cancer screening process. The aim of this study was to identify and adapt care quality indicators related to the coordination and continuity of the cancer screening process to assess nursing care in cancer screening programs. The indicators proposed in this study were selected in 2 phases. The first consisted of a literature review, and the second was made by consensus of an expert group. An electronic literature search was conducted, through June 2016. From a total of 225 articles retrieved, 14 studies met inclusion criteria, and these 14 documents were delivered to the group of experts for evaluation and to propose a final list of agreed-upon indicators. The group of experts selected 7 indicators: adequacy and waiting time derivation of participants, delivery and availability of the report of the process, understanding professionals involved in the process, and satisfaction and understanding of participants. These indicators should help identify areas for improvement and measure the outcome of coordination and continuity of care. The results provided a common set of indicators to evaluate the coordination and continuity of care for cancer screening and to consequently assess the contribution of nursing care in cancer screening programs. The identification and adaptation of these quality indicators will help to identify areas for improvement and measure the effect of coordination and continuity of care.

  16. Continuity of care for acutely unwell older adults from nursing homes.

    Science.gov (United States)

    Crilly, Julia; Chaboyer, Wendy; Wallis, Marianne

    2006-06-01

    Continuity of care (COC) for acutely unwell older adults, particularly those who are nursing home residents, who present to hospital, is complicated by the presence of co-morbid conditions, long waiting times, both for the ambulance and in the department, and poor after-hours general practitioner access. To present a critical review of the literature on COC for older adults from nursing homes who present to hospital and who are acutely unwell. The review will answer the following questions: (i) What is the contemporary meaning of the construct continuity of care? (ii) What is the relevance of continuity of care to the population of older adults who reside in nursing homes and present to hospital? and (iii) What models exist for promoting continuity of care to older adults who present to hospital? Guided by the conceptual analysis process a database search of CINAHL and MEDLINE was carried out utilizing the search terms 'continuity of care', 'older adults', 'nursing homes', 'emergency department' and 'acute illness'. A hand-search of additional references was also conducted. Retrieved articles were critically reviewed if they focused on older adult patients, the acute care/community settings and COC. The contemporary meaning of the COC is that it incorporates care of an individual patient over time by bridging discrete elements in the care pathway. Four distinct models of COC were identified. These were Primary Health Care; General Practice and Primary Medical Care; Consumers; and Health Policy and Systems. All are based on the proviso that the individual is sufficiently independent to be able to coordinate their own care and to take overall responsibility. The connection between COC and acutely unwell older adults who present to hospital is a prolific area for further research. In particular, the effectiveness of programmes aimed at enhancing the advanced nursing practice role and the COC process for older adults, needs investigation.

  17. Mortality and continuity of care - Definitions matter! A cohort study in diabetics.

    Science.gov (United States)

    Geroldinger, Angelika; Sauter, Simone Katja; Heinze, Georg; Endel, Gottfried; Dorda, Wolfgang; Duftschmid, Georg

    2018-01-01

    To demonstrate that when investigating the relevance of continuity of care for patient outcomes, different definitions can lead to contradicting results. We used claims data from the regional public health insurer of Lower Austria covering the period from 2008 to 2011. The study sample included subjects with repeated dispensings of anti-diabetic drugs. The continuity of care index was calculated firstly based on a patient's contacts with general practitioners (primary COCI) and secondly based on contacts at all medical disciplines (total COCI). The association of the two continuity of care measures with mortality was assessed in separate univariable and multivariable Cox regression models. Our study sample consisted of 51,717 patients with a median observation time of 3.65 years. The data showed that a high total COCI was associated with increased mortality, while there was no association between primary COCI and mortality. Measures of continuity of care are highly sensitive to the type of medical disciplines taken into account. The continuity of care index calculated from contacts at all medical disciplines might measure diversity rather than continuity of care.

  18. Joint action between child health care nurses and midwives leads to continuity of care for expectant and new mothers

    Directory of Open Access Journals (Sweden)

    Ingrid Hylander

    2012-07-01

    Full Text Available Reduction of the duration of postpartum hospital stay in western countries highlights the need for better support and continuity of care for expectant and new mothers. The aim of this study was to investigate strategies to improve continuity of care for expectant and new mothers. The study also aimed to elaborate on a preliminary substantive grounded theory model of “linkage in the chain of care” that had been developed earlier. Grounded theory methodology, which involved multiple data sources comprising structured interviews with midwives and child healthcare nurses (n=20, as well as mothers (n=21, participant observation, and written material, was used. Comparative analysis was used to analyse the data. To achieve continuity, three main strategies, transfer, establishing and maintaining a relation, and adjustment, were identified. These strategies for continuity formed the basis of the core category, joint action. In all the strategies for continuity, midwives and child healthcare nurses worked together. In addition, mothers benefited from the joint action and recognized continuity of care when strategies for continuity were implemented. The results are discussed in relation to the established concepts of continuity.

  19. Joint action between child health care nurses and midwives leads to continuity of care for expectant and new mothers

    Science.gov (United States)

    Hylander, Ingrid

    2012-01-01

    Reduction of the duration of postpartum hospital stay in western countries highlights the need for better support and continuity of care for expectant and new mothers. The aim of this study was to investigate strategies to improve continuity of care for expectant and new mothers. The study also aimed to elaborate on a preliminary substantive grounded theory model of “linkage in the chain of care” that had been developed earlier. Grounded theory methodology, which involved multiple data sources comprising structured interviews with midwives and child healthcare nurses (n=20), as well as mothers (n=21), participant observation, and written material, was used. Comparative analysis was used to analyse the data. To achieve continuity, three main strategies, transfer, establishing and maintaining a relation, and adjustment, were identified. These strategies for continuity formed the basis of the core category, joint action. In all the strategies for continuity, midwives and child healthcare nurses worked together. In addition, mothers benefited from the joint action and recognized continuity of care when strategies for continuity were implemented. The results are discussed in relation to the established concepts of continuity. PMID:22783367

  20. Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England.

    Science.gov (United States)

    Tammes, Peter; Purdy, Sarah; Salisbury, Chris; MacKichan, Fiona; Lasserson, Daniel; Morris, Richard W

    2017-11-01

    Secondary health care services have been under considerable pressure in England as attendance rates increase, resulting in longer waiting times and greater demands on staff. This study's aim was to examine the association between continuity of care and risk of emergency hospital admission among older adults. We analyzed records from 10,000 patients aged 65 years and older in 2012 within 297 English general practices obtained from the Clinical Practice Research Datalink and linked with Hospital Episode Statistics. We used the Bice and Boxerman (BB) index and the appointed general practitioner index (last general practitioner consulted before hospitalization) to quantify patient-physician continuity. The BB index was used in a prospective cohort approach to assess impact of continuity on risk of admission. Both indices were used in a separate retrospective nested case-control approach to test the effect of changing physician on the odds of hospital admission in the following 30 days. In the prospective cohort analysis, the BB index showed a graded, non-significant inverse relationship of continuity of care with risk of emergency hospital admission, although the hazard ratio for patients experiencing least continuity was 2.27 (95% CI, 1.37-3.76) compared with those having complete continuity. In the retrospective nested case-control analysis, we found a graded inverse relationship between continuity of care and emergency hospital admission for both BB and appointed general practitioner indices: for the latter, the odds ratio for those experiencing least continuity was 2.32 (95% CI, 1.48-3.63) relative to those experiencing most continuity. Marked discontinuity of care might contribute to increased unplanned hospital admissions among patients aged 65 years and older. Schemes to enhance continuity of care have the potential to reduce hospital admissions. © 2017 Annals of Family Medicine, Inc.

  1. The effect of deinstitutionalization on the longitudinal continuity of mental health care in the Netherlands

    NARCIS (Netherlands)

    Pijl, YJ; Sytema, S

    Background Deinstitutionalization has been accompanied by a decreasing continuity of care in a number of countries. This study evaluates the effects of the Dutch model for deinstitutionalizing mental health care. Methods Details of users and their use of community- and hospital-based services

  2. 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

  3. Continuity in care trajectories of older chronically ill patients in a battlefield of competing rationales.

    Science.gov (United States)

    Kjerholt, Mette; Wagner, Lis; Delmar, Charlotte; Clemensen, Jane; Lindhardt, Tove

    2014-12-01

    Continuity is crucial when caring for older chronically ill patients. Research has shown that the integration of patients' own perspectives on their situation is of utmost importance for continuity and quality of care. Studies have, however, demonstrated a number of problems with health 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. 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. Explorative Participatory Action Research (PAR). An acute, general medical ward at a Danish university hospital. Hospital and municipality nurses (n = 29). Nursing records (n = 12). Field studies: observations, interviews, nursing records audits and logs. Data were subject to manifest and latent content analysis. Participants were aware of the importance of ensuring continuity, a comprehensive approach and integration of the patient perspective in care trajectories of older, chronically ill patients. Although they adhered to these ideals, they rarely pursued them in practice. Hindering factors were: organisational values, episodic focus on patients and lack of time. They felt caught in a value conflict between nursing professional values and system values, which caused a feeling of powerlessness, maintaining status quo in their clinical practice. The prevailing episodic focus and the competing rationales on the ward constituted a barrier to continuity and integration of the patient perspective in a comprehensive way. © 2013 Blackwell Publishing Ltd.

  4. Improving HIV/STD Prevention in the Care of Persons Living with HIV Through a National Training Program

    Science.gov (United States)

    Burnside, Helen; Hsu, Katherine; Smock, Laura; Coury-Doniger, Patricia; Hall, Christopher; Marrazzo, Jeanne; Nagendra, Gowri; Rietmeijer, Cornelis; Rompalo, Ann; Thrun, Mark

    2014-01-01

    Abstract Persons living with HIV (PLWH) are living longer, remaining sexually active, and may continue risky sexual behaviors. As such, it is crucial for providers to ask all HIV-positive patients about behaviors related to HIV transmission and STD acquisition. The “Ask, Screen, Intervene” (ASI) curriculum was developed to increase provider knowledge, skills, and motivation to incorporate risk assessment and prevention services into the care of PLWH. The ASI curriculum was delivered to 2558 HIV-care providers at 137 sites between September 30, 2007 and December 31, 2010. Immediately post-training, participants self-reported significant gains in perceived confidence to demonstrate ASI knowledge and skills (pHIV-care providers self-reported more frequently performing ASI skills (pHIV-care providers, significantly increase self-reported capacity to incorporate HIV/STD prevention into the care of PLWH, and increase implementation of national recommendations. PMID:24428796

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

    Directory of Open Access Journals (Sweden)

    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

  6. Effects of continuity of care on emergency department utilization in children with asthma.

    Science.gov (United States)

    Huang, Shu-Tzu; Wu, Shiao-Chi; Hung, Yen-Ni; Lin, I-Po

    2016-01-01

    To examine whether continuity of ambulatory asthma care can lower asthma-specific emergency department (ED) utilization by children with asthma in Taiwan. Retrospective cohort study based on claims data. We used the Taiwan National Health Insurance Dataset, 2006 to 2009. The study population was new asthma patients aged 0 to 17 years in 2007, and every case was observed for 2 years. We used the Continuity of Care Index (COCI) to calculate the continuity of ambulatory asthma care in the first year, and estimated the asthma-specific ED utilization in the second year. Two-part hurdle regression was used for statistical analysis. The 29,277 patients in our study had an average COCI of 0.68 (± 0.31), and 42.3% of patients had an index of 1. More than 1 in 20 patients-1641 (5.61%)-had at least 1 asthma ED visit, and the mean number of visits per user was 1.46 (± 0.99). After controlling for covariates, the groups with medium and low continuity of ambulatory asthma care had 21% (odds ratio [OR], 1.21; 95% CI, 1.06-1.39) and 38% (OR, 1.38; 95% CI, 1.21-1.58) higher asthma-related ED utilization, respectively, than the group with high COCI. However, among users, the number of ED visits was not statistically correlated to the continuity of ambulatory asthma care. High continuity of ambulatory asthma care can decrease asthma-specific ED utilization risk in children with newly diagnosed asthma in Taiwan. We suggest that providers and the government reinforce the use of follow-up care and education for high-risk groups to improve the continuity of ambulatory asthma care.

  7. Sustainable MSD prevention: management for continuous improvement between prevention and production. Ergonomic intervention in two assembly line companies.

    Science.gov (United States)

    Caroly, S; Coutarel, F; Landry, A; Mary-Cheray, I

    2010-07-01

    To increase output and meet customers' needs, companies have turned to the development of production management systems: Kaizen, one piece flow, Kanban, etc. The aim of such systems is to accelerate decisions, react to environmental issues and manage various productions. In the main, this type of management system has led to the continuous improvement of production performance. Consequently, such production management systems can have unexpected negative effects on operators' health and safety. Conversely, regulation and control systems focusing on work-related risks have obliged firms to implement health and safety management systems such as OHSAS 18001. The purpose of this type of system, also based on continuous improvement, is to reduce risks, facilitate work-related activities and identify solutions in terms of equipment and tools. However, the prevention actions introduced through health and safety systems often result in other unexpected and unwanted effects on production. This paper shows how companies can improve the way they are run by taking into account both types of management system. Copyright 2010 Elsevier Ltd. All rights reserved.

  8. Lack of access and continuity of adult health care: a national population-based survey.

    Science.gov (United States)

    Dilélio, Alitéia Santiago; Tomasi, Elaine; Thumé, Elaine; Silveira, Denise Silva da; Siqueira, Fernando Carlos Vinholes; Piccini, Roberto Xavier; Silva, Suele Manjourany; Nunes, Bruno Pereira; Facchini, Luiz Augusto

    2015-01-01

    OBJECTIVE To describe the lack of access and continuity of health care in adults. METHODS A cross-sectional population-based study was performed on a sample of 12,402 adults aged 20 to 59 years in urban areas of 100 municipalities of 23 states in the five Brazilian geopolitical regions. Barriers to the access and continuity of health care and were investigated based on receiving, needing and seeking health care (hospitalization and accident/emergency care in the last 12 months; care provided by a doctor, by other health professional or home care in the last three months). Based on the results obtained by the description of the sample, a projection is provided for adults living in Brazilian urban areas. RESULTS The highest prevalence of lack of access to health services and to provision of care by health professionals was for hospitalization (3.0%), whilst the lowest prevalence was for care provided by a doctor (1.1%). The lack of access to care provided by other health professionals was 2.0%; to accident and emergency services, 2.1%; and to home care, 2.9%. As for prevalences, the greatest absolute lack of access occurred in emergency care (more than 360,000 adults). The main reasons were structural and organizational problems, such as unavailability of hospital beds, of health professionals, of appointments for the type of care needed and charges made for care. CONCLUSIONS The universal right to health care in Brazil has not yet been achieved. These projections can help health care management in scaling the efforts needed to overcome this problem, such as expanding the infrastructure of health services and the workforce.

  9. Information transfer and continuity of care for stroke patients with eating difficulties from the perspectives of nursing staff in Swedish elderly care

    OpenAIRE

    Carlsson, Eva; Ehnfors, Margareta; Eldh, Ann Catrine; Ehrenberg, Anna

    2012-01-01

    Continuity of care is a key issue in the care for elderly people, for example, those having experienced stroke, particularly with regards to informational and managerial continuity based on patient record data.

  10. 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.

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

    Science.gov (United States)

    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.

  12. "Continuity of care" experiences in midwifery education: perspectives from diverse stakeholders.

    Science.gov (United States)

    Browne, Jenny; Haora, Penny J; Taylor, Jan; Davis, Deborah L

    2014-09-01

    At least 20 continuity-of-care experiences are compulsory for student midwives in Australia, but little is known about this learning component. This paper presents an analysis of continuity experiences in one Region, incorporating diverse stakeholder perspectives from student midwives, maternity managers and registered midwives, with the aim of better understanding and optimizing experiences. Qualitative methods were utilized, employing mainly focus groups. Participants included 15 student midwives from the Regional University, 14 midwives and six managers, employed at the Regional referral hospital. Four themes were identified in the data; "woman-centred care", "counting the cost", "mutual benefits" and "into the future". The significant benefits of student continuity-of-care experiences were outlined by all three participant groups. Continuity experiences for student midwives facilitated the development of a woman-centred focus in the provision of maternity care. While the experience was challenging for students it was beneficial not only to them, but to registered midwives, the maternity services, and ultimately childbearing women. In order to appropriately prepare midwives for existing and future maternity services, and to continue to meet women's needs in all service delivery models, we require midwives who are well grounded in a woman-centred care philosophy and have had exposure to various care models. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Continuing Care

    Science.gov (United States)

    ... FAQ’s Article Finder Videos About The Fisher Center Foundation Our Founders Board of Trustees Our Programs Financials Ask The Experts Article Finder News Videos Resource Locator Memory Wall Donate for the Cure Article Finder Browse our ...

  14. The Nordic maintenance care program: the clinical use of identified indications for preventive care

    OpenAIRE

    Ax?n, Iben; Bodin, Lennart

    2013-01-01

    Background Low back pain (LBP) is a prevalent condition and has been found to be recurrent and persistent in a majority of cases. Chiropractors have a preventive strategy, maintenance care (MC), aimed towards minimizing recurrence and progression of such conditions. The indications for recommending MC have been identified in the Nordic countries from hypothetical cases. This study aims to investigate whether these indications are indeed used in the clinical encounter. Methods Data were collec...

  15. Implementation of Continuous Video-Electroencephalography at a Community Hospital Enhances Care and Reduces Costs.

    Science.gov (United States)

    Kolls, Brad J; Mace, Brian E; Dombrowski, Keith E

    2017-10-24

    Despite data indicating the importance of continuous video-electroencephalography (cvEEG) monitoring, adoption has been slow outside major academic centers. Barriers to adoption include the need for technologists, equipment, and cvEEG readers. Advancements in lower-cost lead placement templates and commercial systems with remote review may reduce barriers to allow community centers to implement cvEEG. Here, we report our experience, lessons learned, and financial impact of implementing a community hospital cvEEG-monitoring program. We implemented an adult cvEEG service at Duke Regional Hospital (DRH), a community hospital affiliate, in June of 2012. Lead placement templates were used in the implementation to reduce the impact on technologists by using other bedside providers for EEG initiation. Utilization of the service, study quality, and patient outcomes were tracked over a 3-year period following initiation of service. Service was implemented at essentially no cost. Utilization varied from a number of factors: intensive care unit (ICU) attending awareness, limited willingness of bedside providers to perform lead placement, and variation in practice of the consulting neurologists. A total of 92 studies were performed on 88 patients in the first 3 years of the program, 24 in year one, 27 in year two, and 38 in year three, showing progressive adoption. Seizures were seen in 25 patients (27%), 19 were in status, of which 18 were successfully treated. Transfers to the main hospital, Duke University Medical Center, were prevented for 53 patients, producing an estimated cost savings of $145,750. The retained patients produced a direct contribution margin of about $75,000, and the margin was just over $100,000 for the entire monitored cohort. ICU cvEEG service is feasible and practical to implement at the community hospital level. Service was initiated at little to no cost and clearly enhanced care, increased breadth of care, increased ICU census, and reduced

  16. Living Kidney Donor: Continuity of Care Focused on Professional Expertise, Organisation and Interaction

    DEFF Research Database (Denmark)

    Holch, Kirsten

    -disciplinary collaboration. Methods: -Formulate a frame of reference for the principles of the continuity of care concept -Establishment of a working group with doctors, nurses, secretary and management, who represents the medical and surgical team, the living donor will meet. Furthermore, a research nurse as a coordinator...... and a process manager. The group has the competence to make all decisions concerning the continuity of care concept. - Field observations of current practice describing facts about the actual practice concerning living donors including written testimonials from the patients. - Preparation of a flow diagram...... person at the right time, resulting in improved patient safety - Patients are involved and experience coherence, continuity as well as inter-disciplinary and cross-departmental collaboration. Conclusion A model for "continuity of care" including work process and professional tasks has been developed...

  17. The Effectiveness of Telephone-Based Continuing Care in the Clinical Management of Alcohol and Cocaine Use Disorders: 12-Month Outcomes

    Science.gov (United States)

    McKay, James R.; Lynch, Kevin G.; Shepard, Donald S.; Ratichek, Sara; Morrison, Rebecca; Koppenhaver, Janelle; Pettinati, Helen M.

    2004-01-01

    This study of continuing care for substance dependent patients compared a telephone-based monitoring and brief counseling intervention (TEL) with 2 face-to-face interventions, relapse prevention (RP) and standard 12-step group counseling (STND). The participants were graduates of intensive outpatient programs who had current dependence on alcohol…

  18. Continuity in different care modes and its relationship to quality of life: a randomised controlled trial in patients with COPD

    OpenAIRE

    Uijen, Annemarie A; Bischoff, Erik WMA; Schellevis, Francois G; Bor, Hans HJ; van den Bosch, Wil JHM; Schers, Henk J

    2012-01-01

    BACKGROUND: New care modes in primary care may affect patients' experienced continuity of care. AIM: To analyse whether experienced continuity for patients with chronic obstructive pulmonary disease (COPD) changes after different care modes are introduced, and to analyse the relationship between continuity of care and patients' quality of life. DESIGN AND SETTING: Randomised controlled trial with 2-year follow-up in general practice in the Netherlands. METHOD: A total of 180 patients with COP...

  19. History and measurement of continuity of care in mental health services and evidence of its role in outcomes.

    Science.gov (United States)

    Adair, Carol E; McDougall, Gerald M; Beckie, Anora; Joyce, Anthony; Mitton, Craig; Wild, Cameron T; Gordon, Alan; Costigan, Norman

    2003-10-01

    The objective of this study was to provide a brief history of the concept of continuity of care, to update evidence of its association with patient outcomes, and to identify optimal characteristics of a continuity-of-care instrument. Articles describing recent (1990 to 2002) empirical work on continuity of care were drawn from a broader set of 305 articles about continuity of care that were obtained from a systematic literature search. The literature shows that ideas about continuity of care have changed in concert with general service delivery changes over the decades. Since 1997, only eight studies have used operationally defined measures either to describe continuity of care in mental health services or to examine the association of continuity of care with outcomes for adults with severe and persistent mental illness. Only three groups of researchers have published articles on development of continuity-of-care measures. There is little evidence that continuity of care results in better client outcomes, which may be primarily attributable to the underdevelopment of measures. Measurement of continuity of care must become more sophisticated before key questions about the association of continuity of care with outcomes can be examined and before the effectiveness of interventions designed to improve continuity of care can be rigorously evaluated.

  20. 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.

  1. Prevention of nosocomial infections in neonatal intensive care units.

    Science.gov (United States)

    Manzoni, Paolo; De Luca, Daniele; Stronati, Mauro; Jacqz-Aigrain, Evelyne; Ruffinazzi, Giulia; Luparia, Martina; Tavella, Elena; Boano, Elena; Castagnola, Elio; Mostert, Michael; Farina, Daniele

    2013-02-01

    Neonatal sepsis causes a huge burden of morbidity and mortality and includes bloodstream, urine, cerebrospinal, peritoneal, and lung infections as well as infections starting from burns and wounds, or from any other usually sterile sites. It is associated with cytokine - and biomediator-induced disorders of respiratory, hemodynamic, and metabolic processes. Neonates in the neonatal intensive care unit feature many specific risk factors for bacterial and fungal sepsis. Loss of gut commensals such as Bifidobacteria and Lactobacilli spp., as occurs with prolonged antibiotic treatments, delayed enteral feeding, or nursing in incubators, translates into proliferation of pathogenic microflora and abnormal gut colonization. Prompt diagnosis and effective treatment do not protect septic neonates form the risk of late neurodevelopmental impairment in the survivors. Thus prevention of bacterial and fungal infection is crucial in these settings of unique patients. In this view, improving neonatal management is a key step, and this includes promotion of breast-feeding and hygiene measures, adoption of a cautious central venous catheter policy, enhancement of the enteric microbiota composition with the supplementation of probiotics, and medical stewardship concerning H2 blockers with restriction of their use. Additional measures may include the use of lactoferrin, fluconazole, and nystatin and specific measures to prevent ventilator associated pneumonia. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. Continuity in different care modes and its relationship to quality of life: a randomised controlled trial in patients with COPD.

    NARCIS (Netherlands)

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

    2012-01-01

    BACKGROUND: New care modes in primary care may affect patients' experienced continuity of care. AIM: To analyse whether experienced continuity for patients with chronic obstructive pulmonary disease (COPD) changes after different care modes are introduced, and to analyse the relationship between

  3. Perceived quality of care, receipt of preventive care, and usual source of health care among undocumented and other Latinos.

    Science.gov (United States)

    Rodríguez, Michael A; Bustamante, Arturo Vargas; Ang, Alfonso

    2009-11-01

    Latinos are the largest minority group in the United States and experience persistent disparities in access to and quality of health care. (1) To determine the relationship between nativity/immigration status and self-reported quality of care and preventive care. (2) To assess the impact of a usual source of health care on receipt of preventive care among Latinos. Using cross-sectional data from the 2007 Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey, a nationally representative telephone survey of 4,013 Latino adults, we compared US-born Latinos with foreign-born Latino citizens, foreign-born Latino permanent residents and undocumented Latinos. We estimated odds ratios using separate multivariate ordered logistic models for five outcomes: blood pressure checked in the past 2 years, cholesterol checked in the past 5 years, perceived quality of medical care in the past year, perceived receipt of no health/health-care information from a doctor in the past year, and language concordance. Undocumented Latinos had the lowest percentages of insurance coverage (37% vs 77% US-born, P Undocumented Latinos also reported the highest percentage receiving no health/health-care information from their doctor (40% vs 20% US-born, P undocumented status was associated with lower likelihood of blood pressure checked in the previous 2 years (OR = 0.60; 95% CI, 0.43-0.84), cholesterol checked in the past 5 years (OR = 0.62; 95% CI, 0.39-0.99), and perceived receipt of excellent/good care in the past year (OR = 0.56; 95% CI, 0.39-0.77). Having a usual source of care increased the likelihood of a blood pressure check in the past 2 years and a cholesterol check in the past 5 years. In this national sample, undocumented Latinos were less likely to report receiving blood pressure and cholesterol level checks, less likely to report having received excellent/good quality of care, and more likely to receive no health/health-care information from doctors, even

  4. "An ounce of prevention": a primary care based prevention program for pre-diabetic population.

    Science.gov (United States)

    Liddy, Clare E; Cullen-Arseneau, Pamela; Merizzi, Shannon; Blazhko, Valeriya

    2013-02-01

    Given the existing and projected number of individuals with diabetes mellitus, there is an urgent need to implement effective prevention programs. Research trials have demonstrated reductions in risk through programs targeted at adopting a healthier lifestyle however translating this research evidence into primary care can be challenging. We examined the feasibility of implementing a pre-diabetes program into a primary care clinic in Ottawa, Canada. "An Ounce of Prevention" Healthy Lifestyle and Diabetes Program was adapted from best evidence clinical trials and uses educational tools developed by the Diabetes Prevention Program for long-term behavior change, relies on principles of self-management, is group based and includes an integrated exercise component. We used a multimethod evaluation approach and examined feasibility and practical implementation aspects such as space, staffing, recruitment and retention issues. We have implemented the program and have offered 10 courses from June 2010 through to August 2012 with 74 participants in total. Results of the evaluation surveys show that participants are highly satisfied with the content as well as the format of the program and think that the content is relevant to them. Recruitment of patients is time- intensive and requires dedicated resources. Evaluation of effectiveness with follow-up surveys and clinical measures has been challenging due to limited resources and is ongoing. The translation and implementation of research evidence into clinical practice is complex and requires consideration of real-life practicalities such as time demands on participants, staffing costs, effective recruiting and ongoing evaluation. Copyright © 2013 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  5. Strategic prevention of musculoskeletal disorders in elderly care

    DEFF Research Database (Denmark)

    Seim, Rikke; Edwards, Kasper; Poulsen, Signe

    2015-01-01

    Musculoskeletal disorders (MSDs) are a common designation for pain, stiffness or tenderness in the joints, ligaments, tendons, muscles or bones and the associated cardiovascular and nervous system often resulting in symptoms as swelling, restriction of motion and functional impairment. MSD...... 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...... that the number of cases of occupational musculoskeletal disorders will increase in the coming years. MSD as a result of repetitive movements of the upper extremities will continue to be a challenge. Furthermore a great challenge is the prevention of MSD among younger employees (under 25), who are often more...

  6. Older adults' attitudes about continuing cancer screening later in life: a pilot study interviewing residents of two continuing care communities

    Directory of Open Access Journals (Sweden)

    Walter Louise C

    2006-08-01

    Full Text Available Abstract Background Individualized decision making has been recommended for cancer screening decisions in older adults. Because older adults' preferences are central to individualized decisions, we assessed older adults' perspectives about continuing cancer screening later in life. Methods Face to face interviews with 116 residents age 70 or over from two long-term care retirement communities. Interview content included questions about whether participants had discussed cancer screening with their physicians since turning age 70, their attitudes about information important for individualized decisions, and their attitudes about continuing cancer screening later in life. Results Forty-nine percent of participants reported that they had an opportunity to discuss cancer screening with their physician since turning age 70; 89% would have preferred to have had these discussions. Sixty-two percent believed their own life expectancy was not important for decision making, and 48% preferred not to discuss life expectancy. Attitudes about continuing cancer screening were favorable. Most participants reported that they would continue screening throughout their lives and 43% would consider getting screened even if their doctors recommended against it. Only 13% thought that they would not live long enough to benefit from cancer screening tests. Factors important to consider stopping include: age, deteriorating or poor health, concerns about the effectiveness of the tests, and doctors recommendations. Conclusion This select group of older adults held positive attitudes about continuing cancer screening later in life, and many may have had unrealistic expectations. Individualized decision making could help clarify how life expectancy affects the potential survival benefits of cancer screening. Future research is needed to determine whether educating older adults about the importance of longevity in screening decisions would be acceptable, affect older adults

  7. 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

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  10. Design of intelligent proximity detection zones to prevent striking and pinning fatalities around continuous mining machines.

    Science.gov (United States)

    Bissert, P T; Carr, J L; DuCarme, J P; Smith, A K

    2016-01-01

    The continuous mining machine is a key piece of equipment used in underground coal mining operations. Over the past several decades these machines have been involved in a number of mine worker fatalities. Proximity detection systems have been developed to avert hazards associated with operating continuous mining machines. Incorporating intelligent design into proximity detection systems allows workers greater freedom to position themselves to see visual cues or avoid other hazards such as haulage equipment or unsupported roof or ribs. However, intelligent systems must be as safe as conventional proximity detection systems. An evaluation of the 39 fatal accidents for which the Mine Safety and Health Administration has published fatality investigation reports was conducted to determine whether the accident may have been prevented by conventional or intelligent proximity. Multiple zone configurations for the intelligent systems were studied to determine how system performance might be affected by the zone configuration. Researchers found that 32 of the 39 fatalities, or 82 percent, may have been prevented by both conventional and intelligent proximity systems. These results indicate that, by properly configuring the zones of an intelligent proximity detection system, equivalent protection to a conventional system is possible.

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

    Science.gov (United States)

    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.

  12. Change in Residents' Experience in Continuity Clinic After Patient-Focused Primary Care Redesign.

    Science.gov (United States)

    Fogel, Benjamin N; Warrick, Stephen; Finkelstein, Jonathan A; Klein, Melissa

    2016-01-01

    Evaluation of efforts to redesign primary care has primarily focused on clinical services, with limited assessment of the effect on learners. This study evaluated the change in pediatric residents' perception of training, teamwork, and patient care in 2 different continuity clinic settings that were implementing patient-focused primary care redesign. Continuity clinic residents at 2 large urban pediatric training programs completed a survey, developed de novo, before and after primary care redesign. Differences in the proportion of positive (≥4 of 5) ratings before and after redesign were compared using chi-squared tests in 2 practice sites, each of which focused on improving specific aspects of their practice. The response rate was >70% in both sites and in both years. Residents in the site focused on teamwork and continuity were more likely to report improved teamwork training (64% vs 83%; P care in clinic also improved (47% vs 68%; P continuity clinic. Future redesign efforts deliberately involving residents might further enhance continuity clinic training. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  13. Heart failure patients’ experiences with continuity of care and its relation to medication adherence: a cross-sectional study

    Science.gov (United States)

    2012-01-01

    Background A growing number of health care providers are nowadays involved in heart failure care. This could lead to discontinuity and fragmentation of care, thus reducing trust and hence poorer medication adherence. This study aims to explore heart failure patients’ experiences with continuity of care, and its relation to medication adherence. Methods We collected data from 327 primary care patients with chronic heart failure. Experienced continuity of care was measured using a patient questionnaire and by reviewing patients’ medical records. Continuity of care was defined as a multidimensional concept including personal continuity (seeing the same doctor every time), team continuity (collaboration between care providers in general practice) and cross-boundary continuity (collaboration between general practice and hospital). Medication adherence was measured using a validated patient questionnaire. The relation between continuity of care and medication adherence was analysed by using chi-square tests. Results In total, 53% of patients stated not seeing any care provider in general practice in the last year concerning their heart failure. Of the patients who did contact a care provider in general practice, 46% contacted two or more care providers. Respectively 38% and 51% of patients experienced the highest levels of team and cross-boundary continuity. In total, 14% experienced low levels of team continuity and 11% experienced low levels of cross-boundary continuity. Higher scores on personal continuity were significantly related to better medication adherence (p continuity and medication adherence. Conclusions A small majority of patients that contacted a care provider in general practice for their heart failure, contacted only one care provider. Most heart failure patients experienced high levels of collaboration between care providers in general practice and between GP and cardiologist. However, in a considerable number of patients, continuity of care

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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

    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.

  16. Cultural diversity between hospital and community nurses: implications for continuity of care

    Directory of Open Access Journals (Sweden)

    Ragnhild Hellesø

    2010-02-01

    Full Text Available Introduction: Health care systems and nurses need to take into account the increasing number of people who need post-hospital nursing care in their homes. Nurses have taken a pivotal role in discharge planning for frail patients. Despite considerable effort and focus on how to undertake hospital discharge successfully, the problem of ensuring continuity of care remains. Challenges: In this paper, we highlight and discuss three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning. These three challenges are: how local practices circumvent formal structures, how nurses' different perspectives influence their assessment of patients' need for post-hospital care, and how nurses have different understanding of what it means to be ‘ready to be discharged’. Discussion: We propose that nurses need to discuss these challenges and their implications for nursing care so as to be ready to face changing demands for health care in future.

  17. Continuous flow left ventricular assist devices: shared care goals of monitoring and treating patients.

    Science.gov (United States)

    Estep, Jerry D; Trachtenberg, Barry H; Loza, Laurie P; Bruckner, Brian A

    2015-01-01

    Continuous-flow left ventricular assist devices (CF-LVADs) have been clinically adopted as a long-term standard of care therapy option for patients with end-stage heart failure. For many patients, shared care between the care providers at the implanting center and care providers in the community in which the patient resides is a clinical necessity. The aims of this review are to (1) provide a rationale for the outpatient follow-up exam and surveillance testing used at our center to monitor patients supported by the HeartMate II(®) CF-LVAD (Thoratec Corporation, Pleasanton, CA) and (2) provide the protocol/algorithms we use for blood pressure, driveline exit site, LVAD alarm history, surveillance blood work, and echocardiography monitoring in this patient population. In addition, we define our partnership outpatient follow-up protocol and the "shared care" specific responsibilities we use with referring health care providers to best manage many of our patients.

  18. The Role of eHealth in Optimizing Preventive Care in the Primary Care Setting.

    Science.gov (United States)

    Carey, Mariko; Noble, Natasha; Mansfield, Elise; Waller, Amy; Henskens, Frans; Sanson-Fisher, Rob

    2015-05-22

    Modifiable health risk behaviors such as smoking, overweight and obesity, risky alcohol consumption, physical inactivity, and poor nutrition contribute to a substantial proportion of the world's morbidity and mortality burden. General practitioners (GPs) play a key role in identifying and managing modifiable health risk behaviors. However, these are often underdetected and undermanaged in the primary care setting. We describe the potential of eHealth to help patients and GPs to overcome some of the barriers to managing health risk behaviors. In particular, we discuss (1) the role of eHealth in facilitating routine collection of patient-reported data on lifestyle risk factors, and (2) the role of eHealth in improving clinical management of identified risk factors through provision of tailored feedback, point-of-care reminders, tailored educational materials, and referral to online self-management programs. Strategies to harness the capacity of the eHealth medium, including the use of dynamic features and tailoring to help end users engage with, understand, and apply information need to be considered and maximized. Finally, the potential challenges in implementing eHealth solutions in the primary care setting are discussed. In conclusion, there is significant potential for innovative eHealth solutions to make a contribution to improving preventive care in the primary care setting. However, attention to issues such as data security and designing eHealth interfaces that maximize engagement from end users will be important to moving this field forward.

  19. Information Technology: The Preventive Health Care Application and an Associated Upgrade

    National Research Council Canada - National Science Library

    2002-01-01

    The Preventive Health Care Application was a tool designed to enable clinicians to deliver and track appropriate and timely preventive services provided to all enrolled military health system members...

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

    Science.gov (United States)

    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.

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

    Science.gov (United States)

    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.

  2. Continuity in different care modes and its relationship to quality of life: a randomised controlled trial in patients with COPD.

    Science.gov (United States)

    Uijen, Annemarie A; Bischoff, Erik Wma; Schellevis, Francois G; Bor, Hans Hj; van den Bosch, Wil Jhm; Schers, Henk J

    2012-06-01

    New care modes in primary care may affect patients' experienced continuity of care. To analyse whether experienced continuity for patients with chronic obstructive pulmonary disease (COPD) changes after different care modes are introduced, and to analyse the relationship between continuity of care and patients' quality of life. Randomised controlled trial with 2-year follow-up in general practice in the Netherlands. A total of 180 patients with COPD were randomly assigned to three different care modes: self-management, regular monitoring by a practice nurse, and care provided by the GP at the patient's own initiative (usual care). Experienced continuity of care as personal continuity (proportion of visits with patient's own GP) and team continuity (continuity by the primary healthcare team) was measured using a self-administered patient questionnaire. Quality of life was measured using the Chronic Respiratory Questionnaire. Of the final sample (n = 148), those patients receiving usual care experienced the highest personal continuity, although the chance of not contacting any care provider was also highest in this group (29% versus 2% receiving self-management, and 5% receiving regular monitoring). There were no differences in experienced team continuity in the three care modes. No relationship was found between continuity and changes in quality of life. Although personal continuity decreases when new care modes are introduced, no evidence that this affects patients' experienced team continuity or patients' quality of life was found. Patients still experienced smooth, ongoing care, and considered care to be connected. Overall, no evidence was found indicating that the introduction of new care modes in primary care for patients with COPD should be discouraged.

  3. Continuity in different care modes and its relationship to quality of life: a randomised controlled trial in patients with COPD

    Science.gov (United States)

    Uijen, Annemarie A; Bischoff, Erik WMA; Schellevis, Francois G; Bor, Hans HJ; van den Bosch, Wil JHM; Schers, Henk J

    2012-01-01

    Background New care modes in primary care may affect patients’ experienced continuity of care. Aim To analyse whether experienced continuity for patients with chronic obstructive pulmonary disease (COPD) changes after different care modes are introduced, and to analyse the relationship between continuity of care and patients’ quality of life. Design and setting Randomised controlled trial with 2-year follow-up in general practice in the Netherlands. Method A total of 180 patients with COPD were randomly assigned to three different care modes: self-management, regular monitoring by a practice nurse, and care provided by the GP at the patient's own initiative (usual care). Experienced continuity of care as personal continuity (proportion of visits with patient's own GP) and team continuity (continuity by the primary healthcare team) was measured using a self-administered patient questionnaire. Quality of life was measured using the Chronic Respiratory Questionnaire. Results Of the final sample (n = 148), those patients receiving usual care experienced the highest personal continuity, although the chance of not contacting any care provider was also highest in this group (29% versus 2% receiving self-management, and 5% receiving regular monitoring). There were no differences in experienced team continuity in the three care modes. No relationship was found between continuity and changes in quality of life. Conclusion Although personal continuity decreases when new care modes are introduced, no evidence that this affects patients’ experienced team continuity or patients’ quality of life was found. Patients still experienced smooth, ongoing care, and considered care to be connected. Overall, no evidence was found indicating that the introduction of new care modes in primary care for patients with COPD should be discouraged. PMID:22687235

  4. Exemplary Care and Learning Sites: A Model for Achieving Continual Improvement in Care and Learning in the Clinical Setting.

    Science.gov (United States)

    Headrick, Linda A; Ogrinc, Greg; Hoffman, Kimberly G; Stevenson, Katherine M; Shalaby, Marc; Beard, Albertine S; Thörne, Karin E; Coleman, Mary T; Baum, Karyn D

    2016-03-01

    Current models of health care quality improvement do not explicitly describe the role of health professions education. The authors propose the Exemplary Care and Learning Site (ECLS) model as an approach to achieving continual improvement in care and learning in the clinical setting. From 2008-2012, an iterative, interactive process was used to develop the ECLS model and its core elements--patients and families informing process changes; trainees engaging both in care and the improvement of care; leaders knowing, valuing, and practicing improvement; data transforming into useful information; and health professionals competently engaging both in care improvement and teaching about care improvement. In 2012-2013, a three-part feasibility test of the model, including a site self-assessment, an independent review of each site's ratings, and implementation case stories, was conducted at six clinical teaching sites (in the United States and Sweden). Site leaders reported the ECLS model provided a systematic approach toward improving patient (and population) outcomes, system performance, and professional development. Most sites found it challenging to incorporate the patients and families element. The trainee element was strong at four sites. The leadership and data elements were self-assessed as the most fully developed. The health professionals element exhibited the greatest variability across sites. The next test of the model should be prospective, linked to clinical and educational outcomes, to evaluate whether it helps care delivery teams, educators, and patients and families take action to achieve better patient (and population) outcomes, system performance, and professional development.

  5. Examining Associations Between Relocation, Continuity of Care, and Patient Satisfaction in Military Spouses.

    Science.gov (United States)

    Gleason, Jessica L; Beck, Kenneth H

    2017-05-01

    The purpose of this study was to determine how frequent permanent change of station moves and turnover in primary care providers are associated with continuity of care and patient satisfaction in military spouses. These domains have been studied extensively in civilian populations, but this study seeks to begin filling a gap in the literature surrounding military spouses and their experiences with the military health system. Spouses were recruited via social media to complete a brief online questionnaire to examine factors related to continuity of care and satisfaction with military health care. Results were analyzed using analysis of variance and χ 2 tests, and through logistic regression. Continuity of care scores were significantly lower as the number of moves and providers increased. Patient satisfaction was also significantly associated with continuity. In logistic regression analyses, patient-provider relationship and health status were the only significant predictors across two measures of patient satisfaction. Respondents with higher relationship scores were nearly two times more likely to report being satisfied than those with lower scores. Qualitative results indicated that the majority of dissatisfied spouses were unhappy with their military providers, which supported quantitative findings related to patient-provider relationship. No studies have previously been conducted to determine why military health system beneficiaries are less satisfied with care than their civilian counterparts. Discontinuous care is an ongoing issue for military families, which can impact satisfaction and potentially lead to poorer health outcomes. Although the military culture may not allow for fewer relocations, these results indicate that taking steps to promote enduring, trusting relationships with primary care providers may improve patient satisfaction. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. A Chinese version of the Patient Continuity of Care Questionnaire: reliability and validity assessment.

    Science.gov (United States)

    Chen, Hsiao-Mei; Chen, Ching-Min

    2017-05-01

    To examine the psychometric properties of the Chinese version of Patient Continuity of Care Questionnaire (PCCQ) to see whether the Patient Continuity of Care Questionnaire can be applied in Chinese context. The rapid increase in the number of older adults with chronic diseases has made caring for this vulnerable population a priority healthcare issue in Taiwan. The PCCQ has been widely used in international studies. However, research has not yet assessed the suitability and applicability of the PCCQ in Taiwan. A cross-sectional survey design was applied for the psychometric testing of the scale. A total of 314 older Taiwanese adults with chronic diseases receiving discharge planning intervention were pooled from a hospital in Central Taiwan. After receiving permission from the author of the PCCQ, a Chinese translation and back translation were made. The scale was first rated by eleven experts with a Content Validity Index of 0·93. Two factors were extracted with the exploratory factor analysis, namely 'information transfer to patients' and 'relationships with providers during hospitalisation', with a total of 70·34% of the variance explained. The PCCQ - Chinese can be used to assist professionals to fully understand the continuity of care of the discharged patients under consideration. A PCCQ - Chinese version can be used as a guide for discharging preparation that enables patients to receive high-quality continuity of care and further to self-manage their conditions. © 2016 John Wiley & Sons Ltd.

  8. Women's Preventive Services Guidelines Affordable Care Act Expands Prevention Coverage for Women's Health and Well-Being

    Science.gov (United States)

    ... Act Expands Prevention Coverage for Women’s Health and Well-Being The Affordable Care Act – the health insurance reform ... preventive services are necessary for women’s health and well-being and therefore should be considered in the development ...

  9. Continuing Care in High Schools: A Descriptive Study of Recovery High School Programs

    Science.gov (United States)

    Finch, Andrew J.; Moberg, D. Paul; Krupp, Amanda Lawton

    2014-01-01

    Data from 17 recovery high schools suggest programs are dynamic and vary in enrollment, fiscal stability, governance, staffing, and organizational structure. Schools struggle with enrollment, funding, lack of primary treatment accessibility, academic rigor, and institutional support. Still, for adolescents having received treatment for substance abuse, recovery schools appear to successfully function as continuing care providers reinforcing and sustaining therapeutic benefits gained from treatment. Small size and therapeutic programming allow for a potentially broader continuum of services than currently exists in most of the schools. Recovery schools thus provide a useful design for continuing care warranting further study and policy support. PMID:24591808

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

    Science.gov (United States)

    Biringer, Eva; Hartveit, Miriam; Sundfør, Bengt; Ruud, Torleif; Borg, Marit

    2017-11-21

    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. 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. 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. A discrepancy between aspects of continuity that are essential for service users and their experiences of actual practice

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

    Directory of Open Access Journals (Sweden)

    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

  12. 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.

  13. Cancer preventive services, socioeconomic status, and the Affordable Care Act.

    Science.gov (United States)

    Cooper, Gregory S; Kou, Tzuyung Doug; Dor, Avi; Koroukian, Siran M; Schluchter, Mark D

    2017-05-01

    Out-of-pocket expenditures are thought to be an important barrier to the receipt of cancer preventive services, especially for those of a lower socioeconomic status (SES). The Affordable Care Act (ACA) eliminated out-of-pocket expenditures for recommended services, including mammography and colonoscopy. The objective of this study was to determine changes in the uptake of mammography and colonoscopy among fee-for-service Medicare beneficiaries before and after ACA implementation. Using Medicare claims data, this study identified women who were 70 years old or older and had not undergone mammography in the previous 2 years and men and women who were 70 years old or older, were at increased risk for colorectal cancer, and had not undergone colonoscopy in the past 5 years. The receipt of procedures in the 2-year period before the ACA's implementation (2009-2010) and after its implementation (2011 to September 2012) was also identified. Multivariate generalized estimating equation models were used to determine the independent association and county-level quartile of median income and education with the receipt of testing. For mammography, a lower SES quartile was associated with less uptake, but the post-ACA disparities were smaller than those in the pre-ACA period. In addition, mammography rates increased from the pre-ACA period to the post-ACA period in all SES quartiles. For colonoscopy, in both the pre- and post-ACA periods, there was an association between uptake and educational level and, to some extent, income. However, there were no appreciable changes in colonoscopy and SES after implementation of the ACA. The removal of out-of-pocket expenditures may overcome a barrier to the receipt of recommended preventive services, but for colonoscopy, other procedural factors may remain as deterrents. Cancer 2017;123:1585-1589. © 2017 American Cancer Society. © 2017 American Cancer Society.

  14. The Continuity of Care Experience in Australian midwifery education-What have we achieved?

    Science.gov (United States)

    Tierney, Olivia; Sweet, Linda; Houston, Don; Ebert, Lyn

    2017-06-01

    The Continuity of Care Experience is a mandated workplace based component of midwifery education in Australia. Since its inclusion in midwifery clinical education, the pedagogical approaches used across Australia have varied. The purpose of this integrative review is to determine the outcomes of the Continuity of Care Experience as an educational model. A search for relevant research literature was undertaken in 2015 using a range of databases and by examining relevant bibliographies. Articles published in English, which provided information about the outcomes of Continuity of Care Experiences for midwifery education were included. A total of 20 studies were selected. The included studies were primarily exploratory and descriptive. Studies reported the value that both students and women place on the relationship they developed. This relationship resulted in opportunities that enhanced student learning by providing a context in which clinical practice learning was optimized. Challenges identified included managing time and workload pressures for students in relation to the CCE, inconsistencies in academic use of the experience, and variations in how the healthcare system influences the continuity experience. No research was found that reports on the educational model in terms of defining learning objectives and assessment of outcomes. This represents an important omission in mandating this clinical practice model in midwifery curricula without sufficient guidance to unify and maximize learning for students. Research is required to explore the educational intent and assessment methods of the Continuity of Care Experience as an educational model. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  15. [Continuity of care by Pflegeüberleitung? Results of participant observation].

    Science.gov (United States)

    Bräutigam, Christoph; Klettke, Nicole; Kunstmann, Wilfried; Prietz, Angela; Sieger, Margot

    2005-04-01

    Continuity of care between health care institutions is of increasing importance. In a two-year research project on this topic extensive participant observation was carried out for data gathering in three hospitals in Düsseldorf (Germany). In each institution four patients were observed until their discharge and all interactions between them and health care professionals were documented using a semi-structured data-gathering instrument. Furthermore, the researchers questioned the involved professionals after each situation. Altogether a total of 980 situations were documented during 100 shifts, thus professional activities aiming at continuity of care can be regarded as extensively covered. The results show that care professionals (nurses, physicians, social workers etc.) in the three participating hospitals only incompletely assess individual needs or even fail to do so at all. In addition, there is no regular interprofessional collaboration and the professionals' horizon is essentially limited to their own institution. Patients and their relatives are not systematically involved and their views rarely considered. Two cases are used as examples to illustrate these aspects. A third example shows that also successful processes were observed. In most cases, however, the implicit logic of the hospital system dominates over individual needs and therefore a successful continuity of care processes cannot be assumed. Finally, the necessity for a fundamental change of this counterproductive systems logic is briefly discussed.

  16. Continuity of care to optimize chronic disease management in the community setting: an evidence-based analysis.

    Science.gov (United States)

    2013-01-01

    This evidence-based analysis reviews relational and management continuity of care. Relational continuity refers to the duration and quality of the relationship between the care provider and the patient. Management continuity ensures that patients receive coherent, complementary, and timely care. There are 4 components of continuity of care: duration, density, dispersion, and sequence. The objective of this evidence-based analysis was to determine if continuity of care is associated with decreased health resource utilization, improved patient outcomes, and patient satisfaction. MEDLINE, EMBASE, CINAHL, the Cochrane Library, and the Centre for Reviews and Dissemination database were searched for studies on continuity of care and chronic disease published from January 2002 until December 2011. Systematic reviews, randomized controlled trials, and observational studies were eligible if they assessed continuity of care in adults and reported health resource utilization, patient outcomes, or patient satisfaction. Eight systematic reviews and 13 observational studies were identified. The reviews concluded that there is an association between continuity of care and outcomes; however, the literature base is weak. The observational studies found that higher continuity of care was frequently associated with fewer hospitalizations and emergency department visits. Three systematic reviews reported that higher continuity of care is associated with improved patient satisfaction, especially among patients with chronic conditions. Most of the studies were retrospective cross-sectional studies of large administrative databases. The databases do not capture information on trust and confidence in the provider, which is a critical component of relational continuity of care. The definitions for the selection of patients from the databases varied across studies. There is low quality evidence that: Higher continuity of care is associated with decreased health service utilization.There is

  17. Continuity of care in maternity services: women's views of one team midwifery scheme.

    Science.gov (United States)

    Farquhar, M; Camilleri-Ferrante, C; Todd, C

    2000-03-01

    To describe the views of women using one team midwifery scheme and compare them with women using more traditional models of midwifery care. Postal and interview survey of 1482 consecutive women delivering over a six-month period. Hospital and community in the South-East of England. Three groups of women were surveyed: (1) the Study Group consisted of women who delivered either at Hospital A or at home, and who received their antenatal, intrapartum and postnatal care from one of seven midwifery teams; (2) Comparison Group A consisted of women who received their antenatal and postnatal care from traditionally organised community midwives who were delivered by hospital midwives at Hospital A; and (3) Comparison Group B consisted of women who received their antenatal and postnatal care from traditionally organised community midwives who were delivered by hospital midwives at Hospital B. Postal questionnaires and interviews, and an audit of midwife contacts. Process of care and satisfaction with care. 88% of women responded. Women cared for under the team scheme exhibited no overall advantages in terms of satisfaction with various aspects of their care. Women cared for under the traditional model of care were the most satisfied with antenatal care. They had reported the highest percentage of named midwives, the highest continuity of carer antenatally and were the most likely to say that they had formed a relationship with their midwives. The majority of women who had met their delivering midwives previously did report that it made them feel more at ease, however, the majority of those who had not met their delivering midwives previously reported that it did not affect them one way or the other. In the team scheme, attempts to increase continuity of carer throughout pregnancy, labour and the postnatal period appear to have occurred at the expense of continuity in the ante- and postnatal periods. From the women's perspective the findings of this study support the view

  18. 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

    2016-01-01

    Abstract 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

  19. 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

  20. High experienced continuity in breast cancer care is associated with high health related quality of life.

    Science.gov (United States)

    Plate, Susann; Emilsson, Louise; Söderberg, Martin; Brandberg, Yvonne; Wärnberg, Fredrik

    2018-02-20

    High experienced continuity is known to be associated with lower needs for supportive care and most likely higher quality of life. On this background, the aim of this study was to investigate if patient-experienced continuity of care was associated with health-related quality of life (HRQoL) in breast cancer patients treated at two different-sized breast cancer units. In 2016, two questionnaires, "Statements on experienced continuity of care" and "The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30)", were sent out to patients diagnosed between 2011 and 2014 at two different-sized breast cancer units in Sweden. Lead times and other data reflecting medical quality were collected from the patients' medical records and from the National Swedish Breast Cancer Quality Register. Of 356 eligible patients, 231 (65%) answered the questionnaires, of whom 218 patients were included in the analyses. A statistically significant association was found between high experienced continuity and high global HRQoL (p = 0.03). Continuity was higher at the smaller unit, while no major differences between the units were found regarding medical quality or lead times. The study found that high experienced continuity and HRQoL was strongly associated. A statistically significant higher continuity of care was found at the smaller unit, in line with what was expected. The absence of clinically relevant differences in lead times and medical quality may indicate that continuity could be achieved without loss of quality.

  1. Clinical Updates in Women's Health Care Summary: Ischemic Heart Disease: Primary and Preventive Care Review.

    Science.gov (United States)

    Fuller, Brittany S; Carlyle, Lynn; Voeltz, Michele D

    2017-11-01

    Cardiovascular disease is the leading cause of death among women in the United States. Obstetrician-gynecologists often are the sole health care providers for otherwise healthy women. Therefore, they must be aware of risk factors, signs, and symptoms of cardiovascular disease and be prepared to recognize and treat this condition in patients as well as provide referrals when specialized care is indicated. Women with cardiac problems typically present with chest discomfort; however, they also are more likely than healthy women to present with other common symptoms, such as shortness of breath, back pain, jaw pain, or nausea and vomiting. This monograph, with a primary focus on ischemic heart disease (IHD), discusses the basic anatomy of the heart and coronary arteries; vascular biology; pathogenesis of atherosclerosis; and the screening, prevention, diagnosis, and treatment of IHD as well as the multiple risk factors associated with the development of IHD that contribute to both increased morbidity and mortality.

  2. Continuity in long-term home health care. Perspectives of managers, patients and their next of kin

    OpenAIRE

    Gjevjon, Edith Lillian Roth

    2014-01-01

    Home health care is increasingly preferred as the setting for care for older people who depend on daily and long-term care. During a long-term care trajectory in a context where home health care is a 24-hour service with three shifts of staff patients meet many professional carers. Research on continuity of care abound, studies in such care settings are scarce. Three sub-studies were performed in order to 1) develop a new method for assessing interpersonal continuity of care by adapting exist...

  3. Continuity in home health care: is consistency in nursing personnel associated with better patient outcomes?

    Science.gov (United States)

    Russell, David; Rosati, Robert J; Rosenfeld, Peri; Marren, Joan M

    2011-11-01

    A growing body of evidence suggests that patients who receive coordinated and uninterrupted health care services have better outcomes, more efficient resource utilization, and lower costs of health care. However, limited research has considered whether attributes of continuity in home health care service delivery are associated with improved patient outcomes. The present study examines the relationship between one dimension of continuity of care, consistency in nursing personnel, and three patient outcomes: hospitalization, emergent care, and improvement in activities of daily living. Analyses of data from a large population of home health patients (N=59,854) suggest that greater consistency in nursing personnel decreases the probability of hospitalization and emergent care, and increases the likelihood of improved functioning in activities of daily living between admission and discharge from home health care. These results provide preliminary evidence that efforts to decrease dispersion of nursing personnel across a series of home visits to patients may lead to improved outcomes. The implications of these findings for clinical practice and further research are discussed in the paper. © 2011 National Association for Healthcare Quality.

  4. 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.

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

    Science.gov (United States)

    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.

  6. [New clinical and organizational approaches to preventing cardiovascular diseases in the primary health care system].

    Science.gov (United States)

    Boĭtsov, S A; Kalinina, A M; Ipatov, P V

    2013-01-01

    The paper deals with the justification and description of clinical and organizational approaches to preventing cardiovascular diseases (CVD) in the primary health care system (PHCS) under the present conditions of health care modernization in Russia. It formulates the basic directions of systematic measures in integration strategies for the prevention of noncommunicable diseases (mainly CVD) at a federal level, in which practical measures are presented to improve a system for the early detection of high-risk individuals and to carry out measures for risk factor correction in PHCS, i.e. to implement high-risk strategies, including clinical and organizational approaches to reconstituting the medical prevention infrastructure in PHCS. This is favored by the new normative documents adopted by the Ministry of Health of Russia on the follow-up and prophylactic medical examinations of the adult population. The paper substantiates the objective need for such examinations and characterizes the main clinical and organizational approaches promoted in medical examinations, which is aimed at introducing the current science-based and economically expedient methods in the real practice of PHCS for the early identifications of atherosclerosis-induced major CVDs and, what is particularly important, a risk for their development. Prophylactic counseling as a compulsory component is first being introduced in medical examination procedures. The key clinical and organizational principle of effective CVD prevention in public health is the implementation of the relationship and continuity of preventive measures, which becomes realistic with the adoption of new regulations of clinical examinations, prophylactic medical examinations, and follow-ups. The improvement of CVD prevention is associated not only with the introduction of organizational innovation changes, but also with the need to create a prevention ideology in physicians at all levels. It is emphasized that a comprehensive

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

    Science.gov (United States)

    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.

  8. 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.

  9. The Nordic Maintenance Care Program: when do chiropractors recommend secondary and tertiary preventive care for low back pain?

    OpenAIRE

    Lange Fredrik; Lövgren Peter W; Jørgensen Kristian; Halasz Laszlo; Eklund Andreas; Jensen Irene B; Axén Iben; Rosenbaum Annika; Leboeuf-Yde Charlotte

    2009-01-01

    Abstract Background Among chiropractors the use of long-term treatment is common, often referred to as "maintenance care". Although no generally accepted definition exists, the term has a self-explanatory meaning to chiropractic clinicians. In public health terms, maintenance care can be considered as both secondary and tertiary preventive care. The objective of this study was to explore what factors chiropractors consider before recommending maintenance care to patients with low back pain (L...

  10. Preventing vacuum leaks in the Continuous Electron Beam Accelerator Facility cavity pair bellows

    International Nuclear Information System (INIS)

    Henkel, D.P.; Doolittle, L.R.

    1994-01-01

    Occasional vacuum leaks have occurred in bellows assemblies of helium pressure vessels at the Continuous Electron Beam Accelerator Facility. The flanged stainless steel bellows assemblies are used to connect the niobium rf cavity pairs to the surrounding liquid helium pressure vessels. An investigation of the source of these leaks has revealed a through-thickness network of microcracks in the cuff weld zones. The cuff material contained a mixture of soft and very hard elongated intermetallic inclusions that were oriented parallel with the weld fusion line; these inclusions served as crack initiation sites. Surface-exposed inclusions, in contact with a chlorine residue from a postweld machining process, induced crevice corrosion during a year of storage. Residual stresses in the weld led to a combination of lamellar tearing and stress corrosion cracking. Propagation of the cracks from one inclusion to another resulted in continuous vacuum leakage paths from the primary (2 K) helium circuit to the vacuum insulation space. Additional vacuum leaks were prevented by reconfiguring the weld geometry and avoiding any processing with chlorinated substances

  11. 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

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

    Science.gov (United States)

    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.

  13. Starting insulin in type 2 diabetes : Continue oral hypoglycemic agents? A randomized trial in primary care

    NARCIS (Netherlands)

    Goudswaard, AN; Stolk, RP; Zuithoff, P; de Valk, HW; Rutten, GE

    Objective To evaluate the effects of insulin 30/70 twice daily or bedtime isophane (NPH) insulin plus continued sulfonylurea and metformin in patients with type 2 diabetes in primary care. Study Design Open-label, randomized trial. Population Persons younger than 76 years with type 2 diabetes whose

  14. Association between Continuing Education and Job Satisfaction of Nurses Employed in Long-Term Care Facilities.

    Science.gov (United States)

    Robertson, Ethel M.; Higgins, Leslie; Rozmus, Cathy; Robinson, James P.

    1999-01-01

    Continuing-education participation and job satisfaction of 85 licensed practical nurses and 25 registered nurses in long-term care were compared. There were no differences between full- and part-time staff. Nurses with higher family incomes participated more frequently. Registered nurses participated more and had greater job satisfaction. (SK)

  15. Exploring Continuity of Care in Patients with Alcohol Use Disorders Using Time-Variant Measures

    NARCIS (Netherlands)

    S.C. de Vries (Sjoerd); A.I. Wierdsma (André)

    2008-01-01

    textabstractBackground/Aims: We used time-variant measures of continuity of care to study fluctuations in long-term treatment use by patients with alcohol-related disorders. Methods: Data on service use were extracted from the Psychiatric Case Register for the Rotterdam Region, The Netherlands.

  16. [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.

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

    OpenAIRE

    Hetlevik, Oystein; Hustoft, Merethe; Uijen, A.A.; Assmus, Jorg; Gjesdal, Sturla

    2017-01-01

    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 d...

  18. The effect of topical olive oil on prevention of bedsore in intensive care units patients

    OpenAIRE

    Zahra Abbas Ali Madadi; Reza Zeighami; Jalil Azimian; Amir Javadi

    2015-01-01

    Background: Bedsores are injuries to skin and underlying tissues caused by prolonged pressure. Although, some methods like frequently changing position and using particular tools are used for preventing and caring of pressure ulcers, their prevention would still be as a vital urgency. Olive oil is an herbal product with potential preventive effects to prevent bedsores because of its numerous medical properties. The major aim of this study was to determine whether topical olive oil can prevent...

  19. 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.

  20. Expanding Continuous Quality Improvement Capacity in the Medical Intensive Care Unit: Prehealth Volunteers as a Solution.

    Science.gov (United States)

    Priest, Kelsey C; Lobingier, Hannah; McCully, Nancy; Lombard, Jackie; Hansen, Mark; Uchiyama, Makoto; Hagg, Daniel S

    2016-01-01

    Health care delivery systems are challenged to support the increasing demands for improving patient safety, satisfaction, and outcomes. Limited resources and staffing are common barriers for making significant and sustained improvements. At Oregon Health & Science University, the medical intensive care unit (MICU) leadership team faced internal capacity limitations for conducting continuous quality improvement, specifically for the implementation and evaluation of the mobility portion of an evidence-based care bundle. The MICU team successfully addressed this capacity challenge using the person power of prehealth volunteers. In the first year of the project, 52 trained volunteers executed an evidence-based mobility intervention for 305 critically ill patients, conducting more than 200 000 exercise repetitions. The volunteers contributed to real-time evaluation of the project, with the collection of approximately 26 950 process measure data points. Prehealth volunteers are an untapped resource for effectively expanding internal continuous quality improvement capacity in the MICU and beyond.

  1. Bringing Central Line–Associated Bloodstream Infection Prevention Home: CLABSI Definitions and Prevention Policies in Home Health Care Agencies

    Science.gov (United States)

    Rinke, Michael L.; Bundy, David G.; Milstone, Aaron M.; Deuber, Kristin; Chen, Allen R.; Colantuoni, Elizabeth; Miller, Marlene R.

    2015-01-01

    Background A study was conducted to investigate home health care agency central line–associated bloodstream infection (CLABSI) definitions and prevention policies and compare them to the Joint Commission National Patient Safety Goal (NPSG.07.04.01), the Centers for Disease Control and Prevention (CDC) CLABSI prevention recommendations, and a best-practice central line care bundle for inpatients. Methods A telephone-based survey was conducted in 2011 of a convenience sample of home health care agencies associated with children’s hematology/oncology centers. Results Of the 97 eligible home health care agencies, 57 (59%) completed the survey. No agency reported using all five aspects of the National Healthcare and Safety Network/Association for Professionals in Infection Control and Epidemiology CLABSI definition and adjudication process, and of the 50 agencies that reported tracking CLABSI rates, 20 (40%) reported using none. Only 10 agencies (18%) had policies consistent with all elements of the inpatient-focused NPSG.07.04.01, 10 agencies (18%) were consistent with all elements of the home care targeted CDC CLABSI prevention recommendations, and no agencies were consistent with all elements of the central line care bundle. Only 14 agencies (25%) knew their overall CLABSI rate: mean 0.40 CLABSIs per 1,000 central line days (95% confidence interval [CI], 0.18 to 0.61). Six agencies (11%) knew their agency’s pediatric CLABSI rate: mean 0.54 CLABSIs per 1,000 central line days (95% CI, 0.06 to 1.01). Conclusions The policies of a national sample of home health care agencies varied significantly from national inpatient and home health care agency targeted standards for CLABSI definitions and prevention. Future research should assess strategies for standardizing home health care practices consistent with evidence-based recommendations. PMID:23991509

  2. Factors associated with the effectiveness of continuing education in long-term care.

    Science.gov (United States)

    Stolee, Paul; Esbaugh, Jacquelin; Aylward, Sandra; Cathers, Tamzin; Harvey, David P; Hillier, Loretta M; Keat, Nancy; Feightner, John W

    2005-06-01

    This article examines factors within the long-term-care work environment that impact the effectiveness of continuing education. In Study 1, focus group interviews were conducted with staff and management from urban and rural long-term-care facilities in southwestern Ontario to identify their perceptions of the workplace factors that affect transfer of learning into practice. Thirty-five people were interviewed across six focus groups. In Study 2, a Delphi technique was used to refine our list of factors. Consensus was achieved in two survey rounds involving 30 and 27 participants, respectively. Management support was identified as the most important factor impacting the effectiveness of continuing education. Other factors included resources (staff, funding, space) and the need for ongoing expert support. Organizational support is necessary for continuing education programs to be effective and ongoing expert support is needed to enable and reinforce learning.

  3. The association between continuity of care and readmission to hospital in patients with severe psychosis.

    Science.gov (United States)

    Puntis, Stephen Robert; Rugkåsa, Jorun; Burns, Tom

    2016-12-01

    Providing good continuity of care to patients is considered a vital component of community mental health services, but there is limited evidence that it is associated with good outcomes. We measured service use and a multidimensional concept of continuity of care in 323 patients who were to be discharged from hospital following compulsory treatment for psychosis to investigate the association between continuity and rehospitalisation. We conducted a 36-month prospective cohort study of the patients recruited to the Oxford Community Treatment Order Trial (OCTET). We collected data from medical records on eight previously operationalized measures of continuity. We conducted regression analyses to determine the association between these measures and readmission to hospital, time to readmission, and the number of days spent in hospital. Almost two thirds (n = 206, 63.8%) of patients were readmitted. Patients were seen frequently, with a mean of 2.9 (SD = 2.47) contacts a month throughout the follow-up. Less frequent contact was significantly associated with lower odds of rehospitalisation and fewer days in hospital. More changes in the patient's care coordinator were associated with more time in hospital. Patients who had a higher proportion of clinical correspondence copied to them spent fewer days in hospital. Patients with severe and relapsing psychotic illness are seen frequently and consistently in community mental health services. Higher levels of patient contact could be a response to the severity of illness rather than a marker of quality of care. Using a simple linear interpretation of contact frequency as a measure of continuity of care in this patient group may be of limited value in modern services.

  4. Prevention and Control of Dental Disease through Improved Access to Comprehensive Care.

    Science.gov (United States)

    American Dental Association, Chicago, IL.

    Prevention of dental disease is the key to improving the nation's oral health. The American Dental Association (ADA) program of prevention and control of dental disease through improved access to comprehensive care concentrates on those who have special difficulties in receiving care: the poor, the elderly, the handicapped, the institutionalized…

  5. Social capital and preventive care use among the elderly under Taiwan's National Health Insurance.

    Science.gov (United States)

    Peng, Yu-I; Lin, Tsui-Fang

    The National Health Insurance (NHI) system in Taiwan provides free annual preventive care services and other disease-specific preventive care services under low copayments to people aged 65 and older, yet their utilization rates remain low ever since implementation. This study investigates whether social capital is associated with preventive care use among people aged 65 and older. Using the 2009 National Health Interview Study, this study measures social capital by the elderly's social network and social participation, and employs the logistic regressions to estimate the association between social capital and the odds of using a variety of preventive care services. The results show that social capital in terms of social network and social participation is significantly associated with the use of NHI general preventive care services. For disease-specific preventive care, it is social participation, rather than social network, that is related to the utilization rate. The associations between social capital and different types of preventive care use found in our study could be considered as an important factor when making policies to promote the utilization of preventive care. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Improved Prevention Counseling by HIV Care Providers in a Multisite, Clinic-Based Intervention: Positive STEPs

    Science.gov (United States)

    Thrun, Mark; Cook, Paul F.; Bradley-Springer, Lucy A.; Gardner, Lytt; Marks, Gary; Wright, Julie; Wilson, Tracey E.; Quinlivan, E. Byrd; O'Daniels, Christine; Raffanti, Stephen; Thompson, Melanie; Golin, Carol

    2009-01-01

    The Centers for Disease Control and Prevention have recommended that HIV care clinics incorporate prevention into clinical practice. This report summarizes HIV care providers' attitudes and counseling practices before and after they received training to deliver a counseling intervention to patients. Providers at seven HIV clinics received training…

  7. The Interplay Between Continuity of Care, Multimorbidity, and Adverse Events in Patients With Diabetes.

    Science.gov (United States)

    Weir, Daniala L; McAlister, Finlay A; Majumdar, Sumit R; Eurich, Dean T

    2016-04-01

    To evaluate the impact of continuity of care and multimorbidity on health outcomes in patients with diabetes. Using a US claims database of insured patients, we identified those with incident diabetes between 2004 and 2008 and followed them until death, disenrollment, or December 31, 2010. Continuity of care was defined using Breslau's Usual Provider of Continuity (UPC; proportion of visits to the usual or predominant provider within 2 y of diabetes diagnosis). Multivariable logistic regression was used to determine the association between UPC in the first 2 years after diabetes diagnosis and subsequent 1-year composite primary outcome of all-cause hospitalization or death in year 3 in patients with/without multimorbidity. Of the 285,231 patients with incident diabetes, 74% had multimorbidity; their average age was 53 years (SD=10.5) and 49% were female. A total of 77,270 (27%) individuals had a mean UPC≥75% in the first 2 years. During year 3 of follow-up, 33,632 (12%) patients died or were hospitalized for any cause. Greater continuity of care (UPC≥75%) was associated with reduced risk of subsequent death or hospitalization [7.2% vs. 13.5%; adjusted odds ratio (aOR)=0.72; 95% CI, 0.70-0.75]. Although multimorbidity was independently associated with an increased risk of our primary composite endpoint (13.4% vs. 7.2%; aOR=1.26; 95% CI, 1.21-1.30), the association between greater continuity and better outcomes was similar in those with multimorbidity (aOR=0.71; 95% CI, 0.69-0.71) as in those without (aOR=0.75; 95% CI, 0.71-0.80). In patients with incident diabetes, greater continuity of care is associated with improved outcomes, irrespective of whether or not they have multimorbidity.

  8. Prevention and treatment of periodontal diseases in primary care.

    Science.gov (United States)

    Matthews, Debora C

    2014-09-01

    The aim of this guidance is to support the dental team to; manage patients with periodontal diseases in primary care appropriately; improve the quality of decision making for referral to secondary care; improve the overall oral health of the population. It focuses on the prevention and non-surgical treatment of periodontal diseases and implant diseases in primary care. The surgical treatment of periodontal and implant diseases and the management of patients by periodontal specialists or in a secondary care setting are outwith the scope of this guidance and are not discussed in detail. The guidance is based on existing guidelines, including those from the British Society of Periodontology, relevant systematic reviews, research evidence and the opinion of experts and experienced practitioners. The methodological approach is based on the international standards set out by the Appraisal of Guidelines Research and Evaluation (AGREE) Collaboration (www.agreetrust.org). The guiding principle for developing guidance within SDCEP is to first source existing guidelines, policy documents, legislation or other recommendations. Similarly, relevant systematic reviews are also initially identified. These documents are appraised for their quality of development, evidence base and applicability to the remit of the guidance under development. In the absence of these documents or when supplementary information is required, other published literature and unpublished work may be sought.Review and updating. The guidance will be reviewed in three years and updated accordingly. Recommendations are provided for assessment and diagnosis; changing patient behaviour; treatment of gingival conditions; periodontal conditions; long term maintenance; management of patients with dental implants; referral and record keeping. The key recommendations highlighted are: Assess and explain risk factors for periodontal diseases to patients. Screen all patients for periodontal diseases at every routine

  9. [Psychological effects of preventive voice care training in student teachers].

    Science.gov (United States)

    Nusseck, M; Richter, B; Echternach, M; Spahn, C

    2017-07-01

    Studies on the effectiveness of preventive voice care programs have focused mainly on voice parameters. Psychological parameters, however, have not been investigated in detail so far. The effect of a voice training program for German student teachers on psychological health parameters was investigated in a longitudinal study. The sample of 204 student teachers was divided into the intervention group (n = 123), who participated in the voice training program, and the control group (n = 81), who received no voice training. Voice training contained ten 90-min group courses and an individual visit by the voice trainer in a teaching situation with feedback afterwards. Participants were asked to fill out questionnaires (self-efficacy, Short-Form Health Survey, self-consciousness, voice self-concept, work-related behaviour and experience patterns) at the beginning and the end of their student teacher training period. The training program showed significant positive influences on psychological health, voice self-concept (i.e. more positive perception and increased awareness of one's own voice) and work-related coping behaviour in the intervention group. On average, the mental health status of all participants reduced over time, whereas the status in the trained group diminished significantly less than in the control group. Furthermore, the trained student teachers gained abilities to cope with work-related stress better than those without training. The training program clearly showed a positive impact on mental health. The results maintain the importance of such a training program not only for voice health, but also for wide-ranging aspects of constitutional health.

  10. Continuity of care for women with breast cancer: a survey of the views and experiences of patients, carers and health care professionals.

    Science.gov (United States)

    Lafferty, Joan; Rankin, Fiona; Duffy, Celine; Kearney, Patricia; Doherty, Elaine; McMenamin, Mary; Coates, Vivien

    2011-12-01

    The need for continuity of care in the management of women diagnosed with breast cancer is important yet challenging. The aim was twofold; to explore 1) the concept of continuity of care from the perspectives of women diagnosed with breast cancer, their carers and their health care professionals (HCPs), 2) actual experiences amongst these three groups relating to continuity of care. A three-phase cross-sectional survey was conducted involving eight focus group interviews with women who had been diagnosed with breast cancer (n = 47) and structured questionnaires to both carers (n = 33) and HCPs (n = 44). Data were analysed according to three categories of continuity of care; relational, informational and managerial. According to the patients: 'Continuity of Care' is the continuous care over time; it involves the relationship between the HCP and the patient. It is not just a follow-up review. The relationship is built on trust, loyalty and constancy. The perception is that the providers of care know you, know your case history and your future care is agreed on.' Across all phases of the study the three categories of continuity of care were identified but there were differences as to the weight different groups placed on them. Continuity of care was reported to be achieved for the majority of the respondents across all three samples however deficiencies in the service were identified. The results provide an opportunity to improve service; recommendations have been made and steps to implementation taken. Copyright © 2010 Elsevier Ltd. All rights reserved.

  11. Evaluation of a Continuing Educational Intervention for Primary Health Care Professionals about Nutritional Care of Patients at Home.

    Science.gov (United States)

    Berggren, E; Orrevall, Y; Olin, A Ödlund; Strang, P; Szulkin, R; Törnkvist, L

    2016-04-01

    Evaluate the effectiveness of a continuing educational intervention on primary health care professionals' familiarity with information important to nutritional care in a palliative phase, their collaboration with other caregivers, and their level of knowledge about important aspects of nutritional care. Observational cohort study. 10 primary health care centers in Stockholm County, Sweden. 140 district nurses/registered nurses and general practitioners/physicians working with home care. 87 professionals participated in the intervention group (IG) and 53 in the control group (CG). The intervention consisted of a web-based program offering factual knowledge; a practical exercise linking existing and new knowledge, abilities, and skills; and a case seminar facilitating reflection. The intervention's effects were measured by a computer-based study-specific questionnaire before and after the intervention, which took approximately 1 month. The CG completed the questionnaire twice (1 month between response occasions). The intervention effects, odds ratios, were estimated by an ordinal logistic regression. In the intra-group analyses, statistically significant changes occurred in the IG's responses to 28 of 32 items and the CG's responses to 4 of 32 items. In the inter-group analyses, statistically significant effects occurred in 20 of 32 statements: all 14 statements that assessed familiarity with important concepts and all 4 statements about collaboration with other caregivers but only 2 of the 14 statements concerning level of knowledge. The intervention effect varied between 2.5 and 12.0. The intervention was effective in increasing familiarity with information important to nutritional care in a palliative phase and collaboration with other caregivers, both of which may create prerequisites for better nutritional care. However, the intervention needs to be revised to better increase the professionals' level of knowledge about important aspects of nutritional care.

  12. 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.

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  15. Assessment of Continuity of Care among Patients with Multiple Chronic Conditions in Italy.

    Directory of Open Access Journals (Sweden)

    Francesco Napolitano

    Full Text Available The aims of the present study were to evaluate the extent of continuity of care and to investigate its association with several factors among a sample of outpatients with chronic diseases in Italy. The survey was conducted, using face to face interview, from March to December 2014 in a random sample of 633 outpatients with chronic conditions who were going in cardiology, metabolic disorders, and respiratory ambulatory center of four hospitals. A multivariate ordered logistic regression model was used to identify factors associated with the outpatients continuity of care. The mean of the Bice-Boxerman continuity of care (COC index related to the entire sample was 0.44, and 27.9%, 58.4%, 13.7% had a low, intermediate, and high value of the index based on the tertiles of the distribution. The results of the ordered logistic regression analysis showed that female patients, those older, those who had a lower score of Katz Index of independence in activities of daily living, those who had a lower Charlson et al. comorbidity score, and those who had no hospitalization in the last year, were significantly more likely to have a higher value of the COC index. Patients who had completed a secondary school education had significantly lower odds of having a high value of COC index in comparison to patients with a college degree educational level. Policy makers and clinicians involved in the care of patients should implement comprehensively and efficiently efforts in order to improve the continuity of care in patients with chronic diseases.

  16. Of poverty prevention in the Pentateuch as a continuing contemporary challenge

    Directory of Open Access Journals (Sweden)

    Eben Scheffler

    2013-09-01

    Full Text Available This article surveyed how the theme of poverty and caring for the poor functions in the Pentateuch in its legal as well as narrative sections. It included the discussion of a (hopefully representative selection of texts where the various Hebrew terms (ani or anw, ebjon and dal are employed, but also where they are absent but the issue is present. Attention is (amongst others paid to the goodness of creation as counter-pole for poverty in Genesis 1�3, poverty prevention in the Joseph novella, the Exodus as liberation text, the survival of the Israelites during the desert journey (Dt 8 and the specific measures prescribed in the Covenant Code (Ex 20:22�23:33, the Deuteronomic Code (Dt 12�26 and the Holiness Code (Lv 17�26. It is contended that the various expressions regarding poverty originated and functioned contingently in their ancient contemporary contexts but that they can also be critically appropriated in present-day contemporary contexts � for which a great need exists. The article concluded with ten (preliminary statements to the latter effect.

  17. Primary Health Care Follow-Up Visits: Investigation Of Care Continuity Of Preterm Newborns From A Kangaroo-Mother Care Unit

    Directory of Open Access Journals (Sweden)

    Marielle Ribeiro Feitosa

    2017-02-01

    Full Text Available INTRODUCTION: The kangaroo-mother care method is an approach adopted in Brazil as a public police, which has helped in the reduction of neonatal mortality rate. Premature birth and its vulnerabilities can trigger, especially in mothers, feelings of fear and insecurity related to taking care of newborns. OBJECTIVE: Investigate care continuity of preterm newborns from a kangaroo-mother care method unit in primary health care facilities. METHODS: It was a transversal study performed with 43 mothers of preterm newborns who were hospitalized in the rooming-in care unit of a kangaroo-mother care method unit of a Brazilian public maternity school. Data collection was carried out through a questionnaire, which was used to interview mothers between September 2015 and February 2016. RESULTS: It was found a relationship between sociodemographic status and risk of premature birth, and the following variables: age, education, marital status, and family income. Regarding findings from the follow-up home visits in primary health care, most of the participants were still breastfeeding and using the kangaroo position. However, 60.5% of the interviewed mothers reported not receiving home visits from health professionals of primary health care facilities. CONCLUSION: It is essential the support of health professionals and the participation of mothers and families to improve, through health education, quality of life promotion for newborns from kangaroo care approach.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. 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.

  20. Effects of continuity of care on hospital admission in patients with type 2 diabetes: analysis of nationwide insurance data.

    Science.gov (United States)

    Cho, Kyoung Hee; Lee, Sang Gyu; Jun, Byungyool; Jung, Bo-Young; Kim, Jae-Hyun; Park, Eun-Cheol

    2015-03-17

    A system for managing chronic disease including diabetes mellitus based on primary care clinics has been used in Korea since April 2012. This system can reduce copayments for patients that are managed by a single primary-care provider and lead to improve continuity of care. The aim of this study is to determine whether there is an association between continuity of care for outpatients and hospital admission and identify the continuity index that best explains hospital admissions for patients with type 2 diabetes. We performed a cross-sectional study using 2009 National Health Insurance Sample (NHIS) from the Health Insurance Review & Assessment Services (HIRA) of Korea. The dependent variable was hospital admission due to type 2 diabetes mellitus. Continuity of care was measured using the Usual Provider Care index (UPC), Continuity of Care index (COC), Sequential Continuity of Care index (SECON), and Integrated Continuity of Care index (ICOC). Patients with low COC scores (continuity of care may reduce the likelihood for hospital admission. The COC had marginally more explanatory power.

  1. Implementing a Continuity of Cancer Care nursing role into a New Zealand primary health organisation - the patient's perspective.

    Science.gov (United States)

    Scrymgeour, Gill; Forrest, Rachel; Marshall, Bob

    2013-12-01

    A Continuity of Cancer Care pilot project was established in two urban general practices, with the goal of improving cancer care and patient access to services. Practice nurses were engaged as coordinators to implement a model of care and patient navigation to offer continued and consistent care, and to assist the patient to navigate their cancer experience. The aim was to evaluate the effectiveness of the Continuity of Cancer Care pilot project. Patients enrolled in the pilot project were invited to participate. Each participant completed a Patient Satisfaction Questionnaire and SF-12 Health Survey, and was then invited to take part in an interview. The evaluation framework utilised concepts of informational, management and relational continuity. The SF-12 subcategories of physical functioning, role physical, bodily pain and role emotional were lower than other results from cancer patients in the literature. The Patient Satisfaction Questionnaire and interviews indicated patients were satisfied with the relational continuity components of the project, but that gaps existed within the management and informational continuity aspects of care. Overall, the participants were satisfied with the Continuity of Cancer Care programme and valued the support, clarification and listening aspects of the programme. However, when evaluated in relation to a more comprehensive definition of continuity of care, there were distinct gaps. While the relational aspects of continuity of care were mostly achieved, the management and informational aspects appeared to be limited primarily to nurses acting to interpret hospital and general practitioner comments for patients.

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

    Science.gov (United States)

    DuGoff, Eva H; Bandeen-Roche, Karen; Anderson, Gerard F

    2016-01-01

    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. To assess the relationship between measurement of continuity of care, number of chronic conditions, and health outcomes. 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 hospitalization occurring in the following 12-month period. After adjusting for baseline covariates, high known provider continuity (KPC) was associated with an 84% (adjusted odds ratio 0.16; 95% confidence interval 0.09-0.26) reduction in the risk of the composite outcome. High KPC was significantly associated with a lower risk of the composite outcome among individuals with ≥6 conditions. However, the usual provider of care and continuity of care indices were not significantly related with the composite outcome in the overall sample or in those with ≥6 conditions. The relationship between continuity of care and adverse outcomes depends on the measure of continuity of care employed. High morbidity patients are more likely to benefit from continuity of care interventions as measured by the KPC, which measures the proportion of a patient's visits that are with the same providers over time.

  3. The effectiveness of holistic diabetic management between Siriraj Continuity of Care clinic and medical out-patient department.

    Science.gov (United States)

    Chalermsri, Chalobol; Paisansudhi, Supalerg; Kantachuvesiri, Pitchaporn; Pramyothin, Pornpoj; Washirasaksiri, Chaiwat; Srivanichakorn, Weerachai; Nopmaneejumruslers, Cherdchai; Chouriyagune, Charoen; Pandejpong, Denla; Phisalprapa, Pochamana

    2014-03-01

    Diabetes mellitus is one of the most common diseases in the Thai population, and it is well known that diabetic complications could be prevented with appropriate management. Despite published guidelines, most Thai patients with diabetes do not achieve treatment goals. Siriraj Continuity of Care clinic (CC clinic) was recently established in order to provide training for medical students and internal medicine residents. It is possible that the training component in the CC clinic may contribute to better overall outcomes in type 2 diabetes mellitus (type 2 DM) patients when compared with usual care at the medical out-patient department (OPD). To compare the effectiveness of diabetic management in type 2 diabetes mellitus patients who attended the CC clinic and the medical OPD. Retrospective chart review was performed in type 2 diabetes mellitus patients who were treated at either clinic at Siriraj Hospital in 2007-2011. Baseline demographics, treatment strategies and outcomes, and participation in an appropriate health maintenance program were assessed in both groups. Seven hundred and fifty seven medical records were reviewed, including 383 patients in the CC clinic group and 374 in the OPD group. Mean HbA1c was significantly lower in the CC clinic group compared with the OPD group (7.3 +/- 0.9% and 7.8 +/- 1.3%, respectively, 3.0% vs. 7.4%, p < 0.001 for colon cancer). Moreover, significantly more patients in the CC clinic group received recommended immunization (influenza, diphtheria tetanus and pneumococcal vaccine) compared with the control group (p < or = 0.001). Diabetic patients treated at the CC clinic had better clinical outcomes and healthcare maintenance compared with those who received usual care at the medical OPD. Continuity of care and integrated training component may have contributed to the improved outcomes.

  4. Prevention of respiratory complications of the surgical patient: actionable plan for continued process improvement.

    Science.gov (United States)

    Ruscic, Katarina J; Grabitz, Stephanie D; Rudolph, Maíra I; Eikermann, Matthias

    2017-06-01

    Postoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to $35 000. These outcomes measures have gained prominence as bundled payments have become more common. Results of recent quantitative effectiveness studies and clinical trials provide a framework that helps develop center-specific treatment guidelines, tailored to minimize the risk of PRCs. The implementation of those protocols should be guided by a local, respected, and visible facilitator who leads proper implementation while inviting center-specific input from surgeons, anesthesiologists, and other perioperative stakeholders. Preoperatively, patients should be risk-stratified for PRCs to individualize intraoperative choices and postoperative pathways. Laparoscopic compared with open surgery improves respiratory outcomes. High-risk patients should be treated by experienced providers based on locally developed bundle-interventions to optimize intraoperative treatment and ICU bed utilization. Intraoperatively, lung-protective ventilation (procedure-specific positive end-expiratory pressure utilization, and low driving pressure) and moderately restrictive fluid therapy should be used. To achieve surgical relaxation, high-dose neuromuscular blocking agents (and reversal agents) as well as high-dose opioids should be avoided; inhaled anesthetics improve surgical conditions while protecting the lungs. Patients should be extubated in reverse Trendelenburg position. Postoperatively, continuous positive airway pressure helps prevent airway collapse and protocolized, early mobilization improves cognitive and respiratory function.

  5. Correlates of continued risky sex among pregnant African American teens: implications for STD prevention.

    Science.gov (United States)

    Crosby, Richard A; DiClemente, Ralph J; Wingood, Gina M; Rose, Eve; Lang, Delia

    2003-01-01

    African American adolescent females have been understudied with regard to their continued sexually transmitted disease (STD) risk behavior during pregnancy. Preintervention studies of this population are especially important because the sequelae of STDs during pregnancy can be particularly problematic. This exploratory study identified correlates of engaging in relatively frequent penile-vaginal sex, unprotected by a condom, among inner-city African American adolescents during their first or second trimester of pregnancy. Baseline data collected as part of an HIV prevention study were used. Adolescents at their first prenatal visit completed a self-administered survey and face-to-face interview. Only adolescents reporting a current boyfriend were included in this exploratory analysis (n = 144). Significant bivariate correlates were assessed for multivariate significance. Significant bivariate correlates of relatively frequent unprotected vaginal sex were older age (P parent (P communication (communicating about sex) with the boyfriend (P parent (adjusted odds ratio [AOR] = 2.24; P communication with the boyfriend (AOR = 2.88; P parents.

  6. Prevention of falls, malnutrition and pressure ulcers among older persons - nursing staff's experiences of a structured preventive care process.

    Science.gov (United States)

    Lannering, Christina; Ernsth Bravell, Marie; Johansson, Linda

    2017-05-01

    A structured and systematic care process for preventive work, aimed to reduce falls, pressure ulcers and malnutrition among older people, has been developed in Sweden. The process involves risk assessment, team-based interventions and evaluation of results. Since development, this structured work process has become web-based and has been implemented in a national quality registry called 'Senior Alert' and used countrywide. The aim of this study was to describe nursing staff's experience of preventive work by using the structured preventive care process as outlined by Senior Alert. Eight focus group interviews were conducted during 2015 including staff from nursing homes and home-based nursing care in three municipalities. The interview material was subjected to qualitative content analysis. In this study, both positive and negative opinions were expressed about the process. The systematic and structured work flow seemed to only partly facilitate care providers to improve care quality by making better clinical assessments, performing team-based planned interventions and learning from results. Participants described lack of reliability in the assessments and varying opinions about the structure. Furthermore, organisational structures limited the preventive work. © 2016 John Wiley & Sons Ltd.

  7. A Profile of Patients With Traumatic Brain Injury Within Home Care, Long-Term Care, Complex Continuing Care, and Institutional Mental Health Settings in a Publicly Insured Population.

    Science.gov (United States)

    Colantonio, Angela; Hsueh, Jayden; Petgrave, Josian; Hirdes, John P; Berg, Katherine

    2015-01-01

    To describe the sociodemographic and clinical profile of people with traumatic brain injury (TBI) in home care, nursing homes, and complex continuing care settings in a national sample. Cross-sectional study using available Resident Assessment Instrument (RAI 2.0 and RAI Home Care [HC]) national databases in Canada from 1996 to 2011. The profile of people with TBI was compared with patients with and without prespecified neurological conditions within each setting. Adults 18 years and older identified with TBI (n = 10 878) and adult patients with other neurological (n = 422 300) and non-neurological (n = 571 567) conditions. Demographic and clinical characteristics, functional characteristics, mood and behavior, and treatment and medication variables. Data from Canadian home care (RAI-HC), mental health (RAI-MH), nursing home, and complex continuing care facilities (RAI Minimum Data Set 2.0). Patients with TBI were significantly different on almost all items. They were among the youngest in care settings, and psychotropic drug use by this population was among the highest in at least 2 settings. These data can inform the planning for appropriate care and resources for patients with TBI in a range of settings.

  8. 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 ...

  9. Physical and Occupational Therapy From the Acute to Community Setting After Stroke: Predictors of Use, Continuity of Care, and Timeliness of Care.

    Science.gov (United States)

    Freburger, Janet K; Li, Dongmei; Johnson, Anna M; Fraher, Erin P

    2017-04-04

    To identify predictors of therapist use (any use, continuity of care, timing of care) in the acute care hospital and community (home or outpatient) for patients discharged home after stroke. Retrospective cohort analysis of Medicare claims (2010-2013) linked to hospital-level and county-level data. Acute care hospital and community. Patients (N=23,413) who survived the first 30 days at home after being discharged from an acute care hospital after stroke. Not applicable. Physical and occupational therapist use in acute care and community settings; continuity of care across the inpatient and home or the inpatient and outpatient settings; and early therapist use in the home or outpatient setting. Multivariate logistic and multinomial logistic regression analyses were conducted to identify hospital-level, county-level, and sociodemographic characteristics associated with therapist use, continuity, and timing, controlling for clinical characteristics. Seventy-eight percent of patients received therapy in the acute care hospital, but only 40.8% received care in the first 30 days after discharge. Hospital nurse staffing was positively associated with inpatient and outpatient therapist use and continuity of care across settings. Primary care provider supply was associated with inpatient and outpatient therapist use, continuity of care, and early therapist care in the home and outpatient setting. Therapist supply was associated with continuity of care and early therapist use in the community. There was consistent evidence of sociodemographic disparities in therapist use. Therapist use after stroke varies in the community and for specific sociodemographic subgroups and may be underused. Inpatient nurse staffing levels and primary care provider supply were the most consistent predictors of therapist use, continuity of care, and early therapist use. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  10. Compliance With Infection Prevention Guidelines By Health Care ...

    African Journals Online (AJOL)

    USER

    infection prevention. The study further reviewed revealed varied levels of compliance on different components of infection prevention. The highest level of compliance (100%) was ... having a Surgical Site Infection (SSI) increases a patient's hospital stay by ... operative wound infection rate of 5%10. LITERATURE REVIEW.

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

    OpenAIRE

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

    2001-01-01

    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 stat...

  12. Standardized nomenclatures: keys to continuity of care, nursing accountability and nursing effectiveness.

    Science.gov (United States)

    Keenan, G; Aquilino, M L

    1998-01-01

    Standardized nursing nomenclatures must be included in clinical documentation systems to generate data that more accurately represent nursing practice than outcomes-related measures currently used to support important policy decisions. NANDA, NIC, and NOC--comprehensive nomenclatures for the needed variables of nursing diagnoses, interventions, and outcomes--are described. Added benefits of using NANDA, NIC, and NOC in everyday practice are outlined, including facilitation of the continuity of care of patients in integrated health systems.

  13. Feasibility of an intervention to enhance preventive care for people with low health literacy in primary health care.

    Science.gov (United States)

    Faruqi, Nighat; Lloyd, Jane; Ahmad, Raghib; Yeong, Lin-Lee; Harris, Mark

    2015-01-01

    The objective of the study was to explore the feasibility of an intervention that enhances preventive care for primary care patients with low health literacy. A mixed method study was conducted in four Sydney general practices in areas of socioeconomic disadvantage. The intervention included screening for low health literacy in patients aged 40-69 years, clinical record audits of care for prevention of diabetes and cardiovascular disease, and provider training and meetings. Surveys and interviews were conducted to identify providers' approaches to, and delivery of, preventive care for people with low health literacy. Our study found variable response rates and prevalence of low health literacy. Of the eligible patients screened, 29% had low health literacy. Providers described three approaches to preventive care, which remained largely unchanged. However, they demonstrated recognition of the importance of better communication and referral support for patients with low health literacy. Fewer patients with low health literacy were identified than expected. Despite improved awareness of the need for better communication, there was limited evidence of change in providers' approach to providing preventive care, suggesting a need for more attention towards providers' attitudes to support these patients.

  14. Enabling new graduate midwives to work in midwifery continuity of care models: A conceptual model for implementation.

    Science.gov (United States)

    Cummins, Allison M; Catling, Christine; Homer, Caroline S E

    2017-12-04

    High-level evidence demonstrates midwifery continuity of care is beneficial for women and babies. Women have limited access to midwifery continuity of care models in Australia. One of the factors limiting women's access is recruiting enough midwives to work in continuity. Our research found that newly graduated midwives felt well prepared to work in midwifery led continuity of care models, were well supported to work in the models and the main driver to employing them was a need to staff the models. However limited opportunities exist for new graduate midwives to work in midwifery continuity of care. The aim of this paper therefore is to describe a conceptual model developed to enable new graduate midwives to work in midwifery continuity of care models. The findings from a qualitative study were synthesised with the existing literature to develop a conceptual model that enables new graduate midwives to work in midwifery continuity of care. The model contains the essential elements to enable new graduate midwives to work in midwifery continuity of care models. Each of the essential elements discussed are to assist midwifery managers, educators and new graduates to facilitate the organisational changes required to accommodate new graduates. The conceptual model is useful to show maternity services how to enable new graduate midwives to work in midwifery continuity of care models. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  15. Parents' perceptions of continuity of care in the neonatal intensive care unit: pilot testing an instrument and implications for the nurse-parent relationship.

    Science.gov (United States)

    Epstein, Elizabeth Gingell; Miles, Alison; Rovnyak, Virginia; Baernholdt, Marianne

    2013-01-01

    Nurse-parent relationships are a key aspect of high-quality family-centered care in the neonatal intensive care unit. Few studies have examined nursing continuity of care that includes (a) chronological continuity, that is, the number of nurses caring for an infant over time, (b) the consistency of information transferred to the parent and colleagues, and (c) the consistency of interactions between parent and nurse as an important factor in the nurse-parent relationship. The aims of this pilot study were to develop and test a scale of parental perceptions of nursing continuity of care in the newborn intensive care setting and to characterize the association between parents' perceptions and chronological nursing continuity. Fifty-four parents completed the Parents' Perceptions of Continuity Scale and a demographic questionnaire. Also, medical record and a count of the number of nurses caring for infant in past 7 days were collected. The Parents' Perceptions of Continuity Scale demonstrated good internal consistency (Cronbachα, 0.81). Parents' Perceptions of Continuity Scale scores were significantly associated with chronological nursing continuity, suggesting that the number of nurses caring for an infant plays a role in parents' perceptions of overall nursing continuity.

  16. 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

  17. The effects of nursing turnover on continuity of care in isolated First Nation communities.

    Science.gov (United States)

    Minore, Bruce; Boone, Margaret; Katt, Mae; Kinch, Peggy; Birch, Stephen; Mushquash, Christopher

    2005-03-01

    Many of Canada's northern First Nation communities experience difficulty recruiting and retaining appropriate nursing staff and must rely on relief nurses for short-term coverage. The latter often are not adequately prepared for the demanding nature of the practice. This study examined the consequences of nursing turnover on the continuity of care provided to residents of three Ojibway communities in northern Ontario. The findings are based on a review of 135 charts of oncology, diabetes, and mental health clients, and on interviews with 30 professional and paraprofessional health-care providers who served the communities. Nursing turnover is shown to detrimentally affect communications, medications management, and the range of services offered; it also results in compromised follow-up, client disengagement, illness exacerbation, and an added burden of care for family and community members.

  18. Perspectives on continuing education in the health professions: improving health care through lifelong learning.

    Science.gov (United States)

    Leach, David C; Fletcher, Suzanne W

    2008-12-01

    In November 2007, the Josiah Macy, Jr. Foundation convened a conference to address a number of complex issues concerning continuing education (CE) in the health professions. Participants concluded that CE, as currently practiced, does not focus adequately on improving clinician performance and patient care, is too dependent on lectures and too removed from the daily practice of clinicians, does not encourage or emphasize newer technologies and point-of-care learning, is poorly integrated across disciplines, and is inappropriately financed. Recommendations concerning educational methods, metrics, responsibilities, research in CE, financing, and oversight are reviewed. The relationship between the goals of improving clinician performance and patient care, while maintaining high standards of accountability and transparency, are reviewed.

  19. Vaccines for preventing hepatitis B in health-care workers

    DEFF Research Database (Denmark)

    Chen, Weikeng; Gluud, C

    2005-01-01

    Hepatitis B virus (HBV) causes acute and chronic liver diseases. Hepatitis B vaccination is recommended for health-care workers.......Hepatitis B virus (HBV) causes acute and chronic liver diseases. Hepatitis B vaccination is recommended for health-care workers....

  20. Continuity of care during end of life: an evolutionary concept analysis.

    Science.gov (United States)

    D'Angelo, Daniela; Mastroianni, Chiara; Hammer, J Marilyn; Piredda, Michela; Vellone, Ercole; Alvaro, Rosaria; De Marinis, Maria Grazia

    2015-04-01

    The purpose of this study was to clarify the concept of continuity of care during the end of life with a focus on the patient's perspective. Rodgers' method of evolutionary concept analysis was used. The analysis was based on literature published in English in the databases Cumulative Index for Nursing and Allied Health Literature, Medline, and PsycINFO. Analysis revealed that the continuity at life's end is a dynamic process that depends on the interaction among patients, families, and providers, and is strictly interwoven with the patient's time perception. This analysis showed the complexities surrounding the patient's experience of continuity at life's end. Nurses can benefit from a deeper understanding of the patient's experience, both theoretically and in practice. © 2014 NANDA International, Inc.

  1. 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

  2. Does continuity of care by well-trained breastfeeding counselors improve a mother's perception of support?

    Science.gov (United States)

    Ekström, Anette; Widström, Ann-Marie; Nissen, Eva

    2006-06-01

    Social support has been shown to be greatly important for breastfeeding success. The objective of this study was to investigate if mothers who were attended by midwives and nurses specially trained in breastfeeding counseling perceived better continuity of care and emotional and informative breastfeeding support than mothers who received only routine care. Ten municipalities, each with an antenatal center and child health center, in southwest Sweden were randomized either to intervention or control municipalities. The intervention included a process-oriented training in breastfeeding counseling and continuity of care at the antenatal and child health centers. Primiparas were asked to evaluate the care given, and those living in the control municipalities were divided into control groups A and B. Data collection took place at different points in time for the two control groups. The 540 mothers responded to 3 questionnaires at 3 days and at 3 and 9 months postpartum. The perception of support provided by the health professionals and from the family classes was rated on Likert scales. Intervention group mothers rated the breastfeeding information given during the family class as significantly better during pregnancy than both control groups, and better than control group B mothers at 3 months postpartum; compared with both control groups, intervention group mothers perceived that they received significantly better overall support and that postnatal nurses provided better information about breastfeeding and the baby's needs. At 9 months, intervention group mothers were more satisfied with knowledge about social rights, information about the baby's needs, and their social network than control group B mothers. Both intervention group and control group B mothers perceived better overall support than control group A during pregnancy. At 3 and 9 months, intervention group mothers perceived that postnatal nurses were more sensitive and understanding compared with both

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

    Science.gov (United States)

    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.

  4. Point-of-care testing of HbA1c in diabetes care and preventable hospital admissions

    DEFF Research Database (Denmark)

    Kristensen, Troels; Rose Olsen, Kim

    Background: Point-of-care testing (POCT) of HbA1c may result in improved diabetic control, better patient outcomes and enhanced clinical efficiency with fewer patient visits and subsequent reductions in hospitalizations and costs. In 2008, the Danish regulators agreed to create a new tariff...... for the remuneration of POCT of HbA1c in primary care. Aim: The aim of this study is to assess whether there is an association between the use of POCT of HbA1c and preventable hospital admissions among diabetes patients in general practice. Method: We apply logistic regression analyses to examine whether......, socioeconomic covariates, municipality classifications and case mix measure in terms of the charlson index and costs of care in primary care and secondary care. Results: There was a significant link between POCT of HbA1c among diabetes patients in general practice and an ACSC-measure of preventable out...

  5. Interventions for prevention of childhood obesity in primary care: a qualitative study.

    Science.gov (United States)

    Bourgeois, Nicole; Brauer, Paula; Simpson, Janis Randall; Kim, Susie; Haines, Jess

    2016-01-01

    Preventing childhood obesity is a public health priority, and primary care is an important setting for early intervention. Authors of a recent national guideline have identified a need for effective primary care interventions for obesity prevention and that parent perspectives on interventions are notably absent from the literature. Our objective was to determine the perspectives of primary care clinicians and parents of children 2-5 years of age on the implementation of an obesity prevention intervention within team-based primary care to inform intervention implementation. We conducted focus groups with interprofessional primary care clinicians (n = 40) and interviews with parents (n = 26). Participants were asked about facilitators and barriers to, and recommendations for implementing a prevention program in primary care. Data were recorded and transcribed, and we used directed content analysis to identify major themes. Barriers existed to addressing obesity-related behaviours in this age group and included a gap in well-child primary care between ages 18 months and 4-5 years, lack of time and sensitivity of the topic. Trust and existing relationships with primary care clinicians were facilitators to program implementation. Offering separate programs for parents and children, and addressing both general parenting topics and obesity-related behaviours were identified as desirable. Despite barriers to addressing obesity-related behaviours within well-child primary care, both clinicians and parents expressed interest in interventions in primary care settings. Next steps should include pilot studies to identify feasible strategies for intervention implementation.

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

    Science.gov (United States)

    Hetlevik, Øystein; Hustoft, Merethe; Uijen, Annemarie; Aßmus, Jörg; Gjesdal, Sturla

    2017-11-21

    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). 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. 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. Psychometric assessment of the NCQ-N supports that this instrument, based

  7. Effect of Continuous Care model on lifestyle modification in patients with hypertension: Randomized clinical trial study

    Directory of Open Access Journals (Sweden)

    Afsane Shahrani

    2016-07-01

    Full Text Available Hypertension is the most important modifiable cardiovascular disease. One of the main factors affecting the risk of hypertension is people’s lifestyle, for which appropriate changes in lifestyle-related factors creating cardiovascular risks need to be developed through new and effective approaches in long-term. Follow-up is an important tool for active participation in treatment and behavior changes; therefore, the present study aimed to evaluate the effect of continuous care model on the lifestyle of patients with hypertension. In this two-stage clinical trial, two groups of 64 patients with hypertension at the Isfahan Hypertension Center were selected through simple sampling, who hold the study criteria. The samples were randomly divided into two groups of 32 people as the experimental and control groups. The continuous care in the test group was carried out in the form of a four-stage program including orientation, sensitization, control and evaluation for 3 months. The control patients received usual care. Two questionnaires were employed to collect demographic data and lifestyle inventory data for hypertension used in two stages of pre- and post-intervention. Data were analyzed using descriptive statistics and statistical tests such as chisquare, Mann-Whitney, independent and paired t-test and analysis of covariance by SPSS version 20. Statistical tests showed no significant differences between the mean scores of two groups in life style dimensions before the intervention. After the intervention, however, the mean scores of lifestyle and its dimensions were significantly higher in the test group than those in the control group (p <0.001 According to the results, it can be concluded that applying continuous care model has significantly been effective in lifestyle modification of patients with high blood pressure. Training the patients and strengthening by repetition, monitoring and management of nurses can be important factors in promoting

  8. Feasibility and Safety of Physical Therapy during Continuous Renal Replacement Therapy in the Intensive Care Unit.

    Science.gov (United States)

    Toonstra, Amy L; Zanni, Jennifer M; Sperati, C John; Nelliot, Archana; Mantheiy, Earl; Skinner, Elizabeth H; Needham, Dale M

    2016-05-01

    Early rehabilitation in an intensive care unit is associated with improved physical functioning and patient outcomes. However, relatively few data have been reported on physical therapy interventions during continuous renal replacement therapy (CRRT) for patients in intensive care units. To evaluate the feasibility and safety of physical therapy interventions, delivered as part of routine clinical care, for patients undergoing CRRT in an intensive care unit. Consecutive patients in the adult medical intensive care unit of one large tertiary care hospital who received physical therapy sessions while on CRRT were prospectively evaluated over 13 months. Physical therapy sessions were individualized on the basis of patients' physical impairments and activity tolerance, with patients' highest level of mobility recorded. Data on 15 different physiological abnormalities and potential safety events, including bleeding, dislodgement, or dysfunction of the CRRT catheter or circuit, were prospectively collected. Eleven physical therapists delivered 268 rehabilitation sessions to 57 patients while they were receiving CRRT, with the following highest levels of mobility achieved during individual sessions: 78 (29%) bed exercises, 72 (27%) supine cycle ergometry, 80 (30%) sitting at edge of bed, 13 (5%) transfer to chair, and 25 (9%) standing or marching in place. No CRRT-specific safety events occurred (0%; 95% upper confidence interval, 6.3%). There were six non-CRRT-related potential safety events (2.2% of all physical therapy sessions; 95% confidence interval, 0.6-8.2%), all of which were transient changes in blood pressure. In this prospective observational study at one adult medical intensive care unit, we found that provision of bedside physical therapy while patients underwent CRRT is feasible, and appears safe.

  9. The Nordic Maintenance Care Program: when do chiropractors recommend secondary and tertiary preventive care for low back pain?

    Science.gov (United States)

    Axén, Iben; Jensen, Irene B; Eklund, Andreas; Halasz, Laszlo; Jørgensen, Kristian; Lange, Fredrik; Lövgren, Peter W; Rosenbaum, Annika; Leboeuf-Yde, Charlotte

    2009-01-22

    Among chiropractors the use of long-term treatment is common, often referred to as "maintenance care". Although no generally accepted definition exists, the term has a self-explanatory meaning to chiropractic clinicians. In public health terms, maintenance care can be considered as both secondary and tertiary preventive care. The objective of this study was to explore what factors chiropractors consider before recommending maintenance care to patients with low back pain (LBP). Structured focus group discussions with Swedish chiropractors were used to discuss pre-defined cases. A questionnaire was then designed on the basis of the information obtained. In the questionnaire, respondents were asked to grade the importance of several factors when considering recommending maintenance care to a patient. The grading was done on a straight line ranging from "Very important" to "Not at all important". All members of the Swedish Chiropractors' Association (SCA) were invited to participate in the discussions and in the questionnaire survey. Thirty-six (22%) of SCA members participated in the group discussions and 129 (77%) returned the questionnaires. Ninety-eight percent of the questionnaire respondents claimed to believe that chiropractic care can prevent future relapses of back pain. According to the group discussions tertiary preventive care would be considered appropriate when a patient improves by 75% or more. According to the results of the questionnaire survey, two factors were considered as "very important" by more than 70% of the respondents in recommending secondary preventive care, namely frequency past year and frequency past 10 years of the low back pain problem. Eight other factors were considered "very important" by 50-69% of the respondents, namely duration (over the past year and of the present attack), treatment (effect and durability), lifestyle, work conditions, and psychosocial factors (including attitude). The vast majority of our respondents believe

  10. The Nordic Maintenance Care Program: when do chiropractors recommend secondary and tertiary preventive care for low back pain?

    Directory of Open Access Journals (Sweden)

    Lange Fredrik

    2009-01-01

    Full Text Available Abstract Background Among chiropractors the use of long-term treatment is common, often referred to as "maintenance care". Although no generally accepted definition exists, the term has a self-explanatory meaning to chiropractic clinicians. In public health terms, maintenance care can be considered as both secondary and tertiary preventive care. The objective of this study was to explore what factors chiropractors consider before recommending maintenance care to patients with low back pain (LBP. Method Structured focus group discussions with Swedish chiropractors were used to discuss pre-defined cases. A questionnaire was then designed on the basis of the information obtained. In the questionnaire, respondents were asked to grade the importance of several factors when considering recommending maintenance care to a patient. The grading was done on a straight line ranging from "Very important" to "Not at all important". All members of the Swedish Chiropractors' Association (SCA were invited to participate in the discussions and in the questionnaire survey. Results Thirty-six (22% of SCA members participated in the group discussions and 129 (77% returned the questionnaires. Ninety-eight percent of the questionnaire respondents claimed to believe that chiropractic care can prevent future relapses of back pain. According to the group discussions tertiary preventive care would be considered appropriate when a patient improves by 75% or more. According to the results of the questionnaire survey, two factors were considered as "very important" by more than 70% of the respondents in recommending secondary preventive care, namely frequency past year and frequency past 10 years of the low back pain problem. Eight other factors were considered "very important" by 50–69% of the respondents, namely duration (over the past year and of the present attack, treatment (effect and durability, lifestyle, work conditions, and psychosocial factors (including

  11. Marriage, Cohabitation, and Men's Use of Preventive Health Care Services

    Science.gov (United States)

    ... received these screenings in the past 12 months. Definitions Blood pressure screening : Based on responses to the ... of service, such as accidents or dental care. Hypertension : To be classified with diagnosed hypertension, also called ...

  12. Midwife-led continuity models versus other models of care for childbearing women.

    Science.gov (United States)

    Sandall, Jane; Soltani, Hora; Gates, Simon; Shennan, Andrew; Devane, Declan

    2016-04-28

    Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care. To compare midwife-led continuity models of care with other models of care for childbearing women and their infants. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (25 January 2016) and reference lists of retrieved studies. All published and unpublished trials in which pregnant women are randomly allocated to midwife-led continuity models of care or other models of care during pregnancy and birth. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. We included 15 trials involving 17,674 women. We assessed the quality of the trial evidence for all primary outcomes (i.e. regional analgesia (epidural/spinal), caesarean birth, instrumental vaginal birth (forceps/vacuum), spontaneous vaginal birth, intact perineum, preterm birth (less than 37 weeks) and all fetal loss before and after 24 weeks plus neonatal death using the GRADE methodology: all primary outcomes were graded as of high quality.For the primary outcomes, women who had midwife-led continuity models of care were less likely to experience regional analgesia (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.78 to 0.92; participants = 17,674; studies = 14; high quality), instrumental vaginal birth (average RR 0.90, 95% CI 0.83 to 0.97; participants = 17,501; studies = 13; high quality), preterm birth less than 37 weeks (average RR 0.76, 95% CI 0.64 to 0.91; participants = 13,238; studies = eight; high quality) and less all fetal loss before and after 24 weeks plus neonatal death (average RR 0.84, 95% CI 0.71 to 0.99; participants

  13. Patient-centred communication intervention study to evaluate nurse-patient interactions in complex continuing care

    Directory of Open Access Journals (Sweden)

    McGilton Katherine S

    2012-10-01

    Full Text Available Abstract Background Communication impairment is a frequent consequence of stroke. Patients who cannot articulate their needs respond with frustration and agitation, resulting in poor optimization of post-stroke functions. A key component of patient-centred care is the ability of staff to communicate in a way that allows them to understand the patient’s needs. We developed a patient-centred communication intervention targeting registered and unregulated nursing staff caring for complex continuing care patients with communication impairments post stroke. Research objectives include 1 examining the effects of the intervention on patients’ quality of life, depression, satisfaction with care, and agitation; and (2 examining the extent to which the intervention improves staff’s attitudes and knowledge in caring for patients with communication impairments. The intervention builds on a previous pilot study. Methods/design A quasi-experimental repeated measures non-equivalent control group design in a complex continuing care facility is being used. Patients with a communication impairment post-stroke admitted to the facility are eligible to participate. All staff nurses are eligible. Baseline data are collected from staff and patients. Follow-up will occur at 1 and 3 months post-intervention. Subject recruitment and data collection from 60 patients and 30 staff will take approximately 36 months. The Patient-Centred Communication Intervention consists of three components: (1 development of an individualized patient communication care plan; (2 a one-day workshop focused on communication and behavioural management strategies for nursing staff; and (3 a staff support system. The intervention takes comprehensive patient assessments into account to inform the development of communication and behavioural strategies specifically tailored to each patient. Discussion The Patient-Centred Communication Intervention will provide staff with strategies to

  14. The quality of pressure ulcer prediction and prevention in home health care.

    Science.gov (United States)

    Bergquist, Sandra

    2005-08-01

    The purpose of this study was to assess the quality of pressure ulcer prediction and prevention in home health care. Randomly selected Medicare-certified home care agencies in four midwestern states were surveyed. The overall response rate was 44% (n = 128). Approximately half (57.8%) of the responding agencies assessed all patients for pressure ulcer risk upon admission; another 4.7% assessed only chair or bed-bound patients. Clinical nursing judgment was the most commonly (72%) used method for assessing risk; only 21% of the agencies used a validated tool such as the Braden Scale or the Norton Scale to identify those at risk. Approximately one third of the reporting agencies had prediction and/or prevention policies. Only 18.0% of home health car